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Maternal genitourinary infections and poor nutritional status increase risk of preterm birth in Gasabo District,
Etienne Nsereko1, Aline Uwase2, Assumpta Mukabutera3
1University of Rwanda College of Medicine and Health Sciences School of Health Sciences, P.O. Box: 3538, Kigali, Rwanda. etiennen70@gmail.com.
Insights
Maternal anemia, urinary tract infections (UTIs), chlamydia, and poor nutrition increase preterm birth (PTB) risk in Rwanda. Interventions should target these factors to reduce PTB rates and improve maternal and child health outcomes.
Area of Science:
- Obstetrics and Gynecology
- Maternal Health
- Infectious Diseases
Background:
- Preterm birth (PTB) is a major cause of infant mortality and long-term disability.
- Risk factors for PTB are multifactorial, including maternal nutrition and infections.
- Identifying modifiable risk factors is crucial for targeted interventions in Rwanda.
Purpose of the Study:
- To identify independent risk factors for preterm birth in a Rwandan population.
- To inform targeted interventions aimed at reducing PTB incidence.
- To investigate associations between maternal health indicators and PTB.
Main Methods:
- Prospective longitudinal cohort study of 367 pregnant women in Rwanda.
- Recruitment between 9-15 gestational weeks with age estimation via ultrasound and last menstrual period.
- Multivariable logistic regression analysis to identify independent predictors of PTB.
Main Results:
- The overall PTB rate was 10.1%.
- Independent risk factors for PTB included anemia (OR: 4.27), UTI (OR: 9.82), chlamydia (OR: 2.79), low dietary diversity (OR: 3.94), and low mid-upper arm circumference (OR: 3.12).
- Nutritional inadequacy predicted low birth weight (LBW), while UTI was associated with LBW, but not PTB.
Conclusions:
- Targeted interventions are needed to improve maternal nutrition and prevent anemia before pregnancy.
- Enhanced antenatal care screening for UTIs and sexually transmitted infections is recommended.
- Strengthening prevention and treatment of maternal infections is essential to reduce PTB.
Background:
Preterm birth (PTB) is a leading cause of early childhood mortality and morbidity, including long-term physical and mental impairment. The risk factors for PTB are complex and include maternal nutritional status and infections. This study aimed to identify potentially modifiable risk factors for targeted interventions to reduce the occurrence of PTB in Rwanda.
Methods:
We conducted a prospective, longitudinal cohort study of healthy pregnant women aged 18 to 49 years. Women at 9-15 gestational weeks were recruited from 10 health centers in Gasabo District, Kigali Province between September and October 2017. Pregnancy age was estimated using ultrasonography and date of last menstruation. Anthropometric and laboratory measurements were performed using standard procedures for both mothers and newborns. Surveys were administered to assess demographic and health histories. Categorical and continuous variables were depicted as proportions and means, respectively. Variables with p < 0.25 in bivariate analyses were included in multivariable logistic regression models to determine independent predictors of PTB. The results were reported as odds ratios (ORs) and 95% confidence intervals (CI), with statistical significance set at p < 0.05.
Results:
Among 367 participants who delivered at a mean of 38.0 ± 2.2 gestational weeks, the overall PTB rate was 10.1%. After adjusting for potential confounders, we identified the following independent risk factors for PTB: anemia (hemoglobin < 11 g/dl) (OR: 4.27; 95%CI: 1.85-9.85), urinary tract infection (UTI) (OR:9.82; 95%CI: 3.88-24.83), chlamydia infection (OR: 2.79; 95%CI: 1.17-6.63), inadequate minimum dietary diversity for women (MDD-W) score (OR:3.94; CI: 1.57-9.91) and low mid-upper arm circumference (MUAC) < 23 cm (OR: 3.12, 95%CI; 1.31-7.43). indicators of nutritional inadequacy (low MDD-W and MUAC) predicted risk for low birth weight (LBW) but only UTI was associated with LBW in contrast with PTB.
Conclusion:
Targeted interventions are needed to improve the nutritional status of pregnant women, such as maternal education on dietary diversity and prevention of anemia pre-pregnancy. Additionally, prevention and treatment of maternal infections, especially sexually transmitted infections and UTIs should be reinforced during standard antenatal care screening which currently only includes HIV and syphilis testing.
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