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CC BY-NC-ND 4.0 · AJP Rep 2019; 09(01): e44-e53
DOI: 10.1055/s-0039-1678716
Case Report
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Risk Factors for Very Preterm Births in French Guiana: The Burden of Induced Preterm Birth

Malika Leneuve-Dorilas
1   University of French Guiana, Cayenne General Hospital, Cayenne, French Guiana
,
Anne Favre
2   French Guiana Perinat Network, Cayenne General Hospital, Cayenne, French Guiana
,
Alphonse Louis
3   Cayenne General Hospital, Cayenne, French Guiana
,
Stéphanie Bernard
2   French Guiana Perinat Network, Cayenne General Hospital, Cayenne, French Guiana
,
Gabriel Carles
4   Hospital of Saint–Laurent du Maroni, Saint–Laurent du Maroni, French Guiana
,
Mathieu Nacher
1   University of French Guiana, Cayenne General Hospital, Cayenne, French Guiana
› Author Affiliations
Further Information

Publication History

06 June 2018

08 September 2018

Publication Date:
04 March 2019 (online)

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Abstract

Background Early preterm births are still represented as a major public health problem in French Guiana. The objective of the present study was to study factors associated with early preterm birth in French Guiana.

Methods A monocentric age-matched case control study was conducted at the sole level 3 maternity in French Guiana. In utero fetal deaths and multiple pregnancies were not included. Cases were defined as giving birth prematurely between 22 and 32 weeks of pregnancy. Controls were defined as women delivering on term. For each case three controls were matched on age. In utero deaths, medical pregnancy interruptions and multiple pregnancies (a known major cause of preterm delivery) were excluded from the study. Sociodemographic variables, medical and obstetrical history, the complications of the current pregnancy, and the results of the last vaginal swab before delivery were recorded in the second or the third trimester. Thematic conditional logistic regression models were computed.

Results Overall 94 cases and 282 matched controls were included. Preterm delivery was spontaneous in 47.9% (45/94) of the cases and induced in 52.1% (49/94).A history of preterm birth was associated with both spontaneous and induced preterm delivery. The absence of health insurance was associated with spontaneous early preterm delivery AOR (adjusted odd ratio) = 9.1 (2.2–38.3), p = 0.002 but not induced preterm delivery adjusted odd ratio (AOR) = 2.1 (0.6–6.7), p = 0.2. Gravidic hypertension, placenta praevia, intrauterine growth retardation and mostly preeclampsia (66%, 32/49) were linked to induced preterm delivery but not spontaneous delivery. Gardnerellavaginalis and group B Streptococcus infections were significantly associated with induced early preterm delivery but not spontaneous early preterm delivery.

Conclusions Social factors were associated with spontaneous early preterm delivery, suggesting that efforts to reduce psychosocial stressors could lead to potential improvements. Vaginal infections were also associated with induced preterm labor suggesting that early diagnosis and treatment could reduce induced early preterm delivery. Preeclampsia was a major contributor to induced early preterm delivery. Reliable routine predictors of preeclampsia are still not available which makes its prevention impossible in first pregnancies.

Keywords

preterm delivery - preeclampsia - vaginosis - social stressors - access to care

Consent for Publication

All patients gave consent to participate in the study and for the publication of its results.


Authors' Contributions

M.L.D. analyzed and interpreted data. She has been involved in drafting the manuscript and performed the statistical analysis. A.F., G.C., A.L., and S.B. have been involved in revising the article. M.L.D. and M.N. have given final approval of the version to be published. M.N. drafted the manuscript and has made substantial contributions to the presentation, outline organization of this article.


Availability of Data and Materials

There is no personal identification risk within this anonymized raw data which is available after notification and authorization of the competent authorities. In France, all computer data (including databases, in particular patient data) are protected by the National Commission for Information Technology and Civil Liberties (CNIL), the national data protection authority for France. CNIL is an independent French administrative regulatory body whose mission is to ensure that data privacy law is applied to the collection, storage, and use of personal data. As the database of this study was authorized by the CNIL, the authors cannot make available data without prior agreement of the CNIL. Additionally, interested researchers may contact MalikaLeneuve with data accession requests at the following email address: malika.leneuve@ch-cayenne.fr.


Ethics Approval and Consent to Participate/Consent for Publication

The retrospective analysis of anonymized monocentric data from medical records is authorized by French authorities. The project was approved by the local Ethical committee (n°3–2016-V1). The database was declared to the regulatory authorities, the Commission Nationale Informatiqueet Libertés CNIL (1914209v 0 le 18/12/2015).


 

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