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Are risk factors for preterm and early-term live singleton birth the same? A population-based study in France.

ABSTRACT: OBJECTIVES:To investigate whether risk factors for preterm (<37 weeks gestation) and early-term birth (37 and 38 weeks gestation) are similar. DESIGN:Nationally representative cross-sectional study of births. SETTING:France in 2010. PARTICIPANTS:Live singleton births (n=14 326). PRIMARY AND SECONDARY OUTCOME MEASURES:Preterm and early-term birth rates overall and by mode of delivery (spontaneous and indicated). Risk factors were maternal sociodemographic characteristics, previous preterm birth, height, prepregnancy body mass index (BMI) and smoking, assessed using multinomial regression models with full-term births 39 weeks and over as the reference group. RESULTS:There were 5.5% preterm and 22.5% early-term births. Common risk factors were: a previous preterm delivery (adjusted relative risk ratio (aRRR) 8.2 (95% CI 6.2 to 10.7) and aRRR 2.4 (95% CI 2.0 to 3.0), respectively), short stature, underweight (overall and in spontaneous deliveries), obesity (in indicated deliveries only), a low educational level and Sub-Saharan African origin. In contrast, primiparity was a risk factor only for preterm birth, aRRR 1.8 (95% CI 1.5 to 2.2), while higher parity was associated with greater risk of early-term birth. CONCLUSIONS:Most population-level risk factors were common to both preterm and early-term birth with the exception of primiparity, and BMI which differed by mode of onset of delivery. Our results suggest that preterm and early-term birth share similar aetiologies and thus potentially common strategies for prevention.

SUBMITTER: Delnord M

PROVIDER: S-EPMC5786124 | biostudies-literature | 2018 Jan

REPOSITORIES: biostudies-literature

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Are risk factors for preterm and early-term live singleton birth the same? A population-based study in France.

Delnord Marie M Blondel Béatrice B Prunet Caroline C Zeitlin Jennifer J

BMJ open 20180124 1

<h4>Objectives</h4>To investigate whether risk factors for preterm (<37 weeks gestation) and early-term birth (37 and 38 weeks gestation) are similar.<h4>Design</h4>Nationally representative cross-sectional study of births.<h4>Setting</h4>France in 2010.<h4>Participants</h4>Live singleton births (n=14 326).<h4>Primary and secondary outcome measures</h4>Preterm and early-term birth rates overall and by mode of delivery (spontaneous and indicated). Risk factors were maternal sociodemographic chara ...[more]

PMID: 29371276

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Project description:BackgroundPrevious studies have showed that the early diagnosis of threatened preterm labor decreases neonatal morbidity and mortality, avoids maternal morbidity induced by antepartum bed rest and unnecessary treatment, and reduces costs. Although there are many diagnostic tests, none is clearly recommended by international guidelines. The aim of our study was to compare seven diagnostic methods in terms of effectiveness and cost using a decision analysis model in singleton pregnancy presenting threatened preterm labor, between 24 and 34 weeks of gestation.MethodsSeven diagnostic strategies based on individual or combined use of the following tests: cervical length, cervical fibronectin test, cervical interleukin test and protein in maternal serum, were compared using a decision analysis model. Effectiveness was expressed in terms of serious adverse neonatal events avoided (neonatal morbidity and mortality) at the hospital discharge. The economic analysis was performed from the health care system perspective. Deterministic and probabilistic analyses were performed to test the robustness of the model.ResultsAt 24-34 weeks of gestation, the association of cervical length and qualitative fibronectin was the most efficient strategy dominating all alternatives, reducing the perinatal death or severe neonatal morbidity rate up to 15% and the costs up to 31% according to the gestational age. This result was confirmed by the deterministic sensitivity analyses. The probabilistic analysis showed that the association of cervical length and qualitative fibronectin dominated cervical length < 15 mm in more than 90% of the simulations. The comparison with the other tests revealed more uncertainty.ConclusionsA test using cervical length and qualitative fetal fibronectin appears to be the best diagnostic strategy. Decisions regarding its generalization and funding in France in this population of women should take into account the high, lifetime costs induced by prematurity.

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Are risk factors for preterm and early-term live singleton birth the same? A population-based study in France.

Publications

Are risk factors for preterm and early-term live singleton birth the same? A population-based study in France.

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