Incidence, Risk Factors, and Outcomes of Preterm and Early Term Births: A Population-Based Register Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Data Collection
2.2. Neonatal Factors
2.3. Maternal Factors
2.4. Statistical Analysis
3. Results
3.1. Characteristics of the Study Population and Differences between Pre and Early Term Groups in Comparison to Full Term Group
3.2. Risk Factors Associated with PTB and ETB
3.3. Adverse Outcomes Associated with PTB and ETB
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Extreme to Very PTB (n = 214) | Moderate PTB (n = 160) | Late PTB (n = 1015) | ETB (n = 5348) | FTB (n = 9128) (Ref.) | |||||
---|---|---|---|---|---|---|---|---|---|
n (%) | p Value | n (%) | p Value | n (%) | p Value | n (%) | p Value | n (%) | |
Maternal age | <0.001 | <0.001 | <0.001 | <0.001 | |||||
Normal (20–34 yr) | 149 (69.6) | 107 (66.9) | 718 (70.7) | 3973 (74.3) | 7402 (81.1) | ||||
Young (<20 yr) | 5 (2.3) | 7 (4.4) | 20 (2) | 99 (1.9) | 219 (2.4) | ||||
Advanced (35–39 yr) | 46 (21.5) | 36 (22.5) | 217 (21.4) | 937 (17.5) | 1209 (13.2) | ||||
Very advanced (40–44 yr) | 14 (6.5) | 9 (5.6) | 53 (5.2) | 310 (5.8) | 285 (3.1) | ||||
Extremely advanced (≥45 yr) | 0 (0) | 1 (0.6) | 7 (0.7) | 29 (0.5) | 13 (0.1) | ||||
Parity | 0.001 | 0.283 | 0.105 | <0.001 | |||||
Nulliparous | 85 (39.7) | 53 (33.1) | 272 (26.8) | 1232 (23) | 2668 (29.2) | ||||
Parity ≥ 1 | 129 (60.3) | 107 (66.9) | 743 (73.2) | 4116 (77) | 6460 (70.8) | ||||
Nationality | <0.05 | <0.05 | <0.001 | 0.001 | |||||
Qatari | 61 (28.5) | 57 (35.6) | 343 (33.8) | 1730 (32.4) | 2750 (30.1) | ||||
Other Arabs | 75 (35) | 48 (30) | 349 (34.4) | 2048 (38.3) | 3786 (41.5) | ||||
Other Nationalities | 78 (36.4) | 55 (34.4) | 323 (31.8) | 1569 (29.3) | 2589 (28.4) | ||||
Consanguineous | 0.161 | 0.651 | 0.163 | 0.634 | |||||
No | 42 (75) | 27 (62.8) | 217 (62.4) | 1435 (66.7) | 2444 (66.1) | ||||
Yes | 14 (25) | 16 (37.2) | 131 (37.6) | 717 (33.3) | 1255 (33.9) | ||||
Education | 0.570 | 0.168 | <0.05 | 0.248 | |||||
Elementary and below | 4 (6.5) | 1 (2.2) | 47 (12.4) | 205 (9) | 355 (8.9) | ||||
Secondary/Highschool | 23 (37.1) | 12 (26.7) | 130 (34.3) | 673 (29.5) | 1254 (31.5) | ||||
University or above | 35 (56.5) | 32 (71.1) | 202 (53.3) | 1404 (61.5) | 2373 (59.6) | ||||
Diabetes status | <0.001 | <0.001 | <0.001 | <0.001 | |||||
No DM | 161 (75.2) | 103 (64.4) | 613 (60.4) | 3259 (60.9) | 6981 (76.5) | ||||
GDM | 43 (20.1) | 48 (30) | 348 (34.3) | 1829 (34.2) | 2099 (23) | ||||
PGDM | 10 (4.7) | 9 (5.6) | 54 (5.3) | 260 (4.9) | 48 (0.5) | ||||
Chronic hypertension | <0.001 | <0.001 | <0.001 | <0.001 | |||||
No | 205 (95.8) | 149 (93.1) | 982 (96.7) | 5243 (98) | 9078 (99.5) | ||||
Yes | 9 (4.2) | 11 (6.9) | 33 (3.3) | 105 (2) | 50 (0.5) | ||||
PP obesity | <0.05 | 0.529 | <0.001 | <0.001 | |||||
No | 43 (58.9) | 33 (67.3) | 262 (62.7) | 1403 (63.4) | 2369 (71.4) | ||||
Yes | 30 (41.1) | 16 (32.7) | 156 (37.3) | 811 (36.6) | 947 (28.6) | ||||
Baby gender | <0.01 | <0.05 | <0.001 | <0.001 | |||||
Male | 125 (58.4) | 95 (59.4) | 557 (54.9) | 2843 (53.2) | 4482 (49.1) | ||||
Female | 89 (41.6) | 65 (40.6) | 457 (45) | 2503 (46.8) | 4646 (50.9) | ||||
Ambiguous | 0 (0) | 0 (0) | 1 (0.1) | 1 (0) | 0 (0) | ||||
Chromosomal/congenital abnormality | <0.001 | <0.001 | <0.001 | <0.05 | |||||
No | 185 (86.4) | 148 (92.5) | 968 (95.4) | 5271 (98.6) | 9032 (98.9) | ||||
Yes | 29 (13.6) | 12 (7.5) | 47 (4.6) | 77 (1.4) | 96 (1.1) | ||||
Smoking | <0.05 | 0.308 | 0.452 | 0.862 | |||||
No | 148 (97.4) | 120 (98.4) | 745 (98.9) | 4117 (99.2) | 6932 (99.2) | ||||
Yes | 4 (2.6) | 2 (1.6) | 8 (1.1) | 32 (0.8) | 56 (0.8) | ||||
Preterm history | <0.001 | <0.001 | <0.001 | <0.001 | |||||
No | 172 (80.4) | 130 (81.3) | 860 (84.7) | 4895 (91.5) | 8758 (95.9) | ||||
Yes | 42 (19.6) | 30 (18.8) | 155 (15.3) | 453 (8.5) | 370 (4.1) | ||||
Employment status | 0.477 | 0.346 | 0.357 | 0.151 | |||||
Employed | 54 (100) | 42 (97.7) | 344 (98.6) | 2159 (98.7) | 3737 (99.1) | ||||
Unemployed | 0 (0) | 1 (2.3) | 5 (1.4) | 29 (1.3) | 35 (0.9) | ||||
Birth weight | <0.001 | <0.001 | <0.001 | <0.001 | |||||
≤2499 g | 210 (98.6) | 148 (92.5) | 432 (42.6) | 375 (7) | 127 (1.4) | ||||
≥2500 g | 3 (1.4) | 12 (7.5) | 583 (57.4) | 4972 (93) | 8996 (98.6) | ||||
Fetal weight by GA | <0.001 | <0.001 | <0.001 | <0.001 | |||||
AGA | 120 (56.3) | 96 (60) | 682 (67.2) | 4126 (77.2) | 6453 (81.6) | ||||
SGA | 41 (19.2) | 28 (17.5) | 112 (11) | 250 (4.7) | 451 (5.7) | ||||
LGA | 52 (24.4) | 36 (22.5) | 221 (21.8) | 971 (18.2) | 1002 (12.7) | ||||
Pregnancy mode | <0.001 | <0.01 | <0.001 | <0.001 | |||||
Spontaneous | 202 (94.4) | 150 (94.3) | 961 (95.1) | 5159 (97) | 8906 (98.1) | ||||
Assisted | 12 (5.6) | 9 (5.7) | 49 (4.9) | 157 (3) | 169 (1.9) | ||||
Delivery mode | <0.001 | <0.001 | <0.001 | <0.001 | |||||
Vaginal | 77 (36) | 63 (39.4) | 502 (49.5) | 3236 (60.5) | 7169 (78.5) | ||||
Caesarean | 137 (64) | 97 (60.6) | 513 (50.5) | 2112 (39.5) | 1959 (21.5) | ||||
Apgar < 7 at 1 min | <0.001 | <0.001 | <0.001 | <0.05 | |||||
No | 112 (53.1) | 137 (87.3) | 956 (94.5) | 5280 (99) | 8975 (98.6) | ||||
Yes | 99 (46.9) | 20 (12.7) | 56 (5.5) | 56 (1) | 131 (1.4) | ||||
Apgar < 7 at 5 min | <0.001 | <0.001 | <0.001 | 0.251 | |||||
No | 196 (92.9) | 154 (98.1) | 1003 (99) | 5328 (99.8) | 9102 (99.9) | ||||
Yes | 15 (7.1) | 3 (1.9) | 10 (1) | 9 (0.2) | 9 (0.1) | ||||
Baby outcome | <0.001 | <0.001 | <0.001 | 0.052 | |||||
Discharged alive | 190 (88.8) | 153 (95.6) | 1002 (98.7) | 5335 (99.8) | 9118 (99.9) | ||||
In-hospital mortality | 24 (11.2) | 7 (4.4) | 13 (1.3) | 13 (0.2) | 10 (0.1) | ||||
Baby disposition | <0.001 | <0.001 | <0.001 | <0.001 | |||||
Postnatal ward | 1 (0.5) | 8 (5) | 640 (63.1) | 4853 (90.8) | 8528 (93.4) | ||||
NICU or death in LR/OT | 213 (99.5) | 152 (95) | 375 (36.9) | 494 (9.2) | 600 (6.6) |
Risk Factors | Extreme to Very PTB (n = 214) | Moderate PTB (n = 160) | Late PTB (n = 1015) | ETB (n = 5348) |
---|---|---|---|---|
aOR a (95% CI) | aOR b (95% CI) | aOR c (95% CI) | aOR d (95% CI) | |
Maternal age | ||||
Normal (20–34 yr) | ref | ref | ref | ref |
Young (<20 yr) | 0.96 (0.34–2.72) | 2.76 (1.26–6.07) ‡ | 1.01 (0.48–2.13) | 1.02 (0.8–1.31) |
Advanced (35–39 yr) | 1.81 (1.15–2.83) ‡ | 1.48 (0.98–2.23) | 1.39 (1.05–1.86) ‡ | 1.18 (1.07–1.31) * |
Very advanced (40–44 yr) | 2.39 (1.12–5.11) ‡ | 1.77 (0.87–3.63) | 1.57 (0.91–2.71) | 1.53 (1.28–1.82) * |
Extremely advanced (≥45 yr) | NA | 1.64 (0.16–16.9) | 4.97 (0.79–31.38) | 2.36 (1.18–4.71) ‡ |
Parity | ||||
Nulliparous | ref | ref | ||
Parity ≥ 1 | 0.34 (0.23–0.51) * | 1.21 (1.11–1.32) * | ||
Nationality | ||||
Qataris | 0.78 (0.51–1.2) | 0.87 (0.59–1.28) | 0.8 (0.61–1.05) | 0.99 (0.9–1.08) |
Other Arabs | 0.73 (0.48–1.09) | 0.6 (0.4–0.89) ‡ | 0.64 (0.49–0.83) * | 0.89 (0.81–0.96) † |
Other Nationalities | ref | ref | ref | ref |
Education | ||||
Elementary and below | 1.46 (1.02–2.08) ‡ | |||
Secondary/Highschool | 1.25 (0.98–1.59) | |||
University or above | ref | |||
Diabetes status | ||||
No DM | ref | ref | ref | ref |
GDM | 0.88 (0.58–1.33) | 1.47 (1.03–2.1) ‡ | 1.61 (1.27–2.05) * | 1.8 (1.67–1.94) * |
PGDM | 7.37 (2.97–18.31) * | 5.03 (2.08–12.17) * | 6.55 (3.17–13.52) * | 9.72 (7.07–13.35) * |
Chronic hypertension | ||||
No | ref | ref | ref | ref |
Yes | 2.97 (0.96–9.18) | 6.5 (2.92–14.46) * | 1.14 (0.37–3.49) | 2.39 (1.67–3.43) * |
Baby gender | ||||
Female | ref | ref | ref | ref |
Male | 1.39 (0.99–1.95) | 1.46 (1.06–2.03) ‡ | 1.12 (0.9–1.39) | 1.2 (1.11–1.28) * |
Chromosomal/Congenital abnormalities | ||||
No | ref | ref | ref | ref |
Yes | 15.52 (8.91–27.02) * | 7.9 (4.14–15.04) * | 3.9 (1.97–7.7) * | 1.26 (0.92–1.72) |
Smoking | ||||
No | ref | |||
Yes | 3.01 (0.99–9.13) | |||
Preterm history | ||||
No | ref | ref | ref | ref |
Yes | 7.23 (4.44–11.77) * | 4.7 (3.04–7.28) * | 3.5 (2.48–4.94) * | 1.95 (1.68–2.26) * |
Pregnancy mode | ||||
Spontanious pregnancy | ref | ref | ref | ref |
Assisted pregnancy | 2.49 (1.19–5.21) ‡ | 2.82 (1.38–5.79) † | 3.11 (1.9–5.08) * | 1.61 (1.28–2.02) * |
LBW | SGA | LGA | Caesarean Delivery | Apgar < 7 at 1 Min | Apgar < 7 at 5 Min | In-Hospital Mortality | NICU/Death in LR/OT | |
---|---|---|---|---|---|---|---|---|
aOR (95%CI) | aOR (95%CI) | aOR (95%CI) | aOR (95%CI) | aOR (95%CI) | aOR (95%CI) | aOR (95%CI) | aOR (95%CI) | |
Extreme to very PTB a | 5669.36 (1317.88–24,388.98) * | 4.11 (2.55–6.64) * | 3.8 (2.5–5.79) * | 5.26 (3.71–7.47) * | 52.3 (33.89–80.71) * | 69.2 (20.54–233.09) * | 84.73 (28.87–248.69) * | 2417.24 (332.79–17,557.67) * |
Moderate PTB b | 1021.64 (520.79–2004.19) * | 3.78 (2.38–6.00) * | 2.44 (1.63–3.64) * | 4.54 (3.26–6.34) * | 7.73 (4.43–13.50) * | 9.81 (2.01–47.91) † | 27.76 (7.52–102.48) * | 274.38 (132.59–567.78) * |
Late PTB c | 57.41 (40.1–82.19) * | 1.9 (1.28–2.82) * | 1.87 (1.39–2.5) * | 2.47 (1.96–3.12) * | 1.64 (0.73–3.69) | NA | NA | 8.48 (6.37–11.28) * |
ETB d | 5.96 (4.83–7.35) * | 0.9 (0.77–1.07) | 1.37 (1.24–1.52) * | 2.14 (1.98–2.32) * | 0.71 (0.51–0.99) ‡ | 1.2 (0.45–3.19) | 2.11 (0.84–5.32) | 1.31 (1.15–1.51) * |
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Younes, S.; Samara, M.; Al-Jurf, R.; Nasrallah, G.; Al-Obaidly, S.; Salama, H.; Olukade, T.; Hammuda, S.; Ismail, M.A.; Abdoh, G.; et al. Incidence, Risk Factors, and Outcomes of Preterm and Early Term Births: A Population-Based Register Study. Int. J. Environ. Res. Public Health 2021, 18, 5865. https://doi.org/10.3390/ijerph18115865
Younes S, Samara M, Al-Jurf R, Nasrallah G, Al-Obaidly S, Salama H, Olukade T, Hammuda S, Ismail MA, Abdoh G, et al. Incidence, Risk Factors, and Outcomes of Preterm and Early Term Births: A Population-Based Register Study. International Journal of Environmental Research and Public Health. 2021; 18(11):5865. https://doi.org/10.3390/ijerph18115865
Chicago/Turabian StyleYounes, Salma, Muthanna Samara, Rana Al-Jurf, Gheyath Nasrallah, Sawsan Al-Obaidly, Husam Salama, Tawa Olukade, Sara Hammuda, Mohamed A. Ismail, Ghassan Abdoh, and et al. 2021. "Incidence, Risk Factors, and Outcomes of Preterm and Early Term Births: A Population-Based Register Study" International Journal of Environmental Research and Public Health 18, no. 11: 5865. https://doi.org/10.3390/ijerph18115865