Division of Obstetrics and Gynaecology, University of Western Australia, King Edward Memorial Hospital, 374 Bagot Road, Subiaco, Perth, WA, 6008, Australia.
Department of Obstetrics and Gynaecology, Royal Darwin Hospital, Rocklands Drive, Tiwi, Darwin, NT, 0811, Australia.
BMC Pregnancy Childbirth. 2023 Jan 4;23(1):7. doi: 10.1186/s12884-022-05222-9.
Preterm birth (PTB) is the greatest cause of mortality and morbidity in children up to five years of age globally. The Western Australian (WA) PTB Prevention Initiative, the world's first whole-of-population whole-of-state program aimed at PTB prevention, was implemented across WA in 2014.
We conducted a prospective population-based cohort study using pregnancy data for singleton births in WA from 2009 to 2019. Logistic regression using the last full year before the Initiative (2013) as the reference, and run charts were used to examine changes in PTB rates compared to pre-Initiative levels, by gestational age group, hospital type, low and high risk of PTB in mid-pregnancy, and onset of labour (spontaneous/medically initiated). Analyses were stratified by Aboriginal and non-Aboriginal maternal ethnicity.
Amongst non-Aboriginal women, there was initially a reduction in the PTB rate across the state, and in recent years it returned to pre-Initiative levels. Amongst Aboriginal women there was a small, non- significant reduction in the state-wide PTB rate in the first three years of the Initiative, followed by a rise in recent years. For non-Aboriginal women, the reduction in the rate of PTB at the tertiary centre was sustained and improved further for women of all risk levels and onsets of labour. This reduction was not observed for Aboriginal women giving birth at the tertiary centre, amongst whom there was an increase in the PTB rate overall and in all subgroups, with the exception of medically initiated PTB. Amongst Aboriginal women the PTB rate has also increased across the state. At non-tertiary hospitals there was a large increase in PTB amongst both Aboriginal and non-Aboriginal women, largely driven by medically initiated late PTB. Maternal risk factors cannot account for this increase.
The reduction in PTB rates amongst non-Aboriginal women at the state's tertiary hospital demonstrates that with the right strategies, PTB can be reduced. A sustained collaborative model is required to realise this success in non-tertiary hospitals. The series of interventions was of limited use in Aboriginal women, and future efforts will need to be directed at strategies more likely to be successful, such as midwifery continuity of care models, with Aboriginal representation in the healthcare workforce.
早产（PTB）是全球五岁以下儿童死亡和发病的最大原因。西澳大利亚州（WA）的早产预防计划是全球首个针对早产预防的全人群全州计划，于 2014 年在 WA 全面实施。
我们使用 2009 年至 2019 年 WA 单胎妊娠数据进行了一项前瞻性基于人群的队列研究。使用计划实施前的最后一年（2013 年）作为参考，采用逻辑回归，运行图表用于根据妊娠年龄组、医院类型、中孕期早产低危和高危以及产程开始（自发/医学启动）检查与计划实施前相比早产率的变化。分析按土著和非土著产妇种族分层。
在非土著女性中，全州的早产率最初有所下降，近年来又回到了计划实施前的水平。在土著女性中，该计划实施的前三年全州早产率略有下降，但近年来有所上升。对于非土著女性，三级中心早产率的下降持续存在，并且对于所有风险水平和产程开始的女性进一步改善。这一减少在三级中心分娩的土著女性中并未观察到，其中总体早产率以及所有亚组（除医学启动的早产外）都有所增加。在整个州，土著女性的早产率也有所增加。在非三级医院，土著和非土著女性的早产率都大幅上升，主要是由医学启动的晚期早产引起的。产妇风险因素不能解释这一增加。
三级医院非土著女性的早产率下降表明，只要有正确的策略，就可以降低早产率。需要建立持续的协作模式，才能在非三级医院实现这一成功。针对土著女性的一系列干预措施效果有限，未来的努力需要针对更有可能成功的策略，例如助产士连续护理模式，并在医疗保健劳动力中增加土著代表。
