Volume 21, Issue 3 (10-2024)
J Res Dev Nurs Midw 2024, 21(3): 26-29 |
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Rohaninasab M, Hesari M, Mollazadeh Narestan Z, Gazerani A. Prevalence and risk factors associated with preterm births in Neyshabur hospitals, Eastern Iran. J Res Dev Nurs Midw 2024; 21 (3) :26-29
URL: http://nmj.goums.ac.ir/article-1-1403-en.html
URL: http://nmj.goums.ac.ir/article-1-1403-en.html
1- Department of Operating Room, Neyshabur University of Medical Sciences, Neyshabur, Iran
2- Students Research Committee, Neyshabur University of Medical Sciences, Neyshabur, Iran
3- Department of Midwifery, Faculty of Nursing and Midwifery, Neyshabur University of Medical Sciences, Neyshabur, Iran
4- . Noncommunicable Diseases Research Center, Neyshabur University of Medical Sciences, Neyshabur, Iran ; Department of Operating Room and Nursing, Neyshabur University of Medical Sciences, Neyshabur, Iran ,akramgazrany@gmail.com
2- Students Research Committee, Neyshabur University of Medical Sciences, Neyshabur, Iran
3- Department of Midwifery, Faculty of Nursing and Midwifery, Neyshabur University of Medical Sciences, Neyshabur, Iran
4- . Noncommunicable Diseases Research Center, Neyshabur University of Medical Sciences, Neyshabur, Iran ; Department of Operating Room and Nursing, Neyshabur University of Medical Sciences, Neyshabur, Iran ,
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Introduction
Despite advancements in medical science, preterm birth remains a significant concern in many societies. By definition, a preterm newborn is an infant born before 37 full weeks of gestation. This premature birth can lead to serious health problems for infants, including death, cerebral palsy, and other disabilities (1). The prevalence of preterm birth varies worldwide, with higher rates reported in some regions, particularly in developing countries. Studies have also shown a considerable prevalence of preterm birth in Iran (2,3). Various factors, such as maternal diseases and disorders (e.g., diabetes, hypertension, infections), maternal lifestyle factors (e.g., smoking, alcohol consumption, malnutrition), and fetal problems (e.g., twins or multiples), can contribute to preterm birth (4). Therefore, understanding the reasons for preterm births and the factors influencing them and providing proper education to families are crucial steps in reducing their prevalence (3,5). Since no study has been conducted in Neyshabur to identify the factors affecting preterm births and develop strategies to mitigate their occurrence, this study was undertaken to determine the prevalence and factors associated with preterm births in Neyshabur.
Methods
This descriptive, cross-sectional, retrospective study investigated the prevalence and factors associated with preterm births at Hakim and Qamar Bani Hashem hospitals in Neyshabur city. The study population included all preterm infants born at a gestational age of less than 37 weeks between April 2017 and March 2019. Information was collected through a census of medical records, and in cases where records were incomplete, mothers were contacted to provide the missing information.
The exclusion criteria included mothers of preterm infants who did not consent to participate in the study, did not answer phone calls, or had incomplete medical records. The research tool consisted of a checklist developed by the researcher based on the literature on pregnancy and childbirth, including works by Williams and Nelson. This checklist was reviewed and approved by professors and specialists in the field.
Data collection was conducted via phone, and informed consent was obtained from the participants. Complete explanations of the research purpose and the confidentiality of the information were also provided. Data analysis was performed using SPSS version 22 software.
Among the 20,850 live newborns recorded between 2017 and 2019 in the hospitals of Neyshabur, 596 preterm infants were born, of which 273 were included in the study.
Results
Among the preterm newborns, the majority were boys (58.2%) and were delivered via cesarean section (61.9%). Most mothers reported no pregnancy complications (96%) and had no history of abortion (71.8%). Additionally, many were experiencing their first or second pregnancy (69.2%) and had no history of drug use (64.5%) (Table 1). The average age of the mothers was 31.54 ± 4.27 years, and the average gestational age was 32.57 ± 3.12 weeks.
According to the results of the present study, the prevalence of preterm newborns in Neyshabur over a three-year period (2018–2020) was 2.85%. The yearly prevalence of preterm newborns is shown in Figure 1.
Table 2 shows the maternal and fetal complications among preterm infants born in neonatal educational hospitals. According to this table, factors such as maternal uterine complications, placental complications, and fetal complications are listed separately by type. The most common fetal issue was breech presentation (10.98%), and the most prevalent systemic disease among mothers was anemia (9.52%).
The samples were divided into three groups based on the length of pregnancy: very early, early, and late. These groups were compared with other variables using the chi-square and Fisher's exact tests. A significant difference was observed between the duration of pregnancy and the type of delivery (Vaginal or cesarean section). In the very early preterm group, vaginal delivery was more common than cesarean section. However, in the early preterm and late preterm groups, cesarean sections outnumbered vaginal deliveries (P=0.003) (Table 3).
Discussion
The findings of this study indicate that the prevalence of preterm newborns in Neyshabur is 2.85%. Factors such as maternal age, number of children, multiple pregnancies, and pregnancy complications significantly influence this outcome.
A study conducted in Nepal in 2020 reported a prevalence of preterm newborns of 3.4% over 14 months (6). In the present study, the prevalence rate was 2.85%, consistent with the Nepal study's findings. In Iran, Nepal, and Qatar, the rate of preterm newborns ranges from 8% to 26%. This rate is even higher in Italy, where it is approximately 26%. These rate differences may be attributed to variations in study populations, geographical regions, and time periods (7)
Research conducted in Iran has shown that the prevalence of preterm infants in different cities ranges from approximately 5.1% to 7.2% (8,9). These discrepancies may arise from differences in diagnostic criteria, population characteristics, cultural factors, health conditions, and total pregnancies and live births.
The results of the present study indicate that various complications may contribute to preterm birth. Among these, maternal complications such as a bicornuate uterus and cervical insufficiency had the highest prevalence rates. Women with a bicornuate uterus are more susceptible to preterm delivery, which is attributed to cervical weakness (10).
Regarding placental factors, placenta accreta, and umbilical cord prolapse were the most prevalent complications observed. Umbilical cord prolapse occurs when the cord slips out of the cervix before the fetal head. This condition is more common in preterm deliveries because of the smaller fetal head and increased space in the mother's pelvis. The cervix tends to open earlier in preterm labor (11). Regarding fetal complications, breech presentation was one of the most frequently observed complications co-occurring with preterm birth, which aligns with the findings of Shojaei et al. (2016) (12). The incidence of breech presentation at delivery decreases with increasing gestational age. At 28 weeks of gestation, one in five fetuses is in a breech position, whereas in term pregnancies, fewer than 4% of all singleton fetuses are in a breech position at the time of delivery. This is attributed to a lack of fetal movement or incomplete rotation of the fetus. Preterm labor is often associated with breech presentation at delivery, as the fetus has not yet had the opportunity to rotate. This fact makes preterm labor one of the strongest risk factors for breech presentation (13).
The results of the study also indicated that anemia during pregnancy increases the risk of preterm labor, a finding supported by the study of Kildal (2020) (14). The findings revealed that the duration of pregnancy was not significantly correlated with variables such as infant sex, fertility complications, history of abortion, or medication use during pregnancy. However, a significant difference was observed between the duration of pregnancy and the type of delivery (Vaginal or cesarean section).
The method of delivery for very-low-birth-weight preterm infants is still a topic of debate. There is no definitive evidence supporting the benefits of cesarean section. One study indicated that cesarean section delivery reduces the overall incidence of intraventricular hemorrhage (IVH), but it does not decrease the incidence of severe IVH. Additionally, a previous cesarean section increases the risk of preterm labor in subsequent pregnancies (15). Concerning sex, the current study revealed that women with male fetuses are more likely to experience preterm labor, which is consistent with the findings of Peelon (2021) (16). Limitations of the study include the failure to analyze some important risk factors, conducting the study in one city and two hospitals, and the lack of participation from all mothers in the interviews. A strength of the study is the collection of relevant data over three years. It is recommended that further research be conducted using relevant prospective studies with larger populations. Such research could aid in identifying risk factors and predictors of preterm labor in high-risk groups, leading to the development of effective interventions to improve pregnancy outcomes.
Conclusion
In a three-year study conducted at the educational hospitals of Neyshabur University of Medical Sciences, 2.85% of infants were born preterm. Placenta accreta and umbilical cord prolapse were the most significant placental complications observed. Additionally, breech presentation was frequently observed alongside preterm birth. The most common comorbidities observed were anemia, hyperthyroidism, and hypothyroidism. Pregnant mothers should undergo periodic evaluations for associated complications and underlying diseases before and during pregnancy to ensure prompt identification and management if any issues arise.
Acknowledgement
We would like to express our gratitude to the Research vice Presidency and the Student Research Committee of Neyshabur University of Medical Sciences, as well as to the administration and management of Hakim and Qamar Bani Hashem hospitals in Neyshabur. We also extend our heartfelt thanks to all mothers who assisted us in this research.
Funding sources
The funding for this study was provided by the Research Vice Presidency of Neyshabur University of Medical Sciences.
Ethical statement
A formal approval letter for conducting this study was obtained from the Ethics Committee of Neyshabur University of Medical Sciences, with the code IR.NUMS.REC.1399.042.
Conflicts of interest
This research does not present any conflicts of interest.
Author contributions
M.R., M.H., and A.G.: Data collection; M.R., A.G., and Z.M.N.: Analysis and interpretation of results; and M.R., M.H., A.G., and Z.M.N.: Draft manuscript preparation. All authors reviewed the results and approved the final version of the manuscript.
Despite advancements in medical science, preterm birth remains a significant concern in many societies. By definition, a preterm newborn is an infant born before 37 full weeks of gestation. This premature birth can lead to serious health problems for infants, including death, cerebral palsy, and other disabilities (1). The prevalence of preterm birth varies worldwide, with higher rates reported in some regions, particularly in developing countries. Studies have also shown a considerable prevalence of preterm birth in Iran (2,3). Various factors, such as maternal diseases and disorders (e.g., diabetes, hypertension, infections), maternal lifestyle factors (e.g., smoking, alcohol consumption, malnutrition), and fetal problems (e.g., twins or multiples), can contribute to preterm birth (4). Therefore, understanding the reasons for preterm births and the factors influencing them and providing proper education to families are crucial steps in reducing their prevalence (3,5). Since no study has been conducted in Neyshabur to identify the factors affecting preterm births and develop strategies to mitigate their occurrence, this study was undertaken to determine the prevalence and factors associated with preterm births in Neyshabur.
Methods
This descriptive, cross-sectional, retrospective study investigated the prevalence and factors associated with preterm births at Hakim and Qamar Bani Hashem hospitals in Neyshabur city. The study population included all preterm infants born at a gestational age of less than 37 weeks between April 2017 and March 2019. Information was collected through a census of medical records, and in cases where records were incomplete, mothers were contacted to provide the missing information.
The exclusion criteria included mothers of preterm infants who did not consent to participate in the study, did not answer phone calls, or had incomplete medical records. The research tool consisted of a checklist developed by the researcher based on the literature on pregnancy and childbirth, including works by Williams and Nelson. This checklist was reviewed and approved by professors and specialists in the field.
Data collection was conducted via phone, and informed consent was obtained from the participants. Complete explanations of the research purpose and the confidentiality of the information were also provided. Data analysis was performed using SPSS version 22 software.
Among the 20,850 live newborns recorded between 2017 and 2019 in the hospitals of Neyshabur, 596 preterm infants were born, of which 273 were included in the study.
Results
Among the preterm newborns, the majority were boys (58.2%) and were delivered via cesarean section (61.9%). Most mothers reported no pregnancy complications (96%) and had no history of abortion (71.8%). Additionally, many were experiencing their first or second pregnancy (69.2%) and had no history of drug use (64.5%) (Table 1). The average age of the mothers was 31.54 ± 4.27 years, and the average gestational age was 32.57 ± 3.12 weeks.
According to the results of the present study, the prevalence of preterm newborns in Neyshabur over a three-year period (2018–2020) was 2.85%. The yearly prevalence of preterm newborns is shown in Figure 1.
Table 2 shows the maternal and fetal complications among preterm infants born in neonatal educational hospitals. According to this table, factors such as maternal uterine complications, placental complications, and fetal complications are listed separately by type. The most common fetal issue was breech presentation (10.98%), and the most prevalent systemic disease among mothers was anemia (9.52%).
The samples were divided into three groups based on the length of pregnancy: very early, early, and late. These groups were compared with other variables using the chi-square and Fisher's exact tests. A significant difference was observed between the duration of pregnancy and the type of delivery (Vaginal or cesarean section). In the very early preterm group, vaginal delivery was more common than cesarean section. However, in the early preterm and late preterm groups, cesarean sections outnumbered vaginal deliveries (P=0.003) (Table 3).
Table 1. Frequency distribution of preterm infants’ demographic information.PNG) Figure 1. Frequency and prevalence of preterm newborns from 2017-2019 .PNG) Table 2. Associated complications and disorders among preterm newborns (n=273) .PNG) Table 3. Relationships between pregnancy length and demographic factors*Chi-square test .PNG) |
Discussion
The findings of this study indicate that the prevalence of preterm newborns in Neyshabur is 2.85%. Factors such as maternal age, number of children, multiple pregnancies, and pregnancy complications significantly influence this outcome.
A study conducted in Nepal in 2020 reported a prevalence of preterm newborns of 3.4% over 14 months (6). In the present study, the prevalence rate was 2.85%, consistent with the Nepal study's findings. In Iran, Nepal, and Qatar, the rate of preterm newborns ranges from 8% to 26%. This rate is even higher in Italy, where it is approximately 26%. These rate differences may be attributed to variations in study populations, geographical regions, and time periods (7)
Research conducted in Iran has shown that the prevalence of preterm infants in different cities ranges from approximately 5.1% to 7.2% (8,9). These discrepancies may arise from differences in diagnostic criteria, population characteristics, cultural factors, health conditions, and total pregnancies and live births.
The results of the present study indicate that various complications may contribute to preterm birth. Among these, maternal complications such as a bicornuate uterus and cervical insufficiency had the highest prevalence rates. Women with a bicornuate uterus are more susceptible to preterm delivery, which is attributed to cervical weakness (10).
Regarding placental factors, placenta accreta, and umbilical cord prolapse were the most prevalent complications observed. Umbilical cord prolapse occurs when the cord slips out of the cervix before the fetal head. This condition is more common in preterm deliveries because of the smaller fetal head and increased space in the mother's pelvis. The cervix tends to open earlier in preterm labor (11). Regarding fetal complications, breech presentation was one of the most frequently observed complications co-occurring with preterm birth, which aligns with the findings of Shojaei et al. (2016) (12). The incidence of breech presentation at delivery decreases with increasing gestational age. At 28 weeks of gestation, one in five fetuses is in a breech position, whereas in term pregnancies, fewer than 4% of all singleton fetuses are in a breech position at the time of delivery. This is attributed to a lack of fetal movement or incomplete rotation of the fetus. Preterm labor is often associated with breech presentation at delivery, as the fetus has not yet had the opportunity to rotate. This fact makes preterm labor one of the strongest risk factors for breech presentation (13).
The results of the study also indicated that anemia during pregnancy increases the risk of preterm labor, a finding supported by the study of Kildal (2020) (14). The findings revealed that the duration of pregnancy was not significantly correlated with variables such as infant sex, fertility complications, history of abortion, or medication use during pregnancy. However, a significant difference was observed between the duration of pregnancy and the type of delivery (Vaginal or cesarean section).
The method of delivery for very-low-birth-weight preterm infants is still a topic of debate. There is no definitive evidence supporting the benefits of cesarean section. One study indicated that cesarean section delivery reduces the overall incidence of intraventricular hemorrhage (IVH), but it does not decrease the incidence of severe IVH. Additionally, a previous cesarean section increases the risk of preterm labor in subsequent pregnancies (15). Concerning sex, the current study revealed that women with male fetuses are more likely to experience preterm labor, which is consistent with the findings of Peelon (2021) (16). Limitations of the study include the failure to analyze some important risk factors, conducting the study in one city and two hospitals, and the lack of participation from all mothers in the interviews. A strength of the study is the collection of relevant data over three years. It is recommended that further research be conducted using relevant prospective studies with larger populations. Such research could aid in identifying risk factors and predictors of preterm labor in high-risk groups, leading to the development of effective interventions to improve pregnancy outcomes.
Conclusion
In a three-year study conducted at the educational hospitals of Neyshabur University of Medical Sciences, 2.85% of infants were born preterm. Placenta accreta and umbilical cord prolapse were the most significant placental complications observed. Additionally, breech presentation was frequently observed alongside preterm birth. The most common comorbidities observed were anemia, hyperthyroidism, and hypothyroidism. Pregnant mothers should undergo periodic evaluations for associated complications and underlying diseases before and during pregnancy to ensure prompt identification and management if any issues arise.
Acknowledgement
We would like to express our gratitude to the Research vice Presidency and the Student Research Committee of Neyshabur University of Medical Sciences, as well as to the administration and management of Hakim and Qamar Bani Hashem hospitals in Neyshabur. We also extend our heartfelt thanks to all mothers who assisted us in this research.
Funding sources
The funding for this study was provided by the Research Vice Presidency of Neyshabur University of Medical Sciences.
Ethical statement
A formal approval letter for conducting this study was obtained from the Ethics Committee of Neyshabur University of Medical Sciences, with the code IR.NUMS.REC.1399.042.
Conflicts of interest
This research does not present any conflicts of interest.
Author contributions
M.R., M.H., and A.G.: Data collection; M.R., A.G., and Z.M.N.: Analysis and interpretation of results; and M.R., M.H., A.G., and Z.M.N.: Draft manuscript preparation. All authors reviewed the results and approved the final version of the manuscript.
Type of study: Short Communication |
Subject:
Midwifery
References
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