Iatrogenic and spontaneous preterm birth in England: a population-based cohort study

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dc.cclicenceCC-BY-NCen
dc.contributor.authorAughey, H
dc.contributor.authorJardine, J
dc.contributor.authorKnight, H
dc.contributor.authorGurol-Urganci, I
dc.contributor.authorWalker, K
dc.contributor.authorHarris, T
dc.contributor.authorvan der Meulen, J
dc.contributor.authorHawdon, J
dc.contributor.authorPasupathy, D
dc.contributor.authorOn behalf of the NMPA project team
dc.date.acceptance2022-08-22
dc.date.accessioned2022-09-22T15:14:42Z
dc.date.available2022-09-22T15:14:42Z
dc.date.issued2022-09-08
dc.descriptionopen access articleen
dc.description.abstractObjective: To describe the rates of and risk factors associated with iatrogenic and spontaneous preterm birth and the variation in rates between hospitals. Design: Cohort study using electronic health records. Setting: English National Health Service. Population: Singleton births between 1st April 2015 and 31st March 2017. Methods: Multivariable Poisson regression models were used to estimate adjusted risk ratios (adjRR) to measure association with maternal demographic and clinical risk factors. Main outcome measures: Preterm births (<37 weeks gestation) were defined as iatrogenic or spontaneous according to mode of onset of labour. Results: 6.1% of births were preterm and of these, 52.8% were iatrogenic. The proportion of preterm births that were iatrogenic increased after 32 weeks. Both sub-groups are associated with previous preterm birth, extremes of maternal age, socio-economic deprivation and smoking. Iatrogenic preterm birth was associated with higher BMI (adjRR BMI >40 1.59 (1.50, 1.69)), and previous caesarean (adjRR 1.88 (1.83, 1.95)). Spontane-ous preterm birth was less common in women with a higher BMI (adjRR BMI>40 0.77 (0.70, 0.84)) and in women with a previous caesarean (adjRR 0.87 (0.83, 0.90)). More variation be-tween NHS hospital trusts was observed in rates of iatrogenic, compared to spontaneous, pre-term births. Conclusions: Just over half of all preterm births resulted from iatrogenic intervention. Iatro-genic births have overlapping but different patterns of maternal demographic and clinical risk factors to spontaneous preterm births. Iatrogenic and spontaneous sub-groups should therefore be measured and monitored separately, as well as in aggregate, to facilitate different preven-tion strategies. This is feasible using routinely acquired hospital data.en
dc.funderOther external funder (please detail below)en
dc.funder.otherThe National Maternity and Perinatal Audit is commissioned by the Healthcare Quality Improvement Partnership as part of the National Clinical Audit and Patients Outcomes Programme and funded by NHS England and the Scottish and Welsh governments. Neither HQIP nor the funders had any involvement in designing the study; collecting , analysing, and interpreting the data; writing the report; or in making the decision to submit the article for publication.en
dc.identifier.citationAughey, H., Jardine, J., Gurol-Urganci, I., Walker, K., Harris, T., van der Meulen, J., Hawdon, J., Pasupathy, D., The NMPA Project Team (2022) Iatrogenic and spontaneous preterm birth in England: a population-based cohort study. British Journal of Obstetrics and Gynaecology,en
dc.identifier.doihttps://doi.org/10.1111/1471-0528.17291
dc.identifier.urihttps://hdl.handle.net/2086/22182
dc.language.isoenen
dc.peerreviewedYesen
dc.projectidHQIPNCA170en
dc.publisherWileyen
dc.researchinstituteCentre for Reproduction Research (CRR)en
dc.subjectinductionen
dc.subjectpreterm birthen
dc.subjectspontaneousen
dc.subjectIatrogenicen
dc.titleIatrogenic and spontaneous preterm birth in England: a population-based cohort studyen
dc.typeArticleen

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