Determinants of preterm birth among women delivered in public hospitals of Western Ethiopia, 2020: Unmatched case-control study

Determinants of preterm delivery among mothers who gave birth in hospitals of Wolaita zone, southern Ethiopia, 2023: unmatched case-control study

BACKGROUND

Preterm delivery refers to childbirth that occurs before 37 full weeks' gestation. Globally, around 13.4 million babies are born preterm annually, a million died due to its complications. Identifying its determinants is mandatory to decrease preterm birth and thereby neonatal deaths. Therefore, this study aimed to identify the determinants of preterm delivery among mothers who gave birth in hospitals in the Wolaita zone, southern Ethiopia.

METHODS

A hospital-based unmatched case-control study design was conducted from March 29 to May 20, 2023, in the Wolaita zone, southern Ethiopia. Cases were women who gave birth after 28 weeks and before 37 completed weeks, and controls were women who gave birth at and after 37 and before 42 weeks of gestation from the first day of the last normal menstrual period. A consecutive sampling method was used. Data were collected by a structured interviewer-administered questionnaire. Data were coded and entered into Epi data 3.1 and analyzed by using SPSS version 25. Variables that had a P-value < 0.25 in the bivariate logistic regression analysis were entered into a multivariable logistic regression model. Finally, p-value < 0.05 was used to claim statistical significance.

RESULT

From a total of 405 eligible participants, 399 respondents (133 cases and 266 controls) participated in this study with a response rate of 98.52%. The result of the multivariable analysis shows that mothers who resided in rural areas [AOR = 2.78:95% CI (1.51-5.12)], not receiving support from their partner [AOR = 2.37:95% CI (1.24-4.51)], less than four antenatal care visits [AOR = 4.52:95%CI (2.38-8.57)], developed pregnancy-induced hypertension [AOR = 5.25:95%CI (2.27-12.14)] and exposed for intimate partner violence [AOR = 2.95:95%CI (1.105-7.85)], had statistically significant association with experiencing preterm delivery.

CONCLUSION AND RECOMMENDATION

Most of the determinants for preterm delivery have been proven modifiable. Thus, designing new strategies, providing comprehensive mobile clinic services to address hard-to-reach areas and Health care providers should give due attention to mothers with pregnancy-induced hypertension and exposure to intimate partner violence and increase the awareness of antenatal care follow-up and benefit of support during pregnancy to reduce preterm delivery.

Clinical validation of the nursing diagnosis risk for disturbed maternal-fetal dyad in high-risk pregnancy: A case-control study

PURPOSE

To obtain evidence of the clinical validity of the nursing diagnosis (ND) risk for disturbed maternal-fetal dyad in high-risk pregnancy.

METHOD

Causal validation of the ND through a case-control study performed in a university hospital with 155 high-risk pregnant women: 31 cases and 124 controls. A causal association was found between the ND etiological factors and the occurrence of disruption of the symbiotic maternal-fetal dyad; an association was verified when the etiological factor presented a p-value <0.05 and odds ratio >1.

FINDINGS

The risk factor absent-inadequate prenatal care; populations at risk, such as young-advanced maternal age and economically disadvantaged pregnant women; and association conditions, such as maternal conditions and compromised fetal oxygen transport, increased the outcome likelihood. The associated condition maternal illnesses appeared as a protective factor.

CONCLUSIONS

Evidence of clinical validity of the ND risk for disturbed maternal-fetal dyad was obtained, and an association between etiological factors and disruption of the symbiotic maternal-fetal dyad was found.

IMPLICATIONS FOR NURSING PRACTICE

The results contribute to advance scientific knowledge in nursing teaching, research, and practice and support the nursing process in high-risk pregnancies.

Risk factors associated with preterm birth among mothers delivered at Lira Regional Referral Hospital

BACKGROUND

The World Health Organization (WHO) defines Preterm Birth (PTB) as "a live birth taking place before the expected 37 weeks of gestation". Annually, approximately 15 million infants are born prematurely, constituting significantly to infant mortality during the initial four weeks of life, responsible for 40% of deaths among children under the age of five. Evidently, preterm deliveries have contributed to 46% of admissions to the neonatal intensive care unit (NICU) at Lira Regional Referral Hospital (LRRH) over the past three years. Paradoxically, while the prevalence of preterm births remains high, there is a lack of documented information regarding the underlying risk factors. Consequently, the primary objective of this study was to assess the potential risk factors associated with preterm birth at LRRH.

METHODS

An analytical cross-sectional research was undertaken at LRRH, employing a quantitative methodology. The study utilized secondary data obtained from a total of 590 comprehensive maternal medical records, of deliveries that occurred at the facility between April 2020 and July 2021. The collected data underwent analysis using STATA version 17 software. To identify predictors of preterm birth, a Logistic regression model was applied, yielding adjusted odds ratios (AOR) alongside 95% confidence intervals (CI). The significance level was set at p < 0.05 to establish statistical significance. Furthermore, assessments for multicollinearity and model fitness were conducted using the Variance Inflation Factor (VIF) and linktest, respectively.

RESULTS

The prevalence of preterm delivery among mothers who gave birth at LRRH stood at 35.8%. The outcomes of logistic regression analysis revealed that maternal employment status had a statistically significant association with preterm birth (AOR = 0.657, p = 0.037, 95%CI: 0.443-0.975); having a baby with low birth weight (AOR = 0.228, p < 0.001, 95% CI: 0.099-0.527) and experiencing preeclampsia (AOR = 0.142, p < 0.001, 95% CI: 0.088-0.229) were also identified as significant predictors of preterm birth in the study.

CONCLUSIONS AND RECOMMENDATIONS

The occurrence of preterm delivery is significantly higher (35.8%) among mothers who gave birth at LRRH when compared to the national average (13.6%). The prevalence of preterm birth among mothers was linked to factors such as employment status, delivery of low birth weight infants, and the presence of preeclampsia. Consequently, the research proposes a set of recommendations. Firstly, the Ministry of Health (MoH) should evaluate the present state of readiness within the healthcare system to effectively handle cases of preterm birth both within medical facilities and the community. Secondly, the Ministry of Gender, Labour, and Social Development should leverage Labor Officers to implement and uphold the regulations stipulated in the Employment Act and Labor Laws.

Development and validation of a prognosis risk score model for preterm birth among pregnant women who had antenatal care visit, Northwest, Ethiopia, retrospective follow-up study

BACKGROUND

Prematurity is the leading cause of neonatal morbidity and mortality, specifically in low-resource settings. The majority of prematurity can be prevented if early interventions are implemented for high-risk pregnancies. Developing a prognosis risk score for preterm birth based on easily available predictors could support health professionals as a simple clinical tool in their decision-making. Therefore, the study aims to develop and validate a prognosis risk score model for preterm birth among pregnant women who had antenatal care visit at Debre Markos Comprehensive and Specialized Hospital, Ethiopia.

METHODS

A retrospective follow-up study was conducted among a total of 1,132 pregnant women. Client charts were selected using a simple random sampling technique. Data were extracted using structured checklist prepared in the Kobo Toolbox application and exported to STATA version 14 and R version 4.2.2 for data management and analysis. Stepwise backward multivariable analysis was done. A simplified risk prediction model was developed based on a binary logistic model, and the model's performance was assessed by discrimination power and calibration. The internal validity of the model was evaluated by bootstrapping. Decision Curve Analysis was used to determine the clinical impact of the model.

RESULT

The incidence of preterm birth was 10.9%. The developed risk score model comprised of six predictors that remained in the reduced multivariable logistic regression, including age < 20, late initiation of antenatal care, unplanned pregnancy, recent pregnancy complications, hemoglobin < 11 mg/dl, and multiparty, for a total score of 17. The discriminatory power of the model was 0.931, and the calibration test was p > 0.05. The optimal cut-off for classifying risks as low or high was 4. At this cut point, the sensitivity, specificity and accuracy is 91.0%, 82.1%, and 83.1%, respectively. It was internally validated and has an optimism of 0.003. The model was found to have clinical benefit.

CONCLUSION

The developed risk-score has excellent discrimination performance and clinical benefit. It can be used in the clinical settings by healthcare providers for early detection, timely decision making, and improving care quality.

Maternal low and high hemoglobin concentrations and associations with adverse maternal and infant health outcomes: an updated global systematic review and meta-analysis

BACKGROUND

Growing evidence suggests low and high maternal hemoglobin (Hb) concentrations may have adverse consequences for maternal and child health. There remain questions on specific Hb thresholds to define anemia and high Hb as well as how cutoffs may vary by anemia etiology and timing of assessment.

METHODS

We conducted an updated systematic review (using PubMed and Cochrane Review) on low (< 110 g/L) and high (≥ 130 g/L) maternal Hb concentrations and associations with a range of maternal and infant health outcomes. We examined associations by timing of Hb assessment (preconception; first, second, and third trimesters, as well as at any time point in pregnancy), varying cutoffs used for defining low and high hemoglobin concentrations and performed stratified analyses by iron-deficiency anemia. We conducted meta-analyses to obtain odds ratios (OR) and 95% confidence intervals.

RESULTS

The updated systematic review included 148 studies. Low maternal Hb at any time point in pregnancy was associated with: low birthweight, LBW (OR (95% CI) 1.28 (1.22-1.35)), very low birthweight, VLBW (2.15 (1.47-3.13)), preterm birth, PTB (1.35 (1.29-1.42)), small-for-gestational age, SGA (1.11 (1.02-1.19)), stillbirth 1.43 (1.24-1.65)), perinatal mortality (1.75 (1.28-2.39)), neonatal mortality (1.25 (1.16-1.34), postpartum hemorrhage (1.69 (1.45-1.97)), transfusion (3.68 (2.58-5.26)), pre-eclampsia (1.57 (1.23-2.01)), and prenatal depression (1.44 (1.24-1.68)). For maternal mortality, the OR was higher for Hb < 90 (4.83 (2.17-10.74)) than for Hb < 100 (2.87 (1.08-7.67)). High maternal Hb was associated with: VLBW (1.35 (1.16-1.57)), PTB (1.12 (1.00-1.25)), SGA (1.17 (1.09-1.25)), stillbirth (1.32 (1.09-1.60)), maternal mortality (2.01 (1.12-3.61)), gestational diabetes (1.71 (1.19-2.46)), and pre-eclampsia (1.34 (1.16-1.56)). Stronger associations were noted earlier in pregnancy for low Hb and adverse birth outcomes while the role of timing of high Hb was inconsistent. Lower Hb cutoffs were associated with greater odds of poor outcomes; for high Hb, data were too limited to identify patterns. Information on anemia etiology was limited; relationships did not vary by iron-deficiency anemia.

CONCLUSION

Both low and high maternal Hb concentrations during pregnancy are strong predictors of adverse maternal and infant health outcomes. Additional research is needed to establish healthy reference ranges and design effective interventions to optimize maternal Hb during pregnancy.

Prevalence of preterm birth and associated factors among mothers who gave birth in public hospitals of east Gojjam zone, Ethiopia

BACKGROUNDS

Preterm birth is defined as babies born alive before 37 weeks of pregnancy or fewer than 259 days since the first day of a woman's last menstrual period. Globally, 14.84 million babies were preterm births. Preterm infants are at risk for specific diseases related to the immaturity of various organ systems. This study aimed to assess the prevalence of preterm birth and associated factors among mothers who gave birth in public hospitals of east Gojjam zone, Ethiopia.

METHODS

An institutional-based cross-sectional study was conducted from April 1 up to June 30, 2021, in public hospitals in the east Gojjam zone. Systematic random sampling was used. Data were collected through structured questionnaires, patient interviews and patient card reviews. We used binary logistic regression analysis with 95% CI and P-value < 0.05 to identify the significant factors with preterm birth.

RESULTS

Out of 615 mothers, 13.2% gave a preterm birth. Antenatal care (AOR = 2.87; 95% CI = (1.67, 5.09)), educational status of mother (AOR = 2.79; 95% CI = (1.27, 6.67)), husband educational status(AOR = 2.11; 95% CI = (1.10, 4.18)), Average monthly family income(AOR = 1.95; 95% CI = (1.05, 3.75)),family size(AOR = 0.15; 95% CI = (0.03, 0.67)), multifetal gestation (AOR = 3.30; 95% CI = (1.29, 8.69), having Premature Rupture Of Membrane (AOR = 6.46; 95% CI= (2.52, 18.24)), history of chronic illness (AOR = 3.94; 95% CI = (1.67, 9.45)), being HIV positive(AOR = 6.99; 95% CI= (1.13, 44.65)), Ante-Partum Hemorrhage (AOR = 3.62; 95% CI= (1.12, 12.59)), pregnancy Induced Hypertension (AOR = 3.61; 95% CI= (1.19, 11.84)), mode of delivery (AOR = 7.16; 95% CI = (2.09, 29.29)), and onset of labor (AOR = 0.10; 95% CI = (0.03, 0.29)) were found to be significantly associated with preterm birth.

CONCLUSIONS

antenatal care, educational status of the mother, husband's educational status, family income, family size, multifetal gestation, Premature Rupture of the membrane, history of chronic illness, being HIV positive, Ante-Partum Hemorrhage, pregnancy Induced Hypertension, mode of delivery, and the onset of labor were found to be significantly associated with preterm birth. To minimize the proportion of preterm birth focusing on this important variables, timely identification of obstetric complications, strengthening early screening of HIV and high-risk pregnancies like multiple gestations, PIH and APH were important.

Effect of optimal antenatal care on maternal and perinatal health in Ethiopia

INTRODUCTION

Receiving at least four antenatal care (ANC) visits have paramount importance on the health of mothers and perinates. In Ethiopia, several studies were conducted on ANC service utilization; however, limited studies quantified the effect of care on maternal and perinate health. In response to this gap, this study is conducted to quantify the effect of optimal ANC care (≥4 visits) on maternal and perinatal health among women who received optimal care in comparison to women who did not receive optimal care.

METHODS

The study utilized the Ethiopian perinatal death surveillance and response (PDSR) system dataset. A total of 3,814 reviewed perinatal deaths were included in the study. Considering the nature of the data, preferential within propensity score matching (PWPSM) was performed to determine the effect of optimal ANC care on maternal and perinatal health. The effect of optimal care was reported using average treatment effects of the treated [ATT].

RESULT

The result revealed that optimal ANC care had a positive effect on reducing perinatal death, due to respiratory and cardiovascular disorders, [ATT = -0.015, 95%CI (-0.029 to -0.001)] and extending intrauterine life by one week [ATT = 1.277, 95%CI: (0.563-1.991)]. While it's effect on maternal health includes, avoiding the risk of having uterine rupture [ATT = -0.012, 95%CI: (-0.018 to -0.005)], improving the utilization of operative vaginal delivery (OVD) [ATT = 0.032, 95%CI: (0.001-0.062)] and avoiding delay to decide to seek care [ATT = -0.187, 95%CI: (-0.354 to -0.021)].

CONCLUSION

Obtaining optimal ANC care has a positive effect on both maternal and perinatal health. Therefore, policies and interventions geared towards improving the coverage and quality of ANC services should be the top priority to maximize the benefit of the care.

Maternal Risk Factors Associated with Preterm Births among Pregnant Women in Mogadishu, Somalia

Background: Premature birth impacts millions of newborns annually. Sixty percent of the world’s preterm births occur in Sub-Saharan Africa and South Asia. Somalia’s premature birth rates and maternal risk factors are poorly studied; hence, this study aims to identify maternal risk factors related to premature births in Mogadishu, Somalia. Methods: This unmatched case-control study was conducted at four maternity hospitals in Mogadishu, Somalia. The cases were newborns with gestational ages of less than 37 weeks; controls were newborns with gestational ages of 37 to 42 weeks. All were live singletons. Cross-tabulation and binary logistic regression were used to analyze the data; a p-value of 0.05 was deemed statistically significant. Result: Of the total of 499 newborns, 70 were cases, and 429 were controls. Adequate prenatal care, maternal urine analysis, tetanus toxoid (TT) vaccination, hemoglobin (Hb) measurement, ultrasound monitoring, intake of iron + folic acid (IFA) supplement, blood pressure (BP) measurement during the current pregnancy, as well as partograph usage during labor all significantly decreased risk of having premature births. A prior history of preterm delivery and preeclampsia, obstetric complications, and female genital mutilation (FGM) significantly increased the risk of preterm births. Conclusion: The utilization of antenatal care services, use of a partograph, obstetric complications, and prior history of premature birth and preeclampsia had a substantial effect on preterm birth rates. This study identifies female genital mutilation (FGM) as a previously unidentified risk factor for preterm birth that needs additional investigation.

Cause and risk factors of early neonatal death in Ethiopia

Background

Globally, three fourth of neonatal deaths occur during the early neonatal period, this makes it a critical time to reduce the burden of neonatal death. The survival status of a newborn is determined by the individual (neonatal and maternal), and facility-level factors. Several studies were conducted in Ethiopia to assess early neonatal death; however, most of the studies had limited participants and did not well address the two main determinant factors covered in this study. In response to this gap, this study attempted to examine factors related to early neonatal death based on perinatal death surveillance data in consideration of all the possible determinants of early neonatal death.

Methods

The national perinatal death surveillance data were used for this study. A total of 3814 reviewed perinatal deaths were included in the study. Bayesian multilevel parametric survival analysis was employed to identify factors affecting the survival of newborns during the early neonatal period. Adjusted time ratio (ATR) with 95% Bayesian credible intervals (CrI) was reported and log-likelihood was used for model comparison. Statistical significance was declared based on the non-inclusion of 1.0 in the 95% CrI.

Result

More than half (52.4%) of early neonatal deaths occurred within the first two days of birth. Per the final model, as gestational age increases by a week the risk of dying during the early neonatal period is reduced by 6% [ATR = 0.94,95%CrI:(0.93–0.96)]. There was an increased risk of death during the early neonatal period among neonates deceased due to birth injury as compared to neonates who died due to infection [ATR = 2.05,95%CrI:(1.30–3.32)]; however, perinates who died due to complication of an intrapartum event had a lower risk of death than perinates who died due to infection [ATR = 0.87,95%CrI:(0.83–0.90)]. As the score of delay one and delay three increases by one unit, the newborn’s likelihood of surviving during the early neonatal period is reduced by 4% [ATR = 1.04,95%CrI:(1.01–1.07)] and 21% [ATR = 1.21,95%CrI:(1.15–1.27)] respectively. Neonates born from mothers living in a rural area had a higher risk of dying during the early neonatal period than their counterparts living in an urban area [ATR = 3.53,95%CrI:(3.34–3.69)]. As compared to neonates treated in a primary health facility, being treated in secondary [ATR = 1.14,95%CrI:(1.02–1.27)] and tertiary level of care [ATR = 1.15,95%CrI:(1.04–1.25)] results in a higher risk of death during the early neonatal period.

Conclusion

The survival of a newborn during the early neonatal period is determined by both individual (gestational age, cause of death, and delay one) and facility (residence, type of health facility and delay three) level factors. Thus, to have a positive early neonatal outcome, a tailored intervention is needed for the three major causes of death (i.e Infection, birth injury, and complications of the intrapartum period). Furthermore, promoting maternal health, improving the health-seeking behaviour of mothers, strengthening facility readiness, and narrowing down inequalities in service provision are recommended to improve the newborn’s outcomes during the early neonatal period.

Adverse obstetric outcome and its associated factors in public hospitals of North Ethiopia: does parity make a difference?

BACKGROUND

Direct obstetric causes account for nearly 75% of all maternal deaths. Controversy prevails in the effect of grand multiparity on adverse obstetric outcomes. This study thus aimed to determine and compare the obstetric outcomes in low multiparous (LM) and grand multiparous (GM) women in Public Hospitals of North Ethiopia.

METHOD

An institution-based comparative cross-sectional study was done among 540 (180 GM and 360 LM) participants from January 1 to March 30, 2021. The data was collected through face-to-face interviews and a review of clinical records and birth registries. Epi-Data version 4.6 was used for data entry and analysis was performed using SPSS version 25.0 statistical software. A p-value of ≤ 0.05 (2-tailed) was used to consider the significance of statistical tests.

RESULT

The prevalence of adverse obstetric outcomes was 32.6% (95% CI: 28.7-36.5). Antepartum hemorrhage, anemia, and postpartum hemorrhage were higher in grand multiparous women. Whereas, prolonged labor, induction/augmentation, prelabor rupture of membrane, episiotomy, and post-term pregnancy was higher in low multiparous women. Income (AOR (CI) = 3.15 (1.30-7.63), alcohol consumption (AOR (CI) = 3.15 (1.49-6.64), preterm delivery (AOR (CI) = 9.24 (2.28-27.3), cesarean delivery (AOR (CI) = 13.6 (6.18-30.1), and low birth weight (AOR (CI) = 3.46 (1.33-9.03) significant predictors of adverse obstetric outcomes. However, parity did not show a statistically significant difference in obstetric outcomes.

CONCLUSION

In the study area, obstetric complications were high compared to a systematic review and meta-analysis study done in the country (26.88%). Socio-economic status, alcohol consumption, gestational age at delivery, mode of delivery, and birth weight were significant associates of the obstetric outcome. There was no statistically significant difference in obstetric outcomes between GM and LM women. Socio-economic development, avoiding alcohol consumption, early identification and treatment of complications, and adequate nutrition and weight gain during pregnancy are needed regardless of parity.

A Scoping Review of Preterm Births in Sub-Saharan Africa: Burden, Risk Factors and Outcomes

Preterm births (PTB) are the leading cause of neonatal deaths, the majority of which occur in low- and middle-income countries, particularly those in Sub-Saharan Africa (SSA). Understanding the epidemiology of prematurity is an essential step towards tackling the challenge of PTB in the sub-continent. We performed a scoping review of the burden, predictors and outcomes of PTB in SSA. We searched PubMed, Embase, and three other databases for articles published from the database inception to 10 July 2021. Studies reporting the prevalence of PTB, the associated risk factors, and/or its outcomes were eligible for inclusion in this review. Our literature search identified 4441 publications, but only 181 met the inclusion criteria. Last menstrual period (LMP) was the most commonly used method of estimating gestational age. The prevalence of PTB in SSA ranged from 3.4% to 49.4%. Several risk factors of PTB were identified in this review. The most frequently reported risk factors (i.e., reported in ≥10 studies) were previous history of PTB, underutilization of antenatal care (<4 visits), premature rupture of membrane, maternal age (≤20 or ≥35 years), inter-pregnancy interval, malaria, HIV and hypertension in pregnancy. Premature babies had high rates of hospital admissions, were at risk of poor growth and development, and were also at a high risk of morbidity and mortality. There is a high burden of PTB in SSA. The true burden of PTB is underestimated due to the widespread use of LMP, an unreliable and often inaccurate method for estimating gestational age. The associated risk factors for PTB are mostly modifiable and require an all-inclusive intervention to reduce the burden and improve outcomes in SSA.

Evaluation of the association between haemoglobin levels and preterm birth at Khartoum, Sudan: A hospital-based study

Objective

The objective of this study was to determine the association between haemoglobin level and PB.

Methods

A cross-sectional study was conducted in Khartoum, Sudan. Questionnaires on demographics and medical and obstetric factors were completed. A logistic regression analysis was performed.

Results

Of the 1,716 pregnant women, approximately two-thirds (65.7%) had anaemia (haemoglobin < 11 g/dl) and six (0.3%) had severe anaemia (haemoglobin < 8 g/dl). Of the 1,716 women, 283 (16.5%) had a PB. In multivariable logistic regression, parity (AOR = 1.15, 95% CI = 1.09–1.21, P < 0.001) was positively associated with PB. Compared to those with haemoglobin levels of 10–10.9 g/dl, pregnant women with haemoglobin levels of 8–8.9 (AOR = 0.41, 95% CI = 0.22–0.77), 9–9.9 (AOR = 0.59, 95% CI = 0.38–0.91), and 11–11.9 g/dl (AOR = 0.53, 95% CI = 0.36–0.77) were at a lower risk of PB. Women with haemoglobin levels of 12–13 g/dl were at a higher risk of PB (AOR = 1.62, 95% CI = 1.06–2.45). There was no significant association between women with haemoglobin levels < 8 g/dl and > 13 g/dl and PB.

Conclusion

This study showed different levels of association between haemoglobin levels and PB.

Prevalence of preterm birth and risk factors associated with it at different gestational ages: A multicenter retrospective survey in China

OBJECTIVES

To investigate the prevalence of preterm birth (PTB) and the risk factors for different gestational age subgroups of preterm birth in China.

METHODS

We carried out a descriptive cross-sectional study encompassing all singleton live births (24⁺⁰ to 41⁺⁶ weeks) with completed data in 23 provinces in China from 2010 to 2017 during investigation period. We compared both the preterm group (24⁺⁰ to 36⁺⁶ weeks) and preterm subgroups (<32 weeks, 32⁺⁰ to 33⁺⁶ weeks, and 34⁺⁰ t0 36⁺⁶ weeks) with the term group (37⁺⁰ to 41⁺⁶ weeks). We collected information on maternal and fetal characteristics from medical records. Logistic regression was use.

RESULTS

The prevalence of PTB was 7.4% (15,833/215,254) in singleton births. After adjusting for maternal age, parity, and potential risk factors in univariate analysis, the high-risk factors for PTB at <32 weeks were placental abruption (aOR=41.52; 95% CI, 25.89-66.58), placenta previa (aOR=40.04; 95% CI, 32.00-50.09), chorioamnionitis (aOR=11.06; 95% CI, 8.738-14.02), and hypertension disorders in pregnancy (HDP) (aOR=3.564; 95% CI, 2.930-4.335). Intrahepatic cholestasis of pregnancy (ICP) was significantly associated with PTB at 34-36 weeks (aOR=5.763; 95% CI, 5.049-6.577), particularly with spontaneous PTB (aOR=10.04; 95% CI, 8.79-11.47). Gestational diabetes mellitus (GDM) was significantly associated with PTB at 34-36 weeks only (aOR=1.156; 95% CI, 1.054-1.267).

CONCLUSION

Placental abruption, placenta previa, chorioamnionitis, and HDP were more predictive of early PTB; GDM and ICP were more predictive of late PTB.

Nutritional-Related Predictors of Preterm Birth in North Shewa Hospitals, Central Ethiopia: A Case-Control Study

Background

Preterm birth (PTB) is the leading cause of newborn death and the second cause of mortality among under-five children. Globally, about 15 million infants are born preterm every year. However, there is a lack of data on the nutritional-related predictors of preterm birth among Ethiopian women. The objective of the study was to identify nutritional-related predictors of preterm birth among women who gave birth at North Shewa public Hospitals in central Ethiopia.

Methods

A case–control study was undertaken in public hospitals in the North Shewa zone, central Ethiopia. Interviewer-administered questionnaire was used to gather data, which was then entered into EPI INFO version 7 and then exported to SPSS version 23 for analysis. Data were presented using texts, tables, and proportions. To find predictors of preterm birth, researcher used binary and multiple logistic regression models. The presence of a relationship between PTB and predictor factors was determined using the adjusted odds ratio (AOR), 95% confidence interval (CI), and p-value <0.05.

Results

A total of 161 cases and 322 controls participated in the study making a response rate of 97.6%. Unable to get iron folic acid (IFA) (AOR=2.26, 95% CI: 1.22, 4.18), not eating additional meals (AOR=2.63, 95% CI: 1.1, 4.62), restriction of foods (AOR=2.85, 95% CI: 1.58, 5.12), not taking dark green leafy vegetables (DGLV), (AOR=4.46, 95% CI: 1.72, 11.61), and mid upper arm circumference of mother (MUAC) <23 centimeters (AOR=3.7, 95% CI: 2.25, 6.11) had statistically significant association with premature birth.

Conclusion

IFA supplementation, additional meals, food taboo, frequency of DGLV, and MUAC were identified predictors of preterm birth. Encouraging such women to eat additional meals, varieties of diets like vegetables, and fruits during pregnancy, and adhering to culturally appropriate nutrition education to reverse food taboo is compulsory.