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  1. Occupational lifting, fetal death and preterm birth

    DEFF Research Database (Denmark)

    Mocevic, Emina; Svendsen, Susanne Wulff; Jørgensen, Kristian Tore

    2014-01-01

    OBJECTIVE: We examined the association between occupational lifting during pregnancy and risk of fetal death and preterm birth using a job exposure matrix (JEM). METHODS: For 68,086 occupationally active women in the Danish National Birth Cohort, interview information on occupational lifting...... was collected around gestational week 16. We established a JEM based on information from women, who were still pregnant when interviewed. The JEM provided mean total loads lifted per day within homogeneous exposure groups as informed by job and industry codes. All women were assigned an exposure estimate from...

  2. Predicting preterm birth: Cervical length and fetal fibronectin.

    Science.gov (United States)

    Son, Moeun; Miller, Emily S

    2017-12-01

    Spontaneous preterm birth remains the leading cause of neonatal morbidity and mortality worldwide, and accounts for a significant global health burden. Several obstetric strategies to screen for spontaneous preterm delivery, such as cervical length and fetal fibronectin measurement, have emerged. However, the effectiveness of these strategies relies on their ability to accurately predict those pregnancies at increased risk for spontaneous preterm birth (SPTB). Transvaginal cervical shortening is predictive of preterm birth and when coupled with appropriate preterm birth prevention strategies, has been associated with reductions in SPTB in asymptomatic women with a singleton gestation. The use of qualitative fetal fibronectin may be useful in conjunction with cervical length assessment in women with acute preterm labor symptoms, but data supporting its clinical utility remain limited. As both cervical length and qualitative fetal fibronectin have limited capacity to predict preterm birth, further studies are needed to investigate other potential screening modalities. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Antepartum Fetal Monitoring and Spectral Analysis of Preterm Birth Risk

    Science.gov (United States)

    Păsăricără, Alexandru; Nemescu, Dragoş; Arotăriţei, Dragoş; Rotariu, Cristian

    2017-11-01

    The monitoring and analysis of antepartum fetal and maternal recordings is a research area of notable interest due to the relatively high value of preterm birth. The interest stems from the improvement of devices used for monitoring. The current paper presents the spectral analysis of antepartum heart rate recordings conducted during a study in Romania at the Cuza Voda Obstetrics and Gynecology Clinical Hospital from Iasi between 2010 and 2014. The study focuses on normal and preterm birth risk subjects in order to determine differences between these two types or recordings in terms of spectral analysis.

  4. Maternal and fetal factors observed with late preterm births

    OpenAIRE

    Madhusudan Dey; Raju Agarwal; Devkalyan Maji; Uttara A. Kohli

    2015-01-01

    Backround: Although neonatal morbidity and mortality rates are fallen in recent decades, the prevalence of preterm deliveries has increased especially late preterm births. Late preterm deliveries are at increased risk of various neonatal complications compared to term deliveries. This study was carried out to identify the maternal characteristics and co-morbidites found with late preterm births and feto-maternal outcome in terms of indication of delivery, route of delivery, Apgar score and...

  5. Preterm Birth

    Science.gov (United States)

    ... After hours (404) 639-2888 Contact Media Preterm Birth Recommend on Facebook Tweet Share Compartir Preterm birth ... Can anything be done to prevent a preterm birth? Preventing preterm birth remains a challenge because there ...

  6. Fetal adrenal gland biometry and cervical elastography as predictors of preterm birth: A comparative study.

    Science.gov (United States)

    Agarwal, Shubhra; Agarwal, Arjit; Joon, Pawan; Saraswat, Shalini; Chandak, Shruti

    2018-02-01

    Preterm birth is a major health problem in developing and developed countries leading to rising health care costs and long-term neurodevelopmental disability. The study aims to evaluate the role of new quantitative markers, like the elastography of cervix (shear wave speed estimation), fetal adrenal zone enlargement, and corrected fetal adrenal gland volume; in preterm birth prediction and analyze their relative importance. Thus, these markers may be beneficial in early preterm birth detection and prevent the related morbidities. Thirty pregnant females (from 28 to 37 weeks of gestational age), showing clinical signs and delivery outcome of preterm birth were included in the study with an equal number of not-in-labor antenatal females at ≥37 weeks as controls. These patients were categorized as preterm and term groups. Both the groups were subjected to trans-abdominal ultrasonography where cervical length, cervical shear wave speed (dynamic elastography) and fetal adrenal gland parameters were measured. Shear wave speed estimation of the antenatal cervix showed the highest sensitivity and specificity (96.7% and 87% respectively) in the prediction of preterm birth and also showed a strong correlation with fetal adrenal gland enlargement. Fetal adrenal zone enlargement was also shown to be a reliable marker of preterm birth, however, with reduced sensitivity and specificity than shear wave speed. The elastographic advancement and fetal adrenal biometry derived quantitative markers can be used as an objective and standard criterion for accurate prediction of preterm birth.

  7. Quantitative fetal fibronectin predicts preterm birth in women with bulging fetal membranes.

    Science.gov (United States)

    Fiorini, Francesco; Isted, Alexander; Hezelgrave, Natasha L; Shennan, Andrew H

    2016-08-01

    To assess the predictive value of quantitative fetal fibronectin (fFN) concentration in cervicovaginal fluid for spontaneous preterm birth in women with bulging fetal membranes. This was a prospective observational study from five UK tertiary centres of a cohort of women with singleton pregnancy and bulging fetal membranes presenting between 18 and 32 weeks of gestation (n=62), in the period 2010-2014. fFN concentrations in cervicovaginal fluid were measured both quantitatively and qualitatively at presentation in all women. Predictive statistics and receiver operating characteristic (ROC) curves were calculated for both tests to predict spontaneous preterm birth within 14 days from testing and before 34 weeks of gestation. 62 eligible women with bulging fetal membranes were recruited from screening of 2571 women at high risk of preterm birth. The median gestational age was 24(+0) (LQ-UQ, 21(+2)-25(+3)) at presentation and 34(+4) (25(+2)-39(+0)) at delivery, with a median time from testing to delivery of 58 days (17-110). Concentration of quantitative fFN at presentation correlated negatively with time to delivery (Spearman's rs=-0.615, pmembranes, suggesting that fFN leakage could potentially be an active process. This may aid the clinical management of this high-risk group in the future. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  8. Inhibition of gingipains prevents Porphyromonas gingivalis-induced preterm birth and fetal death in pregnant mice.

    Science.gov (United States)

    Takii, Ryosuke; Kadowaki, Tomoko; Tsukuba, Takayuki; Yamamoto, Kenji

    2018-04-05

    Accumulating epidemiological evidence indicates that infection with Porphyromonas gingivalis which is a major periodontal pathogen, causes preterm birth and low birth weight. However, virulence factors of P. gingivalis responsible for preterm birth/low birth weight remain to be elucidated. In this study, using P. gingivalis-infected pregnant mice as an in vivo model, we investigated whether gingipains-cysteine proteinases produced by P. gingivalis-affect preterm birth and low birth weight. We found that intravenous infection of pregnant mice with P. gingivalis induced higher accumulation of the bacterium in the placenta than that in other organs. Compared to infection with P. gingivalis wild-type, infection with a gingipain-deficient P. gingivalis mutant KDP136 led to significant reduction in preterm birth and pregnancy loss. Although repetitive low-level infections of P. gingivalis failed to induce preterm birth and fetal death, it induced suppressive effects on IFN-γ production. Therapeutically, treatment with ginginpain inhibitors prevented fetal death and preterm birth caused by P. gingivalis infection and resulted in recovery of IFN-γ suppression caused by repetitive chronic P. gingivalis infection. These results indicate that gingipains are major virulence factors of P. gingivalis responsible for preterm birth/low birth, and gingipain inhibitors may be useful not only as a therapeutic agent for periodontal diseases, but also as a preventive medicine for preterm birth/low birth weight. Copyright © 2018 Elsevier B.V. All rights reserved.

  9. IL-27 induces a pro-inflammatory response in human fetal membranes mediating preterm birth.

    Science.gov (United States)

    Yin, Nanlin; Wang, Hanbing; Zhang, Hua; Ge, Huisheng; Tan, Bing; Yuan, Yu; Luo, Xiaofang; Olson, David M; Baker, Philip N; Qi, Hongbo

    2017-09-01

    Inflammation at the maternal-fetal interface has been shown to be involved in the pathogenesis of preterm birth. Interleukin 27 (IL-27), a heterodimeric cytokine, is known to mediate an inflammatory response in some pregnancy complications. In this study, we aimed to determine whether IL-27 could induce an inflammatory reaction at the maternal-fetal interface that would mediate the onset of preterm birth. We found elevated expression of IL-27 in human peripheral serum and elevated expression of its specific receptor (wsx-1) on fetal membranes in cases of preterm birth. Moreover, the release of inflammatory markers (CXCL10, IFN-γ, MCP-1, IL-6, IL-1β and TNF-α), especially CXCL10, was markedly augmented upon stimulation of IL-27 in the fetal membranes. Additionally, IL-27 and IFN-γ cooperated to amplify the expression of CXCL10 in the fetal membranes. Moreover, the production of CXCL10 was increased in IL-27-treated fetal membrane through JNK, PI3K or Erk signaling pathways. Finally, MMP2 and MMP9 were activated by IL-27 in human fetal membranes, which may be related to the onset of preterm premature rupture of membranes (pPROM). In conclusion, for the first time, we reported that the aberrant expression of IL-27 could mediate an excessive inflammatory response in fetal membranes through the JNK, PI3K or Erk signaling pathways, which contributes to preterm birth. Copyright © 2017 Elsevier B.V. All rights reserved.

  10. PRETERM BIRTH AND FETAL GROWTH RESTRICTION IN HIV-INFECTED BRAZILIAN PREGNANT WOMEN

    Science.gov (United States)

    dos REIS, Helena Lucia Barroso; ARAUJO, Karina da Silva; RIBEIRO, Lilian Paula; da ROCHA, Daniel Ribeiro; ROSATO, Drielli Petri; PASSOS, Mauro Romero Leal; de VARGAS, Paulo Roberto Merçon

    2015-01-01

    Introduction: Maternal HIV infection and related co-morbidities may have two outstanding consequences to fetal health: mother-to-child transmission (MTCT) and adverse perinatal outcomes. After Brazilian success in reducing MTCT, the attention must now be diverted to the potentially increased risk for preterm birth (PTB) and intrauterine fetal growth restriction (IUGR). Objective: To determine the prevalence of PTB and IUGR in low income, antiretroviral users, publicly assisted, HIV-infected women and to verify its relation to the HIV infection stage. Patients and Methods: Out of 250 deliveries from HIV-infected mothers that delivered at a tertiary public university hospital in the city of Vitória, state of Espírito Santo, Southeastern Brazil, from November 2001 to May 2012, 74 single pregnancies were selected for study, with ultrasound validated gestational age (GA) and data on birth dimensions: fetal weight (FW), birth length (BL), head and abdominal circumferences (HC, AC). The data were extracted from clinical and pathological records, and the outcomes summarized as proportions of preterm birth (PTB, fetal dimensions than the expected population distribution in this small casuistry of newborn from the HIV-infected, low income, antiretroviral users, and publicly assisted pregnant women. A trend for higher prevalence of PTB, LBW and SGA fetal dimensions was also observed in infants born to mothers with AIDS compared to HIV-infected mothers without AIDS. PMID:25923889

  11. Periconception folic acid supplementation, fetal growth and the risks of low birth weight and preterm birth: the Generation R Study.

    Science.gov (United States)

    Timmermans, Sarah; Jaddoe, Vincent W V; Hofman, Albert; Steegers-Theunissen, Régine P M; Steegers, Eric A P

    2009-09-01

    Countries worldwide, including the Netherlands, recommend that women planning pregnancy use a folic acid supplement during the periconception period. Some countries even fortify staple foods with folic acid. These recommendations mainly focus on the prevention of neural tube defects, despite increasing evidence that folic acid may also influence birth weight. We examined whether periconception folic acid supplementation affects fetal growth and the risks of low birth weight, small for gestational age (SGA) and preterm birth, in the Generation R Study in Rotterdam, the Netherlands. Main outcome measures were fetal growth measured in mid- and late pregnancy by ultrasound, birth weight, SGA and preterm birth in relation to periconception folic supplementation (0.4-0.5 mg). Data on 6353 pregnancies were available. Periconception folic acid supplementation was positively associated with fetal growth. Preconception folic acid supplementation was associated with 68 g higher birth weight (95 % CI 37.2, 99.0) and 13 g higher placental weight (95 % CI 1.1, 25.5), compared to no folic acid supplementation. In these analyses parity significantly modified the effect estimates. Start of folic acid supplementation after pregnancy confirmation was associated with a reduced risk of low birth weight (OR 0.61, 95 % CI 0.40, 0.94). Similarly, reduced risks for low birth weight and SGA were observed for women who started supplementation preconceptionally, compared to those who did not use folic acid (OR 0.43, 95 % CI 0.28, 0.69 and OR 0.40, 95 % CI 0.22, 0.72). In conclusion, periconception folic acid supplementation is associated with increased fetal growth resulting in higher placental and birth weight, and decreased risks of low birth weight and SGA.

  12. Fetal adrenal gland volume and preterm birth: a prospective third-trimester screening evaluation.

    Science.gov (United States)

    Hoffman Sage, Yael; Lee, Lydia; Thomas, Ann M; Benson, Carol B; Shipp, Thomas D

    2016-01-01

    Given the importance of the fetal adrenal gland in producing hormones critical to labor, we sought to evaluate whether sonographic three-dimensional measurements of the adrenal gland are a useful screening tool for spontaneous preterm birth (SPTB). We prospectively screened 128 non-anomalous singletons from 24 to 36 weeks' gestation with volumetric measurements of the fetal adrenal gland at their indicated antenatal sonogram. Labor and delivery outcomes were assessed and compared with respect to adrenal volume. When corrected for estimated fetal weight, the 11 women (9%) who delivered following SPTB had smaller adrenals than those who did not, 0.33 cm(3)/kg compared with 0.57 cm(3)/kg, respectively (p = 0.006). There was no difference in volumes between those who delivered by SPTB within 7 days or greater than 14 days from measurement (0.34 cm(3)/kg versus 0.33 cm(3)/kg, p = 0.79). Among women at increased risk of SPTB, those with SPTB had smaller adrenals than those who did not: 0.32 cm(3)/kg versus 0.53 cm(3)/kg, p = 0.06. We found fetal adrenal glands significantly smaller for those delivering preterm. Given the prior literature and our asymptomatic population, our data support multiple pathways leading to SPTB.

  13. Fetal growth and preterm birth in children exposed to maternal or paternal rheumatoid arthritis. A nationwide cohort study

    DEFF Research Database (Denmark)

    Rom, Ane L; Wu, Chunsen; Olsen, Jørn

    2014-01-01

    OBJECTIVE: To assess indicators of fetal growth and risk of preterm birth in children of parents with rheumatoid arthritis (RA). METHODS: Through linkage of Danish national registries, we identified all children born in Denmark between 1977 and 2008. We used general linear regression models to es...

  14. What is the impact of interventions that prevent fetal mortality on the increase of preterm live births in the State of Sao Paulo, Brazil?

    Science.gov (United States)

    Alencar, Gizelton Pereira; da Silva, Zilda Pereira; Santos, Patrícia Carla; Raspantini, Priscila Ribeiro; Moura, Barbara Laisa Alves; de Almeida, Marcia Furquim; do Nascimento, Felipe Parra; Rodrigues, Laura C

    2015-07-23

    There is a global growing trend of preterm births and a decline trend of fetal deaths. Is there an impact of the decline of fetal mortality on the increase of preterm live births in State of Sao Paulo, Brazil? The time trends were evaluated by gestational age through exponential regression analysis. Data analyzed included the fetal mortality ratio, proportion of preterm live births, fertility rate of women 35 years and over, prenatal care, mother's education, multiple births and cesarean section deliveries. A survival analysis was carried out for 2000 and 2010. Preterm births showed the highest annual increase (3.2%) in the less than 28 weeks of gestation group and fetal mortality ratio decreased (7.4%) in the same gestational age group. There was an increase of cesarean section births and it was higher in the increased trend in multiple births and fertility rates of women of 35 years and over. The variables were highly correlated to which other over time. In 2000, 8.2% of all pregnancies resulted in preterm births (0.9% in fetal deaths and 7.3% in live births). In 2010, the preterm birth increased to 9.4% (0.8% were preterm fetal deaths and 8.6% preterm live births). The results suggest that 45.2% could be the maximum contribution of successful interventions to prevent a fetal death on the increase in preterm live births. This increasing trend is also related to changes of the women reproductive profile with the change of the women reproductive profile and access to prenatal care.

  15. Evaluation of a quantitative fetal fibronectin test for spontaneous preterm birth in symptomatic women.

    Science.gov (United States)

    Abbott, Danielle S; Radford, Samara K; Seed, Paul T; Tribe, Rachel M; Shennan, Andrew H

    2013-02-01

    The purpose of this study was to determine whether quantification of cervicovaginal fluid fetal fibronectin (fFN) improves diagnostic accuracy of spontaneous preterm birth (sPTB) in symptomatic women. A prospective blinded predefined secondary analysis of a larger study of cervicovaginal fluid fFN concentration (nanograms per milliliter) in women symptomatic of preterm labor (n =300 women; 22-35 weeks' gestation) with a Hologic 10Q system (Hologic, Marlborough, MA). Clinicians were blinded to the result until after the delivery, but the qualitative Hologic TLI(IQ) fFN result was made available. The positive predictive value for sPTB (<34 weeks' gestation) increased from 19%, 32%, 61%, and 75% with increasing thresholds (10, 50, 200, and 500 ng/mL, respectively). Compared with <10 ng/mL fFN, the relative risk of delivery was 5.6 (95% confidence interval [CI], 1.05-29.57), 7.9 (95% CI, 1.38-45.0), 22.8 (95% CI, 3.84-135.5), and 51.3 (95% CI, 12.49-211.2; P < .01). Quantitative fFN provides thresholds (10 and 200 ng/mL) in addition to the qualitative method (50 ng/mL) to discriminate the risk of sPTB in symptomatic women. Copyright © 2013 Mosby, Inc. All rights reserved.

  16. Growth perturbations in a phenotype with rapid fetal growth preceding preterm labor and term birth.

    Science.gov (United States)

    Lampl, Michelle; Kusanovic, Juan Pedro; Erez, Offer; Gotsch, Francesca; Espinoza, Jimmy; Goncalves, Luis; Lee, Wesley; Gomez, Ricardo; Nien, Jyh Kae; Frongillo, Edward A; Romero, Roberto

    2009-01-01

    The variability in fetal growth rates and gestation duration in humans is not well understood. Of interest are women presenting with an episode of preterm labor and subsequently delivering a term neonate, who is small relative to peers of similar gestational age. To further understand these relationships, fetal growth patterns predating an episode of preterm labor were investigated. Retrospective analysis of fetal biometry assessed by serial ultrasound in a prospectively studied sample of pregnancies in Santiago, Chile, tested the hypothesis that fetal growth patterns among uncomplicated pregnancies (n = 3,706) and those with an episode of preterm labor followed by term delivery (n = 184) were identical across the time intervals 16-22 weeks, 22-28 weeks, and 28-34 weeks in a multilevel mixed-effects regression. The hypothesis was not supported. Fetal weight growth rate was faster from 16 weeks among pregnancies with an episode of preterm labor (P term-delivered neonates. Perturbations in abdominal circumference growth and patterns of proportionality suggest an altered growth strategy pre-dating the preterm labor episode.

  17. Quantitative fetal fibronectin and cervical length to predict preterm birth in asymptomatic women with previous cervical surgery.

    Science.gov (United States)

    Vandermolen, Brooke I; Hezelgrave, Natasha L; Smout, Elizabeth M; Abbott, Danielle S; Seed, Paul T; Shennan, Andrew H

    2016-10-01

    Quantitative fetal fibronectin testing has demonstrated accuracy for prediction of spontaneous preterm birth in asymptomatic women with a history of preterm birth. Predictive accuracy in women with previous cervical surgery (a potentially different risk mechanism) is not known. We sought to compare the predictive accuracy of cervicovaginal fluid quantitative fetal fibronectin and cervical length testing in asymptomatic women with previous cervical surgery to that in women with 1 previous preterm birth. We conducted a prospective blinded secondary analysis of a larger observational study of cervicovaginal fluid quantitative fetal fibronectin concentration in asymptomatic women measured with a Hologic 10Q system (Hologic, Marlborough, MA). Prediction of spontaneous preterm birth (<30, <34, and <37 weeks) with cervicovaginal fluid quantitative fetal fibronectin concentration in primiparous women who had undergone at least 1 invasive cervical procedure (n = 473) was compared with prediction in women who had previous spontaneous preterm birth, preterm prelabor rupture of membranes, or late miscarriage (n = 821). Relationship with cervical length was explored. The rate of spontaneous preterm birth <34 weeks in the cervical surgery group was 3% compared with 9% in previous spontaneous preterm birth group. Receiver operating characteristic curves comparing quantitative fetal fibronectin for prediction at all 3 gestational end points were comparable between the cervical surgery and previous spontaneous preterm birth groups (34 weeks: area under the curve, 0.78 [95% confidence interval 0.64-0.93] vs 0.71 [95% confidence interval 0.64-0.78]; P = .39). Prediction of spontaneous preterm birth using cervical length compared with quantitative fetal fibronectin for prediction of preterm birth <34 weeks of gestation offered similar prediction (area under the curve, 0.88 [95% confidence interval 0.79-0.96] vs 0.77 [95% confidence interval 0.62-0.92], P = .12 in the cervical

  18. Fetal fibronectin testing for prevention of preterm birth in singleton pregnancies with threatened preterm labor: a systematic review and metaanalysis of randomized controlled trials.

    Science.gov (United States)

    Berghella, Vincenzo; Saccone, Gabriele

    2016-10-01

    Fetal fibronectin is an extracellular matrix glycoprotein that is produced by amniocytes and cytotrophoblasts and has been shown to predict spontaneous preterm birth. The aim of this systematic review and metaanalysis of randomized clinical trials was to evaluate the effect of the use of fetal fibronectin in the prevention of preterm birth in singleton pregnancies with threatened preterm labor. The research was conducted with the use of MEDLINE, EMBASE, Web of Sciences, Scopus, ClinicalTrial.gov, OVID, and Cochrane Library as electronic databases from the inception of each database to February 2016. Selection criteria included randomized clinical trials of singleton gestations with threatened preterm labor that were assigned randomly to management based on fetal fibronectin results (ie, intervention group) or not (ie, comparison group). Types of participants included women with singleton gestations at 23 0/7 to 34 6/7 weeks with threatened preterm labor. Studies that included management that was also based on the use of sonographic cervical length were excluded. The primary outcome was preterm birth at birth at control group. No differences were found in the number of women who delivered within 7 days (12.8% vs 14.5%; relative risk, 0.76; 95% confidence interval, 0.47-1.21), in the mean of gestational age at delivery (mean difference, 0.20 week; 95% confidence interval, -0.26 to 0.67), in the rate of maternal hospitalization (27.4% vs 26.9%; relative risk, 1.07; 95% confidence interval, 0.80-1.44), in the use of tocolysis (25.3% vs 28.2%; relative risk, 0.97; 95% confidence interval, 0.75-1.24), antenatal steroids (29.2% vs 29.2%; relative risk, 1.05; 95% confidence interval, 0.79-1.39), in the mean time in the triage unit (mean difference, 0.60 hour; 95% confidence interval, -0.03 to 1.23) and in neonatal outcomes that included respiratory distress syndrome (1.3% vs 1.5%; relative risk, 0.91; 95% confidence interval, 0.06-14.06), and admission to the neonatal

  19. Onset of human preterm and term birth is related to unique inflammatory transcriptome profiles at the maternal fetal interface

    Directory of Open Access Journals (Sweden)

    Radek Bukowski

    2017-09-01

    Full Text Available Background Preterm birth is a main determinant of neonatal mortality and morbidity and a major contributor to the overall mortality and burden of disease. However, research of the preterm birth is hindered by the imprecise definition of the clinical phenotype and complexity of the molecular phenotype due to multiple pregnancy tissue types and molecular processes that may contribute to the preterm birth. Here we comprehensively evaluate the mRNA transcriptome that characterizes preterm and term labor in tissues comprising the pregnancy using precisely phenotyped samples. The four complementary phenotypes together provide comprehensive insight into preterm and term parturition. Methods Samples of maternal blood, chorion, amnion, placenta, decidua, fetal blood, and myometrium from the uterine fundus and lower segment (n = 183 were obtained during cesarean delivery from women with four complementary phenotypes: delivering preterm with (PL and without labor (PNL, term with (TL and without labor (TNL. Enrolled were 35 pregnant women with four precisely and prospectively defined phenotypes: PL (n = 8, PNL (n = 10, TL (n = 7 and TNL (n = 10. Gene expression data were analyzed using shrunken centroid analysis to identify a minimal set of genes that uniquely characterizes each of the four phenotypes. Expression profiles of 73 genes and non-coding RNA sequences uniquely identified each of the four phenotypes. The shrunken centroid analysis and 10 times 10-fold cross-validation was also used to minimize false positive finings and overfitting. Identified were the pathways and molecular processes associated with and the cis-regulatory elements in gene’s 5′ promoter or 3′-UTR regions of the set of genes which expression uniquely characterized the four phenotypes. Results The largest differences in gene expression among the four groups occurred at maternal fetal interface in decidua, chorion and amnion. The gene expression profiles showed

  20. Preterm Labor and Birth

    Science.gov (United States)

    ... Facebook Twitter Pinterest Email Print Preterm Labor and Birth In general, a normal human pregnancy lasts about ... is called preterm labor (or premature labor). A birth that occurs before 37 weeks is considered a ...

  1. Rapid fetal fibronectin testing to predict preterm birth in women with symptoms of premature labour: a systematic review and cost analysis

    NARCIS (Netherlands)

    N.V. Deshpande (Niteen Vijay); A.D.I. van Asselt (Antoinette); F. Tomini; N. Armstrong (Nigel); A. Allen (Alex); C. Noake; K.S. Khan (Kalid); J.L. Severens (Hans); J. Kleijnen (Jos); M. Westwood (Marie)

    2013-01-01

    markdownabstract__Background__: Premature birth is defined as birth of before 37 completed weeks' gestation. Not all pregnant women showing symptoms of preterm labour will go on to deliver before 37weeks' gestation. Hence, addition of fetal fibronectin (fFN) testing to the diagnostic workup of

  2. Rapid fetal fibronectin testing to predict preterm birth in women with symptoms of premature labour : a systematic review and cost analysis

    NARCIS (Netherlands)

    Deshpande, S N; van Asselt, A D I; Tomini, F; Armstrong, N; Allen, A; Noake, C; Khan, K; Severens, J L; Kleijnen, J; Westwood, M E

    2013-01-01

    BACKGROUND: Premature birth is defined as birth of before 37 completed weeks' gestation. Not all pregnant women showing symptoms of preterm labour will go on to deliver before 37 weeks' gestation. Hence, addition of fetal fibronectin (fFN) testing to the diagnostic workup of women with suspected

  3. Epidemiology of preterm birth.

    Science.gov (United States)

    Purisch, Stephanie E; Gyamfi-Bannerman, Cynthia

    2017-11-01

    Preterm birth is a worldwide epidemic with a global incidence of 15 million per year. Though rates of preterm birth in the United States have declined over the last decade, nearly 1 in 10 babies is still born preterm. The incidence, gestational age, and underlying etiology of preterm birth is highly variable across different racial and ethnic groups and geographic boundaries. In this article, we review the epidemiology of preterm birth in the United States and globally, with a focus on temporal trends and racial, ethnic, and geographic disparities. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Effects of antenatal dexamethasone administration on fetal and uteroplacental Doppler waveforms in women at risk for spontaneous preterm birth

    Directory of Open Access Journals (Sweden)

    Elwani Elsnosy

    2017-03-01

    Conclusion: Maternal dexamethasone administration to pregnant women at risk of preterm labor improves the blood flow of the maternal uterine artery, fetal MCA, descending aorta and umbilical artery 24 h after its administration.

  5. Candida Chorioamnionitis Leads to Preterm Birth and Adverse Fetal-Neonatal Outcome

    Directory of Open Access Journals (Sweden)

    Yohei Maki

    2017-01-01

    Full Text Available Candida chorioamnionitis is rare but can lead to neonatal infection, high mortality, and neurodevelopmental impairment. We aimed to investigate maternal clinical features and perinatal outcomes and discuss future management strategies. We reviewed the medical records of women with Candida chorioamnionitis at our hospital over a 10-year period (n=9 and previous published case reports and case series. The most prevalent Candida species was C. albicans (71.3% of the all cases. The most prevalent predisposing condition was preterm premature rupture of membranes (31/123, 25.2%, followed by pregnancy with a retained intrauterine contraceptive device (26/123, 21.1% and pregnancy after in vitro fertilization (25/123, 20.3%. Preterm labor was the most common symptom (52/123, 42.3%, and only 13% of cases involved fever. Of the infants, 27% of the singletons and 23.8% of the twins were born before 22 gestational weeks, while 60% of the singletons and 76.2% of the twins were born at 22–36 weeks. The median birth weight of the babies born after 22 weeks was 1230 g. The mortality rates of the singletons and twins born after 22 weeks of gestation in the year 2000 or later were 28.6% and 52.4%, respectively. Antenatal treatment for Candida chorioamnionitis has not been established.

  6. Understanding fetal factors that contribute to preterm birth: Sjögren-Larsson syndrome as a model.

    Science.gov (United States)

    Staps, Pippa; Hogeveen, Marije; Fuijkschot, Joris; van Drongelen, Joris; Willemsen, Michèl A A P

    2017-09-15

    Preterm birth is the world's leading cause of neonatal death. Unfortunately, the pathophysiology of preterm birth remains poorly understood. Sjögren-Larsson syndrome is a rare, neurometabolic disorder caused by a fatty aldehyde dehydrogenase deficiency. A majority of patients with Sjögren-Larsson syndrome is born preterm. Data of all known Dutch patients with Sjögren-Larsson syndrome and all cases reported in literature were analyzed to learn from preterm birth in context of this rare disease. Exact gestational age was known in 33 Dutch patients; 24 (73%) of them were born preterm, with a median gestational age of 36 weeks. The literature search confirmed our findings: 13 (59%) of 22 cases was born preterm. Preterm birth is a hallmark of Sjögren-Larsson syndrome, presumably caused by the abnormal lipid metabolism of the fetus. At least five additional rare genetic disorders (namely Ehlers-Danlos syndrome, ichthyosis prematurity syndrome, congenital analbuminemia, osteogenesis imperfecta type II and restrictive dermopathy) were found in literature that lead to preterm birth of the affected fetus. These disorders are in fact "experiments of nature" and as such they shed new lights on the mechanisms causing preterm birth.

  7. Fetal growth restriction but not preterm birth is a risk factor for severe hypospadias.

    Science.gov (United States)

    Hashimoto, Yukiko; Kawai, Masahiko; Nagai, Sizuyo; Matsukura, Takashi; Niwa, Fusako; Hasegawa, Takeshi; Heike, Toshio

    2016-07-01

    Hypospadias has multifactorial causes and occurs at a high frequency among very low-birthweight infants. Placental insufficiency is hypothesized to be one cause of hypospadias; that is, decreased human chorionic gonadotropin (hCG) secretion caused by placental insufficiency is suspected to result in abnormal male external genitalia, but there is little direct evidence to support this. The aim of this study was therefore to identify the features of hypospadias and to clarify the male genital abnormalities caused by fetal growth restriction (FGR). We reviewed the clinical data of boys who underwent hypospadias repair between 2005 and 2011 at Kyoto University Hospital. Twenty boys were included in this study. Fifteen (75%) of the subjects were preterm or low-birthweight infants. Thirteen (65%) had FGR, 60% of whom had severe hypospadias regardless of gestational age. In addition, 92% of the FGR infants also had other genital anomalies, such as cryptorchidism, bifid scrotum, or micropenis. In contrast, only 14% and 43% of the non-FGR infants had severe hypospadias or genital anomalies other than hypospadias, respectively. Placental histopathology was available in eight FGR infants, in seven of whom it was suggestive of blood flow deficiency such as infarction and single umbilical artery. Infants with FGR have a high incidence of hypospadias. FGR caused by placental dysfunction, but not low birthweight, is a risk factor for severe hypospadias associated with multiple genital anomalies. © 2015 Japan Pediatric Society.

  8. Genetic associations of relaxin: preterm birth and premature rupture of fetal membranes

    Science.gov (United States)

    ROCHA, Frederico G.; SLAVIN, Thomas P.; LI, Dongmei; TIIRIKAINEN, Maarit I.; BRYANT-GREENWOOD, Gillian D.

    2013-01-01

    Objectives Relaxin H2 (RLN2) is a systemic hormone (sRLN) produced by the corpus luteum, whereas decidual (dRLN) only acts locally. Elevated sRLN is associated with spontaneous preterm birth (sPTB) and elevated dRLN with preterm premature rupture of membranes (PPROM). Associations were sought between single nucleotide polymorphisms (SNPs) in the RLN2 promoter with levels of dRLN and sRLN in Filipino patients with sPTB, PPROM or normal term delivery. Study Design Stringent selection of women with sPTB (n=20) or PPROM (n=20) and term controls (n=20) was made from over 8,000 samples from Filipino patients delivered at 34–36 weeks gestation. Twelve SNPs were genotyped on maternal blood with exclusion of nine based on high linkage disequilibrium (LD) or being the same as in the control population. Quantitative immunocytochemistry on parietal decidual tissue was performed (n=60) and sRLN measured by ELISA in a subset of patients (n=21). Results SNP rs4742076 was significantly associated with PPROM (p<0.001) and increased expression of dRLN (p<0.001). The genotype TT had increased dRLN in PPROM (p<0.05). SNP rs3758239 was significantly associated with both PPROM and sPTB (p<0.01), and genotype AA had increased dRLN expression (p<0.05). The sRLN showed a trend of higher levels in PPROM and sPTB, but was not significant. Conclusions SNP rs4742076 in the RLN2 promoter was associated with increased dRLN expression and PPROM while SNP rs3758239 was associated with both PPROM and sPTB in these Filipino patients. Specific homozygous genotypes were identified for both SNPs and were shown to be associated with increased dRLN tissue expression. PMID:23727041

  9. Genetic associations of relaxin: preterm birth and premature rupture of fetal membranes.

    Science.gov (United States)

    Rocha, Frederico G; Slavin, Thomas P; Li, Dongmei; Tiirikainen, Maarit I; Bryant-Greenwood, Gillian D

    2013-09-01

    Relaxin H2 (RLN2) is a systemic hormone (sRLN) that is produced by the corpus luteum, whereas decidual RLN (dRLN) acts only locally. Elevated sRLN is associated with spontaneous preterm birth (sPTB) and elevated dRLN with preterm premature rupture of membranes (PPROM). Associations were sought between single nucleotide polymorphisms (SNPs) in the RLN2 promoter with levels of dRLN and sRLN in Filipino patients with sPTB, PPROM, or normal term delivery. Stringent selection of women with sPTB (n = 20) or PPROM (n = 20) and term control subjects (n = 20) was made from >8000 samples from Filipino patients who delivered at 34-36 weeks' gestation. Twelve SNPs were genotyped on maternal blood, with 9 excluded based on the high linkage disequilibrium or being the same as in the control population. Quantitative immunocytochemistry on parietal decidual tissue was performed (n = 60); sRLN was measured by enzyme-linked immunosorbent assay in a subset of patients (n = 21). SNP rs4742076 was associated significantly with PPROM (P < .001) and increased expression of dRLN (P < .001). The genotype TT had increased dRLN in PPROM (P < .05). SNP rs3758239 was associated significantly with both PPROM and sPTB (P < .01), and genotype AA had increased dRLN expression (P < .05). The sRLN showed a trend of higher levels in PPROM and sPTB, but was not significant. SNP rs4742076 in the RLN2 promoter was associated with increased dRLN expression and PPROM; SNP rs3758239 was associated with both PPROM and sPTB in these Filipino patients. Specific homozygous genotypes were identified for both SNPs and were shown to be associated with increased dRLN tissue expression. Copyright © 2013 Mosby, Inc. All rights reserved.

  10. Preterm Labor and Birth

    Science.gov (United States)

    ... NICHD Research Information Find a Study More Information Pharmacology Condition Information NICHD Research Information Find a Study ... Pinterest Email Print Preterm Labor and Birth In general, a normal human pregnancy lasts about 40 weeks, ...

  11. Prevention of preterm birth.

    LENUS (Irish Health Repository)

    Flood, Karen

    2012-02-01

    Preterm birth (delivery before 37 completed weeks of gestation) is common and rates are increasing. In the past, medical efforts focused on ameliorating the consequences of prematurity rather than preventing its occurrence. This approach resulted in improved neonatal outcomes, but it remains costly in terms of both the suffering of infants and their families and the economic burden on society. Increased understanding of the pathophysiology of preterm labor has altered the approach to this problem, with increased focus on preventive strategies. Primary prevention is a limited strategy which involves public education, smoking cessation, improved nutritional status and avoidance of late preterm births. Secondary prevention focuses on recurrent preterm birth which is the most recognisable risk factor. Widely accepted strategies include cervical cerclage, progesterone and dedicated clinics. However, more research is needed to explore the role of antibiotics and anti-inflammatory treatments in the prevention of this complex problem.

  12. Extremely Preterm Birth

    Science.gov (United States)

    ... Search FAQs Extremely Preterm Birth Page Navigation ▼ ACOG Pregnancy Book Patient Education FAQs Patient Education Pamphlets - Spanish FAQ173, June 2016 ... Labor and Birth (FAQ087) Tobacco, Alcohol, Drugs, and Pregnancy (FAQ170) Patient Education ... Committee Opinions Practice Bulletins Patient ...

  13. Late preterm birth, post-term birth, and abnormal fetal growth as risk factors for severe mental disorders from early to late adulthood.

    Science.gov (United States)

    Lahti, M; Eriksson, J G; Heinonen, K; Kajantie, E; Lahti, J; Wahlbeck, K; Tuovinen, S; Pesonen, A-K; Mikkonen, M; Osmond, C; Barker, D J P; Räikkönen, K

    2015-04-01

    Late preterm births constitute the majority of preterm births. However, most evidence suggesting that preterm birth predicts the risk of mental disorders comes from studies on earlier preterm births. We examined if late preterm birth predicts the risks of severe mental disorders from early to late adulthood. We also studied whether adulthood mental disorders are associated with post-term birth or with being born small (SGA) or large (LGA) for gestational age, which have been previously associated with psychopathology risk in younger ages. Of 12 597 Helsinki Birth Cohort Study participants, born 1934-1944, 664 were born late preterm, 1221 post-term, 287 SGA, and 301 LGA. The diagnoses of mental disorders were identified from national hospital discharge and cause of death registers from 1969 to 2010. In total, 1660 (13.2%) participants had severe mental disorders. Individuals born late preterm did not differ from term-born individuals in their risk of any severe mental disorder. However, men born late preterm had a significantly increased risk of suicide. Post-term birth predicted significantly increased risks of any mental disorder in general and particularly of substance use and anxiety disorders. Individuals born SGA had significantly increased risks of any mental and substance use disorders. Women born LGA had an increased risk of psychotic disorders. Although men born late preterm had an increased suicide risk, late preterm birth did not exert widespread effects on adult psychopathology. In contrast, the risks of severe mental disorders across adulthood were increased among individuals born SGA and individuals born post-term.

  14. Prognostic Significance of Preterm Isolated Decreased Fetal Movement

    Directory of Open Access Journals (Sweden)

    Ertuğrul Karahanoğlu

    2017-12-01

    Full Text Available Objective: Our aim is to evaluate the prognostic significance of isolated, preterm decreased fetal movement following normal initial full diagnostic workup. Study design: A retrospective observational study was conducted at a tertiary centre. The applied protocol was approved by the Medical Research Ethics Department of the hospital where the research was conducted. Obstetrics outcomes of preterm- and term-decreased fetal movement were compared following an initial, normal diagnostic work up. Evaluated outcomes were birth weight, mode of delivery, stillbirth rate, induction of labour, development of gestational hypertension, small for gestational age and oligohydramnios, polyhydramnios during the follow up period. Result: Obstetric complications related to placental insufficiency develops more frequently for decreased fetal movement in preterm cases with respect to that of in term cases. Following the diagnosis of decreased fetal movement, pregnancy hypertension occurred in 17% of preterm decreased fetal movement cases and in 4.7% of term decreased fetal movement cases. Fetal growth restriction developed in 6.6% of preterm decreased fetal movement and in 2.3% of term decreased fetal movement. Amniotic fluid abnormalities more frequently developed in preterm decreased fetal movement. Conclusion: Following an initial normal diagnostic workup, preterm decreased fetal movement convey a higher risk for the development of pregnancy complications associated with placental insufficiency. The patient should be monitored closely and management protocols must be developed for initial normal diagnostic workups in cases of preterm decreased fetal movement.

  15. [Prevention of spontaneous preterm birth in asymptomatic twin pregnancies].

    Science.gov (United States)

    Sentilhes, L; Bouhours, A-C; Bouet, P-E; Boussion, F; Biquard, F; Gillard, P; Descamps, P

    2009-12-01

    To determine prenatal methods to predict and prevent spontaneous preterm birth in asymptomatic twin pregnancies. Articles were searched using PubMed, Embase and Cochrane library. Uterine activity monitoring and bacterial vaginosis screening are not useful to predict preterm birth (EL2 and EL3 respectively). Current literature data are contradictory and insufficient to determine whether fetal fibronectin and digital cervical assessment are predictors of preterm birth. History of preterm birth (EL4), and cervical length measurement by transvaginal ultrasonography (EL2) predict preterm birth. Nevertheless, there are no intervention studies that have evaluated cervical length measurement in the prevention of preterm birth. Hospital bedrest, prophylactic tocolytic and progesterone therapy, and prophylactic cervical cerclage in patients with or without short cervix have not been shown to be effective in preventing preterm birth. Prenatal methods to prevent spontaneous preterm birth in asymptomatic twin pregnancies are currently very limited. Copyright © 2009 Elsevier Masson SAS. All rights reserved.

  16. Screening for spontaneous preterm birth

    NARCIS (Netherlands)

    van Os, M.A.; van Dam, A.J.E.M.

    2015-01-01

    Preterm birth is the most important cause of perinatal morbidity and mortality worldwide. In this thesis studies on spontaneous preterm birth are presented. The main objective was to investigate the predictive capacity of mid-trimester cervical length measurement for spontaneous preterm birth in a

  17. Risk of stillbirth, preterm delivery, and fetal growth restriction following exposure in a previous birth: systematic review and meta-analysis.

    Science.gov (United States)

    Malacova, E; Regan, A; Nassar, N; Raynes-Greenow, C; Leonard, H; Srinivasjois, R; W Shand, A; Lavin, T; Pereira, G

    2018-01-01

    Little is known about the risk of non-recurrent adverse birth outcomes. To evaluate the risk of stillbirth, preterm birth (PTB), and small for gestational age (SGA) as a proxy for fetal growth restriction (FGR) following exposure to one or more of these factors in a previous birth. We searched MEDLINE, EMBASE, Maternity and Infant Care, and Global Health from inception to 30 November 2016. Studies were included if they investigated the association between stillbirth, PTB, or SGA (as a proxy for FGR) in two subsequent births. Meta-analysis and pooled association presented as odds ratios (ORs) and adjusted odds ratios (aORs). Of the 3399 studies identified, 17 met the inclusion criteria. A PTB or SGA (as a proxy for FGR) infant increased the risk of subsequent stillbirth ((pooled OR 1.70; 95% confidence interval, 95% CI, 1.34-2.16) and (pooled OR 1.98; 95% CI 1.70-2.31), respectively). A combination of exposures, such as a preterm SGA (as a proxy for FGR) birth, doubled the risk of subsequent stillbirth (pooled OR 4.47; 95% CI 2.58-7.76). The risk of stillbirth also varied with prematurity, increasing three-fold following PTB preterm SGA (as a proxy for FGR) preterm (preterm or small for gestational age can increase the chance of long-term health problems. The effect of having a stillbirth, preterm birth, or small-for-gestational-age infant in a previous pregnancy on future pregnancy health has not been summarised. We identified 3399 studies of outcomes of previous pregnancies, and 17 were summarised by our study. What were the main findings? The outcome of the previous pregnancy influenced the risk of poor outcomes in the next pregnancy. Babies born to mothers who had a previous preterm birth or small-for-gestational-age birth were more likely to be stillborn. The smaller and the more preterm the previous baby, the higher the risk of stillbirth in the following pregnancy. The risk of stillbirth in the following pregnancy was doubled if the previous baby was born

  18. Fetal programming and environmental exposures: Implications for prenatal care and preterm birth

    Science.gov (United States)

    Fetal programming is an enormously complex process that relies on numerous environmental inputs from uterine tissue, the placenta, the maternal blood supply, and other sources. Recent evidence has made clear that the process is not based entirely on genetics, but rather on a deli...

  19. Twins and neurodevelopmental outcomes: the effect of IVF, fetal growth restriction, and preterm birth.

    Science.gov (United States)

    Briana, Despina D; Malamitsi-Puchner, Ariadne

    2018-01-16

    This invited review aimed at presenting the evidence concerning neurodevelopmental outcomes, particularly cerebral palsy (CP), motor disability, cognitive impairment, mental retardation, any major disability, blindness and deafness in cases of twins, conceived after in vitro fertilization, presenting fetal/intrauterine growth restriction (FGR/IUGR) or being prematurely born. FGR/IUGR, prematurity and zygosity affect neurodevelopmental outcome; CP is higher in term infants, those presenting with FGR/IUGR, as well as in survivors of intrauterine co-twin death; cognitive ability of twins versus singletons mainly relates to confounding factors, as FGR/IUGR and prematurity, while evidence for differences in behavioral and psychiatric disorders between twins and singletons is limited. The impact of IVF per se has not been documented. Nevertheless, available literature, usually of heterogeneous and retrospective nature, diverges in the criteria for neurodevelopmental delay. Furthermore, differences in selection/exclusion criteria and small mixed cohorts, including the full range of complications, make comparison of the existing studies difficult. Future studies should focus in confirming the lack of IVF impact on twins' neurodevelopment and general health, in comparing long-term outcome of naturally conceived twins with those conceived following assisted reproduction techniques and in including evaluation of individual, longitudinal trajectories of growth, and development. In this respect, worldwide population-based registries will enable more precise description of neurodevelopmental outcomes among twins.

  20. Size at birth and preterm birth in women with lifetime eating disorders

    DEFF Research Database (Denmark)

    Micali, N.; Larsen, P. Stemann; Strandberg-Larsen, K.

    2016-01-01

    OBJECTIVE: To investigate whether eating disorders are associated with lower size at birth, symmetric growth restriction, and preterm birth; and whether pregnancy smoking explains the association between anorexia nervosa and fetal growth. DESIGN: Longitudinal population-based cohort study. SETTING...

  1. Genomics of Preterm Birth

    Science.gov (United States)

    Swaggart, Kayleigh A.; Pavlicev, Mihaela; Muglia, Louis J.

    2015-01-01

    The molecular mechanisms controlling human birth timing at term, or resulting in preterm birth, have been the focus of considerable investigation, but limited insights have been gained over the past 50 years. In part, these processes have remained elusive because of divergence in reproductive strategies and physiology shown by model organisms, making extrapolation to humans uncertain. Here, we summarize the evolution of progesterone signaling and variation in pregnancy maintenance and termination. We use this comparative physiology to support the hypothesis that selective pressure on genomic loci involved in the timing of parturition have shaped human birth timing, and that these loci can be identified with comparative genomic strategies. Previous limitations imposed by divergence of mechanisms provide an important new opportunity to elucidate fundamental pathways of parturition control through increasing availability of sequenced genomes and associated reproductive physiology characteristics across diverse organisms. PMID:25646385

  2. Biomarkers of spontaneous preterm birth

    DEFF Research Database (Denmark)

    Polettini, Jossimara; Cobo, Teresa; Kacerovsky, Marian

    2017-01-01

    predictors of pregnancy outcome. This systematic review was conducted to synthesize the knowledge on PTB biomarkers identified using multiplex analysis. Three electronic databases (PubMed, EMBASE and Web of Science) were searched for studies in any language reporting the use of multiplex assays for maternal......Despite decades of research on risk indicators of spontaneous preterm birth (PTB), reliable biomarkers are still not available to screen or diagnose high-risk pregnancies. Several biomarkers in maternal and fetal compartments have been mechanistically linked to PTB, but none of them are reliable......) followed by MIP-1β, GM-CSF, Eotaxin, and TNF-RI (two studies) were reported more than once in maternal serum. However, results could not be combined due to heterogeneity in type of sample, study population, assay, and analysis methods. By this systematic review, we conclude that multiplex assays...

  3. Prediction of Spontaneous Preterm Birth

    NARCIS (Netherlands)

    Dijkstra, Karolien

    2002-01-01

    Preterm birth is a leading cause of neonatal morbidity and mortality. It is a major goal in obstetrics to lower the incidence of spontaneous preterm birth (SPB) and related neonatal morbidity and mortality. One of the principal objectives is to discover early markers that would allow us to identify

  4. Bacterial Hyaluronidase Promotes Ascending GBS Infection and Preterm Birth

    Directory of Open Access Journals (Sweden)

    Jay Vornhagen

    2016-06-01

    Full Text Available Preterm birth increases the risk of adverse birth outcomes and is the leading cause of neonatal mortality. A significant cause of preterm birth is in utero infection with vaginal microorganisms. These vaginal microorganisms are often recovered from the amniotic fluid of preterm birth cases. A vaginal microorganism frequently associated with preterm birth is group B streptococcus (GBS, or Streptococcus agalactiae. However, the molecular mechanisms underlying GBS ascension are poorly understood. Here, we describe the role of the GBS hyaluronidase in ascending infection and preterm birth. We show that clinical GBS strains associated with preterm labor or neonatal infections have increased hyaluronidase activity compared to commensal strains obtained from rectovaginal swabs of healthy women. Using a murine model of ascending infection, we show that hyaluronidase activity was associated with increased ascending GBS infection, preterm birth, and fetal demise. Interestingly, hyaluronidase activity reduced uterine inflammation but did not impact placental or fetal inflammation. Our study shows that hyaluronidase activity enables GBS to subvert uterine immune responses, leading to increased rates of ascending infection and preterm birth. These findings have important implications for the development of therapies to prevent in utero infection and preterm birth.

  5. Preterm Birth: Transition to Adulthood

    Science.gov (United States)

    Allen, Marilee C.; Cristofalo, Elizabeth; Kim, Christina

    2010-01-01

    Preterm birth is associated with greater difficulty with transitions from childhood to adolescence to adulthood. Adolescents and young adults born preterm have higher rates of cerebral palsy, intellectual disability, cognitive impairment, learning disability, executive dysfunction, attention deficit disorder, and social-emotional difficulties than…

  6. Prevention of Preterm Birth with Pessary in Singletons (PoPPS): a randomized controlled trial.

    Science.gov (United States)

    Dugoff, Lorraine; Berghella, Vincenzo; Sehdev, Harish; Mackeen, A Dhanya; Goetzl, Laura; Ludmir, Jack

    2017-09-20

    To determine if pessary use prevents preterm birth in singleton gestations with a short transvaginal ultrasound cervical length and without a prior spontaneous preterm birth. In this open-label multicenter randomized trial we enrolled asymptomatic women with singleton gestations with a transvaginal ultrasound cervical length ≤ 25 mm at 18 0 -23 6 weeks and no prior spontaneous preterm birth. Subjects were randomized to receive the Bioteque cup pessary or no pessary. Pessaries were inserted by trained maternal fetal medicine staff.. Vaginal progesterone was recommended to women with a cervical length ≤20mm. The primary outcome was preterm birth preterm birth preterm birth preterm birth preterm birth in women with singleton gestations with a short transvaginal ultrasound cervical length and without a prior spontaneous preterm birth in this small underpowered randomized controlled trial. This trial was registered on ClinicalTrials.gov, number NCT 02056652. This article is protected by copyright. All rights reserved.

  7. Cost of Racial Disparity in Preterm Birth: Evidence from Michigan

    OpenAIRE

    Xu, Xiao; Grigorescu, Violanda; Siefert, Kristine A.; Lori, Jody R.; Ransom, Scott B.

    2009-01-01

    This study examined the economic costs associated with racial disparity in preterm birth and preterm fetal death in Michigan. Linked 2003 Michigan vital statistics and hospital discharge data were used for data analysis. Thirteen percent of the singleton births among non-Hispanic Blacks were before 37 completed weeks of gestation, compared to only 7.7% among non-Hispanic Whites (risk ratio = 1.66, 95% confidence interval: 1.59-1.72; p

  8. Spontaneous preterm birth : prevention, management and outcome

    NARCIS (Netherlands)

    Vermeulen, Gustaaf Michiel

    1999-01-01

    Preterm birth (birth before 37 completed weeks of pregnancy) is a major cause of perinatal morbidity and mortality. Strategies to prevent and adequately treat preterm labour, in order to postpone birth and to identify risk factors for neonatal damage due to preterm birth, have to be developed by

  9. Rapid fetal fibronectin testing to predict preterm birth in women with symptoms of premature labour: a systematic review and cost analysis.

    Science.gov (United States)

    Deshpande, S N; van Asselt, A D I; Tomini, F; Armstrong, N; Allen, A; Noake, C; Khan, K; Severens, J L; Kleijnen, J; Westwood, M E

    2013-09-01

    Premature birth is defined as birth of before 37 completed weeks' gestation. Not all pregnant women showing symptoms of preterm labour will go on to deliver before 37 weeks' gestation. Hence, addition of fetal fibronectin (fFN) testing to the diagnostic workup of women with suspected preterm labour may help to identify those women who do not require active management, and thus avoid unnecessary interventions, hospitalisations and associated costs. To assess the clinical effectiveness and cost-effectiveness of rapid fFN testing in predicting preterm birth (PTB) in symptomatic women. Bibliographic databases (including EMBASE, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials) were searched from 2000 to September/November 2011. Trial registers were also searched. Systematic review methods followed published guidance; we assessed clinical effectiveness and updated a previous systematic review of test accuracy. Risk of bias was assessed using the Cochrane tool (randomised controlled trials; RCTs) and a modification of QUADAS-2 (diagnostic test accuracy studies; DTAs). Summary risk ratios or weighted mean difference were calculated using random-effects models. Summary sensitivity and specificity used a bivariate summary receiver operating characteristic model. Heterogeneity was investigated using subgroup and sensitivity analyses. Health economic analysis focused on cost consequences. The time horizon was hospital admission for observation. A main structural assumption was that, compared with usual care, fFN testing doesn't increase adverse events or negative pregnancy outcomes. Five RCTs and 15 new DTAs were identified. No RCT reported significant effects of fFN testing on maternal or neonatal outcomes. One study reported a subgroup analysis of women with negative fFN test observed > 6 hours, which showed a reduction in length of hospital stay where results were known to clinicians. Combining data from new studies and the

  10. Particulate matter and preterm birth

    Science.gov (United States)

    Particulate matter (PM) has been variably associated with preterm birth (PTB) (gestation <37 weeks), but the role played by specific chemical components of PM has been little studied. We examined the association between ambient PM <2.5 micrometers in aerodynamic diameter (PM2.S) ...

  11. Are fetal growth impairment and preterm birth causally related to child attention problems and ADHD? Evidence from a comparison between high-income and middle-income cohorts.

    Science.gov (United States)

    Murray, Elizabeth; Pearson, Rebecca; Fernandes, Michelle; Santos, Iná S; Barros, Fernando C; Victora, Cesar G; Stein, Alan; Matijasevich, Alicia

    2016-07-01

    Cross-cohort comparison is an established method for improving causal inference. This study compared 2 cohorts, 1 from a high-income country and another from a middle-income country, to (1) establish whether birth exposures may play a causal role in the development of childhood attention problems; and (2) identify whether confounding structures play a different role in parent-reported attention difficulties compared with attention deficit hyperactivity disorder (ADHD) diagnoses. Birth exposures included low birth weight (LBW), small-for-gestational age (SGA), small head circumference (HC) and preterm birth (PTB)). Outcomes of interest were attention difficulties (Strengths and Difficulties Questionnaire, SDQ) and ADHD (Development and Well-Being Assessment, DAWBA). Associations between exposures and outcomes were compared between 7-year-old children from the Avon Longitudinal Study of Parents and Children (ALSPAC) in the UK (N=6849) and the 2004 Pelotas cohort in Brazil (N=3509). For attention difficulties (SDQ), the pattern of association with birth exposures was similar between cohorts: following adjustment, attention difficulties were associated with SGA (OR=1.59, 95% CI 1.20 to 2.19) and small HC (OR=1.64, 95% CI 1.11 to 2.41) in ALSPAC and SGA (OR=1.35, 95% CI 1.04 to 1.75) in Pelotas. For ADHD, however, the pattern of association following adjustment differed markedly between cohorts. In ALSPAC, ADHD was associated with LBW (OR=2.29, 95% CI 1.09 to 4.80) and PTB (OR=2.33, 95% CI 1.23 to 4.42). In the Pelotas cohort, however, ADHD was associated with SGA (OR=1.69, 95% CI 1.02 to 2.82). The findings suggest that fetal growth impairment may play a causal role in the development of attention difficulties in childhood, as similar associations were identified across both cohorts. Confounding structures, however, appear to play a greater role in determining whether a child meets the full diagnostic criteria for ADHD. Published by the BMJ Publishing Group Limited

  12. Maternal race and intergenerational preterm birth recurrence.

    Science.gov (United States)

    Smid, Marcela C; Lee, Jong Hyung; Grant, Jacqueline H; Miles, Gandarvaka; Stoddard, Gregory J; Chapman, Derek A; Manuck, Tracy A

    2017-10-01

    Preterm birth is a complex disorder with a heritable genetic component. Studies of primarily White women born preterm show that they have an increased risk of subsequently delivering preterm. This risk of intergenerational preterm birth is poorly defined among Black women. Our objective was to evaluate and compare intergenerational preterm birth risk among non-Hispanic Black and non-Hispanic White mothers. This was a population-based retrospective cohort study, using the Virginia Intergenerational Linked Birth File. All non-Hispanic Black and non-Hispanic White mothers born in Virginia 1960 through 1996 who delivered their first live-born, nonanomalous, singleton infant ≥20 weeks from 2005 through 2009 were included. We assessed the overall gestational age distribution between non-Hispanic Black and White mothers born term and preterm (preterm (preterm birth, 34-36 weeks; and early preterm birth, preterm birth among all eligible births; and (2) suspected spontaneous preterm birth among births to women with medical complications (eg, diabetes, hypertension, preeclampsia and thus higher risk for a medically indicated preterm birth). Multivariable logistic regression was used to estimate odds of preterm birth and spontaneous preterm birth by maternal race and maternal gestational age after adjusting for confounders including maternal education, maternal age, smoking, drug/alcohol use, and infant gender. Of 173,822 deliveries captured in the intergenerational birth cohort, 71,676 (41.2%) women met inclusion criteria for this study. Of the entire cohort, 30.0% (n = 21,467) were non-Hispanic Black and 70.0% were non-Hispanic White mothers. Compared to non-Hispanic White mothers, non-Hispanic Black mothers were more likely to have been born late preterm (6.8% vs 3.7%) or early preterm (2.8 vs 1.0%), P preterm were not at an increased risk of early or late preterm delivery compared to non-Hispanic White mothers born term. The risk of early preterm birth was most

  13. Allostatic Load and Preterm Birth

    Directory of Open Access Journals (Sweden)

    David M. Olson

    2015-12-01

    Full Text Available Preterm birth is a universal health problem that is one of the largest unmet medical needs contributing to the global burden of disease. Adding to its complexity is that there are no means to predict who is at risk when pregnancy begins or when women will actually deliver. Until these problems are addressed, there will be no interventions to reduce the risk because those who should be treated will not be known. Considerable evidence now exists that chronic life, generational or accumulated stress is a risk factor for preterm delivery in animal models and in women. This wear and tear on the body and mind is called allostatic load. This review explores the evidence that chronic stress contributes to preterm birth and other adverse pregnancy outcomes in animal and human studies. It explores how allostatic load can be used to, firstly, model stress and preterm birth in animal models and, secondly, how it can be used to develop a predictive model to assess relative risk among women in early pregnancy. Once care providers know who is in the highest risk group, interventions can be developed and applied to mitigate their risk.

  14. Strategies to Prevent Preterm Birth

    Science.gov (United States)

    Newnham, John P.; Dickinson, Jan E.; Hart, Roger J.; Pennell, Craig E.; Arrese, Catherine A.; Keelan, Jeffrey A.

    2014-01-01

    After several decades of research, we now have evidence that at least six interventions are suitable for immediate use in contemporary clinical practice within high-resource settings and can be expected to safely reduce the rate of preterm birth. These interventions involve strategies to prevent non-medically indicated late preterm birth; use of maternal progesterone supplementation; surgical closure of the cervix with cerclage; prevention of exposure of pregnant women to cigarette smoke; judicious use of fertility treatments; and dedicated preterm birth prevention clinics. Quantification of the extent of success is difficult to predict and will be dependent on other clinical, cultural, societal, and economic factors operating in each environment. Further success can be anticipated in the coming years as other research discoveries are translated into clinical practice, including new approaches to treating intra-uterine infection, improvements in maternal nutrition, and lifestyle modifications to ameliorate maternal stress. The widespread use of human papillomavirus vaccination in girls and young women will decrease the need for surgical interventions on the cervix and can be expected to further reduce the risk of early birth. Together, this array of clinical interventions, each based on a substantial body of evidence, is likely to reduce rates of preterm birth and prevent death and disability in large numbers of children. The process begins with an acceptance that early birth is not an inevitable and natural feature of human reproduction. Preventative strategies are now available and need to be applied. The best outcomes may come from developing integrated strategies designed specifically for each health-care environment. PMID:25477878

  15. Is the accuracy of prior preterm birth history biased by delivery characteristics?

    Science.gov (United States)

    Hackney, David N; Durie, Danielle E; Dozier, Ann M; Suter, Barbara J; Glantz, J Christopher

    2012-08-01

    To assess the sensitivity of birth certificates to preterm birth history and determine whether omissions are randomly or systemically biased. Subjects who experienced a preterm birth followed by a subsequent pregnancy were identified in a regional database. The variable "previous preterm birth" was abstracted from birth certificates of the subsequent pregnancy. Clinical characteristics were compared between subjects who were correctly versus incorrectly coded. 713 subjects were identified, of whom 65.5% were correctly coded in their subsequent pregnancy. Compared to correctly coded patients, patients who were not correctly identified tended to have late and non-recurrent preterm births or deliveries that were secondary to maternal or fetal indications. A recurrence of preterm birth in the subsequent pregnancy was also associated with correct coding. The overall sensitivity of birth certificates to preterm birth history is suboptimal. Omissions are not random, and are associated with obstetrical characteristics from both the current and prior deliveries. As a consequence, resulting associations may be flawed.

  16. Does fish oil prevent preterm birth?

    DEFF Research Database (Denmark)

    Secher, Niels Jørgen

    2007-01-01

    A literature review was performed on the effect of fish oil on preterm birth in observational and randomized studies. The only weak effect on preterm birth found in meta-analyses could be caused by the low compliance, and the fact that many women stop supplementation before term together with a f......A literature review was performed on the effect of fish oil on preterm birth in observational and randomized studies. The only weak effect on preterm birth found in meta-analyses could be caused by the low compliance, and the fact that many women stop supplementation before term together...... with a fast acting effect on fish oil....

  17. INCOME INCONGRUITY, RACE AND PRETERM BIRTH

    Science.gov (United States)

    Previous research with vital records finds income incongruity associated with adverse birth outcomes. We examined the effects of negative income incongruity (reporting lower household income than the census tract median household income) on preterm birth (PTB <37 weeks completed ...

  18. Births and deaths including fetal deaths

    Data.gov (United States)

    U.S. Department of Health & Human Services — Access to a variety of United States birth and death files including fetal deaths: Birth Files, 1968-2009; 1995-2005; Fetal death file, 1982-2005; Mortality files,...

  19. Socio-economic inequality in preterm birth

    DEFF Research Database (Denmark)

    Petersen, Christina Bjørk; Mortensen, Laust Hvas; Morgen, Camilla Schmidt

    2009-01-01

    by maternal educational attainment and analysed in 5-year intervals from 1981 to 2000. Compared with mothers with >12 years of education, mothers with years of education had similarly increased risks of very, and to a lesser extent moderately, preterm birth in all four countries. The educational gradient...... increased slightly over time in very preterm births in Denmark, while there was a slight narrowing of the gap in Sweden. In moderately preterm births, the educational inequality gap was constant over the study period in Denmark, Norway and Sweden, but narrowed in Finland. The educational gradient in preterm...

  20. Genetic Influences on Preterm Birth in Argentina

    Science.gov (United States)

    Mann, Paul C.; Cooper, Margaret E.; Ryckman, Kelli K.; Comas, Belén; Gili, Juan; Crumley, Suzanne; Bream, Elise N.A.; Byers, Heather M.; Piester, Travis; Schaefer, Amanda; Christine, Paul J.; Lawrence, Amy; Schaa, Kendra L.; Kelsey, Keegan J.P.; Berends, Susan K.; Gadow, Enrique; Cosentino, Viviana; Castilla, Eduardo E.; Camelo, Jorge López; Saleme, Cesar; Day, Lori J.; England, Sarah K.; Marazita, Mary L.; Dagle, John M.; Murray, Jeffrey C.

    2013-01-01

    Objective To investigate genetic etiologies of preterm birth (PTB) in Argentina through evaluation of single-nucleotide polymorphisms (SNP) in candidate genes and population genetic admixture. Study Design Genotyping was performed in 389 families. Maternal, paternal, and fetal effects were studied separately. Mitochondrial DNA (mtDNA) was sequenced in 50 males and 50 females. Y-chromosome anthropological markers were evaluated in 50 males. Results Fetal association with PTB was found in the progesterone receptor (PGR, rs1942836; p= 0.004). Maternal association with PTB was found in small conductance calcium activated potassium channel isoform 3 (KCNN3, rs883319; p= 0.01). Gestational age associated with PTB in PGR rs1942836 at 32 –36 weeks (p= 0.0004). MtDNA sequencing determined 88 individuals had Amerindian consistent haplogroups. Two individuals had Amerindian Y-chromosome consistent haplotypes. Conclusions This study replicates single locus fetal associations with PTB in PGR, maternal association in KCNN3, and demonstrates possible effects for divergent racial admixture on PTB. PMID:23018797

  1. Does fish oil prevent preterm birth?

    DEFF Research Database (Denmark)

    Secher, Niels Jørgen

    2007-01-01

    A literature review was performed on the effect of fish oil on preterm birth in observational and randomized studies. The only weak effect on preterm birth found in meta-analyses could be caused by the low compliance, and the fact that many women stop supplementation before term together...

  2. Progesterone to prevent spontaneous preterm birth

    Science.gov (United States)

    Romero, Roberto; Yeo, Lami; Chaemsaithong, Piya; Chaiworapongsa, Tinnakorn; Hassan, Sonia

    2014-01-01

    Summary Preterm birth is the leading cause of perinatal morbidity and mortality worldwide, and its prevention is an important healthcare priority. Preterm parturition is one of the ‘great obstetrical syndromes’ and is caused by multiple etiologies. One of the mechanisms of disease is the untimely decline in progesterone action, which can be manifested by a sonographic short cervix in the midtrimester. The detection of a short cervix in the midtrimester is a powerful risk factor for preterm delivery. Vaginal progesterone can reduce the rate of preterm delivery by 45%, and the rate of neonatal morbidity (admission to neonatal intensive care unit, respiratory distress syndrome, need for mechanical ventilation, etc.). To prevent one case of spontaneous preterm birth birth in women with a short cervix both with and without a prior history of preterm birth. In patients with a prior history of preterm birth, vaginal progesterone is as effective as cervical cerclage to prevent preterm delivery. 17α-Hydroxyprogesterone caproate has not been shown to be effective in reducing the rate of spontaneous preterm birth in women with a short cervix. PMID:24315687

  3. Outcomes of Pre-Term Premature Rupture of Fetal Membranes at ...

    African Journals Online (AJOL)

    Context: Pre-term premature rupture of fetal membranes (pPROM) contributes to maternal and fetal morbidity and mortality. These include chorioamnionitis, prematurity and still-births. Various microbial organisms have been implicated. Few studies have been done on pPROM in this environment. Objectives: To determine ...

  4. Spontaneous preterm birth: advances toward the discovery of genetic predisposition.

    Science.gov (United States)

    Strauss, Jerome F; Romero, Roberto; Gomez-Lopez, Nardhy; Haymond-Thornburg, Hannah; Modi, Bhavi P; Teves, Maria E; Pearson, Laurel N; York, Timothy P; Schenkein, Harvey A

    2018-03-01

    Evidence from family and twin-based studies provide strong support for a significant contribution of maternal and fetal genetics to the timing of parturition and spontaneous preterm birth. However, there has been only modest success in the discovery of genes predisposing to preterm birth, despite increasing sophistication of genetic and genomic technology. In contrast, DNA variants associated with other traits/diseases have been identified. For example, there is overwhelming evidence that suggests that the nature and intensity of an inflammatory response in adults and children are under genetic control. Because inflammation is often invoked as an etiologic factor in spontaneous preterm birth, the question of whether spontaneous preterm birth has a genetic predisposition in the case of pathologic inflammation has been of long-standing interest to investigators. Here, we review various genetic approaches used for the discovery of preterm birth genetic variants in the context of inflammation-associated spontaneous preterm birth. Candidate gene studies have sought genetic variants that regulate inflammation in the mother and fetus; however, the promising findings have often not been replicated. Genome-wide association studies, an approach to the identification of chromosomal loci responsible for complex traits, have also not yielded compelling evidence for DNA variants predisposing to preterm birth. A recent genome-wide association study that included a large number of White women (>40,000) revealed that maternal loci contribute to preterm birth. Although none of these loci harbored genes directly related to innate immunity, the results were replicated. Another approach to identify DNA variants predisposing to preterm birth is whole exome sequencing, which examines the DNA sequence of protein-coding regions of the genome. A recent whole exome sequencing study identified rare mutations in genes encoding for proteins involved in the negative regulation (dampening) of the

  5. Factors associated with preterm, early preterm and late preterm birth in Malawi.

    Directory of Open Access Journals (Sweden)

    Nynke R van den Broek

    Full Text Available Assessment of risk factors for preterm birth in a population with high incidence of preterm birth and HIV infection.Secondary analysis of data for 2,149 women included in a community based randomized placebo controlled trial for the prevention of preterm birth (APPLe trial (ISRCTN84023116 with gestational age at birth determined through ultrasound measurement in early pregnancy. Multivariate Logistic Regression analyses to obtain models for three outcome variables: all preterm, early preterm, and late preterm birth.No statistical differences were noted for the prevalence of HIV infection (p = 0.30 or syphilis (p = 0.12 between women who delivered preterm versus term. BMI (Adjusted OR 0.91 (0.85-0.97; p = 0.005 and weight gain (Adjusted OR 0.89 (0.82-0.97; p = 0.006 had an independent, protective effect. Previous preterm birth doubled the odds of preterm birth (Adjusted OR 2.13 (1.198-3.80; p = 0.01. Persistent malaria (despite malaria prophylaxis increased the risk of late preterm birth (Adjusted OR 1.99 (1.05-3.79; p = 0.04. Age <20 (Adjusted OR 1.73 (1.03-2.90; p = 0.04 and anemia (Adjusted OR 1.95 (1.08-3.52; p = 0.03 were associated with early preterm birth (<34 weeks.Despite claims that HIV infection is an important cause of preterm birth in Africa, we found no evidence of an association in this population (unexposed to anti-retroviral treatment. Persistent malaria was associated with late preterm birth. Maternal undernourishment and anemia were independently associated with early preterm birth. The study did not assess whether the link was direct or whether a common precursor such as chronic infection was responsible for both maternal effects and early labour.

  6. Long-term childhood outcomes after interventions for prevention and management of preterm birth.

    Science.gov (United States)

    Murray, Sarah R; Stock, Sarah J; Norman, Jane E

    2017-12-01

    Globally, preterm birth rates are rising and have a significant impact on neonatal morbidity and mortality. Preterm birth remains difficult to prevent and a number of strategies for preterm birth prevention (progesterone, cervical pessaries, cervical cerclage, tocolytics, and antibiotics) have been identified. While some of these show more promise, there is a paucity of evidence regarding the long-term effects of these strategies on childhood outcomes. Strategies used to improve the health of babies if born preterm, such as antenatal magnesium sulfate for fetal neuroprotection and antenatal corticosteroids for fetal lung maturation, show evidence of short-term benefit but lack large-scale follow-up data of long-term childhood outcomes. Future research on preterm birth interventions should include long-term follow-up of the children, ideally with similar outcome measures to allow for future meta-analyses. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Challenges and Consequences of Preterm Birth

    Directory of Open Access Journals (Sweden)

    Sribas Goswami

    2014-11-01

    Full Text Available Preterm births have been a challenge to obstetricians and paediatricians. Preterm births affect all population irrespective of age, race and economic status due to lack of seriousness and awareness among the pregnant women. Preterm birth is one of the leading causes of infant morbidity and mortality, amounting to billions of dollars each year, thus increasing the cost for health care. Proper awareness programs about preterm birth may help the women population to know and understand better the signs and symptoms of preterm labour. Preterm birth is a complex cluster of problems with a set of overlapping factors of influence. Its causes may include individual-level behavioral and psychosocial factors, neighborhood characteristics, environmental exposures, medical conditions, infertility treatments, biological factors and genetics. Many of these factors occur in combination, particularly in those who are socioeconomically disadvantaged or who are members of racial and ethnic minority groups. The empirical investigation was carried out to draw correlation between preterm birth and eventuality through this study.

  8. Born too soon: preterm birth matters.

    Science.gov (United States)

    Howson, Christopher P; Kinney, Mary V; McDougall, Lori; Lawn, Joy E

    2013-01-01

    Urgent action is needed to address preterm birth given that the fi rst country-level estimates show that globally 15 million babies are born too soon and rates are increasing in most countries with reliable time trend data. As the fi rst in a supplement entitled “Born Too Soon”, this paper focuses on the global policy context. Preterm birth is critical for progress on Millennium Development Goal 4 (MDG) for child survival by 2015 and beyond, and gives added value to maternal health (MDG 5) investments also linking to non-communicable diseases. For preterm babies who survive, the additional burden of prematurity-related disability may aff ect families and health systems. Prematurity is an explicit priority in many high-income settings; however, more attention is needed especially in low- and middle-income countries where the invisibility of preterm birth as well as its myths and misconceptions have slowed action on prevention and care. Recent global attention to preterm birth hit a tipping point in 2012, with the May 2 publication of Born Too Soon: The Global Action Report on Preterm Birth and with the 2nd annual World Prematurity Day on November 17 which mobilised the actions of partners in many countries to address preterm birth and newborn health. Interventions to strengthen preterm birth prevention and care span the continuum of care for reproductive, maternal, newborn and child health. Both prevention of preterm birth and implementation of care of premature babies require more research, as well as more policy attention and programmatic investment.

  9. Thickness of fetal membranes: a possible ultrasound marker for preterm delivery.

    Science.gov (United States)

    Severi, F M; Bocchi, C; Voltolini, C; Borges, L E; Florio, P; Petraglia, F

    2008-08-01

    To evaluate whether measurement of the thickness of the fetal membranes by high-resolution ultrasound is a useful marker to predict preterm delivery. One hundred and fifty-eight women with singleton pregnancies at 18-35 gestational weeks were enrolled consecutively at our referral center for obstetric care and the thickness of their fetal membranes was measured using high-resolution ultrasound equipment. Data were analyzed to determine whether there were significant differences between those delivering at term and those delivering preterm. Receiver-operating characteristics (ROC) curves were used to determine the best cut-off point of membrane thickness for predicting preterm birth. Women who delivered preterm had greater fetal membrane thickness than did those who delivered at term (1.67 +/- 0.27 mm vs. 1.14 +/- 0.30 mm, P membrane thickness could be helpful in the prediction of preterm delivery. (c) 2008 ISUOG. Published by John Wiley & Sons, Ltd.

  10. Hypothyroxinaemia and thyroid function after preterm birth

    NARCIS (Netherlands)

    van Wassenaer, Aleid G.; Kok, Joke H.

    2004-01-01

    The concentration of thyroid hormone in preterm infants is lower than that in term infants. This phenomenon is referred to as transient hypothyroxinaemia of prematurity. Low thyroid hormone levels after very preterm birth are associated with worse developmental outcome in childhood, but only one

  11. SOCIODEMOGRAPHIC DOAMINS OF DEPRIVATION AND PRETERM BIRTH

    Science.gov (United States)

    Background. Neighborhood-level deprivation has long been associated with adverse outcomes, including preterm birth (PTB), as observed in the authors' previous work using a composite deprivation index. Area disadvantage is multifaceted comprising income, employment, education and...

  12. Preterm Birth: An Overview of Risk Factors and Obstetrical Management

    Science.gov (United States)

    Stewart, Amanda; Graham, Ernest

    2010-01-01

    Preterm birth is the leading cause of neonatal mortality and a major public health concern. Risk factors for preterm birth include a history of preterm birth, short cervix, infection, short interpregnancy interval, smoking, and African-American race. The use of progesterone therapy to treat mothers at risk for preterm delivery is becoming more…

  13. Brazilian multicentre study on preterm birth (EMIP: prevalence and factors associated with spontaneous preterm birth.

    Directory of Open Access Journals (Sweden)

    Renato Passini

    Full Text Available BACKGROUND: Preterm birth rate is increasing and is currently a worldwide concern. The purpose of this study was to estimate the prevalence of preterm birth in a sample of health facilities in Brazil and to identify the main risk factors associated with spontaneous preterm births. METHODS AND FINDINGS: This was a multicentre cross sectional study on preterm births in 20 referral obstetric hospitals with a case-control component to identify factors associated with spontaneous preterm birth. Surveillance was implemented at all centres to identify preterm births. For eligible consenting women, data were collected through a post-delivery questionnaire completed with information from all mother-newborn medical records until death or discharge or at a maximum of 60 days post-delivery, whichever came first. The risk of spontaneous preterm birth was estimated with OR and 95%CI for several predictors. A non-conditional logistic regression analysis was then performed to identify independently associated factors. The overall prevalence of preterm birth was 12.3%. Among them, 64.6% were spontaneous and 35.4% therapeutic. In the case-control component, 2,682 spontaneous preterm births were compared to a sample of 1,146 term births. Multivariate analyses identified the following as risk factors for spontaneous preterm birth among women with at least one previous birth: a previous preterm birth (ORadj = 3.19, 2.30-4.43, multiple pregnancy (ORadj = 29.06, 8.43-100.2, cervical insufficiency (ORadj = 2.93, 1.07-8.05, foetal malformation (ORadj = 2.63, 1.43-4.85, polyhydramnios (ORadj = 2.30, 1.17-4.54, vaginal bleeding (ORadj = 2.16, 1.50-3.11, and previous abortion (ORadj = 1.39, 1.08-1.78. High BMI (ORadj = 0.94, 0.91-0.97 and weight gain during gestation (ORadj = 0.92, 0.89-0.95 were found to be protective factors. CONCLUSIONS: The preterm birth rate in these health facilities in Brazil is high and spontaneous preterm births

  14. A Role for the Liver in Parturition and Preterm Birth.

    Science.gov (United States)

    Mawson, Anthony R

    Neither the mechanisms of parturition nor the pathogenesis of preterm birth are well understood. Poor nutritional status has been suspected as a major causal factor, since vitamin A concentrations are low in preterm infants. However, even large enteral doses of vitamin A from birth fail to increase plasma concentrations of vitamin A or improve outcomes in preterm and/or extremely low birthweight infants. These findings suggest an underlying impairment in the secretion of vitamin A from the liver, where about 80% of the vitamin is stored. Vitamin A accumulates in the liver and breast during pregnancy in preparation for lactation. While essential in low concentration for multiple biological functions, vitamin A in higher concentration can be pro-oxidant, mutagenic, teratogenic and cytotoxic, acting as a highly surface-active, membrane-seeking and destabilizing compound. Regarding the mechanism of parturition, it is conjectured that by nine months of gestation the hepatic accumulation of vitamin A (retinol) from the liver is such that mobilization and secretion are impaired to the point where stored vitamin A compounds in the form of retinyl esters and retinoic acid begin to spill or leak into the circulation, resulting in amniotic membrane destabilization and the initiation of parturition. If, however, the accumulation and spillage of stored retinoids reaches a critical threshold prior to nine months, e.g., due to cholestatic liver disease, which is common in mothers of preterm infants, the increased retinyl esters and/or retinoic acid rupture the fetal membranes, inducing preterm birth and its complications, including retinopathy, necrotizing enterocolitis and bronchopulmonary dysplasia. Subject to testing, the model suggests that measures taken prior to and during pregnancy to improve liver function could reduce the risk of adverse birth outcomes, including preterm birth.

  15. Antimicrobials for Preterm Birth Prevention: An Overview

    Directory of Open Access Journals (Sweden)

    Akila Subramaniam

    2012-01-01

    Full Text Available Objective. Preterm birth (PTB remains a major cause of neonatal morbidity and mortality. The association between PTB and infection is clear. The purpose of this report is to present a focused review of information on the use of antibiotics to prevent PTB. Methods. We performed a search of the PubMed database restricted to clinical trials or meta-analyses published in English from 1990 through May 2011 using keywords “antibiotics or antimicrobials” and “preterm.” Results. The search yielded 67 abstracts for review. We selected 31 clinical trials (n=26 or meta-analysis (n=5 for further full-text review. Discussion of each eligible clinical trial, its specific inclusion criteria, antibiotic regimen used, and study results are presented. Overall, trials evaluating antibiotic treatment to prevent preterm birth have yielded mixed results regarding any benefit. Conclusion. Routine antibiotic prophylaxis is not recommended for prevention of preterm birth.

  16. Behavioral influences on preterm birth: a review.

    Science.gov (United States)

    Savitz, David A; Murnane, Pamela

    2010-05-01

    Epidemiologic studies of potential behavioral influences on preterm birth have proliferated and yet, with the exception of tobacco smoking, none can be considered an established cause. We conducted a comprehensive summary of the epidemiologic evidence on tobacco, alcohol, and illicit drug use, and physical, sexual, and occupational activity, to identify promising research directions, as well as research topics that are at an impasse based on currently available methods. Tobacco use is weakly but consistently associated with preterm birth-stronger for heavier smoking, and for spontaneous preterm birth and earlier preterm births. Weaker evidence suggests an adverse effect of environmental tobacco smoke, heavy alcohol or cocaine use, and physically strenuous work. Low levels of alcohol use, caffeine, sexual activity, and employment have generally not been found to be associated with preterm birth, and leisure-time physical activity has generated mixed results. Progress will require more detailed consideration of antecedents, new technologies for assessing exposure, and examination of biologic consequences of the behaviors of interest, focusing on pathways thought to mediate preterm delivery. New strategies-rather than more applications of the same approaches used in past studies-will move the research toward identifying causal relationships and, ultimately, may suggest preventive measures.

  17. Use of metabolomics for the identification and validation of clinical biomarkers for preterm birth: Preterm SAMBA

    OpenAIRE

    Cecatti, Jose G.; Souza, Renato T.; Sulek, Karolina; Costa, Maria L.; Kenny, Louise C.; McCowan, Lesley M. E.; Pacagnella, Rodolfo C.; Villas-Boas, Silas G.; Mayrink, Jussara; Passini, Renato; Franchini, Kleber G.; Baker, Philip N.

    2016-01-01

    Background: Spontaneous preterm birth is a complex syndrome with multiple pathways interactions determining its occurrence, including genetic, immunological, physiologic, biochemical and environmental factors. Despite great worldwide efforts in preterm birth prevention, there are no recent effective therapeutic strategies able to decrease spontaneous preterm birth rates or their consequent neonatal morbidity/mortality. The Preterm SAMBA study will associate metabolomics technologies to identi...

  18. Oral environment, inflammation and preterm birth

    Directory of Open Access Journals (Sweden)

    Silvio Abati

    2015-10-01

    Full Text Available Adverse obstetric outcomes are determinants of neonatal mortality and serious morbidity, often leading to neurologic and developmental alterations in early childhood and/or adult life. Several studies have focused the relationships between maternal inflammation and diseases and those conditions.The role of oral inflammation and gingival diseases as factors with potential maternal and fetal detrimental effects on the outcomes of pregnancy is a relatively new area of investigation that has attracted a lot of interest and research in the last twenty years. The new evidences now strongly support a role for maternal infection and inflammation of the genital tract, as well as inflammation from sites distant from the pelvis, in the etiology of preterm birth. The aim of the present paper is to outline and summarize the current knowledge about the relations between oral biofilms, periodontal inflammation and the pathogenic mechanisms linking periodontal diseases with adverse pregnancy outcomes, concluding with some practical advices for clinicians on the prevention and control of the oral inflammation and the related adverse outcomes in pregnant patients. Proceedings of the 11th International Workshop on Neonatology and Satellite Meetings · Cagliari (Italy · October 26th-31st, 2015 · From the womb to the adultGuest Editors: Vassilios Fanos (Cagliari, Italy, Michele Mussap (Genoa, Italy, Antonio Del Vecchio (Bari, Italy, Bo Sun (Shanghai, China, Dorret I. Boomsma (Amsterdam, the Netherlands, Gavino Faa (Cagliari, Italy, Antonio Giordano (Philadelphia, USA

  19. The immune consequences of preterm birth

    Directory of Open Access Journals (Sweden)

    Jacqueline M Melville

    2013-05-01

    Full Text Available Preterm birth occurs in 11% of live births globally and accounts for 35% of all newborn deaths. Preterm newborns have immature immune systems, with reduced innate and adaptive immunity; their immune systems may be further compromised by various factors associated with preterm birth.The immune systems of preterm infants have a smaller pool of monocytes and neutrophils, impaired ability of these cells to kill pathogens, and lower production of cytokines which limits T cell activation and reduces the ability to fight bacteria and detect viruses in cells, compared to term infants.Intrauterine inflammation is a major contributor to preterm birth, and causes premature immune activation and cytokine production. This can induce immune tolerance leading to reduced newborn immune function. Intrauterine inflammation is associated with an increased risk of early-onset sepsis and likely has long-term adverse immune consequences.Requisite medical interventions further impact on immune development and function. Antenatal corticosteroid treatment to prevent newborn respiratory disease is routine but may be immunosuppressive, and has been associated with febrile responses, reductions in lymphocyte proliferation and cytokine production, and increased risk of infection. Invasive medical procedures result in an increased risk of late-onset sepsis. Respiratory support can cause chronic inflammatory lung disease associated with increased risk of long-term morbidity.Colonisation of the infant by microorganisms at birth is a significant contributor to the establishment of the microbiome. Caesarean section affects infant colonisation, potentially contributing to lifelong immune function and wellbeing.Several factors associated with preterm birth alter immune function. A better understanding of perinatal modification of the preterm immune system will allow for the refinement of care to minimise lifelong adverse immune consequences.

  20. Fetal exposure to lead during pregnancy and the risk of preterm and early-term deliveries.

    Science.gov (United States)

    Cheng, Lu; Zhang, Bin; Huo, Wenqian; Cao, Zhongqiang; Liu, Wenyu; Liao, Jiaqiang; Xia, Wei; Xu, Shunqing; Li, Yuanyuan

    2017-08-01

    Studies have reported the association between lead exposure during pregnancy and preterm birth. However, findings are still inconsistent. This prospective birth cohort study evaluated the risks of preterm and early-term births and its association with prenatal lead exposure in Hubei, China. A total of 7299 pregnant women were selected from the Healthy Baby Cohort. Maternal urinary lead levels were measured by the Inductively Coupled Plasma Mass Spectrometry. The associations between tertiles of urinary lead levels and the risks of preterm and early-term deliveries were assessed using multiple logistic regression models. The geometric mean of creatinine-adjusted urinary lead concentrations among all participating mothers, preterm birth, and early-term birth were 3.19, 3.68, and 3.17μg/g creatinine, respectively. A significant increase in the risk of preterm births was associated with the highest urinary lead tertile after adjusting for confounders with odds ratio (OR) of 1.96. The association was more pronounced among 25-36 years old mothers with OR of 2.03. Though significant p trends were observed between lead exposure (medium and high tertiles) and the risk of early-term births, their ORs were not significant. Our findings indicate that the risk of preterm birth might increase with higher fetal lead exposure, particularly among women between the age of 25 and 36 years. Copyright © 2017 Elsevier GmbH. All rights reserved.

  1. Ethanol for preventing preterm birth in threatened preterm labor.

    Science.gov (United States)

    Haas, David M; Morgan, Amanda M; Deans, Samantha J; Schubert, Frank P

    2015-11-05

    Preterm birth is the leading cause of death and disability in newborns worldwide. A wide variety of tocolytic agents have been utilized to delay birth for women in preterm labor. One of the earliest tocolytics utilized for this purpose was ethanol infusion, although this is not generally used in current practice due to safety concerns for both the mother and her baby. To determine the efficacy of ethanol in stopping preterm labor, preventing preterm birth, and the impact of ethanol on neonatal outcomes. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 May 2015) and reference lists of retrieved studies. We included randomized and quasi-randomized studies. Cluster-randomized trials and cross-over design trials were not eligible for inclusion. We only included studies published in abstract form if there was enough information on methods and relevant outcomes. Trials were included if they compared ethanol infusion to stop preterm labor versus placebo/control or versus other tocolytic drugs. At least two review authors independently assessed studies for inclusion and risk of bias. At least two review authors independently extracted data. Data were checked for accuracy. Twelve trials involving 1586 women met inclusion criteria for this review. One trial did not report on the outcomes of interest in this review.Risk of bias of included studies: The included studies generally were of low quality based on inadequate reporting of methodology. Only three trials had low risk of bias for random sequence generation and one had low risk of bias for allocation concealment and participant blinding. Most studies were either high risk of bias or uncertain in these key areas. Comparison 1: Ethanol versus placebo/control (two trials, 77 women) Compared to controls receiving pain medications and dextrose solution, ethanol did not improve any of the primary outcomes: birth confidence interval (CI) 0.43 to 2.00), or neonatal mortality (one trial, 35 women; RR

  2. Occupational lifting of heavy loads and preterm birth:

    DEFF Research Database (Denmark)

    Runge, Stine Bjerrum; Pedersen, Jacob Krabbe; Svendsen, Susanne Wulff

    2013-01-01

    To examine the association between occupational lifting during pregnancy and preterm birth. The risk of preterm birth was estimated for total burden lifted per day and number of medium and heavy loads lifted per day.......To examine the association between occupational lifting during pregnancy and preterm birth. The risk of preterm birth was estimated for total burden lifted per day and number of medium and heavy loads lifted per day....

  3. Singleton preterm births in Korle bu teaching hospital, Accra, Ghana ...

    African Journals Online (AJOL)

    Objective: To determine the singleton preterm birth rate, the relative proportions of the clinical categories of preterm births and to compare the outcomes in these categories. Setting: Department of Obstetrics & Gynaecol-ogy, Korle Bu Teaching Hospital. Participants: Preterm births from 1st July to 31st December 2003.

  4. Risk assessment and management to prevent preterm birth

    NARCIS (Netherlands)

    Koullali, B.; Oudijk, M. A.; Nijman, T. A. J.; Mol, B. W. J.; Pajkrt, E.

    2016-01-01

    Preterm birth is the most important cause of neonatal mortality and morbidity worldwide. In this review, we review potential risk factors associated with preterm birth and the subsequent management to prevent preterm birth in low and high risk women with a singleton or multiple pregnancy. A history

  5. Preterm (Premature) Labor and Birth

    Science.gov (United States)

    ... these signs or symptoms: • Change in type of vaginal discharge (watery, mucus, or bloody) • Increase in amount of ... of a protein called fetal fibronectin in the vaginal discharge may be measured. The presence of this protein ...

  6. Role of perceived stress in the occurrence of preterm labor and preterm birth among urban women.

    Science.gov (United States)

    Seravalli, Laura; Patterson, Freda; Nelson, Deborah B

    2014-01-01

    This study examined whether prenatal perceived stress levels during pregnancy were associated with preterm labor or preterm birth. Perceived stress levels were measured at 16 weeks' gestation or less and between 20 and 24 weeks' gestation in a sample of 1069 low-income pregnant women attending Temple University prenatal care clinics. Scores were averaged to create a single measure of prenatal stress. Preterm birth was defined as the occurrence of a spontaneous birth prior to 37 weeks' gestation. Preterm labor was defined as the occurrence of regular contractions between 20 and 37 weeks' gestation that were associated with changes in the cervix. Independent of potential confounding factors, prenatal perceived stress was not associated with preterm labor (odds ratio [OR], 1.10; 95% confidence interval [CI], 0.69-1.78; P = .66); however, prenatal stress trended toward an association with preterm birth (OR, 1.49; 95% CI, 1.00-2.23; P = .05). The strongest predictor of preterm labor was a history of preterm labor in a prior pregnancy. Women with a history of preterm labor were 2 times more likely to experience preterm labor in the current pregnancy than women who did not have a preterm labor history (OR, 2.16; 95% CI, 1.05-4.41; P = .04). Historical risk factors for preterm birth, such as African American race, a history of abortion, or a history of preterm birth, were not related to preterm labor. The strongest predictor of preterm birth was having a history of preterm birth in a prior pregnancy (OR, 2.55; 95% CI, 1.54-4.24; P stress levels may be a risk factor for preterm birth independent of preterm labor; however, prenatal stress was not associated with preterm labor. Risk factors for preterm labor may be different from those of preterm birth. © 2014 by the American College of Nurse-Midwives.

  7. Proteomic Biomarkers for Spontaneous Preterm Birth

    DEFF Research Database (Denmark)

    Kacerovsky, Marian; Lenco, Juraj; Musilova, Ivana

    2014-01-01

    This review aimed to identify, synthesize, and analyze the findings of studies on proteomic biomarkers for spontaneous preterm birth (PTB). Three electronic databases (Medline, Embase, and Scopus) were searched for studies in any language reporting the use of proteomic biomarkers for PTB published...

  8. Preterm birth, osteoporosis, and periodontal disease.

    Science.gov (United States)

    Jeffcoat, M K

    2000-01-01

    The purpose of this two-part article is to review two major events in the life span of a woman. These include the putative relationship between oral health, pregnancy, and postmenopausal osteoporosis. Current knowledge about risk factors for preterm birth and for osteoporosis are discussed. The newest studies that address the relationship between oral and systemic health are also reviewed.

  9. Synergistic effects of pyrrolizidine alkaloids and lipopolysaccharide on preterm delivery and intrauterine fetal death in mice.

    Science.gov (United States)

    Guo, Yu; Ma, Zhenguo; Kou, Hao; Sun, Rongze; Yang, Hanxiao; Smith, Charles Vincent; Zheng, Jiang; Wang, Hui

    2013-08-29

    Preterm birth is the leading cause of death for newborn infants, and lipopolysaccharide (LPS) is commonly used to induce preterm delivery in experimental animals. Pyrrolizidine alkaloids (PAs) are widespread and occur in foods, herbs, and other plants. This study was to investigate the synergistic effects of LPS and two representative PAs, retrorsine (RTS) and monocrotaline (MCT), on preterm delivery and fetal death. Pregnant Kunming mice were divided into seven groups: control, RTS, MCT, LPS, RTS+LPS and two MCT+LPS groups. Animals in PAs and PAs+LPS groups were dosed intragastrically with RTS (10mg/kg) or MCT (20 mg/kg or 60 mg/kg) from gestational day (GD) 9 to GD16; mice given LPS were injected intraperitoneally with 150 μg/kg on GD15.5. Latencies to delivery, numbers of pups live and dead at birth were recorded, and livers of live neonates were collected. The incidence of LPS-induced preterm birth was enhanced in dams pretreated with MCT, and combination of PAs and LPS increased fetal mortality from PAs. The enhancement of LPS-induced preterm delivery and fetal demise in animals exposed chronically to PAs and other substances found in foods and beverages consumed widely by humans merits further focused investigation. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  10. PRETERM BIRTH ASSOCIATION WITH CEREBRAL PALSY

    Directory of Open Access Journals (Sweden)

    Srinivasa Rao

    2015-04-01

    Full Text Available INTRODUCTION: Cerebral palsy ( CP is a group of permanent movement disorders that appear in early childhood. Preterm birth is the birth of baby before 37 completed weeks, a full term birth is birth at 37 to 42 weeks of gestation . AIM: To show the extent of association of preterm deliveries as a risk factor in development of cerebral palsy. MATERIALS AND METHODS: This r etrospective cohort study was conducted by eliciting history from the mothers of 99 cerebral palsy children who w ere treated in Rani Chandra Mani Devi Hospital, Visakhapatnam, Andhra Pradesh, India. De tailed history was taken from the mothers of 99 cerebral palsy children who were treated in this hospital. History regarding the period of gestation at which the child was born (preterm or full term, any previous history of pre - term delivery or abortions, was obtained from the mothers and the data analyzed . RESULTS: From this study it was observed the proportional association of pre - term births to cerebral palsy is 33 out 99 i.e., about 33.33%, Of these 33 cerebral palsy children highest association being with birth at 28 wks gestation (51 %. This study also shows th at the mothers with a previous history of preterm delivery have 14.4 times higher risk of subsequent pre term delivery; those with previous history of abortions have 5.7 times risk of pre - term delivery than mothers without such history. CONCLUSION: From th is study it was concluded that the pre - term birth plays a major role as a risk factor in the development of cerebral palsy with mothers having previous pre term delivery and previous abortions adding further to this risk.

  11. preterm births in a resource constrained setting: soci

    African Journals Online (AJOL)

    2015-12-01

    Dec 1, 2015 ... cerebral palsy, visual and hearing impairment are also more common in preterm infants. Preterm birth in it- ... vious history of induced abortion, previous history of pre-term delivery, history of antenatal ..... cioeconomic status with stress which has been found to be a trigger for preterm labour and delivery.6 ...

  12. Large social disparities in spontaneous preterm birth rates in transitional Russia.

    Science.gov (United States)

    Grjibovski, A M; Bygren, L O; Yngve, A; Sjöström, M

    2005-02-01

    This study estimated the effect of maternal sociodemographic, obstetric and lifestyle factors on the risk of spontaneous preterm birth in a Russian town. All women with singleton pregnancies registered at prenatal care centres in Severodvinsk in 1999 comprised the cohort for this study (n=1559). Analysis was based on spontaneous live singleton births at the maternity home (n=1103). Multivariable logistic regression was applied to quantify the effect of the studied factors on the risk of preterm birth. Differences in gestation duration were studied using multiple linear regression. In total, 5.6% of all spontaneous births were preterm. Increased risks of preterm delivery were found in women with lower levels of education and in students. Placental complications, stress and a history of fetal death in previous pregnancies were also associated with elevated risks for preterm delivery. Smoking, hypertension and multigravidity were associated with reduced length of pregnancy in metric form. In addition to medical risk factors, social factors are important determinants of preterm birth in transitional Russia. Large disparities in preterm birth rates may reflect the level of inequalities in transitional Russia. Social variations in pregnancy outcomes should be monitored.

  13. Predicting preeclampsia from a history of preterm birth.

    Science.gov (United States)

    Rasmussen, Svein; Ebbing, Cathrine; Irgens, Lorentz M

    2017-01-01

    To assess whether women with a history of preterm birth, independent on the presence of prelabour rupture of the membranes (PROM) and growth deviation of the newborn, are more likely to develop preeclampsia with preterm or preterm birth in a subsequent pregnancy. We conducted a population-based cohort study, based on Medical Birth Registry of Norway between 1967 and 2012, including 742,980 women with singleton pregnancies who were followed up from their 1st to 2nd pregnancy. In the analyses we included 712,511 women after excluding 30,469 women with preeclampsia in the first pregnancy. After preterm birth without preeclampsia in the first pregnancy, the risk of preterm preeclampsia in the second pregnancy was 4-7 fold higher than after term birth (odds ratios 3.5; 95% confidence interval (CI) 3.0-4.0 to 6.5; 95% CI 5.1-8.2). The risk of term preeclampsia in the pregnancy following a preterm birth was 2-3 times higher than after term birth (odds ratios 1.6; 95% CI 1.5-1.8 to 2.6; 95% CI 2.0-3.4). After spontaneous non-PROM preterm birth and preterm PROM, the risk of preterm preeclampsia was 3.3-3.6 fold higher than after spontaneous term birth. Corresponding risks of term preeclampsia was 1.6-1.8 fold higher. No significant time trends were found in the effect of spontaneous preterm birth in the first pregnancy on preterm or term preeclampsia in the second pregnancy. The results suggest that preterm birth, regardless of the presence of PROM, and preeclampsia share pathophysiologic mechanisms. These mechanisms may cause preterm birth in one pregnancy and preeclampsia in a subsequent pregnancy in the same woman. The association was particularly evident with preterm preeclampsia.

  14. Contribution of risk factors to extremely, very and moderately preterm births - register-based analysis of 1,390,742 singleton births.

    Directory of Open Access Journals (Sweden)

    Sari Räisänen

    Full Text Available Preterm birth, defined as birth occurring before 37 weeks gestation, is one of the most significant contributors to neonatal mortality and morbidity, with long-term adverse consequences for health, and cognitive outcome.The aim of the present study was to identify risk factors of preterm birth (≤36+6 weeks gestation among singleton births and to quantify the contribution of risk factors to socioeconomic disparities in preterm birth.A retrospective population-based case-control study using data derived from the Finnish Medical Birth Register. A total population of singleton births in Finland from 1987-2010 (n = 1,390,742 was reviewed.Among all singleton births (n = 1,390,742, 4.6% (n = 63,340 were preterm (<37 weeks, of which 0.3% (n = 4,452 were classed as extremely preterm, 0.4% (n = 6,213 very preterm and 3.8% (n = 54,177 moderately preterm. Smoking alone explained up to 33% of the variation in extremely, very and moderately preterm birth incidence between high and the low socioeconomic status (SES groups. Reproductive risk factors (placental abruption, placenta previa, major congenital anomaly, amniocentesis, chorionic villus biopsy, anemia, stillbirth, small for gestational age (SGA and fetal sex altogether explained 7.7-25.0% of the variation in preterm birth between SES groups.Smoking explained about one third of the variation in preterm birth groups between SES groups whereas the contribution of reproductive risk factors including placental abruption, placenta previa, major congenital anomaly, amniocentesis, chorionic villus biopsy, anemia, stillbirth, SGA and fetal sex was up to one fourth.

  15. Low levels of anti-secretory factor in placenta are associated with preterm birth and inflammation.

    Science.gov (United States)

    Gustafsson, Anna M; Fransson, Emma; Dubicke, Aurelija; Hjelmstedt, Anna K; Ekman-Ordeberg, Gunvor; Silfverdal, Sven-Arne; Lange, Stefan; Jennische, Eva; Bohlin, Kajsa

    2018-03-01

    Anti-secretory factor is a protein that regulates secretory and inflammatory processes and preterm birth is associated with inflammation. Therefore, our hypothesis was that anti-secretory factor might play a role in immune reactivity and homeostasis during pregnancy. Following spontaneous onset of labor and preterm or term delivery, placenta biopsies were collected. The levels of anti-secretory factor and markers of inflammation (CD68, CD163) and vascularization (CD34, smooth muscle actin) were analyzed by immunohistochemistry. The 61 placental biopsies included 31 preterm (preterm placentas exhibited lower levels of anti-secretory factor (p = 0.008) and larger numbers of CD68-positive cells (p Preterm placentas had blood vessel of smaller diameter (p = 0.036) indicative of immaturity. The level of interleukin-6 in cord blood was higher after very preterm than term birth, suggesting a fetal inflammatory response. The placenta level of anti-secretory factor was positively correlated to the length of gestation (p = 0.025) and negatively correlated to the levels of the inflammatory markers CD68 (p = 0.015) and CD163 (p = 0.028). Preterm delivery is associated with low levels of anti-secretory factor in placenta. Inflammation, a potential trigger of preterm birth, is more pronounced in the preterm placenta and inversely related to the placental level of anti-secretory factor, suggesting both a link and a potential target for intervention. © 2017 Nordic Federation of Societies of Obstetrics and Gynecology.

  16. Recurrence risk of preterm birth in subsequent twin pregnancy after preterm singleton delivery

    NARCIS (Netherlands)

    Schaaf, J. M.; Hof, M. H. P.; Mol, B. W. J.; Abu-Hanna, A.; Ravelli, A. C. J.

    2012-01-01

    Please cite this paper as: Schaaf J, Hof M, Mol B, Abu-Hanna A, Ravelli A. Recurrence risk of preterm birth in subsequent twin pregnancy after preterm singleton delivery.BJOG 2012;119:16241629. Objective To determine the risk of preterm birth in a subsequent twin pregnancy after previous singleton

  17. The Burden of Provider-Initiated Preterm Birth and Associated Factors: Evidence from the Brazilian Multicenter Study on Preterm Birth (EMIP.

    Directory of Open Access Journals (Sweden)

    Renato T Souza

    Full Text Available About 15 million children are born under 37 weeks of gestation worldwide. Prematurity is the leading cause of neonatal deaths and short/long term morbidities, entailing consequences not only for the individual, but also their family, health agencies, facilities and all community. The provider-initiated preterm birth is currently one of the most important obstetric conditions related to preterm births, particularly in middle and high income countries, thus decreasing the need for therapeutic preterm birth is essential to reduce global prematurity. Therefore detailed knowledge on the factors associated with provider-initiated preterm birth is essential for the efforts to reduce preterm birth rates and its consequences. In this current analysis we aimed to assess the proportion of provider-initiated (pi-PTB among preterm births in Brazil and identify associated factors.This is an analysis of a multicenter cross-sectional study with a nested case-control component called Brazilian Multicenter Study on Preterm Birth (EMIP. EMIP was conducted in 20 referral obstetric hospitals located in the three most populated of the five Brazilian regions. We analysed data of women with pi-PTB, defined as childbirth occurring at less than 37 weeks, medically indicated for maternal/fetal compromise or both; and women with term birth, childbirth at or after 37 weeks. Maternal, sociodemographic, obstetric, prenatal care, delivery, and postnatal characteristics were assessed as possible factors associated with pi-PTB, compared to term births. The overall prevalence of preterm births was 12.3%. Of these, approximately one-third of cases were initiated by the provider. Hypertensive disorders, placental abruption, and diabetes were the main maternal conditions leading to pi-PTB. Caesarean section was the most common mode of delivery. Chronic hypertension (OR 7.47; 95%CI 4.02-13.88, preeclampsia/eclampsia/HELLP syndrome (OR 15.35; 6.57-35.88, multiple pregnancy (OR 12

  18. Progestogens to prevent preterm birth in twin pregnancies

    DEFF Research Database (Denmark)

    Schuit, Ewoud; Stock, Sarah; Groenwold, Rolf H H

    2012-01-01

    Preterm birth is the principal factor contributing to adverse outcomes in multiple pregnancies. Randomized controlled trials of progestogens to prevent preterm birth in twin pregnancies have shown no clear benefits. However, individual studies have not had sufficient power to evaluate potential...... benefits in women at particular high risk of early delivery (for example, women with a previous preterm birth or short cervix) or to determine adverse effects for rare outcomes such as intrauterine death....

  19. [Bacterial vaginosis and spontaneous preterm birth].

    Science.gov (United States)

    Brabant, G

    2016-12-01

    To determine if bacterial vaginosis is a marker for risk of spontaneous preterm delivery and if its detection and treatment can reduce this risk. Consultation of the database Pubmed/Medline, Science Direct, and international guidelines of medical societies. Bacterial vaginosis (BV) is a dysbiosis resulting in an imbalance in the vaginal flora through the multiplication of anaerobic bacteria and jointly of a disappearance of well-known protective Lactobacilli. His diagnosis is based on clinical Amsel criteria and/or a Gram stain with establishment of the Nugent score. The prevalence of the BV extraordinarily varies according to ethnic and/or geographical origin (4-58 %), in France, it is close to 7 % in the first trimester of pregnancy (EL2). The link between BV and spontaneous premature delivery is low with an odds ratio between 1.5 and 2 in the most recent studies (EL3). Metronidazole or clindamycin is effective to treat BV (EL3). It is recommended to prescribe one of these antibiotics in the case of symptomatic BV (Professional Consensus). The testing associated with the treatment of BV in the global population showed no benefit in the prevention of the risk of spontaneous preterm delivery (EL2). Concerning low-risk asymptomatic population (defined by the absence of antecedent of premature delivery), it has been failed profit to track and treat the BV in the prevention of the risk of spontaneous preterm delivery (EL1). Concerning the high-risk population (defined by a history of preterm delivery), it has been failed profit to track and treat the VB in the prevention of the risk of spontaneous preterm delivery (EL3). However, in the sub population of patients with a history of preterm delivery occurred in a context of materno-fetal bacterial infection, there may be a benefit to detect and treat early and systematically genital infection, and in particular the BV (Professional Consensus). The screening and treatment of BV during pregnancy in asymptomatic low

  20. What Are the Risks Factors for Preterm Labor and Birth?

    Science.gov (United States)

    ... cdc.gov/reproductivehealth/maternalinfanthealth/PretermBirth.htm [top] « What causes it? Is it possible ... research links air pollution and extreme temperature to stillbirth risk All related ...

  1. Prevalence and perinatal mortality associated with preterm births in a tertiary medical center in South East Nigeria

    Directory of Open Access Journals (Sweden)

    Iyoke CA

    2014-10-01

    Full Text Available Chukwuemeka Anthony Iyoke,1 Osaheni Lucky Lawani,2 Euzebus Chinonye Ezugwu,1 Gideon Ilechukwu,3 Peter Onubiwe Nkwo,1 Sunday Gabriel Mba,1 Isaac Nwabueze Asinobi41Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria; 2Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Abakaliki, Nigeria; 3Department of Paediatrics, Whiston Hospital, St Helen's and Knowsley Teaching Hospitals NHS Trust, Prescot, Lancashire, UK; 4Department of Paediatrics, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, NigeriaBackground: Preterm birth is a high risk condition associated with significant mortality and morbidity in the perinatal, neonatal, and childhood periods, and even in adulthood. Knowledge of the epidemiology of preterm births is necessary for planning appropriate maternal and fetal care.Objective: The objective of this study was to determine the prevalence, pattern, and perinatal mortality associated with preterm births at the University of Nigeria Teaching Hospital, Enugu, South East Nigeria.Methods: This was a review of prospectively collected routine delivery data involving preterm deliveries that occurred between 1 January 2009 and 31 December 2013. Data analysis involved descriptive and inferential statistics at 95% level of confidence using SPSS version 17.0 for Windows.Results: There were 3,760 live births over the 5-year study period out of which 636 were preterm births, giving a prevalence rate of 16.9%. Spontaneous preterm births occurred in approximately 57% of preterm births while provider-initiated births occurred in 43%. The mean gestational age at preterm deliveries was 32.6±3.2 weeks while the mean birth weight was 2.0±0.8 kilograms. Approximately 89% of preterm births involved singleton pregnancies. Sixty-eight percent of preterm births were moderate to late preterm. The male:female ratio of preterm babies born during the period was 1.2:1. The adjusted

  2. The Role of Body, Mind, and Environment in Preterm Birth: Mind the Gap.

    Science.gov (United States)

    Yamamoto, Shelby; Premji, Shahirose

    2017-11-01

    Preterm birth continues to be a problem affecting low-, middle-, and high-income countries, with rates increasing in some areas despite ongoing efforts to reduce the incidence. This emphasizes the need for more effective interventions, particularly if we aim to achieve the broad health targets of the Sustainable Development Goals (SDGs) by 2030. The current focus on medically-oriented interventions such as reducing nonmedically-indicated induction of labor, cesarean birth, and multiple embryo transfers associated with assisted reproductive technologies, as well as the application of cervical cerclage and use of progesterone therapy, though important, are likely only partial solutions to the complex phenomenon of preterm birth. Preterm birth has multiple etiologies. The biologic mechanisms involved in preterm labor and how it may be triggered are not well understood. There is growing evidence to suggest some of these triggers may also be related to stress and environmental conditions. In this review, we focus on evidence concerning psychosocial (mind) and environmental factors (environment) as well as briefly review the evidence related to maternal and fetal factors (body) associated with the risk of preterm birth, with reference to some of the SDGs. We also assess emerging evidence regarding the interaction of the body, mind, and environment in relation to preterm birth, currently a gap in our knowledge, and how these interactions could impact clinical practice. Findings suggest that multidisciplinary expertise and approaches will be needed to develop effective interventions to address the complex etiologies of preterm birth, as opposed to single-risk-factor mitigation. Clinicians and researchers will play key roles in identifying many of these risk factors and shaping interventions that address this complex issue. Addressing the interlinkages between body, mind, and environment through the integration of research and clinical practice is critical to reducing the

  3. What Interventions Are Being Used to Prevent Preterm Birth and When?

    Science.gov (United States)

    Feng, Yu Yang; Jarde, Alexander; Seo, Ye Rin; Powell, Anne; Nwebube, Nwachukwu; McDonald, Sarah D

    2018-01-04

    This study sought to determine the proportions of women at risk of preterm birth who received progesterone, elective and rescue cerclage, or pessary to prevent preterm birth, by using medical records. The authors also sought to determine whether these proportions differed among primary-, secondary-, and tertiary-level centres. The authors conducted a retrospective cohort study and extracted data from consecutive medical charts of women with an estimated date of confinement over 3 months in primary-, secondary-, and tertiary-level centres in Southern Ontario. The study identified women with a previous spontaneous preterm birth or a short cervix and determined whether they were offered and whether they received a preventive intervention for preterm birth. Descriptive statistics and Fisher exact tests were calculated. The authors reviewed 1024 consecutive charts at primary, secondary, and tertiary centres and identified 31 women with a previous spontaneous preterm birth or a short cervix. Of these women, less than one half (42%) received progesterone or cerclage for prevention of preterm birth, and none received pessary. One in four women (26%) were not referred to an obstetrician or maternal-fetal medicine specialist in time for an intervention, and among those referred before 24 weeks of gestation, an intervention was offered to 57% of the women. Less than half of women at risk of spontaneous preterm birth received progesterone, cerclage, or pessary, attesting to the importance of improving knowledge translation methods to encourage timely referral and use of progesterone for the prevention of preterm birth. Copyright © 2017 Society of Obstetricians and Gynaecologists of Canada. Published by Elsevier Inc. All rights reserved.

  4. Oxygen supplementation to stabilize preterm infants in the fetal to neonatal transition: no satisfactory answer.

    Directory of Open Access Journals (Sweden)

    Isabel eTorres-Cuevas

    2016-04-01

    Full Text Available Fetal life elapses in a relatively low oxygen environment. Immediately after birth with the initiation of breathing the lung expands and oxygen availability to tissue rises by twofold generating a physiologic oxidative stress. However, both lung anatomy and function and the antioxidant defense system do not mature until late in gestation and therefore very preterm infants often need respiratory support and oxygen supplementation in the delivery room to achieve postnatal stabilization. Notably, interventions in the first minutes of life can have long-lasting consequences. Recent trials have aimed to assess what initial inspiratory fraction of oxygen and what oxygen targets during this transitional period are best for extremely preterm infants based on the available nomogram. However, oxygen saturation nomogram informs only of term and late preterm infants but not on extremely preterm infants. Therefore, the solution to this conundrum may still have to wait before a satisfactory answer is available.

  5. Microbiome in parturition and preterm birth.

    Science.gov (United States)

    Mysorekar, Indira U; Cao, Bin

    2014-01-01

    Preterm parturition is a one of the most significant global maternal-child health problem. In recent years, there has been an explosion in reports on a role for microbiomes (i.e., a microbial biomass) on a plethora of physiologic and pathologic human conditions. This review aims to describe our current understanding of the microbiome and its impact on parturition, with particular emphasis on preterm birth. We will focus on the roles of vaginal and oral mucosal microbiomes in premature parturition and describe the state-of-the-art methodologies used in microbiome studies. Next, we will present new studies on a potential microbiome in the placenta and how it may affect pregnancy outcomes. Finally, we will propose that host genetic factors can perturb the normal "pregnancy microbiome" and trigger adverse pregnancy outcomes. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  6. The relationship between preterm birth and underweight in Asian women.

    Science.gov (United States)

    Neggers, Yasmin H

    2015-08-15

    Although vast improvements have been made in the survival of preterm infants, the toll of preterm birth (PTB) is particularly severe in Asia, with the Indian subcontinent leading the preterm birth rate. Despite the obesity epidemic, maternal underweight remains a common occurrence in developing countries. An association between maternal underweight and preterm birth has been reported in developed countries. A review of epidemiological studies in Asian women in whom association between maternal body mass index (BMI) and risk of PTB was measured, indicated no significant association between low maternal BMI and preterm birth. A hindrance in comparison of these studies is the use of different cut-off point for BMI in defining maternal underweight. As a commentary on published studies it is proposed that that country-specific BMI cut points should be applied for defining underweight for Asian women for the purpose of evaluating the association between maternal underweight and preterm birth. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Preterm Birth and Adult Wealth: Mathematics Skills Count.

    Science.gov (United States)

    Basten, Maartje; Jaekel, Julia; Johnson, Samantha; Gilmore, Camilla; Wolke, Dieter

    2015-10-01

    Each year, 15 million babies worldwide are born preterm. Preterm birth is associated with adverse neurodevelopmental outcomes across the life span. Recent registry-based studies suggest that preterm birth is associated with decreased wealth in adulthood, but the mediating mechanisms are unknown. This study investigated whether the relationship between preterm birth and low adult wealth is mediated by poor academic abilities and educational qualifications. Participants were members of two British population-based birth cohorts born in 1958 and 1970, respectively. Results showed that preterm birth was associated with decreased wealth at 42 years of age. This association was mediated by decreased intelligence, reading, and, in particular, mathematics attainment in middle childhood, as well as decreased educational qualifications in young adulthood. Findings were similar in both cohorts, which suggests that these mechanisms may be time invariant. Special educational support in childhood may prevent preterm children from becoming less wealthy as adults. © The Author(s) 2015.

  8. Pathways of job style and preterm low birth weight.

    Science.gov (United States)

    Salehi, Katayoun; Mahmoodi, Zohreh; Kabir, Kourosh; Dolatian, Mahrokh

    2016-09-01

    Preterm and low birth weight tend to occur as a direct result of prenatal risky behaviors, diseases, as well as fetal exposure to harmful social and environmental factors. The present study aimed to investigate the relationship between job style and preterm low birth weight. The present case-control study was conducted in the Kamali hospital, Teheran, Iran in 2014. Participants included 156 mothers having a gestational age of less than 37 weeks and infants weighing less than 2500 gm. Additionally, the control group consisted of 433 mothers with a gestational age of over 37 weeks and having infants weighing between 2500-4000 gm. The data were collected using the Mother's Lifestyle Scale (MLS) during pregnancy based on recognized social determinants of health and those developed by the researchers. The domain of the mother's job style was assessed using a questionnaire consisting of 18 items on topics such as working conditions, job satisfaction, and perceived employer empathy. Higher overall scores in this instrument indicate the mother's poorer job style. The data were analyzed using SPSS version 16 and Lisrel version 8.8 through a statistical path analysis. The model fit indices indicated that there was found to be high favorability, demonstrated that the model fit and that there were rational relationships (CFI=1, RMSEA=0.00), and showed that on the direct path that the mother's job style had the most adverse effect (B=-0.3) with weight gain during pregnancy showing the most positive effect (B=0.16) on PLBW. The mother's level of education was found to be the only variable that affected PLBW negatively in both the direct and indirect paths through the mother's job style and household income (B=-0.17). According the path analysis model, job style has a direct influence on preterm low birth weight. Thus, special consideration should be placed on aspects surrounding a mother's job situation in order to prevent any adverse effects.

  9. Use of metabolomics for the identification and validation of clinical biomarkers for preterm birth: Preterm SAMBA.

    Science.gov (United States)

    Cecatti, Jose G; Souza, Renato T; Sulek, Karolina; Costa, Maria L; Kenny, Louise C; McCowan, Lesley M; Pacagnella, Rodolfo C; Villas-Boas, Silas G; Mayrink, Jussara; Passini, Renato; Franchini, Kleber G; Baker, Philip N

    2016-08-08

    Spontaneous preterm birth is a complex syndrome with multiple pathways interactions determining its occurrence, including genetic, immunological, physiologic, biochemical and environmental factors. Despite great worldwide efforts in preterm birth prevention, there are no recent effective therapeutic strategies able to decrease spontaneous preterm birth rates or their consequent neonatal morbidity/mortality. The Preterm SAMBA study will associate metabolomics technologies to identify clinical and metabolite predictors for preterm birth. These innovative and unbiased techniques might be a strategic key to advance spontaneous preterm birth prediction. Preterm SAMBA study consists of a discovery phase to identify biophysical and untargeted metabolomics from blood and hair samples associated with preterm birth, plus a validation phase to evaluate the performance of the predictive modelling. The first phase, a case-control study, will randomly select 100 women who had a spontaneous preterm birth (before 37 weeks) and 100 women who had term birth in the Cork Ireland and Auckland New Zealand cohorts within the SCOPE study, an international consortium aimed to identify potential metabolomic predictors using biophysical data and blood samples collected at 20 weeks of gestation. The validation phase will recruit 1150 Brazilian pregnant women from five participant centres and will collect blood and hair samples at 20 weeks of gestation to evaluate the performance of the algorithm model (sensitivity, specificity, predictive values and likelihood ratios) in predicting spontaneous preterm birth (before 34 weeks, with a secondary analysis of delivery before 37 weeks). The Preterm SAMBA study intends to step forward on preterm birth prediction using metabolomics techniques, and accurate protocols for sample collection among multi-ethnic populations. The use of metabolomics in medical science research is innovative and promises to provide solutions for disorders with multiple

  10. Differing prevalence and diversity of bacterial species in fetal membranes from very preterm and term labor.

    Directory of Open Access Journals (Sweden)

    Hannah E Jones

    Full Text Available BACKGROUND: Intrauterine infection may play a role in preterm delivery due to spontaneous preterm labor (PTL and preterm prolonged rupture of membranes (PPROM. Because bacteria previously associated with preterm delivery are often difficult to culture, a molecular biology approach was used to identify bacterial DNA in placenta and fetal membranes. METHODOLOGY/PRINCIPAL FINDINGS: We used broad-range 16S rDNA PCR and species-specific, real-time assays to amplify bacterial DNA from fetal membranes and placenta. 74 women were recruited to the following groups: PPROM <32 weeks (n = 26; 11 caesarean; PTL with intact membranes <32 weeks (n = 19; all vaginal birth; indicated preterm delivery <32 weeks (n = 8; all caesarean; term (n = 21; 11 caesarean. 50% (5/10 of term vaginal deliveries were positive for bacterial DNA. However, little spread was observed through tissues and species diversity was restricted. Minimal bacteria were detected in term elective section or indicated preterm deliveries. Bacterial prevalence was significantly increased in samples from PTL with intact membranes [89% (17/19 versus 50% (5/10 in term vaginal delivery p = 0.03] and PPROM (CS [55% (6/11 versus 0% (0/11 in term elective CS, p = 0.01]. In addition, bacterial spread and diversity was greater in the preterm groups with 68% (13/19 PTL group having 3 or more positive samples and over 60% (12/19 showing two or more bacterial species (versus 20% (2/10 in term vaginal deliveries. Blood monocytes from women with PTL with intact membranes and PPROM who were 16S bacterial positive showed greater level of immune paresis (p = 0.03. A positive PCR result was associated with histological chorioamnionitis in preterm deliveries. CONCLUSION/SIGNIFICANCE: Bacteria are found in both preterm and term fetal membranes. A greater spread and diversity of bacterial species were found in tissues of women who had very preterm births. It is unclear to what extent the greater bacterial prevalence

  11. Short fetal leukocyte telomere length and preterm prelabor rupture of the membranes.

    Directory of Open Access Journals (Sweden)

    Ramkumar Menon

    Full Text Available BACKGROUND: Rupture of the fetal membranes is a common harbinger of imminent labor and delivery. Telomere shortening is a surrogate for oxidative stress (OS and senescence. Fetal leukocyte and placental membrane DNA telomere lengths were evaluated to determine their association with preterm prelabor rupture of the membranes (pPROM or spontaneous preterm births with intact membranes (PTB, compared to term birth. METHODS: Telomere lengths were quantified in cord blood leukocytes (n = 133 from three major groups: 1 pPROM (n = 28, 2 PTB (n = 69 and 3 uncomplicated full term births (controls, n = 35, using real-time quantitative PCR. Placental membrane specimens (n = 18 were used to correlate fetal leukocyte and placental telomere lengths. Telomere length differences among the groups were analyzed by ANOVA. Pearson correlation coefficients determined relationships between leukocyte and placental membrane telomere lengths. RESULTS: In pregnancies with intact membranes, fetal leukocyte telomere length was inversely proportional to gestational age. The mean telomere length decreased as gestation progressed, with the shortest at term. pPROM had telomere lengths (9962 ± 3124 bp that were significantly shorter than gestational age-matched PTB (11546 ± 4348 bp, p = 0.04, but comparable to term births (9011 ± 2497 bp, p = 0.31. Secondary analyses revealed no effects of race (African American vs. Caucasian or intraamniotic infection on telomere length. A strong Pearson's correlation was noted between fetal leukocyte and placental membrane telomere lengths (ρ = 0.77; p<0.01. CONCLUSIONS: Fetal leukocyte telomere length is reduced in pPROM compared to PTB but is similar to term births. pPROM represents a placental membrane disease likely mediated by OS-induced senescence.

  12. A mouse model of spontaneous preterm birth based on the genetic ablation of biglycan and decorin

    Science.gov (United States)

    Calmus, Megan L.; Macksoud, Elyse E.; Tucker, Richard; Iozzo, Renato V.; Lechner, Beatrice E.

    2011-01-01

    Preterm premature rupture of membranes is responsible for one third of preterm births. Ehlers-Danlos syndrome (EDS) is associated with preterm premature rupture of membranes in humans. Notably, an EDS variant is caused by a genetic mutation resulting in abnormal secretion of biglycan and decorin, two small leucine-rich proteoglycans highly expressed in reproductive tissues. Because biglycan/decorin null mutant (Bgn−/−Dcn−/−) mice demonstrate phenotypic changes similar to EDS, we utilized this model to test whether either or both biglycan and decorin play a role in the attainment of successful term gestation. Wild-type, biglycan null mutant, decorin null mutant and biglycan/decorin null mutant pregnancies were assessed for length of gestation, pup and placenta weight and litter size. Quantitative real-time polymerase chain reaction was performed to measure biglycan and decorin gene expression and immunohistochemistry was performed to assess protein expression in placenta and fetal membranes at embryonic day E12, E15 and E18. Bgn−/−Dcn−/− dams displayed preterm birth, whereas the possession of at least two biglycan or decorin wild-type alleles was protective of preterm birth. Bgn−/−Dcn−/− pups were decreased at postnatal day P1 but not at E18. Biglycan and decorin were upregulated in the placenta in each other’s absence and were developmentally regulated in fetal membranes, suggesting that these two proteoglycans demonstrate genetic complementation and contribute to gestational success in a dose dependent manner. Thus, the biglycan/decorin null mutant mouse is a model of genetically induced preterm birth and perinatal loss. This model presents novel targets for preventive or therapeutic manipulation of preterm birth. PMID:21502335

  13. The relationship of the subtypes of preterm birth with retinopathy of prematurity.

    Science.gov (United States)

    Lynch, Anne M; Wagner, Brandie D; Hodges, Jennifer K; Thevarajah, Tamara S; McCourt, Emily A; Cerda, Ashlee M; Mandava, Naresh; Gibbs, Ronald S; Palestine, Alan G

    2017-09-01

    Retinopathy of prematurity is an adverse outcome of preterm birth and is a leading cause of childhood blindness. The relationship between the subtypes of preterm birth with retinopathy of prematurity is understudied. To investigate whether there is a difference in the incidence of type 1 or type 2 retinopathy of prematurity in infants with preterm birth resulting from spontaneous preterm labor, a medical indication of preterm birth, or preterm premature rupture of the membranes. A retrospective cohort study was conducted of 827 infants screened for retinopathy of prematurity who were delivered at a single tertiary care center in Colorado. All infants fulfilled the American Academy of Pediatrics 2013 screening criteria for retinopathy of prematurity defined as "infants with a birth weight of ≤1500 g or gestational age of 30 weeks or less (as defined by the attending neonatologist) and selected infants with a birth weight between 1500 and 2000 g or gestational age of >30 weeks with an unstable clinical course, including those requiring cardiorespiratory support and who are believed by their attending pediatrician or neonatologist to be at high risk for retinopathy of prematurity." Two independent reviewers masked to retinopathy of prematurity outcomes determined whether preterm birth resulted from spontaneous preterm labor, medical indication of preterm birth, or preterm premature rupture of the membranes. Discrepancies were resolved by a third reviewer. Data were analyzed with univariate and multivariable logistic regression. In our cohort, the frequency of preterm birth resulting from spontaneous preterm labor, medical indication of preterm birth, or preterm premature rupture of the membranes was 34%, 40%, and 26%, respectively. The mean gestational age (weeks, days) ± SD (range) in the cohort and across the preterm birth subtypes was as follows: entire cohort, 28 weeks, 6 days ± 2 weeks, 3 days (23 weeks, 3 days - 36 weeks, 4 days); spontaneous preterm labor

  14. Preterm birth in rural Malawi — high incidence. in

    African Journals Online (AJOL)

    6.32, 95%CI 3.21,12.45). Conclusions: This population has a very high rate of preterm birth, which is probably infection-related. It may be representative of many rural populations in sub-Saharan Africa. Tackling the problem of neonatal mortality in low income countries will require effective methods to prevent preterm birth.

  15. Multilevel factors influencing preterm birth in an urban setting

    Directory of Open Access Journals (Sweden)

    Saba W. Masho

    2014-01-01

    Full Text Available Racial disparity in preterm is a major problem in the US. Although significant strides have been made in identifying some of the risk factors, the complexities between community and individual factors are not understood. This study examines the influence of individual and community level factors affecting preterm birth among Black and White women in an urban setting. A 10-year live birth registry dataset from a mid-sized, racially diverse city was analyzed (N = 30,591. Data were geocoded and merged with block group level Census data. Five hierarchical models were examined using PROC GLIMMIX. Education, illicit drug use, pregnancy complications, previous preterm birth, paternal presence, inadequate and adequate plus prenatal care, and poverty were associated with preterm births in both Blacks and Whites. In Black women, increasing maternal age, maternal smoking, and a previous infant death were significant predictors of preterm births, which was not the case for White women. Residing in medium or high poverty neighborhoods resulted in 19% and 28% higher odds, respectively, of preterm birth for Black women. In addition to individual level factors, neighborhood poverty is an important risk factor influencing preterm birth. It is essential to engage multisectoral agencies in addressing factors influencing preterm birth.

  16. Antenatal corticosteroid use in preterm birth at Kenyatta National ...

    African Journals Online (AJOL)

    Background: Preterm birth causes about 75% of neonatal deaths that are not attributable to congenital malformations. Antenatal corticosteroids (ACS) given to mothers at risk of preterm birth reduce the incidence/severity of RDS, intraventricular haemmorhage, necrotizing enterocolitis and neonatal deaths. The WHO ...

  17. Low Birth Weight, Small for Gestational Age and Preterm Births before and after the Economic Collapse in Iceland: A Population Based Cohort Study

    Science.gov (United States)

    Eiríksdóttir, Védís Helga; Ásgeirsdóttir, Tinna Laufey; Bjarnadóttir, Ragnheiður Ingibjörg; Kaestner, Robert; Cnattingius, Sven; Valdimarsdóttir, Unnur Anna

    2013-01-01

    Objective Infants born small for gestational age (SGA) or preterm have increased rates of perinatal morbidity and mortality. Stressful events have been suggested as potential contributors to preterm birth (PB) and low birth weight (LBW). We studied the effect of the 2008 economic collapse in Iceland on the risks of adverse birth outcomes. Study design The study population constituted all Icelandic women giving birth to live-born singletons from January 1st 2006 to December 31st 2009. LBW infants were defined as those weighing Icelandic national economy. The increase in LBW seems to be driven by reduced fetal growth rate rather than shorter gestation. PMID:24324602

  18. Racial and ethnic differences in preterm birth: A complex, multifactorial problem.

    Science.gov (United States)

    Manuck, Tracy A

    2017-12-01

    Preterm birth remains the leading cause of morbidity and mortality among nonanomalous neonates, and is a major public health problem. Non-Hispanic black women have a 2-fold greater risk for preterm birth compared with non-Hispanic white race. The reasons for this disparity are poorly understood and cannot be explained solely by sociodemographic factors. Underlying factors including a complex interaction between maternal, paternal, and fetal genetics, epigenetics, the microbiome, and these sociodemographic risk factors likely underlies the differences between racial groups, but these relationships are currently poorly understood. This article reviews the epidemiology of disparities in preterm birth rates and adverse pregnancy outcomes and discuss possible explanations for the racial and ethnic differences, while examining potential solutions to this major public health problem. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. The role of progesterone in prevention of preterm birth

    Directory of Open Access Journals (Sweden)

    Jodie M Dodd

    2009-07-01

    Full Text Available Jodie M Dodd, Caroline A CrowtherDiscipline of Obstetrics and Gynaecology, The University of Adelaide, Adelaide, South Australia, AustraliaAbstract: Preterm birth continues to provide an enormous challenge in the delivery of perinatal health care, and is associated with considerable short and long-term health consequences for surviving infants. Progesterone has a role in maintaining pregnancy, by suppression of the calcium–calmodulin–myosin light chain kinase system. Additionally, progesterone has recognized anti-inflammatory properties, raising a possible link between inflammatory processes, alterations in progesterone receptor expression and the onset of preterm labor. Systematic reviews of randomized controlled trials evaluating the use of intramuscular and vaginal progesterone in women considered to be at increased risk of preterm birth have been published, with primary outcomes of perinatal death, preterm birth <34 weeks, and neurodevelopmental handicap in childhood. Eleven randomized controlled trials were included in the systematic review, involving 2714 women and 3452 infants, with results presented according to the reason women were considered to be at increased risk of preterm birth. While there is a potential beneficial effect in the use of progesterone for some women considered to be at increased risk of preterm birth, primarily in the reduction in the risk of preterm birth before 34 weeks gestation, it remains unclear if the observed prolongation of pregnancy translates into improved health outcomes for the infant.Keywords: progesterone, preterm birth, systematic review, randomized trial

  20. Second-Trimester Sonographic Thymus Measurements Are Not Associated With Preterm Birth and Other Adverse Obstetric Outcomes.

    Science.gov (United States)

    Brandt, Justin S; Bastek, Jamie A; Wang, Eileen; Purisch, Stephanie; Schwartz, Nadav

    2016-05-01

    Previous studies have demonstrated an association between adverse obstetric outcomes, such as preterm birth, and in utero inflammation. The fetal thymus, which can be visualized in the anterior mediastinum on obstetric sonography, may involute in response to such inflammation and thus may identify pregnancies at increased risk for these outcomes. We therefore sought to determine whether second-trimester fetal thymus measurements are associated with preterm birth. Transabdominal fetal thymus measurements were prospectively obtained in singleton pregnancies at gestational ages of 18 weeks to 23 weeks 6 days during a 5-month period. The transverse and anterorposterior thymus diameters and the thymic-thoracic ratio were measured. Delivery outcomes were collected from our clinical database. The primary outcome was preterm birth, which we defined as delivery between 24 weeks and 36 weeks 6 days. Small for gestational age (SGA) and pregnancy-related hypertension, which are adverse obstetric outcomes that may also be associated with in utero inflammation, were included as secondary outcomes. We included 520 patients with thymus measurements and obstetric outcome data. The prevalence of preterm birth was 12.3% (n = 64). None of the thymus measurements were associated with preterm birth. Similarly, there was no association between thymus measurements and SGA or pregnancy-related hypertension. Sonographic assessment of the second-trimester fetal thymus did not identify patients at increased risk for preterm birth, SGA, and pregnancy-related hypertension. Routine thymus measurements during the second-trimester anatomic scan are not clinically useful for prediction of preterm birth and other adverse outcomes. © 2016 by the American Institute of Ultrasound in Medicine.

  1. The Canadian Preterm Birth Network: a study protocol for improving outcomes for preterm infants and their families.

    Science.gov (United States)

    Shah, Prakesh S; McDonald, Sarah D; Barrett, Jon; Synnes, Anne; Robson, Kate; Foster, Jonathan; Pasquier, Jean-Charles; Joseph, K S; Piedboeuf, Bruno; Lacaze-Masmonteil, Thierry; O'Brien, Karel; Shivananda, Sandesh; Chaillet, Nils; Pechlivanoglou, Petros

    2018-01-18

    Preterm birth (birth before 37 wk of gestation) occurs in about 8% of pregnancies in Canada and is associated with high mortality and morbidity rates that substantially affect infants, their families and the health care system. Our overall goal is to create a transdisciplinary platform, the Canadian Preterm Birth Network (CPTBN), where investigators, stakeholders and families will work together to improve childhood outcomes of preterm neonates. Our national cohort will include 24 maternal-fetal/obstetrical units, 31 neonatal intensive care units and 26 neonatal follow-up programs across Canada with planned linkages to provincial health information systems. Three broad clusters of projects will be undertaken. Cluster 1 will focus on quality-improvement efforts that use the Evidence-based Practice for Improving Quality method to evaluate information from the CPTBN database and review the current literature, then identify potentially better health care practices and implement identified strategies. Cluster 2 will assess the impact of current practices and practice changes in maternal, perinatal and neonatal care on maternal, neonatal and neurodevelopmental outcomes. Cluster 3 will evaluate the effect of preterm birth on babies, their families and the health care system by integrating CPTBN data, parent feedback, and national and provincial database information in order to identify areas where more parental support is needed, and also generate robust estimates of resource use, cost and cost-effectiveness around preterm neonatal care. These collaborative efforts will create a flexible, transdisciplinary, evaluable and informative research and quality-improvement platform that supports programs, projects and partnerships focused on improving outcomes of preterm neonates. Copyright 2018, Joule Inc. or its licensors.

  2. Interplay of cytokines in preterm birth

    Directory of Open Access Journals (Sweden)

    Monika Pandey

    2017-01-01

    Full Text Available Preterm infants (i.e., born before <37 wk of gestation are at increased risk of morbidity and mortality and long-term disabilities. Global prevalence of preterm birth (PTB varies from 5 to 18 per cent. There are multiple aetiological causes and factors associated with PTB. Intrapartum infections are conventionally associated with PTB. However, maternal genotype modulates response to these infections. This review highlights the association of cytokine gene polymorphisms and their levels with PTB. Varying PTB rates across the different ethnic groups may be as a result of genetically mediated varying cytokines response to infections. Studies on genetic variations in tumour necrosis factor-alpha, interleukin-1 alpha (IL-1α, IL-1β, IL-6, IL-10 and toll-like receptor-4 genes and their association with PTB, have been reviewed. No single polymorphism of the studied genes was found to be associated with PTB. However, increased maternal levels of IL-1β and IL-6 and low levels of IL-10 have been found to be associated with PTB.

  3. Why are We Waiting to Start Large Scale Clinical Testing of Human Chorionic Gonadotropin for the Treatment of Preterm Births?

    Science.gov (United States)

    Rao, C V

    2016-07-01

    Preterm births are an expensive global health problem. Despite the basic science and clinical research advances to better understand and prevent preterm births, the rates are increasing. There are several therapeutic options. While some options such as progestins work for selected women, others such as magnesium sulfate can only be used for delaying births for 24 to 48 hours so that the patients can be treated with corticosteroids to promote fetal lung maturity. Based on the scientific and clinical evidence, we recommend testing human chorionic gonadotropin in a large multicenter, randomized, double-blind, and placebo-controlled clinical trials in women with active preterm labor and those with a previous history of preterm births. Human chorionic gonadotropin is not only inexpensive but also has not shown any side effects so far in the infants or in the mothers. © The Author(s) 2015.

  4. Progesterone for the prevention of preterm birth: indications, when to initiate, efficacy and safety

    Directory of Open Access Journals (Sweden)

    Helen Y How

    2008-12-01

    Full Text Available Helen Y How, Baha M SibaiDivision of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, OH USAAbstract: Preterm birth is the leading cause of neonatal mortality and morbidity and long-term disability of non-anomalous infants. Previous studies have identified a prior early spontaneous preterm birth as the risk factor with the highest predictive value for recurrence. Two recent double blind randomized placebo controlled trials reported lower preterm birth rate with the use of either intramuscular 17 alpha-hydroxyprogesterone caproate (IM 17OHP-C or intravaginal micronized progesterone suppositories in women at risk for preterm delivery. However, it is still unclear which high-risk women would truly benefit from this treatment in a general clinical setting and whether socio-cultural, racial and genetic differences play a role in patient’s response to supplemental progesterone. In addition the patient’s acceptance of such recommendation is also in question. More research is still required on identification of at risk group, the optimal gestational age at initiation, mode of administration, dose of progesterone and long-term safety.Keywords: preterm birth prevention, 17-alpha-hydroxyprogesterone caproate

  5. Study of Relation between Physical Activity and Preterm Birth

    Directory of Open Access Journals (Sweden)

    Mehran N.

    2012-04-01

    Full Text Available Background and Objectives: Preterm birth is the main cause of neonatal mortality and morbidity and the importance of knowing its causes is clear. Since the effect of physical activity on preterm birth is unknown and its prevention is the priority in health care, we decided to do this study with the aim of determining the relation between physical activity and preterm birth. Methods: In this case-control study, 300 pregnant women delivering in Izadi Hospital in Qom, Iran in the second half of 2008, selected through simple sampling. The data were collected using standard pregnancy physical activity questionnaire that categorizes the physical activity into 4 groups: work activities, home activities, transport activities and fun/exercise activities. The physical activity severity was calculated as MET (Metabolic Equivalence Test. Finally, the data were analyzed using descriptive and analytic (x2 and t test statistics. A p<0.05 was considered as significant.Results: The findings didn't show any significant relation between physical activity and preterm birth. In addition, in view of activity type, fun/exercise and work activities (respectively and in view of activity severity, sedentary and moderate activities (respectively were associated with higher, but insignificant rate of preterm birth. Among demographic factors, only gravidity of women was significantly associated with preterm birth.Conclusion: Although, in this study the significant relation between physical activity and preterm delivery wasn't observed, the same research with further sample is recommended.

  6. Obesity, gestational weight gain and preterm birth: a study within the Danish National Birth Cohort

    DEFF Research Database (Denmark)

    Nøhr, Ellen Aagaard; Bech, Bodil Hammer; Vaeth, Michael

    2007-01-01

    prepregnancy body mass index (BMI) and gestational weight gain was available. Information about spontaneous preterm birth with or without preterm premature rupture of membranes (PPROM) and about induced preterm deliveries was obtained from national registers. Cox regression analyses were used to examine...

  7. Cost effects of preterm birth: a comparison of health care costs associated with early preterm, late preterm, and full-term birth in the first 3 years after birth.

    Science.gov (United States)

    Jacob, Josephine; Lehne, Moritz; Mischker, Andrea; Klinger, Normen; Zickermann, Claudia; Walker, Jochen

    2017-11-01

    Preterm birth is one of the main causes for infant morbidity and mortality. Apart from negative health outcomes, preterm birth also produces significant health care expenditures. This study evaluates the costs associated with preterm birth in different health sectors during the first 3 years of infants' lives. In a retrospective observational study based on claims data from a German statutory health insurance company, average costs for medication, hospital treatment, ambulatory treatment, and non-medical remedies during the first 3 years after birth were analyzed for early preterm, late preterm, and full-term births. Costs associated with preterm births were generally higher than for full-term births, with the highest costs for the hospital treatment of early preterm births. Cost differences tended to decrease in the second and third year after birth except for ambulatory treatment costs, which decreased for late preterm and full-term births but not for early preterm births. The study shows that preterm birth is associated with increased health care costs, particularly during the first year after birth, indicating that the implementation of adequate programs and policies for preventing preterm birth is not only desirable from a medical but also from a health economic perspective.

  8. Transient Hypoxemia Chronically Disrupts Maturation of Preterm Fetal Ovine Subplate Neuron Arborization and Activity.

    Science.gov (United States)

    McClendon, Evelyn; Shaver, Daniel C; Degener-O'Brien, Kiera; Gong, Xi; Nguyen, Thuan; Hoerder-Suabedissen, Anna; Molnár, Zoltán; Mohr, Claudia; Richardson, Ben D; Rossi, David J; Back, Stephen A

    2017-12-06

    -long cognitive and learning disabilities. We investigated the fate of subplate neurons (SPNs), which are a master regulator of brain development that plays critical roles in establishing cortical connections to other brain regions. We used a preterm fetal sheep model that reproduces key features of brain injury in human preterm survivors. We analyzed the responses of fetal SPNs to transient disturbances in fetal oxygenation. We discovered that SPNs are surprisingly resistant to cell death from low oxygen states but acquire chronic structural and functional changes that suggest new strategies to prevent learning problems in children and adults that survive preterm birth. Copyright © 2017 the authors 0270-6474/17/3711912-18$15.00/0.

  9. Sleep Disorder Diagnosis During Pregnancy and Risk of Preterm Birth.

    Science.gov (United States)

    Felder, Jennifer N; Baer, Rebecca J; Rand, Larry; Jelliffe-Pawlowski, Laura L; Prather, Aric A

    2017-09-01

    To test the hypothesis that sleep disorder diagnosis would be associated with increased risk of preterm birth and to examine risk by gestational age, preterm birth type, and specific sleep disorder (insomnia, sleep apnea, movement disorder, and other). In this observational study, participants were from a cohort of nearly 3 million women in California between 2007 and 2012. Inclusion criteria were women with singleton neonates liveborn between 20 and 44 weeks of gestation without chromosomal abnormalities or major structural birth defects linked to a hospital discharge database maintained by the California Office of Statewide Health Planning and Development and without mental illness during pregnancy. Sleep disorder was defined based on International Classification of Diseases, 9th Revision, Clinical Modification diagnostic code (n=2,265). Propensity score matching was used to select a referent population at a one-to-one ratio. Odds of preterm birth were examined by gestational age (less than 34 weeks, 34-36 weeks, and less than 37 weeks of gestation) and type (spontaneous, indicated). Prevalence of preterm birth (before 37 weeks of gestation) was 10.9% in the referent group compared with 14.6% among women with a recorded sleep disorder diagnosis. Compared with the referent group, odds (95% CI, P value, percentage) of preterm birth were 1.3 (1.0-1.7, P=.023, 14.1%) for insomnia and 1.5 (1.2-1.8, P<.001, 15.5%) for sleep apnea. Risk varied by gestational age and preterm birth type. Odds of preterm birth were not significantly increased for sleep-related movement disorders or other sleep disorders. Insomnia and sleep apnea were associated with significantly increased risk of preterm birth. Considering the high prevalence of sleep disorders during pregnancy and availability of evidence-based nonpharmacologic interventions, current findings suggest that screening for severe presentations would be prudent.

  10. Fetal size monitoring and birth-weight prediction: a new population-based approach.

    Science.gov (United States)

    Gjessing, H K; Grøttum, P; Økland, I; Eik-Nes, S H

    2017-04-01

    To develop a complete, population-based system for ultrasound-based fetal size monitoring and birth-weight prediction for use in the second and third trimesters of pregnancy. Using 31 516 ultrasound examinations from a population-based Norwegian clinical database, we constructed fetal size charts for biparietal diameter, femur length and abdominal circumference from 24 to 42 weeks' gestation. A reference curve of median birth weight for gestational age was estimated using 45 037 birth weights. We determined how individual deviations from the expected ultrasound measures predicted individual percentage deviations from expected birth weight. The predictive quality was assessed by explained variance of birth weight and receiver-operating characteristics curves for prediction of small-for-gestational age. A curve for intrauterine estimated fetal weight was constructed. Charts were smoothed using the gamlss non-linear regression method. The population-based approach, using bias-free ultrasound gestational age, produces stable estimates of size-for-age and weight-for-age curves in the range 24-42 weeks' gestation. There is a close correspondence between percentage deviations and percentiles of birth weight by gestational age, making it easy to convert between the two. The variance of birth weight that can be 'explained' by ultrasound increases from 8% at 20 weeks up to 67% around term. Intrauterine estimated fetal weight is 0-106 g higher than median birth weight in the preterm period. The new population-based birth-weight prediction model provides a simple summary measure, the 'percentage birth-weight deviation', to be used for fetal size monitoring throughout the third trimester. Predictive quality of the model can be measured directly from the population data. The model computes both median observed birth weight and intrauterine estimated fetal weight. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. Copyright © 2016 ISUOG. Published by John

  11. Early Postnatal Growth Of Preterm Low Birth Weight, Appropriately ...

    African Journals Online (AJOL)

    Background: Postnatal growth monitoring is useful in assessing the health of preterm babies but their growth patterns have not been sufficiently studied in Africans. Aim: To describe the growth achievements of preterm, low birth weight, appropriately-sized, Nigerian infants. Study design: The subjects were prospectively ...

  12. Maternal 25-hydroxyvitamin d and preterm birth in twin gestations.

    LENUS (Irish Health Repository)

    Bodnar, Lisa M

    2013-07-01

    To assess whether there was an independent association between maternal 25-hydroxyvitamin D concentrations at 24-28 weeks of gestation and preterm birth in a multicenter U.S. cohort of twin pregnancies.

  13. [Prevention of preterm birth complications by antenatal corticosteroid administration].

    Science.gov (United States)

    Schmitz, T

    2016-12-01

    NEC (LE3). Repeated antenatal corticosteroid administration is associated in the neonatal period with respiratory benefits (LE1) but decreased birth weight (LE1) and, in childhood, with possible neurological impairment (LE2). Therefore, this strategy is not recommended (grade A). Rescue courses are only associated with neonatal respiratory benefits (LE2). Because of the possible adverse effects associated with this strategy when delivery occurs during the 24hours following the first injection and because of the doubts raised by repeated courses, rescue courses are not recommended (Professional consensus). It is not possible to recommend one corticosteroid (betamethasone or dexamethasone) over another (Professional consensus). In case of contraindication for the intramuscular (IM) route, the intravenous route might be proposed (Professional consensus). The oral route is not recommended (grade A) because of increased rates of IVH and neonatal sepsis in comparison with the IM route (LE1). Either betamethasone as 2 injections of 12mg 24hours apart or dexamethasone as 4 injections of 6mg 12hours apart is recommended (grade A). Antenatal corticosteroid-induced alterations of fetal heart rate and movements should be recognized by the care providers of women at risk of preterm birth to avoid unjustified decision of labor induction or cesarean (Professional consensus). Gestational diabetes and pre-existing diabetes are not contraindication to antenatal corticosteroid therapy (Professional consensus). However, caution should be exercised in women with poorly controlled type 1 diabetes (Professional consensus). The apprehension to provoke maternal or neonatal infection should not delay antenatal corticosteroid administration even in case of preterm premature rupture of membranes (grade A). Antenatal corticosteroid administration is recommended to every woman at risk of preterm delivery before 34 weeks of gestation (grade A). Repeated courses of antenatal corticosteroids are

  14. Progesterone supplementation and the prevention of preterm birth.

    Science.gov (United States)

    Norwitz, Errol R; Caughey, Aaron B

    2011-01-01

    Preterm birth is currently the most important problem in maternal-child health in the United States and possibly throughout the world. It complicates one in eight US deliveries, and accounts for over 85% of all perinatal morbidity and mortality. Although survival of preterm infants has increased steadily over the past four decades-due in large part to the use of antenatal corticosteroids, improvements in neonatal resuscitation, and the introduction of neonatal intensive care units-efforts to prevent preterm birth have been largely unsuccessful. On February 3, 2011, the US Food and Drug Administration (FDA) approved the use of progesterone supplementation (hydroxyprogesterone caproate) during pregnancy to reduce the risk of recurrent preterm birth in women with a history of at least one prior spontaneous preterm delivery. This is the first time that the FDA has approved a medication for the prevention of preterm birth, and represents the first approval of a drug specifically for use in pregnancy in almost 15 years. This article reviews the evidence behind the use of progesterone for the prevention of preterm birth, and provides guidelines for the use of progesterone supplementation in clinical practice. A number of areas of ongoing controversy are addressed, including the optimal formulation and route of administration, the safety of progesterone supplementation in pregnancy, and its proposed mode of action.

  15. Impact of Preterm Birth on Glucocorticoid Variability in Human Milk.

    Science.gov (United States)

    Pundir, Shikha; Mitchell, Cameron J; Thorstensen, Eric B; Wall, Clare R; Perrella, Sharon L; Geddes, Donna T; Cameron-Smith, David

    2018-02-01

    Preterm birth is a stressful event for both the mother and infant. Whereas the initiation of breastfeeding is important for preterm infant health, little is known of the glucocorticoid hormones (cortisol and cortisone) in human milk following preterm birth. Research aim: The aim of this study was to investigate the relationship between human milk glucocorticoid concentrations and preterm birth. Human milk was sampled weekly for up to 6 weeks from 22 women who delivered a preterm infant at 28 to 32 weeks' gestation. Human milk was analyzed for total and free cortisol and cortisone concentrations using liquid chromatography-tandem mass spectrometry. Milk sampled from mothers of preterm infants had more cortisone than cortisol ( p hormones ( p = .001, r = .85). The cortisone was significantly higher in the milk of mothers who delivered infants after 30 weeks compared with those who delivered before 30 weeks of gestation ( p = .02). Glucocorticoid concentrations did not change over the sampling time (weeks 1 to 6 postpartum) and did not differ by infant gender. Glucocorticoids were present in all milk samples following preterm birth. Cortisone concentration tended to be higher in those who delivered after 30 weeks' gestation but did not increase further over the weeks following birth.

  16. Psychological, cultural and neuroendocrine profiles of risk for preterm birth.

    Science.gov (United States)

    Ruiz, R Jeanne; Dwivedi, Alok Kumar; Mallawaarachichi, Indika; Balcazar, Hector G; Stowe, Raymond P; Ayers, Kimberly S; Pickler, Rita

    2015-09-03

    Preterm birth remains a major obstetrical problem and identification of risk factors for preterm birth continues to be a priority in providing adequate care. Therefore, the purpose of this study was to elucidate risk profiles for preterm birth using psychological, cultural and neuroendocrine measures. From a cross sectional study of 515 Mexican American pregnant women at 22-24 weeks gestation, a latent profile analysis of risk for preterm birth using structural equation modeling (SEM) was conducted. We determined accurate gestational age at delivery from the prenatal record and early ultrasounds. We also obtained demographic and prenatal data off of the chart, particularly for infections, obstetrical history, and medications. We measured depression (Beck Depression Inventory), mastery (Mastery scale), coping (The Brief Cope), and acculturation (Multidimensional Acculturation Scale) with reliable and valid instruments. We obtained maternal whole blood and separated it into plasma for radioimmunoassay of Corticotrophin Releasing Hormone (CRH). Delivery data was obtained from hospital medical records. Using a latent profile analysis, three psychological risk profiles were identified. The "low risk" profile had a 7.7% preterm birth rate. The "moderate risk" profile had a 12% preterm birth rate. The "highest risk" profile had a 15.85% preterm birth rate. The highest risk profile had double the percentage of total infections compared to the low risk profile. High CRH levels were present in the moderate and highest risk profiles. These risk profiles may provide a basis for screening for Mexican American women to predict risk of preterm birth, particularly after they are further validated in a prospective cohort study. Future research might include use of such an identified risk profile with targeted interventions tailored to the Hispanic culture.

  17. Expression of eight glucocorticoid receptor isoforms in the human preterm placenta vary with fetal sex and birthweight.

    Science.gov (United States)

    Saif, Z; Hodyl, N A; Stark, M J; Fuller, P J; Cole, T; Lu, N; Clifton, V L

    2015-07-01

    Administration of betamethasone to women at risk of preterm delivery is known to be associated with reduced fetal growth via alterations in placental function and possibly direct effects on the fetus. The placental glucocorticoid receptor (GR) is central to this response and recent evidence suggests there are numerous isoforms for GR in term placentae. In this study we have questioned whether GR isoform expression varies in preterm placentae in relation to betamethasone exposure, fetal sex and birthweight. Preterm (24-36 completed weeks of gestation, n = 55) and term placentae (>37 completed weeks of gestation, n = 56) were collected at delivery. Placental GR expression was examined using Western Blot and analysed in relation to gestational age at delivery, fetal sex, birthweight and betamethasone exposure. Data was analysed using non-parametric tests. Eight known isoforms of the GR were detected in the preterm placenta and include GRα (94 kDa), GRβ (91 kDa), GRα C (81 kDa) GR P (74 kDa) GR A (65 kDa), GRα D1-3 (50-55 kDa). Expression varied between preterm and term placentae with a greater expression of GRα C in preterm placentae relative to term placentae. The only sex differences in preterm placentae was that GRα D2 expression was higher in males than females. There were no alterations in preterm placental GR expression in association with betamethasone exposure. GRα C is the isoform involved in glucocorticoid induced apoptosis and suggests that its predominance in preterm placentae may contribute to the pathophysiology of preterm birth. Copyright © 2015 Elsevier Ltd. All rights reserved.

  18. High prevalence of maternal vitamin D deficiency in preterm births in northeast China, Shenyang.

    Science.gov (United States)

    Zhu, Tong; Liu, Tian-Jing; Ge, Xin; Kong, Juan; Zhang, Li-Jun; Zhao, Qun

    2015-01-01

    Maternal vitamin D deficiency has been associated with a number of fetal and neonatal health problems. Preterm birth is one of the most detrimental, and the role of maternal vitamin D deficiency in preterm births has not been universally acknowledged. There had been limited epidemiological studies of vitamin D deficiency on the Chinese population. 1103 women delivered in Shengjing Hospital, China Medical University from January 1(st), 2012 to January 1(st), 2013. Finally, 821 mother-newborn pairs which contained 143 mother-newborn pairs who were preterm delivery were recruited for analysis. There was significant difference between spring and summer (Pwomen in very preterm group, compared with 36.61% in in-term group. Vitamin D nutritional status of pregnant women and their newborns in Shenyang were relatively good compared to cities in similar latitudes. Vitamin D deficiency was most severe in late spring and least in summer. Severe preterm births before 31 weeks of gestation was associated with maternal vitamin D deficiency.

  19. Global report on preterm birth and stillbirth (3 of 7: evidence for effectiveness of interventions

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    Rubens Craig E

    2010-02-01

    Full Text Available Abstract Introduction Interventions directed toward mothers before and during pregnancy and childbirth may help reduce preterm births and stillbirths. Survival of preterm newborns may also be improved with interventions given during these times or soon after birth. This comprehensive review assesses existing interventions for low- and middle-income countries (LMICs. Methods Approximately 2,000 intervention studies were systematically evaluated through December 31, 2008. They addressed preterm birth or low birth weight; stillbirth or perinatal mortality; and management of preterm newborns. Out of 82 identified interventions, 49 were relevant to LMICs and had reasonable amounts of evidence, and therefore selected for in-depth reviews. Each was classified and assessed by the quality of available evidence and its potential to treat or prevent preterm birth and stillbirth. Impacts on other maternal, fetal, newborn or child health outcomes were also considered. Assessments were based on an adaptation of the Grades of Recommendation Assessment, Development and Evaluation criteria. Results Most interventions require additional research to improve the quality of evidence. Others had little evidence of benefit and should be discontinued. The following are supported by moderate- to high-quality evidence and strongly recommended for LMICs: • Two interventions prevent preterm births—smoking cessation and progesterone • Eight interventions prevent stillbirths—balanced protein energy supplementation, screening and treatment of syphilis, intermittant presumptive treatment for malaria during pregnancy, insecticide-treated mosquito nets, birth preparedness, emergency obstetric care, cesarean section for breech presentation, and elective induction for post-term delivery • Eleven interventions improve survival of preterm newborns—prophylactic steroids in preterm labor, antibiotics for PROM, vitamin K supplementation at delivery, case management of

  20. Early pregnancy vaginal microbiome trends and preterm birth.

    Science.gov (United States)

    Stout, Molly J; Zhou, Yanjiao; Wylie, Kristine M; Tarr, Phillip I; Macones, George A; Tuuli, Methodius G

    2017-09-01

    Despite decades of attempts to link infectious agents to preterm birth, an exact causative microbe or community of microbes remains elusive. Nonculture 16S ribosomal RNA gene sequencing suggests important racial differences and pregnancy specific changes in the vaginal microbial communities. A recent study examining the association of the vaginal microbiome and preterm birth documented important findings but was performed in a predominantly white cohort. Given the important racial differences in bacterial communities within the vagina as well as persistent racial disparities in preterm birth, it is important to examine cohorts with varied demographic compositions. To characterize vaginal microbial community characteristics in a large, predominantly African-American, longitudinal cohort of pregnant women and test whether particular vaginal microbial community characteristics are associated with the risk for subsequent preterm birth. This is a nested case-control study within a prospective cohort study of women with singleton pregnancies, not on supplemental progesterone, and without cervical cerclage in situ. Serial mid-vaginal swabs were obtained by speculum exam at their routine prenatal visits. Sequencing of the V1V3 region of the 16S rRNA gene was performed on the Roche 454 platform. Alpha diversity community characteristics including richness, Shannon diversity, and evenness as well as beta diversity metrics including Bray Curtis Dissimilarity and specific taxon abundance were compared longitudinally in women who delivered preterm to those who delivered at term. A total of 77 subjects contributed 149 vaginal swabs longitudinally across pregnancy. Participants were predominantly African-American (69%) and had a preterm birth rate of 31%. In subjects with subsequent term delivery, the vaginal microbiome demonstrated stable community richness and Shannon diversity, whereas subjects with subsequent preterm delivery had significantly decreased vaginal richness

  1. Preterm birth, respiratory failure and BPD: which neonatal management?

    Science.gov (United States)

    Castoldi, Francesca; Lista, Gianluca; Scopesi, Fabio; Somaschini, Marco; Cuttano, Armando; Grappone, Lidia; Maffei, Gianfranco

    2013-10-01

    Preterm birth is a significant problem in the world regarding perinatal mortality and morbidity in the long term, especially bronchopulmonary dysplasia (BPD). Premature delivery is often associated to failure in transition to create an early functional residual capacity (FRC), since many preterm babies need frequently respiratory support. The first and most effective preventive measure to reduce the incidence of BPD is represented by the attempt to avoid preterm birth. Whenever this fails, the prevention of every known risk factors for BPD should start in the delivery room and should be maintained in the NICU through the use of tailored management of high-risk infants. © 2013 Elsevier Ireland Ltd. All rights reserved.

  2. Maintenance therapy with oxytocin antagonists for inhibiting preterm birth after threatened preterm labour.

    Science.gov (United States)

    Papatsonis, Dimitri N M; Flenady, Vicki; Liley, Helen G

    2013-10-13

    In some women, an episode of preterm labour settles and does not result in immediate preterm birth. Subsequent treatment with tocolytic agents such as oxytocin receptor antagonists may then have the potential to prevent the recurrence of preterm labour, prolonging gestation, and preventing the adverse consequences of prematurity for the infant. To assess the effects of maintenance therapy with oxytocin antagonists administered by any route after an episode of preterm labour in order to delay or prevent preterm birth. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 July 2013), sought ongoing and unpublished trials by contacting experts in the field and searched the reference lists of relevant articles. Randomised controlled trials comparing oxytocin antagonists with any alternative tocolytic agent, placebo or no treatment, used for maintenance therapy after an episode of preterm labour. We used the standard methods of The Cochrane Collaboration and the Cochrane Pregnancy and Childbirth Group. Two review authors independently undertook evaluation of methodological quality and extracted trial data. This review includes one trial of 513 women. When compared with placebo, atosiban did not reduce preterm birth before 37 weeks (risk ratio (RR) 0.89; 95% confidence intervals (CI) 0.71 to 1.12), 32 weeks (RR 0.85; 95% CI 0.47 to 1.55), or 28 weeks (RR 0.75; 95% CI 0.28 to 2.01). No difference was shown in neonatal morbidity, or perinatal mortality. There is insufficient evidence to support the use of oxytocin receptor antagonists to inhibit preterm birth after a period of threatened or actual preterm labour. Any future trials using oxytocin antagonists or other drugs as maintenance therapy for preventing preterm birth should examine a variety of important infant outcome measures, including reduction of neonatal morbidity and mortality, and long-term infant follow-up. Future research should also focus on the pathophysiological pathways that

  3. The effects of preterm birth on visual development.

    Science.gov (United States)

    Leung, Myra Ps; Thompson, Benjamin; Black, Joanna; Dai, Shuan; Alsweiler, Jane M

    2018-01-01

    Children born very preterm are at a greater risk of abnormal visual and neurological development when compared to children born at full term. Preterm birth is associated with retinopathy of prematurity (a proliferative retinal vascular disease) and can also affect the development of brain structures associated with post-retinal processing of visual information. Visual deficits common in children born preterm, such as reduced visual acuity, strabismus, abnormal stereopsis and refractive error, are likely to be detected through childhood vision screening programs, ophthalmological follow-up or optometric care. However, routine screening may not detect other vision problems, such as reduced visual fields, impaired contrast sensitivity and deficits in cortical visual processing, that may occur in children born preterm. For example, visual functions associated with the dorsal visual processing stream, such as global motion perception and visuomotor integration, may be impaired by preterm birth. These impairments can continue into adolescence and adulthood and may contribute to the difficulties in learning (particularly reading and mathematics), attention, behaviour and cognition that some children born preterm experience. Improvements in understanding the mechanisms by which preterm birth affects vision will inform future screening and interventions for children born preterm. © 2017 Optometry Australia.

  4. Characteristics and risk factors of preterm births in a tertiary center in Lagos, Nigeria.

    Science.gov (United States)

    Butali, Azeez; Ezeaka, Chinyere; Ekhaguere, Osayame; Weathers, Nancy; Ladd, Jenna; Fajolu, Iretiola; Esezobor, Christopher; Makwe, Christian; Odusanya, Bukola; Anorlu, Rose; Adeyemo, Wasiu; Iroha, Edna; Egri-Okwaji, Mathias; Adejumo, Prisca; Oyeneyin, Lawal; Abiodun, Moses; Badejoko, Bolaji; Ryckman, Kelli

    2016-01-01

    Preterm birth is a dire complication of pregnancy that poses huge long-term medical and financial burdens for affected children, their families, and the health care system. The aim of the present study was to identify characteristics associated with preterm births at the Lagos University Teaching Hospital (LUTH), Lagos, Nigeria from 2011 to 2013. We obtained Information from 5,561 maternal, fetal/neonatal and obstetric records from the labor ward. We excluded delivery at less than 22 weeks (0.25%), post-term birth at ≥42 weeks gestation (1.3%), and unknown gestation (1.4%). Additionally, we excluded records of multiple births (5.4%) and stillbirths (8.3%) leaving 4,691 records of singleton live-births for analysis. Logistic regression analysis was performed comparing preterm birth (22-36 weeks gestation) to term birth (37-41 weeks gestation). Multiple variable models adjusting for maternal age, parity, fetal position, delivery method and booking status were also evaluated. Multinomial regression was used to identify characteristics associated with preterm birth (PTB) defined as early PTB (22-31 weeks gestation), moderate PTB (32-34 weeks gestation), late PTB (35-36 weeks gestation), compared to term birth (37-41 completed weeks gestation). From our data, 16.8% of the singleton live-birth deliveries were preterm (<37 weeks gestation). Of these, 4.7% were early (22-31 weeks), 4.5% were moderate (32-34 weeks) and 7.7% were late (35-36) PTBs. Older maternal age (≥35 years) [odds ratio (OR) = 1.41], hypertension (OR = 3.44) and rupture of membranes (OR = 4.03) were significantly associated with increased odds of PTB. Women being treated for the prevention of mother-to-child transmission of HIV were at a significantly decreased risk for PTB (OR = 0.70). Sixteen percent of women in this cohort were not registered for antenatal care in LUTH. These non-registered subjects had significantly greater odds of all categories of PTB, including early (odds ratio (OR) = 20

  5. Recurrence risk of preterm birth in subsequent singleton pregnancy after preterm twin delivery

    NARCIS (Netherlands)

    Schaaf, Jelle M.; Hof, Michel H. P.; Mol, Ben Willem J.; Abu-Hanna, Ameen; Ravelli, Anita C. J.

    2012-01-01

    OBJECTIVE: The purpose of this study was to investigate the recurrence risk of preterm birth ( <37 weeks' gestation) in a subsequent singleton pregnancy after a previous nulliparous preterm twin delivery. STUDY DESIGN: We included 1957 women who delivered a twin gestation and a subsequent singleton

  6. Association between unintentional injury during pregnancy and excess risk of preterm birth and its neonatal sequelae.

    Science.gov (United States)

    Liu, Shiliang; Basso, Olga; Kramer, Michael S

    2015-11-01

    The sequelae of preterm births may differ, depending on whether birth follows an acute event or a chronic condition. In a population-based cohort study of 2,711,645 Canadian hospital deliveries from 2003 to 2012, 3,059 women experienced unintentional injury during pregnancy. We assessed the impact of the acute event on pregnancy outcome and on neonatal complications, such as nontraumatic intracranial hemorrhage, respiratory distress syndrome, intubation, and death. We adjusted for maternal age, parity, pregnancy conditions, and (for neonates) gestational age in logistic regression analyses. Injury was significantly associated with fetal mortality and early preterm delivery. For preterm infants born to injured women during the hospitalization for injury versus those born to noninjured women, the adjusted odds ratios were 2.25 (95% confidence interval (CI): 1.23, 4.17) for neonatal death, 2.44 (95% CI: 1.76, 3.37) for respiratory distress, 2.20 (95% CI: 1.26, 3.84) for nontraumatic intracranial hemorrhage, and 2.17 (95% CI: 1.60, 2.96) for intubation, despite more favorable fetal growth in those born to noninjured women (adjusted birth-weight-for-gestational-age z score: 0.154 vs. 0.024, P = 0.041; small-for-gestational-age rate: 4.5% vs. 9.5%, P = 0.001). Our findings suggest that adaptation to the suboptimal intrauterine environment underlying chronic causes of preterm birth may protect preterm infants from adverse sequelae. © The Author 2015. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  7. Preterm birth and periodontal disease: A medical perspective

    Directory of Open Access Journals (Sweden)

    Neeta Dhabhai

    2016-01-01

    Full Text Available Births occurring before 37 weeks resulting in prematurity poses serious hazards to the baby from delayed growth, neurodevelopmental anomalies to death and unfortunately India is in the top four countries with maximum preterm births and leads globally in deaths by prematurity. Infection is a very important component of the etiopathogenesis of preterm labor and periodontal disease is a rather unexplored aspect of infection very often overlooked by the general gynecologist and the dental practitioner equally. Periodontal disease is a potential foci of infectious pathogens which may disseminate hematogenously and effect the fetus. In this article, an effort has been made to find an evidence-based link between periodontal disease and preterm labor to drive home the conclusion that an early screening and diagnosis in pregnancy followed up with effective treatment of periodontal disease may significantly reduce the burden of preterm births.

  8. Distending Pressure Did Not Activate Acute Phase or Inflammatory Responses in the Airways and Lungs of Fetal, Preterm Lambs.

    Directory of Open Access Journals (Sweden)

    Rebecca Y Petersen

    Full Text Available Mechanical ventilation at birth causes airway injury and lung inflammation in preterm sheep. Continuous positive airway pressure (CPAP is being increasingly used clinically to transition preterm infants at birth.To test if distending pressures will activate acute phase reactants and inflammatory changes in the airways of fetal, preterm lambs.The head and chest of fetal lambs at 128±1 day GA were surgically exteriorized. With placental circulation intact, fetal lambs were then randomized to one of five 15 minute interventions: PEEP of 0, 4, 8, 12, or 16 cmH2O. Recruitment volumes were recorded. Fetal lambs remained on placental support for 30 min after the intervention. The twins of each 0 cmH2O animal served as controls. Fetal lung fluid (FLF, bronchoalveolar lavage fluid (BAL, right mainstem bronchi and peripheral lung tissue were evaluated for inflammation.Recruitment volume increased from 0.4±0.04 mL/kg at 4 cmH2O to 2.4±0.3 mL/kg at 16 cmH2O. The lambs were surfactant deficient, and all pressures were below the opening inflection pressure on pressure-volume curve. mRNA expression of early response genes and pro-inflammatory cytokines did not increase in airway tissue or lung tissue at any pressure compared to controls. FLF and BAL also did not have increases in early response proteins. No histologic changes or Egr-1 activation was present at the pressures used.Distending pressures as high as 16 cmH2O did not recruit lung volume at birth and did not increase markers of injury in the lung or airways in non-breathing preterm fetal sheep.

  9. Reduction of preterm birth rates starts at preconception

    NARCIS (Netherlands)

    Oudijk, M. A.

    2017-01-01

    Obesity, in the absence of other chronic disease, is associated with preterm birth (PTB) according to the article by Kim et al. Perhaps their most interesting finding is that obesity is positively associated in nulliparous women with extremely PTB rates (birth at < 28 weeks of gestation), both

  10. Maternal Plasma Metabolomic Profiles in Spontaneous Preterm Birth: Preliminary Results

    Directory of Open Access Journals (Sweden)

    Barbara Lizewska

    2018-01-01

    Full Text Available Objective. To profile maternal plasma metabolome in spontaneous preterm birth. Method. In this retrospective case-control study, we have examined plasma of patient with preterm birth (between 22 and 36 weeks of pregnancy (n=57, with threatened preterm labor (between 23 and 36 weeks of pregnancy (n=49, and with term delivery (n=25. Plasma samples were analysed using liquid chromatography quadrupole time-of-flight mass spectrometry (LC-Q-TOF-MS in positive and negative polarity modes. Results. We found 168 differentially expressed metabolites that were significantly distinct between study groups. We determined 51 metabolites using publicly available databases that could be subdivided into one of the five groups: amino acids, fatty acids, lipids, hormones, and bile acids. PLS-DA models, verified by SVM classification accuracy, differentiated preterm birth and term delivery groups. Conclusions. Maternal plasma metabolites are different between term and preterm parturitions. Part of them may be related with preterm labor, while others may be affected by gestational age or the beginning of labor. Metabolite profile can classify preterm or term delivery groups raising the potential of metabolome as a biomarker to identify high-risk pregnancies. Metabolomic studies are also a tool to detect individual compounds that may be further tested in targeted researches.

  11. Socioeconomic inequality in preterm birth in four Brazilian birth cohort studies.

    Science.gov (United States)

    Sadovsky, Ana Daniela Izoton de; Matijasevich, Alicia; Santos, Iná S; Barros, Fernando C; Miranda, Angelica Espinosa; Silveira, Mariangela Freitas

    To analyze economic inequality (absolute and relative) due to family income in relation to the occurrence of preterm births in Southern Brazil. Four birth cohort studies were conducted in the years 1982, 1993, 2004, and 2011. The main exposure was monthly family income and the primary outcome was preterm birth. The inequalities were calculated using the slope index of inequality and the relative index of inequality, adjusted for maternal skin color, education, age, and marital status. The prevalence of preterm births increased from 5.8% to approximately 14% (p-trend<0.001). Late preterm births comprised the highest proportion among the preterm births in all studies, although their rates decreased over the years. The analysis on the slope index of inequality demonstrated that income inequality arose in the 1993, 2004, and 2011 studies. After adjustment, only the 2004 study maintained the difference between the poorest and the richest subjects, which was 6.3 percentage points. The relative index of inequality showed that, in all studies, the poorest mothers were more likely to have preterm newborns than the richest. After adjustment for confounding factors, it was observed that the poorest mothers only had a greater chance of this outcome in 2004. In a final model, economic inequalities resulting from income were found in relation to preterm births only in 2004, although a higher prevalence of prematurity continued to be observed in the poorest population, in all the studies. Copyright © 2017 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  12. Fetal-to-maternal signaling in the timing of birth.

    Science.gov (United States)

    Mendelson, Carole R; Montalbano, Alina P; Gao, Lu

    2017-06-01

    Preterm birth remains the major cause of neonatal morbidity and mortality throughout the world. This is due, in part, to our incomplete understanding of the mechanisms that underlie the maintenance of pregnancy and the initiation of parturition at term. In this article, we review our current knowledge of the complex, interrelated and concerted mechanisms whereby progesterone maintains myometrial quiescence throughout most of pregnancy, as well as those that mediate the upregulation of the inflammatory response and decline in progesterone receptor function leading to parturition. Herein, we review findings that demonstrate a role of the fetus in the timing of birth. Specifically, we focus on our own studies indicating that maturation of the fetal lung and enhanced secretion of the surfactant components, surfactant protein A (SP-A) and the potent inflammatory glycerophospholipid, platelet-activating factor (PAF), initiate a signaling cascade culminating in parturition. Our studies suggest an essential role of steroid receptor coactivators, SRC-1 and SRC-2, which activate expression of genes encoding SP-A and LPCAT1. LPCAT1 is a key enzyme in the synthesis of PAF, as well as DPPC, a highly surface-active glycerophospholipid component of surfactant. Thus, we describe a novel pathway through which the fetus contributes to the initiation of labor by signaling the mother when its lungs have achieved sufficient maturity for survival in an aerobic environment. Copyright © 2016 Elsevier Ltd. All rights reserved.

  13. Evaluation of factors affecting birth weight and preterm birth in southern Turkey.

    Science.gov (United States)

    Col-Araz, Nilgun

    2013-04-01

    To identify factors affecting birth weight and pre-term birth, and to find associations with electromagnetic devices such as television, computer and mobile phones. The study was conducted in Turkey at Gazintep University, Faculty of Medicine's Outpatient Clinic at the Paediatric Ward. It comprised 500 patients who presented at the clinic from May to December 2009. All participants were administered a questionnaire regarding their pregnancy history. SPSS 13 was used for statistical analysis. In the study, 90 (19%) patients had pre-term birth, and 64 (12.9%) had low birth weight rate Birth weight was positively correlated with maternal age and baseline maternal weight (r = 0.115, p history of disease during pregnancy (p computer by mothers did not demonstrate any relationship with birth weight. Mothers who used mobile phones or computers during pregnancy had more deliveries before 37 weeks (p computers during pregnancy (p computers may have an effect on pre-term birth.

  14. Are intrauterine growth restriction and preterm birth associated with dental caries?

    Science.gov (United States)

    Saraiva, Maria C D; Bettiol, Heliosa; Barbieri, Marco A; Silva, Antonio A

    2007-10-01

    To assess the association between two intrauterine growth restriction (IUGR) surrogates - IUGR [small for gestational age birth (SGA) and fetal growth restriction (FGR)] and preterm birth with dental caries. Data from the Third National Health and Nutritional Examination Survey (1988-1994) were used, including 2- to 5.9-year-old singletons (n = 3189). Dental caries was defined as presence of any teeth with dental caries (treated or untreated) and also as presence of at least two teeth with dental caries. Exposure variables were preterm birth (education of head of household, breastfeeding, and use of baby bottle. Separate statistical analyses were conducted for IUGR and for preterm birth through the estimation of prevalence ratio (PR), taking complex sampling design into consideration and adjusting for confounders. Sensitivity analysis was conducted including and excluding 2-year-old children and also with the two definitions of dental caries. In general, the inclusion of 2-year-old children and the case definition of presence of any teeth with dental caries biased the results toward the null, but with no major changes in the results. In bivariate analysis, SGA and FGR birth were both negatively but not significantly associated with dental caries while a significant positive association was found for preterm birth. Sensitivity analysis showed that the PR for preterm in bivariate analysis varied from 1.65 (95% CI 1.14-2.40) to 1.84 (95% CI 1.19-2.83). After adjusting for confounders, the PR for preterm birth varied from 1.38 (95% CI 1.00-1.89) to 1.64 (95% CI 1.22-2.20). After adjustment, the PR for SGA varied from 0.79 (95% CI 0.56-101) to 0.66 (95% CI 0.33-0.96). For children from 3 to 5.9 years old, the adjusted PR for FGR using the category 'none' as reference were mild (PR 1.10; 95% CI 0.76-1.58), moderate (PR 0.66; 95% CI 0.26-167), and severe (PR 0.59; 95% CI 0.36-0.99). These values for FGR were very similar for the other models using other classifications of

  15. Preterm premature rupture of the fetal membranes: association with sociodemographic factors and maternal genitourinary infections ,

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    Arnildo A. Hackenhaar

    2014-04-01

    Full Text Available OBJECTIVE:tthis study aimed to investigate the incidence of premature rupture of fetal membranes in preterm singleton pregnancies and its association with sociodemographic factors and maternal self-reported genitourinary infections.METHODS:this was a population-based cross-sectional study, which included all mothers of newborns of singleton deliveries that occurred in 2010, with birth weight > 500 grams, who resided in the city of Rio Grande. Women were interviewed in the two maternity hospitals. Cases were women who had lost amniotic fluid before hospitalization and whose gestational age was less than 37 weeks. Statistical analysis was performed by levels to control for confounding factors using Poisson regression.RESULTS:of the 2,244 women eligible for the study, 3.1% had preterm premature rupture of fetal membranes, which was more frequent, after adjustment, in women of lower socioeconomic status, (prevalence ratio [PR] = 1.94, with lower level of schooling (PR = 2.43, age > 29 years (PR = 2.49, and smokers (PR = 2.04. It was also associated with threatened miscarriage (PR = 1.68 and preterm labor, (PR = 3.40. There was no association with maternal urinary tract infection or presence of genital discharge.CONCLUSIONS:the outcome was more common in puerperal women with lower level of schooling, lower socioeconomic status, older, and smokers, as well as those with a history of threatened miscarriage and premature labor. These factors should be considered in the prevention, diagnosis, and therapy approach.

  16. Institutional racism, neighborhood factors, stress, and preterm birth.

    Science.gov (United States)

    Mendez, Dara D; Hogan, Vijaya K; Culhane, Jennifer F

    2014-01-01

    Racial/ethnic disparities in the risk of preterm birth may be explained by various factors, and previous studies are limited in examining the role of institutional racism. This study focused on the following questions: what is the association between preterm birth and institutional racism as measured by residential racial segregation (geographic separation by race) and redlining (black-white disparity in mortgage loan denial); and what is the association between preterm birth and reported stress, discrimination, and neighborhood quality. We used data from a clinic-based sample of pregnant women (n = 3462) participating in a stress and pregnancy study conducted from 1999 to 2004 in Philadelphia, PA (USA). We linked data from the 2000 US Census and Home Mortgage Disclosure Act (HMDA) data from 1999 to 2004 and developed measures of residential redlining and segregation. Among the entire population, there was an increased risk for preterm birth among women who were older, unmarried, tobacco users, higher number of previous births, high levels of experiences of everyday discrimination, owned their homes, lived in nonredlined areas, and areas with high levels of segregation measured by the isolation index. Among black women, living in a redlined area (where blacks were more likely to be denied mortgage loans compared to whites) was moderately associated with a decreased risk of preterm birth (aRR = 0.8, 95% CI: 0.6, 0.99). Residential redlining as a form institutional racism and neighborhood characteristic may be important for understanding racial/ethnic disparities in pregnancy and preterm birth.

  17. Epigenetic Consequences of Low Birth-Weight and Preterm Birth in Adult Twins

    DEFF Research Database (Denmark)

    Tan, Qihua

    2018-01-01

    Adverse birth outcomes including low birth-weight and preterm birth are associated with long-term morbidity and health consequences at adult ages. Molecular mechanisms including epigenetic modification may have been involved in the adaptation to the stressful condition in peridelivery period whic...

  18. Indicadores de risco para o parto prematuro Risk predictors for preterm birth

    Directory of Open Access Journals (Sweden)

    Roberto Eduardo Bittar

    2009-04-01

    Full Text Available Entre os vários fatores clínicos para o parto prematuro, alguns apresentam riscos substanciais, tais como história de parto prematuro, gemelidade e sangramento vaginal do segundo trimestre. No entanto, tais fatores estão presentes na minoria das mulheres que evoluem para o parto prematuro e, portanto, possuem baixa sensibilidade. A dilatação, o esvaecimento e a posição do colo uterino diagnosticados pelo toque vaginal têm sido relacionados ao aumento do risco para o parto prematuro, mas possuem baixas sensibilidades e baixos valores preditivos positivos. A diminuição do comprimento do colo uterino detectada pela ultrassonografia transvaginal também constitui risco para parto prematuro. Sua sensibilidade é melhor quando são considerados outros testes, mas o valor preditivo positivo é baixo. A principal utilidade do teste da fibronectina fetal reside em seu valor preditivo negativo em mulheres sintomáticas. Observa-se aumento da sensibilidade para a detecção do parto prematuro quando a medida do colo do útero é utilizada juntamente com o teste da fibronectina fetal.Among the clinical factors for preterm birth, some confer substantial increased risk, including a history of preterm birth, multiple gestation and vaginal bleeding in the second trimester. However, these factors are present only in a minority of women who ultimately deliver preterm and thus have low sensitivity. Cervical dilatation, effacement and position as determined by manual examination have been related to an increased risk of preterm birth but also suffer from low sensitivity and positive predictive values. Cervical length measured with transvaginal ultrasound has also been related to an increased risk of preterm birth as cervical length decreases. The reported sensitivity is better than other tests, but positive predictive value is low. The principal utility of the fetal fibronectin assay lies in its negative predictive value in symptomatic women. Increased

  19. Preterm Birth Affects Dorsal-Stream Functioning Even after Age 6

    Science.gov (United States)

    Santos, A.; Duret, M.; Mancini, J.; Gire, C.; Deruelle, C.

    2009-01-01

    With increasing numbers of preterm infants surviving, the impact of preterm birth on later cognitive development presents a major interest. This study investigates the impact of preterm birth on later dorsal- and ventral-stream functioning. An atypical pattern of performance was found for preterm children relative to full-term controls, but in the…

  20. Socioeconomic inequality in preterm birth in four Brazilian birth cohort studies

    Directory of Open Access Journals (Sweden)

    Ana Daniela Izoton de Sadovsky

    2018-01-01

    Conclusion: In a final model, economic inequities resulting from income were found in relation to preterm births only in 2004, although a higher prevalence of prematurity continued to be observed in the poorest population, in all the studies.

  1. Population-based estimate of sibling risk for preterm birth, preterm premature rupture of membranes, placental abruption and pre-eclampsia.

    Science.gov (United States)

    Plunkett, Jevon; Borecki, Ingrid; Morgan, Thomas; Stamilio, David; Muglia, Louis J

    2008-07-08

    Adverse pregnancy outcomes, such as preterm birth, preeclampsia and placental abruption, are common, with acute and long-term complications for both the mother and infant. Etiologies underlying such adverse outcomes are not well understood. As maternal and fetal genetic factors may influence these outcomes, we estimated the magnitude of familial aggregation as one index of possible heritable contributions. Using the Missouri Department of Health's maternally-linked birth certificate database, we performed a retrospective population-based cohort study of births (1989-1997), designating an individual born from an affected pregnancy as the proband for each outcome studied. We estimated the increased risk to siblings compared to the population risk, using the sibling risk ratio, lambdas, and sibling-sibling odds ratio (sib-sib OR), for the adverse pregnancy outcomes of preterm birth, preterm premature rupture of membranes (PPROM), placental abruption, and pre-eclampsia. Risk to siblings of an affected individual was elevated above the population prevalence of a given disorder, as indicated by lambdaS (lambdaS (95% CI): 4.3 (4.0-4.6), 8.2 (6.5-9.9), 4.0 (2.6-5.3), and 4.5 (4.4-4.8), for preterm birth, PPROM, placental abruption, and pre-eclampsia, respectively). Risk to siblings of an affected individual was similarly elevated above that of siblings of unaffected individuals, as indicated by the sib-sib OR (sib-sib OR adjusted for known risk factors (95% CI): 4.2 (3.9-4.5), 9.6 (7.6-12.2), 3.8 (2.6-5.5), 8.1 (7.5-8.8) for preterm birth, PPROM, placental abruption, and pre-eclampsia, respectively). These results suggest that the adverse pregnancy outcomes of preterm birth, PPROM, placental abruption, and pre-eclampsia aggregate in families, which may be explained in part by genetics.

  2. Child neurodevelopmental outcomes following preterm and term birth: What can the placenta tell us?

    Science.gov (United States)

    Hodyl, Nicolette A; Aboustate, Natalie; Bianco-Miotto, Tina; Roberts, Claire T; Clifton, Vicki L; Stark, Michael J

    2017-09-01

    A significant proportion of children born preterm will experience some level of neurodevelopmental impairment. Changes in placental function have been observed with many antenatal conditions that are risk factors for preterm birth and/or poor neurodevelopment including fetal growth restriction and in-utero inflammation. This review will highlight placental factors that have been studied to understand the underlying mechanisms and identify biomarkers that lead to poor child neurodevelopmental outcomes. These include changes in gross morphological and histopathological structure and the placental inflammatory response to prenatal infection. Further, we will describe the placenta's role as both a barrier to maternally-derived bioactive substances critical for normal fetal brain development, such as cortisol, and a source of neuroactive steroids and neurotrophins known to have critical functions in neuronal proliferation, axonal growth, myelination and the regulation of apoptosis. Finally, emerging data supporting the potential utility of novel placental biomarkers in the early prediction of poor neurodevelopmental outcome in infants born both preterm and term will be discussed. These include the assessment of genetic variants (e.g. single nucleotide polymorphisms in placental tissue) and epigenetic biomarkers (e.g. placental microRNAs and placental DNA methylation). With the placenta the key tissue regulating the fetal environment, integration of observed changes in placental function with genetic and epigenetic variations may advance our ability to predict future infant health. Ultimately, this may facilitate targeted allocation of health resources with the aim of improving lifelong neurodevelopmental capability. Copyright © 2017 Elsevier Ltd. All rights reserved.

  3. Membrane Vesicles of Group B Streptococcus Disrupt Feto-Maternal Barrier Leading to Preterm Birth.

    Directory of Open Access Journals (Sweden)

    Manalee Vishnu Surve

    2016-09-01

    Full Text Available Infection of the genitourinary tract with Group B Streptococcus (GBS, an opportunistic gram positive pathogen, is associated with premature rupture of amniotic membrane and preterm birth. In this work, we demonstrate that GBS produces membrane vesicles (MVs in a serotype independent manner. These MVs are loaded with virulence factors including extracellular matrix degrading proteases and pore forming toxins. Mice chorio-decidual membranes challenged with MVs ex vivo resulted in extensive collagen degradation leading to loss of stiffness and mechanical weakening. MVs when instilled vaginally are capable of anterograde transport in mouse reproductive tract. Intra-amniotic injections of GBS MVs in mice led to upregulation of pro-inflammatory cytokines and inflammation mimicking features of chorio-amnionitis; it also led to apoptosis in the chorio-decidual tissue. Instillation of MVs in the amniotic sac also resulted in intrauterine fetal death and preterm delivery. Our findings suggest that GBS MVs can independently orchestrate events at the feto-maternal interface causing chorio-amnionitis and membrane damage leading to preterm birth or fetal death.

  4. Membrane Vesicles of Group B Streptococcus Disrupt Feto-Maternal Barrier Leading to Preterm Birth

    Science.gov (United States)

    Sthanam, Lakshmi Kavitha; Srivastava, Rohit; Basu, Bhakti; Dutta, Suryendu; Sen, Shamik; Modi, Deepak

    2016-01-01

    Infection of the genitourinary tract with Group B Streptococcus (GBS), an opportunistic gram positive pathogen, is associated with premature rupture of amniotic membrane and preterm birth. In this work, we demonstrate that GBS produces membrane vesicles (MVs) in a serotype independent manner. These MVs are loaded with virulence factors including extracellular matrix degrading proteases and pore forming toxins. Mice chorio-decidual membranes challenged with MVs ex vivo resulted in extensive collagen degradation leading to loss of stiffness and mechanical weakening. MVs when instilled vaginally are capable of anterograde transport in mouse reproductive tract. Intra-amniotic injections of GBS MVs in mice led to upregulation of pro-inflammatory cytokines and inflammation mimicking features of chorio-amnionitis; it also led to apoptosis in the chorio-decidual tissue. Instillation of MVs in the amniotic sac also resulted in intrauterine fetal death and preterm delivery. Our findings suggest that GBS MVs can independently orchestrate events at the feto-maternal interface causing chorio-amnionitis and membrane damage leading to preterm birth or fetal death. PMID:27583406

  5. Learning problems in kindergarten students with extremely preterm birth.

    Science.gov (United States)

    Taylor, H Gerry; Klein, Nancy; Anselmo, Marcia G; Minich, Nori; Espy, Kimberly A; Hack, Maureen

    2011-09-01

    To assess learning problems among kindergarten students with extremely preterm birth and to identify risk factors. Cohort study. Children's hospital. A cohort of 148 children born between January 1, 2001, and December 31, 2003, with extremely preterm birth, defined as less than 28 weeks' gestation or having a birth weight of less than 1000 g, and 111 classmate control individuals born at term with normal birth weight. The children were enrolled in the study during their first year in kindergarten and were assessed on measures of learning progress. Achievement testing, teacher ratings of learning progress, and individual educational assistance. Children with extremely preterm birth had lower mean standard scores than controls on achievement tests of spelling (8.52; 95% confidence interval, 4.58-12.46) and applied mathematics (11.02; 6.76-15.28). They had higher rates of substandard learning progress by teacher report in written language (odds ratio, 4.23; 95% CI, 2.32-7.73) and mathematics (7.08; 2.79-17.95). Group differences in mathematics achievement and in teacher ratings of learning progress were statistically significant even in children without neurosensory deficits or low global cognitive ability. Neonatal risk factors, early childhood neurodevelopmental impairment, and socioeconomic status predicted learning problems in children with extremely preterm birth; however, many children with problems were not enrolled in a special education program. Learning problems in children with extremely preterm birth are evident in kindergarten and are associated with neonatal and early childhood risk factors. Our findings support efforts to provide more extensive monitoring and interventions before and during the first year of school.

  6. Physically strenuous work during pregnancy and risk of preterm birth

    DEFF Research Database (Denmark)

    Knudsen, Iben Risager; Bonde, Jens Peter; Bondo, Sesilje

    2017-01-01

    computed by logistic regression using a population sample of gainfully employed women as reference (n = 345,915). The risk of preterm birth was increased in women lifting heavy loads during pregnancy (OR 1.40, 95% CI [0.88, 2.23]) but not in women with physically strenuous work (OR 0.98, 95% CI [0.66, 1......The aim of the study was to examine the risk of preterm birth following physically strenuous work during pregnancy. We included 343 pregnant women referred to an occupational medical clinic. Data on preterm birth and covariates were retrieved from the Danish Birth Registry. Risk estimates were.......46]). The mean gestational age in the heavy-lifting group compared to the reference group was 2.4 days shorter (95% CI [0.36, 4.41]). The study challenges earlier reassuring findings as heavy-lifting pregnant women had a reduced gestational age, indicating a possibility of increased risk of preterm birth....

  7. Digital examination and transvaginal scan - competing or complementary for predicting preterm birth?

    DEFF Research Database (Denmark)

    Reiter, Eva; Nielsen, Kurt Aagaard; Fedder, Jens

    2012-01-01

    The transvaginal ultrasonographic cervix scan has partly replaced digital examination for diagnosing preterm birth; conflicting results are reported about their respective contribution to birth prediction....

  8. Placental histology in spontaneous and indicated preterm birth: A case control study

    NARCIS (Netherlands)

    Nijman, Tobias A. J.; van Vliet, Elvira O. G.; Benders, Manon J. N.; Mol, Ben Willem J.; Franx, Arie; Nikkels, Peter G. J.; Oudijk, Martijn A.

    2016-01-01

    Placental pathology is an important contributor in preterm birth, both spontaneous and indicated. The aim of this study was to describe and compare placental histological features of spontaneous preterm birth versus indicated preterm birth. A case control study was performed at the University

  9. Placental histology in spontaneous and indicated preterm birth : A case control study

    NARCIS (Netherlands)

    Nijman, Tobias A J; van Vliet, Elvira O G; Benders, Manon J N; Mol, Ben Willem J; Franx, Arie; Nikkels, Peter G J; Oudijk, Martijn A

    2016-01-01

    INTRODUCTION: Placental pathology is an important contributor in preterm birth, both spontaneous and indicated. The aim of this study was to describe and compare placental histological features of spontaneous preterm birth versus indicated preterm birth. METHODS: A case control study was performed

  10. Practices for predicting and preventing preterm birth in Ireland: a national survey.

    LENUS (Irish Health Repository)

    Smith, V

    2011-03-01

    Preterm birth can result in adverse outcomes for the neonate and\\/or his\\/her family. The accurate prediction and prevention of preterm birth is paramount. This study describes and critically analyses practices for predicting and preventing preterm birth in Ireland.

  11. Trends in preterm birth: singleton and multiple pregnancies in the Netherlands, 2000-2007

    NARCIS (Netherlands)

    Schaaf, J. M.; Mol, B. W. J.; Abu-Hanna, A.; Ravelli, A. C. J.

    2011-01-01

    Several studies have reported increasing trends in preterm birth in developed countries, mainly attributable to an increase in medically indicated preterm births. Our aim was to describe trends in preterm birth among singleton and multiple pregnancies in the Netherlands. Prospective cohort study.

  12. Improving identification and treatment of women with increased risk of preterm birth

    NARCIS (Netherlands)

    Hermans, F.J.R.

    2017-01-01

    Preterm birth is one of the major global health problems. It is globally defined as birth before 37 weeks of gestation. Annually 15 million babies are born preterm worldwide, with an incidence rate varying between five and fifteen percent. Preterm birth and its associated complications are held

  13. Late preterm birth and neurocognitive performance in late adulthood: a birth cohort study.

    Science.gov (United States)

    Heinonen, Kati; Eriksson, Johan G; Lahti, Jari; Kajantie, Eero; Pesonen, Anu-Katriina; Tuovinen, Soile; Osmond, Clive; Raikkonen, Katri

    2015-04-01

    We studied if late preterm birth (34 weeks 0 days-36 weeks 6 days of gestation) is associated with performance on the Consortium to Establish a Registry for Alzheimer's Disease Neuropsychological Battery (CERAD-NB) in late adulthood and if maximum attained lifetime education moderated these associations. Participants were 919 Finnish men and women born between 1934 and 1944, who participated in the Helsinki Birth Cohort Study. They underwent the CERAD-NB at a mean age of 68.1 years. Data regarding gestational age (late preterm versus term) were extracted from hospital birth records, and educational attainment data were gathered from Statistics Finland. After adjustment for major confounders, those born late preterm scored lower on word list recognition (mean difference: -0.33 SD; P = .03) than those born at term. Among those who had attained a basic or upper secondary education, late preterm birth was associated with lower scores on word list recognition, constructional praxis, constructional praxis recall, clock drawing, Mini-Mental State Examination, and memory total and CERAD total 2 compound scores (mean differences: >0.40 SD; P values late preterm birth was not associated with CERAD-NB scores. Our findings offer new insight into the lifelong consequences of late preterm birth, and they add late preterm birth as a novel risk factor to the list of neurocognitive impairment in late adulthood. Our findings also suggest that attained lifetime education may mitigate aging-related neurocognitive impairment, especially among those born late preterm. Copyright © 2015 by the American Academy of Pediatrics.

  14. Maternal Factors for Low Birth Weight and Preterm Birth At Tertiary Care Hospital

    Directory of Open Access Journals (Sweden)

    Neebha Ojha

    2016-10-01

    Full Text Available Introduction: Low birth weight and preterm birth are the major community health problems in developing countries. They are the major determinants of perinatal survival and infant morbidity and mortality. The aim of this study was to determine the proportion and the maternal risk factors for low birth weight and preterm birth among hospital deliveries in Tribhuvan University Teaching Hospital. Methods: A cross sectional retrospective study was carried out in the Department of Obstetrics and Gynecology of TUTH. Maternal risk factors like age, parity, ethnicity, history of previous abortion, history of previous cesarean section, antepartum hemorrhage and medical disorders were studied. Information on all births that occurred was extracted from maternity case notes and delivery registers.  Results: During the study period, there were 685 singleton live births. Among these 78(11.4% were low birth weight and 47(6.9% were preterm birth. The mean birth weight was 2950±488 gm. The mean weight of female was statistically less compared to male babies (p=0.032. The signi cant risk factors for LBW were primiparity (OR 2.12; 95%CI 1.25-3.58, Indo-Aryan ethnicity (OR 1.97; 95%CI 1.12-3.45 and history of medical disorder (OR 3.08; 95%CI 1.17-8.12. As for PTB antepartum hemorrhage (OR 8.63; 95%CI 1.99-37.30 and history of medical disorder (OR 3.20; 95%CI 1.04-.89 were signi cant risk factors.  Conclusions: Parity, ethnicity, and medical disorders were the main risk factors for low birth weight. Antepartum hemorrhage and medical disorders were signi cant risk factors for preterm birth. Keywords: low birth weight; preterm birth; risk factors.

  15. Different Risk Factors for Very Low Birth Weight, Term-Small-for-Gestational-Age, or Preterm Birth in Japan

    Directory of Open Access Journals (Sweden)

    Naomi Tamura

    2018-02-01

    Full Text Available From 1985 to 2013, the mean birth weight of infants in Japan decreased from 3120 g to 3000 g, and the low-birth-weight rate among live births increased from 6.3% to 9.6%. No prospective study has elucidated the risk factors for poor fetal growth and preterm birth in recent Japanese parents, such as increased parental age, maternal body figure, assisted reproductive technology (ART, and socioeconomic status. Participants were mother–infant pairs (n = 18,059 enrolled in a prospective birth cohort in Hokkaido, Japan from 2002 to 2013. Parental characteristics were obtained via self-reported questionnaires during pregnancy. Medical records helped identify very-low-birth-weight (VLBW; <1500g, term-small-for-gestational-age (term-SGA, and preterm-birth (PTB; <37 weeks infants. We calculated relative risks (RRs for PTB, VLBW, and term-SGA birth based on parental characteristics. The prevalence of PTB, VLBW, and term-SGA was 4.5%, 0.4%, and 6.5%, respectively. Aged parents and ART were risk factors for PTB and VLBW. Maternal alcohol drinking during pregnancy increased the risk; a parental educational level of ≥16 years reduced risk of term-SGA. Maternal pre-pregnancy BMI of <18.5 kg/m2 increased the risk of PTB and term-SGA. The RR for low BMI was highest among mothers who have low educational level. Among various factors, appropriate nutritional education to maintain normal BMI is important to prevent PTB and term-SGA in Japan.

  16. Potential Peripartum Markers of Infectious-Inflammatory Complications in Spontaneous Preterm Birth

    Directory of Open Access Journals (Sweden)

    Vojtech Tambor

    2015-01-01

    Full Text Available Spontaneous preterm birth significantly contributes to the overall neonatal morbidity associated with preterm deliveries. Nearly 50% of cases are associated with microbial invasion of the amniotic cavity followed by an inflammatory response. Robust diagnostic tools for neonates jeopardized by infection and inflammation may thus decrease the overall neonatal morbidity substantially. Amniotic fluid retrieved during labor retains fetal and pregnancy-related protein fingerprint and its sampling does not place any unwanted stress on women. Using exploratory and targeted methods we analyzed proteomes of amniotic fluid sampled at the end of spontaneous preterm labor prior to delivery from women with and without infection and inflammation. Exploratory data indicated several amniotic fluid proteins to be associated with infectious-inflammatory complications in spontaneous preterm birth. LC-SRM analysis subsequently verified statistically significant changes in lipocalin-1 (P=0.047 and AUC = 0.67, P=0.046, glycodelin (P=0.013 and AUC = 0.73, P=0.013, and nicotinamide phosphoribosyltransferase (P=0.018 and AUC = 0.71, P=0.01.

  17. Potential Peripartum Markers of Infectious-Inflammatory Complications in Spontaneous Preterm Birth.

    Science.gov (United States)

    Tambor, Vojtech; Vajrychova, Marie; Kacerovsky, Marian; Link, Marek; Domasinska, Petra; Menon, Ramkumar; Lenco, Juraj

    2015-01-01

    Spontaneous preterm birth significantly contributes to the overall neonatal morbidity associated with preterm deliveries. Nearly 50% of cases are associated with microbial invasion of the amniotic cavity followed by an inflammatory response. Robust diagnostic tools for neonates jeopardized by infection and inflammation may thus decrease the overall neonatal morbidity substantially. Amniotic fluid retrieved during labor retains fetal and pregnancy-related protein fingerprint and its sampling does not place any unwanted stress on women. Using exploratory and targeted methods we analyzed proteomes of amniotic fluid sampled at the end of spontaneous preterm labor prior to delivery from women with and without infection and inflammation. Exploratory data indicated several amniotic fluid proteins to be associated with infectious-inflammatory complications in spontaneous preterm birth. LC-SRM analysis subsequently verified statistically significant changes in lipocalin-1 (P = 0.047 and AUC = 0.67, P = 0.046), glycodelin (P = 0.013 and AUC = 0.73, P = 0.013), and nicotinamide phosphoribosyltransferase (P = 0.018 and AUC = 0.71, P = 0.01).

  18. Ultrasound cervical length in predicting preterm birth: Prospective study

    Directory of Open Access Journals (Sweden)

    Achour Radhouane

    2017-08-01

    Full Text Available Background Preterm birth is a leading cause of perinatal morbidity and mortality and represents a major public health problem. It is associated with a 15–20 per cent mortality rate and remains responsible for 75 per cent of perinatal deaths in foetuses without anomalies. Aims The aim of this study was to evaluate the importance of cervical length measured in the first trimester (11–14 Weeks of amenorrhea “WA” and the second trimester (20–24 Weeks of amenorrhea” WA” in an asymptomatic population of singleton pregnancies to assess the risk of spontaneous preterm birth compared to the digital assessment. Methods We conducted a prospective, longitudinal study involving 117 asymptomatic women with singleton pregnancies between January and December 2015. Results In our study, the clinical examination had a low positive predictive value and a low sensibility for screening women at risk of preterm delivery. Cervical length less than 35mm between 12–14WA and 30mm between 22–24WA predicts the occurrence of preterm birth with a high sensitivity (Se, and specificity (Sp. Conclusion We conclude that ultrasound screening of preterm delivery is now highly recommended.

  19. [Relation Between Stress During Pregnancy and Spontaneous Preterm Birth].

    Science.gov (United States)

    Ortiz Martínez, Roberth Alirio; Castillo, Alejandro

    2016-01-01

    Preterm birth occurs before 37 completed weeks, its causes are multifactorial and vary according to the gestational age, ethnicity and geographical context. Although several medical/social factors have been clearly identified, over 50% of cases are unknown or unclear; however, psychopathological components emerge as potentially important risk factors. To determine the relationship between the presence of stress during pregnancy and spontaneous preterm birth. Through a study of cases and controls in a level III hospital, with a sample of 360 patients during the period from March to November of 2013, where sociodemographic characteristics were collected. In addition, they were applied scales social adjustment, coping strategies and social support. Logistic regression models were developed; psychological, biological and social. Based on the significant variables in each of these generated a final one. The final model was found that stress during pregnancy increases the odds of spontaneous preterm birth 1.91 times (adjusted OR=2.91; 95%CI, 1.67-5.08; P<.05). Other significant variables were: history of preterm delivery, unplanned pregnancy, no emotional support, rural residence, inadequate prenatal care and non-stable partner. The findings support the hypothesis that stress during pregnancy is associated with spontaneous preterm delivery. Copyright © 2015 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

  20. Evaluation of factors affecting birth weight and preterm birth in southern Turkey

    International Nuclear Information System (INIS)

    Araz, N. C.

    2013-01-01

    Objective: To identify factors affecting birth weight and pre-term birth, and to find associations with electromagnetic devices such as television, computer and mobile phones. Methods: The study was conducted in Turkey at Gazintep University, Faculty of Medicine Outpatient Clinic at the Paediatric Ward. It comprised 500 patients who presented at the clinic from May to December 2009. All participants were administered a questionnaire regarding their pregnancy history. SPSS 13 was used for statistical analysis. Results: In the study, 90 (19%) patients had pre-term birth , and 64 (12.9%) had low birth weight rate Birth weight was positively correlated with maternal age and baseline maternal weight (r= 0.115, p= 0.010; r= 0.168, p=0.000, respectively). Pre-term birth and birth weight less than 2500g were more common in mothers with a history of disease during pregnancy (p=0.046 and p=0.008, respectively). The habit of watching television and using mobile phones and computer by mothers did not demonstrate any relationship with birth weight. Mothers who used mobile phones or computers during pregnancy had more deliveries before 37 weeks (p=0.018, p=0.034; respectively). Similarly, pregnancy duration was shorter in mothers who used either mobile phone or computers during pregnancy (p=0.005, p=0.048, respectively). Conclusion: Mobile phones and computers may have an effect on pre-term birth. (author)

  1. [Progesterone and prevention of preterm birth].

    Science.gov (United States)

    Fuchs, F; Senat, M-V

    2015-10-01

    The literature confirms the interest of progesterone for prevention of preterm delivery in specific indications for patients carrying a singleton pregnancy. In contrast, randomized trials have shown no benefit using progesterone in the prevention of prematurity in twins and even an adverse effect. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  2. Faith, existence and birth of preterm babies

    DEFF Research Database (Denmark)

    Rasmussen, Christina Prinds

    The aim is to explore if becoming a mother preterm of a premature baby, actualises existential and religious issues, and to explore the impact of the considerations in their way of coping. It is thus to shed light on these issues, that can both function as a positive coping-resource and the oppos...

  3. Early preterm delivery due to placenta previa is an independent risk factor for a subsequent spontaneous preterm birth

    Science.gov (United States)

    2012-01-01

    Background To determine whether patients with placenta previa who delivered preterm have an increased risk for recurrent spontaneous preterm birth. Methods This retrospective population based cohort study included patients who delivered after a primary cesarean section (n = 9983). The rate of placenta previa, its recurrence, and the risk for recurrent preterm birth were determined. Results Patients who had a placenta previa at the primary CS pregnancy had an increased risk for its recurrence [crude OR of 2.65 (95% CI 1.3-5.5)]. The rate of preterm birth in patients with placenta previa in the primary CS pregnancy was 55.9%; and these patients had a higher rate of recurrent preterm delivery than the rest of the study population (p placenta previa in the primary CS pregnancy, those who delivered preterm had a higher rate of recurrent spontaneous preterm birth regardless of the location of their placenta in the subsequent delivery [OR 3.09 (95% CI 2.1-4.6)]. In comparison to all patients with who had a primary cesarean section, patients who had placenta previa and delivered preterm had an independent increased risk for recurrent preterm birth [OR of 3.6 (95% CI 1.5-8.5)]. Conclusions Women with placenta previa, who deliver preterm, especially before 34 weeks of gestation, are at increased risk for recurrent spontaneous preterm birth regardless to the site of placental implantation in the subsequent pregnancy. Thus, strict follow up by high risk pregnancies specialist is recommended. PMID:22876799

  4. Genetic Associations with Gestational Duration and Spontaneous Preterm Birth

    DEFF Research Database (Denmark)

    Zhang, Ge; Feenstra, Bjarke; Bacelis, Jonas

    2017-01-01

    Background Despite evidence that genetic factors contribute to the duration of gestation and the risk of preterm birth, robust associations with genetic variants have not been identified. We used large data sets that included the gestational duration to determine possible genetic associations. Me...

  5. Successful management of a set of preterm, low birth weight ...

    African Journals Online (AJOL)

    Case report: We report a case of successful management of preterm, low birth weight quadruplets (QI, QII, QIII, and QIV) delivered at 32 weeks by Caesarean section to a 30 year old primiparous mother. QIII and QIV developed septicaemia with conjugated bilirubinaemia and were managed with intravenous antibiotics, and ...

  6. Cervical cerclage for prevention of preterm birth: a commentary ...

    African Journals Online (AJOL)

    Cervical cerclage remains a proven method for the prevention of preterm birth caused by a 'weak cervix'. However, there is controversy as regards the precise diagnosis and definition of 'cervical incompetence', the actual surgical technique, choice of suture material and number of sutures and ties to be made during the ...

  7. Maternal psychosocial outcome after early onset preeclampsia and preterm birth.

    NARCIS (Netherlands)

    Gaugler-Senden, I.P.; Duivenvoorden, H.J.; Filius, A.; de Groot, C.J.M.; Steegers, EA; Passchier, J.

    2012-01-01

    Objective.To evaluate the impact of severe, early onset preeclampsia on long-term maternal psychosocial outcome after preterm birth. Methods.Women with severe, early onset preeclampsia before 32 weeks' gestation (cases) admitted in a tertiary university referral center between 1993 and 2004, and

  8. Maternal serum C-reactive protein in early pregnancy and occurrence of preterm premature rupture of membranes and preterm birth.

    Science.gov (United States)

    Moghaddam Banaem, Lida; Mohamadi, Bita; Asghari Jaafarabadi, Mohamad; Aliyan Moghadam, Narges

    2012-05-01

    The aim of this study was to determine the relationship between maternal serum C-reactive protein (CRP) levels in the first 20 weeks of pregnancy and later occurrence of preterm premature rupture of membranes and preterm birth. A prospective cohort study that measured maternal serum CRP levels in 778 pregnant women in the first half of pregnancy was performed in the city of Noor (north Iran), and included follow-up of patients up to time of delivery. Preterm premature rupture of membranes and preterm birth were defined as the occurrence of membranes rupture and birth, respectively before 37 weeks of gestation. Of the 778 pregnancies studied, 19 (2.41%) preterm premature rupture of membranes and 58 (7.3%) preterm births were seen. Median CRP levels in preterm premature rupture of membranes and preterm birth cases were much higher than in term deliveries (7 and 6.8 respectively vs 2.4 mg/L; 66.67 and 64.76, respectively vs 24.38 nmol/L). CRP levels >4 mg/L had statistically significant relationships with preterm premature rupture of membranes (OR 5.91, 95% CI 2.07-16.89) and preterm birth (OR 8.95, 95% CI 4.60-17.43). With a cut-off level of 4 mg/L of CRP, sensitivity, specificity, and likelihood ratios (LR(+) and LR(-) ) for preterm birth were 81, 70, 2.70, 0.28%, respectively, and for preterm premature rupture of membranes they were 79, 67, 2.41 and 0.31%, respectively. It seems that the inflammatory marker, CRP, can be used in the early stages of pregnancy to identify women at risk of experiencing preterm premature rupture of membranes and preterm birth. © 2012 The Authors. Journal of Obstetrics and Gynaecology Research © 2012 Japan Society of Obstetrics and Gynecology.

  9. Hydroxychloroquine Use in Lupus Patients during Pregnancy Is Associated with Longer Pregnancy Duration in Preterm Births

    Directory of Open Access Journals (Sweden)

    S. J. Kroese

    2017-01-01

    Full Text Available Objective. To investigate the effect of hydroxychloroquine (HCQ in pregnant women with systemic lupus erythematosus (SLE. Methods. In SLE pregnancies of a single Dutch center (2000–2015, lupus activity and flares before and during pregnancy and postpartum were assessed using the SLE Disease Activity Index (SLEDAI/SLEPDAI (SLEDAI adjusted for pregnancy. The association between HCQ use and pregnancy outcomes (early spontaneous abortion, fetal death, and preterm and term live birth was analyzed using generalized estimating equations (GEE accounting for the occurrence of multiple pregnancies per patient. Analyses were adjusted for antiphospholipid antibody (aPL status. Results. 110 pregnancies (63 mostly Caucasian patients were included, of which, in 30, HCQ was used; overall occurrence of flares was low (non-HCQ group: 5 mild (6.4% and 2 severe (2.6%; HCQ group: 2 mild (6.7% and no severe flares. The HCQ group showed a trend towards lower dosage of prednisone (OR 0.2 (95% CI 0.0–1.4; p=0.10. Pregnancy outcomes were comparable between groups. Among preterm live births, pregnancy duration was significantly longer in HCQ users (2.4 weeks (95% CI 1.0–3.8; p≤0.001. Conclusion. HCQ use was associated with longer pregnancy duration in the vulnerable preterm birth population, underscoring the beneficial effect of HCQ use during pregnancy.

  10. Maternal and neonatal epidemiological features in clinical subtypes of preterm-birth

    Science.gov (United States)

    Gimenez, Lucas G.; Krupitzki, Hugo B.; Momany, Allison M.; Gili, Juan A.; Poletta, Fernando A.; Campaña, Hebe; Cosentino, Viviana R.; Saleme, César; Pawluk, Mariela; Murray, Jeffrey C.; Castilla, Eduardo E.; Gadow, Enrique C.; Lopez-Camelo, Jorge S.

    2016-01-01

    Objective This study was designed to characterize and compare the maternal and newborn epidemiological characteristics through analysis of environmental factors, socio-demographic characteristics, and clinical characteristics between the different clinical subtypes of preterm birth (PTB): Idiopathic (PTB-I), premature rupture of the membranes (PTB-PPROM) and medically indicated (PTB-M). The two subtypes PTB-I and PTB-PPROM grouped are called spontaneous preterm births (PTB-S). Methods A retrospective, observational study was conducted in 1.291 preterm non-malformed singleton live-born children to nulliparous and multiparous mother’s in Tucumán-Argentina between 2005 and 2010. Over 50 maternal variables and ten newborn variables were compared between the different clinical subtypes. The comparisons were done to identify heterogeneity between subtypes of preterm birth: (PTB-S) vs. (PTB-M), and within spontaneous subtype: (PTB-I) vs. (PTB-PPROM). In the same way, two conditional logistic multivariate regressions were used to compare the odds ratio (OR) between PTB-S and PTB-M, as well as PTB-I and PTB-PPROM. We matched for maternal age when comparing maternal variables and gestational age when comparing infant variables. Results The PTB-I subtype was characterized by younger mothers of lower socioeconomic status, PTB-PPROM was characterized by environmental factors resulting from inflammatory processes, and PTB-M was characterized by increased maternal or fetal risk pregnancies. Conclusions The main risk factor for PTB-I and PTB-M was having had a prior preterm delivery, however previous spontaneous abortion was not a risk factor, suggesting a reproductive selection mechanism. PMID:26701680

  11. Selected maternal, fetal and placental trace element and heavy metal and maternal vitamin levels in preterm deliveries with or without preterm premature rupture of membranes.

    Science.gov (United States)

    Kucukaydin, Zehra; Kurdoglu, Mertihan; Kurdoglu, Zehra; Demir, Halit; Yoruk, Ibrahim H

    2018-01-25

    To compare maternal, fetal and placental trace element (magnesium, zinc and copper) and heavy metal (cadmium and lead) and maternal vitamin (retinol, α [alpha]-tocopherol, vitamin D 3 , 25-hydroxyvitamin D 3 and 1,25-dihydroxyvitamin D 3 ) levels in preterm deliveries with and without preterm premature rupture of membranes (PPROM). Sixty-eight patients giving birth preterm were grouped into preterm deliveries with PPROM (n = 35) and without PPROM (n = 33). Following delivery, maternal and umbilical cord blood sera and placental tissue samples were obtained. While magnesium, zinc, copper, cadmium and lead levels were measured in all samples, the levels of retinol, α-tocopherol, vitamin D 3 , 25-hydroxyvitamin D 3 and 1,25-dihydroxyvitamin D 3 were measured only in maternal serum. While magnesium level in maternal serum and zinc levels in both maternal and umbilical cord sera were lower, placental magnesium level was higher in preterm deliveries with PPROM (P 0.05). In preterm deliveries with PPROM, 25-hydroxyvitamin D 3 and retinol levels were higher, while vitamin D 3 and 1,25-dihydroxyvitamin D 3 levels were lower in maternal serum (P < 0.05). Maternal serum α-tocopherol levels were similar between the groups. Compared to spontaneous preterm births, PPROM is associated with low maternal serum together with high placental tissue magnesium and low maternal and umbilical cord sera zinc levels. Higher retinol and 25-hydroxyvitamin D 3 and lower vitamin D 3 and 1,25-dihydroxyvitamin D 3 maternal serum levels are also evident in these patients. © 2018 Japan Society of Obstetrics and Gynecology.

  12. What factors are related to recurrent preterm birth among underweight women?

    Science.gov (United States)

    Girsen, Anna I; Mayo, Jonathan A; Wallenstein, Matthew B; Gould, Jeffrey B; Carmichael, Suzan L; Stevenson, David K; Lyell, Deirdre J; Shaw, Gary M

    2018-03-01

    Our objective was to identify factors associated with recurrent preterm birth among underweight women. Maternally linked hospital and birth certificate records of deliveries in California between 2007 and 2010 were used. Consecutive singleton pregnancies of women with underweight body mass index (BMI preterm; preterm-term and preterm-preterm. We analyzed 4971 women with underweight BMI in the first pregnancy. Of these, 670 had at least one preterm birth. Among these 670, 86 (21.8%) women experienced a recurrent preterm birth. Odds for first term - second preterm birth were decreased for increases in maternal age (aOR: 0.90, 95%CI: 0.95-0.99) whereas inter-pregnancy interval preterm birth (aOR:1.66, 95%CI: 1.21-2.28) and first preterm birth - second term birth (aOR: 1.43, 95%CI: 1.04-1.96). Factors associated with recurrent preterm birth were: negative or no change in pre-pregnancy weight between pregnancies (aOR: 1.67, 95%CI: 1.07-2.60), inter-pregnancy interval preterm birth among underweight women was associated with younger age, short inter-pregnancy interval, and negative or no weight change between pregnancies.

  13. Physically demanding work, fetal growth and the risk of adverse birth outcomes. The Generation R Study.

    Science.gov (United States)

    Snijder, Claudia A; Brand, Teus; Jaddoe, Vincent; Hofman, Albert; Mackenbach, Johan P; Steegers, Eric A P; Burdorf, Alex

    2012-08-01

    Work-related risk factors, such as long work hours, and physically demanding work have been suggested to adversely influence pregnancy outcome. The authors aimed to examine associations between various aspects of physically demanding work with fetal growth in different trimesters during pregnancy and the risks of adverse birth outcomes. Associations between physically demanding work and fetal growth were studied in 4680 pregnant women participating in a population-based prospective cohort study from early pregnancy onwards in The Netherlands (2002-2006). Mothers who filled out a questionnaire during mid-pregnancy (response 77% of enrolment) were included if they conducted paid employment and had a spontaneously conceived singleton live born pregnancy. Questions on physical workload were obtained from the Dutch Musculoskeletal Questionnaire and concerned questions on lifting, long periods of standing or walking, night shifts and working hours. Fetal growth characteristics were repeatedly measured by ultrasound and were used in combination with measurements at birth. There were no consistent significant associations between physically demanding work nor working hours in relation to small for gestational age, low birth weight or preterm delivery. Women exposed to long periods of standing had lower growth rates for fetal head circumference (HC), resulting in a reduction of approximately 1 cm (3%) of the average HC at birth. Compared with women working working 25-39 h/week and >40 h/week had lower growth rates for both fetal weight and HC, resulting in a difference of approximately 1 cm in HC at birth and a difference of 148-198 g in birth weight. Long periods of standing and long working hours per week during pregnancy seem to negatively influence intrauterine growth.

  14. Preterm birth, infant weight gain, and childhood asthma risk

    DEFF Research Database (Denmark)

    Sonnenschein-van der Voort, Agnes M M; Arends, Lidia R; de Jongste, Johan C

    2014-01-01

    birth cohort studies to determine the associations of birth and infant growth characteristics with the risks of preschool wheezing (1-4 years) and school-age asthma (5-10 years). METHODS: First, we performed an adjusted 1-stage random-effect meta-analysis to assess the combined associations...... of gestational age, birth weight, and infant weight gain with childhood asthma. Second, we performed an adjusted 2-stage random-effect meta-analysis to assess the associations of preterm birth (gestational age childhood asthma outcomes. RESULTS: Younger gestational...... age at birth and higher infant weight gain were independently associated with higher risks of preschool wheezing and school-age asthma (P childhood asthma were explained by gestational age at birth. Compared with term-born children with normal...

  15. The impact of postpartum contraception on reducing preterm birth: findings from California.

    Science.gov (United States)

    Rodriguez, Maria I; Chang, Richard; Thiel de Bocanegra, Heike

    2015-11-01

    Family planning is recommended as a strategy to prevent adverse birth outcomes. The potential contribution of postpartum contraceptive coverage to reducing rates of preterm birth is unknown. In this study, we examine the impact of contraceptive coverage and use within 18 months of a birth on preventing preterm birth in a Californian cohort. We identified records for second or higher-order births among women from California's 2011 Birth Statistical Master File and their prior births from earlier Birth Statistical Master Files. To identify women who received contraceptive services from publicly funded programs, we applied a probabilistic linking methodology to match birth files with enrollment records for women with Medi-Cal or Family Planning, Access, Care, and Treatment Program (PACT) claims. The length of contraceptive coverage was determined through applying an algorithm based on the specified method and the quantity dispensed. Preterm birth was defined as a birth occurring birth using subcategories defined by the World Health Organization: extremely preterm (birth and control for key covariates. The cohort consisted of 111,948 women who were seen at least once by a Medi-Cal or Family PACT provider within 18 months of delivery. Of the cohort, 9.75% had a preterm birth. Contraceptive coverage was found to be protective against preterm birth. For every month of contraceptive coverage, odds of a preterm birth confidence interval, 0.986-0.993). Improving postpartum contraceptive use has the potential to reduce preterm births. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. Socioeconomic disparities in small-for-gestational-age birth and preterm birth.

    Science.gov (United States)

    Bushnik, Tracey; Yang, Seungmi; Kaufman, Jay S; Kramer, Michael S; Wilkins, Russell

    2017-11-15

    Maternal socioeconomic disadvantage has been associated with increased risk of small-for-gestational-age birth and preterm birth. Few studies, however, have considered maternal education and income simultaneously to better understand the mechanisms underlying perinatal health disparities. This analysis examines both maternal education and income and their association with the risk of small-for-gestational-age birth and preterm birth. The study is based on 127,694 singleton live births from the 2006 Canadian Birth-Census Cohort, a national cohort of births registered from May 2004 to May 2006 that were linked to the 2006 long-form Census. Unadjusted rates of small-for-gestational-age birth (sex-specific birth weight below the 10th percentile for gestational age) and preterm birth (before 37 completed weeks of gestation) were estimated across selected maternal characteristics. Logistic regression was used to estimate crude and covariate-adjusted risk ratios of both outcomes according to maternal education and income adequacy quintiles. Small-for-gestational-age birth was associated with both maternal education and income adequacy, while preterm birth was associated with maternal education only. These findings persisted after taking factors including maternal age, ethnicity, and marital status into account. The results suggest that the mechanism by which maternal education is associated with these outcomes is likely not through income, nor does income replace education as a potentially meaningful measure of socioeconomic position. The mechanisms underlying associations between socioeconomic position and perinatal health disparities are complex. The results of this study indicate that more than one socioeconomic factor may play a role.

  17. Gestational age at initiation of 17-alpha hydroxyprogesterone caproate and recurrent preterm birth.

    Science.gov (United States)

    Ning, Angela; Vladutiu, Catherine J; Dotters-Katz, Sarah K; Goodnight, William H; Manuck, Tracy A

    2017-09-01

    Preterm birth is the leading cause of neonatal morbidity and mortality in nonanomalous neonates in the United States. Women with a previous early spontaneous preterm birth are at highest risk for recurrence. Weekly intramuscular 17-alpha hydroxyprogesterone caproate reduces the risk of recurrent prematurity. Although current guidelines recommend 17-alpha hydroxyprogesterone caproate initiation between 16 and 20 weeks, in clinical practice, 17-alpha hydroxyprogesterone caproate is started across a spectrum of gestational ages. The objective of the study was to examine the relationship between the gestational age at 17-alpha hydroxyprogesterone caproate initiation and recurrent preterm birth among women with a prior spontaneous preterm birth 16-28 weeks' gestation. This was a retrospective cohort study of women from a single tertiary care center, 2005-2016. All women with ≥1 singleton preterm births because of a spontaneous onset of contractions, preterm prelabor rupture of membranes, or painless cervical dilation between 16 and 28 weeks followed by a subsequent singleton pregnancy treated with 17-alpha hydroxyprogesterone caproate were included. Women were grouped based on quartiles of gestational age of 17-alpha hydroxyprogesterone caproate initiation (quartile 1, 14 0/7 to 16 1/7 ; quartile 2, 16 2/7 to 17 0/7 ; quartile 3, 17 1/7 to 18 6/7 ; and quartile 4, 19 0/7 to 27 5/7 ). Women with a gestational age of 17-alpha hydroxyprogesterone caproate initiation in quartiles 1 and 2 were considered to have early-start 17-alpha hydroxyprogesterone caproate; those in quartiles 3 and 4 were considered to have late-start 17-alpha hydroxyprogesterone caproate. The primary outcome was recurrent preterm birth preterm birth preterm birth preterm birth preterm birth preterm birth preterm birth among women with a prior spontaneous preterm birth 16-28 weeks are high. Women beginning 17-alpha

  18. Factors influencing the incidence of pre-term birth in Calabar, Nigeria

    African Journals Online (AJOL)

    Women who had pre-term birth in the University of Calabar Teaching Hospital, Calabar, over a 2 ½ year period were studied. The aim was to establish the factors influencing the incidence of pre-term birth in Calabar. Factors which significantly increase the incidence of pre-term delivery included: previous induced abortion ...

  19. A blueprint for the prevention of preterm birth: vaginal progesterone in women with a short cervix

    Science.gov (United States)

    Romero, Roberto; Yeo, Lami; Miranda, Jezid; Hassan, Sonia; Conde-Agudelo, Agustin; Chaiworapongsa, Tinnakorn

    2014-01-01

    Preterm birth is the leading cause of perinatal morbidity and mortality worldwide, and is the most important challenge to modern obstetrics. A major obstacle has been that preterm birth is treated (implicitly or explicitly) as a single condition. Two-thirds of preterm births occur after the spontaneous onset of labor, and the remaining one-third after “indicated” preterm birth; however, the causes of spontaneous preterm labor and “indicated” preterm birth are different. Spontaneous preterm birth is a syndrome caused by multiple etiologies, one of which is a decline in progesterone action, which induces cervical ripening. A sonographic short cervix (identified in the midtrimester) is a powerful predictor of spontaneous preterm delivery. Randomized clinical trials and individual patient meta-analyses have shown that vaginal progesterone reduces the rate of preterm delivery at cervix, and therefore, the compound of choice is natural progesterone (not the synthetic progestin). Routine assessment of the risk of preterm birth with cervical ultrasound coupled with vaginal progesterone for women with a short cervix is cost-effective, and implementation of such a policy is urgently needed. Vaginal progesterone is as effective as cervical cerclage in reducing the rate of preterm delivery in women with a singleton gestation, history of preterm birth, and a short cervix (<25mm). PMID:23314512

  20. Preterm premature rupture of the fetal membranes: association with sociodemographic factors and maternal genitourinary infections.

    Science.gov (United States)

    Hackenhaar, Arnildo A; Albernaz, Elaine P; da Fonseca, Tânia M V

    2014-01-01

    this study aimed to investigate the incidence of premature rupture of fetal membranes in preterm singleton pregnancies and its association with sociodemographic factors and maternal self-reported genitourinary infections. this was a population-based cross-sectional study, which included all mothers of newborns of singleton deliveries that occurred in 2010, with birth weight ≥ 500 grams, who resided in the city of Rio Grande. Women were interviewed in the two maternity hospitals. Cases were women who had lost amniotic fluid before hospitalization and whose gestational age was less than 37 weeks. Statistical analysis was performed by levels to control for confounding factors using Poisson regression. of the 2,244 women eligible for the study, 3.1% had preterm premature rupture of fetal membranes, which was more frequent, after adjustment, in women of lower socioeconomic status, (prevalence ratio [PR]=1.94), with lower level of schooling (PR=2.43), age > 29 years (PR=2.49), and smokers (PR=2.04). It was also associated with threatened miscarriage (PR=1.68) and preterm labor, (PR=3.40). There was no association with maternal urinary tract infection or presence of genital discharge. the outcome was more common in puerperal women with lower level of schooling, lower socioeconomic status, older, and smokers, as well as those with a history of threatened miscarriage and premature labor. These factors should be considered in the prevention, diagnosis, and therapy approach. Copyright © 2013 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  1. Effects of socioeconomic position and clinical risk factors on spontaneous and iatrogenic preterm birth.

    Science.gov (United States)

    Joseph, K S; Fahey, John; Shankardass, Ketan; Allen, Victoria M; O'Campo, Patricia; Dodds, Linda; Liston, Robert M; Allen, Alexander C

    2014-03-27

    The literature shows a variable and inconsistent relationship between socioeconomic position and preterm birth. We examined risk factors for spontaneous and iatrogenic preterm birth, with a focus on socioeconomic position and clinical risk factors, in order to explain the observed inconsistency. We carried out a retrospective population-based cohort study of all singleton deliveries in Nova Scotia from 1988 to 2003. Data were obtained from the Nova Scotia Atlee Perinatal Database and the federal income tax T1 Family Files. Separate logistic models were used to quantify the association between socioeconomic position, clinical risk factors and spontaneous preterm birth and iatrogenic preterm birth. The study population included 132,714 singleton deliveries and the rate of preterm birth was 5.5%. Preterm birth rates were significantly higher among the women in the lowest (versus the highest) family income group for spontaneous (rate ratio 1.14, 95% confidence interval (CI) 1.03, 1.25) but not iatrogenic preterm birth (rate ratio 0.95, 95% CI 0.75, 1.19). Adjustment for maternal characteristics attenuated the family income-spontaneous preterm birth relationship but strengthened the relationship with iatrogenic preterm birth. Clinical risk factors such as hypertension were differentially associated with spontaneous (rate ratio 3.92, 95% CI 3.47, 4.44) and iatrogenic preterm (rate ratio 14.1, 95% CI 11.4, 17.4) but factors such as diabetes mellitus were not (rate ratio 4.38, 95% CI 3.21, 5.99 for spontaneous and 4.02, 95% CI 2.07, 7.80 for iatrogenic preterm birth). Socioeconomic position and clinical risk factors have different effects on spontaneous and iatrogenic preterm. Recent temporal increases in iatrogenic preterm birth appear to be responsible for the inconsistent relationship between socioeconomic position and preterm birth.

  2. Miracle baby: managing extremely preterm birth in rural Uganda.

    Science.gov (United States)

    Mitchell, Hannah Katherine; Thomas, Rhianne; Hogan, Michael; Bresges, Carolin

    2014-06-04

    Preterm birth is an important cause of neonatal morbidity and mortality globally. Uganda has one of the highest rates of preterm birth in East Africa but few resources to care for these infants. This case highlights the clinical course of an extremely premature infant born at 26 weeks gestation to a nulliparous 24-year-old woman. Her mother was involved in her care and taught the principles of kangaroo mother care. After initial problems establishing feeds she progressed well and was discharged in the fifth week of life. The case describes some of the low technology conservative and medical measures which can be used to care for neonates, such as antenatal steroids and kangaroo care. The use of antibiotics and aminophylline are also discussed. The approach to the common challenges faced by premature infants such as respiratory disease, sepsis and necrotising enterocolitis in a resource-poor environment are discussed. 2014 BMJ Publishing Group Ltd.

  3. New Option in the Lives Saved Tool (LiST) Allows for the Conversion of Prevalence of Small-for-Gestational-Age and Preterm Births to Prevalence of Low Birth Weight.

    Science.gov (United States)

    Kozuki, Naoko; Katz, Joanne; Clermont, Adrienne; Walker, Neff

    2017-11-01

    Background: The Lives Saved Tool (LiST) is a software model that estimates the health impact of scaling up interventions on maternal and child health. One of the outputs of the model is an estimation of births by fetal size [appropriate-for-gestational-age (AGA) or small-for-gestational-age (SGA)] and by length of gestation (term or preterm), both of which influence birth weight. LiST uses prevalence estimates of births in these categories rather than of birth weight categories, because the causes and health consequences differ between SGA and preterm birth. The World Health Assembly nutrition plan, however, has set the prevalence of low birth weight (LBW) as a key indicator, with a specific goal of a 30% reduction in LBW prevalence by 2025. Objective: The objective of the study is to develop an algorithm that will allow LiST users to estimate changes in prevalence of LBW on the basis of changes in coverage of interventions and the resulting impact on prevalence estimates of SGA and preterm births. Methods: The study used 13 prospective cohort data sets from low- and middle-income countries (LMICs; 4 from sub-Saharan Africa, 5 from Asia, and 4 from Latin America), with reliable measures of gestational age and birth weight. By calculating the proportion of LBW births among SGA and preterm births in each data set and meta-analyzing those estimates, we calculated region-specific pooled rates of LBW among SGA and preterm births. Results: In Africa, 0.4% of term-AGA, 36.7% of term-SGA, 49.3% of preterm-AGA, and 100.0% of preterm-SGA births were LBW. In Asia, 1.0% of term-SGA, 47.0% of term-SGA, 36.7% of preterm-AGA, and 100.0% of preterm-SGA births were LBW. In Latin America, 0.4% of term-AGA, 34.4% of term-SGA, 32.3% of preterm-AGA, and 100.0% of preterm-SGA births were LBW. Conclusions: The simple conversion factor proposed here allows for the estimation of LBW within LiST for most LMICs. This will allow LiST users to approximate the impact of their health programs on

  4. Morphology and Function of the Lamb Ileum following Preterm Birth

    Directory of Open Access Journals (Sweden)

    Tracey J. Flores

    2018-01-01

    Full Text Available BackgroundFor infants born moderately/late preterm (32–37 weeks of gestation, immaturity of the intestine has the potential to impact both short- and long-term gastrointestinal function. The aim of this study conducted in sheep was to compare the morphology and smooth muscle contractility of the ileum in term and late preterm lambs.Materials and methodsLambs delivered preterm (132 days gestation; n = 7 or term (147 days gestation; n = 9 were milk-fed after birth and euthanased at 2 days of age. A segment of distal ileum was collected for analysis of the length and cellular composition of the villi and crypts, smooth muscle width and contractility, and mRNA expression of the cell markers Ki67, lysozyme, mucin 2, synaptophysin, chromogranin A, olfactomedin 4, axis inhibition protein 2, and leucine-rich repeat-containing G-protein coupled receptor 5 (LGR5.ResultsThere was no difference in the proportion of inflammatory, proliferating, apoptotic, enterocyte, or goblet cells between groups, but preterm lambs exhibited a significant upregulation of the stem cell marker LGR5 (p = 0.01. Absolute villus height (term: 1,032 ± 147 µm, preterm: 651 ± 52 µm; p < 0.0001 and crypt depth (term: 153 ± 11 µm, preterm: 133 ± 17 µm; p = 0.01 were significantly shorter in the preterm ileums, with a trend (p = 0.06 for a reduction in muscularis externa width. There was no difference between groups in the contractile response to acetylcholine, but peak contractility in response to bradykinin (p = 0.02 and angiotensin II (p = 0.03 was significantly greater in the preterm lambs.ConclusionFindings demonstrate that the crypt-villus units are shorter in the ileum of late preterm offspring, but functionally mature with an equivalent cellular composition and normal contractile response to acetylcholine compared with term offspring. The exaggerated contractility to inflammatory mediators evident in the

  5. Morphology and Function of the Lamb Ileum following Preterm Birth.

    Science.gov (United States)

    Flores, Tracey J; Nguyen, Vivian B; Widdop, Robert E; Sutherland, Megan R; Polglase, Graeme R; Abud, Helen E; Black, Mary Jane

    2018-01-01

    For infants born moderately/late preterm (32-37 weeks of gestation), immaturity of the intestine has the potential to impact both short- and long-term gastrointestinal function. The aim of this study conducted in sheep was to compare the morphology and smooth muscle contractility of the ileum in term and late preterm lambs. Lambs delivered preterm (132 days gestation; n  = 7) or term (147 days gestation; n  = 9) were milk-fed after birth and euthanased at 2 days of age. A segment of distal ileum was collected for analysis of the length and cellular composition of the villi and crypts, smooth muscle width and contractility, and mRNA expression of the cell markers Ki67, lysozyme, mucin 2, synaptophysin, chromogranin A, olfactomedin 4, axis inhibition protein 2, and leucine-rich repeat-containing G-protein coupled receptor 5 (LGR5). There was no difference in the proportion of inflammatory, proliferating, apoptotic, enterocyte, or goblet cells between groups, but preterm lambs exhibited a significant upregulation of the stem cell marker LGR5 ( p  = 0.01). Absolute villus height (term: 1,032 ± 147 µm, preterm: 651 ± 52 µm; p  preterm: 133 ± 17 µm; p  = 0.01) were significantly shorter in the preterm ileums, with a trend ( p  = 0.06) for a reduction in muscularis externa width. There was no difference between groups in the contractile response to acetylcholine, but peak contractility in response to bradykinin ( p  = 0.02) and angiotensin II ( p  = 0.03) was significantly greater in the preterm lambs. Findings demonstrate that the crypt-villus units are shorter in the ileum of late preterm offspring, but functionally mature with an equivalent cellular composition and normal contractile response to acetylcholine compared with term offspring. The exaggerated contractility to inflammatory mediators evident in the preterm ileum, however, may be of concern.

  6. Risk Factors for Early Preterm Birth at King Salman Armed Force Hospital in 2010

    Directory of Open Access Journals (Sweden)

    Badriah Ali Alansi

    2017-11-01

    CONCLUSIONS: Current study indicated that early preterm births differed from preterm as a whole; primigravida, multiple gestations and a history of placental abruption are independent risk factors for them.

  7. The Beneficial Effects of Melatonin Administration Following Hypoxia-Ischemia in Preterm Fetal Sheep

    Directory of Open Access Journals (Sweden)

    Tamara Yawno

    2017-09-01

    Full Text Available Melatonin (MLT is an endogenous hormone that controls circadian cycle. MLT has additional important properties that make it appealing as a neuroprotective agent—it is a potent anti-oxidant, with anti-apoptotic and anti-inflammatory properties. MLT is safe for administration during pregnancy or to the newborn after birth, and can reduce white matter brain injury under conditions of chronic fetal hypoxia. Accordingly, in the current study, we examined whether an intermediate dose of MLT could restore white matter brain development when administered after an acute hypoxic ischemic (HI insult in preterm fetal sheep. Fifteen fetal sheep at 95–98 days gestation were instrumented with femoral artery and vein catheters, and a silastic cuff placed around the umbilical cord. At 102 days gestation, the cuff was inflated, causing complete umbilical cord occlusion for 25 min in 10 fetuses, to induce acute severe HI. Five HI fetuses received intravenous MLT for 24 h beginning at 2 h after HI. The remaining five fetuses were administered saline alone. Ten days after HI, the fetal brain was collected from each animal and white and gray matter neuropathology assessed. HI caused a significant increase in apoptotic cell death (TUNEL+, activated microglia (Iba-1+, and oxidative stress (8-OHdG+ within the subventricular and subcortical white matter. HI reduced the total number of oligodendrocytes and CNPase+ myelin density. MLT administration following HI decreased apoptosis, inflammation and oxidative stress within the white matter. MLT had intermediate benefits for the developing white matter: it increased oligodendrocyte cell number within the periventricular white matter only, and improved CNPase+ myelin density within the subcortical but not the striatal white matter. MLT administration following HI was also associated with improved neuronal survival within the cortex. Neuropathology in preterm infants is complex and mediated by multiple mechanisms

  8. Sleep duration, vital exhaustion, and odds of spontaneous preterm birth: a case-control study.

    Science.gov (United States)

    Kajeepeta, Sandhya; Sanchez, Sixto E; Gelaye, Bizu; Qiu, Chunfang; Barrios, Yasmin V; Enquobahrie, Daniel A; Williams, Michelle A

    2014-09-27

    Preterm birth is a leading cause of perinatal morbidity and mortality worldwide, resulting in a pressing need to identify risk factors leading to effective interventions. Limited evidence suggests potential relationships between maternal sleep or vital exhaustion and preterm birth, yet the literature is generally inconclusive. We examined the relationship between maternal sleep duration and vital exhaustion in the first six months of pregnancy and spontaneous (non-medically indicated) preterm birth among 479 Peruvian women who delivered a preterm singleton infant (exhaustion were ascertained through in-person interviews. Spontaneous preterm birth cases were further categorized as those following either spontaneous preterm labor or preterm premature rupture of membranes. In addition, cases were categorized as very (exhaustion was also associated with increased odds of preterm birth (aOR = 2.41; 95% CI 1.79-3.23) compared to no exhaustion (Ptrend exhaustion on the odds of spontaneous preterm birth. The results of this case-control study suggest maternal sleep duration, particularly short sleep duration, and vital exhaustion may be risk factors for spontaneous preterm birth. These findings call for increased clinical attention to maternal sleep and the study of potential intervention strategies to improve sleep in early pregnancy with the aim of decreasing risk of preterm birth.

  9. Interconception Challenges of Women Who Had Prior Preterm Births.

    Science.gov (United States)

    Boutain, Doris M; Foreman, Shuyuann Wang; Hitti, Jane E

    To describe the interconception challenges of women who had prior preterm births. We used a cross-sectional design and collected data via survey. King County, Washington. Ninety-two women who had prior early preterm births (20-33 weeks gestation) were included. Women were recruited from a larger study focused on exploring the infectious pathways for early preterm birth. Participants were interviewed once using open-ended and close-ended surveys. The primary open-ended survey question was What are the five greatest challenges you experience now? We analyzed data using inductive and summative content analysis and descriptive statistics. Ninety-one participants described challenges. One participant had no challenge. We categorized 11 challenges during the interconception period: Mothering (n = 70, 76%), Self-Care Desires (n = 35, 38%), Finances (n = 31, 34%), Employment (n = 31, 34%), Partner Relationships (n = 29, 32%), Individualized Concerns (n = 25, 27%), Mental Health (n = 23, 25%), Balance (n = 22, 24%), Physical Health (n = 19, 21%), Housing (n = 18, 20%), and Family (n = 17, 19%). Participants described an array of challenges that often related to their roles as mothers, employees, and partners. Our research advances knowledge by describing contemporary challenges of women during the interconception period. Copyright © 2017 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.

  10. Quantitative Ultrasound Texture Analysis for Differentiating Preterm From Term Fetal Lungs.

    Science.gov (United States)

    Ghorayeb, Sleiman R; Bracero, Luis A; Blitz, Matthew J; Rahman, Zara; Lesser, Martin L

    2017-07-01

    To differentiate preterm (quantitative texture analysis of ultrasound images. This study retrospectively evaluated singleton gestations with valid dating at 20 weeks' gestational age (GA) or later between January 2015 and December 2015. Images were obtained from Voluson E8 ultrasound systems (GE Healthcare, Milwaukee, WI). A region of interest was selected in each fetal lung image at the level of the 4 heart chambers from an area that appeared most representative of the overall lung tissue and had the least shadow. Ultrasonic tissue heterogeneity (heterogeneity index) based on dynamic range calculation was determined for all lung images. This quantification was performed with a custom-made software program that used a dithering technique based on the Floyd-Steinberg algorithm, in which the pixels are transformed into a binary map. Regression analysis was used to determine the correlation and functional association between the heterogeneity index and GA. A receiver operating characteristic curve was used to identify the optimal heterogeneity index cutoff point for differentiating preterm from term fetal lungs. A total of 425 fetal lung ultrasound images (313 preterm and 112 term) were analyzed. Quantitative texture analysis predicted GA with sensitivity and specificity of 87.9% and 92.0%, respectively, based on the optimal receiver operating characteristic cutoff point. Quantitative ultrasound texture analysis of fetal lung tissue can differentiate preterm fetal lungs from term fetal lungs. Our data suggest that decreased fetal lung heterogeneity on ultrasound imaging is associated with preterm fetuses. © 2017 by the American Institute of Ultrasound in Medicine.

  11. A Preterm Birth Caused By Postoperative Peritonitis and Peritoneal Abscess

    Directory of Open Access Journals (Sweden)

    Sukru Yildiz

    2013-08-01

    Full Text Available Appendicitis is the most common condition leading to an intraabdominal operation for a non obstetric problem in pregnancy and diagnosis of appendicitis is complicated by the physiologic and anatomic changes that occur during pregnancy. Although a surgical procedure carries the risk of fetal loss or preterm delivery, delay in diagnosis also increases the risk of complications in both mother and fetus. The following case illustrates our experience and to analyze clinical characteristic and the pregnancy outcome of appendicitis during the third trimester of pregnancy. [Cukurova Med J 2013; 38(4.000: 751-753

  12. Cervical pessary placement for prevention of preterm birth in unselected twin pregnancies: a randomized controlled trial.

    Science.gov (United States)

    Nicolaides, Kypros H; Syngelaki, Argyro; Poon, Liona C; de Paco Matallana, Catalina; Plasencia, Walter; Molina, Francisca S; Picciarelli, Gemma; Tul, Natasa; Celik, Ebru; Lau, Tze Kin; Conturso, Roberto

    2016-01-01

    Preterm birth is the leading cause of neonatal death and handicap in survivors. Although twins are found in 1.5% of pregnancies they account for about 25% of preterm births. Randomized controlled trials in singleton pregnancies reported that the prophylactic use of progestogens, cervical cerclage and cervical pessary reduce significantly the rate of early preterm birth. In twin pregnancies, progestogens and cervical cerclage have been shown to be ineffective in reducing preterm birth. The objective of this study was to test the hypothesis that the insertion of a cervical pessary in twin pregnancies would reduce the rate of spontaneous early preterm birth. This was a multicenter, randomized controlled trial in unselected twin pregnancies of cervical pessary placement from 20(+0)-24(+6) weeks' gestation until elective removal or delivery vs. expectant management. Primary outcome was spontaneous birth control groups in rates of spontaneous birth birth. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Growth pattern and final height of very preterm vs. very low birth weight infants

    NARCIS (Netherlands)

    Hollanders, J.J.; Pal, S.M. van der; Dommelen, P. van; Rotteveel, J.; Finken, M.J.J.

    2017-01-01

    BackgroundBoth very preterm (VP; i.e., gestational age <32 weeks) and very low birth weight (VLBW; i.e., birth weight <1,500 g) are used as inclusion criteria by studies on preterm birth. We aimed to quantify the impact of these entities on postnatal growth until final height.MethodsSubjects born VP

  14. Maternal psychosocial outcome after early onset preeclampsia and preterm birth.

    Science.gov (United States)

    Gaugler-Senden, Ingrid P M; Duivenvoorden, Hugo J; Filius, Anika; De Groot, Christianne J M; Steegers, Eric A P; Passchier, Jan

    2012-03-01

    To evaluate the impact of severe, early onset preeclampsia on long-term maternal psychosocial outcome after preterm birth. Women with severe, early onset preeclampsia before 32 weeks' gestation (cases) admitted in a tertiary university referral center between 1993 and 2004, and women with preterm delivery without preeclampsia (controls), matched for age, parity, gestational age at delivery, ethnicity, and year of delivery. Women who consented to participation received three questionnaires in 2008 concerning depression (Zung Depression Scale: score range 0-20; 20 items with 2-point frequency scale: no = 0 and yes = 1), posttraumatic stress symptoms (Impact of Event Scale: score range 0-75; 15 items with 4-point frequency scale: not at all = 0, rarely = 1, sometimes = 3 and often = 5. Scores > 19 are regarded as high symptom levels), and social aspects (Social Readjustment Rating Scale: selection of six items concerning relational aspects with husband/partner, employer, or future family planning). Included in the study were 104 cases and 78 controls (response rate 79% and 58%, respectively). There was no difference in depression scores between cases (5.4 ± 4.0) and controls (5.4 ± 4.3). Patients with severe, early onset preeclampsia had significantly higher scores of posttraumatic stress symptoms (28.7 ± 8.6 vs. 25.7 ± 7.9). The majority of women among both cases and controls had high-posttraumatic stress symptom levels (88% vs. 79%). No differences could be found in relational aspects. Women with preterm birth due to severe, early onset preeclampsia experience more often posttraumatic stress symptoms on average 7 years after the pregnancy compared to women with preterm birth without preeclampsia.

  15. Maternal risk factors for singleton preterm births and survival at the ...

    African Journals Online (AJOL)

    2015-02-24

    Feb 24, 2015 ... ratio [aOR] = 2.63; 95% confidence interval [CI] 1.92, 6.07), Previous preterm birth (aOR = 5.06; 95% CI: 2.66, 9.12), ... on gestational age at birth and mode of delivery, but not on maternal sociodemographic risk factors for singleton preterm births. ... of preterms in this area have become important in order to.

  16. Identification of preterm birth in women with threatened preterm labour between 34 and 37 weeks of gestation.

    Science.gov (United States)

    Gezer, Cenk; Ekin, Atalay; Solmaz, Ulas; Sahingoz Yildirim, Alkim Gulsah; Dogan, Askin; Ozeren, Mehmet

    2018-02-09

    The aim of this study was to assess whether serum markers would be useful as a new predictor of preterm birth in patients with spontaneous, late preterm labour. Patients diagnosed with late preterm labour were divided into preterm delivery (229 patients) and term delivery (178 patients) groups. The two groups were compared in terms of clinical characteristics and levels of serum markers (leukocyte subtypes, platelet, C-reactive protein [CRP], neutrophil to lymphocyte ratio [NLR] and platelet to lymphocyte ratio [PLR]), which were obtained at admission. The levels of leukocyte (p preterm delivery group, compared to the term delivery group. On multivariate regression analysis, NLR positive was the most powerful predictive variable (OR = 1.41; 95%CI: 1.32-1.51; p = .005). NLR had the highest area under curve (0.711; 95%CI 0.662-0.760) in predicting preterm birth and a NLR >6.2 had the highest sensitivity (65.1%) and specificity (62.5%). High NLR at admission is an independent predictor of preterm birth in patients with spontaneous, late preterm labour. Impact statement What is already known on this subject: Preterm birth accounts for 5-12% of all births, and is a major factor associated with perinatal morbidity and mortality worldwide. However, more than 70% of preterm births occur at late preterm between 34 0/7 and 36 6/7 weeks of gestation. The central role of systemic and subclinical infections in preterm labour is well documented. Intrauterine infection leading to delivery can be measured by using a variety of laboratory parameters. What do the results of this study add: Neutrophil to lymphocyte ratio is an inexpensive, easily interpretable and promising haematologic parameter that is widely available. This study explored the association of high neutrophil to lymphocyte ratio with the risk of preterm birth in women with preterm labour between 34 and 37 weeks of gestation. What are the implications of these findings for clinical practice and/or further

  17. Twin transvaginal cervical length at 16-20 weeks and prediction of preterm birth.

    Science.gov (United States)

    Hester, Ashley E; Ankumah, Nana-Ama E; Chauhan, Suneet P; Blackwell, Sean C; Sibai, Baha M

    2017-10-08

    Our objective was to determine if transvaginal cervical length at 16-20 weeks is predictive of preterm birth preterm birth. Transvaginal cervical length was performed at 16-20-week gestation. The inclusion criteria were non-anomalous twins with transvaginal cervical length at 16-20 weeks. Receiver-operating characteristic (ROC) curves were generated to determine the transvaginal cervical length associated with preterm birth. Of 655 pregnancies, 27% (N = 178) women met our inclusion criteria. The rate of spontaneous preterm birth before 34 weeks was 16% (N = 29). A receiver operator characteristic curve was generated for all preterm birth preterm birth (n = 15) were excluded, the area under the curve was 0.59 (95% CI 0.47-0.70), indicating that transvaginal cervical length values were not a clinically useful test for the prediction of spontaneous preterm birth. A transvaginal cervical length of 30 mm from this model would produce a sensitivity of detecting spontaneous preterm birth of 95% and a specificity of 14%. In an asymptomatic twin population, a single transvaginal cervical length between 16 and 20 weeks was not predictive of spontaneous preterm birth before 34 weeks. Thus, our findings suggest that routine transvaginal cervical length screening of twins should not be performed between 16-20 weeks.

  18. Histological evidence of oxidative stress and premature senescence in preterm premature rupture of the human fetal membranes recapitulated in vitro.

    Science.gov (United States)

    Menon, Ramkumar; Boldogh, Istvan; Hawkins, Hal K; Woodson, Michael; Polettini, Jossimara; Syed, Tariq Ali; Fortunato, Stephen J; Saade, George R; Papaconstantinou, John; Taylor, Robert N

    2014-06-01

    Preterm prelabor rupture of the membranes (pPROM) may lead to preterm births (PTBs). We investigated premature senescence of fetal membranes in women with pPROM and spontaneous PTB with intact membranes (membrane senescence phenotype by oxidative stress in vitro. IHC was performed for p53, p21, and phospho (p)-p38 mitogen-activated protein kinase (MAPK) as markers of senescence phenotype in pPROM, PTBs, and term births. Term fetal membranes were exposed to cigarette smoke extract to induce oxidative stress. Western blots documented p-p53 and p-p38 MAPK. Transmission electron microscopy assessed cellular morphologic features in clinical and cigarette smoke extract-treated membranes. A total of 80% of pPROM cells and >60% of term cells were positive for all three senescence phenotype markers, and concentrations were higher than in PTBs (P membranes from PTB and term birth pregnancies, whereas only membranes in vivo and after cigarette smoke extract treatment in vitro but was less apparent in PTBs. Histologic and biochemical resemblance of pPROM and term membranes suggests premature senescence of the membranes is a mechanistic feature in pPROM, and this can be phenocopied in an in vitro model. Copyright © 2014 American Society for Investigative Pathology. Published by Elsevier Inc. All rights reserved.

  19. Oxidative stress damage-associated molecular signaling pathways differentiate spontaneous preterm birth and preterm premature rupture of the membranes.

    Science.gov (United States)

    Dutta, Eryn H; Behnia, Faranak; Boldogh, Istvan; Saade, George R; Taylor, Brandie D; Kacerovský, Marian; Menon, Ramkumar

    2016-02-01

    In women with preterm premature rupture of the membranes (PPROM), increased oxidative stress may accelerate premature cellular senescence, senescence-associated inflammation and proteolysis, which may predispose them to rupture. We demonstrate mechanistic differences between preterm birth (PTB) and PPROM by revealing differences in fetal membrane redox status, oxidative stress-induced damage, distinct signaling pathways and senescence activation. Oxidative stress-associated fetal membrane damage and cell cycle arrest determine adverse pregnancy outcomes, such as spontaneous PTB and PPROM. Fetal membranes and amniotic fluid samples were collected from women with PTB and PPROM. Molecular, biochemical and histologic markers were used to document differences in oxidative stress and antioxidant enzyme status, DNA damage, secondary signaling activation by Ras-GTPase and mitogen-activated protein kinases, and activation of senescence between membranes from the two groups. Oxidative stress was higher and antioxidant enzymes were lower in PPROM compared with PTB. PTB membranes had minimal DNA damage and showed activation of Ras-GTPase and ERK/JNK signaling pathway with minimal signs of senescence. PPROM had higher numbers of cells with DNA damage, prosenescence stress kinase (p38 MAPK) activation and signs of senescence. Samples were obtained retrospectively after delivery. The markers of senescence that we tested are specific but are not sufficient to confirm senescence as the pathology in PPROM. Oxidative stress-induced DNA damage and senescence are characteristics of fetal membranes from PPROM, compared with PTB with intact membranes. PTB and PPROM arise from distinct pathophysiologic pathways. Oxidative stress and oxidative stress-induced cellular damages are likely determinants of the mechanistic signaling pathways and phenotypic outcome. This study is supported by developmental funds to Dr R. Menon from the Department of Obstetrics and Gynecology at The University of

  20. Population-based estimate of sibling risk for preterm birth, preterm premature rupture of membranes, placental abruption and pre-eclampsia

    Directory of Open Access Journals (Sweden)

    Borecki Ingrid

    2008-07-01

    Full Text Available Abstract Background Adverse pregnancy outcomes, such as preterm birth, preeclampsia and placental abruption, are common, with acute and long-term complications for both the mother and infant. Etiologies underlying such adverse outcomes are not well understood. As maternal and fetal genetic factors may influence these outcomes, we estimated the magnitude of familial aggregation as one index of possible heritable contributions. Using the Missouri Department of Health's maternally-linked birth certificate database, we performed a retrospective population-based cohort study of births (1989–1997, designating an individual born from an affected pregnancy as the proband for each outcome studied. We estimated the increased risk to siblings compared to the population risk, using the sibling risk ratio, λs, and sibling-sibling odds ratio (sib-sib OR, for the adverse pregnancy outcomes of preterm birth, preterm premature rupture of membranes (PPROM, placental abruption, and pre-eclampsia. Results Risk to siblings of an affected individual was elevated above the population prevalence of a given disorder, as indicated by λS (λS (95% CI: 4.3 (4.0–4.6, 8.2 (6.5–9.9, 4.0 (2.6–5.3, and 4.5 (4.4–4.8, for preterm birth, PPROM, placental abruption, and pre-eclampsia, respectively. Risk to siblings of an affected individual was similarly elevated above that of siblings of unaffected individuals, as indicated by the sib-sib OR (sib-sib OR adjusted for known risk factors (95% CI: 4.2 (3.9–4.5, 9.6 (7.6–12.2, 3.8 (2.6–5.5, 8.1 (7.5–8.8 for preterm birth, PPROM, placental abruption, and pre-eclampsia, respectively. Conclusion These results suggest that the adverse pregnancy outcomes of preterm birth, PPROM, placental abruption, and pre-eclampsia aggregate in families, which may be explained in part by genetics.

  1. Kangaroo position in low birth weight preterm newborns: descriptive study

    Directory of Open Access Journals (Sweden)

    Samilly Rodrigues Farias

    2017-11-01

    Full Text Available To describe the number of periods that very low birth weight preterm newborns were in kangaroo position during admission in the neonatal unit and to look for relations between maternal and neonatal variables with kangaroo position. A retrospective and descriptive study with all preterm newborns admitted in 2012, weighing 1500g or less and, gestational age lower than 31 weeks, classified as high clinical risk patients according to the Clinical Risk Index for Babies. We identified 38 babies whose admittance time ranged from 18 to 136 days. The beginning of kangaroo position occurred on average at 30.8 days of post-natal life (SD=18.5 and the number of periods in kangaroo position was on average 10.7 times. The occurrence of kangaroo position was less frequent than opportunities from the maternal presence, and the position was related to a higher offering of free milk demand.

  2. Maternal history of adoption or foster care placement in childhood: a risk factor for preterm birth.

    Science.gov (United States)

    Bublitz, Margaret H; Rodriguez, Daniel; Polly Gobin, Asi; Waldemore, Marissa; Magee, Susanna; Stroud, Laura R

    2014-10-01

    The objective of the study was to assess the impact of maternal history of adoption or foster care placement in childhood on the risk for preterm birth (PTB), controlling for other known risk factors for PTB. Participants were 302 pregnant women from a low-income, diverse sample drawn from 2 intensive prospective studies of maternal mood and behavior and fetal and infant development. Gestational age was determined by best obstetric estimate. Maternal history of adoption or foster care placement prior to age 18 years was determined by maternal report. Other maternal characteristics, including maternal medical conditions, psychosocial characteristics, and health behaviors, were measured during the second and third trimesters of pregnancy. The odds of delivering preterm (gestational age foster care placement compared with women who were never placed out of the home during childhood. This association remained significant after adjusting for other known risk factors for PTB including maternal medical conditions, psychosocial characteristics, and negative health behaviors in pregnancy. Findings suggest that a history of adoption/foster care placement is an important risk factor for PTB and may be comparable with other established risk factors for PTB including prior history of PTB, body mass index, African-American race, and advanced maternal age. More studies are needed to understand why women with placement histories may be at increased risk to deliver preterm. Copyright © 2014 Elsevier Inc. All rights reserved.

  3. Enteral iron supplementation in preterm and low birth weight infants.

    Science.gov (United States)

    Mills, Ryan John; Davies, Mark W

    2012-03-14

    Preterm infants are at risk of exhausting their body iron stores much earlier than healthy term newborns. It is widespread practice to give enteral iron supplementation to preterm and low birth weight infants to prevent iron deficiency anaemia. However, it is unclear whether supplementing preterm and low birth weight infants with iron improves growth and neurodevelopment. It is suspected that excess exogenous iron can contribute to oxidative injury in preterm babies, causing or exacerbating conditions such as necrotising enterocolitis and retinopathy of prematurity. Additionally, the optimal dose and timing of commencement and cessation of iron supplementation are uncertain. To evaluate the effect of prophylactic enteral iron supplementation on growth and neurodevelopmental outcomes in preterm and low birth weight infants. The secondary objectives were to determine whether iron supplementation results in improved haematological parameters and prevents other causes of morbidity and mortality. We used the standard search strategy of the Cochrane Neonatal Review Group. We searched Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 8), MEDLINE (1951 to August 2011), CINAHL (1982 to August 2011) and conference proceedings and previous reviews. Randomised controlled trials (RCTs) and quasi-randomised trials that compared enteral iron supplementation with no iron supplementation, or different regimens of enteral iron supplementation in preterm or low birth weight infants or both. We extracted data using the standard methods of the Cochrane Neonatal Review Group. Both review authors separately evaluated trial quality and data extraction. We synthesised data using risk ratios (RRs), risk differences (RDs) and weighted mean differences (WMDs). Where data about the methodology and results or both were lacking, we made an attempt to contact the study authors for further information. We included twenty-six studies (2726 infants) in the

  4. Late-preterm birth and lifetime socioeconomic attainments: the Helsinki birth cohort study.

    Science.gov (United States)

    Heinonen, Kati; Eriksson, Johan G; Kajantie, Eero; Pesonen, Anu-Katriina; Barker, David J; Osmond, Clive; Raikkonen, Katri

    2013-10-01

    We examined if those born late-preterm (at 34 to 36 weeks of gestation) differed from those born at term in their maximum attained lifetime socioeconomic position (SEP) across the adult years up to 56 to 66 years, and in intergenerational social mobility from childhood parental SEP to own attained SEP. Participants were 8993 Finnish men and women of the Helsinki Birth Cohort Study born between 1934 and 1944. Gestational age was extracted from hospital birth records and socioeconomic attainments from Finnish National Census. Compared with those born at term, those born late-preterm were more likely to be manual workers, have a basic or upper secondary level of education, belong to the lowest third based on their incomes, and less likely to belong to the highest third based on their incomes. Late-preterm individuals were also less likely to be upwardly mobile and more likely to be downwardly mobile; they were less likely to have higher occupations and more likely to have lower occupations than their fathers. They were also less likely to be upwardly mobile if incomes were used as the outcome of own attained SEP, and men were more likely to be downwardly mobile if education was used as the outcome of own attained SEP. This study demonstrates that there are considerable long-term socioeconomic disadvantages associated with late-preterm birth, which are not explained by the parent-of-origin SEP.

  5. Assessment of Fetal Kidney Growth and Birth Weight in an Indigenous Australian Cohort

    Directory of Open Access Journals (Sweden)

    Christopher J. Diehm

    2018-01-01

    Full Text Available Introduction: Indigenous Australians experience higher rates of renal disease and hypertension than non-Indigenous Australians. Low birth weight is recognized as a contributing factor in chronic disease and has been shown to increase the risk of renal failure in adulthood. A smaller kidney volume with fewer nephrons places an individual at risk of hypertension and renal failure. Indigenous Australians have fewer nephrons than non-Indigenous Australians. In this study, intrauterine fetal and kidney growth were evaluated in 174 Indigenous Australian babies throughout gestation in order to record and evaluate fetal growth and kidney size, within a population that is at high risk for chronic illness.Methods: Pregnant women that identified as Indigenous, or non-Indigenous women that were pregnant with a partner who identified as an Indigenous Australian were eligible to participate. Maternal history, smoking status, blood and urine samples and fetal ultrasounds were collected throughout pregnancy. Fetal kidney measurements were collected using ultrasound. Statistical analysis was performed using the Stata 14.1 software package.Results: 15.2% of babies were born prematurely. 44% of the mothers reported smoking in pregnancy. The median birth weight of this cohort was 3,240 g. Male fetuses had higher kidney to body weight ratios than female fetuses (P = 0.02. The birth weights of term neonates whose mothers smoked during pregnancy were lower (327 g, P < 0.001 than the birth weights of term babies from non-smoking mothers. The kidney volumes of babies whose mothers smoked were also smaller (P = 0.02, but were in proportion to body weight.Conclusion: In this cohort of Indigenous women smoking was associated with both increased number of preterm births and with a reduction in birth weights, even of term infants. Since kidney volume is a surrogate measure of nephron number and nephrogenesis is complete at birth, babies whose mothers smoked during pregnancy

  6. Cervical conization doubles the risk of preterm and very preterm birth in assisted reproductive technology twin pregnancies

    DEFF Research Database (Denmark)

    Pinborg, A; Ortoft, G; Loft, A

    2015-01-01

    biopsies. The main outcomes measures were PTB (PTB ≤ 37 + 0 gestational weeks), very preterm birth (VPTB ≤ 32 + 0 gestational weeks) and preterm premature rupture of membranes (PPROM). PARTICIPANTS/MATERIALS, SETTING, METHODS: In all 16 923 ART singletons and 4829 ART twin deliveries were included...

  7. Cervical hyaluronan biology in pregnancy, parturition and preterm birth.

    Science.gov (United States)

    Mahendroo, Mala

    2018-03-03

    Cervical hyaluronan (HA) synthesis is robustly induced in late pregnancy in numerous species including women and mice. Recent evidence highlights the diverse and dynamic functions of HA in cervical biology that stem from its expression in the cervical stroma, epithelia and immune cells, changes in HA molecular weight and cell specific expression of HA binding partners. Mice deficient in HA in the lower reproductive tract confirm a structural role of HA to increase spacing and disorganization of fibrillar collagen, though this function is not critical for pregnancy and parturition. In addition, cervical HA depletion via targeted deletion of HA synthase genes, disrupts cell signaling required for the differentiation of epithelia and their mucosal and junctional barrier, resulting in increased susceptibility to ascending infection-mediated preterm birth. Finally the generation of HA disaccharides by bacterial hyaluronidases as made by Group B streptococcus can ligate toll like receptors TLR2/4 thus preventing appropriate inflammatory responses as needed to fight ascending infection and preterm birth. This review summarizes our current understanding of HA's novel and unique roles in cervical remodeling in the process of birth. Copyright © 2017 International Society of Matrix Biology. Published by Elsevier B.V. All rights reserved.

  8. Antidepressant Use During Pregnancy and the Risk of Preterm Delivery and Fetal Growth Restriction

    Science.gov (United States)

    Toh, Sengwee; Mitchell, Allen A.; Louik, Carol; Werler, Martha M.; Chambers, Christina D.; Hernández-Díaz, Sonia

    2011-01-01

    Objective The associations between prenatal exposure to antidepressants and preterm delivery and fetal growth restriction are controversial and poorly understood. We studied the relation between antidepressant use and these outcomes. Methods Analysis included women with nonmalformed infants interviewed in the Slone Epidemiology Center Birth Defects Study between 1998 and 2008. We estimated odds ratios (ORs) and 95% confidence intervals (CIs) for premature and small-for–gestational age (SGA) offsprings, adjusting for sociodemographic, lifestyle, medical, and reproductive factors. Results The frequencies of preterm delivery were 7.3% among the 5710 nonusers (reference), 8.9% among the 192 selective serotonin reuptake inhibitor (SSRI) users (OR, 1.1; 95% CI, 0.6–2.0), and 15.3% among the 59 non-SSRI antidepressant users (OR, 2.2; 95% CI, 1.0–4.9); the respective frequencies of delivering an SGA offspring were 7.2%, 10.9% (OR, 1.7; 95% CI, 1.0–2.7), and 13.6% (OR, 2.2; 95% CI, 1.0–4.9). Compared with nonusers, the frequencies of preterm delivery (7.6%) and SGA offspring (5.7%) were not increased among the 106 women who discontinued SSRIs before the end of the first trimester. Among women who continued SSRIs beyond the first trimester, 10.5% delivered a preterm infant (OR, 1.3; 95% CI, 0.6–2.8) and 17.4% had an SGA offspring (OR, 3.0; 95% CI, 1.7–5.5). Conclusions Women treated with SSRIs late in pregnancy had a higher frequency of delivering SGA infants, and women receiving non-SSRI antidepressants were more likely to deliver premature and SGA offsprings. The findings suggest an effect of underlying mood disorder or an effect common to both drug classes. In any case, prenatal antidepressant use may help identify women at elevated risks of delivering preterm and SGA infants. PMID:19910720

  9. Evolving changes in fetal heart rate variability and brain injury after hypoxia-ischaemia in preterm fetal sheep.

    Science.gov (United States)

    Yamaguchi, Kyohei; Lear, Christopher A; Beacom, Michael J; Ikeda, Tomoaki; Gunn, Alistair J; Bennet, Laura

    2018-01-08

    Fetal heart rate variability is a critical index of fetal wellbeing. Suppression of heart rate variability may provide prognostic information on the risk of hypoxic-ischaemic brain injury after birth. In the present study, we report the evolution of fetal heart rate variability after both mild and severe hypoxia-ischaemia. Both mild and severe hypoxia-ischaemia were associated with an initial, brief suppression of multiple measures of heart rate variability. This was followed by normal or increased levels of heart rate variability during the latent phase of injury. Severe hypoxia-ischaemia was subsequently associated with the prolonged suppression of measures of heart rate variability during the secondary phase of injury, which is the period of time when brain injury is no longer treatable. These findings suggest that a biphasic pattern of heart rate variability may be an early marker of brain injury when treatment or intervention is probably most effective. Hypoxia-ischaemia (HI) is a major contributor to preterm brain injury, although there are currently no reliable biomarkers for identifying infants who are at risk. We tested the hypothesis that fetal heart rate (FHR) and FHR variability (FHRV) would identify evolving brain injury after HI. Fetal sheep at 0.7 of gestation were subjected to either 15 (n = 10) or 25 min (n = 17) of complete umbilical cord occlusion or sham occlusion (n = 12). FHR and four measures of FHRV [short-term variation, long-term variation, standard deviation of normal to normal R-R intervals (SDNN), root mean square of successive differences) were assessed until 72 h after HI. All measures of FHRV were suppressed for the first 3-4 h in the 15 min group and 1-2 h in the 25 min group. Measures of FHRV recovered to control levels by 4 h in the 15 min group, whereas the 25 min group showed tachycardia and an increase in short-term variation and SDNN from 4 to 6 h after occlusion. The measures of FHRV then progressively

  10. Folic acid supplementation, dietary folate intake and risk of preterm birth in China.

    Science.gov (United States)

    Liu, Xiaohui; Lv, Ling; Zhang, Hanru; Zhao, Nan; Qiu, Jie; He, Xiaochun; Zhou, Min; Xu, Xiaoying; Cui, Hongmei; Liu, Sufen; Lerro, Catherine; Lin, Xiaojuan; Zhang, Chong; Zhang, Honghong; Xu, Ruifeng; Zhu, Daling; Dang, Yun; Han, Xudong; Bai, Haiya; Chen, Ya; Tang, Zhongfeng; Lin, Ru; Yao, Tingting; Su, Jie; Wang, Wendi; Wang, Yueyuan; Ma, Bin; Huang, Huang; Liang, Jiaxin; Qiu, Weitao; Liu, Qing; Zhang, Yawei

    2016-06-01

    Folic acid supplementation has been suggested to reduce the risk of preterm birth. However, results from previous epidemiologic studies have been inconclusive. We investigated the hypothesis that folic acid supplementation and dietary folate intake during pre- and post-conception reduces the risk of preterm birth. We analyzed data from a birth cohort study conducted between 2010 and 2012 in Lanzhou, China, including 10,179 pregnant women with live singleton births. Compared to non-users, folic acid supplement users with >12-week duration had a reduced risk of preterm birth (OR 0.67, 95 % CI 0.55-0.83) with a significant dose-response relationship (P for trend = 0.01). A similar pattern was observed for spontaneous preterm birth. Stronger associations were seen for ever use of folic acid supplement and very preterm birth (OR 0.50, 95 % CI 0.36-0.69) and spontaneous very preterm birth (OR 0.42, 95 % CI 0.29-0.63). Dietary folate intake during preconception and pregnancy were also associated with reduced risk of preterm birth (OR 0.68, 95 % CI 0.56-0.83, OR 0.57, 95 % CI 0.47-0.70 for the highest quartiles, respectively), particularly for spontaneous very preterm (OR 0.41, 95 % CI 0.24-0.72, OR 0.26, 95 % CI 0.15-0.47 for the highest quartiles, respectively). There were also decreased risks of preterm birth observed per 10-µg increase in dietary folate intake, and similar associations were found after stratification by folic acid supplementation status. Our results suggest that folic acid supplementation and higher dietary folate intake during preconception and pregnancy reduces the risk of preterm birth, and the protective effect varies by preterm subtypes.

  11. Loss of cannabinoid receptor CB1 induces preterm birth.

    Directory of Open Access Journals (Sweden)

    Haibin Wang

    2008-10-01

    Full Text Available Preterm birth accounting approximate 10% of pregnancies in women is a tremendous social, clinical and economic burden. However, its underlying causes remain largely unknown. Emerging evidence suggests that endocannabinoid signaling via cannabinoid receptor CB1 play critical roles in multiple early pregnancy events in both animals and humans. Since our previous studies demonstrated that loss of CB1 defers the normal implantation window in mice, we surmised that CB1 deficiency would influence parturition events.Exploiting mouse models with targeted deletion of Cnr1, Cnr2 and Ptgs1 encoding CB1, CB2 and cyclooxygenase-1, respectively, we examined consequences of CB1 or CB2 silencing on the onset of parturition. We observed that genetic or pharmacological inactivation of CB1, but not CB2, induced preterm labor in mice. Radioimmunoassay analysis of circulating levels of ovarian steroid hormones revealed that premature birth resulting from CB1 inactivation is correlated with altered progesterone/estrogen ratios prior to parturition. More strikingly, the phenotypic defects of prolonged pregnancy length and parturition failure in mice missing Ptgs1 were corrected by introducing CB1 deficiency into Ptgs1 null mice. In addition, loss of CB1 resulted in aberrant secretions of corticotrophin-releasing hormone and corticosterone during late gestation. The pathophysiological significance of this altered corticotrophin-releasing hormone-driven endocrine activity in the absence of CB1 was evident from our subsequent findings that a selective corticotrophin-releasing hormone antagonist was able to restore the normal parturition timing in Cnr1 deficient mice. In contrast, wild-type females receiving excessive levels of corticosterone induced preterm birth.CB1 deficiency altering normal progesterone and estrogen levels induces preterm birth in mice. This defect is independent of prostaglandins produced by cyclooxygenase-1. Moreover, CB1 inactivation resulted in

  12. Fetal MRI for prediction of neonatal mortality following preterm premature rupture of the fetal membranes

    Energy Technology Data Exchange (ETDEWEB)

    Messerschmidt, Agnes; Sauer, Alexandra; Pollak, Arnold [Medical University of Vienna, Department of Pediatrics and Adolescent Medicine, Vienna (Austria); Pataraia, Anna; Kasprian, Gregor; Weber, Michael; Prayer, Daniela [Medical University of Vienna, Department of Radiology, Vienna (Austria); Helmer, Hanns [Medical University of Vienna, Department of Obstetrics and Maternal-Fetal Medicine, Vienna (Austria); Brugger, Peter C. [Medical University of Vienna, Center of Anatomy and Cell Biology, Vienna (Austria)

    2011-11-15

    Lung MRI volumetrics may be valuable for fetal assessment following early preterm premature rupture of the foetal membranes (pPROM). To evaluate the predictive value of MRI lung volumetrics after pPROM. Retrospective cohort study of 40 fetuses after pPROM in a large, tertiary, perinatal referral center. Fetuses underwent MRI lung volumetrics. Estimated lung volume was expressed as percentage of expected lung volume (our own normal references). Primary outcome was neonatal mortality due to respiratory distress before discharge from hospital. Gestational age range was 16-27 weeks. Estimated-to-expected lung volume was 73% in non-survivors and 102% in survivors (P < 0.05). There were no survivors with a lung volume less than 60% of expected. By logistic regression, mortality could be predicted with a sensitivity of 80%, specificity of 86% and accuracy of 85%. Fetal MR lung volumetrics may be useful for predicting mortality due to respiratory distress in children with early gestational pPROM. (orig.)

  13. Fetal MRI for prediction of neonatal mortality following preterm premature rupture of the fetal membranes

    International Nuclear Information System (INIS)

    Messerschmidt, Agnes; Sauer, Alexandra; Pollak, Arnold; Pataraia, Anna; Kasprian, Gregor; Weber, Michael; Prayer, Daniela; Helmer, Hanns; Brugger, Peter C.

    2011-01-01

    Lung MRI volumetrics may be valuable for fetal assessment following early preterm premature rupture of the foetal membranes (pPROM). To evaluate the predictive value of MRI lung volumetrics after pPROM. Retrospective cohort study of 40 fetuses after pPROM in a large, tertiary, perinatal referral center. Fetuses underwent MRI lung volumetrics. Estimated lung volume was expressed as percentage of expected lung volume (our own normal references). Primary outcome was neonatal mortality due to respiratory distress before discharge from hospital. Gestational age range was 16-27 weeks. Estimated-to-expected lung volume was 73% in non-survivors and 102% in survivors (P < 0.05). There were no survivors with a lung volume less than 60% of expected. By logistic regression, mortality could be predicted with a sensitivity of 80%, specificity of 86% and accuracy of 85%. Fetal MR lung volumetrics may be useful for predicting mortality due to respiratory distress in children with early gestational pPROM. (orig.)

  14. What Treatments Can Reduce the Chances of Preterm Labor and Birth?

    Science.gov (United States)

    ... treatments can reduce the chances of preterm labor & birth? If a pregnant woman is showing signs of ... to stop labor (tocolytics) and medications administered before birth to improve outcomes for the infant if born ...

  15. Expectant management of severe preterm preeclampsia: a comparison of maternal and fetal indications for delivery.

    Science.gov (United States)

    Mooney, Samantha S; Lee, Rilka M; Tong, Stephen; Brownfoot, Fiona C

    2016-12-01

    To examine the delivery indication (maternal or fetal) for patients with preterm preeclampsia and assess whether disease characteristics at presentation are predictive of delivery indication. We conducted a retrospective cohort study at a tertiary hospital in Melbourne, Australia (Mercy Hospital for Women). We assessed indication for delivery for participants presenting with preeclampsia from 23(+0) to 32(+6) weeks gestation. We compared baseline disease characteristics, disease features at delivery and postnatal outcomes between those delivered for maternal or fetal indications, or for both maternal and fetal indications. Two hundred sixty six participants presented with preterm preeclampsia and 108 were eligible for inclusion in our study. More participants were delivered for maternal indications at 65.7% compared to those requiring delivery on fetal grounds at 19.4% or for both indications at 14.8% (p preeclampsia were predominantly delivered due to maternal disease progression compared to fetal compromise.

  16. Global report on preterm birth and stillbirth (1 of 7): definitions, description of the burden and opportunities to improve data.

    Science.gov (United States)

    Lawn, Joy E; Gravett, Michael G; Nunes, Toni M; Rubens, Craig E; Stanton, Cynthia

    2010-02-23

    This is the first of seven articles from a preterm birth and stillbirth report. Presented here is an overview of the burden, an assessment of the quality of current estimates, review of trends, and recommendations to improve data. Few countries have reliable national preterm birth prevalence data. Globally, an estimated 13 million babies are born before 37 completed weeks of gestation annually. Rates are generally highest in low- and middle-income countries, and increasing in some middle- and high-income countries, particularly the Americas. Preterm birth is the leading direct cause of neonatal death (27%); more than one million preterm newborns die annually. Preterm birth is also the dominant risk factor for neonatal mortality, particularly for deaths due to infections. Long-term impairment is an increasing issue. Stillbirths are currently not included in Millennium Development Goal tracking and remain invisible in global policies. For international comparisons, stillbirths include late fetal deaths weighing more than 1000g or occurring after 28 weeks gestation. Only about 2% of all stillbirths are counted through vital registration and global estimates are based on household surveys or modelling. Two global estimation exercises reached a similar estimate of around three million annually; 99% occur in low- and middle-income countries. One million stillbirths occur during birth. Global stillbirth cause-of-death estimates are impeded by multiple, complex classification systems. (1) increase the capture and quality of pregnancy outcome data through household surveys, the main data source for countries with 75% of the global burden; (2) increase compliance with standard definitions of gestational age and stillbirth in routine data collection systems; (3) strengthen existing data collection mechanisms--especially vital registration and facility data--by instituting a standard death certificate for stillbirth and neonatal death linked to revised International

  17. Prevention of preterm birth based on short cervix: symptomatic women with preterm labor or premature prelabor rupture of membranes.

    Science.gov (United States)

    Ness, Amen

    2009-10-01

    The diagnosis of preterm labor (PTL) is challenging, especially in women whose cervical dilatation is 15 mm. Transvaginal ultrasound CL can also be performed in the presence of ruptured membranes and predicts latency. Although additional data are needed, the evidence so far suggests that the use of transvaginal ultrasound CL and fetal fibronectin can be used to better identify and manage women with PTL likely to have an imminent preterm delivery, and to avoid interventions in women who would not.

  18. Evaluation of proteomic biomarkers associated with circulating microparticles as an effective means to stratify the risk of spontaneous preterm birth.

    Science.gov (United States)

    Cantonwine, David E; Zhang, Zhen; Rosenblatt, Kevin; Goudy, Kevin S; Doss, Robert C; Ezrin, Alan M; Page, Gail; Brohman, Brian; McElrath, Thomas F

    2016-05-01

    The analysis of circulating microparticles in pregnancy is of revolutionary potential because it represents an in vivo biopsy of active gestational tissues. We hypothesized that circulating microparticle signaling will differ in pregnancies that experience spontaneous preterm birth from those delivering at term and that these differences will be evident many weeks in advance of clinical presentation. Utilizing plasma specimens obtained between 10 and 12 weeks' gestation as part of a prospectively collected birth cohort in which pregnancy outcomes are independently validated by 2 board-certified maternal-fetal medicine physicians, 25 singleton cases of spontaneous preterm birth ≤ 34 weeks were matched by maternal age, race, and gestational age of sampling (±2 weeks) with 50 uncomplicated term deliveries. Circulating microparticles from these first-trimester specimens were isolated and analyzed by multiple reaction monitoring mass spectrometry for potential protein biomarkers following previous studies. Markers with robust univariate performance in correlating spontaneous preterm birth were further evaluated for their biological relevance via a combined functional profiling/pathway analysis and for multivariate performance. Among the 132 proteins evaluated, 62 demonstrated robust power of detecting spontaneous preterm birth in a bootstrap receiver-operating characteristic curve analysis at a false discovery rate of deliver spontaneously ≤ 34 weeks. These changes, with further validation, will allow the stratification of patients at risk of spontaneous preterm birth before clinical presentation. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Association between air pollution and preterm birth among neonates born in Isfahan, Iran

    Directory of Open Access Journals (Sweden)

    Mohsen Janghorbani

    2013-01-01

    Full Text Available Background: Although several studies have investigated the association between maternal exposure to air pollution and preterm birth, the results are inconsistent. The aim of this study was to further investigate the relation between maternal exposure to ambient air pollution during pregnancy and the risk of preterm birth and low birth weight (LBW in an Iranian pregnant population. Materials and Methods: In this study, we identified 4758 consecutive singleton birth records from one large referral hospital (2010-2012 in Isfahan, Iran. We identified cases of preterm birth and LBW, which were combined with meteorological and air pollution monitoring data. We estimated the effect of air pollution exposure during the entire pregnancy, each trimester, and last month, and preterm birth (gestational age <37 weeks and LBW (<2500 g by Pollutant Standard Index (PSI using logistic regression adjusted for gestational age, neonate gender, birth order, and mother′s age. Results: The PSI for entire pregnancy was significantly associated with preterm birth [Odds Ratio (95% CI = 1.26 (1.20, 1.33]. There was no association between maternal exposure to ambient air pollution and each trimester and the last month of pregnancy, and preterm birth or LBW. Conclusion: Maternal exposure to ambient air pollution during the entire pregnancy was associated with preterm birth in Isfahani women.

  20. Trends in preterm birth in singleton deliveries in a Hong Kong population

    NARCIS (Netherlands)

    Hui, Annie S. Y.; Lao, Terence T.; Leung, Tak Yeung; Schaaf, Jelle M.; Sahota, Daljit S.

    2014-01-01

    To examine trends in preterm birth and its relationship with perinatal mortality in Hong Kong. In a retrospective cohort study, data were reviewed from singletons delivered between 1995 and 2011 at a university teaching hospital. Trends in preterm birth (between 24 and 36 weeks of pregnancy),

  1. Antiplatelet Agents and the Prevention of Spontaneous Preterm Birth A Systematic Review and Meta-analysis

    NARCIS (Netherlands)

    van Vliet, Elvira O. G.; Askie, Lisa A.; Mol, Ben W. J.; Oudijk, Martijn A.

    2017-01-01

    OBJECTIVE: Spontaneous preterm birth is an important cause of neonatal mortality and morbidity. An increasing body of evidence suggests that uteroplacental ischemia plays an important role in the etiology of spontaneous preterm birth. We aimed to study whether antiplatelet agents reduce the risk of

  2. Systematic review of progesterone for the prevention of preterm birth in singleton pregnancies

    DEFF Research Database (Denmark)

    Rode, Line; Langhoff-Roos, Jens; Andersson, Charlotte

    2009-01-01

    BACKGROUND: A Cochrane review in 2006 concluded that further knowledge is required before recommendation can be made with regard to progesterone in the prevention of preterm birth. OBJECTIVE: To provide an update on the preventive effect of progesterone on preterm birth in singleton pregnancies. ...

  3. Blood Pressure in Young Adults Born at Very Low Birth Weight: Adults Born Preterm International Collaboration

    NARCIS (Netherlands)

    Hovi, P.; Vohr, B.; Ment, L.R.; Doyle, L.W.; McGarvey, L.; Morrison, K.M.; Evensen, K.A.I.; Pal, S. van der; Grunau, R.E.; Brubakk, A.M.; Andersson, S.; Saigal, S.; Kajantie, E.

    2016-01-01

    Adults born preterm at very low birth weight (VLBW; <1500 g) have higher blood pressure than those born at term. It is not known whether all VLBW adults are at risk or whether higher blood pressure could be attributed to some of the specific conditions underlying or accompanying preterm birth. To

  4. Characteristics and risk factors of preterm births in a tertiary center in ...

    African Journals Online (AJOL)

    Introduction: preterm birth is a dire complication of pregnancy that poses huge long-term medical and financial burdens for affected children, their families, and the health care system. The aim of the present study was to identify characteristics associated with preterm births at the Lagos University Teaching Hospital (LUTH), ...

  5. Species of fine particulate matter and the risk of preterm birth

    Science.gov (United States)

    Particulate matter (PM) has been variably associated with preterm birth (PTB), but the roles of PM species have been less studied. We estimated risk of birth in 4 preterm categories (risks reported as PTBs per 106 pregnancies; PTB categories = gestational age of 20-27; 28-31; 32-...

  6. Socioeconomic position and the risk of preterm birth--a study within the Danish National Birth Cohort

    DEFF Research Database (Denmark)

    Morgen, Camilla Schmidt; Bjørk, Christina; Andersen, Per Kragh

    2008-01-01

    BACKGROUND: Low socioeconomic position is generally associated with increased risk of preterm birth, but it remains unclear whether the inequality depends on the socioeconomic measure used, if the associations differ according to the degree of prematurity, and how individual level risk factors...... mediate the association. METHODS: The hazard ratios (HR) of preterm birth associated with five different measures of socioeconomic position and three degrees of preterm birth were analysed in a dataset of 75 890 singleton pregnancies (1996-2002) from the Danish National Birth Cohort. This......, and the mediating role of selected individual level risk factors (smoking, alcohol consumption, binge drinking, pre-pregnancy body mass index, gestational weight gain) were estimated, using Cox regression analyses. RESULTS: Mothers with preterm birth compared...

  7. Role of Perceived Stress on the Occurrence of Preterm Labor and Preterm Birth among Urban Women

    Science.gov (United States)

    Seravalli, Laura; Patterson, Freda; Nelson, Deborah B.

    2013-01-01

    Introduction This study examined whether prenatal perceived stress levels during pregnancy were associated with preterm labor (PTL) or preterm birth (PTB). Methods Perceived stress levels were measured at 16 weeks gestation or less and between 20 and 24 weeks gestation in a sample of 1,069 low-income pregnant women attending Temple University prenatal care clinics. Scores were averaged to create a single measure of prenatal stress. PTB was defined as the occurrence of a spontaneous birth prior to 37 weeks gestation. PTL was defined as the occurrence of regular contractions between 20 and 37 weeks of pregnancy that were associated with changes in the cervix. Results Independent of potential confounding factors, prenatal perceived stress was not associated with PTL (OR 1.10; 95% CI 0.69-1.78, P = .66); however, prenatal stress trended toward an association with PTB (OR 1.49; 95% CI: 1.00-2.23, P =.05). The strongest predictor of preterm labor was a history of preterm labor in a prior pregnancy. Women with a history of PTL were two times more likely to experience PTL in the current pregnancy than women who did not have a PTL history (OR 2.16; 95% CI 1.05-4.41, P =.04). Historical risk factors of PTB, such as African American race, a history of abortion or a history of PTB were not related to PTL. The strongest predictor of PTB was having a history of PTB in a prior pregnancy (OR 2.55; 95% CI 1.54-4.24, P stress levels may be a risk factor for PTB independent of PTL; however, prenatal stress was not associated with PTL. Risk factors for PTL may be different from those of PTB. PMID:24890400

  8. Preterm birth rates in Japan from 1979 to 2014: Analysis of national vital statistics.

    Science.gov (United States)

    Sakata, Soyoko; Konishi, Shoko; Ng, Chris Fook Sheng; Watanabe, Chiho

    2018-03-01

    Secular trends of preterm birth in Japan between 1979 and 2014 were examined to determine whether changes could be explained by a shift in the distribution of maternal age at delivery and parity and/or by changes in age-specific preterm birth rates. Live birth data for 1979 to 2014 were obtained from the Japanese Ministry of Health, Labour and Welfare. Analyses were limited to singleton children born in Japan (n = 43 632 786). Preterm birth was defined using two cut-offs at < 37 or < 34 weeks of gestation. Crude and standardized rates of preterm birth were calculated for firstborn and later-born singletons by maternal age at delivery for specific time periods. Throughout the study period, the rates of preterm birth (both at < 37 and < 34 weeks of gestation) were higher among mothers aged 20 and younger, and mid-30s and older, compared to mothers in their 20s or early 30s. The rates of preterm birth at < 37 (but not at < 34) weeks decreased for mothers aged in their late 30s and 40s, and increased for mothers in their 20s and early 30s. Standardized rates of preterm birth showed a secular increase for preterm births at < 37 but not < 34 weeks of gestation. The rates of preterm birth among mothers aged in their 20s and early 30s increased between 1979 and 2014, which contributed to the secular increase in rates of preterm birth at < 37 weeks. © 2017 Japan Society of Obstetrics and Gynecology.

  9. Early preterm delivery due to placenta previa is an independent risk factor for a subsequent spontaneous preterm birth

    Directory of Open Access Journals (Sweden)

    Erez Offer

    2012-08-01

    Full Text Available Abstract Background To determine whether patients with placenta previa who delivered preterm have an increased risk for recurrent spontaneous preterm birth. Methods This retrospective population based cohort study included patients who delivered after a primary cesarean section (n = 9983. The rate of placenta previa, its recurrence, and the risk for recurrent preterm birth were determined. Results Patients who had a placenta previa at the primary CS pregnancy had an increased risk for its recurrence [crude OR of 2.65 (95% CI 1.3-5.5]. The rate of preterm birth in patients with placenta previa in the primary CS pregnancy was 55.9%; and these patients had a higher rate of recurrent preterm delivery than the rest of the study population (p Conclusions Women with placenta previa, who deliver preterm, especially before 34 weeks of gestation, are at increased risk for recurrent spontaneous preterm birth regardless to the site of placental implantation in the subsequent pregnancy. Thus, strict follow up by high risk pregnancies specialist is recommended.

  10. The Effect of Prior Term Birth on Risk of Recurrent Spontaneous Preterm Birth.

    Science.gov (United States)

    Purisch, Stephanie E; Turitz, Amy L; Elovitz, Michal A; Levine, Lisa D

    2018-03-01

     The objective of this study was to evaluate the effect of prior term birth on recurrent spontaneous preterm birth (sPTB) risk.  Retrospective cohort study of 211 women with prior sPTB, comparing women with and without prior term births. The primary outcome was recurrent sPTB term births (28.9 vs. 37.7%, p  = 0.2). Among women with prior second-trimester loss (16-23 6/7 weeks), those with a term birth had a decreased sPTB rate (15.4 vs. 43.2%, p  = 0.02), which persisted after adjusting for age and 17-α hydroxyprogesterone caproate use. For women with prior sPTB ≥24 weeks, there was no difference in sPTB with and without prior term births (29.5 vs. 26.6%, p  = 0.7). A term birth as the most recent delivery lowered, but did not eliminate, the sPTB risk (19.1 vs. 36.4%, p  = 0.1).  Prior term birth lowers the risk of recurrent sPTB for women with prior second-trimester loss, but not for women with prior sPTB ≥24 weeks. Women with prior preterm and term births should be counseled accordingly and all sPTB prevention strategies should be recommended. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  11. Divergence of estimated fetal weight and birth weight in singleton fetuses.

    Science.gov (United States)

    Sotiriadis, Alexandros; Eleftheriades, Makarios; Papadopoulos, Vassileios; Sarafidis, Kosmas; Pervanidou, Panagiota; Assimakopoulos, Efstratios

    2018-03-01

    To evaluate differences in distribution of estimated fetal weight (EFW) and birth weight (BW) of ongoing fetuses and neonates of the same gestational age. Reference curves for EFW (Hadlock BPD-HC-AC-FL formula, N = 1191) and BW (N = 1036) in singleton pregnancies from 24 +0 to 40 +6 gestational weeks were calculated. Multiple pregnancies, fetuses with major or multiple abnormalities or syndromes and iatrogenic preterm deliveries due to preeclampsia or abnormal fetal Doppler were excluded. The standardized residuals for EFW and BW were calculated and compared. EFW and BW can be accurately described by quadratic equations (R 2  = 0.944 and 0.807, respectively). The distribution of standardized residuals for BW using the EFW formula was negative from 28 +0 to 35 +6 weeks. The 50th and 5th centiles of BW were lower than those of EFW throughout prematurity, and they converged at approximately 38 gestational weeks. The 5th centile for BW was 30% lower than the 5th centile for EFW at 27 weeks, 27.5% lower at 30 weeks and 19.4% at 34 weeks. Preterm infants have lower BW distribution compared to the expected EFW of ongoing pregnancies of the same gestational age, supporting the concept of hidden intrauterine morbidity for a proportion of these infants.

  12. Divergent Patterns of Mitochondrial and Nuclear Ancestry Are Associated with the Risk for Preterm Birth.

    Science.gov (United States)

    Crawford, Nicholas; Prendergast, D'Arcy; Oehlert, John W; Shaw, Gary M; Stevenson, David K; Rappaport, Nadav; Sirota, Marina; Tishkoff, Sarah A; Sondheimer, Neal

    2018-03-01

    To examine linkages between mitochondrial genetics and preterm birth by assessing the risk for preterm birth associated with the inheritance of nuclear haplotypes that are ancestrally distinct from mitochondrial haplogroup. Genome-wide genotyping studies of cohorts of preterm and term individuals were evaluated. We determined the mitochondrial haplogroup and nuclear ancestry for individuals and developed a scoring for the degree to which mitochondrial ancestry is divergent from nuclear ancestry. Infants with higher degrees of divergent mitochondrial ancestry were at increased risk for preterm birth (0.124 for preterm vs 0.105 for term infants; Pancestry correlated with earlier delivery within the primary study population, but this finding was not replicated in secondary cohorts born preterm. Individuals with divergent patterns of mitochondrial and nuclear ancestry are at increased risk for preterm birth. These findings may in part explain the higher rates of preterm birth in African Americans and in individuals with a matrilineal family history of preterm birth. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Article Commentary: Activity in Pregnancy for Patients with a History of Preterm Birth

    Directory of Open Access Journals (Sweden)

    Nichelle Satterfield

    2016-01-01

    Full Text Available Preterm birth remains a leading cause of neonatal morbidity and mortality throughout the world. Numerous risk factors for preterm birth have been identified, including non-Hispanic black race, a variety of social and behavioral factors, infections, and history of a prior preterm delivery. Of these, a history of prior spontaneous preterm birth is one of the strongest risk factors. Traditionally, women with a history of preterm birth or those deemed at high risk for preterm delivery have been placed on bed rest or a reduced activity regimen during their pregnancy. However, there is little evidence to support this recommendation. Recent research has suggested that regular physical activity and exercise during pregnancy is safe and does not increase the risk of preterm delivery. Therefore, physicians should encourage women with a history of preterm birth to exercise throughout pregnancy according to guidelines published by the American College of Obstetricians and Gynecologists as long as they are receiving regular prenatal care and their current health status permits exercise. However, there are no randomized controlled trials evaluating exercise prescription in women with a history of preterm birth, hence additional research is needed in this area.

  14. Mass Spectrometry-Based Proteomics for Pre-Eclampsia and Preterm Birth

    Directory of Open Access Journals (Sweden)

    Kai P. Law

    2015-05-01

    Full Text Available Pregnancy-related complications such as pre-eclampsia and preterm birth now represent a notable burden of adverse health. Pre-eclampsia is a hypertensive disorder unique to pregnancy. It is an important cause of maternal death worldwide and a leading cause of fetal growth restriction and iatrogenic prematurity. Fifteen million infants are born preterm each year globally, but more than one million of those do not survive their first month of life. Currently there are no predictive tests available for diagnosis of these pregnancy-related complications and the biological mechanisms of the diseases have not been fully elucidated. Mass spectrometry-based proteomics have all the necessary attributes to provide the needed breakthrough in understanding the pathophysiology of complex human diseases thorough the discovery of biomarkers. The mass spectrometry methodologies employed in the studies for pregnancy-related complications are evaluated in this article. Top-down proteomic and peptidomic profiling by laser mass spectrometry, liquid chromatography or capillary electrophoresis coupled to mass spectrometry, and bottom-up quantitative proteomics and targeted proteomics by liquid chromatography mass spectrometry have been applied to elucidate protein biomarkers and biological mechanism of pregnancy-related complications. The proteomes of serum, urine, amniotic fluid, cervical-vaginal fluid, placental tissue, and cytotrophoblastic cells have all been investigated. Numerous biomarkers or biomarker candidates that could distinguish complicated pregnancies from healthy controls have been proposed. Nevertheless, questions as to the clinically utility and the capacity to elucidate the pathogenesis of the pre-eclampsia and preterm birth remain to be answered.

  15. Mass Spectrometry-Based Proteomics for Pre-Eclampsia and Preterm Birth

    Science.gov (United States)

    Law, Kai P.; Han, Ting-Li; Tong, Chao; Baker, Philip N.

    2015-01-01

    Pregnancy-related complications such as pre-eclampsia and preterm birth now represent a notable burden of adverse health. Pre-eclampsia is a hypertensive disorder unique to pregnancy. It is an important cause of maternal death worldwide and a leading cause of fetal growth restriction and iatrogenic prematurity. Fifteen million infants are born preterm each year globally, but more than one million of those do not survive their first month of life. Currently there are no predictive tests available for diagnosis of these pregnancy-related complications and the biological mechanisms of the diseases have not been fully elucidated. Mass spectrometry-based proteomics have all the necessary attributes to provide the needed breakthrough in understanding the pathophysiology of complex human diseases thorough the discovery of biomarkers. The mass spectrometry methodologies employed in the studies for pregnancy-related complications are evaluated in this article. Top-down proteomic and peptidomic profiling by laser mass spectrometry, liquid chromatography or capillary electrophoresis coupled to mass spectrometry, and bottom-up quantitative proteomics and targeted proteomics by liquid chromatography mass spectrometry have been applied to elucidate protein biomarkers and biological mechanism of pregnancy-related complications. The proteomes of serum, urine, amniotic fluid, cervical-vaginal fluid, placental tissue, and cytotrophoblastic cells have all been investigated. Numerous biomarkers or biomarker candidates that could distinguish complicated pregnancies from healthy controls have been proposed. Nevertheless, questions as to the clinically utility and the capacity to elucidate the pathogenesis of the pre-eclampsia and preterm birth remain to be answered. PMID:26006232

  16. Association of maternal CNVs in GSTT1/GSTT2 with smoking, preterm delivery, and low birth weight

    Directory of Open Access Journals (Sweden)

    Xiaojing eZheng

    2013-10-01

    Full Text Available Preterm delivery (PTD is an adverse birth outcome associated with increased infant mortality and negative lifelong health consequences. PTD may be the result of interactions between genetics and maternal/fetal environmental factors including smoking exposure (SMK. A common deletion in the GSTT1 gene was previously reported to affect birth outcomes in smokers. In this study, we dissect the associations among SMK, birth outcomes, and copy number variations (CNVs in the GSTT1/GSTT2 region.A preterm birth case-control dataset of 1937 mothers was part of the GENEVA preterm birth study, which included genome-wide genotyping used to identify CNVs. We examined the association of SMK with birth outcomes, detected CNVs within the GSTT1/GSTT2 region using PennCNV, and examined associations of the identified CNVs with preterm birth and with birth weight (BW in full term birth controls, including interactions with SMK. Finally, we tested the association of CNVs in GSTT1/GSTT2 with SMK.We confirmed the association of smoking with low BW and PTD. We identified 2 CNVs in GSTT2 (GSTT2a and GSTT2b, 1 CNV in GSTTP1 and 2 CNVs in GSTT1 (GSTT1a and GSTT1b. The GSTT2a deletion was associated with reduced BW (-284g, p=2.5E-7 in smokers, and was more common in smokers (odds ratio[OR]=1.3, p=0.036. We found that the size of the reported common deletion CNV in GSTT1 was larger than previously shown. The GSTTP1 and GSTT1b null genotypes were in high linkage disequilibrium (LD (D’=0.89 and less common in smokers (OR=0.68, p=0.019 and OR=0.73, p=0.055 respectively. These two deletions were in partial LD with GSTT2a and GSTT2b duplications. All 5 CNVs seem to be associated with increased risk of preterm birth before 35 completed weeks.CNVs in the GSTTT1/GSTT2 region appear associated with low BW and PTD outcomes, but LD complicated these CNVs in GSTT1/GSTT2. In genetic association studies of BW, multiple CNVs in this region need to be investigated instead of a single

  17. Maternal haemoglobin concentration and risk of preterm birth in a Chinese population.

    Science.gov (United States)

    Zhang, Yiting; Li, Zhiwen; Li, Hongtian; Jin, Lei; Zhang, Yali; Zhang, Le; Liu, Jufen; Ye, Rongwei; Liu, Jianmeng; Ren, Aiguo

    2018-01-01

    The aim was to examine the relationship between maternal haemoglobin (Hb) concentrations and risk of preterm birth by secondary analysis of data from a randomised controlled trial. This analysis included 10,430 women who were at least 20 years old and no more than 20 weeks of gestation. Results revealed neither first- nor second-trimester Hb concentrations were associated with the risk of preterm births. However, the risk of preterm birth increased when the Hb level was low (preterm birth. A low-Hb level in the first trimester but coupled with a high Hb level in the second was associated with an elevated risk of preterm birth. Impact statement What is already known on this subject: The relationship between maternal Hb concentration and preterm birth remains inconclusive. Some studies have shown an association between a low- or a high-Hb level and an increased risk of preterm birth. Others have not found such an association. Yet others have shown a U-shaped relationship. What do the results of this study add: Overall, maternal Hb concentrations in first or second trimester were not statistically associated with the risk of preterm birth. However, women with a low Hb concentration in the first trimester together with a high Hb concentration in the second trimester had an increased risk of preterm birth, compared to women who had a higher Hb concentration in the first trimester that remained similar during the second trimester. What are the implications are of these findings for clinical practice and/or further research: Our finding helps identify mothers who are at risk of having a preterm delivery. Investigating the underlying clinical causes of the unfavourable change in Hb levels and close follow-up to these women may help improve birth outcomes.

  18. Resistin levels in preterms: are they influenced by fetal inflammatory course?

    Science.gov (United States)

    Gursoy, T; Aliefendioglu, D; Caglayan, O; Aktas, A; Ovali, F

    2011-03-01

    Many different factors are involved in the pathogenesis of preterm deliveries and among them maternal or perinatal infections and inflammatory response have the major role. Researches were carried out about resistin, which is thought to have a role in inflammatory cytokine cycle and it was shown to be associated with growth in neonates. However, no research has been carried out showing its relationship with inflammation in neonates. In this study, we aimed to evaluate the resistin levels in premature neonates and the effect of events such as preterm prelabour rupture of the membranes (PPROMs) and the use of antenatal steroids on these levels. The study included 118 preterm neonates. Their medical data together with their mothers' were recorded. Serum resistin levels together with interleukin (IL)-6, C-reactive protein (CRP) and procalcitonin were evaluated in the first 2 h of life. Mean gestational age and birth weight of babies included in the study were 29.6 ± 2.7 weeks and 1306.4 ± 393.4 g, respectively. Babies with PPROMs had significantly higher levels of resistin ((n=30); 70.7 (7.8 to 568.4) ng ml(-1)) than babies without PPROM ((n=88); 25.9 (5.5 to 528.9) ng ml(-1)) (P=0.005), and the babies of mothers who received antenatal steroids had significantly lower resistin levels ((n=44); 20.8 (5.5 to 159.9) ng ml(-1)) than the babies of mothers who did not ((n=66); 34.6 (7.2 to 568.4) ng ml(-1)) (P=0.015). There were significant correlations between resistin and IL-6 levels and between IL-6 and procalcitonin and CRP levels in babies whose mothers did not receive antenatal steroids. However, no correlation was found between these parameters in babies whose mothers received antenatal steroids. Preterm delivery and PPROM involve complex cascade of events including inflammation, and steroids are potent anti-inflammatory agents. Elevated resistin levels in babies with PPROM and suppressed levels in babies whose mothers received antenatal steroids reported in this

  19. Use of nonhuman primate models to investigate mechanisms of infection-associated preterm birth

    Science.gov (United States)

    Adams Waldorf, Kristina M.; Rubens, Craig E.; Gravett, Michael G.

    2010-01-01

    Preterm birth is the most important direct cause of neonatal mortality and remains a major challenge for obstetrics and global health. Intrauterine infection causes approximately 50% of early preterm births. Animal models using pregnant mice, rabbits, or sheep, demonstrate the key link between infection and premature birth, but differ in mechanisms of parturition and placental structure from humans. The nonhuman primate (NHP) is a powerful model which emulates many features of human placentation and parturition. The contributions of the NHP model to preterm birth research are reviewed emphasizing the role of infections, and potential development of preventative and therapeutic strategies. PMID:21040390

  20. Socioeconomic position and the risk of preterm birth--a study within the Danish National Birth Cohort.

    Science.gov (United States)

    Morgen, Camilla Schmidt; Bjørk, Christina; Andersen, Per Kragh; Mortensen, Laust Hvas; Nybo Andersen, Anne-Marie

    2008-10-01

    Low socioeconomic position is generally associated with increased risk of preterm birth, but it remains unclear whether the inequality depends on the socioeconomic measure used, if the associations differ according to the degree of prematurity, and how individual level risk factors mediate the association. The hazard ratios (HR) of preterm birth associated with five different measures of socioeconomic position and three degrees of preterm birth were analysed in a dataset of 75 890 singleton pregnancies (1996-2002) from the Danish National Birth Cohort. This, and the mediating role of selected individual level risk factors (smoking, alcohol consumption, binge drinking, pre-pregnancy body mass index, gestational weight gain) were estimated, using Cox regression analyses. Mothers with preterm birth compared with mothers with >12 years of education and the association interacted with parity, while income and occupation affected the risk to a lesser degree. The adjusted HR for less educated nulliparous and parous women were 1.22 (95% CI 1.04-1.42) and 1.56 (95% CI 1.31-1.87), respectively, compared with women with >12 years of education. For parous women with preterm birth to 1.43 (95% CI 1.19-1.72). Maternal educational level was the strongest predictor of preterm birth among five socioeconomic measures and the gradient did not differ significantly according to the degree of preterm birth. For parous women smoking explained some of the educational gradient but in general the selected risk factors only reduced the relative educational gradient in preterm birth marginally.

  1. Effect of Modifiable Risk Factors on Preterm Birth: A Population Based-Cohort.

    Science.gov (United States)

    Lengyel, Candice S; Ehrlich, Shelley; Iams, Jay D; Muglia, Louis J; DeFranco, Emily A

    2017-04-01

    Objectives The purpose of this study is to evaluate the prevalence, impact, and interaction of short interpregnancy interval (IPI), pre-pregnancy body mass index (BMI) category, and pregnancy weight gain (PWG) on the rate of preterm birth. Methods This is a population-based retrospective cohort study using vital statistics birth records from 2006 to 2011 in OH, US, analyzing singleton live births to multiparous mothers with recorded IPI (n = 393,441). Preterm birth rate at preterm birth rate of 7.6 % for this group. Short IPIs of preterm birth rate to 12.9 and 10.4 %, respectively. Low PWG compared to IOM recommendations for pre-pregnancy BMI class was also associated with increased preterm birth rate of 13.2 % for all BMI classes combined. However, the highest rate of preterm birth of 25.2 % occurred in underweight women with short IPI and inadequate weight gain with adj OR 3.44 (95 % CI 2.80, 4.23). The fraction of preterm births observed in this cohort that can be attributed to short IPIs is 5.9 %, long IPIs is 8.3 %, inadequate PWG is 7.5 %, and low pre-pregnancy BMI is 2.2 %. Conclusions Our analysis indicates that a significant proportion of preterm births in Ohio are associated with potentially modifiable risk factors. These data suggest public health initiatives focused on preterm birth prevention could include counseling and interventions to optimize preconception health and prenatal nutrition.

  2. Born Too Soon: The global epidemiology of 15 million preterm births

    Science.gov (United States)

    2013-01-01

    This second paper in the Born Too Soon supplement presents a review of the epidemiology of preterm birth, and its burden globally, including priorities for action to improve the data. Worldwide an estimated 11.1% of all livebirths in 2010 were born preterm (14.9 million babies born before 37 weeks of gestation), with preterm birth rates increasing in most countries with reliable trend data. Direct complications of preterm birth account for one million deaths each year, and preterm birth is a risk factor in over 50% of all neonatal deaths. In addition, preterm birth can result in a range of long-term complications in survivors, with the frequency and severity of adverse outcomes rising with decreasing gestational age and decreasing quality of care. The economic costs of preterm birth are large in terms of immediate neonatal intensive care, ongoing long-term complex health needs, as well as lost economic productivity. Preterm birth is a syndrome with a variety of causes and underlying factors usually divided into spontaneous and provider-initiated preterm births. Consistent recording of all pregnancy outcomes, including stillbirths, and standard application of preterm definitions is important in all settings to advance both the understanding and the monitoring of trends. Context specific innovative solutions to prevent preterm birth and hence reduce preterm birth rates all around the world are urgently needed. Strengthened data systems are required to adequately track trends in preterm birth rates and program effectiveness. These efforts must be coupled with action now to implement improved antenatal, obstetric and newborn care to increase survival and reduce disability amongst those born too soon. Declaration This article is part of a supplement jointly funded by Save the Children's Saving Newborn Lives programme through a grant from The Bill & Melinda Gates Foundation and March of Dimes Foundation and published in collaboration with the Partnership for Maternal

  3. Does moderate preterm birth lead to altered arterial pressure? Studies in sheep.

    Science.gov (United States)

    De Matteo, Robert; Stacy, Victoria; Probyn, Megan E; Brew, Nadine; Blasch, Natasha; Harding, Richard

    2008-12-01

    1. Low birth weight (LBW) is associated with an increased risk of cardiovascular disease. Preterm birth is a major determinant of LBW and has been shown to result in elevated arterial pressure (AP) in humans, but few studies have investigated the effects of preterm birth in the absence of potentially confounding factors. Our aim was to determine whether moderately preterm birth per se alters the postnatal development of AP in lambs. 2. Preterm lambs were delivered approximately 14 days before term (i.e. approximately 133 days of gestation); controls were born at term (approximately 147 days). Mean arterial pressure (MAP), heart rate (HR), blood composition and indices of growth were measured at 4 and 8 weeks post term-equivalent age (PTEA). We also studied a separate cohort of preterm and term sheep as young adults (approximately 1.1 years). 3. Preterm lambs had significantly lower birth weights than term lambs, but bodyweights were not significantly different by Day 12 PTEA. In addition, MAP, HR and most blood variables did not differ between term and preterm lambs at 4 or 8 weeks PTEA. Preterm birth per se did not alter MAP or HR in young adult sheep. 4. Low birth weight due to preterm birth does not result in an altered AP during early postnatal life or at maturity. Moderate intrauterine growth restriction (IUGR) due to twinning, which further reduces birth weight, does not affect MAP in preterm lambs. Other factors, such as the degree of prematurity or IUGR, exposure to corticosteroids or postnatal nutrition, may be important in the later development of elevated AP.

  4. Management of preterm delivery in women with abnormal fetal presentation

    NARCIS (Netherlands)

    Bergenhenegouwen, L.A.

    2015-01-01

    The aim of the thesis was to answer the following questions. 1. What is the optimal mode of delivery in preterm breech presentation? 2. Does an intended caesarean section reduce the risk of perinatal mortality and morbidity as compared to intended vaginal delivery in preterm breech presentation? 3.

  5. Maternal vaccination and preterm birth: using data mining as a screening tool

    DEFF Research Database (Denmark)

    Orozova-Bekkevold, Ivanka; Jensen, Henrik; Stensballe, Lone

    2007-01-01

    Objective The main purpose of this study was to identify possible associations between medicines used in pregnancy and preterm deliveries using data mining as a screening tool. Settings Prospective cohort study. Methods We used data mining to identify possible correlates between preterm delivery...... and medicines used by 92,235 pregnant Danish women who took part in the Danish National Birth Cohort (DNBC). We then evaluated the association between one of the identified exposures (vaccination) and the risk for preterm birth by using logistic regression. The women were classified into groups according...... measure Preterm birth, a delivery occurring before the 259th day of gestation (i.e., less than 37 full weeks). Results Data mining had indicated that maternal vaccination (among other factors) might be related to preterm birth. The following regression analysis showed that, the women who reported being...

  6. Assisted reproductive technology and the risk of preterm birth among primiparas.

    Science.gov (United States)

    Dunietz, Galit Levi; Holzman, Claudia; McKane, Patricia; Li, Chenxi; Boulet, Sheree L; Todem, David; Kissin, Dmitry M; Copeland, Glenn; Bernson, Dana; Sappenfield, William M; Diamond, Michael P

    2015-04-01

    To investigate the risk of preterm birth among liveborn singletons to primiparas who conceived with assisted reproductive technology (ART) using four mutually exclusive categories of infertility (female infertility only, male infertility only, female and male infertility, and unexplained infertility) and to examine preterm birth risk along the gestational age continuum. Retrospective cohort study. Not applicable. Singletons born to primiparas who conceived with or without ART. None. Preterm (risk for preterm birth, even when only the male partner had been diagnosed with infertility. The risk of preterm birth for ART-conceived infants whose mothers were diagnosed with infertility included the earliest deliveries. Copyright © 2015 American Society for ReproductiveMedicine. All rights reserved.

  7. Offspring preterm birth and birth size are related to long-term risk of maternal diabetes

    DEFF Research Database (Denmark)

    Naver, Klara Vinsand; Secher, Niels Jørgen; Ovesen, Per Glud

    2013-01-01

    The aim of the study is to investigate the association between gestational age, birth size, and the long-term risk of maternal diabetes. We conducted a nation-wide prospective follow-up study of the cohort of all Danish women with a singleton delivery in 1982/1983 (index delivery) and no history...... of diabetes (n = 100,669). Registries were used to extract information on patients with a hospital or outpatient diagnosis of diabetes, subsequent deliveries, and death/emigration in the period from the index delivery until the end of 2006. The association between the maternal risk of diabetes and the index...... birth size (adjusted HR 9.0, 95 % CI 6.17-13.12) and a preterm delivery at 32-37 weeks (adjusted HR 2.22, 95 % CI 1.46-3.40). Offspring preterm birth and large size for gestational age at birth are associated with increased risk of maternal diabetes....

  8. Ethnicity, smoking status, and preterm birth as predictors of maternal locus of control.

    Science.gov (United States)

    Ashford, Kristin B; Rayens, Mary Kay

    2015-04-01

    A woman's psychological health can affect prenatal behaviors. The purpose of this study was to examine the relationship between maternal beliefs, prenatal behaviors, and preterm birth (PTB) in a multiethnic population. This was a planned secondary analysis of a cross-sectional trial of postpartum women with singleton gestation. In all, 210 participants were given the Fetal Health Locus of Control (FHLC) scale to measure three primary maternal beliefs that influenced their prenatal behaviors (Internal Control, Chance, Powerful Others). Women who experienced preterm delivery and those who smoked during pregnancy scored the Chance category significantly higher than those who delivered term infants (p = .05; p = .004, respectively). This suggests those who smoked during pregnancy had a greater degree of belief that Chance influenced their infant's health status. Cultural differences also emerged specific to the impact of health care providers on PTB; with Hispanic women scoring Powerful Others the highest among the groups (p = .02). Nurses can plan a critical role in identifying at-risk women (smoking, strong Chance beliefs) while providing a clear message that taking action and modifying high-risk behaviors can reduce risk for adverse pregnancy outcome. © The Author(s) 2013.

  9. Relationships among neighborhood environment, racial discrimination, psychological distress, and preterm birth in African American women.

    Science.gov (United States)

    Giurgescu, Carmen; Zenk, Shannon N; Dancy, Barbara L; Park, Chang G; Dieber, William; Block, Richard

    2012-01-01

    To (a) examine the relationships among objective and perceived indicators of neighborhood environment, racial discrimination, psychological distress, and gestational age at birth; (b) determine if neighborhood environment and racial discrimination predicted psychological distress; (c) determine if neighborhood environment, racial discrimination, and psychological distress predicted preterm birth; and (d) determine if psychological distress mediated the effects of neighborhood environment and racial discrimination on preterm birth. Descriptive correlational comparative. Postpartum unit of a medical center in Chicago. African American women (n(1)  = 33 with preterm birth; n(2)  = 39 with full-term birth). Women completed the instruments 24 to 72 hours after birth. Objective measures of the neighborhood were derived using geographic information systems (GIS). Women who reported higher levels of perceived social and physical disorder and perceived crime also reported higher levels of psychological distress. Women who reported more experiences of racial discrimination also had higher levels of psychological distress. Objective social disorder and perceived crime predicted psychological distress. Objective physical disorder and psychological distress predicted preterm birth. Psychological distress mediated the effect of objective social disorder and perceived crime on preterm birth. Women's neighborhood environments and racial discrimination were related to psychological distress, and these factors may increase the risk for preterm birth. © 2012 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

  10. An observational study of type, timing, and severity of childhood maltreatment and preterm birth.

    Science.gov (United States)

    Selk, Sabrina C; Rich-Edwards, Janet W; Koenen, Karestan; Kubzansky, Laura D

    2016-06-01

    Childhood maltreatment has been linked to preterm birth (preterm birth. The aim of this observational study was to explore type of maltreatment (child and adolescent physical and sexual abuse and harsh parenting) as risk factors for preterm birth. We examined these associations in a cross-sectional analysis of the Nurses' Health Study II cohort of female nurses. Women completed a questionnaire about experiences of sexual abuse, physical abuse or harsh parenting, along with pregnancy outcomes. Logistic regression models adjusted for relevant covariates including age, race, alcohol and cigarette use during pregnancy, age at menarche, marital status, adult income, body mass index (kg/m(2)) at age 18, physical abuse in pregnancy, and childhood socioeconomic position. Among 51 434 first births, 4110 were preterm (8% of births). Forced sexual activity in childhood or adolescence was associated with a 22% increased odds of preterm birth (OR=1.22, 95% CI 1.10 to 1.35). Maltreatment involving sexual touch, physical abuse or harsh parenting was not associated with preterm birth in this sample. Women who experience forced sexual activity in childhood or adolescence may have an increased likelihood of delivering preterm in adulthood. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  11. The Perfect Storm: Preterm Birth, Neurodevelopmental Mechanisms, and Autism Causation.

    Science.gov (United States)

    Erdei, Carmina; Dammann, Olaf

    2014-01-01

    A unifying model of autism causation remains elusive, and thus well-designed explanatory models are needed to develop appropriate therapeutic and preventive interventions. This essay argues that autism is not a static disorder, but rather an ongoing process. We discuss the link between preterm birth and autism and briefly review the evidence supporting the link between immune system characteristics and both prematurity and autism. We then propose a causation process model of autism etiology and pathogenesis, in which both neurodevelopment and ongoing/prolonged neuroinflammation are necessary pathogenetic component mechanisms. We suggest that an existing model of sufficient cause and component causes can be interpreted as a mechanistic view of etiology and pathogenesis and can serve as an explanatory model for autism causal pathways.

  12. Advances in the Prevention of infection-Related Preterm Birth

    DEFF Research Database (Denmark)

    Lamont, R. F.

    2015-01-01

    metronidazole) or used antibiotics not recommended for the treatment of bacterial vaginosis (BV) or BV-related organisms; (b) used antibiotics too late in pregnancy to influence outcome (23-27 weeks); and (c) included women whose risk of PTB was not due to abnormal genital tract colonization and hence unlikely...... and attempts to explain the confusion using new information from culture-independent molecular-based techniques. It also gives guidance on the structure of putative future antibiotic intervention studies.......Infection-related preterm birth (PTB) is more common at early gestational ages and is associated with major neonatal mortality and morbidity. Abnormal genital tract microflora in early pregnancy predicts late miscarriage and early PTB. Accordingly, it is logical to consider antibiotics...

  13. Mutations in fetal genes involved in innate immunity and host defense against microbes increase risk of preterm premature rupture of membranes (PPROM).

    Science.gov (United States)

    Modi, Bhavi P; Teves, Maria E; Pearson, Laurel N; Parikh, Hardik I; Haymond-Thornburg, Hannah; Tucker, John L; Chaemsaithong, Piya; Gomez-Lopez, Nardhy; York, Timothy P; Romero, Roberto; Strauss, Jerome F

    2017-11-01

    Twin studies have revealed a significant contribution of the fetal genome to risk of preterm birth. Preterm premature rupture of membranes (PPROM) is the leading identifiable cause of preterm delivery. Infection and inflammation of the fetal membranes is commonly found associated with PPROM. We carried out whole exome sequencing (WES) of genomic DNA from neonates born of African-American mothers whose pregnancies were complicated by PPROM (76) or were normal term pregnancies (N = 43) to identify mutations in 35 candidate genes involved in innate immunity and host defenses against microbes. Targeted genotyping of mutations in the candidates discovered by WES was conducted on an additional 188 PPROM cases and 175 controls. We identified rare heterozygous nonsense and frameshift mutations in several of the candidate genes, including CARD6, CARD8, DEFB1, FUT2, MBL2, NLP10, NLRP12, and NOD2. We discovered that some mutations (CARD6, DEFB1, FUT2, MBL2, NLRP10, NOD2) were present only in PPROM cases. We conclude that rare damaging mutations in innate immunity and host defense genes, the majority being heterozygous, are more frequent in neonates born of pregnancies complicated by PPROM. These findings suggest that the risk of preterm birth in African-Americans may be conferred by mutations in multiple genes encoding proteins involved in dampening the innate immune response or protecting the host against microbial infection and microbial products. © 2017 The Authors. Molecular Genetics & Genomic Medicine published by Wiley Periodicals, Inc.

  14. Quantifying the impact of deprivation on preterm births: a retrospective cohort study.

    Directory of Open Access Journals (Sweden)

    David Taylor-Robinson

    Full Text Available Social deprivation is associated with higher rates of preterm birth and subsequent infant mortality. Our objective was to identify risk factors for preterm birth in the UK's largest maternity unit, with a particular focus on social deprivation, and related factors.Retrospective cohort study of 39,873 women in Liverpool, UK, from 2002-2008. Singleton pregnancies were stratified into uncomplicated low risk pregnancies and a high risk group complicated by medical problems. Multiple logistic regression, and generalized additive models were used to explore the effect of covariates including area deprivation, smoking status, BMI, parity and ethnicity on the risk of preterm birth (34⁺⁰ weeks. In the low risk group, preterm birth rates increased with deprivation, reaching 1.6% (CI₉₅ 1.4 to 1.8 in the most deprived quintile; the unadjusted odds ratio comparing an individual in the most deprived quintile, to one in the least deprived quintile was 1.5 (CI₉₅ 1.2 to 1.9. Being underweight and smoking were both independently associated with preterm birth in the low risk group, and adjusting for these factors explained the association between deprivation and preterm birth. Preterm birth was five times more likely in the high risk group (RR 4.8 CI₉₅ 4.3 to 5.4, and there was no significant relationship with deprivation.Deprivation has significant impact on preterm birth rates in low risk women. The relationship between low socio-economic status and preterm births appears to be related to low maternal weight and smoking in more deprived groups.

  15. Quantifying the impact of deprivation on preterm births: a retrospective cohort study.

    Science.gov (United States)

    Taylor-Robinson, David; Agarwal, Umber; Diggle, Peter J; Platt, Mary Jane; Yoxall, Bill; Alfirevic, Zarko

    2011-01-01

    Social deprivation is associated with higher rates of preterm birth and subsequent infant mortality. Our objective was to identify risk factors for preterm birth in the UK's largest maternity unit, with a particular focus on social deprivation, and related factors. Retrospective cohort study of 39,873 women in Liverpool, UK, from 2002-2008. Singleton pregnancies were stratified into uncomplicated low risk pregnancies and a high risk group complicated by medical problems. Multiple logistic regression, and generalized additive models were used to explore the effect of covariates including area deprivation, smoking status, BMI, parity and ethnicity on the risk of preterm birth (34⁺⁰ weeks). In the low risk group, preterm birth rates increased with deprivation, reaching 1.6% (CI₉₅ 1.4 to 1.8) in the most deprived quintile; the unadjusted odds ratio comparing an individual in the most deprived quintile, to one in the least deprived quintile was 1.5 (CI₉₅ 1.2 to 1.9). Being underweight and smoking were both independently associated with preterm birth in the low risk group, and adjusting for these factors explained the association between deprivation and preterm birth. Preterm birth was five times more likely in the high risk group (RR 4.8 CI₉₅ 4.3 to 5.4), and there was no significant relationship with deprivation. Deprivation has significant impact on preterm birth rates in low risk women. The relationship between low socio-economic status and preterm births appears to be related to low maternal weight and smoking in more deprived groups.

  16. Organisation of obstetric services for very preterm births in Europe: results from the MOSAIC project

    DEFF Research Database (Denmark)

    Blondel, B; Papiernik, E; Delmas, D

    2009-01-01

    OBJECTIVE: To study the impact of the organisation of obstetric services on the regionalisation of care for very preterm births. DESIGN: Cohort study. SETTING: Ten European regions covering 490 000 live births. POPULATION: All children born in 2003 between 24 and 31 weeks of gestation. METHOD...... with a large neonatal unit (at least 50 annual very preterm admissions). RESULTS: The organisation of obstetric care varied in these regions with respect to the supply of level III units (from 2.3 per 10 000 births in the Portuguese region to 0.2 in the Polish region), their characteristics (annual number...... of deliveries, 24 hour presence of a trained obstetrician) and the proportion of all births (term and preterm) that occur in these units. The proportion of very preterm births in level III units ranged from 93 to 63% in the regions. Different approaches were used to obtain a high level of regionalisation: high...

  17. Predictors of thallium exposure and its relation with preterm birth.

    Science.gov (United States)

    Jiang, Yangqian; Xia, Wei; Zhang, Bin; Pan, Xinyun; Liu, Wenyu; Jin, Shuna; Huo, Wenqian; Liu, Hongxiu; Peng, Yang; Sun, Xiaojie; Zhang, Hongling; Zhou, Aifen; Xu, Shunqing; Li, Yuanyuan

    2018-02-01

    Thallium (Tl) is a well-recognized hazardous toxic heavy metal that has been reported to have embryotoxicity and fetotoxicity. However, little is known about its association with preterm birth (PTB) in humans. We aimed to evaluate the predictors of Tl exposure and assessed its relation with PTB. The study population included 7173 mother-infant pairs from a birth cohort in Wuhan, China. Predictors of Tl concentrations were explored using linear regression analyses, and associations of Tl exposure with risk of PTB or gestational age at birth were estimated using logistic regression or generalized linear models. The geometric mean and median values of urinary Tl concentrations were 0.28 μg/L (0.55 μg/g creatinine) and 0.29 μg/L (0.53 μg/g creatinine). We found that maternal urinary Tl concentrations varied by gestational weight gain, educational attainment, multivitamin and iron supplementations. Women with Tl concentrations higher than 0.80 μg/g creatinine were at higher risk of giving birth prematurely versus those with Tl concentrations lower than 0.36 μg/g creatinine [adjusted odds ratio (95% confidence interval (CI)): 1.55 (1.05, 2.27)], and the association was more pronounced in PTB with premature rupture of membranes (PROM) rather than in PTB without PROM. About 3-fold increase in creatinine-corrected Tl concentrations were associated with 0.99-day decrease in gestational length (95% CI: -1.36, -0.63). This is the first report on the associations between maternal Tl exposure and the risk of PTB. Copyright © 2017 Elsevier Ltd. All rights reserved.

  18. Intracervical procedures and the risk of subsequent very preterm birth: a case-control study.

    Science.gov (United States)

    Watson, Lyndsey F; Rayner, Jo-Anne; King, James; Jolley, Damien; Forster, Della

    2012-02-01

    To investigate the relation of prior intracervical procedures with very preterm birth. A population-based case-control study. The study was conducted in Australia between 2002 and 2004. Three hundred and forty-five women having a medically indicated and 236 having a spontaneous singleton birth between 20 and 31 weeks of gestation and 796 women selected randomly from all those giving birth at ≥37 weeks of gestation. Interview data were analysed using logistic regression. Very preterm birth. Very preterm birth was significantly associated with having any intracervical procedure [adjusted odds ratio (AOR) 2.07; 95% confidence interval (CI) 1.6-2.7], in particular curettage associated with abortion (AOR 1.80; 95% CI 1.2-2.6). Assisted reproductive technology procedures were significantly associated with medically indicated very preterm birth (AOR 3.07; 95% CI 1.8-5.3) and treatments for precancerous cervical changes were significantly associated with spontaneous very preterm birth, as follows: conization/cone biopsy (AOR 3.33; 95% CI 1.8-6.2) and cauterization/ablation (AOR 2.27; 95% CI 1.4-3.8). Suction aspiration for abortion, abnormal Pap smear without treatment and abortion without instrumentation were not associated with very preterm birth. Intracervical procedures are associated with very preterm birth. Notably, curettage rather than any other procedure associated with abortion appears to be implicated in the risk. The introduction of infection during cervical procedures may be the common link with risks found. Changing clinical practice in the management of abortion and human papillomavirus vaccination may lead to lowering the risks of very preterm birth. © 2012 The Authors Acta Obstetricia et Gynecologica Scandinavica© 2012 Nordic Federation of Societies of Obstetrics and Gynecology.

  19. Neonatology oxidative status in preterm infants with premature preterm rupture of membranes and fetal inflammatuar response syndrome.

    Science.gov (United States)

    Özalkaya, Elif; Karatekin, Güner; Topçuoğlu, Sevilay; Karatepe, Hande Özgün; Hafızoğlu, Taner; Baran, Pervin; Ovalı, Fahri

    2017-10-01

    The aim of this study, to determine an index of oxidative stress index in preterm infants less than 34 weeks gestational age with premature preterm rupture of membrane (PPROM) and fetal inflammatory response syndrome (FIRS). This study was designed as a prospective study. Fifty-one premature infants less than 35 weeks of gestational age were included in the study. The umbilical cord blood concentrations of IL-6, TAC (total antioxidant capacity) and PON-1 (paraoxonase-1) levels and TOS (total oxidative stress) were studied. The oxidative stress index (OSI = TAC/TOS) was calculated in all of prematüre infants. PPROM was defined as rupture of membranes at least 24 hours before the onset of labor. FIRS was defined by an umbilical cord IL-6 level greater than 11 pg/mL. Premature infants included in the study were divided into 4 groups. Group 1 included preterm infants without FIRS and with PPROM (n = 16), while Group 2 included preterm infants without PPROM and with FIRS (n = 9), Group 3 consisted of premature infants with PPROM and FIRS (n = 21) and Group 4 included premature infants without PPROM or FIRS (n = 5). Umbilical cord TOS level was found to be higher in the preterm infants without FIRS and with PPROM (36.1 μmol H 2 O 2 Equiv./L) compared to the preterm infants without PPROM or FIRS (11.9 μmol H 2 O 2 Equiv./L) (p = 0.03). Umbilical cord PON-1 level was found to be lower in the preterms without FIRS and with PPROM (32 U/L), preterms without PPROM and with FIRS (30. 3 U/L) and the preterm infants with both PPROM and FIRS (48.6 U/L) compared to the preterm infants having no PPROM or FIRS (85.6 U/L) (p = 0.001). High pro-oxidant capacity was found in PPROM and low antioxidant capacity in PPROM and FIRS. Copyright © 2017. Published by Elsevier B.V.

  20. [Comparative analysis of risk factors for preterm and small-for-gestational-age births].

    Science.gov (United States)

    Zhong, Xin-Qi; Cui, Qi-Liang

    2014-12-01

    To compare the risk factors between preterm and small-for-gestational-age (SGA) births. A total of 1 270 newborns who had no obstetric risk factors or maternal diseases were enrolled in this study. Their mothers' stature, body weight, passive smoking, and history of abnormal pregnancy were investigated using the self-designed questionnaire. The infants were divided into four groups: preterm, appropriate-for-gestational-age (AGA), SGA, and term infants. Multivariate logistic regression analysis was performed to compare the risk factors between preterm and SGA births. A weight gain less than 9 kg during pregnancy increased the risks of preterm (OR=1.63, 95% CI: 1.12-2.07) and SGA (OR=1.92, 95% CI: 1.56-2.58). The histories of abortion (OR=1.46, 95% CI: 1.09-1.93) and preterm birth (OR=2.63, 95% CI: 1.81-3.92) were independent risk factors for preterm births, while low pre-pregnancy body mass index (births. Due to different risk factors between preterm and SGA births, specific preventive measures should be taken pertinently to reduce the incidence of the two bad pregnancy outcomes.

  1. The interaction between maternal race/ethnicity and chronic hypertension on preterm birth.

    Science.gov (United States)

    Premkumar, Ashish; Henry, Dana E; Moghadassi, Michelle; Nakagawa, Sanae; Norton, Mary E

    2016-12-01

    In both the biomedical and public health literature, the risk for preterm birth has been linked to maternal racial/ethnic background, in particular African-American heritage. Despite this well-documented health disparity, the relationship of comorbid conditions, such as chronic hypertension, to maternal race/ethnicity and preterm birth has received relatively limited attention in the literature. The objective of the study was to evaluate the interaction between chronic hypertension and maternal racial/ethnic background on preterm birth. This is a retrospective cohort study of singleton pregnancies among women who delivered between 2002 and 2015 at the University of California, San Francisco. The associations of chronic hypertension with both spontaneous and medically indicated preterm birth were examined by univariate and multivariate logistical regression, adjusting for confounders including for maternal age, history of preterm birth, maternal body mass index, insurance type (public vs private), smoking, substance abuse, history of pregestational diabetes mellitus, and use of assisted reproductive technologies. The interaction effect of chronic hypertension and racial/ethnicity was also evaluated. All values are reported as odds ratios, with 95% confidence intervals and significance set at P = .05. In this cohort of 23,425 singleton pregnancies, 8.8% had preterm deliveries (3% were medically indicated preterm birth, whereas 5.5% were spontaneous preterm births), and 3.8% of women carried the diagnosis of chronic hypertension. Chronic hypertension was significantly associated with preterm birth in general (adjusted odds ratio, 2.74, P American women (adjusted odds ratio, 3.91, P Asian-American/Pacific Islander women (adjusted odds ratio, 3.51, P American women (adjusted odds ratio, 6.85, P Asian-American/Pacific Islander women (adjusted odds ratio, 9.87, P American and Asian/Pacific Islander women on medically indicated and total preterm birth rates raises the

  2. Slow fetal growth between first and early second trimester ultrasound scans and risk of small for gestational age (SGA birth.

    Directory of Open Access Journals (Sweden)

    Marija Simic

    Full Text Available To investigate the association between fetal growth between first and early second trimester ultrasound scan and the risk of severe small for gestational age (SGA birth.This cohort study included 69 550 singleton pregnancies with first trimester dating and an early second trimester growth scan in Stockholm and Gotland Counties, Sweden between 2008 and 2014. Exposure was difference in biparietal diameter growth between observed and expected at the second trimester scan, calculated by z-scores. Risk of birth of a severe SGA infant (birth weight for gestational age by fetal sex less than the 3rd centile was calculated using multivariable logistic regression analysis and presented as adjusted odds ratio (aOR.Parietal growth less than 2.5 percentile between first and second trimester ultrasound examination was associated with elevated risk of being born severe SGA. (aOR 1.67; 95% Confidence Interval 1.28-2.18. The risks of preterm severe SGA (birth before 37 weeks and term severe SGA (birth 37 weeks or later were at similar levels, and risk of severe SGA were also elevated in the absence of preeclampsia, hypertensive diseases or gestational diabetes.Fetuses with slow growth of biparietal diameter at ultrasound examination in early second trimester exhibit increased risk of being born SGA independent of gestational age at birth and presence of maternal hypertensive diseases or diabetes mellitus.

  3. Slow fetal growth between first and early second trimester ultrasound scans and risk of small for gestational age (SGA) birth.

    Science.gov (United States)

    Simic, Marija; Stephansson, Olof; Petersson, Gunnar; Cnattingius, Sven; Wikström, Anna-Karin

    2017-01-01

    To investigate the association between fetal growth between first and early second trimester ultrasound scan and the risk of severe small for gestational age (SGA) birth. This cohort study included 69 550 singleton pregnancies with first trimester dating and an early second trimester growth scan in Stockholm and Gotland Counties, Sweden between 2008 and 2014. Exposure was difference in biparietal diameter growth between observed and expected at the second trimester scan, calculated by z-scores. Risk of birth of a severe SGA infant (birth weight for gestational age by fetal sex less than the 3rd centile) was calculated using multivariable logistic regression analysis and presented as adjusted odds ratio (aOR). Parietal growth less than 2.5 percentile between first and second trimester ultrasound examination was associated with elevated risk of being born severe SGA. (aOR 1.67; 95% Confidence Interval 1.28-2.18). The risks of preterm severe SGA (birth before 37 weeks) and term severe SGA (birth 37 weeks or later) were at similar levels, and risk of severe SGA were also elevated in the absence of preeclampsia, hypertensive diseases or gestational diabetes. Fetuses with slow growth of biparietal diameter at ultrasound examination in early second trimester exhibit increased risk of being born SGA independent of gestational age at birth and presence of maternal hypertensive diseases or diabetes mellitus.

  4. Residential proximity to gasoline service stations and preterm birth.

    Science.gov (United States)

    Huppé, Vicky; Kestens, Yan; Auger, Nathalie; Daniel, Mark; Smargiassi, Audrey

    2013-10-01

    Preterm birth (PTB) is a growing public health problem potentially associated with ambient air pollution. Gasoline service stations can emit atmospheric pollutants, including volatile organic compounds potentially implicated in PTB. The objective of this study was to evaluate the relationship between residential proximity to gasoline service stations and PTB. Singleton live births on the Island of Montreal from 1994 to 2006 were obtained (n=267,478). Gasoline service station locations, presence of heavy-traffic roads, and neighborhood socioeconomic status (SES) were determined using a geographic information system. Multivariable logistic regression was used to analyze the association between PTB and residential proximity to gasoline service stations (50, 100, 150, 200, 250, and 500 m), accounting for maternal covariates, neighborhood SES, and heavy-traffic roads. For all distance categories beyond 50 m, presence of service stations was associated with a greater odds of PTB. Associations were robust to adjustment for maternal covariates for distance categories of 150 and 200 m but were nullified when adjusting for neighborhood SES. In analyses accounting for the number of service stations, the likelihood of PTB within 250 m was statistically significant in unadjusted models. Associations were, however, nullified in models accounting for maternal covariates or neighborhood SES. Our results suggest that there is no clear association between residential proximity to gasoline service stations in Montreal and PTB. Given the correlation between proximity of gasoline service stations and SES, it is difficult to delineate the role of these factors in PTB.

  5. Folic acid supplementation and preterm birth: results from observational studies.

    Science.gov (United States)

    Mantovani, Elena; Filippini, Francesca; Bortolus, Renata; Franchi, Massimo

    2014-01-01

    Folic acid (FA) supplementation is recommended worldwide in the periconceptional period for the prevention of neural tube defects. Due to its involvement in a number of cellular processes, its role in other pregnancy outcomes such as miscarriage, recurrent miscarriage, low birth weight, preterm birth (PTB), preeclampsia, abruptio placentae, and stillbirth has been investigated. PTB is a leading cause of perinatal mortality and morbidity; therefore its association with FA supplementation is of major interest. The analysis of a small number of randomized clinical trials (RCTs) has not found a beneficial role of FA in reducing the rate of PTBs. The aim of this review was to examine the results from recent observational studies about the effect of FA supplementation on PTB. We carried out a search on Medline and by manual search of the observational studies from 2009 onwards that analyzed the rate of PTB in patients who received supplementation with FA before and/or throughout pregnancy. The results from recent observational studies suggest a slight reduction of PTBs that is not consistent with the results from RCTs. Further research is needed to better understand the role of FA supplementation before and during pregnancy in PTB.

  6. Folic Acid Supplementation and Preterm Birth: Results from Observational Studies

    Directory of Open Access Journals (Sweden)

    Elena Mantovani

    2014-01-01

    Full Text Available Introduction. Folic acid (FA supplementation is recommended worldwide in the periconceptional period for the prevention of neural tube defects. Due to its involvement in a number of cellular processes, its role in other pregnancy outcomes such as miscarriage, recurrent miscarriage, low birth weight, preterm birth (PTB, preeclampsia, abruptio placentae, and stillbirth has been investigated. PTB is a leading cause of perinatal mortality and morbidity; therefore its association with FA supplementation is of major interest. The analysis of a small number of randomized clinical trials (RCTs has not found a beneficial role of FA in reducing the rate of PTBs. Aim of the Study. The aim of this review was to examine the results from recent observational studies about the effect of FA supplementation on PTB. Materials and Methods. We carried out a search on Medline and by manual search of the observational studies from 2009 onwards that analyzed the rate of PTB in patients who received supplementation with FA before and/or throughout pregnancy. Results. The results from recent observational studies suggest a slight reduction of PTBs that is not consistent with the results from RCTs. Further research is needed to better understand the role of FA supplementation before and during pregnancy in PTB.

  7. Effect of probiotics on perinatal outcome in patients at high risk of preterm birth.

    Science.gov (United States)

    Kirihara, Nami; Kamitomo, Masato; Tabira, Tatsunori; Hashimoto, Takashi; Taniguchi, Hiroko; Maeda, Takatsugu

    2018-02-01

    Recent reports have shown lower levels of Clostridium and higher levels of Lactobacillales in the intestinal microbiota in preterm birth patients compared to term birth patients. However, the influence of probiotics on perinatal status has not been elucidated. The aim of our study was to evaluate the effects of probiotics on perinatal outcomes. We retrospectively evaluated the effects of oral probiotics on perinatal outcome in patients at high risk of preterm birth. Probiotics containing Streptococcus faecalis, Clostridium butyricum and Bacillus mesentericus were administered for prophylaxis of bacterial vaginosis or treatment of constipation starting at 12.5 ± 4.1 weeks until delivery. Patients not administered probiotics were defined as the non-probiotics group. Between these two groups, perinatal outcomes including gestational age at birth, birth weight, chorioamnionitis or funisitis and preterm birth before 32 weeks were compared. In addition, multivariate regression analyses were performed to evaluate factors influencing preterm birth before 32 weeks, chorioamnionitis/funisitis and normal vaginal flora. The probiotics group showed longer gestation, higher birth weight, lower rates of chorioamnionitis and higher rates of normal vaginal flora compared to the non-probiotics group. Multivariate regression analysis showed that probiotics significantly suppressed preterm birth before 32 weeks and tended to suppress chorioamnionitis/funisitis. The adjusted odds ratios (95% confidence interval) for preterm birth before 32 weeks and chorioamnionitis/funisitis were 0.05 (0.01-0.71) and 0.07 (0.01-1.03), respectively. Oral probiotics containing Clostridium had a significant effect on the prevention of preterm birth before 32 weeks of gestation. © 2017 Japan Society of Obstetrics and Gynecology.

  8. Exploring preterm birth as a polymicrobial disease: An overview of the uterine microbiome.

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    Matthew S Payne

    2014-11-01

    Full Text Available Infection is the leading cause of preterm birth. A focus of many studies over the past decade has been to characterise microorganisms present in the uterine cavity and document any association with negative pregnancy outcome. A range of techniques have been used to achieve this, including microbiological culture and targeted polymerase chain reaction assays, and more recently, microbiome-level analyses involving either conserved, phylogenetically informative genes such as the bacterial 16S rRNA gene or whole shotgun metagenomic sequencing. These studies have contributed vast amounts of data towards characterisation of the uterine microbiome, specifically that present in the amniotic fluid, fetal membranes and placenta. However, an overwhelming emphasis has been placed on the bacterial microbiome, with far less data produced on the viral and fungal/yeast microbiomes. With numerous studies now referring to preterm birth as a polymicrobial condition, there is the need to investigate the role of viruses and fungi in more detail and in particular, look for associations between colonisation with these microorganisms and bacteria in the same samples. Although the major pathway by which microorganisms are believed to colonise the uterine cavity is vertical ascension from the vagina, numerous studies are now emerging suggesting haematogenous transfer of oral microbiota to the uterine cavity. Evidence of this has been produced in mouse models and although DNA-based evidence in humans appears convincing in some aspects, use of methodologies that only detect viable cells as opposed to lysed cells and extracellular DNA are needed to clarify this. Such techniques as RNA analyses and viability PCR are likely to play key roles in the clinical translation of future microbiome-based data, particularly in confined environments such as the uterus, as detection of viable cells plays a key role in diagnosis and treatment of infection.

  9. Dietary Flavonoids as Therapeutics for Preterm Birth: Luteolin and Kaempferol Suppress Inflammation in Human Gestational Tissues In Vitro

    Science.gov (United States)

    Wall, Courtney; Lim, Ratana; Poljak, Marin; Lappas, Martha

    2013-01-01

    Infection/inflammation is commonly associated with preterm birth (PTB), initiating uterine contractions and rupture of fetal membranes. Proinflammatory cytokines induce matrix metalloproteinases (MMPs) that degrade the extracellular matrix (ECM) and prostaglandins which initiate uterine contractions. Nuclear factor-κB (NF-κB) and activator-protein- (AP-)1 have key roles in the formation of these prolabour mediators. In nongestational tissues, dietary flavonoids such as luteolin and kaempferol inhibit NF-κB, AP-1, and their downstream targets. The aim of this study was to determine if luteolin and kaempferol reduce infection-induced prolabour mediators in human gestational tissues. Fetal membranes were incubated with LPS, and primary amnion cells and myometrial cells were incubated with IL-1β in the absence or presence of luteolin or kaempferol. Luteolin and kaempferol significantly reduced LPS-induced secretion of proinflammatory cytokines (IL-6 and IL-8) and prostaglandins (PGE2 and PGF2α) in fetal membranes, IL-1β-induced COX-2 gene expression and prostaglandin production in myometrium, and IL-1β-induced MMP-9 activity in amnion and myometrial cells. Luteolin and kaempferol decreased IL-1β-induced NF-κB p65 DNA binding activity and nuclear c-Jun expression. In conclusion, luteolin and kaempferol inhibit prolabour mediators in human gestational tissues. Given the central role of inflammation in provoking preterm labour, phytophenols may be a therapeutic approach to reduce the incidence of PTB. PMID:23840918

  10. The effects of preterm birth and its antecedents on the cardiovascular system.

    Science.gov (United States)

    Bensley, Jonathan G; De Matteo, Robert; Harding, Richard; Black, Mary J

    2016-06-01

    Preterm birth occurs in approximately 10% of all births worldwide. It prematurely exposes the developing cardiovascular system to the hemodynamic transition that occurs at birth and to the subsequent functional demands of life ex utero. This review describes the current knowledge of the effects of preterm birth, and some of its common antecedents (chorioamnionitis, intra-uterine growth restriction, and maternal antenatal corticosteroid administration), on the structure of the myocardium. A thorough literature search was conducted for articles relating to how preterm birth, and its antecedents, affect development of the heart. Given that sheep are an excellent model for the studies of cardiac development, this review has focused on experimental studies in sheep as well as clinical findings. Our review of the literature demonstrates that individuals born preterm are at an increased risk of cardiovascular disease later in life, including increased mean arterial pressure, abnormally shaped and sub-optimally performing hearts and changes in the vasculature. The review highlights how antenatal corticosteroids, intra-uterine growth restriction, and exposure to chorioamnionitis also have the potential to impact cardiac growth in the preterm newborn. Preterm birth and its common antecedents (antenatal corticosteroids, intra-uterine growth restriction, and chorioamnionitis) have the potential to adversely impact cardiac structure immediately following birth and in later life. © 2016 Nordic Federation of Societies of Obstetrics and Gynecology.

  11. Maternal attachment representations after very preterm birth and the effect of early intervention

    NARCIS (Netherlands)

    Meijssen, Dominique; Wolf, Marie-Jeanne; van Bakel, Hedwig; Koldewijn, Karen; Kok, Joke; van Baar, Anneloes

    2011-01-01

    Objective: For very preterm infants the mother-infant relationship may be compromised. Maternal attachment representations 18 (corrected) months after very preterm birth and the effect of the post-discharge Infant Behavioral Assessment and Intervention Program (IBAIP) were studied. The IBAIP is

  12. Corpus Callosum and Prefrontal Functions in Adolescents with History of Very Preterm Birth

    Science.gov (United States)

    Narberhaus, Ana; Segarra, Dolors; Caldu, Xavier; Gimenez, Monica; Pueyo, Roser; Botet, Francesc; Junque, Carme

    2008-01-01

    Very preterm (VPT) birth can account for thinning of the corpus callosum and poorer cognitive performance. Research findings about preterm and VPT adolescents usually describe a small posterior corpus callosum, although our research group has also found reductions of the anterior part, specifically the genu. The aim of the present study was to…

  13. Physical exercise during pregnancy and the risk of preterm birth: a study within the Danish National Birth Cohort

    DEFF Research Database (Denmark)

    Juhl, Mette; Andersen, Per Kragh; Olsen, Jørn

    2008-01-01

    According to many national recommendations, women should be physically active during pregnancy, but empirical evidence to support this recommendation is sparse. The authors' aim in this study was to examine the relation between physical exercise during pregnancy and the risk of preterm birth. Self......-reported data on physical exercise during pregnancy were collected prospectively for 87,232 singleton pregnancies included in the Danish National Birth Cohort between 1996 and 2002. Hazard ratios for preterm birth according to hours of exercise per week, type of exercise, and metabolic equivalent-hours per week...

  14. Umbilical cord blood and maternal visfatin (PBEF/NAMPT) concentrations in preterm birth with and without preterm premature rupture of membranes.

    Science.gov (United States)

    Pavlová, Tereza; Zlámal, Filip; Šplíchal, Zbyněk; Tomandl, Josef; Hodická, Zuzana; Ventruba, Pavel; Bienertová-Vašků, Julie

    2018-07-01

    The aim of the study is to investigate differences in visfatin concentrations between mothers with term and preterm birth (PTB) and between mothers who delivered within seven days and after more than seven days following admission for PTB/preterm premature rupture of membranes (PPROMs). Maternal peripheral blood and cord blood were collected from 56 mothers with PTB (31 with PPROM) and 71 mothers with term delivery (three with PPROM). Maternal visfatin concentration was significantly higher for given gestational age in PTBs compared to term deliveries (p = .021) and also in mothers who delivered within seven days after admission for PTB or PPROM, compared to those who delivered after more than seven days (p = .027; p = .039). Cord blood visfatin concentration was found to be decreased in preterm compared to term infants (p = .007). Visfatin in both maternal and fetal circulation may play an important role in the pathogenesis of PTB/PPROM and could be used to distinguish between women who will deliver in a short period of time after clinical presentation of PTB/PPROM and those who deliver later. Nevertheless, additional research is necessary in order to identify its direct involvement in PTB/PPROM.

  15. Modulation of amniotic fluid activin-a and inhibin-a in women with preterm premature rupture of the membranes and infection-induced preterm birth.

    Science.gov (United States)

    Rosenberg, Victor A; Buhimschi, Irina A; Dulay, Antonette T; Abdel-Razeq, Sonya S; Oliver, Emily A; Duzyj, Christina M; Lipkind, Heather; Pettker, Christian M; Buhimschi, Catalin S

    2012-02-01

    Activins and inhibins are important modulators of inflammatory processes. We explored activation of amniotic fluid (AF) activin-A and inhibin-A system in women with intra-amniotic infection and preterm premature rupture of the membranes (PPROM). We analyzed 78 AF samples: '2nd trimester-control' (n=12), '3rd trimester-control' (n=14), preterm labor with intact membranes [positive-AF-cultures (n=13), negative-AF-cultures (n=13)], and PPROM [positive-AF-cultures (n=13), negative-AF-cultures (n=13)]. Activin-A levels were evaluated ex-vivo following incubation of amniochorion and placental villous explants with Gram-negative lipopolysaccharide (LPS) or Gram-positive (Pam3Cys) bacterial mimics. Ability of recombinant activin-A and inhibin-A to modulate inflammatory reactions in fetal membranes was explored through explants' IL-8 release. Activin-A and inhibin-A were present in human AF and were gestational age-regulated. Activin-A was significantly upregulated by infection. Lower inhibin-A levels were seen in PPROM. LPS elicited release of activin-A from amniochorion, but not from villous explants. Recombinant activin-A stimulated IL-8 release from amniochorion, an effect that was not reversed by inhibin-A. Human AF activin-A and inhibin-A are involved in biological processes linked to intra-amniotic infection/inflammation-induced preterm birth. © 2011 John Wiley & Sons A/S.

  16. Effects of socioeconomic position and clinical risk factors on spontaneous and iatrogenic preterm birth

    OpenAIRE

    Joseph, KS; Fahey, John; Shankardass, Ketan; Allen, Victoria M; O’Campo, Patricia; Dodds, Linda; Liston, Robert M; Allen, Alexander C

    2014-01-01

    Background The literature shows a variable and inconsistent relationship between socioeconomic position and preterm birth. We examined risk factors for spontaneous and iatrogenic preterm birth, with a focus on socioeconomic position and clinical risk factors, in order to explain the observed inconsistency. Methods We carried out a retrospective population-based cohort study of all singleton deliveries in Nova Scotia from 1988 to 2003. Data were obtained from the Nova Scotia Atlee Perinatal Da...

  17. Effectiveness of individualized lung recruitment strategies at birth: an experimental study in preterm lambs.

    Science.gov (United States)

    Tingay, David G; Rajapaksa, Anushi; Zannin, Emanuela; Pereira-Fantini, Prue M; Dellaca, Raffaele L; Perkins, Elizabeth J; Zonneveld, Cornelis E E; Adler, Andy; Black, Don; Frerichs, Inéz; Lavizzari, Anna; Sourial, Magdy; Grychtol, Bartłomiej; Mosca, Fabio; Davis, Peter G

    2017-01-01

    Respiratory transition at birth involves rapidly clearing fetal lung liquid and preventing efflux back into the lung while aeration is established. We have developed a sustained inflation (SI OPT ) individualized to volume response and a dynamic tidal positive end-expiratory pressure (PEEP) (open lung volume, OLV) strategy that both enhance this process. We aimed to compare the effect of each with a group managed with PEEP of 8 cmH 2 O and no recruitment maneuver (No-RM), on gas exchange, lung mechanics, spatiotemporal aeration, and lung injury in 127 ± 1 day preterm lambs. Forty-eight fetal-instrumented lambs exposed to antenatal steroids were ventilated for 60 min after application of the allocated strategy. Spatiotemporal aeration and lung mechanics were measured with electrical impedance tomography and forced-oscillation, respectively. At study completion, molecular and histological markers of lung injury were analyzed. Mean (SD) aeration at the end of the SI OPT and OLV groups was 32 (22) and 38 (15) ml/kg, compared with 17 (10) ml/kg (180 s) in the No-RM (P = 0.024, 1-way ANOVA). This translated into better oxygenation at 60 min (P = 0.047; 2-way ANOVA) resulting from better distal lung tissue aeration in SI OPT and OLV. There was no difference in lung injury. Neither SI OPT nor OLV achieved homogeneous aeration. Histological injury and mRNA biomarker upregulation were more likely in the regions with better initial aeration, suggesting volutrauma. Tidal ventilation or an SI achieves similar aeration if optimized, suggesting that preventing fluid efflux after lung liquid clearance is at least as important as fluid clearance during the initial inflation at birth. Copyright © 2017 the American Physiological Society.

  18. Preterm birth in Caucasians is associated with coagulation and inflammation pathway gene variants.

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    Digna R Velez

    Full Text Available Spontaneous preterm birth (<37 weeks gestation-PTB occurs in approximately 12% of pregnancies in the United States, and is the largest contributor to neonatal morbidity and mortality. PTB is a complex disease, potentially induced by several etiologic factors from multiple pathophysiologic pathways. To dissect the genetic risk factors of PTB a large-scale high-throughput candidate gene association study was performed examining 1536 SNP in 130 candidate genes from hypothesized PTB pathways. Maternal and fetal DNA from 370 US Caucasian birth-events (172 cases and 198 controls was examined. Single locus, haplotype, and multi-locus association analyses were performed separately on maternal and fetal data. For maternal data the strongest associations were found in genes in the complement-coagulation pathway related to decidual hemorrhage in PTB. In this pathway 3 of 6 genes examined had SNPs significantly associated with PTB. These include factor V (FV that was previously associated with PTB, factor VII (FVII, and tissue plasminogen activator (tPA. The single strongest effect was observed in tPA marker rs879293 with a significant allelic (p = 2.30x10(-3 and genotypic association (p = 2.0x10(-6 with PTB. The odds ratio (OR for this SNP was 2.80 [CI 1.77-4.44] for a recessive model. Given that 6 of 8 markers in tPA were statistically significant, sliding window haplotype analyses were performed and revealed an associating 4 marker haplotype in tPA (p = 6.00x10(-3. The single strongest effect in fetal DNA was observed in the inflammatory pathway at rs17121510 in the interleukin-10 receptor antagonist (IL-10RA gene for allele (p = 0.01 and genotype (p = 3.34x10(-4. The OR for the IL-10RA genotypic additive model was 1.92 [CI 1.15-3.19] (p = 2.00x10(-3. Finally, exploratory multi-locus analyses in the complement and coagulation pathway were performed and revealed a potentially significant interaction between a marker in FV (rs2187952 and FVII (rs3211719 (p

  19. Time course study of blood pressure in term and preterm infants immediately after birth.

    Directory of Open Access Journals (Sweden)

    Gerhard Pichler

    Full Text Available To describe temporal changes in systolic, diastolic, and mean blood pressure (SBP, DBP, and MBP, respectively in term and preterm infants immediately after birth.Prospective observational two-center study. In term infants SBP, DBP, and MBP were assessed non-invasively every minute for the first 15 minutes, and in preterm infants every minute for the first 15 minutes, as well as at 20, 25, 30, 45, and 60 minutes after birth. Regression analyses were performed by gender and respiratory support in all neonates; and by mode of delivery, cord clamping time, and development of ultrasound-detected brain injury in preterm neonates.Term infants (n = 54 had a mean (SD birth weight of 3298 (442 g and gestational age of 38 (1 weeks, and preterm infants (n = 94 weighed 1340 (672 g and were 30 (3 weeks gestation. Term infants' SBP, DBP and MBP within the first 15 minutes after birth were independent of gender or respiratory support. Linear mixed regression analysis showed that preterm infants, who were female, born vaginally, had delayed cord clamping and did not require positive pressure ventilation nor develop periventricular injury or ventriculomegaly, had significantly higher SBP, DBP, and MBP at some measurement points within the first hour after birth.We present novel reference ranges of BP immediately after birth in a cohort of term and preterm neonates. They may aid in optimization of cardiovascular support during early transition at all gestations.

  20. Gonadotropin levels in urine during early postnatal period in small for gestational age preterm male infants with fetal growth restriction.

    Science.gov (United States)

    Nagai, S; Kawai, M; Myowa-Yamakoshi, M; Morimoto, T; Matsukura, T; Heike, T

    2017-07-01

    The objective of this study was to estimate gonadotropin concentrations in small for gestational age (SGA) male infants with the reactivation of the hypothalamic-pituitary-gonadal axis during the first few months of life that is important for genital development. We prospectively examined 15 SGA and 15 appropriate for gestational age (AGA) preterm male infants between 2013 and 2014 at Kyoto University Hospital. Gonadotropin concentrations (luteinizing hormone (LH) and follicle-stimulating hormone (FSH)) were measured in serial urine samples from the postnatal days 7 to 168 and compared between SGA and AGA infants using the Mann-Whitney test. A longitudinal analysis showed that SGA infants had higher LH and lower FSH concentrations (P=0.004 and P=0.006, respectively) than AGA infants. Male infants who are SGA at birth because of fetal growth restriction have gonadotropin secretion abnormalities in the first few months of life.

  1. Progesterone for the prevention of preterm birth in women with multiple pregnancies: the AMPHIA trial

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    Scheepers Hubertina CJ

    2007-06-01

    Full Text Available Abstract Background 15% of multiple pregnancies ends in a preterm delivery, which can lead to mortality and severe long term neonatal morbidity. At present, no generally accepted strategy for the prevention of preterm birth in multiple pregnancies exists. Prophylactic administration of 17-alpha hydroxyprogesterone caproate (17OHPC has proven to be effective in the prevention of preterm birth in women with singleton pregnancies with a previous preterm delivery. At present, there are no data on the effectiveness of progesterone in the prevention of preterm birth in multiple pregnancies. Methods/Design We aim to investigate the hypothesis that 17OHPC will reduce the incidence of the composite neonatal morbidity of neonates by reducing the early preterm birth rate in multiple pregnancies. Women with a multiple pregnancy at a gestational age between 15 and 20 weeks of gestation will be entered in a placebo-controlled, double blinded randomised study comparing weekly 250 mg 17OHPC intramuscular injections from 16–20 weeks up to 36 weeks of gestation versus placebo. At study entry, cervical length will be measured. The primary outcome is composite bad neonatal condition (perinatal death or severe morbidity. Secondary outcome measures are time to delivery, preterm birth rate before 32 and 37 weeks, days of admission in neonatal intensive care unit, maternal morbidity, maternal admission days for preterm labour and costs. We need to include 660 women to indicate a reduction in bad neonatal outcome from 15% to 8%. Analysis will be by intention to treat. We will also analyse whether the treatment effect is dependent on cervical length. Discussion This trial will provide evidence as to whether or not 17OHPC-treatment is an effective means of preventing bad neonatal outcome due to preterm birth in multiple pregnancies. Trial registration Current Controlled Trials ISRCTN40512715

  2. Preconceptional folate supplementation and the risk of spontaneous preterm birth: a cohort study.

    Science.gov (United States)

    Bukowski, Radek; Malone, Fergal D; Porter, Flint T; Nyberg, David A; Comstock, Christine H; Hankins, Gary D V; Eddleman, Keith; Gross, Susan J; Dugoff, Lorraine; Craigo, Sabrina D; Timor-Tritsch, Ilan E; Carr, Stephen R; Wolfe, Honor M; D'Alton, Mary E

    2009-05-05

    Low plasma folate concentrations in pregnancy are associated with preterm birth. Here we show an association between preconceptional folate supplementation and the risk of spontaneous preterm birth. In a cohort of 34,480 low-risk singleton pregnancies enrolled in a study of aneuploidy risk, preconceptional folate supplementation was prospectively recorded in the first trimester of pregnancy. Duration of pregnancy was estimated based on first trimester ultrasound examination. Natural length of pregnancy was defined as gestational age at delivery in pregnancies with no medical or obstetrical complications that may have constituted an indication for delivery. Spontaneous preterm birth was defined as duration of pregnancy between 20 and 37 wk without those complications. The association between preconceptional folate supplementation and the risk of spontaneous preterm birth was evaluated using survival analysis. Comparing to no supplementation, preconceptional folate supplementation for 1 y or longer was associated with a 70% decrease in the risk of spontaneous preterm delivery between 20 and 28 wk (41 [0.27%] versus 4 [0.04%] spontaneous preterm births, respectively; HR 0.22, 95% confidence interval [CI] 0.08-0.61, p = 0.004) and a 50% decrease in the risk of spontaneous preterm delivery between 28 and 32 wk (58 [0.38%] versus 12 [0.18%] preterm birth, respectively; HR 0.45, 95% CI 0.24-0.83, p = 0.010). Adjustment for maternal characteristics age, race, body mass index, education, marital status, smoking, parity, and history of prior preterm birth did not have a material effect on the association between folate supplementation for 1 y or longer and spontaneous preterm birth between 20 and 28, and 28 to 32 wk (adjusted HR 0.31, 95% CI 0.11-0.90, p = 0.031 and 0.53, 0.28-0.99, p = 0.046, respectively). Preconceptional folate supplementation was not significantly associated with the risk of spontaneous preterm birth beyond 32 wk. The association between shorter duration

  3. Preconceptional folate supplementation and the risk of spontaneous preterm birth: a cohort study.

    Directory of Open Access Journals (Sweden)

    Radek Bukowski

    2009-05-01

    Full Text Available Low plasma folate concentrations in pregnancy are associated with preterm birth. Here we show an association between preconceptional folate supplementation and the risk of spontaneous preterm birth.In a cohort of 34,480 low-risk singleton pregnancies enrolled in a study of aneuploidy risk, preconceptional folate supplementation was prospectively recorded in the first trimester of pregnancy. Duration of pregnancy was estimated based on first trimester ultrasound examination. Natural length of pregnancy was defined as gestational age at delivery in pregnancies with no medical or obstetrical complications that may have constituted an indication for delivery. Spontaneous preterm birth was defined as duration of pregnancy between 20 and 37 wk without those complications. The association between preconceptional folate supplementation and the risk of spontaneous preterm birth was evaluated using survival analysis. Comparing to no supplementation, preconceptional folate supplementation for 1 y or longer was associated with a 70% decrease in the risk of spontaneous preterm delivery between 20 and 28 wk (41 [0.27%] versus 4 [0.04%] spontaneous preterm births, respectively; HR 0.22, 95% confidence interval [CI] 0.08-0.61, p = 0.004 and a 50% decrease in the risk of spontaneous preterm delivery between 28 and 32 wk (58 [0.38%] versus 12 [0.18%] preterm birth, respectively; HR 0.45, 95% CI 0.24-0.83, p = 0.010. Adjustment for maternal characteristics age, race, body mass index, education, marital status, smoking, parity, and history of prior preterm birth did not have a material effect on the association between folate supplementation for 1 y or longer and spontaneous preterm birth between 20 and 28, and 28 to 32 wk (adjusted HR 0.31, 95% CI 0.11-0.90, p = 0.031 and 0.53, 0.28-0.99, p = 0.046, respectively. Preconceptional folate supplementation was not significantly associated with the risk of spontaneous preterm birth beyond 32 wk. The association between

  4. Relationship between periodontal disease and preterm low birth weight: systematic review.

    Science.gov (United States)

    Teshome, Amare; Yitayeh, Asmare

    2016-01-01

    Periodontal disease is a neglected bacterial infection that causes destruction of the periodontium in pregnant women. Yet its impact on the occurrence of adverse pregnancy outcomes has not systematically evaluated and there is no clear statement on the relationship between periodontal disease and preterm low birth weight. The objective of this study was to summarize the evidence on the impact of periodontal disease on preterm low birth weight. We searched the following data bases from January 2005 to December 2015: CINAHL (cumulative index to nursing and allied health literature), MEDLINE, AMED, EMBASE (excerpta medica database), Cochrane library and Google scholar. Only case-control studies with full text in English were eligible. Critical appraisal of the identified articles was done by two authors independently to provide the possible relevance of the papers for inclusion in the review process. The selected Case control studies were critically appraised with 12 items structured checklist adapted from national institute of health (NIH). Odds ratio (OR) or risk ratios (RR) were extracted from the selected studies. The two reviewers who selected the appropriate studies also extracted the data and evaluated the risk of bias. Of 229 articles, ten studies with a total of 2423 participants with a mean age ranged from 13 to 49 years were met the inclusion criteria. The studies focused on preterm birth, low birth weight and /or preterm low birth weight and periodontitis. Of the selected studies, 9 implied an association between periodontal disease and increased risk of preterm birth, low birth weight and /or preterm low birth weight outcome (ORs ranging from 2.04 to 4.19) and only one study found no evidence of association. Periodontal disease may be one of the possible risk factor for preterm low birth weight infant. However, more precise studies with randomized clinical trial with sufficient follow-up period must be done to confirm the association.

  5. Cerebral oximetry in preterm infants

    DEFF Research Database (Denmark)

    Greisen, Gorm; Andresen, Bjørn; Plomgaard, Anne Mette

    2016-01-01

    Preterm birth constitutes a major cause of death before 5 years of age and it is a major cause of neurodevelopmental impairment across the world. Preterm infants are most unstable during the transition between fetal and newborn life during the first days of life and most brain damage occurs...

  6. Neonatal outcomes after preterm birth by mothers’ health insurance status at birth: a retrospective cohort study

    Directory of Open Access Journals (Sweden)

    Einarsdóttir Kristjana

    2013-02-01

    Full Text Available Abstract Background Publicly insured women usually have a different demographic background to privately insured women, which is related to poor neonatal outcomes after birth. Given the difference in nature and risk of preterm versus term births, it would be important to compare adverse neonatal outcomes after preterm birth between these groups of women after eliminating the demographic differences between the groups. Methods The study population included 3085 publicly insured and 3380 privately insured, singleton, preterm deliveries (32–36 weeks gestation from Western Australia during 1998–2008. From the study population, 1016 publicly insured women were matched with 1016 privately insured women according to the propensity score of maternal demographic characteristics and pre-existing medical conditions. Neonatal outcomes were compared in the propensity score matched cohorts using conditional log-binomial regression, adjusted for antenatal risk factors. Outcomes included Apgar scores less than 7 at five minutes after birth, time until establishment of unassisted breathing (>1 minute, neonatal resuscitation (endotracheal intubation or external cardiac massage and admission to a neonatal special care unit. Results Compared with infants of privately insured women, infants of publicly insured women were more likely to receive a low Apgar score (ARR = 2.63, 95% CI = 1.06-6.52 and take longer to establish unassisted breathing (ARR = 1.61, 95% CI = 1.25-2.07, yet, they were less likely to be admitted to a special care unit (ARR = 0.84, 95% CI = 0.80-0.87. No significant differences were evident in neonatal resuscitation between the groups (ARR = 1.20, 95% CI = 0.54-2.67. Conclusions The underlying reasons for the lower rate of special care admissions in infants of publicly insured women compared with privately insured women despite the higher rate of low Apgar scores is yet to be determined. Future research is

  7. Short and inflamed cervix predicts spontaneous preterm birth (COLIBRI study).

    Science.gov (United States)

    Raiche, Evelyne; Ouellet, Annie; Berthiaume, Maryse; Rousseau, Éric; Pasquier, Jean-Charles

    2014-07-01

    To develop a new strategy of predicting spontaneous preterm birth (sPTB) by combination of transvaginal ultrasound (TVUS) assessment and inflammatory proteins detection in vaginal secretions. Prospective study of 87 women referred for cervical length assessment with a standardized TVUS combined to vaginal secretions sampling. Samples were analyzed for presence of 10 cytokines. Main outcome was sPTB (cervix (cervix and IL-8 in vaginal secretions were independently associated with sPTB (OR 3.58 (95%CI 1.02; 12.61) and 14.55 (95%CI 1.64; 128.83), respectively) as their combination (OR 4.33 (95%CI 1.25; 14.95)). By categorizing cervical length by presence of IL-8, sPTB occurred in 55.6% of women with a short inflamed cervix. COLIBRI study used a novel, single-step method of vaginal secretions sampling during TVUS and demonstrated that combination of short cervix and IL-8 in vaginal secretions is a promising sPTB predictive test.

  8. The impact of domestic violence and depressive symptoms on preterm birth in South India.

    Science.gov (United States)

    Rao, Deepa; Kumar, Shuba; Mohanraj, Rani; Frey, Sarah; Manhart, Lisa E; L Kaysen, Debra

    2016-02-01

    India has the highest absolute number of maternal deaths, preterm birth cases, and under-5 mortality in the world, as well as high domestic violence (DV) rates. We sought to examine the impact of DV and its psychosocial correlates on pregnancy and birth outcomes. Women seeking antenatal care in Tamil Nadu, South India (N = 150) were assessed during pregnancy, and birth outcomes were abstracted from medical records after the babies were born. We found that psychological abuse (OR 3.9; 95% CI 1.19-12.82) and mild or greater depressive symptoms (OR 3.3; 95% CI 0.99-11.17) were significantly associated with increased risk of preterm birth. Physical abuse was also associated with increased risk of preterm birth, but this was not statistically significant (OR 1.9; 95% CI 0.59-6.19). In each of the above adjusted models, low maternal education was associated with increased risk of preterm birth, in the analysis with depressive symptoms OR 0.18, CI 0.04-0.86 and in the analyses with psychological abuse OR 0.19, CI 0.04-0.91. These findings suggest that future research should focus on understanding the psychosocial antecedents to preterm birth, to better target interventions and improve maternal child health in limited resource settings.

  9. Association of Mothers’ Perception of Neighborhood Quality and Maternal Resilience with Risk of Preterm Birth

    Directory of Open Access Journals (Sweden)

    Namrata Bhatia

    2015-08-01

    Full Text Available We examined the associations of mothers’ perception of neighborhood quality and maternal resilience with risk of preterm birth and whether maternal resilience moderated the effect of neighborhood quality perception. We analyzed data from 10,758 women with singleton births who participated in 2010–2012 Los Angeles Mommy and Baby surveys. Multilevel logistic regression models assessed the effects of mothers’ perception of neighborhood quality and maternal resilience on preterm birth (yes/no, controlling for potential confounders and economic hardship index, a city-level measure of neighborhood quality. Interaction terms were assessed for moderation. Mothers’ perception of neighborhood quality and maternal resilience were each uniquely associated with preterm birth, independent of potential confounders (p-values < 0.05. The risk of preterm birth among mothers who perceived their neighborhood as of poor quality was about 30% greater compared to mothers who perceived their neighborhood as of good quality; the risk was 12% greater among mothers with low resilience compared to those with high resilience. Effects of neighborhood quality were not modified by maternal resilience. The findings suggest that mothers’ perception of neighborhood quality and resilience are associated with the risk of preterm birth. Further research should explore whether initiatives aimed at improving neighborhood quality and women’s self-esteem may improve birth outcomes.

  10. Association of Mothers’ Perception of Neighborhood Quality and Maternal Resilience with Risk of Preterm Birth

    Science.gov (United States)

    Bhatia, Namrata; Chao, Shin Margaret; Higgins, Chandra; Patel, Suvas; Crespi, Catherine M.

    2015-01-01

    We examined the associations of mothers’ perception of neighborhood quality and maternal resilience with risk of preterm birth and whether maternal resilience moderated the effect of neighborhood quality perception. We analyzed data from 10,758 women with singleton births who participated in 2010–2012 Los Angeles Mommy and Baby surveys. Multilevel logistic regression models assessed the effects of mothers’ perception of neighborhood quality and maternal resilience on preterm birth (yes/no), controlling for potential confounders and economic hardship index, a city-level measure of neighborhood quality. Interaction terms were assessed for moderation. Mothers’ perception of neighborhood quality and maternal resilience were each uniquely associated with preterm birth, independent of potential confounders (p-values < 0.05). The risk of preterm birth among mothers who perceived their neighborhood as of poor quality was about 30% greater compared to mothers who perceived their neighborhood as of good quality; the risk was 12% greater among mothers with low resilience compared to those with high resilience. Effects of neighborhood quality were not modified by maternal resilience. The findings suggest that mothers’ perception of neighborhood quality and resilience are associated with the risk of preterm birth. Further research should explore whether initiatives aimed at improving neighborhood quality and women’s self-esteem may improve birth outcomes. PMID:26274966

  11. Association of Mothers' Perception of Neighborhood Quality and Maternal Resilience with Risk of Preterm Birth.

    Science.gov (United States)

    Bhatia, Namrata; Chao, Shin Margaret; Higgins, Chandra; Patel, Suvas; Crespi, Catherine M

    2015-08-12

    We examined the associations of mothers' perception of neighborhood quality and maternal resilience with risk of preterm birth and whether maternal resilience moderated the effect of neighborhood quality perception. We analyzed data from 10,758 women with singleton births who participated in 2010-2012 Los Angeles Mommy and Baby surveys. Multilevel logistic regression models assessed the effects of mothers' perception of neighborhood quality and maternal resilience on preterm birth (yes/no), controlling for potential confounders and economic hardship index, a city-level measure of neighborhood quality. Interaction terms were assessed for moderation. Mothers' perception of neighborhood quality and maternal resilience were each uniquely associated with preterm birth, independent of potential confounders (p-values < 0.05). The risk of preterm birth among mothers who perceived their neighborhood as of poor quality was about 30% greater compared to mothers who perceived their neighborhood as of good quality; the risk was 12% greater among mothers with low resilience compared to those with high resilience. Effects of neighborhood quality were not modified by maternal resilience. The findings suggest that mothers' perception of neighborhood quality and resilience are associated with the risk of preterm birth. Further research should explore whether initiatives aimed at improving neighborhood quality and women's self-esteem may improve birth outcomes.

  12. Prenatal arsenic exposure, child marriage, and pregnancy weight gain: Associations with preterm birth in Bangladesh.

    Science.gov (United States)

    Rahman, Mohammad L; Kile, Molly L; Rodrigues, Ema G; Valeri, Linda; Raj, Anita; Mazumdar, Maitreyi; Mostofa, Golam; Quamruzzaman, Quazi; Rahman, Mahmudur; Hauser, Russ; Baccarelli, Andrea; Liang, Liming; Christiani, David C

    2017-12-12

    Preterm birth is a disease of multifactorial etiologies that has environmental, social, and maternal health components. Individual studies have shown that exposure to arsenic contaminated drinking water, child marriage, and low maternal weight gain during pregnancy contribute to preterm birth. These factors are highly prevalent and often co-exist in Bangladesh, a country in South Asia with one of the world's highest prevalences of preterm birth. To evaluate the individual and interactive effects of prenatal arsenic exposure, child marriage, and pregnancy weight gain on preterm birth in a prospective birth cohort in Bangladesh. During 2008-2011, we recruited 1613 pregnant women aged ≥18years at ≤16weeks of gestation and followed them until 1-month post-partum. We measured total arsenic in drinking water (n=1184) and in maternal toenails (n=1115) collected at enrollment and ≤1-month post-partum, respectively using inductively coupled plasma mass spectrometry. Child marriage (child marriage, and 0.64 (95% CI: 0.42-0.97) for a pound per week increase in maternal weight during the 2nd and 3rd trimesters. In stratified analysis by child marriage, pregnancy weight gain was inversely associated with preterm birth among women with a history of child marriage (RR=0.58; 95% CI: 0.37-0.92), but not among women with no history of child marriage (RR=86; 95% CI: 0.37-2.01). Mediation analysis revealed that both arsenic exposure and child marriage had small but significant associations with preterm birth via lowering pregnancy weight gain. Similar associations were observed when arsenic exposure was assessed using maternal toenail arsenic concentrations. Reducing arsenic exposure and ending child marriage could reduce the risk of preterm birth in Bangladesh. Furthermore, enhancing nutritional support to ensure adequate weight gain during pregnancy may provide additional benefits especially for women with a history of child marriage. Copyright © 2017 Elsevier Ltd. All rights

  13. Reducing tobacco smoking and smoke exposure to prevent preterm birth and its complications.

    Science.gov (United States)

    Wagijo, Mary-Ann; Sheikh, Aziz; Duijts, Liesbeth; Been, Jasper V

    2017-03-01

    Tobacco smoking and smoke exposure during pregnancy are associated with a range of adverse health outcomes, including preterm birth. Also, children born preterm have a higher risk of complications including bronchopulmonary dysplasia and asthma when their mothers smoked during pregnancy. Smoking cessation in early pregnancy can help reduce the adverse impact on offspring health. Counselling interventions are effective in promoting smoking cessation and reducing the incidence of preterm birth. Peer support and incentive-based approaches are likely to be of additional benefit, whereas the effectiveness of pharmacological interventions, including nicotine replacement therapy, has not definitely been established. Smoke-free legislation can help reduce smoke exposure as well as maternal smoking rates at a population level, and is associated with a reduction in preterm birth. Helping future mothers to stop smoking and protect their children from second hand smoke exposure must be a key priority for health care workers and policy makers alike. Copyright © 2015 Elsevier Ltd. All rights reserved.

  14. Risk factors for preterm birth in five Maternal and Child Health hospitals in Beijing.

    Directory of Open Access Journals (Sweden)

    Yun-Ping Zhang

    Full Text Available BACKGROUND: Preterm birth, the birth of an infant prior to 37 completed weeks of gestation, is the leading cause of perinatal morbidity and mortality. Preterm infants are at greater risk of respiratory, gastrointestinal and neurological diseases. Despite significant research in developed countries, little is known about the causes of preterm birth in many developing countries, especially China. This study investigates the association between sciodemographic data, obstetric risk factor, and preterm birth in five Maternal and Child Health hospitals in Beijing, China. METHODS AND FINDINGS: A case-control study was conducted on 1391 women with preterm birth (case group and 1391 women with term delivery (control group, who were interviewed within 48 hours of delivery. Sixteen potential factors were investigated and statistical analysis was performed by univariate analysis and logistic regression analysis. Univariate analysis showed that 14 of the 16 factors were associated with preterm birth. Inter-pregnancy interval and inherited diseases were not risk factors. Logistic regression analysis showed that obesity (odds ratio (OR = 3.030, 95% confidence interval (CI 1.166-7.869, stressful life events (OR = 5.535, 95%CI 2.315-13.231, sexual activity (OR = 1.674, 95%CI 1.279-2.191, placenta previa (OR 13.577, 95%CI 2.563-71.912, gestational diabetes mellitus (OR = 3.441, 95%CI1.694-6.991, hypertensive disorder complicating pregnancy (OR = 6.034, 95%CI = 3.401-10.704, history of preterm birth (OR = 20.888, 95%CI 2.519-173.218 and reproductive abnormalities (OR = 3.049, 95%CI 1.010-9.206 were independent risk factors. Women who lived in towns and cities (OR = 0.603, 95%CI 0.430-0.846, had a balanced diet (OR = 0.533, 95%CI 0.421-0.675 and had a record of prenatal care (OR = 0.261, 95%CI 0.134-0.510 were less likely to have preterm birth. CONCLUSIONS: Obesity, stressful life events, sexual activity, placenta previa

  15. Association of Antenatal Depression Symptoms and Antidepressant Treatment With Preterm Birth.

    Science.gov (United States)

    Venkatesh, Kartik K; Riley, Laura; Castro, Victor M; Perlis, Roy H; Kaimal, Anjali J

    2016-05-01

    To evaluate the association of antenatal depression symptoms with preterm birth and small for gestational age (SGA). This was an observational cohort study conducted among women who completed Edinburgh Postnatal Depression Scale screening and delivered at 20 weeks of gestation or greater. The primary outcomes were preterm birth and an SGA neonate at birth (less than 10th percentile for gestational age); the primary predictor was an Edinburgh Postnatal Depression Scale antepartum score of 10 or greater, indicating symptoms of depression. Logistic regression models were used with and without consideration of antidepressant exposure during pregnancy. Among 7,267 women, 831 (11%) screened positive for depression. In multivariable analyses adjusting for maternal age, race, income, body mass index, tobacco use, lifetime diagnosis of major depression and anxiety, diabetes, hypertension, and preeclampsia, women who screened positive for depression experienced an increased risk of preterm birth (less than 37 weeks of gestation) (adjusted odds ratio [OR] 1.27, 95% confidence interval [CI] 1.04-1.55) and very preterm birth (less than 32 weeks of gestation) (adjusted OR 1.82, 95% CI 1.09-3.02) as well as of having an SGA neonate (adjusted OR 1.28, 95% CI 1.04-1.58). In secondary analyses, among women who were treated with an antidepressant during pregnancy (19% of those who screened positive and 5% of those who screened negative), depressive symptoms were not associated with a significantly increased risk of preterm and very preterm birth or an SGA neonate. In a large cohort of women screened for depression antepartum, those with depressive symptoms had an increased likelihood of preterm and very preterm delivery as well having an SGA neonate. Such risk was not apparent among women who were treated with an antidepressant medication.

  16. Variability in the management and outcomes of extremely preterm births across five European countries

    DEFF Research Database (Denmark)

    Smith, Lucy K; Blondel, Beatrice; Van Reempts, Patrick

    2017-01-01

    OBJECTIVE: To explore international variations in the management and survival of extremely low gestational age and birthweight births. DESIGN: Area-based prospective cohort of births SETTING: 12 regions across Belgium, France, Italy, Portugal and the UK PARTICIPANTS: 1449 live births and fetal de...

  17. The Impact of Neighborhood Conditions and Psychological Distress on Preterm Birth in African-American Women.

    Science.gov (United States)

    Giurgescu, Carmen; Zenk, Shannon N; Templin, Thomas N; Engeland, Christopher G; Kavanaugh, Karen; Misra, Dawn P

    2017-05-01

    Prior research suggests that adverse neighborhood conditions are related to preterm birth. One potential pathway by which neighborhood conditions increase the risk for preterm birth is by increasing women's psychological distress. Our objective was to examine whether psychological distress mediated the relationship between neighborhood conditions and preterm birth. One hundred and one pregnant African-American women receiving prenatal care at a medical center in Chicago participated in this cross-sectional design study. Women completed the self-report instruments about their perceived neighborhood conditions and psychological distress between 15-26 weeks gestation. Objective measures of the neighborhood were derived using geographic information systems (GIS). Birth data were collected from medical records. Perceived adverse neighborhood conditions were related to psychological distress: perceived physical disorder (r = .26, p = .01), perceived social disorder (r = .21, p = .03), and perceived crime (r = .30, p = .01). Objective neighborhood conditions were not related to psychological distress. Psychological distress mediated the effects of perceived neighborhood conditions on preterm birth. Psychological distress in the second trimester mediated the effects of perceived, but not objective, neighborhood conditions on preterm birth. If these results are replicable in studies with larger sample sizes, intervention strategies could be implemented at the individual level to reduce psychological distress and improve women's ability to cope with adverse neighborhood conditions. © 2016 Wiley Periodicals, Inc.

  18. Pesticides exposure through environment and risk of pre-term birth: a study from Agra city.

    Science.gov (United States)

    Anand, M; Singh, L; Agarwal, P; Saroj, R; Taneja, A

    2017-12-18

    Pre-term birth is an increasingly prevalent complex condition with multiple risk factors including environmental pollutants. Evidences linking organochlorine pesticides with adverse pregnancy outcomes are inconsistent for link between organochlorine pesticides and adverse pregnancy outcomes. We performed a case-control study of 50 cases of full-term births and 40 cases of pre-term births in this study. Placental organochlorine pesticides like metabolites of dichlorodiphenyltrichloroethane that is, (p,p-DDE, p,p-DDT and o,p-DDD) and isomers of hexachlorocyclohexane (α, β, γ and δ HCH) were analyzed by gas chromatography. Although the mean levels of pesticide were found higher in the placenta of the women with pre-term delivery cases placentas, but only α-HCH, total-HCH, p,p-DDE and total-DDT were found statistically significant. It was observed that pesticide exposed women were approximately 1.7 times more likely to deliver pre-term baby as compare to pregnant women that were not exposed to any pesticides. We also observed that increasing maternal age reduced the risk of having pre-term birth (OR = 0.99). Among all pesticides, α-HCH was found to be strongest isomer to induce premature baby birth (p term births.

  19. Vitamin C supplementation in pregnancy--does it decrease rates of preterm birth? A systematic review.

    Science.gov (United States)

    Swaney, Paul; Thorp, John; Allen, Ian

    2014-02-01

    To assess the evidence available on the use of vitamin C supplementation greater than recommended dietary intake to reduce preterm birth rates. Systematic review of randomized controlled trials using vitamin C alone or with one other supplement other than iron. Trials must report preterm birth rates but can have other primary outcomes. Preterm birth is defined as birth at less than 37 weeks' gestational age for this review. Review focused on studies with populations representative of Organization for Economic Co-operation and Development countries. Inadequate level of evidence on the use of vitamin C alone to prevent preterm birth rates in low-risk populations based on one study. Three studies provided convincing evidence of no benefit in low-risk groups of use of vitamins C and E combined. Three studies provided adequate evidence of no benefit in high-risk groups of use of vitamins C and E combined. The available evidence supports no benefit gained from using vitamin C to prevent preterm birth. Evidence does not support limiting use of vitamin C supplementation for other indications. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  20. Intracluster correlation coefficients for the Brazilian Multicenter Study on Preterm Birth (EMIP): methodological and practical implications

    Science.gov (United States)

    2014-01-01

    Background Cluster-based studies in health research are increasing. An important characteristic of such studies is the presence of intracluster correlation, typically quantified by the intracluster correlation coefficient (ICC), that indicate the proportion of data variability that is explained by the way of clustering. The purpose of this manuscript was to evaluate ICC of variables studied in the Brazilian Multicenter Study on Preterm Birth. Methods This was a multicenter cross-sectional study on preterm births involving 20 referral hospitals in different regions of Brazil plus a nested case–control study to assess associated factors with spontaneous preterm births. Estimated prevalence rates or means, ICC with 95% confidence intervals, design effects and mean cluster sizes were presented for more than 250 maternal and newborn variables. Results Overall, 5296 cases were included in the study (4,150 preterm births and 1,146 term births). ICC ranged from 0.3 was found in some clinical management aspects well defined in literature such as use of corticosteroids, indicating there was homogeneity in clusters for these variables. Conclusions Clusters selected for Brazilian Multicenter Study on Preterm Birth had mainly heterogeneous findings and these results can help researchers estimate the required sample size for future studies on maternal and perinatal health. PMID:24755392

  1. Sonographic cervical length, vaginal bleeding, and the risk of preterm birth.

    Science.gov (United States)

    Ramaeker, Devon M; Simhan, Hyagriv N

    2012-03-01

    We sought to evaluate the contributions of vaginal bleeding and cervical length to the risk of preterm birth. This was a secondary analysis of a cohort study designed to study predictors of preterm birth. The study included 2988 women with singleton gestations. Women underwent midtrimester transvaginal ultrasound assessment of cervical length and were queried regarding first- and second-trimester vaginal bleeding. There was a significant second-order relation between cervical length and preterm birth (P birth (odds ratio, 1.5; 95% confidence interval, 1.3-2.0). There was a significant interaction between cervical length and vaginal bleeding (P = .015). After accounting for cervical length and interaction, the adjusted odds ratio for vaginal bleeding and preterm birth was 4.8 (95% confidence interval, 1.89-12.4; P = .001). The magnitude of risk of preterm birth associated with sonographic cervical length depends on a woman's history of first- and second-trimester vaginal bleeding. Copyright © 2012 Mosby, Inc. All rights reserved.

  2. Racial and ethnic disparities in use of 17-alpha hydroxyprogesterone caproate for prevention of preterm birth.

    Science.gov (United States)

    Yee, Lynn M; Liu, Lilly Y; Sakowicz, Allie; Bolden, Janelle R; Miller, Emily S

    2016-03-01

    Racial/ethnic disparities in preterm birth remain a major public health challenge in the United States. While 17-alpha hydroxyprogesterone caproate (17OHP-C) is recommended for preterm birth prevention in women with a prior preterm birth, non-Hispanic black women continue to experience higher rates of recurrent preterm birth than white women receiving the same treatment. Further investigation of disparities in 17OHP-C use and adherence is warranted. We sought to evaluate whether racial and ethnic disparities exist in the use of and adherence to 17OHP-C within a population of eligible women. This was a retrospective cohort study of women with a prior spontaneous, singleton preterm birth who were eligible for 17OHP-C for preterm birth prevention and received care at a single institution from 2010 through 2014. Associations between self-identified race/ethnicity (non-Hispanic black vs women in all other racial/ethnic groups) and documented counseling about 17OHP-C, receipt of any 17OHP-C, and adherence to 17OHP-C administration were each estimated by bivariable analysis and multivariable logistic regression. Adherence to 17OHP-C was defined as not >1 missed dose, initiation racial/ethnic groups. After adjustment for potential confounders, non-Hispanic black women were significantly less likely to be adherent to 17OHP-C (adjusted odds ratio, 0.16; 95% confidence interval, 0.04-0.65). A significant interaction between non-Hispanic black race/ethnicity and public insurance was identified (adjusted odds ratio, 0.16; 95% confidence interval, 0.05-0.52). In a diverse cohort of women eligible for preterm birth prevention, non-Hispanic black women are at an increased risk of nonadherence to 17OHP-C. Non-Hispanic black women with public insurance are at a particularly increased risk of nonadherence. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Economic costs associated with moderate and late preterm birth: a prospective population-based study.

    Science.gov (United States)

    Khan, K A; Petrou, S; Dritsaki, M; Johnson, S J; Manktelow, B; Draper, E S; Smith, L K; Seaton, S E; Marlow, N; Dorling, J; Field, D J; Boyle, E M

    2015-10-01

    We sought to determine the economic costs associated with moderate and late preterm birth. An economic study was nested within a prospective cohort study. Infants born between 32(+0) and 36(+6)  weeks of gestation in the East Midlands of England. A sample of infants born at ≥37 weeks of gestation acted as controls. Data on resource use, estimated from a National Health Service (NHS) and personal social services perspective, and separately from a societal perspective, were collected between birth and 24 months corrected age (or death), and valued in pounds sterling, at 2010-11 prices. Descriptive statistics and multivariable analyses were used to estimate the relationship between gestational age at birth and economic costs. Cumulative resource use and economic costs over the first two years of life. Of all eligible births, 1146 (83%) preterm and 1258 (79%) term infants were recruited. Mean (standard error) total societal costs from birth to 24 months were £12 037 (£1114) and £5823 (£1232) for children born moderately preterm (32(+0) -33(+6)  weeks of gestation) and late preterm (34(+0) -36(+6)  weeks of gestation), respectively, compared with £2056 (£132) for children born at term. The mean societal cost difference between moderate and late preterm and term infants was £4657 (bootstrap 95% confidence interval, 95% CI £2513-6803; P economic costs over the first 2 years of life. Our economic estimates can be used to inform budgetary and service planning by clinical decision-makers, and economic evaluations of interventions aimed at preventing moderate and late preterm birth or alleviating its adverse consequences. Moderate and late preterm birth is associated with increased economic costs over the first 2 years of life. © 2015 Royal College of Obstetricians and Gynaecologists.

  4. Preterm birth time trends in Europe: A study of 19 countries

    NARCIS (Netherlands)

    Zeitlin, J.; Szamotulska, K.; Drewniak, N.; Mohangoo, A.D.; Chalmers, J.; Sakkeus, L.; Irgens, L.; Gatt, M.; Gissler, M.; Blondel, B.

    2013-01-01

    Objective To investigate time trends in preterm birth in Europe by multiplicity, gestational age, and onset of delivery. Design Analysis of aggregate data from routine sources. Setting Nineteen European countries. Population Live births in 1996, 2000, 2004, and 2008. Methods Annual risk ratios of

  5. Segregation and preterm birth: The effects of neighborhood racial composition in North Carolina

    Science.gov (United States)

    Epidemiologic research suggests that racial segregation is associated with poor health among blacks in the United States (US). We used geocoded birth records and US census data to investigate whether neighborhood-level percent black is associated with preterm birth (PTB) for blac...

  6. Arousal from sleep pathways are affected by the prone sleeping position and preterm birth: preterm birth, prone sleeping and arousal from sleep.

    Science.gov (United States)

    Richardson, Heidi L; Horne, Rosemary S C

    2013-09-01

    Preterm infants exhibit depressed arousability from sleep when compared with term infants. As the final cortical element of the arousal process may be the most critical for survival, we hypothesized that the increased vulnerability of preterm infants to the Sudden Infant Death Syndrome (SIDS) could be explained by depressed cortical arousal (CA) responses. We evaluated the effects of preterm birth on stimulus-induced arousal processes in both the prone and supine sleeping positions. 10 healthy preterm infants were studied with daytime polysomnography, in both supine and prone sleeping positions, at 36 weeks gestational age, 2-4 weeks, 2-3 months and 5-6 months post-term corrected age. Sub-cortical activations and cortical arousals (CA) were expressed as proportions of total arousal responses. Preterm data were compared with data from 13 healthy term infants studied at the same corrected ages. In preterm infants increased CAs were observed in the prone position at all ages studied. Compared to term infants, preterm infants had significantly fewer CAs in QS when prone at 2-3 months of age and more CAs when prone at 2-4 weeks in AS. There were no differences in either sleep state when infants slept supine. Prone sleeping promoted CA responses in healthy preterm infants throughout the first six months of post-term age. We have previously suggested that in term infants enhanced CA represents a critical protection against a potentially harmful situation; we speculate that for preterm-born infants the need for this protection is greater than in term infants. Crown Copyright © 2013. Published by Elsevier Ireland Ltd. All rights reserved.

  7. Association of rotating shiftwork with preterm births and low birth weight among never smoking women textile workers in China.

    Science.gov (United States)

    Xu, X; Ding, M; Li, B; Christiani, D C

    1994-07-01

    1035 married women workers in three modern textile mills in Anhui, China were surveyed to investigate the association of rotating shiftwork with low birth weight and preterm birth in 1992. Information on reproductive health, occupational exposure history, and other covariates including age at pregnancy, time and duration of leave from job since pregnancy, and mill location was obtained by trained nurses with a standardised questionnaire. This analysis was limited to 845 women (887 live births), who were middle or high school graduates, never smokers, and non-alcohol drinkers. About 72% of the women worked an eight day cycle with shift changes every two days throughout pregnancy. Mean gestational age was 38.8 and 39.0 weeks for shift and regular schedule workers, respectively. Multiple linear regression was used to adjust for confounding factors including maternal age at pregnancy, order of live birth, mill location, job title, occupational exposure to dust/gases/fumes, stress, carrying and lifting of heavy loads, working in a squat position, time and duration of leave from the job since pregnancy, and indoor coal combustion for heating. The adjusted difference in gestational age associated with rotating shifts was statistically significant (beta = -0.44 (SE 0.20) weeks.) Mean birth weights were 3248 g and 3338 g for rotating shift workers and regular schedule workers respectively. The estimated effect of rotating shiftwork on birth weight was -79 (SE 42) g. When the analysis was restricted to first order live births or to production workers, the estimated effects of rotating shiftwork on both gestational age and birth weight were significant. The proportions of preterm birth (regular schedule workers. The adjusted odds ratio of shiftwork was 2.0 (95% CI) 1.1-3.4) for preterm birth and 2.1 (95% CI 1.1-4.1) for low birth weight. This association remained significant when the analysis was restricted to production workers or first order live births.

  8. Maternal exposure to benzodiazepine and risk of preterm birth and low birth weight: A case-control study using a claims database in Japan.

    Science.gov (United States)

    Ogawa, Yusuke; Takeshima, Nozomi; Furukawa, Toshi A

    2018-01-03

    To examine (1) if the use of benzodiazepines and antidepressants during pregnancy may increase the risk of preterm birth and/or low birth weight (LBW), and, if yes, (2) which types of benzodiazepines or antidepressants have stronger influences. A case-control study was performed using a large claims database in Japan. Cases were mothers who had given birth to preterm and/or LBW infants between 2005 and 2014 (737 with preterm births and 1615 with LBW). Controls were mothers who had neither experienced preterm birth nor given birth to an LBW infant. Overall, 42 058 births were included. The maternal use of benzodiazepines was significantly associated with an increased risk of preterm birth (adjusted odds ratio [OR], 2.03; 95% confidence interval [CI], 1.11-3.69, P preterm deliveries (adjusted OR, 0.57; 0.08-4.16) and LBW (adjusted OR, 0.56; 0.14-2.29). Benzodiazepine use was associated with increased risk of preterm birth but not with LBW. Antidepressant use was not associated with both preterm deliveries and LBW. © 2018 John Wiley & Sons Australia, Ltd.

  9. Cyst(e)ine requirements in enterally fed very low birth weight preterm infants.

    Science.gov (United States)

    Riedijk, Maaike A; Voortman, Gardi; van Beek, Ron H T; Baartmans, Martin G A; Wafelman, Leontien S; van Goudoever, Johannes B

    2008-03-01

    Optimal nutrition is of utmost importance for the preterm infant's later health and developmental outcome. Amino acid requirements for preterm infants differ from those for term and older infants, because growth rates differ. Some nonessential amino acids, however, cannot be sufficiently synthesized endogenously. Cyst(e)ine is supposed to be such a conditionally essential amino acid in preterm infants. The objective of this study was to determine, at 32 and 35 weeks' postmenstrual age, cyst(e)ine requirements in fully enterally fed very low birth weight preterm infants with gestational ages of ine requirement was determined with the indicator amino acid oxidation technique ([1-(13)C]phenylalanine) after 24-hour adaptation. Fractional [1-(13)C]phenylalanine oxidation was established in 47 very low birth weight preterm infants (mean gestational age: 28 weeks +/- 1 week SD; birth weight: 1.07 kg +/- 0.21 kg SD). Increase in dietary cyst(e)ine intake did not result in a decrease in fractional [1-(13)C]phenylalanine oxidation. These data do not support the hypothesis that endogenous cyst(e)ine synthesis is limited in very low birth weight preterm infants with gestational ages of ine requirement is ine is probably not a conditionally essential amino acid in these infants.

  10. Multidimensional proteomics analysis of amniotic fluid to provide insight into the mechanisms of idiopathic preterm birth.

    Directory of Open Access Journals (Sweden)

    Irina A Buhimschi

    2008-04-01

    Full Text Available Though recent advancement in proteomics has provided a novel perspective on several distinct pathogenetic mechanisms leading to preterm birth (inflammation, bleeding, the etiology of most preterm births still remains elusive. We conducted a multidimensional proteomic analysis of the amniotic fluid to identify pathways related to preterm birth in the absence of inflammation or bleeding.A proteomic fingerprint was generated from fresh amniotic fluid using surface-enhanced laser desorbtion ionization time of flight (SELDI-TOF mass spectrometry in a total of 286 consecutive samples retrieved from women who presented with signs or symptoms of preterm labor or preterm premature rupture of the membranes. Inflammation and/or bleeding proteomic patterns were detected in 32% (92/286 of the SELDI tracings. In the remaining tracings, a hierarchical algorithm was applied based on descriptors quantifying similarity/dissimilarity among proteomic fingerprints. This allowed identification of a novel profile (Q-profile based on the presence of 5 SELDI peaks in the 10-12.5 kDa mass area. Women displaying the Q-profile (mean+/-SD, gestational age: 25+/-4 weeks, n = 40 were more likely to deliver preterm despite expectant management in the context of intact membranes and normal amniotic fluid clinical results. Utilizing identification-centered proteomics techniques (fluorescence two-dimensional differential gel electrophoresis, robotic tryptic digestion and mass spectrometry coupled with Protein ANalysis THrough Evolutionary Relationships (PANTHER ontological classifications, we determined that in amniotic fluids with Q-profile the differentially expressed proteins are primarily involved in non-inflammatory biological processes such as protein metabolism, signal transduction and transport.Proteomic profiling of amniotic fluid coupled with non-hierarchical bioinformatics algorithms identified a subgroup of patients at risk for preterm birth in the absence of intra

  11. Racism in the form of micro aggressions and the risk of preterm birth among black women.

    Science.gov (United States)

    Slaughter-Acey, Jaime C; Sealy-Jefferson, Shawnita; Helmkamp, Laura; Caldwell, Cleopatra H; Osypuk, Theresa L; Platt, Robert W; Straughen, Jennifer K; Dailey-Okezie, Rhonda K; Abeysekara, Purni; Misra, Dawn P

    2016-01-01

    This study sought to examine whether perceived interpersonal racism in the form of racial micro aggressions was associated with preterm birth (PTB) and whether the presence of depressive symptoms and perceived stress modified the association. Data stem from a cohort of 1410 black women residing in Metropolitan Detroit, Michigan, enrolled into the Life-course Influences on Fetal Environments (LIFE) study. The Daily Life Experiences of Racism and Bother (DLE-B) scale measured the frequency and perceived stressfulness of racial micro aggressions experienced during the past year. Severe past-week depressive symptomatology was measured by the Centers for Epidemiologic Studies-Depression scale (CES-D) dichotomized at ≥ 23. Restricted cubic splines were used to model nonlinearity between perceived racism and PTB. We used the Perceived Stress Scale to assess general stress perceptions. Stratified spline regression analysis demonstrated that among those with severe depressive symptoms, perceived racism was not associated with PTB. However, perceived racism was significantly associated with PTB among women with mild to moderate (CES-D score ≤ 22) depressive symptoms. Perceived racism was not associated with PTB among women with or without high amounts of perceived stress. Our findings suggest that racism, at least in the form of racial micro aggressions, may not further impact a group already at high risk for PTB (those with severe depressive symptoms), but may increase the risk of PTB for women at lower baseline risk. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Term induction of labor and subsequent preterm birth.

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    Levine, Lisa D; Bogner, Hillary R; Hirshberg, Adi; Elovitz, Michal A; Sammel, Mary D; Srinivas, Sindhu K

    2014-04-01

    Although the rate of inductions continues to rise, there is a paucity of data investigating subsequent pregnancy outcomes after induction. Our objective was to compare term inductions with term spontaneous labor and evaluate the rate of subsequent spontaneous preterm birth (sPTB). A retrospective cohort study of women with 2 consecutive deliveries from 2005 through 2010 was performed. Term inductions or term spontaneous labor in the index pregnancy was included, and those with a prior sPTB were excluded. Data were obtained through chart abstraction. The primary outcome was sPTB (Term inductions were less likely to have a subsequent sPTB compared with term spontaneous labor (6% vs 11%; odds ratio [OR], 0.49; 95% confidence interval, 0.29-0.81; P = .005). This remained after adjusting for confounders (adjusted OR, 0.55; P = .04). The sPTB risk depended on gestational age of index delivery. At 37-38.9 weeks, the sPTB rate after spontaneous labor was 24% vs 9% after induction (OR, 3.0; 95% confidence interval, 1.44-6.16; P = .003). This was not significant for 39-39.9 weeks (P = .2) or 40 weeks or longer (P = .8). Induction is not a risk factor for subsequent sPTB. Spontaneous labor, however, in the early term period is associated with subsequent sPTB. Further investigation among early term deliveries is warranted to evaluate the risk of sPTB and target interventions in this cohort. Copyright © 2014 Mosby, Inc. All rights reserved.

  13. Maternal obesity, fish intake, and recurrent spontaneous preterm birth.

    Science.gov (United States)

    Smid, Marcela C; Stuebe, Alison M; Manuck, Tracy A; Sen, Sarbattama

    2018-02-21

    Moderate fish intake in early pregnancy is associated with decreased risk of preterm birth (PTB). Obesity during pregnancy is characterized by inflammation and insufficiency of essential fatty acids. The objective of this study was to measure the association between fish intake during pregnancy and risk of recurrent spontaneous (s) PTB among lean, overweight, and obese women. This is secondary analysis of a randomized controlled trial of omega-3 fatty acid supplementation for recurrent PTB prevention, 2005-2006. The primary exposure was fish intake at time of enrollment (16-22.9-week gestation). The primary outcomes were sPTB <37 weeks and sPTB <35 weeks. Maternal prepregnancy body mass index was treated as an effect modifier. Eight hundred and fifty-two women were included, 47% were lean, 25% overweight, and 28% obese. In this cohort, among lean, but not overweight or obese women, ≥1 serving of fish per week was associated with decreased frequency of sPTB <37 weeks compared with <1 serving of fish per week (45.1% versus 27.5%, p = .001) and spontaneous PTB <35 (21.4% versus 11.6%, p = .01). In adjusted models, as fish intake increased, the predicted probability of sPTB decreased in lean women but increased in overweight and obese women (p for interaction < .10). Fish intake was associated with lower probability of sPTB in lean women and higher probability in obese women. These findings warrant further investigation to understand the dietary or metabolic factors associated with obesity that may modulate benefit of fish intake during pregnancy.

  14. Preterm birth and structural brain alterations in early adulthood

    Directory of Open Access Journals (Sweden)

    Chiara Nosarti

    2014-01-01

    Full Text Available Alterations in cortical development and impaired neurodevelopmental outcomes have been described following very preterm (VPT birth in childhood and adolescence, but only a few studies to date have investigated grey matter (GM and white matter (WM maturation in VPT samples in early adult life. Using voxel-based morphometry (VBM we studied regional GM and WM volumes in 68 VPT-born individuals (mean gestational age 30 weeks and 43 term-born controls aged 19–20 years, and their association with cognitive outcomes (Hayling Sentence Completion Test, Controlled Oral Word Association Test, Visual Reproduction test of the Wechsler Memory Scale-Revised and gestational age. Structural MRI data were obtained with a 1.5 Tesla system and analysed using the VBM8 toolbox in SPM8 with a customized study-specific template. Similarly to results obtained at adolescent assessment, VPT young adults compared to controls demonstrated reduced GM volume in temporal, frontal, insular and occipital areas, thalamus, caudate nucleus and putamen. Increases in GM volume were noted in medial/anterior frontal gyrus. Smaller subcortical WM volume in the VPT group was observed in temporal, parietal and frontal regions, and in a cluster centred on posterior corpus callosum/thalamus/fornix. Larger subcortical WM volume was found predominantly in posterior brain regions, in areas beneath the parahippocampal and occipital gyri and in cerebellum. Gestational age was associated with GM and WM volumes in areas where VPT individuals demonstrated GM and WM volumetric alterations, especially in temporal, parietal and occipital regions. VPT participants scored lower than controls on measures of IQ, executive function and non-verbal memory. When investigating GM and WM alterations and cognitive outcome scores, subcortical WM volume in an area beneath the left inferior frontal gyrus accounted for 14% of the variance of full-scale IQ (F = 12.9, p < 0.0001. WM volume in posterior corpus

  15. Low-dose aspirin and preterm birth: a randomized controlled trial.

    Science.gov (United States)

    Silver, Robert M; Ahrens, Katherine; Wong, Luchin F; Perkins, Neil J; Galai, Noya; Lesher, Laurie L; Faraggi, David; Wactawski-Wende, Jean; Townsend, Janet M; Lynch, Anne M; Mumford, Sunni L; Sjaarda, Lindsey; Schisterman, Enrique F

    2015-04-01

    To evaluate the association between low-dose aspirin initiated before conception and the risk of preterm birth. This was a secondary analysis of the Effects of Aspirin in Gestation and Reproduction trial. Women with a history of pregnancy loss (original stratum: one loss less than 20 weeks of gestation during the previous year; expanded stratum: one or two losses with no restrictions on timing or gestational age of the losses) were randomized to either daily low-dose aspirin (81 mg, n=615) and folic acid or folic acid alone (placebo; n=613). Preterm birth was compared between groups using intent-to-treat analysis. Preterm birth rates were 4.1% (22/535 low-dose aspirin) and 5.7% (31/543 placebo) (relative risk [RR] 0.72, 95% confidence interval [CI] 0.42-1.23); spontaneous preterm birth rates were 1.1% (6/535 low-dose aspirin) and 2.2% (12/543 placebo) (RR 0.51, 95% CI 0.19-1.34); medically indicated preterm birth rates were 2.6% (14/535 low-dose aspirin) and 2.9% (16/543 placebo) (RR 0.89, 95% CI 0.44-1.80). After restriction to confirmed pregnancies using inverse probability weighting, preterm birth rates were 5.7% and 9.0% (RR 0.63, 95% CI 0.37-1.09) and spontaneous preterm birth rates were 1.4% and 3.2% (RR 0.44, 95% CI 0.17-1.18). In confirmed pregnancies in the original stratum, preterm birth occurred in 3.8% and 9.7% of the low-dose aspirin and placebo groups, respectively (RR 0.39, 95% CI 0.16-0.94). Preconception low-dose aspirin was not significantly associated with the overall rate of preterm birth. Although the study was underpowered for this secondary analysis, numeric trends in favor of benefit, particularly in the women with a recent, single early pregnancy loss, warrant further investigation. ClinicalTrials.gov, www.clinicaltrials.gov, NCT00467363.

  16. Effect of periodontal treatment on preterm birth rate: a systematic review of meta-analyses.

    Science.gov (United States)

    López, Néstor J; Uribe, Sergio; Martinez, Benjamín

    2015-02-01

    Preterm birth is a major cause of neonatal morbidity and mortality in both developed and developing countries. Preterm birth is a highly complex syndrome that includes distinct clinical subtypes in which many different causes may be involved. The results of epidemiological, molecular, microbiological and animal-model studies support a positive association between maternal periodontal disease and preterm birth. However, the results of intervention studies carried out to determine the effect of periodontal treatment on reducing the risk of preterm birth are controversial. This systematic review critically analyzes the methodological issues of meta-analyses of the studies to determine the effect of periodontal treatment to reduce preterm birth. The quality of the individual randomized clinical trials selected is of highest relevance for a systematic review. This article describes the methodological features that should be identified a priori and assessed individually to determine the quality of a randomized controlled trial performed to evaluate the effect of periodontal treatment on pregnancy outcomes. The AMSTAR and the PRISMA checklist tools were used to assess the quality of the six meta-analyses selected, and the bias domain of the Cochrane Collaboration's Tool was applied to evaluate each of the trials included in the meta-analyses. In addition, the methodological characteristics of each clinical trial were assessed. The majority of the trials included in the meta-analyses have significant methodological flaws that threaten their internal validity. The lack of effect of periodontal treatment on preterm birth rate concluded by four meta-analyses, and the positive effect of treatment for reducing preterm birth risk concluded by the remaining two meta-analyses are not based on consistent scientific evidence. Well-conducted randomized controlled trials using rigorous methodology, including appropriate definition of the exposure, adequate control of confounders for

  17. Expression of selected genes in preterm premature rupture of fetal membranes.

    Science.gov (United States)

    Kuć, Paweł; Laudański, Piotr; Kowalczuk, Oksana; Chyczewski, Lech; Laudański, Tadeusz

    2012-08-01

    To analyse the expression of 15 genes encoding receptors and enzymes associated with the molecular mechanism of the tocolytic drugs atosiban (oxytocin receptor antagonist), nifedipine (calcium channel blocker) and celecoxib (selective cyclo-oxygenase-2 inhibitor) in preterm labor patients with premature rupture of fetal membranes in relation to symptoms of intrauterine infection and preterm labor risk factors. Experimental molecular study. Tertiary obstetric care center. Myometrial samples were obtained during cesarean sections from 35 patients who delivered preterm with unverified symptoms of intrauterine infection, 35 patients who delivered preterm without symptoms of intrauterine infection and 90 women who delivered at term. The Micro Fluidic Profiling Card analytic system was used to evaluate mRNA expression of the genes of interest. The relative quantification values for mRNA expression. The median oxytocin receptor and cyclo-oxygenase-2 mRNA expression in preterm patients with clinical symptoms of intrauterine infection was significantly higher than in preterm patients without symptoms. The median mRNA expression of β(1) , β(3) and β(4) subunits of the L-type calcium channel and prostaglandin E(2) receptor was significantly higher in preterm patients compared with term patients. The mRNA expression of hormones, enzymes and their receptors associated with tocolytic actions can differ in various clinical conditions. The expression of these genes is regulated at different levels and can be modified by inflammatory factors, which affect their functions. © 2012 The Authors Acta Obstetricia et Gynecologica Scandinavica© 2012 Nordic Federation of Societies of Obstetrics and Gynecology.

  18. Psychosocial Stress and Preterm Birth: The Impact of Parity and Race.

    Science.gov (United States)

    Wheeler, Sarahn; Maxson, Pamela; Truong, Tracy; Swamy, Geeta

    2018-03-29

    Objectives Studies examining risk factors for preterm birth (PTB) such as psychosocial stress are often focused on women with a history of PTB; however, most preterm babies are born to women with no history of preterm birth. Our objective was to determine if the relationship between psychosocial stress and PTB is altered by parity. Non-Hispanic black (NHB) women have increased psychosocial stress and PTB; therefore, we further aimed to determine if race alters the relationship between psychosocial stress, parity, and PTB. Methods We performed a secondary analysis of the Healthy Pregnancy, Healthy Baby Study comparing pregnant women who were primiparous (first pregnancy), multiparous with history of preterm birth, or multiparous with history of term birth. Perceived stress, perceived racism, interpersonal support, John Henryism and self-efficacy were measured using validated instruments. Logistic regression was used to model the effect of psychosocial stress on PTB stratified by parity and race. Results The analysis entire cohort included 1606 subjects, 426 were primiparous, 268 had a history of presterm birth, and 912 had a history of term birth. In women with a history of term birth, higher self-efficacy was associated with lower odds of spontaneous PTB, and this association was amplified in NHB women. In women with a history of spontaneous PTB, John Henryism Active Coping was associated with lower odds of spontaneous PTB in the index pregnancy. Conclusions for Practice The relationship between psychosocial stress and PTB may be mediated by parity and race.

  19. Preterm birth and low birth weight continue to increase the risk of asthma from age 7 to 43.

    Science.gov (United States)

    Matheson, Melanie C; D Olhaberriague, Ana López-Polín; Burgess, John A; Giles, Graham G; Hopper, John L; Johns, David P; Abramson, Michael J; Walters, E Haydn; Dharmage, Shyamali C

    2017-08-01

    Perinatal events can influence the development of asthma in childhood but current evidence is contradictory concerning the effects on life-time asthma risk. To assess the relationship between birth characteristics and asthma from childhood to adulthood. All available birth records for the Tasmanian Longitudinal Health Study (TAHS) cohort, born in 1961 were obtained from the Tasmanian State Archives and Tasmanian hospitals. Low birth weight (LBW) was defined as less than 2500 grams. Preterm birth was defined as delivery before 37 weeks' gestation. Small for gestational age (SGA) was defined as a birth weight below the 10 th percentile for a given gestational age. Multivariate logistic and cox regression were used to examine associations between birth characteristics and lifetime risk of current and incident asthma, adjusting for confounders. The prevalence of LBW was 5.2%, SGA was 13.8% and preterm was 3.3%. LBW (OR = 1.65, 95%CI 1.12,2.44) and preterm birth (OR = 1.81, 95%CI 0.99, 3.31) were both associated with an increased risk of current asthma between the ages of 7 to 43 years. There was no association between SGA and current asthma risk. However, SGA was associated with incident asthma (HR = 1.32, 95%CI 1.00, 1.74), and there was an interaction with sex (p value = 0.08), with males having a greater risk of incident asthma (HR = 1.70, 95%CI 1.16-2.49) than females (HR = 1.04, 95%CI 0.70-1.54). Preterm birth and LBW were associated with an increased risk of current asthma into middle-age. These findings are the first to demonstrate the continuing impact of these characteristics on asthma risk into middle-age.

  20. Heightened risk of preterm birth and growth restriction after a first-born son.

    Science.gov (United States)

    Bruckner, Tim A; Mayo, Jonathan A; Gould, Jeffrey B; Stevenson, David K; Lewis, David B; Shaw, Gary M; Carmichael, Suzan L

    2015-10-01

    In Scandinavia, delivery of a first-born son elevates the risk of preterm delivery and intrauterine growth restriction of the next-born infant. External validity of these results remains unclear. We test this hypothesis for preterm delivery and growth restriction using the linked California birth cohort file. We examined the hypothesis separately by race and/or ethnicity. We retrieved data on 2,852,976 births to 1,426,488 mothers with at least two live births. Our within-mother tests applied Cox proportional hazards (preterm delivery, defined as less than 37 weeks gestation) and linear regression models (birth weight for gestational age percentiles). For non-Hispanic whites, Hispanics, Asians, and American Indian and/or Alaska Natives, analyses indicate heightened risk of preterm delivery and growth restriction after a first-born male. The race-specific hazard ratios for preterm delivery range from 1.07 to 1.18. Regression coefficients for birth weight for gestational age percentile range from -0.73 to -1.49. The 95% confidence intervals for all these estimates do not contain the null. By contrast, we could not reject the null for non-Hispanic black mothers. Whereas California findings generally support those from Scandinavia, the null results among non-Hispanic black mothers suggest that we do not detect adverse outcomes after a first-born male in all racial and/or ethnic groups. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. Risk Factors for Early Preterm Birth at King Salman Armed Force Hospital in 2010.

    Science.gov (United States)

    Alansi, Badriah Ali; Mukhtar, Hytham Bahaeldin; Alazizi, Maher Ahmad; Zuiran, Amjad Ahmad; Al-Atawi, Areej Mohammed; Al-Sabah, Badriah Abdulrahman; Al-Yami, Shrooq Salem

    2017-12-15

    To investigate risk factors for early preterm birth. A retrospective comparative study was conducted at Tabuk, Kingdom of Saudi Arabia during the period from January to December 2010. Five hundred and ninety-five patient's files and delivery registry logbooks were reviewed, the following information was collected; demographic data, current and past obstetric histories. Then the early and late preterm births were compared for various risk factors. The Statistical Package for Social Sciences (SPSS version 22) was used. The Chi-square and t-test were used to test the statistical significance and a P-valuepreterm birth was found to be 2.5% in our study group. Women at risk for early preterm birth were: primigravidas (33.7% vs. 26.2% for control), P-value 0.039, OR 1.429 and 95% CI 0.982 - 2.079); multiple gestations (87.7% vs. 95.1% for control, P-value 0.002, OR 0.368 and 95% CI 0.196 - 0.688); and patients with a prior history of placental abruption (3.7% vs. 1.0% for control, P-value 0.027, OR3.928 and 95% CI 1.1360 - 13.586). Current study indicated that early preterm births differed from preterm as a whole; primigravida, multiple gestations and a history of placental abruption are independent risk factors for them.

  2. Prenatal supplementation with Corn Soya Blend Plus reduces the risk of maternal anemia in late gestation and lowers the rate of preterm birth but does not significantly improve maternal weight gain and birth anthropometric measurements in rural Cambodian women: a randomized trial.

    Science.gov (United States)

    Janmohamed, Amynah; Karakochuk, Crystal D; Boungnasiri, Somchit; Chapman, Gwen E; Janssen, Patricia A; Brant, Rollin; Green, Timothy J; McLean, Judy

    2016-02-01

    Corn Soya Blend (CSB) Plus is a fortified dietary supplement used to help Cambodian women meet their nutritional requirements in pregnancy, although little is known about its ability to improve pregnancy outcomes. This study assessed the effect of prenatal CSB Plus supplementation on birth weight and secondary outcomes of low birth weight (birth length and head circumference, preterm birth (birth weight between the CSB Plus and control group (46 g; 95% CI: -31, 123 g; P = 0.24). Significant reductions were observed in preterm birth (OR = 0.33; 95% CI: 0.12, 0.89) and anemia at 36-38 wk (OR = 0.51; 95% CI: 0.34, 0.77). There were no significant differences in low birth weight, small for gestational age, birth length, head circumference, or maternal weight gain. A higher rate of fetal loss was observed in the treatment group (10.2% compared with 3.7%; P birth size but did reduce maternal anemia in late gestation and preterm birth in comparison with women consuming a normal diet. The unexpectedly higher rate of fetal loss in the treatment group is concerning and warrants further investigation. This trial was registered at clinicaltrials.gov as NCT01413776. © 2016 American Society for Nutrition.

  3. History of induced abortion as a risk factor for preterm birth in European countries: results of the EUROPOP survey.

    Science.gov (United States)

    Ancel, Pierre-Yves; Lelong, Nathalie; Papiernik, Emile; Saurel-Cubizolles, Marie-Josèphe; Kaminski, Monique

    2004-03-01

    The objective of this study was to investigate the relationship between history of induced abortion and preterm delivery in various parts of Europe, and according to the main cause of preterm birth. We used data from a case-control survey, the EUROPOP study; 2938 preterm births and 4781 controls at term from ten European countries were included. Based on national statistics, we distinguished three groups of countries with high, intermediate and low rates of induced abortion. Previous induced abortions were significantly associated with preterm delivery and the risk of preterm birth increased with the number of abortions. Odds ratios did not differ significantly between the three groups of countries. The extent of association with previous induced abortion varied according to the cause of preterm delivery. Previous induced abortions significantly increased the risk of preterm delivery after idiopathic preterm labour, preterm premature rupture of membranes and ante-partum haemorrhage, but not preterm delivery after maternal hypertension. The strength of the association increased with decreasing gestational age at birth. Identifying subgroups of preterm births on the basis of the complications involved in delivery increases our understanding of the mechanisms by which previous induced abortion affects subsequent pregnancy outcomes.

  4. Long-term effects of preterm birth on language and literacy at eight years.

    Science.gov (United States)

    Guarini, Annalisa; Sansavini, Alessandra; Fabbri, Cristina; Savini, Silvia; Alessandroni, Rosina; Faldella, Giacomo; Karmiloff-Smith, Annette

    2010-09-01

    The aims of this study were to investigate whether specific linguistic difficulties in preterm children persist at eight years and to examine the interrelationships between language and literacy in this population, compared with a control group of full-term children. Sixty-eight monolingual Italian preterms and 26 chronologically matched controls were recruited. Language (grammar comprehension, lexical production and phonological awareness), literacy (reading comprehension, reading and writing) and general cognitive development were investigated. Results showed no general delay in preterms, but slight difficulties in specific linguistic abilities (grammar, lexicon, phoneme synthesis and deletion of the first syllable), more difficulties in literacy (speed in reading and accuracy in writing) and certain correlations among competencies turning out to be different from the control group. In conclusion, our study established that a partially atypical trajectory emerged in preterms, showing specific long-term effects of preterm birth on language and literacy development.

  5. PP170. Prenatal vitamin C and E supplementation is associated with a reduction in placental abruption and preterm birth in smokers.

    Science.gov (United States)

    Gandley, R; Abramovici, A

    2012-07-01

    Maternal tobacco use increases the incidence of numerous adverse pregnancy outcomes including miscarriage, small for gestational age infants, spontaneous preterm birth and placental abruption. We evaluated the relationship between prenatal vitamin C/E supplementation and perinatal outcomes by maternal smoking status. Secondary analysis of a multicenter trial of vitamin C/E starting at 9-16 weeks in low-risk nulliparous women with singletons. We examined the effect of vitamin supplementation by reported smoker or non-smoker at time of randomization. The primary outcomes were preeclampsia (new onset hypertension and proteinuria) and a composite outcome of severe pregnancy associated hypertension (severe hypertension OR mild or severe hypertension with elevated liver enzymes, elevated serum creatinine, thrombocytopenia, eclamptic seizure, fetal growth restriction, medically indicated preterm birth or perinatal death). Perinatal outcomes included preterm birth and abruption. The Breslow-Day test was used to ascertain whether there was an interaction between smoking status and vitamin supplementation. Of 9969 women, 4993 received vitamins C/E and 4976 received placebo. The prevalence of smoking (15.6% overall; 788 vitamin, 763 placebo) was similar in treatment groups. The analysis of vitamin C/E by smoking status for perinatal outcomes is given (Table 1). The effect of prenatal vitamin C/E on the risk preeclampsia or pregnancy associated hypertension composite outcome did not differ by smoking status. Vitamin C/E was protective for placental abruption and preterm birth among smokers. The effect of vitamin C/E supplementation on preeclampsia/pregnancy associated hypertension did not differ by smoking status. However, vitamin C/E supplementation was associated with a >40% reduction in placental abruption and >30% reduction in preterm birth among smokers warranting further study. This project supported in part by National Institutes of Health Grant PO1-HD30367. Copyright

  6. Maternal Obesity and Risk of Preterm Birth and Low Birthweight in Hawaii PRAMS, 2000-2011.

    Science.gov (United States)

    Ju, Alana C; Heyman, Melvin B; Garber, Andrea K; Wojcicki, Janet M

    2018-03-01

    Objective Maternal obesity is a risk factor for preterm birth, a leading cause of infant morbidity and mortality. Native Hawaiian and other Pacific Islanders (NHOPI) have high rates of poor birth outcomes. Despite the high rates of obesity in NHOPI in Hawaii, the association with preterm birth has not been examined in this population. Methods We performed a retrospective cohort study of 20,061 women using data collected by Hawaii's Pregnancy Risk Assessment Monitoring System (PRAMS) from 2000 to 2011. We investigated the contribution of maternal age, pre-pregnancy BMI, gestational diabetes, hypertension, race, socioeconomic status, and smoking to our primary outcomes of preterm birth and low birthweight using multivariable logistic regression, stratified by NHOPI versus non-NHOPI race. Results Pre-pregnancy obesity was more common in NHOPI than non-NHOPI women (23.9 and 10.5%, respectively; p < 0.01). Overall, the risk for preterm birth increased with maternal obesity (BMI ≥ 30.0; aOR = 1.24, 95% CI 1.06-1.45, p < 0.01), compared with normal weight women. Among NHOPI women, the prevalence of preterm birth was elevated compared with non-NHOPI women although the prevalence of low birth weight was lower. After adjusting for confounders, risk for preterm birth and low birth weight were elevated in NHOPI women compared with White women. Maternal obesity did not significantly affect the risk of prematurity within the NHOPI group. Conclusions for Practice Our study demonstrates an association between maternal pre-pregnancy obesity and preterm deliveries in Hawaii. NHOPI have high rates of pre-pregnancy obesity as well as increased risk of both preterm delivery and low birthweight when compared to White women. Further data are needed to assess interactions between race, maternal health, and neonatal morbidity, and to identify ways to improve birth outcomes for minority populations in the state of Hawaii.

  7. Epidemiologic factors and urogenital infections associated with preterm birth in a midwestern U.S. population.

    Science.gov (United States)

    Agger, William A; Siddiqui, Danish; Lovrich, Steven D; Callister, Steven M; Borgert, Andrew J; Merkitch, Kenneth W; Mason, Tina C; Baumgardner, Dennis J; Burmester, James K; Shukla, Sanjay K; Welter, Joseph D; Stewart, Katharina S; Washburn, M J; Bailey, Howard H

    2014-11-01

    To correlate epidemiologic factors with urogenital infections associated with preterm birth. Pregnant women were sequentially included from four Wisconsin cohorts: large urban, midsize urban, small city, and rural city. Demographic, clinical, and current pregnancy data were collected. Cervical and urine specimens were analyzed by microscopy, culture, and polymerase chain reaction for potential pathogens. Six hundred seventy-six women were evaluated. Fifty-four (8.0%) had preterm birth: 12.1% (19/157) large urban, 8.8% (15/170) midsize urban, 9.4% (16/171) small city, and 2.3% (4/178) rural city. Associated host factors and infections varied significantly among sites. Urogenital infection rates, especially Mycoplasma hominis and Ureaplasma parvum, were highest at the large urban site. Large urban site, minority ethnicity, multiple infections, and certain historical factors were associated with preterm birth by univariable analysis. By multivariable analysis, preterm birth was associated with prior preterm birth (adjusted odds ratio [aOR] 2.76, 95% confidence interval [CI] 1.27-6.02) and urinary tract infection (aOR 2.62, 95% CI 1.32-519), and negatively associated with provider-assessed good health (aOR 0.42, 95% CI 0.23-0.76) and group B streptococcal infection treatment (surrogate for health care use) (aOR 0.38, 95% CI 0.15-.99). Risk and protective factors were similar for women with birth at less than 35 weeks, and additionally associated with M hominis (aOR 3.6, 95% CI 1.4-9.7). These measured differences among sites are consistent with observations that link epidemiologic factors, both environmental and genetic, with minimally pathogenic vaginal bacteria, inducing preterm birth, especially at less than 35 weeks of gestation.

  8. Appendicectomy during pregnancy and the risk of preterm birth: A population data linkage study.

    Science.gov (United States)

    Ibiebele, Ibinabo; Schnitzler, Margaret; Nippita, Tanya; Ford, Jane B

    2018-03-30

    Suspected appendicitis is a common non-obstetric indication for emergency abdominal surgery during pregnancy. Assess the risk of preterm birth and other maternal and neonatal adverse birth outcomes following appendicectomy during pregnancy. Population-based data linkage study of women with singleton births in New South Wales, Australia, 2002-2014. Pregnancies with appendicitis and appendicectomy were compared to pregnancies without appendicitis. Crude and adjusted hazard ratios (aHR) with 95% confidence intervals (CI) for preterm birth were estimated. Modified Poisson regression with robust variance was used to estimate crude and adjusted risk ratios (aRR) with 99% CI for other outcomes. Of 1 124 551 eligible pregnancies, 1024 (0.9/1000 pregnancies) had appendicitis and appendicectomy. Of these, 566 (55.3%) had laparoscopic and 458 (44.7%) had open appendicectomy. Appendicectomy at later gestational ages was associated with increasing rates of preterm birth. After adjustment for maternal and pregnancy factors, appendicectomy was associated with increased risk of preterm birth (overall aHR 1.73, 95% CI 1.42-2.09; planned aHR 2.08, 95% CI 1.60-2.72), maternal morbidity (aRR 2.68, 99% CI 1.88-3.83) and neonatal morbidity (aRR 1.42, 99% CI 1.03-1.94). However, there was no difference in perinatal mortality rates. Appendicectomy during pregnancy is associated with increased risk of spontaneous and planned preterm birth, maternal and neonatal morbidity. Availability of resources to prevent or manage preterm labour should be considered when appendicectomy is performed at gestational ages of 20 weeks or more. © 2018 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

  9. Previous Preterm Birth and Current Maternal Complications as a Risk Factor of Subsequent Stillbirth

    Directory of Open Access Journals (Sweden)

    Boubakari Ibrahimou

    2015-01-01

    Full Text Available Purpose. To examine the association between previous preterm birth and the risk of stillbirth. Methods. This population-based retrospective cohort study analyzed live births and stillbirth records in Missouri (1989–1997. The main outcome of interest was stillbirth occurrence while the exposures were prior preterm birth. Adjusted odds ratios and 95% confidence intervals were computed using logistic regression. Results. Women who had a previous preterm birth have 63% increased odds of stillbirth in singleton pregnancies and 75% increased odds in twins as compared to those who did not have a preterm birth in a prior pregnancy (AOR = 1.63, 95% CI = 1.41–1.88 and AOR = 1.75, 95% CI = 1.20–2.56, respectively. The most significant risk factor for stillbirth in singleton pregnancies was uterine bleeding (AOR = 5.89, 95% CI = 5.13–6.76. In twin pregnancies, it was the condition hydramnios/oligohydramnios (AOR = 4.72, 95% CI = 3.70–6.02. Eclampsia was associated with a heightened risk of stillbirth in singletons (AOR = 2.45, 95% CI = 1.41–4.12, but not in twins (AOR = 0.96, 95% CI = 0.13–7.00. Black mothers were more likely than white to experience stillbirth (AOR = 2.10, 95% CI = 1.99–2.22 for singletons and AOR = 1.51, 95% CI = 1.27–1.79 for twins. Conclusion. Stillbirth is a vital public health issue and its etiology is not well understood. Previous history of preterm birth was found to be associated with future stillbirth. Targeted early medical and obstetric care and interventions among women with preterm birth history may potentially reduce the likelihood of stillbirth.

  10. Preterm Birth and Social Support during Pregnancy: a Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Hetherington, Erin; Doktorchik, Chelsea; Premji, Shahirose S; McDonald, Sheila W; Tough, Suzanne C; Sauve, Reg S

    2015-11-01

    Additional social support is often recommended for women during the prenatal period to optimise birth outcomes, specifically to avoid preterm birth. Social support is thought to act in one of two ways: by reducing stress and anxiety, or by providing coping mechanisms for women with high stress. However, evidence in this area is mixed. The purpose of this meta-analysis is to determine if low levels of social support are associated with an increased risk for preterm birth. Six databases were searched for randomised control trials and cohort studies regarding social support and preterm birth with no limits set on date or language. Inclusion criteria included the use of a validated instrument to measure social support, and studies conducted in high-income or high-middle-income countries. There were 3467 records retrieved, 16 of which met the inclusion criteria. Eight studies (n = 14 630 subjects) demonstrated a pooled odds ratio (OR) of 1.22 (95% CI 0.84, 1.76) for preterm birth in women with low social support compared with high social support. Among women with high stress levels, two studies (n = 6374 subjects) yielded a pooled OR of 1.52 (95% CI 1.18, 1.97). The results of six studies could not be pooled due to incompatibility of outcome measures. There is no evidence for a direct association between social support and preterm birth. Social support, however, may provide a buffering mechanism between stress and preterm birth. © 2015 John Wiley & Sons Ltd.

  11. Socio-economic inequality in preterm birth: a comparative study of the Nordic countries from 1981 to 2000.

    Science.gov (United States)

    Petersen, Christina B; Mortensen, Laust H; Morgen, Camilla S; Madsen, Mia; Schnor, Ole; Arntzen, Annett; Gissler, Mika; Cnattingius, Sven; Andersen, Anne-Marie Nybo

    2009-01-01

    During the 1980s and 1990s, there were large social and structural changes within the Nordic countries. Here we examine time changes in risks of preterm birth by maternal educational attainment in Denmark, Finland, Norway and Sweden. Information on gestational age and maternal socio-economic position was obtained from the NorCHASE database, which includes comparable population-based register data of births from Denmark, Finland, Sweden and Norway from 1981 to 2000. The risks of very preterm birth (preterm birth (32-36 gestational weeks) were calculated by maternal educational attainment and analysed in 5-year intervals from 1981 to 2000. Compared with mothers with >12 years of education, mothers with preterm birth in all four countries. The educational gradient increased slightly over time in very preterm births in Denmark, while there was a slight narrowing of the gap in Sweden. In moderately preterm births, the educational inequality gap was constant over the study period in Denmark, Norway and Sweden, but narrowed in Finland. The educational gradient in preterm birth remained broadly stable from 1981 to 2000 in all four countries. Consequently, the socio-economic inequalities in preterm birth were not strongly influenced by structural changes during the period.

  12. Dental Infection of Porphyromonas gingivalis Induces Preterm Birth in Mice.

    Directory of Open Access Journals (Sweden)

    Min Ao

    Full Text Available Epidemiological studies have revealed a link between dental infection and preterm birth or low birth weight (PTB/LBW, however, the underlying mechanisms remain unclear. Progress in understanding the associated mechanisms has been limited in part by lack of an animal model for chronic infection-induced PTB/LBW, mimicking pregnancy under conditions of periodontitis. We aimed to establish a mouse model of chronic periodontitis in order to investigate the link between periodontitis and PTB/LBW.To establish chronic inflammation beginning with dental infection, we surgically opened mouse (female, 8 weeks old 1st molar pulp chambers and directly infected with w83 strain Porphyromonas gingivalis (P.g., a keystone periodontal pathogen. Mating was initiated at 6 wks post-infection, by which time dental granuloma tissue had developed and live P.g. was cultured from extracted tooth root, which serves as a persistent source of P.g. The gestational day (gd and birth weight were recorded during for P.g.-infected and control mice, and serum and placental tissues were collected at gd 15 to evaluate the systemic and local conditions during pregnancy.Dental infection with P.g. significantly increased circulating TNF-α (2.5-fold, IL-17 (2-fold, IL-6 (2-fold and IL-1β (2-fold. The P.g.-infected group delivered at gd 18.25 vs. gd 20.45 in the non-infected control (NC group (p < 0.01, and pups exhibited LBW compared to controls (p < 0.01. P.g. was localized to placental tissues by immunohistochemistry and PCR, and defects in placental tissues of P.g. infected mice included premature rupture of membrane, placental detachment, degenerative changes in trophoblasts and endothelial cells, including necrotic areas. P.g. infection caused significantly increased numbers of polymorphonuclear leukocytes (PMNLs and macrophages in placental tissues, associated with increased local expression of pro-inflammatory mediators including TNF-α and COX-2. Further placental tissue

  13. Antenatal steroids in preterm labour for the prevention of neonatal deaths due to complications of preterm birth.

    Science.gov (United States)

    Mwansa-Kambafwile, Judith; Cousens, Simon; Hansen, Thomas; Lawn, Joy E

    2010-04-01

    In high-income countries, administration of antenatal steroids is standard care for women with anticipated preterm labour. However, although >1 million deaths due to preterm birth occur annually, antenatal steroids are not routine practice in low-income countries where most of these deaths occur. To review the evidence for and estimate the effect on cause-specific neonatal mortality of administration of antenatal steroids to women with anticipated preterm labour, with additional analysis for the effect in low- and middle-income countries. We conducted systematic reviews using standardized abstraction forms. Quality of evidence was assessed using an adapted GRADE approach. Existing meta-analyses were reviewed for relevance to low/middle-income countries, and new meta-analysis was performed. We identified 44 studies, including 18 randomised control trials (RCTs) (14 in high-income countries) in a Cochrane meta-analysis, which suggested that antenatal steroids decrease neonatal mortality among preterm infants (preterm babies currently receive little or no medical care. It is plausible that antenatal steroids may be of even greater effect when tested in these settings. Based on high-grade evidence, antenatal steroid therapy is very effective in preventing neonatal mortality and morbidity, yet remains at low coverage in low/middle-income countries. If fully scaled up, this intervention could save up to 500 000 neonatal lives annually.

  14. Effect of aspirin treatment on TNFalpha production by women with a history of preterm birth.

    Science.gov (United States)

    Peltier, Morgan R; Faux, David S; Hamblin, Steven D; Cooper, Corrina; Silver, Robert M; Esplin, M Sean

    2009-06-01

    Lipopolysaccharide (LPS)-stimulated TNFalpha production is reported to be greater for whole blood (WB) cultures prepared from patients with a history of preterm birth than cultures obtained from women with a history of term birth. The objectives of this study were (1) to determine if there is a similar differential responsiveness for peripheral blood mononuclear leukocytes (PBML) and (2) to determine if treatment with aspirin influences LPS-stimulated TNFalpha production in these patients. WB and PBML were obtained from women with a history of preterm delivery before 32 weeks (cases; n=5) and age- and race-matched controls (n=5) with a history of uncomplicated term delivery. WB and PBML were cultured and stimulated with LPS. All participants then took aspirin daily for 1 week and responsiveness of PBML and WB cultures to LPS was retested. The history of preterm labor was found to have no effect on LPS-stimulated TNFalpha production in cultures of WB or PBML. Aspirin treatment enhanced LPS-stimulated TNFalpha production by PBML from controls but not cases. We conclude that endotoxin responsiveness of women with a history of preterm birth is similar to that of women with a history of term birth in terms of in vitro TNFalpha production. Aspirin increases TNFalpha production by PBML in control women but not in women with a history of preterm birth. The divergent responses to aspirin treatment in patients with and without prior preterm labor may reflect differential regulation of cytokine production by prostaglandins in women with preterm labor associated with infection or inflammation.

  15. Cerebral autoregulation in the first day after preterm birth

    DEFF Research Database (Denmark)

    Hahn, Gitte Holst; Maroun, Lisa L; Larsen, Nanna Brink

    2012-01-01

    Both systemic inflammation and impaired cerebral autoregulation (CA) have been associated with brain injury in preterm infants. We hypothesized that impaired CA represents a hemodynamic link between inflammation and brain injury....

  16. Maternal air pollution exposure and preterm birth in Wuxi, China: Effect modification by maternal age.

    Science.gov (United States)

    Han, Yingying; Jiang, Panhua; Dong, Tianyu; Ding, Xinliang; Chen, Ting; Villanger, Gro Dehli; Aase, Heidi; Huang, Lu; Xia, Yankai

    2018-08-15

    Numerous studies have investigated prenatal air pollution and shown that air pollutants have adverse effect on birth outcomes. However, which trimester was the most sensitive and whether the effect was related to maternal age is still ambiguous. This study aims to explore the association between maternal air pollution exposure during pregnancy and preterm birth, and if this relationship is modified by maternal age. In this retrospective cohort study, we examine the causal relationship of prenatal exposure to air pollutants including particulate matters, which are less than 10 µm (PM 10 ), and ozone (O 3 ), which is one of the gaseous pollutants, on preterm birth by gestational age. A total of 6693 pregnant women were recruited from Wuxi Maternal and Child Health Care Hospital. The participants were dichotomized into child-bearing age group ( = 35 years old) in order to analyze the effect modification by maternal age. Logistic and linear regression models were performed to assess the risk for preterm birth (gestational age air pollution exposure. With adjustment for covariates, the highest level of PM 10 exposure significantly increased the risk of preterm birth by 1.42-fold (95% CI: 1.10, 1.85) compared those with the lowest level in the second trimester. Trimester-specific PM 10 exposure was positively associated with gestational age, whereas O 3 exposure was associated with gestational age in the early pregnancy. When stratified by maternal age, PM 10 exposure was significantly associated with an increased risk of preterm birth only in the advanced age group during pregnancy (OR:2.15, 95% CI: 1.13, 4.07). The results suggested that PM 10 exposure associated with preterm birth was modified by advanced maternal age (OR interaction = 2.00, 95% CI: 1.02, 3.91, P interaction = 0.032). Prenatal air pollution exposure would increase risk of preterm birth and reduced gestational age. Thus, more attention should be paid to the effects of ambient air pollution

  17. Genetic variations of MTHFR gene and their association with preterm-birth in Korean women.

    Science.gov (United States)

    Hwang, In Wook; Kang, Yun Dan; Kwon, Bit Na; Hong, Jun Ho; Han, Seung Hun; Kim, Jong Soo; Park, Jin Wan; Jin, Han Jun

    2018-02-03

    The MTHFR gene encodes the methylenetetrahydrofolate reductase known to be involved in the homocysteine-methionine pathway. It has been reported that the deficiency of MTHFR activity may cause hyperhomocysteinemia which results in adverse pregnancy outcomes. Previous studies reported a correlation between the MTHFR gene polymorphisms (677 T/C and 1298 A/C) and lower MTHFR activity and its association with preterm birth in various populations. Since these results were conflicting, we analyzed the genetic association of MTHFR gene 677 T/C and 1298 A/C polymorphisms with preterm birth in Korean women. The subjects for case-control study were collected a total of 226 Korean women (98 preterm-birth patients and 128 controls). Genotype frequency differences between the case and the control were assessed using chi-square tests. Mann-Whitney t-test was used to estimate the effects of 1298 A/C genotype on clinicopathological characteristics (systolic blood pressure, diastolic blood pressure, birth weight, and gestational age at delivery) in preterm-birth patients. Our results showed that the MTHFR 677 C/T polymorphism was significantly associated with preterm-birth patients in the analysis of genotype frequency (P=0.044) and the over-dominant model (OR=0.54; 95% CI, 0.320-0.920; P=0.023). The recessive model showed a marginal trend toward significance (OR=0.47; 95% CI, 0.220-1.010; P=0.046). The 1298 A/C polymorphism was also associated with reduced preterm-birth risk in the recessive model (P=0.032). In the correlation analysis, the 1298 C allele was significantly associated with increasing of gestational age at delivery in preterm-birth patients (P=0.034). Our findings suggested that the MTHFR gene 677 C/T and 1298 A/C polymorphisms might have protective effects for preterm birth in the Korean women. Copyright © 2018 The Lithuanian University of Health Sciences. Production and hosting by Elsevier Sp. z o.o. All rights reserved.

  18. Preterm Birth Associated With Group B Streptococcus Maternal Colonization Worldwide: Systematic Review and Meta-analyses.

    Science.gov (United States)

    Bianchi-Jassir, Fiorella; Seale, Anna C; Kohli-Lynch, Maya; Lawn, Joy E; Baker, Carol J; Bartlett, Linda; Cutland, Clare; Gravett, Michael G; Heath, Paul T; Ip, Margaret; Le Doare, Kirsty; Madhi, Shabir A; Saha, Samir K; Schrag, Stephanie; Sobanjo-Ter Meulen, Ajoke; Vekemans, Johan; Rubens, Craig E

    2017-11-06

    Preterm birth complications are the leading cause of deaths among children birth in order to inform estimates of the burden of GBS. We conducted systematic literature reviews (PubMed/Medline, Embase, Latin American and Caribbean Health Sciences Literature [LILACS], World Health Organization Library Information System [WHOLIS], and Scopus) and sought unpublished data from investigator groups on the association of preterm birth (birth with maternal GBS colonization to be 1.21 (95% confidence interval [CI], .99-1.48; P = .061) in cohort and cross-sectional studies, and the odds ratio to be 1.85 (95% CI, 1.24-2.77; P = .003) in case-control studies. Preterm birth was associated with GBS bacteriuria in cohort studies (RR, 1.98 [95% CI, 1.45-2.69]; P birth is associated with maternal GBS colonization, especially where there is evidence of ascending infection (bacteriuria). Several biases reduce the chance of detecting an effect. Equally, however, results, including evidence for the association, may be due to confounding, which is rarely addressed in studies. Assessment of any effect on preterm delivery should be included in future maternal GBS vaccine trials. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.

  19. Providing antenatal corticosteroids for preterm birth: a quality improvement initiative in Cambodia and the Philippines.

    Science.gov (United States)

    Smith, Jeffrey Michael; Gupta, Shivam; Williams, Emma; Brickson, Kate; Ly Sotha, Keth; Tep, Navuth; Calibo, Anthony; Castro, Mary Christine; Marinduque, Bernabe; Hathaway, Mark

    2016-12-01

    To determine whether a simple quality improvement initiative consisting of a technical update and regular audit and feedback sessions will result in increased use of antenatal corticosteroids among pregnant women at risk of imminent preterm birth delivering at health facilities in the Philippines and Cambodia. Non-randomized, observational study using a pre-/post-intervention design conducted between October 2013 and June 2014. A total of 12 high volume facilities providing Emergency Obstetric and Newborn Care services in Cambodia (6) and Philippines (6). A technical update on preterm birth and use of antenatal corticosteroids, followed by monthly audit and feedback sessions. The proportion of women at risk of imminent preterm birth who received at least one dose of dexamethasone. Coverage of at least one dose of dexamethasone increased from 35% at baseline to 86% at endline in Cambodia (P Cambodia and Philippines. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care.

  20. Effect of preterm birth and antenatal corticosteroid treatment on lactogenesis II in women.

    Science.gov (United States)

    Henderson, Jennifer J; Hartmann, Peter E; Newnham, John P; Simmer, Karen

    2008-01-01

    The onset of copious milk secretion after birth is known as lactogenesis II. The objective of this study was to investigate the effect of preterm birth and antenatal corticosteroids on the timing of lactogenesis II after birth. Women who had received antenatal betamethasone treatment and were expressing for a preterm infant whose gestational age was lactogenesis II. The volume of milk was reduced further when antenatal corticosteroids were administered between 28 and 34 weeks' gestation and delivery occurred 3 to 9 days later. In view of the advantages of mothers' own milk, additional support with lactation is recommended for mothers of preterm infants, particularly those who have been treated with corticosteroids before the delivery.

  1. Sex of the first-born and risk of preterm birth in the subsequent pregnancy

    DEFF Research Database (Denmark)

    Mortensen, Laust H; Nielsen, Henriette Svarre; Cnattingius, Sven

    2011-01-01

    BACKGROUND: Recent data suggest that the chance of successfully maintaining a pregnancy may be influenced by the sex of previously born children. We explored a possible relation between sex of the first-born infant and the risk of preterm birth in the second pregnancy. METHODS: Using data from...... regression analysis was used to estimate the hazard ratio of preterm birth in the second pregnancy according to the sex of the first-born infant. RESULTS: Compared with women whose first baby was a girl, women with boys had an increased risk of preterm birth in a second pregnancy (hazard ratio = 1.10 [95......% confidence interval = 1.07-1.13]). This result was consistent in the 2 populations. The association was not confounded by maternal age, interpregnancy interval, or sex of the second infant or by maternal characteristics that do not vary from one pregnancy to the next. CONCLUSIONS: Exposure to a male fetus...

  2. Aging of intrauterine tissues in spontaneous preterm birth and preterm premature rupture of the membranes: A systematic review of the literature.

    Science.gov (United States)

    Polettini, J; Dutta, E H; Behnia, F; Saade, G R; Torloni, M R; Menon, R

    2015-09-01

    Many adverse pregnancy outcomes (APOs), including spontaneous preterm birth (PTB), are associated with placental dysfunction. Recent clinical and experimental evidences suggest that premature aging of the placenta may be involved in these events. Although placental aging is a well-known concept, the mechanisms of aging during normal pregnancy and premature aging in APOs are still unclear. This review was conducted to assess the knowledge on placental aging related biochemical changes leading to placental dysfunction in PTB and/or preterm premature rupture of membranes (pPROM). We performed a systematic review of studies published over the last 50 years in two electronic databases (Pubmed and Embase) on placental aging and PTB or pPROM. The search yielded 554 citations, 30 relevant studies were selected for full-text review and three were included in the review. Only one study reported oxidative stress-related aging and degenerative changes in human placental membranes and telomere length reduction in fetal cells as part of PTB and/or pPROM mechanisms. Similarly, two animal studies reported findings of decidual senescence and referred to PTB mechanisms. Placental and fetal membrane oxidative damage and telomere reduction are linked to premature aging in PTB and pPROM but the risk factors and biomolecular pathways causing this phenomenon are not established in the literature. However, no biomarkers or clinical indicators of premature aging as a pathology of PTB and pPROM have been reported. We document major knowledge gaps and propose several areas for future research to improve our understanding of premature aging linked to placental dysfunction. Copyright © 2015 Elsevier Ltd. All rights reserved.

  3. Short Maternal Stature Increases Risk of Small-for-Gestational-Age and Preterm Births in Low- and Middle-Income Countries: Individual Participant Data Meta-Analysis and Population Attributable Fraction.

    Science.gov (United States)

    Kozuki, Naoko; Katz, Joanne; Lee, Anne C C; Vogel, Joshua P; Silveira, Mariangela F; Sania, Ayesha; Stevens, Gretchen A; Cousens, Simon; Caulfield, Laura E; Christian, Parul; Huybregts, Lieven; Roberfroid, Dominique; Schmiegelow, Christentze; Adair, Linda S; Barros, Fernando C; Cowan, Melanie; Fawzi, Wafaie; Kolsteren, Patrick; Merialdi, Mario; Mongkolchati, Aroonsri; Saville, Naomi; Victora, Cesar G; Bhutta, Zulfiqar A; Blencowe, Hannah; Ezzati, Majid; Lawn, Joy E; Black, Robert E

    2015-11-01

    Small-for-gestational-age (SGA) and preterm births are associated with adverse health consequences, including neonatal and infant mortality, childhood undernutrition, and adulthood chronic disease. The specific aims of this study were to estimate the association between short maternal stature and outcomes of SGA alone, preterm birth alone, or both, and to calculate the population attributable fraction of SGA and preterm birth associated with short maternal stature. We conducted an individual participant data meta-analysis with the use of data sets from 12 population-based cohort studies and the WHO Global Survey on Maternal and Perinatal Health (13 of 24 available data sets used) from low- and middle-income countries (LMIC). We included those with weight taken within 72 h of birth, gestational age, and maternal height data (n = 177,000). For each of these studies, we individually calculated RRs between height exposure categories of < 145 cm, 145 to < 150 cm, and 150 to < 155 cm (reference: ≥ 155 cm) and outcomes of SGA, preterm birth, and their combination categories. SGA was defined with the use of both the International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st) birth weight standard and the 1991 US birth weight reference. The associations were then meta-analyzed. All short stature categories were statistically significantly associated with term SGA, preterm appropriate-for-gestational-age (AGA), and preterm SGA births (reference: term AGA). When using the INTERGROWTH-21st standard to define SGA, women < 145 cm had the highest adjusted risk ratios (aRRs) (term SGA-aRR: 2.03; 95% CI: 1.76, 2.35; preterm AGA-aRR: 1.45; 95% CI: 1.26, 1.66; preterm SGA-aRR: 2.13; 95% CI: 1.42, 3.21). Similar associations were seen for SGA defined by the US reference. Annually, 5.5 million term SGA (18.6% of the global total), 550,800 preterm AGA (5.0% of the global total), and 458,000 preterm SGA (16.5% of the global total) births may be associated

  4. Evaluation of Maternal Serum 25-Hydroxyvitamin D, Paraoxonase 1 Levels, and Neutrophil-to-Lymphocyte Ratio in Spontaneous Preterm Birth.

    Science.gov (United States)

    Bozoklu Akkar, Ozlem; Sancakdar, Enver; Karakus, Savas; Yildiz, Caglar; Akkar, Ismail; Arslan, Murat; Sahin, Irfan Oguz; Imir Yenicesu, Ayse Gonca; Cetin, Ali

    2016-04-13

    BACKGROUND The aim of this study was to evaluate the association of maternal serum 25-hydroxyvitamin D, paraoxonase 1, and neutrophil-to-lymphocyte ratio in women having early spontaneous preterm birth without clinical chorioamnionitis. MATERIAL AND METHODS This study was prospectively administered in women referred to our obstetrics service with preterm labor that resulted in preterm birth (n=35) and term labor that ended in term birth (n=44). The maternal serum levels of 25-hydroxyvitamin D and paraoxonase 1 were measured and neutrophil-to-lymphocyte ratio was calculated. RESULTS The 25-hydroxyvitamin D and paraoxonase 1 levels of the preterm group were significantly lower than those of the term group (pparaoxonase 1 in the preterm group (r=0.35; p=0.021). CONCLUSIONS Decreased maternal serum 25-hydroxyvitamin D and paraoxonase 1 levels and increased neutrophil-to-lymphocyte ratio may have a role in the etiology of spontaneous preterm birth.

  5. Relationships among psychosocial factors, biomarkers, preeclampsia, and preterm birth in African American women: a pilot.

    Science.gov (United States)

    Giurgescu, Carmen; Sanguanklin, Natthananporn; Engeland, Christopher G; White-Traut, Rosemary C; Park, Chang; Mathews, Herbert L; Janusek, Linda Witek

    2015-02-01

    To explore the relationships among psychosocial factors (optimism, uncertainty, social support, coping, psychological distress), biomarkers (cortisol, cytokines), preeclampsia, and preterm birth in African American women. Forty-nine pregnant African American women completed psychosocial questionnaires and had blood collected for biomarkers between 26 and 36 weeks of gestation. Birth outcomes were obtained from birth records. Women reporting higher levels of social support had lower levels of pro-inflammatory cytokines (IL-2, IL-5, and IL-6). Surprisingly, compared with low-risk pregnant women, women diagnosed with preeclampsia reported more optimism and less avoidance, and had lower levels of cortisol and IFN-γ. Similarly, compared to women with full-term birth, women with preterm birth reported higher levels of optimism and lower levels of avoidance, and had lower levels of IL-10. Psychosocial factors influence inflammation and pregnancy outcomes. Close assessment and monitoring of psychosocial factors may contribute to improved pregnancy outcomes. Copyright © 2014. Published by Elsevier Inc.

  6. The Matrix Metalloproteases and Endothelin-1 in Infection-Associated Preterm Birth

    Directory of Open Access Journals (Sweden)

    Nicole S. Olgun

    2010-01-01

    Full Text Available Preterm birth (PTB is clinically defined as any delivery which occurs before the completion of 37 weeks of gestation, and is currently the most important problem in obstetrics. In the United States, PTB accounts for 12-13% of all live births, and, with the exception of fetuses suffering from anomalies, is the primary cause of perinatal mortality. While the risk factors for PTB are numerous, the single most common cause is intrauterine infection. As there is currently no FDA-approved therapy for infection-associated PTB, understanding the pathogenesis of preterm labor (PTL and delivery should be given high priority. The matrix metalloproteinases (MMPs are a family of enzymes that have been implicated in normal parturition as well as infection-triggered rupture of membranes and preterm birth. Several lines of evidence also suggest a role for endothelin-1 (ET-1 in infection-associated preterm delivery. This paper focuses on the evidence that the MMPs and ET-1 act in the same molecular pathway in preterm birth.

  7. Vitamin D, pre-eclampsia, and preterm birth among pregnancies at high risk for pre-eclampsia: an analysis of data from a low-dose aspirin trial.

    Science.gov (United States)

    Gernand, A D; Simhan, H N; Baca, K M; Caritis, S; Bodnar, L M

    2017-11-01

    To examine the relation between maternal vitamin D status and risk of pre-eclampsia and preterm birth in women at high risk for pre-eclampsia. Analysis of prospectively collected data and blood samples from a trial of prenatal low-dose aspirin. Thirteen sites across the USA. Women at high risk for pre-eclampsia. We measured 25-hydroxyvitamin D [25(OH)D] concentrations in stored maternal serum samples drawn at 12-26 weeks' gestation (n = 822). We used mixed effects models to examine the association between 25(OH)D and risk of pre-eclampsia and preterm birth, controlling for confounders including prepregnancy BMI and race. Pre-eclampsia and preterm birth. Twelve percent of women were vitamin D deficient [25(OH)D preterm birth at preterm births at preterm birth at preterm birth at preterm birth at <35 weeks in high-risk pregnancies. © 2016 Royal College of Obstetricians and Gynaecologists.

  8. Undiagnosed coeliac disease in a father does not influence birthweight and preterm birth.

    LENUS (Irish Health Repository)

    Khashan, Ali S

    2012-01-31

    There is conflicting evidence regarding the effect of coeliac disease (CD) in the father on birthweight and preterm birth. We investigated the association between paternal CD and birthweight and preterm birth. Medical records of all singleton live-born children in Denmark between 1 January 1979 and 31 December 2004 were linked to information about parents\\' diseases. Fathers who were diagnosed with CD were then identified. Fathers with CD were considered treated if they were diagnosed before pregnancy and untreated if they were diagnosed after the date of conception. The outcome measures were: birthweight, small-for-gestational age (birthweight<10th centile for gestational age) and preterm birth (<37 weeks). We compared the offspring of men without CD (n = 1 472 352) and offspring of those with CD [untreated (n = 138) and treated (n = 473)]. There was no significant association between untreated CD in the father and birthweight (adjusted mean difference = -3 g; [95% CI -46, 40]) or preterm birth (adjusted odds ratio (OR) = 0.86, [95% CI 0.53, 1.37]) (compared with no CD). There was some evidence for an association between treated paternal CD and birthweight (adjusted mean difference = -81 g; [95% CI -161, -3]), but not preterm birth (adjusted OR = 1.76, [95% CI 0.95, 3.26]). Untreated paternal CD was not associated with an increased risk of reduced birthweight, or of preterm birth. There was some evidence that diagnosis and presumed treatment of paternal CD with a gluten-free diet is associated with reduced birthweight.

  9. Association among Maternal Obesity, Cervical Length, and Preterm Birth.

    Science.gov (United States)

    Palatnik, Anna; Miller, Emily S; Son, Moeun; Kominiarek, Michelle A

    2017-04-01

    Objective  The objective of this study was to determine if mid-trimester cervical length is associated with the inverse relationship between maternal body mass index (BMI) at delivery and spontaneous preterm birth (SPTB). Materials and Methods  This was a retrospective cohort of women with a singleton pregnancy without prior SPTB who underwent routine transvaginal cervical length assessment between 18 and 24 weeks. Women were categorized into four BMI groups: (1) 18.5 to 24.9, (2) 25 to 29.9, (3) 30 to 34.9, and (4) ≥ 35 kg/m 2 . Univariable and multivariable analyses were conducted to determine whether BMI group was associated with SPTB at < 37, 34, or 32 weeks independent of the cervical length. Results  Of the 18,100 women in this analysis, 43.5% had a BMI ≥ 30. In univariable analysis, increasing BMI group was associated with longer cervical length but not with cervical length < 10th percentile. SPTB at < 37, 35, and 32 weeks was less common among women with higher BMI. In multivariable regression, a higher BMI group was associated with a lower frequency of SPTB at 37 weeks (adjusted odds ratios [aORs] of 0.64, 0.68, and 0.51), at 34 weeks (aORs of 0.53, 0.54, and 0.31) and at 32 weeks (aORs of 0.47, 0.60, and 0.27) for BMI groups 2 to 4, respectively. This association persisted even when cervical length was entered into the model as a covariate. Conclusion  Women with a higher BMI group had longer mid-trimester cervical length, and correspondingly reduced SPTB. However, the decreased risk of SPTB was not associated with cervical length. The reason for the potential protective effect from prematurity is unknown and its mechanisms require further investigation. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  10. Risk factors associated with late preterm births in the underdeveloped region of China: A cohort study and systematic review

    Directory of Open Access Journals (Sweden)

    Liqun Lu

    2015-12-01

    Conclusion: A number of factors are associated with late preterm births, and the incidence in underdeveloped regions is high. The inconsistent results between our study and previous reports indicate more attention towards preventing late preterm births in undeveloped regions is needed.

  11. Impact of obstetric history on the risk of spontaneous preterm birth in singleton and multiple pregnancies: a systematic review

    NARCIS (Netherlands)

    Kazemier, B. M.; Buijs, P. E.; Mignini, L.; Limpens, J.; de Groot, C. J. M.; Mol, B. W. J.; von Dadelszen, P.; Magee, L.; Sawchuck, D.; Gao, E.; Oude Rengerink, K.; Zamora, J.; Fox, C.; Daniels, J.; Khan, K. S.; Thangaratinam, S.; Meads, C.

    2014-01-01

    Information about the recurrence of spontaneous preterm birth in subsequent twin/singleton pregnancies is scattered. To quantify the risk of recurrence of spontaneous preterm birth in different subtypes of subsequent pregnancies. An electronic literature search in OVID MEDLINE and EMBASE,

  12. Birth weight of twins: 2. Fetal genetic effect on birth weight

    Directory of Open Access Journals (Sweden)

    Bernardo Beiguelman

    1998-03-01

    Full Text Available Intraclass correlation coefficients were calculated for the birth weights of twins born at three southeastern Brazilian hospitals, after adjustment of the natural logarithms of these weights for gestational age, its quadratic and cubic terms, sex, and their interactions. The data indicate that fetal genetic effect on birth weight might have the opportunity to be demonstrated by children born to undernourished women. Undernourishment, acting as a selective force, might enhance the existence of genotypes that determine less need of food for normal development.Os coeficientes de correlação intraclasse foram calculados para o peso de gêmeos nascidos em três maternidades do sudeste brasileiro, depois de ajustar os logaritmos naturais desses pesos para a idade gestacional, seus termos quadrático e cúbico, sexo e interações dessas variáveis. Os dados obtidos indicaram que o efeito genético fetal sobre o peso ao nascer teria a oportunidade de ser demonstrado por recém-nascidos de mães subnutridas. A subnutrição, atuando como força seletiva, realçaria a existência de genótipos que determinam menor necessidade nutricional para o desenvolvimento normal.

  13. Maternal bipolar disorder increased low birthweight and preterm births: a nationwide population-based study.

    Science.gov (United States)

    Lee, Hsin-Chien; Lin, Herng-Ching

    2010-02-01

    To investigate pregnancy outcomes, including low birthweight, preterm births, and small-for-gestational-age (SGA) among women with bipolar disorder, schizophrenia compared with women with no history of mental illness using nationwide population-based data. This study linked the Taiwan National Health Insurance Research Dataset with the national birth certificate registry. A total of 528,398 singleton births between 2001 and 2003 were included; 337 were diagnosed with bipolar disorder. Multivariate logistic regression analyses were carried out to examine the relationship between maternal bipolar disorder, schizophrenia and the odds of low birthweight, preterm births, and SGA, after adjusting for characteristics of infant, mother and father. It shows that pregnant women with bipolar disorder were more likely to have LBW infants (9.8% vs. 5.7%), preterm births (14.2% vs. 6.9%) and SGA (22.3% vs. 15.7%) than pregnant women with no history of mental illness. The adjusted odds of low birthweight for women with bipolar disorder was 1.66 times (95% CI, 1.16-2.38) that of women with no history of mental illness. In terms of preterm births and SGA, the adjusted odds ratios were 2.08 (95% CI, 1.53-2.83) and 1.47 (95% CI, 1.14-1.91) respectively, for women with bipolar disorder, compared to their counterparts with no history of mental illness. We conclude that women with bipolar disorder had increased risk of low birthweight, preterm births, and SGA than women without a history of mental illness. More active monitoring and early intervention to counter potential adverse pregnancy outcomes for pregnant women with bipolar disorder should be initiated. 2009 Elsevier B.V. All rights reserved.

  14. Investigation on some maternal factors affecting the birth of preterm infants: a case – control study

    Directory of Open Access Journals (Sweden)

    Sakineh Dadipoor

    2017-02-01

    Full Text Available Background: Infant mortality is considered as the key healthcare index in every country. The outcomes of a preterm birth are among the main and direct causes of neonate mortality. Therefore, the present research aims to investigate some maternal factors influencing the immature birth. Materials and Methods: This observational case study was conducted on 100 term babies as the control group. The questionnaires were completed through interviewed mothers or perused hospital files. Results: The results of this study showed the high chances of premature birth in women with multiple pregnancies, smoking, placenta previa, uterine problems and placental abruption compared to most of the mothers with no history of such problems. In mothers with cervical incompetence, the chances of delivering a preterm baby are 11 times as high as mothers with no such problems. Similarly, the chances are 9.33 times as high among the mothers who had a history of placenta previa. Conclusion: Identifying maternal factors influencing the preterm infant birth as well as attentive care taken during pregnancy can significantly reduce the preterm infant birth.

  15. Effect of bidet toilet use on preterm birth and vaginal flora in pregnant women.

    Science.gov (United States)

    Asakura, Keiko; Nakano, Makiko; Yamada, Mutsuko; Takahashi, Kaori; Sueoka, Kou; Omae, Kazuyuki

    2013-06-01

    To estimate the association between bidet toilet use and preterm birth, as well as the effect of bidet toilet use on bacterial vaginosis, in pregnant women. Questionnaires about bidet toilet usage were sent to 2,545 women who gave birth between 2006 and 2010 in Tokyo. Crude and multivariable adjusted odds ratios (ORs) for the incidence of preterm birth (delivery at less than 37 completed weeks of gestation) and the prevalence of bacterial vaginosis between users and nonusers of the bidet toilet were calculated using data from the questionnaire and delivery records. Bacterial vaginosis was estimated by the balance of lactobacilli and nonlactobacillus microbes based on routine prenatal microbiologic test results. Of 1,293 women who responded to the questionnaire, 63.3% were users of the bidet toilet. The incidence of preterm birth was 15.8% among bidet users and 16.0% among nonusers (adjusted OR 1.04, 95% confidence interval [CI] 0.72-1.48). Additionally, no association was found between bidet toilet use and bacterial vaginosis (adjusted OR 0.96, 95% CI 0.70-1.33). Normal use of the bidet toilet by pregnant women poses no clinical health risk for preterm birth and bacterial vaginosis.

  16. Impact of obstetric history on the risk of spontaneous preterm birth in singleton and multiple pregnancies: a systematic review.

    Science.gov (United States)

    Kazemier, B M; Buijs, P E; Mignini, L; Limpens, J; de Groot, C J M; Mol, B W J

    2014-09-01

    Information about the recurrence of spontaneous preterm birth in subsequent twin/singleton pregnancies is scattered. To quantify the risk of recurrence of spontaneous preterm birth in different subtypes of subsequent pregnancies. An electronic literature search in OVID MEDLINE and EMBASE, complemented by PubMed, to find recent studies. Studies comparing the risk of spontaneous preterm birth after a previous preterm and previous term pregnancy. The absolute risk of recurrence with a 95% confidence interval and the absolute risk of preterm birth after a term delivery were calculated. Data from studies were pooled using the Mantel-Haenszel method. We detected 13 relevant studies. The risk of recurrence of preterm birth was significantly increased in all preterm pregnancy subtypes, compared with their term counterparts. Women pregnant with twins after a previous preterm singleton had the highest absolute risk of recurrence (57.0%, 95% CI 51.9-61.9%), and after a previous term singleton their absolute risk was 25% (95% CI 24.3-26.5%). Women pregnant with a singleton after a previous preterm twin pregnancy have an absolute recurrence risk of 10% (95% CI 8.2-12.3%), whereas a singleton pregnancy after delivering a previous twin up to term yields a low absolute risk of only 1.3% (95% CI 0.8-2.2). Women pregnant with a singleton after a previous preterm singleton have an absolute recurrence risk of 20% (95% CI 19.9-20.6). The risk of recurrence of preterm birth is influenced by the singleton/twin order in both pregnancies, and varies between 10% for a singleton after previous preterm twins to 57% for twins after a previous preterm singleton. © 2014 Royal College of Obstetricians and Gynaecologists.

  17. Antenatal corticosteroids trial in preterm births to increase neonatal survival in developing countries: study protocol

    Directory of Open Access Journals (Sweden)

    Althabe Fernando

    2012-09-01

    Full Text Available Abstract Background Preterm birth is a major cause of neonatal mortality, responsible for 28% of neonatal deaths overall. The administration of antenatal corticosteroids to women at high risk of preterm birth is a powerful perinatal intervention to reduce neonatal mortality in resource rich environments. The effect of antenatal steroids to reduce mortality and morbidity among preterm infants in hospital settings in developed countries with high utilization is well established, yet they are not routinely used in developing countries. The impact of increasing antenatal steroid use in hospital or community settings with low utilization rates and high infant mortality among premature infants due to lack of specialized services has not been well researched. There is currently no clear evidence about the safety of antenatal corticosteroid use for community-level births. Methods We hypothesize that a multi country, two-arm, parallel cluster randomized controlled trial to evaluate whether a multifaceted intervention to increase the use of antenatal corticosteroids, including components to improve the identification of pregnancies at high risk of preterm birth and providing and facilitating the appropriate use of steroids, will reduce neonatal mortality at 28 days of life in preterm newborns, compared with the standard delivery of care in selected populations of six countries. 102 clusters in Argentina, Guatemala, Kenya, India, Pakistan, and Zambia will be randomized, and around 60,000 women and newborns will be enrolled. Kits containing vials of dexamethasone, syringes, gloves, and instructions for administration will be distributed. Improving the identification of women at high risk of preterm birth will be done by (1 diffusing recommendations for antenatal corticosteroids use to health providers, (2 training health providers on identification of women at high risk of preterm birth, (3 providing reminders to health providers on the use of the kits, and

  18. Antenatal corticosteroids trial in preterm births to increase neonatal survival in developing countries: study protocol.

    Science.gov (United States)

    Althabe, Fernando; Belizán, José M; Mazzoni, Agustina; Berrueta, Mabel; Hemingway-Foday, Jay; Koso-Thomas, Marion; McClure, Elizabeth; Chomba, Elwyn; Garces, Ana; Goudar, Shivaprasad; Kodkany, Bhalchandra; Saleem, Sarah; Pasha, Omrana; Patel, Archana; Esamai, Fabian; Carlo, Waldemar A; Krebs, Nancy F; Derman, Richard J; Goldenberg, Robert L; Hibberd, Patricia; Liechty, Edward A; Wright, Linda L; Bergel, Eduardo F; Jobe, Alan H; Buekens, Pierre

    2012-09-19

    Preterm birth is a major cause of neonatal mortality, responsible for 28% of neonatal deaths overall. The administration of antenatal corticosteroids to women at high risk of preterm birth is a powerful perinatal intervention to reduce neonatal mortality in resource rich environments. The effect of antenatal steroids to reduce mortality and morbidity among preterm infants in hospital settings in developed countries with high utilization is well established, yet they are not routinely used in developing countries. The impact of increasing antenatal steroid use in hospital or community settings with low utilization rates and high infant mortality among premature infants due to lack of specialized services has not been well researched. There is currently no clear evidence about the safety of antenatal corticosteroid use for community-level births. We hypothesize that a multi country, two-arm, parallel cluster randomized controlled trial to evaluate whether a multifaceted intervention to increase the use of antenatal corticosteroids, including components to improve the identification of pregnancies at high risk of preterm birth and providing and facilitating the appropriate use of steroids, will reduce neonatal mortality at 28 days of life in preterm newborns, compared with the standard delivery of care in selected populations of six countries. 102 clusters in Argentina, Guatemala, Kenya, India, Pakistan, and Zambia will be randomized, and around 60,000 women and newborns will be enrolled. Kits containing vials of dexamethasone, syringes, gloves, and instructions for administration will be distributed. Improving the identification of women at high risk of preterm birth will be done by (1) diffusing recommendations for antenatal corticosteroids use to health providers, (2) training health providers on identification of women at high risk of preterm birth, (3) providing reminders to health providers on the use of the kits, and (4) using a color-coded tape to measure

  19. Bacteriuria with group B streptococcus and preterm birth

    DEFF Research Database (Denmark)

    Khalil, M. R.; Uldbjerg, N.; Thorsen, P.

    2015-01-01

    Objectives: Preterm delivery (PTD) contributes to 70% of all perinatal deaths and nearly 50% of permanent neurological damages in children. Treatment and follow-up to prevent recolonization in pregnant women with Group B Streptococcus (GBS) in the urine may reduce the frequency of PTD. In a Cochr......Objectives: Preterm delivery (PTD) contributes to 70% of all perinatal deaths and nearly 50% of permanent neurological damages in children. Treatment and follow-up to prevent recolonization in pregnant women with Group B Streptococcus (GBS) in the urine may reduce the frequency of PTD...... (10.9%), while among the GBS BU negative 1,085 (8.7%) delivered preterm; indicating an association between GBS BU and PTD in crude analyzes (Odds Ratio 1.8; 95% Confidence Interval 1.5-2.2; P30, and 19.0% were smokers in pregnancy. Conclusions: Group B Streptococcus bacteriuria might be a risk factor...

  20. Born early and born poor: An eco-bio-developmental model for poverty and preterm birth.

    Science.gov (United States)

    Brumberg, H L; Shah, S I

    2015-01-01

    Poverty is associated with adverse long-term cognitive outcomes in children. Poverty is also linked with preterm delivery which, in turn, is associated with adverse cognitive outcomes. However, the extent of the effect of poverty on preterm delivery, as well as proposed mechanisms by which they occur, have not been well described. Further, the impact of poverty on preterm school readiness has not been reviewed. As the childhood poverty level continues to increase in the U.S., we examine the evidence around physiological, neurological, cognitive and learning outcomes associated with prematurity in the context of poverty. We use the evidence gathered to suggest an Eco-Bio-Developmental model, emphasizing poverty as a toxic stress which predisposes preterm birth and which, via epigenetic forces, can continue into the next generation. Continued postnatal social disadvantage for these developmentally high-risk preterm infants is strongly linked with poor neurodevelopmental outcomes, decreased school readiness, and decreased educational attainment which can perpetuate the poverty cycle. We suggest social remedies aimed at decreasing the impact of poverty on mothers, fathers, and children which may be effective in reducing the burden of preterm birth.

  1. Preterm labor and premature birth: Are you at risk?

    Science.gov (United States)

    ... premature birth The newborn intensive care unit (NICU) Birth defects & other health conditions Loss & grief Tools & Resources Frequently asked health questions Calculating your due date Ovulation calendar Order bereavement materials News Moms Need Blog Stories & Media ...

  2. Infertility and preterm delivery, birthweight, and Caesarean section: a study within the Danish National Birth Cohort

    DEFF Research Database (Denmark)

    Basso, Olga; Baird, Donna D.

    2003-01-01

    , longitudinal studies enrolling couples irrespective of infertility treatment. METHODS: We used data from the Danish National Birth Cohort: 55 906 singleton live births from women who reported their waiting time to pregnancy (TTP) and other covariates in an interview during the 2nd trimester of pregnancy....... RESULTS: A TTP >1 year was associated with an increased risk of all outcomes studied, including preterm birth [odds ratios and 95% confidence intervals were 1.5 (1.2, 1.8) among primiparas and 1.9 (1.5, 2.4) among multiparas]. Odds ratios for preterm remained elevated after adjustment for covariates....... Among couples with a TTP >1 year, infertility treatment was associated with added risk only among multiparas. CONCLUSION: Infertile women are at higher risk of adverse birth outcomes even if they conceive without treatment. With >10% of babies born to infertile couples, it is important to consider...

  3. Serial fetal abdominal circumference measurements in predicting normal birth weight in gestational diabetes mellitus.

    LENUS (Irish Health Repository)

    Neff, Karl J

    2013-06-24

    To construct a clinical management matrix using serial fetal abdominal circumference measurements (ACMs) that will predict normal birth weight in pregnancies complicated by gestational diabetes (GDM) and reduce unnecessary ultrasound examination in women with GDM.

  4. Mothers and Fathers in NICU: The Impact of Preterm Birth on Parental Distress

    Directory of Open Access Journals (Sweden)

    Chiara Ionio

    2016-11-01

    Full Text Available Preterm birth is a stressful event for families. In particular, the unexpectedly early delivery may cause negative feelings in mothers and fathers. The aim of this study was to examine the relationship between preterm birth, parental stress and negative feelings, and the environmental setting of NICU. 21 mothers (age = 36.00 ± 6.85 and 19 fathers (age = 34.92 ± 4.58 of preterm infants (GA = 30.96 ± 2.97 and 20 mothers (age = 40.08 ± 4.76 and 20 fathers (age = 40.32 ± 6.77 of full-term infants (GA = 39.19 ± 1.42 were involved. All parents filled out the Parental Stressor Scale: Neonatal Intensive Care Unit, the Impact of Event Scale Revised, Profile of Mood States, the Multidimensional Scale of Perceived Social Support and the Post-Partum Bonding Questionnaire. Our data showed differences in emotional reactions between preterm and full-term parents. Results also revealed significant differences between mothers and fathers’ responses to preterm birth in terms of stress, negative feelings, and perceptions of social support. A correlation between negative conditions at birth (e.g., birth weight and Neonatal Intensive Care Unit stay and higher scores in some scales of Impact of Event Scale Revised, Profile of Mood States and Post-Partum Bonding Questionnaire were found. Neonatal Intensive Care Unit may be a stressful place both for mothers and fathers. It might be useful to plan, as soon as possible, interventions to help parents through the experience of the premature birth of their child and to begin an immediately adaptive mode of care.

  5. A debate about ultrasound and anatomic aspects of the cervix in spontaneous preterm birth.

    Science.gov (United States)

    Bohîlțea, R E; Munteanu, O; Turcan, N; Baros, A; Bodean, O; Voicu, D; Cîrstoiu, M M

    2016-01-01

    Preterm birth is the legal first global cause of neonatal death. The cervix has two roles: it has to stay closed to allow the fetus to undergo a normal development during gestation, and at term, the cervix has to dilate under the pressure of uterine contractions to allow the delivery. The purpose of this article is to establish if the ultrasound measured length of the cervix and its appearance are predictive for the spontaneous preterm birth. Cervical insufficiency can be described by painless cervical dilatation leading to pregnancy losses/ births, with no other risk factors present. During gestation, the physiological softening of the cervix is determined by the extracellular matrix components, particular decorin, and thrombospondin 2. The direction of the collagen fibers remains the same - circumferential direction, but the collagen solubility increases. Therefore, during pregnancy, the cervical tissue is more hydrated and has higher collagen extractability than non-pregnant tissue. Women with cervical incompetence have increased levels of smooth muscle cells than normal pregnant women, the number of elastic fibers is low, and also the concentration of hydroxyproline is decreased. Transvaginal ultrasound is the suitable gold standard exam that can offer essential information about the cervical length and state of the internal os in early asymptomatic stage of cervical insufficiency for predicting and preventing preterm birth. In our experience, a transvaginal ultrasound screening for the measurement of the cervix is required. We consider that the proper gestational age for the prediction of a preterm birth is at 18-22 weeks of gestation for the general population and earlier for patients with a history of preterm birth. Just from an observational point of view, we concluded with the fact that the cerclage of the cervix is unnecessary if the cervical length is above 2 cm and if the internal cervical os is closed. In the absence of funneling, the probability of

  6. Determinants of the competing outcomes of intrauterine infection, abruption, or spontaneous preterm birth after preterm premature rupture of membranes.

    Science.gov (United States)

    Hackney, David N; Kuo, Kelly; Petersen, Rebecca J; Lappen, Justin R

    2016-01-01

    Patients with PPROM are at risk for a variety of outcomes, including chorioamnionitis (CA), placental abruption (PA), or preterm labor (PTL). Competing risk regression can analyze a cohort's risk of individual outcomes while accounting for ongoing deliveries secondary to competing events. A secondary analysis of the subjects from MFMU BEAM study of neuroprotection after preterm birth (BEAM) with conservative PPROM management. Deliveries were categorized as: PA, CA, PTL, "elective" or "indicated". The association between outcomes of PA, CA or PTL and clinical predictors of twins, ethnicity, parity, gestational age at rupture, bleeding, contractions, cervical dilation, preterm birth history, weight, and genitourinary infections were evaluated via competing risk regression. 1970 subjects were included. The significance and directionality of predictors varied according to specific outcomes. Patients with twins had an increased PTL hazard (1.85) though reductions in CA- (0.66) or PA-specific (0.56) hazards. Decreased latency in African-Americans was almost entirely due to an increased CA hazard (1.44) without a significant association with PTL. Increasing gestational age at membrane rupture was associated with a decreasing hazard of CA although increasing hazard of PTL. For patients with PPROM, the hazards associated with different clinical predictors vary according to exact outcomes.

  7. Neonatal outcomes of preterm infants in breech presentation according to mode of birth in Canadian NICUs.

    Science.gov (United States)

    Lodha, Abhay; Zhu, Qiaohao; Lee, Shoo K; Shah, Prakesh S

    2011-03-01

    Many medical practitioners have adopted the practice of caesarean section for preterm infants in breech presentation based on term infant data. Some studies have highlighted deleterious effects on survival, such as intraventricular haemorrhage and periventricular leucomalacia, while others have reported no difference from the outcomes after vaginal delivery. To compare outcomes of preterm infants of ≤32 weeks' gestational age who were in breech position at the time of birth according to mode of birth in Canadian neonatal intensive care units (NICUs). 29 Canadian NICUs. Neonates admitted to participating NICUs in the Canadian Neonatal Network between 2003 and 2007 were included in this retrospective study. Infants who were in breech position at the time of birth were divided into two groups: vaginal birth (VB) and caesarean section (CS). Data on common neonatal outcomes were compared using univariate and multivariate logistic regression. Neonatal mortality and other neonatal morbidities. Of 3552 preterm infants in breech position at birth, 2937 (83%) were delivered by CS and 615 (17%) by VB. Multivariate regression analysis with adjustment for perinatal risk factors indicated that VB was associated with an increased risk of death (OR 1.7; 95% CI 1.3 to 2.3), chronic lung disease (OR 1.5; 95% CI 1.1 to 1.9) and severe retinopathy of prematurity (OR 1.6; 95% CI 1.1 to 2.3). Vaginal birth for preterm infants in breech presentation is possibly associated with a higher risk of adverse neonatal outcomes compared with caesarean birth in Canadian NICUs. It is not clear whether adverse outcomes are due to the mode of delivery or whether breech birth is associated with other risk factors, an issue that can only be resolved by a randomised controlled trial.

  8. Early weight changes after birth and serum high-molecular-weight adiponectin level in preterm infants.

    Science.gov (United States)

    Yoshida, Tomohide; Nagasaki, Hiraku; Asato, Yoshihide; Ohta, Takao

    2011-12-01

    Extra-uterine growth retardation (EUGR) is associated with an increased risk for cardiometabolic diseases later in life. The aim of the present study was to examine the relationship between early weight change after birth in preterm infants and adiponectin (adn) multimeric complexes. Subjects included 28 preterm infants born between weeks 24 and 33 of gestation. Serum adn multimeric complexes and the anthropometric parameters were measured in preterm infants at birth and at corrected term. Bodyweight (BW) decreased during the first week of life, with birthweight restored at approximately 19 days after birth. Nineteen of the subjects had EUGR at corrected term. Total (T)-adn, high-molecular-weight (H)-adn, and the ratio of H-adn to T-adn (H/T-adn) were significantly elevated at corrected term than at birth. Postmenstrual age, birthweight, birth length and lowest BW after birth were positively correlated with H-adn and H/T-adn. Weight reduction after birth was negatively correlated with H-adn. Age to restore birthweight was negatively correlated with T-adn, H-adn and H/T-adn. Stepwise multiple regression analysis indicated age to restore birthweight as the major predictor of T-adn and H-adn. Early weight changes after birth may alter serum adn level in preterm infants at corrected term. The appropriate nutritional support in the early postnatal period could reduce the prevalence of EUGR and the future risk for cardiometabolic diseases. © 2011 The Authors. Pediatrics International © 2011 Japan Pediatric Society.

  9. Low birth weight and fetal anaemia as risk factors for infant morbidity ...

    African Journals Online (AJOL)

    Low birth weight (LBW) and fetal anaemia (FA) are common in malaria endemic areas. To investigate the .... with 95% confidence and 80% power, with a 6 to 1 ratio of infants in the NBW to LBW group, a sample of 162 NBW ..... community and in order to improve prevention strategies. Fetal anaemia and morbidity incidence.

  10. Stress and preterm labor and birth in Black women.

    Science.gov (United States)

    Gennaro, Susan; Shults, Justine; Garry, David J

    2008-01-01

    To examine (a) 3 commonly used measures of stress during pregnancy, (b) changes in stress over time to determine when stress is highest, and (c) whether any of the stress measures predict who will deliver preterm in pregnant Black women. Prospective descriptive study. Perinatal evaluation center and outpatient clinics of a teaching hospital in the northeast. Fifty-nine Black women: 39 were recruited in preterm labor from a Perinatal Evaluation Center, and 20 experiencing healthy pregnancies were recruited from the prenatal clinic. Stress was measured using 2 paper and pencil tests (the Prenatal Distress Questionnaire and the Perceived Stress Scale) and corticotropin-releasing hormone. There was not a high correlation between stress measures. Stress at 28 weeks as measured by Prenatal Distress Questionnaire and Perceived Stress Scale was at its highest, but corticotropin-releasing hormone increased to 32 weeks and then decreased. Perceived stress, prenatal distress, and corticotropin-releasing hormone do not all appear to be measuring the same phenomenon. Screening for stress in Black women at 28 weeks requires further research as perceived stress levels in Black women experiencing preterm labor around 28 weeks differentiated women who delivered preterm infants from Black women who delivered at term.

  11. Preterm Birth and Leisure Participation: A Synthesis of the Literature

    Science.gov (United States)

    Dahan-Oliel, Noemi; Mazer, Barbara; Majnemer, Annette

    2012-01-01

    Leisure participation has been associated with happiness and well-being in children. Individuals born preterm are at greater risk for motor, cognitive and behavioral difficulties which may contribute to difficulties participating in leisure activities. This systematic review examined the current knowledge on participation in leisure activities in…

  12. Preterm Birth and Necrotizing Enterocolitis Alter Gut Colonization in Pigs

    DEFF Research Database (Denmark)

    Cilieborg, Malene S.; Boye, Mette; Mølbak, Lars

    2011-01-01

    ). Colonization in both groups of term pigs differed from preterm pigs and was dominated by Lactobacilli spp. In conclusion, gestational age (GA) and NEC influence neonatal gut colonization, whereas diet has minor effects. C. perfringens is more abundant in pigs with NEC but rather as a consequence than a cause...

  13. Noise exposure during pregnancy, birth outcomes and fetal development: meta-analyses using quality effects model.

    Science.gov (United States)

    Dzhambov, Angel M; Dimitrova, Donka D; Dimitrakova, Elena D

    2014-01-01

    Many women are exposed daily to high levels of occupational and residential noise, so the effect of noise exposure on pregnancy should be considered because noise affects both the fetus and the mother herself. However, there is a controversy in the literature regarding the adverse effects of occupational and residential noise on pregnant women and their fetuses. The aim of this study was to conduct systematic review of previously analyzed studies, to add additional information omitted in previous reviews and to perform meta-analyses on the effects of noise exposure on pregnancy, birth outcomes and fetal development. Previous reviews and meta-analyses on the topic were consulted. Additionally, a systematic search in MEDLINE, EMBASE and Internet was carried out. Twenty nine studies were included in the meta-analyses. Quality effects meta-analytical model was applied. Women exposed to high noise levels (in most of the studies ≥ 80 dB) during pregnancy are at a significantly higher risk for having small-for-gestational-age newborn (RR = 1.19, 95% CI: 1.03, 1.38), gestational hypertension (RR = 1.27, 95% CI: 1.03, 1.58) and infant with congenital malformations (RR = 1.47, 95% CI: 1.21, 1.79). The effect was not significant for preeclampsia, perinatal death, spontaneous abortion and preterm birth. The results are consistent with previous findings regarding a higher risk for small-for-gestational-age. They also highlight the significance of residential and occupational noise exposure for developing gestational hypertension and especially congenital malformations.

  14. Lipopolysaccharide-binding protein as marker of fetal inflammatory response syndrome after preterm premature rupture of membranes.

    Science.gov (United States)

    Pavcnik-Arnol, Maja; Lucovnik, Miha; Kornhauser-Cerar, Lilijana; Premru-Srsen, Tanja; Hojker, Sergej; Derganc, Metka

    2014-01-01

    Intra-amniotic inflammation with preterm premature rupture of membranes (PPROM) is a risk factor for fetal inflammatory response syndrome (FIRS) and adverse neonatal outcome. To evaluate the diagnostic accuracy of lipopolysaccharide-binding protein (LBP) for detecting FIRS in preterm neonates born after PPROM. This was a prospective study in the level III neonatal intensive care unit (42 neonates; 23 + 6 to 31 + 6 weeks' gestation) of mothers with PPROM. Umbilical cord blood concentrations of LBP, C-reactive protein (CRP), interleukin (IL)-6 and white blood cell count with differential were measured at delivery and 24 h after birth. Neonates were classified into FIRS (n = 22) and no FIRS (n = 20) groups according to clinical criteria and IL-6 level (≥17.5 pg/ml). Histological examination of the placenta and umbilical cord was performed. Neurological examination at 12 months' corrected age was performed. Umbilical cord blood concentration of LBP was significantly higher in the FIRS group than in the no FIRS group at delivery (median 21.6 mg/l vs. median 2.3 mg/l; p < 0.0001) and 24 h after birth (median 17.2 mg/l vs. median 20.0 mg/l; p < 0.001). The area under the ROC curve for FIRS at delivery was 0.98 (95% CI 0.88-1.0) for LBP, 0.92 (95% CI 0.80-0.99) for CRP and 0.82 (95% CI 0.64-0.94) for immature to total neutrophil ratio. Similar results were obtained if FIRS was defined by funisitis. Umbilical cord blood concentration of LBP at delivery was significantly higher in neonates with abnormal neurological exam at 12 months than in those with normal exam (median 19.5 mg/l vs. median 3.75 mg/l; p < 0.015). In preterm neonates born to asymptomatic women with PPROM, LBP in cord blood at delivery is an excellent diagnostic biomarker of FIRS/funisitis with prognostic potential. © 2013 S. Karger AG, Basel.

  15. Preterm birth and cerebral palsy. Predictive value of pregnancy complications, mode of delivery, and Apgar scores

    DEFF Research Database (Denmark)

    Topp, Monica Wedell; Langhoff-Roos, J; Uldall, P

    1997-01-01

    .01), and low Apgar scores at 1 minute (45% vs. 36%, p or = 3 (adjusted OR = 1.53 (95% CI 1.00-2.34), p ... complications preceding preterm birth did not imply a higher risk of cerebral palsy. Delivery by Cesarean section was a prognostic factor for developing cerebral palsy, and the predictive value of Apgar scores was highly limited....

  16. Growth of preterm low birth weight infants until 24 months corrected age: effect of maternal hypertension

    Directory of Open Access Journals (Sweden)

    Alice M. Kiy

    2015-05-01

    Conclusion: Preterm low birth weight born infants to hypertensive mothers have an increased risk of overweight at 24 months CA. Being born small for gestational age and inadequate growth in the 1st year of life are risk factors for growth disorders at 24 months CA.

  17. [Description and evaluation of creative thinking in preterm low birth weight infants].

    Science.gov (United States)

    Parisi, L; Di Filippo, T; Firrigno, L; La Grutta, S; Testa, D; Roccella, M

    2007-04-01

    Since the 1950s, the problem of how to evaluate creativity has been addressed in studies on the definition of measurement criteria and on the relationship between intelligence and creative thinking. Many revealed cognitive and relational disorders in preterm infants, particularly in preterm very low birth weight infants (birth weight 2500 g. The test battery included: Torrance Test of Creative Thinking (TCTT); WISC-R intelligence test; Goodenough Human Figure Drawing Test. Statistical analysis (Mann-Whitney U test) showed a statistically significant difference (P>0.05) between the 2 groups; scores for figure originality, figure fluidity and figure elaboration were consistently higher in the control group. Within the low birth weight group, there was a significant correlation (Spearman r) between verbal IQ and verbal fluidity and verbal flexibility subscale scores and between IQ performance and figure elaboration. Scores on the figure drawing tests showed higher creative ability in the control group. In children born preterm with low birth weight, emotive dynamics and flow of affection may influence the channels of communication between child and family. The low figure originality subscale scores support the hypothesis that psychodynamic and relational factors (worry about the preterm condition, overprotective behaviour by parents and others) could lead to diminished autonomy, flexibility and manipulatory interest in the child.

  18. Hearing loss by week of gestation and birth weight in very preterm neonates

    NARCIS (Netherlands)

    Dommelen, P. van; Verkerk, P.H.; Straaten, H.L. van

    2015-01-01

    Objective To gain insight into health and related costs associated with very preterm births, one needs accurate information about the prevalence of the disabling conditions, including neonatal hearing loss (NHL). Study design We assessed the prevalence of NHL by week of gestation and categories of

  19. Ethnic disparities in the risk of adverse neonatal outcome after spontaneous preterm birth

    NARCIS (Netherlands)

    Schaaf, Jelle M.; Mol, Ben-Willem J.; Abu-Hanna, Ameen; Ravelli, Anita C. J.

    2012-01-01

    Objective. To describe ethnic disparities in the risk of spontaneous preterm birth and related adverse neonatal outcome. Design. Nationwide prospective cohort study. Setting. The Netherlands, 19992007. Population. Nine hundred and sixty-nine thousand, four hundred and ninety-one singleton

  20. Air pollution, inflammation and preterm birth in Mexico City: Study design and methods

    Science.gov (United States)

    O’Neill, Marie S.; Osornio-Vargas, Alvaro; Buxton, Miatta A.; Sanchez, Brisa N.; Rojas-Bracho, Leonora; Castillo-Castrejon, Marisol; Mordhukovich, Irina B.; Brown, Daniel G.; Vadillo-Ortega, Felipe

    2012-01-01

    Preterm birth is one of the leading causes of perinatal mortality and is associated with long-term adverse health consequences for surviving infants. Preterm birth rates are rising worldwide, and no effective means for prevention currently exists. Air pollution exposure may be a significant cause of prematurity, but many published studies lack the individual, clinical data needed to elucidate possible biological mechanisms mediating these epidemiological associations. This paper presents the design of a prospective study now underway to evaluate those mechanisms in a cohort of pregnant women residing in Mexico City. We address how air quality may act together with other factors to induce systemic inflammation and influence the duration of pregnancy. Data collection includes: biomarkers relevant to inflammation in cervico-vaginal exudate and peripheral blood, along with full clinical information, pro-inflammatory cytokine gene polymorphisms and air pollution data to evaluate spatial and temporal variability in air pollution exposure. Samples are collected on a monthly basis and participants are followed for the duration of pregnancy. The data will be used to evaluate whether ambient air pollution is associated with preterm birth, controlling for other risk factors. We will evaluate which time windows during pregnancy are most influential in the air pollution and preterm birth association. In addition, the epidemiological study will be complemented with a parallel toxicology invitro study, in which monocytic cells will be exposed to air particle samples to evaluate the expression of biomarkers of inflammation. PMID:23177781

  1. Preterm birth in rural Malawi – high incidence in ultrasound-dated ...

    African Journals Online (AJOL)

    Background: Preterm birth is a major cause of neonatal death, and has an incidence in industrialised countries of 7%. There are still very limited data from developing countries. Methods: Cohort study of 512 unselected pregnant women in rural communities in Malawi. All had ultrasound foetal measurements before 24 ...

  2. Contribution of Congenital Anomalies to Preterm Birth Risk in the Netherlands: poster presentation

    NARCIS (Netherlands)

    Mohangoo1, A.; Lanting, C.; Bennebroek Gravenhorst, J.; Verloove-Vanhorick, P.; Buitendijk, S.

    2010-01-01

    Objective: To asses the extents to which congenital anomalies affect risk of preterm birth. Methods: For the present study, we analysed data on 1,972,058 newborns registered in the Netherlands Perinatal Registry database (inclusion criteria 16 weeks of gestation). Logistic regression techniques were

  3. The Peculiarities of Observation of Preterm Babies with Very Low Birth Weight

    Directory of Open Access Journals (Sweden)

    S.V. Alifanova

    2015-10-01

    Full Text Available The article presents the results of follow-up of 59 preterm babies with very low birth weight during the first year of life. It was found that the most frequent causes of disability are cerebral palsy, retinopathy of prematurity, sensorineural deafness, congenital malformations. The main tasks and the algorithm of observation of these children in policlinic are described.

  4. Preterm birth in singleton and multiple pregnancies : evaluation of costs and perinatal outcomes

    NARCIS (Netherlands)

    van Baaren, Gert J.; Peelen, Myrthe J. C. S.; Schuit, Ewoud; van der Post, Joris A. M.; Mol, Ben W. J.; Kok, Marjolein; Hajenius, Petra J.

    Objective: To estimate costs of preterm birth in singleton and multiple pregnancies. Study design: Cost analysis based on data from a prospective cohort study and three multicentre randomised controlled trials (2006-2012) in a Dutch nationwide consortium for women's health research. Women with

  5. An individualized approach to sustained inflation duration at birth improves outcomes in newborn preterm lambs.

    Science.gov (United States)

    Tingay, David G; Lavizzari, Anna; Zonneveld, Cornelis E E; Rajapaksa, Anushi; Zannin, Emanuela; Perkins, Elizabeth; Black, Don; Sourial, Magdy; Dellacà, Raffaele L; Mosca, Fabio; Adler, Andy; Grychtol, Bartłomiej; Frerichs, Inéz; Davis, Peter G

    2015-11-15

    A sustained first inflation (SI) at birth may aid lung liquid clearance and aeration, but the impact of SI duration relative to the volume-response of the lung is poorly understood. We compared three SI strategies: 1) variable duration defined by attaining volume equilibrium using real-time electrical impedance tomography (EIT; SIplat); 2) 30 s beyond equilibrium (SIlong); 3) short 30-s SI (SI30); and 4) positive pressure ventilation without SI (no-SI) on spatiotemporal aeration and ventilation (EIT), gas exchange, lung mechanics, and regional early markers of injury in preterm lambs. Fifty-nine fetal-instrumented lambs were ventilated for 60 min after applying the allocated first inflation strategy. At study completion molecular and histological markers of lung injury were analyzed. The time to SI volume equilibrium, and resultant volume, were highly variable; mean (SD) 55 (34) s, coefficient of variability 59%. SIplat and SIlong resulted in better lung mechanics, gas exchange and lower ventilator settings than both no-SI and SI30. At 60 min, alveolar-arterial difference in oxygen was a mean (95% confidence interval) 130 (13, 249) higher in SI30 vs. SIlong group (two-way ANOVA). These differences were due to better spatiotemporal aeration and tidal ventilation, although all groups showed redistribution of aeration towards the nondependent lung by 60 min. Histological lung injury scores mirrored spatiotemporal change in aeration and were greatest in SI30 group (P < 0.01, Kruskal-Wallis test). An individualized volume-response approach to SI was effective in optimizing aeration, homogeneous tidal ventilation, and respiratory outcomes, while an inadequate SI duration had no benefit over positive pressure ventilation alone. Copyright © 2015 the American Physiological Society.

  6. Intraocular pressure in very low birth weight preterm infants and its association with postconceptional age

    Directory of Open Access Journals (Sweden)

    Rodrigo L. Lindenmeyer

    2012-11-01

    Full Text Available OBJECTIVE: To evaluate intraocular pressure in very low birth weight preterm infants and correlate it with postconceptional age. METHODS: The intraocular pressure in a prospective cohort of very low birth weight premature infants (defined as a birth weight <1,500 g and gestational age <32 weeks admitted to Hospital de Clínicas de Porto Alegre , Brazil was evaluated weekly. The evaluated outcome was the variation in the intraocular pressure following changes in the postconceptional age (defined as the gestational age at birth plus the age in weeks at the time of examination in the weeks following preterm birth. Mixed-effects models were used for the statistical analysis to determine the intraocular pressure variation according to postconceptional age, and means and 10th and 90th percentiles were calculated for the intraocular pressure values. RESULTS: Fifty preterm infants with a mean gestational age of 29.7 ± 1.6 weeks and a mean birth weight of 1,127.7 ± 222.7 g were evaluated. The mean intraocular pressure for the entire cohort considering both eyes was 14.9 ± 4.5 mmHg, and 13.5% of all recorded intraocular pressure values were greater than 20 mmHg. The analysis revealed a mean reduction in the intraocular pressure of 0.29 mmHg for each increase in postconceptional age (p = 0.047; 95% CI: -0.58 to -0.0035. The mean intraocular pressure (P10-P90 decreased from 16.3 mmHg (10.5222.16 at 26.3 weeks to 13.1 mmHg (7.28-18.92 at 37.6 weeks of postconceptional age. CONCLUSIONS: The mean intraocular pressure in very low birth weight preterm infants was 14.9 ± 4.5 mmHg. This value decreased 0.29 mmHg per week as the postconceptional age increased.

  7. Fetal Doppler to predict cesarean delivery for non-reassuring fetal status in the severe small-for-gestational-age fetuses of late preterm and term.

    Science.gov (United States)

    Jo, Ji Hye; Choi, Yong Hee; Wie, Jeong Ha; Ko, Hyun Sun; Park, In Yang; Shin, Jong Chul

    2018-03-01

    To evaluate the significance of fetal Doppler parameters in predicting adverse neonatal outcomes and the risk of cesarean delivery due to non-reassuring fetal status, in severe small for gestational age (SGA) fetuses of late preterm and term gestation. Fetal brain and umbilical artery (UmA) Doppler parameters of cerebroplacental ratio (CPR) and UmA pulsatility index (PI) were evaluated in a cohort of 184 SGA fetuses between 34 and 41 weeks gestational age, who were less than the 5th percentile. The risks of neonatal morbidities and cesarean delivery due to non-reassuring fetal status were analyzed. Univariate analysis revealed that abnormal CPR was significantly associated with cesarean delivery due to non-reassuring fetal status ( P =0.018), but not with neonatal morbidities. However, abnormal CPR did not increase the risk of cesarean delivery due to non-reassuring fetal status in multivariate logistic regression analysis. Abnormal CPR with abnormal PI of UmA was associated with low Apgar score at 1 minute ( P =0.048), mechanical ventilation ( P =0.013) and cesarean delivery due to non-reassuring fetal status ( P cesarean delivery for non-reassuring fetal status (adjusted odds ratio, 7.0; 95% confidence interval, 1.2-41.3; P =0.033), but did not increase risk of low Apgar score or mechanical ventilation in multivariate logistic regression analysis. Abnormal CPR with abnormal PI of UmA increases the risk of cesarean delivery for non-reassuring fetal status, in severe SGA fetuses of late preterm and term. Monitoring of CPR and PI of UmA can help guide management including maternal hospitalization and fetal monitoring.

  8. Short term effect of air pollution, noise and heat waves on preterm births in Madrid (Spain).

    Science.gov (United States)

    Arroyo, Virginia; Díaz, Julio; Ortiz, Cristina; Carmona, Rocío; Sáez, Marc; Linares, Cristina

    2016-02-01

    Preterm birth (PTB) refers to delivery before 37 weeks of gestation and represents the leading cause of early-life mortality and morbidity in developed countries. PTB can lead to serious infant health outcomes. The etiology of PTB remains uncertain, but epidemiologic studies have consistently shown elevated risks with different environmental variables as traffic-related air pollution (TRAP). The aim of the study was to evaluate with time series methodology the short-term effect of air pollutants, noise levels and ambient temperature on the number of births and preterm births occurred in Madrid City during the 2001-2009 period. A time-series analysis was performed to assess the short term impact of daily mean concentrations (µg/m(3)) of PM2.5 and PM10, O3 and NO2. Measurements of Acoustic Pollution in dB(A) analyzed were: Leqd, equivalent diurnal noise level and Leqn, equivalent nocturnal noise level. Maximum and Minimum daily temperature (°C), mean Humidity in the air (%) and Atmospheric Pressure (HPa), were included too. Linear trends, seasonality, as well as the autoregressive nature of the series itself were controlled. We added as covariate the day of the week too. Autoregressive over-dispersed Poisson regression models were performed and the environmental variables were included with short-term lags (from 0 to 7 days) in reference to the date of birth. Firstly, simple models for the total number of births and preterm births were done separately. In a second stage, a model for total births adjusted for preterm births was performed. A total of 298,705 births were analyzed. The results of the final models were expressed in relative risks (RRs) for interquartile increase. We observed evidence of a short term effect at Lag 0, for the following environmental variables analyzed, PM2.5 (RR: 1.020; 95% CI:(1.008 1.032)) and O3 (RR: 1.012; 95% CI:(1.002 1.022)) concentrations and Leqd (RR: 1.139; 95% CI:( (1.124 1.154)) for the total number of births, and besides

  9. Detection and risk stratification of women at high risk of preterm birth in rural communities near Nagpur, India.

    Science.gov (United States)

    Patel, Archana; Prakash, Amber Abhijeet; Pusdekar, Yamini V; Kulkarni, Hemant; Hibberd, Patricia

    2017-09-19

    Presently, preterm birth is globally the leading cause of neonatal mortality. Prompt community based identification of women at high risk for preterm births (HRPB) can either help to avert preterm births or avail effective interventions to reduce neonatal mortality due to preterm births. We evaluated the performance of a package to train community workers to detect the presence of signs or symptoms of HRPB. Pregnant women enrolled in the intervention arm of a cluster randomized trial of Antenatal Corticosteroids (ACT Trial) conducted at Nagpur, India were informed about 4 directly observable signs and symptoms of preterm labor. Community health workers actively monitored these women from 24 to 36 weeks of gestation for these signs or symptoms. If they were present (HRPB positive) the identified women were brought to government health facilities for assessment and management. HRPB positive could also be determined by the provider if the woman presented directly to the facility. Risk stratification was based on the number of signs or symptoms present. The outcome of preterm birth was based on the clinical assessment of gestational age birth weight of birth in the HRPB positives was 8.14 (95% confidence interval 7.16-9.26). The LR of a preterm birth increased in women who had more signs or symptoms of HRBP (p birth weight and higher rates of stillbirths, neonatal deaths and postnatal complications. Addition of risk stratification improved the prediction of preterm delivery (Integrated Discrimination Improvement 17% (95% CI 15-19%)). The package for detection of signs and symptoms of HRPB is feasible, promising and likely to improve management of preterm labor. NCT01073475 on February 21, 2010 and NCT01084096 on March 9, 2010.

  10. [Relationship between reproductive history and preterm births in the last pregnancy, in Shaanxi province].

    Science.gov (United States)

    Qin, B W; Ying, J; Lei, Q; Qu, P F; Lei, F L; Li, J M; Yan, H

    2017-02-10

    Objective: To analyze the incidence of preterm delivery among single live neonates and the association between maternal reproductive history and preterm birth. Methods: A questionnaire survey was conducted on reproductive history among women at childbearing age who were selected through multi-stage stratified random sampling method in Shaanxi, during 2010-2013. Samples would include women at childbearing age and in pregnancy or having had definite pregnancy outcomes. Results: A total of 29 608 women at childbearing age with their infants, were studied. The overall incidence of premature delivery among the single live birth neonates under this study, was 2.7% during 2010-2013. Results from the logistic regression model showed that factors as: having had history with preterm delivery ( OR =7.99, 95 %CI : 5.59-11.43), age of the mothers, older than 35 ( OR = 2.03, 95 % CI : 1.59-2.59) and with history of birth defects ( OR =1.54, 95 % CI : 1.01-2.34) were at higher risks for premature delivery in neonates. Intervals on pregnancies between 3-4 years (compared with ≤2 years, OR =0.74, 95 % CI : 0.58-0.93), between 5-6 years (compared with ≤2 years, OR =0.66, 95 %CI : 0.52-0.82), or> 6 years (compared with ≤2 years, OR =0.48, 95 %CI :0.37-0.61) together with numbers of parity as 1 (compared with primiparas, OR =0.80, 95 %CI : 0.67-0.95), as ≥2 (compared with primiparas, OR =0.62, 95 % CI : 0.39-0.97) etc. were protective factors to preterm delivery. Factors as: history of preterm delivery, mothers age (older than 35 years) and intervals of pregnancy, appeared influential to the age of gestation, under the ordinal polytomous logistic regression analysis. Conclusion: The incidence of preterm births among single live birth neonates in Shaanxi was lower than the average national level. Programs related to health care services prior to conception and during pregnancy, together with increasing the self-care consciousness of childbearing aged women etc, should all be

  11. Endogenous human milk peptide release is greater after preterm birth than term birth.

    Science.gov (United States)

    Dallas, David C; Smink, Christina J; Robinson, Randall C; Tian, Tian; Guerrero, Andres; Parker, Evan A; Smilowitz, Jennifer T; Hettinga, Kasper A; Underwood, Mark A; Lebrilla, Carlito B; German, J Bruce; Barile, Daniela

    2015-03-01

    Hundreds of naturally occurring milk peptides are present in term human milk. Preterm milk is produced before complete maturation of the mammary gland, which could change milk synthesis and secretion processes within the mammary gland, leading to differences in protein expression and enzymatic activity, thereby resulting in an altered peptide profile. This study examined differences in peptides present between milk from women delivering at term and women delivering prematurely. Nano-LC tandem mass spectrometry was employed to identify naturally occurring peptides and compare their abundances between term and preterm human milk samples at multiple time points over lactation. Term milk samples were collected from 8 mothers and preterm milk was collected from 14 mothers. The 28 preterm and 32 term human milk samples were divided into 4 groups based on day of collection (term milk. Bioinformatic analysis of the cleavage sites for peptides identified suggested that plasmin was more active in preterm milk than term milk and that cytosol aminopeptidase and carboxypeptidase B2 likely contribute to extensive milk protein breakdown. Many identified milk peptides in both term and preterm milk overlapped with known functional peptides, including antihypertensive, antimicrobial, and immunomodulatory peptides. The high protein degradation by endogenous proteases in preterm milk might attenuate problems because of the preterm infant's immature digestive system. This trial was registered at clinicaltrials.gov as NCT01817127. © 2015 American Society for Nutrition.

  12. Intermittent auscultation versus continuous fetal monitoring: exploring factors that influence birthing unit nurses' fetal surveillance practice using theoretical domains framework.

    Science.gov (United States)

    Patey, Andrea M; Curran, Janet A; Sprague, Ann E; Francis, Jill J; Driedger, S Michelle; Légaré, France; Lemyre, Louise; Pomey, Marie-Pascale A; Grimshaw, Jeremy M

    2017-09-25

    Intermittent Auscultation (IA) is the recommended method of fetal surveillance for healthy women in labour. However, the majority of women receive continuous electronic monitoring. We used the Theoretical Domains Framework (TDF) to explore the views of Birthing Unit nurses about using IA as their primary method of fetal surveillance for healthy women in labour. Using a semi-structured interview guide, we interviewed a convenience sample of birthing unit nurses throughout Ontario, Canada to elicit their views about fetal surveillance. Interviews were recorded and transcribed verbatim. Transcripts were content analysed using the TDF and themes were framed as belief statements. Domains potentially key to changing fetal surveillance behaviour and informing intervention design were identified by noting the frequencies of beliefs, content, and their reported influence on the use of IA. We interviewed 12 birthing unit nurses. Seven of the 12 TDF domains were perceived to be key to changing birthing unit nurses' behaviour The nurses reported that competing tasks, time constraints and the necessity to multitask often limit their ability to perform IA (domains Beliefs about capabilities; Environmental context and resources). Some nurses noted the decision to use IA was something that they consciously thought about with every patient while others stated it their default decision as long as there were no risk factors (Memory, attention and decision processes, Nature of behaviour). They identified positive consequences (e.g. avoid unnecessary interventions, mother-centered care) and negative consequences of using IA (e.g. legal concerns) and reported that the negative consequences can often outweigh positive consequences (Beliefs about consequences). Some reported that hospital policies and varying support from care teams inhibited their use of IA (Social influences), and that support from the entire team and hospital management would likely increase their use (Social

  13. Vaginal progesterone for preventing preterm birth and adverse perinatal outcomes in singleton gestations with a short cervix: a meta-analysis of individual patient data.

    Science.gov (United States)

    Romero, Roberto; Conde-Agudelo, Agustin; Da Fonseca, Eduardo; O'Brien, John M; Cetingoz, Elcin; Creasy, George W; Hassan, Sonia S; Nicolaides, Kypros H

    2018-02-01

    The efficacy of vaginal progesterone for preventing preterm birth and adverse perinatal outcomes in singleton gestations with a short cervix has been questioned after publication of the OPPTIMUM study. To determine whether vaginal progesterone prevents preterm birth and improves perinatal outcomes in asymptomatic women with a singleton gestation and a midtrimester sonographic short cervix. We searched MEDLINE, EMBASE, LILACS, and CINAHL (from their inception to September 2017); Cochrane databases; bibliographies; and conference proceedings for randomized controlled trials comparing vaginal progesterone vs placebo/no treatment in women with a singleton gestation and a midtrimester sonographic cervical length ≤25 mm. This was a systematic review and meta-analysis of individual patient data. The primary outcome was preterm birth preterm birth preterm birth preterm birth preterm birth and improves perinatal outcomes in singleton gestations with a midtrimester sonographic short cervix, without any demonstrable deleterious effects on childhood neurodevelopment. Published by Elsevier Inc.

  14. Preterm Birth Reduces Nutrient Absorption With Limited Effect on Immune Gene Expression and Gut Colonization in Pigs

    DEFF Research Database (Denmark)

    Østergaard, Mette V; Cilieborg, Malene S.; Skovgaard, Kerstin

    2015-01-01

    The primary risk factors for necrotizing enterocolitis (NEC) are preterm birth, enteral feeding, and gut colonization. It is unclear whether feeding and colonization induce excessive expression of immune genes that lead to NEC. Using a pig model, we hypothesized that reduced gestational age would...... upregulate immune-related genes and cause bacterial imbalance after birth. Preterm (85%-92% gestation, n = 53) and near-term (95%-99% gestation, n = 69) pigs were delivered by cesarean section and euthanized at birth or after 2 days of infant formula or bovine colostrum feeding. At birth, preterm delivery...... reduced 5 of 30 intestinal genes related to nutrient absorption and innate immunity, relative to near-term pigs, whereas 2 genes were upregulated. Preterm birth also reduced ex vivo intestinal glucose and leucine uptake (40%-50%), but failed to increase cytokine secretions from intestinal explants...

  15. Ambient air pollution and preterm birth: A prospective birth cohort study in Wuhan, China.

    Science.gov (United States)

    Qian, Zhengmin; Liang, Shengwen; Yang, Shaoping; Trevathan, Edwin; Huang, Zhen; Yang, Rong; Wang, Jing; Hu, Ke; Zhang, Yiming; Vaughn, Michael; Shen, Longjiao; Liu, Wenjin; Li, Pu; Ward, Patrick; Yang, Li; Zhang, Wei; Chen, Wei; Dong, Guanghui; Zheng, Tongzhang; Xu, Shunqing; Zhang, Bin

    2016-03-01

    Although studies in western countries suggest that ambient air pollution is positively associated with adverse pregnancy outcomes, the upper levels of pollutant exposures have been relatively low, thus eroding confidence in the conclusions. Meanwhile, in Asia, where upper levels of exposure have been greater, there have been limited studies of the association between air pollution and adverse pregnancy outcomes. The primary objective was to evaluate whether high levels of pollution, including particulate matter pollution with a mass median aerodynamic diameter of less than 2.5 μm (PM2.5) and 10 μm (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), ozone (O3), and carbon monoxide (CO) are related to increased occurrence of preterm birth (PTB). We conducted a population-based study in Wuhan, China in a cohort of 95,911 live births during a two-year period from 2011 to 2013. The exposure was estimated based on daily mean concentrations of pollutants estimated using the pollutants' measurements from the nine closest monitors. Logistic regressions were performed to determine the relationships between exposure to each of the pollutants during different pregnancy periods and PTB while controlling for key covariates. We found 3% (OR=1.03; 95% CI: 1.02, 1.05), 2% (OR=1.02; 95% CI: 1.02, 1.03), 15% (OR=1.15; 95% CI: 1.11, 1.19), and 5% (OR=1.05; 95% CI: 1.02, 1.07) increases in risk of PTB with each 5-μg/m(3) increase in PM2.5 and PM10 concentrations, 100-μg/m(3) increase in CO concentrations, and 10-μg/m(3) increase in O3 concentrations, respectively. There was negligible evidence for associations for SO2 and NO2. The effects from two-pollutant models were similar to the estimated effects from single pollutant models. No critical exposure windows were identified consistently: the strongest effect for PTB was found in the second trimester for PM2.5, PM10, and CO, but for SO2 it was in the first trimester, second month, and third month. For NO2 it was in the first

  16. Disruptions to the cerebellar GABAergic system in juvenile guinea pigs following preterm birth.

    Science.gov (United States)

    Shaw, Julia C; Palliser, Hannah K; Dyson, Rebecca M; Berry, Mary J; Hirst, Jonathan J

    2018-04-01

    Children that are born preterm are at an increased risk of developing cognitive problems and behavioural disorders, such as attention deficit hyperactivity disorder (ADHD). There is increasing interest in the role of the cerebellum in these processes and the potential involvement of GABAergic pathways in neurodevelopmental disorders. We propose that preterm birth, and the associated loss of the trophic intrauterine environment, alters the development of the cerebellum, contributing to ongoing neurobehavioral disorders. Guinea pigs were delivered preterm (GA62) or spontaneously at term (GA69), and tissues collected at corrected postnatal day (PND) 28. Neurodevelopmental and GABAergic markers myelin basic protein (MBP), neuronal nuclei (NeuN), calbindin (Purkinje cells), and GAD67 (GABA synthesis enzyme) were analysed in cerebellar lobules IX and X by immunohistochemistry. Protein expression of GAD67 and GAT1 (GABA transporter enzyme) were quantified by western blot, whilst neurosteroid-sensitive GABA A receptor subunits were measured by RT-PCR. MBP immunostaining was increased in lobule IX of preterm males, and reduced in lobule X of preterm females when compared to their term counterparts. GAD67 staining was decreased in lobule IX and X of the preterm males, but only in lobule X of the preterm females compared to term cohorts for each sex. Internal granule cell layer width of lobule X was decreased in preterm cohorts of both sexes compared to terms. There were no differences between gestational age groups for NeuN staining, GAD67 and GAT1 protein expression as measured by western blotting, or GABA A receptor subunits as measured by RT-PCR between preterm and term for either sex. The present findings suggest that components of the cerebellar GABAergic system of the ex-preterm cerebellum are disrupted. The higher expression of myelin in the preterm males may be due to a deficit in axonal pruning, whereas females have a deficit in myelination at 28 corrected days of

  17. Changes in haemoglobin levels in infants in Malawi: effect of low birth weight and fetal anaemia

    NARCIS (Netherlands)

    le Cessie, S.; Verhoeff, F. H.; Mengistie, G.; Kazembe, P.; Broadhead, R.; Brabin, B. J.

    2002-01-01

    Objectives: To examine the effect of low birth weight (LBW) and fetal anaemia (FA) on haemoglobin (Hb) patterns in infancy. To study the additional contribution of other risk factors known at birth. To examine the effect of iron supplementation during infancy on Hb levels. Methods: A stratified

  18. No association between periodontitis and preterm low birth weight: a case-control study.

    Science.gov (United States)

    Fogacci, Mariana Fampa; Cardoso, Elaine de O C; Barbirato, Davi da S; de Carvalho, Denise Pires; Sansone, Carmelo

    2018-01-01

    This study aimed to investigate the association between periodontitis in pregnant women and adverse pregnancy outcomes by heeding confounding risk factors for preterm low birth weight infants. This study was reported according to The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement. A case-control study was conducted. Medical records of all pregnant women attending a prenatal care clinic were screened. Those between 21 and 34 years and gestational age of 28-32 weeks were initially enrolled in the study. The exclusion criteria were then applied: diabetes mellitus, genitourinary tract infections, or HIV infection; previous multiple gestations; previous preterm birth/low birth weight infants; in vitro fertilization procedures; placental, cervical/uterine abnormalities; history of infertility; history of drug abuse; and any medical conditions that required antibiotics prophylaxis. Patients' anthropometric, demographic, and behavioral characteristics were collected. The periodontal clinical parameters were obtained from six sites per tooth: clinical attachment level, probing pocket depth, dental plaque index, and gingival bleeding index. Women were then allocated into two groups: mothers of preterm and/or low birth weight newborns (cases) and mothers of full-term and normal birth weight newborns (controls). Periodontal clinical parameters were analyzed and reported separately for each group, and no significant differences were observed (p > 0.05). Logistic regression analysis revealed that periodontal clinical parameters were not associated with the adverse pregnancy outcomes. After controlling for confounding factors, our results suggest that maternal periodontal disease is not a risk factor associated with preterm low birth weight infants.

  19. Relationship Between Common Mental Disorder Symptoms During Pregnancy and Preterm Birth Among Chinese Women in Wuhan.

    Science.gov (United States)

    Yang, Rong; Liang, Shengwen; Flick, Louise H; Yang, Shaoping; Hu, Ke; Wang, Jing; Hu, Ronghua; Huang, Zhen; Dong, Guanghui; Zhang, Yiming; Shen, Longjiao; Peng, Anna; Zheng, Tongzhang; Xu, Shunqing; Zhang, Bin; Qian, Zhengmin

    2016-10-01

    Objectives Few studies focus on the symptoms of common mental disorders during pregnancy (CMDP) and risk of preterm birth subtypes (PTB). The purpose of this study was to estimate the association between CMDP and PTB, and to examine whether or not the association between CMDP and PTB varies with the subtype of PTB in Chinese. Methods This population-based case control study, conducted in Wuhan, China, defined cases as every pregnant woman who had a PTB among all births in Wuhan, from June 10, 2011, to June 9, 2013. The same number of pregnant women who had term births was randomly selected as controls. The Electronic Perinatal Health Care Information System, a questionnaire designed for the study, provided data about the participants. Logistic regression analyses were used to model associations between CMDP and PTB, and to test associations between CMDP and two subtypes of PTB. Results The study recruited 8616 cases and an equal number of controls. We successfully collected maternal information on 6656 cases and controls for a response rate of 77.3 %. The incidence of PTB in Wuhan was 4.5 %. Spontaneous preterm births (SPTB) accounted for 60.1 %, and medically induced preterm births (IPTB) accounted for 39.9 % of preterm births. The prevalence rate of CMDP was 15.8 %. CMDP was slightly associated with PTB (crude OR 1.16, 95 % CI 1.01-1.32; adjusted OR 1.15, 95 % CI 1.00-1.32), further analyses showed CMDP was associated with IPTB (aOR 1.25, 95 % CI 1.04-1.50), but not with SPTB. Conclusion Our data suggest that CMDP is related to an increased risk of PTB, and that this association is primarily due to IPTB rather than SPTB.

  20. Antenatal Corticosteroids for Reducing Adverse Maternal and Child Outcomes in Special Populations of Women at Risk of Imminent Preterm Birth: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Amiya, Rachel M; Mlunde, Linda B; Ota, Erika; Swa, Toshiyuki; Oladapo, Olufemi T; Mori, Rintaro

    2016-01-01

    This study synthesizes available evidence on antenatal corticosteroids (ACS) use among special subgroups of women at risk of imminent preterm birth, including those (1) with pregestational and gestational diabetes mellitus, (2) undergoing elective caesarean section (CS) in late preterm (34 to<37 weeks), (3) with chorioamnionitis, and (4) with growth-restricted fetuses. A systematic search of MEDLINE, EMBASE, CINAHL, Cochrane Library, POPLINE, and World Health Organization Regional Databases was conducted for all comparative studies. Two reviewers independently determined study eligibility, extracted data, and assessed study quality. Pooled mean differences and odds ratios with 95% confidence intervals were estimated from available data, based on fixed- and random-effects models, as appropriate. No eligible studies were identified for ACS use in diabetic pregnant women or those undergoing elective CS at late preterm. Nine studies each on ACS use in women with chorioamnionitis and in women with fetal growth restriction met inclusion criteria; eight studies were separately included in the meta-analyses for the two subpopulations. For ACS administration in women with chorioamnionitis, pooled analyses showed reductions in neonatal mortality (OR: 0.49, 95% CI: 0.34-0.73), respiratory distress syndrome (OR: 0.58, 95% CI: 0.44-0.76), intraventricular haemorrhage (OR: 0.41, 95% CI: 0.24-0.69), and severe intraventricular haemorrhage (OR: 0.40, 95% CI: 0.24-0.69). Maternal and long-term newborn outcomes were not reported. Effects of ACS use were inconclusive for cases with fetal growth restriction. Direct evidence on the effectiveness and safety of ACS is lacking for diabetic pregnant women at risk of preterm birth and those undergoing elective late-preterm CS, though this does not necessarily recommend against their use in diabetic women. While evidence remains inconclusive for women with growth-restricted preterm neonates, ACS appears to benefit preterm neonates delivered

  1. Aortic isthmus Doppler velocimetry: role in assessment of preterm fetal growth restriction.

    LENUS (Irish Health Repository)

    Kennelly, M M

    2012-02-01

    Intrauterine fetal growth restriction (IUGR) is an important pregnancy complication associated with significant adverse clinical outcome, stillbirth, perinatal morbidity and cerebral palsy. To date, no uniformly accepted management protocol of Doppler surveillance that reduces mortality and cognitive morbidity has emerged. Aortic isthmus (AoI) evaluation has been proposed as a potential monitoring tool for IUGR fetuses. In this review, the current knowledge of the relationship between AoI Doppler velocimetry and preterm fetal growth restriction is reviewed. Relevant technical aspects and reproducibility data are reviewed as we discuss AoI Doppler and its place within the existing repertoire of Doppler assessments in placental insufficiency. The AoI is a link between the right and left ventricles which perfuse the lower and upper body, respectively. The clinical use of AoI waveforms for monitoring fetal deterioration in IUGR has been limited, but preliminary work suggests that abnormal AoI impedance indices are an intermediate step between placental insufficiency-hypoxemia and cardiac decompensation. Further prospective studies correlating AoI indices with arterial and venous Doppler indices and perinatal outcome are required before encorporating this index into clinical practice.

  2. 15 million preterm births annually: what has changed this year?

    Directory of Open Access Journals (Sweden)

    Kinney Mary V

    2012-11-01

    Full Text Available Abstract Each year, more than 1 in 10 of the world’s babies are born preterm, resulting in 15 million babies born too soon. World Prematurity Day, November 17, is a global effort to raise awareness about prematurity. This past year, there has been increased awareness of the problem, through new data and evidence, global partnership and country champions. Actions to improve care would save hundreds of thousands of babies born too soon from death and disability. Accelerated prevention requires urgent research breakthroughs.

  3. Single and Serial Fetal Biometry to Detect Preterm and Term Small- and Large-for-Gestational-Age Neonates: A Longitudinal Cohort Study

    Science.gov (United States)

    Hernandez-Andrade, Edgar; Ahn, Hyunyoung; Garcia, Maynor; Xu, Zhonghui; Korzeniewski, Steven J.; Saker, Homam; Chaiworapongsa, Tinnakorn; Hassan, Sonia S.; Yeo, Lami; Romero, Roberto

    2016-01-01

    Objectives To assess the value of single and serial fetal biometry for the prediction of small- (SGA) and large-for-gestational-age (LGA) neonates delivered preterm or at term. Methods A cohort study of 3,971 women with singleton pregnancies was conducted from the first trimester until delivery with 3,440 pregnancies (17,334 scans) meeting the following inclusion criteria: 1) delivery of a live neonate after 33 gestational weeks and 2) two or more ultrasound examinations with fetal biometry parameters obtained at ≤36 weeks. Primary outcomes were SGA (95th centile) at birth based on INTERGROWTH-21st gender-specific standards. Fetus-specific estimated fetal weight (EFW) trajectories were calculated by linear mixed-effects models using data up to a fixed gestational age (GA) cutoff (28, 32, or 36 weeks) for fetuses having two or more measurements before the GA cutoff and not already delivered. A screen test positive for single biometry was based on Z-scores of EFW at the last scan before each GA cut-off so that the false positive rate (FPR) was 10%. Similarly, a screen test positive for the longitudinal analysis was based on the projected (extrapolated) EFW at 40 weeks from all available measurements before each cutoff for each fetus. Results Fetal abdominal and head circumference measurements, as well as birth weights in the Detroit population, matched well to the INTERGROWTH-21st standards, yet this was not the case for biparietal diameter (BPD) and femur length (FL) (up to 9% and 10% discrepancy for mean and confidence intervals, respectively), mainly due to differences in the measurement technique. Single biometry based on EFW at the last scan at ≤32 weeks (GA IQR: 27.4–30.9 weeks) had a sensitivity of 50% and 53% (FPR = 10%) to detect preterm and term SGA and LGA neonates, respectively (AUC of 82% both). For the detection of LGA using data up to 32- and 36-week cutoffs, single biometry analysis had higher sensitivity than longitudinal analysis (52% vs 46

  4. The association between parity, infant gender, higher level of paternal education and preterm birth in Pakistan: a cohort study

    Directory of Open Access Journals (Sweden)

    Shaikh Kiran

    2011-11-01

    Full Text Available Abstract Background High rates of antenatal depression and preterm birth have been reported in Pakistan. Self reported maternal stress and depression have been associated with preterm birth; however findings are inconsistent. Cortisol is a biological marker of stress and depression, and its measurement may assist in understanding the influence of self reported maternal stress and depression on preterm birth. Methods In a prospective cohort study pregnant women between 28 to 30 weeks of gestation from the Aga Khan Hospital for Women and Children completed the A-Z Stress Scale and the Centre for Epidemiology Studies Depression Scale to assess stress and depression respectively, and had a blood cortisol level drawn. Women were followed up after delivery to determine birth outcomes. Correlation coefficients and Wilcoxon rank sum test was used to assess relationship between preterm birth, stress, depression and cortisol. Logistic regression analysis was used to determine the key factors predictive of preterm birth. Results 132 pregnant women participated of whom 125 pregnant women had both questionnaire and cortisol level data and an additional seven had questionnaire data only. Almost 20% of pregnant women (19·7%, 95% CI 13·3-27·5 experienced a high level of stress and nearly twice as many (40·9%, 95% CI 32·4-49·8% experienced depressive symptoms. The median of cortisol level was 27·40 ug/dl (IQR 22·5-34·2. The preterm birth rate was 11·4% (95% CI 6·5-18. There was no relationship between cortisol values and stress scale or depression. There was a significant positive relationship between maternal depression and stress. Preterm birth was associated with higher parity, past delivery of a male infant, and higher levels of paternal education. Insufficient numbers of preterm births were available to warrant the development of a multivariable logistic regression model. Conclusions Preterm birth was associated with higher parity, past delivery

  5. Cervical HSV-2 infection causes cervical remodeling and increases risk for ascending infection and preterm birth

    Science.gov (United States)

    McGee, Devin; Poncil, Sharra; Patterson, Amanda

    2017-01-01

    Preterm birth (PTB), or birth before 37 weeks gestation, is the leading cause of neonatal mortality worldwide. Cervical viral infections have been established as risk factors for PTB in women, although the mechanism leading to increased risk is unknown. Using a mouse model of pregnancy, we determined that intra-vaginal HSV2 infection caused increased rates of preterm birth following an intra-vaginal bacterial infection. HSV2 infection resulted in histological changes in the cervix mimicking cervical ripening, including significant collagen remodeling and increased hyaluronic acid synthesis. Viral infection also caused aberrant expression of estrogen and progesterone receptor in the cervical epithelium. Further analysis using human ectocervical cells demonstrated a role for Src kinase in virus-mediated changes in estrogen receptor and hyaluronic acid expression. In conclusion, HSV2 affects proteins involved in tissue hormone responsiveness, causes significant changes reminiscent of premature cervical ripening, and increases risk of preterm birth. Studies such as this improve our chances of identifying clinical interventions in the future. PMID:29190738

  6. Biphasic changes in fetal heart rate variability in preterm fetal sheep developing hypotension after acute on chronic lipopolysaccharide exposure.

    Science.gov (United States)

    Lear, Christopher A; Davidson, Joanne O; Booth, Lindsea C; Wassink, Guido; Galinsky, Robert; Drury, Paul P; Fraser, Mhoyra; Bennet, Laura; Gunn, Alistair J

    2014-08-15

    Perinatal exposure to infection is highly associated with adverse outcomes. Experimentally, acute, severe exposure to gram-negative bacterial lipopolysaccharide (LPS) is associated with increased fetal heart rate variability (FHRV). It is unknown whether FHRV is affected by subclinical infection with or without acute exacerbations. We therefore tested the hypothesis that FHRV would be associated with hypotension after acute on chronic exposure to LPS. Chronically instrumented fetal sheep at 0.7 gestation were exposed to a continuous low-dose LPS infusion (n = 12, 100 ng/kg over 24 h, followed by 250 ng·kg(-1)·24 h(-1) for a further 96 h) or the same volume of saline (n = 10). Boluses of either 1 μg LPS or saline were given at 48, 72, and 96 h. Low-dose infusion was not associated with hemodynamic or FHRV changes. The first LPS bolus was associated with tachycardia and suppression of nuchal electromyographic activity in all fetuses. Seven of twelve fetuses developed hypotension (a fall in mean arterial blood pressure ≥5 mmHg). FHRV was transiently increased only at the onset of hypotension, in association with increased cytokine induction and electroencephalogram suppression. FHRV then fell before the nadir of hypotension, with transient suppression of short-term FHRV. After the second LPS bolus, the hypotension group showed a biphasic pattern of a transient increase in FHRV followed by more prolonged suppression. These findings suggest that infection-related hypotension in the preterm fetus mediates the transient increase in FHRV and that repeated exposure to LPS leads to progressive loss of FHRV. Copyright © 2014 the American Physiological Society.

  7. Indoor Exposure and Adverse Birth Outcomes Related to Fetal Growth, Miscarriage and Prematurity—A Systematic Review

    Directory of Open Access Journals (Sweden)

    Evridiki Patelarou

    2014-06-01

    Full Text Available The purpose of this review was to summarize existing epidemiological evidence of the association between quantitative estimates of indoor air pollution and all-day personal exposure with adverse birth outcomes including fetal growth, prematurity and miscarriage. We carried out a systematic literature search of MEDLINE and EMBASE databases with the aim of summarizing and evaluating the results of peer-reviewed epidemiological studies undertaken in “westernized” countries that have assessed indoor air pollution and all-day personal exposure with specific quantitative methods. This comprehensive literature search identified 16 independent studies which were deemed relevant for further review and two additional studies were added through searching the reference lists of all included studies. Two reviewers independently and critically appraised all eligible articles using the Critical Appraisal Skills Programme (CASP tool. Of the 18 selected studies, 14 adopted a prospective cohort design, three were case-controls and one was a retrospective cohort study. In terms of pollutants of interest, seven studies assessed exposure to electro-magnetic fields, four studies assessed exposure to polycyclic aromatic hydrocarbons, four studies assessed PM2.5 exposure and three studies assessed benzene, phthalates and noise exposure respectively. Furthermore, 12 studies examined infant growth as the main birth outcome of interest, six examined spontaneous abortion and three studies assessed gestational age at birth and preterm delivery. This survey demonstrates that there is insufficient research on the possible association of indoor exposure and early life effects and that further research is needed.

  8. Investigating the variations in survival rates for very preterm infants in ten European regions: the MOSAIC birth cohort

    DEFF Research Database (Denmark)

    Draper, Elizabeth S; Zeitlin, Jennifer; Fenton, Alan C

    2008-01-01

    OBJECTIVE: To investigate the variation in the survival rate and the mortality rates for very preterm infants across Europe. DESIGN: A prospective birth cohort of very preterm infants for ten geographically defined European regions during 2003 followed to discharge home from hospital. PARTICIPANTS...... for NIC. For babies order...

  9. Role of acoustic radiation force impulse and shear wave velocity in prediction of preterm birth: a prospective study.

    Science.gov (United States)

    Agarwal, Arjit; Agarwal, Shubhra; Chandak, Shruti

    2017-01-01

    Background Preterm birth is one of the important causes of neonatal morbidity where we rely on subjective criteria such as modified Bishop's scoring and contemporary sonographic measurement of cervical length. Acoustic radiation force impulse (ARFI) is a technological advancement in elastography that can be employed in prediction of cervical softening and preterm labor. Purpose To evaluate the role of ARFI technique and shear wave velocity (SWV) estimates as a predictor of preterm birth and its comparison with other clinical and sono-elastographic measures. Material and Methods Thirty-four pregnant women (gestation age = 28-37 weeks age) showing features suggestive of preterm labor were included and evaluated with modified Bishop's score, cervical length by ultrasound (US), ARFI to derive Elastography index (EI), and SWV of the cervix. The patients were later divided into two groups, using the clinical outcome of preterm or term delivery. Results Twenty patients delivered at term (gestational age > 37 weeks) and 14 were preterm. Receiver operating characteristics (ROC) curves showed SWV with highest sensitivity and specificity (93% and 90%, respectively) for the prediction of preterm birth at a cutoff value of 2.83 m/s. EI and modified Bishop's score were comparable to each other, but were less sensitive techniques. Conclusion Elastographic assessment of antenatal cervix is a novel technique of virtual palpation of internal os and can be utilized as an objective criterion for preterm birth prediction.

  10. Hot Executive Function Following Moderate-to-Late Preterm Birth: Altered Delay Discounting at 4 Years of Age

    Science.gov (United States)

    Hodel, Amanda S.; Brumbaugh, Jane E.; Morris, Alyssa R.; Thomas, Kathleen M.

    2016-01-01

    Interest in monitoring long-term neurodevelopmental outcomes of children born moderate-to-late preterm (32-36 weeks gestation) is increasing. Moderate-to-late preterm birth has a negative impact on academic achievement, which may relate to differential development of executive function (EF). Prior studies reporting deficits in EF in preterm…

  11. Early corticosteroid treatment does not affect severity of unconjugated hyperbilirubinemia in extreme low birth weight preterm infants

    NARCIS (Netherlands)

    Hulzebos, Christian V.; Bos, Arend F.; Anttila, Eija; Hallman, Mikko; Verkade, Henkjan J.

    Aim: To determine the relationship between early postnatal dexamethasone (DXM) treatment and the severity of hyperbilirubinemia in extreme low birth weight (ELBW) preterm infants. Methods: In 54 ELBW preterm infants, total serum bilirubin concentrations (TSB) and phototherapy (PT) data during the

  12. Ubiquitin-Proteasome-Collagen (CUP Pathway in Preterm Premature Rupture of Fetal Membranes

    Directory of Open Access Journals (Sweden)

    Xinliang Zhao

    2017-06-01

    Full Text Available Spontaneous preterm birth (sPTB occurs before 37 gestational weeks, with preterm premature rupture of the membranes (PPROM and spontaneous preterm labor (sPTL as the predominant adverse outcomes. Previously, we identified altered expression of long non-coding RNAs (lncRNAs and message RNAs (mRNAs related to the ubiquitin proteasome system (UPS in human placentas following pregnancy loss and PTB. We therefore hypothesized that similar mechanisms might underlie PPROM. In the current study, nine pairs of ubiquitin-proteasome-collagen (CUP pathway–related mRNAs and associated lncRNAs were found to be differentially expressed in PPROM and sPTL. Pathway analysis showed that the functions of their protein products were inter-connected by ring finger protein. Twenty variants including five mutations were identified in CUP-related genes in sPTL samples. Copy number variations were found in COL19A1, COL28A1, COL5A1, and UBAP2 of sPTL samples. The results reinforced our previous findings and indicated the association of the CUP pathway with the development of sPTL and PPROM. This association was due not only to the genetic variation, but also to the epigenetic regulatory function of lncRNAs. Furthermore, the findings suggested that the loss of collagen content in PPROM could result from degradation and/or suppressed expression of collagens.

  13. [Incidence of preterm births in the IMSS (2007-2012)].

    Science.gov (United States)

    Minguet-Romero, Ramón; Cruz-Cruz, Polita del Rocío; Ruíz-Rosas, Roberto Aguli; Hernández-Valencia, Marcelino

    2014-07-01

    The birth of a premature child implies an expense raised for the families and the systems of health for the possibilities of visual, auditory disability and problems of learning. The rate of premature births, according to the WHO, goes from 5 to 18 %, for what it was found that it will have to diminish. Knows the behavior of the incident of the childbirth pretérmino in the Mexican Institute of the Social Insurance (IMSS) during the period 2007-2012 in the hospitals of the second and third level of attention ginecoobstétrica. Descriptive and retrospective study in which there was analyzed the existing information of the cases brought of birth pretérmino in the IMSS (2007-2012). Proved: the total of births was of born 3,135,755 alive, of this 7.7 % they were pretérmino in all the conditions of the Republic, which on having differed with the second level of attention existed 188,715 (6.8%) born pretérmino and the third level of attention (Medical Units of Alta Especialidad, UMAES) with 51,635 (13.7%) born pretérmino (p life for what it is necessary to reinforce the contraceptive Council in the teenagers, to spread the births, as well as the detection and treatment of the infections genitourinarias.

  14. Cervical conization doubles the risk of preterm and very preterm birth in assisted reproductive technology twin pregnancies.

    Science.gov (United States)

    Pinborg, A; Ortoft, G; Loft, A; Rasmussen, S C; Ingerslev, H J

    2015-01-01

    Does cervical conization add an additional risk of preterm birth (PTB) in assisted reproduction technology (ART) singleton and twin pregnancies? Cervical conization doubles the risk of preterm and very PTB in ART twin pregnancies. ART and cervical conization are both risk factors for PTB. In this national population-based controlled cohort study, we included all ART singletons and twin deliveries from 1995 to 2009 in Denmark by cross-linkage of maternal and child data from the National IVF register and the Medical Birth register. Furthermore, control groups of naturally conceived (NC) singletons and twins were extracted. Cervical diagnoses were obtained from the Danish Pathology register. Cervical conization included both cold knife cone and LEEP (loop electrosurgical excision procedure) but not cervical biopsies. The main outcomes measures were PTB (PTB ≤ 37 + 0 gestational weeks), very preterm birth (VPTB ≤ 32 + 0 gestational weeks) and preterm premature rupture of membranes (PPROM). In all 16 923 ART singletons and 4829 ART twin deliveries were included. A random sample of NC singletons, 2-fold the size of the ART singleton group matched by date and year of birth (n = 33 835) and all NC twin deliveries (n = 15 112), was also extracted. Multiple logistic regression analyses were performed to adjust for the following confounders: maternal age, parity, year of child birth and sex of child. Cervical morbidity (dysplasia and conization) was more often observed in ART pregnancies (6.2% of ART singletons and 5.4% ART twins) than in NC pregnancies (4.2% for NC singletons and 4.5% for NC twins), both for singletons and twins. In ART singleton deliveries, the PTB rate was 13.1 versus 8.2% in women with and without conization, respectively, with an adjusted odds ratio (aOR) of 1.56 [95% confidence interval (CI) 1.21-2.01]. In ART twin deliveries, the prevalence of PTB was 58.2 versus 41.3% in women with and without conization, respectively, with an aOR 1.94 (95% CI 1

  15. Second trimester cervical length and risk of preterm birth in women with twin gestations treated with 17-α hydroxyprogesterone caproate.

    LENUS (Irish Health Repository)

    Durnwald, Celeste P

    2010-12-01

    To compare rates of preterm birth before 35 weeks based on cervical length measurement at 16-20 weeks in women with twin gestations who received 17-α hydroxyprogesterone caproate (17OHPC) or placebo.

  16. VAGINAL PROGESTERONE VERSUS CERVICAL CERCLAGE FOR THE PREVENTION OF PRETERM BIRTH IN WOMEN WITH A SONOGRAPHIC SHORT CERVIX, SINGLETON GESTATION, AND PREVIOUS PRETERM BIRTH: A SYSTEMATIC REVIEW AND INDIRECT COMPARISON META-ANALYSIS

    Science.gov (United States)

    CONDE-AGUDELO, Agustin; ROMERO, Roberto; NICOLAIDES, Kypros; CHAIWORAPONGSA, Tinnakorn; O'BRIEN, John M.; CETINGOZ, Elcin; DA FONSECA, Eduardo; CREASY, George; SOMA-PILLAY, Priya; FUSEY, Shalini; CAM, Cetin; ALFIREVIC, Zarko; HASSAN, Sonia S.

    2012-01-01

    OBJECTIVE No randomized controlled trial has directly compared vaginal progesterone and cervical cerclage for the prevention of preterm birth in women with a sonographic short cervix in the midtrimester, singleton gestation, and previous spontaneous preterm birth. We performed an indirect comparison of vaginal progesterone versus cerclage, using placebo/no cerclage as the common comparator. STUDY DESIGN Adjusted indirect meta-analysis of randomized controlled trials. RESULTS Four studies evaluating vaginal progesterone versus placebo (158 patients) and five evaluating cerclage versus no cerclage (504 patients) were included. Both interventions were associated with a statistically significant reduction in the risk of preterm birth <32 weeks of gestation and composite perinatal morbidity and mortality compared with placebo/no cerclage. Adjusted indirect meta-analyses did not show statistically significant differences between vaginal progesterone and cerclage in reducing preterm birth or adverse perinatal outcomes. CONCLUSION Based on state-of-the-art methodology for indirect comparisons, either vaginal progesterone or cerclage are equally efficacious in the prevention of preterm birth in women with a sonographic short cervix in the midtrimester, singleton gestation, and previous preterm birth. The selection of the optimal treatment may depend upon adverse events, cost and patient/clinician preferences. PMID:23157855

  17. Effect of parenteral amino acid supplementation in preterm low birth weight newborn.

    Science.gov (United States)

    Alo, D; Shahidullah, M; Mannan, M A; Noor, K

    2010-07-01

    This interventional study was done to determine the effect of parenteral amino acid supplementation on weight change, biochemical effect and incidence of sepsis in preterm low birth weight newborns during their hospital stay. It was carried out during the period of June 2006-May 2007 in the Newborn unit of a tertiary care hospital of Bangladesh. Sixty preterm (28-34weeks), low birth weight (1000-1800g) AGA (appropriate for gestational age) newborns were enrolled within 24 hours of birth. Intervention and control newborns were matched in terms of birth weight and gestational age. Samples were volunteers. Parenteral amino acid (5%) supplementation in addition to usual nutritional management until enteral feeding reached three fourth of total calorie intake. Usual nutritional management was 10% intravenous dextrose and subsequent enteral feeding. Main outcome measured with weight change, biochemical effect and incidence of sepsis. Weight change was observed by two parameters such as mean percentage of maximum postnatal weight loss and mean days to reach birth weight, both were significantly lower in intervention than control group (psupplementation investigated in this study has been shown to have no effect. There was no difference in incidence of sepsis between intervention and control group (p>0.05). Improved nutritional supplementation with parenteral amino acids resulted in better growth as evident by lesser degree of weight loss and earlier regaining of birth weight in the early neonatal period. Biochemical parameters are not affected by parenteral amino acid supplementation.

  18. Brief mechanical ventilation causes differential epithelial repair along the airways of fetal, preterm lambs.

    Science.gov (United States)

    Deptula, Nicole; Royse, Emily; Kemp, Matthew W; Miura, Yuichiro; Kallapur, Suhas G; Jobe, Alan H; Hillman, Noah H

    2016-08-01

    Mechanical ventilation of preterm lambs causes lung inflammation and injury to the airway epithelium, which is repaired by 15 days after ventilation. In mice, activated basal cells (p63+, KRT14+, KRT8+) initiate injury repair to the trachea, whereas club cells coordinate distal airway repair. In both human and sheep, basal cells line the pseudostratified airways to the distal bronchioles with club cells only present in terminal bronchioles. Mechanical ventilation causes airway epithelial injury that is repaired through basal cell activation in the fetal lung. Ewes at 123 ± 1 day gestational age had the head and chest of the fetus exteriorized and tracheostomy placed. With placental circulation intact, fetal lambs were mechanically ventilated with up to 15 ml/kg for 15 min with 95% N2/5% CO2 Fetal lambs were returned to the uterus for up to 24 h. The trachea, left mainstem bronchi, and peripheral lung were evaluated for epithelial injury and cellular response consistent with repair. Peripheral lung tissue had inflammation, pro-inflammatory cytokine production, epithelial growth factor receptor ligand upregulation, increased p63 expression, and proliferation of pro-SPB, TTF-1 positive club cells. In bronchi, KRT14 and KRT8 mRNA increased without increases in Notch pathway mRNA or proliferation. In trachea, mRNA increased for Notch ligands, SAM pointed domain-containing Ets transcription factor and mucin 5B, but not for basal cell markers. A brief period of mechanical ventilation causes differential epithelial activation between trachea, bronchi, and peripheral lung. The repair mechanisms identified in adult mice occur at different levels of airway branching in fetal sheep with basal and club cell activation. Copyright © 2016 the American Physiological Society.

  19. Preterm birth among women living within 600 meters of high voltage overhead Power Lines: a case-control study.

    Science.gov (United States)

    Sadeghi, Taktom; Ahmadi, Amirmasoud; Javadian, Maryam; Gholamian, Sayyed Asghar; Delavar, Mouloud Agajani; Esmailzadeh, Sedigheh; Ahmadi, Bahare; Hadighi, Mozhgan Sadat Hassanpour

    2017-09-26

    The issue of preterm birth due to exposure to magnetic fields from power lines is unclear. Exposure to electromagnetic field in uterus has been hypothesized as possible preterm birth. The aim of the present study was to determine whether living closer to high voltage power lines increased the risk of preterm labor. In a nested case-control study, 135 cases of singleton live spontaneous preterm birth in Rohani hospital, Babol, Iran, during the period between 2013 and 2014 were studied. The 150 control subjects were singleton term live birth in the same year of birth and city of residence using randomized-digit dialing. The shortest distance to any of the high voltage power lines to the maternal residence during pregnancy was measured using ArcGIS software for every case and control. To test the association between the preterm births and the residential proximity to power lines, stepwise multiple logistic regression was used. There were 28 households, 20 cases (14.8%) and 8 controls (5.3%) situated within 600 meters of high voltage power lines. The adjusted OR for spontaneous preterm birth and birth defect in women who were living in less than 600 meters from high voltage power lines was higher compared to those living at farther distance (OR = 3.28, CI: 1.37 to 7.85) and (OR = 5.05, CI: 1.52 to 16.78), respectively. Therefore, installing overhead power lines and stations within 600 meters or making overhead underground would be useful in the prevention of both preterm birth and birth defect.

  20. A prospective observational study of early fetal growth velocity and its association with birth weight, gestational age at delivery, preeclampsia, and perinatal mortality

    Energy Technology Data Exchange (ETDEWEB)

    Vasudeva, Akhila, E-mail: akhilavasudeva@gmail.com [Department of Obstetrics and Gynaecology, Kasturba Medical College, Manipal University, Manipal 576104, Karnataka State (India); Abraham, Anu Annie, E-mail: anuannieabraham@yahoo.com [Department of Obstetrics and Gynaecology, Kasturba Medical College, Manipal University, Manipal 576104, Karnataka State (India); Kamath, Asha, E-mail: aashakamat@gmail.com [Department of Community Medicine, Kasturba Medical College, Manipal, A Constituent College of Manipal University (India)

    2013-08-15

    Objectives: We aimed to measure early fetal growth velocity and to correlate this with the birth weight, gestational age at delivery, and with the incidence of adverse pregnancy outcomes specifically preeclampsia and perinatal mortality. Methods: A data based prospective observational study, wherein sonographic biometry data and specific pregnancy outcome related data were collected from pregnant women's records, starting soon after their first antenatal visit. Early fetal growth velocity was measured using BPD growth between 11 and 14 weeks scan and anomaly scan and standardizing this by Z scoring. Results: Out of 607 fetuses, 41 (6.7%) were slow growing, 531 (87.4%) normally growing, and 35 (5.7%) fast growing (Z scoring <10th{sup ,} 10–90th, and >90th percentiles respectively). As fetal growth velocity increased, the mean birth weight decreased from 2958.7 ± 388.9 (<10th centile), 2742.1 ± 576.6 (10–90th centile), to 2339.3 ± 729.4 (>90th centile); and gestational age at delivery decreased from 38.5 ± 1.3 (<10th centile), 37.5 ± 2.1 (10–90th centile), to 36.4 ± 2.2 (>90th centile), and both these trends were statistically significant (p < 0.001).Faster growing fetuses had a higher risk of preterm delivery(spontaneous + indicated) compared to other 2 groups [OR 4.42 (2.18,8.98)], and slower growing fetuses had a higher risk of postdated deliveries compared to other 2 groups [OR 3.042 (1.44, 6.45)].We found no significant association between early fetal growth velocity and incidence of small for gestational age at birth/low birth weight at term, preeclampsia, and perinatal mortality. Conclusions: Early fetal growth velocity between first and second trimesters, may be one of the important factors influencing ultimate birthweight and gestational age at delivery.

  1. Exhaled Carbon Dioxide and Neonatal Breathing Patterns in Preterm Infants after Birth.

    Science.gov (United States)

    Nicoll, Jessica; Cheung, Po-Yin; Aziz, Khalid; Rajani, Vishaal; O'Reilly, Megan; Pichler, Gerhard; Schmölzer, Georg M

    2015-10-01

    To examine the amount of exhaled carbon dioxide (ECO2) with different breathing patterns in spontaneously breathing preterm infants after birth. Preterm infants had a facemask attached to a combined carbon dioxide/flow sensor placed over their mouth and nose to record ECO2 and gas flow. A breath-by-breath analysis of the first 5 minutes of the recording was performed. Thirty spontaneously breathing preterm infants, gestational age (mean ± SD) 30 ± 2 weeks and birth weight 1635 ± 499 g were studied. ECO2 from normal breaths and slow expirations was significantly larger than with other breathing patterns (P breath also increased with gestational age P breathing pattern both during the first minute of recording and overall. Breathing pattern proportions also varied by gestational age. Finally, ECO2 from the fifth minute of recording was significantly greater than that produced during the first 4 minutes of recording (P ≤ .029). ECO2 varies with different breathing patterns and increases with gestational age and over time. ECO2 may be an indicator of lung aeration and that postnatal ECO2 monitoring may be useful in preterm infants in the delivery room. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Maternal attachment representations after very preterm birth and the effect of early intervention.

    Science.gov (United States)

    Meijssen, Dominique; Wolf, Marie-Jeanne; van Bakel, Hedwig; Koldewijn, Karen; Kok, Joke; van Baar, Anneloes

    2011-02-01

    For very preterm infants the mother-infant relationship may be compromised. Maternal attachment representations 18 (corrected) months after very preterm birth and the effect of the post-discharge Infant Behavioral Assessment and Intervention Program (IBAIP) were studied. The IBAIP is designed to assist parents to support and enhance their infant's regulatory competence and development. The intervention consisted of 6-8 home visits during the first 8 months after birth. Seventy-eight mothers of very preterm infants (attachment representations were assessed with the Working Model of the Child Interview (WMCI). The interviews resulted in a classification of the attachment representations into balanced or non-balanced. 30% of the mothers had non-balanced attachment representations. Qualitative content analysis of the answers showed that negative feelings when first seeing their baby and negative or ambivalent feelings in the first weeks at home with their baby are related to non-balanced attachment representations. The WMCI revealed no differences between the intervention and control group. Early support for mothers of very preterm born infants to develop a healthy mother-infant relationship is recommended especially for mothers who report negative first experiences. Copyright © 2010 Elsevier Inc. All rights reserved.

  3. Chlamydia trachomatis C-complex serovars are a risk factor for preterm birth

    DEFF Research Database (Denmark)

    Hollegaard, Stine; Vogel, Ida; Thorsen, Poul

    2007-01-01

    BACKGROUND: Potential associations between current or previous C. trachomatis infections (general IgG and serovars) and spontaneous preterm birth (PTB) were examined and associations between C. trachomatis infections and previous fertility problems were explored. PATIENTS AND METHODS: At week 17......, Chlamydia antigen, Chlamydia IgG, Chlamydia complex B, C and GF levels were measured. Spontaneous preterm birth (...) and odds ratios (OR) were estimated by logistic regression. RESULTS: C. trachomatis C-complex positivity was associated with spontaneous PTB [RR 2.6 (1.1-6.29)] and additionally with a prior history of subfertility [OR 4.4 [2.5-7.7]), infertility treatment [OR 7.2 (4.0-12.8)] and ectopic pregnancy [5.2 (2...

  4. Bone Mineral Density and Osteoporosis after Preterm Birth: The Role of Early Life Factors and Nutrition

    Directory of Open Access Journals (Sweden)

    Claire L. Wood

    2013-01-01

    Full Text Available The effects of preterm birth and perinatal events on bone health in later life remain largely unknown. Bone mineral density (BMD and osteoporosis risk may be programmed by early life factors. We summarise the existing literature relating to the effects of prematurity on adult BMD and the Developmental Origins of Health and Disease hypothesis and programming of bone growth. Metabolic bone disease of prematurity and the influence of epigenetics on bone metabolism are discussed and current evidence regarding the effects of breastfeeding and aluminium exposure on bone metabolism is summarised. This review highlights the need for further research into modifiable early life factors and their effect on long-term bone health after preterm birth.

  5. Thymic size at birth in preterm infants with severe respiratory ...

    African Journals Online (AJOL)

    The only maternal and postnatal factors influencing CT/T ratio were the presence of pre-eclamptic toxaemia (PET) and birth by caesarean section (CS), but these factors did not influence likelihood of survival. Factors found to be not associated with thymic size were antenatal steroid administration, maternal HIV status, ...

  6. Black-white preterm birth disparity: a marker of inequality

    Science.gov (United States)

    Purpose. The racial disparity in preterrn birth (PTB) is a persistent feature of perinatal epidemiology, inconsistently modeled in the literature. Rather than include race as an explanatory variable, or employ race-stratified models, we sought to directly model the PTB disparity ...

  7. Neonatal Outcomes of Late-Preterm Birth Associated or Not with Intrauterine Growth Restriction

    Directory of Open Access Journals (Sweden)

    Cristiane Ortigosa Rocha

    2010-01-01

    Full Text Available Objective. To compare neonatal morbidity and mortality between late-preterm intrauterine growth-restricted (IUGR and appropriate-for-gestational-age (AGA infants of the comparable gestational ages (GAs. Methods. We retrospectively analyzed neonatal morbidity and mortality of 50 singleton pregnancies involving fetuses with IUGR delivered between 34 and 36 6/7 weeks of GA due to maternal and/or fetal indication. The control group consisted of 36 singleton pregnancies with spontaneous preterm delivery at the same GA, in which the infant was AGA. Categorical data were compared between IUGR and AGA pregnancies by 2 analysis and Fisher's exact test. Ordinal measures were compared using the Kruskal-Wallis test. Results. The length of stay of newborns in the nursery, as well as the need for and duration of hospitalization in the neonatal intensive care unit, was longer in the group with IUGR. Transient tachypnea of the newborn or apnea rates did not differ significantly between the IUGR and AGA groups. IUGR infants were found to be at a higher risk of intraventricular hemorrhage. No respiratory distress syndrome, pulmonary hemorrhage or bronchopulmonary dysplasia was observed in either group. The frequency of sepsis, thrombocytopenia and hyperbilirubinemia was similar in the two groups. Hypoglycemia was more frequent in the IUGR group. No neonatal death was observed. Conclusion. Our study showed that late-preterm IUGR infants present a significantly higher risk of neonatal complications when compared to late-preterm AGA infants.

  8. Effect of Hurricane Katrina on Low Birth Weight and Preterm Deliveries in African American Women in Louisiana, Mississippi, and Alabama

    Directory of Open Access Journals (Sweden)

    Chau-Kuang Chen

    2012-04-01

    Full Text Available Using three modeling techniques (GLR, GEP, and GM, the effect of Hurricane Katrina on low birth weight and preterm delivery babies for African American women is examined in Louisiana, Mississippi and Alabama. The study results indicate that risk factors associated with low birth weight and preterm delivery for American African women include unemployment and percent of mothers between the ages of 15-19. Among White women, ages 15-19, risk factors included poverty rate, median household income, and total birth rate. The GMs performed accurate predictions with increasing low birth weight and preterm delivery trends for African American women in the Gulf Coast states and other U.S. states, and decreasing low birth weight and preterm delivery trends for their White counterparts in the same state locations. Data presented between 2007-2010 show low birth weight and preterm delivery for White women as a decreasing tendency while adverse birth outcomes for African American women exhibited a monotonically increasing trend. The empirical findings suggest that health disparities will continue to exist in the foreseeable future, if no effective intervention is taken. The models identify risk factors that contribute to adverse birth outcomes and offer some insight into strategies and programs to address and ameliorate these effects.

  9. Area-level poverty and preterm birth risk: A population-based multilevel analysis

    Directory of Open Access Journals (Sweden)

    Muglia Louis A

    2008-09-01

    Full Text Available Abstract Background Preterm birth is a complex disease with etiologic influences from a variety of social, environmental, hormonal, genetic, and other factors. The purpose of this study was to utilize a large population-based birth registry to estimate the independent effect of county-level poverty on preterm birth risk. To accomplish this, we used a multilevel logistic regression approach to account for multiple co-existent individual-level variables and county-level poverty rate. Methods Population-based study utilizing Missouri's birth certificate database (1989–1997. We conducted a multilevel logistic regression analysis to estimate the effect of county-level poverty on PTB risk. Of 634,994 births nested within 115 counties in Missouri, two levels were considered. Individual-level variables included demographics factors, prenatal care, health-related behavioral risk factors, and medical risk factors. The area-level variable included the percentage of the population within each county living below the poverty line (US census data, 1990. Counties were divided into quartiles of poverty; the first quartile (lowest rate of poverty was the reference group. Results PTB th quartile (4.9%, p adjOR 1.18 (95% CI 1.03, 1.35, with a similar effect at earlier gestational ages (adjOR 1.27 (95% CI 1.06, 1.52. Conclusion Women residing in socioeconomically deprived areas are at increased risk of preterm birth, above other underlying risk factors. Although the risk increase is modest, it affects a large number of pregnancies.

  10. Area-level poverty and preterm birth risk: a population-based multilevel analysis.

    Science.gov (United States)

    DeFranco, Emily A; Lian, Min; Muglia, Louis A; Schootman, Mario

    2008-09-15

    Preterm birth is a complex disease with etiologic influences from a variety of social, environmental, hormonal, genetic, and other factors. The purpose of this study was to utilize a large population-based birth registry to estimate the independent effect of county-level poverty on preterm birth risk. To accomplish this, we used a multilevel logistic regression approach to account for multiple co-existent individual-level variables and county-level poverty rate. Population-based study utilizing Missouri's birth certificate database (1989-1997). We conducted a multilevel logistic regression analysis to estimate the effect of county-level poverty on PTB risk. Of 634,994 births nested within 115 counties in Missouri, two levels were considered. Individual-level variables included demographics factors, prenatal care, health-related behavioral risk factors, and medical risk factors. The area-level variable included the percentage of the population within each county living below the poverty line (US census data, 1990). Counties were divided into quartiles of poverty; the first quartile (lowest rate of poverty) was the reference group. PTB poverty and increased through the 4th quartile (4.9%), p poverty was significantly associated with PTB risk. PTB risk (poverty, adjusted odds ratio (adj OR) 1.18 (95% CI 1.03, 1.35), with a similar effect at earlier gestational ages (< 32 weeks), adj OR 1.27 (95% CI 1.06, 1.52). Women residing in socioeconomically deprived areas are at increased risk of preterm birth, above other underlying risk factors. Although the risk increase is modest, it affects a large number of pregnancies.

  11. Exploration of Preterm Birth Rates Using the Public Health Exposome Database and Computational Analysis Methods

    OpenAIRE

    Kershenbaum, Anne D.; Langston, Michael A.; Levine, Robert S.; Saxton, Arnold M.; Oyana, Tonny J.; Kilbourne, Barbara J.; Rogers, Gary L.; Gittner, Lisaann S.; Baktash, Suzanne H.; Matthews-Juarez, Patricia; Juarez, Paul D.

    2014-01-01

    Recent advances in informatics technology has made it possible to integrate, manipulate, and analyze variables from a wide range of scientific disciplines allowing for the examination of complex social problems such as health disparities. This study used 589 county-level variables to identify and compare geographical variation of high and low preterm birth rates. Data were collected from a number of publically available sources, bringing together natality outcomes with attributes of the natu...

  12. Poor Sleep Quality and Associated Inflammation Predict Preterm Birth: Heightened Risk among African Americans.

    Science.gov (United States)

    Blair, Lisa M; Porter, Kyle; Leblebicioglu, Binnaz; Christian, Lisa M

    2015-08-01

    Poor sleep promotes inflammation. In turn, inflammation is a causal mechanism in term as well as preterm parturition. In the United States, a persistent racial disparity in preterm birth exists, with African Americans showing ∼1.5 times greater risk. This study examined associations among sleep quality, serum proinflammatory cytokines, and length of gestation in a racially diverse sample of 138 pregnant women. Observational. Women completed the Pittsburgh Sleep Quality Index (PSQI) and other psychosocial and behavioral measures during midpregnancy. Serum levels of interleukin (IL)-6, IL-8, IL-1β, and tumor necrosis factor (TNF)-α were determined by high-sensitivity assays. Birth outcomes were determined via medical record review. Among African American women (n = 79), shorter gestation was predicted by poorer overall sleep (rs = -0.35, P = 0.002) as well the following PSQI subscales: subjective sleep quality (rs = -0.34, P = 0.002), sleep latency (rs = -0.27, P = 0.02), and sleep efficiency (rs = -0.27, P = 0.02). African American women with poor sleep quality (PSQI > 5) had 10.2 times the odds of preterm birth compared to those with good sleep quality. In contrast, among European American women (n = 53), gestational length was not significantly predicted by sleep quality (Ps > 0.12). Bootstrapping analyses showed that, among African Americans, IL-8 significantly mediated the association between sleep quality and length of gestation (indirect effect estimate -0.029; 95% confidence interval -0.06, -0.002). The data provide novel evidence that African American women exhibit greater inflammation in response to sleep disturbance than European American women and these effects correspond with length of gestation. Racial differences in susceptibility to sleep induced immune dysregulation may contribute to marked racial disparities in preterm birth. © 2015 Associated Professional Sleep Societies, LLC.

  13. Maternal Stress, Preterm Birth, and DNA Methylation at Imprint Regulatory Sequences in Humans

    OpenAIRE

    Adriana C. Vidal; Sara E. Benjamin Neelon; Ying Liu; Abbas M. Tuli; Bernard F. Fuemmeler; Cathrine Hoyo; Amy p. Murtha; Zhiqing Huang; Joellen Schildkraut; Francine Overcash; Joanne Kurtzberg; Randy L. Jirtle; Edwin s. Iversen; Susan K. Murphy

    2014-01-01

    In infants exposed to maternal stress in utero, phenotypic plasticity through epigenetic events may mechanistically explain increased risk of preterm birth (PTB), which confers increased risk for neurodevelopmental disorders, cardiovascular disease, and cancers in adulthood. We examined associations between prenatal maternal stress and PTB, evaluating the role of DNA methylation at imprint regulatory regions. We enrolled women from prenatal clinics in Durham, NC. Stress was measured in 537 wo...

  14. Risk factors associated with pre-term birth in Dar es Salaam ...

    African Journals Online (AJOL)

    ... p-value 0.004), cervical incompetence (AOR = 11.6; 95%CI 1.1-121.5; p-value 0.04), polyhydramnios (AOR = 8.3; 95%CI 1.7-40.2; p-value 0.008), and lack of antenatal visits (AOR = 5.1; 95%CI 1.4-17.8; p-value 0.042).Conclusion: This study has identified several risk factors for preterm birth in the city of Dar es Salaam.

  15. Autoimmune conditions and comorbid depression in pregnancy: examining the risk of preterm birth and preeclampsia

    OpenAIRE

    Bandoli, Gretchen; Chambers, Christina D.

    2017-01-01

    Objective Determine whether prenatal depression interacts with autoimmune conditions to further increase the risk of preterm birth or preeclampsia. Study design Our sample included 3,034 pregnant women with rheumatoid art