Epidemiology of Preterm Delivery in Two Birth Cohorts with an Interval of 20 Years

Olsén, Päivi; Läärä, Esa; Rantakallio, Paula; Järvelin, Marjo‐Riitta; Sarpola, Ari; Hartikainen, Anna-Liisa

doi:10.1093/oxfordjournals.aje.a117577

Cited by 96 publications

(68 citation statements)

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“…Socioeconomic disparities in PTB are consistent findings in perinatal epidemiology both in Sweden, other European countries, and the U.S. [22][23][24][25][26][27]. For example, even in such countries as Sweden [28], Finland [29], Scotland [30], and Canada [31] with smaller socioeconomic differences than in the U.S. and universal access to high-quality prenatal care [22], there are higher rates of PTB among mothers with low income than those with high income. A Canadian case-control study found that mothers with low income had a three-fold increased odds of having preterm premature rupture of membranes [32].…”

Section: Discussionmentioning

confidence: 73%

Immigrants and Preterm Births: A Nationwide Epidemiological Study in Sweden

Sundquist

2012

Matern Child Health J

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Objective. To examine, nationwide, if there is an association between country of birth in mothers and preterm birth and to study whether any such association remains in second-generation immigrant women.Methods. In this follow-up study, a nationwide research database located at Lund University, Sweden, was used to identify all preterm born singletons in Sweden between January 1, 1982, and December 31, 2006. Incidence ratios were standardized with regard to maternal age at birth, marital status, geographical region, body height, and smoking history as well as period of birth, family income, and gender of the infant. Singletons of mothers born in Sweden were used as reference group.Results. There were 2 192 843 records for singletons over the study period, of whom 4.9% were preterm births and 0.8% were very preterm births. Increased risks of preterm birth was observed for mothers from Austria, Yugoslavia, Romania, Central Europe, and Asia. Increased risks of very preterm birth was observed for mothers from Eastern Europe, Central Europe, Africa, and Asia; these increased risks disappeared, however, in the second-generation female immigrants.Conclusion. Country of birth in mothers affected the risk of preterm birth; maternity care should pay a special attention to women from certain population groups.

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Section: Discussionmentioning

confidence: 73%

Immigrants and Preterm Births: A Nationwide Epidemiological Study in Sweden

Sundquist

2012

Matern Child Health J

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“…Predisposing genetic attributes, pre-existing and emerging parental biological and behavioural factors, and social and economic circumstances have all been found to contribute (either in concert or isolation) to the risk of preterm birth. [11][12][13][14][15][16] A number of studies have suggested that obstetric complications and pre-existing medical conditions, moderated by sociodemographic factors, may influence a clinician's decision to induce labour based on the perceived threat of neonatal mortality or serious morbidity. 17,18 Clinicians' perception of risk may also have changed over time, favouring intervention at lower perceived levels of risk to avoid potential complications for mother and child.…”

Section: Introductionmentioning

confidence: 99%

Changes in risk factors for preterm birth in Western Australia 1984–2006

Hammond

Langridge

Leonard

et al. 2013

BJOG

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Objective To characterise changing risk factors of preterm birth in Western Australia between 1984 and 2006. Design Population‐based study. Setting Western Australia. Population All non‐Aboriginal women giving birth to live singleton infants between 1984 and 2006. Methods Multinomial, multivariable regression models were used to assess antecedent profiles by preterm status and labour onset types (spontaneous, medically indicated, prelabour rupture of membranes [PROM]). Population attributable fraction (PAF) estimates characterized the contribution of individual antecedents as well as the overall contribution of two antecedent groups: pre‐existing medical conditions (including previous obstetric history) and pregnancy complications. Main outcome measure Antecedent relationships with preterm birth, stratified by labour onset type. Results Marked increases in maternal age and primiparous births were observed. A four‐fold increase in the rates of pre‐existing medical complications over time was observed. Rates of pregnancy complications remained stable. Multinomial regression showed differences in antecedent profiles across labour onset types. PAF estimates indicated that 50% of medically indicated preterm deliveries could be eliminated after removing six antecedents from the population; estimates for PROM and spontaneous preterm reduction were between 10 and 20%. Variables pertaining to previous and current obstetric complications (previous preterm birth, previous caesarean section, pre‐eclampsia and antepartum haemorrhage) were the most influential predictors of preterm birth and adverse labour onset (PROM and medically indicated). Conclusions Preterm antecedent profiles have changed markedly over the 23 years studied. Some changes may be attributable to true change, others to advances in surveillance and detection. Still others may signify change in clinical practice.

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“…10 The trend towards being unmarried during pregnancy is increasing: in 1989 22.9% and in 2001 39.2% of pregnancies in our study population were outside marriage; and a comparable change has taken place in all Western countries. 10,11 It has been suggested that the additional risks of extramarital pregnancies are higher in societies where pregnancies outside marriage are uncommon; in a recent French study a cutoff point of 20% of births to unmarried mothers was suggested to divide societies into those with high risks of adverse pregnancy outcomes outside marriage and those with no excess risks of pregnancies outside marriage. 4 Unmarried status may reflect other risk factors rather than being an independent risk factor.…”

Section: Introductionmentioning

confidence: 99%

“…13 In previous studies at least some of the risks have been suggested to be the result of inadequate access to maternity care. 4,11,14 However, in Finland maternity care is provided free of charge and is used virtually by the entire pregnant population, up to 99.7%. 15 The opportunity to receive maternity care during pregnancy is not affected by the economic situation of a woman; this asset should lower the risks associated with unmarried status during pregnancy.…”

Section: Introductionmentioning

confidence: 99%

Marriage still protects pregnancy

Raatikainen

Heiskanen

Heinonen

2005

BJOG

114

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Objective To assess the risk factors and outcome of pregnancy outside marriage in the 1990s, in conditions of a high percentage of extramarital pregnancies and high standard maternity care, used by the entire pregnant population. Design Hospital-based cohort study.Setting A university-teaching hospital in Finland.Population The 25,373 singleton pregnancies of known marital and cohabiting status.Methods Odds ratios (ORs) with 95% confidence intervals were calculated to estimate the effect of extramarital childbearing on pregnancy outcome. Multiple logistic regression analyses were conducted to control for confounding maternal risk factors. Main outcome measures Small-for-gestational age (SGA) infants, preterm birth (less than 37 completed weeks), low birthweight (LBW; under 2500 g). ResultsOf the study population, 67.5% were married and 32.5% were unmarried; 24.2% of all mothers were cohabiting. Unmarried status was strongly associated with social disadvantage and particular risk factors, specifically unemployment, smoking and previous pregnancy terminations, which in turn had an impact on obstetric outcome. There were significantly more SGA infants among unmarried mothers (P < 0.001), with an absolute difference of 45%; more preterm deliveries (P ¼ 0.001), with an absolute difference of 17.5%; and more LBW infants (P < 0.001), with an absolute difference of 26%. The differences in adverse pregnancy outcomes between study groups (i) all unmarried women, (ii) cohabiting women and (iii) single women, remained significant after multivariate analysis at adjusted ORs of 1.11, 1.11 and 1.07 for SGA, 1.17, 1.15 and 1.21 for LBW and 1.15, 1.15 and 1.29 for the preterm births, respectively. Conclusion Even in the 1990s when cohabitation was already common, pregnancy outside marriage was associated with an overall 20% increase of adverse outcomes, and free maternity care did not overcome the difference.

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Epidemiology of Preterm Delivery in Two Birth Cohorts with an Interval of 20 Years

Cited by 96 publications

References 0 publications

Immigrants and Preterm Births: A Nationwide Epidemiological Study in Sweden

Immigrants and Preterm Births: A Nationwide Epidemiological Study in Sweden

Changes in risk factors for preterm birth in Western Australia 1984–2006

Marriage still protects pregnancy

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