title: What contributes to disparities in the preterm birth rate in European countries?
abstract: OBJECTIVE
  In countries with comparable levels of development and healthcare systems, preterm birth rates vary markedly--a range from 5 to 10% among live births in Europe. This review seeks to identify the most likely sources of heterogeneity in preterm birth rates, which could explain differences between European countries.
  
  
  RESULTS
  Multiple risk factors impact on preterm birth. Recent studies reported on measurement issues, population characteristics, reproductive health policies as well as medical practices, including those related to subfertility treatments and indicated deliveries, which affect preterm birth rates and trends in high-income countries. We showed wide variation in population characteristics, including multiple pregnancies, maternal age, BMI, smoking, and percentage of migrants in European countries.
  
  
  CONCLUSIONS
  Many potentially modifiable population factors (BMI, smoking, and environmental exposures) as well as health system factors (practices related to indicated preterm deliveries) play a role in determining preterm birth risk. More knowledge about how these factors contribute to low and stable preterm birth rates in some countries is needed for shaping future policy. It is also important to clarify the potential contribution of artifactual differences owing to measurement.
authors.affiliation: INSERM U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Research Center for Epidemiology and Biostatistics Sorbonne Paris Cité (CRESS), Paris Descartes University, Paris, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Delnord
authors.forename: Béatrice
authors.initials: B
authors.lastname: Blondel
authors.forename: Jennifer
authors.initials: J
authors.lastname: Zeitlin
mesh_terms: D000328:Adult; D015992:Body Mass Index; D004781:Environmental Exposure / Q000009:adverse effects*; D005060:Europe / Q000453:epidemiology; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D008425:Maternal Behavior; D011050:Policy Making; D011159:Population Surveillance; D011247:Pregnancy; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000453:epidemiology*; D027724:Reproductive Techniques, Assisted / Q000706:statistics & numerical data*; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*