{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T03:08:17Z","timestamp":1774926497175,"version":"3.50.1"},"reference-count":50,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2024,7,29]],"date-time":"2024-07-29T00:00:00Z","timestamp":1722211200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Prematurity rates remain high and represent a challenge for the public health systems of any country, with a high impact on neonatal mortality. This study aimed to evaluate the frequency and environmental and maternal\u2013fetal risk factors for premature birth in a cohort of parturient women, with their newborns monitored in a neonatal intensive care unit at a private reference hospital. Methods: A cohort was carried out between 2013 and 2018 among parturient women living in a capital city in the Northeast of Brazil whose newborns were admitted to the neonatal intensive care unit. This study was approved by the Research Ethics Committee of the University of Fortaleza. The information collected comprised data from both medical records and hydrosanitary data from maternal homes. Results: The prevalence of prematurity among live births (n = 9778) between 2013 and 2018 at this hospital was 23%. The frequency of prematurity among those eligible (n = 480) was 76.9%, and the frequency of eligible premature babies (n = 369) in relation to the total number of births in this period was 3.8%. In the multivariate analysis, the significant risk factors for prematurity were primigravida (RR = 1.104, 95%CI: 1.004\u20131.213) and hypertensive syndromes during pregnancy (RR = 1.262, 95%CI: 1.161\u20131.371), and the significant protective factor was the highest number of prenatal consultations (RR = 0.924, 95%CI: 0.901\u20130.947). Conclusions: This study contributes to providing greater visibility to prenatal care and the understanding of complications during pregnancy and childbirth care. These results indicate the need to implement public policies that promote improvements in the population\u2019s living conditions and care for pregnant women to reduce premature births and, consequently, neonatal and infant mortality.<\/jats:p>","DOI":"10.3390\/jcm13154437","type":"journal-article","created":{"date-parts":[[2024,7,29]],"date-time":"2024-07-29T16:37:17Z","timestamp":1722271037000},"page":"4437","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Frequency and Risk Factors Associated with Prematurity: A Cohort Study in a Neonatal Intensive Care Unit"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2845-6216","authenticated-orcid":false,"given":"Maria Goretti Policarpo","family":"Barreto","sequence":"first","affiliation":[{"name":"Faculdade de Ci\u00eancias e Tecnologias, Universidade Fernando Pessoa, Pra\u00e7a 9 de Abril 349, 4249-004 Porto, Portugal"},{"name":"Hospital Regional Unimed Fortaleza (HRU), Avenida Visconde do Rio Branco, 400, S\u00e3o Jo\u00e3o do Tauape, Fortaleza 60420-570, Brazil"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1774-1337","authenticated-orcid":false,"given":"Maria Concei\u00e7\u00e3o","family":"Manso","sequence":"additional","affiliation":[{"name":"Faculdade de Ci\u00eancias da Sa\u00fade, RISE-Health, Universidade Fernando Pessoa, Rua Carlos da Maia, 296, 4200-150 Porto, Portugal"},{"name":"FP-I3ID, FP-BHS, Universidade Fernando Pessoa, Pra\u00e7a de 9 de Abril 349, 4249-004 Porto, Portugal"},{"name":"REQUIMTE-LAQV (Laborat\u00f3rio Associado de Qu\u00edmica Verde), Universidade do Porto, 4050-313 Porto, Portugal"}]},{"given":"Renata Policarpo","family":"Barreto","sequence":"additional","affiliation":[{"name":"Hospital Regional Unimed Fortaleza (HRU), Avenida Visconde do Rio Branco, 400, S\u00e3o Jo\u00e3o do Tauape, Fortaleza 60420-570, Brazil"},{"name":"Centro de Ci\u00eancias da Sa\u00fade, Universidade de Fortaleza (UNIFOR), Avenida Washington Soares, 1321, Edson Queiroz, Fortaleza 60811-905, Brazil"}]},{"given":"Roberta Policarpo","family":"Barreto","sequence":"additional","affiliation":[{"name":"Hospital Regional Unimed Fortaleza (HRU), Avenida Visconde do Rio Branco, 400, S\u00e3o Jo\u00e3o do Tauape, Fortaleza 60420-570, Brazil"},{"name":"Centro de Ci\u00eancias da Sa\u00fade, Universidade Federal do Cear\u00e1 (UFC), Avenida da Universidade, 2853, Benfica, Fortaleza 60020-181, Brazil"}]},{"given":"Lara Moreira Teles de","family":"Vasconcelos","sequence":"additional","affiliation":[{"name":"Hospital Regional Unimed Fortaleza (HRU), Avenida Visconde do Rio Branco, 400, S\u00e3o Jo\u00e3o do Tauape, Fortaleza 60420-570, Brazil"},{"name":"Centro de Ci\u00eancias da Sa\u00fade, Universidade de Fortaleza (UNIFOR), Avenida Washington Soares, 1321, Edson Queiroz, Fortaleza 60811-905, Brazil"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9777-8406","authenticated-orcid":false,"given":"Cl\u00e1udia","family":"Silva","sequence":"additional","affiliation":[{"name":"Faculdade de Ci\u00eancias da Sa\u00fade, RISE-Health, Universidade Fernando Pessoa, Rua Carlos da Maia, 296, 4200-150 Porto, Portugal"},{"name":"FP-I3ID, FP-BHS, Universidade Fernando Pessoa, Pra\u00e7a de 9 de Abril 349, 4249-004 Porto, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2024,7,29]]},"reference":[{"key":"ref_1","unstructured":"Brasil (2019, October 30). Minist\u00e9rio da Sa\u00fade. Beb\u00eas Prematuros, Available online: http:\/\/www.saude.gov.br\/noticias\/823-assuntos\/saude-para-voce\/40775-bebes-prematuros."},{"key":"ref_2","unstructured":"World Health Organization\u2014WHO (2019, October 30). Preterm Birth [Internet]. Geneva, Switzerland; 19 February 2018. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/preterm-birth."},{"key":"ref_3","unstructured":"Mandy, G.T. (2024, April 23). Preterm Birth: Definitions of Prematurity, Epidemiology, and Risk Factors for Infant Mortality\u2014UpToDate. Uptodate. Available online: https:\/\/www.uptodate.com\/contents\/preterm-birth-definitions-of-prematurity-epidemiology-and-risk-factors-for-infant-mortality?source=mostViewed_widget."},{"key":"ref_4","first-page":"26","article-title":"Prematuridade eletiva e as suas repercuss\u00f5es perinatais nas s\u00edndromes hipertensivas da gesta\u00e7\u00e3o","volume":"13","author":"Marra","year":"2016","journal-title":"Rev. UNILUS Ensino Pesqui."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2162","DOI":"10.1016\/S0140-6736(12)60820-4","article-title":"National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: A systematic analysis and implications","volume":"379","author":"Blencowe","year":"2012","journal-title":"Lancet"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"3027","DOI":"10.1016\/S0140-6736(16)31593-8","article-title":"Global, regional, and national causes of under-5 mortality in 2000\u201315: An updated systematic analysis with implications for the Sustainable Development Goals","volume":"388","author":"Liu","year":"2016","journal-title":"Lancet"},{"key":"ref_7","first-page":"1","article-title":"Births: Final Data for 2019","volume":"70","author":"Martin","year":"2021","journal-title":"Natl. Vital Stat. Rep."},{"key":"ref_8","unstructured":"Brasil (2021, August 07). Minist\u00e9rio da Sa\u00fade. Portal da Sa\u00fade [Internet] DATASUS: Informa\u00e7\u00f5es de Sa\u00fade. Estat\u00edsticas Vitais, Available online: https:\/\/datasus.saude.gov.br\/informacoes-de-saude-tabnet\/."},{"key":"ref_9","unstructured":"World Health Organization\u2014WHO (2021, June 15). The Top 10 Causes of Death. Geneva, Switzerland; 9 December 2020. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/the-top-10-causes-of-death."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1016\/j.midw.2012.06.010","article-title":"World Health Organization\u2014WHO. Born too soon: The global issue of preterm birth","volume":"4","author":"Bick","year":"2012","journal-title":"Midwifery"},{"key":"ref_11","unstructured":"United Nations Inter-Agency Group for Child Mortality Estimation (2017). Level and Trends in Child Mortality: Report 2017, United Nacional Children\u2019s Fund."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1590\/S1983-14472012000200013","article-title":"Fatores de risco maternos para prematuridade em uma maternidade p\u00fablica de Imperatriz-MA","volume":"33","author":"Almeida","year":"2012","journal-title":"Rev. Ga\u00facha Enferm."},{"key":"ref_13","first-page":"1251","article-title":"Preval\u00eancia de intercorr\u00eancias cl\u00ednicas maternas relacionadas \u00e0 prematuridade","volume":"10","author":"Seidler","year":"2011","journal-title":"Rev. Contexto Saude"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1016\/j.jped.2017.03.003","article-title":"Motor development of preterm infants assessed by the Alberta Infant Motor Scale: Systematic review article","volume":"93","author":"Fuentefria","year":"2017","journal-title":"J. Pediatr."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"17","DOI":"10.6061\/clinics\/2017(01)04","article-title":"Late Preterm Infants\u2019 Motor Development Until Term Age","volume":"72","author":"Santos","year":"2017","journal-title":"Clinics"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1","DOI":"10.22298\/rfs.2020.v8.n1.5171","article-title":"Interven\u00e7\u00e3o precoce no desenvolvimento neuromotor de lactentes prematuros de risco. Early intervention in the neuromotor development of preterm infants at risk","volume":"8","author":"Israel","year":"2020","journal-title":"Rev. FisiSenectus"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Mart\u00ednez-Nadal, S., and Bosch, L. (2021). Cognitive and Learning Outcomes in Late Preterm Infants at School Age: A Systematic Review. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18010074"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1590\/S0100-72032013001000001","article-title":"Prematuridade: Quando \u00e9 poss\u00edvel evitar?","volume":"35","author":"Bittar","year":"2013","journal-title":"Rev. Bras. Ginecol. Obstet."},{"key":"ref_19","first-page":"398","article-title":"An\u00e1lise multivariada dos fatores de risco para prematuridade no Sul do Brasil. Multivariate analysis of risk factors for prematurity in Southern Brazil","volume":"5","author":"Melo","year":"2014","journal-title":"Rev. Eletron. Gest. Saude"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e37","DOI":"10.1016\/S2214-109X(18)30451-0","article-title":"Global, regional, and national estimates of levels of preterm birth in 2014: A systematic review and modelling analysis","volume":"7","author":"Chawanpaiboon","year":"2019","journal-title":"Lancet Glob. Health"},{"key":"ref_21","unstructured":"Robinson, J.N., and Norwitz, E.R. (2024, April 23). Spontaneous Preterm Birth: Overview of Risk Factors and Prognosis\u2013UpToDate. Uptodate. Available online: https:\/\/www.uptodate.com\/contents\/spontaneous-preterm-birth-overview-of-risk-factors-and-prognosis?source=mostViewed_widget."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1024","DOI":"10.1590\/S0102-311X2008000500009","article-title":"Prematurity and associated factors in Santa Catarina State, Brazil, in 2005: An analysis based on data from the Information System on Live Births","volume":"24","author":"Cascaes","year":"2008","journal-title":"Cad. Saude Publica"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"969","DOI":"10.22278\/2318-2660.2012.v36.n4.a791","article-title":"Fatores de Risco associados \u00e0 prematuridade em nascidos vivos no Estado do Cear\u00e1","volume":"36","author":"Sampaio","year":"2012","journal-title":"Rev. Baiana Saude Publica"},{"key":"ref_24","first-page":"e00107014","article-title":"Telephone monitoring service for pregnant women and impact on prevalence of prematurity and associated risk factors in Piracicaba, S\u00e3o Paulo State, Brazil","volume":"32","author":"Tuon","year":"2016","journal-title":"Cad. Saude Publica"},{"key":"ref_25","first-page":"e2110","article-title":"Fatores de risco associados \u00e0 prematuridade e baixo peso ao nascer nos extremos da vida reprodutiva em uma maternidade privada. Risk factors associated with prematurity and low birth weight at the extremes of reproductive life in a private maternity","volume":"39","author":"Chermont","year":"2020","journal-title":"Rev. Eletron. Acervo Saude\/Electron. J. Collect. Health"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"69","DOI":"10.17267\/2238-2704rpf.v10i1.2653","article-title":"Fatores relacionados \u00e0 prematuridade em uma maternidade p\u00fablica de Teresina\u2013PI: Estudo retrospectivo. Factors related to prematurity in a public maternity hospital of Teresina\u2013PI: Retrospective study","volume":"10","author":"Gomes","year":"2020","journal-title":"Rev. Pesqui. Fisioter."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1780","DOI":"10.1080\/14767058.2018.1527897","article-title":"Late preterms: Are they all the same?","volume":"33","author":"Carrapato","year":"2020","journal-title":"J. Matern. Fetal Neonatal Med."},{"key":"ref_28","first-page":"354","article-title":"Fatores de risco associado ao parto pr\u00e9-termo em hospital de refer\u00eancia de Santa Catarina. Risk factors associated with pre-term labor in a reference hospital in Santa Catarina","volume":"53","author":"Rojas","year":"2009","journal-title":"Rev. AMRIGS"},{"key":"ref_29","first-page":"43","article-title":"Fatores de risco maternos associados \u00e0 prematuridade em uma maternidade-escola. Maternal risk factors associated with prematurity in a university maternity hospital","volume":"18","author":"Penha","year":"2019","journal-title":"SANARE-Rev. Politicas Publicas"},{"key":"ref_30","first-page":"S41","article-title":"Fatores de risco materno-fetais para o nascimento pr\u00e9-termo em hospital de refer\u00eancia de Minas Gerais. Maternal and fetal risk factors for preterm birth in a reference hospital in Minas Gerais","volume":"30","author":"Brandi","year":"2020","journal-title":"Rev. Med. Minas Gerais"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"204.e1","DOI":"10.1016\/j.ajog.2020.02.003","article-title":"Risk of singleton preterm birth after prior twin preterm birth: A systematic review and meta-analysis","volume":"223","author":"Menzies","year":"2020","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"American College of Obstetricians and Gynecologists\u2019 Committee on Obstetric Practice, Society for Maternal-Fetal Medicine (2021). Medically Indicated Late-Preterm and Early-Term Deliveries: ACOG Committee Opinion, Number 831. Obstet. Gynecol., 138, e35\u2013e39.","DOI":"10.1097\/AOG.0000000000004447"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.ejogrb.2023.08.013","article-title":"Systematic review and meta-analysis of maternal and fetal outcomes among pregnant women with bacterial vaginosis","volume":"289","author":"Kenmoe","year":"2023","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1907","DOI":"10.1111\/1471-0528.16774","article-title":"Trichomoniasis and adverse birth outcomes: A systematic review and meta-analysis","volume":"128","author":"Jones","year":"2021","journal-title":"BJOG Int. J. Obstet. Gynaecol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"106473","DOI":"10.1016\/j.ypmed.2021.106473","article-title":"Preterm birth rate after bivalent HPV vaccination: Registry-based follow-up of a randomized clinical trial","volume":"146","author":"Kalliala","year":"2021","journal-title":"Prev. Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e2125308","DOI":"10.1001\/jamanetworkopen.2021.25308","article-title":"Association Between Human Papillomavirus Infection among Pregnant Women and Preterm Birth","volume":"4","author":"Niyibizi","year":"2021","journal-title":"JAMA Netw. Open"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1111\/1471-0528.17349","article-title":"Spontaneous preterm birth risk among HPV-vaccinated and -unvaccinated women: A nationwide retrospective cohort study of over 240000 singleton births","volume":"130","author":"McClymont","year":"2023","journal-title":"BJOG Int. J. Obstet. Gynaecol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1111\/aogs.14509","article-title":"Maternal human papillomavirus infection during pregnancy and preterm delivery: A mother-child cohort study in Norway and Sweden","volume":"102","author":"Wiik","year":"2023","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e2018136","DOI":"10.1590\/1984-0462\/2020\/38\/2018136","article-title":"Fatores de risco materno-fetais associados \u00e0 prematuridade tardia\/ Maternal and fetal risk factors associated with late preterm infants","volume":"38","author":"Vanin","year":"2020","journal-title":"Rev. Paul. Pediatr."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1542\/peds.32.5.793","article-title":"Intrauterine growth as estimated from liveborn birth-weight data at 24 to 42 weeks of gestation","volume":"32","author":"Lubchenco","year":"1963","journal-title":"Pediatrics"},{"key":"ref_41","first-page":"12829","article-title":"Preval\u00eancia de partos prematuros entre os anos de 2018 e 2019 em uma maternidade p\u00fablica no munic\u00edpio de Manaus-Amazonas","volume":"87","author":"Sarrazin","year":"2023","journal-title":"Saude Coletiva"},{"key":"ref_42","first-page":"385","article-title":"Sociodemographic determinants and mortality of premature newborns in a medium and low-income population in Colombia, 2017\u20132019","volume":"43","author":"Murillo","year":"2023","journal-title":"Biomed"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1590\/S1519-38292006000200010","article-title":"Preval\u00eancia e fatores associados \u00e0 prematuridade entre gestantes submetidas \u00e0 inibi\u00e7\u00e3o de trabalho de parto prematuro. [Prevalence and risk factors associated to preterm delivery among pregnant women submitted to preterm labor inhibition treatment]","volume":"6","author":"Bezerra","year":"2006","journal-title":"Rev. Bras. Sa\u00fade Matern. Infant."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1590\/S1414-81452009000200009","article-title":"Fatores de risco para prematuridade: Pesquisa documental. [Risk factors for prematurity: Document search]","volume":"13","author":"Ramos","year":"2009","journal-title":"Esc. Anna Nery Rev. Enferm."},{"key":"ref_45","unstructured":"Chacko, M.R. (2024, April 25). Pregnancy in Adolescents, Uptodate. Available online: https:\/\/www.uptodate.com\/contents\/pregnancy-in-adolescents\/print?sectionName=Pregnancy%20outcome&topicRef=6761&anchor=H13&source=see_link."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.bpobgyn.2018.04.003","article-title":"The global epidemiology of preterm birth","volume":"52","author":"Vogel","year":"2018","journal-title":"Best Pract. Res. Clin. Obstet. Gynaecol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1186\/s12978-016-0230-0","article-title":"Prevalence and risk factors related to preterm birth in Brazil","volume":"13","author":"Leal","year":"2016","journal-title":"Reprod. Health"},{"key":"ref_48","first-page":"28","article-title":"The incidence, risk factors, and mortality of preterm neonates: A prospective study from Jordan (2012\u20132013)","volume":"14","author":"Khader","year":"2017","journal-title":"Turk. J. Obstet. Gynecol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"862","DOI":"10.3109\/00016349.2010.486827","article-title":"Parity and low birth weight and preterm birth: A systematic review and meta-analyses","volume":"89","author":"Shah","year":"2010","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Nguyen, P.N., Vuong, A.D.B., and Pham, X.T.T. (2024). Neonatal outcomes in the surgical management of placenta accreta spectrum disorders: A retrospective single-center observational study from 468 Vietnamese pregnancies beyond 28 weeks of gestation. BMC Pregnancy Childbirth, 24.","DOI":"10.1186\/s12884-024-06349-7"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/15\/4437\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:25:53Z","timestamp":1760109953000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/15\/4437"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7,29]]},"references-count":50,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2024,8]]}},"alternative-id":["jcm13154437"],"URL":"https:\/\/doi.org\/10.3390\/jcm13154437","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7,29]]}}}