Exploring New Risk Factors and Preventive Strategies for Premature Rupture of Fetal Membranes: A Systematic Review of Current Prevalence of Traditional, Lifestyle, Nutritional, Physiological and Haematological Factors
Jacques Forwah Ndeh *
Department of Hematology and Blood Transfusion Sciences, Faculty of Clinical Sciences, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria.
Ofonime Benjamin Essien
Department of Hematology and Blood Transfusion Sciences, Faculty of Clinical Sciences, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria.
Edung Emen Samuel
Emergency Department, Basildon and Thurock University Hospital London NHS Trust Foundation, United Kingdom.
Esther N. Okpako
Department of Community Medicine/Public Health Federal Medical Centre, Yenagoa, Bayelsa State, Nigeria.
Khadijah Garba Nabayi
Department of Pediatrics, Cedar Pediatric Clinic, Kaduna, Kaduna State, Nigeria.
Mfonabasi J. Ekanem
Department of Obstetrics and Gynaecology, University Teaching Hospital, Uyo, Akwa, Ibiom State, Nigeria.
Egbunonwo Clement Chukwuma
Department of Emergency, University Hospital Doset Poole, United Kingdom.
Frank Oluseyi Olaniru
Department of Acute Medicine, University Hospital, Coventry and Warwickshire (UHCW), United Kingdom.
Chiamaka Vianney Ndimele
Department of Internal Medicine, York and Scarborough Teaching Hospital, NHS Foundation Trust, United Kingdom.
Obasi Chukwuebuka Michael
Department of Anesthesiology, Enugu State University of Science and Technology, Enugu, State, Nigeria.
Ngwogu Kelechi Kenneth
Department of Community Medicine, Abia State University Teaching Hospital, Aba, Abia State, Nigeria.
Peculiar Osaromoye Ajayi
Department of Internal Medicine/ General Medicine, Ipswich, United Kingdom.
Yewande Bamgbade
Department of CAMHS, Whittington Health NHS Trust, Manchester, United Kingdom.
Samuel Akinkunmi Akinremi
Department of Internal Medicine, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Osun State, Nigeria.
Idayat Adejumoke Salami-Folami
Department of Obstetrics and Gynaecology, Preston, Bolton NHS Foundation Trust, United Kingdom.
Ayobami Olukayode Alalade
Department of Internal Medicine, Redi-Med Consulting Services /University Hospitals of Lagos, Lagos State, Nigeria.
Mujidat Adenike Badmus
Obstetrics and Gynaecology, General Medicine, Trauma and Orthopedics, Northampton General Hospital NHS Trust, United Kingdom.
Nathan Ehizeme Ehioghae
Department: General Medicine, Zitadel Medicals and Diagnostics, Abuja Nigeria.
Adeagbo Jesutomi Boluwatife
Department of Obstetrics and Gynaecology, Babcock University Teaching Hospital, Ilisan-Remo, Ogun State, Nigeria.
Fajuyigbe Bolatito Mary
Department of Family Medicine, Federal Teaching Hospital, Ido Ekiti Ekiti State, Nigeria.
Chukuamaka Iweze Ifukor
Department of Obstetrics and Gynaecology, Lakeland Specialist Clinic Warri, Delta State, Nigeria.
Olumayowa Jacob Mosaku
Department of Obstetrics and Gynaecology, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria.
Medinat Enimire Abubakar
Department of Obstetrics and Gynaecology, South West Acute Hospital M, Northern Ireland, Luton, United Kingdom.
Chatt Usaini
Department of Internal Medicine, Birmingham City University/Genomics Medicals and Multi-specialist Walsall, United Kingdom.
Chimmuanya Chuka-Okoli
Department of Obstetrics and Gynecology Gbagada General Hospital, Lagos, Lagos State, Nigeria.
Habiba Abdulkadir
Department of Primary Health Care Board, Lagos, Lagos State, Nigeria.
Ibuje Taghogho Emuobo
Department of Internal Medicine, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria.
Oluleke Ruth
Department of Public Health, NHS Lanarkahire Glasgow, United Kingdom.
Abadat Moyosore Liadi
Department of Obstetrics & Gynaecology, Daisy Hill Hospital, Newry, United Kingdom.
Idedia Princess Chinonyerem
Department of General outpatient, Ministry of Defence, Sunderland, Abuja, Nigeria.
Oluwaseyi Mary Omosaye
Department of Medicine/ Anaesthesia, Leeds, United Kingdom.
Kunna Noral Ugaliegbulam
Aneurin Bevan University Health Board, Wales, United Kingdom.
Chuba Emmanuel Ifedigbo
Aneurin Bevan University Health Board, Wales, United Kingdom.
Edeani Bobby David
Department of Radiation, University of Nigeria Teaching Hospital Ituku -Ozalla, Enugu State, Nigeria.
Ewa Anthony Obi
Department of Family Medicine, University of Calabar Teaching hospital Calabar, Cross River State, Nigeria.
Etukemo Ubong Amos
Department of Obstetrics and Gynecology, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria.
Idiege Idiege Omang
Department of surgery, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria.
Ngha James Ngah
Department of Obstetrics and Gynecology, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria.
Ofor Joshua Obase-Otumoyi
Department of Public Health National Open University, Lagos State, Nigeria.
Immaculate Ihuoma Ekeagba
Worcaccce Union Group Integrated Healthcare Sciences, Technological Development and Training and Innovative Research Foundation (WUGIHSTTAIRF), P.O Box 45 Bamenda, North West Region, Cameroon.
Nwafor Kelvin Chidera
Department of General Practioneer, Meridian Hospital, Port Harcourt, River State, Nigeria.
Ekpe Okpala Aribo
Department of Physiology, Faculty of Basic Medical Sciences, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria.
Ushie Godwin Abua
Department of Hematology and Blood Transfusion Sciences, Faculty of Clinical Sciences, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria
Kingsley Akabat O
Department of Obstetrics and Gynecology, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria.
Abeshi Sylvester Etenikang
Department of Obstetrics and Gynecology, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria.
James kolawole Ogah
Department of Obstetrics and Gynaecology, 161 Nigeria Air Force hospital Markurdi, Benue State, Nigeria.
Bridget Mosy Likico
Department of Obstetrics of the & Gynaecology and Accident & Emergency unit Royal Free London, North Middlesex University Hospital, London, United Kingdom.
*Author to whom correspondence should be addressed.
Abstract
Background: According to most recent hypotheses, premature rupture of fetal membranes (PROM) remains a leading cause of preterm birth and neonatal morbidity worldwide, affecting approximately 5–10% of all pregnancies. Harmful traditional practices, lifestyle choices, nutritional deficiencies, physiological factors, and haematological conditions have been implicated in the etiology of PROM, yet their collective and individual prevalence and impact are still poorly quantified and exploited.
Objective: To systematically review the current prevalence of harmful traditional practices, lifestyle, nutritional, physiological, and hematological risk factors among pregnant women that contribute to PROM, and to identify evidence‑based preventive measures.
Methodology: A comprehensive search was performed across ten databases and websites using defined search terms (e.g., “premature rupture of fetal membranes,” “PROM,” “risk factors,” “pregnant women”). Of 550 retrieved articles, 466 met the inclusion criteria after applying pre‑specified exclusion criteria. The review adhered to a registered systematic‑review protocol and followed PRISMA guidelines.
Results: The synthesis revealed that female genital mutilation, vaginal douching, smoking, alcohol use, low dietary intake of vitamins C and E, omega‑3 deficiency, prior PROM, cervical insufficiency, short cervical length, uterine anomalies, polyhydramnios, bacterial vaginosis, and chorioamnionitis are consistently associated with increased PROM risk. Haematological parameters showed that maternal anemia (hemoglobin < 11 g/dL) and thrombophilic disorders (e.g., factor V Leiden, antiphospholipid syndrome) also elevate risk. Prevalence varied widely across regions, with the highest burdens reported in sub‑Saharan Africa and South Asia. Interventions such as antenatal education, smoking‑cessation programs, micronutrient supplementation, progesterone therapy in high‑risk women, treatment of vaginal infections, correction of anemia, and thrombophilia management showed promise in reducing PROM incidence.
Conclusion: Addressing modifiable risk factors through targeted antenatal interventions and policy reforms could substantially lower PROM rates and improve maternal‑fetal outcomes. Future research should focus on longitudinal studies and randomized trials to strengthen causal inference and evaluate scalable preventive strategies.
Keywords: PROM, risk factors, traditional practices, nutrition, lifestyle, physiological factors, haematological implications, systematic review, preventive measures