Multiple Factors in the Second Trimester of Pregnancy on Preterm Labor Symptoms and Preterm Birth

Jeung-Im Kim; Mi-Ock Cho; Gyu-Yeon Choi

doi:10.4040/jkan.2017.47.3.357

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This article has been corrected. See "Corrigendum: Multiple Factors in the Second Trimester of Pregnancy on Preterm Labor Symptoms and Preterm Birth" in Volume 47 on page 575.

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Kim, Cho, and Choi: Multiple Factors in the Second Trimester of Pregnancy on Preterm Labor Symptoms and Preterm Birth

Original Article

J Korean Acad Nurs 2017;47(3):357-366.

Published online: 15 January 2017

DOI: https://doi.org/10.4040/jkan.2017.47.3.357

Multiple Factors in the Second Trimester of Pregnancy on Preterm Labor Symptoms and Preterm Birth

Jeung-Im Kim¹, Mi-Ock Cho^2,, Gyu-Yeon Choi³

¹School of Nursing, Soonchunhyang University, Cheonan

²Department of Nursing, Soonchunhyang University Hospital Cheonan, Cheonan

³Department of Obstetrics and Gynecology, Soonchunhyang University Hospital Seoul, Seoul, Korea

Address reprint requests to : Cho, Mi-Ock Department of Nursing, Soonchunhyang University Hospital Cheonan, 31 Soonchunhyang 6-gil, Dongnam-gu, Cheonan 31151, Korea Tel: +82-41-570-2158 Fax: +82-41-571-7887 E-mail: dash1117@naver.com

Received 30 December 2016 Revised 20 April 2017 Accepted 20 April 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

Abstract

Purpose

The aim of this study was to determine the influence of various factors on preterm labor symptoms (PLS) and preterm birth (PB).

Methods

This prospective cohort study included 193 women in the second stage of pregnancy. Multiple characteristics including body mass index (BMI), smoking, and pregnancy complications were collected through a self-report questionnaire. Pregnancy stress and PLS were each measured with a related scale. Cervical length and birth outcome were evaluated from medical charts. Multiple regression was used to predict PLS and logistic regression was used to predict PB.

Results

Multiple regression showed smoking experience, pregnancy complications and pregnancy specific stress were predictors of PLS and accounted for 19.2% of the total variation. Logistic regression showed predictors of PB to be twins (OR=13.68, CI=3.72~50.33, p<.001), shorter cervix (<25mm) (OR=5.63, CI=1.29~24.54, p<.05), BMI >25 (kg/m²) (OR=3.50, CI=1.35~9.04, p<.01) and a previous PB (OR=4.15, CI=1.07~16.03, p<.05).

Conclusion

The results of this study show that the multiple factors affect stage II pregnant women can result in PLS or PB. And preterm labor may predict PB. These findings highlight differences in predicting variables for pretrm labor and for PB. Future research is needed to develop a screening tool to predict the risk of preterm birth in pregnant women.

Keywords: Pregnancy, Preterm labor, Preterm birth, Stress, Cervical length measurement

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Figure 1.

Supplementary analysis after birth.

Table 1.

Comparison of Multifactorial Characteristics by Birth Outcome (N=193)

Variables		Categories	Total	TB	PB	c² or t	p
			n=193, n (%)	n=158, n (%)	n=35, n (%)
Demographic	cs Age (yr)	<24	2 (1.1)	2 (1.3)	0	2.28^†	.517
		24～29	41 (21.2)	36 (22.8)	5 (14.3)
		30～34	98 (50.8)	80 (50.6)	18 (51.4)
		≥35	52 (26.9)	40 (25.3)	12 (34.3)
		M±SD	32.26±3.83	32.04±3.79	33.26±3.90
	Pre-pregnancy BMI (kg/m²)	<25	157 (81.3)	133 (84.2)	24 (68.6)	6.94	.031
		≥25	36 (18.7)	25 (15.8)	11 (31.4)
		M±SD	22.33±4.24	21.98±4.24	23.93±3.93
	Educational status (years)	≤12	57 (29.6)	44 (27.8)	13 (37.1)	1.19	.275
		≥13	136 (70.4)	114 (7.2)	22 (62.9)
	Smoking before pregnancy	No	167 (86.5)	138 (87.3)	29 (82.9)	0.49	.583
		Yes	26 (13.5)	20 (12.7)	6 (17.1)
	Smoking after pregnancy	No	183 (94.8)	150 (94.9)	33 (94.3)	0.03^†	>.999
		Yes	10 (5.2)	8 (5.1)	2 (5.7)
	Smoking indirectly	No	90 (46.6)	73 (46.2)	17 (48.6)	0.07	.799
		Yes	103 (53.4)	85 (53.8)	18 (51.4)
	Alcohol consumption before	No	58 (30.1)	47 (29.7)	11 (31.4)	0.04	.844
	pregnancy	Yes	135 (69.9)	111 (70.3)	24 (68.6)
	Alcohol consumption after	No	174 (90.2)	143 (90.5)	31 (88.6)	0.12^†	.755
	pregnancy	Yes	19 (9.8)	15 (9.5)	4 (11.4)
Obstetrics	Gestation age (wks)	16～23	120 (62.2)	96 (60.8)	24 (68.6)	0.74	.389
		24～28	73 (37.8)	62 (39.2)	11 (31.4)
		M±SD	21.95±3.49	22.21±3.46	20.81±3.42
	Parity	Primi	104 (53.9)	90 (57.0)	14 (40.0)	3.32	.069
		Multi	89 (46.1)	68 (43.0)	21 (60.0)
		M±SD	2.13±1.41	2.06±1.21	2.49±2.08
	Number of fetuses	Single	180 (93.3)	153 (6.8)	27 (77.1)	17.69	<.001
		Twin	13 (6.7)	5 (3.2)	8 (22.9)
	ART	No	172 (89.1)	147 (93.0)	25 (71.4)	13.80	<.001
		Yes	21 (10.9)	11 (7.0)	10 (28.6)
	Sexual interco-<24wks	No	86 (44.6)	70 (44.3)	16 (45.7)	0.02	.879
	urse	Yes	107 (55.4)	88 (55.7)	19 (54.3)
	≥24wks	No	172 (89.1)	141 (89.2)	31 (88.6)	0.01^†	.908
		Yes	21 (10.9)	17 (10.8)	4 (11.4)
	Vaginitis treatment	No	163 (84.5)	137 (86.7)	26 (74.3)	3.37	.066
		Yes	30 (15.5)	21 (13.3)	9 (25.7)
	Pregnancy complication	No	132 (68.4)	113 (71.5)	19 (54.3)	3.94	.047
		Yes	61 (31.6)	45 (28.5)	16 (45.7)
	Previous abortion	No	133 (68.9)	108 (68.4)	25 (71.4)	0.13	.722
		Yes	60 (31.1)	50 (31.6)	10 (28.6)
	Previous fetal death	No	186 (96.4)	154 (97.5)	32 (91.4)	2.99^†	.114
		Yes	7 (3.6)	4 (2.5)	3 (8.6)
	Previous preterm birth	No	178 (92.2)	149 (94.3)	29 (82.9)	5.24	.034
		Yes	15 (7.8)	9 (5.7)	6 (17.1)
	Family history of preterm	No	183 (94.8)	151 (95.6)	32 (91.4)	1.00	.392
	birth	Yes	10 (5.2)	7 (4.4)	3 (8.6)
	Past conization	No	185 (95.9)	152 (96.2)	33 (94.3)	0.27	.638
		Yes	8 (4.1)	6 (3.8)	2 (5.7)
	Pregnancy specific stress	M±SD	61.34±14.22	61.48±14.20	60.74±14.51	0.42^‡	.675
	Cervical length	<25mm	12 (6.2)	7 (4.4)	5 (14.3)	4.77	.045
		≥25mm	181 (93.8)	151 (95.6)	30 (85.7)
		M±SD	36.99±7.84	37.71±7.14	33.71±9.91
	Preterm labor symptoms	M±SD	7.10±2.07	7.05±2.12	7.34±1.85	-.75^‡	.452

TB=Term birth; PB=Preterm birth; BMI=Body mass index; ART=Artificial reproduction technology.

^†Fisher's exact test.

^‡t-test.

Table 2.

Correlations between Significant Demographic and Obstetric Variables (N=193)

Variables (rs/p)	1	2	3	4	5	6	7	8	9
1 Smoking before pregnancy*	1
2 Smoking after pregnancy*	.59	1
	(<.001)
3 Smoking Indirectly*	.34	.22	1
	(<.001)	(.002)
4 Pregnancy complication*	-.01	-.06	-.04	1
	(.922)	(.420)	(.632)
5 Body mass index before pregnancy	.04	.03	.12	.14	1
	(.565)	(.654)	(.094)	(.052)
6 Preterm birth history*	-.06	.07	-.08	.261	-.02	1
	(.424)	(.348)	(.282)	(<.001)	(.764)
7 Cervical length	-.05	.01	.02	-.28	.06	-.04	1
	(.458)	(.897)	(.779)	(<.001)	(.398)	(.566)
8 Pregnancy specific stress	.14	.04	.23	.003	-.003	-.07	.004	1
	(.048)	(.546)	(.002)	(.967)	(.968)	(.316)	(.959)
9 Pregnancy labor symptoms	.25	.20	.22	.15	.19	-.07	.01	.36	1
	(<.001)	(.005)	(.002)	(.038)	(.009)	(.328)	(.857)	(<.001)

^*Spearman’s correlation.

Table 3.

Factors Predicting Preterm Labor Symptoms (N=193)

Variables	B	SE	β	t	p	R²	F	p
Constant	2.55	.71	0	3.58	<.001	.19	14.94	<.001
Smoking before pregnancy (reference, no smoking)	1.25	.40	0.21	3.12	.002
Pregnancy complication (reference, no complication)	0.67	.29	0.15	2.29	.023
Pregnancy specific stress	0.05	.01	0.33	4.96	<.001

Table 4.

Factors Predicting Preterm Birth (N=193)

Variables	B	SE	Wald	p	OR	95% CI
						Lower	Upper
Constant	-2.31	.31	55.05	<.001	0.10
Twins (Reference= single)	2.62	.67	15.50	<.001	13.68	3.72	50.33
Cervical length <25mm (Reference >25)	1.73	.75	5.29	.021	5.63	1.29	24.54
BMI>25kg/m² (Reference <25)	1.25	.48	6.69	.010	3.50	1.35	9.04
Previous preterm birth (Reference, no preterm)	1.42	.69	4.25	.039	4.15	1.07	16.03
Pregnancy complications (Reference, no complication)	-0.19	.49	0.14	.706	0.83	0.31	2.19

OR=Odds ratio; CI=Confidence interval.

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