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

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.