{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T05:52:27Z","timestamp":1789192347567,"version":"build-2803163510"},"update-to":[{"DOI":"10.12688\/gatesopenres.13046.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2020,1,24]],"date-time":"2020-01-24T00:00:00Z","timestamp":1579824000000}}],"reference-count":61,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2020,1,24]],"date-time":"2020-01-24T00:00:00Z","timestamp":1579824000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Gates Foundation","award":["OPP1033514"],"award-info":[{"award-number":["OPP1033514"]}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"crossref","award":["P30 AI50410, T32 HD075731, K01 TW010857, D43 TW009340, K24 AI120796"],"award-info":[{"award-number":["P30 AI50410, T32 HD075731, K01 TW010857, D43 TW009340, K24 AI120796"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["gatesopenresearch.org"],"crossmark-restriction":false},"short-container-title":["Gates Open Res"],"abstract":"<ns4:p>\n                    <ns4:bold>Background<\/ns4:bold>\n                    : Few cohort studies of pregnancy in sub-Saharan Africa use rigorous gestational age dating and clinical phenotyping. As a result, incidence and risk factors of adverse birth outcomes are inadequately characterized.\n                  <\/ns4:p>\n                  <ns4:p>\n                    <ns4:bold>Methods<\/ns4:bold>\n                    : The Zambian Preterm Birth Prevention Study (ZAPPS) is a prospective observational cohort established to investigate adverse birth outcomes at a referral hospital in urban Lusaka. This report describes ZAPPS phase I, enrolled August 2015 to September 2017. Women were followed through pregnancy and 42 days postpartum. At delivery, study staff assessed neonatal vital status, birthweight, and sex, and assigned a delivery phenotype. Primary outcomes were: (1) preterm birth (PTB; delivery &lt;37 weeks), (2) small-for-gestational-age (SGA; &lt;10\n                    <ns4:sup>th<\/ns4:sup>\n                    percentile weight-for-age at birth), and (3) stillbirth (SB; delivery of an infant without signs of life).\n                  <\/ns4:p>\n                  <ns4:p>\n                    <ns4:bold>Results<\/ns4:bold>\n                    : ZAPPS phase I enrolled 1450 women with median age 27 years (IQR 23\u201332). Most participants (68%) were multiparous, of whom 41% reported a prior PTB and 14% reported a prior stillbirth. Twins were present in 3% of pregnancies, 3% of women had short cervix (&lt;25mm), 24% of women were HIV seropositive, and 5% were syphilis seropositive. Of 1216 (84%) retained at delivery, 15% were preterm, 18% small-for-gestational-age, and 4% stillborn. PTB risk was higher with prior PTB (aRR 1.88; 95%CI 1.32\u20132.68), short cervix (aRR 2.62; 95%CI 1.68\u20134.09), twins (aRR 5.22; 95%CI 3.67\u20137.43), and antenatal hypertension (aRR 2.04; 95%CI 1.43\u20132.91). SGA risk was higher with twins (aRR 2.75; 95%CI 1.81\u20134.18) and antenatal hypertension (aRR 1.62; 95%CI 1.16\u20132.26). SB risk was higher with short cervix (aRR 6.42; 95%CI 2.56\u201316.1).\n                  <\/ns4:p>\n                  <ns4:p>\n                    <ns4:bold>Conclusio<\/ns4:bold>\n                    <ns4:bold>ns<\/ns4:bold>\n                    : This study confirms high rates of PTB, SGA, and SB among pregnant women in Lusaka, Zambia. Accurate gestational age dating and careful ascertainment of delivery data are critical to understanding the scope of adverse birth outcomes in low-resource settings.\n                  <\/ns4:p>","DOI":"10.12688\/gatesopenres.13046.2","type":"journal-article","created":{"date-parts":[[2020,1,24]],"date-time":"2020-01-24T10:10:38Z","timestamp":1579860638000},"page":"1533","update-policy":"https:\/\/doi.org\/10.12688\/gatesopenres.crossmark-policy","source":"Crossref","is-referenced-by-count":11,"title":["Adverse birth outcomes and their clinical phenotypes in an urban Zambian cohort"],"prefix":"10.12688","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4178-0405","authenticated-orcid":false,"given":"Joan T","family":"Price","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bellington","family":"Vwalika","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katelyn 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status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.21956\/gatesopenres.14168.r28081, Ge Zhang, Division of Human Genetics, Cincinnati Children\u2019s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA, 04 Nov 2019, version 1, 1 approved, 1 approved with reservations","URL":"https:\/\/gatesopenresearch.org\/articles\/3-1533\/v1#referee-response-28081","order":0,"name":"referee-response-28081","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Joan Price<\/b>; \n<i>Posted: 07 Feb 2020<\/i>; The authors thank the reviewer for the thoughtful and constructive comments. Please find a point-by-point response to each comment here.&nbsp;  \n<i>We have elected not to include <\/i>p\n<i> values in our tables beyond Table 1 because the we think point estimates and their 95% confidence intervals are the best estimates of association. (see Harrington et al NEJM 2019 https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMe1906559).&nbsp;&nbsp;<\/i> \n<i>Thank you for this suggestion. In response to the other reviewer\u2019s comment regarding the increased risk of PTB with EGA at enrollment, we have repeated analyses of preterm delivery outcomes restricting our sample to those participants who presented &lt;20 weeks and again those who presented &lt;16 weeks to evaluate the potential for bias and our results proved stable. We also include EGA at enrollment in all multivariable analyses. We think that additional reporting of which baseline characteristics differ by EGA at enrollment and investigation of the effect of ultrasound algorithms used for EGA calculation is beyond the scope (and page limit) of this analysis but may be explored in future analyses.&nbsp;<\/i> \n<i>Thank you for this suggestion. We have added a second Euler diagram to Figure 2 to illustrate the co-occurrence of very PTB, very SGA, and stillbirth.<\/i> \n<i>We have added linear regression of continuous exposures and continuous outcomes (Table 6).&nbsp;<\/i> \n<i>We have noted in the results section that maternal height was not associated with either PTB or SGA. It was similarly not associated with gestational duration.<\/i> \n<i>We have added additional global context to our estimates of the frequencies of adverse birth outcomes in the discussion section. However, we acknowledge significant limitations to direct comparisons of risk estimates due to inconsistent definitions. Furthermore, as there is still no undisputed global standard by which to identify small for gestational age neonates, we have not directly compared the incidence of SGA in our cohort to estimates from high-income countries. <\/i>","URL":"https:\/\/gatesopenresearch.org\/articles\/3-1533\/v2#referee-comment-3291","order":1,"name":"referee-comment-3291","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/gatesopenres.14236.r28503, Shinjini Bhatnagar, Ramachandran Thiruvengadam, Maternal and Child Health program, Translational Health Science and Technology Institute, Faridabad, Haryana, India, 26 Feb 2020, version 2, indexed","URL":"https:\/\/gatesopenresearch.org\/articles\/3-1533\/v2#referee-response-28503","order":2,"name":"referee-response-28503","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"This study was supported by the Bill and Melinda Gates Foundation [OPP1033514] through a grant to the Global Alliance to Prevent Prematurity and Stillbirth. Additional support was provided by the US National Institutes of Health through the UNC Center for AIDS Research [P30 AI50410] and trainee \/ mentor support: [T32 HD075731] (JTP), [K01 TW010857] (JTP), [D43 TW009340] (KJR), and [K24 AI120796] (BHC). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.","order":3,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}