TY - JOUR
T1 - Perinatal outcomes from preterm and early term births in a multicenter cohort of low risk nulliparous women
AU - Souza, Renato T.
AU - Costa, Maria L.
AU - Mayrink, Jussara
AU - Feitosa, Francisco E.
AU - Rocha Filho, Edilberto A.
AU - Leite, Débora F.
AU - Vettorazzi, Janete
AU - Calderon, Iracema M.
AU - Sousa, Maria H.
AU - Passini, Renato
AU - Baker, Philip N.
AU - Kenny, Louise
AU - Cecatti, Jose G.
AU - The Preterm SAMBA study group
N1 - Data availability: The dataset used and analysed during the current study is available from the corresponding author on reasonable request.
Acknowledgements: This was one of the two big studies selected for sponsoring from the research call “Grand Challenges Brazil: Reducing the burden of preterm birth” number 05/2013 jointly issued by the Brazilian National Research Council (CNPq - Award 401636/2013–5) and the Bill and Melinda Gates Foundation (OPP1107597). The funders played no role at all in the study design, writing the manuscript nor in the decision to submit the manuscript for publication.
PY - 2020/5/12
Y1 - 2020/5/12
N2 - Preterm birth is the major contributor for neonatal and under-five years mortality rates and also accounts for a short- and long-term adverse consequences up to adulthood. Perinatal outcomes may vary according to lots of factors as preterm subtype, late prematurity, which account for the vast majority of cases, country and population characteristics. An under-recognition of the perinatal outcomes and its associated factors might have underpowered strategies to provide adequate care and prevent its occurrence. We aim to estimate the frequency of maternal and perinatal outcomes in women with different categories of preterm and term births, factors associated with poorer perinatal outcomes and related management interventions. A multicentre prospective cohort in five maternities in Brazil between 2015 and 2018. Nulliparous low-risk women with singletons were included. Comprehensive data were collected during three antenatal visits (at 19–21weeks, 27–29 weeks and 37–39 weeks). Maternal and perinatal outcomes were also collected according to maternal and neonatal medical records. Women who had spontaneous (sPTB) and provider-initiated (pi-PTB) preterm birth were compared to those who had term birth. Also, late preterm birth (after 34 weeks), and early term (37–38 weeks) were compared to full term birth (39–40 weeks). Bivariate analysis estimated risk ratios for maternal and adverse outcomes. Finally, a multivariate analysis was conducted to address factors independently associated with any adverse perinatal outcome (APO). In total, 1,165 women had outcome data available, from which 6.7% had sPTB, 4.0% had pi-PTB and 89.3% had a term birth. sPTB and pi-PTb were associated with poorer perinatal outcomes, as well as late sPTB, late pi-PTB and early term neonates. pi-PTB (RRadj 8.12, 95% CI [2.54–25.93], p-value 0.007), maternal weight gain between 20 and 27 weeks adj 2.04, 95% CI [1.23–3.38], p-value 0.018) and participants from the Northeast centres (RRadj 2.35, 95% CI [1.11–4.95], p-value 0.034) were independently associated with APO. According to our findings, Brazil would benefit from strategies to more accurately identify women at higher risk for PTB, to promote evidenced-based decision in preterm and early term provider-initiated deliveries, and to prevent perinatal adverse outcomes.
AB - Preterm birth is the major contributor for neonatal and under-five years mortality rates and also accounts for a short- and long-term adverse consequences up to adulthood. Perinatal outcomes may vary according to lots of factors as preterm subtype, late prematurity, which account for the vast majority of cases, country and population characteristics. An under-recognition of the perinatal outcomes and its associated factors might have underpowered strategies to provide adequate care and prevent its occurrence. We aim to estimate the frequency of maternal and perinatal outcomes in women with different categories of preterm and term births, factors associated with poorer perinatal outcomes and related management interventions. A multicentre prospective cohort in five maternities in Brazil between 2015 and 2018. Nulliparous low-risk women with singletons were included. Comprehensive data were collected during three antenatal visits (at 19–21weeks, 27–29 weeks and 37–39 weeks). Maternal and perinatal outcomes were also collected according to maternal and neonatal medical records. Women who had spontaneous (sPTB) and provider-initiated (pi-PTB) preterm birth were compared to those who had term birth. Also, late preterm birth (after 34 weeks), and early term (37–38 weeks) were compared to full term birth (39–40 weeks). Bivariate analysis estimated risk ratios for maternal and adverse outcomes. Finally, a multivariate analysis was conducted to address factors independently associated with any adverse perinatal outcome (APO). In total, 1,165 women had outcome data available, from which 6.7% had sPTB, 4.0% had pi-PTB and 89.3% had a term birth. sPTB and pi-PTb were associated with poorer perinatal outcomes, as well as late sPTB, late pi-PTB and early term neonates. pi-PTB (RRadj 8.12, 95% CI [2.54–25.93], p-value 0.007), maternal weight gain between 20 and 27 weeks adj 2.04, 95% CI [1.23–3.38], p-value 0.018) and participants from the Northeast centres (RRadj 2.35, 95% CI [1.11–4.95], p-value 0.034) were independently associated with APO. According to our findings, Brazil would benefit from strategies to more accurately identify women at higher risk for PTB, to promote evidenced-based decision in preterm and early term provider-initiated deliveries, and to prevent perinatal adverse outcomes.
UR - http://www.scopus.com/inward/record.url?scp=85085264508&partnerID=8YFLogxK
U2 - 10.1038/s41598-020-65022-z
DO - 10.1038/s41598-020-65022-z
M3 - Article
C2 - 32444773
AN - SCOPUS:85085264508
SN - 2045-2322
VL - 10
JO - Scientific Reports
JF - Scientific Reports
M1 - 8508
ER -