title: Risk factors for spontaneous and provider-initiated preterm delivery in high and low Human Development Index countries: a secondary analysis of the World Health Organization Multicountry Survey on Maternal and Newborn Health.
abstract: OBJECTIVE
  To evaluate how the effect of maternal complications on preterm birth varies between spontaneous and provider-initiated births, as well as among different countries.
  
  
  METHODS
  Secondary analysis of a cross-sectional study.
  
  
  METHODS
  Twenty-nine countries participating in the World Health Organization Multicountry Survey on Maternal and Newborn Health.
  
  
  METHODS
  299 878 singleton deliveries of live neonates or fresh stillbirths.
  
  
  METHODS
  Countries were categorised into very high, high, medium and low developed countries using the Human Development Index (HDI) of 2012 by the World Bank. We described the prevalence and risk of maternal complications, their effect on outcomes and their variability by country development.
  
  
  METHODS
  Preterm birth, fresh stillbirth and early neonatal death.
  
  
  RESULTS
  The proportion of provider-initiated births among preterm deliveries increased with development: 19% in low to 40% in very high HDI countries. Among preterm deliveries, the socially disadvantaged were less likely, and the medically high risk were more likely, to have a provider-initiated delivery. The effects of anaemia [adjusted odds ratio (AOR), 2.03; 95% confidence interval (CI), 1.84; 2.25], chronic hypertension (AOR, 2.28; 95% CI, 1.94; 2.68) and pre-eclampsia/eclampsia (AOR, 5.03; 95% CI, 4.72; 5.37) on preterm birth were similar among all four HDI subgroups.
  
  
  CONCLUSIONS
  The provision of adequate obstetric care, including optimal timing for delivery in high-risk pregnancies, especially to the socially disadvantaged, could improve pregnancy outcomes. Avoiding preterm delivery in women when maternal complications, such as anaemia or hypertensive disorders, are present is important for countries at various stages of development, but may be more challenging to achieve.
authors.affiliation: Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan; Department of Paediatrics, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Morisaki
authors.forename: G
authors.initials: G
authors.lastname: Togoobaatar
authors.forename: J P
authors.initials: JP
authors.lastname: Vogel
authors.forename: J P
authors.initials: JP
authors.lastname: Souza
authors.forename: C J
authors.initials: CJ
authors.lastname: Rowland Hogue
authors.forename: K
authors.initials: K
authors.lastname: Jayaratne
authors.forename: E
authors.initials: E
authors.lastname: Ota
authors.forename: R
authors.initials: R
authors.lastname: Mori
mesh_terms: D000293:Adolescent; D000328:Adult; D000349:Africa / Q000453:epidemiology; D000740:Anemia / Q000401:mortality; D001208:Asia / Q000453:epidemiology; D002585:Cesarean Section / Q000401:mortality / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000401:mortality / Q000706:statistics & numerical data*; D004461:Eclampsia / Q000401:mortality*; D005260:Female; D005865:Gestational Age; D019538:Health Care Surveys; D006801:Humans; D007843:Latin America / Q000453:epidemiology; D008877:Middle East / Q000453:epidemiology; D011225:Pre-Eclampsia / Q000401:mortality*; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000401:mortality* / Q000517:prevention & control; D011251:Pregnancy Complications, Infectious / Q000401:mortality* / Q000517:prevention & control; D011256:Pregnancy Outcome; D018566:Pregnancy, High-Risk; D047928:Premature Birth / Q000453:epidemiology*; D012307:Risk Factors; D050497:Stillbirth; D014944:World Health Organization; D055815:Young Adult
keywords: Preterm birth; scheduled delivery; spontaneous labour