Causes, trends, and newborn outcomes following preterm birth in a middle-income setting

Abstract

Understanding the epidemiology is essential in reducing the burden of preterm birth in East Asia and the Pacific, including Vietnam. The aim was to describe preterm birth in Asian middle-income settings.

A systematic review was conducted to determine preterm birth rates, contributing factors and neonatal outcomes in middle-income settings of East Asia and the Pacific. The trends in singleton preterm birth and outcomes were compared by using data from Tu Du Hospital and linked NSW population data. A retrospective cohort study of singleton livebirths at 28-36 weeks was conducted to describe the neonatal outcomes and the association between outcomes and labour onset by gestational age at birth in Tu Du Hospital, Vietnam.

The main findings were:

•Singleton preterm birth rates in China varied from 4.16% to 5.95%. Contributing factors included low education, single marital status, low antenatal visits number, maternal antepartum complications, multiple pregnancy, winter, birth cohort and maternal age.

•The singleton preterm birth rate in Tu Du Hospital was higher. Rates of C-section were higher in Tu Du Hospital than in NSW, while instrumental delivery rates were lower. In NSW, there was a decrease in normal vaginal birth rate and an increase in C-section rate.

•Among liveborn infants at 28-36 weeks, the neonatal mortality rate decreased with each advancing week of gestation. The overall morbidity rate was 56.1%. The neonatal morbidity odds were higher in pregnancies with labour induction and prelabour C-section than with spontaneous labour. The neonatal morbidity rate was higher in pregnancies with antenatal corticosteroids administration than in pregnancies without administration.

These findings highlight the higher preterm birth rates in Asian middle-income settings than in high-income settings. We described the week-specific preterm neonatal outcomes at 28-36 weeks, and the association between neonatal outcomes and labour onset by gestational age at birth in Vietnam.