Variations in very preterm birth rates in 30 high-income countries: are valid international comparisons possible using routine data?
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Objective: Concerns about differences in registration practices across countries have limited the use of routine data for international very preterm birth (VPT) rate comparisons. Design: Population‐based study. Setting: Twenty‐seven European countries, the United States, Canada and Japan in 2010. Population: A total of 9 376 252 singleton births. Method: We requested aggregated gestational age data on live births, stillbirths and terminations of pregnancy (TOP) before 32 weeks of gestation, and information on registration practices for these births. We compared VPT rates and assessed the impact of births at 22–23 weeks of gestation, and different criteria for inclusion of stillbirths and TOP on country rates and rankings. Main outcome measures: Singleton very preterm birth rate, defined as singleton stillbirths and live births before 32 completed weeks of gestation per 1000 total births, excluding TOP if identifiable in the data source. Results: Rates varied from 5.7 to 15.7 per 1000 total births and 4.0 to 11.9 per 1000 live births. Country registration practices were related to percentage of births at 22–23 weeks of gestation (between 1% and 23% of very preterm births) and stillbirths (between 6% and 40% of very preterm births). After excluding births at 22–23 weeks, rate variations remained high and with a few exceptions, country rankings were unchanged. Conclusions: International comparisons of very preterm birth rates using routine data should exclude births at 22–23 weeks of gestation and terminations of pregnancy. The persistent large rate variations after these exclusions warrant continued surveillance of VPT rates at 24 weeks and over in high‐income countries. Tweetable abstract: International comparisons of VPT rates should exclude births at 22–23 weeks of gestation and terminations of pregnancy.
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In Western Europe, overall early neonatal death rates from neonatal disorders are similar across the region, but death rates within Level 3 causes differ by as much as three-fold.
“Western Europe is an example where the overall death rate due to neonatal disorders in the early neonatal period is quite similar across the region, but there is as much as a three-fold difference in death rates within Level 3 causes (eg, neonatal preterm birth complications, cardiovascular diseases).65,66”
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History of the establishment of the Preterm Birth international collaborative (PREBIC)
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Limits of Prenatal Care Coordination for Improving Birth Outcomes Among Medicaid Participants
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Current Evidence: Seizures in Extremely Low Gestational Age Newborns (ELGANs)
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- Authors
- Delnord, M., Hindori‐Mohangoo, A., Smith, L., Szamotulska, K., Richards, J., Deb‐Rinker, P., Rouleau, J., Velebil, P., Zile, I., Sakkeus, L., Gissler, M., Morisaki, N., Dolan, S., Kramer, M., Kramer, M., Zeitlin, J., & the Euro‐Peristat Scientific Committee
- Affiliations
- Inserm (FR)
- Department Child Health TNO, The Netherlands Organisation for Applied Scientific Research Leiden The Netherlands
- The Infant Mortality and Morbidity Studies Group (TIMMS) Department of Health Sciences College of Medicine, Biological Sciences and Psychology University of Leicester Leicester UK
- Instytut Matki i Dziecka (PL)
- Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA USA
- Public Health Agency of Canada (CA)
- Ústav pro Péči o Matku a Dítě (CZ)
- Centre for Disease Prevention and Control of Latvia Riga Latvia
- Tallinn University (EE)
- Karolinska Institutet (SE)
- National Center For Child Health and Development (JP)
- Department of Obstetrics & Gynecology and Women's Health Albert Einstein College of Medicine/Montefiore Medical Center Bronx NY USA
- Departments of Pediatrics and of Epidemiology, Biostatistics and Occupational Health McGill University Faculty of Medicine Montreal QC Canada
- Corresponding author
- Delnord, M
- Venue
- BJOG: An International Journal of Obstetrics & Gynaecology
- Publisher
- Wiley
- Published
- 2016-09-10
- Volume
- 124
- Issue
- 5
- Pages
- 785-794
- ISSN
- 0306-5456 (ISSN-L)
- 1470-0328
- 1471-0528
- PMC
- PMC5346062
- OpenAlex
- W2515236995
- Cited by
- 64
- References
- 42
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 5 · 2023: 8 · 2022: 3 · 2021: 4 · 2020: 10 · 2019: 12 · 2018: 8 · 2017: 9
- FWCI
- 11.25
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- BJOG An International Journal of Obstetrics & Gynaecology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion, other-oa)
- Figshare (submittedVersion, cc-by)
- Leicester Research Archive (University of Leicester) (submittedVersion, cc-by-nc-nd)
- STM:n Hallinnonalan avoin julkaisuarkisto (Julkari) (submittedVersion)
- Funders
- European Commission (2010 13 01, 664691)
- Université Paris Descartes
- Eunice Kennedy Shriver National Institute of Child Health and Human Development
- National Institutes of Health (T32HD052460)
- Ministry of Health and Welfare (H28‐ICT‐001)
- Japan Agency for Medical Research and Development (AMED‐6013)
- National Institute for Health Research
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Infant Development and Preterm Care
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Health Sciences › Medicine › Epidemiology › Preterm Birth and Chorioamnionitis
- Keywords
- very preterm birth, preterm birth rate, cross-national comparison, stillbirth, gestational age, singleton live births, high-income countries
- MeSH terms
- Birth Rate, Canada, Europe, Female, Gestational Age, Humans, Infant, Newborn, Japan, Pregnancy, Pregnancy Outcome, United States, Developed Countries, Premature Birth
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