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Prevention of premature birth: Impact of the Explicit Health Guarantee
Fernando Carvajal-Encina1, Luciano Carvajal Rojas2
1Hospital de La Serena, La Serena, Chile.
Insights
The Explicit Health Guarantees (GES) did not lower prematurity rates, but were linked to reduced perinatal mortality. Further research is needed to confirm causality and guide future interventions for preventing premature birth.
Area of Science:
- Perinatal health
- Public health policy
- Epidemiology
Background:
- Prematurity poses significant challenges due to high morbidity and mortality rates.
- The Explicit Health Guarantees (GES) for Premature Birth Prevention were implemented in 2005 but have not been evaluated.
- Assessing the impact of public health policies on perinatal outcomes is crucial for improving maternal and infant health.
Purpose of the Study:
- To evaluate the impact of the GES on key perinatal indicators.
- To analyze trends in prematurity rates and mortality before and after GES implementation.
- To forecast future trends in prematurity and perinatal mortality.
Main Methods:
- A cross-sectional study analyzed premature births (stillbirths and live births ≥ 22 weeks gestational age) from 2001 to 2023.
- Data were sourced from Ministry of Health statistics, focusing on prematurity rate (PR), perinatal mortality rate (PMR), fetal mortality rate (FMR), and early neonatal mortality rate (ENMR).
- Statistical analyses included linear regression, time series analysis, and ARIMA models for 5-year forecasting.
Main Results:
- The prematurity rate (PR) showed a linear increase from 5.74% to 9.85% (R2 = 0.97), with no significant change post-GES implementation.
- The risk of prematurity increased by 49% in the most recent five-year period compared to the pre-GES period.
- While the perinatal mortality rate (PMR) initially rose, it subsequently declined, primarily due to decreased fetal mortality rates.
Conclusions:
- The GES policy was not associated with a reduction in prematurity rates.
- A potential association between GES and lower perinatal mortality warrants further investigation to establish causality.
- Findings highlight the need for continued evaluation of public health interventions and potential policy adjustments to address prematurity challenges.
Abstract:
Prematurity is a challenge due to its high morbidity and mortality. The Explicit Health Guarantees (GES) for Premature Birth Prevention, implemented in 2005, have not been evaluated.
Objective:
To evaluate the impact of the GES on perinatal indicators.
Patients And Method:
Cross-sectional study of premature births between 2001 and 2023, including both stillbirths and live births (LB) ≥ 22 weeks' gestational age. Data were obtained from the Department of Health Statistics and Information of the Ministry of Health databases. Prematurity rate (PR), perinatal mortality rate (PMR), fetal mortality rate (FMR), and early neonatal mortality rate (ENMR) were analyzed using linear regression, time series, and 5-year forecasting using ARIMA models.
Results:
The PR increased linearly from 5.74% to 9.85% (R2 = 0.97), with no changes after the implementation of the GES. The risk of prematurity increased by 49% between the pre-GES five-year period and the most recent one. The PR forecasting showed a continued upward trend, reaching 10.6 per 1,000 LB in 2027 (95% CI: 9.9-11.3). The PMR showed a linear upward trend reaching 10.4 per 1,000 LB in 2009 (R2 = 0.96), followed by a linear decline to 8.3 per 1,000 LB in 2021 (R2 = 0.89), explained by a decrease in FMR and stable ENMR. The PMR forecasting showed a sustained trend (2026: 5.8 per 1,000 LB; 95% CI: 5.8-9).
Conclusions:
GES did not reduce PR but was associated with lower PMR. This potential impact requires further analysis to establish causality and guide future improvements.
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