Risk factors for spontaneous and provider-initiated preterm delivery in high and low Human Development Index countries: a secondary analysis of the World Health Organization Multicountry Survey on Maternal and Newborn Health

Authors

  • N Morisaki,

    Corresponding author
    1. Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
    2. Department of Paediatrics, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
    • Correspondence: Dr N Morisaki, Division of Health Policy, National Center for Child Health and Development, 10-1-2 Okura, Setagaya-ku, Tokyo 157-8535, Japan. Email morisaki-n@ncchd.go.jp

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  • G Togoobaatar,

    1. Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
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  • JP Vogel,

    1. UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
    2. School of Population Health, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Perth, WA, Australia
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  • JP Souza,

    1. UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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  • CJ Rowland Hogue,

    1. Rollins School of Public Health, Emory University, Atlanta, GA, USA
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  • K Jayaratne,

    1. Family Health Bureau, Ministry of Health, Colombo, Sri Lanka
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  • E Ota,

    1. Department of Maternal and Child Health, National Center for Child Health and Development, Tokyo, Japan
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  • R Mori,

    1. Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
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  • on behalf of the WHO Multicountry Survey on Maternal and Newborn Health Research Network


Abstract

Objective

To evaluate how the effect of maternal complications on preterm birth varies between spontaneous and provider-initiated births, as well as among different countries.

Design

Secondary analysis of a cross-sectional study.

Setting

Twenty-nine countries participating in the World Health Organization Multicountry Survey on Maternal and Newborn Health.

Population

299 878 singleton deliveries of live neonates or fresh stillbirths.

Methods

Countries were categorised into very high, high, medium and low developed countries using the Human Development Index (HDI) of 2012 by the World Bank. We described the prevalence and risk of maternal complications, their effect on outcomes and their variability by country development.

Main outcome measures

Preterm birth, fresh stillbirth and early neonatal death.

Results

The proportion of provider-initiated births among preterm deliveries increased with development: 19% in low to 40% in very high HDI countries. Among preterm deliveries, the socially disadvantaged were less likely, and the medically high risk were more likely, to have a provider-initiated delivery. The effects of anaemia [adjusted odds ratio (AOR), 2.03; 95% confidence interval (CI), 1.84; 2.25], chronic hypertension (AOR, 2.28; 95% CI, 1.94; 2.68) and pre-eclampsia/eclampsia (AOR, 5.03; 95% CI, 4.72; 5.37) on preterm birth were similar among all four HDI subgroups.

Conclusions

The provision of adequate obstetric care, including optimal timing for delivery in high-risk pregnancies, especially to the socially disadvantaged, could improve pregnancy outcomes. Avoiding preterm delivery in women when maternal complications, such as anaemia or hypertensive disorders, are present is important for countries at various stages of development, but may be more challenging to achieve.

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