Abstract
This study aimed to identify maternal determinants shaping the structure of perinatal morbidity and clinical outcomes in preterm neonates in the Republic of Kazakhstan. A retrospective analysis of 700 cases of preterm birth was conducted, including a detailed evaluation of maternal and neonatal histories. Key causal relationships were identified. Advanced maternal age (≥35 years), particularly when combined with arterial hypertension, was found to be a leading risk factor for extremely preterm birth, accounting for approximately 30% of the cohort. The presence of preeclampsia was significantly associated with reduced gestational age and lower birth weight and was linked to the development of severe intraventricular hemorrhage (grade III–IV) in 42% of extremely low birth weight (ELBW) infants. A strong correlation (r = 0.78) was observed between prolonged rupture of membranes (>18 hours) and elevated C-reactive protein levels (31.0 mg/L), which manifested as congenital pneumonia in 33% of cases. Severe maternal anemia demonstrated a critical impact on neonatal lactate levels (6.5–8.2 mmol/L). The findings support the need for a paradigm shift in perinatal care—from predominantly reactive intensive care strategies to proactive antenatal risk monitoring at the primary healthcare level. Active correction of maternal risk factors may prolong gestation and significantly reduce the burden of neonatal disability.