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Trends in singleton preterm birth in Victoria, 2007 to 2017: A consecutive cross-sectional study
Renée J Burger1,2, Josephina D Temmink1,2, Dagmar Wertaschnigg1,3
1Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia.
Insights
Singleton preterm birth rates are rising in Victoria, primarily due to increased iatrogenic preterm births. This trend occurred across various pregnancy types, with no significant reduction in stillbirth risk for low-risk pregnancies.
Area of Science:
- Obstetrics and Gynecology
- Perinatal Epidemiology
- Public Health
Background:
- Preterm birth is a significant global contributor to infant morbidity and mortality.
- Increasing preterm birth rates are observed in many countries, often linked to iatrogenic interventions.
- Understanding regional trends is crucial for targeted clinical care improvements.
Purpose of the Study:
- To analyze trends in singleton preterm births in Victoria, Australia, from 2007 to 2017.
- To examine the relationship between preterm birth trends and perinatal mortality rates.
- To identify potential areas for enhancing clinical management of preterm births.
Main Methods:
- A consecutive cross-sectional study design was employed.
- Data included all singleton births at or after 20 weeks gestation in Victoria (2007-2017).
- Analysis focused on preterm birth and perinatal mortality rates across different pregnancy complication categories.
Main Results:
- The overall singleton preterm birth rate increased from 5.9% to 6.4% between 2007 and 2017.
- Iatrogenic preterm births significantly increased from 2.5% to 3.6% during the study period.
- Perinatal mortality decreased in pregnancies with complications (SGA, hypertension, preeclampsia, PROM), but not in uncomplicated pregnancies.
Conclusions:
- Victoria experienced a rise in singleton preterm birth rates, driven by iatrogenic births.
- This increase was observed in both complicated and uncomplicated pregnancies.
- While mortality improved for complicated pregnancies, no significant reduction in stillbirth risk was seen for uncomplicated cases, highlighting a need for further investigation.
Introduction:
Preterm birth is a major cause of perinatal morbidity and mortality worldwide. In many countries preterm birth rates are increasing, largely as a result of increases in iatrogenic preterm birth, whereas in other countries rates are stable or even declining. The objective of the study is to describe trends in singleton preterm births in Victoria from 2007 to 2017 in relation to trends in perinatal mortality to identify opportunities for improvements in clinical care.
Material And Methods:
We conducted a consecutive cross-sectional study in all women with a singleton pregnancy giving birth at ≥20 weeks of pregnancy in Victoria, Australia, between 2007 and 2017, inclusive. Rates of preterm birth and perinatal mortality were calculated and trends were analyzed in all pregnancies, in pregnancies complicated by fetal growth problems, hypertension, (pre)eclampsia or prelabor rupture of membranes (PROM), and in (low-risk) pregnancies not complicated by any of these conditions.
Results:
There were 811 534 singleton births between 2007 and 2017. Preterm birth increased from 5.9% (4074 births) to 6.4% (4893 births; P < .001), due to an increase in iatrogenic preterm birth from 2.5% (1730 births) to 3.6% (2730 births; P < .001). Comparable trends were seen in pregnancies complicated by fetal growth problems and hypertension and in pregnancies not complicated by small for gestational age (SGA), hypertension, (pre)eclampsia or PROM (all P < .001). In pregnancies complicated by SGA, hypertension, (pre)eclampsia or PROM the perinatal mortality rate from 20 weeks of gestation fell (13 to 12 per 1000 births; P < .001). In pregnancies not complicated by SGA, hypertension, (pre)eclampsia or PROM there was no significant change in the perinatal mortality from 28 weeks and no decrease in the preterm weekly prospective stillbirth risk.
Conclusions:
The singleton preterm birth rate in Victoria is increasing, driven by an increase in iatrogenic preterm birth, both in pregnancies complicated by SGA and hypertension, and in pregnancies not complicated by SGA, hypertension, (pre)eclampsia or PROM. While perinatal mortality decreased in the pregnancies complicated by SGA, hypertension, (pre)eclampsia or PROM, no significant reduction in perinatal mortality from 28 weeks or in preterm weekly prospective stillbirth risk was noted in the pregnancies not complicated by any of these conditions.
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