Abstract
Complications from preterm birth are a leading cause of infant mortality, with long-term implications for morbidity and quality of life of preterm infants. There are many important risk factors for preterm births however in this article, we focus on the maternal infection etiological pathway, given its significance in low-to-middle income countries. In high preterm birth settings such as sub-Saharan Africa, maternal HIV infection and antiretroviral therapy (ART) use have been associated with an increased risk of preterm births. Consequently, we highlight methodological considerations related to selection and measurement bias in preterm birth research. We further illustrate the potential impact of these biases in studies investigating the relationship between HIV/ART and preterm births. We also briefly discuss issues related to population-level estimations based on routinely collected clinical or civil registration data. We conclude by emphasizing the importance of strengthening of antenatal care services to improve quality of population data as well as optimizing current and future study designs, by taking into account the important methodological considerations described in this article.
Highlights
Preterm birth (PTB) is defined by the duration of gestation at the time of delivery with a cut-off of 37 weeks distinguishing preterm from term infants
We briefly reflected on some important methodological considerations that should be regarded when designing studies or information systems for the monitoring or study of PTB, and the interpretation of findings
We advocate for the strengthening of antenatal care services to improve pregnancy outcomes and the quality of population data, gestational age
Summary
Preterm birth (PTB) is defined by the duration of gestation at the time of delivery with a cut-off of 37 weeks distinguishing preterm from term infants. Information Bias: HIV/ART and Preterm Birth Examples Two studies investigating this association have shown the impact of gestational age measurement error. The discrepancy observed in findings between the GA assessment methods was considered to be due to random measurement error This analysis highlights that the association between maternal ART use and preterm birth may be substantially influenced by GA assessment methods. This comparative analysis highlights the need to improve understanding of maternal and fetal factors leading to biased GA estimates These examples of studies with unexpected or counterintuitive results highlight the importance of considering and addressing selection and measurement bias when designing and analyzing studies investigating the association between PTB and infections and/or their treatments
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