Maternal Risk Factors and Neonatal Outcomes of Preterm Birth Despite High Antenatal Care Coverage: A Comparative Study from a Tertiary Care Centre, Western India

Background: Preterm birth remains a major cause of neonatal morbidity and mortality. This study evaluated maternal factors associated with preterm birth and the corresponding neonatal clinical burden in an urban tertiary-care setting. Methods: A prospective hospital-based comparative observational study was conducted from January to December 2024. Consecutive live-born preterm (<37 weeks) and term (37-42 weeks) neonates were enrolled in a fixed 1:1 ratio. Maternal risk factors, antenatal care (ANC) indicators, neonatal morbidity, and outcomes were recorded. Multivariable logistic regression identified independent maternal predictors of preterm birth. Results: Among 760 neonates, 380 were preterm and 380 term. Reported ANC coverage was high, with ≥4 visits in 95.3% of preterm and 95.5% of term pregnancies. However, maternal illiteracy, hypertensive disorders, and anemia were significantly more frequent among preterm births. Adjusted analysis identified hypertensive disorders (aOR 5.9, 95% CI 3.2-10.8), maternal illiteracy (aOR 4.5, 95% CI 3.0-6.8), moderate anemia (aOR 2.8, 95% CI 1.9-4.1), and severe anemia (aOR 4.6, 95% CI 1.2-17.5) as independent predictors. ANC visit count and IFA intake were not independently associated with preterm birth. Preterm mortality was substantially higher than term mortality (19.2% vs 2.9%, p<0.001), with respiratory distress syndrome, birth asphyxia, and sepsis prominent among deaths. Conclusion: High ANC attendance may not reflect effective maternal risk detection and management. Strengthening quality, continuity, and risk-focused content of ANC may help reduce preterm birth and its neonatal consequences.