Abstract
Objectives Preterm birth is the leading pregnancy outcome associated with perinatal morbidity and mortality and remains difficult to prevent. There is evidence that some modifiable maternal health characteristics may influence the risk of preterm birth. Our aim was to investigate the relationships of self-reported maternal health behaviour and psychological characteristics in nulliparous women with spontaneous preterm birth in prenatal primary care. Methods The data of our prospective study was obtained from the nationwide DELIVER multicentre cohort study (September 2009–March 2011), which was designed to examine perinatal primary care in the Netherlands. In our study, consisting of 2768 nulliparous women, we estimated the relationships of various self-reported health behaviours (smoking, alcohol consumption, folic acid supplementation, daily fruit, daily fresh vegetables, daily hot meal and daily breakfast consumption) and psychological characteristics (anxious/depressed mood and health control beliefs) with spontaneous preterm birth as a dichotomous outcome. Due to the clustering of clients within midwife practices, Generalized Estimating Equations was used for these analyses. Results Low health control beliefs was the sole characteristic significantly associated with spontaneous preterm birth (odds ratio 2.26; 95 % confidence interval 1.51, 3.39) after being adjusted for socio-demographics, anthropometrics and the remaining health behaviour and psychological characteristics. The other characteristics were not significantly associated with spontaneous preterm birth. Conclusions for Practice Maternal low health control beliefs need to be explored further as a possible marker for women at risk for preterm birth, and as a potentially modifiable characteristic to be used in interventions which are designed to reduce the risk of spontaneous preterm birth.
Highlights
Preterm birth occurs in about 7.6 % of all pregnancies in the Netherlands (Stichting Perinatale Registratie Nederland 2013) and is the leading pregnancy outcome associated with perinatal morbidity and mortality (McIntire and Leveno 2008), as well as with physical and mental disabilities later in life (Crump 2015; Loe et al 2011)
Low health control beliefs was the sole characteristic significantly associated with spontaneous preterm birth after being adjusted for socio-demographics, anthropometrics and the remaining health behaviour and psychological characteristics
Conclusions for Practice Maternal low health control beliefs need to be explored further as a possible marker for women at risk for preterm birth, and as a potentially modifiable characteristic to be used in interventions which are designed to reduce the risk of spontaneous preterm birth
Summary
Preterm birth occurs in about 7.6 % of all pregnancies in the Netherlands (Stichting Perinatale Registratie Nederland 2013) and is the leading pregnancy outcome associated with perinatal morbidity and mortality (McIntire and Leveno 2008), as well as with physical and mental disabilities later in life (Crump 2015; Loe et al 2011). Health behaviours and psychological factors, such as smoking (Ion and Bernal 2014), lack of folic acid supplementation (Li et al 2014), alcohol consumption (O’Leary 2012) and maternal stress and depression (Grote et al 2010; Vrekoussis et al 2010) have been found by some studies to be associated with preterm birth. Medical interventions to prevent preterm birth have been minimally successful as well, and it is possible that preventive measures in primary care, focusing on relevant health behaviours and factors related to lower socio-economic status may turn out to be more effective (Wisanskoonwong et al 2011). To develop primary care interventions, it is important to examine the relationship of various potentially modifiable factors, such as health behaviour and psychological characteristics with preterm birth
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