Preterm birth time trends in Europe: a study of 19 countries

Authors

  • J Zeitlin,

    Corresponding author
    1. INSERM, UMRS 953, Epidemiological Research Unit on Perinatal and Women's and Children's Health, Paris, France
    2. UPMC, Paris, France
    • Correspondence: J Zeitlin, INSERM, UMRS 953, Epidemiological Research Unit on Perinatal and Women's and Children's Health, 53 avenue de l'Observatoire, 75014 Paris, France. Email jennifer.zeitlin@inserm.fr

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  • K Szamotulska,

    1. Department of Epidemiology, National Research Institute of Mother and Child, Warsaw, Poland
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  • N Drewniak,

    1. INSERM, UMRS 953, Epidemiological Research Unit on Perinatal and Women's and Children's Health, Paris, France
    2. UPMC, Paris, France
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  • AD Mohangoo,

    1. Department Child Health, TNO Netherlands Organization for Applied Scientific Research, Leiden, the Netherlands
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  • J Chalmers,

    1. Information Services Division, NHS National Services Scotland, Edinburgh, UK
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  • L Sakkeus,

    1. Estonian Institute for Population Studies, Tallinn University, Tallinn, Estonia
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  • L Irgens,

    1. Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway
    2. Medical Birth Registry of Norway, Norwegian Institute of Public Health, Bergen, Norway
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  • M Gatt,

    1. Department of Health Information and Research, National Obstetric Information Systems (NOIS) Register, G'Mangia, Malta
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  • M Gissler,

    1. Department of Information, THL National Institute for Health and Welfare, Helsinki, Finland
    2. Nordic School of Public Health, Gothenburg, Sweden
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  • B Blondel,

    1. INSERM, UMRS 953, Epidemiological Research Unit on Perinatal and Women's and Children's Health, Paris, France
    2. UPMC, Paris, France
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  • The Euro-Peristat Preterm Study Group

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    • Euro-Peristat Preterm Study Group: C Vutuc (Austria); E Martens (Flanders); P Velebil (Czech Republic); L Sakkeus (Estonia); M Gissler (Finland); B Blondel (France); N Lack, B Misselwitz, P Wenzlaff (Germany); S Bonham (Ireland); J Jaselioniene (Lithuania); M Gatt (Malta); A Mohangoo, J Nijhuis (the Netherlands); L Irgens, K Klungsøyr (Norway); K Szamotulska (Poland); H Barros (Portugal); Z Novak (Slovenia); F Bolumar (Spain); K Gottvall (Sweden); James Chalmers (UK).

Abstract

Objective

To investigate time trends in preterm birth in Europe by multiplicity, gestational age, and onset of delivery.

Design

Analysis of aggregate data from routine sources.

Setting

Nineteen European countries.

Population

Live births in 1996, 2000, 2004, and 2008.

Methods

Annual risk ratios of preterm birth in each country were estimated with year as a continuous variable for all births and by subgroup using log-binomial regression models.

Main outcome measures

Overall preterm birth rate and rate by multiplicity, gestational age group, and spontaneous versus non-spontaneous (induced or prelabour caesarean section) onset of labour.

Results

Preterm birth rates rose in most countries, but the magnitude of these increases varied. Rises in the multiple birth rate as well as in the preterm birth rate for multiple births contributed to increases in the overall preterm birth rate. About half of countries experienced no change or decreases in the rates of singleton preterm birth. Where preterm birth rates rose, increases were no more prominent at 35–36 weeks of gestation than at 32–34 weeks of gestation. Variable trends were observed for spontaneous and non-spontaneous preterm births in the 13 countries with mode of onset data; increases were not solely attributed to non-spontaneous preterm births.

Conclusions

There was a wide variation in preterm birth trends in European countries. Many countries maintained or reduced rates of singleton preterm birth over the past 15 years, challenging a widespread belief that rising rates are the norm. Understanding these cross-country differences could inform strategies for the prevention of preterm birth.

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