Determinants of preterm birth: proposal for a hierarchical theoretical model

Area of Science:

• Obstetrics and Gynecology
• Public Health
• Reproductive Epidemiology

Background:

• Preterm birth (PB) is a complex syndrome with incompletely understood causality.
• Multiple maternal factors, including sociodemographic, psychosocial, nutritional, behavioral, and biological aspects, are associated with increased PB risk.
• Existing models often fail to capture the intricate interrelationships between these determinants.

Purpose of the Study:

• To present a hierarchical theoretical model of preterm birth determinants.
• To elucidate the complex interrelationships between various factors contributing to PB.
• To identify potential intervention points in the causal chain of preterm birth.

Main Methods:

• Development of a hierarchical theoretical model.
• Categorization of variables into six dimensions across three hierarchical levels: distal, intermediate, and proximal.
• Analysis of indirect and direct effects of determinants on preterm birth.

Main Results:

• Socioeconomic determinants exert indirect effects on PB via intermediate-level variables.
• Intermediate-level factors influence proximal-level biological risk factors.
• Proximal biological risk factors have a direct impact on preterm birth.
• The model illustrates a chain of influence from distal to proximal determinants.

Conclusions:

• The proposed hierarchical model provides a framework for understanding preterm birth etiology.
• Interventions targeting socioeconomic and intermediate factors may indirectly reduce PB risk.
• Further research into these interrelationships is crucial for effective preterm birth prevention strategies.