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Association between maternal risk factors and prematurity in multivariate analysis

Association between maternal risk factors and prematurity in multivariate analysis

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Background: Prematurity and low birth weight are significant predictors of perinatal morbidity and mortality and are influenced by the overall health and socioeconomic status of the pregnant mother. Although Cyprus is characterized by the highest prematurity rate in Europe (13.1% in 2014), the relationship between maternal health and socioeconomic...

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... results of multivariate analysis for prematurity are summarized in Table 2. ...

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... This was attributed to nutritional and socioeconomic factors related to the setting. In contrast, a study in Cyprus found that long working hours was associated with premature deliveries [60]. This is similar to the increase in babies born SGA among women with class I obesity by population birth weight centiles reported after an intervention comprising dietary advice and increasing physical activity in pregnant women with obesity [40 ••]. ...
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Purpose of Review Maternal conditions and exposures during pregnancy including over- and undernutrition are associated with poor childbirth outcomes, growth, development and chronic childhood diseases. We examined contemporary pregnancy-related determinants of child health. Recent Findings While maternal undernutrition remains a major contributor to low birth weight, maternal obesity affects foetal growth, birth weight, survival and is associated with childhood obesity, asthma and autistic spectrum disorders. Emerging evidence suggests that epigenetic changes, the prenatal microbiome and maternal immune activation (MIA), a neuroinflammatory process induced by diet and other exposures cause foetal programming resulting in these chronic childhood diseases. Summary Maternal diet is potentially a modifiable risk factor for controlling low birth weight, obesity and chronic disease in childhood. Further studies are warranted to refine guidance on dietary restriction and physical activity during pregnancy and determine how MIA and prenatal microbiota can be applied to control childhood diseases arising from programming.
... Low birth weight (LBW) is a major determinant of mortality, morbidity and disability in neonatal, infancy and childhood and has a long-term impact on health outcomes in adult life. Low birth weight results in substantial costs to the health sector and imposes a significant burden on the society as a whole (1)(2)(3)(4)(5)(6)(7)(8). ...
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Objectives: Low birth weight (LBW) is one of the major factors affecting child morbidity and mortality worldwide. Every day, approximately 800 women die from causes related to pregnancy and childbirth worldwide. Maternal ill health increases the risk of LBW. This study seeks to investigate determinants and incidence of LBW. Methods: This study was conducted based on the medical records of mothers and their 1,946 infants born in 2016-2019 at the Department of Gynaecology and Obstetrics of Louis Pasteur University Hospital in Košice. Data on mothers and newborn infants were obtained from the Reports on mothers at childbirth. The inclusion criteria were singleton births and birth weight > 500 g. The exclusion criteria were twins or multiple births, congenital anomalies and stillbirths, birth weight ≥ 4,000 g or ≤ 500 g, and Roma ethnicity. Roma children are more likely to be born prematurely, with low birth weight. Roma mothers have different lifestyle. Univariate analysis was employed to evaluate the association between the independent variables and LBW. Variables that were found to be statistically significant were then further analysed using multivariable logistic analysis for each dependent variable. The implementation of the research was approved by the Ethics Committee. Results: Of 1,946 newborns, 271 (13.90%) have low birth weight. The mean of birth weight at delivery was 3,068.62 (SD 671.16) grams. Factors that were associated with LBW were primary maternal education (OR = 2.98, 95% CI: 1.08-8.21, p = 0.034), marital status single (OR = 2.88, 95% CI: 1.68-4.94, p < 0.001), number of prenatal care visits less than 8 (OR = 1.62, 95% CI: 1.01-2.61, p = 0.047), and preterm birth (OR = 74.94, 95% CI: 45.44-123.61, p < 0.001). Conclusion: The reducing of LBW requires strategies to improve maternal lifestyle, maternal care before, during and after birth and to strengthen social support.
... Women working excessively long hours (over 43 h/week) were found to have a preterm delivery odds ratio of 1.33 compared the unity (30-39 h/week), and women who had to work in standing position for over 6 h had an odds ratio of 1.26 compared to the unity (less than 2 h). These findings put working conditions and stressful situations as some of the possible non-biological factors to influence PTB, a view also strengthened by the results observed by [38], whose study observes the same relation of work, stress and PTB in Cypriot women. ...
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Preterm birth (PTB) is a phenomenon that brings risks and challenges for the survival of the newborn child. Despite many advances in research, not all the causes of PTB are already clear. It is understood that PTB risk is multi-factorial and can also be associated with socioeconomic factors. Thereby, this article seeks to use unsupervised learning techniques to stratify PTB risk in Brazil using only socioeconomic data. Through the use of datasets made publicly available by the Federal Government of Brazil, a new dataset was generated with municipality-level socioeconomic data and a PTB occurrence rate. This dataset was processed using various unsupervised learning techniques, such as k-means, principal component analysis (PCA), and density-based spatial clustering of applications with noise (DBSCAN). After validation, four clusters with high levels of PTB occurrence were discovered, as well as three with low levels. The clusters with high PTB were comprised mostly of municipalities with lower levels of education, worse quality of public services—such as basic sanitation and garbage collection—and a less white population. The regional distribution of the clusters was also observed, with clusters of high PTB located mostly in the North and Northeast regions of Brazil. The results indicate a positive influence of the quality of life and the offer of public services on the reduction in PTB risk.
... In the importance analysis of the RF model, we found that age was the greatest effect on preterm birth. A case-control study showed that premature delivery was associated with greater maternal age [32]. We also found that serum magnesium had a great influence on the results of the model. ...
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Objective: Preterm birth (PTB) was one of the leading causes of neonatal death. Predicting PTB in the first trimester and second trimester will help improve pregnancy outcomes. The aim of this study is to propose a prediction model based on machine learning algorithms for PTB. Method: Data for this study were reviewed from 2008 to 2018, and all the participants included were selected from a hospital in China. Six algorisms, including Naive Bayesian (NBM), support vector machine (SVM), random forest tree (RF), artificial neural networks (ANN), K-means, and logistic regression, were used to predict PTB. The receiver operating characteristic curve (ROC), accuracy, sensitivity, and specificity were used to assess the performance of the model. Results: A total of 9550 pregnant women were included in the study, of which 4775 women had PTB. A total of 4775 people were randomly selected as controls. Based on 27 weeks of gestation, the area under the curve (AUC) and the accuracy of the RF model were the highest compared with other algorithms (accuracy: 0.816; AUC = 0.885, 95% confidence interval (CI): 0.873-0.897). Meanwhile, there was positive association between the accuracy and AUC of the RF model and gestational age. Age, magnesium, fundal height, serum inorganic phosphorus, mean platelet volume, waist size, total cholesterol, triglycerides, globulins, and total bilirubin were the main influence factors of PTB. Conclusion: The results indicated that the prediction model based on the RF algorithm had a potential value to predict preterm birth in the early stage of pregnancy. The important analysis of the RF model suggested that intervention for main factors of PTB in the early stages of pregnancy would reduce the risk of PTB.
... An inadequate supply of nutrients during gestation is probably the single most important environmental factor affecting pregnancy outcomes. Previous studies suggest that the group of young girls, who conceive within two years of menarche and who get pregnant with low nutrient reserves and a short inter-pregnancy gap, tend to be at higher risk of having LBW babies which eventually become risky for mothers [4,5]. ...
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Background The study aims to investigate the changes in the socio-economic and demographic status of young mothers of age 15–24 years and to examine the association between mothers’ nutrition, i.e., Body Mass Index (BMI) and anaemia with child low birth weight for almost two decades during 1998–2016 in India. Methods National Family Health Survey (NFHS) round II and IV were used. The sample of this study included 3405 currently married young mothers from NFHS II and 44,742 from NFHS IV who gave birth at least one child in the last three years preceding the surveys. Logistic regression and Blinder-Oaxaca decomposition analysis have been used in this study to examine the corresponding association between the concerned variables. Results The analysis showed that the prevalence of low birth weight (LBW) babies has decreased from 26.1 to 22.8 for the 15 to 19 age group and from 20.4 to 18.7 for the 20 to 24 age group over time. Young mothers with low BMI or severe anaemia have shown higher odds of having LBW babies. For instance, the odds of having a LBW child was 1.44 ( p -value = 0.000; 95% CI: 1.05, 1.65) for mothers with low BMI and 1.55 ( p -value = 0.000; 95% CI: 1.27, 1.90) with severe anaemia. Over the decade, the association of LBW babies with mothers’ nutrition has decreased. The odds of LBW with mothers with low BMI decreased from 1.63 ( p -value = 0.004; 95% CI: 1.21, 2.21) to 1.41 ( p -value = 0.000; 95% CI: 1.27, 1.55). Similarly, mothers with severe anaemia, the odds of LBW child decreased from 2.6 ( p -value = 0.000; 95% CI: 1.75, 3.8) in 1998 to 1.3 ( p -value = 0.024; 95% CI: 1.02, 1.65) in 2016. Conclusions The maternal and child health improvement in India has been moderate over the decade. Still, a significant proportion of the women are suffering from poor health and young mothers are at more risk to deliver LBW babies. It is highly recommended to integrate maternal and child health programmes with the ongoing health policies to improve the situation while taking additional care of the young pregnant mother and their nutritional health.
... Covariates that were controlled for in the GLM regressions were selected based on published evidence and included: (i) clinical variables such as small for gestational age (SGA) status (birthweight < 3rd, 3rd-9th, ≥10th centile for gestational age), presence of a congenital anomaly (yes or no), diagnosis of bronchopulmonary dysplasia (BPD) [defined as oxygen or respiratory support at 36 weeks' GA] (yes or no), sex of baby (female or male), any neonatal morbidity (yes or no) [defined as having at least one of the following symptoms: intraventricular haemorrhage grades III-IV, cystic periventricular leukomalacia, retinopathy of prematurity stages III-V or necrotising enterocolitis needing surgery], multiplicity status (singletons, twins, triplets and quadruplets), and parity (nulliparous, multiparous) 14 and (ii) sociodemographic variables including maternal country of birth (European born or non-European born), 32 household employment status (at least one parent unemployed), 23 maternal age (< 25, 25-34, > 34 years old) at delivery and maternal education level (high school or less, university). 32 We also conducted sensitivity analyses that excluded: (1) the BPD and any neonatal morbidity variables; (2) the BPD, any neonatal morbidity and presence of a congenital anomaly variables; and (3) the BPD, any neonatal morbidity, presence of a congenital anomaly and employment status variables; as these variables plausibly lie on the causal pathway between preterm birth status and total economic costs. Inverse probability weights were also embedded within the regression analyses to account for attrition during follow-up. ...
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Background This study aims to estimate the economic costs of care provided to children born very preterm and extremely preterm across 11 European countries, and to understand what perinatal and socioeconomic factors contribute to higher costs. Methods Generalised linear modelling was used to explore the association between perinatal and sociodemographic characteristics and total economic costs (€, 2016 prices) during the fifth year of life. Results Lower gestational age was associated with increased mean societal costs of €2755 ( p < 0.001), €752 ( p < 0.01) and €657 ( p < 0.01) for children born at < 26, 26–27 and 28–29 weeks, respectively, in comparison to the reference group born at 30–31 weeks. A sensitivity analyses that excluded variables (BPD, any neonatal morbidity and presence of congenital anomaly) plausibly lying on the causal pathway between gestational age at birth and economic outcomes elevated incremental societal costs by €1482, €763 and €144 at < 26, 26–27 and 28–29 weeks, respectively, in comparison to the baseline model. Conclusion This study provides new evidence about the main cost drivers associated with preterm birth in European countries. Evidence identified by this study can act as inputs within cost-effectiveness models for preventive or treatment interventions for preterm birth. Impact What is the key message of your article? This study provides new evidence about the magnitude and drivers of economic costs associated with preterm birth in European countries. What does it add to the existing literature? Lower gestational age is associated with increased mean societal costs during mid-childhood with indirect costs representing a key driver of increased costs. What is the impact? For policy makers, this study adds to sparse evidence about the main cost drivers associated with preterm birth in European countries beyond the first 2 years of life.
... This was reported in the USA study, which highlighted that the risk of having low birth weight or preterm birth for adolescent mothers is at least 50 per cent greater than that of adult women with an interpregnancy interval of 18-59 months (Zhu et al., 2001). However, some scholars argue that the risk of having poor pregnancies due to short birth intervals is attributed to various factors including socioeconomic and maternal lifestyle-related factors (King, 2003;Stylianou-Riga et al., 2018). ...
Thesis
Sri Lanka has been able to achieve satisfactory progress in health and developmental goals, characterized by substantial declines in infant, child and maternal mortality rates. Despite low mortality levels, better access to healthcare, food security and economic growth, there is little improvement in child nutrition – a paradox and a critical policy challenge that remain unresolved for over the last two decades. Low Birth Weight (LBW), child stunting, wasting and underweight have remained high at constant levels for past 10 years, with increasing health inequalities across different social and ethnic groups. On the other hand, rapid socioeconomic and nutrition transitions can lead to the emergence of a double burden of malnutrition (DBM). This has not been systematically investigated at the national level. Using the data from most recent Sri Lankan Demographic and Health Survey (SDHS), this research investigates the bio-behavioural, socioeconomic and demographic factors underlying inequalities in child nutritional outcomes in Sri Lanka. Further, it examines the risk factors associated with the prevalence of DBM at the household level. The first paper investigates social inequalities underlying LBW outcomes using fixed and random intercept logistic regression models and inequality measures. The results show that LBW is linked to socioeconomic disadvantage, as it is highly concentrated among poor households and in rural and the estate sector; in particular Indian Tamils in the estate sector have the highest risk of LBW of any comparable sub-group of the population. There was substantial unobserved variation in LBW outcomes between mothers. Regression models confirmed that LBW is more closely associated with maternal biological factors, including maternal depletion, than it is with socioeconomic factors. The second paper examines the extent of inequalities in child stunting, wasting and underweight and how these are distributed across different socioeconomic groups, residential sectors and geographical regions. The results show that LBW and BMI are associated with all three outcomes. The effect of child immunisation and feeding practices was not strong for child undernutrition outcomes. Results also suggested that characteristics of the children, their mothers and the households in which they live explain most of the variance in child undernutrition. There is relatively little variation between communities that is not accounted by the composition of those communities. The third paper assesses the driving factors associated with coexistence of child stunting and maternal overweight and obesity at the same household. The results confirm that Sri Lanka is facing a DBM at the household level, with the coexistence of child stunting and maternal overweight. LBW status, maternal age, number of household members, delivery mode, wealth status, ethnicity and province are significantly associated with DBM. Overall, the survey evidence demonstrates that LBW and undernutrition among children are clearly interlinked with socioeconomic disadvantages. The findings of this study suggest that Sri Lanka is facing a dual nutrition challenge of reducing both child undernutrition and maternal overweight and obesity, which are intertwined. The study recommends that child health policies and interventions in Sri Lanka should address both under-nutrition as well as preventing obesity and obesity-related chronic disease risks of malnourished children and their mothers.
... 7 Low family socioeconomic status, maternal age, parity, harmful parental behaviors such as smoking and excessive alcohol consumption, and poor nutrition during pregnancy, as well as a poor level of prenatal care, are risk factors for LBW. 8 Food insecurity, the major predictor of LBW associated with poor-quality dietary intake and decreased nutritional status among women, and poor nutritional status in pregnancy and pre-pregnancy, is linked to poor birth outcomes. 9,10 During pregnancy, women must have both an adequate quantity and quality of food; however, food insecurity prevents many women from meeting the guidelines for healthy nutrition during pregnancy and is associated with an increased risk of LBW. ...
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Markos Desalegn, Bekana Terefe, Haile Bikila Department of Public Health, Institute of Health Science, Wollega University, Nekemte, EthiopiaCorrespondence: Markos DesalegnDepartment of Public Health, Institute of Health Science, Wollega University, Nekemte, EthiopiaTel +251927619190Email markosdesalegn@gmail.comBackground: More than 20 million births annually in developing countries are classed as low birth weight, with short- and long-term consequences. Food insecurity is the major determinant of low birth weight in developing countries.Objective: This study aimed to identify the effects of food insecurity and other possible factors associated with low birth weight in West Wollega, West Ethiopia.Methods: This facility-based unmatched case–control study was conducted among mothers who gave birth to live newborns in randomly selected hospitals in West Wollega. Data were collected using a structured interviewer-administered questionnaire. Collected data were coded and entered into Epi Info version 7.2.0.1 and analyzed by SPSS version 24. Adjusted odds ratios were used to identify predictors of low birth weight at a p-value less than 0.05.Results: The study indicated that the mother living in a food-insecure household (AOR [95% CI] = 2.9 [1.05– 8]), uneducated mother (AOR [95% CI] = 5 [1.8– 14]), birth interval of < 24 months (AOR [95% CI] = 4.6 [1.2– 18]), age at first birth of < 18 years (AOR [95% CI] = 4 [1.1– 15]), late initiation of antenatal care (ANC) (AOR [95% CI] = 4.4 [1.3– 15.7]), pregnancy-induced hypertension (AOR [95% CI] = 3.6 [1.03– 12.9]), and maternal mid-upper arm circumference (MUAC) of < 23 cm (AOR [95% CI] = 11 [4– 35]) were predictors of low birth weight.Conclusion: Household food insecurity, a birth interval of < 24 months, age at first birth < 18 years, late initiation of first ANC, pregnancy-induced hypertension, and maternal MUAC of < 23 cm were predictors of low birth weight in this study. Early screening for medical and obstetric conditions, as well as maternal nutritional status and household food insecurity, is a key action needed to reduce low birth weight in this study area.Keywords: low birth weight, predictors, newborn, food insecurity
... Although the frequency of preterm labor varies considerably between countries, almost 90% of these premature births occur in developing countries in Africa and Asia. In 2014, the rate of preterm births was 10% in the US, while in Europe in 2010, preterm birth rates varied markedly from 5 to 10.6% among live births [2]. ...
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Background: Admission of preterm infants in the neonatal intensive care unit limits the mother's interaction with their infants, delaying accepting and playing the motherhood role. Besides, mothers of preterm infants have low self-esteem due to their infants' condition. Accordingly, the present study explored the effect of implementing the training program on maternal role adaptation and self-esteem of mothers of preterm infants admitted to the neonatal intensive care unit. Methods: This study employed a quasi-experimental design with two groups. The participants were 80 mothers of preterm infants. The participants were selected using convenience sampling and simply randomly assigned to the intervention and control groups. The instruments included a demographic information questionnaire, the Rosenberg Self-Esteem Scale, and the Maternal Role Adaptation Scale. The participants in the intervention group attended the training program, while the control group did not receive any intervention. The questionnaires were completed by the two groups before and 2 weeks after the intervention. The collected data were analyzed using SPSS software version 21, a significance level of 0.05. Results: The maternal role adaptation scores before the intervention in the control and intervention groups were 134.222 ± 11.84 and 138.800 ± 12.42, respectively, showing no statistically significant difference (P = 0.096). The corresponding scores after the intervention for the control and intervention groups were 139.17 ± 12.46 and 154.05 ± 8.57, showing a significant intergroup difference (P < 0.001). Similarly, the pre-intervention self-esteem scores in the control and intervention groups were 30.30 ± 3.79 and 30.95 ± 8.61, showing no statistically significant difference between the two groups (P = 0.664). Besides, the post-intervention self-esteem scores in the control and intervention groups were 31.52 ± 3.42 and 36.001 ± 7.74, respectively, indicating a statistically significant difference between the two groups (P < 0.001). Conclusion: Given the insight from this study, implementing training programs is a suitable solution for improving maternal role adaptation and increasing mothers' self-esteem. Furthermore, nurses' training packages can help the mother accept the maternal role more quickly and improve the mother's self-esteem for better care of the baby. Trial registration The registration number for this study was obtained from Kerman University of Medical Sciences, and the number of the grant was 98000150.
... Prematurity is an important ABO and is associated with severe morbidity and increased mortality; for example, infants born between 33 and 37 weeks of pregnancy have a higher risk of airway disorders [4,5]. Maternal determinants such as smoking, low body mass index, previous PTB, social deprivation, levels of education, unemployment, single motherhood, and maternal age of <20 years or >35 years are all associated with a higher risk of prematurity [6]. Stillbirth, another important ABO, accounts for approximately 7% of the global burden of disease and is often associated with maternal morbidity and longlasting psychosocial distress for mothers [7]. ...
... In line with previous studies, increased risk of ABO including PTB was associated with adolescent maternity [51][52][53][54]. In some studies, this association did not hold after controlling for socioeconomic and reproductive factors, thus indicating that social disadvantage rather than biological factors may be the explanation [6]. However, in other studies, the association persisted after adjustment. ...
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Information regarding adverse birth outcomes (ABO) of Indigenous and Tribal women living in the remote tropical rainforest of Suriname, where mercury (Hg) use is abundant in artisanal gold mining, is not available. In the context of a health system analysis, we examined the association between Hg exposure, maternal sociodemographics on the ABO of Indigenous and Tribal women living in Suriname’s interior and its capital, Paramaribo. ABO were determined in pregnant women enrolled from December 2016 to July 2019 in the Caribbean Consortium for Environmental and Occupational Health prospective environmental epidemiologic cohort study. Associations were explored using Pearson’s χ2-test and the Mann–Whitney U-test. Among 351 singleton participants, 32% were Indigenous, residing mainly in the interior (86.8%), and 23.1% had ABO. Indigenous participants had higher rates of ABO (29.8% vs. 19.8%) and preterm birth (PTB) (21.2% vs. 12.4%), higher Hg levels, delivered at a younger age, were less educated, and had lower household income compared to Tribal participants. Multivariate logistic regression models revealed that Indigenous participants had higher odds of ABO (OR = 3.60; 95% CI 1.70–7.63) and PTB (OR = 3.43; 95% CI 1.48–7.96) compared with Tribal participants, independent of Hg exposure and age at delivery. These results highlight the importance of effective risk reduction measures in support of Indigenous mothers, families, and communities.