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Changes in incidence of iatrogenic and spontaneous preterm births over time: a population-based study.

Abstract：

OBJECTIVE:To examine the proportion of iatrogenic births among all preterm births over a 26-year period. PATIENTS AND METHODS:A registry-based survey of preterm deliveries between 1987 and 2012 analyzed by the onset of labor: spontaneous with intact membranes, preterm premature rupture of membranes (PPROM) or iatrogenic. Stratification into categories by gestation (22 weeks to 27 weeks and 6 days, 28 weeks to 31 weeks and 6 days, 32 weeks to 33 weeks and 6 days, 34 weeks to 36 weeks and 6 days) was performed. Preterm birth rates were analyzed using the Mantel-Haenszel linear-by-linear association χ2-test (P<0.05 significant). Logistic regression was used to account for potential confounders. RESULTS:Overall preterm birth rate was 5.9% (31328 deliveries) including 2358 (0.4%) before 28 completed weeks, 3388 (0.6%) between 28 weeks and 31 weeks 6 days, 3970 (0.8%) between 32 weeks and 33 weeks and 6 days, and 21611 (4.1%) between 34 weeks and 36 weeks and 6 days There was an increase in overall preterm birth rate (P<0.001). The rate of iatrogenic preterm births and PPROM increased over time (P<0.001 and P<0.014, respectively). Rates of spontaneous preterm birth decreased (P<0.001). After accounting for potential confounders, year of birth remained an independent risk factor for iatrogenic preterm delivery in all four gestational age categories (P<0.001). CONCLUSION:The incidence of iatrogenic preterm birth is increasing with a concomitant decrease in the incidence of spontaneous preterm birth. Attempts to analyze, interpret and decrease preterm birth rates should consider spontaneous and iatrogenic preterm births separately.

journal_name

J Perinat Med

journal_title

Journal of perinatal medicine

authors

Lucovnik M,Bregar AT,Steblovnik L,Verdenik I,Gersak K,Blickstein I,Tul N

doi

10.1515/jpm-2015-0271

subject

Has Abstract

pub_date

2016-07-01 00:00:00

pages

505-9

issue

5

eissn

0300-5577

issn

1619-3997

pii

/j/jpme.ahead-of-print/jpm-2015-0271/jpm-2015-0271

journal_volume

44

pub_type

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