Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2014

Open Access 01-12-2014 | Research article

Effects of socioeconomic position and clinical risk factors on spontaneous and iatrogenic preterm birth

Authors: KS Joseph, John Fahey, Ketan Shankardass, Victoria M Allen, Patricia O’Campo, Linda Dodds, Robert M Liston, Alexander C Allen

Published in: BMC Pregnancy and Childbirth | Issue 1/2014

Login to get access

Abstract

Background

The literature shows a variable and inconsistent relationship between socioeconomic position and preterm birth. We examined risk factors for spontaneous and iatrogenic preterm birth, with a focus on socioeconomic position and clinical risk factors, in order to explain the observed inconsistency.

Methods

We carried out a retrospective population-based cohort study of all singleton deliveries in Nova Scotia from 1988 to 2003. Data were obtained from the Nova Scotia Atlee Perinatal Database and the federal income tax T1 Family Files. Separate logistic models were used to quantify the association between socioeconomic position, clinical risk factors and spontaneous preterm birth and iatrogenic preterm birth.

Results

The study population included 132,714 singleton deliveries and the rate of preterm birth was 5.5%. Preterm birth rates were significantly higher among the women in the lowest (versus the highest) family income group for spontaneous (rate ratio 1.14, 95% confidence interval (CI) 1.03, 1.25) but not iatrogenic preterm birth (rate ratio 0.95, 95% CI 0.75, 1.19). Adjustment for maternal characteristics attenuated the family income-spontaneous preterm birth relationship but strengthened the relationship with iatrogenic preterm birth. Clinical risk factors such as hypertension were differentially associated with spontaneous (rate ratio 3.92, 95% CI 3.47, 4.44) and iatrogenic preterm (rate ratio 14.1, 95% CI 11.4, 17.4) but factors such as diabetes mellitus were not (rate ratio 4.38, 95% CI 3.21, 5.99 for spontaneous and 4.02, 95% CI 2.07, 7.80 for iatrogenic preterm birth).

Conclusions

Socioeconomic position and clinical risk factors have different effects on spontaneous and iatrogenic preterm. Recent temporal increases in iatrogenic preterm birth appear to be responsible for the inconsistent relationship between socioeconomic position and preterm birth.
Appendix
Available only for authorised users
Literature
1.
2.
Ananth CV, Vintzileos AM: Epidemiology of preterm birth and its clinical subtypes. J Matern Fetal Neonatal Med. 2006, 19: 773-82. 10.1080/14767050600965882.CrossRefPubMed
3.
Goldenberg RL, Culhane JF, Iams JD, Romero R: Epidemiology and causes of preterm birth. Lancet. 2008, 371: 75-84. 10.1016/S0140-6736(08)60074-4.CrossRefPubMed
4.
Shapiro-Mendoza CK, Lackritz EM: Epidemiology of late and moderate preterm birth. Semin Fetal Neonatal Med. 2012, 17: 120-5. 10.1016/j.siny.2012.01.007.CrossRefPubMedPubMedCentral
5.
Blumenshine P, Egerter S, Barclay CJ, Cubbin C, Braveman PA: Socioeconomic disparities in adverse birth outcomes: a systematic review. Am J Prev Med. 2010, 39: 263-72. 10.1016/j.amepre.2010.05.012.CrossRefPubMed
6.
El-Sayed AM, Galea S: Temporal changes in socioeconomic influences on health: maternal education and preterm birth. Am J Public Health. 2012, 102: 1715-21. 10.2105/AJPH.2011.300564.CrossRefPubMedPubMedCentral
7.
Craig ED, Thompson JM, Mitchell EA: Socioeconomic status and preterm birth: New Zealand trends, 1980 to 1999. Arch Dis Child Fetal Neonatal Ed. 2002, 86: F142-6. 10.1136/fn.86.3.F142.CrossRefPubMedPubMedCentral
8.
Mortensen LH, Lauridsen JT, Diderichsen F, Kaplan GA, Gissler M, Andersen AM: Income-related and educational inequality in small-for-gestational age and preterm birth in Denmark and Finland 1987–2003. Scand J Public Health. 2010, 38: 40-5. 10.1177/1403494809353820.CrossRefPubMed
9.
Fair M, Cyr M, Allen AC, Wen SW, Guyon G, MacDonald RC: An assessment of the validity of a computer system for probabilistic record linkage of birth and infant death records in Canada. Chronic Dis Can. 2000, 21: 8-13.PubMed
10.
Joseph KS, Fahey J: Validation of perinatal data in the Canadian Institute for Health Information’s Discharge Abstract Database. Chron Dis Canada. 2009, 29: 96-100.
11.
Kramer MS, Platt RW, Yang H, Haglund B, Cnattingius S, Bergsjo P: Registration artifacts in international comparisons of infant mortality. Paediatr Perinat Epidemiol. 2002, 16: 16-22.CrossRefPubMed
12.
Joseph KS, Liu S, Rouleau J, Lisonkova S, Hutcheon JA, Sauve R, Allen AC, Kramer MS, Fetal and Infant Health Study Group of the Canadian Perinatal Surveillance System: Influence of definition based versus pragmatic birth registration on international comparisons of perinatal and infant mortality: population based retrospective study. BMJ. 2012, 344: e746-10.1136/bmj.e746.CrossRefPubMedPubMedCentral
13.
Joseph KS, Fahey J, Dendukuri N, Allen VM, O’Campo P, Dodds L, Liston RM, Allen AC: Recent changes in maternal characteristics by socioeconomic status. J Obstet Gynaecol Can. 2009, 31: 422-33.CrossRefPubMed
14.
15.
16.
Smith GD, Shipley MJ, Rose G: Magnitude and causes of socioeconomic differentials in mortality: further evidence from the Whitehall Study. J Epidemiol Community Health. 1990, 44: 265-70. 10.1136/jech.44.4.265.CrossRefPubMedPubMedCentral
17.
Breslow NE, Day NE: Statistical methods in cancer research: Vol. I - The analysis of case–control studies. 1980, Lyon: IARC, Scientific Publ. No 32
18.
Kramer MS, Séguin L, Lydon J, Goulet L: Socio-economic disparities in pregnancy outcome: why do the poor fare so poorly?. Paediatr Perinat Epidemiol. 2000, 143: 194-210.CrossRef
19.
Ananth CV, Savitz DA, Luther ER, Bowes WA: Preeclampsia and preterm birth subtypes in Nova Scotia, 1986 to 1992. Am J Perinatol. 1997, 14: 17-23. 10.1055/s-2007-994090.CrossRefPubMed
20.
Meis PJ, Michielutte R, Peters TJ, Wells HB, Sands RE, Coles EC, Johns KA: Factors associated with preterm birth in Cardiff, Wales. II. Indicated and spontaneous preterm birth. Am J Obstet Gynecol. 1995, 173: 597-602. 10.1016/0002-9378(95)90288-0.CrossRefPubMed
21.
Meis PJ, Goldenberg RL, Mercer BM, Iams JD, Moawad AH, Miodovnik M, Menard MK, Caritis SN, Thurnau GR, Bottoms SF, Das A, Roberts JM, McNellis D: The Preterm Prediction Study: Risk factors for indicated preterm births. Maternal-Fetal Medicine Units Network of the National Institute of Child Health and Human Development. Am J Obstet Gynecol. 1998, 178: 562-567. 10.1016/S0002-9378(98)70439-9.CrossRefPubMed
22.
Gardner MO, Goldenberg RL, Cliver SP, Tucker JM, Nelson KG, Copper RL: The origin and outcome of preterm twin pregnancies. Obstet Gynecol. 1995, 85: 553-557. 10.1016/0029-7844(94)00455-M.CrossRefPubMed
23.
Ananth CV, Vintzileos AM: Maternal-fetal conditions necessitating a medical intervention resulting in preterm birth. Am J Obstet Gynecol. 2006, 195: 1557-1563. 10.1016/j.ajog.2006.05.021.CrossRefPubMed
24.
Morken NH, Källen K, Hagberg H, Jacobsson B: Preterm birth in Sweden 1973-2001: rate, subgroups, and effect of changing patterns in multiple births, maternal age, and smoking. Acta Obstet Gynecol Scand. 2005, 84: 558-65. 10.1080/j.0001-6349.2005.00765.x.CrossRefPubMed
25.
Joseph KS, Dodds L, Allen AC, Jones DV, Monterrosa L, Robinson H, Liston RM, Young DM: Socioeconomic status and the receipt of obstetric services in Canada. Obstet Gynecol. 2006, 107: 641-50. 10.1097/01.AOG.0000201977.45284.3c.CrossRefPubMed
26.
Joseph KS, Liston RM, Dodds L, Dahlgren L, Allen AC: Socioeconomic status and perinatal outcomes in a setting with universal access to essential health care services. CMAJ. 2007, 177: 583-90. 10.1503/cmaj.061198.CrossRefPubMedPubMedCentral
27.
Canada H: Canadian Perinatal Health Report, 2000. 2000, Ottawa: Minister of Public Works and Government Services Canada
28.
Armson BA, Dodds L, Cervin C, Christie-Haliburton S, Rinaldo K: A preterm birth prevention project in Nova Scotia, Canada. Matern Child Health J. 2001, 5: 189-97. 10.1023/A:1011300102132.CrossRefPubMed
29.
Joseph KS, Allen AC, Dodds L, Vincer MJ, Armson BA: Causes and consequences of recent increases in preterm birth among twins. Obstet Gynecol. 2001, 98: 57-64. 10.1016/S0029-7844(01)01394-1.PubMed
30.
Moutquin JM: Classification and heterogeneity of preterm birth. BJOG. 2003, 110 (S20): 30-3. 10.1046/j.1471-0528.2003.00021.x.CrossRefPubMed
31.
McElrath TF, Hecht JL, Dammann O, Boggess K, Onderdonk A, Markenson G, Harper M, Delpapa E, Allred EN, Leviton A, ELGAN Study Investigators: Pregnancy disorders that lead to delivery before the 28th week of gestation: an epidemiologic approach to classification. Am J Epidemiol. 2008, 168: 980-9.CrossRefPubMedPubMedCentral
32.
Savitz DA: Invited commentary: disaggregating preterm birth to determine etiology. Am J Epidemiol. 2008, 168: 990-2. discussion 993–4CrossRefPubMed
Metadata
Title
Effects of socioeconomic position and clinical risk factors on spontaneous and iatrogenic preterm birth
Authors
KS Joseph
John Fahey
Ketan Shankardass
Victoria M Allen
Patricia O’Campo
Linda Dodds
Robert M Liston
Alexander C Allen
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2014
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/1471-2393-14-117

Other articles of this Issue 1/2014

BMC Pregnancy and Childbirth 1/2014 Go to the issue

Study protocol

Implementation and evaluation of the Helping Babies Breathe curriculum in three resource limited settings: does Helping Babies Breathe save lives? A study protocol

Research article

Comparing satisfaction and burnout between caseload and standard care midwives: findings from two cross-sectional surveys conducted in Victoria, Australia

Research article

Factors associated with severe maternal morbidity and near miss in the São FranciscoValley, Brazil: a retrospective, cohort study

Research article

Impact of singlehood during pregnancy on dietary intake and birth outcomes- a study in the Norwegian Mother and Child Cohort Study

Research article

Maternal mortality at muhimbili national hospital in Dar-es-Salaam, Tanzania in the year 2011

Research article

Improving interprofessional coordination in Dutch midwifery and obstetrics: a qualitative study