Journal of Preventive Medicine and Public Health

The Korean Society for Preventive Medicine (대한예방의학회)
권호 표지
DOI QR코드

DOI QR Code

Risk Factors for Preterm Birth and Low Birth Weight Among Pregnant Indian Women: A Hospital-based Prospective Study

  • Tellapragada, Chaitanya (Directorate of Research (Health Sciences), Manipal University) ;
  • Eshwara, Vandana Kalwaje (Department of Microbiology, Kasturba Medical College, Manipal University) ;
  • Bhat, Parvati (Department of Obstetrics and Gynecology, Melaka Manipal Medical College, Manipal University) ;
  • Acharya, Shashidhar (Department of Community Dentistry, Manipal College of Dental Sciences, Manipal University) ;
  • Kamath, Asha (Department of Community Medicine, Kasturba Medical College, Manipal University) ;
  • Bhat, Shashikala (Department of Obstetrics and Gynecology, Melaka Manipal Medical College, Manipal University) ;
  • Rao, Chythra (Department of Community Medicine, Kasturba Medical College, Manipal University) ;
  • Nayak, Sathisha (Department of Obstetrics and Gynecology, Melaka Manipal Medical College, Manipal University) ;
  • Mukhopadhyay, Chiranjay (Department of Microbiology, Kasturba Medical College, Manipal University)
  • Received : 2016.02.22
  • Accepted : 2016.05.19
  • Published : 2016.05.31
Download PDF
⟨ Previous Next ⟩

Abstract

Objectives: The present study was undertaken to study the maternal risk factors for preterm birth (PTB) and low birth weight (LBW) with a special emphasis on assessing the proportions of maternal genitourinary and periodontal infections among Indian women and their association with adverse pregnancy outcomes. Methods: A hospital-based prospective study comprising 790 pregnant women visiting the obstetrics clinic for a routine antenatal check-up was undertaken. Once recruited, all study participants underwent clinical and microbiological investigations for genitourinary infections followed by a dental check-up for the presence of periodontitis. The study participants were followed up until their delivery to record the pregnancy outcomes. Infectious and non-infectious risk factors for PTB and LBW were assessed using univariate and multivariate Cox regression analysis. Independent risk factors for PTB and LBW were reported in terms of adjusted relative risk (ARR) with the 95% confidence interval (CI). Results: Rates of PTB and LBW in the study population were 7.6% and 11.4%, respectively. Previous preterm delivery (ARR, 5.37; 95% CI, 1.5 to 19.1), periodontitis (ARR, 2.39; 95% CI, 1.1 to 4.9), Oligohydramnios (ARR, 5.23; 95% CI, 2.4 to 11.5), presence of Nugent's intermediate vaginal flora (ARR, 2.75; 95% CI, 1.4 to 5.1), gestational diabetes mellitus (ARR, 2.91; 95% CI, 1.0 to 8.3), and maternal height <1.50 m (ARR, 2.21; 95% CI, 1.1 to 4.1) were risk factors for PTB, while periodontitis (ARR, 3.38; 95% CI, 1.6 to 6.9), gestational hypertension (ARR, 3.70; 95% CI, 1.3 to 10.8), maternal height <1.50 m (ARR, 2.66; 95% CI, 1.3 to 5.1) and genital infection during later stages of pregnancy (ARR, 2.79; 95% CI, 1.2 to 6.1) were independent risk factors for LBW. Conclusions: Our study findings underscore the need to consider screening for potential genitourinary and periodontal infections during routine antenatal care in developing countries.

Keywords

References

  1. Blencowe H, Cousens S, Chou D, Oestergaard M, Say L, Moller AB, et al. Born too soon: the global epidemiology of 15 million preterm births. Reprod Health 2013;10 Suppl 1:S2. https://doi.org/10.1186/1742-4755-10-S1-S2
  2. United Nations Children's Fund; World Health Organization. Low birthweight: country, regional and global estimates; 2004 [cited 2016 May 28]. Available from: http://www.unicef.org/publications/files/low_birthweight_from_EY.pdf.
  3. Chan RL. Biochemical markers of spontaneous preterm birth in asymptomatic women. Biomed Res Int 2014;2014:164081.
  4. Paige DM, Augustyn M, Adih WK, Witter F, Chang J. Bacterial vaginosis and preterm birth: a comprehensive review of the literature. J Nurse Midwifery 1998;43(2):83-89. https://doi.org/10.1016/S0091-2182(97)00161-4
  5. Svare JA, Schmidt H, Hansen BB, Lose G. Bacterial vaginosis in a cohort of Danish pregnant women: prevalence and relationship with preterm delivery, low birthweight and perinatal infections. BJOG 2006;113(12):1419-1425. https://doi.org/10.1111/j.1471-0528.2006.01087.x
  6. Offenbacher S, Boggess KA, Murtha AP, Jared HL, Lieff S, McKaig RG, et al. Progressive periodontal disease and risk of very preterm delivery. Obstet Gynecol 2006;107(1):29-36. https://doi.org/10.1097/01.AOG.0000190212.87012.96
  7. Tarannum F, Faizuddin M. Effect of periodontal therapy on pregnancy outcome in women affected by periodontitis. J Periodontol 2007;78(11):2095-2103. https://doi.org/10.1902/jop.2007.060388
  8. Nugent RP, Krohn MA, Hillier SL. Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation. J Clin Microbiol 1991;29(2):297-301.
  9. Mahony JB, Luinstra KE, Sellors JW, Jang D, Chernesky MA. Confirmatory polymerase chain reaction testing for Chlamydia trachomatis in first-void urine from asymptomatic and symptomatic men. J Clin Microbiol 1992;30(9):2241-2245.
  10. World Health Organization. Oral health surveys: basic methods. 3rd ed. Geneva: World Health Organization; 1987.
  11. Goldenberg RL, Goepfert AR, Ramsey PS. Biochemical markers for the prediction of preterm birth. Am J Obstet Gynecol 2005;192(5 Suppl):S36-S46. https://doi.org/10.1016/j.ajog.2005.02.015
  12. Zhang YP, Liu XH, Gao SH, Wang JM, Gu YS, Zhang JY, et al. Risk factors for preterm birth in five Maternal and Child Health hospitals in Beijing. PLoS One 2012;7(12):e52780. https://doi.org/10.1371/journal.pone.0052780
  13. Vogel JP, Lee AC, Souza JP. Maternal morbidity and preterm birth in 22 low- and middle-income countries: a secondary analysis of the WHO Global Survey dataset. BMC Pregnancy Childbirth 2014;14:56. https://doi.org/10.1186/1471-2393-14-56
  14. Thomre PS, Borle AL, Naik JD, Rajderkar SS. Maternal risk factors determining birth weight of newborns: a tertiary care hospital based study. Int J Recent Trends Sci Technol 2012;5 (1):3-8.
  15. Mumbare SS, Maindarkar G, Darade R, Yenge S, Tolani MK, Patole K. Maternal risk factors associated with term low birth weight neonates: a matched-pair case control study. Indian Pediatr 2012;49(1):25-28. https://doi.org/10.1007/s13312-012-0010-z
  16. Nair NS, Rao RS, Chandrashekar S, Acharya D, Bhat HV. Sociodemographic and maternal determinants of low birth weight: a multivariate approach. Indian J Pediatr 2000;67(1):9-14. https://doi.org/10.1007/BF02802625
  17. Balamurugan SS, Bendigeri N. Community-based study of reproductive tract infections among women of the reproductive age group in the urban health training centre area in hubli, karnataka. Indian J Community Med 2012;37(1):34-38. https://doi.org/10.4103/0970-0218.94020
  18. Laxmi U, Agrawal S, Raghunandan C, Randhawa VS, Saili A. Association of bacterial vaginosis with adverse fetomaternal outcome in women with spontaneous preterm labor: a prospective cohort study. J Matern Fetal Neonatal Med 2012;25 (1):64-67. https://doi.org/10.3109/14767058.2011.565390
  19. Mittal V, Jain A, Pradeep Y. Development of modified diagnostic criteria for bacterial vaginosis at peripheral health centres in developing countries. J Infect Dev Ctries 2012;6(5):373-377.
  20. Koumans EH, Sternberg M, Bruce C, McQuillan G, Kendrick J, Sutton M, et al. The prevalence of bacterial vaginosis in the United States, 2001-2004; associations with symptoms, sexual behaviors, and reproductive health. Sex Transm Dis 2007;34 (11):864-869. https://doi.org/10.1097/OLQ.0b013e318074e565
  21. Larsson PG, Fahraeus L, Carlsson B, Jakobsson T, Forsum U. Predisposing factors for bacterial vaginosis, treatment efficacy and pregnancy outcome among term deliveries; results from a preterm delivery study. BMC Womens Health 2007;7:20. https://doi.org/10.1186/1472-6874-7-20
  22. Misra DP, Trabert B. Vaginal douching and risk of preterm birth among African American women. Am J Obstet Gynecol 2007;196(2):140.e1-140.e8. https://doi.org/10.1016/j.ajog.2006.10.880
  23. Klebanoff MA, Carey JC, Hauth JC, Hillier SL, Nugent RP, Thom EA, et al. Failure of metronidazole to prevent preterm delivery among pregnant women with asymptomatic Trichomonas vaginalis infection. N Engl J Med 2001;345(7):487-493. https://doi.org/10.1056/NEJMoa003329
  24. Giraldo PC, Araujo ED, Junior JE, do Amaral RL, Passos MR, Goncalves AK. The prevalence of urogenital infections in pregnant women experiencing preterm and full-term labor. Infect Dis Obstet Gynecol 2012;2012:878241.
  25. Carey JC, Klebanoff MA. Is a change in the vaginal flora associated with an increased risk of preterm birth? Am J Obstet Gynecol 2005;192(4):1341-1346. https://doi.org/10.1016/j.ajog.2004.12.069
  26. Donders GG, Van Calsteren K, Bellen G, Reybrouck R, Van den Bosch T, Riphagen I, et al. Predictive value for preterm birth of abnormal vaginal flora, bacterial vaginosis and aerobic vaginitis during the first trimester of pregnancy. BJOG 2009;116 (10):1315-1324. https://doi.org/10.1111/j.1471-0528.2009.02237.x
  27. Donati L, Di Vico A, Nucci M, Quagliozzi L, Spagnuolo T, Labianca A, et al. Vaginal microbial flora and outcome of pregnancy. Arch Gynecol Obstet 2010;281(4):589-600. https://doi.org/10.1007/s00404-009-1318-3
  28. Smaill F, Vazquez JC. Antibiotics for asymptomatic bacteriuria in pregnancy. Cochrane Database Syst Rev 2007;(2):CD000490.
  29. Jain V, Das V, Agarwal A, Pandey A. Asymptomatic bacteriuria & obstetric outcome following treatment in early versus late pregnancy in north Indian women. Indian J Med Res 2013;137 (4):753-758.
  30. Murthy S, Mubashir A, Kodkany BS, Mallapur MD. Pregnancy periodontitis and low birth weight: a cohort study in rural Belgaum, India. Glob J Med Public Health 2012;1(4):42-48.
  31. Kimura S, Ooshima T, Takiguchi M, Sasaki Y, Amano A, Morisaki I, et al. Periodontopathic bacterial infection in childhood. J Periodontol 2002;73(1):20-26. https://doi.org/10.1902/jop.2002.73.1.20
  32. Vogt M, Sallum AW, Cecatti JG, Morais SS. Factors associated with the prevalence of periodontal disease in low-risk pregnant women. Reprod Health 2012;9:3. https://doi.org/10.1186/1742-4755-9-3
  33. Yadav H, Lee N. Maternal factors in predicting low birth weight babies. Med J Malaysia 2013;68(1):44-47.
  34. Kim BJ, Romero R, Mi Lee S, Park CW, Shin Park J, Jun JK, et al. Clinical significance of oligohydramnios in patients with preterm labor and intact membranes. J Perinat Med 2011;39(2): 131-136. https://doi.org/10.1515/JPM.2010.168

Cited by

  1. Genetic polymorphism of MTHFR C677T with preterm birth and low birth weight susceptibility: a meta-analysis vol.295, pp.5, 2016, https://doi.org/10.1007/s00404-017-4322-z
  2. Genetic variations of MTHFR gene and their association with preterm birth in Korean women vol.53, pp.6, 2016, https://doi.org/10.1016/j.medici.2018.01.001
  3. Role of Maternal Periodontitis in Preterm Birth vol.8, pp.None, 2016, https://doi.org/10.3389/fimmu.2017.00139
  4. Distribution and Determinants of Low Birth Weight in Developing Countries vol.50, pp.1, 2016, https://doi.org/10.3961/jpmph.16.087
  5. DOHaD at the intersection of maternal immune activation and maternal metabolic stress: a scoping review vol.8, pp.3, 2017, https://doi.org/10.1017/s2040174417000010
  6. Co‐causation of reduced newborn size by maternal undernutrition, infections, and inflammation vol.14, pp.3, 2016, https://doi.org/10.1111/mcn.12585
  7. Maternal Risk Factors Associated with Low Birth Weight in Indonesia vol.11, pp.None, 2016, https://doi.org/10.2174/1874944501811010376
  8. Associations between maternal weekly air pollutant exposures and low birth weight: a distributed lag non-linear model vol.13, pp.2, 2016, https://doi.org/10.1088/1748-9326/aaa346
  9. Influence of dental diseases of pregnant women on newborns’ health state vol.99, pp.4, 2018, https://doi.org/10.17816/kmj2018-586
  10. Early Identification of Preterm Neonates at Birth With a Tablet App for the Simplified Gestational Age Score (T-SGAS) When Ultrasound Gestational Age Dating Is Unavailable: Protocol for a Validation S vol.8, pp.3, 2016, https://doi.org/10.2196/11913
  11. PRETERM LABOR MANAGEMENT: A NARRATIVE REVIEW vol.8, pp.4, 2016, https://doi.org/10.26634/jnur.8.4.14910
  12. Association Between Periodontal Diseases and Adverse Gestation Outcomes: a Review of the Current Literature vol.6, pp.1, 2016, https://doi.org/10.1007/s40496-019-0209-3
  13. Role of Social Support and Spouse Abuse in Low Birth Weight: A Case–control Study from Puducherry, India vol.44, pp.1, 2016, https://doi.org/10.4103/ijcm.ijcm_114_18
  14. A Pregnancy Cohort to Study Multidimensional Correlates of Preterm Birth in India: Study Design, Implementation, and Baseline Characteristics of the Participants vol.188, pp.4, 2016, https://doi.org/10.1093/aje/kwy284
  15. Incidence and recurrence risk of low birth weight in Northern Tanzania: A registry based study vol.14, pp.4, 2016, https://doi.org/10.1371/journal.pone.0215768
  16. Development of Risk Scoring Scale Tool for Prediction of Preterm Birth vol.44, pp.2, 2016, https://doi.org/10.4103/ijcm.ijcm_262_18
  17. The Role of Early Pregnancy Maternal Selenium Levels on the Risk for Small-for-Gestational Age Newborns vol.11, pp.10, 2019, https://doi.org/10.3390/nu11102298
  18. Mother’s Knowledge and Behaviour Towards Oral Health During Pregnancy vol.20, pp.None, 2016, https://doi.org/10.1590/pboci.2020.113
  19. Periodontal Disease and Birth Outcomes: Are We Missing Something? vol.7, pp.1, 2016, https://doi.org/10.1007/s40496-020-00255-5
  20. Determinants of Low Birth Weight in Ghana: Does Quality of Antenatal Care Matter? vol.24, pp.5, 2016, https://doi.org/10.1007/s10995-020-02895-6
  21. Periodontal disease and adverse pregnancy outcomes vol.83, pp.1, 2016, https://doi.org/10.1111/prd.12294
  22. Population estimates, consequences, and risk factors of obesity among pregnant and postpartum women in India: Results from a national survey and policy recommendations vol.151, pp.suppl1, 2016, https://doi.org/10.1002/ijgo.13319
  23. Pregnancy, oral health and dental education: an overview on the northeast of Italy vol.48, pp.8, 2016, https://doi.org/10.1515/jpm-2020-0032
  24. Evaluation of maternal risk factors for preterm delivery in Fatemieh Hospital of Hamadan, Iran, 2019: A case-control study vol.10, pp.10, 2016, https://doi.org/10.4103/jfmpc.jfmpc_1032_21
  25. Preterm birth associated with periodontal and dental indicators: a pilot case-control study in a developing country vol.34, pp.5, 2016, https://doi.org/10.1080/14767058.2019.1613363
  26. Maternal periodontal status, oral inflammatory load, and systemic inflammation are associated with low infant birth weight vol.92, pp.8, 2016, https://doi.org/10.1002/jper.20-0266
  27. Relationship of Anemia in Pregnancy and Low Birth Weight Infants vol.18, pp.3, 2016, https://doi.org/10.7199/ped.oncall.2021.38
  28. Screening and management options for severe thinness during pregnancy in India vol.155, pp.3, 2016, https://doi.org/10.1002/ijgo.13939
  29. Population estimates and determinants of severe maternal thinness in India vol.155, pp.3, 2021, https://doi.org/10.1002/ijgo.13940
  30. Risk factors associated with preterm birth in the Dominican Republic: a case-control study vol.11, pp.12, 2016, https://doi.org/10.1136/bmjopen-2020-045399