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The Contribution of Birth Defects to Preterm Birth and Low Birth Weight

From ¹Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York; ²DM-STAT, Inc, Malden, Massachusetts; ³Boston University, Boston, Massachusetts; ⁴Royal College of Surgeons in Ireland, Dublin, Ireland; ⁵University of Utah and Intermountain Healthcare, Salt Lake City, Utah; ⁶Swedish Medical Center, Seattle, Washington; ⁷William Beaumont Hospital, Royal Oak, Michigan; ⁸University of Texas Medical Branch, Galveston, Texas; ⁹Mount Sinai Medical Center, New York, New York; ¹⁰University of Colorado Health Sciences, Denver, Colorado; ¹¹Tufts University, Boston, Massachusetts; ¹²New York University Medical Center, New York, New York; ¹³Women and Infants' Hospital, Providence, Rhode Island; ¹⁴University of North Carolina, Chapel Hill, North Carolina; ¹⁵Tufts University, Boston, Massachusetts; and ¹⁶Columbia University, New York, New York.

OBJECTIVE: To assess the impact of birth defects on preterm birth and low birth weight.

METHODS: Data from a large, prospective multi-center trial, the First and Second Trimester Evaluation of Risk (FASTER) Trial, were examined. All live births at more than 24 weeks of gestation with data on outcome and confounders were divided into two comparison groups: 1) those with a chromosomal or structural abnormality (birth defect) and 2) those with no abnormality detected in chromosomes or anatomy. Propensity scores were used to balance the groups, account for confounding, and reduce the bias of a large number of potential confounding factors in the assessment of the impact of a birth defect on outcome. Multiple logistic regression analysis was applied.

RESULTS: A singleton liveborn infant with a birth defect was 2.7 times more likely to be delivered preterm before 37 weeks of gestation (95% confidence interval [CI] 2.3–3.2), 7.0 times more likely to be delivered preterm before 34 weeks (95% CI 5.5–8.9), and 11.5 times more likely to be delivered very preterm before 32 weeks (95% CI 8.7–15.2). A singleton liveborn with a birth defect was 3.6 times more likely to have low birth weight at less than 2,500 g (95% CI 3.0–4.3) and 11.3 times more likely to be very low birth weight at less than 1,500 g (95% CI 8.5–15.1).

CONCLUSION: Birth defects are associated with preterm birth and low birth weight after controlling for multiple confounding factors, including shared risk factors and pregnancy complications, using propensity scoring adjustment in multivariable regression analysis. The independent effects of risk factors on perinatal outcomes such as preterm birth and low birth weight, usually complicated by numerous confounding factors, may benefit from the application of this methodology, which can be used to minimize bias and account for confounding. Furthermore, this suggests that clinical and public health interventions aimed at preventing birth defects may have added benefits in preventing preterm birth and low birth weight.

LEVEL OF EVIDENCE: II

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				G. K. Swamy, T. Ostbye, and R. Skjaerven Association of Preterm Birth With Long-term Survival, Reproduction, and Next-Generation Preterm Birth JAMA, March 26, 2008; 299(12): 1429 - 1436. [Abstract] [Full Text] [PDF]