Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands.
Acta Obstet Gynecol Scand. 2024 Mar;103(3):449-458. doi: 10.1111/aogs.14684. Epub 2023 Oct 30.
Preterm birth (PTB) is the leading cause of infant mortality and morbidity worldwide. Rates of PTB in the Netherlands are declining, possibly due to the implementation of preventive strategies. In this study we assessed the overall trend in PTB rates in the Netherlands in recent years, and in more detail in specific subgroups to investigate potential groups that require scrutiny in the near future.
Based on the national perinatal registry, we included all pregnancies without severe congenital abnormalities resulting in a birth from 24 to 42 completed weeks of gestation between 2011 and 2019 in the Netherlands. We assessed PTB rates in two different clinical subtypes (spontaneous vs. iatrogenic) and in five gestational age subgroups: 24-27 weeks (extreme), 28-31 weeks (very), 32-33 weeks (moderate, 34-36 weeks [late] and, in general, 24-36 weeks [overall PTB]). Trend analysis was performed using the Cochran Armitage test. We also compared PTB rates in different subgroups in the first 2 years compared to the last 2 years. Singleton and multiple gestations were analyzed separately.
We included 1 447 689 singleton and 23 250 multiple pregnancies in our study. In singletons, we observed a significant decline in PTB from 5.5% to 5.0% (p < 0.0001), mainly due to a decrease in iatrogenic PTBs. When focusing on different gestational age subgroups, there was a decrease in all iatrogenic PTB and in moderate to late spontaneous PTB. However, in spontaneous extreme and very PTB there was an significant increase. When assessing overall PTB risk in different subgroups, the decline was only visible in women with age ≥25 years, nulliparous and primiparous women, women with a medium or high socioeconomic status and hypertensive women. In multiples, the rate of PTB remained fairly stable, from 52.3% in 2011 to 54.1% in 2019 (p = 0.57).
In the Netherlands, between 2011 and 2019, PTB decreased, mainly due to a reduction in late PTB, and more in iatrogenic than in spontaneous PTB. Focus for the near future should be on specific subgroups in which the decline was not visible, such as women with a low socioeconomic status or a young age.
早产（PTB）是全球婴儿死亡和发病的主要原因。荷兰的 PTB 发生率正在下降，这可能是由于预防策略的实施。在这项研究中，我们评估了近年来荷兰 PTB 发生率的总体趋势，并在更详细的特定亚组中进行了研究，以调查未来需要关注的潜在人群。
基于全国围产期登记处，我们纳入了 2011 年至 2019 年期间在荷兰妊娠 24 至 42 周且无严重先天性异常导致出生的所有妊娠。我们评估了两种不同临床亚型（自发性与医源性）和五个不同胎龄亚组的 PTB 发生率：24-27 周（极早产）、28-31 周（早产）、32-33 周（中度早产）、34-36 周（晚期早产）和一般 24-36 周（总体 PTB）。采用 Cochran-Armitage 检验进行趋势分析。我们还比较了前 2 年和后 2 年不同亚组的 PTB 发生率。分别分析单胎和多胎妊娠。
我们的研究纳入了 1447689 例单胎妊娠和 23250 例多胎妊娠。在单胎妊娠中，我们观察到 PTB 从 5.5%降至 5.0%（p<0.0001），主要是由于医源性 PTB 下降。当我们关注不同的胎龄亚组时，所有医源性 PTB 和中度至晚期自发性 PTB 均有下降。然而，自发性极早产和早产的发生率显著增加。当评估不同亚组的总体 PTB 风险时，仅在年龄≥25 岁、初产妇、经产妇、中高社会经济地位和高血压女性中可见下降。在多胎妊娠中，PTB 率相对稳定，从 2011 年的 52.3%降至 2019 年的 54.1%（p=0.57）。
在荷兰，2011 年至 2019 年间，PTB 下降，主要是由于晚期 PTB 减少，且医源性 PTB 多于自发性 PTB。未来的重点应放在下降不明显的特定亚组，如社会经济地位较低或年龄较小的女性。
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