Recurrence rate of preterm birth and associated factors among women who delivered at Kilimanjaro Christian Medical Centre in Northern Tanzania: A registry based cohort study

Kalengo, Nathaniel; Sanga, Leah Anku; Philemon, Rune; Obure, Joseph; Mahande, Michael Johnson

doi:10.1371/journal.pone.0239037

Cited by 15 publications

(15 citation statements)

References 16 publications

(33 reference statements)

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“…Previous history of PTB was found in 14 studies [ 9 , 19 , 26 , 27 , 54 , 58 , 61 , 68 , 90 , 91 , 94 , 101 , 104 , 110 ] to be significantly associated with increased risk of PTB in subsequent pregnancies. One study in Tanzania [ 68 ] evaluating the impact of previous PTB on successive deliveries found an increasing risk of PTB with an increase in the number of previous PTBs.…”

Section: Resultsmentioning

confidence: 99%

“…Inter-pregnancy interval was also consistently reported to significantly influence PTB in 11 of the included studies [ 19 , 27 , 39 , 47 , 48 , 50 , 71 , 77 , 97 ]. In ten of these studies, a short Inter Pregnancy Interval (<24 months) was reported as being associated with a higher risk of PTB while a long inter-pregnancy interval (>60 months) was reported as a risk factor in two of these studies [ 61 , 70 ].…”

Section: Resultsmentioning

confidence: 99%

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A Scoping Review of Preterm Births in Sub-Saharan Africa: Burden, Risk Factors and Outcomes

Mabrouk

Abubakar

Too

et al. 2022

IJERPH

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Preterm births (PTB) are the leading cause of neonatal deaths, the majority of which occur in low- and middle-income countries, particularly those in Sub-Saharan Africa (SSA). Understanding the epidemiology of prematurity is an essential step towards tackling the challenge of PTB in the sub-continent. We performed a scoping review of the burden, predictors and outcomes of PTB in SSA. We searched PubMed, Embase, and three other databases for articles published from the database inception to 10 July 2021. Studies reporting the prevalence of PTB, the associated risk factors, and/or its outcomes were eligible for inclusion in this review. Our literature search identified 4441 publications, but only 181 met the inclusion criteria. Last menstrual period (LMP) was the most commonly used method of estimating gestational age. The prevalence of PTB in SSA ranged from 3.4% to 49.4%. Several risk factors of PTB were identified in this review. The most frequently reported risk factors (i.e., reported in ≥10 studies) were previous history of PTB, underutilization of antenatal care (<4 visits), premature rupture of membrane, maternal age (≤20 or ≥35 years), inter-pregnancy interval, malaria, HIV and hypertension in pregnancy. Premature babies had high rates of hospital admissions, were at risk of poor growth and development, and were also at a high risk of morbidity and mortality. There is a high burden of PTB in SSA. The true burden of PTB is underestimated due to the widespread use of LMP, an unreliable and often inaccurate method for estimating gestational age. The associated risk factors for PTB are mostly modifiable and require an all-inclusive intervention to reduce the burden and improve outcomes in SSA.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

A Scoping Review of Preterm Births in Sub-Saharan Africa: Burden, Risk Factors and Outcomes

Mabrouk

Abubakar

Too

et al. 2022

IJERPH

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“…Following informed consent, mothers were interviewed within the first 24 hours after birth given a normal delivery or as soon as a mother has recovered from a complicated delivery. The questionnaire used for data collection is available elsewhere [ 45 ]. Although the printed questionnaires were in the English language, the Project Midwives performing the interviews were well versed in English, Swahili, and one other tribal language.…”

Section: Methodsmentioning

confidence: 99%

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

et al. 2021

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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.

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“…In addition to elective cesarean section, maternal clinical complications also relate to provider-initiated preterm birth. Retrospective cohort conducted in Northern Tanzania showed that women who had preeclampsia in previous pregnancies had a 50% higher risk of recurrent prematurity compared to women with normal blood pressure 33 . Therefore, the recommendation is to identify early women with a history of prematurity associated with comorbidities and treat them timely in the prenatal period and during labor to prevent negative maternal-fetal outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Além da cesariana eletiva, as complicações clínicas maternas também se relacionam com a prematuridade por intervenção obstétrica. Coorte retrospectiva realizada na região Norte da Tanzânia mostrou que mulheres que tiveram pré-eclâmpsia em gestações anteriores apresentaram risco 50% maior de prematuridade recorrente em comparação às mulheres com pressão arterial normal 33 . Por isso, recomenda-se que mulheres com histórico de prematuridade associada a comorbidades sejam identificadas precocemente e oportunamente tratadas no período pré-natal e durante o trabalho parto para prevenir desfechos materno-fetais negativos.…”

Section: Discussionunclassified

Prematuridade recorrente: dados do estudo “Nascer no Brasil”

et al. 2022

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OBJETIVO Descrever e estimar a taxa de prematuridade recorrente no Brasil segundo o tipo de parto, ponderado pelos fatores associados. MÉTODOS Os dados foram obtidos do estudo nacional de base hospitalar “Nascer no Brasil”, realizado em 2011 e 2012, a partir de entrevistas com 23.894 mulheres. Inicialmente foi utilizado o teste qui-quadrado para verificar as diferenças entre os recém-nascidos, segundo a prematuridade prévia e o tipo de prematuridade recorrente. Sequencialmente, aplicou-se o método de ponderação pelo escore de propensão para equilibrar os grupos de acordo com as seguintes covariáveis: idade materna, classificação socioeconômica, tabagismo durante a gravidez, paridade, cesárea anterior, natimorto ou óbito neonatal anterior, hipertensão crônica e diabetes crônica. Por último, foi realizada regressão logística múltipla para estimar a prematuridade recorrente. RESULTADOS Foram analisados 6.701 recém-nascidos. A taxa de prematuridade recorrente foi de 42,0%, considerando todas as mulheres com prematuridade prévia. Dentre os prematuros recorrentes, 62,2% foram espontâneos e 37,8% ocorreram por intervenção-obstétrica. Após a ponderação pelo escore de propensão, verificou-se que mulheres com prematuridade prévia têm 3,89 vezes a chance de terem prematuridade recorrente espontânea (ORaj = 3,89; IC95% 3,01–5,03) e 3,47 vezes a chance de terem prematuridade recorrente por intervenção obstétrica (ORaj = 3,47; IC95% 2,59–4,66), em comparação às mulheres que tiveram recém-nascidos termo completo. CONCLUSÕES A prematuridade prévia revelou-se um forte preditor para sua recorrência. Assim, ampliar e melhorar o monitoramento e manejo de gestantes com história de prematuridade impacta fortemente na redução das taxas e, consequentemente, na redução dos riscos de morbimortalidade infantil no país.

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Recurrence rate of preterm birth and associated factors among women who delivered at Kilimanjaro Christian Medical Centre in Northern Tanzania: A registry based cohort study

Cited by 15 publications

References 16 publications

A Scoping Review of Preterm Births in Sub-Saharan Africa: Burden, Risk Factors and Outcomes

A Scoping Review of Preterm Births in Sub-Saharan Africa: Burden, Risk Factors and Outcomes

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

Prematuridade recorrente: dados do estudo “Nascer no Brasil”

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