title: Changes in risk factors for preterm birth in Western Australia 1984-2006.
abstract: OBJECTIVE
  To characterise changing risk factors of preterm birth in Western Australia between 1984 and 2006.
  
  
  METHODS
  Population-based study.
  
  
  METHODS
  Western Australia.
  
  
  METHODS
  All non-Aboriginal women giving birth to live singleton infants between 1984 and 2006.
  
  
  METHODS
  Multinomial, multivariable regression models were used to assess antecedent profiles by preterm status and labour onset types (spontaneous, medically indicated, prelabour rupture of membranes [PROM]). Population attributable fraction (PAF) estimates characterized the contribution of individual antecedents as well as the overall contribution of two antecedent groups: pre-existing medical conditions (including previous obstetric history) and pregnancy complications.
  
  
  METHODS
  Antecedent relationships with preterm birth, stratified by labour onset type.
  
  
  RESULTS
  Marked increases in maternal age and primiparous births were observed. A four-fold increase in the rates of pre-existing medical complications over time was observed. Rates of pregnancy complications remained stable. Multinomial regression showed differences in antecedent profiles across labour onset types. PAF estimates indicated that 50% of medically indicated preterm deliveries could be eliminated after removing six antecedents from the population; estimates for PROM and spontaneous preterm reduction were between 10 and 20%. Variables pertaining to previous and current obstetric complications (previous preterm birth, previous caesarean section, pre-eclampsia and antepartum haemorrhage) were the most influential predictors of preterm birth and adverse labour onset (PROM and medically indicated).
  
  
  CONCLUSIONS
  Preterm antecedent profiles have changed markedly over the 23 years studied. Some changes may be attributable to true change, others to advances in surveillance and detection. Still others may signify change in clinical practice.
authors: Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, Perth, WA, Australia. ghammond@ichr.uwa.edu.au
authors: G
authors: G
authors: Hammond
authors: A
authors: A
authors: Langridge
authors: H
authors: H
authors: Leonard
authors: R
authors: R
authors: Hagan
authors: P
authors: P
authors: Jacoby
authors: N
authors: N
authors: DeKlerk
authors: C
authors: C
authors: Pennell
authors: F
authors: F
authors: Stanley
mesh_terms: D000328:Adult; D001249:Asthma / Q000150:complications / Q000453:epidemiology*; D017604:Cesarean Section, Repeat / Q000009:adverse effects; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000453:epidemiology; D006558:Herpes Genitalis / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000453:epidemiology*; D007231:Infant, Newborn; D008423:Maternal Age; D007752:Obstetric Labor, Premature / Q000453:epidemiology*; D010298:Parity; D011225:Pre-Eclampsia / Q000453:epidemiology*; D011237:Predictive Value of Tests; D011247:Pregnancy; D018566:Pregnancy, High-Risk; D047928:Premature Birth / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D012044:Regression Analysis; D012307:Risk Factors; D012959:Socioeconomic Factors; D014904:Western Australia / Q000453:epidemiology
keywords: Antecedents; labour onset; medically indicated; population attributable risk; prelabour rupture of membranes; preterm birth