Abstract
BackgroundAssessment of risk factors for preterm birth in a population with high incidence of preterm birth and HIV infection.MethodsSecondary analysis of data for 2,149 women included in a community based randomized placebo controlled trial for the prevention of preterm birth (APPLe trial (ISRCTN84023116) with gestational age at birth determined through ultrasound measurement in early pregnancy. Multivariate Logistic Regression analyses to obtain models for three outcome variables: all preterm, early preterm, and late preterm birth.FindingsNo statistical differences were noted for the prevalence of HIV infection (p = 0.30) or syphilis (p = 0.12) between women who delivered preterm versus term. BMI (Adjusted OR 0.91 (0.85–0.97); p = 0.005) and weight gain (Adjusted OR 0.89 (0.82–0.97); p = 0.006) had an independent, protective effect. Previous preterm birth doubled the odds of preterm birth (Adjusted OR 2.13 (1.198–3.80); p = 0.01). Persistent malaria (despite malaria prophylaxis) increased the risk of late preterm birth (Adjusted OR 1.99 (1.05–3.79); p = 0.04). Age <20 (Adjusted OR 1.73 (1.03–2.90); p = 0.04) and anemia (Adjusted OR 1.95 (1.08–3.52); p = 0.03) were associated with early preterm birth (<34 weeks).ConclusionsDespite claims that HIV infection is an important cause of preterm birth in Africa, we found no evidence of an association in this population (unexposed to anti-retroviral treatment). Persistent malaria was associated with late preterm birth. Maternal undernourishment and anemia were independently associated with early preterm birth. The study did not assess whether the link was direct or whether a common precursor such as chronic infection was responsible for both maternal effects and early labour.
Highlights
Mortality in the first four weeks of life accounts for 24–56% of all deaths among children under five and 75% of these occur in the first week of life
Despite claims that HIV infection is an important cause of preterm birth in Africa, we found no evidence of an association in this population
Persistent malaria was associated with late preterm birth
Summary
Mortality in the first four weeks of life accounts for 24–56% of all deaths among children under five and 75% of these occur in the first week of life. Of the estimated 4 million neonatal deaths each year, 99% occur in low income countries [1], and approximately 35% are attributed to preterm birth [2], making prematurity the leading direct cause of neonatal mortality. Around 10–11% of all births, or an estimated 15 million births per year, are estimated to be preterm [4],[5]. There are few reliable estimates from developing countries because of uncertainty around assessment of gestational age and consequent reliance on low birth weight as a proxy measure. Assessment of risk factors for preterm birth in a population with high incidence of preterm birth and HIV infection
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