Characteristics of Preterm Births in the Setting of Reduced Preterm Birth Rates During COVID-19 Lockdown

A reduction in preterm births has been observed in Haguenau (Eastern France) during a 12-year intervention study with a program for prevention of preterm deliveries. The Perinatal Study of Haguenau was an observation tool used in a stable population, and it allowed measurement of the way women have progressively responded to the new proposals in prenatal care. It also allowed measurement of the results of the interventions: low birth weight (less than 2,500 g) and preterm birth rates (less than 37 weeks of gestation) among single live births. The total duration of the study was divided into three periods of four years (1971 through 1974, 1975 through 1978, and 1979 through 1982), for which the numbers of single live births are 5,763, 4,957, and 5,919, respectively. For the same periods, the low-birth-weight rates, 4.6%, 4.0%, and 3.8%, respectively, showed a significant decrease (P < .001). Following a similar pattern, the rates of preterm birth were 5.4%, 4.1%, and 3.7% (a significant reduction with P < .001). These improvements in pregnancy outcome do not disappear after standardization of mother's age, high blood pressure, or social class distribution. These findings, which concur with the results of others, enhance the hypothesis of a direct relationship between a prevention program and a reduction in preterm birth rates.

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Preterm births in Iceland 1997‐2016: Preterm birth rates by gestational age groups and type of preterm birth

Birth ◽

10.1111/birt.12467 ◽

2019 ◽

Vol 47 (1) ◽

pp. 105-114

Author(s):

Áslaug Salka Grétarsdóttir ◽

Thor Aspelund ◽

Þóra Steingrímsdóttir ◽

Ragnheiður Ingibjörg Bjarnadóttir ◽

Kristjana Einarsdóttir

Keyword(s):

Preterm Birth ◽

Gestational Age ◽

Age Groups ◽

Preterm Births ◽

Birth Rates

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Changes in incidence of iatrogenic and spontaneous preterm births over time: a population-based study

Journal of Perinatal Medicine ◽

10.1515/jpm-2015-0271 ◽

2016 ◽

Vol 44 (5) ◽

Cited By ~ 13

Author(s):

Miha Lucovnik ◽

Andreja Trojner Bregar ◽

Lili Steblovnik ◽

Ivan Verdenik ◽

Ksenija Gersak ◽

...

Keyword(s):

Preterm Birth ◽

Birth Rate ◽

Preterm Births ◽

Population Based ◽

Spontaneous Preterm Birth ◽

Birth Rates ◽

Population Based Study ◽

Preterm Birth Rate ◽

Iatrogenic Preterm Delivery ◽

Over Time

AbstractTo examine the proportion of iatrogenic births among all preterm births over a 26-year period.A registry-based survey of preterm deliveries between 1987 and 2012 analyzed by the onset of labor: spontaneous with intact membranes, preterm premature rupture of membranes (PPROM) or iatrogenic. Stratification into categories by gestation (22 weeks to 27 weeks and 6 days, 28 weeks to 31 weeks and 6 days, 32 weeks to 33 weeks and 6 days, 34 weeks to 36 weeks and 6 days) was performed. Preterm birth rates were analyzed using the Mantel-Haenszel linear-by-linear associationOverall preterm birth rate was 5.9% (31328 deliveries) including 2358 (0.4%) before 28 completed weeks, 3388 (0.6%) between 28 weeks and 31 weeks 6 days, 3970 (0.8%) between 32 weeks and 33 weeks and 6 days, and 21611 (4.1%) between 34 weeks and 36 weeks and 6 days There was an increase in overall preterm birth rate (P<0.001). The rate of iatrogenic preterm births and PPROM increased over time (P<0.001 and P<0.014, respectively). Rates of spontaneous preterm birth decreased (P<0.001). After accounting for potential confounders, year of birth remained an independent risk factor for iatrogenic preterm delivery in all four gestational age categories (P<0.001).The incidence of iatrogenic preterm birth is increasing with a concomitant decrease in the incidence of spontaneous preterm birth. Attempts to analyze, interpret and decrease preterm birth rates should consider spontaneous and iatrogenic preterm births separately.

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Preterm birth rates in a large tertiary Australian maternity centre during COVID-19 mitigation measures

10.1101/2020.11.24.20237529 ◽

2020 ◽

Author(s):

Linda A. Gallo ◽

Tania F. Gallo ◽

Danielle J. Borg ◽

Karen M. Moritz ◽

Vicki L. Clifton ◽

...

Keyword(s):

Preterm Birth ◽

Preterm Infants ◽

Preterm Births ◽

Late Preterm ◽

Mitigation Measures ◽

Hypertensive Disorder ◽

Birth Rates ◽

Very Preterm Infants ◽

Very Preterm ◽

Multiple Covariates

AbstractObjectivesTo compare the prevalence of live preterm birth rates during COVID-19 restriction measures with infants born during the same weeks in 2013-2019 in Queensland, Australia.Design, setting, participantsDeidentified obstetric and neonatal data were extracted from the Mater Mothers’ electronic healthcare records database. This is a supra-regional tertiary perinatal centre.Main outcome measuresLogistic regressions were used to examine preterm birth rates during the beginning of COVID-19 restrictions (16 March-17 April; “early”; 6,955 births) and during the strictest part of COVID-19 restrictions (30 March-1 May; “late”; 6,953 births), according to gestational age subgroups and birth onset (planned or spontaneous). We adjusted for multiple covariates, including maternal age, body mass index, ethnicity, parity, socioeconomic status, maternal asthma, diabetes mellitus and/or hypertensive disorder. Stillbirth rates were also examined (16 March-1 May).ResultsA reduction in planned moderate/late preterm births was observed primarily during the early restriction period compared with the same calendar weeks in the previous seven years (29 versus an average of 64 per 1,000 births; adjusted odds ratio [aOR] 0.39, 95% CI 0.22-0.71). There was no effect on extremely or very preterm infants, spontaneous preterm births, or stillbirth rates. Rolling averages from January to June revealed a two-week non-significant spike in spontaneous preterm births from late-April to early-May, 2020.ConclusionsPlanned births for moderate/late preterm infants more than halved during early COVID-19 mitigation measures. Together with evidence from other nations, the COVID-19 pandemic provides a unique opportunity to identify causal and preventative factors for preterm birth.

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Association between antenatal care visit and preterm birth: a cohort study in rural Bangladesh

BMJ Open ◽

10.1136/bmjopen-2019-036699 ◽

2020 ◽

Vol 10 (7) ◽

pp. e036699

Author(s):

Jesmin Pervin ◽

Syed Moshfiqur Rahman ◽

Monjur Rahman ◽

Shaki Aktar ◽

Anisur Rahman

Keyword(s):

Cohort Study ◽

Preterm Birth ◽

Antenatal Care ◽

Linear Trend ◽

Preterm Births ◽

Population Level ◽

Estimating Equation ◽

Population Based ◽

Birth Rates ◽

Care Programme

BackgroundStrengthening the antenatal care programme is suggested as one of the public health strategies to reduce preterm birth burden at a population level. However, the evidence so far available is inconclusive.ObjectivesTo evaluate the association between antenatal care (ANC) visit and preterm birth; and also to explore to what extent the increased usage of ANC after the initiation of the Maternal, Neonatal and Child Health (MNCH) project in Matlab, Bangladesh, contributed to the reduction of preterm birth.SettingThis population-based cohort study was conducted in Matlab, a subdistrict under Chandpur. The analysis was based on data collected from 2005 to 2009. In 2007, an MNCH project was initiated in the area that strengthened the ongoing ANC services.ParticipantsIn total, 12 980 live births with their mothers during the study period were included in the analysis.AnalysisWe performed logistic regression with generalised estimating equation models to evaluate the associations.Outcome measuresPreterm birth.ResultsThe number of ANC visits was associated with preterm birth in a dose-dependent way (p for linear trend <0.001). The adjusted odds of preterm birth were 2.4-times higher (OR 2.37, 95% CI 2.07 to 2.70) among women who received ≤1 ANC compared with women who received ≥3 ANC. We observed a significant reduction of preterm birth rates (OR 0.69, 95% CI 0.61 to 0.77) in the period after (2008 to 2009) MNCH project initiation in comparison to the period before (2005 to 2006). Controlling for ANC visits substantially attenuated this observed effect of the MNCH project on preterm birth (OR 0.88, 95% CI 0.77 to 0.99) (Sobel test of mediation p<0.001).ConclusionsANC visits are associated with decreased occurrences of preterm births. Strengthening the ANC services should be prioritised in countries with high preterm birth rates to reduce the preterm birth burden at the population level.

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A birth population-based survey of preterm morbidity and mortality by gestational age

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03726-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Xiaojing Guo ◽

Xiaoqiong Li ◽

Tingting Qi ◽

Zhaojun Pan ◽

Xiaoqin Zhu ◽

...

Keyword(s):

Birth Weight ◽

Preterm Birth ◽

Preterm Infants ◽

Birth Defects ◽

Gestational Age ◽

Death Rate ◽

Preterm Births ◽

Mortality Rates ◽

Morbidity And Mortality ◽

Hospital Death

Abstract Background Despite 15–17 millions of annual births in China, there is a paucity of information on prevalence and outcome of preterm birth. We characterized the outcome of preterm births and hospitalized preterm infants by gestational age (GA) in Huai’an in 2015, an emerging prefectural region of China. Methods Of 59,245 regional total births, clinical data on 2651 preterm births and 1941 hospitalized preterm neonates were extracted from Huai’an Women and Children’s Hospital (HWCH) and non-HWCH hospitals in 2018–2020. Preterm prevalence, morbidity and mortality rates were characterized and compared by hospital categories and GA spectra. Death risks of preterm births and hospitalized preterm infants in the whole region were analyzed with multivariable Poisson regression. Results The prevalence of extreme, very, moderate, late and total preterm of the regional total births were 0.14, 0.53, 0.72, 3.08 and 4.47%, with GA-specific neonatal mortality rates being 44.4, 15.8, 3.7, 1.5 and 4.3%, respectively. There were 1025 (52.8% of whole region) preterm admissions in HWCH, with significantly lower in-hospital death rate of inborn (33 of 802, 4.1%) than out-born (23 of 223, 10.3%) infants. Compared to non-HWCH, three-fold more neonates in HWCH were under critical care with higher death rate, including most extremely preterm infants. Significantly all-death risks were found for the total preterm births in birth weight < 1000 g, GA < 32 weeks, amniotic fluid contamination, Apgar-5 min < 7, and birth defects. For the hospitalized preterm infants, significantly in-hospital death risks were found in out-born of HWCH, GA < 32 weeks, birth weight < 1000 g, Apgar-5 min < 7, birth defects, respiratory distress syndrome, necrotizing enterocolitis and ventilation, whereas born in HWCH, antenatal glucocorticoids, cesarean delivery and surfactant use decreased the death risks. Conclusions The integrated data revealed the prevalence, GA-specific morbidity and mortality rate of total preterm births and their hospitalization, demonstrating the efficiency of leading referral center and whole regional perinatal-neonatal network in China. The concept and protocol should be validated in further studies for prevention of preterm birth.

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Spontaneous Preterm Birth: Is Prevention with Aspirin Possible?

Geburtshilfe und Frauenheilkunde ◽

10.1055/a-1226-6599 ◽

2021 ◽

Author(s):

Richard Berger ◽

Ioannis Kyvernitakis ◽

Holger Maul

Keyword(s):

Preterm Birth ◽

Low Dose ◽

Randomized Study ◽

Preterm Births ◽

Spontaneous Preterm Birth ◽

Dose Aspirin ◽

Nulliparous Women ◽

Low Dose Aspirin ◽

Secondary Analyses ◽

Double Blinded

Abstract Background The rate of preterm births in Germany is 8.6%, which is very high compared to other European countries. As preterm birth contributes significantly to perinatal morbidity and mortality rates, the existing prevention strategies need to be optimized and expanded further. About ⅔ of all women with preterm birth have preterm labor or premature rupture of membranes. They are bracketed together under the term “spontaneous preterm birth” as opposed to iatrogenic preterm birth, for example as a consequence of preeclampsia or fetal growth retardation. Recent studies suggest that low-dose aspirin does not just reduce the rate of iatrogenic preterm births but can also further reduce the rate of spontaneous preterm births. This review article presents the current state of knowledge. Method A selective literature search up until April 2020 was done in PubMed, using the terms “randomized trial”, “randomized study”, “spontaneous preterm birth”, and “aspirin”. Results Secondary analyses of prospective randomized studies on the prevention of preeclampsia with low-dose aspirin show that this intervention also significantly reduced the rate of spontaneous preterm births in both high-risk and low-risk patient populations. The results of the ASPIRIN trial, a prospective, randomized, double-blinded multicenter study carried out in six developing countries, also point in this direction, with the figures showing that the daily administration of 81 mg aspirin starting before 14 weeks of gestation lowered the preterm birth rate of nulliparous women without prior medical conditions by around 11% (11.6 vs. 13.1%; RR 0.89; 95% CI: 0.81 – 0.98, p = 0.012). Conclusion Further studies on this issue are urgently needed. If these confirm the currently available results, then it would be worth discussing whether general aspirin prophylaxis for all pregnant women starting at the latest in 12 weeks of gestation is indicated.

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Magnitude of spontaneous preterm birth and its associated factors among preterm birth in NICU wards in Asella Teaching and Referral Hospital, Asella, Oromia, Ethiopia

Journal of International Medical Research ◽

10.1177/03000605211034693 ◽

2021 ◽

Vol 49 (8) ◽

pp. 030006052110346

Author(s):

Techane Sisay Tuji ◽

Addisu Dabi Wake ◽

Gezahegn Badeg Adere ◽

Aselefu Beka Wedajo ◽

Batu Dekeba Obole ◽

...

Keyword(s):

Risk Factors ◽

Preterm Birth ◽

Healthcare Providers ◽

Preterm Births ◽

Cross Sectional Study ◽

Spontaneous Preterm Birth ◽

Related Factors ◽

Cross Sectional ◽

Bivariate Logistic Regression ◽

Associated Risk Factors

Objective To assess the prevalence of spontaneous preterm births and to identify the associated risk factors. Methods This single-centre cross-sectional study enrolled women that experienced a preterm birth as registered on the neonatal log-book between 30 December 2019 and 30 December 2020. A pre-tested structured checklist was used to collect data (sociodemographic characteristics; obstetric-related factors; medical history; and pregnancy-related factors). Bivariate logistic regression analyses were applied to identify factors associated with spontaneous preterm birth. A multivariate model identified significant independent risk factors. Results A total of 310 patients participated in the study. The prevalence of spontaneous preterm birth in this population was 67.1% (208 of 310; 95% confidence interval [CI] 61.5, 71.9). Patients without a partner (adjusted odds ratio [AOR] = 1.470, 95% CI 1.23, 4.42), patients residing in a rural area (AOR = 2.51, 95% CI 1.123, 5.513) and those with a history of PIH during their current pregnancy (AOR = 0.104, 95% CI 0.053, 0.014) were significantly more likely to have a spontaneous preterm birth. Conclusion The prevalence of spontaneous preterm birth in in this study was high. Healthcare providers and all stakeholders should focus on screening pregnant women at the risk of spontaneous preterm birth.

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Impact of smoking and fetal gender on preterm delivery

Journal of Developmental Origins of Health and Disease ◽

10.1017/s2040174420000999 ◽

2020 ◽

pp. 1-6

Author(s):

Veronika Günther ◽

Ibrahim Alkatout ◽

Alexandra Stein ◽

Nicolai Maass ◽

Alexander Strauss ◽

...

Keyword(s):

Risk Factors ◽

Preterm Birth ◽

Preterm Delivery ◽

Preterm Infants ◽

Preterm Births ◽

World Health ◽

Smoking During Pregnancy ◽

Fetal Gender ◽

Extremely Preterm ◽

Heavy Smokers

Abstract According to the World Health Organization, smoking is the most important risk factor for adverse pregnancy outcomes in industrialized nations. We aimed to establish how fetal gender and smoking interact with regard to perinatal outcomes, especially preterm delivery. Data from 220,339 singleton pregnancies, obtained from the German Perinatal Survey in Schleswig-Holstein and registered between 2004 and 2017 were analyzed in regard to smoking behavior, fetal gender, and preterm delivery. The rate of preterm births was directly proportional to the women’s consumption of nicotine. The rate of preterm deliveries was 6.8% among nonsmokers, and 13.2% in women who were very heavy smokers (≥22 cigarettes/day). Very heavy smoking (≥22 cigarettes/day) had a marked impact on extremely preterm births (<28 weeks of gestation) and very preterm births (28–31 weeks of gestation). Preterm births increased by 1.2% from heavy smokers to very heavy smokers; the differences between the other groups ranged between 0.1% and 0.4%. Fetal gender also had an impact on preterm birth: male infants were predominant in nearly all groups of women who delivered preterm infants. Smoking during pregnancy and male gender are both risk factors for preterm delivery. Fetal gender should be given greater attention as one of the several risk factors of preterm birth. Due to the high rate of morbidity among preterm infants and enormous costs for the healthcare system, women should be encouraged to cease or at least reduce smoking during pregnancy.

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