The effect of changing patterns of obstetric care in Scotland (1980-2004) on rates of preterm birth and its neonatal consequences: perinatal database study
- PMID: 19771156
- PMCID: PMC2740823
- DOI: 10.1371/journal.pmed.1000153
The effect of changing patterns of obstetric care in Scotland (1980-2004) on rates of preterm birth and its neonatal consequences: perinatal database study
Abstract
Background: Rates of preterm birth are rising worldwide. Studies from the United States and Latin America suggest that much of this rise relates to increased rates of medically indicated preterm birth. In contrast, European and Australian data suggest that increases in spontaneous preterm labour also play a role. We aimed, in a population-based database of 5 million people, to determine the temporal trends and obstetric antecedents of singleton preterm birth and its associated neonatal mortality and morbidity for the period 1980-2004.
Methods and findings: There were 1.49 million births in Scotland over the study period, of which 5.8% were preterm. We found a percentage increase in crude rates of both spontaneous preterm birth per 1,000 singleton births (10.7%, p<0.01) and medically indicated preterm births (41.2%, p<0.01), which persisted when adjusted for maternal age at delivery. The greater proportion of spontaneous preterm births meant that the absolute increase in rates of preterm birth in each category were similar. Of specific maternal complications, essential and pregnancy-induced hypertension, pre-eclampsia, and placenta praevia played a decreasing role in preterm birth over the study period, with gestational and pre-existing diabetes playing an increasing role. There was a decline in stillbirth, neonatal, and extended perinatal mortality associated with preterm birth at all gestation over the study period but an increase in the rate of prolonged hospital stay for the neonate. Neonatal mortality improved in all subgroups, regardless of obstetric antecedent of preterm birth or gestational age. In the 28 wk and greater gestational groups we found a reduction in stillbirths and extended perinatal mortality for medically induced but not spontaneous preterm births (in the absence of maternal complications) although at the expense of a longer stay in neonatal intensive care. This improvement in stillbirth and neonatal mortality supports the decision making behind the 34% increase in elective/induced preterm birth in these women. Although improvements in neonatal outcomes overall are welcome, preterm birth still accounts for over 66% of singleton stillbirths, 65% of singleton neonatal deaths, and 67% of infants whose stay in the neonatal unit is "prolonged," suggesting this condition remains a significant contributor to perinatal mortality and morbidity.
Conclusions: In our population, increases in spontaneous and medically induced preterm births have made equal contributions to the rising rate of preterm birth. Despite improvements in related perinatal mortality, preterm birth remains a major obstetric and neonatal problem, and its frequency is increasing. Please see later in the article for the Editors' Summary.
Conflict of interest statement
JN has received grants from government (Medical Research Council, UK; Chief Scientist's Office, Scottish Executive) and charitable organisations for research into understanding the mechanism of term and preterm labour and investigating treatments (charities currently include Tommy's, Piggy Bank Kids, and Action Medical Research, and formerly include Wellbeing of Women), has acted as a consultant to a small drug company (Preglem, Geneva) that was considering developing treatments for preterm labour, and is named as an inventor on patent applications for a compound (a prokineticin antagonist) potentially useful in preterm labour prevention. CM and JC have read this journal's policy and have no competing interests.
Figures
Similar articles
-
Trends in singleton preterm birth in Victoria, 2007 to 2017: A consecutive cross-sectional study.Acta Obstet Gynecol Scand. 2021 Jul;100(7):1230-1238. doi: 10.1111/aogs.14074. Epub 2021 Feb 12. Acta Obstet Gynecol Scand. 2021. PMID: 33382080 Free PMC article.
-
Maternal age ≥45 years and maternal and perinatal outcomes: a review of the evidence.Midwifery. 2013 May;29(5):479-89. doi: 10.1016/j.midw.2012.04.001. Epub 2012 Nov 16. Midwifery. 2013. PMID: 23159159 Review.
-
Temporal trends in neonatal outcomes following iatrogenic preterm delivery.BMC Pregnancy Childbirth. 2011 May 25;11:39. doi: 10.1186/1471-2393-11-39. BMC Pregnancy Childbirth. 2011. PMID: 21612655 Free PMC article.
-
Rates of and factors associated with delivery-related perinatal death among term infants in Scotland.JAMA. 2009 Aug 12;302(6):660-8. doi: 10.1001/jama.2009.1111. JAMA. 2009. PMID: 19671907
-
Theory of obstetrics: an epidemiologic framework for justifying medically indicated early delivery.BMC Pregnancy Childbirth. 2007 Mar 28;7:4. doi: 10.1186/1471-2393-7-4. BMC Pregnancy Childbirth. 2007. PMID: 17391525 Free PMC article. Review.
Cited by
-
Cohort profile: Born in Wales-a birth cohort with maternity, parental and child data linkage for life course research in Wales, UK.BMJ Open. 2024 Jan 18;14(1):e076711. doi: 10.1136/bmjopen-2023-076711. BMJ Open. 2024. PMID: 38238056 Free PMC article.
-
Prediction of Preterm Delivery among Low-risk Indian Pregnant Women: Discriminatory Power of Cervical Length, Serum Ferritin, and Serum Alpha-fetoprotein.Int J Appl Basic Med Res. 2023 Oct-Dec;13(4):198-203. doi: 10.4103/ijabmr.ijabmr_179_23. Epub 2023 Dec 8. Int J Appl Basic Med Res. 2023. PMID: 38229722 Free PMC article.
-
Ethnic differences in preterm birth in Southwest China, 2014-2018: A population-based observational study.Front Med (Lausanne). 2022 Aug 4;9:972917. doi: 10.3389/fmed.2022.972917. eCollection 2022. Front Med (Lausanne). 2022. PMID: 35991656 Free PMC article.
-
Placental transcriptomic signatures of spontaneous preterm birth.Am J Obstet Gynecol. 2023 Jan;228(1):73.e1-73.e18. doi: 10.1016/j.ajog.2022.07.015. Epub 2022 Jul 19. Am J Obstet Gynecol. 2023. PMID: 35868418 Free PMC article.
-
Preterm births in China between 2012 and 2018: an observational study of more than 9 million women.Lancet Glob Health. 2021 Sep;9(9):e1226-e1241. doi: 10.1016/S2214-109X(21)00298-9. Lancet Glob Health. 2021. PMID: 34416213 Free PMC article.
References
-
- Institute of Medicine of the National Academies. Preterm birth: causes consequences and prevention. Washington, DC: Institute of Medicine; 2007.
-
- Martin JA, Hamilton BE, Sutton PD, Ventura SJ, Menacker F, et al. Births: final data for 2004. Natl Vital Stat Rep. 2006;55:1–101. - PubMed
-
- Barros FC, Velez Mdel P. Temporal trends of preterm birth subtypes and neonatal outcomes. Obstet Gynecol. 2006;107:1035–1041. - PubMed
-
- Department of Health. NHS Maternity Statistics England 2002–2003. London: 2008.
-
- Chalmers J. Preterm deliveries in Scotland. 2006. BMJ.com Available: http://www.bmj.com/cgi/eletters/322/7547/937#132366. Accessed: 26.8.09.
Publication types
MeSH terms
Grants and funding
LinkOut - more resources
Full Text Sources
Medical