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Obstetrics & Gynecology:
Original Research

Preterm Birth in Two Urban Areas of Ukraine

MONAGHAN, SUSAN C. DPH; LITTLE, RUTH E. ScD; HULCHIY, OLESYA MD, DPH; STRASSNER, HOWARD MD; GLADEN, BETH C. PhD

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Abstract

Objective: To determine whether the preterm birth rate was elevated in two urban areas of Ukraine, a former eastern bloc country that experienced serious economic, social, and health problems during its transition from a socialist republic.

Methods: We identified every pregnancy in a defined period in two urban sites where a separate study of pregnancy and childhood was being conducted. We obtained gestational age and vital status at delivery for each. Information about onset of labor and conduct of delivery was available for the subgroup enrolled in the collaborating study.

Results: Among 17,137 pregnancies, all but 6774 were terminated voluntarily. Among the continuing pregnancies, the preterm birth rate was 6.6% for live-born singletons of 20 or more weeks' gestation. Only 12% of preterm births involved medical intervention, the rest were idiopathic. The preterm birth rate was higher than in Europe (4.0% to 5.4%) and Canada (5.9%) but lower than for whites in the United States (8.4%).

Conclusion: Live-born preterm birth rates are influenced by whether infants survive to be included in calculations. The high fetal mortality rate in Ukraine causes many preterm births to be excluded, thus lowering the rate. Frequent pregnancy termination and lack of ultrasound dating in Ukraine also might cause the preterm birth rate to be lower. Preterm birth rates, especially among live-born infants, are difficult to interpret and treacherous to compare across nations. Survival of the fetus and its health and development at birth are better indicators of reproductive outcome.

Preterm birth is a key indicator of maternal and child health.1 Increased risk of early delivery has been reported when economic, health, and social conditions are unfavorable.2 Many countries in the former eastern bloc have had severe problems in those areas since the collapse of the Soviet Union. UNICEF termed the crisis in the countries “without precedent in the European peacetime history of this century.”3 The deteriorating situation has affected the health of millions of women,3 but no systematic study of their reproductive performance has been published.

We studied pregnancy outcome in Ukraine, a former Soviet republic. To the best of our knowledge all pregnancies in two urban areas over a specified period were identified. Our work was done in collaboration with an ongoing multinational study whose subjects were drawn from the same population that we enumerated; their records provided additional details on a subgroup. We report the rate of preterm birth and compare it with rates from other countries.

© 2000 The American College of Obstetricians and Gynecologists

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