Temporal Patterns in Preterm Birth Subtypes and Perinatal Survival, 2000–2023: Population‐Based, Repeated Cross‐Sectional Time‐Series

ABSTRACT Objective Evaluate the rate and trend of preterm birth (PTB) and the associated perinatal survival in Hong Kong. Design Population‐based, repeated cross‐sectional time series. Setting All public maternity hospitals. Population 845 640 singleton and 26 748 twin deliveries from 2000 to 2023. Methods Two analyses were performed (i) spontaneous PTB (sPTB) vs. iatrogenic PTB (iPTB), (ii) spontaneous PTB with no preterm prelabour rupture of membranes (PPROM) (sPTB‐noPPROM) versus. PTB following PPROM (PTB‐PPROM) vs. iPTB. Main Outcome Measures PTB rate and perinatal survival. Results Simply dividing PTB into sPTB and iPTB demonstrated increasing PTB rates for both types amongst singleton and twin pregnancy. Subclassification of sPTB into sPTB‐noPPROM and PTB‐PPROM demonstrated a downward trend in sPTB‐noPPROM while PTB‐PPROM increased significantly (singleton: sPTB‐noPPROM average annual percent change (AAPC) −0.96, 95% CI −1.67 to −0.41; PTB‐PPROM AAPC 3.4, 95% CI 2.89 to 4.18; iPTB AAPC 2.01, 95% CI 1.57 to 2.45; twin: sPTB‐noPPROM AAPC −2.62, 95% CI −4.09 to −1.58; PTB‐PPROM AAPC 3.05, 95% CI 2.46 to 3.72; iPTB AAPC 2.75, 95% CI 1.82 to 3.69). PTB‐PPROM and iPTB were the leading causes of PTB for singleton and twin pregnancy, respectively. Hypertensive disorders were the predominant causes of iPTB for both singleton and twin pregnancy while iPTB indicated by maternal illnesses reduced over time. Reduction of neonatal mortality rates were noted amongst iPTB for singleton < 37 weeks and twin pregnancies at 34 +0 –36 +6 weeks. The rate of stillbirth and perinatal mortality also reduced amongst PTB of twin pregnancies. Conclusions Perinatal survival improved despite increasing PTB rates. The trend of PTB should be interpreted in the context of perinatal health indicators, and categorisation of PTB could aid with truly reflecting and explaining the trends and patterns of PTB within a population.