scholarly journals Predictors of singleton preterm birth using multinomial regression models accounting for missing data: A birth registry-based cohort study in northern Tanzania

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0249411
Author(s):  
Innocent B. Mboya ◽  
Michael J. Mahande ◽  
Joseph Obure ◽  
Henry G. Mwambi
Keyword(s):  
Preterm Birth ◽  
Regression Models ◽  
Perinatal Death ◽  
Placenta Previa ◽  
Preterm Births ◽  
Late Preterm ◽  
Multinomial Regression ◽  
Birth Registry ◽  
Northern Tanzania ◽  
Extremely Preterm

Background Preterm birth is a significant contributor of under-five and newborn deaths globally. Recent estimates indicated that, Tanzania ranks the tenth country with the highest preterm birth rates in the world, and shares 2.2% of the global proportion of all preterm births. Previous studies applied binary regression models to determine predictors of preterm birth by collapsing gestational age at birth to <37 weeks. For targeted interventions, this study aimed to determine predictors of preterm birth using multinomial regression models accounting for missing data. Methods We carried out a secondary analysis of cohort data from the KCMC zonal referral hospital Medical Birth Registry for 44,117 women who gave birth to singletons between 2000-2015. KCMC is located in the Moshi Municipality, Kilimanjaro region, northern Tanzania. Data analysis was performed using Stata version 15.1. Assuming a nonmonotone pattern of missingness, data were imputed using a fully conditional specification (FCS) technique under the missing at random (MAR) assumption. Multinomial regression models with robust standard errors were used to determine predictors of moderately to late ([32,37) weeks of gestation) and very/extreme (<32 weeks of gestation) preterm birth. Results The overall proportion of preterm births among singleton births was 11.7%. The trends of preterm birth were significantly rising between the years 2000-2015 by 22.2% (95%CI 12.2%, 32.1%, p<0.001) for moderately to late preterm and 4.6% (95%CI 2.2%, 7.0%, p = 0.001) for very/extremely preterm birth category. After imputation of missing values, higher odds of moderately to late preterm delivery were among adolescent mothers (OR = 1.23, 95%CI 1.09, 1.39), with primary education level (OR = 1.28, 95%CI 1.18, 1.39), referred for delivery (OR = 1.19, 95%CI 1.09, 1.29), with pre-eclampsia/eclampsia (OR = 1.77, 95%CI 1.54, 2.02), inadequate (<4) antenatal care (ANC) visits (OR = 2.55, 95%CI 2.37, 2.74), PROM (OR = 1.80, 95%CI 1.50, 2.17), abruption placenta (OR = 2.05, 95%CI 1.32, 3.18), placenta previa (OR = 4.35, 95%CI 2.58, 7.33), delivery through CS (OR = 1.16, 95%CI 1.08, 1.25), delivered LBW baby (OR = 8.08, 95%CI 7.46, 8.76), experienced perinatal death (OR = 2.09, 95%CI 1.83, 2.40), and delivered male children (OR = 1.11, 95%CI 1.04, 1.20). Maternal age, education level, abruption placenta, and CS delivery showed no statistically significant association with very/extremely preterm birth. The effect of (<4) ANC visits, placenta previa, LBW, and perinatal death were more pronounced on the very/extremely preterm compared to the moderately to late preterm birth. Notably, extremely higher odds of very/extreme preterm birth were among the LBW babies (OR = 38.34, 95%CI 31.87, 46.11). Conclusions The trends of preterm birth have increased over time in northern Tanzania. Policy decisions should intensify efforts to improve maternal and child care throughout the course of pregnancy and childbirth towards preterm birth prevention. For a positive pregnancy outcome, interventions to increase uptake and quality of ANC services should also be strengthened in Tanzania at all levels of care, where several interventions can easily be delivered to pregnant women, especially those at high-risk of experiencing adverse pregnancy outcomes.

scholarly journals Joint Modeling of Singleton Preterm Birth and Perinatal Death Using Birth Registry Cohort Data in Northern Tanzania

2021 ◽  
Vol 9 ◽  
Author(s):  
Innocent B. Mboya ◽  
Michael J. Mahande ◽  
Joseph Obure ◽  
Henry G. Mwambi
Keyword(s):  
Preterm Birth ◽  
Pregnancy Outcomes ◽  
Perinatal Death ◽  
Substantial Reduction ◽  
Adverse Pregnancy Outcomes ◽  
Birth Registry ◽  
Cohort Data ◽  
Northern Tanzania ◽  
Management Of Complications ◽  
Adverse Pregnancy

Understanding independent and joint predictors of adverse pregnancy outcomes is essential to inform interventions toward achieving sustainable development goals. We aimed to determine the joint predictors of preterm birth and perinatal death among singleton births in northern Tanzania based on cohort data from the Kilimanjaro Christian Medical Center (KCMC) zonal referral hospital birth registry between 2000 and 2017. We determined the joint predictors of preterm birth and perinatal death using the random-effects models to account for the correlation between these outcomes. The joint predictors of higher preterm birth and perinatal death risk were inadequate (&lt;4) antenatal care (ANC) visits, referred for delivery, experiencing pre-eclampsia/eclampsia, postpartum hemorrhage, low birth weight, abruption placenta, and breech presentation. Younger maternal age (15–24 years), premature rupture of membranes, placenta previa, and male children had higher odds of preterm birth but a lessened likelihood of perinatal death. These findings suggest ANC is a critical entry point for delivering the recommended interventions to pregnant women, especially those at high risk of experiencing adverse pregnancy outcomes. Improved management of complications during pregnancy and childbirth and the postnatal period may eventually lead to a substantial reduction of adverse perinatal outcomes and improving maternal and child health.

scholarly journals Correlation between placental pathology and neonatal morbidity: a case-control study

2017 ◽  
Vol 6 (2) ◽  
pp. 599
Author(s):  
Anna Kornete ◽  
Natalija Vedmedovska ◽  
Solvita Blazuka
Keyword(s):  
Preterm Birth ◽  
Case Control Study ◽  
Preterm Births ◽  
Neonatal Morbidity ◽  
Case Control ◽  
Late Preterm ◽  
Very Preterm ◽  
Very Preterm Birth ◽  
Extremely Preterm ◽  
Control Study

Background: Preterm births occur in approximately 12% of pregnancies worldwide and in 5.6% of pregnancies in Latvia, and the incidence has increased. Prematurity poses the major challenge in perinatology and pediatrics, accounting for 75% of perinatal mortalities and 50% of long-term complication. The placenta is a unique organ in explaining the incomprehensible pathogenesis of prematurity.Methods: The retrospective case-control study was conducted to determine placental histological and microbiological findings associated with gestational age and neonatal morbidity.Results: Histological chorioamnionitis was the most prevalent lesion in extremely preterm and very preterm birth groups compared with moderate to late preterm and term birth groups (P=0.027). A higher rate of funisitis was detected among extremely preterm and very preterm birth cases (P=0.001). Microbiological examination of placentas in preterm birth cases most commonly revealed Streptococcus agalactiae, Staphylococcus epidermidis, Staphylococcus haemolyticus. Umbilical cord vessels thrombosis and placental thrombotic vasculopathy were found mostly in moderate to late preterm birth category (P=0.032; P=0.008, respectively). Intrauterine growth restriction was linked to chorionic villous edema (P=0.007) and chorionic villous fibrinoid necrosis (P=0.014). Chorion-decidual hemorrhage and deciduitis were significantly associated with respiratory distress syndrome (P=0.036; P=0.022, respectively). Chorion-decidual hemorrhage was the main predisposing factor for hypoxic-ischemic encephalopathy (P=0.058).Conclusions: Comprehension of the pathogenic mechanisms of prematurity of the placenta and preterm births, and the impact of placental prematurity on neonatal morbidity may lead to improved prenatal diagnostic and enhanced preventive care for both the mother and the child.

scholarly journals Preterm Delivery; Who Is at Risk?

2021 ◽  
Vol 10 (11) ◽  
pp. 2279
Author(s):  
Dvora Kluwgant ◽  
Tamar Wainstock ◽  
Eyal Sheiner ◽  
Gali Pariente
Keyword(s):  
Risk Factors ◽  
Preterm Birth ◽  
Prenatal Care ◽  
Recurrent Pregnancy Loss ◽  
Placental Abruption ◽  
Placenta Previa ◽  
Population Based ◽  
Perinatal Morbidity ◽  
Multiple Gestations ◽  
Extremely Preterm

Preterm birth (PTB) is the leading cause of perinatal morbidity and mortality. Adverse effects of preterm birth have a direct correlation with the degree of prematurity, in which infants who are born extremely preterm (24–28 weeks gestation) have the worst outcomes. We sought to determine prominent risk factors for extreme PTB and whether these factors varied between various sub-populations with known risk factors such as previous PTB and multiple gestations. A population-based retrospective cohort study was conducted. Risk factors were examined in cases of extreme PTB in the general population, as well as various sub-groups: singleton and multiple gestations, women with a previous PTB, and women with indicated or induced PTB. A total of 334,415 deliveries were included, of which 1155 (0.35%) were in the extreme PTB group. Placenta previa (OR = 5.8, 95%CI 4.14–8.34, p < 0.001), multiple gestations (OR = 7.7, 95% CI 6.58–9.04, p < 0.001), and placental abruption (OR = 20.6, 95%CI 17.00–24.96, p < 0.001) were the strongest risk factors for extreme PTB. In sub-populations (multiple gestations, women with previous PTB and indicated PTBs), risk factors included placental abruption and previa, lack of prenatal care, and recurrent pregnancy loss. Singleton extreme PTB risk factors included nulliparity, lack of prenatal care, and placental abruption. Placental abruption was the strongest risk factor for extreme preterm birth in all groups, and risk factors did not differ significantly between sub-populations.

Impact of smoking and fetal gender on preterm delivery

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.

scholarly journals Predictors of perinatal death in the presence of missing data: A birth registry-based study in northern Tanzania

PLoS ONE ◽  
2020 ◽  
Vol 15 (4) ◽  
pp. e0231636
Author(s):  
Innocent B. Mboya ◽  
Michael J. Mahande ◽  
Joseph Obure ◽  
Henry G. Mwambi
Keyword(s):  
Missing Data ◽  
Perinatal Death ◽  
Birth Registry ◽  
Northern Tanzania

scholarly journals Preterm birth and sustained inflammation: consequences for the neonate

2020 ◽  
Vol 42 (4) ◽  
pp. 451-468 ◽  
Author(s):  
Alexander Humberg ◽  
◽  
Ingmar Fortmann ◽  
Bastian Siller ◽  
Matthias Volkmar Kopp ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Preterm Infants ◽  
Defense Mechanisms ◽  
Preterm Births ◽  
Immune Defense ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Organ Systems ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

Abstract Almost half of all preterm births are caused or triggered by an inflammatory process at the feto-maternal interface resulting in preterm labor or rupture of membranes with or without chorioamnionitis (“first inflammatory hit”). Preterm babies have highly vulnerable body surfaces and immature organ systems. They are postnatally confronted with a drastically altered antigen exposure including hospital-specific microbes, artificial devices, drugs, nutritional antigens, and hypoxia or hyperoxia (“second inflammatory hit”). This is of particular importance to extremely preterm infants born before 28 weeks, as they have not experienced important “third-trimester” adaptation processes to tolerate maternal and self-antigens. Instead of a balanced adaptation to extrauterine life, the delicate co-regulation between immune defense mechanisms and immunosuppression (tolerance) to allow microbiome establishment is therefore often disturbed. Hence, preterm infants are predisposed to sepsis but also to several injurious conditions that can contribute to the onset or perpetuation of sustained inflammation (SI). This is a continuing challenge to clinicians involved in the care of preterm infants, as SI is regarded as a crucial mediator for mortality and the development of morbidities in preterm infants. This review will outline the (i) role of inflammation for short-term consequences of preterm birth and (ii) the effect of SI on organ development and long-term outcome.

Placental malperfusion as a possible mechanism of preterm birth in patients with Müllerian anomalies

2017 ◽  
Vol 45 (1) ◽  
Author(s):  
Jovana Lekovich ◽  
Joshua Stewart ◽  
Sarah Anderson ◽  
Erin Niemasik ◽  
Nigel Pereira ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Gestational Age ◽  
Placenta Previa ◽  
Preterm Births ◽  
Mullerian Anomalies ◽  
Müllerian Anomalies ◽  
Increased Risk ◽  
Uterine Anomalies ◽  
Gestational Age At Delivery ◽  
Term Births

AbstractObjective:Müllerian anomalies are associated with increased risk of miscarriage, intrauterine growth restriction (IUGR) and preterm birth. While a commonly implicated cause is restricted expansion of endometrial cavity, alternatively it could be due to abnormal placentation. We sought to examine clinical and histopathologic factors associated with preterm delivery in women with Müllerian anomalies.Study design:One hundred and eleven singleton pregnancies in 85 women were analyzed retrospectively. There were 42 pregnancies with bicornaute, 24 with unicornuate, 24 with septate, 19 with didelphys and one each with arcuate and T-shaped uterus. Primary outcomes included gestational age at delivery, placental histopathology, placenta previa and accreta.Results:Twenty-eight (25.2%) of pregnancies were delivered prior to term. Of those, only 14 (50%) were due to preterm labor or preterm premature rupture of membranes (PPROM). Histological evidence of placental malperfusion was present in 22% of all pregnancies and those delivered at an earlier median gestational age [34 (IQR 31–37) vs. 37 weeks (IQR 34–39); P=0.001]. Malperfusion was more common in preterm than in full term births (46% vs. 14%; P=0.04). Conversely, inflammation was not more common in preterm compared to term deliveries (17.9% vs. 16.9%; P=0.89). Five pregnancies had placenta previa, three of which were complicated by accreta.Conclusion:Placental malperfusion, rather than inflammation, was more commonly associated with preterm births in women with uterine anomalies.

scholarly journals Burden and risk factors of preterm birth in Nasarawa State, North Central, Nigeria: A five-year case review

2021 ◽  
Vol 7 (2) ◽  
pp. 36-41
Author(s):  
Ikrama Hassan ◽  
◽  
Surajudeen Bello ◽  
Michael Anazodo ◽  
Abdulmumuni Ahmed Lawal ◽  
...  
Keyword(s):  
Risk Factors ◽  
Preterm Birth ◽  
Preterm Delivery ◽  
Placenta Previa ◽  
Preterm Births ◽  
Cross Sectional Study ◽  
Multiple Gestation ◽  
Case Review ◽  
Premature Rupture ◽  
Cross Sectional

Background: Preterm birth has been on the increase globally and accounting for morbidities and mortalities. Preterm delivery referred to the birth of a newborn prior to thirty seven completed gestational weeks. There is dearth of knowledge on the burden of preterm birth in this state. This study therefore determined the burden of preterm deliveries in Nasarawa State, evaluate the risk factors and identify the outcome of such deliveries. Methods: A descriptive cross-sectional study of all preterm delivered from the 1st of January 2014 to the 31st of December 2013 at the Dalhatu Araf Specialist Hospital (DASH) Lafia, General Hospital Akwanga and Medical Centre Mararaba Gurku in the Southern, Northern and Western senatorial zones of Nasarawa State respectively. Data was analyzed using SPSS version 20. Results: The mean age of mothers of preterm in this study is 26.5±5.7 years. More than three-quarter of preterm birth in Nasarawa State were at the DASH Lafia. The prevalence of preterm birth and admissions were 1.5% and 10.8% respectively. One in four of the preterm were either late preterm or extreme preterm. Singleton gestation accounted for 82.1% of the preterm births while 75.6% of such deliveries where through the vaginal mode of deliveries. Risk factors for preterm deliveries were multiple gestation, antepartum haemorrhage (placenta previa), premature rupture of membrane and previous preterm delivery. Deaths among the preterm was 11% in this study. Conclusion: The burden of preterm births in this study is comparable to other centre in same region. Half of the preterm were either late or extreme preterm. Risk factors for preterm deliveries were placenta previa, premature rupture of membrane, multiple gestation and previous preterm child birth. Death was recorded in one out of every nine preterm

scholarly journals PREGNANCY RELATED PLASMA PROTEIN–A AND PREMATURE BIRTH

2021 ◽  
Vol 19 (2) ◽  
pp. 172-177
Author(s):  
Iv. Todorov ◽  
N. Tododrov ◽  
M. Angelova ◽  
K. Peeva
Keyword(s):  
Preterm Birth ◽  
Pregnant Women ◽  
Plasma Protein ◽  
Premature Birth ◽  
Chromosomal Abnormalities ◽  
Placenta Previa ◽  
Protein A ◽  
Preterm Births ◽  
Sonographic Examination ◽  
Increased Risk

Introduction: Children born prematurely are at higher risk of mortality, morbidity, and impaired motor and cognitive development in childhood than prematurely born babies. Aim: To establish the relationship between the corresponding levels of pregnancy-related plasma protein-A (PAPP-A) and the frequency of premature birth. Materials and methods: The study is prospective. The data was collected through monitoring patients through a questionnaire and sonographic examination at 11-13 gestational weeks. The study excluded all known risk factors for preterm birth, such as previous preterm births, pregnant women with gestational diabetes, preeclampsia, hypertension, placenta previa, hydramnion, multiple pregnancies, smoking, structural and chromosomal abnormalities of the fetus and planned preterm birth. The data from the measured values of PAPP-A and the frequency of premature birth in 636 pregnant women were analyzed. Conclusions: PAPP-A levels are a statistically significant factor for preterm birth. It is expected with a 95% probability in the population with PAPP-A values below 0,515 that the cases with premature birth will be from 7 to 14 times more. Pregnant women with PAPP-A level less than 10th per cent are significantly associated with an increased risk of preterm birth.

Sign in / Sign up

Export Citation Format

Share Document