A matched case–control study of preterm birth in one hospital in Beijing, China

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Abstract

Background

Preterm birth is an unresolved global health issue. The etiologies of preterm birth are complex and multifactorial. To examine risk factors related to preterm birth, a matched case–control study was conducted in a hospital in Beijing, China where little data on preterm birth have been published in the scientific literature.

Methods

A 1:1 matched case–control study was conducted in 172 pairs of women with preterm birth (case group) and term delivery (control group). Eligible subjects were interviewed in person by well-trained investigators using a questionnaire. Information on obstetric diagnosis and newborns were abstracted from inpatients’ medical records. Univariate and multivariate conditional logistic regression models were used to measure the associations between related factors and preterm birth.

Results

Univariate analysis showed that 6 of 12 factors were associated with preterm birth. Multivariate results showed that gestational hypertension (OR = 7.76), low gestational weight gain (OR = 3.02), frequent prenatal care (OR = 0.16), balanced diet (OR = 0.36), and high gestational weight gain (OR = 0.41) were associated with preterm birth.

Conclusion

This study provides information on preterm birth in Beijing, China, and it also lends support to existing evidence about the role of maternal nutritional status, prenatal care and gestational hypertension as risk factors for preterm birth.

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Most cited references 23

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Overweight and obesity in mothers and risk of preterm birth and low birth weight infants: systematic review and meta-analyses

Sarah McDonald, Zhen-Hai Han, Sohail M. Mulla … (2010)

Objective To determine the relation between overweight and obesity in mothers and preterm birth and low birth weight in singleton pregnancies in developed and developing countries. Design Systematic review and meta-analyses. Data sources Medline and Embase from their inceptions, and reference lists of identified articles. Study selection Studies including a reference group of women with normal body mass index that assessed the effect of overweight and obesity on two primary outcomes: preterm birth (before 37 weeks) and low birth weight (<2500 g). Data extraction Two assessors independently reviewed titles, abstracts, and full articles, extracted data using a piloted data collection form, and assessed quality. Data synthesis 84 studies (64 cohort and 20 case-control) were included, totalling 1 095 834 women. Although the overall risk of preterm birth was similar in overweight and obese women and women of normal weight, the risk of induced preterm birth was increased in overweight and obese women (relative risk 1.30, 95% confidence interval 1.23 to 1.37). Although overall the risk of having an infant of low birth weight was decreased in overweight and obese women (0.84, 0.75 to 0.95), the decrease was greater in developing countries than in developed countries (0.58, 0.47 to 0.71 v 0.90, 0.79 to 1.01). After accounting for publication bias, the apparent protective effect of overweight and obesity on low birth weight disappeared with the addition of imputed “missing” studies (0.95, 0.85 to 1.07), whereas the risk of preterm birth appeared significantly higher in overweight and obese women (1.24, 1.13 to 1.37). Conclusions Overweight and obese women have increased risks of preterm birth and induced preterm birth and, after accounting for publication bias, appeared to have increased risks of preterm birth overall. The beneficial effects of maternal overweight and obesity on low birth weight were greater in developing countries and disappeared after accounting for publication bias.

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Premature birth and later insulin resistance.

Wayne S. Cutfield, Craig Jefferies, Sharon D M Robinson … (2004)

Term infants who are small for gestational age appear prone to the development of insulin resistance during childhood. We hypothesized that insulin resistance, a marker of type 2 diabetes mellitus, would be prevalent among children who had been born prematurely, irrespective of whether they were appropriate for gestational age or small for gestational age. Seventy-two healthy prepubertal children 4 to 10 years of age were studied: 50 who had been born prematurely (32 weeks' gestation or less), including 38 with a birth weight that was appropriate for gestational age (above the 10th percentile) and 12 with a birth weight that was low (i.e., who were small) for gestational age, and 22 control subjects (at least 37 weeks' gestation, with a birth weight above the 10th percentile). Insulin sensitivity was measured with the use of paired insulin and glucose data obtained by frequent measurements during intravenous glucose-tolerance tests. Children who had been born prematurely, whether their weight was appropriate or low for gestational age, had an isolated reduction in insulin sensitivity as compared with controls (appropriate-for-gestational-age group, 14.2x10(-4) per minute per milliunit per liter [95 percent confidence interval, 11.5 to 16.2]; small-for-gestational-age group, 12.9x10(-4) per minute per milliunit per liter [95 percent confidence interval, 9.7 to 17.4]; and control group, 21.6x10(-4) per minute per milliunit per liter [95 percent confidence interval, 17.1 to 27.4]; P=0.002). There were no significant differences in insulin sensitivity between the two premature groups (P=0.80). As compared with controls, both groups of premature children had a compensatory increase in acute insulin release (appropriate-for-gestational-age group, 2002 pmol per liter [95 percent confidence interval, 1434 to 2432] [corrected]; small-for-gestational-age group, 2253 pmol per liter [95 percent confidence interval, 1622 to 3128]; and control group, 1148 pmol per liter [95 percent confidence interval, 875 to 1500]; P<0.001). Like children who were born at term but who were small for gestational age, children who were born prematurely have an isolated reduction in insulin sensitivity, which may be a risk factor for type 2 diabetes mellitus. Copyright 2004 Massachusetts Medical Society.

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[Predictive values of body mass index and waist circumference to risk factors of related diseases in Chinese adult population].

B. Zhou, (2002)

For prevention of obesity in Chinese population, it is necessary to define the optimal range of healthy weight and the appropriate cut-off points of body mass index (BMI) and waist circumference for Chinese adults. The Working Group on Obesity in China (WGOC) under the support of International Life Sciences Institute Focal point in China organized a meta-analysis on the relation between BMI, waist circumference and risk factors of related chronic diseases. All together 13 population studies met the criteria for enrollment, with data of 239 972 adults (20 - 70 year) surveyed in the 1990s. Data on waist circumference was available for 111 411 persons and data on serum lipids and glucose were available for more than 80 000. The study populations located in 21 provinces, municipalities and autonomous regions in mainland China as well as in Taiwan. Each enrolled study group provided data according to a common protocol and uniform format. The center for data management in the Department of Epidemiology, Fu Wai Hospital was responsible for statistical analysis. The prevalence of hypertension, diabetes, dyslipidemia and clustering of risk factors all increased with increasing levels of BMI or waist circumference. BMI at 24 with best sensitivity and specificity for identification of the risk factors, was recommended as the cut-off point for overweight since and BMI at 28 which might identify the risk factors with specificity around 90% to be recommended as the cut-off point for obesity. Waist circumference beyond 85 cm for men and beyond 80 cm for women were recommended as the cut-off points for central obesity. Analysis of population attributable risk percent illustrated that reducing BMI to normal range ( /= 28) with drugs could prevent 15% - 17% clustering of risk factors. Control the waist circumference under 85 cm for men and under 80 cm for women, could prevent 47% - 58% clustering of risk factors.

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Author and article information

Contributors

AiQun Huang: aqhuang@chinawch.org.cn

Xi Jin: jinxi@chinawch.org.cn

XiaoHong Liu: 13522099566@163.com

SuHong Gao: gaosuhong2001@126.com

Journal

Journal ID (nlm-ta): Reprod Health

Journal ID (iso-abbrev): Reprod Health

Title: Reproductive Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1742-4755

Publication date (Electronic): 5 January 2015

Publication date PMC-release: 5 January 2015

Publication date Collection: 2015

Volume: 12

Issue: 1

Electronic Location Identifier: 1

Affiliations

[ ]National Center for Women’s and Children’s Health, China CDC, Beiyuan Road, Chaoyang District, Beijing, China

[ ]Haidian Maternal and Child Health Care Hospital, Haidian Nan Road, Haidian District, Beijing, China

Article

Publisher ID: 337

DOI: 10.1186/1742-4755-12-1

PMC ID: 4290090

PubMed ID: 25561377

SO-VID: 61341604-ff69-4aca-992f-aad975ad5adc

License:

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 28 April 2014

Date accepted : 15 December 2014

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ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: preterm birth,case–control study,risk factors

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ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: preterm birth, case–control study, risk factors

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A matched case–control study of preterm birth in one hospital in Beijing, China

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Most cited references 23

Overweight and obesity in mothers and risk of preterm birth and low birth weight infants: systematic review and meta-analyses

Premature birth and later insulin resistance.

[Predictive values of body mass index and waist circumference to risk factors of related diseases in Chinese adult population].

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Cited by 118

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