Research Article
Methodological Issues on Planning and Running the Brazilian
Multicenter Study on Preterm Birth
Giuliane J. Lajos,
1
Ricardo P. Tedesco,
1
Renato Passini Jr.,
1
Tabata Z. Dias,
1
Marcelo L. Nomura,
1
Patrícia M. Rehder,
1
Samira M. Haddad,
1
Maria H. Sousa,
2
Jose G. Cecatti,
1,2
and Brazilian Multicenter Study on Preterm Birth Study Group
3
1
Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, 13083-881 Campinas, SP, Brazil
2
Center for Studies in Reproductive Health of Campinas (CEMICAMP), 13083-881 Campinas, SP, Brazil
3
University of Campinas, 13083-881 Campinas, SP, Brazil
Correspondence should be addressed to Giuliane J. Lajos; giuliane@unicamp.br
Received 2 September 2014; Accepted 8 January 2015
Academic Editor: Emmanouil Karteris
Copyright © 2015 Giuliane J. Lajos et al. Tis is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Objectives. Assuming that the occurrence of preterm births and their maternal and neonatal associated conditions in Brazil are not
completely known, a multicenter study was proposed. Te purpose of this paper is to describe the methods used, its processes,
achievements, and challenges. Study Design. A multicenter cross-sectional study on preterm births in Brazilian facilities plus
a nested case-control study to assess their associated factors. A description of all steps of planning and implementing such a
nationwide study, including strategies for dealing with problems arising during the process, is presented. Results. 20 referral
hospitals in diferent regions of Brazil participated in the study. A detailed questionnaire for data collection, an electronic platform
for data transcription and monitoring, research materials, and specifc monitoring tools were developed; then data management
and analyses were performed. Finally, we got information on 4,150 preterm births and 1,146 term births. Conclusions. Tis study
represented the frst step of a planned comprehensive assessment of preterm birth in Brazil, with detailed information that will
lead to several analyses and further studies, bringing the knowledge to improve screening, diagnosis, and treatment practices in
maternal and perinatal health with the fnal purpose of reducing the burden of this condition in the country.
1. Introduction
Preterm birth currently is a major cause of neonatal mor-
bidity and mortality worldwide. Classically defned as the
birth that occurs before the 37th week of pregnancy [1],
prematurity is the leading cause of newborn deaths and now
the second leading cause of death afer pneumonia in children
under the age of 5 [2]. It is estimated that 15 million babies
are born too soon every year and over 1 million children
die each year due to complications of preterm birth [3].
Many survivors face a lifetime of disability, including learning
disabilities and vision and hearing problems [4].
Preterm birth is a syndrome with a variety of causes,
which can be classifed in spontaneous preterm birth (sponta-
neous onset of labor or following prelabor premature rupture
of membranes, pPROM) and provider-initiated preterm birth
(defned as induction of labor or elective caesarean birth
before 37 completed weeks of gestation for maternal or
fetal indications, both “urgent” and “discretionary,” or other
nonmedical reasons) [5]. Preterm births are spontaneous
in approximately 75% of the cases [6] and its etiology is
probably a multifactorial process, resulting from the interplay
of factors causing the uterus to change from quiescence to
active contractions and to birth before term. Te precursors
to spontaneous preterm birth vary by gestational age [7]
and social and environmental factors, but the cause of
spontaneous preterm labor remains unidentifed in up to
half of all cases [8]. Maternal history of preterm birth is a
strong risk factor and most likely is driven by the interaction
of genetic, epigenetic, and environmental risk factors [9].
Many other maternal factors have been associated with an
increased risk of spontaneous preterm birth, including young
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e Scientific World Journal
Volume 2015, Article ID 719104, 10 pages
http://dx.doi.org/10.1155/2015/719104