المؤلفون: Abuduxike, Gulifeiya, Cali, Sanda, Vaizoğlu, Songül Acar, Aşut, Özen, Çavuş, Mahmut, Olgu, Musa, Çavuş, Simay Naime, Arkut, Meryem, Idehen, Blessing Oluwaseun, Almezghwi, Heyam Abdalla Saleh, Asswayeh, Hana Muftah Ali, Abawu, Janet James, Hossain, Mohammad Jayed, Almawali, Nusaiba AbdulMunaem

المصدر: Maternal & Child Health Journal; Apr2024, Vol. 28 Issue 4, p667-678, 12p

مصطلحات موضوعية: CESAREAN section, RISK assessment, PUBLIC hospitals, DELIVERY (Obstetrics), VAGINA, CYPRIOTS, SCIENTIFIC observation, PREMATURE infants, RETROSPECTIVE studies, DESCRIPTIVE statistics, CHI-squared test, AGE distribution, BIRTH rate, RESEARCH methodology, MEDICAL records, ACQUISITION of data, DATA quality, COMPARATIVE studies, DATA analysis software, TURKISH Cypriots, PREGNANCY complications, CHILDBIRTH, FETAL presentation, PREMATURE labor

مصطلحات جغرافية: ISLANDS of the Mediterranean

مستخلص: Objective: We aimed to understand the utilization of the mode of delivery and related risk factors. Further aimed to apply the Robson classification system to evaluate the data quality and analyze the CS rates in subgroups. Methods: We conducted a retrospective descriptive study by reviewing the medical records of all women who delivered at the State Hospital in 2019. A proforma was developed for extracting data from patient records. All women with six obstetric parameters were categorized into Robson groups to determine the absolute and relative contributions of each group to the overall CS rate. Results: Of 797 deliveries, 401 (50.2%) were CSs. Being older, being Turkish Cypriot, having preterm births, previous CS, multiple fetuses, and having breech or transverse fetal presentations were related to having higher risks of CS. The most common medical indication for CSs (52.3%) was a history of previous CSs. Robson Group 5 contributed the most (50.7%) to the overall CS rate, with the highest absolute contribution of 21.8%. Group 10 and Group 8 were the second and third highest contributors to the overall CS rate, with relative contributions of 25.3% and 9.0%, respectively. Conclusions: Findings revealed the substandard quality of obstetric data and a noticeably high overall CS rate. The top priority should be given to improving the quality of medical records. It underscored the necessity of implementing the Robson classification system as a standard clinical practice to enhance data quality, which helps to effectively evaluate and monitor the CS rates in obstetric populations. Significance: Caesarean section rates are increasing worldwide, and the Robson Classification System is recommended by the WHO to evaluate and monitor the CS rates. This study is the first to use Robson classifications and revealed high CS rates in specific subgroups of the obstetric population. The inadequate, substandard data quality highlighted the areas that urgently needed improvement in clinical practices at the largest state hospital. The study lays the foundation for further nationwide studies and demonstrates the importance of the Robson classification system. Specific recommendations were provided to the hospital management for improving the quality of the obstetric data and monitoring CS rates. [ABSTRACT FROM AUTHOR]

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المؤلفون: Pradhan, Dinesh¹ (AUTHOR) dinesh.bhutan@gmail.com, Nishizawa, Yoriko¹ (AUTHOR), Chhetri, Hari P² (AUTHOR)

المصدر: Journal of Tropical Pediatrics. Apr2020, Vol. 66 Issue 2, p163-170. 8p.

مصطلحات موضوعية: *PREMATURE labor, *PREMATURE infants, *NEONATAL mortality, *CHILDBIRTH, *BIRTH rate, *PUBLIC hospitals, *CESAREAN section, *RESEARCH, *NEONATAL intensive care, *NEONATAL diseases, *RESEARCH methodology, *NEONATAL intensive care units, *FETAL growth retardation, *DISEASES, *EVALUATION research, *MEDICAL cooperation, *COMPARATIVE studies, *PREGNANCY complications, *MEDICAL referrals, *DISEASE prevalence, *INFANT mortality, *SMALL for gestational age

مصطلحات جغرافية: BHUTAN

مستخلص: Introduction: Preterm birth-related complications are the leading cause of under-5 mortality globally. Bhutan does not have a reliable preterm birth rate or data regarding outcome of preterm babies.Aim: To determine the preterm birth rate at the Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) in Thimphu, Bhutan, and assess their outcomes.Methods: All live preterm births at JDWNRH from 1 January 2017 to 31 December 2017 were followed from birth till hospital discharge. Maternal demographic data, pregnancy details and delivery details were collected. Morbidity and mortality information as well as discharge outcome were collected on babies admitted to neonatal intensive care unit (NICU).Results: Preterm birth rate among live births was 6.4%. Most mothers were younger than 30 years, housewives and had secondary education. Pregnancy registration rate and adequacy of antenatal visits were high. Most preterm births were singleton and the predominant mode of delivery was cesarean section. More than half of the births were initiated spontaneously, and the male:female ratio was 1.2:1. Most babies were late preterm and low birth weight. Half of them required NICU admission. Overall mortality rate was 11% and 21.6% for admitted preterm neonates. Preterm small-for-gestational-age neonates, and those born after provider-initiated preterm birth had significantly increased risk of mortality. Most preterm neonates were discharged without complications. The rate of extrauterine growth restriction was high.Conclusion: This is the first study on the prevalence of preterm births and their outcomes in the largest tertiary-care hospital in Bhutan. [ABSTRACT FROM AUTHOR]

المؤلفون: Wang, H.^1,2 (AUTHOR), Yue, H.¹ (AUTHOR) yuehongni@hotmail.com, Sun, B.³ (AUTHOR) bsun@shmu.edu.cn, Zhu, X.¹ (AUTHOR), Niu, H.¹ (AUTHOR), Qi, T.¹ (AUTHOR), Ding, W.¹ (AUTHOR), Han, L.¹ (AUTHOR), Zhang, M.⁴ (AUTHOR), Tian, Z.⁴ (AUTHOR), Guan, H.⁵ (AUTHOR), Yang, J.⁵ (AUTHOR), Li, S.⁶ (AUTHOR), Zhu, K.⁶ (AUTHOR), Tang, C.⁷ (AUTHOR), Dong, M.⁷ (AUTHOR), Yin, Y.² (AUTHOR), Cao, X.⁸ (AUTHOR), Zhang, J.⁸ (AUTHOR), Liu, H.⁹ (AUTHOR)

المصدر: Journal of Maternal-Fetal & Neonatal Medicine. Mar2020, Vol. 33 Issue 5, p838-846. 9p.

مصطلحات موضوعية: *NEONATAL mortality, *PREMATURE labor, *BIRTH rate, *DEMOGRAPHIC surveys, *CHILDBIRTH, *MULTIPLE birth, *PREMATURE infants, *INFANT mortality

مصطلحات جغرافية: JIANGSU Sheng (China), CHINA

مستخلص: Objective: This survey followed the birth population-based study conducted in 2010 in Huai'an, Jiangsu Province, with the aim to estimate perinatal-neonatal mortality and preterm birth rate in emerging regions with similar maternal-fetal and neonatal care conditions in China.Materials and methods: Data of total births in 2015 were prospectively collected by regional perinatal network collaboration in Huai'an, a subprovincial region with a population of 5,644,500 and gross domestic production of 9082 USD per capita.Results: The 59,424 birth registries (including 59,023 live births and 167 stillbirths) corresponded to a birth rate of 10.5‰ and a Male-to-female ratio of 113.7:100. All births there were from 85, 16, and 6 level I, II, and III hospitals, with a delivery rate of 30.4, 40.2, and 29.4%, respectively. Of all births, 14.1% had pregnancy-associated comorbidities and complications, 54.4% (32,226/59,190) had cesarean delivery, and multiple pregnancies and birth defects occurred in 2.1% (1,250) and 5.5‰ (324), respectively. The mean birth weight was 3448 ± 507 g with 13.9% being macrosomia, and 2.86% (1695/59,190) low birth weight. Preterm birth rate was 4.06% (2404/59,190) with a mortality rate of 8.5%. There were 94.5% recorded as healthy newborns and 5.5% (3263) requiring hospitalization after birth. The perinatal and neonatal mortality rate was 5.2‰ (167 stillbirths, 139 early neonatal deaths) and 4.0‰, respectively. Compared with the 2010 survey, these data demonstrated generally improved status of perinatal-neonatal healthcare.Conclusions: The low rates of perinatal-neonatal mortality, preterm birth and preterm mortality suggest that the concept and study protocol of perinatal-neonatal healthcare in Huai'an may serve as the benchmark for estimating regional vital statistics and perinatal and neonatal outcomes. [ABSTRACT FROM AUTHOR]

المؤلفون: Leneuve-Dorilas, Malika¹ malika.leneuve@hotmail.fr, Favre, Anne¹, Carles, Gabriel², Louis, Alphonse¹, Nacher, Mathieu¹

المصدر: Journal of Maternal-Fetal & Neonatal Medicine. Apr2019, Vol. 32 Issue 8, p1388-1396. 9p.

مصطلحات موضوعية: *PREMATURE labor, *DISEASE risk factors, *CHILDBIRTH, *BIRTH rate, *HEALTH

مصطلحات جغرافية: FRENCH Guiana, SOUTH America

مستخلص: Objectives: French Guiana has the highest birth rate in South America. This French territory also has the highest premature birth rate and perinatal mortality rate of all French territories. The objective was to determine the premature birth rate and to identify the prevalence of risk factors of premature birth in French Guiana.Methods: A retrospective study of all births in French Guiana was conducted between January 2013 and December 2014 using the computerized registry compiling all live births over 22 weeks of gestation on the territory.Results: During this period 12 983 live births were reported on the territory. 13.5% of newborns were born before 37 (1755/12 983). The study of the registry revealed that common sociodemographic risk factors of prematurity were present. In addition, past obstetrical history was also important: a scarred uterus increased the risk of prematurity adjusted odds ratio =1.4, 95%CI (1.2-1.6). Similarly, obstetrical surveillance, the absence of preparation for birth or of prenatal interview increased the risk of prematurity by 2.4 and 2.3, the excess fraction in the population was 69% and 72.2%, respectively.Conclusions: Known classical risk factors are important. In the present study excess fractions were calculated in order to prioritize interventions to reduce the prematurity rate. [ABSTRACT FROM AUTHOR]

المؤلفون: Creel, Liza M.¹, Gregory, Sean^2,3,4 seangregory@health.usf.edu, McNeal, Catherine J.^5,6, Beeram, Madhava R.⁵, Krauss, David R.⁵

المصدر: BMC Research Notes. 1/13/2017, Vol. 10, p1-8. 8p. 1 Diagram, 1 Chart, 2 Graphs.

مصطلحات موضوعية: *RISK factors in premature labor, *LOW birth weight, *BIRTH rate, *CHILDBIRTH, *NEONATAL mortality, RISK factors

مستخلص: Background: In the US, approximately 12.7% of all live births are preterm, 8.2% of live births were low birth weight (LBW), and 1.5% are very low birth weight (VLBW). Although technological advances have improved mortality rates among preterm and LBW infants, improving overall rates of prematurity and LBW remains a national priority. Monitoring short- and long-term outcomes is critical for advancing medical treatment and minimizing morbidities associated with prematurity or LBW; however, studying these infants can be challenging. Several large, multi-center neonatal databases have been developed to improve research and quality improvement of treatments for and outcomes of premature and LBW infants. The purpose of this systematic review was to describe three multi-center neonatal databases. Methods: We conducted a literature search using PubMed and Google Scholar over the period 1990 to August 2014. Studies were included in our review if one of the databases was used as a primary source of data or comparison. Included studies were categorized by year of publication; study design employed, and research focus. Results: A total of 343 studies published between 1991 and 2014 were included. Studies of premature and LBW infants using these databases have increased over time, and provide evidence for both neonatology and communitybased pediatric practice. Conclusions: Research into treatment and outcomes of premature and LBW infants is expanding, partially due to the availability of large, multicenter databases. The consistency of clinical conditions and neonatal outcomes studied since 1990 demonstrates that there are dedicated research agendas and resources that allow for long-term, and potentially replicable, studies within this population. [ABSTRACT FROM AUTHOR]

المؤلفون: Sunkara, Sesh Kamal¹ sesh.sunkara1@nhs.net, LaMarca, Antonio², Polyzos, Nikolaos P.³, Seed, Paul T.⁴, Khalaf, Yakoub⁵

المصدر: Human Reproduction. Oct2016, Vol. 31 Issue 10, p2261-2267. 7p. 1 Diagram, 2 Charts, 2 Graphs.

مصطلحات موضوعية: *CHILDBIRTH, *PREMATURE labor, *PREGNANCY complications, *FERTILIZATION in vitro, *HEALTH outcome assessment, *LOW birth weight, *BIRTH rate, *GESTATIONAL age, *PREMATURE infants, *EVALUATION of medical care, *INDUCED ovulation, *PREGNANCY, PERINATAL care

مستخلص: Study Question: Does ovarian stimulation affect perinatal outcomes of preterm birth (PTB) and low birth weight (LBW) following IVF treatment.Summary Answer: Despite no significant differences in the risks of PTB and LBW between stimulated and unstimulated IVF in the present study, the study cannot exclude the effect of ovarian stimulation on the perinatal outcomes following IVF.What Is Already Known: Pregnancies resulting from assisted reproductive treatments (ART) are associated with a higher risk of pregnancy complications compared to spontaneously conceived pregnancies attributed to the underlying infertility and the in vitro fertilization techniques. It is of interest to determine the effect size of ovarian stimulation use in achieving a live birth and whether ovarian stimulation that is routinely used in IVF, affects perinatal outcomes of birth weight and gestational age at delivery compared to unstimulated IVF.Study Design, Size, Duration: Anonymous data were obtained from the Human Fertilisation and Embryology Authority (HFEA), the statutory regulator of ART in the UK. The HFEA has collected data prospectively on all ART performed in the UK since 1991. Data from 1991 to 2011 comprising a total of 591 003 fresh IVF ± ICSI cycles involving 584 835 stimulated IVF cycles and 6168 unstimulated IVF cycles were analyzed.Participants/materials, Setting, Methods: Data on all women undergoing either stimulated or unstimulated fresh IVF ± ICSI cycles during the period from 1991 to 2011 were analyzed to compare live birth rates, singleton live birth rates, perinatal outcomes of PTB, early PTB (<32 weeks), LBW and very LBW (<1500 grams) among singleton live births. Adjusted logistic regression was performed for each perinatal outcome for confounding factors: female age, period of treatment, cause of infertility, number of previous IVF cycles and previous live birth.Main Results and the Role Of Chance: Analysis of the large nationwide data demonstrated 3.5 times (95% confidence interval (CI): 3.1-3.9) as many unstimulated IVF cycles being required to achieve one live birth compared to stimulated IVF and 2.9 times (95% CI: 2.6-3.2) as many unstimulated IVF cycles being required to achieve one singleton live birth compared to stimulated IVF. There was no significant difference in the unadjusted odds for PTB (odds ratio (OR) 1.27, 95% CI: 0.80-2.00) and LBW (OR 1.48, 95% CI: 0.90-2.42) between stimulated and unstimulated IVF cycles. There was no significant difference in the risk of the adverse perinatal outcomes after adjusting for potential confounders; PTB (adjusted odds ratio (aOR) 1.43, 95% CI: 0.91-2.26) and LBW (aOR 1.58, 95% CI: 0.96-2.58).Limitations, Reasons For Caution: Although the analysis was adjusted for a number of important confounders, the dataset had no information on smoking, body mass index (BMI) and the medical history of women during pregnancy to allow adjustment. Anonymized nature of the dataset did not make it permissible to analyse one cycle per woman. Given the smaller number of perinatal events with unstimulated IVF, a larger study is needed to investigate further.Wider Implications Of the Findings: Analysis of this large dataset demonstrates that ovarian stimulation has a vital role in maximizing efficacy of IVF. Although there were no significant differences for PTB and LBW following stimulated compared to unstimulated IVF, the CIs were wide enough to include possible clinically important effects.Study Funding/competing Interests: No funding was obtained. There are no competing interests to declare. [ABSTRACT FROM AUTHOR]

المؤلفون: Sheykhi, Mohammad Taghi

المصدر: Middle East Journal of Internal Medicine; Nov2020, Vol. 13 Issue 2, p39-45, 7p

مصطلحات موضوعية: CHILDBIRTH, HIGH-risk pregnancy, PREMATURE labor, HUMAN fertility, BIRTH rate

مصطلحات جغرافية: CHINA

مستخلص: Sociology as a dominant discipline usually assesses the two groups of countries in various terms. The industrial world (The North) is widely different from the countries of developing world (The South) including their demographic trends. The North world countries that experienced socio-cultural change earlier, their demographic norms and values have changed too in that, women have started giving birth to fewer children, followed by less maternal mortality and longer life expectancy for them. In African countries where women give birth to 7-8 children, they usually remain at very high risk. Sociology as a comprehensive social science investigates the causeand- effect of high and low fertility rate within women. Quality of children in the South world countries among other factors remain poor from nutritional and educational viewpoints. One of the risks of high pregnancy and child birth is associated with deaths of mothers. Babies of such mothers are at the risk of low birth weight and often preterm birth. Average age of the first birth between 26 and 29 years, overall, provides better opportunities and quality of life to the newborns. While Africa is a great threat, as far as high birth rate is concerned, Asian (especially East Asian) countries are improving well, and currently have a Total Fertility Rate (TFR) of 1.5 children in their life time by an average woman. China also took a revolutionary step since 1979 to modify its population patterns. Method of research used in the present paper is of qualitative type, using documents to complete the manuscript. [ABSTRACT FROM AUTHOR]

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المؤلفون: Zhang, Xiaohui, Chen, Lijin, Wang, Xuemiao, Wang, Xiaoyan, Jia, Menghan, Ni, Saili, He, Wei, Zhu, Shankuan

المصدر: PLoS Medicine; 2/24/2020, Vol. 17 Issue 2, p1-19, 19p, 1 Diagram, 4 Charts, 2 Graphs

مصطلحات موضوعية: MATERNAL age, CHILDBIRTH, BIRTH rate, PREMATURE labor, ONE-child policy, China

مصطلحات جغرافية: ZHEJIANG Sheng (China), CHINA

مستخلص: Background: China implemented a partial two-child policy (2013) followed by a universal two-child policy (2015), replacing the former one-child policy mandated by the government. The changes affect many aspects of China's population as well as maternal and infant health, but their potential impact on birth defects (BDs) remains unknown. In this study, we investigated the associations of these policy changes with BDs in Zhejiang Province, China.Methods and Findings: We used data from the BD surveillance system in Zhejiang Province, China, which covers 90 hospitals in 30 urban districts and rural counties, capturing one-third of the total births in this province. To fully consider the time interval between conception and delivery, we defined the one-child policy period as data from 2013 (births from October 2012 to September 2013), the partial two-child policy period as data from 2015 (births from October 2014 to September 2015), and the universal two-child policy period as data from 2017 (births from October 2016 to September 2017). Data from 2009 and 2011 were also used to show the changes in the proportion of births to women with advanced maternal age (35 years and older) prior to the policy changes. Main outcome measures were changes in the proportion of mothers with advanced maternal age, prevalence of BDs, rankings of BD subtypes by prevalence, prenatal diagnosis rate, and live birth rate of BDs over time. A total of 1,260,684 births (including live births, early fetal losses, stillbirths, and early neonatal deaths) were included in the analyses. Of these, 644,973 (51.16%) births were to women from urban areas, and 615,711 (48.84%) births were to women from rural areas. In total, 135,543 (10.75%) births were to women with advanced maternal age. The proportion increased by 85.68%, from 8.52% in 2013 to 15.82% in 2017. However, it had remained stable prior to policy changes. Overall, 23,095 BDs were identified over the policy changes (2013-2017). The prevalence of BDs during 2013, 2015, and 2017 was 245.95, 264.86, and 304.36 per 10,000 births, respectively. Trisomy 21 and other chromosomal defects increased in both risk and ranking from 2013 to 2017 (crude odds ratio [95% confidence interval] 2.13 [1.75-2.60], from ranking 10th to 5th, and 3.63 [2.84-4.69], from ranking 16th to 6th, respectively). The prenatal diagnosis rate increased by 3.63 (2.2-5.1) percentage points (P < 0.001), from 31.10% to 34.72%, and identification of BDs occurred 1.88 (1.81-1.95) weeks earlier (P < 0.001). The live birth rate for infants with BDs born before 28 gestational weeks increased from 1.29% to 11.45%. The major limitations of this observational study include an inability to establish causality and the possible existence of unknown confounding factors, some of which could contribute to BDs.Conclusions: In this study, we observed significant increases in maternal age and the prevalence of total and age-related anomalies following China's new two-child policy. Increases in live birth rate for infants with BDs born before 28 gestational weeks suggest that healthcare for very preterm births with BDs may be warranted in the future, as well as updating the definition of perinatal period. [ABSTRACT FROM AUTHOR]

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المؤلفون: Jamali, Qamar Zaman, Shah, Rashed, Shahid, Farhana, Fatima, Aisha, Khalsa, Saraswati, Spacek, Jana, Regmi, Presha

المصدر: PLoS ONE; 6/17/2019, Vol. 14 Issue 6, p1-15, 15p

مصطلحات موضوعية: HEALTH facilities, FOCUS groups, PREMATURE labor, CHILDBIRTH, PREMATURE infants, BIRTH rate

مصطلحات جغرافية: PAKISTAN, SINDH (Pakistan)

مستخلص: Background: More than 2.5 million newborns die each year, accounting for 47% of children dying worldwide before their age of five years. Complications of preterm birth are the leading cause of death among newborns. Pakistan is amongst the top ten countries with highest preterm birth rate per 1000 live births. Globally, Every Newborn Action Plan (ENAP) has emphasized on Kangaroo Mother Care (KMC) as an essential component of neonatal health initiatives. Materials and methods: We conducted this qualitative study with 12 in-depth interviews (IDIs) and 14 focus group discussion (FGD) sessions, in two health facilities of Sindh, Pakistan during October-December 2016, to understand the key barriers and enablers to a mother's ability to practice KMC and the feasibility of implementing and improving these practices. Results: The findings revealed that community stakeholders were generally aware of health issues especially related to maternal and neonatal health. Both the health care providers and managers were supportive of implementing KMC in their respective health facilities as well as for continuous use of KMC at household level. In order to initiate KMC at facility level, study respondents emphasized on ensuring availability of equipment, supplies, water-sanitation facility, modified patient ward (e.g., curtain, separate room) and quality of services as well as training of health providers as critical prerequisites. Also in order to continue practicing KMC at household level, engaging the community and establishing functional referral linkage between community and facilities were focused issues in facility and community level FGDs and IDIs. Conclusion: The study participants considered it feasible to initiate KMC practice at health facility and to continue practicing at home after returning from facility. Ensuring facility readiness to initiate KMC, improving capacity of health providers both at facility and community levels, coupled with focusing on community mobilization strategy, targeting specific audiences, may help policy makers and program planners to initiate KMC at health facility and keep KMC practice continued at household level. [ABSTRACT FROM AUTHOR]

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المؤلفون: Ferguson, Kelly K., Rosario, Zaira, McElrath, Thomas F., Vélez Vega, Carmen, Cordero, José F., Alshawabkeh, Akram, Meeker, John D.

المصدر: PLoS ONE; 6/13/2019, Vol. 14 Issue 6, p1-15, 15p

مصطلحات موضوعية: LABOR (Obstetrics), CHILDBIRTH, PREGNANT women, DISEASE risk factors, BIRTH rate, PREMATURE labor

مصطلحات جغرافية: PUERTO Rico

مستخلص: Preterm birth is a major public health problem, especially in Puerto Rico where the rates are among the highest observed worldwide, reaching 18% in 2011. The Puerto Rico Testsite for Exploring Contamination Threats (PROTECT) study is an ongoing investigation of environmental factors that contribute to this condition. In the present analysis, we sought to examine common risk factors for preterm birth and other adverse birth outcomes which have not been characterized previously in this unique population. Pregnant women from the PROTECT cohort are recruited from the heavily contaminated Northern coast of the island of Puerto Rico and are free of pre-existing conditions like diabetes. We examined associations between basic demographic, behavioral (e.g., tobacco and alcohol use), and pregnancy (e.g., season and year of delivery) characteristics as well as municipality of residence in relation to preterm birth (<37 weeks gestation), postterm birth (≥41 weeks gestation), and small and large for gestational age in univariate and multivariate logistic regression models. Between 2011 and 2017, 1028 live singleton births were delivered as part of the PROTECT cohort. Of these, 107 (10%) were preterm. Preterm birth rates were higher among women with low socioeconomic status, as indicated by education level and income, and among women with high pre-pregnancy body mass index (BMI). Odds ratios of small for gestational age delivery were higher for women who reported tobacco use in pregnancy and lower for women who delivered in the hurricane and dengue season (July-October). Overall, in pregnant women residing in Puerto Rico, socioeconomic status was associated with preterm birth but few other factors were associated with this or other adverse outcomes of pregnancy. Research to understand environmental factors that could be contributing to the preterm birth epidemic in Puerto Rico is necessary. [ABSTRACT FROM AUTHOR]

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