Prevalence, Underlying Causes, and Uptake of Interventions for Preventing Recurrent Preterm Births at Kenyatta National Hospital– a Cross-sectional Study

Abstract

Background: Globally, the prevalence of recurrent preterm births is between 9.6% and 31.6% with 81% of preterm births occurring in sub-Saharan Africa according to the World Health Organization (WHO). Ten percent (10%) of mortalities in this cohort are attributed to prematurity-related complications, the majority of which are preventable. Progesterone, low-dose aspirin, heparin, and antihypertensive treatments are effective interventions for decreasing preterm births. In Low- and Middle-income countries, local data on rates of recurrent preterm births, causes of recurrent preterm births, and interventions for preventing recurrent preterm births, which is critical for prevention and management, are limited. Objectives: To determine the prevalence, underlying causes, and uptake of interventions for preventing recurrent preterm births at Kenyatta National Hospital between 2019 and 2020. Methodology: This was a descriptive cross-sectional study where hospital files of 211 postpartum women with a history of preterm birth at <37 weeks in the immediately preceding pregnancy who delivered at the Kenyatta National Hospital, between December 2019 and December 2020 were used. The files were retrieved from the records department and maternal demographic and reproductive characteristics, treatment modalities, and birth outcomes were recorded. Uptake of interventions for preventing recurrent preterm birth such as aspirin, progesterone, or cervical cerclage was also extracted. Data analysis was conducted using version 25 of the Statistical Package for Social Scientists (SPSS) software. Descriptive data were summarized in a table and the prevalence of recurrent preterm births determined using the Clopper Pearson method at 95% confidence level and presented in a pie chart. The causes of recurrent preterm birth and uptake of interventions analyzed using frequency distribution and percentages. Results: The hospital files of 211 women with a mean age of 29.4±5.8 years were evaluated. Most were in age group <35 years (76.9%), married (88.0%), and unemployed (57.6%); had an interpregnancy interval (IPI) of 2-5 years (44.1%) and did not use alcohol (99.1%) or cigarettes (99.5%). About 28.4% had comorbidities, mainly preeclampsia/eclampsia (75.0%). Prevalence of recurrent preterm births was 40.3% (95% CI=33.6-47.2%) with spontaneous preterm births accounting for 64.5% (95%CI=53.6-74.8) of recurrent preterm births. Comorbidities, diabetes, hypertension, and congenital anomalies were associated with 44.7%, 1.2%, 10.6%, and 1.2% of recurrent preterm birth cases, mostly provider-initiated. Human Immunodeficiency Virus (HIV), fibroids, cervical insufficiency, and Urinary Tract Infections (UTI) were associated with 2.4%, 3.5%, 17.6%, and 8.2% of recurrent preterm births, mostly spontaneous. The prevalence of cervical cerclage, vaginosis treatment, progesterone use, heparin treatment, and aspirin use were 14.1%, 8.2%, 1.2%, and 3.5%. The uptake of progesterone, bacterial vaginosis treatment, and cervical cerclage were higher among patients who had spontaneous recurrent preterm births (12.7%, 0.2%, and 18.1%) compared to provider-initiated recurrent preterm births (0.0%, 0.0%, and 0.0%). Heparin treatment and aspirin treatment were higher among patients who had provider-initiated preterm births (3.3% and 6.7% respectively) compared to spontaneous preterm birth (0.0% and 0.2% respectively). Conclusions: The prevalence of recurrent preterm births was high at 40.3%. Most recurrent preterm births were spontaneous at 64.5%. Comorbidities, mainly hypertension, cervical insufficiency, and UTIs, were the main risk factors. Patients who have provider-initiated recurrent preterm births are likely to receive aspirin and heparin treatment, while those who xiii have spontaneous preterm births are more likely to receive progesterone, bacterial vaginosis treatment, and cervical cerclage.