Maternal Risk Factors and Neonatal Outcomes of Uncomplicated Spontaneous Preterm Birth in Ghana: A Multicentre Case–Control Study

Abstract Background Spontaneous preterm birth (SPTB) remains a major contributor to neonatal mortality and long-term morbidity worldwide, yet its underlying aetiology continues to challenge clinicians and researchers. This study aimed to identify maternal predispositions to spontaneous preterm birth (SPTB) as well as neonatal outcomes of SPTB in the absence of other birth-related complications in Ghana. Methods A multicentre unmatched case-control study design involving 604 post-partum mothers with singleton births was conducted across six hospitals in Ghana. The cases comprised 277 mothers with SPTB neonates, while controls comprised 327 mothers with term neonates. Demographic and clinical data were obtained from health records and structured interviews. Neonatal measurements, including birth weight, head circumference, length, and Apgar scores, were assessed. Univariate and multivariate regression analyses identified maternal and neonatal factors associated with outcomes. The main outcome measures were: association of maternal demographic and clinical characteristics, and SPTB, comparison of term and SPTB neonatal clinical characteristics, foetal growth trajectory using the Olsen curve. Results Maternal age < 20 years and attending ≤ 3 antenatal visits independently increased the risk of SPTB by about twofold (aOR = 1.9, 95% CI [1.03–3.57]) and 2.5-fold (aOR = 2.55, 95% CI [1.31–5.11]), respectively. Maternal anaemia at booking also showed an independent borderline association with SPTB (aOR = 1.39 95% CI [1.00–1.94]). Nulliparity, unmarried status, and early menarche (≤ 12 years) were linked to increased risk, although not independently. Preterm neonates had significantly lower neonatal anthropometries, and first- and fifth-minute Apgar scores compared with the term neonates (p < 0.00001). Neonatal anthropometric measures across gestational ages declined relative to the Olsen curve from 29 weeks’ gestation onward. Conclusions Adolescent pregnancy, inadequate antenatal care, and maternal anaemia at booking increase the risk of SPTB among Ghanaian women. SPTB is linked to poorer neonatal growth outcomes. The Ghanaian intrauterine growth trajectory differs from the Olsen reference. The findings highlight the need for integrated multidisciplinary strategies to reduce SPTB, improve neonatal outcomes, and advance our understanding of foetal growth in Ghana.