IMPACT OF BIOMEDICAL AND BEHAVIORAL FACTORS ON PRETERM BIRTH

Preterm birth, in a long-term perspective, is a priority for medicine and public health, as it is directly associated with health index of the population. Georgian clinical management guidelines for preterm birth is based on non-Georgian experience, due to lack of population-based research in Georgia. For this purpose, it was implemented Cause-effect epidemiological study with the purpose on risk factors of preterm birth. Study based on 2018 Georgian Birth Registry (GBR) with registered 50468 childbirth cases, data was conducted for total Georgian single-fetus (n=49762) population according to known biomedical and behavior-related expositions based on a review of the scientific literature from 1999-2020. Target variable was divided into two sub-variables (dichotomy variable), according to which, pregnancy term of 258 days including was determined as preterm, while 259 and above was considered as timely. Study of risk factors of preterm birth was implemented using stages of backward selection modelling of analysis, while possible expositions linked to preterm birth was included in logistic regression model. According to the final model, male gender and fetus of less than 2,500 grams are statistically relevant factors for the outcome of preterm birth. Also mother's age below 18 and above 35. Severe anemia remains a risk factor on the final model with and diabetes during pregnancy. Small increase of body mass index (BMI<5) is a reliable risk factor for the preterm birth, and increases risk for interesting outcomes by 1.3 (95% CI 1.1-1.5). According to regression analysis, out of behavior expositions, inducted abortions during previous pregnancies ensure statistically reliable increase of premature termination of future pregnancies. Insufficient antenatal care (≤4 visits) are statistically reliable risk factors for premature termination of pregnancy. Results of study based on population registry enable to conclude that biomedical and behavior factors, as proven by evidence, are important for prevention of preterm birth. This process requires shared responsibility between medical personnel, pregnant woman and environment. Prevention should be ensured through effective use of medical technologies, formulation of interventions of different levels on behavior-related factors: public awareness, education, active interventions.