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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.
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.
Mantovani, Elena; Filippini, Francesca; Bortolus, Renata; Franchi, Massimo
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.
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.
... 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 ...
Blondel, B; Papiernik, E; Delmas, D
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...
Purisch, Stephanie E; Gyamfi-Bannerman, Cynthia
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.
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Swaggart, Kayleigh A.; Pavlicev, Mihaela; Muglia, Louis J.
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
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van Os, M.A.; van Dam, A.J.E.M.
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
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
Allen, Marilee C.; Cristofalo, Elizabeth; Kim, Christina
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…
Ancel, Pierre-Yves; Lelong, Nathalie; Papiernik, Emile; Saurel-Cubizolles, Marie-Josèphe; Kaminski, Monique
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.
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.
Vermeulen, Gustaaf Michiel
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
Savitz, David A; Murnane, Pamela
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.
Rasmussen, Svein; Ebbing, Cathrine; Irgens, Lorentz M
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.
Jacqueline M Melville
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.
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) ...
Polettini, Jossimara; Cobo, Teresa; Kacerovsky, Marian
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...
Smid, Marcela C; Lee, Jong Hyung; Grant, Jacqueline H; Miles, Gandarvaka; Stoddard, Gregory J; Chapman, Derek A; Manuck, Tracy A
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
David M. Olson
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.
Newnham, John P.; Dickinson, Jan E.; Hart, Roger J.; Pennell, Craig E.; Arrese, Catherine A.; Keelan, Jeffrey A.
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
Basten, Maartje; Jaekel, Julia; Johnson, Samantha; Gilmore, Camilla; Wolke, Dieter
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.
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.
Secher, Niels Jørgen
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....
Saba W. Masho
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.
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 ...
Petersen, Christina Bjørk; Mortensen, Laust Hvas; Morgen, Camilla Schmidt
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...
Jodie M Dodd
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
Secher, Niels Jørgen
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...
Romero, Roberto; Yeo, Lami; Chaemsaithong, Piya; Chaiworapongsa, Tinnakorn; Hassan, Sonia
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
Reiter, Eva; Nielsen, Kurt Aagaard; Fedder, Jens
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....
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.
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.
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.
Howson, Christopher P; Kinney, Mary V; McDougall, Lori; Lawn, Joy E
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.
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.
van Wassenaer, Aleid G.; Kok, Joke H.
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
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...
Stewart, Amanda; Graham, Ernest
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…
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
Papatsonis, Dimitri N M; Flenady, Vicki; Liley, Helen G
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
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.
Hackney, David N; Durie, Danielle E; Dozier, Ann M; Suter, Barbara J; Glantz, J Christopher
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.
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.
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...
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.
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
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
Ana Daniela Izoton de Sadovsky
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.
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
Haas, David M; Morgan, Amanda M; Deans, Samantha J; Schubert, Frank P
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
Sentilhes, L; Bouhours, A-C; Bouet, P-E; Boussion, F; Biquard, F; Gillard, P; Descamps, P
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.
Runge, Stine Bjerrum; Pedersen, Jacob Krabbe; Svendsen, Susanne Wulff
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....
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.
Koullali, B.; Oudijk, M. A.; Nijman, T. A. J.; Mol, B. W. J.; Pajkrt, E.
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
Kajeepeta, Sandhya; Sanchez, Sixto E; Gelaye, Bizu; Qiu, Chunfang; Barrios, Yasmin V; Enquobahrie, Daniel A; Williams, Michelle A
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.
Seravalli, Laura; Patterson, Freda; Nelson, Deborah B
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.
Takii, Ryosuke; Kadowaki, Tomoko; Tsukuba, Takayuki; Yamamoto, Kenji
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.
Kacerovsky, Marian; Lenco, Juraj; Musilova, Ivana
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...
Jeffcoat, M K
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.
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.
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.
Effect of maternal height and weight on risk of preterm birth in singleton and twin births resulting from in vitro fertilization: a retrospective cohort study using the Society for Assisted Reproductive Technology Clinic Outcome Reporting System.
Dickey, Richard P; Xiong, Xu; Gee, Rebekah E; Pridjian, Gabriella
To examine the effect of height, weight, and body mass index (BMI) on the risk of preterm birth of singleton and twin pregnancies conceived by vitro fertilization (IVF). Retrospective cohort study using 2006-2008 data from the Society for Reproductive Technology Clinic Outcome Reporting System (SART CORS). SART-associated assisted reproductive technology programs. 56,556 singleton and 23,804 twin live births resulting from fresh nondonor IVF cycles. None. Rates of very early preterm (VEPTB; risk of preterm birth. Maternal overweight and obesity were associated with significantly increased risk of VEPTB and VPTB in twin pregnancies. For very obese women (BMI > 35 kg/m(2)) twins were associated with a threefold increased risk of VEPTB (6.1% vs. 2.0%) and a twofold increased risk of VPTB (11.5% vs. 5.9%) compared with women of normal weight (BMI 18.4-24.9 kg/m(2)). Obesity and short stature significantly increase the risk of VEPTB and VPTB in twins conceived by IVF. Copyright © 2012 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
Araz, N. C.
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)
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 ...
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.
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.
Mocevic, Emina; Svendsen, Susanne Wulff; Jørgensen, Kristian Tore
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...
Madhusudan Dey; Raju Agarwal; Devkalyan Maji; Uttara A. Kohli
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...
Son, Moeun; Miller, Emily S
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.
Bushnik, Tracey; Yang, Seungmi; Kaufman, Jay S; Kramer, Michael S; Wilkins, Russell
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.
Schaaf, J. M.; Hof, M. H. P.; Mol, B. W. J.; Abu-Hanna, A.; Ravelli, A. C. J.
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
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
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.
Schuit, Ewoud; Stock, Sarah; Groenwold, Rolf H H
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....
Gezer, Cenk; Ekin, Atalay; Solmaz, Ulas; Sahingoz Yildirim, Alkim Gulsah; Dogan, Askin; Ozeren, Mehmet
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
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.
... 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 ...
Sonnenschein-van der Voort, Agnes M M; Arends, Lidia R; de Jongste, Johan C
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...
Pfinder, M.; Kunst, A.E.; Feldmann, R.; van Eijsden, M.; Vrijkotte, T.G.M.
Background: Inconsistent data on the association between prenatal alcohol exposure and a range of pregnancy outcomes, such as preterm birth (PTB) and small for gestational age (SGA) raise new questions. This study aimed to assess whether the association between low-moderate prenatal alcohol exposure
Pfinder, Manuela; Kunst, Anton E.; Feldmann, Reinhold; van Eijsden, Manon; Vrijkotte, Tanja G. M.
Inconsistent data on the association between prenatal alcohol exposure and a range of pregnancy outcomes, such as preterm birth (PTB) and small for gestational age (SGA) raise new questions. This study aimed to assess whether the association between low-moderate prenatal alcohol exposure and PTB and
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.
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.
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
Mysorekar, Indira U; Cao, Bin
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.
Neggers, Yasmin H
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.
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
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
Zhang, Yiting; Li, Zhiwen; Li, Hongtian; Jin, Lei; Zhang, Yali; Zhang, Le; Liu, Jufen; Ye, Rongwei; Liu, Jianmeng; Ren, Aiguo
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.
Morgen, Camilla Schmidt; Bjørk, Christina; Andersen, Per Kragh
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...
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.
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 ...
De Matteo, Robert; Stacy, Victoria; Probyn, Megan E; Brew, Nadine; Blasch, Natasha; Harding, Richard
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.
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
Orozova-Bekkevold, Ivanka; Jensen, Henrik; Stensballe, Lone
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...
Tracey J. Flores
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
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.
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
Nøhr, Ellen Aagaard; Bech, Bodil Hammer; Vaeth, Michael
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...
Jacob, Josephine; Lehne, Moritz; Mischker, Andrea; Klinger, Normen; Zickermann, Claudia; Walker, Jochen
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.
Micali, N.; Larsen, P. Stemann; Strandberg-Larsen, K.
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...
Felder, Jennifer N; Baer, Rebecca J; Rand, Larry; Jelliffe-Pawlowski, Laura L; Prather, Aric A
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.
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
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
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 ...
Bodnar, Lisa M
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.
Norwitz, Errol R; Caughey, Aaron B
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.
Pundir, Shikha; Mitchell, Cameron J; Thorstensen, Eric B; Wall, Clare R; Perrella, Sharon L; Geddes, Donna T; Cameron-Smith, David
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.
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
Ruiz, R Jeanne; Dwivedi, Alok Kumar; Mallawaarachichi, Indika; Balcazar, Hector G; Stowe, Raymond P; Ayers, Kimberly S; Pickler, Rita
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.
Xu, Xiao; Grigorescu, Violanda; Siefert, Kristine A.; Lori, Jody R.; Ransom, Scott B.
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
Stout, Molly J; Zhou, Yanjiao; Wylie, Kristine M; Tarr, Phillip I; Macones, George A; Tuuli, Methodius G
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
Mills, Ryan John; Davies, Mark W
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
Castoldi, Francesca; Lista, Gianluca; Scopesi, Fabio; Somaschini, Marco; Cuttano, Armando; Grappone, Lidia; Maffei, Gianfranco
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.
Leung, Myra Ps; Thompson, Benjamin; Black, Joanna; Dai, Shuan; Alsweiler, Jane M
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.
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
Schaaf, Jelle M.; Hof, Michel H. P.; Mol, Ben Willem J.; Abu-Hanna, Ameen; Ravelli, Anita C. J.
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
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.
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
Dugoff, Lorraine; Berghella, Vincenzo; Sehdev, Harish; Mackeen, A Dhanya; Goetzl, Laura; Ludmir, Jack
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.
Salehi, Katayoun; Mahmoodi, Zohreh; Kabir, Kourosh; Dolatian, Mahrokh
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.
Bozoklu Akkar, Ozlem; Sancakdar, Enver; Karakus, Savas; Yildiz, Caglar; Akkar, Ismail; Arslan, Murat; Sahin, Irfan Oguz; Imir Yenicesu, Ayse Gonca; Cetin, Ali
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.
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.
Oudijk, M. A.
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
Seravalli, Laura; Patterson, Freda; Nelson, Deborah B.
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
Predicting the effect of maternal docosahexaenoic acid (DHA) supplementation to reduce early preterm birth in Australia and the United States using results of within country randomized controlled trials.
Yelland, L N; Gajewski, B J; Colombo, J; Gibson, R A; Makrides, M; Carlson, S E
The DHA to Optimize Mother Infant Outcome (DOMInO) and Kansas DHA Outcomes Study (KUDOS) were randomized controlled trials that supplemented mothers with 800 and 600mg DHA/day, respectively, or a placebo during pregnancy. DOMInO was conducted in Australia and KUDOS in the United States. Both trials found an unanticipated and statistically significant reduction in early preterm birth (ePTB; i.e., birth before 34 weeks gestation). However, in each trial, the number of ePTBs were small. We used a novel Bayesian approach to estimate statistically derived low, moderate or high risk for ePTB, and to test for differences between the DHA and placebo groups. In both trials, the model predicted DHA would significantly reduce the expected proportion of deliveries in the high risk group under the trial conditions of the parent studies. Among the next 300,000 births in Australia we estimated that 1112 ePTB (95% credible interval 51-2189) could be avoided by providing DHA. And in the USA we estimated that 106,030 ePTB (95% credible interval 6400 to 175,700) could be avoided with DHA. Copyright © 2016 Elsevier Ltd. All rights reserved.
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.
Mendez, Dara D; Hogan, Vijaya K; Culhane, Jennifer F
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.
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
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...
Santos, A.; Duret, M.; Mancini, J.; Gire, C.; Deruelle, C.
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…
Giurgescu, Carmen; Zenk, Shannon N; Templin, Thomas N; Engeland, Christopher G; Kavanaugh, Karen; Misra, Dawn P
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.
Păsăricără, Alexandru; Nemescu, Dragoş; Arotăriţei, Dragoş; Rotariu, Cristian
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.
Riedijk, Maaike A; Voortman, Gardi; van Beek, Ron H T; Baartmans, Martin G A; Wafelman, Leontien S; van Goudoever, Johannes B
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.
Irina A Buhimschi
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
Taylor, H Gerry; Klein, Nancy; Anselmo, Marcia G; Minich, Nori; Espy, Kimberly A; Hack, Maureen
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.
Knudsen, Iben Risager; Bonde, Jens Peter; Bondo, Sesilje
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....
Bruckner, Tim A; Mayo, Jonathan A; Gould, Jeffrey B; Stevenson, David K; Lewis, David B; Shaw, Gary M; Carmichael, Suzan L
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.
López, Néstor J; Uribe, Sergio; Martinez, Benjamín
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
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.
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
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
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
Schaaf, J. M.; Mol, B. W. J.; Abu-Hanna, A.; Ravelli, A. C. J.
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.
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
Heinonen, Kati; Eriksson, Johan G; Lahti, Jari; Kajantie, Eero; Pesonen, Anu-Katriina; Tuovinen, Soile; Osmond, Clive; Raikkonen, Katri
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.
Wheeler, Sarahn; Maxson, Pamela; Truong, Tracy; Swamy, Geeta
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.
Ortiz Martínez, Roberth Alirio; Castillo, Alejandro
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.
Guarini, Annalisa; Sansavini, Alessandra; Fabbri, Cristina; Savini, Silvia; Alessandroni, Rosina; Faldella, Giacomo; Karmiloff-Smith, Annette
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.
Fuchs, F; Senat, M-V
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.
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...
Mortensen, Laust H; Nielsen, Henriette Svarre; Cnattingius, Sven
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...
Zhang, Ge; Feenstra, Bjarke; Bacelis, Jonas
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...
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 ...
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 ...
Gaugler-Senden, I.P.; Duivenvoorden, H.J.; Filius, A.; de Groot, C.J.M.; Steegers, EA; Passchier, J.
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
Ju, Alana C; Heyman, Melvin B; Garber, Andrea K; Wojcicki, Janet M
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.
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.
Hetherington, Erin; Doktorchik, Chelsea; Premji, Shahirose S; McDonald, Sheila W; Tough, Suzanne C; Sauve, Reg S
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.
Moghaddam Banaem, Lida; Mohamadi, Bita; Asghari Jaafarabadi, Mohamad; Aliyan Moghadam, Narges
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.
Hwang, In Wook; Kang, Yun Dan; Kwon, Bit Na; Hong, Jun Ho; Han, Seung Hun; Kim, Jong Soo; Park, Jin Wan; Jin, Han Jun
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.
Smith, Jeffrey Michael; Gupta, Shivam; Williams, Emma; Brickson, Kate; Ly Sotha, Keth; Tep, Navuth; Calibo, Anthony; Castro, Mary Christine; Marinduque, Bernabe; Hathaway, Mark
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.
Girsen, Anna I; Mayo, Jonathan A; Wallenstein, Matthew B; Gould, Jeffrey B; Carmichael, Suzan L; Stevenson, David K; Lyell, Deirdre J; Shaw, Gary M
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.
Calmus, Megan L.; Macksoud, Elyse E.; Tucker, Richard; Iozzo, Renato V.; Lechner, Beatrice E.
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
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
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.
Han, Yingying; Jiang, Panhua; Dong, Tianyu; Ding, Xinliang; Chen, Ting; Villanger, Gro Dehli; Aase, Heidi; Huang, Lu; Xia, Yankai
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
Rodriguez, Maria I; Chang, Richard; Thiel de Bocanegra, Heike
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.
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.
Ning, Angela; Vladutiu, Catherine J; Dotters-Katz, Sarah K; Goodnight, William H; Manuck, Tracy A
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
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 ...
Romero, Roberto; Yeo, Lami; Miranda, Jezid; Hassan, Sonia; Conde-Agudelo, Agustin; Chaiworapongsa, Tinnakorn
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
Asakura, Keiko; Nakano, Makiko; Yamada, Mutsuko; Takahashi, Kaori; Sueoka, Kou; Omae, Kazuyuki
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.
Huppé, Vicky; Kestens, Yan; Auger, Nathalie; Daniel, Mark; Smargiassi, Audrey
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.
Joseph, K S; Fahey, John; Shankardass, Ketan; Allen, Victoria M; O'Campo, Patricia; Dodds, Linda; Liston, Robert M; Allen, Alexander C
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.
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.
Basso, Olga; Baird, Donna D.
, 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...
Agarwal, Arjit; Agarwal, Shubhra; Chandak, Shruti
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.
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
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
Mitchell, Hannah Katherine; Thomas, Rhianne; Hogan, Michael; Bresges, Carolin
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.
Flores, Tracey J; Nguyen, Vivian B; Widdop, Robert E; Sutherland, Megan R; Polglase, Graeme R; Abud, Helen E; Black, Mary Jane
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.
Badriah Ali Alansi
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.
Saraiva, Maria C D; Bettiol, Heliosa; Barbieri, Marco A; Silva, Antonio A
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
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.
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.
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
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.
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
Rubens Craig E
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
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.
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
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.
Hollanders, J.J.; Pal, S.M. van der; Dommelen, P. van; Rotteveel, J.; Finken, M.J.J.
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
Gaugler-Senden, Ingrid P M; Duivenvoorden, Hugo J; Filius, Anika; De Groot, Christianne J M; Steegers, Eric A P; Passchier, Jan
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.
Norman, Mikael; Piedvache, Aurelie; Børch, Klaus; Huusom, Lene Drasbek; Bonamy, Anna Karin Edstedt; Howell, Elizabeth A.; Jarreau, Pierre Henri; Maier, Rolf F.; Pryds, Ole; Toome, Liis; Varendi, Heili; Weber, Tom; Wilson, Emilija; van Heijst, Arno; Cuttini, Marina; Mazela, Jan; Barros, Henrique; Van Reempts, Patrick; Draper, Elizabeth S.; Zeitlin, Jennifer; Martens, Evelyne; Martens, Guy; Hasselager, Asbjoern; Ancel, Pierre Yves; Blondel, Béatrice; Bonet, Mercedes; Burguet, Antoine; Truffert, Patrick; Misselwitz, Bjoern; Schmidt, Stephan; Gortner, Ludvig; Baronciani, Dante; Gargano, Giancarlo; Agostino, Rocco; DiLallo, Domenico; Franco, Francesco; Carnielli, Virgilio; Croci, Ileana; Koopman-Esseboom, Corrine|info:eu-repo/dai/nl/14117739X; Nijman, Joppe; Gadzinowski, Janusz; Graça, Luís Mendes; Do Céu Machado, Maria; Rodrigues, Carina; Ribeiro-Rodrigues, Teresa; Boyle, Elaine M.; Manktelow, Brad N.; Fenton, Alan C.
IMPORTANCE Administration-to-birth intervals of antenatal corticosteroids (ANS) vary. The significance of this variation is unclear. Specifically, to our knowledge, the shortest effective administration-to-birth interval is unknown. OBJECTIVE To explore the associations between ANS
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.
Rodrigo L. Lindenmeyer
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.
Zeitlin, Jennifer; Di Lallo, Dominico; Blondel, Béatrice
Given the continuing debate about the benefits of caesarean section for very preterm infants, we sought to describe caesarean section rates for infants between 28 and 31 weeks of gestation in European regions and their association with regional mortality and short-term morbidity....
Timmermans, Sarah; Jaddoe, Vincent W V; Hofman, Albert; Steegers-Theunissen, Régine P M; Steegers, Eric A P
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.
Hester, Ashley E; Ankumah, Nana-Ama E; Chauhan, Suneet P; Blackwell, Sean C; Sibai, Baha M
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.
Arroyo, Virginia; Díaz, Julio; Ortiz, Cristina; Carmona, Rocío; Sáez, Marc; Linares, Cristina
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
Qin, B W; Ying, J; Lei, Q; Qu, P F; Lei, F L; Li, J M; Yan, H
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
Samilly Rodrigues Farias
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.
Plunkett, Jevon; Borecki, Ingrid; Morgan, Thomas; Stamilio, David; Muglia, Louis J
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.
Heinonen, Kati; Eriksson, Johan G; Kajantie, Eero; Pesonen, Anu-Katriina; Barker, David J; Osmond, Clive; Raikkonen, Katri
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.
Children born preterm constitute one of the largest populations of children at risk for the development of language impairments. A little over one in ten pregnancies result in a preterm birth and approximately 25% of these children go on to experience subsequent difficulties with language (CDC, 2015; Foster-Cohen, Friesen, Champion, &…
Pinborg, A; Ortoft, G; Loft, A
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...
Fogacci, Mariana Fampa; Cardoso, Elaine de O C; Barbirato, Davi da S; de Carvalho, Denise Pires; Sansone, Carmelo
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.
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
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.
... 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 ...
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
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.
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
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.
McGee, Devin; Poncil, Sharra; Patterson, Amanda
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
Hui, Annie S. Y.; Lao, Terence T.; Leung, Tak Yeung; Schaaf, Jelle M.; Sahota, Daljit S.
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),
van Vliet, Elvira O. G.; Askie, Lisa A.; Mol, Ben W. J.; Oudijk, Martijn A.
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
Rode, Line; Langhoff-Roos, Jens; Andersson, Charlotte
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. ...
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.
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
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), ...
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-...
Sakata, Soyoko; Konishi, Shoko; Ng, Chris Fook Sheng; Watanabe, Chiho
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.
Dubicke, Aurelija; Ekman-Ordeberg, Gunvor; Mazurek, Patricia; Miller, Lindsay; Yellon, Steven M
Remodeling of the cervix occurs in advance of labor both at term and at preterm birth. Morphological characteristics associated with remodeling in rodents were assessed in cervix biopsies from women at term (39 weeks' gestation) and preterm (cervix biopsies from women in labor at term and preterm compared to that in the cervix from nonlaboring women. Extracellular collagen was more degraded in sections of cervix from women at term, based on optical density of picrosirius red stain, versus that in biopsies from nonpregnant women. However, collagen structure was unchanged in the cervix from women at preterm labor versus the nonpregnant group. As an indication of inflammation, cell nuclei density was decreased in cervix biopsies from pregnant women irrespective of labor compared to the nonpregnant group. Moreover, CD68-stained macrophages increased to an equivalent extent in cervix subepithelium and stroma from groups in labor, both at term and preterm, as well as in women not in labor at term. Evidence for a similar inflammatory process in the remodeled cervix of women at term and preterm birth parallels results in rodent models. Thus, a conserved final common mechanism involving macrophages and inflammation may characterize the transition to a ripe cervix before birth at term and in advance of premature birth. © The Author(s) 2015.
Purisch, Stephanie E; Turitz, Amy L; Elovitz, Michal A; Levine, Lisa D
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.
Crawford, Nicholas; Prendergast, D'Arcy; Oehlert, John W; Shaw, Gary M; Stevenson, David K; Rappaport, Nadav; Sirota, Marina; Tishkoff, Sarah A; Sondheimer, Neal
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.
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.
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.
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
Alo, D; Shahidullah, M; Mannan, M A; Noor, K
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.
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
Bandoli, Gretchen; Chambers, Christina D.
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 arthritis (RA), Crohn’s disease (CD), psoriasis, or controls that were prospectively enrolled into MothertoBaby pregnancy studies. We estimated the independent and joint effects of the three autoimmune conditions and depression on the select outcomes. Results We found an increas...
Agarwal, Shubhra; Agarwal, Arjit; Joon, Pawan; Saraswat, Shalini; Chandak, Shruti
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.
Hollegaard, Stine; Vogel, Ida; Thorsen, Poul
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...
Meijssen, Dominique; Wolf, Marie-Jeanne; van Bakel, Hedwig; Koldewijn, Karen; Kok, Joke; van Baar, Anneloes
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.
Adams Waldorf, Kristina M.; Rubens, Craig E.; Gravett, Michael G.
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
Morgen, Camilla Schmidt; Bjørk, Christina; Andersen, Per Kragh; Mortensen, Laust Hvas; Nybo Andersen, Anne-Marie
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.
To evaluate short- and long-term benefits and risks associated with antenatal administration of a single course of corticosteroids and the related strategies: multiple and rescue courses. The PubMed database, the Cochrane Library and the recommendations from the French and foreign obstetrical societies or colleges have been consulted. Antenatal administration of a single course of corticosteroids before 34 weeks of gestation is associated in the neonatal period with a significant reduction of respiratory distress syndrome (RDS), intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC) and death (LE1), and in possibly childhood with a reduction of cerebral palsy and increased psychomotor development index and intact survival (LE3). However, this treatment is associated with alterations of the HPA axis response persisting until 8 weeks after birth (LE2) and possibly with insulin resistance in adulthood (LE3). Antenatal corticosteroid administration after 34 weeks is associated, with high number needed to treat, with reduced respiratory morbidity (LE2), with no significant effect on neurological (LE2) or digestive (LE2) morbidities. Because of a very favourable benefit/risk balance, antenatal administration of a single course of corticosteroids is recommended for women at risk of preterm delivery before 34 weeks (grade A). The minimum gestational age for treatment will depend on the threshold chosen to start neonatal intensive care in maternity units and perinatal networks (Professional consensus). After 34 weeks, evidences are not consistent enough to recommend systematic antenatal corticosteroid treatment (grade B), however, a course might be indicated in the clinical situations associated with the higher risk of "severe" RDS, mainly in case of planned cesarean delivery (gradeC). In case of imminent preterm birth, pre-empting the second betamethasone injection is not recommended (gradeC), because this policy might be associated with increased rates of
Lengyel, Candice S; Ehrlich, Shelley; Iams, Jay D; Muglia, Louis J; DeFranco, Emily A
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.
Khashan, A S
BACKGROUND: Adverse pregnancy outcomes have been associated with maternal celiac disease (CD). In this study, we investigate the effect of treated and untreated maternal CD on infant birthweight and preterm birth. METHODS: A population-based cohort study consisted of all singleton live births in Denmark between 1 January 1979 and 31 December 2004 was used. A total of 1,504,342 babies were born to 836,241 mothers during the study period. Of those, 1105 babies were born to women with diagnosed CD and 346 were born to women with undiagnosed CD. Women with diagnosed CD were considered as treated with a gluten free diet while women with undiagnosed CD were considered as untreated. The outcome measures were: birthweight, small for gestational age (SGA: birthweight <10th centile), very small for gestational age (VSGA: birthweight <5th centile) and preterm birth. We compared these measures in treated and untreated women with those of a reference group (no history of CD). RESULTS: Women with untreated CD delivered smaller babies [difference = -98 g (95% CI: -130, -67)], with a higher risk of SGA infants [OR = 1.31 (95% CI: 1.06, 1.63)], VSGA infants [OR = 1.54 (95% CI: 1.17, 2.03)] and preterm birth [OR = 1.33 (95% CI: 1.02, 1.72)] compared with women without CD. Women with treated CD had no increased risk of reduced mean birthweight, risk of delivering SGA and VSGA infants or preterm birth compared with women without CD. CONCLUSION: Untreated maternal CD increases the risk of reduced birthweight, the risk of delivering SGA and VSGA infants and preterm birth. Diagnosis and presumed treatment of maternal CD with a gluten-free diet appeared to result in a birthweight and preterm birth rate similar to those in women without CD.
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
Muglia Louis A
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.
Baker Philip N
Full Text Available Abstract Background Higher risks of preterm birth and small for gestational age babies have been reported in teenagers. The aim of this study was to investigate the relationship between first and second teenage pregnancies and preterm birth, birthweight and small for gestational age (SGA. Methods All women aged 14 to 29 yrs who gave birth to live singletons in the North Western Region of England between January 1st 2004 and December 31st 2006 were identified. Women were classified in three groups; 14-17 yrs, 18-19 yrs and 20-29 yrs (reference group. The outcome measures were preterm birth, very preterm birth, birthweight, SGA (th percentile, very SGA (VSGArd percentile. We compared these outcome measures in teenagers' first and second pregnancies with those of mothers aged 20 to 29 yrs. Results The risk of preterm birth was increased in first (OR = 1.21, [95% CI: 1.01-1.45] and second (OR = 1.93, [95% CI: 1.38-2.69] time mothers aged 14-17 yrs compared to the reference group. Birthweight was reduced in the first (mean difference = -24 g; [95% CI: -40, -7] and second (mean difference = -80 g; [95% CI: -115, -46] time mothers aged 14-17 yrs compared to the reference group. There was some evidence of a protective effect against VSGA in 14-17 yr old first time mothers (OR = 0.79, [95% CI: 0.63-0.99]. Conclusions Teenage mothers are at increased risk of preterm birth compared to adult mothers and this risk is further increased in second time teen pregnancies. This study highlights the importance of ensuring pregnant teenagers have appropriate antenatal care. A first pregnancy may be the first and only time a pregnant teenager interacts with health services and this opportunity for health education and the promotion of contraception should not be overlooked.
Khashan, Ali S
BACKGROUND: Higher risks of preterm birth and small for gestational age babies have been reported in teenagers. The aim of this study was to investigate the relationship between first and second teenage pregnancies and preterm birth, birthweight and small for gestational age (SGA). METHODS: All women aged 14 to 29 yrs who gave birth to live singletons in the North Western Region of England between January 1st 2004 and December 31st 2006 were identified. Women were classified in three groups; 14-17 yrs, 18-19 yrs and 20-29 yrs (reference group). The outcome measures were preterm birth, very preterm birth, birthweight, SGA (< 5th percentile), very SGA (VSGA< 3rd percentile). We compared these outcome measures in teenagers\\' first and second pregnancies with those of mothers aged 20 to 29 yrs. RESULTS: The risk of preterm birth was increased in first (OR = 1.21, [95% CI: 1.01-1.45]) and second (OR = 1.93, [95% CI: 1.38-2.69]) time mothers aged 14-17 yrs compared to the reference group. Birthweight was reduced in the first (mean difference = -24 g; [95% CI: -40, -7]) and second (mean difference = -80 g; [95% CI: -115, -46]) time mothers aged 14-17 yrs compared to the reference group. There was some evidence of a protective effect against VSGA in 14-17 yr old first time mothers (OR = 0.79, [95% CI: 0.63-0.99]). CONCLUSIONS: Teenage mothers are at increased risk of preterm birth compared to adult mothers and this risk is further increased in second time teen pregnancies. This study highlights the importance of ensuring pregnant teenagers have appropriate antenatal care. A first pregnancy may be the first and only time a pregnant teenager interacts with health services and this opportunity for health education and the promotion of contraception should not be overlooked.
Murray, Sarah R; Stock, Sarah J; Norman, Jane E
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.
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
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.
S. J. Kroese
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.
Naver, Klara Vinsand; Secher, Niels Jørgen; Ovesen, Per Glud
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....
Kozuki, Naoko; Katz, Joanne; Clermont, Adrienne; Walker, Neff
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
Sheryl L. Coley
Full Text Available Few studies have examined disparities in adverse birth outcomes and compared contributing socioeconomic factors specifically between African-American and White teen mothers. This study examined intersections between neighborhood socioeconomic status (as defined by census-tract median household income, maternal age, and racial disparities in preterm birth (PTB outcomes between African-American and White teen mothers in North Carolina. Using a linked dataset with state birth record data and socioeconomic information from the 2010 US Census, disparities in preterm birth outcomes for 16,472 teen mothers were examined through bivariate and multilevel analyses. African-American teens had significantly greater odds of PTB outcomes than White teens (OR = 1.38, 95% CI 1.21, 1.56. Racial disparities in PTB rates significantly varied by neighborhood income; PTB rates were 2.1 times higher for African-American teens in higher income neighborhoods compared to White teens in similar neighborhoods. Disparities in PTB did not vary significantly between teens younger than age 17 and teens ages 17–19, although the magnitude of racial disparities was larger between younger African-American and White teens. These results justify further investigations using intersectional frameworks to test the effects of racial status, neighborhood socioeconomic factors, and maternal age on birth outcome disparities among infants born to teen mothers.
Giurgescu, Carmen; Zenk, Shannon N; Dancy, Barbara L; Park, Chang G; Dieber, William; Block, Richard
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.
Selk, Sabrina C; Rich-Edwards, Janet W; Koenen, Karestan; Kubzansky, Laura D
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/
Erdei, Carmina; Dammann, Olaf
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.
Lamont, R. F.
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...
Delnord, Marie; Blondel, Béatrice; Prunet, Caroline; Zeitlin, Jennifer
To investigate whether risk factors for preterm (term birth (37 and 38 weeks gestation) are similar. Nationally representative cross-sectional study of births. France in 2010. Live singleton births (n=14 326). Preterm and early-term birth rates overall and by mode of delivery (spontaneous and indicated). Risk factors were maternal sociodemographic characteristics, previous preterm birth, height, prepregnancy body mass index (BMI) and smoking, assessed using multinomial regression models with full-term births 39 weeks and over as the reference group. There were 5.5% preterm and 22.5% early-term births. Common risk factors were: a previous preterm delivery (adjusted relative risk ratio (aRRR) 8.2 (95% CI 6.2 to 10.7) and aRRR 2.4 (95% CI 2.0 to 3.0), respectively), short stature, underweight (overall and in spontaneous deliveries), obesity (in indicated deliveries only), a low educational level and Sub-Saharan African origin. In contrast, primiparity was a risk factor only for preterm birth, aRRR 1.8 (95% CI 1.5 to 2.2), while higher parity was associated with greater risk of early-term birth. Most population-level risk factors were common to both preterm and early-term birth with the exception of primiparity, and BMI which differed by mode of onset of delivery. Our results suggest that preterm and early-term birth share similar aetiologies and thus potentially common strategies for prevention. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
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.
Taylor-Robinson, David; Agarwal, Umber; Diggle, Peter J; Platt, Mary Jane; Yoxall, Bill; Alfirevic, Zarko
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.
Roberts, Christine L; Algert, Charles S; Rickard, Kristen L; Morris, Jonathan M
treatment of asymptomatic candidiasis may reduce the risk of preterm birth, the result needs to be interpreted with caution as the primary driver for the pooled estimate comes from a post-hoc (unplanned) subgroup analysis. A prospective trial with sufficient power to answer the clinical question 'does treatment of asymptomatic candidiasis in early pregnancy prevent preterm birth' is warranted. PROSPERO CRD42014009241.
Full Text Available Abstract Background The onset of birth in humans, like other apes, differs from non-primate mammals in its endocrine physiology. We hypothesize that higher primate-specific gene evolution may lead to these differences and target genes involved in human preterm birth, an area of global health significance. Methods We performed a comparative genomics screen of highly conserved noncoding elements and identified PLA2G4C, a phospholipase A isoform involved in prostaglandin biosynthesis as human accelerated. To examine whether this gene demonstrating primate-specific evolution was associated with birth timing, we genotyped and analyzed 8 common single nucleotide polymorphisms (SNPs in PLA2G4C in US Hispanic (n = 73 preterm, 292 control, US White (n = 147 preterm, 157 control and US Black (n = 79 preterm, 166 control mothers. Results Detailed structural and phylogenic analysis of PLA2G4C suggested a short genomic element within the gene duplicated from a paralogous highly conserved element on chromosome 1 specifically in primates. SNPs rs8110925 and rs2307276 in US Hispanics and rs11564620 in US Whites were significant after correcting for multiple tests (p PLA2G4C activity. Conclusions Our findings suggest that variation in PLA2G4C may influence preterm birth risk by increasing levels of prostaglandins, which are known to regulate labor.
Full Text Available INTRODUCTION: Globally, 11% of infants are born preterm. In adulthood, individuals born preterm are at increased risk of cardiovascular morbidity and mortality, but the mechanistic basis of this remains unknown. Clinically overt cardiovascular disease may be preceded by altered cardiac autonomic activity characterised by increased sympathetic activity and/or reduced parasympathetic activity. Thus, altered cardiac autonomic activity in survivors of preterm birth may underlie later cardiovascular risk. OBJECTIVE: To investigate the impact of gestational age on cardiac autonomic activity in juvenile and adult sheep. METHODS AND RESULTS: Singleton-bearing ewes were randomised antenatally to spontaneous term birth (TC; n=73 or corticosteroid induced preterm birth (PT; n=60. Cardiac autonomic modulation was assessed using heart rate variability analysis in juvenile and adult offspring. Preterm birth in adult males was associated with altered sympatho-vagal modulation (LFnu: PT 64 ± 4 vs. TC 49 ± 4, p<0.05; LogLF/HF: PT 1.8 ± 0.1 vs. TC 1.5 ± 0.1, p<0.05 and reduced parasympathetic modulation (LogRMSSD: PT 2.9 ± 0.2 vs. TC 3.4 ± 0.1, p<0.05; LogNN50: PT 0.3 ± 0.4 vs. TC 1.6 ± 0.4, p<0.05. Within the range of term birth, each one-day increment in gestational age was associated with a decrement in LFnu in juvenile females and with a decrement in LFnu and LF/HF ratio, but an increment in RMSSD and NN50 in adult females. CONCLUSIONS: Cardiac autonomic function in adult sheep is affected in a sex-specific manner by gestational age at birth, even within the term range. Altered cardiac autonomic function may contribute to increased later cardiovascular morbidity in those born preterm.
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
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.
Watson, Lyndsey F; Rayner, Jo-Anne; King, James; Jolley, Damien; Forster, Della
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.
Palatnik, Anna; Miller, Emily S; Son, Moeun; Kominiarek, Michelle A
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.
Full Text Available Neonatal asphyxia can cause irreversible injury of multiple organs resulting in hypoxic-ischemic encephalopathy and necrotizing enterocolitis (NEC. This injury is dependent on time, severity, and gestational age, once the preterm babies need ventilator support. Our aim was to assess the different brain and intestinal effects of ischemia and reperfusion in neonate rats after birth anoxia and mechanical ventilation. Preterm and term neonates were divided into 8 subgroups (n=12/group: 1 preterm control (PTC, 2 preterm ventilated (PTV, 3 preterm asphyxiated (PTA, 4 preterm asphyxiated and ventilated (PTAV, 5 term control (TC, 6 term ventilated (TV, 7 term asphyxiated (TA, and 8 term asphyxiated and ventilated (TAV. We measured body, brain, and intestine weights and respective ratios [(BW, (BrW, (IW, (BrW/BW and (IW/BW]. Histology analysis and damage grading were performed in the brain (cortex/hippocampus and intestine (jejunum/ileum tissues, as well as immunohistochemistry analysis for caspase-3 and intestinal fatty acid-binding protein (I-FABP. IW was lower in the TA than in the other terms (P<0.05, and the IW/BW ratio was lower in the TA than in the TAV (P<0.005. PTA, PTAV and TA presented high levels of brain damage. In histological intestinal analysis, PTAV and TAV had higher scores than the other groups. Caspase-3 was higher in PTAV (cortex and TA (cortex/hippocampus (P<0.005. I-FABP was higher in PTAV (P<0.005 and TA (ileum (P<0.05. I-FABP expression was increased in PTAV subgroup (P<0.0001. Brain and intestinal responses in neonatal rats caused by neonatal asphyxia, with or without mechanical ventilation, varied with gestational age, with increased expression of caspase-3 and I-FABP biomarkers.
Kaaresen, Per Ivar; Rønning, John A; Ulvund, Stein Erik; Dahl, Lauritz B
Preterm birth has been associated with increased parenting stress in early infancy, and some reports have found this to be a risk factor for later behavioral problems. There are, however, few studies and conflicting results. Information about the fathers is scarce. Our goal was to study the effects of an early-intervention program on parenting stress after a preterm birth until 1 year corrected age. A randomized, controlled trial was conducted including infants with a birth weight effects of a modified version of the Mother-Infant Transaction Program on parenting stress measured by the Parenting Stress Index. A term control group was also recruited. The Parenting Stress Index was administered to the mothers at 6 and 12 months' corrected age and to the fathers at 12 months' corrected age. The intervention consisted of 8 sessions shortly before discharge and 4 home visits by specially trained nurses focusing on the infant's unique characteristics, temperament, and developmental potential and the interaction between the infant and the parents. Seventy-one infants were included in the preterm intervention group, and 69 were included in the preterm control group. The preterm groups were well balanced. Seventy-four infants were included in the term control group. Compared with the preterm controls, both the mothers and fathers in the preterm intervention group reported significant lower scores in child domain, parent domain, and total stress on all occasions except the mother-reported child domain at 12 months. These differences were not related to birth weight or gestational age. The level of stress among the preterm intervention group was comparable to their term peers. Both parents in the intervention group reported consistently lower scores within the distractibility/hyperactivity, reinforces parents, competence, and attachment subscales compared with the preterm control group. There were no differences in mean summary stress scores between the mothers and fathers in
Grjibovski, A M; Bygren, L O; Yngve, A; Sjöström, M
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.
Zhong, Xin-Qi; Cui, Qi-Liang
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.
Full Text Available Preterm infants are born during a critical period of brain maturation, in which even subtle events can result in substantial behavioral, motor and cognitive deficits, as well as psychiatric diseases. Recent evidence shows that the main source for these devastating disabilities is not necessarily white matter damage but could also be disruptions of cortical microstructure. Animal studies showed how moderate hypoxic-ischemic conditions did not result in significant neuronal loss in the developing brain, but did cause significantly impaired dendritic growth and synapse formation alongside a disturbed development of neuronal connectivity as measured using diffusion magnetic resonance imaging (dMRI. When using more advanced acquisition settings such as high-angular resolution diffusion imaging, more advanced reconstruction methods can be applied to investigate the cortical microstructure with higher levels of detail. Recent advances in dMRI acquisition and anlysis have great potential to contribute to a better understanding of neuronal connectivity impairment in preterm birth. We will review the current understanding of abnormal preterm cortical development, novel approaches in dMRI, and the pitfalls in scanning vulnerable preterm infants.
Pinborg, A; Ortoft, G; Loft, A; Rasmussen, S C; Ingerslev, H J
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
Premkumar, Ashish; Henry, Dana E; Moghadassi, Michelle; Nakagawa, Sanae; Norton, Mary E
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
Berghella, Vincenzo; Saccone, Gabriele
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
Manalee Vishnu Surve
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.
Sthanam, Lakshmi Kavitha; Srivastava, Rohit; Basu, Bhakti; Dutta, Suryendu; Sen, Shamik; Modi, Deepak
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
Kirihara, Nami; Kamitomo, Masato; Tabira, Tatsunori; Hashimoto, Takashi; Taniguchi, Hiroko; Maeda, Takatsugu
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.
Gustafsson, Anna M; Fransson, Emma; Dubicke, Aurelija; Hjelmstedt, Anna K; Ekman-Ordeberg, Gunvor; Silfverdal, Sven-Arne; Lange, Stefan; Jennische, Eva; Bohlin, Kajsa
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.
Bensley, Jonathan G; De Matteo, Robert; Harding, Richard; Black, Mary J
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.
Meijssen, Dominique; Wolf, Marie-Jeanne; van Bakel, Hedwig; Koldewijn, Karen; Kok, Joke; van Baar, Anneloes
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
Narberhaus, Ana; Segarra, Dolors; Caldu, Xavier; Gimenez, Monica; Pueyo, Roser; Botet, Francesc; Junque, Carme
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…
Juhl, Mette; Andersen, Per Kragh; Olsen, Jørn
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...
Iqbal, I.; Azhar, I.A.
Preterm birth is the most significant problem in current obstetric practice and according to WHO is the direct cause accounting for 24% of neonatal deaths. Objective: To assess frequency and neonatal outcome in patients with preterm birth. Methodology: A prospective descriptive study was conducted at Gynae Unit III Jinnah Hospital Lahore over a period of one year (from 1st July 2011 to 30th June included in the study. For data collection two groups were made depending upon duration of pregnancy. Group l was allotted to women who were pregnant 2012) in collaboration with Paediatrics department. All labouring women who presented after 28 weeks and before 37 completed weeks of gestation were less ( ) than 32 weeks of gestation. Data was collected and analyzed by SPSS version 16. Results: During the study period total 5171 deliveries took place. Out of 5171 neonates born, 460 were preterm making the frequency of 8.86%. Majority 62.82% were > 32 weeks of gestation, 67.39% were male, 57.60% were > 1.5 kg by weight, 57.17% delivered vaginally and 80.86% were born alive. Neonatal morbidity was more common in neonates less than 32 weeks of gestation. Perinatal mortality was 10.48% in this study. Conclusion: Neonatal morbidity and mortality is more common in neonates less than 32 weeks of gestation, this can be improved by improving prenatal health services and advanced neonatal care. (author)
Full Text Available Abstract Background Preterm birth (PTB is a major cause of infant morbidity and mortality, but the relationship between comorbidity and PTB by clinical subtype and severity of gestational age remains poorly understood. We evaluated associations between maternal comorbidities and PTB by clinical subtype and gestational age. Methods We conducted a retrospective cohort study of 1,329,737 singleton births delivered in hospitals in the province of Québec, Canada, 1989-2006. PTB was classified by clinical subtype (medically indicated, preterm premature rupture of membranes (PPROM, spontaneous preterm labour and gestational age ( Results PTB rates were higher among mothers with comorbidity (10.9% compared to those without comorbidity (4.7%. Several comorbidities were associated with greater odds of medically indicated PTB compared with no comorbidity, but only comorbidities localized to the reproductive system were associated with spontaneous PTB. Drug dependence and mental disorders were strongly associated with PPROM and spontaneous PTBs across all gestational ages (OR > 2.0. At the population level, several major comorbidities (placental abruption, chorioamnionitis, oliogohydramnios, structural abnormality, cervical incompetence were key contributors to all clinical subtypes of PTB, especially at Conclusions The relationship between comorbidity and clinical subtypes of PTB depends on gestational age. Prevention of PPROM and spontaneous PTB may benefit from greater attention to preeclampsia, anemia and comorbidities localized to the reproductive system.
Kessey M. B. Garcia
Full Text Available OBJECTIVE: To compare thoracic musculoskeletal static alterations in adolescents born prematurely with those born at term and investigate neonatal and post-neonatal variables associated with thoracic alterations. METHOD: This is a cross-sectional study with 57 adolescents aged 10-15 years born prematurely and 57 adolescents born at term paired by gender and age. Photographs of the head and thorax in the front, back, and right side views were studied using a computer program. The two groups were compared in regards to: elevation of clavicles, elevation of shoulders, protrusion of the head, and anteroposterior and mediolateral thoracic length. Factor associated with thoracic disorders were evaluated by linear regression analysis. RESULTS: The Preterm group had mean gestational age of 32.0±2.8 weeks and the birth weight was 1462±338 and 3342±430 g for the Preterm and Term adolescents, respectively. Preterm adolescents had higher elevation of the left shoulder (22.7±5.4o vs. 20.6±5.3o;sim, p=0.038 and the right shoulder (22.2±4.4o vs. 18.5±5.7o; p5 days (p=0.009. CONCLUSION: Adolescents born prematurely presented greater thoracic musculoskeletal static alterations compared to those born at term. Factors associated with these alterations were: very low birth weight and longer duration of mechanical ventilation in the neonatal unit.
Aggarwal, Rahul; Gathwala, Geeta; Yadav, Sudesh; Kumar, Pawan
Neonatal mortality continues to be a significant problem in the Indian setting, especially in very low birth weight (VLBW) neonates. Selenium (Se) has been shown to possess antioxidant properties, and some recent studies have shown a reduction in the sepsis-attributable neonatal mortality with its use. India is a Se-deficient country. Blood Se concentrations in newborns are lower than those of their mothers and lower still in preterm infants. To evaluate the efficacy of Se in preventing the first episode of late-onset sepsis in VLBW preterm neonates. Ninety neonates weighing birth and admitted to the neonatal intensive-care unit (NICU) in the first 12 h of birth with no maternal risk factors for sepsis were analyzed in the study. Se or placebo was supplemented orally once daily from 1st to 28th day of life to the test (n = 45) or control (n = 45) groups, respectively, followed by daily clinical assessment for signs or symptoms of sepsis in the hospital and weekly after discharge. Preterm VLBW neonates (mean birth weight 1464.22 ± 50.14 g and mean gestational age 221.75 ± 4 days) are Se deficient at birth, with mean (SD) Se levels 31.1 ± 14.8 µg/l. Se supplementation at 10 µg/day increased serum Se levels significantly (63.9 ± 13.9 µg/l on Day 28 in Se vs. 40.9 ± 17.3 on Day 28 in placebo; p supplementation. [7/45 (15.55%) in Se vs. 22/45 (48.88%) in placebo; p = 0.001]. Preterm VLBW neonates are Se deficient at birth. Se supplementation at 10 µg/day resulted in getting the Se levels into the acceptable normal level and reduced the incidence of the first episode of late-onset sepsis in these neonates. © The Author . Published by Oxford University Press. All rights reserved. For Permissions, please email: firstname.lastname@example.org.
Heinonen, Annu; Gissler, Mika; Paavonen, Jorma; Tapper, Anna-Maija; Jakobsson, Maija
In this population-based register study our objective was to explore the association of cervical intraepithelial neoplasia, grade 1 and loop electrosurcigal excision procedure with preterm birth. Our population consisted of 4759 women diagnosed with cervical intraepithelial neoplasia, grade 1 during 1997-2009 and their 3021 subsequent deliveries analyzed by loop electrosurcigal excision procedure and parity. Hospital Discharge Register was used to identify women diagnosed for cervical intraepithelial neoplasia, grade 1 and these data were linked with the Medical Birth Register data. We calculated odds ratios with 95% confidence intervals. Cervical intraepithelial neoplasia, grade 1 patients with loop electrosurcigal excision procedure had 54 (6.7%) subsequent preterm births and the corresponding figure among cervical intraepithelial neoplasia, grade 1 patients without loop electrosurcigal excision procedure was 116 (5.2%). This results in odds ratios 1.31 (95% confidence interval 0.94-1.83). We assessed the risk before and after diagnosis of cervical intraepithelial neoplasia, grade 1 both for patients with loop electrosurcigal excision procedure (odds ratios 1.47, 95% confidence interval 1.05-2.06) and without loop electrosurcigal excision procedure (odds ratios 0.90, 95% confidence interval 0.71-1.13). An increased risk for preterm birth after diagnosis of cervical intraepithelial neoplasia, grade 1 and loop electrosurcigal excision procedure was observed. We also compared both groups to the background population in the Medical Birth Register. For cervical intraepithelial neoplasia, grade 1 patients without loop electrosurcigal excision procedure the risk for preterm birth was not increased (odds ratios 0.95, 95% confidence interval 0.76-1.21) whereas for cervical intraepithelial neoplasia, grade 1 patients treated with loop electrosurcigal excision procedure the risk for preterm birth was increased (odds ratios 1.45, 95% confidence interval 1.02-1.92). Loop
Sigalla, Geofrey Nimrod; Mushi, Declare; Meyrowitsch, Dan Wolf
Introduction: Intimate partner violence (IPV) is a public health problem that affects millions of women worldwide. The role of violence as an underlying factor in poor birth outcomes remains an area where strong evidence is lacking. The aim of this study was to determine the association between...... intimate partner violence (IPV) and preterm delivery (PTB) and low birth weight (LBW). Materials and methods: A prospective cohort study was conducted among 1112 pregnant women attending antenatal care in Moshi–Tanzania. The women were enrolled before 24 weeks gestation, followed-up at week 34 to determine...... analysis based on previous history of adverse pregnancy outcome was performed. Results: One-third of the women experienced IPV during pregnancy, 22.3% reported emotional, 15.4% sexual and 6.3% physical violence. Women exposed to physical IPV were three times more likely to experience PTB (AOR = 2.9; CI 95...
Scott M Nelson
Full Text Available The extent to which baseline couple characteristics affect the probability of live birth and adverse perinatal outcomes after assisted conception is unknown.We utilised the Human Fertilisation and Embryology Authority database to examine the predictors of live birth in all in vitro fertilisation (IVF cycles undertaken in the UK between 2003 and 2007 (n = 144,018. We examined the potential clinical utility of a validated model that pre-dated the introduction of intracytoplasmic sperm injection (ICSI as compared to a novel model. For those treatment cycles that resulted in a live singleton birth (n = 24,226, we determined the associates of potential risk factors with preterm birth, low birth weight, and macrosomia. The overall rate of at least one live birth was 23.4 per 100 cycles (95% confidence interval [CI] 23.2-23.7. In multivariable models the odds of at least one live birth decreased with increasing maternal age, increasing duration of infertility, a greater number of previously unsuccessful IVF treatments, use of own oocytes, necessity for a second or third treatment cycle, or if it was not unexplained infertility. The association of own versus donor oocyte with reduced odds of live birth strengthened with increasing age of the mother. A previous IVF live birth increased the odds of future success (OR 1.58, 95% CI 1.46-1.71 more than that of a previous spontaneous live birth (OR 1.19, 95% CI 0.99-1.24; p-value for difference in estimate <0.001. Use of ICSI increased the odds of live birth, and male causes of infertility were associated with reduced odds of live birth only in couples who had not received ICSI. Prediction of live birth was feasible with moderate discrimination and excellent calibration; calibration was markedly improved in the novel compared to the established model. Preterm birth and low birth weight were increased if oocyte donation was required and ICSI was not used. Risk of macrosomia increased with advancing
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.
Cox, Bianca; Martens, Evelyne; Nemery, Benoit; Vangronsveld, Jaco; Nawrot, Tim S
To investigate the incidence of preterm delivery in the Belgian population after implementation of smoke-free legislation in three phases (in public places and most workplaces January 2006, in restaurants January 2007, and in bars serving food January 2010). Logistic regression analyses on routinely collected birth data from January 2002 to December 2011. Flanders, Belgium. All live born singleton births delivered at 24-44 weeks of gestation (n = 606,877, with n = 448,520 spontaneous deliveries). Preterm birth (gestational age trend was evident in the years or months before the bans. We observed a step change in the risk of spontaneous preterm delivery of -3.13% (95% CI -4.37% to -1.87%; Prestaurants), and an annual slope change of -2.65% (-5.11% to -0.13%; P=0.04) after 1 January 2010 (ban on smoking in bars serving food). The analysis for all births gave similar results: a step change of -3.18% (-5.38% to -0.94%; Ptrends, month of the year, day of the week); or population related factors (public holidays, influenza epidemics, and short term changes in apparent temperature and particulate air pollution). Our study shows a consistent pattern of reduction in the risk of preterm delivery with successive population interventions to restrict smoking. This finding is not definitive but it supports the notion that smoking bans have public health benefits from early life.
C.S.H. Aarnoudse-Moens (Cornelieke); N. Weisglas-Kuperus (Nynke); J.B. van Goudoever (Hans); J. Oosterlaan (Jaap)
textabstractOBJECTIVE: Sequelae of academic underachievement, behavioral problems, and poor executive function (EF) have been extensively reported for very preterm (≤33 weeks' gestation) and/or very low birth weight (VLBW) (≤1500 g) children. Great variability in the published results, however,
Joseph, KS; Fahey, John; Shankardass, Ketan; Allen, Victoria M; O’Campo, Patricia; Dodds, Linda; Liston, Robert M; Allen, Alexander C
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...
Yamamoto, Shelby; Premji, Shahirose
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
Feng, Yu Yang; Jarde, Alexander; Seo, Ye Rin; Powell, Anne; Nwebube, Nwachukwu; McDonald, Sarah D
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.
Urlesberger, P; Schienle, A; Pichler, G; Baik, N; Schwaberger, B; Urlesberger, B; Pichler-Stachl, E
Background Preterm birth is known to be a stressful and anxious situation for parents, which might have long-term impact on the psychological health of mothers and even on the development of their preterm infants. Objective The Parental Stressor Scale: Neonatal Intensive Care Unit (PSS:NICU) was developed to assess parental stress after preterm birth through three subscales . The aim of the present study was to examine the psychometric properties and the dimensionality of the German version of the PSS:NICU to develop a reliable German version of the PSS:NICU. Methods For the development (exploratory factor analysis) 100 parents of preterm infants answered the questionnaire. Results The Sights and Sounds subscale was removed from the German version of the PSS:NICU due to low number of items. NICU_German/2-scales was developed consisting of 2 subscales: Infant Behavior and Appearance (7 Items, Cronbach's α=0,82) and Parental Role Alteration (6 Items, Cronbach's α=0,87). Conclusions The PSS:NICU_German/2-scales is a reliable and economic scale for the assessment of parental stress after preterm birth. © Georg Thieme Verlag KG Stuttgart · New York.
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.
Scheepers Hubertina CJ
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
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
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
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
Full Text Available Preterm birth is a major cause for neonatal morbidity and mortality, and is frequently associated with adverse neurological outcomes. The transition from intrauterine to extrauterine life at birth is particularly challenging for preterm infants. The main physiological driver for extrauterine transition is the establishment of spontaneous breathing. However, preterm infants have difficulty clearing lung liquid, have insufficient surfactant levels, and underdeveloped lungs. Further, preterm infants have an underdeveloped brainstem, resulting in reduced respiratory drive. These factors facilitate the increased requirement for respiratory support. A principal cause of preterm birth is intrauterine infection/inflammation (chorioamnionitis, and infants with chorioamnionitis have an increased risk and severity of neurological damage, but also demonstrate impaired autoresuscitation capacity and prevalent apnoeic episodes. The brainstem contains vital respiratory centers which provide the neural drive for breathing, but the impact of preterm birth and/or chorioamnionitis on this brain region is not well understood. The aim of this review is to provide an overview of the role and function of the brainstem respiratory centers, and to highlight the proposed mechanisms of how preterm birth and chorioamnionitis may affect central respiratory functions.
Stojanovska, Vanesa; Miller, Suzanne L; Hooper, Stuart B; Polglase, Graeme R
Preterm birth is a major cause for neonatal morbidity and mortality, and is frequently associated with adverse neurological outcomes. The transition from intrauterine to extrauterine life at birth is particularly challenging for preterm infants. The main physiological driver for extrauterine transition is the establishment of spontaneous breathing. However, preterm infants have difficulty clearing lung liquid, have insufficient surfactant levels, and underdeveloped lungs. Further, preterm infants have an underdeveloped brainstem, resulting in reduced respiratory drive. These factors facilitate the increased requirement for respiratory support. A principal cause of preterm birth is intrauterine infection/inflammation (chorioamnionitis), and infants with chorioamnionitis have an increased risk and severity of neurological damage, but also demonstrate impaired autoresuscitation capacity and prevalent apnoeic episodes. The brainstem contains vital respiratory centers which provide the neural drive for breathing, but the impact of preterm birth and/or chorioamnionitis on this brain region is not well understood. The aim of this review is to provide an overview of the role and function of the brainstem respiratory centers, and to highlight the proposed mechanisms of how preterm birth and chorioamnionitis may affect central respiratory functions.
Teshome, Amare; Yitayeh, Asmare
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.
Bell, Michelle L; Ebisu, Keita; Belanger, Kathleen
Previously we identified associations between the mother's air pollution exposure and birth weight for births in Connecticut and Massachusetts from 1999-2002. Other studies also found effects, though results are inconsistent. We explored potential uncertainties in earlier work and further explored associations between air pollution and birth weight for PM 10 , PM 2.5 , CO, NO 2 , and SO 2 . Specifically we investigated: (1) whether infants of younger (≤24 years) and older (≥40 years) mothers are particularly susceptible to air pollution's effects on birth weight; (2) whether the relationship between air pollution and birth weight differed by infant sex; (3) confounding by co-pollutants and differences in pollutants' measurement frequencies; and (4) whether observed associations were influenced by inclusion of pre-term births. Findings did not indicate higher susceptibility to the relationship between air pollution and birth weight based on the mother's age or the infant's sex. Results were robust to exclusion of pre-term infants and co-pollutant adjustment, although sample size decreased for some pollutant pairs. These findings provide additional evidence for the relationship between air pollution and birth weight, and do not identify susceptible sub-populations based on infant sex or mother's age. We conclude with discussion of key challenges in research on air pollution and pregnancy outcomes.
Rachel Gick Fan
Full Text Available OBJECTIVE: The aim of this study was to assess the cognitive and behavioral development of preterm and low birth weight newborns living in a disadvantageous socioeconomic environment at school age. METHODS: This cross-sectional study included children aged 6-7 from a historical birth cohort of preterm (gestational age <37 weeks and low birth weight (<2,500 g infants. The Wechsler Intelligence Scale for Children III (WISC-III was administered by a psychologist while the parents completed the Child Behavior Checklist. The results were compared to the test's reference. The perinatal information and follow-up data were collected from the hospital files. The demographic data were collected from the parents. The current performance was compared with the results from the Denver II and Bayley II tests, which were administered during the first years of life. RESULTS: The total intelligence quotient varied from 70 to 140 (mean 98.7±15.8. The borderline intelligence quotient was observed in 9.3% of the children. The Child Behavior Checklist indicated a predominance of social competence problems (27.8%, CI 19.2 to 37.9 compared with behavioral problems (15.5%, CI 8.9 to 24.2. Both the Child Behavior Checklist domains, such as schooling, social and attention problems, and the cognitive scores were significantly associated with maternal education and family income. The results of the Denver and Bayley tests were associated with the cognitive performance (p<0.001 and the Child Behavior Checklist social profile, including aggressive and externalizing behavior (p<0.001. CONCLUSIONS: Our data suggest that even low-risk preterm newborns are at risk for developing disturbances in early school age, such as mild cognitive deficits and behavioral disorders. This risk might increase under unfavorable socioeconomic conditions.
Kinney Mary V
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.
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
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.
Malouf, Reem; Redshaw, Maggie
Preterm birth (PTB) is the leading cause of perinatal morbidity and mortality. Women with previous prenatal loss are at higher risk of preterm birth. A specialist antenatal clinic is considered as one approach to improve maternity and pregnancy outcomes. A systematic review of quantitative, qualitative and mixed method studies conducted on women at high risk of preterm birth (PTB). The review primary outcomes were to report on the specialist antenatal clinics effect in preventing or reducing preterm birth, perinatal mortality and morbidity and women's perceptions and experiences of a specialist clinic whether compared or not compared with standard antenatal care. Other secondary maternal, infant and economic outcomes were also determined. A comprehensive search strategy was carried out in English within electronic databases as far back as 1980. The reviewers selected studies, assessed the quality, and extracted data independently. Results were summarized and tabulated. Eleven studies fully met the review inclusion criteria, ten were quantitative design studies and only one was a qualitative design study. No mixed method design study was included in the review. All were published after 1989, seven were conducted in the USA and four in the UK. Results from five good to low quality randomised controlled trials (RCTs), all conducted before 1990, did not illustrate the efficacy of the clinic in reducing preterm birth. Whereas results from more recent low quality cohort studies showed some positive neonatal outcomes. Themes from one good quality qualitative study reflected on the emotional and psychological need to reduce anxiety and stress of women referred to such a clinic. Women expressed their negative emotional responses at being labelled as high risk and positive responses to being assessed and treated in the clinic. Women also reported that their partners were struggling to cope emotionally. Findings from this review were mixed. Evidence from cohort studies
Raiche, Evelyne; Ouellet, Annie; Berthiaume, Maryse; Rousseau, Éric; Pasquier, Jean-Charles
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.
Rao, Deepa; Kumar, Shuba; Mohanraj, Rani; Frey, Sarah; Manhart, Lisa E; L Kaysen, Debra
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.
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.
Bhatia, Namrata; Chao, Shin Margaret; Higgins, Chandra; Patel, Suvas; Crespi, Catherine M.
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
Bhatia, Namrata; Chao, Shin Margaret; Higgins, Chandra; Patel, Suvas; Crespi, Catherine M
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.
Background Preterm birth confers a high risk of adverse long term health outcomes for survivors, yet the underlying molecular mechanisms are unclear. We hypothesized that effects of preterm birth can be mediated through measurable epigenomic changes throughout development. We therefore used a longitudinal birth cohort to measure the epigenetic mark of DNA methylation at birth and 18 years comparing survivors of extremely preterm birth with infants born at term. Methods Using 12 extreme preterm birth cases and 12 matched, term controls, we extracted DNA from archived neonatal blood spots and blood collected in a similar way at 18 years of age. DNA methylation was measured at 347,789 autosomal locations throughout the genome using Infinium HM450 arrays. Representative methylation differences were confirmed by Sequenom MassArray EpiTYPER. Results At birth we found 1,555 sites with significant differences in methylation between term and preterm babies. At 18 years of age, these differences had largely resolved, suggesting that DNA methylation differences at birth are mainly driven by factors relating to gestational age, such as cell composition and/or maturity. Using matched longitudinal samples, we found evidence for an epigenetic legacy associated with preterm birth, identifying persistent methylation differences at ten genomic loci. Longitudinal comparisons of DNA methylation at birth and 18 years uncovered a significant overlap between sites that were differentially-methylated at birth and those that changed with age. However, we note that overlapping sites may either differ in the same (300/1,555) or opposite (431/1,555) direction during gestation and aging respectively. Conclusions We present evidence for widespread methylation differences between extreme preterm and term infants at birth that are largely resolved by 18 years of age. These results are consistent with methylation changes associated with blood cell development, cellular composition, immune
Sammallahti, Sara; Lahti, Marius; Pyhälä, Riikka; Lahti, Jari; Pesonen, Anu-Katriina; Heinonen, Kati; Hovi, Petteri; Eriksson, Johan G.; Strang-Karlsson, Sonja; Järvenpää, Anna-Liisa; Andersson, Sture; Kajantie, Eero; Räikkönen, Katri
Objectives Faster growth after preterm birth benefits long-term cognitive functioning. Whether these benefits extend to mental health remains largely unknown. We examined if faster growth in infancy is associated with better self-reported mental health in young adults born preterm at very low birth weight (VLBW) (term, and 12 months of corrected age, and growth between these time points. Growth data were collected from records and measures at term and at 12 months of corrected age were interpolated. Additionally, we examined the moderating effects of intrauterine growth restriction. Results Size at birth, term, or 12 months of corrected age, or growth between these time points were not associated with mental health outcomes (p-values >0.05). Intrauterine growth restriction did not systematically moderate any associations. Conclusions Despite the high variability in early growth of VLBW infants, the previously described association between slow growth in infancy and poorer cognitive functioning in later life is not reflected in symptoms of depression, ADHD, and other psychiatric problems. This suggests that the development of cognitive and psychiatric problems may have dissimilar critical periods in VLBW infants. PMID:26327229
Timothy O. Ihongbe
Full Text Available Background. Postpartum depression and preterm birth (PTB are major problems affecting women’s health. PTB has been associated with increased risk of postpartum depressive symptoms (PDS. However, it is unclear if PTB in women with a prior history of PTB is associated with an incremental risk of PDS. This study aims to determine if PTB in women with a prior history of PTB is associated with an incremental risk of PDS. Methods. Data come from the 2009–2011 national Pregnancy Risk Assessment Monitoring System. Study sample included 55,681 multiparous women with singleton live births in the index delivery. Multiple logistic regression was used to examine the association between PTB and PDS. Results. The risk of PDS was 55% higher in women with PTB in both deliveries (aRR = 1.55; 95% CI = 1.28–1.88 and 74% higher in women with PTB in the index delivery only (aRR = 1.74; 95% CI = 1.49–2.05, compared to women with term deliveries. Conclusions. Preterm birth is a risk factor for PDS. PTB in women with a prior history of PTB is not associated with an incremental risk of PDS. Routine screening for PDS should be conducted for all women and closer monitoring should be done for high risk women with PTB.
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
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
Wagijo, Mary-Ann; Sheikh, Aziz; Duijts, Liesbeth; Been, Jasper V
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.
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
Full Text Available Background and Objective: Preterm birth (PTB is an important issue in public health and is a major cause for infant mortality and morbidity. There is a growing consensus that systemic diseases elsewhere in the body may influence PTB. Recent studies have hypothesized that maternal periodontitis could be a high-risk factor for PTB. The aim of the present study was to investigate the relationship between maternal periodontitis on PTB. Materials and Methods: Forty systemically healthy primiparous mothers aged 18–35 years were recruited for the study. Based on inclusion and exclusion criteria, they were categorized into PTB group as cases and full term birth group (FTB as controls. PTB cases (n = 20 defined as spontaneous delivery before/<37 completed weeks of gestation. Controls (FTB were normal births at or after 37 weeks of gestation. Data on periodontal status, pregnancy outcome variables, and information on other factors that may influence adverse pregnancy outcomes were collected within 2 days of labor. Data were subjected to Student's t-test and Pearson's correlation coefficient statistical analysis. Results: Statistically significant difference with respect to the gestational period at the time of delivery and birth weight of the infants in (PTB group (<0.001 compared to (FTB group was observed. Overall, there was statistically significant poor periodontal status in the (PTB group compared to (FTB group. The statistical results also showed a positive correlation between gestational age and clinical parameters. Conclusion: An observable relationship was noticed between periodontitis and gestational age, and a positive correlation was found with respect to PTB and periodontitis. Further studies should be designed to establish periodontal disease as an independent risk factor for PTB/preterm low birth weight.
Venkatesh, Kartik K; Riley, Laura; Castro, Victor M; Perlis, Roy H; Kaimal, Anjali J
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.
Suzan L Carmichael
Full Text Available We examined the contribution of social disadvantage to the black-white disparity in preterm birth. Analyses included linked vital and hospital discharge records from 127,358 black and 615,721 white singleton California births from 2007-11. Odds ratios (OR were estimated by 4 logistic regression models for 2 outcomes: early (<32 wks and moderate (32-36 wks spontaneous preterm birth (ePTB, mPTB, stratified by 2 race-ethnicity groups (blacks and whites. We then conducted a potential impact analysis. The OR for less than high school education (vs. college degree was 1.8 (95% confidence interval 1.6, 2.1 for ePTB among whites but smaller for the other 3 outcome groups (ORs 1.3-1.4. For all 4 groups, higher census tract poverty was associated with increased odds (ORs 1.03-1.05 per 9% change in poverty. Associations were less noteworthy for the other variables (payer, and tract percent black and Gini index of income inequality. Setting 3 factors (education, poverty, payer to 'favorable' values was associated with lower predicted probability of ePTB (25% lower among blacks, 31% among whites but a 9% higher disparity, compared to probabilities based on observed values; for mPTB, respective percentages were 28% and 13% lower probability, and 17% lower disparity. Results suggest that social determinants contribute to preterm delivery and its disparities, and that future studies should focus on ePTB and more specific factors related to social circumstances.
Ryckman, Kelli K; Feenstra, Bjarke; Shaffer, John R.; Bream, Elise NA; Geller, Frank; Feingold, Eleanor; Weeks, Daniel E; Gadow, Enrique; Cosentino, Viviana; Saleme, Cesar; Simhan, Hyagriv N; Merrill, David; Fong, Chin-To; Busch, Tamara; Berends, Susan K; Comas, Belen; Camelo, Jorge L; Boyd, Heather; Laurie, Cathy; Crosslin, David; Zhang, Qi; Doheny, Kim F; Pugh, Elizabeth; Melbye, Mads; Marazita, Mary L; Dagle, John M; Murray, Jeffrey C
Objective To examine associations in a preterm population between rs9883204 in ADCY5 and rs900400 near LEKR1 and CCNL1 with birth weight. Both markers were associated with birth weight in a term population in a recent genome-wide association (GWA) study by Freathy et al. Study design A meta-analysis of mother and infant samples was performed for associations of rs900400 and rs9883204 with birth weight in 393 families from the U.S., 265 families from Argentina and 735 mother-infant pairs from Denmark. Z scores adjusted for infant sex and gestational age were generated for each population separately and regressed on allele counts. Association evidence was combined across sites by inverse-variance weighted meta-analysis. Results Each additional C allele of rs900400 (LEKR1/CCNL1) in infants was marginally associated with a 0.069 standard deviation (SD) lower birth weight (95% CI = −0.159 – 0.022, P = 0.068). This result was slightly more pronounced after adjusting for smoking (P = 0.036). There were no significant associations identified with rs9883204 or in maternal samples. Conclusions These results indicate the potential importance of this marker on birth weight irrespective of gestational age. PMID:21885063
Anand, M; Singh, L; Agarwal, P; Saroj, R; Taneja, A
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.
Swaney, Paul; Thorp, John; Allen, Ian
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.
Ramaeker, Devon M; Simhan, Hyagriv N
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.
Irám P Rodríguez-Sánchez
Full Text Available Introduction: Preterm birth is the most important cause of neonatal mortality and morbidity. It is a multifactorial disease with different etiologies, including genetic factors. Genetic variability is represented by single nucleotide polymorphisms (SNPs in genes of proteins involved in the contractile activity. We determine the association between SNP 12109G> A in REN associated with preterm birth and premature rupture of membrane. Materials and methods: A study of cases (N=112, 22–36 weeks of gestation; mean: 31, 95% confidence interval 30.7–32.2 and controls (N=66; 38–40 weeks of gestation from the last menstrual period; mean: 39.8, 95% confidence interval 38.9–39.4 was performed. Genomic DNA was isolated in all patients from peripheral blood. The SNP 12109G> A (Mbo I in REN was typified by PCR-restriction fragment length polymorphism. Results: A significant difference in the case group for the SNP 12109G>A was observed. The A allele was increased in women with preterm birth (81% cases vs. 15% control, p A has odds ratio 6.62 (95% confidence interval 3.14–14.15, which means a high risk of preterm birth/premature rupture of membrane in presence of allele A, both in homozygotes and in heterozygotes. Conclusion: Allelic frequency of A of SNP 12109G>A was higher in women with preterm birth than in women with normal vaginal delivery and could be considered a risk factor.
Yee, Lynn M; Liu, Lilly Y; Sakowicz, Allie; Bolden, Janelle R; Miller, Emily S
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.
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
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.
Zeitlin, J.; Szamotulska, K.; Drewniak, N.; Mohangoo, A.D.; Chalmers, J.; Sakkeus, L.; Irgens, L.; Gatt, M.; Gissler, M.; Blondel, B.
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
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...
Petrou, Stavros; Abangma, Giselle; Johnson, Samantha; Wolke, Dieter; Marlow, Neil
for the extremely preterm children as a cohort was 0.789 (0.264), compared to 0.956 (0.102) for the classmates born at term, a mean difference in utility score of 0.167 (95% CI 0.124, 0.209) that was statistically significant (P Utilities Index Mark III multi-attribute utility score by an average of 0.312 (95% CI 0.169, 0.455; P < 0.001), 0.337 (95% CI 0.235, 0.439; P < 0.001) and 0.243 (95% CI 0.159, 0.327; P < 0.001), respectively. The results of this study should be used to inform the development of future economic evaluations of interventions aimed at preventing extremely preterm birth or alleviating its effects.
Richardson, Heidi L; Horne, Rosemary S C
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.
Xu, X; Ding, M; Li, B; Christiani, D C
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.
Ogawa, Yusuke; Takeshima, Nozomi; Furukawa, Toshi A
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.
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
Caldinelli, Chiara; Froudist-Walsh, Sean; Karolis, Vyacheslav; Tseng, Chieh-En; Allin, Matthew P; Walshe, Muriel; Cuddy, Marion; Murray, Robin M; Nosarti, Chiara
Very preterm birth (VPT; fornix, with greater alterations in those individuals who experienced high-grade PBI. When investigating the association between these tracts and memory scores, perseveration errors were associated with the volume of the fornix and dorsal cingulum (connecting medial frontal and parietal lobes). Visuospatial memory scores were associated with the volume of the ventral cingulum (connecting medial parietal and temporal lobes). These results suggest that structural connectivity alterations could underlie memory difficulties in preterm born individuals. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.
Levine, Lisa D; Bogner, Hillary R; Hirshberg, Adi; Elovitz, Michal A; Sammel, Mary D; Srinivas, Sindhu K
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.
Smid, Marcela C; Stuebe, Alison M; Manuck, Tracy A; Sen, Sarbattama
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.
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
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.
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
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.
Alansi, Badriah Ali; Mukhtar, Hytham Bahaeldin; Alazizi, Maher Ahmad; Zuiran, Amjad Ahmad; Al-Atawi, Areej Mohammed; Al-Sabah, Badriah Abdulrahman; Al-Yami, Shrooq Salem
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.
Ishfaq A. Sheikh
Full Text Available Abstract Background Preterm birth (PTB, birth at <37 weeks of gestation, is a significant global public health problem. World-wide, about 15 million babies are born preterm each year resulting in more than a million deaths of children. Preterm neonates are more prone to problems and need intensive care hospitalization. Health issues may persist through early adulthood and even be carried on to the next generation. Majority (70 % of PTBs are spontaneous with about a half without any apparent cause and the other half associated with a number of risk factors. Genetic factors are one of the significant risks for PTB. The focus of this review is on single nucleotide gene polymorphisms (SNPs that are reported to be associated with PTB. Results A comprehensive evaluation of studies on SNPs known to confer potential risk of PTB was done by performing a targeted PubMed search for the years 2007–2015 and systematically reviewing all relevant studies. Evaluation of 92 studies identified 119 candidate genes with SNPs that had potential association with PTB. The genes were associated with functions of a wide spectrum of tissue and cell types such as endocrine, tissue remodeling, vascular, metabolic, and immune and inflammatory systems. Conclusions A number of potential functional candidate gene variants have been reported that predispose women for PTB. Understanding the complex genomic landscape of PTB needs high-throughput genome sequencing methods such as whole-exome sequencing and whole-genome sequencing approaches that will significantly enhance the understanding of PTB. Identification of high risk women, avoidance of possible risk factors, and provision of personalized health care are important to manage PTB.
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
Stricker, Nathanael; Timmesfeld, Nina; Kyvernitakis, Ioannis; Goerges, Janina; Arabin, Birgit
Precocious cervical ripening, as defined by cervical shortening on transvaginal sonography, has prompted a broad evaluation of secondary strategies (such as cerclage, vaginal progesterone, or a cervical pessary) to prevent preterm delivery. However, there is still a lack of direct comparisons between individual treatments or their combinations. We sought to compare at-risk patients and screening patients who had been treated with cervical pessary alone with patients who had been treated with pessary plus vaginal progesterone. This is a pre- and postintervention cohort study from a preterm labor clinic where placement of a cervical pessary has been the standard treatment since 2008 for at-risk women defined by (1) a history of spontaneous preterm birth at suppositories) was prescribed in addition to the pessary. Both at-risk patients (n = 55) and screening patients (n = 51) were treated at the time of diagnosis. The primary outcome was the rate of preterm deliveries at <34 weeks of gestation. Secondary outcomes included deliveries at <28, <32, and <37 weeks of gestation, the days from start of therapy until delivery, a composite index of neonatal outcome, and the number of days in the neonatal intensive care unit. Primary and secondary outcomes were compared between groups with the use of multivariable models to adjust for possible confounders. Delivery at <34 weeks of gestation occurred in 17 of 53 patients (32.1%) who were treated with pessary plus progesterone, compared with 13 of 53 patients (24.5%) who were treated with pessary alone (P = .57). Similarly, there was no difference in the rate of preterm delivery at <28, <32, or <37 weeks of gestation. The composite poor neonatal outcome was 15.1% in the pessary group vs 18.9% in the combined group (P = .96). The mean duration of stay in the neonatal intensive care unit was 46.5 days (range, 9-130 days) in the combined vs 52.0 days (range, 3-151 days) in the pessary group (P < .001). In this cohort study
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.
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
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.
Ibiebele, Ibinabo; Schnitzler, Margaret; Nippita, Tanya; Ford, Jane B
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.
Jeroen J van Vonderen
Full Text Available To retrospectively investigate the changes of SpO2 and respiratory drive in preterm infants at birth after administration of 100% oxygen.Respiratory parameters, FiO2 and oximetry of infants 95% occurred more often in PPV group (53% vs. 69% and lasted longer (70(40-95 vs. 120(50-202 s. In CPAP group, minute volume increased from 134 (76-265 mL/kg/min 1 minute before to 240 (157-370 mL/kg/min (p<0.01 1 minute after start FiO2 1.0 and remained stable at 2 minutes (252 (135-376 mL/kg/min; ns. The rate of rise to maximum tidal volume increased (from 13.8 (8.0-22.4 mL/kg/s to 18.2 (11.0-27.5 mL/kg/s; p<0.0001 to 18.8 (11.8-27.8 mL/kg/s; ns. In the PPV group respiratory rate increased from 0(0-4 to 9(0-20 at 1 minute (p<0.001 to 23 (0-34 breaths per minute at 2 minutes (p<0.01.In preterm infants at birth, a rapid increase in oxygenation, resulting from a transient increase to 100% oxygen might improve respiratory drive, but increases the risk for hyperoxia.
Érica Cesário Defilipo
Full Text Available Abstract Introduction: The Kangaroo Mother Care (KMC method is a significant neonatal alternative that ensures better quality humanized care for preterm and low birth weight newborns. Objective: To analyze the immediate physiological effects of the kangaroo position in critically ill newborns. Methods: Open clinical trial with parallel interventions, involving preterm (up to 28 days old low or very low birth weight newborns (minimum weight of 1,250 grams of both sexes, that were clinically stable and undergoing enteral nutrition. The degree of respiratory distress was assessed and quantified using the Silverman-Anderson scoring system. Heart rate and peripheral oxygen saturation were collected using a pulse oximeter. Respiratory rate was determined by auscultation for one minute. The newborns were submitted to the kangaroo position once only, for 90 minutes. Results: Participants were 30 newborns, 56.7% of which were girls. Comparison of the variables before and after application of the kangaroo position using the Wilcoxon test showed a statistically significant reduction in respiratory rate (p = 0.02 and Silverman-Anderson score (p < 0.01. The remaining variables showed no significant differences: heart rate (p = 0.21, peripheral oxygen saturation (p = 0.26 and axillary temperature (p = 0.12. Conclusion: There was a decline in the respiratory rate and Silverman-Anderson score after application of the kangaroo position, while peripheral oxygen saturation, axillary temperature and heart rate remained stable.
Petersen, Christina B; Mortensen, Laust H; Morgen, Camilla S; Madsen, Mia; Schnor, Ole; Arntzen, Annett; Gissler, Mika; Cnattingius, Sven; Andersen, Anne-Marie Nybo
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.
Stephen S C Chim
Full Text Available BACKGROUND: Spontaneous preterm birth (SPB, before 37 gestational weeks is a major cause of perinatal mortality and morbidity, but its pathogenesis remains unclear. Studies on SPB have been hampered by the limited availability of markers for SPB in predelivery clinical samples that can be easily compared with gestational age-matched normal controls. We hypothesize that SPB involves aberrant placental RNA expression, and that such RNA transcripts can be detected in predelivery maternal plasma samples, which can be compared with gestational age-matched controls. PRINCIPAL FINDINGS: Using gene expression microarray to profile essentially all human genes, we observed that 426 probe signals were changed by >2.9-fold in the SPB placentas, compared with the spontaneous term birth (STB placentas. Among the genes represented by those probes, we observed an over-representation of functions in RNA stabilization, extracellular matrix binding, and acute inflammatory response. Using RT-quantitative PCR, we observed differences in the RNA concentrations of certain genes only between the SPB and STB placentas, but not between the STB and term elective cesarean delivery placentas. Notably, 36 RNA transcripts were observed at placental microarray signals higher than a threshold, which indicated the possibility of their detection in maternal plasma. Among them, the IL1RL1 mRNA was tested in plasma samples taken from 37 women. It was detected in 6 of 10 (60% plasma samples collected during the presentation of preterm labor (≤32.9 weeks in women eventually giving SPB, but was detected in only 1 of 27 (4% samples collected during matched gestational weeks from women with no preterm labor (Fisher exact test, p = 0.00056. CONCLUSION: We have identified 36 SPB-associated RNA transcripts, which are possibly detectable in maternal plasma. We have illustrated that the IL1RL1 mRNA was more frequently detected in predelivery maternal plasma samples collected from women
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
Mwansa-Kambafwile, Judith; Cousens, Simon; Hansen, Thomas; Lawn, Joy E
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.
Peltier, Morgan R; Faux, David S; Hamblin, Steven D; Cooper, Corrina; Silver, Robert M; Esplin, M Sean
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.
Hahn, Gitte Holst; Maroun, Lisa L; Larsen, Nanna Brink
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....
Henderson, Jennifer J; Hartmann, Peter E; Newnham, John P; Simmer, Karen
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.
Manuck, Tracy A
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.
Giurgescu, Carmen; Sanguanklin, Natthananporn; Engeland, Christopher G; White-Traut, Rosemary C; Park, Chang; Mathews, Herbert L; Janusek, Linda Witek
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.
Helen Y How
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
Nicole S. Olgun
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.
Yin, Nanlin; Wang, Hanbing; Zhang, Hua; Ge, Huisheng; Tan, Bing; Yuan, Yu; Luo, Xiaofang; Olson, David M; Baker, Philip N; Qi, Hongbo
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.
Gernand, A D; Simhan, H N; Baca, K M; Caritis, S; Bodnar, L M
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.
Khashan, Ali S
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.
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.
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,
Almeida, Joanna; Bécares, Laia; Erbetta, Kristin; Bettegowda, Vani R; Ahluwalia, Indu B
Introduction Racial/ethnic inequities in low birth weight (LBW) and preterm birth (PTB) persist in the United States. Research has identified numerous risk factors for adverse birth outcomes; however, they do not fully explain the occurrence of, or inequalities in PTB/LBW. Stress has been proposed as one explanation for differences in LBW and PTB by race/ethnicity. Methods Using the Pregnancy Risk Assessment Monitoring System (PRAMS) data from 2012 to 2013 for 21 states and one city (n = 15,915) we used Poisson regression to estimate the association between acute, financial and relationship stressors and LBW and PTB, and to examine the contribution of these stressors individually and simultaneously to racial/ethnic differences in LBW and PTB. Results Adjusting for age and race/ethnicity, acute (p < 0.001), financial (p < 0.001) and relationship (p < 0.05) stressors were associated with increased risk of LBW, but only acute (p < 0.05) and financial (p < 0.01) stress increased risk of PTB. Across all models, non-Hispanic blacks had higher risk of LBW and PTB relative to non-Hispanic whites (IRR 1.87, 95% CI 1.55, 2.27 and IRR 1.46, 95% CI 1.18, 1.79). Accounting for the effects of stressors attenuated the risk of LBW and PTB by 17 and 22% respectively, but did not fully explain the increased likelihood of LBW and PTB among non-Hispanic blacks. Discussion Results of this study demonstrate that stress may increase the risk of LBW and PTB. While stressors may contribute to racial/ethnic differences in LBW and PTB, they do not fully explain them. Mitigating stress during pregnancy may help promote healthier birth outcomes and reduce racial/ethnic inequities in LBW and PTB.
Hemsworth, Erin M; O'Reilly, Amanda M; Allen, Victoria M; Kuhle, Stefan; Brock, Jo-Ann K
To estimate the association of a maternal factor V Leiden (FVL) mutation with SGA and preterm birth. We performed a search of PubMed, Embase, Scopus, CINAHL, and the Cochrane Library from inception to April 2016 for cohort and case-control studies of women with FVL mutation and associated outcomes of SGA and preterm birth that included a reference group without FVL mutation. Additional studies were identified from reference lists of relevant research and review articles. Two authors (JKB, AMO) independently examined the abstracts of the potentially eligible studies, and full texts of eligible studies were retrieved for further evaluation. Disagreements were resolved by consensus. We identified 42 studies suitable for inclusion in the meta-analysis. Thirty-two studies evaluated SGA, and 18 studies assessed preterm birth. Study quality was assessed using the Newcastle Ottawa Scale. A random effects model with inverse variance weighting was used to calculate pooled ORs and 95% CIs. Subgroup analyses were performed by study design. The overall OR associating FVL mutation with SGA was significant (OR 1.40, 95% CI 1.18 to 1.67). Analysis of 13 cohort studies resulted in an OR of 1.20 (95% CI 1.03 to 1.41), and data from 19 case-control studies yielded an OR of 1.86 (95% CI 1.35 to 2.56). There was no significant association between FVL mutation and preterm birth (OR 1.17, 95% CI 1.00 to 1.37) when all groups were studied, but the association was significant for case-control studies alone (OR 1.40, 95% CI 1.05 to 1.86). There is an increased risk for SGA in pregnancies complicated by FVL mutation in both cohort and case-control study designs. The risk of preterm birth with FVL mutation is less clear, although there is conflicting evidence from cohort and case-control studies regarding the risk of preterm birth associated with FVL mutation. Copyright © 2016 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada
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
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.
Staps, Pippa; Hogeveen, Marije; Fuijkschot, Joris; van Drongelen, Joris; Willemsen, Michèl A A P
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.
Lee, Hsin-Chien; Lin, Herng-Ching
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.
Lawn, Joy E; Mwansa-Kambafwile, Judith; Horta, Bernardo L; Barros, Fernando C; Cousens, Simon
Background ‘Kangaroo mother care’ (KMC) includes thermal care through continuous skin-to-skin contact, support for exclusive breastfeeding or other appropriate feeding, and early recognition/response to illness. Whilst increasingly accepted in both high- and low-income countries, a Cochrane review (2003) did not find evidence of KMC’s mortality benefit, and did not report neonatal-specific data. Objectives The objectives of this study were to review the evidence, and estimate the effect of KMC on neonatal mortality due to complications of preterm birth. Methods We conducted systematic reviews. Standardized abstraction tables were used and study quality assessed by adapted GRADE methodology. Meta-analyses were undertaken. Results We identified 15 studies reporting mortality and/or morbidity outcomes including nine randomized controlled trials (RCTs) and six observational studies all from low- or middle-income settings. Except one, all were hospital-based and included only babies of birth-weight community-based trial had missing birthweight data, as well as other limitations and was excluded. Neonatal-specific data were supplied by two authors. Meta-analysis of three RCTs commencing KMC in the first week of life showed a significant reduction in neonatal mortality [relative risk (RR) 0.49, 95% confidence interval (CI) 0.29–0.82] compared with standard care. A meta-analysis of three observational studies also suggested significant mortality benefit (RR 0.68, 95% CI 0.58–0.79). Five RCTs suggested significant reductions in serious morbidity for babies <2000 g (RR 0.34, 95% CI 0.17–0.65). Conclusion This is the first published meta-analysis showing that KMC substantially reduces neonatal mortality amongst preterm babies (birth weight <2000 g) in hospital, and is highly effective in reducing severe morbidity, particularly from infection. However, KMC remains unavailable at-scale in most low-income countries. PMID:20348117
Kazemier, B M; Buijs, P E; Mignini, L; Limpens, J; de Groot, C J M; Mol, B W J
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.
Full Text Available Abstract Background This study compares the Bayesian and frequentist (non-Bayesian approaches in the modelling of the association between the risk of preterm birth and maternal proximity to hazardous waste and pollution from the Sydney Tar Pond site in Nova Scotia, Canada. Methods The data includes 1604 observed cases of preterm birth out of a total population of 17559 at risk of preterm birth from 144 enumeration districts in the Cape Breton Regional Municipality. Other covariates include the distance from the Tar Pond; the rate of unemployment to population; the proportion of persons who are separated, divorced or widowed; the proportion of persons who have no high school diploma; the proportion of persons living alone; the proportion of single parent families and average income. Bayesian hierarchical Poisson regression, quasi-likelihood Poisson regression and weighted linear regression models were fitted to the data. Results The results of the analyses were compared together with their limitations. Conclusion The results of the weighted linear regression and the quasi-likelihood Poisson regression agrees with the result from the Bayesian hierarchical modelling which incorporates the spatial effects.
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
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
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
BACKGROUND: Human milk banking has been available in many countries for the last three decades. The milk provided from milk banking is predominantly term breast milk, but some milk banks provide preterm breast milk. There are a number of differences between donor term and donor preterm human milk. OBJECTIVES: To determine the effect of banked preterm milk compared with banked term milk regarding growth and developmental outcome in very low birth weight infants (infants weighing less than 1500 g). SEARCH STRATEGY: We used the standard methods of the Cochrane Neonatal Review Group, including a search of the Cochrane Neonatal Group specialized register and the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, January 2010). We searched the computerised bibliographic databases MEDLINE (1966 to February 2010), EMBASE (1988 to February 2010) and Web of Science (1975 to February 2010). We searched reference lists of all selected articles, review articles and the Oxford Database of Perinatal Trials. We also searched abstracts from neonatal and pediatric meetings (PAS electronic version from 2000 to 2009, ESPR hand search from 2000 to 2009). We applied no language restrictions. SELECTION CRITERIA: Randomised and quasi-randomised trials comparing banked donor preterm milk with banked donor term milk regarding growth and developmental outcomes in very low birth weight infants DATA COLLECTION AND ANALYSIS: We planned to perform assessment of methodology regarding blinding of randomisation, intervention and outcome measurements as well as completeness of follow-up. We planned to evaluate treatment effect using a fixed-effect model using relative risk (RR), relative risk reduction, risk difference (RD) and number needed to treat (NNT) for categorical data and using mean, standard deviation and weighted mean difference (WMD) for continuous data. We planned an evaluation of heterogeneity. MAIN RESULTS: No studies met the inclusion criteria. AUTHORS
Yellon, Steven M.; Dobyns, Abigail E.; Beck, Hailey L.; Kurtzman, James T.; Garfield, Robert E.; Kirby, Michael A.
A decline in serum progesterone or antagonism of progesterone receptor function results in preterm labor and birth. Whether characteristics of premature remodeling of the cervix after antiprogestins or ovariectomy are similar to that at term was the focus of the present study. Groups of pregnant rats were treated with vehicle, a progesterone receptor antagonist (onapristone or mifepristone), or ovariectomized on day 17 postbreeding. As expected, controls given vehicle delivered at term while rats delivered preterm after progesterone receptor antagonist treatment or ovariectomy. Similar to the cervix before term, the preterm cervix of progesterone receptor antagonist-treated rats was characterized by reduced cell nuclei density, decreased collagen content and structure, as well as a greater presence of macrophages per unit area. Thus, loss of nuclear progesterone receptor-mediated actions promoted structural remodeling of the cervix, increased census of resident macrophages, and preterm birth much like that found in the cervix at term. In contrast to the progesterone receptor antagonist-induced advance in characteristics associated with remodeling, ovariectomy-induced loss of systemic progesterone did not affect hypertrophy, extracellular collagen, or macrophage numbers in the cervix. Thus, the structure and macrophage census in the cervix appear sufficient for premature ripening and birth to occur well before term. With progesterone receptors predominantly localized on cells other than macrophages, the findings suggest that interactions between cells may facilitate the loss of progesterone receptor-mediated actions as part of a final common mechanism that remodels the cervix in certain etiologies of preterm and with parturition at term. PMID:24339918
Khalil, M. R.; Uldbjerg, N.; Thorsen, P.
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...
Kátia Maria Dmytraczenko Franco
Full Text Available This study investigated possible prenatal and neonatal variables that may influence the prevalence of tooth enamel hypoplasia in preterm and low birth weight children (LBW and a matched control group of term children with normal birth weight (NBW. The study sample consisted of 61 children born preterm and with LBW examined at 18-34 months of age. The control group was formed by 61 infants born full term and with NBW examined at 31-35 months of age. All children were born at the Center of Integrated Attention of Women's Health (CAISM-UNICAMP. FDI criteria were followed for dental examination. Medical data was collected retrospectively from hospital records. Among preterms, 57.4% had some type of developmental defects of enamel (DDE, 52.5 % had opacities and 21.3 % presented hypoplasia. Among full-term children, 24.6% presented DDE, 24.6% had opacities and 3.3% had hypoplasia. LBW preterm infants presented a higher prevalence of hypoplasia than NBW controls. The deciduous teeth most affected by hypoplasia were maxillary incisors. There was no significant association with prenatal variables; among neonatal variables there was a significant association with respiratory distress syndrome and neurological examination at discharge with an altered result.
Brumberg, H L; Shah, S I
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.
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Zhu, Tong; Liu, Tian-Jing; Ge, Xin; Kong, Juan; Zhang, Li-Jun; Zhao, Qun
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.
Bohîlțea, R E; Munteanu, O; Turcan, N; Baros, A; Bodean, O; Voicu, D; Cîrstoiu, M M
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
Hackney, David N; Kuo, Kelly; Petersen, Rebecca J; Lappen, Justin R
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.
Lodha, Abhay; Zhu, Qiaohao; Lee, Shoo K; Shah, Prakesh S
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.
Yoshida, Tomohide; Nagasaki, Hiraku; Asato, Yoshihide; Ohta, Takao
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.
Gennaro, Susan; Shults, Justine; Garry, David J
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.
Dahan-Oliel, Noemi; Mazer, Barbara; Majnemer, Annette
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…
Cilieborg, Malene S.; Boye, Mette; Mølbak, Lars
). 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...
Eveline Campos Monteiro de Castro
Full Text Available Abstract Objective: To evaluate factors associated with neonatal death within 24 hours after birth in very low birth weight preterm newborns. Methods: Prospective cohort of live births with gestational age of 230/7–316/7 weeks, birth weight of 500–1499g without malformations, in 19 public maternity hospitals in nine capitals in northeastern Brazil from July to December 2007. The 19 hospitals were assessed in relation to physical resources, equipment, human resources and aiming at quality in care initiatives. Hospital, maternal and neonatal characteristics, neonatal morbidity, neonatal procedures and interventions were compared between preterm newborns that died or survived up to 24 hours of life. The variables associated with death within 24 hours after birth were determined by logistic regression. Results: Of the 627 newborns enrolled in the study, 179 (29% died within 168 hours after birth, of which 59 (33% up to 24 hours and 97 (54% up to 48 hours after birth. The variables associated with death <24h were: weight <1000g (2.94; 1.32–6.53, 5th minute Apgar <7 (7.17; 3.46–14.88, male gender (2.99; 1.39–6.47. A better hospital structure was a protective factor for early neonatal death (odds ratio: 0.34; 95% confidence interval: 0.17–0.71. Conclusions: The high neonatal mortality on the first day of life in capital cities of Northeast Brazil is associated with biological variables such as weight and gender of the newborn, as well as low vitality at birth and a worse infrastructure of the hospital where the birth occurred.
Abbott, Danielle S; Radford, Samara K; Seed, Paul T; Tribe, Rachel M; Shennan, Andrew H
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.
Topp, Monica Wedell; Langhoff-Roos, J; Uldall, P
.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....
Alice M. Kiy
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.
Parisi, L; Di Filippo, T; Firrigno, L; La Grutta, S; Testa, D; Roccella, M
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.
Dommelen, P. van; Verkerk, P.H.; Straaten, H.L. van
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
Schaaf, Jelle M.; Mol, Ben-Willem J.; Abu-Hanna, Ameen; Ravelli, Anita C. J.
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
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
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
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 ...
Mohangoo1, A.; Lanting, C.; Bennebroek Gravenhorst, J.; Verloove-Vanhorick, P.; Buitendijk, S.
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
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
Ju Young Yoon
Full Text Available PurposeThis study investigated blood glucose levels in preterm babies according to gestational age (GA.MethodsSubjects were 141 preterm infants with a GA180 mg/dL.ResultsDuring the 7 days after birth, hypo- and hyperglycemia occurred in 29 (29 of 141, 20.6% and 42 (42 of 141, 29.8% neonates, respectively. During the first 2 hours, 18 neonates (12.8% exhibited hypoglycemia, and only 2 (2 of 141, 1.4% developed hyperglycemia. From 6 to 24 hours, hypo- and hyperglycemia were observed in 0 and 9 (9 of 141, 6.4% neonates, respectively. Infants small for their GA (SGA were at risk for hypoglycemia both within 24 hours (odds ratio [OR], 2.718; P=0.045 and during days 2 to 7 (OR, 4.454; P=0.006, and hyperglycemia during days 2 to 7 (OR, 3.200; P=0.005. Low 1-minite Apgar score was risk factor for both hypo- and hyperglycemia during days 2 to 7 (OR, 0.756; P=0.035 for hypoglycemia and OR, 0.789; P=0.016 for hyperglycemia. Both hypo- and hyperglycemia within 24 hours were less common in those who started feeding (OR, 0.294; P=0.013 for hypoglycemia and OR, 0.162; P=0.011 for hyperglycemia.ConclusionCareful blood glucose level monitoring is required in preterm infants, especially SGA infants or those with low Apgar score. Early feeding could be beneficial for maintaining euglycemia.
Wei, S; Lai, K; Yang, Z; Zeng, K
We performed a meta-analysis to identify the association between systemic lupus erythematosus (SLE) and preterm birth. In this study, we studied the effects of SLE, SLE disease activity, a history of nephritis and active nephritis on preterm birth. Searches were conducted before 20 May 2016 of PubMed, Embase, Medline and Cochrane Library of literature and article reference lists. Eleven observational case-control studies and thirteen cohort studies met the inclusion criteria. The pooled relative risk (RR) for the risk of preterm birth in SLE patients versus controls was 2.05 (95% confidence interval (CI): 1.72-3.32); for active SLE patients versus inactive was 2.98 (95% CI: 2.32-3.83); for SLE patients with a history of lupus nephritis versus those without nephritis it was 1.62 (95% CI: 1.35-1.95); and for SLE patients with active nephritis versus those with quiescent nephritis it was 1.78 (95% CI: 1.17-2.70). In summary, this study identified a significant association in the above results. This association was more significant in active SLE patients versus inactive. With respect to SLE itself, active inflammation (such as disease activity) may be more hazardous for the management of the pregnancy. This suggests that it is essential to control disease activity in order to achieve a better outcome of SLE pregnancy.
Stayner, Leslie Thomas; Almberg, Kirsten; Jones, Rachael
between the exposures and the adverse birth outcomes. Models were fitted with varying restrictions on the percentage of private well usage in the counties in order to limit the degree of exposure misclassification. Results: Estimated water concentrations of atrazine (mean=0.42 ppb) and nitrate (mean=0......Background: Atrazine and nitrate are common contaminants in water, and there is limited evidence that they are associated with adverse birth outcomes. The objective of this study was to examine whether atrazine and nitrate in water are associated with an increased risk of preterm delivery (PTD......) and term low birth weight (LBW). Methods: The study included a total of 134,258 singletons births born between January 1, 2004 and December 31, 2008 from 46 counties in four Midwestern states with public water systems that were included in the U.S. Environmental Protection Agency (EPA)’s atrazine...
Hollegaard, Stine; Vogel, Ida; Thorsen, Poul
, Chlamydia antigen, Chlamydia IgG, Chlamydia complex B, C and GF levels were measured. Spontaneous preterm birth (ectopic pregnancies. Crude and adjusted relative risks (RR......) 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.......2-12.4)]. CONCLUSION: A previous infection with C. trachomatis C-complex was associated with an increased risk for spontaneous PTB and may potentially contribute to subfertility, infertility and ectopic pregnancy....
Shahirose S. Premji
Full Text Available Preterm birth (PTB is a final common outcome resulting from many interrelated etiological pathways; of particular interest is antenatal psychosocial distress (i.e., stress, anxiety, and depression. In LMI countries, both exposure to severe life stressors and rate of PTB are on average greater when compared with high-income countries. In LMI countries women are exposed to some of the most extreme psychosocial stress worldwide (e.g., absolute poverty, limited social resources. High prevalence of antenatal stress and depression have been observed in some studies from LMI countries. We propose a psychosocial, biological, and behavioral model for investigating the complex multisystem interactions in stress responses leading to PTB and explain the basis of this approach. We discuss ethical considerations for a psychosocial, biological, and behavioral screening tool to predict PTB from a LMI country perspective.
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
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
Patel, Archana; Prakash, Amber Abhijeet; Pusdekar, Yamini V; Kulkarni, Hemant; Hibberd, Patricia
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.
Romero, Roberto; Conde-Agudelo, Agustin; Da Fonseca, Eduardo; O'Brien, John M; Cetingoz, Elcin; Creasy, George W; Hassan, Sonia S; Nicolaides, Kypros H
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.
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.
Østergaard, Mette V; Cilieborg, Malene S.; Skovgaard, Kerstin
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...
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
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
Shaw, Julia C; Palliser, Hannah K; Dyson, Rebecca M; Berry, Mary J; Hirst, Jonathan J
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
Liu, Shiliang; Basso, Olga; Kramer, Michael S
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: email@example.com.
Huynh, M; Maroko, A R
Adverse birth outcomes have been linked to neighborhood level socioeconomic status. However, little work has examined the influence of social and economic change over time (i.e., gentrification) on health. This study aims to assess the association between gentrification and preterm birth (PTB) while examining the modifying effect of maternal race/ethnicity and educational attainment. New York City births, 2008–2010, (n=126,165) were linked to a measure of gentrification at the community district level (n=59). The gentrification measure was calculated using percent change in education level, poverty level, and median household income (MHI) between the 2005–2009 American Community Survey and the 1990 Census. PTB was defined as clinical gestational age less than 37 weeks. Generalized estimating equations were utilized to examine the association. Gentrification (i.e., increase in residents with a college education, increase in MHI, and decrease in residents living below the poverty line) was not associated with PTB. However, among Non-Hispanic Blacks, very high gentrification was adversely associated with PTB (AOR, 1.16; 95 % CI, 1.01–1.33) as compared to those who lived in a very low gentrified neighborhood. Among non- Hispanic Whites, living in a very high gentrified neighborhood was protective as compared to living in a very low gentrified neighborhood (AOR, 0.78; 95 % CI, 0.64– 0.94). Although there is a need to develop a more nuanced measure of gentrification, these results indicate that changes in the economic character of a neighborhood may have a significant influence on birth outcomes.
Full Text Available Maternal depression and anxiety represent risk factors for the quality of early mother-preterm infant interactions, especially in the case of preterm birth. Despite the presence of many studies on this topic, the comorbidity of depressive and anxious symptoms has not been sufficiently investigated, as well as their relationship with the severity of prematurity and the quality of early interactions. The Aim of this study was to evaluate the quality of early mother-infant interactions and the prevalence of maternal depression and anxiety comparing dyads of Extremely Low Birth Weight-ELBW and Very Low Birth Weight-VLBW preterm infants with full-term ones. 77 preterm infants (32 ELBW; 45 VLBW and 120 full term (FT infants and their mothers were recruited. At 3 months of corrected age, 5 minutes of mother-infant interactions were recorded and later coded through the Global Ratings Scales. Mothers completed the Edinburgh Postnatal Depression Scale and Penn State Worry Questionnaire. Infant levels of development were assessed through the Griffiths Mental Development Scales. A relation emerged among the severity of prematurity, depression, anxiety, and the quality of interactions. When compared with the FT group, the ELBW interactions were characterized by high maternal intrusiveness and low remoteness, while the VLBW dyads showed high levels of maternal sensitivity and infant communication. Depression was related to maternal remoteness and negative affective state, anxiety to low sensitivity, while infant interactive behaviours were impaired only in case of comorbidity. ELBW’s mothers showed the highest prevalence of depressive and anxious symptoms; moreover, only in FT dyads, low maternal sensitivity, negative affective state and minor infant communication were associated to the presence of anxious symptoms. The results confirmed the impact of prematurity on mother–infant interactions and on maternal affective state. Early diagnosis help to plan
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
Eiríksdóttir, Védís Helga; Ásgeirsdóttir, Tinna Laufey; Bjarnadóttir, Ragnheiður Ingibjörg; Kaestner, Robert; Cnattingius, Sven; Valdimarsdóttir, Unnur Anna
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
Hulzebos, Christian V; Bos, Arend F; Anttila, Eija; Hallman, Mikko; Verkade, Henkjan J
To determine the relationship between early postnatal dexamethasone (DXM) treatment and the severity of hyperbilirubinemia in extreme low birth weight (ELBW) preterm infants. In 54 ELBW preterm infants, total serum bilirubin concentrations (TSB) and phototherapy (PT) data during the first 10 days were evaluated retrospectively. ELBW infants had participated in a randomized controlled trial of early DXM treatment which aimed to assess effects on chronic lung disease. Infants had been treated with DXM (0.25 mg/kg twice daily at postnatal day 1 and 2) or with placebo (normal saline). Analysis was performed on an intention to treat basis. Twenty-five Infants had been randomized into the DXM group; 29 into the placebo group. Mean (±SD) TSB [120 (±19) μmol/L vs. 123 (±28) μmol/L, DXM versus placebo, respectively] and maximum TSB [178 (±23) μmol/L vs. 176 (±48), DXM versus placebo, respectively] concentrations were similar. TSB concentrations peaked 30 h earlier in the DXM group (p ≤ 0.05). The need for PT as well as the duration of PT was similar in both groups. Early DXM treatment does not affect the severity of neonatal hyperbilirubinemia in ELBW preterm infants. Our results seem compatible with the concept that factors other than bilirubin conjugation capacity are important for the pathophysiology of neonatal jaundice in ELBW preterm infants. © 2010 The Author(s)/Acta Paediatrica © 2010 Foundation Acta Paediatrica.
Draper, Elizabeth S; Zeitlin, Jennifer; Fenton, Alan C
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...
Hodel, Amanda S.; Brumbaugh, Jane E.; Morris, Alyssa R.; Thomas, Kathleen M.
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…
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
Grance, Thayana Regina de Souza; Serafin, Paula de Oliveira; Thomaz, Débora Marchetti Chaves; Palhares, Durval Batista
OBJECTIVE: To develop a homologous human milk supplement for very low-birth weight infant feeding, using an original and simplified methodology, to know the nutritional composition of human milk fortified with this supplement and to evaluate its suitability for feeding these infants. METHODS: For the production and analysis of human milk with the homologous additive, 25 human milk samples of 45mL underwent a lactose removal process, lyophilization and then were diluted in 50mL of human milk. Measurements of lactose, proteins, lipids, energy, sodium, potassium, calcium, phosphorus and osmolality were performed. RESULTS: The composition of the supplemented milk was: lactose 9.22±1.00g/dL; proteins 2.20±0.36g/dL; lipids 2.91±0.57g/dL; calories 71.93±8.69kcal/dL; osmolality 389.6±32.4mOsmol/kgH2O; sodium 2.04±0.45mEq/dL; potassium 1.42±0.15mEq/dL; calcium 43.44±2.98mg/dL; and phosphorus 23.69±1.24mg/dL. CONCLUSIONS: According to the nutritional contents analyzed, except for calcium and phosphorus, human milk with the proposed supplement can meet the nutritional needs of the very low-birth weight preterm infant. PMID:25662564
Thayana Regina de Souza Grance
Full Text Available OBJECTIVE: To develop a homologous human milk supplement for very low-birth weight infant feeding, using an original and simplified methodology, to know the nutritional composition of human milk fortified with this supplement and to evaluate its suitability for feeding these infants. METHODS: For the production and analysis of human milk with the homologous additive, 25 human milk samples of 45mL underwent a lactose removal process, lyophilization and then were diluted in 50mL of human milk. Measurements of lactose, proteins, lipids, energy, sodium, potassium, calcium, phosphorus and osmolality were performed. RESULTS: The composition of the supplemented milk was: lactose 9.22±1.00g/dL; proteins 2.20±0.36g/dL; lipids 2.91±0.57g/dL; calories 71.93±8.69kcal/dL; osmolality 389.6±32.4mOsmol/kgH2O; sodium 2.04±0.45mEq/dL; potassium 1.42±0.15mEq/dL; calcium 43.44±2.98mg/dL; and phosphorus 23.69±1.24mg/dL. CONCLUSIONS: According to the nutritional contents analyzed, except for calcium and phosphorus, human milk with the proposed supplement can meet the nutritional needs of the very low-birth weight preterm infant.
Al-Dabbagh Samim A
Full Text Available Abstract Background Preterm birth (PTBis a major clinical problem associated with perinatal mortality and morbidity. The aim of the present study is to identify risk factors associated with PTB in Mosul, Iraq. Methods A case-control study was conducted in Mosul, Iraq, from 1st September, 2003 to 28th February, 2004. Results A total of 200 cases of PTB and 200 controls of full-term births were screened and enrolled in the study. Forward logistic regression analysis was used in the analysis. Several significant risk associations between PTB and the following risk factors were identified: poor diet (OR = 4.33, heavy manual work (OR = 1.70, caring for domestic animals (OR = 5.06, urinary tract infection (OR = 2.85, anxiety (OR = 2.16, cervical incompetence (OR = 4.74, multiple pregnancies (OR = 7.51, direct trauma to abdomen (OR = 3.76 and abortion (OR = 6.36. Conclusion The main determinants of PTB in Iraq were low socio-economic status and factors associated with it, such as heavy manual work and caring for domestic animals, in addition to urinary tract infections and poor obstetric history.
Minguet-Romero, Ramón; Cruz-Cruz, Polita del Rocío; Ruíz-Rosas, Roberto Aguli; Hernández-Valencia, Marcelino
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.
Saccone, Gabriele; Maruotti, Giuseppe Maria; Giudicepietro, Antonia; Martinelli, Pasquale
singleton pregnancies and short transvaginal cervical length, use of a cervical pessary, compared with no pessary use, resulted in a lower rate of spontaneous preterm birth at less than 34 weeks of gestation. The results of this single-center, nonblinded study among selected pregnant women require confirmation in multicenter clinical trials. clinicaltrials.gov Identifier: NCT02716909.
Rao, C V
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.
Durnwald, Celeste P
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.
Aanes, Synne; Bjuland, Knut Jørgen; Skranes, Jon; Løhaugen, Gro C C
The hippocampi are regarded as core structures for learning and memory functions, which is important for daily functioning and educational achievements. Previous studies have linked reduction in hippocampal volume to working memory problems in very low birth weight (VLBW; ≤ 1500 g) children and reduced general cognitive ability in VLBW adolescents. However, the relationship between memory function and hippocampal volume has not been described in VLBW subjects reaching adulthood. The aim of the study was to investigate memory function and hippocampal volume in VLBW young adults, both in relation to perinatal risk factors and compared to term born controls, and to look for structure-function relationships. Using Wechsler Memory Scale-III and MRI, we included 42 non-disabled VLBW and 61 control individuals at age 19-20 years, and related our findings to perinatal risk factors in the VLBW-group. The VLBW young adults achieved lower scores on several subtests of the Wechsler Memory Scale-III, resulting in lower results in the immediate memory indices (visual and auditory), the working memory index, and in the visual delayed and general memory delayed indices, but not in the auditory delayed and auditory recognition delayed indices. The VLBW group had smaller absolute and relative hippocampal volumes than the controls. In the VLBW group inferior memory function, especially for the working memory index, was related to smaller hippocampal volume, and both correlated with lower birth weight and more days in the neonatal intensive care unit (NICU). Our results may indicate a structural-functional relationship in the VLBW group due to aberrant hippocampal development and functioning after preterm birth. Copyright © 2014 Elsevier Inc. All rights reserved.
Johnson, Samantha; Waheed, Ghazala; Manktelow, Bradley N; Field, David J; Marlow, Neil; Draper, Elizabeth S; Boyle, Elaine M
To explore patterns of comorbidity in cognitive and behavioral outcomes at 2 years' corrected age among children born late or moderately preterm (LMPT) and to identify predictors of different patterns of comorbidity. Geographical, prospective population-based cohort study of 1139 infants born LMPT (32 0/7 to 36 6/7 weeks' gestation) and 1255 infants born at term (37 0/7 to 42 6/7 weeks' gestation). Parent questionnaires were obtained to identify impaired cognitive and language development, behavioral problems, delayed social-emotional competence, autistic features, and clinically significant eating difficulties at 24 months corrected age for 638 (57%) children born LMPT and 765 (62%) children born at term. Latent class analysis revealed 2 profiles of development among the term group: optimal (84%) and a profile of social, emotional, and behavioral impairments termed "nonoptimal" (16%). These 2 profiles were also identified among the LMPT group (optimal: 67%; nonoptimal: 26%). In the LMPT group, a third profile was identified (7%) that was similar to the phenotype previously identified in infants born very preterm. Nonwhite ethnicity, socioeconomic risk, and not receiving breast milk at hospital discharge were risk factors for nonoptimal outcomes in both groups. Male sex, greater gestational age, and pre-eclampsia were only associated with the preterm phenotype. Among children born LMPT with parent-reported cognitive or behavioral impairments, most had problems similar to the profile of difficulties observed in children born at term. A smaller proportion of children born LMPT had impairments consistent with the "very preterm phenotype" which are likely to have arisen through a preterm pathway. These results suggest that prematurity may affect development through several etiologic pathways in the late and moderately preterm population. Copyright © 2017 Elsevier Inc. All rights reserved.
Duvekot Johannes J
Full Text Available Abstract Background Women with a short cervical length in mid-trimester pregnancy have a higher risk of preterm birth and therefore a higher rate of neonatal mortality and morbidity. Progesterone can potentially decrease the number of preterm births and lower neonatal mortality and morbidity. Previous studies showed good results of progesterone in women with either a history of preterm birth or a short cervix. However, it is unknown whether screening for a short cervix and subsequent treatment in mid trimester pregnancy is effective in low risk women. Methods/Design We plan a combined screen and treat study among women with a singleton pregnancy without a previous preterm birth. In these women, we will measure cervical length at the standard anomaly scan performed between 18 and 22 weeks. Women with cervical length ≤ 30 mm at two independent measurements will be randomly allocated to receive either vaginal progesterone tablets or placebo between 22 and 34 weeks. The primary outcome of this trial is adverse neonatal condition, defined as a composite outcome of neonatal mortality and severe morbidity. Secondary outcomes are time to delivery, preterm birth rate before 32, 34 and 37 weeks, days of admission in neonatal intensive care unit, maternal morbidity, maternal admission days for preterm labour and costs. We will assess growth, physical condition and neurodevelopmental outcome of the children at two years of age. Discussion This study will provide evidence for the usefulness and cost-effectiveness of screening for short cervical length at the 18-22 weeks and subsequent progesterone treatment among low risk women. Trial registration Netherlands Trial Register (NTR: NTR207
Sadeghi, Taktom; Ahmadi, Amirmasoud; Javadian, Maryam; Gholamian, Sayyed Asghar; Delavar, Mouloud Agajani; Esmailzadeh, Sedigheh; Ahmadi, Bahare; Hadighi, Mozhgan Sadat Hassanpour
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.
Nicoll, Jessica; Cheung, Po-Yin; Aziz, Khalid; Rajani, Vishaal; O'Reilly, Megan; Pichler, Gerhard; Schmölzer, Georg M
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.
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.
Tambor, Vojtech; Vajrychova, Marie; Kacerovsky, Marian; Link, Marek; Domasinska, Petra; Menon, Ramkumar; Lenco, Juraj
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).
Claire L. Wood
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.
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, ...
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 ...
DeFranco, Emily A; Lian, Min; Muglia, Louis A; Schootman, Mario
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.
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.
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...
Blair, Lisa M; Porter, Kyle; Leblebicioglu, Binnaz; Christian, Lisa M
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.
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
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...
... 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.
Gustaaf Albert Dekker
Full Text Available OBJECTIVES: To identify risk factors for spontaneous preterm birth (birth <37 weeks gestation with intact membranes (SPTB-IM and SPTB after prelabour rupture of the membranes (SPTB-PPROM for nulliparous pregnant women. DESIGN: Prospective international multicentre cohort. PARTICIPANTS: 3234 healthy nulliparous women with a singleton pregnancy, follow up was complete in 3184 of participants (98.5%. RESULTS: Of the 3184 women, 156 (4.9% had their pregnancy complicated by SPTB; 96 (3.0% and 60 (1.9% in the SPTB-IM and SPTB-PPROM categories, respectively. Independent risk factors for SPTB-IM were shorter cervical length, abnormal uterine Doppler flow, use of marijuana pre-pregnancy, lack of overall feeling of well being, being of Caucasian ethnicity, having a mother with diabetes and/or a history of preeclampsia, and a family history of low birth weight babies. Independent risk factors for SPTB-PPROM were shorter cervical length, short stature, participant's not being the first born in the family, longer time to conceive, not waking up at night, hormonal fertility treatment (excluding clomiphene, mild hypertension, family history of recurrent gestational diabetes, and maternal family history of any miscarriage (risk reduction. Low BMI (<20 nearly doubled the risk for SPTB-PPROM (odds ratio 2.64; 95% CI 1.07-6.51. The area under the receiver operating characteristics curve (AUC, after internal validation, was 0.69 for SPTB-IM and 0.79 for SPTB-PPROM. CONCLUSION: The ability to predict PTB in healthy nulliparous women using clinical characteristics is modest. The dissimilarity of risk factors for SPTB-IM compared with SPTB-PPROM indicates different pathophysiological pathways underlie these distinct phenotypes. TRIAL REGISTRATION: ACTR.org.au ACTRN12607000551493.
Full Text Available Preterm birth (born before 37 completed weeks of gestation is one of the leading causes of death among children under 5 years of age. Several recent studies have examined the association between extreme temperature and preterm births, but there have been almost no such studies in arid Australia. In this paper, we explore the potential association between exposures to extreme temperatures during the last 3 weeks of pregnancy in a Central Australian town. An immediate effect of temperature exposure is observed with an increased relative risk of 1%–2% when the maximum temperature exceeded the 90th percentile of the summer season maximum temperature data. Delayed effects are also observed closer to 3 weeks before delivery when the relative risks tend to increase exponentially. Immediate risks to preterm birth are also observed for cold temperature exposures (0 to –6 °C, with an increased relative risk of up to 10%. In the future, Central Australia will face more hot days and less cold days due to climate change and hence the risks posed by extreme heat is of particular relevance to the community and health practitioners.
Honest, Honest; Bachmann, Lucas M; Khan, Khalid
Published systematic reviews on prediction of preterm birth have tended to focus on a limited number of tests and their search strategies have often been relatively simple. Evaluation of all available tests in a systemic review will require a broad search strategy. To describe a case study of electronic searching for a systematic review of accuracy studies evaluating all tests for predicting preterm birth. The search strategy, developed to capture literatures concerning all the tests en-masse consisted of formulation of an appropriate combination of search terms, pilot searches to refine the search term combination, selection of relevant databases, and citation retrieval from the refined searches for selection of potentially relevant papers. Electronic searches were carried out on general bibliographic databases (Biosis, Embase, Medline, Pascal and Scisearch), specialised databases (Database of Abstracts of Reviews of Effectiveness, Medion, National Research Register, Cochrane Controlled Trial Register and Cochrane Database of Systematic Reviews). A total of 30076 citations were identified. Of these 8855 (29%) citations were duplications either within a database or across databases. Of the remaining 21221 citations, 3333 were considered potentially relevant to the review after assessment by two reviewers. These citations covered 19 different tests for predicting preterm birth. This case study suggests that with use of a concerted effort to organise and manage the electronic searching it is feasible to undertake broad searches for systematic reviews with multiple questions.
Fiorini, Francesco; Isted, Alexander; Hezelgrave, Natasha L; Shennan, Andrew H
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.
Bandoli, G; Chambers, C D
The objective of this study was to determine whether prenatal depression interacts with autoimmune conditions to further increase the risk of preterm birth or preeclampsia. Our sample included 3034 pregnant women with rheumatoid arthritis (RA), Crohn's disease (CD) or psoriasis, or controls that were prospectively enrolled into MothertoBaby pregnancy studies. We estimated the independent and joint effects of the three autoimmune conditions and depression on the select outcomes. We found an increased risk of preterm birth among women with RA (2.10; 95% confidence interval (CI) 1.54, 2.87), CD (1.87; 95% CI 1.25, 2.81) or psoriasis (1.88; 95% CI 1.27, 2.79) independent of depression status. RA was also independently associated with preeclampsia. Prenatal depression was not independently associated with preterm birth or preeclampsia, nor was there any synergism with autoimmune conditions. If these findings are confirmed, the absence of synergism should be encouraging news to the many women with select autoimmune conditions and depression in pregnancy.
Brittain, Philip J; Froudist Walsh, Sean; Nam, Kie-Woo; Giampietro, Vincent; Karolis, Vyacheslav; Murray, Robin M; Bhattacharyya, Sagnik; Kalpakidou, Anastasia; Nosarti, Chiara
Very preterm birth (VPT; brain insult; however, adaptive neuroplastic processes may subsequently occur in the developing preterm brain which ameliorate, to an extent, the potential sequelae of altered neurophysiology. Here, we used functional magnetic resonance imaging (fMRI) to compare neuronal activation in 24 VPT individuals and 22 controls (CT) in young adulthood during a learning task consisting of the encoding and subsequent recognition of repeated visual paired associates. Structural MRI data were also collected and analysed in order to explore possible structure-function associations. Whilst the two groups did not differ in their learning ability, as demonstrated by their capacity to recognize previously-seen and previously-unseen visual pairs, between-group differences in linear patterns of Blood Oxygenation Level Dependant (BOLD) activity were observed across the four repeated blocks of the task for both the encoding and recognition conditions, suggesting that the way learning takes place differs between the two groups. During encoding, significant between-group differences in patterns of BOLD activity were seen in clusters centred on the cerebellum, the anterior cingulate gyrus, the midbrain/substantia nigra, medial temporal (including parahippocampal) gyrus and inferior and superior frontal gyri. During the recognition condition, significant between-group differences in patterns of BOLD activity were seen in clusters centred on the claustrum and the posterior cerebellum. Structural analysis revealed smaller grey matter volume in right middle temporal gyrus in VPT individuals compared to controls, however volume in this region was not significantly associated with functional activation. These results demonstrate that although cognitive task performance between VPT individuals and controls may be comparable on certain measures, differences in BOLD signal may also be evident, some of which could represent compensatory neural processes following VPT
ROCHA, Frederico G.; SLAVIN, Thomas P.; LI, Dongmei; TIIRIKAINEN, Maarit I.; BRYANT-GREENWOOD, Gillian D.
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
Mei-Dan, Elad; Shah, Jyotsna; Lee, Shoo; Shah, Prakesh S; Murphy, Kellie E
Objective This retrospective cohort study examined the effect of birth order on neonatal morbidity and mortality in very preterm twins. Study Design Using 2005 to 2012 data from the Canadian Neonatal Network, very preterm twins born between 24 0/7 and 32 6/7 weeks of gestation were included. Odds of morbidity and mortality of second-born cotwins compared with first-born cotwins were examined by matched-pair analysis. Outcomes were neonatal death, severe brain injury (intraventricular hemorrhage grade 3 or 4 or persistent periventricular echogenicity), bronchopulmonary dysplasia, severe retinopathy of prematurity (ROP) (> stage 2), necrotizing enterocolitis (≥ stage 2), and respiratory distress syndrome (RDS). Multivariable analysis was performed adjusting for confounders. Result There were 6,636 twins (3,318 pairs) included with a mean gestational age (GA) of 28.9 weeks. A higher rate of small for GA occurred in second-born twins (10 vs. 6%). Mortality was significantly lower for second-born twins (4.3 vs. 5.3%; adjusted odds ratio: 0.75; 95% confidence interval [CI]: 0.59-0.95). RDS (66 vs. 60%; adjusted odds ratio: 1.40; 95% CI: 1.29-1.52) and severe retinopathy (9 vs. 7%; adjusted odds ratio: 1.46; 95% CI: 1.07-2.01) were significantly higher in second-born twins. Conclusion Thus, while second-born twins had reduced odds of mortality, they also had increased odds of RDS and ROP. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Lambert, JS; Watts, DH; Mofenson, L; Stiehm, ER; Harris, DR; Bethel, J; Whitehouse, J; Jimenez, E; Gandia, J; Scott, G; O'Sullivan, MJ; Kovacs, A; Stek, A; Shearer, WT; Hammill, H; van Dyke, R; Maupin, R; Silio, M; Fowler, MG
Objective: To evaluate independent contributions of maternal factors to adverse pregnancy outcomes (APO) in HIV-infected women receiving antiretroviral therapy (ART). Design: Risk factors for preterm birth (<37 weeks gestation), low birth weight (LBW) (<2500 g), and intrauterine growth retardation
Ferreira, Rachel C; Mello, Rosane R; Silva, Kátia S
to evaluate neonatal sepsis as a risk factor for abnormal neuromotor and cognitive development in very low birth weight preterm infants at 12 months of corrected age. this was a prospective cohort study that followed the neuromotor and cognitive development of 194 very low birth weight preterm infants discharged from a public neonatal intensive care unit. The Bayley Scale of Infant Development (second edition) at 12 months of corrected age was used. The outcomes were the results of the clinical/neurological evaluation and the scores of the psychomotor development index (PDI) and mental development index (MDI) of the Bayley Scale of Infant Development II. The association between neonatal sepsis and neuromotor development and between neonatal sepsis and cognitive development was verified by logistic regression analysis. mean birth weight was 1,119g (SD: 247) and mean gestational age was 29 weeks and 6 days (SD: 2). Approximately 44.3%(n=86) of the infants had neonatal sepsis and 40.7% (n=79) had abnormal neuromotor development and/or abnormal psychomotor development index (PDI de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.
Philip J. Brittain
Full Text Available Very preterm birth (VPT; < 33 weeks of gestation is associated with an increased risk of learning disability, which contributes to more VPT-born children repeating grades and underachieving in school. Learning problems associated with VPT birth may be caused by pathophysiological alterations in neurodevelopment resulting from perinatal brain insult; however, adaptive neuroplastic processes may subsequently occur in the developing preterm brain which ameliorate, to an extent, the potential sequelae of altered neurophysiology. Here, we used functional magnetic resonance imaging (fMRI to compare neuronal activation in 24 VPT individuals and 22 controls (CT in young adulthood during a learning task consisting of the encoding and subsequent recognition of repeated visual paired associates. Structural MRI data were also collected and analysed in order to explore possible structure-function associations. Whilst the two groups did not differ in their learning ability, as demonstrated by their capacity to recognize previously-seen and previously–unseen visual pairs, between-group differences in linear patterns of Blood Oxygenation Level Dependant (BOLD activity were observed across the four repeated blocks of the task for both the encoding and recognition conditions, suggesting that the way learning takes place differs between the two groups. During encoding, significant between-group differences in patterns of BOLD activity were seen in clusters centred on the cerebellum, the anterior cingulate gyrus, the midbrain/substantia nigra, medial temporal (including parahippocampal gyrus and inferior and superior frontal gyri. During the recognition condition, significant between-group differences in patterns of BOLD activity were seen in clusters centred on the claustrum and the posterior cerebellum. Structural analysis revealed smaller grey matter volume in right middle temporal gyrus in VPT individuals compared to controls, however volume in this region
Liane J Kang
Full Text Available If infants fail to initiate spontaneous breathing, resuscitation guidelines recommend respiratory support with positive pressure ventilation (PPV. The purpose of PPV is to establish functional residual capacity and deliver an adequate tidal volume (VT to achieve gas exchange.The aim of our pilot study was to measure changes in exhaled carbon dioxide (ECO2, VT, and rate of carbon dioxide elimination (VCO2 to assess lung aeration in preterm infants requiring respiratory support immediately after birth.A prospective observational study was performed between March and July 2013. Infants born at <37 weeks gestational age who received continuous positive airway pressure (CPAP or PPV immediately after birth had VT delivery and ECO2 continuously recorded using a sensor attached to the facemask.Fifty-one preterm infants (mean (SD gestational age 29 (3 weeks and birth weight 1425 (592 g receiving respiratory support in the delivery room were included. Infants in the CPAP group (n = 31 had higher ECO2 values during the first 10 min after birth compared to infants receiving PPV (n = 20 (ranging between 18-30 vs. 13-18 mmHg, p<0.05, respectively. At 10 min no significant difference in ECO2 values was observed. VT was lower in the CPAP group compared to the PPV group over the first 10 min ranging between 5.2-6.6 vs. and 7.2-11.3 mL/kg (p<0.05, respectively.Immediately after birth, spontaneously breathing preterm infants supported via CPAP achieved better lung aeration compared to infants requiring PPV. PPV guided by VT and ECO2 potentially optimize lung aeration without excessive VT administered.
Yang, Seung Woo; Kwon, Han Sung; Sohn, In Sook; Kim, Young Ju; Hwang, Han Sung
To better understand the correlation between Helicobacter pylori (H. pylori) seropositivity and spontaneous preterm birth. A total of 320 pregnant women were classified into two groups: normal control singleton pregnant group (n = 264) and singleton spontaneous preterm birth group (n = 56). Blood samples were collected at the time of delivery, and the H. pylori IgG, various virulence factors and systemic inflammation status were compared between the two groups. Between the two groups, the serum H. pylori IgG, Cytotoxin-associated agntigen A (Cag A), Vacuolating cytotoxin A (Vac A) significantly increased in spontaneous preterm birth group than in the control group. Also, in preterm group, highly sensitive C-reactive protein (hsCRP) as a systemic inflammatory marker is statistically elevated at inflammatory status range. Whereas in the term pregnant group, hsCRP was normal range even though high incidence of H. pylori IgG seropositivity. Also, in the seropositive group, hsCRP is statistically correlated with H. pylori IgG, Cag A and Vac A. There is an association between the presence of antibodies against H. pylori in maternal serum and the development of preterm birth. Furthermore, serology type of H. pylori with Vac A, Cag A relates to preterm birth even though high H. pylori prevalence rate.
Dallas, D.C.; Smink, C.J.; Robinson, R.C.; Tian, T.; Guerrero, A.; Parker, E.A.; Smilowitz, J.T.; Hettinga, K.A.; Underwood, M.A.; Lebrilla, C.B.; German, J.B.; Barile, D.
Background: 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
Chmait, Ramen H; Chon, Andrew H; Korst, Lisa M; Llanes, Arlyn; Kontopoulos, Eftichia V; Quintero, Ruben A
The objective of this study was to assess whether the location of the trocar insertion site for laser treatment of twin-twin transfusion syndrome was associated with preterm-premature rupture of membranes (PPROM) and preterm birth (PTB). In this study trocar location was documented in the operating room. Lower uterine segment (LUS) location was defined as any insertion location was defined as ≥5 cm horizontally from the midline. Patient characteristics were tested against three outcomes: PPROM ≤ 21 days postoperative, PTB location, controlling for potential risk factors. A total of 743 patients were studied. Patients with LUS location were twice as likely as those with a more superior location to have PPROM ≤ 21 days (OR = 2.33, 1.12-4.83, p = 0.0236). Patients with both a LUS and Lateral location were over six times more likely to have PPROM ≤ 21 days (OR = 6.66, 2.36-18.78, p = 0.0003). Trocar insertion site was not associated with PTB. We found that trocar insertion in the LUS, particularly the lateral LUS, was associated with an increased risk of PPROM. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Lasiuk, Gerri C; Comeau, Thea; Newburn-Cook, Christine
Preterm birth (PTB) places a considerable emotional, psychological, and financial burden on parents, families, health care resources, and society as a whole. Efforts to estimate these costs have typically considered the direct medical costs of the initial hospital and outpatient follow-up care but have not considered non-financial costs associated with PTB such as adverse psychosocial and emotional effects, family disruption, strain on relationships, alterations in self-esteem, and deterioration in physical and mental health. The aim of this inquiry is to understand parents' experience of PTB to inform the design of subsequent studies of the direct and indirect cost of PTB. The study highlights the traumatic nature of having a child born preterm and discusses implications for clinical care and further research. Through interviews and focus groups, this interpretive descriptive study explored parents' experiences of PTB. The interviews were audiotaped, transcribed, and analyzed for themes. Analysis was ongoing throughout the study and in subsequent interviews, parents were asked to reflect and elaborate on the emerging themes as they were identified. PTB is a traumatic event that shattered parents' taken-for-granted expectations of parenthood. For parents in our study, the trauma they experienced was not related to infant characteristics (e.g., gestational age, birth weight, Apgar scores, or length of stay in the NICU), but rather to prolonged uncertainty, lack of agency, disruptions in meaning systems, and alterations in parental role expectations. Our findings help to explain why things like breast feeding, kangaroo care, and family centered practices are so meaningful to parents in the NICU. As well as helping to (re)construct their role as parents, these activities afford parents a sense of agency, thereby moderating their own helplessness. These findings underscore the traumatic nature and resultant psychological distress related to PTB. Obstetrical and
Wolf, Hans; Hegaard, H K; Greisen, G
Premature birth increases a child's risk of cerebral palsy and death. The aim of this work is to investigate the association between treatment with magnesium sulphate during premature deliveries and infants' cerebral palsy and mortality through a meta-analysis of observational studies. A comprehe......Premature birth increases a child's risk of cerebral palsy and death. The aim of this work is to investigate the association between treatment with magnesium sulphate during premature deliveries and infants' cerebral palsy and mortality through a meta-analysis of observational studies....... A comprehensive search of the Cochrane Library, EMBASE and the PubMed database from their inceptions to 1 October, 2010 using the keywords 'magnesium sulphate, children/infant/pre-term/premature and cerebral palsy/mortality/morbidity/adverse effects/outcome' identified 11 reports of observational studies. Two...... authors working independently extracted the data. A meta-analysis of the data found an association between magnesium sulphate treatment and a significantly reduced risk of mortality (RR 0.73; 95% CI 0.61-0.89) and cerebral palsy (OR 0.64; 95% CI 0.47-0.89). Antenatal treatment with magnesium sulphate...
Usynina, Anna A; Postoev, Vitaly A; Grjibovski, Andrej M; Krettek, Alexandra; Nieboer, Evert; Odland, Jon Øyvind; Anda, Erik Eik
Globally, about 11% of all liveborn infants are preterm. To date, data on prevalence and risk factors of preterm birth (PTB) in Russia are limited. The aims of this study were to estimate the prevalence of PTB in Murmansk County, Northwestern Russia and to investigate associations between PTB and selected maternal factors using the Murmansk County Birth Registry. We conducted a registry-based study of 52 806 births (2006-2011). In total, 51 156 births were included in the prevalence analysis, of which 3546 were PTBs. Odds ratios with 95% confidence intervals of moderate-to-late PTB, very PTB and extremely PTB for a range of maternal characteristics were estimated using multinomial logistic regression, adjusting for potential confounders. The overall prevalence of PTB in Murmansk County was 6.9%. Unmarried status, prior PTBs, spontaneous and induced abortions were strongly associated with PTB at any gestational age. Maternal low educational level increased the risk of extremely and moderate-to-late PTB. Young (Murmansk County, Russia was comparable with data on live PTB from European countries. Adverse prior pregnancy outcomes, maternal low educational level, unmarried status, alcohol abuse, and diabetes mellitus or gestational diabetes were the most common risk factors for PTB. © 2016 John Wiley & Sons Ltd.
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
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
Full Text Available Very preterm birth (VPT; <32 weeks of gestation has been associated with an increased risk to develop cognitive and socio-emotional problems, as well as with increased vulnerability to psychiatric disorder, both with childhood and adult onset.Socio-emotional impairments that have been described in VPT individuals include diminished social competence and self-esteem, emotional dysregulation, shyness and timidity.However, the aetiology of socio-emotional problems in VPT samples and their underlying mechanisms are far from understood. To date, research has focused on the investigation of both biological and environmental risk factors associated with socio-emotional problems, including structural and functional alterations in brain areas involved in processing emotions and social stimuli, perinatal stress and pain and parenting strategies.Considering the complex interplay of the aforementioned variables, the review attempts to elucidate the mechanisms underlying the association between very preterm birth, socio-emotional vulnerability and psychopathology. After a comprehensive overview of the socio-emotional impairments associated with VPT birth, three main models of socio-emotional development are presented and discussed. These focus on biological vulnerability, early life adversities and parenting, respectively. To conclude, a developmental framework is used to consider different pathways linking VPT birth to psychopathology, taking into account the interaction between medical, biological and psychosocial factors.
Brandt, Justin S; Bastek, Jamie A; Wang, Eileen; Purisch, Stephanie; Schwartz, Nadav
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.
Hart, Anthony R.; Smith, Michael F.; Rigby, Alan S.; Wallis, Lauren I.; Whitby, Elspeth H.
Diffuse damage to the periventricular white matter has recently been suggested to be a cause of the cognitive deficits seen following preterm birth. It is unclear whether this form of injury can be visualised on MR imaging, but one group has described diffuse excessive high signal intensity (DEHSI) as a possible form of diffuse white matter injury. This finding is dependant on window imaging and the subjective assessment of the reviewer, but little data have been published on the degree of subjectivity on its appearance among raters. To assess the subjectivity of DEHSI on conventional and ultrafast T2-weighted MR imaging following preterm birth. An observational study of 40 preterm infants who had MR imaging of the brain around term-equivalent age, including conventional fast spin-echo (FSE) and ultrafast single-shot fast spin-echo (SSFSE) T2-weighted sequences in the axial plane. Images were anonymised and scored twice by four observers for the presence of DEHSI. Inter- and intra-observer agreement were calculated. Sixty-five percent of conventional and 100% of the ultrafast images were of diagnostic quality. DEHSI was noted in between 0% and 69.2% of conventional images and 27.5-90% of the ultrafast images. Inter- and intra-observer agreement ranged from none to moderate. The visual appearances of DEHSI on conventional FSE and ultrafast SSFSE T2-W images are highly subjective, limiting its clinical application. (orig.)
Hart, Anthony R; Smith, Michael F; Rigby, Alan S; Wallis, Lauren I; Whitby, Elspeth H
Diffuse damage to the periventricular white matter has recently been suggested to be a cause of the cognitive deficits seen following preterm birth. It is unclear whether this form of injury can be visualised on MR imaging, but one group has described diffuse excessive high signal intensity (DEHSI) as a possible form of diffuse white matter injury. This finding is dependent on window imaging and the subjective assessment of the reviewer, but little data have been published on the degree of subjectivity on its appearance among raters. To assess the subjectivity of DEHSI on conventional and ultrafast T2-weighted MR imaging following preterm birth. An observational study of 40 preterm infants who had MR imaging of the brain around term-equivalent age, including conventional fast spin-echo (FSE) and ultrafast single-shot fast spin-echo (SSFSE) T2-weighted sequences in the axial plane. Images were anonymised and scored twice by four observers for the presence of DEHSI. Inter- and intra-observer agreement were calculated. Sixty-five percent of conventional and 100% of the ultrafast images were of diagnostic quality. DEHSI was noted in between 0% and 69.2% of conventional images and 27.5-90% of the ultrafast images. Inter- and intra-observer agreement ranged from none to moderate. The visual appearances of DEHSI on conventional FSE and ultrafast SSFSE T2-W images are highly subjective, limiting its clinical application.
Hart, Anthony R. [Sheffield Teaching Hospital NHS Foundation Trust, Department of Neonatology, Jessop Wing, Sheffield (United Kingdom); University of Sheffield, Academic Unit of Radiology, Royal Hallamshire Hospital, Sheffield (United Kingdom); University of Sheffield, Department of Academic Radiology, Royal Hallamshire Hospital, Sheffield (United Kingdom); Smith, Michael F. [Sheffield Teaching Hospital NHS Foundation Trust, Department of Neonatology, Jessop Wing, Sheffield (United Kingdom); Rigby, Alan S. [University of Hull, Postgraduate Medical Centre, Castle Hill Hospital, East Yorkshire (United Kingdom); Wallis, Lauren I.; Whitby, Elspeth H. [University of Sheffield, Academic Unit of Radiology, Royal Hallamshire Hospital, Sheffield (United Kingdom)
Diffuse damage to the periventricular white matter has recently been suggested to be a cause of the cognitive deficits seen following preterm birth. It is unclear whether this form of injury can be visualised on MR imaging, but one group has described diffuse excessive high signal intensity (DEHSI) as a possible form of diffuse white matter injury. This finding is dependant on window imaging and the subjective assessment of the reviewer, but little data have been published on the degree of subjectivity on its appearance among raters. To assess the subjectivity of DEHSI on conventional and ultrafast T2-weighted MR imaging following preterm birth. An observational study of 40 preterm infants who had MR imaging of the brain around term-equivalent age, including conventional fast spin-echo (FSE) and ultrafast single-shot fast spin-echo (SSFSE) T2-weighted sequences in the axial plane. Images were anonymised and scored twice by four observers for the presence of DEHSI. Inter- and intra-observer agreement were calculated. Sixty-five percent of conventional and 100% of the ultrafast images were of diagnostic quality. DEHSI was noted in between 0% and 69.2% of conventional images and 27.5-90% of the ultrafast images. Inter- and intra-observer agreement ranged from none to moderate. The visual appearances of DEHSI on conventional FSE and ultrafast SSFSE T2-W images are highly subjective, limiting its clinical application. (orig.)
Roberto Eduardo Bittar
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
Petersen, Christina B; Mortensen, Laust H; Morgen, Camilla S
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 posi......-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 (12 years of education, mothers with......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...
Full Text Available Introduction. Infants born between the 34[sup]th[/sup] – 36[sup]th[/sup] week of pregnancy account for 75% of all preterm infants. Their seemingly slight immaturity is related to serious health problems. Objective. The aim of the study was to analyse perinatal factors that influence the occurrence in infants of such problems as respiratory failure, metabolic problems and early onset sepsis (EOS. Materials and method. The material for the study included all mothers and their late preterm infants: 34+0 – 36+6 born in our hospital (a tertiary referral academic centre in 2010 and 2011. The course of pregnancy and delivery, the type of delivery, applied preventive measures and treatment, as well as demographic data and the clinical state of infants were all analysed. Data from individual documentation of each mother and infant were collected by 5 designated people and data reliability was independently monitored by a random control of the documentation conducted by the supervising person. Results. A statistically significant relationship between the occurrence of respiratory distress syndrome and infant immaturity, bad state after birth and sepsis in infants were confirmed. Sepsis was more common in the case of vaginal delivery, and coexisted with respiratory distress syndrome. The mother’s diseases during pregnancy, a perinatal preventive antibiotic therapy, and possible delivery complications did not influence the infection. Perinatal asphyxia in an infant positively correlated with a Caesarean section and respiratory distress syndrome after birth. Conclusions. It is necessary to thoroughly establish the type of delivery of a late preterm infant in order to prevent an infection in the newborn child. The improvement of diagnosis of intrauterine hypoxia may reduce the number of Caesarean sections. The decision about late preterm delivery should be based on indices of the mother’s state of health. Premature delivery is related to the