Incidence and risk factors of preterm birth in a rural Bangladeshi cohort

Abstract

BackgroundGlobally, about 15 million neonates are born preterm and about 85% of global preterm birth occurs in Asia and Africa regions. We aimed to estimate the incidence and risk factors for preterm birth in a rural Bangladeshi cohort.MethodsBetween June 2007 and September 2009, community health workers prospectively collected data from 32,126 mother-live-born baby pairs on household socio-demographic status, pregnancy history, antenatal care seeking and newborn gestational age determined by recall of date of last menstrual period.ResultsAmong all live births, 22.3% were delivered prior to 37 weeks of gestation (i.e. preterm); of which 12.3% were born at 35–36 weeks of gestation (late preterm), 7.1% were born at 32–34 weeks (moderate preterm), and 2.9% were born at 28–31 weeks of gestation (very preterm). Overall, the majority of preterm births (55.1%) were late preterm. Risk of preterm birth was lower among women with primary or higher level of education (RR: 0.92; 95% CI: 0.88, 0.97), women who sought antenatal care at least once during the index pregnancy (RR: 0.86; 95% CI: 0.83, 0.90), and women who had completed all birth preparedness steps (RR: 0.32; 95% CI: 0.30, 0.34). In contrast, risk of preterm birth was higher among women with a history of child death (RR: 1.05; 95% CI: 1.01, 1.10), who had mid-upper arm circumference (MUAC) ≤250 mm, indicative of under nutrition (for women having MUAC <214 mm the risk was higher; RR: 1.26; 95% CI: 1.17, 1.35), who reported an antenatal complication (RR: 1.32; 95% CI: 1.14, 1.53), and who received iron-folic acid supplementation for 2–6 months during the index pregnancy (RR: 1.33; 95% CI: 1.24, 1.44).ConclusionsIn resource poor settings with high burden of preterm birth, alike Bangladesh, preterm birth risk could be reduced by close monitoring and/or frequent follow-up of women with history of child death and antenatal complications, by encouraging women to seek antenatal care from qualified providers, to adopt birth preparedness planning and to maintain good nutritional status. Additional research is needed to further explore the associations of antenatal iron supplementation and maternal nutritional status on preterm birth.

Study of Risk Factors for Preterm Births in a Teaching Hospital: A Prospective Study

“…Similar observations have been made in other studies. [6,9,12] In the present study, elderly mothers (maternal age more than 34 years) were at a significantly higher risk of a preterm delivery (P-value<0.01) as was observed by other researchers. [8,9] In the present study, 58% of preterm babies were born to mothers from low socioeconomic strata as compared to 39% babies in term group.…”

“…These findings are similar to observations made in other studies. [6] In our study maximum mothers who delivered prematurely were in the age group 25-34 years. Similar observations have been made in other studies.…”

“…These findings are consistent with other studies. [6][7][8][9][10] In our study 44 % patients underwent a caesaerean section in the mothers who delivered prematurely; of these almost an equal number of patients had an emergency caesaerean section and a planned caesaerean section and fetal distress was the most common indication for emergency caesaerean section. In the mothers who had a term delivery only 32% mothers were delivered by a caesaerean section.…”

“…[20,21] In our study, majority of the preterm births were late preterm as has been observed in other studies. [6] Preterm babies continue to die in perinatal period or have severe neonatal complications which predispose to a higher incidence of developmental complications and sensory deficits. Impressive advances in neonatal care have steadily improved neonatal mortality over last many years; however it is unlikely to reduce it further to a significant level.…”

The preterm placental microbiome varies in association with excess maternal gestational weight gain

“…Additionally, like folate supplementation, iron supplementation has been found to possibly be more harmful than helpful. 82,83 Combined, our findings raise the notion that the impact of exogenous supplementation may be mitigated by the microbiome-encoded metabolic pathways of the placenta. However, this is speculative, and further research in this area is required.…”