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A comparison of risk factors for preterm labor and term small-for-gestational-age birth
J M Lang1, E Lieberman, A Cohen
1Department of Epidemiology and Biostatistics, Boston University School of Public Health, MA 02118, USA.
Insights
This study identifies key risk factors for preterm labor and fetal growth retardation, emphasizing the need to differentiate causes of low birthweight. Understanding these factors is crucial for improving pregnancy outcomes and controlling confounding variables.
Area of Science:
- Obstetrics and Gynecology
- Perinatal Epidemiology
- Reproductive Health
Background:
- Low birthweight is a significant predictor of infant mortality and morbidity.
- Preterm labor and fetal growth retardation are distinct pathways leading to low birthweight.
- Identifying specific risk factors is essential for targeted interventions.
Purpose of the Study:
- To estimate the effects of 23 factors on preterm labor and fetal growth retardation.
- To analyze risk factors for preterm labor in appropriate-for-gestational-age infants.
- To analyze risk factors for fetal growth retardation in term infants.
Main Methods:
- Retrospective cohort study.
- Analysis of risk factors for preterm labor (N=9,490) and fetal growth retardation (N=10,889).
- Statistical analysis to identify independent associations and calculate odds ratios.
Main Results:
- Preterm labor associated with young maternal age, low maternal weight/weight gain, nulliparity, prior preterm birth, abortions, DES exposure, incompetent cervix, uterine anomaly, and pyelonephritis (ORs 1.7-5.9).
- Fetal growth retardation associated with black race, young maternal age, short maternal height, low maternal weight/weight gain, smoking, nulliparity, prior preterm birth, multiple abortions, uterine anomaly, and DES exposure (ORs 1.6-2.8).
- Identified distinct sets of risk factors for each outcome.
Conclusions:
- Separating diverse etiologies of low birthweight is critical for understanding adverse pregnancy outcomes.
- Findings highlight the importance of considering the entire birthweight spectrum.
- Emphasizes the need for rigorous control of confounding factors in pregnancy outcome research.
Abstract:
This study estimates the effects of 23 factors on the prevalence of premature labor and fetal growth retardation across the entire birthweight spectrum. We studied risk factors for premature labor within the domain of babies of appropriate size for their gestational age (N = 9,490). We also studied risk factors for fetal growth retardation among babies born at term (N = 10,889). Preterm labor was associated independently with young maternal age, low pre-pregnant weight, low weekly weight gain, nulliparity, previous preterm birth, histories of two or more induced abortions, spontaneous abortions, or stillbirths, uterine exposure to diethylstilbestrol (DES), incompetent cervix, uterine anomaly, and pyelonephritis. Odds ratios ranged from 1.7 to 5.9. Fetal growth retardation, as estimated by small-for-gestational-age birth, was associated independently with black race, young maternal age, short maternal height, low prepregnancy weight, low weekly weight gain, and smoking, as well as nulliparity, previous preterm birth, three or more abortions, uterine anomaly, and uterine exposure to DES. Odds ratios ranged from 1.6 to 2.8. Our study shows the importance for etiologic understanding of separating diverse routes to low birthweight and considering the occurrence of adverse pregnancy outcomes along the entire birthweight spectrum. The findings reinforce the need for comprehensive control of confounding in studies of pregnancy outcome.