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Gestational age-dependent risk factors for preterm birth: associations with maternal education and age early in

Nathalie Auger1, Michal Abrahamowicz2, Willy Wynant2

  • 1Institut national de santé publique du Québec, Montréal, Canada; Research Centre of the University of Montréal Hospital Centre, Montréal, Canada; Department of Social and Preventive Medicine, University of Montréal, Montréal, Canada.

European Journal of Obstetrics, Gynecology, and Reproductive Biology
|March 27, 2014
PubMed

Insights

Maternal low education and older age are associated with increased preterm birth (PTB) risk, particularly early in gestation. These associations vary significantly over the duration of pregnancy.

Area of Science:

  • Reproductive Health
  • Perinatal Epidemiology
  • Obstetrics

Background:

  • Preterm birth (PTB) before 37 weeks is a major concern in perinatal health.
  • Few studies have investigated how risk factor associations with PTB change throughout gestation.

Purpose of the Study:

  • To evaluate if the associations between maternal education, maternal age, and PTB vary depending on gestational age at delivery.
  • To assess time-dependent associations of major risk factors with PTB.

Main Methods:

  • Retrospective cohort study of 223,756 live singleton births in Québec, Canada (2001-2005).
  • Time-to-event analysis using Cox proportional hazards models with linear and nonlinear time interaction terms.
  • Adjusted for maternal characteristics.

Main Results:

  • Associations of PTB with lower maternal education and older maternal age strengthened progressively at earlier gestational ages.
  • The risk of PTB associated with these factors was not constant throughout gestation.

Conclusions:

  • Risk factors like low maternal education and advanced maternal age may have stronger associations with PTB early in gestation.
  • Time-dependent models are valuable for assessing associations at early gestational ages and avoiding bias.
Abstract

Keywords:
Educational statusGestational ageMaternal agePreterm birthSurvival analysis

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