Methodological Considerations for Preterm Birth Research

Thokozile R Malaba; Marie-Louise Newell; Landon Myer; Vundli Ramokolo

doi:10.3389/fgwh.2021.821064

Methodological Considerations for Preterm Birth Research

Front Glob Womens Health. 2022 Jan 11:2:821064. doi: 10.3389/fgwh.2021.821064. eCollection 2021.

Authors

Thokozile R Malaba¹, Marie-Louise Newell^{2

3}, Landon Myer^{1

4}, Vundli Ramokolo^{5

6}

Affiliations

¹ Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
² School of Human Development and Health, University of Southampton, Southampton, United Kingdom.
³ School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
⁴ Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
⁵ HIV Prevention Research Unit, South African Medical Research Council, Cape Town, South Africa.
⁶ Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, United States.

Abstract

Complications from preterm birth are a leading cause of infant mortality, with long-term implications for morbidity and quality of life of preterm infants. There are many important risk factors for preterm births however in this article, we focus on the maternal infection etiological pathway, given its significance in low-to-middle income countries. In high preterm birth settings such as sub-Saharan Africa, maternal HIV infection and antiretroviral therapy (ART) use have been associated with an increased risk of preterm births. Consequently, we highlight methodological considerations related to selection and measurement bias in preterm birth research. We further illustrate the potential impact of these biases in studies investigating the relationship between HIV/ART and preterm births. We also briefly discuss issues related to population-level estimations based on routinely collected clinical or civil registration data. We conclude by emphasizing the importance of strengthening of antenatal care services to improve quality of population data as well as optimizing current and future study designs, by taking into account the important methodological considerations described in this article.

Keywords: HIV; antiretroviral therapy (ART); bias (epidemiology); low middle income countries (LMICs); maternal infections; methodology; preterm birth (PTB).