Physiological Predictors of Preterm Birth in High-Risk Pregnancies at Usmanu Danfodiyo University Teaching Hospital, Sokoto

Preterm birth remains a leading cause of neonatal morbidity and mortality in Nigeria, and identifying modifiable physiological predictors in high-risk pregnancies could significantly improve outcomes. This study assessed physiological predictors of preterm birth in high-risk pregnancies at Usmanu Danfodiyo University Teaching Hospital, Sokoto, North West Nigeria. A prospective cohort design enrolled 120 women with at least one high-risk obstetric factor including hypertension, multiple gestation, previous preterm delivery, or cervical incompetence. Clinical and physiological variables assessed included cervical length by transvaginal ultrasound, maternal blood pressure, haemoglobin, C-reactive protein, and insulin resistance. Participants were followed until delivery, and gestational age at birth was recorded. Cox proportional hazards and logistic regression models were applied. Results showed that short cervical length below 25 millimetres was the strongest independent predictor of preterm birth. Elevated C-reactive protein and maternal anaemia significantly increased the risk. Insulin resistance also contributed independently to preterm delivery risk. Blood pressure variability was a weaker predictor in this cohort. This study provides original evidence on the physiological determinants of preterm birth in a high-burden northern Nigerian population, addressing a critical evidence gap. Cervical length screening, anaemia treatment, and inflammatory risk reduction are recommended for high-risk antenatal care. Keywords: preterm birth, cervical length, anaemia, inflammation, Sokoto.