Marital status, cohabitation, and the risk of preterm birth in Europe: where births outside marriage are common and uncommon.

This article explores whether the impact of marital status on the risk of preterm birth varies in relation to marital practices in the population, defined by the proportion of out-of-marriage births. Data come from a case–control study of the determinants of preterm birth in 16 European countries (5456 cases and 8234 controls). There is a significantly elevated risk of preterm birth associated with both cohabitation (OR = 1.29 [1.08, 1.55]) and single motherhood (OR = 1.61 [1.26, 2.07]) for women living in countries where fewer than 20% of births occur outside marriage. In contrast, there is no excess risk associated with marital status when out-of-marriage births are more common. This overall result does not apply to all subgroups of preterm births: different patterns emerge for early preterm births and preterm births induced for medical reasons. It is important to consider social context in the analysis of individual risk factors.