lancet-header
Preprints with The Lancet is part of SSRN´s First Look, a place where journals and other research experts identify content of interest prior to publication. These preprint papers are not peer-reviewed. Authors have either opted in at submission to The Lancet family of journals to post their preprints on Preprints with The Lancet, or submitted directly via SSRN. The usual SSRN checks and a Lancet-specific check for appropriateness and transparency have been applied. Preprints available here are not Lancet publications or necessarily under review with a Lancet journal. These papers should not be used for clinical decision making or reporting of research to a lay audience without indicating that this is preliminary research that has not been peer-reviewed. For more information see the Comment published in The Lancet, or visit The Lancet´s FAQ page, and for any feedback please contact preprints@lancet.com

Impact of Diabetes, Obesity and Hypertension on Preterm Birth: Population-Based Study

18 Pages Posted: 18 Apr 2019

See all articles by Howard Berger

Howard Berger

University of Toronto - Division of Maternal-Fetal Medicine

Nir Melamed

University of Toronto - Division of Maternal-Fetal Medicine

Beth Murray Davis

McMaster University - Department of Obstetrics and Gynecology

Haroon Hasan

Children's Hospital of Eastern Ontario Research Institute (CHEO)

Karizma Mawjee

University of Toronto - Division of Maternal-Fetal Medicine

Jon Barrett

McMaster University - Department of Obstetrics and Gynecology

Sarah D. McDonald

McMaster University

Michael Geary

Rotunda Hospital

Diabetes, Obesity and Hypertension in Pregnancy Research Network (DOH-NET)

Southern Ontario Obstetrical Network

More...

Abstract

Background: Preterm birth (PTB) is a major cause of infant death globally. The rising rates of pre-pregnancy diabetes mellitus (D), obesity (O) and chronic hypertension (H) will place a significant burden on maternal-fetal health but their combined influence on PTB is unknown.

Methods: Population-based cohort study, Ontario, Canada, April 1, 2012 to March 31 2016. Participants were 506,483 women with a singleton livebirth or stillbirth at > 20 weeks' gestation. The exposures of interest were D, O and H, individually, and in various combinations. The primary outcome was PTB at 241/7 to 366/7 weeks. PTB was further analyzed by spontaneous or provider-initiated, early (< 34 weeks) or late (34-37 weeks), and the co-presence of preeclampsia, large for gestational age (LGA), and small for gestational age (SGA) birthweight. Multivariable Poisson regression models with robust error variance were used to generate relative risks (RR), further adjusted for maternal age and parity (aRR). Population attributable fractions were then calculated for each of the outcomes by exposure state.

Findings: Relative to women without D or O or H, the aRR for PTB were (3.09, 95% CI 2.80-3.40) with D + O, 6.34 (95% CI 5.15-7.81) with D + H, 2.96 (95% CI 2.70-3.24) with O + H, and 5.55 (95% CI 4.76-6.47) with D + O + H. In women with D + H, aRR was more pronounced for provider-initiated PTB (10.99, 95% CI 8.40-14.38) than for spontaneous PTB (3.05, 95% CI 1.92-4.85). Those with D + O + H had an aRR of 9.21 (95% CI 4.97-17.04) for PTB with an SGA newborn relative to those without D or O or H.

Interpretation: Combinations of D, O and H significantly magnify the risk of PTB, especially provider-initiated PTB, and PTB with altered fetal growth or preeclampsia. These data may inform health policy and clinical decision-making both at the population and patient level.

Funding: CIHR.

Declaration of Interest: All authors report no conflict of interest

Ethical Approval: Ethics approval was obtained from the St. Michael’s Hospital Research Ethics Board (REB # 16-345).

Keywords: Pregnancy, Preterm Birth, Diabetes, Hypertension, Obesity

Suggested Citation

Berger, Howard and Melamed, Nir and Davis, Beth Murray and Hasan, Haroon and Mawjee, Karizma and Barrett, Jon and McDonald, Sarah D. and Geary, Michael and (DOH-NET), Diabetes, Obesity and Hypertension in Pregnancy Research Network and Network, Southern Ontario Obstetrical, Impact of Diabetes, Obesity and Hypertension on Preterm Birth: Population-Based Study (April 17, 2019). Available at SSRN: https://ssrn.com/abstract=3373850 or http://dx.doi.org/10.2139/ssrn.3373850

Howard Berger (Contact Author)

University of Toronto - Division of Maternal-Fetal Medicine ( email )

Canada

Nir Melamed

University of Toronto - Division of Maternal-Fetal Medicine

Canada

Beth Murray Davis

McMaster University - Department of Obstetrics and Gynecology

Canada

Haroon Hasan

Children's Hospital of Eastern Ontario Research Institute (CHEO)

401 Smyth Road
Ottawa, Ontario K1H 8L1
Canada

Karizma Mawjee

University of Toronto - Division of Maternal-Fetal Medicine ( email )

Canada

Jon Barrett

McMaster University - Department of Obstetrics and Gynecology

Canada

Sarah D. McDonald

McMaster University

1280 Main Street West
Hamilton, Ontario L8S 4M4
Canada

Michael Geary

Rotunda Hospital

Ireland

No contact information is available for Diabetes, Obesity and Hypertension in Pregnancy Research Network (DOH-NET)
No contact information is available for Southern Ontario Obstetrical Network

Click here to go to TheLancet.com

Paper statistics

Abstract Views
197
Downloads
23