title: Characteristics and risk factors of preterm births in a tertiary center in Lagos, Nigeria.
abstract: BACKGROUND
  Preterm birth is a dire complication of pregnancy that poses huge long-term medical and financial burdens for affected children, their families, and the health care system. The aim of the present study was to identify characteristics associated with preterm births at the Lagos University Teaching Hospital (LUTH), Lagos, Nigeria from 2011 to 2013.
  
  
  METHODS
  We obtained Information from 5,561 maternal, fetal/neonatal and obstetric records from the labor ward. We excluded delivery at less than 22 weeks (0.25%), post-term birth at ≥42 weeks gestation (1.3%), and unknown gestation (1.4%). Additionally, we excluded records of multiple births (5.4%) and stillbirths (8.3%) leaving 4,691 records of singleton live-births for analysis. Logistic regression analysis was performed comparing preterm birth (22-36 weeks gestation) to term birth (37-41 weeks gestation). Multiple variable models adjusting for maternal age, parity, fetal position, delivery method and booking status were also evaluated. Multinomial regression was used to identify characteristics associated with preterm birth (PTB) defined as early PTB (22-31 weeks gestation), moderate PTB (32-34 weeks gestation), late PTB (35-36 weeks gestation), compared to term birth (37-41 completed weeks gestation).
  
  
  RESULTS
  From our data, 16.8% of the singleton live-birth deliveries were preterm (<37 weeks gestation). Of these, 4.7% were early (22-31 weeks), 4.5% were moderate (32-34 weeks) and 7.7% were late (35-36) PTBs. Older maternal age (≥35 years) [odds ratio (OR) = 1.41], hypertension (OR = 3.44) and rupture of membranes (OR = 4.03) were significantly associated with increased odds of PTB. Women being treated for the prevention of mother-to-child transmission of HIV were at a significantly decreased risk for PTB (OR = 0.70). Sixteen percent of women in this cohort were not registered for antenatal care in LUTH. These non-registered subjects had significantly greater odds of all categories of PTB, including early (odds ratio (OR) = 20.8), moderate (OR = 8.68), and late (OR = 2.15).
  
  
  CONCLUSIONS
  PTB and risks for PTB remain high in Nigeria. We recommend that any high risk pregnancy should be referred to a tertiary center for prenatal care in order to significantly reduce adverse birth outcomes such as PTBs.
authors: Department of Oral Pathology, Radiology and Medicine, College of Dentistry, University of Iowa, IA, USA.
authors: Azeez
authors: A
authors: Butali
authors: Department of Pediatrics, College of Medicine, University of Lagos, Nigeria.
authors: Chinyere
authors: C
authors: Ezeaka
authors: Department of Pediatrics, University of Iowa, IA, USA.
authors: Osayame
authors: O
authors: Ekhaguere
authors: Department of Pediatrics, University of Iowa, IA, USA.
authors: Nancy
authors: N
authors: Weathers
authors: Department of Epidemiology, College of Public Health, University of Iowa, IA, USA.
authors: Jenna
authors: J
authors: Ladd
authors: Department of Pediatrics, College of Medicine, University of Lagos, Nigeria.
authors: Iretiola
authors: I
authors: Fajolu
authors: Department of Pediatrics, College of Medicine, University of Lagos, Nigeria.
authors: Christopher
authors: C
authors: Esezobor
authors: Department of Obstetrics and Gynecology, College of Medicine, University of Lagos, Nigeria.
authors: Christian
authors: C
authors: Makwe
authors: Department of Pediatrics, College of Medicine, University of Lagos, Nigeria.
authors: Bukola
authors: B
authors: Odusanya
authors: Department of Pediatrics, College of Medicine, University of Lagos, Nigeria.
authors: Rose
authors: R
authors: Anorlu
authors: Department of Oral and Maxillofacial Surgery, College of Medicine, University of Lagos, Nigeria.
authors: Wasiu
authors: W
authors: Adeyemo
authors: Department of Pediatrics, College of Medicine, University of Lagos, Nigeria.
authors: Edna
authors: E
authors: Iroha
authors: Department of Pediatrics, College of Medicine, University of Lagos, Nigeria.
authors: Mathias
authors: M
authors: Egri-Okwaji
authors: Department of Nursing, University of Ibadan, Nigeria.
authors: Prisca
authors: P
authors: Adejumo
authors: Department of Obstetrics and Gynecology, Mother and Child Hospital Ondo, Ondo, Nigeria.
authors: Lawal
authors: L
authors: Oyeneyin
authors: Department of Pediatrics, Mother and Child Hospital Ondo, Ondo, Nigeria.
authors: Moses
authors: M
authors: Abiodun
authors: Department of Pediatrics, Mother and Child Hospital Ondo, Ondo, Nigeria.
authors: Bolaji
authors: B
authors: Badejoko
authors: Department of Epidemiology, College of Public Health, University of Iowa, IA, USA.
authors: Kelli
authors: K
authors: Ryckman
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005865:Gestational Age; D006785:Hospitals, University; D006801:Humans; D016015:Logistic Models; D008297:Male; D008423:Maternal Age; D009549:Nigeria / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D047928:Premature Birth / Q000453:epidemiology / Q000209:etiology*; D011295:Prenatal Care / Q000706:statistics & numerical data*; D012307:Risk Factors; D055815:Young Adult
keywords: Nigeria; Preterm birth; not registered for antenatal care