Preterm delivery rate in China: a systematic review and meta-analysis

BACKGROUND: Preterm delivery rate is a crucial public health indicator, yet reliable statistic is currently not available in China. In this systematic review and meta-analysis, we aimed to review studies on preterm delivery rate in China, explore sources of heterogeneity, and estimate the preterm delivery rate in China. METHODS: Published studies on preterm delivery rate in China since 2010 were electronically searched from PubMed, Embase, Web of Science, China National Knowledge Infrastructure, China Science and Technology Journal Database, and Wanfang Database, and complemented by manual search. Study selection, data extraction, and quality and bias assessment (using the Joanna Briggs Institute Critical Appraisal Checklist) were conducted by two reviewers independently. Random-effects meta-analysis was performed to estimate the pooled preterm delivery rate, and prespecified stratified analysis was conducted to explore sources of heterogeneity. RESULTS: The database search returned 4494 articles and manual search identified 10 additional studies. In total, 162 studies were eligible, of which 124 were hospital-based and 38 population-based. The pooled preterm delivery rate of hospital-based studies (7.2%; 95% CI: 6.9% to 7.6%) was significantly higher than that of population-based studies (4.9%; 95% CI: 4.5% to 5.4%) (P for subgroup difference < 0.001). Among population-based studies, the rate tended to differ by geography (P for subgroup difference = 0.07): 5.3% for Eastern, 4.6% for Central, and 3.8% for Western. CONCLUSIONS: According to population-based studies, the preterm delivery rate in China is around 5%. This rate is substantially lower than estimates from hospital-based studies or estimates from a combination of both hospital-based and population-based studies as having been done in previous studies.