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Food insecurity as a risk factor for preterm birth: a prospective facility-based cohort study in rural Haiti
  1. Aaron Richterman1,2,
  2. Maxi Raymonville3,
  3. Azfar Hossain4,
  4. Christophe Millien3,
  5. Jean Paul Joseph3,
  6. Gregory Jerome3,
  7. Molly F Franke5,
  8. Louise C Ivers2,5
  1. 1Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts, USA
  2. 2Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
  3. 3Partners in Health/Zanmi Lasante, Mirebalais, Haiti
  4. 4Harvard Medical School, Boston, Massachusetts, USA
  5. 5Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Dr Aaron Richterman; aarichter{at}


Introduction Haiti has an estimated neonatal mortality rate of 32/1000 live births, the highest in the Western Hemisphere. Preterm birth and being born small for gestational age (SGA) are major causes of adverse neonatal outcomes worldwide. To reduce preterm birth and infants born SGA, it is important to understand which women are most at risk and how risk varies within countries. There are few studies estimating the prevalence and risk factors for these conditions in Haiti, particularly in rural regions.

Methods We conducted a prospective cohort study of pregnant women at a rural tertiary care centre in Haiti from May to December 2017. We collected data during interviews and from the medical record. We built multivariable models to identify risk factors for preterm birth and being born SGA among women who had a facility-based delivery.

Results 1089 pregnant women delivered at the hospital and were included in this analysis. Median gestational age at delivery was 38 weeks (IQR 36–40). In multivariable analyses, risk factors for preterm birth included maternal age <20 years (adjusted OR (AOR) 1.76, 95% CI 1.14 to 2.72) and >34 years (AOR 1.46, 95% CI 1.01 to 2.11) and severe hunger in the household (AOR 1.57, 95% CI 1.09 to 2.26). Risk factors for SGA were age >34 years (AOR 1.76, 95% CI 1.18 to 2.59), twin pregnancy (AOR 3.28, 95% CI 1.20 to 8.95) and first pregnancy (AOR 1.57, 95% CI 1.12 to 2.23). Number of prior abortions was associated with reduced risk for SGA (AOR 0.41, 95% CI 0.17 to 0.97).

Conclusions Food insecurity as a risk factor for preterm birth stands out as an important addition to the understanding of the risk of neonatal morbidity and mortality. This association highlights a potentially important intervention target to improve birth outcomes and suggests that food support has an important role to play for pregnant women who are food insecure in low-income settings.

  • child health
  • epidemiology
  • maternal health
  • nutrition
  • cohort study

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  • Handling editor Seye Abimbola

  • Twitter @drlouiseivers

  • Contributors LIC, MFF, GJ, JPJ, CM and MR designed and implemented the study. AR performed the primary data analysis and wrote the first draft of the manuscript. AH performed the literature review. All authors provided critical feedback on the manuscript.

  • Funding The study was funded by the US Centers for Disease Control and Prevention/Unite de Gestion de Projets, Haiti (5U01GGH001060-04) and the Global Health Research Core of Harvard Medical School.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was granted by the Institutional Review Boards of Partners HealthCare (Boston, Massachusetts; protocol number 2017P000366) and Haiti’s National Bioethics Committee (Port-au-Prince, Haiti; protocol number 1617-28).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on request. Deidentified data can be made available for legitimate research purposes if requested from the senior author (LCI).

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