The Western Australian preterm birth prevention initiative: a whole of state singleton pregnancy cohort study showing the need to embrace alternative models of care for Aboriginal women

BMC Pregnancy and Childbirth

Research

Kiarna Brown¹  John P. Newnham²  Ye’elah E. Berman²  Dorota A. Doherty²  Scott W. White² 

[1] Department of Obstetrics and Gynaecology, Royal Darwin Hospital, Rocklands Drive, Tiwi, 0811, Darwin, NT, Australia;Menzies School of Health Research, John Matthews Building, Corner of Nightingale and Paracelsus Road, Tiwi, 0810, Darwin, NT, Australia;Division of Obstetrics and Gynaecology, University of Western Australia, King Edward Memorial Hospital, 374 Bagot Road, Subiaco, 6008, Perth, WA, Australia;

关键词: Preterm birth;    Prevention;    Pregnancy;    Aboriginal;    Population-based study;   

DOI  :  10.1186/s12884-022-05222-9

 received in 2022-05-01, accepted in 2022-11-15,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundPreterm birth (PTB) is the greatest cause of mortality and morbidity in children up to five years of age globally. The Western Australian (WA) PTB Prevention Initiative, the world’s first whole-of-population whole-of-state program aimed at PTB prevention, was implemented across WA in 2014.MethodsWe conducted a prospective population-based cohort study using pregnancy data for singleton births in WA from 2009 to 2019. Logistic regression using the last full year before the Initiative (2013) as the reference, and run charts were used to examine changes in PTB rates compared to pre-Initiative levels, by gestational age group, hospital type, low and high risk of PTB in mid-pregnancy, and onset of labour (spontaneous/medically initiated). Analyses were stratified by Aboriginal and non-Aboriginal maternal ethnicity.ResultsAmongst non-Aboriginal women, there was initially a reduction in the PTB rate across the state, and in recent years it returned to pre-Initiative levels. Amongst Aboriginal women there was a small, non- significant reduction in the state-wide PTB rate in the first three years of the Initiative, followed by a rise in recent years. For non-Aboriginal women, the reduction in the rate of PTB at the tertiary centre was sustained and improved further for women of all risk levels and onsets of labour. This reduction was not observed for Aboriginal women giving birth at the tertiary centre, amongst whom there was an increase in the PTB rate overall and in all subgroups, with the exception of medically initiated PTB. Amongst Aboriginal women the PTB rate has also increased across the state. At non-tertiary hospitals there was a large increase in PTB amongst both Aboriginal and non-Aboriginal women, largely driven by medically initiated late PTB. Maternal risk factors cannot account for this increase.ConclusionsThe reduction in PTB rates amongst non-Aboriginal women at the state’s tertiary hospital demonstrates that with the right strategies, PTB can be reduced. A sustained collaborative model is required to realise this success in non-tertiary hospitals. The series of interventions was of limited use in Aboriginal women, and future efforts will need to be directed at strategies more likely to be successful, such as midwifery continuity of care models, with Aboriginal representation in the healthcare workforce.

【 授权许可】

CC BY   
© The Author(s) 2023

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