Temporal trends, patterns, and predictors of preterm birth in California from 2007 to 2016, based on the obstetric estimate of gestational age

Anura W G Ratnasiri, Steven S Parry, Vivi N Arief, Ian H DeLacy, Satyan Lakshminrusimha, Laura A Halliday, Ralph J DiLibero, Kaye E Basford, Anura W G Ratnasiri, Steven S Parry, Vivi N Arief, Ian H DeLacy, Satyan Lakshminrusimha, Laura A Halliday, Ralph J DiLibero, Kaye E Basford

Abstract

Background: Preterm birth (PTB) is associated with increased infant mortality, and neurodevelopmental abnormalities among survivors. The aim of this study is to investigate temporal trends, patterns, and predictors of PTB in California from 2007 to 2016, based on the obstetric estimate of gestational age (OA).

Methods: A retrospective cohort study evaluated 435,280 PTBs from the 5,137,376 resident live births (8.5%) documented in the California Birth Statistical Master Files (BSMF) from 2007 to 2016. The outcome variable was PTB; the explanatory variables were birth year, maternal characteristics and health behaviors. Descriptive statistics and logistic regression analysis were used to identify subgroups with significant risk factors associated with PTB. Small for gestational age (SGA), appropriate for gestational age (AGA) and large for gestational age (LGA) infants were identified employing gestational age based on obstetric estimates and further classified by term and preterm births, resulting in six categories of intrauterine growth.

Results: The prevalence of PTB in California decreased from 9.0% in 2007 to 8.2% in 2014, but increased during the last 2 years, 8.4% in 2015 and 8.5% in 2016. Maternal age, education level, race and ethnicity, smoking during pregnancy, and parity were significant risk factors associated with PTB. The adjusted odds ratio (AOR) showed that women in the oldest age group (40-54 years) were almost twice as likely to experience PTB as women in the 20- to 24-year reference age group. The prevalence of PTB was 64% higher in African American women than in Caucasian women. Hispanic women showed less disparity in the prevalence of PTB based on education and socioeconomic level. The analysis of interactions between maternal characteristics and perinatal health behaviors showed that Asian women have the highest prevalence of PTB in the youngest age group (< 20 years; AOR, 1.40; 95% confidence interval (CI), 1.28-1.54). Pacific Islander, American Indian, and African American women ≥40 years of age had a greater than two-fold increase in the prevalence of PTB compared with women in the 20-24 year age group. Compared to women in the Northern and Sierra regions, women in the San Joaquin Valley were 18%, and women in the Inland Empire and San Diego regions 13% more likely to have a PTB. Women who smoked during both the first and second trimesters were 57% more likely to have a PTB than women who did not smoke. Compared to women of normal prepregnancy weight, underweight women and women in obese class III were 23 and 33% more likely to experience PTB respectively.

Conclusions: Implementation of public health initiatives focusing on reducing the prevalence of PTB should focus on women of advanced maternal age and address race, ethnic, and geographic disparities. The significance of modifiable maternal perinatal health behaviors that contribute to PTB, e.g. smoking during pregnancy and prepregnancy obesity, need to be emphasized during prenatal care.

Keywords: Appropriate for gestational age; Gestational age; Large for gestational age; Low birth weight; Maternal age; Maternal smoking; Prepregnancy obesity; Preterm birth; Small for gestational age; WIC.

Conflict of interest statement

The study was approved by the California Committee for the Protection of Human Subjects (Protocol ID: 16-10-2759) and the California Department of Public Health Vital Statistics Advisory Committee (ID: 16-10-2759). Patient consent was waived by the California Committee for the Protection of Human Subjects (Protocol ID: 16-10-2759).Permission for publication was included when requesting approval from both California Committee for the Protection of Human Subjects (Protocol ID: 16–10-2759) and the California Department of Public Health Vital Statistics Advisory Committee. We are to provide published materials to both institutions.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Unadjusted prevalence of and adjusted odds ratio for preterm singleton birth for each maternal age group in California for the period 2007–2016
Fig. 2
Fig. 2
Unadjusted prevalence of preterm birth for maternal age group by maternal race and ethnicity in California for the period 2007–2016
Fig. 3
Fig. 3
Unadjusted prevalence of preterm birth for maternal education level by maternal race and ethnicity in California for the period 2007–2016
Fig. 4
Fig. 4
Adjusted odds ratio (with 95% confidence interval in parenthesis) for the prevalence of preterm birth by each demographic region identified on a map of California for the period 2007–2016. Northern and Sierra region is the reference group

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