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      Assessing the risk factors before pregnancy of preterm births in Iran: a population-based case-control study

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          Abstract

          Background

          Preterm birth is a major cause of prenatal and postnatal mortality particularly in developing countries. This study investigated the maternal risk factors associated with the risk of preterm birth.

          Methods

          A population-based case-control study was conducted in several provinces of Iran on 2463 mothers referred to health care centers. Appropriate descriptive and analytical statistical methods were used to evaluate the association between maternal risk factors and the risk of preterm birth. All tests were two-sided, and P values < 0.05 were considered to be statistically significant.

          Results

          The mean gestational age was 31.5 ± 4.03 vs. 38.8 ± 1.06 weeks in the case and control groups, respectively. Multivariate regression analysis showed a statistically significant association between preterm birth and mother’s age and ethnicity. Women of Balooch ethnicity and age ≥ 35 years were significantly more likely to develop preterm birth (OR: 1.64; 95% CI: 1.01–-2.44 and OR: 9.72; 95% CI: 3.07–30.78, respectively). However, no statistically significant association was observed between preterm birth and mother’s place of residence, level of education, past history of cesarean section, and BMI.

          Conclusion

          Despite technological advances in the health care system, preterm birth still remains a major concern for health officials. Providing appropriate perinatal health care services as well as raising the awareness of pregnant women, especially for high-risk groups, can reduce the proportion of preventable preterm births.

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          Most cited references33

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          Racial differences in birth outcomes: the role of general, pregnancy, and racism stress.

          This study examined the role of psychosocial stress in racial differences in birth outcomes. Maternal health, sociodemographic factors, and 3 forms of stress (general stress, pregnancy stress, and perceived racism) were assessed prospectively in a sample of 51 African American and 73 non-Hispanic White pregnant women. The outcomes of interest were birth weight and gestational age at delivery. Only predictive models of birth weight were tested as the groups did not differ significantly in gestational age. Perceived racism and indicators of general stress were correlated with birth weight and tested in regression analyses. In the sample as a whole, lifetime and childhood indicators of perceived racism predicted birth weight and attenuated racial differences, independent of medical and sociodemographic control variables. Models within each race group showed that perceived racism was a significant predictor of birth weight in African Americans, but not in non-Hispanic Whites. These findings provide further evidence that racism may play an important role in birth outcome disparities, and they are among the first to indicate the significance of psychosocial factors that occur early in the life course for these specific health outcomes. Copyright (c) 2008 APA, all rights reserved.
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            Self-reported experiences of racial discrimination and Black-White differences in preterm and low-birthweight deliveries: the CARDIA Study.

            We examined the effects of self-reported experiences of racial discrimination on Black-White differences in preterm (less than 37 weeks gestation) and low-birthweight (less than 2500 g) deliveries. Using logistic regression models, we analyzed data on 352 births among women enrolled in the Coronary Artery Risk Development in Young Adults Study. Among Black women, 50% of those with preterm deliveries and 61% of those with low-birthweight infants reported having experienced racial discrimination in at least 3 situations; among White women, the corresponding percentages were 5% and 0%. The unadjusted odds ratio for preterm delivery among Black versus White women was 2.54 (95% confidence interval [CI]=1.33, 4.85), but this value decreased to 1.88 (95% CI=0.85, 4.12) after adjustment for experiences of racial discrimination and to 1.11 (95% CI=0.51, 2.41) after additional adjustment for alcohol and tobacco use, depression, education, and income. The corresponding odds ratios for low birthweight were 4.24 (95% CI=1.31, 13.67), 2.11 (95% CI=0.75, 5.93), and 2.43 (95% CI=0.79, 7.42). Self-reported experiences of racial discrimination were associated with preterm and low-birthweight deliveries, and such experiences may contribute to Black-White disparities in perinatal outcomes.
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              Gestational diabetes mellitus and lesser degrees of pregnancy hyperglycemia: association with increased risk of spontaneous preterm birth.

              To investigate whether different degrees of maternal glucose intolerance are associated with the risk of spontaneous preterm birth. We performed a cohort study of 46,230 pregnancies screened by a 50-g, 1-hour oral glucose tolerance test between 24 and 28 gestation weeks at the Northern California Kaiser Permanente Medical Care Program. Spontaneous preterm birth was defined as an infant born at less than 37 gestation weeks with at least one of the following: spontaneous labor, preterm premature rupture of membranes, or incompetent cervix. Glucose tolerance status was categorized as normal screening (1-hour plasma glucose less than 140 mg/dL), abnormal screening (1-hour plasma glucose of at least 140 mg/dL with a normal diagnostic 100-g, 3-hour oral glucose tolerance test result), Carpenter-Coustan (plasma glucose measurements during the diagnostic oral glucose tolerance test met the thresholds but were lower than the National Diabetes Data Group thresholds), and gestational diabetes mellitus (GDM) by the National Diabetes Data Group criteria. One thousand nine hundred fifty-six spontaneous preterm births occurred. Age-adjusted incidences of spontaneous preterm birth were 4.0% in normal screening, 5.0% in abnormal screening, 6.7% in Carpenter-Coustan, and 6.7% in GDM. In a logistic regression model adjusted for age, race-ethnicity, preeclampsia-eclampsia-pregnancy-induced hypertension, chronic hypertension, polyhydramnios, and birth weight for gestational age, pregnancies with abnormal screening, Carpenter-Coustan, and GDM had a significantly higher risk of spontaneous preterm birth than pregnancies with normal screening (relative risk [95% confidence interval]: 1.23 [1.08, 1.41], 1.53 [1.16, 2.03], and 1.42 [1.15-1.77], respectively). The risk of spontaneous preterm birth increased with increasing levels of pregnancy glycemia. This association was independent of perinatal complications that could have triggered early delivery.
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                Author and article information

                Contributors
                +98-7137256007 , Tanazvaladbeigi@gmail.com
                Journal
                BMC Pregnancy Childbirth
                BMC Pregnancy Childbirth
                BMC Pregnancy and Childbirth
                BioMed Central (London )
                1471-2393
                6 February 2019
                6 February 2019
                2019
                : 19
                : 57
                Affiliations
                [1 ]ISNI 0000 0004 0417 4622, GRID grid.411701.2, Razi Clinical Research Development Unit(RCRDU), Birjand University of Medical Sciences(BUMS), ; Birjand, Iran
                [2 ]ISNI 0000 0000 8819 4698, GRID grid.412571.4, Research Center for Health Sciences, Department of Epidemiology, School of Health, , Shiraz University of Medical Sciences, ; Shiraz, Iran
                [3 ]ISNI 0000 0001 2198 6209, GRID grid.411583.a, Department of Health Education and Health Promotion, School of Health Sciences, , Mashhad University of Medical Sciences, ; Mashhad, Iran
                [4 ]ISNI 0000 0000 8819 4698, GRID grid.412571.4, Department of Epidemiology, School of Health, , Shiraz University of Medical Sciences, ; Shiraz, Iran
                [5 ]ISNI 0000 0004 0385 452X, GRID grid.412237.1, Social Determinants in Health Promotion Research Center, , Hormozgan University of Medical Sciences, ; Bandar Abbas, Iran
                [6 ]ISNI 0000 0004 0611 9280, GRID grid.411950.8, Department of Epidemiology, School of Public Health, , Hamadan University of Medical Sciences, ; Hamadan, Iran
                [7 ]ISNI 0000 0004 4911 7066, GRID grid.411746.1, Department of Epidemiology, Faculty of Health, , Iran University of Medical Sciences, ; Tehran, Iran
                [8 ]ISNI 0000 0004 0417 4622, GRID grid.411701.2, Birjand University of Medical Sciences, ; Birjand, Iran
                [9 ]ISNI 0000 0004 0612 5912, GRID grid.412505.7, Department of Biostatistics Epidemiology, Health Faculty, , Shahid Sadoughi University of Medical Sciences, ; Yazd, Iran
                [10 ]GRID grid.411600.2, Epidemiology Department, School of Public Health, , Shahid Beheshti University of Medical Sciences, ; Tehran, Iran
                [11 ]ISNI 0000 0004 0418 0096, GRID grid.411747.0, Medical Education, Health Management and Social Development Research Center, , Golestan University of Medical Sciences, ; Gorgan, Iran
                [12 ]ISNI 0000 0004 0385 452X, GRID grid.412237.1, Health Care Management, Mother and Child Welfare Research Center, , Hormozgan University of Medical Sciences, ; Bandar Abbas, Iran
                [13 ]ISNI 0000 0004 0384 8816, GRID grid.444858.1, Clinical Research Development Unit, Imam Hossein Hospital, , Shahroud University of Medical Sciences, ; Shahroud, Iran
                [14 ]GRID grid.411600.2, Department of Epidemiology, Environmental and Occupational Hazards Control Research Center, Faculty of Public Health, , Shahid Beheshti University of Medical Sciences, ; Tehran, Iran
                [15 ]ISNI 0000 0001 2198 6209, GRID grid.411583.a, Health Sciences Research Centre, Cancer Research Center, Department of Biostatistics and Epidemiology, , School of Health, Faculty of Mashhad University of Medical Sciences, ; Mashhad, Iran
                [16 ]ISNI 0000 0004 0384 8939, GRID grid.413020.4, Social Determinants of Health Research Center, , Yasuj University of Medical Sciences, ; Yasuj, Iran
                [17 ]GRID grid.411600.2, Student Research Committee, Epidemiology Department, School of Public Health and Safety, , Shahid Beheshti University of Medical Sciences, ; Tehran, Iran
                Article
                2183
                10.1186/s12884-019-2183-0
                6364407
                30727983
                680ec3f2-9055-4e0d-843a-7ccbfe6d378c
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. 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
                : 17 January 2017
                : 8 January 2019
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100004320, Shiraz University of Medical Sciences;
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2019

                Obstetrics & Gynecology
                preterm birth,risk factor,case-control,iran
                Obstetrics & Gynecology
                preterm birth, risk factor, case-control, iran

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