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Comparative Study
. 2017 Aug;124(9):1346-1354.
doi: 10.1111/1471-0528.14548. Epub 2017 Feb 20.

Impact of stillbirths on international comparisons of preterm birth rates: a secondary analysis of the WHO multi-country survey of Maternal and Newborn Health

N Morisaki  1 , T Ganchimeg  2 , J P Vogel  3 , J Zeitlin  4 , J G Cecatti  5 , J P Souza  6 , C Pileggi Castro  7 , M R Torloni  8 , E Ota  9 , R Mori  10 , S M Dolan  11 , S Tough  12 , S Mittal  13 , V Bataglia  14 , B Yadamsuren  15 , M S Kramer  16 ; PREBIC Epidemiology Working Group and the WHO-MCS Research Network
Affiliations
Comparative Study

Impact of stillbirths on international comparisons of preterm birth rates: a secondary analysis of the WHO multi-country survey of Maternal and Newborn Health

N Morisaki et al. BJOG. 2017 Aug.

Abstract

Objective: To evaluate the extent to which stillbirths affect international comparisons of preterm birth rates in low- and middle-income countries.

Design: Secondary analysis of a multi-country cross-sectional study.

Setting: 29 countries participating in the World Health Organization Multicountry Survey on Maternal and Newborn Health.

Population: 258 215 singleton deliveries in 286 hospitals.

Methods: We describe how inclusion or exclusion of stillbirth affect rates of preterm births in 29 countries.

Main outcome measures: Preterm delivery.

Results: In all countries, preterm birth rates were substantially lower when based on live births only, than when based on total births. However, the increase in preterm birth rates with inclusion of stillbirths was substantially higher in low Human Development Index (HDI) countries [median 18.2%, interquartile range (17.2-34.6%)] compared with medium (4.3%, 3.0-6.7%), and high-HDI countries (4.8%, 4.4-5.5%).

Conclusion: Inclusion of stillbirths leads to higher estimates of preterm birth rate in all countries, with a disproportionately large effect in low-HDI countries. Preterm birth rates based on live births alone do not accurately reflect international disparities in perinatal health; thus improved registration and reporting of stillbirths are necessary.

Tweetable abstract: Inclusion of stillbirths increases preterm birth rates estimates, especially in low-HDI countries.

Keywords: Global health; low income country; perinatal health; preterm birth; stillbirth.

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Figures

Figure 1
Figure 1
Study population flow chart. *Used Alexander et al. US reference for fetal growth.
Figure 2
Figure 2
Proportions of live births among all deliveries [live births/(live births + stillbirths)] by gestational age category. Comparison between countries of high‐, medium‐ and low‐Human Developmental Index participating in the WHO Multicountry Survey. Centre lines show the medians; box limits indicate the 25th and 75th percentiles; whiskers extend 1.5 times the interquartile range from 25th and 75th percentiles; circles show outliers.
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