Prevalence and associated risk factors of preterm birth in India: A review

Main Article Content

Thangjam Chitralekha Devi
Huidrom Suraj Singh


Preterm birth (PTB) is an important health concern and a leading cause of infant mortality and morbidity worldwide. This review article determined potential risk factor(s) associated with PTB and evaluated the overall trend of PTB prevalence  in India. A systematic search was conducted in PubMed, Medline, Google Scholar, and Web of Science databases. Appropriate statistical tools were employed to identify the PTB associated risk factor(s). The prevalence of PTB was found to vary across the country. The overall pooled risk of PTB was found to vary with different  risk factors such as gestational hypertension of 19.16% (95% CI 8.54 to 29.78, I2 = 84.09 %); 9.49% for gravida (95% CI 2.99 to 16.00, I2 = 86.07%), 8.34 %  for anemia (95% CI 4.45 to 12.24, I2 = 79.88%); 8.34% for prior PTB (95% CI 4.45 to 12.24, I2 = 94.89%) and 4.61% for gestational diabetes (95% CI 1.48 to 7.73, I2 = 53.27%). Moreover, low socioeconomic status, inadequate antenatal care, infections during pregnancy, and advanced maternal age were also potential risk factors of PTB among the Indian population. The rate of PTB showed an increasing trend with the high frequency of occurrence in India. Pregnancy induced hypertension, gestational diabetes, prior history of PTB, maternal anemia, and gravida were found to be potential risk factors causing PTB. Understanding the harmful effects of PTB and providing preconception counseling to those mothers who are at high PTB risk should be emphasized to address the PTB associated health consequences.


Article Details

How to Cite
Thangjam Chitralekha Devi, Singh HS. Prevalence and associated risk factors of preterm birth in India: A review. J Public Hlth Dev [Internet]. 2021 May 25 [cited 2024 Apr. 15];19(2):209-26. Available from:
Review articles
Author Biographies

Thangjam Chitralekha Devi, Department of Anthropology, Manipur University, Canchipur, India

Department of Anthropology, Manipur University, Canchipur, Manipur, India

Huidrom Suraj Singh, Department of Anthropology, Manipur University, Canchipur, India

Department of Anthropology, Manipur University, Canchipur, India


Howson CP, Kinney MV, Lawn J. Born Too Soon: the global action report on preterm birth March of Dimes, PMNCH, Save the Children, WHO 2012.

Blencowe H, Cousens S, Oestergaard MZ. National, regional and worldwide estimates of PTB rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet 2012;379(9832): 2162–72.

Liu L, Oza S, Hogan D, Chu Y, Perin J, Chu Y, Perin J, Zhu J, Lawn JE, Cousens S, Mathers C, Black RE. Global, regional, and national causes of under-5 mortality in 2000-15:an updated systematic analysis with implications for the Sustainable Development Goals. Lancet 2016; 388:3027-35.

WHO. Preterm birth. PTB [Internet]. 2018 [cited 2019 May 23]. available from:

Beck S, Wojdyla D, Say L, Betran AP, Merialdi M, Requejo JH, Rubens RM, Van Look PFA. The worldwide incidence of PTB: a systematic review of maternal mortality and morbidity. Bull World Health Organ 2010;88(1): 31-8.

India-profile for Preterm birth and low birth weight prevention care [Internet]. [cited 2019 May 23]. Available from:

Chawanpaibon S, Vogel JP, Moller AB, Lumbiganon P, Petzold M, Hogan D, Landoulsi S, Jampathong N, Kongwattankochai K, Laopaiboon M, Lewis C, Rattanakanokchai S, Teng DN, Thinkhamrop J, Watananirun K, Zhang J, Zhou W, Gulmezoglu AM. Global, regional, and national estimates of levels of preterm birth in 2014: a systematic review and modelling analysis. Lancet Glob Health 2019;7(1): e37-346.

Wagura P, Wasunna A, Laving A, Wamalwa D, Nganga P. Prevalence and factors associated with PTB at Kenyatta national hospital. BMC Preg childbirth 2018; 18:107.

Alijahan R, Hazrati S, Mirzarahimi M, Pourfarzi F, Hadi PA. Prevalence and risk factors associated with PTB in Ardabil, Iran. Iran J Reprod Med. 2014;12(1): 47-56.

Undela K. Impact of medical conditions and medication use during pregnancy on adverse birth outcomes: A hospital based case-control study [Dissertation]. Shodhganga: a reservoir of Indian theses @ INFLIBNET [Internet]. 2019. Available from: 10603/255656

Gurung A, Wrammert J, Sunny AK, Gurung R, Rana N, Basaula YN, Paudel P, Pokhrel A, Ashish KC. Incidence, risk factors and consequences of preterm birth-findings from a multi-centric observational study for 14 months in Nepal. Arch Public Health 2020;78:64

Neyeloff JL, Fuchs SC, Moreira LB. Meta-analyses and Forest plots using a Microsoft Excel spreadsheet: step-by-step guide focusing on descriptive data analysis. BMC research notes 2012;5(1):52.

Borenstein M, Hedges LV, Higgins JP, Rothstein HR. A basic introduction to fixed‐effect and random‐effects models for meta‐analysis. Res Synth Methods 2010;1(2):97-111.

Vogel JP, Lee AC, Souza JP. Maternal morbidity and preterm birth in 22 low- and middle-income countries: a secondary analysis of the WHO Global Survey dataset. BMC Pregnancy Childbirth 2014; 14:56.

Kuppusamy N, Vidhyadevi A. Prevalence of preterm admissions and the risk factors of preterm labor in a rural medical college hospital. Int J Sci Stud 2016;4(9):125-28.

Ahankari A, Bapat S, Fogarty A, Tata L. Factors associated with preterm delivery and low birth weight: A study from rural Maharashtra, India. F1000Research 2017;6:72.

Dayanithi M. Low birth weight and premature births and their associated maternal factors. Int J Community Med Public Health 2018;5(6): 2277-85.

Jamal S, Srivastava R. A retrospective analytical study of the epidemiology and causes of preterm birth. Int J Reprod Contracept Obstet Gynecol 2017;6(12):5453-7

Singh S, Malhotra AK. Across-sectional study on prevalence of preterm birth in medical college Jhansi (U.P). Indian J Appl Res 2018; 8(10):50-52.

Patel A, Prakash AA, Pusdekar YV, Kulkarni H, Hibberd P. Detection and risk stratification of women at high risk of preterm birth in rural communities near Nagpur, India. BMC Pregnancy Childbirth 2017;17(1):311.

Mahajan A, Magon S. Study of risk factors for preterm births in a teaching hospital: A prospective study. Int J Med Dent Sci 2016; 6:1407-12.

Garg S, Kaur T, Saran AS, Yadav M. A study of etiology and outcome of preterm birth at a tertiary care centre. Int J Reprod Contracept Obstet Gynecol 2017;6(10): 4488-91.

Rao CR, de Ruiter LE, Bhat P, Kamath V, Kamath A, Bhat V. A Case-Control Study on Risk Factors for preterm deliveries in a secondary care hospital, Southern India. ISRN Obstet Gynecol 2014.

Soundarajan P, Muthuramu P, Veerapandi M, Marriapam R. Retrospective study factors related to preterm birth in Government Raja Mirasudar Hospital and obstetric and perinatal outcome. Int J Reprod Contracept Obstet Gynecol 2016;5(9): 3006-10.

Fernandes SF, Chandra S. A study of risk factors for preterm labour. Int J Reprod Contracept Obstet Gynecol 2015;4(5):1306-12.

Patel PK, Pitre DS, Bhooker SP. Predictive value of various risk factors for preterm labor. Natl J Community Med 2015;6(1):121-5

Shetty MB, Krupa BM, Mounica M, Asha S, Davis SP, Suneha P. Preterm birth: associated risk factors and outcome in tertiary care center. Int J Reprod Contracept Obstet Gynecol 2017; 6(8):3271-74.

Bangal V, Shinde K, Khanwelkar G, Patil N. A study of risk factors and perinatal outcome in preterm labour at tertiary care hospital. Int. J. Biomed. Res. 2012;3(3):147-50.

Tellapagadra C, Eshwara VK, Bhat P, Acharya S, Kamath A, Bhat S, Rao C, Nayak S, Mukhopadhyaya. Risk factors for PTB and low birth weight: A hospital-based prospective study. J Prev Med Public Health 2016; 49: 165-175.

Radhanpuri F, Desai DA, Sharma J, Kaur P. PTB and its outcome. Int J Reprod Contracept Obstet Gynecol 2014;3(1):153-57.

Avachet SS, Kambale SV, Phalke BD. Determinants of preterm labour in a rural medical college hospital in Western Maharashtra. Nepal Journal of Obstetrics and Gynaecology 2013; 8(1):31-33.

Dayanithi M. Low birth weight and premature births and their associated maternal factors. Int J Community Med Public Health 2018;5(6): 2277-85.

Rashmi A, Narayanamurthy MR, Vidya GS, Vidyalaxmi K, Renuka M. Risk factors for PTB: a community based longitudinal study in rural Mysuru, Karnataka, India. Int J Community Med Public Health 016;3(12):3576-80.

Trivedi P, Saxena D, Puwar T, Savaliya S, Ganguly P. A cohort study on risk factors for PTBs in rural Gujarat. Indian J Public Health 2018; 62:111-6.

Dwarkanath P, Barzilay JR, Thomas T, Thomas A, Bhat S, Kurpad AV. High folate and low vitamin B-12 intakes during pregnancy are associated with small-for-gestational age infants in South Indian women: a prospective observational cohort study. Am J Clin Nutr 2013;98(6):1450-8

Mahavarkar SH, Madhu CK, Mule VD. A comparative study of teenage pregnancy. J Obstet Gynaecol 2008;28(6):604-7.

Medhi R, Das B, Bas A, Ahmed M, Bawri S, Rai S. Adverse Obstetrical and Perinatal Outcome in Adolescent Mothers Associated with First Birth: A Hospital-Based Case-Control Study in a Tertiary Care Hospital in North-East India Adolesc Health Med Ther 2016; 7:37-42.

Taha Z, Hassan AA, Ludmilla WS, Papandreous D. Factors associated with PTB and low birth weight in Abu dhabi, the United Arab Emirates. Int J Environ Res Public Health 2020; 17:1382.

Gebreslasie M. Preterm birth and associated factors among mothers who gave birth in Gondar Town Health Institutions. Adv Nurs 2016;(6):1-5

Chen C, Zhang J, Xia H, Zhang H, Betran AP, Zhang L, Hua X, Chen D, Sun K, Guo C, Qi H, Duan T, Zhang J. Epidemiology of preterm birth in China in 2015 and 2016: a nationwide survey. The Lancet 2018;392:s73.

De Medeiros BKB, Cornetta MC, Crispim JO, cobucci RN. Risk factors associated with PTB in a Brazilian maternal and child health hospital. Obstetrics Gynecology Cases Review 2018; 5:136.

Chen KH, Chen IC, Yang YC, Chen KT. The trends and associated factors of preterm deliveries from 2001 to 2011 in Taiwan. Medicine 2019; 98:13.

Premkumar A, Henry DE, Moghadassi M, Nakagawa S, Norton ME. The interaction between maternal race/ethnicity and chronic hypertension on preterm birth. Am. J. Obstet. Gynecol. 2016;215(6):787.E1-787.E8.

Baer RJ, Bandoli G, Chambers BD, Chambers CD, Oltman SP, Rand L, Ryckman KK, Jelliffe-Pawlowski LL. Risk of PTB among women with a urinary tract infection by trimester of pregnancy. Am. J. Obstet. Gynecol. 2019;220(1), S433-S434.

Stylianou-Riga P, Kouis P, Kinni P, Rigas A, Papadouri T, Yiallouros PK, Theodorou M. Maternal socioeconomic factors and the risk of premature birth and low birth weight in Cyprus: a case-control study. Reprod. Health 2018;15(1):157.

Mulualem G, Wondim A, Woretaw A. The effect of pregnancy induced hypertension and multiple pregnancies on PTB in Ethoipia: a systematic review and meta-analysis. BMC Research Notes 2019;12(1):91.

Philips C, Velji Z, Hanly C, Metacalfe A. Risk of recurrent spontaneous PTB: a systematic review and meta-analysis. BMJ Open 2017;5;7(6).

Rahmati S, Azami M, Badfar G, Parizad N, Sayehmiri K. The relationship between maternal anemia during pregnancy with PTB: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2019;1-11.

Rahman M, Abe SK, Rahman S, Kanda M, Narita S, Bilano V, Ota E, Gilmour S, Shibuya K. Maternal anemia and risk of adverse birth and health outcomes in low- and middle-income countries: systematic review