Impact of stillbirths on international comparisons of preterm birth rates: a secondary analysis of the WHO multi-country survey of Maternal and Newborn Health

on behalf of the PREBIC Epidemiology Working Group and the WHO-MCS Research Network

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Objective: To evaluate the extent to which stillbirths affect international comparisons of preterm birth rates in low- and middle-income countries. Design: Secondary analysis of a multi-country cross-sectional study. Setting: 29 countries participating in the World Health Organization Multicountry Survey on Maternal and Newborn Health. Population: 258 215 singleton deliveries in 286 hospitals. Methods: We describe how inclusion or exclusion of stillbirth affect rates of preterm births in 29 countries. Main outcome measures: Preterm delivery. Results: In all countries, preterm birth rates were substantially lower when based on live births only, than when based on total births. However, the increase in preterm birth rates with inclusion of stillbirths was substantially higher in low Human Development Index (HDI) countries [median 18.2%, interquartile range (17.2–34.6%)] compared with medium (4.3%, 3.0–6.7%), and high-HDI countries (4.8%, 4.4–5.5%). Conclusion: Inclusion of stillbirths leads to higher estimates of preterm birth rate in all countries, with a disproportionately large effect in low-HDI countries. Preterm birth rates based on live births alone do not accurately reflect international disparities in perinatal health; thus improved registration and reporting of stillbirths are necessary. Tweetable abstract: Inclusion of stillbirths increases preterm birth rates estimates, especially in low-HDI countries.

Original languageEnglish (US)
Pages (from-to)1346-1354
Number of pages9
JournalBJOG: An International Journal of Obstetrics and Gynaecology
Volume124
Issue number9
DOIs
StatePublished - Aug 1 2017

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Stillbirth
Birth Rate
Premature Birth
Human Development
Live Birth
Infant Health
Maternal Health
Surveys and Questionnaires
Cross-Sectional Studies
Outcome Assessment (Health Care)
Parturition
Health
Population

Keywords

  • Global health
  • low income country
  • perinatal health
  • preterm birth
  • stillbirth

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Impact of stillbirths on international comparisons of preterm birth rates : a secondary analysis of the WHO multi-country survey of Maternal and Newborn Health. / on behalf of the PREBIC Epidemiology Working Group and the WHO-MCS Research Network.

In: BJOG: An International Journal of Obstetrics and Gynaecology, Vol. 124, No. 9, 01.08.2017, p. 1346-1354.

Research output: Contribution to journalArticle

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title = "Impact of stillbirths on international comparisons of preterm birth rates: a secondary analysis of the WHO multi-country survey of Maternal and Newborn Health",
abstract = "Objective: To evaluate the extent to which stillbirths affect international comparisons of preterm birth rates in low- and middle-income countries. Design: Secondary analysis of a multi-country cross-sectional study. Setting: 29 countries participating in the World Health Organization Multicountry Survey on Maternal and Newborn Health. Population: 258 215 singleton deliveries in 286 hospitals. Methods: We describe how inclusion or exclusion of stillbirth affect rates of preterm births in 29 countries. Main outcome measures: Preterm delivery. Results: In all countries, preterm birth rates were substantially lower when based on live births only, than when based on total births. However, the increase in preterm birth rates with inclusion of stillbirths was substantially higher in low Human Development Index (HDI) countries [median 18.2{\%}, interquartile range (17.2–34.6{\%})] compared with medium (4.3{\%}, 3.0–6.7{\%}), and high-HDI countries (4.8{\%}, 4.4–5.5{\%}). Conclusion: Inclusion of stillbirths leads to higher estimates of preterm birth rate in all countries, with a disproportionately large effect in low-HDI countries. Preterm birth rates based on live births alone do not accurately reflect international disparities in perinatal health; thus improved registration and reporting of stillbirths are necessary. Tweetable abstract: Inclusion of stillbirths increases preterm birth rates estimates, especially in low-HDI countries.",
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T1 - Impact of stillbirths on international comparisons of preterm birth rates

T2 - a secondary analysis of the WHO multi-country survey of Maternal and Newborn Health

AU - on behalf of the PREBIC Epidemiology Working Group and the WHO-MCS Research Network

AU - Morisaki, N.

AU - Ganchimeg, T.

AU - Vogel, J. P.

AU - Zeitlin, J.

AU - Cecatti, J. G.

AU - Souza, J. P.

AU - Pileggi Castro, C.

AU - Torloni, M. R.

AU - Ota, E.

AU - Mori, R.

AU - Dolan, Siobhan M.

AU - Tough, S.

AU - Mittal, S.

AU - Bataglia, V.

AU - Yadamsuren, B.

AU - Kramer, M. S.

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N2 - Objective: To evaluate the extent to which stillbirths affect international comparisons of preterm birth rates in low- and middle-income countries. Design: Secondary analysis of a multi-country cross-sectional study. Setting: 29 countries participating in the World Health Organization Multicountry Survey on Maternal and Newborn Health. Population: 258 215 singleton deliveries in 286 hospitals. Methods: We describe how inclusion or exclusion of stillbirth affect rates of preterm births in 29 countries. Main outcome measures: Preterm delivery. Results: In all countries, preterm birth rates were substantially lower when based on live births only, than when based on total births. However, the increase in preterm birth rates with inclusion of stillbirths was substantially higher in low Human Development Index (HDI) countries [median 18.2%, interquartile range (17.2–34.6%)] compared with medium (4.3%, 3.0–6.7%), and high-HDI countries (4.8%, 4.4–5.5%). Conclusion: Inclusion of stillbirths leads to higher estimates of preterm birth rate in all countries, with a disproportionately large effect in low-HDI countries. Preterm birth rates based on live births alone do not accurately reflect international disparities in perinatal health; thus improved registration and reporting of stillbirths are necessary. Tweetable abstract: Inclusion of stillbirths increases preterm birth rates estimates, especially in low-HDI countries.

AB - Objective: To evaluate the extent to which stillbirths affect international comparisons of preterm birth rates in low- and middle-income countries. Design: Secondary analysis of a multi-country cross-sectional study. Setting: 29 countries participating in the World Health Organization Multicountry Survey on Maternal and Newborn Health. Population: 258 215 singleton deliveries in 286 hospitals. Methods: We describe how inclusion or exclusion of stillbirth affect rates of preterm births in 29 countries. Main outcome measures: Preterm delivery. Results: In all countries, preterm birth rates were substantially lower when based on live births only, than when based on total births. However, the increase in preterm birth rates with inclusion of stillbirths was substantially higher in low Human Development Index (HDI) countries [median 18.2%, interquartile range (17.2–34.6%)] compared with medium (4.3%, 3.0–6.7%), and high-HDI countries (4.8%, 4.4–5.5%). Conclusion: Inclusion of stillbirths leads to higher estimates of preterm birth rate in all countries, with a disproportionately large effect in low-HDI countries. Preterm birth rates based on live births alone do not accurately reflect international disparities in perinatal health; thus improved registration and reporting of stillbirths are necessary. Tweetable abstract: Inclusion of stillbirths increases preterm birth rates estimates, especially in low-HDI countries.

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KW - stillbirth

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