Comparative Study

. 2017 Apr;124(5):785-794.

doi: 10.1111/1471-0528.14273. Epub 2016 Sep 10.

Variations in very preterm birth rates in 30 high-income countries: are valid international comparisons possible using routine data?

M Delnord¹, A D Hindori-Mohangoo^{2

3}, L K Smith⁴, K Szamotulska⁵, J L Richards⁶, P Deb-Rinker⁷, J Rouleau⁷, P Velebil⁸, I Zile⁹, L Sakkeus¹⁰, M Gissler^{11

12}, N Morisaki¹³, S M Dolan¹⁴, M R Kramer⁶, M S Kramer¹⁵, J Zeitlin¹; Euro-Peristat Scientific Committee

Collaborators, Affiliations

Collaborators

Affiliations

¹ Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France.
² Department Child Health, TNO, The Netherlands Organisation for Applied Scientific Research, Leiden, The Netherlands.
³ Department Public Health, Faculty of Medical Sciences, Anton de Kom University of Suriname, Paramaribo, Suriname.
⁴ The Infant Mortality and Morbidity Studies Group (TIMMS), Department of Health Sciences, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK.
⁵ Department of Epidemiology and Biostatistics, National Research Institute of Mother and Child, Warsaw, Poland.
⁶ Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
⁷ Surveillance and Epidemiology Division, Centre for Chronic Disease Prevention, Public Health Agency of Canada, Ottawa, ON, Canada.
⁸ Institute for the Care of Mother and Child, Prague, Czech Republic.
⁹ Centre for Disease Prevention and Control of Latvia, Riga, Latvia.
¹⁰ Estonian Institute for Population Studies, Tallinn University, Tallinn, Estonia.
¹¹ THL National Institute for Health and Welfare, Helsinki, Finland.
¹² Karolinska Institute, Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Stockholm, Sweden.
¹³ Department of Lifecourse Epidemiology, Department of Social Medicine, National Centre for Child Health and Development, Setagayaku, Tokyo, Japan.
¹⁴ Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA.
¹⁵ Departments of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, QC, Canada.

PMID: 27613083
PMCID: PMC5346062
DOI: 10.1111/1471-0528.14273

Comparative Study

Variations in very preterm birth rates in 30 high-income countries: are valid international comparisons possible using routine data?

M Delnord et al. BJOG. 2017 Apr.

. 2017 Apr;124(5):785-794.

doi: 10.1111/1471-0528.14273. Epub 2016 Sep 10.

Authors

Collaborators

Affiliations

¹ Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France.
² Department Child Health, TNO, The Netherlands Organisation for Applied Scientific Research, Leiden, The Netherlands.
³ Department Public Health, Faculty of Medical Sciences, Anton de Kom University of Suriname, Paramaribo, Suriname.
⁴ The Infant Mortality and Morbidity Studies Group (TIMMS), Department of Health Sciences, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK.
⁵ Department of Epidemiology and Biostatistics, National Research Institute of Mother and Child, Warsaw, Poland.
⁶ Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
⁷ Surveillance and Epidemiology Division, Centre for Chronic Disease Prevention, Public Health Agency of Canada, Ottawa, ON, Canada.
⁸ Institute for the Care of Mother and Child, Prague, Czech Republic.
⁹ Centre for Disease Prevention and Control of Latvia, Riga, Latvia.
¹⁰ Estonian Institute for Population Studies, Tallinn University, Tallinn, Estonia.
¹¹ THL National Institute for Health and Welfare, Helsinki, Finland.
¹² Karolinska Institute, Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Stockholm, Sweden.
¹³ Department of Lifecourse Epidemiology, Department of Social Medicine, National Centre for Child Health and Development, Setagayaku, Tokyo, Japan.
¹⁴ Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA.
¹⁵ Departments of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, QC, Canada.

PMID: 27613083
PMCID: PMC5346062
DOI: 10.1111/1471-0528.14273

Abstract

Objective: Concerns about differences in registration practices across countries have limited the use of routine data for international very preterm birth (VPT) rate comparisons.

Design: Population-based study.

Setting: Twenty-seven European countries, the United States, Canada and Japan in 2010.

Population: A total of 9 376 252 singleton births.

Method: We requested aggregated gestational age data on live births, stillbirths and terminations of pregnancy (TOP) before 32 weeks of gestation, and information on registration practices for these births. We compared VPT rates and assessed the impact of births at 22-23 weeks of gestation, and different criteria for inclusion of stillbirths and TOP on country rates and rankings.

Main outcome measures: Singleton very preterm birth rate, defined as singleton stillbirths and live births before 32 completed weeks of gestation per 1000 total births, excluding TOP if identifiable in the data source.

Results: Rates varied from 5.7 to 15.7 per 1000 total births and 4.0 to 11.9 per 1000 live births. Country registration practices were related to percentage of births at 22-23 weeks of gestation (between 1% and 23% of very preterm births) and stillbirths (between 6% and 40% of very preterm births). After excluding births at 22-23 weeks, rate variations remained high and with a few exceptions, country rankings were unchanged.

Conclusions: International comparisons of very preterm birth rates using routine data should exclude births at 22-23 weeks of gestation and terminations of pregnancy. The persistent large rate variations after these exclusions warrant continued surveillance of VPT rates at 24 weeks and over in high-income countries.

Tweetable abstract: International comparisons of VPT rates should exclude births at 22-23 weeks of gestation and terminations of pregnancy.

Keywords: Euro-Peristat; international comparisons; preterm birth; stillbirths; very preterm.

PubMed Disclaimer

Conflict of interest statement

Disclosure of interests: The authors declare that they have no conflict of interest. The ICMJE disclosure forms are available as online supporting information.

Figures

**Figure 1**
Births at 22 and 23 weeks as a percent of singleton very preterm births in 30 countries in 2010 according to registration practices for births and deaths

**Figure 2**
Stillbirths as a percent of singleton very preterm births in 30 countries in 2010 according to registration practices for births and deaths

See this image and copyright information in PMC

Comment in

Collect and report accurate early gestational age birth data.
Goldenberg RL, McClure EM. Goldenberg RL, et al. BJOG. 2017 Apr;124(5):795. doi: 10.1111/1471-0528.14380. Epub 2016 Oct 20. BJOG. 2017. PMID: 27766719 No abstract available.
Re: Variations in very preterm birth rates in 30 high-income countries: are valid international comparisons possible using routine data?: Croatian experience supporting inclusion of routine very preterm birth data for valid comparison.
Filipović-Grčić B, Rodin U. Filipović-Grčić B, et al. BJOG. 2017 Sep;124(10):1623-1624. doi: 10.1111/1471-0528.14641. Epub 2017 Jun 26. BJOG. 2017. PMID: 28649709 No abstract available.

References

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Variations in very preterm birth rates in 30 high-income countries: are valid international comparisons possible using routine data?

Collaborators

Affiliations

Variations in very preterm birth rates in 30 high-income countries: are valid international comparisons possible using routine data?

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Figures

Comment in

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources