Effects of socioeconomic position and clinical risk factors on spontaneous and iatrogenic preterm birth

Joseph, K. S.; Fahey, John; Shankardass, Ketan; Allen, Victoria M.; O’Campo, Patricia; Dodds, Linda; Liston, Robert; Allen, Alexander C.

doi:10.1186/1471-2393-14-117

Cited by 51 publications

(50 citation statements)

References 29 publications

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“…Advanced mother's age, however, influences the risk for both spontaneous and iatrogenic preterm births. 29,30 In our study, maternal age was increasing during the study period. We adjusted our regression models for maternal age, and despite that, the increase in the preterm birth rate and iatrogenic preterm birth rate was significant as well as the decrease in the spontaneous preterm birth rate.…”

Section: T a B L E 3 Relative Contributingsupporting

confidence: 47%

“…The fact that spontaneous preterm births were decreasing in our study could be because obstetric practices have become better equipped to deal with these risk factors. Advanced mother's age, however, influences the risk for both spontaneous and iatrogenic preterm births . In our study, maternal age was increasing during the study period.…”

Section: Discussionmentioning

confidence: 48%

“…These factors are strongly related to socioeconomic status. 29 To lessen the potential impact of these missing variables, we were able to adjust our regression models for other maternal characteristics that are also strong predictors of socioeconomic status, such as marital status, occupation, residency, and nationality. 35 Another limitation might be that the ICD-10 diagnoses used to identify medical indications for the preterm births may not have been the direct indications for the births.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

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

Grétarsdóttir

Aspelund

Steingrímsdóttir

et al. 2019

Birth

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Background The frequency of preterm births has been increasing globally, mainly due to a rise in iatrogenic late preterm births. The aim of this study was to assess the prevalence of preterm births in Iceland during 1997‐2016 by type of preterm birth. Methods This study included all live births in Iceland during 1997‐2016 identified from the Icelandic Medical Birth Registry. Risk of preterm birth by time period was assessed with Poisson regression models adjusted for demographic variables and indications for iatrogenic births. Results The study population included 87 076 infants, of which 4986 (5.7%) were preterm. The preterm birth rate increased from 5.3% to 6.1% (adjusted rate ratio [ARR] = 1.16, confidence interval [CI] = 1.07‐1.26) between 1997‐2001 and 2012‐2016 overall. The increase was only evident in multiples (ARR 1.41, 95% CI 1.21‐1.65), not singletons (1.07, 0.97‐1.19). The rate of late preterm births (34‐36 weeks) increased significantly (1.24, 1.14‐1.40), and the rate of iatrogenic preterm births more than doubled during this period even after adjustment for identified medical indications (2.40, 2.00‐2.88). The rate of spontaneous preterm births decreased during the study period (0.63, 0.55‐0.73), and the rate of PPROM increased (1.31, 1.09‐1.57). The most common contributing indications for iatrogenic births were fetal distress (26.2%), hypertensive disorders (18.2%), and severe preeclampsia (16.9%). Conclusions Preterm birth rates increased in multiples in Iceland between 1997 and 2016, and late and iatrogenic preterm births increased overall. The increase in iatrogenic preterm births remained significant after adjusting for medical indications, suggesting that other factors might be affecting the rise.

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Section: T a B L E 3 Relative Contributingsupporting

confidence: 47%

Section: Discussionmentioning

confidence: 48%

Section: Strengths and Limitationsmentioning

confidence: 99%

See 1 more Smart Citation

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

Grétarsdóttir

Aspelund

Steingrímsdóttir

et al. 2019

Birth

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“…13 In Nova Scotia, Joseph and colleagues studied the effect of socioeconomic position and clinical risk factors on spontaneous and provider-initiated preterm births among 132,714 singleton deliveries from 1988–2003. 22 Like Trilla, maternal age was a significant predictor for provider-initiated preterm birth. In contrast to our study, Joseph and colleagues found a significant increase in iatrogenic preterm birth over time.…”

Section: Discussionmentioning

confidence: 93%

Trends in provider-initiated versus spontaneous preterm deliveries, 2004–2013

et al. 2017

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Objectives 1) To estimate the proportion of preterm deliveries at a tertiary perinatal center that were provider-initiated vs. spontaneous before and after a 2009 policy to reduce elective early-term deliveries. 2) To evaluate if shifts in type of preterm delivery varied by race/ethnicity. Methods We performed a retrospective cohort study of preterm deliveries over a 10-year period, 2004–2013, including detailed review of 929 of 5,566 preterm deliveries to designate each delivery as provider-initiated or spontaneous. We dichotomized the time period into early (2004–2009) and late (2010–2013). We used log-binomial regression to calculate adjusted risk ratios. Results Of the 46,981 deliveries, 5,566 (11.8%) were preterm, with a significant reduction in the overall incidence of preterm delivery from 12.3% to 11.2% (P=0.0003). Among the 929 preterm deliveries analyzed, there was a reduction in the proportion of provider-initiated deliveries from 48.3% to 41.8% that was not statistically significant. The proportion of provider-initiated preterm deliveries among black, but not white, women declined from 50.8% to 39.7% (adjusted RR: 0.66; 95%CI: 0.45–0.97). This coincided with a larger reduction in overall preterm deliveries among black women (16.2% to 12.8%) vs. white women (12.3% to 11.2%) (P interaction=0.038). By 2013, the incidence of preterm deliveries had decreased for both black (12.1%) and white women (11.4%) and the difference was no longer statistically significant (P=0.7). Conclusion We found a reduction in preterm deliveries after a policy targeted at reducing elective early-term deliveries in 2009 that coincided with reductions in the proportion of provider-initiated preterm deliveries, especially among black women.

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“…Among the wellderly in the study by Erikson et al , 82% had a college degree versus just 19% in the background population 2 . On this background, that the wellderly were enriched with genetic factors associated with cognitive function might not be surprising, especially given that in the control group of 20–44 year olds, one-third were parents of a preterm neonate, a group of individuals who are known to be associated with an adverse socioeconomic position 7 . As the wellderly population increases in size and the statistical power to detect genetic variants increases, confirming that the cognitive function results are meaningful in healthy ageing, rather than simply the peculiarities of sampling, will be important.…”

mentioning

confidence: 99%