Traditionally antibiotics have been viewed as the primary intervention promoting latency (the period between confirmed rupture and delivery) following preterm premature rupture of membranes (PPROM). While most studies have investigated immediate risks to a shortened latency period, few have elucidated the impact of predisposed social disadvantages. The objective of our study is to establish a sociodemographic predictive model among a cohort of patients with the diagnosis of PPROM and their risk of preterm delivery.METHODS:
Centers for Disease Control (CDC) birth-certificate data (2012-2013) were used to identify women with PPROM. Sociodemographic and clinical characteristics of women, who delivered <34 weeks, 34-36 weeks, and ≥37weeks of gestation were compared using chi-squared tests. These included health insurance source, number of prenatal visits, and education. Multinomial logistic regression models were used to calculate the relative risk ratios (RRR) of delivery <34 weeks and 34-36 weeks compared to delivery at ≥37 weeks.RESULTS:
A total of 242,290 women with PPROM were identified; 16.1%, 19.7% and 64.2% delivered at <34weeks, between 34-36 weeks, and ≥37 weeks, respectively. Black race was more likely to have delivery at <34 weeks (28.2%) and 34-36 weeks (19.4%) compared to ≥37 weeks (14.2%)(p<0.001). Black race (<34weeks:RRR:1.99;CI:1.94-2.06; 34-36weeks: RRR:1.35;CI:1.31-1.39), high school education or less(<34weeks:RRR:1.19;CI:1.15-1.23; 34-36weeks: RRR:1.16;CI:1.13-1.19), Medicaid insurance(<34weeks:RRR:1.13;CI:1.10-1.17; 34-36weeks: RRR:1.09;CI:1.05-1.12), and 1-3 prenatal visits(<34weeks:RRR:1.45;CI:1.35-1.56; 34-36weeks: RRR:1.03;CI:0.95-1.12) were more likely to have preterm delivery.CONCLUSION:
Correlates of social disadvantage were associated with a decreased latency period among those patients with PPROM. Targeted interventions among socially disadvantaged groups could help decrease this incidence of preterm birth.