Introduction The term preterm birth (PTB) is defined by World Health Organization (WHO) as babies born alive before completions of 37 weeks of gestational age [1]. In the early days, the determination of prematurity relied on birth weight. The low birth weight (LBW), with less than 2300 or 2500 grams, was considered for describing prematurity [2]. It is sub-categorized based on the gestational age such as extreme preterm (less than 28 weeks), very preterm (28 to 32 weeks), and moderate to late preterm (32 to 37 weeks) [1]. Moreover, preterm birth can also be sub-classified into two broad subtypes based on its cause such as spontaneous preterm birth and provider-initiated preterm birth. The spontaneous preterm birth occurs after spontaneous onset of labor following prelabour premature rupture of membranes whereas, the provider-initiated preterm birth occurs as induction of labor or elective cesarean delivery before 37 weeks of gestation for maternal or fetal indications or non-medical reasons [3]. According to the born too soon report published by WHO (2012), estimated that 15 million babies are born too early every year. Premature birth is one of the leading causes of neonatal morbidity and mortality in children below 5 years of age. Approximately 1 million children die each year due to complications of preterm birth [4]. Across 184 countries, the rate of preterm birth ranges from 5% to 18% of the babies born [5]. In developed and developing countries, medically unnecessary inductions and cesarean section deliveries before full term also increase preterm birth rate. The actual rate of preterm birth remains unexplained in many countries [4,6]. Sub-Saharan Africa and South Asia account for over 60% of preterm births worldwide. In India, 3,341,000 babies are born too early from the expected date [8], and 361,600 children under five years of age die due to complications associated with preterm birth. According to Indian Foundation for Premature Babies (2013), India contributes 23.6% of the global preterm births, of which 13% are live preterm births (babies born <37 weeks), and 28% are with low birth weight [7, 8], and babies born per year <28 weeks are165,800 in India [7,8]. Studies have reported that in India 33,41,000 babies were born preterm per year, the ratio of boys to girls born preterm is 1.23, impaired preterm survivors per year are 80,700, and direct preterm child death per year are 3,61,600 [3,7,8]. According to every preemie scale report of India [8], hypertension (25%), anemia (55%), and diabetes (9%) are found to be significant risk factors that contribute to preterm birth. Though, further studies are required to understand the aetiology of PTB as it is a complex and multifactorial in nature. However, limited studies have been conducted in India to explore the possible risk factors that contribute to PTB. Moreover, most of the available literatures were confined only to some particular regions of the country. Therefore, the present systematic review and meta-analysis was carried out to investigate the potential and absolute risk factor(s) associated with preterm birth from the available literatures to control and take preventive measures in time. Moreover, an attempt was also made to understand the overall trend of the prevalence rate of preterm birth in India