Prematurity and Multidimensional Risk Patterns in Adolescent and Adult Pregnancies: A Principal Component Analysis in an Eastern European Cohort

BACKGROUND: Preterm birth remains a major cause of neonatal morbidity and mortality, with risk shaped by interacting maternal, fetal, placental and behavioural factors. This study examined latent multidimensional risk patterns in adolescent and adult pregnancies in an Eastern European cohort. METHODS: We conducted a retrospective observational study including all non-COVID pregnant women who delivered at the County Emergency Clinical Hospital of Brăila, Romania, between 2020 and 2021. Three cohorts were analyzed: adolescent preterm mothers (Lot E; n = 54), adult preterm mothers (Lot P; n = 231) and adult term mothers (Lot M; n = 3354). Maternal, fetal, placental and behavioural indicators were coded as ordered clinical risk categories, and separate principal component analyses (PCA) with Varimax rotation were performed within each cohort. RESULTS: Across all three groups, PCA identified three latent dimensions that together explained approximately 66-72% of the total variance. The composition of these components differed by cohort: in adolescents, maternal complications, exogenous behaviours and obstetric-placental indicators tended to cluster; in adult preterm pregnancies, placental-obstetric and behavioural indicators formed distinct but interrelated dimensions; and in adult term pregnancies, behavioural and socio-environmental indicators were the most prominent contributors to the latent structure, with fetal outcomes forming a separate dimension. CONCLUSIONS: Prematurity-related risk profiles were multidimensional and varied meaningfully by age and pregnancy outcome. These exploratory PCA-derived dimensions provide a data-driven framework for understanding how risk clusters across different maternal populations and may help generate hypotheses for age-specific preventive and clinical strategies. Confirmation and further validation in prospective, multicentre studies are required before clinical application.