Maternal Preterm Birth Prediction in the United States: a Case-control Database Study

Overview

Journal BMC Pediatr

Publisher Biomed Central

Specialty Pediatrics

Date 2022 Sep 14

PMID 36104673

Authors

Yan Li

Xiaoyu Fu

Xinmeng Guo

Huili Liang

Dongru Cao

Junmei Shi

Affiliations

Soon will be listed here.

Abstract

Background: Preterm birth is serious public health worldwide, and early prediction of preterm birth in pregnant women may provide assistance for timely intervention and reduction of preterm birth. This study aimed to develop a preterm birth prediction model that is readily available and convenient for clinical application.

Methods: Data used in this case-control study were extracted from the National Vital Statistics System (NVSS) database between 2018 and 2019. Univariate and multivariate logistic regression analyses were utilized to find factors associated with preterm birth. Odds ratio (OR) and 95% confidence interval (CI) were used as effect measures. The area under the curve (AUC), accuracy, sensitivity, and specificity were utilized as model performance evaluation metrics.

Results: Data from 3,006,989 pregnant women in 2019 and 3,039,922 pregnant women in 2018 were used for the model establishment and external validation, respectively. Of these 3,006,989 pregnant women, 324,700 (10.8%) had a preterm birth. Higher education level of pregnant women [bachelor (OR = 0.82; 95%CI, 0.81-0.84); master or above (OR = 0.82; 95%CI, 0.81-0.83)], pre-pregnancy overweight (OR = 0.96; 95%CI, 0.95-0.98) and obesity (OR = 0.94; 95%CI, 0.93-0.96), and prenatal care (OR = 0.48; 95%CI, 0.47-0.50) were associated with a reduced risk of preterm birth, while age ≥ 35 years (OR = 1.27; 95%CI, 1.26-1.29), black race (OR = 1.26; 95%CI, 1.23-1.29), pre-pregnancy underweight (OR = 1.26; 95%CI, 1.22-1.30), pregnancy smoking (OR = 1.27; 95%CI, 1.24-1.30), pre-pregnancy diabetes (OR = 2.08; 95%CI, 1.99-2.16), pre-pregnancy hypertension (OR = 2.22; 95%CI, 2.16-2.29), previous preterm birth (OR = 2.95; 95%CI, 2.88-3.01), and plurality (OR = 12.99; 95%CI, 12.73-13.24) were related to an increased risk of preterm birth. The AUC and accuracy of the prediction model in the testing set were 0.688 (95%CI, 0.686-0.689) and 0.762 (95%CI, 0.762-0.763), respectively. In addition, a nomogram based on information on pregnant women and their spouses was established to predict the risk of preterm birth in pregnant women.

Conclusions: The nomogram for predicting the risk of preterm birth in pregnant women had a good performance and the relevant predictors are readily available clinically, which may provide a simple tool for the prediction of preterm birth.

Citing Articles

Clinical and dental predictors of preterm birth using machine learning methods: the MOHEPI study.

Park J, Lee K, Heo J, Ahn K Sci Rep. 2024; 14(1):24664.

PMID: 39433922 PMC: 11494142. DOI: 10.1038/s41598-024-75684-8.

Prediction of Preterm Birth among Infants with Orofacial Cleft Defects.

Ludorf K, Benjamin R, Canfield M, Swartz M, Agopian A Cleft Palate Craniofac J. 2023; 62(1):35-43.

PMID: 37671412 PMC: 11363204. DOI: 10.1177/10556656231198945.

The Effect of Sexual Intercourse during Pregnancy on Preterm Birth: Prospective Single-Center Cohort Study in Japan.

Yo Y, Kawasaki K, Moriuchi K, Shiro R, Shimaoka M, Matsumura N Healthcare (Basel). 2023; 11(11).

PMID: 37297797 PMC: 10252402. DOI: 10.3390/healthcare11111657.

References

Matos J, Amorim M, Silva S, Nogueira C, Alves E . Prematurity-related knowledge among mothers and fathers of very preterm infants. J Clin Nurs. 2020; 29(15-16):2886-2896. DOI: 10.1111/jocn.15361. View

Koullali B, Oudijk M, Nijman T, Mol B, Pajkrt E . Risk assessment and management to prevent preterm birth. Semin Fetal Neonatal Med. 2016; 21(2):80-8. DOI: 10.1016/j.siny.2016.01.005. View

Weber A, Darmstadt G, Gruber S, Foeller M, Carmichael S, Stevenson D . Application of machine-learning to predict early spontaneous preterm birth among nulliparous non-Hispanic black and white women. Ann Epidemiol. 2018; 28(11):783-789.e1. DOI: 10.1016/j.annepidem.2018.08.008. View

Auger N, Roncarolo F, Harper S . Increasing educational inequality in preterm birth in Quebec, Canada, 1981-2006. J Epidemiol Community Health. 2010; 65(12):1091-6. DOI: 10.1136/jech.2009.102350. View

Miller E, Tita A, Grobman W . Second-Trimester Cervical Length Screening Among Asymptomatic Women: An Evaluation of Risk-Based Strategies. Obstet Gynecol. 2015; 126(1):61-6. DOI: 10.1097/AOG.0000000000000864. View

Purisch S, Gyamfi-Bannerman C . Epidemiology of preterm birth. Semin Perinatol. 2017; 41(7):387-391. DOI: 10.1053/j.semperi.2017.07.009. View

Wei Y, Xu Q, Yang H, Yang Y, Wang L, Chen H . Preconception diabetes mellitus and adverse pregnancy outcomes in over 6.4 million women: A population-based cohort study in China. PLoS Med. 2019; 16(10):e1002926. PMC: 6771981. DOI: 10.1371/journal.pmed.1002926. View

Goldenberg R, Culhane J, Iams J, Romero R . Epidemiology and causes of preterm birth. Lancet. 2008; 371(9606):75-84. PMC: 7134569. DOI: 10.1016/S0140-6736(08)60074-4. View

Kondracki A, Hofferth S . A gestational vulnerability window for smoking exposure and the increased risk of preterm birth: how timing and intensity of maternal smoking matter. Reprod Health. 2019; 16(1):43. PMC: 6469085. DOI: 10.1186/s12978-019-0705-x. View

10.

Moons K, Royston P, Vergouwe Y, Grobbee D, Altman D . Prognosis and prognostic research: what, why, and how?. BMJ. 2009; 338:b375. DOI: 10.1136/bmj.b375. View

11.

Ju A, Heyman M, Garber A, Wojcicki J . Maternal Obesity and Risk of Preterm Birth and Low Birthweight in Hawaii PRAMS, 2000-2011. Matern Child Health J. 2018; 22(6):893-902. DOI: 10.1007/s10995-018-2464-7. View

12.

Walani S . Global burden of preterm birth. Int J Gynaecol Obstet. 2020; 150(1):31-33. DOI: 10.1002/ijgo.13195. View

13.

Park H, Kwon H, Frederick McElrath T . Assisted reproductive technology and the risk of unplanned peripartum hysterectomy: analysis using propensity score matching. Hum Reprod. 2018; 33(8):1466-1473. DOI: 10.1093/humrep/dey228. View

14.

Russell R, Green N, Steiner C, Meikle S, Howse J, Poschman K . Cost of hospitalization for preterm and low birth weight infants in the United States. Pediatrics. 2007; 120(1):e1-9. DOI: 10.1542/peds.2006-2386. View

15.

Smith L, Dickens J, Bender Atik R, Bevan C, Fisher J, Hinton L . Parents' experiences of care following the loss of a baby at the margins between miscarriage, stillbirth and neonatal death: a UK qualitative study. BJOG. 2020; 127(7):868-874. PMC: 7383869. DOI: 10.1111/1471-0528.16113. View

16.

Premkumar A, Henry D, Moghadassi M, Nakagawa S, Norton M . The interaction between maternal race/ethnicity and chronic hypertension on preterm birth. Am J Obstet Gynecol. 2016; 215(6):787.e1-787.e8. DOI: 10.1016/j.ajog.2016.08.019. View

17.

Son M, Miller E . Predicting preterm birth: Cervical length and fetal fibronectin. Semin Perinatol. 2017; 41(8):445-451. PMC: 6033518. DOI: 10.1053/j.semperi.2017.08.002. View

18.

Ion R, Lopez Bernal A . Smoking and Preterm Birth. Reprod Sci. 2014; 22(8):918-26. DOI: 10.1177/1933719114556486. View

19.

Ventura S . The U.S. National Vital Statistics System: Transitioning Into the 21st Century, 1990-2017. Vital Health Stat 1. 2018; (62):1-84. View

20.

Stock S, Bauld L . Maternal smoking and preterm birth: An unresolved health challenge. PLoS Med. 2020; 17(9):e1003386. PMC: 7489523. DOI: 10.1371/journal.pmed.1003386. View