Exploring the Decline in the Singleton Preterm Birth Rate in the United States, 2019–2020

This report is limited to singleton births and describes trends in preterm birth rates from 2014 through 2020 and changes in rates between 2019 and 2020 by maternal race and Hispanic origin, age, and state of residence.

Effective questionnaire design: How to use cognitive interviews to refine questionnaire items

BACKGROUND: Cognitive interviewing is a technique that can be used to improve and refine questionnaire items. We describe the basic methodology of cognitive interviewing and illustrate its utility through our experience using cognitive interviews to refine a questionnaire assessing parental understanding of concepts related to preterm birth. METHODS: Cognitive interviews were conducted using current best practices. Results were analyzed by the multidisciplinary research team and questionnaire items that were revealed to be problematic were revised. RESULTS: Revisions to the questionnaire items were made to improve clarity and to elicit responses that truly reflected the participants understanding of the concept. CONCLUSION: Cognitive interviewing is a useful methodology for improving validity of questionnaire items, we recommend researchers developing new questionnaire items design and complete cognitive interviews to improve their items and increase confidence in study conclusions.

Evaluation of Risk Factors for Preterm Birth Outcome in Gujarat, India

Background: Preterm birth (PTB) is a leading cause of neonatal survival complications, mortality, and morbidity worldwide. In India 35% of all neonatal deaths are due to PTB with 36th global ranking, hence, India's healthcare sector has been working towards reducing the rate of PTB effectively. Objective: This study aimed to assess the risk factors such as environmental and pathophysiological causes associated with preterm birth in the population of Gujarat, India. Materials and Methods: In this study, multivariate random sampling was performed and systematically 200 pregnant mothers [PTB <37 weeks (N=100), Full-term >37 weeks (N=100)] were chosen after excluding mothers with vaginal infection, multiple gestations, fetal anomalies, non-cephalic presentation, cesarean delivery, and pregnancy with Mullerian anomalies. Statistical analysis was performed by Chi-square test, and variables with p-value <0.05 were considered statistically significant. Results: Out of all the variables, maternal age below 20 years, extreme BMI, high blood pressure during pregnancy, maternal health complications, medication and doctor's consultation were highly significant (p < 0.0001). Furthermore, variables like type of area, diet, education, Hb levels below 9 g/dL and above 13 g/dL and blood-group of the mother were also significantly associated with PTB outcome (p < 0.05). Among the sub-categories of PTB (extreme-, very-, moderate/late- PTB), maternal age, Hb level and the past obstetric outcome showed very high significance (p < 0.0001). Conclusion: For the prediction of birth outcome, mother's internal physiological and lifestyle factors need to be taken into consideration, and mothers at risk priorly can be screen out, followed by proper healthcare assistance to decrease the preterm birth rate and its consequences. Key words: Preterm birth, maternal age, blood pressure, past obstetric outcome, risk factors

Methodological Considerations for Preterm Birth Research

Complications from preterm birth are a leading cause of infant mortality, with long-term implications for morbidity and quality of life of preterm infants. There are many important risk factors for preterm births however in this article, we focus on the maternal infection etiological pathway, given its significance in low-to-middle income countries. In high preterm birth settings such as sub-Saharan Africa, maternal HIV infection and antiretroviral therapy (ART) use have been associated with an increased risk of preterm births. Consequently, we highlight methodological considerations related to selection and measurement bias in preterm birth research. We further illustrate the potential impact of these biases in studies investigating the relationship between HIV/ART and preterm births. We also briefly discuss issues related to population-level estimations based on routinely collected clinical or civil registration data. We conclude by emphasizing the importance of strengthening of antenatal care services to improve quality of population data as well as optimizing current and future study designs, by taking into account the important methodological considerations described in this article.