Determinants for premature rupture of membranes: a prospective cohort study.

BACKGROUND

Premature rupture of membranes (PROM) and preterm premature rupture of membranes (PPROM) are significant obstetric complications that can lead to adverse maternal and neonatal outcomes. There is an increased concern for various risk factors for PROM and PPROM, in the context of inconsistent findings. This study aimed to investigate determinants for PROM and PPROM.

METHODS

We conducted a prospective cohort study involving 5,500 pregnant women receiving prenatal care at Maternal and Child Health Hospital of Hubei Province. We collected data on demographic characteristics, reproductive history, medical history, behavior and lifestyle factors and pregnancy outcomes, utilizing univariate and multivariate modified Poisson regression analyses to identify determinants associated with PROM and PPROM. Subgroup analyses were conducted to compare differences between nulliparous and multiparous women because parity emerged as a significant confounder.

RESULTS

The overall incidence of PROM in our study was 14.38% (550/3,825), with PPROM accounting for 2.04% (78/3,825). Nulliparity (RR 2.16; 95% CI 1.71-2.74; P < 0.001), and higher education level (RR 1.19; 95% CI 1.00-1.42; P = 0.048) were identified as significant risk factors for PROM, while nulliparity (RR 2.39; 95% CI 1.26-4.52; P = 0.008), presence of uterine fibroids (RR 2.32; 95% CI 1.19-4.52; P = 0.013), and vaginal bleeding at early pregnancy (RR 1.61; 95% CI 1.02-2.56; P = 0.042) were identified as significant risk factors for PPROM. In the nulliparity subgroup, vaginal bleeding at early pregnancy (RR 2.01; 95% CI 1.23-3.27; P = 0.005) and presence of uterine fibroids (RR 2.17; 95% CI 1.03-4.55; P = 0.041) were identified as risk factors for PPROM. In the multiparity subgroup, allergic diseases (RR 7.72; 95% CI 1.60-37.31; P = 0.011), gestational hypertension (RR 5.10; 95% CI 1.05-24.80; P = 0.043) and regular exercise (RR 4.45; 95% CI 0.96-20.60; P = 0.057) were identified as risk factors for PPROM.

CONCLUSIONS

This prospective cohort study underscores the importance of parity, considered as a confounder when analyzing determinants for PROM and PPROM in future research. We also found that in nulliparous women, presence of uterine fibroids increased the risk of PPROM while regular exercise reduced the risk; in multiparous women, presence of uterine fibroids was not correlated while regular exercise increased the risk. While occupational stress exhibited preliminary associations, refined exposure metrics are needed to clarify its role. Future research should integrate biological mediators, objective measures and diverse cohorts to confirm the associations and optimize prevention strategies.