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Background: Preterm birth rate is increasing and is currently a worldwide concern. The purpose of this study was to estimate the prevalence of preterm birth in a sample of health facilities in Brazil and to identify the main risk factors associated with spontaneous preterm births. Methods and Findings: This was a multicentre cross sectional study on preterm births in 20 referral obstetric hospitals with a case-control component to identify factors associated with spontaneous preterm birth. Surveillance was implemented at all centres to identify preterm births. For eligible consenting women, data were collected through a post-delivery questionnaire completed with information from all mother-newborn medical records until death or discharge or at a maximum of 60 days post-delivery, whichever came first. The risk of spontaneous preterm birth was estimated with OR and 95%CI for several predictors. A non-conditional logistic regression analysis was then performed to identify independently associated factors. The overall prevalence of preterm birth was 12.3%. Among them, 64.6% were spontaneous and 35.4% therapeutic. In the case-control component, 2,682 spontaneous preterm births were compared to a sample of 1,146 term births. Multivariate analyses identified the following as risk factors for spontaneous preterm birth among women with at least one previous birth: a previous preterm birth (ORadj = 3.19, 2.30-4.43), multiple pregnancy (ORadj = 29.06, 8.43-100.2), cervical insufficiency (ORadj = 2.93, 1.07-8.05), foetal malformation (ORadj = 2.63, 1.43-4.85), polyhydramnios (ORadj = 2.30, 1.17-4.54), vaginal bleeding (ORadj = 2.16, 1.50-3.11), and previous abortion (ORadj = 1.39, 1.08-1.78). High BMI (ORadj = 0.94, 0.91-0.97) and weight gain during gestation (ORadj = 0.92, 0.89-0.95) were found to be protective factors. Conclusions: The preterm birth rate in these health facilities in Brazil is high and spontaneous preterm births account for two thirds of them. A better understanding of the factors associated with spontaneous preterm birth is of utmost importance for planning effective measures to reduce the burden of its increasing rates.
Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas
Centre for Studies in Reproductive Health of Campinas (CEMICAMP)
Jundiai School of Medicine
Maternidade Escola Assis Chateaubriand
Instituto de Medicina Integral Prof. Fernando Figueira
Hospital das Clinicas, Universidade Federal de Pernambuco
Instituto de Saúde Elidio de Almeida
Hospital Universitário, Universidade Federal Do Maranhao
Hospital Universitário Lauro Wanderley, Universidade Federal da Paraiba
Hospital das Clinicas, Universidade Federal Do Paraná
Maternidade Climério de Oliveira
Hospital das Clinicas, Universidade Federal Do Rio Grande Do sul
Instituto Fernandes Figueira
Faculdade de Medicina de Botucatu, Universidade Estadual Paulista
Faculdade de Medicina de Jundiaí
Hospital São Paulo, Universidade Federal de São Paulo
Hospital das Clinicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo
Santa Casa de Limeira
Santa Casa de São Carlos
Casa Maternal Leonor Mendes de Barros
Maternidade Escola de Vila Nova Cachoeirinha
Hospital Estadual de Sumaré
Faculdade de Medicina de Botucatu, Universidade Estadual Paulista
