Reducing the Risk of Preterm Birth by Ambulatory Risk Factor Management

Abstract

o this day preterm birth continues to constitute one of the biggest problems in obstetrics. It is defined as a birth taking place before completion of 37 weeks' gestation. Rates of preterm births in Europe range from 5.3% (Latvia) to 14.7% (Cyprus) (1). In Germany in 2009, the rate was 9.38% (2) and in 2017, 8.60 (3)-which means it has remained high, with no major changes. Preterm births account for 75% of perinatal mortality (≤ 7 days after the birth) and for 35% of neonatal mortality (≤ 28 days after the birth), as well as for 16% of deaths in children younger than 5 years (e1-e3). In Germany in 2017, perinatal mortality before completion of the 28 th week of gestation was 33.4% (N=1498), in babies born between 28 and 31 weeks' gestation it was 8.0% (N=568), and in those born between 32 and 36 weeks' gestation, 1.6% (N=891) (3). Extremely preterm neonates in particular present a massive psychosocial burden for affected families and a substantial financial burden for the healthcare system (4). Furthermore, preterm birth is considered one of the main risk factors for disability adjusted life years (DALYs, life years lost owing to sickness, disability, or early death) (5). This article studies the risk factors and prevention of spontaneous preterm birth in singleton pregnancies. It has a particular focus on outpatient/ambulatory care. Method We conducted a selective literature search of the years 2000 through March 2019 in PubMed, using the search terms "preterm birth", "preterm delivery", "risk factors", "prediction", and "prevention". We included publications of crucial importance that pre-date 2000. Epidemiology/risk factors The careful documentation of risk factors at the start of antenatal care is the essential prerequisite for individual risk assessment and the basis of prevention. Particular attention during pregnancy should be given to avoiding risk factors that can be influenced-such as smoking, an unhealthy diet or malnutrition, and severe professional stress. The studies included in our review used odds ratios (OR) or relative risks (RR) to describe risks. Where we adjusted these for confounding factors, we denoted this by adding the letter "a" as a prefix (aOR, aRR).

Predictors of transient congenital primary hypothyroidism: data from the German registry for congenital hypothyroidism (AQUAPE “HypoDok”)

“…The prevalence of TCH and PCH was similar in our analyses when mothers were treated with anti-thyroid drugs during pregnancy, but insufficiently treated Morbus Basedow is a rare disease during pregnancy (prevalence 1:100.000-1:310.000 neonates) [28]. The proportion of preterm infants in our analysis is comparable to the overall premature birth rate in Germany [29]. Premature neonates have a higher risk of TCH, mediated by immaturity and medications during the intensive care period [19].…”

An observational claims data analysis on the risk of maternal chronic kidney disease after preterm delivery and preeclampsia

“…Regarding the generalizability of our results, we found similar prevalence rates of preterm births and cesarean sections as in national comparisons 49 , 50 . However, the study population consisted primarily of white European women living in Southern Germany, which limits the generalizability of our results for other ethnic groups.…”

Predictors of Transient Congenital Primary Hypothyroidism: Data from the German Registry for Congenital Hypothyroidism (AQUAPE "HypoDok")

“…The prevalence of TCH and PCH was similar in our analyses when mothers were treated with anti-thyroid drugs during pregnancy, but insufficiently treated Morbus Basedow is a rare disease during pregnancy (prevalence 1:100.000 -1:310.000 neonates, 28). The proportion of preterm infants in our analysis is comparable to the overall premature birth rate in Germany (29). Premature neonates have a higher risk of TCH, mediated by immaturity and medications during the intensive care period (19).…”