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Trends in preterm births in Flanders, Belgium, from 1991 to 2002
Paediatric and Perinatal Epidemiology, 10/16/09

Keirse MJNC et al. – Overall, the data show, first, marked increases in the frequency of known contributors to the preterm birth rate, including twin pregnancies, advanced maternal age, assisted reproduction and obstetric intervention. Second, the preterm birth rate further increased significantly within subgroups of women with one or more of these characteristics. Third, the preterm birth rate also rose, from 4.4% in 1991–93 to 5.6% in 2000–02, in women with none of these contributing factors.

Exclusive Author Commentary
Professor Marc J. N. C. Keirse, 10/25/09

This population-based study of more than 700,000 births showed a steady increase in the preterm birth rate of 0.23% per year (p <0.001) over more than a decade. This was largely due to changes in the childbearing population (older mothers, increasing twinning rates and assisted conception) and changes in obstetric practice (elective delivery). However, this is only part of the explanation, as preterm birth rates increased in all age groups, in twins and singletons, after assisted and spontaneous conceptions, and with elective delivery as well as spontaneous labour. These trends are alarming. In practice, they resulted in nearly a third more preterm (<37 weeks), very preterm (<32 weeks) and severely preterm (<28 weeks) newborns per year than there were at the start of the 1990s. Numerically, most of the increase was in babies who are only mildly preterm, but such babies still have increased morbidity and mortality and poorer long-term outcomes than term infants. The net effect is not only a greater burden on families and provisions for neonatal care. There are also far-reaching consequences for public health in the short and in the long term. Better understanding of the mechanisms behind these trends would seem to be an important priority.

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