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Time trends and risk factor associated with premature birth and infants deaths due to prematurity in Hubei Province, China from 2001 to 2012

Saturday, 9th of January 2016

Time trends and risk factor associated with premature birth and infants deaths due to prematurity in Hubei Province, China from 2001 to 2012

• Haiqing Xu, 
• Qiong Dai, 
• Yusong Xu, 
• Zhengtao Gong, 
• Guohong Dai, 
• Ming Ding, 
• Christopher Duggan, 
• Zubin Hu and 
• Frank B. HuEmail author

BMC Pregnancy and Childbirth201515:329

©  Xu et al. 2015

Published: 10 December 2015

 

Abstract below; full text is at http://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-015-0767-x

Background

The nutrition and epidemiologic transition has been associated with an increasing incidence of preterm birth in developing countries, but data from large observational studies in China have been limited. Our study was to describe the trends and factors associated with the incidence of preterm birth and infant mortality due to prematurity in Hubei Province, China.

Methods

We conducted a population-based survey through the Maternal and Child Health Care Network in Hubei Province from January 2001 to December 2012. We used data from 16 monitoring sites to examine the trend and risk factors for premature birth as well as infant mortality associated with prematurity.

Results

A total of 818,481 live births were documented, including 76,923 preterm infants (94 preterm infants per 1,000 live births) and 2,248 deaths due to prematurity (2.75 preterm deaths per 1,000 live births). From 2001 to 2012, the incidence of preterm birth increased from 56.7 to 105.2 per 1,000 live births (P for trend < 0.05), while the infant mortality rate due to prematurity declined from 95.0 to 13.4 per 1,000 live births (P for trend < 0.05). Older maternal age, lower maternal education, use of assisted reproductive technology (ART), higher income, residence in urban areas, and infant male sex were independently associated with a higher incidence of preterm birth (all p values < 0.05). Shorter gestation, lower birth weight, and lower income were associated with a higher mortality rate, while use of newborn emergency transport services (NETS) was associated with a lower preterm mortality rate (all p values < 0.05).

Conclusion

An increasing incidence of preterm birth and a parallel reduction in infant mortality due to prematurity were observed in Hubei Province from 2001 to 2012. Our results provide important information for areas of improvements in reducing incidence and mortality of premature birth.

Background

Approximately 15 million infants are born prematurely each year, which is more than one tenth of all new-born infants globally [1]. Preterm infants have a high risk of birth complications, including infectious diseases, respiratory insufficiency, intraventricular hemorrhage, neurosensory deficits, and other organ system involvement [2]. Mortality due to complications of prematurity is the leading cause of neonatal death, and the second leading cause of death for children under age five [3]. Achieving Millenium Development Goal to reduce child mortality is therefore in large part dependent on reducing mortality related to premature birth [4].

For preterm infants who do survive, elevated risks for cognitive disorders and chronic non-communicable diseases exist [5,6]. Preterm birth has been associated with elevated plasma insulin levels [7], altered growth patterns [5], and higher risk for cardiovascular diseases in adulthood [5]. The incidence of prematurity and subsequent risk of death due to prematurity-associated conditions is therefore an indicator of how women in a given country have access to safe and effective, pre- and post-natal medical care, as well as an indicator of the overall health of their society.

Large pooled analyses using data from multiple countries showed that the incidence of preterm birth has increased in recent years, with preterm birth an important risk factor for neonatal mortality [8, 9]. However, these analyses did not include data from China. One study analyzing the new-born information covering 2,377 monitoring sites in China showed that preterm birth complications are an important cause of child mortality in China [10]. The estimated number of preterm births (<37 weeks) was more than 250,000 in 2010 in China, ranking the second country behind India with the highest number of annual preterm births [11].

Economic development and government programs in China over the past two decades have together led to improved quantity and quality of maternal, child and newborn health care [11]. Secular trends in improved neonatal outcomes have not been well studied, however, including whether improved medical care has been evident in rural as well as rural settings [12]. Hubei Province is a large, economically, agriculturally and ethnically diverse province located in south-central China with approximately 57 million inhabitants. The aim of this study was therefore to describe secular trends in the incidence of premature birth as well as infant mortality linked with preterm birth in Hubei Province from 2001 to 2012, and to identify risk factors associated with these important health outcomes.