Lund Abbie, Levy Barcey T, Xu Yinghui, Bedell David A, Santillan Mark K
The University of Iowa Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
Department of Family and Community Medicine, The University of Iowa Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
J Prim Care Community Health. 2025 Jan-Dec;16:21501319251357688. doi: 10.1177/21501319251357688. Epub 2025 Jul 29.
Assess whether maternal rural residence was an independent risk factor (RF) for spontaneous preterm birth (sPTB) at a Midwest tertiary care center.
After excluding deliveries complicated by indications for induced preterm birth, there were 16 974 deliveries among 13 339 women between May 1, 2009, and May 31, 2023. Standard descriptive statistics and Generalized Linear Mixed Models were used to identify RFs for sPTB.
Of the 16 974 deliveries, 89.1% were full term, 28.8% were of rural mothers, and the mean maternal age was 29.6 years (y). 15.5% of rural deliveries were sPTBs versus only 9.1% of urban deliveries (P<.001). Significant independent RFs for sPTB included the extremes of maternal age (aOR, 2.14 for age 14 to <20 y and aOR, 3.37 for age ≥40 y) compared to age 20-<30 y, rural vs. urban residence (aOR, 1.56), maternal smoking (aOR, 2.47), transfer from an outside hospital (aOR, 671.3), and female sex of the baby (aOR, 0.79). With the transferred deliveries excluded these factors remained significant with similar aORs and Asian race was an additional significant protective factor (aOR, 0.57). Body mass index, race, ethnicity, type of medical insurance, and primigravidity were not significant RFs.
Rural residence, extremes of maternal age, maternal smoking, female newborn sex, and transfer from an outside hospital were significant and independent RFs for sPTB.
评估在中西部一家三级医疗中心，母亲居住在农村是否是自发性早产（sPTB）的独立危险因素（RF）。
排除因引产指征而导致的复杂分娩后，2009年5月1日至2023年5月31日期间，13339名女性中有16974例分娩。采用标准描述性统计和广义线性混合模型来确定sPTB的危险因素。
在16974例分娩中，89.1%为足月产，28.8%的母亲居住在农村，母亲平均年龄为29.6岁。农村分娩中有15.5%为sPTB，而城市分娩中仅为9.1%（P<0.001）。与20-<30岁相比，sPTB的显著独立危险因素包括母亲年龄极端情况（14至<20岁的调整优势比[aOR]为2.14，≥40岁的aOR为3.37）、农村与城市居住情况（aOR为1.56）、母亲吸烟（aOR为2.47）、从外部医院转诊（aOR为671.3）以及婴儿为女性（aOR为0.79）。排除转诊分娩后，这些因素仍然显著，aOR相似，亚洲种族是另一个显著的保护因素（aOR为0.57）。体重指数、种族、民族、医疗保险类型和初孕情况不是显著的危险因素。
农村居住、母亲年龄极端情况、母亲吸烟、女婴出生以及从外部医院转诊是sPTB的显著且独立的危险因素。
