Open Access Open Badges Research article

Incidence and risk factors of preterm birth in a rural Bangladeshi cohort

Rashed Shah12*, Luke C Mullany1, Gary L Darmstadt3, Ishtiaq Mannan4, Syed Moshfiqur Rahman5, Radwanur Rahman Talukder5, Jennifer A Applegate1, Nazma Begum1, Dipak Mitra15, Shams El Arifeen5, Abdullah H Baqui15 and for the ProjAHNMo Study Group in Bangladesh

Author Affiliations

1 International Center for Maternal and Newborn Health (ICMNH), Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Room # E8624, Baltimore, MD 21205, USA

2 Department of Health and Nutrition, Save the Children USA, 2000 L Street NW, Suite # 500, 20036 Washington DC, USA

3 Family Health Program, Global Development Division, The Bill and Melinda Gates Foundation, Seattle, WA, USA

4 Ma-Moni Project, MCHIP/Save the Children, Bangladesh Country office, Dhaka, Bangladesh

5 International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh

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BMC Pediatrics 2014, 14:112  doi:10.1186/1471-2431-14-112

Published: 24 April 2014



Globally, about 15 million neonates are born preterm and about 85% of global preterm birth occurs in Asia and Africa regions. We aimed to estimate the incidence and risk factors for preterm birth in a rural Bangladeshi cohort.


Between June 2007 and September 2009, community health workers prospectively collected data from 32,126 mother-live-born baby pairs on household socio-demographic status, pregnancy history, antenatal care seeking and newborn gestational age determined by recall of date of last menstrual period.


Among all live births, 22.3% were delivered prior to 37 weeks of gestation (i.e. preterm); of which 12.3% were born at 35–36 weeks of gestation (late preterm), 7.1% were born at 32–34 weeks (moderate preterm), and 2.9% were born at 28–31 weeks of gestation (very preterm). Overall, the majority of preterm births (55.1%) were late preterm. Risk of preterm birth was lower among women with primary or higher level of education (RR: 0.92; 95% CI: 0.88, 0.97), women who sought antenatal care at least once during the index pregnancy (RR: 0.86; 95% CI: 0.83, 0.90), and women who had completed all birth preparedness steps (RR: 0.32; 95% CI: 0.30, 0.34). In contrast, risk of preterm birth was higher among women with a history of child death (RR: 1.05; 95% CI: 1.01, 1.10), who had mid-upper arm circumference (MUAC) ≤250 mm, indicative of under nutrition (for women having MUAC <214 mm the risk was higher; RR: 1.26; 95% CI: 1.17, 1.35), who reported an antenatal complication (RR: 1.32; 95% CI: 1.14, 1.53), and who received iron-folic acid supplementation for 2–6 months during the index pregnancy (RR: 1.33; 95% CI: 1.24, 1.44).


In resource poor settings with high burden of preterm birth, alike Bangladesh, preterm birth risk could be reduced by close monitoring and/or frequent follow-up of women with history of child death and antenatal complications, by encouraging women to seek antenatal care from qualified providers, to adopt birth preparedness planning and to maintain good nutritional status. Additional research is needed to further explore the associations of antenatal iron supplementation and maternal nutritional status on preterm birth.

Preterm birth; Risk factors; Bangladesh; Community-based program