Studies - General Research

PPROM (Preterm Premature Rupture Of Membranes) is a CP (Cerebral Palsy) Risk Factor (2014)

In this 2014 PROSPECTIVE study, Chinese researchers found that multiple (so-called recurrent) induced abortions nearly triple the risk of PPROM (O.R. = 2.75).

In other words: China’s One-Child-Policy is crippling babies:

International Journal of Gynecology and Obstetrics, Risk Factors for Preterm Premature Rupture of Membranes in Chinese Women from Urban Cities

To investigate the prevalence of preterm premature rupture of membranes(PPROM) in urban areas in China and examine the associated risk factors.

A population-based, prospective study was undertaken in 14 cities in China between January 1, 2011, and January 31, 2012. Women were recruited at their first prenatal-
care visit, when maternal characteristics were recorded. Risk factors were analyzed by one-way analysis of variance.

Of 112 439 women included in analyses, 3077 (2.7%) had PPROM. Univariate analysis showed an increased risk of PPROM before 28 weeks of pregnancy in migrant women (odds ratio [OR] 2.25; 95% confidence interval [CI] 1.53 – 3.30; P < 0.001), in those with a history of recurrent induced abortions (OR 2.75; 95% CI1.66 – 4.56; P < 0.001), and in those with a history of preterm birth (OR 3.90; 95% CI 0.77 – 19.61; P < 0.001).

The associations were maintained in multivariate analysis (P < 0.001).

Migration as a result of urbanization, high rates of induced abortion, and preterm birth are potential risk factors for PPROM in Chinese women.

Preterm premature rupture of membranes (PPROM) occurs spontaneously before 37 weeks of pregnancy. It complicates approximately 3% of pregnancies [1] and accounts for 20% – 30% of all preterm births [2].

PPROM is associated with cerebral palsy and behavioral and educational difficulties in children, the risks of which increase as length of gestation at birth decreases [3 – 5].

Midtrimester PPROM occurring before 28 weeks reduces neonatal viability and survival [6 – 8].

There is a significant risk of perinatal morbidities and mortality even after expectant management with tocolytic drugs, antenatal corticosteroids, and prophylactic antibiotics [9 – 13].

Therefore, the prevention of PPROM in women at high risk and reduction of associated disability are important health priorities.

Identification of maternal risk factors before conception or early in pregnancy could lead to the discovery of new and effective interventions that could help to prevent PPROM.

Previous studies have shown that the risk factors for spontaneous preterm birth include black maternal ethnic origin, previous adverse pregnancy outcome, genitourinary infections, smoking, extremes of body weight and social disadvantage, maternal depression, pre-pregnancy stress, poor diet, assisted fertility, and periodontal disease [14].

A focus on low-income settings might be key to reduce preterm birth worldwide [15]

… Women with PPROM were more likely to be migrants, have a history of preterm birth, have had at least two induced or spontaneous abortions, have a lower body mass index (calculated as weight in kilograms divided by the square of height in meters) at delivery, and have a lower weight gain during pregnancy (Table 2).

The earlier gestational age at which PPROM occurred coincided with an increasing proportion of risk factors.

Additionally, women who experienced PPROM at 28 – 36 weeks of pregnancy tended to be older and have a history of multiple pregnancies.

No differences were recorded for smoking and alcohol use…

… Compared with nonmigrant individuals, more migrant women were multiparous, had undergone at least one induced abortion or at least three spontaneous abortions, had a history of fetal abnormality, and had anemia (Table 3). Fewer migrant women had an abnormal medical history or a history of fetal death (Table 3)…

… Moreover, a history of at least three induced abortions was associated with PPROM at 34 – 36 weeks (OR 1.27; 95% CI 1.11 – 1.47; P = 0.051), PPROM at 28 – 33 weeks (OR 1.37; 95% CI 1.12 – 1.67; P = 0.002), and PPROM before 28 weeks (OR 2.75; 95% CI 1.66 – 4.56; P < 0.001).

… The associations for migrant women,history of recurrent induced abortion, and preterm birth were maintained in multivariate analysis (Table 5).

Smoking, alcohol, abnormal medical history, family history of disease, history of spontaneous abortion, fetal death and fetal abnormality were not shown to be associated (Table 4).

On the basis of the results of logistic regression, three risk factors — migrant status, history of recurrent induced abortion, and preterm birth — were chosen for further MLP analyses. In the model for PPROM before 28 weeks, 78 838 (70.1%) women were assigned to the training sample and 33 601 (29.9%) to the holdout sample.

The importance chart showed that history of recurrent induced abortion was significant for the risk of PPROM before 28 weeks, with an importance of 0.436…

… Women with a history of recurrent induced abortion were also at high risk of PPROM before 33 weeks. This finding is in accordance with a previous report from Eastern Europe [20].

Among the participants who had PPROM in the present study, approximately 44% had a history of induced abortion (24% had had one and 13% two).

In 2001,the reported annual rate of induced abortion was 27.3% in China [21].

This high proportion of Chinese people is worthy of attention.

A possible explanation for the association could be a tendency for increased systemic inflammation and stimulation of the infection pathway in women who have had an induced abortion [22].

It is possible that the women at highest risk of PPROM had abortions at a later stage of pregnancy, but risk of PPROM early in pregnancy should be considered if a woman has had many induced abortions.

In summary, the present retrospective cohort study demonstrated that, in China, migrant status and history of recurrent induced abortions are potential risk factors for PPROM at early gestational age.

Further attention should be paid to urban migration and the high rate of induced abortion in China and low-income countries.

Supplementary data to this article can be found online at

[12 June 2015, Brent Rooney, Canada, 24 References listed

Please cite this article as: Zhou Q, et al, Risk factors for preterm premature rupture of membranes in Chinese women from urban cities, Int J Gynecol Obstet (2014), ]

PPROM International J Gyn & Ob Dec 2014