Neonatal jaundice is a prevalent disease that develops in the period immediately following delivery. [1-3]. This inevitable syndrome affects 60% of full-term and 80% of preterm infants worldwide. Jaundice is a frequent reason for newborns to be readmitted to the hospital.[1] The onset of this condition often occurs on the second day after birth and typically resolves within two to three days, resulting in the restoration of bilirubin levels to normal without the need for therapy in the majority of cases.[4,5] Conversely, newborns may have severe jaundice, or even jaundice that progresses to acute bilirubin encephalopathy or kernicterus.[6,7] The significance of hyperbilirubinemia lies in its strong correlation with elevated levels of unconjugated bilirubin, which can result in neurotoxicity and give rise to long-term problems including cerebral palsy, kernicterus, and hearing impairment.[8-10] Severe jaundice is a critical and sometimes fatal issue that can be influenced by various causes, including hereditary and/or regional characteristics.[7] Prompt identification of newborns with a high likelihood of developing severe hyperbilirubinemia is crucial for ensuring timely and effective illness prevention during the initial 14 days after birth. The interval [7,11] The clinical manifestations of hyperbilirubinemia primarily manifest in the head and face, and then impact the organs of the trunk and limbs as a result of elevated amounts of bilirubin in the bloodstream. It is important to mention that elevated levels of haemoglobin might result in the release of haemoglobin from the breakdown of red blood cells, which can cause jaundice in newborns. [12,13]. This condition can also result from reduced hepatic bilirubin excretion. [14,15] Due to the potential adverse consequences of jaundice on baby health, it is important to evaluate the factors related with it in neonates. Kernicterus is a highly significant condition, as its sequelae might be really perilous. Given that jaundice is a prevalent reason for neonates being hospitalised, it is important to focus on promptly diagnosing and preventing it. Conversely, promptly treating jaundice or implementing preventive measures can result in significant cost savings by reducing the need for hospitalisation of babies. As far as we know, a complete examination of the causes and risk factors of neonatal jaundice in neonates has not been conducted in Iran, despite the increasing prevalence of the disease among newborns. Hence, it is recommended to implement a methodical and efficient protocol for assessing the causes and risk factors of jaundice in neonates. To mitigate the dangers of jaundice, it is necessary to conduct thorough and precise studies on a regular and ongoing basis. The objective of this study was to evaluate the impact of maternal variables on the occurrence of neonatal jaundice in neonates.

The present study entitled "A cross-sectional study to evaluate the impact of maternal risk factors among the cases of neonatal jaundice at a tertiary care centre of central

India" was conducted in the Department of Paediatrics, Index Medical College Hospital & Research Centre. Indore, (M.P) during the period of January 2017 to June 2018. This was a Cross-sectional comparative study. All newborns who are delivered during this period included in this study. Data will be collected using newborn medical records checklist consisting of demographic neonatal and maternal information will be used for data collection. neonates from Birth to 28 day old icteric newborns, Term or preterm newborns, Both inborn and outborns neonates, LBW neonates, ABO, Rh incompatibility were included while Age > 28 days, Parents not willing to give consent and patient with  Inadequate information about pregnancy and delivery were excluded.

The distribution of cases according to maternal age, parity, place of delivery, and mode of delivery is as follows: Among the mothers, 13% were aged ≤20 years, 64% were between 21-25 years, 18% were 26-30 years, 3% were 31-35 years, and 2% were 36-40 years. Regarding parity, 50% were Para 1, 41% were Para 2, 7% were Para 3, and 2% were Para 5. In terms of place of delivery, 88% of the births occurred in a hospital, while 12% occurred at home. When considering the type of delivery, 33% of the cases involved vaginal delivery, and 67% involved lower segment cesarean section (LSCS). [table- 1]

The distribution of cases of neonatal jaundice due to maternal factors or illness is as follows: Rh-negative mothers accounted for 11% of the cases, while 14% of the mothers had a fever. Hypothyroidism was present in 6% of the mothers, and anemia was the most common condition, affecting 81%. TORCH infections were noted in 5% of the cases, and 4% of the mothers had diabetes. Drug exposure was reported in 10% of the cases, but there were no cases associated with HIV. Hepatitis B surface antigen (HbsAg) was present in 2% of the mothers, and pregnancy-induced hypertension (PIH) was seen in 14%. Lastly, low placental volume/basal plate volume (LPV/BPV) was identified in 11% of the cases. [table- 2]

The distribution of cases according to the days of presentation and related characteristics is as follows: Among the babies, 24% were less than 2 days old, 64% were between 2-7 days old, and 12% were older than 7 days. Regarding the age at admission, the mean total serum bilirubin was 16.06 mg/dl for those admitted within 72 hours, and 19.92 mg/dl for those admitted after 72 hours, with a P value of 0.03. Gender distribution showed that 65% of the babies were male with a mean bilirubin level of 17.53 mg/dl, and 35% were female with a mean bilirubin level of 18.66 mg/dl, with a P value of 0.04. Overall, the total number of babies in the study was 100, accounting for 100% of the cases. [table- 3]

In our study, out of 100 cases there were 84 newborns who were < 7 days old and 12 newborns who were > 7 days old, this is similar to following studies. In study conducted by Mallick PK et al^[17](2012) found that (88%) of newborns who had jaundice were in 7 days age group and 10% newborns who had jaundice were in 8-15 days age group. A study conducted by Kamara et al^[21] (2014), found most of neonates 75.6% developed jaundice (in 1^st 3 days). In our study, Babies who > 72 hours age had higher bilirubin 19.9 mg/dl than those who were less than 72 hours of age 16.06 mg/dl. p value was 0.03. Similar result was shown by Anjali V. Kale, Pooja K. Sharma et al.^[28.] with a p value of 0.002 These results are comparable with the above studies in which it is also showed that neonatal jaundice generally appears 2-4 days after birth. This observation can be easily explained. As most of the causes of neonatal jaundice including prematurity and septicemia, as observed in our study also, often manifest in first 7 days of life.

Maternal sociodemographic characteristics may affect neonatal jaundice

Maternal age - In ours study 64% mothers were of age group 21-25 years and the Mean age of mother was 22 years.

Parity- 50% of pregnant mothers were primi(1^st pregnancy) similar to studies done by Schneider et al.^[16] in 1986, Primiparity, teenage pregnancy, hardly reported in developing countries, need further investigation to prove their potential influence on the chance of neonatal hyperbilirubinemia

Maternal illness- In our study 35 mothers presented with illness, in which there was Premature –rupture of membranes-11, fever 14, Torch 5, Hypothyroidism 6, Diabetes 4, Hbsag positive 2. All cases developed jaundice. This is similar to a study conducted by

Folorunso Serifat et al.^[18] where 43(18.5%) mothers of newborns who presented with jaundice were presented with any kind of illness during pregnancy, Mahmodi Z, Mahmodi F. et al.^[24] showed that, Among infants with jaundice, 15.9% were premature (35-37week) and 3.45% (20 cases) suffered from neonatal infections because of their mothers’ infection in the course of pregnancy. So, maternal illness play a significant role in development of neonatal jaundice, presence of any kind of acute maternal disease during course of pregnancy may lead to a congenital infection or sepsis in newborn.

Maternal illness may be in following form

PROM/PIH/fever /Torch infections in mother

As shown in study, premature- rupture- of- membrane was there in 11 mothers of neonates. Among them, 7 neonates were born preterm, and out of these 7 Preterm 80% developed sepsis and jaundice. Study done by Kulkarni S.K., Dolas et al^[25] showed similar results were premature- rupture of- membrane was there in 6 neonates of which 3 neonates had septicaemia (50%). Our centre is tertiary centre and mothers are screened for torch infections. We got, 5 cases who had neonatal jaundice whose mothers had torch infections There was a study conducted by Sahoo M et al^[19] where 1 newborn was born to mother with TORCH infection and that newborn too developed jaundice. So, maternal infections/ premature- rupture -of membranes indirectly lead to newborn jaundice by causing neonatal septicemia or preterm births. Existence of an acute maternal disease during pregnancy may lead to a congenital infection of the newborn

Diabetes in Mother- In our study there were 4 neonates whose mothers were Diabetic leading to Jaundice, this is similar to following studies, Mallick PK et al^[17] showed that there were 3% Infants of Diabetic mothers having Jaundice . Bazzazz-adeh V, Doosti H, Boskabadi H, et al^[26] 37 infants(2.7%) had endocrine disorders, Wang Xiao-Fang, Wang Xiao-Jie, LI Zhen et al^[27] found that 9% patients presented with newborn jaundice whose mothers had GDM. So by management of pregnant women with DM and by checking and controlling blood glucose level during course of pregnancy can substantially decrease the incidence of neonatal jaundice. And the newborns whose mothers are Diabetic should be followed dynamically in order to detect and intervene early.

Hypothyroidism in mother - In ours study there were 6 cases(6%) of Maternal hypothyroidism , and babies of all of these mothers presented with prolong jaundice, which was comparable with the following studies. Anton is Voutetakis, Maria Maniati-Christid et al^[22] showed the hypothyroidism and Prolonged jaundice are the main symptoms in a newborn in which novel Prop1 gene mutation (Q83X) was present., Brijmohan Meena et al.^[20] (2017), found hypothyroidism as a cause for 3% Cases of neonatal jaundice, Bazazzadeh V, Doosti H, Boskabadi H, Saffari et al^[26] found ,that 2.7% of infants having jaundice had endocrine disorders. Abdulmoein E Al-Agha1, Dareen S Alghalbi et al^[23] did a study to show the different clinical presentations of congenital hypothyroidism. most common presentation was Prolonged jaundice (79%).

Our study highlights that neonatal jaundice is predominantly observed within the first week of life, with 84% of cases occurring in newborns less than 7 days old, We observed a higher bilirubin level in babies older than 72 hours, underscoring the need for timely monitoring. Maternal sociodemographic factors, including age, parity, and maternal illnesses such as diabetes, hypothyroidism, and infections, significantly contribute to the incidence of neonatal jaundice. The study underscores the importance of managing maternal health conditions during pregnancy to mitigate the risk of neonatal jaundice. Effective screening and early intervention for maternal illnesses can help reduce the occurrence of jaundice in newborns, emphasizing the need for comprehensive prenatal care.

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