Risk factors for prematurity in the Maltese Islands: 1999–2006

Abstract

Prematurity remains one of the main causes of neonatal mortality and morbidity even in countries that have well-developed comprehensive maternity and neonatal services.

Objective: A review of the epidemiology and the short-term complications arising from natural or iatrogenic prematurity in modern practice is necessary to assess the true import of this obstetric complication.

Methodology: All deliveries with known gestational age at delivery in the Maltese Islands during the period 1999–2006 were included in the study (23,073 maternities with a total of 23,422 births). These maternities included a total of 1279 delivered at a documented 36 or less completed weeks of gestation.

Results: During the period under review the prematurity rate amounted to 6.2% of all maternities. Iatrogrenic-induced births accounted for 33.9% of the total. A premature birth was statistically more likely to occur in women at their extremes of reproductive life (≤17 years: OR=1.16; or ≥30 years: OR=1.44: p<0.0001), or who gave a history of multiparity (Para 3+: OR=1.56: p=0.008) or previous recurrent miscarriage (OR=1.79: p=0.008) or fetal loss (OR=3.17: p<0.0001). The current pregnancy was statistically more likely to be a multiple pregnancy (OR=13.52: p<0.0001) or be complicated by hypertension (OR=2.62: p<0.0001), pre-existing (OR=7.50: p<0.0001) or gestational (OR=2.4: p<0.0001) diabetes, or antenatal bleeding (OR=9.22: p<0.0001). Premature births were statistically more likely to deliver by Caesarean section (OR=2.13: p<0.0001). The stillbirth and neonatal mortality is significantly higher (OR=73.0: p<0.0001) in premature births; while the premature infant is very much more likely to require resuscitation and life support interventions (low 5 min Apgar score: OR=36.5: p<0.0001). The neonatal period of the premature infant is fraught with risks of significant serious complications such as respiratory distress syndrome (OR=9.14: p<0.0001), hyperbilirubinaemia (OR=16.0: p<0.0001) and sepsis (OR=16.0: p<0.0001).

Conclusions: The short-term morto-morbidity and the long-term morbidity associated with preterm births necessitates a determined drive to identify those pregnant women at risk so that proactive intervention management can be instituted.