WorldWideScience

Sample records for previous preterm birth

  1. Preterm birth

    Science.gov (United States)

    2010-01-01

    Introduction Preterm birth occurs in about 5% to 10% of all births in resource-rich countries, but in recent years the incidence seems to have increased in some countries, particularly in the USA. We found little reliable evidence for incidence in resource-poor countries. The rate in northwestern Ethiopia has been reported to vary from 11% to 22%, depending on the age group of mothers studied, and is highest in teenage mothers. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of preventive interventions in women at high risk of preterm delivery? What are the effects of interventions to improve neonatal outcome after preterm rupture of membranes? What are the effects of treatments to stop contractions in preterm labour? What are the effects of elective compared with selective caesarean delivery for women in preterm labour? What are the effects of interventions to improve neonatal outcome in preterm delivery? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2009 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 58 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review, we present information relating to the effectiveness and safety of the following interventions: amnioinfusion for preterm rupture of membranes; antenatal corticosteroids; antibiotic treatment; bed rest; beta mimetics; calcium-channel blockers; elective caesarean; enhanced antenatal care programmes; magnesium sulphate; oxytocin receptor antagonists (atosiban); progesterone

  2. Late preterm birth and previous cesarean section: a population-based cohort study.

    Science.gov (United States)

    Yasseen Iii, Abdool S; Bassil, Kate; Sprague, Ann; Urquia, Marcelo; Maguire, Jonathon L

    2018-02-21

    Late preterm birth (LPB) is increasingly common and associated with higher morbidity and mortality than term birth. Yet, little is known about the influence of previous cesarean section (PCS) and the occurrence of LPB in subsequent pregnancies. We aim to evaluate this association along with the potential mediation by cesarean sections in the current pregnancy. We use population-based birth registry data (2005-2012) to establish a cohort of live born singleton infants born between 34 and 41 gestational weeks to multiparous mothers. PCS was the primary exposure, LPB (34-36 weeks) was the primary outcome, and an unplanned or emergency cesarean section in the current pregnancy was the potential mediator. Associations were quantified using propensity weighted multivariable Poisson regression, and mediating associations were explored using the Baron-Kenny approach. The cohort included 481,531 births, 21,893 (4.5%) were LPB, and 119,983 (24.9%) were predated by at least one PCS. Among mothers with at least one PCS, 6307 (5.26%) were LPB. There was increased risk of LPB among women with at least one PCS (adjusted Relative Risk (aRR): 1.20 (95%CI [1.16, 1.23]). Unplanned or emergency cesarean section in the current pregnancy was identified as a strong mediator to this relationship (mediation ratio = 97%). PCS was associated with higher risk of LPB in subsequent pregnancies. This may be due to an increased risk of subsequent unplanned or emergency preterm cesarean sections. Efforts to minimize index cesarean sections may reduce the risk of LPB in subsequent pregnancies.

  3. Extremely Preterm Birth

    Science.gov (United States)

    ... Events Advocacy For Patients About ACOG Extremely Preterm Birth Home For Patients Search FAQs Extremely Preterm Birth ... Spanish FAQ173, June 2016 PDF Format Extremely Preterm Birth Pregnancy When is a baby considered “preterm” or “ ...

  4. Preterm Labor and Birth

    Science.gov (United States)

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

  5. Progesterone for preterm birth prevention

    Directory of Open Access Journals (Sweden)

    Miha Lucovnik

    2015-10-01

    Full Text Available Background: Progesterone is important in maintaining pregnancy. Progesterone supplementation may reduce risk of preterm birth in certain populations of pregnant women. The objective of this review was to develop evidence-based clinical recommendation for progesterone treatment in the prevention of preterm birth.Methods: A search in the Medline database was performed using keywords: progesterone, pregnancy, preterm birth, preterm labour, preterm delivery, randomized trial, and randomized controlled trial. We only included studies of vaginal progesterone treatments for the prevention of preterm birth and excluded studies on 17-α-hydroksiprogesterone caproate.Results: We report findings from twelve randomized trials conducted since 2003. These trials differ regarding inclusion criteria, progesterone dose, vehicle used, and duration of treatment. Inclusion criteria were: short uterine cervix (two trials, history of previous preterm birth (two trials, signs and symptoms of preterm labour (three trials, twin pregnancies (three trials, and multiple risk factors (among these history of previous preterm birth was the most common (two trials. Six of these twelve trials showed a significant reduction in preterm birth in the progesterone groups.Conclusions: Based on current evidence we recommend treatment with 200 mg of micronized progesterone daily, administered vaginally, in pregnant women found to have a short cervix (≤ 25 mm at 19-24 weeks. The treatment should be continued until 37 weeks.

  6. VAGINAL PROGESTERONE VERSUS CERVICAL CERCLAGE FOR THE PREVENTION OF PRETERM BIRTH IN WOMEN WITH A SONOGRAPHIC SHORT CERVIX, SINGLETON GESTATION, AND PREVIOUS PRETERM BIRTH: A SYSTEMATIC REVIEW AND INDIRECT COMPARISON META-ANALYSIS

    Science.gov (United States)

    CONDE-AGUDELO, Agustin; ROMERO, Roberto; NICOLAIDES, Kypros; CHAIWORAPONGSA, Tinnakorn; O'BRIEN, John M.; CETINGOZ, Elcin; DA FONSECA, Eduardo; CREASY, George; SOMA-PILLAY, Priya; FUSEY, Shalini; CAM, Cetin; ALFIREVIC, Zarko; HASSAN, Sonia S.

    2012-01-01

    OBJECTIVE No randomized controlled trial has directly compared vaginal progesterone and cervical cerclage for the prevention of preterm birth in women with a sonographic short cervix in the midtrimester, singleton gestation, and previous spontaneous preterm birth. We performed an indirect comparison of vaginal progesterone versus cerclage, using placebo/no cerclage as the common comparator. STUDY DESIGN Adjusted indirect meta-analysis of randomized controlled trials. RESULTS Four studies evaluating vaginal progesterone versus placebo (158 patients) and five evaluating cerclage versus no cerclage (504 patients) were included. Both interventions were associated with a statistically significant reduction in the risk of preterm birth <32 weeks of gestation and composite perinatal morbidity and mortality compared with placebo/no cerclage. Adjusted indirect meta-analyses did not show statistically significant differences between vaginal progesterone and cerclage in reducing preterm birth or adverse perinatal outcomes. CONCLUSION Based on state-of-the-art methodology for indirect comparisons, either vaginal progesterone or cerclage are equally efficacious in the prevention of preterm birth in women with a sonographic short cervix in the midtrimester, singleton gestation, and previous preterm birth. The selection of the optimal treatment may depend upon adverse events, cost and patient/clinician preferences. PMID:23157855

  7. Preterm Birth

    Science.gov (United States)

    ... for Health Care Providers For Health Care Providers: Electronic Nicotine Delivery Systems and Pregnancy CDC Activities Resources ... births and improving neonatal outcomes. View the archived presentation and publication Related Links Is It Worth It? ...

  8. Genomics of Preterm Birth

    Science.gov (United States)

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

    2015-01-01

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

  9. Prevention of preterm birth.

    LENUS (Irish Health Repository)

    Flood, Karen

    2012-02-01

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

  10. Screening for spontaneous preterm birth

    NARCIS (Netherlands)

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

    2015-01-01

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

  11. Preterm birth, an unresolved issue.

    Science.gov (United States)

    Belizán, Jose M; Hofmeyr, Justus; Buekens, Pierre; Salaria, Natasha

    2013-11-15

    Premature birth is the world's leading cause of neonatal mortality with worldwide estimates indicating 11.1% of all live births were preterm in 2010. Preterm birth rates are increasing in most countries with continual differences in survival rates amongst rich and poor countries. Preterm birth is currently an important unresolved global issue with research efforts focusing on uterine quiescence and activation, the 'omics' approaches and implementation science in order to reduce the incidence and increase survival rates of preterm babies. The journal Reproductive Health has published a supplement entitled Born Too Soon which addresses factors in the preconception and pregnancy period which may increase the risk of preterm birth and also outlines potential interventions which may reduce preterm birth rates and improve survival of preterm babies by as much as 84% annually. This is critical in order to achieve the Millennium Development Goal (MDG 4) for child survival by 2015 and beyond.

  12. Preterm birth, an unresolved issue

    OpenAIRE

    Beliz?n, Jose M; Hofmeyr, Justus; Buekens, Pierre; Salaria, Natasha

    2013-01-01

    Premature birth is the world?s leading cause of neonatal mortality with worldwide estimates indicating 11.1% of all live births were preterm in 2010. Preterm birth rates are increasing in most countries with continual differences in survival rates amongst rich and poor countries. Preterm birth is currently an important unresolved global issue with research efforts focusing on uterine quiescence and activation, the ?omics? approaches and implementation science in order to reduce the incidence ...

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

    Directory of Open Access Journals (Sweden)

    Nynke R van den Broek

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

  14. Preterm birth and dyscalculia.

    Science.gov (United States)

    Jaekel, Julia; Wolke, Dieter

    2014-06-01

    To evaluate whether the risk for dyscalculia in preterm children increases the lower the gestational age (GA) and whether small-for-gestational age birth is associated with dyscalculia. A total of 922 children ranging from 23 to 41 weeks' GA were studied as part of a prospective geographically defined longitudinal investigation of neonatal at-risk children in South Germany. At 8 years of age, children's cognitive and mathematic abilities were measured with the Kaufman Assessment Battery for Children and with a standardized mathematics test. Dyscalculia diagnoses were evaluated with discrepancy-based residuals of a linear regression predicting children's math scores by IQ and with fixed cut-off scores. We investigated each GA group's ORs for general cognitive impairment, general mathematic impairment, and dyscalculia by using binary logistic regressions. The risk for general cognitive and mathematic impairment increased with lower GA. In contrast, preterm children were not at increased risk of dyscalculia after statistically adjusting for child sex, family socioeconomic status, and small-for-gestational age birth. The risk of general cognitive and mathematic impairments increases with lower GA but preterm children are not at increased risk of dyscalculia. Copyright © 2014 Elsevier Inc. All rights reserved.

  15. Prediction of Spontaneous Preterm Birth

    NARCIS (Netherlands)

    Dijkstra, Karolien

    2002-01-01

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

  16. preterm births in a resource constrained setting: soci

    African Journals Online (AJOL)

    2015-12-01

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

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

    NARCIS (Netherlands)

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

    2012-01-01

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

  18. Spontaneous preterm birth : prevention, management and outcome

    NARCIS (Netherlands)

    Vermeulen, Gustaaf Michiel

    1999-01-01

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

  19. Socio-economic inequality in preterm birth

    DEFF Research Database (Denmark)

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

    2009-01-01

    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....

  20. Allostatic Load and Preterm Birth

    Directory of Open Access Journals (Sweden)

    David M. Olson

    2015-12-01

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

  1. Multilevel factors influencing preterm birth in an urban setting

    Directory of Open Access Journals (Sweden)

    Saba W. Masho

    2014-01-01

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

  2. Does fish oil prevent preterm birth?

    DEFF Research Database (Denmark)

    Secher, Niels Jørgen

    2007-01-01

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

  3. Preeclampsia and retinopathy of prematurity in preterm births.

    Science.gov (United States)

    Yu, Xiao Dan; Branch, D Ware; Karumanchi, S Ananth; Zhang, Jun

    2012-07-01

    The relationship between gestational hypertension, preeclampsia, and the risk of retinopathy of prematurity (ROP) remains unclear. Thus, we used a large cohort database to study the influence of maternal gestational hypertension and preeclampsia on the occurrence of ROP in preterm infants. We used data from a previous retrospective cohort study that includes 25,473 eligible preterm neonates. We examined the association between gestational hypertension, preeclampsia, and ROP while controlling for potential confounders by multiple logistic regression analysis. Of the 8758 early preterm infants (gestational age <34 weeks), 1024 (11.69%) had ROP, while of the 16,715 late preterm infants, only 29 (0.17%) had ROP. After adjusting for confounders, preeclampsia was associated with a significantly reduced risk of ROP (adjusted odds ratio [aOR], 0.65; 95% confidence interval [CI], 0.49-0.86 for early preterm birth; aOR, 0.10; 95% CI, 0.01-0.93 for late preterm birth; aOR, 0.66; 95% CI, 0.50-0.87 for all preterm births). Gestational hypertension was not significantly associated with ROP at early or late preterm births. Preeclampsia, but not gestational hypertension, was associated with a reduced risk of ROP in preterm births.

  4. Progesterone to prevent spontaneous preterm birth

    Science.gov (United States)

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

    2014-01-01

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

  5. Socioeconomic inequalities in very preterm birth rates.

    Science.gov (United States)

    Smith, L K; Draper, E S; Manktelow, B N; Dorling, J S; Field, D J

    2007-01-01

    To investigate the extent of socioeconomic inequalities in the incidence of very preterm birth over the past decade. Ecological study of all 549 618 births in the former Trent health region, UK, from 1 January 1994 to 31 December 2003. All singleton births of 22(+0) to 32(+6) weeks gestation (7 185 births) were identified from population surveys of neonatal services and stillbirths. Poisson regression was used to calculate incidence of very preterm birth (22-32 weeks) and extremely preterm birth (22-28 weeks) by year of birth and decile of deprivation (child poverty section of the Index of Multiple Deprivation). Incidence of very preterm singleton birth rose from 11.9 per 1000 births in 1994 to 13.7 per 1000 births in 2003. Those from the most deprived decile were at nearly twice the risk of very preterm birth compared with those from the least deprived decile, with 16.4 per 1000 births in the most deprived decile compared with 8.5 per 1000 births in the least deprived decile (incidence rate ratio 1.94; 95% CI (1.73 to 2.17)). This deprivation gap remained unchanged throughout the 10-year period. The magnitude of socio-economic inequalities was the same for extremely preterm births (22-28 weeks incidence rate ratio 1.94; 95% CI (1.62 to 2.32)). This large, unique dataset of very preterm births shows wide socio-economic inequalities that persist over time. These findings are likely to have consequences on the burden of long-term morbidity. Our research can assist future healthcare planning, the monitoring of socio-economic inequalities and the targeting of interventions in order to reduce this persistent deprivation gap.

  6. Challenges and Consequences of Preterm Birth

    Directory of Open Access Journals (Sweden)

    Sribas Goswami

    2014-11-01

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

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

    African Journals Online (AJOL)

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

  8. Born too soon: preterm birth matters.

    Science.gov (United States)

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

    2013-01-01

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

  9. Prevalence and risk factors related to preterm birth in Brazil

    Directory of Open Access Journals (Sweden)

    Maria do Carmo Leal

    2016-10-01

    Full Text Available Abstract Background The rate of preterm birth has been increasing worldwide, including in Brazil. This constitutes a significant public health challenge because of the higher levels of morbidity and mortality and long-term health effects associated with preterm birth. This study describes and quantifies factors affecting spontaneous and provider-initiated preterm birth in Brazil. Methods Data are from the 2011–2012 “Birth in Brazil” study, which used a national population-based sample of 23,940 women. We analyzed the variables following a three-level hierarchical methodology. For each level, we performed non-conditional multiple logistic regression for both spontaneous and provider-initiated preterm birth. Results The rate of preterm birth was 11.5 %, (95 % confidence 10.3 % to 12.9 % 60.7 % spontaneous - with spontaneous onset of labor or premature preterm rupture of membranes - and 39.3 % provider-initiated, with more than 90 % of the last group being pre-labor cesarean deliveries. Socio-demographic factors associated with spontaneous preterm birth were adolescent pregnancy, low total years of schooling, and inadequate prenatal care. Other risk factors were previous preterm birth (OR 3.74; 95 % CI 2.92–4.79, multiple pregnancy (OR 16.42; 95 % CI 10.56–25.53, abruptio placentae (OR 2.38; 95 % CI 1.27–4.47 and infections (OR 4.89; 95 % CI 1.72–13.88. In contrast, provider-initiated preterm birth was associated with private childbirth healthcare (OR 1.47; 95 % CI 1.09–1.97, advanced-age pregnancy (OR 1.27; 95 % CI 1.01–1.59, two or more prior cesarean deliveries (OR 1.64; 95 % CI 1.19–2.26, multiple pregnancy (OR 20.29; 95 % CI 12.58–32.72 and any maternal or fetal pathology (OR 6.84; 95 % CI 5.56–8.42. Conclusion The high proportion of provider-initiated preterm birth and its association with prior cesarean deliveries and all of the studied maternal/fetal pathologies suggest that a reduction of this type of

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

    Science.gov (United States)

    Stewart, Amanda; Graham, Ernest

    2010-01-01

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

  11. The worldwide incidence of preterm birth: a systematic review of maternal mortality and morbidity.

    Science.gov (United States)

    Beck, Stacy; Wojdyla, Daniel; Say, Lale; Betran, Ana Pilar; Merialdi, Mario; Requejo, Jennifer Harris; Rubens, Craig; Menon, Ramkumar; Van Look, Paul F A

    2010-01-01

    To analyse preterm birth rates worldwide to assess the incidence of this public health problem, map the regional distribution of preterm births and gain insight into existing assessment strategies. Data on preterm birth rates worldwide were extracted during a previous systematic review of published and unpublished data on maternal mortality and morbidity reported between 1997 and 2002. Those data were supplemented through a complementary search covering the period 2003-2007. Region-specific multiple regression models were used to estimate the preterm birth rates for countries with no data. We estimated that in 2005, 12.9 million births, or 9.6% of all births worldwide, were preterm. Approximately 11 million (85%) of these preterm births were concentrated in Africa and Asia, while about 0.5 million occurred in each of Europe and North America (excluding Mexico) and 0.9 million in Latin America and the Caribbean. The highest rates of preterm birth were in Africa and North America (11.9% and 10.6% of all births, respectively), and the lowest were in Europe (6.2%). Preterm birth is an important perinatal health problem across the globe. Developing countries, especially those in Africa and southern Asia, incur the highest burden in terms of absolute numbers, although a high rate is also observed in North America. A better understanding of the causes of preterm birth and improved estimates of the incidence of preterm birth at the country level are needed to improve access to effective obstetric and neonatal care.

  12. Antimicrobials for Preterm Birth Prevention: An Overview

    Directory of Open Access Journals (Sweden)

    Akila Subramaniam

    2012-01-01

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

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

    DEFF Research Database (Denmark)

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

    2009-01-01

    . SEARCH STRATEGY: A search in the PubMed, Embase, and Cochrane database was performed using the keywords: pregnancy, progesterone, preterm birth/preterm delivery, preterm labor, controlled trial, and randomized controlled trial. SELECTION CRITERIA: Studies on singleton pregnancies. DATA COLLECTION...... AND ANALYSIS: A meta-analysis was performed on randomized trials including singleton pregnancies with previous preterm birth. MAIN RESULTS: Two new randomized controlled trials of women with previous preterm birth were added to the four analyzed in the Cochrane review, and the meta-analysis of all six studies......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...

  14. Twins: prevalence, problems, and preterm births.

    Science.gov (United States)

    Chauhan, Suneet P; Scardo, James A; Hayes, Edward; Abuhamad, Alfred Z; Berghella, Vincenzo

    2010-10-01

    The rate of twin pregnancies in the United States has stabilized at 32 per 1000 births in 2006. Aside from determining chorionicity, first-trimester screening and second-trimester ultrasound scanning should ascertain whether there are structural or chromosomal abnormalities. Compared with singleton births, genetic amniocentesis-related loss at births is higher (0.9% vs 2.9%, respectively). Selective termination for an anomalous fetus is an option, although the pregnancy loss rate is 7% at experienced centers. For singleton and twin births for African American and white women, approximately 50% of preterm births are indicated; approximately one-third of these births are spontaneous, and 10% of the births occur after preterm premature rupture of membranes. From 1989-2000, the rate of preterm twin births increased, for African American and white women alike, although the perinatal mortality rate has actually decreased. As with singleton births, tocolytics should be used judiciously and only for a limited time (births. Administration of antenatal corticosteroids is an evidence-based recommendation. Copyright © 2010 Mosby, Inc. All rights reserved.

  15. Midwife in the prevention of preterm birth

    Directory of Open Access Journals (Sweden)

    Joanna Grzesik-Gąsior

    2017-08-01

    Full Text Available Preterm birth is an enormous challenge for the modern obstetrics. Despite the fact that there is a continuous development of prenatal care, the frequency of preterm birth occurrence remains constant. The development of its prophylaxis methods is of utmost interest for many researchers and scholars in Poland and in the world. As a result of multifactorial etiology, the procedure in case of this pathology is vastly difficult and there is no one way, which could effectively eliminate the risk of preterm birth. The most effective way to prevent this kind of pathology, seems to be health promotion and the implementation of prophylaxis methods, not only during the period of pregnancy but also in the pre-pregnancy period. This can be achieved through the education in the field of healthy lifestyle. Health care workers, including midwives, should make every effort to reduce the effects of the preterm birth occurrence. This should be executed by the implementation of the prophylactic methods. The aim of this article is to show the midwife’s responsibilities in the prevention of preterm birth at all levels of its prophylaxis.

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

    Science.gov (United States)

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

    2014-01-01

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

  17. Maternal Risk Factors for Singleton Preterm Births and Survival at ...

    African Journals Online (AJOL)

    Context: Risk factors for and survival of singleton preterm births may vary ... factors and survival‑to‑discharge rate for singleton preterm births at the University of ... Statistical analysis involved descriptive and inferential statistics at 95% level of ...

  18. Occupational lifting of heavy loads and preterm birth:

    DEFF Research Database (Denmark)

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

    2013-01-01

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

  19. Preterm Birth and Low Birth Weight Following Icsi- Pregnancies

    OpenAIRE

    Aygül Demirol; Süleyman Güven; Timur Gürgan

    2006-01-01

    OBJECTIVE: To report preterm birth and low birth weight rate of intracytoplasmic sperm injection (ICSI) related pregnancies and to compare our data with literature findings. STUDY DESIGN: Three-hundred and eighty-nine pregnancies following controlled ovarian hyperstimulation and intracytoplasmic sperm injection were retrospectively evaluated. Patients’ characteristics including age, gestational age at delivery and birth weight were noted from special clinic files. Women with early pregnanc...

  20. Risk assessment and management to prevent preterm birth

    NARCIS (Netherlands)

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

    2016-01-01

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

  1. Proteomic Biomarkers for Spontaneous Preterm Birth

    DEFF Research Database (Denmark)

    Kacerovsky, Marian; Lenco, Juraj; Musilova, Ivana

    2014-01-01

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

  2. Occupational lifting, fetal death and preterm birth

    DEFF Research Database (Denmark)

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

    2014-01-01

    OBJECTIVE: We examined the association between occupational lifting during pregnancy and risk of fetal death and preterm birth using a job exposure matrix (JEM). METHODS: For 68,086 occupationally active women in the Danish National Birth Cohort, interview information on occupational lifting...... the JEM. We used Cox regression models with gestational age as underlying time variable and adjustment for covariates. RESULTS: We observed 2,717 fetal deaths and 3,128 preterm births within the study cohort. No exposure-response relation was observed for fetal death, but for women with a prior fetal...... death, we found a hazard ratio (HR) of 2.87 (95% CI 1.37, 6.01) for stillbirth (fetal death ≥22 completed gestational weeks) among those who lifted >200 kg/day. For preterm birth, we found an exposure-response relation for primigravid women, reaching a HR of 1.43 (95% CI 1.13, 1.80) for total loads >200...

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

    Science.gov (United States)

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

    2015-11-05

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

  4. Risk assessment and management to prevent preterm birth.

    Science.gov (United States)

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

    2016-04-01

    Preterm birth is the most important cause of neonatal mortality and morbidity worldwide. In this review, we review potential risk factors associated with preterm birth and the subsequent management to prevent preterm birth in low and high risk women with a singleton or multiple pregnancy. A history of preterm birth is considered the most important risk factor for preterm birth in subsequent pregnancy. General risk factors with a much lower impact include ethnicity, low socio-economic status, maternal weight, smoking, and periodontal status. Pregnancy-related characteristics, including bacterial vaginosis and asymptomatic bacteriuria, appear to be of limited value in the prediction of preterm birth. By contrast, a mid-pregnancy cervical length measurement is independently associated with preterm birth and could be used to identify women at risk of a premature delivery. A fetal fibronectin test may be of additional value in the prediction of preterm birth. The most effective methods to prevent preterm birth depend on the obstetric history, which makes the identification of women at risk of preterm birth an important task for clinical care providers. Copyright © 2016 Elsevier Ltd. All rights reserved.

  5. Cervical mucus properties stratify risk for preterm birth.

    Directory of Open Access Journals (Sweden)

    Agatha S Critchfield

    Full Text Available Ascending infection from the colonized vagina to the normally sterile intrauterine cavity is a well-documented cause of preterm birth. The primary physical barrier to microbial ascension is the cervical canal, which is filled with a dense and protective mucus plug. Despite its central role in separating the vaginal from the intrauterine tract, the barrier properties of cervical mucus have not been studied in preterm birth.To study the protective function of the cervical mucus in preterm birth we performed a pilot case-control study to measure the viscoelasticity and permeability properties of mucus obtained from pregnant women at high-risk and low-risk for preterm birth. Using extensional and shear rheology we found that cervical mucus from women at high-risk for preterm birth was more extensible and forms significantly weaker gels compared to cervical mucus from women at low-risk of preterm birth. Moreover, permeability measurements using fluorescent microbeads show that high-risk mucus was more permeable compared with low-risk mucus.Our findings suggest that critical biophysical barrier properties of cervical mucus in women at high-risk for preterm birth are compromised compared to women with healthy pregnancy. We hypothesize that impaired barrier properties of cervical mucus could contribute to increased rates of intrauterine infection seen in women with preterm birth. We furthermore suggest that a robust association of spinnbarkeit and preterm birth could be an effectively exploited biomarker for preterm birth prediction.

  6. Bacterial Hyaluronidase Promotes Ascending GBS Infection and Preterm Birth

    Science.gov (United States)

    Vornhagen, Jay; Quach, Phoenicia; Boldenow, Erica; Merillat, Sean; Whidbey, Christopher; Ngo, Lisa Y.; Adams Waldorf, K. M.

    2016-01-01

    ABSTRACT 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. PMID:27353757

  7. Time from cervical conization to pregnancy and preterm birth.

    Science.gov (United States)

    Himes, Katherine P; Simhan, Hyagriv N

    2007-02-01

    To estimate whether the time interval between cervical conization and subsequent pregnancy is associated with risk of preterm birth. Our study is a case control study nested in a retrospective cohort. Women who underwent colposcopic biopsy or conization with loop electrosurgical excision procedure, large loop excision of the transformation zone, or cold knife cone and subsequently delivered at our hospital were identified with electronic databases. Variables considered as possible confounders included maternal race, age, marital status, payor status, years of education, self-reported tobacco use, history of preterm delivery, and dimensions of cone specimen. Conization was not associated with preterm birth or any subtypes of preterm birth. Among women who underwent conization, those with a subsequent preterm birth had a shorter conization-to-pregnancy interval (337 days) than women with a subsequent term birth (581 days) (P=.004). The association between short conization-to-pregnancy interval and preterm birth remained significant when controlling for confounders including race and cone dimensions. The effect of short conization-to-pregnancy interval on subsequent preterm birth was more persistent among African Americans when compared with white women. Women with a short conization-to-pregnancy interval are at increased risk for preterm birth. Women of reproductive age who must have a conization procedure can be counseled that conceiving within 2 to 3 months of the procedure may be associated with an increased risk of preterm birth. II.

  8. Bacterial Hyaluronidase Promotes Ascending GBS Infection and Preterm Birth

    Directory of Open Access Journals (Sweden)

    Jay Vornhagen

    2016-06-01

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

  9. Provider-Initiated Late Preterm Births in Brazil: Differences between Public and Private Health Services.

    Science.gov (United States)

    Leal, Maria do Carmo; Esteves-Pereira, Ana Paula; Nakamura-Pereira, Marcos; Torres, Jacqueline Alves; Domingues, Rosa Maria Soares Madeira; Dias, Marcos Augusto Bastos; Moreira, Maria Elizabeth; Theme-Filha, Mariza; da Gama, Silvana Granado Nogueira

    2016-01-01

    A large proportion of the rise in prematurity worldwide is owing to late preterm births, which may be due to the expansion of obstetric interventions, especially pre-labour caesarean section. Late preterm births pose similar risks to overall prematurity, making this trend a concern. In this study, we describe factors associated with provider-initiated late preterm birth and verify differences in provider-initiated late preterm birth rates between public and private health services according to obstetric risk. This is a sub-analysis of a national population-based survey of postpartum women entitled "Birth in Brazil", performed between 2011 and 2012. We included 23,472 singleton live births. We performed non-conditional multiple logistic regressions assessing associated factors and analysing differences between public and private health services. Provider-initiated births accounted for 38% of late preterm births; 32% in public health services and 61% in private health services. They were associated with previous preterm birth(s) and maternal pathologies for women receiving both public and private services and with maternal age ≥35 years for women receiving public services. Women receiving private health services had higher rates of provider-initiated late preterm birth (rate of 4.8%) when compared to the ones receiving public services (rate of 2.4%), regardless of obstetric risk-adjusted OR of 2.3 (CI 1.5-3.6) for women of low obstetric risk and adjusted OR of 1.6 (CI 1.1-2.3) for women of high obstetric risk. The high rates of provider-initiated late preterm birth suggests a considerable potential for reduction, as such prematurity can be avoided, especially in women of low obstetric risk. To promote healthy births, we advise introducing policies with incentives for the adoption of new models of birth care.

  10. Provider-Initiated Late Preterm Births in Brazil: Differences between Public and Private Health Services.

    Directory of Open Access Journals (Sweden)

    Maria do Carmo Leal

    Full Text Available A large proportion of the rise in prematurity worldwide is owing to late preterm births, which may be due to the expansion of obstetric interventions, especially pre-labour caesarean section. Late preterm births pose similar risks to overall prematurity, making this trend a concern. In this study, we describe factors associated with provider-initiated late preterm birth and verify differences in provider-initiated late preterm birth rates between public and private health services according to obstetric risk.This is a sub-analysis of a national population-based survey of postpartum women entitled "Birth in Brazil", performed between 2011 and 2012. We included 23,472 singleton live births. We performed non-conditional multiple logistic regressions assessing associated factors and analysing differences between public and private health services.Provider-initiated births accounted for 38% of late preterm births; 32% in public health services and 61% in private health services. They were associated with previous preterm birth(s and maternal pathologies for women receiving both public and private services and with maternal age ≥35 years for women receiving public services. Women receiving private health services had higher rates of provider-initiated late preterm birth (rate of 4.8% when compared to the ones receiving public services (rate of 2.4%, regardless of obstetric risk-adjusted OR of 2.3 (CI 1.5-3.6 for women of low obstetric risk and adjusted OR of 1.6 (CI 1.1-2.3 for women of high obstetric risk.The high rates of provider-initiated late preterm birth suggests a considerable potential for reduction, as such prematurity can be avoided, especially in women of low obstetric risk. To promote healthy births, we advise introducing policies with incentives for the adoption of new models of birth care.

  11. Subsequent childbirth after a previous traumatic birth.

    Science.gov (United States)

    Beck, Cheryl Tatano; Watson, Sue

    2010-01-01

    Nine percent of new mothers in the United States who participated in the Listening to Mothers II Postpartum Survey screened positive for meeting the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for posttraumatic stress disorder after childbirth. Women who have had a traumatic birth experience report fewer subsequent children and a longer length of time before their second baby. Childbirth-related posttraumatic stress disorder impacts couples' physical relationship, communication, conflict, emotions, and bonding with their children. The purpose of this study was to describe the meaning of women's experiences of a subsequent childbirth after a previous traumatic birth. Phenomenology was the research design used. An international sample of 35 women participated in this Internet study. Women were asked, "Please describe in as much detail as you can remember your subsequent pregnancy, labor, and delivery following your previous traumatic birth." Colaizzi's phenomenological data analysis approach was used to analyze the stories of the 35 women. Data analysis yielded four themes: (a) riding the turbulent wave of panic during pregnancy; (b) strategizing: attempts to reclaim their body and complete the journey to motherhood; (c) bringing reverence to the birthing process and empowering women; and (d) still elusive: the longed-for healing birth experience. Subsequent childbirth after a previous birth trauma has the potential to either heal or retraumatize women. During pregnancy, women need permission and encouragement to grieve their prior traumatic births to help remove the burden of their invisible pain.

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

    Science.gov (United States)

    Neggers, Yasmin H

    2015-08-15

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

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

    Science.gov (United States)

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

    2015-10-01

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

  14. Microbiome in parturition and preterm birth.

    Science.gov (United States)

    Mysorekar, Indira U; Cao, Bin

    2014-01-01

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

  15. The preterm prediction study: risk factors for indicated preterm births. Maternal-Fetal Medicine Units Network of the National Institute of Child Health and Human Development.

    Science.gov (United States)

    Meis, P J; Goldenberg, R L; Mercer, B M; Iams, J D; Moawad, A H; Miodovnik, M; Menard, M K; Caritis, S N; Thurnau, G R; Bottoms, S F; Das, A; Roberts, J M; McNellis, D

    1998-03-01

    Preterm births occur for many different reasons. Most efforts to identify risk factors for preterm births either ignore cause and consider preterm births as a single entity or examine risk factors for spontaneous preterm births. We performed this study to examine risk factors for indicated preterm births, which constitute more than one quarter of all preterm births. The study included 2929 women evaluated at 24 weeks' gestation at 10 centers. Information was gathered about demographic factors, socioeconomic status, home and work environments, drug and alcohol use, and medical history. In addition vaginal samples were evaluated for fetal fibronectin and bacterial vaginosis and cervical length was measured by transvaginal ultrasonography. Associations with indicated preterm birth were evaluated by univariate tests and by multivariable analysis with logistic regression. Of the women studied at 24 weeks' gestation 15.3% were delivered of their infants at births. Risk factors in the final multivariable model were, in order of decreasing odds ratios, mullerian duct abnormality (odds ratio 7.02), proteinuria at history of chronic hypertension (odds ratio 4.06), history of previous indicated preterm birth (odds ratio 2.79), history of lung disease (odds ratio 2.52), previous spontaneous preterm birth (odds ratio 2.45), age >30 years (odds ratio 2.42), black ethnicity (odds ratio 1.56), and working during pregnancy (odds ratio 1.49). Alcohol use in pregnancy was actually associated with a lower risk of indicated preterm birth (odds ratio 0.35). The risk factors found in this analysis tend to be different from those associated with spontaneous preterm birth.

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

    African Journals Online (AJOL)

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

  17. Obstetric History and Likelihood of Preterm Birth of Twins.

    Science.gov (United States)

    Easter, Sarah Rae; Little, Sarah E; Robinson, Julian N; Mendez-Figueroa, Hector; Chauhan, Suneet P

    2018-01-05

     The objective of this study was to investigate the relationship between preterm birth in a prior pregnancy and preterm birth in a twin pregnancy.  We performed a secondary analysis of a randomized controlled trial evaluating 17-α-hydroxyprogesterone caproate in twins. Women were classified as nulliparous, multiparous with a prior term birth, or multiparous with a prior preterm birth. We used logistic regression to examine the odds of spontaneous preterm birth of twins before 35 weeks according to past obstetric history.  Of the 653 women analyzed, 294 were nulliparas, 310 had a prior term birth, and 49 had a prior preterm birth. Prior preterm birth increased the likelihood of spontaneous delivery before 35 weeks (adjusted odds ratio [aOR]: 2.44, 95% confidence interval [CI]: 1.28-4.66), whereas prior term delivery decreased these odds (aOR: 0.55, 95% CI: 0.38-0.78) in the current twin pregnancy compared with the nulliparous reference group. This translated into a lower odds of composite neonatal morbidity (aOR: 0.38, 95% CI: 0.27-0.53) for women with a prior term delivery.  For women carrying twins, a history of preterm birth increases the odds of spontaneous preterm birth, whereas a prior term birth decreases odds of spontaneous preterm birth and neonatal morbidity for the current twin pregnancy. These results offer risk stratification and reassurance for clinicians. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  18. The role of progesterone in prevention of preterm birth

    Directory of Open Access Journals (Sweden)

    Jodie M Dodd

    2009-07-01

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

  19. Impact of obstetric history on the risk of spontaneous preterm birth in singleton and multiple pregnancies: a systematic review.

    Science.gov (United States)

    Kazemier, B M; Buijs, P E; Mignini, L; Limpens, J; de Groot, C J M; Mol, B W J

    2014-09-01

    Information about the recurrence of spontaneous preterm birth in subsequent twin/singleton pregnancies is scattered. To quantify the risk of recurrence of spontaneous preterm birth in different subtypes of subsequent pregnancies. An electronic literature search in OVID MEDLINE and EMBASE, complemented by PubMed, to find recent studies. Studies comparing the risk of spontaneous preterm birth after a previous preterm and previous term pregnancy. The absolute risk of recurrence with a 95% confidence interval and the absolute risk of preterm birth after a term delivery were calculated. Data from studies were pooled using the Mantel-Haenszel method. We detected 13 relevant studies. The risk of recurrence of preterm birth was significantly increased in all preterm pregnancy subtypes, compared with their term counterparts. Women pregnant with twins after a previous preterm singleton had the highest absolute risk of recurrence (57.0%, 95% CI 51.9-61.9%), and after a previous term singleton their absolute risk was 25% (95% CI 24.3-26.5%). Women pregnant with a singleton after a previous preterm twin pregnancy have an absolute recurrence risk of 10% (95% CI 8.2-12.3%), whereas a singleton pregnancy after delivering a previous twin up to term yields a low absolute risk of only 1.3% (95% CI 0.8-2.2). Women pregnant with a singleton after a previous preterm singleton have an absolute recurrence risk of 20% (95% CI 19.9-20.6). The risk of recurrence of preterm birth is influenced by the singleton/twin order in both pregnancies, and varies between 10% for a singleton after previous preterm twins to 57% for twins after a previous preterm singleton. © 2014 Royal College of Obstetricians and Gynaecologists.

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

    Science.gov (United States)

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

    2011-09-01

    Several studies have reported increasing trends in preterm birth in developed countries, mainly attributable to an increase in medically indicated preterm births. Our aim was to describe trends in preterm birth among singleton and multiple pregnancies in the Netherlands. Prospective cohort study. Nationwide study. We studied 1,451,246 pregnant women from 2000 to 2007. We assessed trends in preterm birth. We subdivided preterm birth into spontaneous preterm birth after premature prelabour rupture of membranes (pPROM), medically indicated preterm birth and spontaneous preterm birth without pPROM. We performed analyses separately for singletons and multiples. The primary outcome was preterm birth, defined as birth before 37 weeks of gestation, with very preterm birth (birth was 7.7% and the risk of very preterm birth was 1.3%. In singleton pregnancies, the preterm birth risk decreased significantly from 6.4% to 6.0% (P birth without pPROM (3.6-3.1%, P birth risk increased significantly (47.3-47.7%, P = 0.047), mainly as a result of medically indicated preterm birth, which increased from 15.0% to 17.9% (P birth risk in singleton pregnancies decreased significantly over the years. The trend of increasing preterm birth risk reported in other countries was only observed in (medically indicated) preterm birth in multiple pregnancies. © 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2011 RCOG.

  1. Prevelance of Spontaneus Preterm Birth and Related Factors

    Directory of Open Access Journals (Sweden)

    Emel Ege

    2009-09-01

    Full Text Available OBJECTIVE: Preterm birth is a process that has social and economical consequences which increase morbidity and mortality of infant and newborn. The aim of this study is to examine the prevalence of spontaneous preterm birth and related factors. METHODS: This descriptive study was conducted in Faruk Sükan maternity and child hospital in Konya province. The universe was composed of the women who apply to hospital for delivery. The three hundred women who had vaginal delivery between February 15 and March 31, 2007 were included in study as using non-randomly sampling method. A questionnaire was used to collect data. Data were collected by a researcher with face to face interview during postpartum 24 hours in hospital. Percentage and mean distribution and student t and chi-square test were used for statistical analyses. RESULTS: Of women, 79.3 % were illiterate and primary school graduated. The prevalence of preterm birth in study group was 17.3 %. In study group who experiencing preterm birth, 51.9 % of the women were reported that they had premature rupture of membranes and 48.1 % had early uterine contraction. It was determined a relationship between preterm birth and age, length of marriage, number of delivery, weight of the last child, history of preterm birth of women and her mother, history of bleeding during pregnancy, having problem with husband’s family, vaginal douching during pregnancy, smoking during pregnancy, multiple pregnancy, hypertension during preganacy. CONCLUSIONS: Preterm birth is an important health problem for mothers and newborns. It becomes important the frequency and quality of preterm follow-up in terms of early diagnosis and early intervention of preterm birth. It seems important that health professionals should be aware of symptoms of preterm birth, making the pregnant women be aware of this symtoms to solve the problem.

  2. Residential Agricultural Pesticide Exposures and Risks of Spontaneous Preterm Birth.

    Science.gov (United States)

    Shaw, Gary M; Yang, Wei; Roberts, Eric M; Kegley, Susan E; Stevenson, David K; Carmichael, Suzan L; English, Paul B

    2018-01-01

    Pesticides exposures are aspects of the human exposome that have not been sufficiently studied for their contribution to risk for preterm birth. We investigated risks of spontaneous preterm birth from potential residential exposures to 543 individual chemicals and 69 physicochemical groupings that were applied in the San Joaquin Valley of California during the study period, 1998-2011. The study population was derived from birth certificate data linked with Office of Statewide Health Planning and Development maternal and infant hospital discharge data. After exclusions, the analytic study base included 197,461 term control births and 27,913 preterm case births. Preterm cases were more narrowly defined as 20-23 weeks (n = 515), 24-27 weeks (n = 1,792), 28-31 weeks (n = 3,098), or 32-36 weeks (n = 22,508). The frequency of any (versus none) pesticide exposure was uniformly lower in each preterm case group relative to the frequency in term controls, irrespective of gestational month of exposure. All odds ratios were below 1.0 for these any versus no exposure comparisons. The majority of odds ratios were below 1.0, many of them statistically precise, for preterm birth and exposures to specific chemical groups or chemicals. This study showed a general lack of increased risk of preterm birth associated with a range of agriculture pesticide exposures near women's residences.

  3. Interplay of cytokines in preterm birth

    Directory of Open Access Journals (Sweden)

    Monika Pandey

    2017-01-01

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

  4. Study of Relation between Physical Activity and Preterm Birth

    Directory of Open Access Journals (Sweden)

    Mehran N.

    2012-04-01

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

  5. The impact of medically indicated and spontaneous preterm birth among hypertensive women.

    Science.gov (United States)

    Kase, Benjamin A; Carreno, Carlos A; Blackwell, Sean C; Sibai, Baha M

    2013-11-01

    To (1) describe the frequency of spontaneous preterm birth (SPTB) and medically indicated preterm birth (PTB) among women with chronic hypertension (CHTN) and (2) to evaluate differences in neonatal outcomes according to SPTB or medically indicated PTB. Retrospective analysis of a previously conducted multicenter randomized trial. Deliveries were categorized as SPTB or medically indicated and stratified by gestational ages (PTBs occurred in the late preterm period (n = 146). SGA was significantly more frequent among those with medically indicated PTB at 0.05). Nearly one-third of women with CHTN delivered preterm. The majority of PTBs were medically indicated and late preterm, but approximately one-third were due to SPTB. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

    Science.gov (United States)

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

    2017-09-01

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

  7. Sex of the first-born and risk of preterm birth in the subsequent pregnancy

    DEFF Research Database (Denmark)

    Mortensen, Laust H; Nielsen, Henriette Svarre; Cnattingius, Sven

    2011-01-01

    BACKGROUND: Recent data suggest that the chance of successfully maintaining a pregnancy may be influenced by the sex of previously born children. We explored a possible relation between sex of the first-born infant and the risk of preterm birth in the second pregnancy. METHODS: Using data from...... the National Medical Birth Registries in Denmark 1980-2004 and Sweden 1980-2001, we selected all women whose first and second births were singleton and who had information on sex of first-born infant and gestational age for the second (Denmark, n = 393,686; Sweden, n = 603,282). Cox proportional hazards...... 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...

  8. Fetal fibronectin in the prediction of preterm birth

    NARCIS (Netherlands)

    Bruijn, M.M.C.

    2016-01-01

    Accurate prediction of preterm birth is a big clinical challenge in obstetrics. Most of the women presenting with symptoms of preterm labour will not deliver within one week and the majority will even deliver at term. Correct discrimination between women with a high and a low risk to deliver on

  9. preterm births in a resource constrained setting: soci

    African Journals Online (AJOL)

    2015-12-01

    Dec 1, 2015 ... Methods: A retrospective study of preterm and term deliveries in a tertiary ... self is a risk factor for a repeat preterm birth in subse- ... strual period and verified with the report of an early ultrasound scan. ... corresponding 95% confidence interval. .... natal visits has been reported to influence the likeli- hood of ...

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

    Directory of Open Access Journals (Sweden)

    Scheepers Hubertina CJ

    2007-06-01

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

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

    LENUS (Irish Health Repository)

    Bodnar, Lisa M

    2013-07-01

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

  12. [Risk factors associated with preterm birth in a second level hospital].

    Science.gov (United States)

    Escobar-Padilla, Beatriz; Gordillo-Lara, Limberg Darinel; Martínez-Puon, Horacio

    2017-01-01

    Preterm birth is one of the biggest problems in obstetrics and gynecology, given that it has an incidence of 10-11%. The objective was to identify the risk factors associated with a preterm birth. A retrospective, observational, transversal and analytic case-control study was made. All premature birth incidences were determined as study objects and controls were integrated with term deliveries. A sample size of 344 patients with a control per case was calculated. A total of 688 patients were studied. Statistical analysis was descriptive, univariate and bivariate and we used the Pearson chi square test, with a p preclampsia, PROM, twin pregnancy, placenta praevia, cervicovaginitis, previous preterm delivery and UTI are risk factors with statistical significance associated with preterm delivery.

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

    DEFF Research Database (Denmark)

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

    2007-01-01

    The aim of the present study was to assess the impact of obesity and gestational weight gain on the risk of subtypes of preterm birth, because little is known about these associations. The study included 62 167 women within the Danish National Birth Cohort for whom self-reported information about...... 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...... associations of prepregnancy BMI and gestational weight gain with subtypes of preterm birth. The crude risks of PPROM and of induced preterm deliveries were higher in obese women (BMI > or = 30) than in normal-weight women (18.5 gestation, when obese...

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

    Science.gov (United States)

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

    2013-10-13

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

  15. Loss of cannabinoid receptor CB1 induces preterm birth.

    Directory of Open Access Journals (Sweden)

    Haibin Wang

    2008-10-01

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

  16. Swedish and American studies show that initiatives to decrease maternal obesity could play a key role in reducing preterm birth.

    Science.gov (United States)

    Gould, Jeffrey B; Mayo, Jonathan; Shaw, Gary M; Stevenson, David K

    2014-06-01

    Maternal obesity is a major source of preventable perinatal morbidity, but studies of the relationship between obesity and preterm birth have been inconsistent. This review looks at two major studies covering just under 3.5 million births, from California, USA, and Sweden. Inconsistent findings in previous studies appear to stem from the complex relationship between obesity and preterm birth. Initiatives to decrease maternal obesity represent an important strategy in reducing preterm birth. ©2014 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  17. Preterm birth and periodontal disease: A medical perspective

    Directory of Open Access Journals (Sweden)

    Neeta Dhabhai

    2016-01-01

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

  18. Early pregnancy vaginal microbiome trends and preterm birth.

    Science.gov (United States)

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

    2017-09-01

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

  19. Effects of Maternal Age and Age-Specific Preterm Birth Rates on Overall Preterm Birth Rates - United States, 2007 and 2014.

    Science.gov (United States)

    Ferré, Cynthia; Callaghan, William; Olson, Christine; Sharma, Andrea; Barfield, Wanda

    2016-11-04

    Reductions in births to teens and preterm birth rates are two recent public health successes in the United States (1,2). From 2007 to 2014, the birth rate for females aged 15-19 years declined 42%, from 41.5 to 24.2 per 1,000 females. The preterm birth rate decreased 8.4%, from 10.41% to 9.54% of live births (1). Rates of preterm births vary by maternal age, being higher among the youngest and oldest mothers. It is unknown how changes in the maternal age distribution in the United States have affected preterm birth rates. CDC used birth data to assess the relative contributions of changes in the maternal age distribution and in age-specific preterm birth rates to the overall decrease in preterm birth rates. The preterm birth rate declined in all age groups. The effects of age distribution changes on the preterm birth rate decrease were different in younger and older mothers. The decrease in the proportion of births to mothers aged ≤19 and 20-24 years and reductions in age-specific preterm rates in all age groups contributed to the overall decline in the preterm birth rate. The increase in births to mothers aged ≥30 years had no effect on the overall preterm birth rate decrease. The decline in preterm births from 2007 to 2014 is related, in part, to teen pregnancy prevention and the changing maternal age distribution. Effective public health strategies for further reducing preterm birth rates need to be tailored to different age groups.

  20. Reduction of preterm birth rates starts at preconception

    NARCIS (Netherlands)

    Oudijk, M. A.

    2017-01-01

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

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

    DEFF Research Database (Denmark)

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

    2014-01-01

    BACKGROUND: Preterm birth, low birth weight, and infant catch-up growth seem associated with an increased risk of respiratory diseases in later life, but individual studies showed conflicting results. OBJECTIVES: We performed an individual participant data meta-analysis for 147,252 children of 31...

  2. Development of a prognostic model for predicting spontaneous singleton preterm birth.

    Science.gov (United States)

    Schaaf, Jelle M; Ravelli, Anita C J; Mol, Ben Willem J; Abu-Hanna, Ameen

    2012-10-01

    To develop and validate a prognostic model for prediction of spontaneous preterm birth. Prospective cohort study using data of the nationwide perinatal registry in The Netherlands. We studied 1,524,058 singleton pregnancies between 1999 and 2007. We developed a multiple logistic regression model to estimate the risk of spontaneous preterm birth based on maternal and pregnancy characteristics. We used bootstrapping techniques to internally validate our model. Discrimination (AUC), accuracy (Brier score) and calibration (calibration graphs and Hosmer-Lemeshow C-statistic) were used to assess the model's predictive performance. Our primary outcome measure was spontaneous preterm birth at model included 13 variables for predicting preterm birth. The predicted probabilities ranged from 0.01 to 0.71 (IQR 0.02-0.04). The model had an area under the receiver operator characteristic curve (AUC) of 0.63 (95% CI 0.63-0.63), the Brier score was 0.04 (95% CI 0.04-0.04) and the Hosmer Lemeshow C-statistic was significant (pvalues of predicted probability. The positive predictive value was 26% (95% CI 20-33%) for the 0.4 probability cut-off point. The model's discrimination was fair and it had modest calibration. Previous preterm birth, drug abuse and vaginal bleeding in the first half of pregnancy were the most important predictors for spontaneous preterm birth. Although not applicable in clinical practice yet, this model is a next step towards early prediction of spontaneous preterm birth that enables caregivers to start preventive therapy in women at higher risk. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Ana Daniela Izoton de Sadovsky

    Full Text Available Abstract Objective: To analyze economic inequality (absolute and relative due to family income in relation to the occurrence of preterm births in Southern Brazil. Methods: 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. Results: 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. Conclusion: 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.

  4. Season and preterm birth in Norway: A cautionary tale.

    Science.gov (United States)

    Weinberg, Clarice R; Shi, Min; DeRoo, Lisa A; Basso, Olga; Skjærven, Rolv

    2015-06-01

    Preterm birth is a common, costly and dangerous pregnancy complication. Seasonality of risk would suggest modifiable causes. We examine seasonal effects on preterm birth, using data from the Medical Birth Registry of Norway (2,321,652 births), and show that results based on births are misleading and a fetuses-at-risk approach is essential. In our harmonic-regression Cox proportional hazards model we consider fetal risk of birth between 22 and 37 completed weeks of gestation. We examine effects of both day of year of conception (for early effects) and day of ongoing gestation (for seasonal effects on labour onset) as modifiers of gestational-age-based risk. Naïve analysis of preterm rates across days of birth shows compelling evidence for seasonality (P distribution of the fetal population at risk. When we instead properly treat fetuses as the individuals at risk, restrict analysis to pregnancies with relatively accurate ultrasound-based assessment of gestational age (available since 1998) and adjust for socio-demographic factors and maternal smoking, we find modest effects of both time of year of conception and time of year at risk, with peaks for early preterm near early January and early July. Analyses of seasonal effects on preterm birth are demonstrably vulnerable to confounding by seasonality of conception, measurement error in conception dating, and socio-demographic factors. The seasonal variation based on fetuses reveals two peaks for early preterm, coinciding with New Year's Day and the early July beginning of Norway's summer break, and may simply reflect a holiday-related pattern of unintended conception. Published by Oxford University Press on behalf of the International Epidemiological Association 2015. This work is written by a US Government employee and is in the public domain in the US.

  5. Cluster analysis of spontaneous preterm birth phenotypes identifies potential associations among preterm birth mechanisms.

    Science.gov (United States)

    Esplin, M Sean; Manuck, Tracy A; Varner, Michael W; Christensen, Bryce; Biggio, Joseph; Bukowski, Radek; Parry, Samuel; Zhang, Heping; Huang, Hao; Andrews, William; Saade, George; Sadovsky, Yoel; Reddy, Uma M; Ilekis, John

    2015-09-01

    We sought to use an innovative tool that is based on common biologic pathways to identify specific phenotypes among women with spontaneous preterm birth (SPTB) to enhance investigators' ability to identify and to highlight common mechanisms and underlying genetic factors that are responsible for SPTB. We performed a secondary analysis of a prospective case-control multicenter study of SPTB. All cases delivered a preterm singleton at SPTB ≤34.0 weeks' gestation. Each woman was assessed for the presence of underlying SPTB causes. A hierarchic cluster analysis was used to identify groups of women with homogeneous phenotypic profiles. One of the phenotypic clusters was selected for candidate gene association analysis with the use of VEGAS software. One thousand twenty-eight women with SPTB were assigned phenotypes. Hierarchic clustering of the phenotypes revealed 5 major clusters. Cluster 1 (n = 445) was characterized by maternal stress; cluster 2 (n = 294) was characterized by premature membrane rupture; cluster 3 (n = 120) was characterized by familial factors, and cluster 4 (n = 63) was characterized by maternal comorbidities. Cluster 5 (n = 106) was multifactorial and characterized by infection (INF), decidual hemorrhage (DH), and placental dysfunction (PD). These 3 phenotypes were correlated highly by χ(2) analysis (PD and DH, P cluster 3 of SPTB. We identified 5 major clusters of SPTB based on a phenotype tool and hierarch clustering. There was significant correlation between several of the phenotypes. The INS gene was associated with familial factors that were underlying SPTB. Copyright © 2015 Elsevier Inc. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Ana Daniela Izoton de Sadovsky

    2018-01-01

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

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

    DEFF Research Database (Denmark)

    Lamont, R. F.

    2015-01-01

    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 as an inte......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...

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

    Science.gov (United States)

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

    2017-11-01

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

  9. Rates of preterm birth following antenatal exposure to severe life events: A population-based cohort study

    DEFF Research Database (Denmark)

    Khashan, Ali; McNamee, R.; Abel, Kathryn

    2009-01-01

    BACKGROUND: Preterm birth and other pregnancy complications have been linked to maternal stress during pregnancy. We investigated the association between maternal exposure to severe life events and risk of preterm birth. METHODS: Mothers of all singleton live births (n = 1.35 million births...... to estimate the effect of exposure on preterm birth, very preterm birth and extremely preterm birth. RESULTS: There were 58 626 (4.34%) preterm births (births and 3288 (0.24%) extremely preterm births in the study cohort. Severe life events in close relatives in the 6...... months before conception increased the risk of preterm birth by 16% (relative risk, RR = 1.16, [95% CI: 1.08-1.23]). Severe life events in older children in the 6 months before conception increased the risk of preterm birth by 23% (RR = 1.23, [95% CI: 1.02-1.49]) and the risk of very preterm birth by 59...

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

    DEFF Research Database (Denmark)

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

    2017-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Helen Y How

    2008-12-01

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

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

    LENUS (Irish Health Repository)

    Smith, V

    2011-03-01

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

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

    NARCIS (Netherlands)

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

    2011-01-01

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

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

    NARCIS (Netherlands)

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

    2016-01-01

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

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

    NARCIS (Netherlands)

    Hermans, F.J.R.

    2017-01-01

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

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

    DEFF Research Database (Denmark)

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

    2012-01-01

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

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

    Science.gov (United States)

    Mawson, Anthony R

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

  18. The Consequences of Chorioamnionitis: Preterm Birth and Effects on Development

    Directory of Open Access Journals (Sweden)

    Robert Galinsky

    2013-01-01

    Full Text Available Preterm birth is a major cause of perinatal mortality and long-term morbidity. Chorioamnionitis is a common cause of preterm birth. Clinical chorioamnionitis, characterised by maternal fever, leukocytosis, tachycardia, uterine tenderness, and preterm rupture of membranes, is less common than subclinical/histologic chorioamnionitis, which is asymptomatic and defined by inflammation of the chorion, amnion, and placenta. Chorioamnionitis is often associated with a fetal inflammatory response. The fetal inflammatory response syndrome (FIRS is defined by increased systemic inflammatory cytokine concentrations, funisitis, and fetal vasculitis. Clinical and epidemiological studies have demonstrated that FIRS leads to poor cardiorespiratory, neurological, and renal outcomes. These observations are further supported by experimental studies that have improved our understanding of the mechanisms responsible for these outcomes. This paper outlines clinical and experimental studies that have improved our current understanding of the mechanisms responsible for chorioamnionitis-induced preterm birth and explores the cellular and physiological mechanisms underlying poor cardiorespiratory, neural, retinal, and renal outcomes observed in preterm infants exposed to chorioamnionitis.

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

    Directory of Open Access Journals (Sweden)

    Achour Radhouane

    2017-08-01

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

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

    Science.gov (United States)

    Ortiz Martínez, Roberth Alirio; Castillo, Alejandro

    2016-01-01

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

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

    Science.gov (United States)

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

    2012-05-01

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

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

    International Nuclear Information System (INIS)

    Araz, N. C.

    2013-01-01

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

  3. Faith, existence and birth of preterm babies

    DEFF Research Database (Denmark)

    Rasmussen, Christina Prinds

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

  4. [Bacterial vaginosis and spontaneous preterm birth].

    Science.gov (United States)

    Brabant, G

    2016-12-01

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

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

    African Journals Online (AJOL)

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

  6. Risk factors leading to preterm births in Morocco: a prospective ...

    African Journals Online (AJOL)

    Introduction: Eminent morbidity and mortality of preterm infants is perceived, especially in developing countries. The aim of the study is to identify the main factors involved in the occurrence of premature births in Morocco. Methods: This was a descriptive and analytical study conducted at the maternity Souissi in Rabat, from ...

  7. Thymic size at birth in preterm infants with severe respiratory ...

    African Journals Online (AJOL)

    To determine whether the thymic size in preterm infants with severe respiratory distress syndrome (RDS) can be used to predict ... chorio-amnionitis is associated with a small thymus at birth.4,7. In those ..... Acta Paediatr 2000; 89: 975-978. 6.

  8. [Fat emulsion tolerance in preterm infants of different gestational ages in the early stage after birth].

    Science.gov (United States)

    Tang, Hui; Yang, Chuan-Zhong; Li, Huan; Wen, Wei; Huang, Fang-Fang; Huang, Zhi-Feng; Shi, Yu-Ping; Yu, Yan-Liang; Chen, Li-Lian; Yuan, Rui-Qin; Zhu, Xiao-Yu

    2017-06-01

    To investigate the fat emulsion tolerance in preterm infants of different gestational ages in the early stage after birth. A total of 98 preterm infants were enrolled and divided into extremely preterm infant group (n=17), early preterm infant group (n=48), and moderate-to-late preterm infant group (n=33). According to the dose of fat emulsion, they were further divided into low- and high-dose subgroups. The umbilical cord blood and dried blood filter papers within 3 days after birth were collected. Tandem mass spectrometry was used to measure the content of short-, medium-, and long-chain acylcarnitines. The extremely preterm infant and early preterm infant groups had a significantly lower content of long-chain acylcarnitines in the umbilical cord blood and dried blood filter papers within 3 days after birth than the moderate-to-late preterm infant group (Pemulsion subgroup had a significantly higher content of short-, medium-, and long-chain acylcarnitines than the high-dose fat emulsion subgroup among the extremely preterm infants (Pemulsion subgroups within 3 days after birth. Compared with moderate-to-late preterm infants, extremely preterm infants and early preterm infants have a lower capacity to metabolize long-chain fatty acids within 3 days after birth. Early preterm infants and moderate-to-late preterm infants may tolerate high-dose fat emulsion in the early stage after birth, but extremely preterm infants may have an insufficient capacity to metabolize high-dose fat emulsion.

  9. The placental microbiome is altered among subjects with spontaneous preterm birth with and without chorioamnionitis

    Science.gov (United States)

    Kannan, Paranthaman S.; Alvarez, Manuel; Gisslen, Tate; Harris, R. Alan; Sweeney, Emma L.; Knox, Christine L.; Lambers, Donna S.; Jobe, Alan H.; Chougnet, Claire A.; Kallapur, Suhas G.; Aagaard, Kjersti M.

    2016-01-01

    BACKGROUND Preterm birth (PTB) is a leading cause of neonatal morbidity and mortality and is not uncommonly associated with chorioamnionitis. We recently have demonstrated that the placenta harbors a unique microbiome with similar flora to the oral community. We also have shown an association of these placental microbiota with PTB, history of antenatal infection, and excess maternal weight gain. On the basis of these previous observations, we hypothesized that the placental membranes would retain a microbiome community that would vary in association with preterm birth and chorioamnionitis. OBJECTIVE In the current study, we aimed to examine the differences in the placental membrane microbiome in association with PTB in both the presence and absence of chorioamnionitis and/ or funisitis using state-of-the-science whole-genome shotgun metagenomics. STUDY DESIGN This was a cross-sectional analysis with 6 nested spontaneous birth cohorts (n = 9–15 subjects/cohort): Term gestations without chorioamnionitis, term with chorioamnionitis, preterm without chorioamnionitis, preterm with mild chorioamnionitis, preterm with severe chorioamnionitis, and preterm with chorioamnionitis and funisitis. Histologic analysis was performed with Redline's criteria, and inflammatory cytokines were analyzed in the cord blood. DNA from placental membranes was extracted from sterile swabs collected at delivery, and whole-genome shotgun sequencing was performed on the Illumina HiSeq platform. Filtered microbial DNA sequences were annotated and analyzed with MG-RAST (ie, Metagenomic Rapid Annotations using Subsystems Technology) and R. RESULTS Subjects were assigned to cohorts on the basis of gestational age at delivery and independent scoring of histologic chorioamnionitis. We found that preterm subjects with severe chorioamnionitis and funisitis had increases in cord blood inflammatory cytokines. Of interest, although the placental membrane microbiome was altered in association with

  10. The placental membrane microbiome is altered among subjects with spontaneous preterm birth with and without chorioamnionitis.

    Science.gov (United States)

    Prince, Amanda L; Ma, Jun; Kannan, Paranthaman S; Alvarez, Manuel; Gisslen, Tate; Harris, R Alan; Sweeney, Emma L; Knox, Christine L; Lambers, Donna S; Jobe, Alan H; Chougnet, Claire A; Kallapur, Suhas G; Aagaard, Kjersti M

    2016-05-01

    Preterm birth (PTB) is a leading cause of neonatal morbidity and mortality and is not uncommonly associated with chorioamnionitis. We recently have demonstrated that the placenta harbors a unique microbiome with similar flora to the oral community. We also have shown an association of these placental microbiota with PTB, history of antenatal infection, and excess maternal weight gain. On the basis of these previous observations, we hypothesized that the placental membranes would retain a microbiome community that would vary in association with preterm birth and chorioamnionitis. In the current study, we aimed to examine the differences in the placental membrane microbiome in association with PTB in both the presence and absence of chorioamnionitis and/or funisitis using state-of-the-science whole-genome shotgun metagenomics. This was a cross-sectional analysis with 6 nested spontaneous birth cohorts (n = 9-15 subjects/cohort): Term gestations without chorioamnionitis, term with chorioamnionitis, preterm without chorioamnionitis, preterm with mild chorioamnionitis, preterm with severe chorioamnionitis, and preterm with chorioamnionitis and funisitis. Histologic analysis was performed with Redline's criteria, and inflammatory cytokines were analyzed in the cord blood. DNA from placental membranes was extracted from sterile swabs collected at delivery, and whole-genome shotgun sequencing was performed on the Illumina HiSeq platform. Filtered microbial DNA sequences were annotated and analyzed with MG-RAST (ie, Metagenomic Rapid Annotations using Subsystems Technology) and R. Subjects were assigned to cohorts on the basis of gestational age at delivery and independent scoring of histologic chorioamnionitis. We found that preterm subjects with severe chorioamnionitis and funisitis had increases in cord blood inflammatory cytokines. Of interest, although the placental membrane microbiome was altered in association with severity of histologic chorioamnionitis

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

    Science.gov (United States)

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

    2015-11-01

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

  12. The Influence of Meteorological Factors and Atmospheric Pollutants on the Risk of Preterm Birth

    NARCIS (Netherlands)

    Giorgis-Allemand, Lise; Pedersen, Marie; Bernard, Claire; Aguilera, Inmaculada; Beelen, Rob M J; Chatzi, Leda; Cirach, Marta; Danileviciute, Asta; Dedele, Audrius; van Eijsden, Manon; Estarlich, Marisa; Fernández-Somoano, Ana; Fernández, Mariana F; Forastiere, Francesco; Gehring, Ulrike; Grazuleviciene, Regina; Gruzieva, Olena; Heude, Barbara; Hoek, Gerard; de Hoogh, Kees; van den Hooven, Edith H; Håberg, Siri E; Iñiguez, Carmen; Jaddoe, Vincent W V; Korek, Michal; Lertxundi, Aitana; Lepeule, Johanna; Nafstad, Per; Nystad, Wenche; Patelarou, Evridiki; Porta, Daniela; Postma, Dirkje; Raaschou-Nielsen, Ole; Rudnai, Peter; Siroux, Valérie; Sunyer, Jordi; Stephanou, Euripides; Sørensen, Mette; Eriksen, Kirsten Thorup; Tuffnell, Derek; Varró, Mihály J; Vrijkotte, Tanja G M; Wijga, Alet; Wright, John; Nieuwenhuijsen, Mark J; Pershagen, Göran; Brunekreef, Bert; Kogevinas, Manolis; Slama, Rémy

    2017-01-01

    Atmospheric pollutants and meteorological conditions are suspected to be causes of preterm birth. We aimed to characterize their possible association with the risk of preterm birth (defined as birth occurring before 37 completed gestational weeks). We pooled individual data from 13 birth cohorts in

  13. The Influence of Meteorological Factors and Atmospheric Pollutants on the Risk of Preterm Birth.

    NARCIS (Netherlands)

    Giorgis-Allemand, Lise; Pedersen, Marie; Bernard, Claire; Aguilera, Inmaculada; Beelen, Rob M J; Chatzi, Leda; Cirach, Marta; Danileviciute, Asta; Dedele, Audrius; van Eijsden, Manon; Estarlich, Marisa; Fernández-Somoano, Ana; Fernández, Mariana F; Forastiere, Francesco; Gehring, Ulrike; Grazuleviciene, Regina; Gruzieva, Olena; Heude, Barbara; Hoek, Gerard; de Hoogh, Kees; van den Hooven, Edith H; Håberg, Siri E; Iñiguez, Carmen; Jaddoe, Vincent W V; Korek, Michal; Lertxundi, Aitana; Lepeule, Johanna; Nafstad, Per; Nystad, Wenche; Patelarou, Evridiki; Porta, Daniela; Postma, Dirkje; Raaschou-Nielsen, Ole; Rudnai, Peter; Siroux, Valérie; Sunyer, Jordi; Stephanou, Euripides; Sørensen, Mette; Eriksen, Kirsten Thorup; Tuffnell, Derek; Varró, Mihály J; Vrijkotte, Tanja G M; Wijga, Alet; Wright, John; Nieuwenhuijsen, Mark J; Pershagen, Göran; Brunekreef, Bert; Kogevinas, Manolis; Slama, Rémy

    2017-01-01

    Atmospheric pollutants and meteorological conditions are suspected to be causes of preterm birth. We aimed to characterize their possible association with the risk of preterm birth (defined as birth occurring before 37 completed gestational weeks). We pooled individual data from 13 birth cohorts in

  14. No. 155-Guidelines for Vaginal Birth After Previous Caesarean Birth.

    Science.gov (United States)

    Martel, Marie-Jocelyne; MacKinnon, Catherine Jane

    2018-03-01

    To provide evidence-based guidelines for the provision of a trial of labour (TOL) after Caesarean section. Fetal and maternal morbidity and mortality associated with vaginal birth after Caesarean (VBAC) and repeat Caesarean section. MEDLINE database was searched for articles published from January 1, 1995, to February 28, 2004, using the key words "vaginal birth after Caesarean (Cesarean) section." The quality of evidence is described using the Evaluation of Evidence criteria outlined in the Report of the Canadian Task Force on the Periodic Health Exam. VALIDATION: These guidelines were approved by the Clinical Practice Obstetrics and Executive Committees of the Society of Obstetricians and Gynaecologists of Canada. Copyright © 2018. Published by Elsevier Inc.

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

    African Journals Online (AJOL)

    2015-02-24

    Feb 24, 2015 ... The mean age of mothers who delivered singleton preterm babies did not differ significantly from that of mothers .... Classification of preterm babies according to gestational age was ... of admission for preterm babies was 16 ± 5.8 days (range: ..... the etiology of preterm births in the US would be expected.

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

    Science.gov (United States)

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

    To analyze economic inequality (absolute and relative) due to family income in relation to the occurrence of preterm births in Southern Brazil. Four birth cohort studies were conducted in the years 1982, 1993, 2004, and 2011. The main exposure was monthly family income and the primary outcome was preterm birth. The inequalities were calculated using the slope index of inequality and the relative index of inequality, adjusted for maternal skin color, education, age, and marital status. The prevalence of preterm births increased from 5.8% to approximately 14% (p-trendinequality 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.

  17. Fetal fibronectin as a predictor of spontaneous preterm birth: a European perspective

    NARCIS (Netherlands)

    Chandiramani, Manju; Di Renzo, Gian C.; Gottschalk, Elisabeth; Helmer, Hanns; Henrich, Wolfgang; Hoesli, Irene; Mol, Ben; Norman, Jane E.; Robson, Stephen; Thornton, Steven; Shennan, Andrew

    2011-01-01

    Preterm birth (PTB) is estimated to account for 6-10% of all births worldwide with 13 million PTBs occurring annually and 1 million resulting in death. The diagnosis of spontaneous preterm labor and accurate prediction of preterm delivery is notoriously difficult. Identification of effective risk

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

    Science.gov (United States)

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

    2014-01-01

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

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

    Science.gov (United States)

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

    2018-03-01

    Secular trends of preterm birth in Japan between 1979 and 2014 were examined to determine whether changes could be explained by a shift in the distribution of maternal age at delivery and parity and/or by changes in age-specific preterm birth rates. Live birth data for 1979 to 2014 were obtained from the Japanese Ministry of Health, Labour and Welfare. Analyses were limited to singleton children born in Japan (n = 43 632 786). Preterm birth was defined using two cut-offs at 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 rates of preterm birth at rates of preterm birth showed a secular increase for preterm births at 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.

  20. The inner state differences of preterm birth rates in Brazil: a time series study

    OpenAIRE

    de Oliveira, Rosana Rosseto; Melo, Emiliana Cristina; Fujimori, Elizabeth; Mathias, Thais Aidar de Freitas

    2016-01-01

    Abstract Background Preterm birth is a serious public health problem, as it is linked to high rates of neonatal and child morbidity and mortality. The prevalence of premature births has increased worldwide, with regional differences. The objective of this study was to analyze the trend of preterm births in the state of Paraná, Brazil, according to Macro-regional and Regional Health Offices (RHOs). Methods This is an ecological time series study using preterm births records from the national l...

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

    Science.gov (United States)

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

    2014-03-27

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

  2. Stress, pre-term labour and birth outcomes.

    Science.gov (United States)

    MacKey, M C; Williams, C A; Tiller, C M

    2000-09-01

    Stress, pre-term labour and birth outcomes Preliminary studies have suggested that stress may be associated with the onset, treatment and outcomes of pre-term labour; however, a systematic comparison of the stress of women with and without pre-term labour has not been reported. Therefore, the purpose of this exploratory study was to compare the stress (daily hassles and mood states) and birth outcomes of black and white women who experienced pre-term labour (PTL) during pregnancy with those who did not. The convenience sample consisted of 35 pregnant women hospitalized in 1996-1997 for the treatment of PTL (24-35 weeks gestation) and 35 controls matched on age, race, parity, gestational age and method of hospital payment. Women in the PTL group had significantly higher tension-anxiety and depression-dejection on the Profile of Mood States (POMS), lower mean birthweight and mean gestational age, and a higher percentage of babies born <37 weeks and weighing 2500 g or less. Black women in the PTL group and white women in the control group had significantly higher scores on the fatigue sub-scale of the POMS and the work and future security sub-scales of the Daily Hassles Scale. Women in the PTL group whose babies weighed 2500 g or less had significantly higher scores on the health, inner concern and financial responsibility sub-scales of the Daily Hassles Scale. The findings from this study indicate the need for further exploration of the interaction of race and stress in understanding and preventing PTL and low birthweight and the need to examine the role of social support in preventing pre-term birth after an episode of PTL.

  3. Periodontal disease and spontaneous preterm birth: a case control study

    Directory of Open Access Journals (Sweden)

    Eley Barry

    2006-07-01

    Full Text Available Abstract Background Several studies have suggested an association between periodontal disease and prematurity but this finding has not been consistently observed. Methods Case control study. Cases (n = 50 were women who had delivered after spontaneous preterm labor at Results There was no difference in the proportion of sites with significant attachment loss (≥3 mm: Cases-3.2%, Controls-2.2% p = 0.21. The gingival crevicular fluid concentrations of elastase and gingipain were elevated in cases vs. controls 238.8 uU/ul vs. 159.6 uU/ul p = .007 and 2.70 uU/ul vs. 1.56 uU/ul p = .001. On multivariate analysis, the mean log concentration of elastase, but not of gingipain, remained a significant predictor of preterm labor p = .0.015. Conclusion We found no evidence that clinical periodontal disease is associated with spontaneous preterm birth. Elevated gingival crevicular fluid levels of elastase were associated with preterm birth but further research is needed before this can be assumed to be a causal relationship.

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

    Directory of Open Access Journals (Sweden)

    Tracey J. Flores

    2018-01-01

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

  5. Revisiting the Table 2 fallacy: A motivating example examining preeclampsia and preterm birth.

    Science.gov (United States)

    Bandoli, Gretchen; Palmsten, Kristin; Chambers, Christina D; Jelliffe-Pawlowski, Laura L; Baer, Rebecca J; Thompson, Caroline A

    2018-05-21

    A "Table Fallacy," as coined by Westreich and Greenland, reports multiple adjusted effect estimates from a single model. This practice, which remains common in published literature, can be problematic when different types of effect estimates are presented together in a single table. The purpose of this paper is to quantitatively illustrate this potential for misinterpretation with an example estimating the effects of preeclampsia on preterm birth. We analysed a retrospective population-based cohort of 2 963 888 singleton births in California between 2007 and 2012. We performed a modified Poisson regression to calculate the total effect of preeclampsia on the risk of PTB, adjusting for previous preterm birth. pregnancy alcohol abuse, maternal education, and maternal socio-demographic factors (Model 1). In subsequent models, we report the total effects of previous preterm birth, alcohol abuse, and education on the risk of PTB, comparing and contrasting the controlled direct effects, total effects, and confounded effect estimates, resulting from Model 1. The effect estimate for previous preterm birth (a controlled direct effect in Model 1) increased 10% when estimated as a total effect. The risk ratio for alcohol abuse, biased due to an uncontrolled confounder in Model 1, was reduced by 23% when adjusted for drug abuse. The risk ratio for maternal education, solely a predictor of the outcome, was essentially unchanged. Reporting multiple effect estimates from a single model may lead to misinterpretation and lack of reproducibility. This example highlights the need for careful consideration of the types of effects estimated in statistical models. © 2018 John Wiley & Sons Ltd.

  6. Cross-Country Individual Participant Analysis of 4.1 Million Singleton Births in 5 Countries with Very High Human Development Index Confirms Known Associations but Provides No Biologic Explanation for 2/3 of All Preterm Births.

    Science.gov (United States)

    Ferrero, David M; Larson, Jim; Jacobsson, Bo; Di Renzo, Gian Carlo; Norman, Jane E; Martin, James N; D'Alton, Mary; Castelazo, Ernesto; Howson, Chris P; Sengpiel, Verena; Bottai, Matteo; Mayo, Jonathan A; Shaw, Gary M; Verdenik, Ivan; Tul, Nataša; Velebil, Petr; Cairns-Smith, Sarah; Rushwan, Hamid; Arulkumaran, Sabaratnam; Howse, Jennifer L; Simpson, Joe Leigh

    2016-01-01

    Preterm birth is the most common single cause of perinatal and infant mortality, affecting 15 million infants worldwide each year with global rates increasing. Understanding of risk factors remains poor, and preventive interventions have only limited benefit. Large differences exist in preterm birth rates across high income countries. We hypothesized that understanding the basis for these wide variations could lead to interventions that reduce preterm birth incidence in countries with high rates. We thus sought to assess the contributions of known risk factors for both spontaneous and provider-initiated preterm birth in selected high income countries, estimating also the potential impact of successful interventions due to advances in research, policy and public health, or clinical practice. We analyzed individual patient-level data on 4.1 million singleton pregnancies from four countries with very high human development index (Czech Republic, New Zealand, Slovenia, Sweden) and one comparator U.S. state (California) to determine the specific contribution (adjusting for confounding effects) of 21 factors. Both individual and population-attributable preterm birth risks were determined, as were contributors to cross-country differences. We also assessed the ability to predict preterm birth given various sets of known risk factors. Previous preterm birth and preeclampsia were the strongest individual risk factors of preterm birth in all datasets, with odds ratios of 4.6-6.0 and 2.8-5.7, respectively, for individual women having those characteristics. In contrast, on a population basis, nulliparity and male sex were the two risk factors with the highest impact on preterm birth rates, accounting for 25-50% and 11-16% of excess population attributable risk, respectively (pbirth within each country lacks a plausible biologic explanation, and 63% of difference between countries cannot be explained with known factors; thus, research is necessary to elucidate the underlying

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

    NARCIS (Netherlands)

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

    2017-01-01

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

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

    African Journals Online (AJOL)

    Characteristics and risk factors of preterm births in a tertiary center in Lagos, Nigeria. ... Introduction: preterm birth is a dire complication of pregnancy that poses ... to a tertiary center for prenatal care in order to significantly reduce adverse birth ...

  9. Influence of preterm birth and small birth size on serum anti-Müllerian hormone levels in young adult women

    NARCIS (Netherlands)

    G.F. Kerkhof (Gerthe); R.W.J. Leunissen (Ralph); R.H. Willemsen (Ruben); F.H. de Jong (Frank); J.A. Visser (Jenny); J.S.E. Laven (Joop); A.C.S. Hokken-Koelega (Anita)

    2010-01-01

    textabstractBackground/objectives: Preterm birth has been associated with reduced reproduction rates, and controversies remain regarding the effect of being born small for gestational age (SGA) on ovarian function. Recent findings in young men showed no effect of preterm and SGA birth on testis

  10. Motor development in very preterm and very low-birth-weight children from birth to adolescence: A meta-analysis

    NARCIS (Netherlands)

    de Kieviet, J.F.; Piek, J.P.; Aarnoudse-Moens, C.S.H.; Oosterlaan, J.

    2009-01-01

    Context: Infants who are very preterm (born ≤32 weeks of gestation) and very low birth weight (VLBW) (weighing ≤1500 g) are at risk for poor developmental outcomes. There is increasing evidence that very preterm birth and VLBW have a considerable effect on motor development, although findings are

  11. The interaction between vaginal microbiota, cervical length, and vaginal progesterone treatment for preterm birth risk

    OpenAIRE

    Kindinger, Lindsay M.; Bennett, Phillip R.; Lee, Yun S; Marchesi, Julian R.; Smith, Ann; Cacciatore, Stefano; Holmes, Elaine; Nicholson, Jeremy K.; Teoh, T. G.; MacIntyre, David A.

    2017-01-01

    Background Preterm birth is the primary cause of infant death worldwide. A short cervix in the second trimester of pregnancy is a risk factor for preterm birth. In specific patient cohorts, vaginal progesterone reduces this risk. Using 16S rRNA gene sequencing, we undertook a prospective study in women at risk of preterm birth (n?=?161) to assess (1) the relationship between vaginal microbiota and cervical length in the second trimester and preterm birth risk and (2) the impact of vaginal pro...

  12. Cervical stitch (cerclage) for preventing preterm birth in singleton pregnancy.

    Science.gov (United States)

    Alfirevic, Zarko; Stampalija, Tamara; Medley, Nancy

    2017-06-06

    women at high-risk of preterm birth and probably reduces risk of perinatal deaths. There was no evidence of any differential effect of cerclage based on previous obstetric history or short cervix indications, but data were limited for all clinical groups. The question of whether cerclage is more or less effective than other preventative treatments, particularly vaginal progesterone, remains unanswered.

  13. Preterm birth research: from disillusion to the search for new mechanisms.

    Science.gov (United States)

    Buekens, P; Klebanoff, M

    2001-07-01

    No intervention has been shown to decrease the rate of preterm birth. There was thus a need for a new research agenda. The new emphasis is on social and biological mechanisms, including the impact on stress of racism and poverty, and gene-environment interactions. New markers are also under study, and pertain mostly to infection and inflammation. The impact on preterm birth of broad contextual factors, such as universal social protection, will need to be explored further. The recent trends toward increased rates of preterm births deserve much attention. New policies and interventions to decrease medically indicated preterm births should be urgently developed and evaluated. The failure to prevent preterm deliveries has been so disappointing that there is a risk that high rates of preterm births will be seen as unavoidable. The research programme launched by March of Dimes is a timely effort to foster new enthusiasm, to test new ideas and to generate new hypotheses.

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

    DEFF Research Database (Denmark)

    Tan, Qihua

    2018-01-01

    could be detrimental to health later in life. Current epigenetic studies using genome-wide DNA methylation profiling have discovered molecular evidence confirming that, as important early life events, both low birth-weight and premature birth can result in long-lasting epigenetic consequences...... that impact health at adult ages. Results from our epigenome-wide association studies indicate that the two moderately correlated traits of adverse pregnancy outcome could be linked to increased susceptibility to different health problems with low birth-weight more relevant to metabolic disorders, while......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 which...

  15. The impact of preterm birth on participation in childhood occupation.

    Science.gov (United States)

    Killeen, Hazel; Shiel, Agnes; Law, Mary; Segurado, Ricardo; O'Donovan, Donough

    2015-03-01

    Outcome studies of premature babies have focused their assessments predominately on neurodevelopmental impairments without relating these deficits to the impact they have on a child's everyday life. This study aims to determine whether very 'preterm birth alone' impacts on a child's ability to participate in and carry out childhood activities. Forty-four former premature infants between 6 months and 5 years 6 months, born in Galway University Hospital, Ireland, without physical or intellectual disability, were compared with 51 age-matched term-born infants. Study infants had an average gestation of 29 weeks and birth weight of 1,145 g. Functional skills were assessed using the Adaptive Behavior Assessment Scale-II and the Assessment of Preschool Children's Participation. Premature infants had significantly lower mean scores in overall adaptive behaviour compared to term infants, regardless of whether chronological (difference = 13.6, 95% (CI) = [8.2, 19.1]) or corrected (difference = 6.6, 95% CI = [1.4, 11.8]) age was used. Premature infants had lower mean scores in conceptual, social and practical skills, but no difference was found between the groups in intensity or diversity of participation. Premature infants had significantly lower scores in adaptive behaviour than term infants. This measurable effect of preterm birth on 'childhood occupations' merits further investigation.

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

    Science.gov (United States)

    Mahendroo, Mala

    2018-03-03

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

  17. Racial and Ethnic Disparities in Preterm Birth Among American Indian and Alaska Native Women.

    Science.gov (United States)

    Raglan, Greta B; Lannon, Sophia M; Jones, Katherine M; Schulkin, Jay

    2016-01-01

    Preterm birth disproportionately affects American Indian/Alaska Native (AI/AN) women. This disparity in birth outcomes may stem from higher levels of exposure to psychosocial, sociodemographic, and medical risk factors. This paper reviews relevant research related to preterm birth in American Indian and Alaska Native women. This narrative review examines disparities in preterm birth rates between AI/AN and other American women, and addresses several maternal risk factors and barriers that contribute to elevated preterm birth rates among this racial minority group. Additionally, this paper focuses on recent evidence that geographical location can significantly impact preterm birth rates among AI/AN women. In particular, access to care among AI/AN women and differences between rural and urban areas are discussed.

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

    Science.gov (United States)

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

    2016-09-01

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

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

    Science.gov (United States)

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

  20. Preterm birth and structural brain alterations in early adulthood

    OpenAIRE

    Nosarti, Chiara; Nam, Kie Woo; Walshe, Muriel; Murray, Robin M.; Cuddy, Marion; Rifkin, Larry; Allin, Matthew P.G.

    2014-01-01

    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 w...

  1. International comparisons of preterm birth: higher rates of late preterm birth are associated with lower rates of stillbirth and neonatal death.

    Science.gov (United States)

    Lisonkova, S; Sabr, Y; Butler, B; Joseph, K S

    2012-12-01

    To examine international rates of preterm birth and potential associations with stillbirths and neonatal deaths at late preterm and term gestation. Ecological study. Canada, USA and 26 countries in Europe. All deliveries in 2004. Information on preterm birth (Statistics Canada, the EURO-PERISTAT project and the National Center for Health Statistics. Pearson correlation coefficients and random-intercept Poisson regression were used to examine the association between preterm birth rates and gestational age-specific stillbirth and neonatal death rates. Rate ratios with 95% confidence intervals were estimated after adjustment for maternal age, parity and multiple births. Stillbirths and neonatal deaths ≥ 32 and ≥ 37 weeks of gestation. International rates of preterm birth (births. Preterm birth rates at 32-36 weeks were inversely associated with stillbirths at ≥ 32 weeks (adjusted rate ratio 0.94, 95% CI 0.92-0.96) and ≥ 37 weeks (adjusted rate ratio 0.88, 95% CI 0.85-0.91) of gestation and inversely associated with neonatal deaths at ≥ 32 weeks (adjusted rate ratio 0.88, 95% CI 0.85-0.91) and ≥ 37 weeks (adjusted rate ratio 0.82, 95% CI 0.78-0.86) of gestation. Countries with high rates of preterm birth at 32-36 weeks of gestation have lower stillbirth and neonatal death rates at and beyond 32 weeks of gestation. Contemporary rates of preterm birth are indicators of both perinatal health and obstetric care services. © 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG.

  2. Benefits of smoking bans on preterm and early-term births: a natural experimental design in Switzerland.

    Science.gov (United States)

    Vicedo-Cabrera, Ana M; Schindler, Christian; Radovanovic, Dragana; Grize, Leticia; Witassek, Fabienne; Dratva, Julia; Röösli, Martin; Perez, Laura

    2016-12-01

    Birth outcomes are relevant for future children's heath. Capitalising on a natural experimental design in Switzerland, we evaluated how regional smoking bans introduced at different time points affected birth outcomes, including preterm and early-term births. We used birth registry data of all singleton neonates born in Switzerland (2007-2012). We developed canton-specific interrupted time-series followed by random meta-analysis to evaluate the benefits of smoking bans on preterm (Switzerland with cantons that adopted more comprehensive smoking bans achieving greater benefits. Early-term births constitute a previously ignored though important group. 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/.

  3. Health care experiences of pregnant, birthing and postnatal women of color at risk for preterm birth.

    Science.gov (United States)

    McLemore, Monica R; Altman, Molly R; Cooper, Norlissa; Williams, Shanell; Rand, Larry; Franck, Linda

    2018-03-01

    Chronic stress is a known risk factor for preterm birth, yet little is known about how healthcare experiences add to or mitigate perceived stress. In this study, we described the pregnancy-related healthcare experiences of 54 women of color from Fresno, Oakland, and San Francisco, California, with social and/or medical risk factors for preterm birth. This study was a secondary analysis of focus group data generated as part of a larger project focused on patient and community involvement in preterm birth research. English and Spanish speaking women, age 18 or greater with social and/or medical risk factors for preterm birth participated in two focus groups, six weeks apart. Data from the first focus groups are included in this analysis. Five themes emerged from thematic analysis of the transcripts. Participants described disrespect during healthcare encounters, including experiences of racism and discrimination; stressful interactions with all levels of staff; unmet information needs; and inconsistent social support. Despite these adverse experiences, women felt confidence in parenting and newborn care. Participant recommendations for healthcare systems improvement included: greater attention to birth plans, better communication among multiple healthcare providers, more careful listening to patients during clinical encounters, increased support for social programs such as California's Black Infant Health, and less reliance on past carceral history and/or child protective services involvement. The women in this study perceived their prenatal healthcare as a largely disrespectful and stressful experience. Our findings add to the growing literature that women of color experience discrimination, racism and disrespect in healthcare encounters and that they believe this affects their health and that of their infants. Copyright © 2018 Elsevier Ltd. All rights reserved.

  4. Low birthweight and preterm birth in young people with special educational needs: a magnetic resonance imaging analysis.

    Science.gov (United States)

    Spencer, Michael D; Moorhead, T William J; Gibson, Rod J; McIntosh, Andrew M; Sussmann, Jessika E D; Owens, David G C; Lawrie, Stephen M; Johnstone, Eve C

    2008-01-30

    Although neuroanatomical and cognitive sequelae of low birthweight and preterm birth have been investigated, little is understood as to the likely prevalence of a history of low birthweight or preterm birth, or neuroanatomical correlates of such a history, within the special educational needs population. Our aim was to address these issues in a sample of young people receiving additional learning support. One hundred and thirty-seven participants aged 13-22 years, receiving additional learning support, were recruited via their schools or colleges and underwent structural magnetic resonance imaging (MRI). Obstetric records, available in 98 cases, included birthweight and gestational data in 90 and 95 cases, respectively. Both qualitative and quantitative voxel-based analyses of MRI data were conducted. A history of low birthweight and preterm birth was present in 13.3% and 13.7% of cases, respectively. Low birthweight and preterm birth were associated with specific qualitative anomalies, including enlargement of subarachnoid cisterns and thinning of the corpus callosum. Low birthweight was associated with reduced grey matter density (GMD) in the superior temporal gyrus (STG) bilaterally, left inferior temporal gyrus and left insula. Prematurity of birth was associated with reduced GMD in the STG bilaterally, right inferior frontal gyrus and left cerebellar hemisphere. Comparison of subjects with no history of low birthweight or preterm birth with a previously defined control sample of cognitively unimpaired adolescents (n = 72) demonstrated significantly greater scores for several anomalies, including thinning of the corpus callosum, loss of white matter and abnormalities of shape of the lateral ventricles. Although a two-fold increased prevalence of a history of low birthweight and preterm birth exists within the special educational needs population, other aetiological factors must be considered for the overwhelming majority of cases. Neuroanatomical findings

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

    NARCIS (Netherlands)

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

    2017-01-01

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

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

    Science.gov (United States)

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

  7. Antepartum and intrapartum interventions to prevent preterm birth and its sequelae

    NARCIS (Netherlands)

    Nijman, T. A. J.; van Vliet, E. O. G.; Koullali, B.; Mol, B. W.; Oudijk, M. A.

    2016-01-01

    Preterm birth is the main cause of neonatal morbidity and mortality. This review provides an overview of antepartum and intrapartum management of threatened preterm birth. The most effective method to identify women at high risk of delivering within seven days is the combination of cervical length

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

    DEFF Research Database (Denmark)

    Blondel, B; Papiernik, E; Delmas, D

    2009-01-01

    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...

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

    NARCIS (Netherlands)

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

    2014-01-01

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

  10. DNA Methylation: An Epigenetic Risk Factor in Preterm Birth

    Science.gov (United States)

    Menon, Ramkumar; Conneely, Karen N.; Smith, Alicia K.

    2012-01-01

    Spontaneous preterm birth (PTB; birth prior to 37 weeks of gestation) is a complex phenotype with multiple risk factors that complicate our understanding of its etiology. A number of recent studies have supported the hypothesis that epigenetic modifications such as DNA methylation induced by pregnancy-related risk factors may influence the risk of PTB or result in changes that predispose a neonate to adult-onset diseases. The critical role of timing of gene expression in the etiology of PTB makes it a highly relevant disorder in which to examine the potential role of epigenetic changes. Because changes in DNA methylation patterns can result in long-term consequences, it is of critical interest to identify the epigenetic patterns associated with adverse pregnancy outcomes. This review examines the potential role of DNA methylation as a risk factor for PTB and discusses several issues and limitations that should be considered when planning DNA methylation studies. PMID:22228737

  11. Critical evaluation of national vital statistics: the case of preterm birth trends in Portugal.

    Science.gov (United States)

    Correia, Sofia; Rodrigues, Teresa; Montenegro, Nuno; Barros, Henrique

    2015-11-01

    Using vital statistics, the Portuguese National Health Plan predicts that 14% of live births will be preterm in 2016. The prediction was based on a preterm birth rise from 5.9% in 2000 to 8.8% in 2009. However, the same source showed an actual decline from 2010 onwards. To assess the plausibility of national preterm birth trends, we aimed to compare the evolution of preterm birth and low birthweight rates between vital statistics and a hospital database. A time-trend analysis (2004-2011) of preterm birth (rates was conducted using data on singleton births from the national birth certificates (n = 801,783) and an electronic maternity unit database (n = 21,392). Annual prevalence estimates, ratios of preterm birth:low birthweight and adjusted prevalence ratios were estimated to compare data sources. Although the national prevalence of preterm birth increased from 2004 (5.4%), particularly between 2006 and 2009 (highest rate was 7.5% in 2007), and decreased after 2009 (5.7% in 2011), the prevalence at the maternity unit remained constant. Between 2006 and 2009, preterm birth was almost 1.4 times higher in the national statistics (using the national or the catchment region samples) than in the maternity unit, but no differences were found for low birthweight. Portuguese preterm birth prevalence seems biased between 2006 and 2009, suggesting that early term babies were misclassified as preterm. As civil registration systems are important to support public health decisions, monitoring strategies should be taken to assure good quality data. © 2015 Nordic Federation of Societies of Obstetrics and Gynecology.

  12. Preterm birth, age at school entry and educational performance.

    Science.gov (United States)

    Odd, David; Evans, David; Emond, Alan

    2013-01-01

    To investigate if the lack of gestational age correction may explain some of the school failure seen in ex-preterm infants. A cohort study based on the Avon Longitudinal Study of Parents and Children (ALSPAC). The primary outcome was a low Key Stage 1 score (KS1) score at age 7 or having special educational needs (SEN). Exposure groups were defined as preterm (birth (DOB), expected date of delivery (EDD) or expected date of delivery and year of school entry. Multiple imputation was used to account for missing covariate data. When matching for DOB, infants born preterm had an increased odds of a low KS1 score (OR 1.73 (1.45-2.06)) and this association persisted after adjusting for potential confounders (OR 1.57 (1.25-1.97)). The association persisted in the analysis matching for EDD (fully adjusted OR 1.53 (1.21-1.94)) but attenuated substantially after additionally restricting to those infants who entered school at the same time as the control infants (fully adjusted OR 1.25 (0.98-1.60)). A compatible reduction in the population attributable risk fraction was seen from 4.60% to 2.12%, and year of school entry appeared to modify the association between gestational age and the risk of a poor KS1 score (p = 0.029). This study provides evidence that the school year placement and assessment of ex-preterm infants based on their actual birthday (rather than their EDD) may increase their risk of learning difficulties with corresponding school failure.

  13. Using Geographic Information Science to Explore Associations between Air Pollution, Environmental Amenities, and Preterm Births.

    Science.gov (United States)

    Ogneva-Himmelberger, Yelena; Dahlberg, Tyler; Kelly, Kristen; Simas, Tiffany A Moore

    2015-01-01

    The study uses geographic information science (GIS) and statistics to find out if there are statistical differences between full term and preterm births to non-Hispanic white, non-Hispanic Black, and Hispanic mothers in their exposure to air pollution and access to environmental amenities (green space and vendors of healthy food) in the second largest city in New England, Worcester, Massachusetts. Proximity to a Toxic Release Inventory site has a statistically significant effect on preterm birth regardless of race. The air-pollution hazard score from the Risk Screening Environmental Indicators Model is also a statistically significant factor when preterm births are categorized into three groups based on the degree of prematurity. Proximity to green space and to a healthy food vendor did not have an effect on preterm births. The study also used cluster analysis and found statistically significant spatial clusters of high preterm birth volume for non-Hispanic white, non-Hispanic Black, and Hispanic mothers.

  14. Relationship between Periodontal Diseases and Preterm Birth: Recent Epidemiological and Biological Data

    Science.gov (United States)

    Huck, O.; Tenenbaum, H.; Davideau, J.-L.

    2011-01-01

    For ten years, the incidence of preterm birth does not decrease in developed countries despite the promotion of public health programs. Many risk factors have been identified including ethnicity, age, tobacco, and infection. However, almost 50% of preterm birth causes remain unknown. The periodontal diseases are highly prevalent inflammatory and infectious diseases of tooth supporting tissues leading to an oral disability. They influence negatively general health worsening cardiovascular diseases and diabetes. Periodontal diseases have been also suspected to increase the rate of preterm birth, but data remain contradictory. The objective of this review is to present the principal results of epidemiological, biological, and interventional studies on the link between periodontal diseases and preterm birth. The conclusions of this work underline the importance for the physician/obstetrician to identify women at risk for preterm birth and to address these patients to dentist for periodontal examination and treatment in order to limit adverse pregnancy outcomes. PMID:22132334

  15. Relationship between Periodontal Diseases and Preterm Birth: Recent Epidemiological and Biological Data

    Directory of Open Access Journals (Sweden)

    O. Huck

    2011-01-01

    Full Text Available For ten years, the incidence of preterm birth does not decrease in developed countries despite the promotion of public health programs. Many risk factors have been identified including ethnicity, age, tobacco, and infection. However, almost 50% of preterm birth causes remain unknown. The periodontal diseases are highly prevalent inflammatory and infectious diseases of tooth supporting tissues leading to an oral disability. They influence negatively general health worsening cardiovascular diseases and diabetes. Periodontal diseases have been also suspected to increase the rate of preterm birth, but data remain contradictory. The objective of this review is to present the principal results of epidemiological, biological, and interventional studies on the link between periodontal diseases and preterm birth. The conclusions of this work underline the importance for the physician/obstetrician to identify women at risk for preterm birth and to address these patients to dentist for periodontal examination and treatment in order to limit adverse pregnancy outcomes.

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

    Science.gov (United States)

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

    2018-03-01

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

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

    Directory of Open Access Journals (Sweden)

    Nichelle Satterfield

    2016-01-01

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

  18. Association of external cephalic version before term with late preterm birth.

    Science.gov (United States)

    Poole, Kristie L; McDonald, Sarah D; Griffith, Lauren E; Hutton, Eileen K

    2017-08-01

    While evidence suggests that beginning an external cephalic version (ECV) before term (34 0/7 to 36 6/7 weeks) compared with after term may be associated with an increase in late preterm birth (34 0/7 to 36 6/7 weeks), it remains unknown what might account for this risk. The objective of the present study is to further investigate the association between ECV before term and late preterm birth. Secondary analysis of data collected from the international, multicenter Early ECV trials. We evaluated the relation between ECV exposure and late preterm birth (34 0/7 to 36 6/7 weeks), as well as whether additional risk factors for preterm birth (such as maternal age, height, body mass index, parity, placental location, and perinatal mortality rate) moderated this relation. Generalized linear mixed methods were used to account for center effect and adjust for covariates. Among 1765 women with breech pregnancies and without a prior preterm birth, 749 (42.4%) received at least one ECV before term. Exposure to an ECV before term was not associated significantly independently with odds of preterm birth. However, placenta location moderated the association between early ECV exposure and late preterm birth. The odds of preterm birth in women who were exposed to an ECV before term and who also had an anterior placenta were doubled (OR 2.05; 95% CI 1.12-3.71; p = 0.02). In a large cohort of women without known risks for preterm birth, those with an anterior placenta who undergo an ECV before term constitute a subgroup at particular risk for late preterm birth. © 2017 Nordic Federation of Societies of Obstetrics and Gynecology.

  19. Secondary recurrent miscarriage is associated with previous male birth.

    LENUS (Irish Health Repository)

    Ooi, Poh Veh

    2012-01-31

    Secondary recurrent miscarriage (RM) is defined as three or more consecutive pregnancy losses after delivery of a viable infant. Previous reports suggest that a firstborn male child is associated with less favourable subsequent reproductive potential, possibly due to maternal immunisation against male-specific minor histocompatibility antigens. In a retrospective cohort study of 85 cases of secondary RM we aimed to determine if secondary RM was associated with (i) gender of previous child, maternal age, or duration of miscarriage history, and (ii) increased risk of pregnancy complications. Fifty-three women (62.0%; 53\\/85) gave birth to a male child prior to RM compared to 32 (38.0%; 32\\/85) who gave birth to a female child (p=0.002). The majority (91.7%; 78\\/85) had uncomplicated, term deliveries and normal birth weight neonates, with one quarter of the women previously delivered by Caesarean section. All had routine RM investigations and 19.0% (16\\/85) had an abnormal result. Fifty-seven women conceived again and 33.3% (19\\/57) miscarried, but there was no significant difference in failure rates between those with a previous male or female child (13\\/32 vs. 6\\/25, p=0.2). When patients with abnormal results were excluded, or when women with only one previous child were considered, there was still no difference in these rates. A previous male birth may be associated with an increased risk of secondary RM but numbers preclude concluding whether this increases recurrence risk. The suggested association with previous male birth provides a basis for further investigations at a molecular level.

  20. Secondary recurrent miscarriage is associated with previous male birth.

    LENUS (Irish Health Repository)

    Ooi, Poh Veh

    2011-01-01

    Secondary recurrent miscarriage (RM) is defined as three or more consecutive pregnancy losses after delivery of a viable infant. Previous reports suggest that a firstborn male child is associated with less favourable subsequent reproductive potential, possibly due to maternal immunisation against male-specific minor histocompatibility antigens. In a retrospective cohort study of 85 cases of secondary RM we aimed to determine if secondary RM was associated with (i) gender of previous child, maternal age, or duration of miscarriage history, and (ii) increased risk of pregnancy complications. Fifty-three women (62.0%; 53\\/85) gave birth to a male child prior to RM compared to 32 (38.0%; 32\\/85) who gave birth to a female child (p=0.002). The majority (91.7%; 78\\/85) had uncomplicated, term deliveries and normal birth weight neonates, with one quarter of the women previously delivered by Caesarean section. All had routine RM investigations and 19.0% (16\\/85) had an abnormal result. Fifty-seven women conceived again and 33.3% (19\\/57) miscarried, but there was no significant difference in failure rates between those with a previous male or female child (13\\/32 vs. 6\\/25, p=0.2). When patients with abnormal results were excluded, or when women with only one previous child were considered, there was still no difference in these rates. A previous male birth may be associated with an increased risk of secondary RM but numbers preclude concluding whether this increases recurrence risk. The suggested association with previous male birth provides a basis for further investigations at a molecular level.

  1. Vaginal progesterone prophylaxis for preterm birth (the OPPTIMUM study): a multicentre, randomised, double-blind trial.

    Science.gov (United States)

    Norman, Jane Elizabeth; Marlow, Neil; Messow, Claudia-Martina; Shennan, Andrew; Bennett, Phillip R; Thornton, Steven; Robson, Stephen C; McConnachie, Alex; Petrou, Stavros; Sebire, Neil J; Lavender, Tina; Whyte, Sonia; Norrie, John

    2016-05-21

    Progesterone administration has been shown to reduce the risk of preterm birth and neonatal morbidity in women at high risk, but there is uncertainty about longer term effects on the child. We did a double-blind, randomised, placebo-controlled trial of vaginal progesterone, 200 mg daily taken from 22-24 to 34 weeks of gestation, on pregnancy and infant outcomes in women at risk of preterm birth (because of previous spontaneous birth at ≤34 weeks and 0 days of gestation, or a cervical length ≤25 mm, or because of a positive fetal fibronectin test combined with other clinical risk factors for preterm birth [any one of a history in a previous pregnancy of preterm birth, second trimester loss, preterm premature fetal membrane rupture, or a history of a cervical procedure to treat abnormal smears]). The objective of the study was to determine whether vaginal progesterone prophylaxis given to reduce the risk of preterm birth affects neonatal and childhood outcomes. We defined three primary outcomes: fetal death or birth before 34 weeks and 0 days gestation (obstetric), a composite of death, brain injury, or bronchopulmonary dysplasia (neonatal), and a standardised cognitive score at 2 years of age (childhood), imputing values for deaths. Randomisation was done through a web portal, with participants, investigators, and others involved in giving the intervention, assessing outcomes, or analysing data masked to treatment allocation until the end of the study. Analysis was by intention to treat. This trial is registered at ISRCTN.com, number ISRCTN14568373. Between Feb 2, 2009, and April 12, 2013, we randomly assigned 1228 women to the placebo group (n=610) and the progesterone group (n=618). In the placebo group, data from 597, 587, and 439 women or babies were available for analysis of obstetric, neonatal, and childhood outcomes, respectively; in the progesterone group the corresponding numbers were 600, 589, and 430. After correction for multiple outcomes

  2. Predicting live birth, preterm delivery, and low birth weight in infants born from in vitro fertilisation: a prospective study of 144,018 treatment cycles.

    Directory of Open Access Journals (Sweden)

    Scott M Nelson

    2011-01-01

    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

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

    Science.gov (United States)

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

    2010-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Ana Daniela Izoton de Sadovsky

    2018-01-01

    Full Text Available Objective: To analyze economic inequality (absolute and relative due to family income in relation to the occurrence of preterm births in Southern Brazil. Methods: 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. Results: 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. Conclusion: 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. Resumo: Objetivo: Analisar a iniquidade econômica (absoluta e relativa decorrente da renda familiar na ocorrência de prematuros no Sul do Brasil. Métodos: Foram realizados quatro estudos do tipo coorte de nascimentos nos anos de 1982, 1993, 2004 e 2011. A exposição principal foi a renda familiar mensal e o desfecho foi nascer prematuro. Foram calculadas as iniquidades através do slope index of inequality e o relative index of

  5. The APPLe study: a randomized, community-based, placebo-controlled trial of azithromycin for the prevention of preterm birth, with meta-analysis.

    Directory of Open Access Journals (Sweden)

    Nynke R van den Broek

    2009-12-01

    Full Text Available Premature birth is the major cause of perinatal mortality and morbidity in both high- and low-income countries. The causes of preterm labour are multiple but infection is important. We have previously described an unusually high incidence of preterm birth (20% in an ultrasound-dated, rural, pregnant population in Southern Malawi with high burdens of infective morbidity. We have now studied the impact of routine prophylaxis with azithromycin as directly observed, single-dose therapy at two gestational windows to try to decrease the incidence of preterm birth.We randomized 2,297 pregnant women attending three rural and one peri-urban health centres in Southern Malawi to a placebo-controlled trial of oral azithromycin (1 g given at 16-24 and 28-32 wk gestation. Gestational age was determined by ultrasound before 24 wk. Women and their infants were followed up until 6 wk post delivery. The primary outcome was incidence of preterm delivery, defined as 6,200 pregnancies shows no effect on preterm birth (relative risk 1.02, 95% confidence interval 0.86-1.22.This study provides no support for the use of antibiotics as routine prophylaxis to prevent preterm birth in high risk populations; prevention of preterm birth requires alternative strategies.Current Controlled Trials ISRCTN84023116

  6. Dental Infection of Porphyromonas gingivalis Induces Preterm Birth in Mice.

    Directory of Open Access Journals (Sweden)

    Min Ao

    Full Text Available Epidemiological studies have revealed a link between dental infection and preterm birth or low birth weight (PTB/LBW, however, the underlying mechanisms remain unclear. Progress in understanding the associated mechanisms has been limited in part by lack of an animal model for chronic infection-induced PTB/LBW, mimicking pregnancy under conditions of periodontitis. We aimed to establish a mouse model of chronic periodontitis in order to investigate the link between periodontitis and PTB/LBW.To establish chronic inflammation beginning with dental infection, we surgically opened mouse (female, 8 weeks old 1st molar pulp chambers and directly infected with w83 strain Porphyromonas gingivalis (P.g., a keystone periodontal pathogen. Mating was initiated at 6 wks post-infection, by which time dental granuloma tissue had developed and live P.g. was cultured from extracted tooth root, which serves as a persistent source of P.g. The gestational day (gd and birth weight were recorded during for P.g.-infected and control mice, and serum and placental tissues were collected at gd 15 to evaluate the systemic and local conditions during pregnancy.Dental infection with P.g. significantly increased circulating TNF-α (2.5-fold, IL-17 (2-fold, IL-6 (2-fold and IL-1β (2-fold. The P.g.-infected group delivered at gd 18.25 vs. gd 20.45 in the non-infected control (NC group (p < 0.01, and pups exhibited LBW compared to controls (p < 0.01. P.g. was localized to placental tissues by immunohistochemistry and PCR, and defects in placental tissues of P.g. infected mice included premature rupture of membrane, placental detachment, degenerative changes in trophoblasts and endothelial cells, including necrotic areas. P.g. infection caused significantly increased numbers of polymorphonuclear leukocytes (PMNLs and macrophages in placental tissues, associated with increased local expression of pro-inflammatory mediators including TNF-α and COX-2. Further placental tissue

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

    Directory of Open Access Journals (Sweden)

    Renato T Souza

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

  8. Sphingosine Kinase: A Novel Putative Target for the Prevention of Infection-Triggered Preterm Birth

    Directory of Open Access Journals (Sweden)

    Vibhuti Vyas

    2013-01-01

    Full Text Available Preterm birth is defined as any delivery before 37 complete weeks of gestation. It is a universal challenge in the field of obstetrics owing to its high rate of mortality, long-term morbidity, associated human suffering and economic burden. In the United States, about 12.18% deliveries in 2009 were preterm, producing an exorbitant cost of $5.8 billion. Infection-associated premature rupture of membranes (PROM accounts for 40% of extremely preterm births (<28 weeks of gestation. Major research efforts are directed towards improving the understanding of the pathophysiology of preterm birth and ways to prevent or at least postpone delivery. Endothelin-1 (ET-1 is a potent vasoconstrictor that plays a significant role in infection-triggered preterm birth. Its involvement in a number of pathological mechanisms and its elevation in preterm delivered amniotic fluid samples implicate it in preterm birth. Sphingosine kinase (SphK is a ubiquitous enzyme responsible for the production of sphingosine-1-phosphate (S1P. S1P acts as second messenger in a number of cell proliferation and survival pathways. SphK is found to play a key role in ET-1 mediated myometrial contraction. This review highlights SphK as a prospective target with great potential to prevent preterm birth.

  9. Risk of preterm birth by subtype among Medi-Cal participants with mental illness.

    Science.gov (United States)

    Baer, Rebecca J; Chambers, Christina D; Bandoli, Gretchen; Jelliffe-Pawlowski, Laura L

    2016-10-01

    Previous studies have demonstrated an association between mental illness and preterm birth (before 37 weeks). However, these investigations have not simultaneously considered gestation of preterm birth, the indication (eg, spontaneous or medically indicated), and specific mental illness classifications. The objective of the study was to examine the likelihood of preterm birth across gestational lengths and indications among Medi-Cal (California's Medicaid program) participants with a diagnostic code for mental illness. Mental illnesses were studied by specific illness classification. The study population was drawn from singleton live births in California from 2007 through 2011 in the birth cohort file maintained by the California Office of Statewide Health Planning and Development, which includes birth certificate and hospital discharge records. The sample was restricted to women with Medi-Cal coverage for prenatal care. Women with mental illness were identified using International Classification of Diseases, ninth revision, codes from their hospital discharge record. Women without a mental illness International Classification of Diseases, ninth revision, code were randomly selected at a 4:1 ratio. Adjusting for maternal characteristics and obstetric complications, relative risks and 95% confidence intervals were calculated for preterm birth comparing women with a mental illness diagnostic code with women without such a code. We identified 6198 women with a mental illness diagnostic code and selected 24,792 women with no such code. The risk of preterm birth in women with a mental illness were 1.2 times higher than women without a mental illness (adjusted relative risk, 1.2, 95% confidence interval, 1.1-1.3). Among the specific mental illnesses, schizophrenia, major depression, and personality disorders had the strongest associations with preterm birth (adjusted relative risks, 2.0, 2.0 and 3.3, respectively). Women receiving prenatal care through California's low

  10. Persistent and progressive long-term lung disease in survivors of preterm birth.

    Science.gov (United States)

    Urs, Rhea; Kotecha, Sailesh; Hall, Graham L; Simpson, Shannon J

    2018-04-13

    Preterm birth accounts for approximately 11% of births globally, with rates increasing across many countries. Concurrent advances in neonatal care have led to increased survival of infants of lower gestational age (GA). However, infants born poor respiratory outcomes throughout childhood, into adolescence and adulthood. Indeed, survivors of preterm birth have shown increased respiratory symptoms, altered lung structure, persistent and even declining lung function throughout childhood. The mechanisms behind this persistent and sometimes progressive lung disease are unclear, and the implications place those born preterm at increased risk of respiratory morbidity into adulthood. This review aims to summarise what is known about the long-term pulmonary outcomes of contemporary preterm birth, examine the possible mechanisms of long-term respiratory morbidity in those born preterm and discuss addressing the unknowns and potentials for targeted treatments. Copyright © 2018 Elsevier Ltd. All rights reserved.

  11. The Growing Trend of Moderate Preterm Births: An Ecological Study in One Region of Brazil

    OpenAIRE

    de Oliveira, Rosana Rosseto; Melo, Emiliana Cristina; Falavina, Larissa Pereira; Mathias, Thais Aidar de Freitas

    2015-01-01

    Background Preterm birth is a serious public health problem, as it is linked to high rates of neonatal and child morbidity and mortality, with Brazil listed among the countries with the ten highest numbers of premature births. Nonetheless, knowledge is scarce regarding prematurity and associated factors in mid-sized cities. The objective of this study was to analyze the trend of preterm births and associated factors in a municipality located in the state of Paran?, Brazil. Methods This was an...

  12. Periodontal Disease And Risk For Pre-Term Birth: A Case-Control Study

    Directory of Open Access Journals (Sweden)

    Andonova Irena

    2015-03-01

    Full Text Available Maternal periodontal infection has been recognizsed as a risk factor for preterm and low birth weight infants. It is hypothesized that pathogens causing periodontal disease might translocate to the amniotic cavity and contribute to triggering an adverse pregnancy outcome. The growing evidence that an infection remote from the foetal-placental unit might have a role in preterm delivery has led to an increased awareness of the potential role of chronic bacterial infections in the body. The aim of this study was to evaluate whether the presence of chronic periodontitis might influence the incidence of preterm labour and preterm birth.

  13. Intimate partner violence during pregnancy and its association with preterm birth and low birth weight in Tanzania

    DEFF Research Database (Denmark)

    Sigalla, Geofrey Nimrod; Mushi, Declare; Meyrowitsch, Dan Wolf

    2017-01-01

    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......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...

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

    Science.gov (United States)

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

    2012-01-01

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

  15. The interaction between vaginal microbiota, cervical length, and vaginal progesterone treatment for preterm birth risk.

    Science.gov (United States)

    Kindinger, Lindsay M; Bennett, Phillip R; Lee, Yun S; Marchesi, Julian R; Smith, Ann; Cacciatore, Stefano; Holmes, Elaine; Nicholson, Jeremy K; Teoh, T G; MacIntyre, David A

    2017-01-19

    Preterm birth is the primary cause of infant death worldwide. A short cervix in the second trimester of pregnancy is a risk factor for preterm birth. In specific patient cohorts, vaginal progesterone reduces this risk. Using 16S rRNA gene sequencing, we undertook a prospective study in women at risk of preterm birth (n = 161) to assess (1) the relationship between vaginal microbiota and cervical length in the second trimester and preterm birth risk and (2) the impact of vaginal progesterone on vaginal bacterial communities in women with a short cervix. Lactobacillus iners dominance at 16 weeks of gestation was significantly associated with both a short cervix vaginal dysbiosis. A longitudinal characterization of vaginal microbiota (vaginal progesterone (400 mg/OD, n = 25) versus controls (n = 42). Progesterone did not alter vaginal bacterial community structure nor reduce L. iners-associated preterm birth (vaginal microbiota at 16 weeks of gestation is a risk factor for preterm birth, whereas L. crispatus dominance is protective against preterm birth. Vaginal progesterone does not appear to impact the pregnancy vaginal microbiota. Patients and clinicians who may be concerned about "infection risk" associated with the use of a vaginal pessary during high-risk pregnancy can be reassured.

  16. Bacteriuria with group B streptococcus and preterm birth

    DEFF Research Database (Denmark)

    Khalil, M. R.; Uldbjerg, N.; Thorsen, P.

    2015-01-01

    Objectives: Preterm delivery (PTD) contributes to 70% of all perinatal deaths and nearly 50% of permanent neurological damages in children. Treatment and follow-up to prevent recolonization in pregnant women with Group B Streptococcus (GBS) in the urine may reduce the frequency of PTD....... In a Cochrane review, the incidence of low birth weight infants was reduced, however, not for PTD. The association between asymptomatic bacteriuria during pregnancy and PTD remains controversial. The objective of this study was to investigate whether there is an association between GBS bacteriuria (BU......) in pregnancy and PTD. Method: A retrospective population-based cohort consisting of 36,097 pregnant women from Hospital Lillebaelt area, Denmark, during January 2002-December 2012, of whom 37.2% (equivalent to 13,417) have undergone culture of their urine at the Department of Clinical Microbiology. Information...

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

    Science.gov (United States)

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

    2014-07-01

    To develop a new strategy of predicting spontaneous preterm birth (sPTB) by combination of transvaginal ultrasound (TVUS) assessment and inflammatory proteins detection in vaginal secretions. Prospective study of 87 women referred for cervical length assessment with a standardized TVUS combined to vaginal secretions sampling. Samples were analyzed for presence of 10 cytokines. Main outcome was sPTB (women at a median gestational age of 35.6 weeks of gestation. Short cervix (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.

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

    Science.gov (United States)

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

    2011-01-01

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

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

    Directory of Open Access Journals (Sweden)

    David Taylor-Robinson

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

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

    DEFF Research Database (Denmark)

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

    2016-01-01

    anorexia nervosa and lifetime anorexia + bulimia nervosa were prospectively associated with restricted fetal growth and higher odds of SGA [respectively, OR = 1.6 [95% CI 1.3-1.8] and OR = 1.5 [95% CI 1.2-1.9)] compared with unexposed women. Active anorexia nervosa was associated with lower birthweight......: Maternal anorexia nervosa (both active and past) is associated with lower size at birth and symmetric growth restriction, with evidence of worse outcomes in women with active disorder. Women with anorexia nervosa should be advised about achieving full recovery before conceiving. Similarly, targeting......OBJECTIVE: To investigate whether eating disorders are associated with lower size at birth, symmetric growth restriction, and preterm birth; and whether pregnancy smoking explains the association between anorexia nervosa and fetal growth. DESIGN: Longitudinal population-based cohort study. SETTING...

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

    Science.gov (United States)

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

    2018-02-01

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

  2. Paternal and maternal birthweights and the risk of infant preterm birth.

    Science.gov (United States)

    Klebanoff, Mark A

    2008-01-01

    Increasing paternal birthweight has been associated with increased risk of fathering a preterm infant, causing speculation that a fetus programmed to grow rapidly can trigger preterm labor. Pregnancies occurring from 1974-1989 among women themselves born in the Danish Perinatal Study (1959-1961) were identified through the Population Register; obstetric records were abstracted. Paternal birthweight was obtained by linking Personal Identification Numbers of the fathers to archived midwifery records. Paternal birthweight was not associated with preterm infants overall. However, there was a significant interaction between paternal and maternal birthweights (P = .003). When the mother weighed less than 3 kg at birth, increasing paternal birthweight was associated with increased occurrence of preterm birth (P for trend = .02); paternal birthweight was unassociated with preterm birth for mothers weighing 3 kg or more at birth (P = .34). When the mother was born small, increasing paternal birthweight was associated with increased risk of preterm birth, suggesting that a fetus growing faster than its mother can accommodate might trigger preterm birth.

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

    Science.gov (United States)

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

    2017-09-01

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

  4. Perinatal Risks in "Late Motherhood" Defined Based On Parity and Preterm Birth Rate - an Analysis of the German Perinatal Survey (20th Communication).

    Science.gov (United States)

    Schure, V; Voigt, M; Schild, R L; Hesse, V; Carstensen, M; Schneider, K T M; Straube, S

    2012-01-01

    Aim: "Late motherhood" is associated with greater perinatal risks but the term lacks precise definition. We present an approach to determine what "late motherhood" associated with "high risk" is, based on parity and preterm birth rate. Materials and Methods: Using data from the German Perinatal Survey of 1998-2000 we analysed preterm birth rates in women with zero, one, or two previous live births. We compared groups of "late" mothers (with high preterm birth rates) with "control" groups of younger women (with relatively low preterm birth rates). Data of 208 342 women were analysed. For women with zero (one; two) previous live births, the "control" group included women aged 22-26 (27-31; 29-33) years. Women in the "late motherhood" group were aged > 33 (> 35; > 38) years. Results: The "late motherhood" groups defined in this way were also at higher risk of adverse perinatal events other than preterm birth. For women with zero (one; two) previous live births, normal cephalic presentation occurred in 89 % (92.7 %; 93.3 %) in the "control" group, but only in 84.5 % (90 %; 90.4 %) in the "late motherhood" group. The mode of delivery was spontaneous or at most requiring manual help in 71.3 % (83.4 %; 85.8 %) in the "control" group, but only in 51.4 % (72.2 %; 76.4 %) in the "late motherhood" group. Five-minute APGAR scores were likewise worse for neonates of "late" mothers and the proportion with a birth weight ≤ 2499 g was greater. Conclusion: "Late motherhood" that is associated with greater perinatal risks can be defined based on parity and preterm birth rate.

  5. Perinatal Risks in “Late Motherhood” Defined Based On Parity and Preterm Birth Rate – an Analysis of the German Perinatal Survey (20th Communication)

    Science.gov (United States)

    Schure, V.; Voigt, M.; Schild, R. L.; Hesse, V.; Carstensen, M.; Schneider, K. T. M.; Straube, S.

    2012-01-01

    Aim: “Late motherhood” is associated with greater perinatal risks but the term lacks precise definition. We present an approach to determine what “late motherhood” associated with “high risk” is, based on parity and preterm birth rate. Materials and Methods: Using data from the German Perinatal Survey of 1998–2000 we analysed preterm birth rates in women with zero, one, or two previous live births. We compared groups of “late” mothers (with high preterm birth rates) with “control” groups of younger women (with relatively low preterm birth rates). Data of 208 342 women were analysed. For women with zero (one; two) previous live births, the “control” group included women aged 22–26 (27–31; 29–33) years. Women in the “late motherhood” group were aged > 33 (> 35; > 38) years. Results: The “late motherhood” groups defined in this way were also at higher risk of adverse perinatal events other than preterm birth. For women with zero (one; two) previous live births, normal cephalic presentation occurred in 89 % (92.7 %; 93.3 %) in the “control” group, but only in 84.5 % (90 %; 90.4 %) in the “late motherhood” group. The mode of delivery was spontaneous or at most requiring manual help in 71.3 % (83.4 %; 85.8 %) in the “control” group, but only in 51.4 % (72.2 %; 76.4 %) in the “late motherhood” group. Five-minute APGAR scores were likewise worse for neonates of “late” mothers and the proportion with a birth weight ≤ 2499 g was greater. Conclusion: “Late motherhood” that is associated with greater perinatal risks can be defined based on parity and preterm birth rate. PMID:25253904

  6. The relationship between air pollution and low birth weight: effects by mother's age, infant sex, co-pollutants, and pre-term births

    International Nuclear Information System (INIS)

    Bell, Michelle L; Ebisu, Keita; Belanger, Kathleen

    2008-01-01

    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.

  7. The relationship between air pollution and low birth weight: effects by mother's age, infant sex, co-pollutants, and pre-term births

    Energy Technology Data Exchange (ETDEWEB)

    Bell, Michelle L; Ebisu, Keita [School of Forestry and Environmental Studies, Yale University, 205 Prospect Street, New Haven, CT 06511 (United States); Belanger, Kathleen [Department of Epidemiology and Public Health, School of Medicine, Yale University, One Church Street, 6th Floor, New Haven, CT 06510 (United States)], E-mail: michelle.bell@yale.edu

    2008-10-15

    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{sub 10}, PM{sub 2.5}, CO, NO{sub 2}, and SO{sub 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.

  8. Pragmatic prevention of preterm birth and evidence based medicine.

    Science.gov (United States)

    Hoyme, Udo B

    2016-07-01

    Effective prevention of preterm birth is one of the unsolved problems in modern medicine. In the Thuringia campaign 2000 based on a simple screening with intravaginal pH self-measurements, adequate medical diagnosis and immediate antimicrobial therapy of genital infection, the rate of newborns ever seen in any of the German states. Therefore, the regime should be implicated as a necessary step of optimizing and rationalizing the health care system. However, in the discussion we had to learn that the best way to inhibit progress is to cope with problems by preferring the most complicated policies under persistent renunciation of simple solutions. As long as we do not have other alternative safe, simple and cheap methods, do we really have to wait even more decades to come for a prospectively randomized double-blinded almost impracticable study to convince the latest skeptical scientist that we have plenty of evidence-based means to reduce the incidence of premature birth, now, by decreasing infectious morbidity in pregnancy and by the same action childbed fever as well? Insisting scholastically on nothing but the 100 % pure evidence sometimes can hamper innovations and potential benefit. Would a similar caution ever had allowed us for instance to introduce handwashing according to Semmelweis? Good news, the Government of the State of Thuringia has decided this year to reestablish a pH selfcare screening programme.

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

    Directory of Open Access Journals (Sweden)

    Elena Mantovani

    2014-01-01

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

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

    Science.gov (United States)

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

    2014-01-01

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

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

    Science.gov (United States)

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

    2013-10-01

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

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

    NARCIS (Netherlands)

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

    2011-01-01

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

  13. Exploring educational disparities in risk of preterm delivery: a comparative study of 12 European birth cohorts

    NARCIS (Netherlands)

    Poulsen, Gry; Strandberg-Larsen, Katrine; Mortensen, Laust; Barros, Henrique; Cordier, Sylvaine; Correia, Sofia; Danileviciute, Asta; van Eijsden, Manon; Fernández-Somoano, Ana; Gehring, Ulrike; Grazuleviciene, Regina; Hafkamp-de Groen, Esther; Henriksen, Tine Brink; Jensen, Morten Søndergaard; Larrañaga, Isabel; Magnus, Per; Pickett, Kate; Raat, Hein; Richiardi, Lorenzo; Rouget, Florence; Rusconi, Franca; Stoltenberg, Camilla; Uphoff, Eleonora P; Vrijkotte, Tanja G M; Wijga, Alet H; Vrijheid, Martine; Osler, Merete; Andersen, Anne-Marie Nybo

    BACKGROUND: An association between education and preterm delivery has been observed in populations across Europe, but differences in methodology limit comparability. We performed a direct cross-cohort comparison of educational disparities in preterm delivery based on individual-level birth cohort

  14. Exploring educational disparities in risk of preterm delivery: a comparative study of 12 European birth cohorts

    NARCIS (Netherlands)

    Poulsen, Gry; Strandberg-Larsen, Katrine; Mortensen, Laust; Barros, Henrique; Cordier, Sylvaine; Correia, Sofia; Danileviciute, Asta; van Eijsden, Manon; Fernández-Somoano, Ana; Gehring, Ulrike; Grazuleviciene, Regina; Hafkamp-de Groen, Esther; Henriksen, Tine Brink; Jensen, Morten Søndergaard; Larrañaga, Isabel; Magnus, Per; Pickett, Kate; Raat, Hein; Richiardi, Lorenzo; Rouget, Florence; Rusconi, Franca; Stoltenberg, Camilla; Uphoff, Eleonora P.; Vrijkotte, Tanja G. M.; Wijga, Alet H.; Vrijheid, Martine; Osler, Merete; Andersen, Anne-Marie Nybo

    2015-01-01

    An association between education and preterm delivery has been observed in populations across Europe, but differences in methodology limit comparability. We performed a direct cross-cohort comparison of educational disparities in preterm delivery based on individual-level birth cohort data. The

  15. Preterm birth and cerebral palsy. Predictive value of pregnancy complications, mode of delivery, and Apgar scores

    DEFF Research Database (Denmark)

    Topp, Monica Wedell; Langhoff-Roos, J; Uldall, P

    1997-01-01

    BACKGROUND: Preterm infants are at 8 times higher risk than term infants for pre- and perinatal brain damage, resulting in cerebral palsy. In this paper we have analysed the influence of prenatal and birth-related risk factors on cerebral palsy in preterm infants. METHODS: In a register-based stu...

  16. The inner state differences of preterm birth rates in Brazil: a time series study.

    Science.gov (United States)

    de Oliveira, Rosana Rosseto; Melo, Emiliana Cristina; Fujimori, Elizabeth; Mathias, Thais Aidar de Freitas

    2016-05-17

    Preterm birth is a serious public health problem, as it is linked to high rates of neonatal and child morbidity and mortality. The prevalence of premature births has increased worldwide, with regional differences. The objective of this study was to analyze the trend of preterm births in the state of Paraná, Brazil, according to Macro-regional and Regional Health Offices (RHOs). This is an ecological time series study using preterm births records from the national live birth registry system of Brazil's National Health Service - Live Birth Information System (Sinasc), for residents of the state of Paraná, Brazil, between 2000 and 2013. The preterm birth rates was calculated on a yearly basis and grouped into three-year periods (2000-2002, 2003-2005, 2006-2008, 2009-2011) and one two-year period (2012-2013), according to gestational age and mother's Regional Health Office of residence. The polynomial regression model was used for trend analysis. The predominance of preterm birth rate increased from 6.8 % in 2000 to 10.5 % in 2013, with an average increase of 0.20 % per year (r(2) = 0.89), and a greater share of moderate preterm births (32 to rate of prematurity and average annual growth during that period (7.55 % and 0.35 %, respectively). The trend analysis of preterm birth rates according to RHO showed a growing trend for almost all RHOs - except for the 7(th) RHO where a declining trend was observed (-0.95 a year); and in the 20(th), 21(st) and 22(nd) RHOs which remained unchanged. In the last three-year of the study period (2011-2013), no RHO showed preterm birth rates below 7.3 % or prevalence of moderate preterm birth below 9.4 %. The results show an increase in preterm births with differences among Macro-regional and RHOs, which indicate the need to improve actions during the prenatal period according to the specificities of each region.

  17. The inner state differences of preterm birth rates in Brazil: a time series study

    Directory of Open Access Journals (Sweden)

    Rosana Rosseto de Oliveira

    2016-05-01

    Full Text Available Abstract Background Preterm birth is a serious public health problem, as it is linked to high rates of neonatal and child morbidity and mortality. The prevalence of premature births has increased worldwide, with regional differences. The objective of this study was to analyze the trend of preterm births in the state of Paraná, Brazil, according to Macro-regional and Regional Health Offices (RHOs. Methods This is an ecological time series study using preterm births records from the national live birth registry system of Brazil’s National Health Service - Live Birth Information System (Sinasc, for residents of the state of Paraná, Brazil, between 2000 and 2013. The preterm birth rates was calculated on a yearly basis and grouped into three-year periods (2000–2002, 2003–2005, 2006–2008, 2009–2011 and one two-year period (2012–2013, according to gestational age and mother’s Regional Health Office of residence. The polynomial regression model was used for trend analysis. Results The predominance of preterm birth rate increased from 6.8 % in 2000 to 10.5 % in 2013, with an average increase of 0.20 % per year (r2 = 0.89, and a greater share of moderate preterm births (32 to <37 weeks, which increased from 5.8 % to 9 %. The same pattern was observed for all Macro-regional Health Offices, with highlight to the Northern Macro-Regional Office, which showed the highest average rate of prematurity and average annual growth during that period (7.55 % and 0.35 %, respectively. The trend analysis of preterm birth rates according to RHO showed a growing trend for almost all RHOs – except for the 7th RHO where a declining trend was observed (−0.95 a year; and in the 20th, 21st and 22nd RHOs which remained unchanged. In the last three-year of the study period (2011–2013, no RHO showed preterm birth rates below 7.3 % or prevalence of moderate preterm birth below 9.4 %. Conclusions The results show an increase in preterm births

  18. Preterm birth and oxidative stress: Effects of acute physical exercise and hypoxia physiological responses

    Directory of Open Access Journals (Sweden)

    Agnès Martin

    2018-07-01

    Full Text Available Preterm birth is a global health issue that can induce lifelong medical sequela. Presently, at least one in ten newborns are born prematurely. At birth, preterm newborns exhibit higher levels of oxidative stress (OS due to the inability to face the oxygen rich environment in which they are born into. Moreover, their immature respiratory, digestive, immune and antioxidant defense systems, as well as the potential numerous medical interventions following a preterm birth, such as oxygen resuscitation, nutrition, phototherapy and blood transfusion further contribute to high levels of OS. Although the acute effects seem well established, little is known regarding the long-term effects of preterm birth on OS. This matter is especially important given that chronically elevated OS levels may persist into adulthood and consequently contribute to the development of numerous non-communicable diseases observed in people born preterm such as diabetes, hypertension or lung disorders. The purpose of this review is to summarize the current knowledge regarding the consequences of preterm birth on OS levels from newborn to adulthood. In addition, the effects of physical activity and hypoxia, both known to disrupt redox balance, on OS modulation in preterm individuals are also explored. Keywords: Reactive oxygen species, Antioxidants, Prematurity, Physical exercise, Hypoxia

  19. Women with preterm birth have a distinct cervicovaginal metabolome.

    Science.gov (United States)

    Ghartey, Jeny; Bastek, Jamie A; Brown, Amy G; Anglim, Laura; Elovitz, Michal A

    2015-06-01

    Metabolomics has the potential to reveal novel pathways involved in the pathogenesis of preterm birth (PTB). The objective of this study was to investigate whether the cervicovaginal (CV) metabolome was different in asymptomatic women destined to have a PTB compared with term birth. A nested case-control study was performed using CV fluid collected from a larger prospective cohort. The CV fluid was collected between 20-24 weeks (V1) and 24-28 weeks (V2). The metabolome was compared between women with a spontaneous PTB (n = 10) to women who delivered at term (n = 10). Samples were extracted and prepared for analysis using a standard extraction solvent method. Global biochemical profiles were determined using gas chromatography/mass spectrometry and ultra-performance liquid chromatography/tandem mass spectrometry. An ANOVA was used to detect differences in biochemical compounds between the groups. A false discovery rate was estimated to account for multiple comparisons. A total of 313 biochemicals were identified in CV fluid. Eighty-two biochemicals were different in the CV fluid at V1 in those destined to have a PTB compared with term birth, whereas 48 were different at V2. Amino acid, carbohydrate, and peptide metabolites were distinct between women with and without PTB. These data suggest that the CV space is metabolically active during pregnancy. Changes in the CV metabolome may be observed weeks, if not months, prior to any clinical symptoms. Understanding the CV metabolome may hold promise for unraveling the pathogenesis of PTB and may provide novel biomarkers to identify women most at risk. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. The Influence of Meteorological Factors and Atmospheric Pollutants on the Risk of Preterm Birth.

    Science.gov (United States)

    Giorgis-Allemand, Lise; Pedersen, Marie; Bernard, Claire; Aguilera, Inmaculada; Beelen, Rob M J; Chatzi, Leda; Cirach, Marta; Danileviciute, Asta; Dedele, Audrius; van Eijsden, Manon; Estarlich, Marisa; Fernández-Somoano, Ana; Fernández, Mariana F; Forastiere, Francesco; Gehring, Ulrike; Grazuleviciene, Regina; Gruzieva, Olena; Heude, Barbara; Hoek, Gerard; de Hoogh, Kees; van den Hooven, Edith H; Håberg, Siri E; Iñiguez, Carmen; Jaddoe, Vincent W V; Korek, Michal; Lertxundi, Aitana; Lepeule, Johanna; Nafstad, Per; Nystad, Wenche; Patelarou, Evridiki; Porta, Daniela; Postma, Dirkje; Raaschou-Nielsen, Ole; Rudnai, Peter; Siroux, Valérie; Sunyer, Jordi; Stephanou, Euripides; Sørensen, Mette; Eriksen, Kirsten Thorup; Tuffnell, Derek; Varró, Mihály J; Vrijkotte, Tanja G M; Wijga, Alet; Wright, John; Nieuwenhuijsen, Mark J; Pershagen, Göran; Brunekreef, Bert; Kogevinas, Manolis; Slama, Rémy

    2017-02-15

    Atmospheric pollutants and meteorological conditions are suspected to be causes of preterm birth. We aimed to characterize their possible association with the risk of preterm birth (defined as birth occurring before 37 completed gestational weeks). We pooled individual data from 13 birth cohorts in 11 European countries (71,493 births from the period 1994-2011, European Study of Cohorts for Air Pollution Effects (ESCAPE)). City-specific meteorological data from routine monitors were averaged over time windows spanning from 1 week to the whole pregnancy. Atmospheric pollution measurements (nitrogen oxides and particulate matter) were combined with data from permanent monitors and land-use data into seasonally adjusted land-use regression models. Preterm birth risks associated with air pollution and meteorological factors were estimated using adjusted discrete-time Cox models. The frequency of preterm birth was 5.0%. Preterm birth risk tended to increase with first-trimester average atmospheric pressure (odds ratio per 5-mbar increase = 1.06, 95% confidence interval: 1.01, 1.11), which could not be distinguished from altitude. There was also some evidence of an increase in preterm birth risk with first-trimester average temperature in the -5°C to 15°C range, with a plateau afterwards (spline coding, P = 0.08). No evidence of adverse association with atmospheric pollutants was observed. Our study lends support for an increase in preterm birth risk with atmospheric pressure. © The Author 2017. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  1. Understanding the role of violence as a social determinant of preterm birth.

    Science.gov (United States)

    Masho, Saba W; Cha, Susan; Chapman, Derek A; Chelmow, David

    2017-02-01

    Preterm birth is one of the leading causes of infant morbidity and mortality. Although major strides have been made in identifying risk factors for preterm birth, the complexities between social and individual risk factors are not well understood. This study examines the association between neighborhood youth violence and preterm birth. A 10-year live birth registry data set (2004 through 2013) from Richmond, VA, a mid-sized, racially diverse city, was analyzed (N = 27,519). Data were geocoded and merged with census tract and police report data. Gestational age at birth was classified as rates were calculated for each census tract area and categorized into quartiles. Hierarchical models were examined fitting multilevel logistic regression models incorporating randomly distributed census tract-specific intercepts assuming a binary distribution and a logit link function. Nearly a fifth of all births occurred in areas with the highest quartiles of violence. After adjusting for maternal age, race/ethnicity, education, paternal presence, parity, adequacy of prenatal care, pregnancy complications, history of preterm birth, insurance, and tobacco, alcohol, and drug use, census tracts with the highest level of violence had 38% higher odds of very preterm births (adjusted odds ratio, 1.38; 95% confidence interval, 1.06-1.80), than census tracts with the lowest level of violence. There is an association between high rate of youth violence and very preterm birth. Findings from this study may help inform future research to develop targeted interventions aimed at reducing community violence and very preterm birth in vulnerable populations. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. The Growing Trend of Moderate Preterm Births: An Ecological Study in One Region of Brazil.

    Directory of Open Access Journals (Sweden)

    Rosana Rosseto de Oliveira

    Full Text Available Preterm birth is a serious public health problem, as it is linked to high rates of neonatal and child morbidity and mortality, with Brazil listed among the countries with the ten highest numbers of premature births. Nonetheless, knowledge is scarce regarding prematurity and associated factors in mid-sized cities. The objective of this study was to analyze the trend of preterm births and associated factors in a municipality located in the state of Paraná, Brazil.This was an ecological time series study of births recorded into the Live Birth Information System for residents of Maringá, Paraná, Brazil, between 2000 and 2013. The polynomial regression model was used for trend analysis of preterm birth, characteristics of the mother, gestation and delivery, and newborn. The association with preterm birth was analyzed using odds ratio (OR.A total of 61,634 live births were analyzed, of which 5,632 were preterm births. Prematurity increased from 7.9% in 2000 to 11.2% in 2013 -an average increase of 0.54% per year (r2 = 0.93-with a growing share of moderate preterm births (32 to <37 weeks, which rose from 7.0% in 2000 to 9.7% in 2013. Between 2011 and 2013, multiple pregnancy (OR = 16.64; CI = 13.24-20.92, inadequate number of prenatal visits (OR = 2.81; CI = 2.51-3.15, Apgar score below 7 at 1 (OR = 4.07; CI = 3.55-4.67 and 5 minutes (OR = 10.88; CI = 7.71-15.36, low birth weight (OR = 38.75; CI = 33.72-44.55 and congenital malformations (OR = 3.18; CI = 2.14-4.74 were associated with preterm birth. A growing trend was observed for multiple pregnancies, with an average annual increase of 0.32% (r2 = 0.90, as well as for C-section birth (2.38% yearly increase. Of all newborn characteristics, Apgar score below 7 at 5 minutes (-0.19% per year and low birth weight (-1.43% decreased, whereas congenital malformations rose (0.20% per year.Efforts are required to prevent premature delivery, particularly during the moderate period, as well as greater care

  3. The Growing Trend of Moderate Preterm Births: An Ecological Study in One Region of Brazil.

    Science.gov (United States)

    Oliveira, Rosana Rosseto de; Melo, Emiliana Cristina; Falavina, Larissa Pereira; Mathias, Thais Aidar de Freitas

    2015-01-01

    Preterm birth is a serious public health problem, as it is linked to high rates of neonatal and child morbidity and mortality, with Brazil listed among the countries with the ten highest numbers of premature births. Nonetheless, knowledge is scarce regarding prematurity and associated factors in mid-sized cities. The objective of this study was to analyze the trend of preterm births and associated factors in a municipality located in the state of Paraná, Brazil. This was an ecological time series study of births recorded into the Live Birth Information System for residents of Maringá, Paraná, Brazil, between 2000 and 2013. The polynomial regression model was used for trend analysis of preterm birth, characteristics of the mother, gestation and delivery, and newborn. The association with preterm birth was analyzed using odds ratio (OR). A total of 61,634 live births were analyzed, of which 5,632 were preterm births. Prematurity increased from 7.9% in 2000 to 11.2% in 2013 -an average increase of 0.54% per year (r2 = 0.93)-with a growing share of moderate preterm births (32 to 2000 to 9.7% in 2013. Between 2011 and 2013, multiple pregnancy (OR = 16.64; CI = 13.24-20.92), inadequate number of prenatal visits (OR = 2.81; CI = 2.51-3.15), Apgar score below 7 at 1 (OR = 4.07; CI = 3.55-4.67) and 5 minutes (OR = 10.88; CI = 7.71-15.36), low birth weight (OR = 38.75; CI = 33.72-44.55) and congenital malformations (OR = 3.18; CI = 2.14-4.74) were associated with preterm birth. A growing trend was observed for multiple pregnancies, with an average annual increase of 0.32% (r2 = 0.90), as well as for C-section birth (2.38% yearly increase). Of all newborn characteristics, Apgar score below 7 at 5 minutes (-0.19% per year) and low birth weight (-1.43%) decreased, whereas congenital malformations rose (0.20% per year). Efforts are required to prevent premature delivery, particularly during the moderate period, as well as greater care during the prenatal period towards

  4. When Parents Ask … about Preterm Birth, Breastfeeding Success, Breast Cancer, or Waterbirth

    OpenAIRE

    Moore, Mary Lou

    2003-01-01

    In this column, the author reviews research on four separate topics: the prevention of preterm birth, the effect of epidurals on breastfeeding success, the possible protective effect of lactation on breast cancer, and laboring in water. In two separate studies—a multisite study in the United States and a second study from Brazil—natural progesterone was shown to significantly reduce the incidence of preterm birth in women at high risk. A third study conducted in the United Kingdom examined th...

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

    Directory of Open Access Journals (Sweden)

    Xiaojing eZheng

    2013-10-01

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

  6. Prepregnancy body mass index and risk of preterm birth: association heterogeneity by preterm subgroups.

    Science.gov (United States)

    Parker, Margaret G; Ouyang, Fengxiu; Pearson, Colleen; Gillman, Matthew W; Belfort, Mandy B; Hong, Xiumei; Wang, Guoying; Heffner, Linda; Zuckerman, Barry; Wang, Xiaobin

    2014-04-30

    To evaluate the association between prepregnancy body mass index (BMI) is associated with early vs. late and medically-induced vs. spontaneous preterm birth (PTB) subtypes. Using data from the Boston Birth Cohort, we examined associations of prepregnancy BMI with 189 early (PTBs and 320 early and 610 late spontaneous PTBs vs. 3281 term births (37-44 weeks) in multinomial regression. To assess for mediation by important pregnancy complications, we performed sequential models with and without hypertensive disorders of pregnancy, chorioamnionitis, and gestational diabetes. Prevalence of prepregnancy obesity (BMI ≥ 30.0 kg/m2) was 28% among mothers with medically-induced PTBs, 18% among mothers with spontaneous PTBs, and 18% among mothers with term births (p = <0.001). After adjustment for demographic and known risk factors for PTB, prepregnancy obesity was associated with higher odds of both early [OR 1.78 (1.19, 2.66)] and late [OR 1.49 (1.09, 2.04)] medically-induced PTB. These effect estimates were attenuated with inclusion of hypertensive disorders of pregnancy and gestational diabetes. For spontaneous deliveries, prepregnancy obesity was associated with decreased odds of PTB (0.76 [0.58, 0.98]) and underweight was nearly associated with increased odds of PTB (1.46 [0.99, 2.16]). Prepregnancy obesity is associated with higher risk of medically-induced, but not spontaneous PTB. Hypertensive disorders of pregnancy and gestational diabetes appear to partially explain the association between prepregnancy obesity and early and late medically-induced PTB.

  7. Specialist antenatal clinics for women at high risk of preterm birth: a systematic review of qualitative and quantitative research.

    Science.gov (United States)

    Malouf, Reem; Redshaw, Maggie

    2017-02-02

    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

  8. Preterm birth: the role of knowledge transfer and exchange.

    Science.gov (United States)

    Horvath, Hacsi; Brindis, Claire D; Reyes, E Michael; Yamey, Gavin; Franck, Linda

    2017-09-06

    Preterm birth (PTB) is the leading cause of death in children under age five. Healthcare policy and other decision-making relevant to PTB may rely on obsolete, incomplete or inapplicable research evidence, leading to worsened outcomes. Appropriate knowledge transfer and exchange (KTE) strategies are an important component of efforts to reduce the global PTB burden. We sought to develop a 'landscape' analysis of KTE strategies currently used in PTB and related contexts, and to make recommendations for optimising programmatic implementation and for future research. In the University of California, San Francisco's Preterm Birth Initiative, we convened a multidisciplinary working group and examined KTE frameworks. After selecting a widely-used, adaptable, theoretically-strong framework we reviewed the literature to identify evidence-based KTE strategies. We analysed KTE approaches focusing on key PTB stakeholders (individuals, families and communities, healthcare providers and policymakers). Guided by the framework, we articulated KTE approaches that would likely improve PTB outcomes. We further applied the KTE framework in developing recommendations. We selected the Linking Research to Action framework. Searches identified 19 systematic reviews, including two 'reviews of reviews'. Twelve reviews provided evidence for KTE strategies in the context of maternal, neonatal and child health, though not PTB specifically; seven reviews provided 'cross-cutting' evidence that could likely be generalised to PTB contexts. For individuals, families and communities, potentially effective KTE strategies include community-based approaches, 'decision aids', regular discussions with providers and other strategies. For providers, KTE outcomes may be improved through local opinion leaders, electronic reminders, multifaceted strategies and other approaches. Policy decisions relevant to PTB may best be informed through the use of evidence briefs, deliberative dialogues, the SUPPORT tools

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

    Science.gov (United States)

    Teshome, Amare; Yitayeh, Asmare

    2016-01-01

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

  10. Association between maternal nutritional status of pre pregnancy, gestational weight gain and preterm birth.

    Science.gov (United States)

    Xinxo, Sonela; Bimbashi, Astrit; Z Kakarriqi, Eduard; Zaimi, Edmond

    2013-01-01

    Maternal nutritional status of pre pregnancy and gestational weight gain affects the preterm birth. The association between maternal nutritional status of pre pregnancy and preterm birth appears to be complex and varied by studies from different countries, thus this association between the gestational weight gain and preterm birth is more consolidated. The study aims to determine any association between the pre pregnancy maternal nutritional status, gestational weight gain and the preterm birth rate in the Albanian context. In case control study, we analyzed women who have delivered in obstetric institutions in Tirana during the year 2012. Body mass index and gestational weight gain of 150 women who had a preterm delivery were compared with those of 150 matched control women who had a normal delivery regarding the gestation age. The self-reported pre pregnancy weight, height, gestational weight gain, age, education and parity are collected through a structured questioner. The body mass index and gestational weight gain are categorized based on the Institute of Medicine recommendation. The multiple logistic regression is used to measure the association between the nutritional status of pre pregnancy and gestational weight gain and the preterm birth rate. The women which have a underweight status or obese of pre pregnancy are more likely to have a preterm birth compared to the women of a normal pre-pregnancy nutritional status (respectively OR =2.7 and 4.3 pnutritional status and gestational weight gain affects the risk for preterm birth. Pre-pregnancy and gestation nutritional assessments should be part of routine prenatal visits.

  11. The distribution of clinical phenotypes of preterm birth syndrome: implications for prevention.

    Science.gov (United States)

    Barros, Fernando C; Papageorghiou, Aris T; Victora, Cesar G; Noble, Julia A; Pang, Ruyan; Iams, Jay; Cheikh Ismail, Leila; Goldenberg, Robert L; Lambert, Ann; Kramer, Michael S; Carvalho, Maria; Conde-Agudelo, Agustin; Jaffer, Yasmin A; Bertino, Enrico; Gravett, Michael G; Altman, Doug G; Ohuma, Eric O; Purwar, Manorama; Frederick, Ihunnaya O; Bhutta, Zulfiqar A; Kennedy, Stephen H; Villar, José

    2015-03-01

    Preterm birth has been difficult to study and prevent because of its complex syndromic nature. To identify phenotypes of preterm delivery syndrome in the Newborn Cross-Sectional Study of the INTERGROWTH-21st Project. A population-based, multiethnic, cross-sectional study conducted at 8 geographically demarcated sites in Brazil, China, India, Italy, Kenya, Oman, the United Kingdom, and the United States. A total of 60,058 births over a 12-month fixed period between April 27, 2009, and March 2, 2014. Of these, 53,871 had an ultrasonography estimate of gestational age, among which 5828 were preterm births (10.8%). Pregnancies were prospectively studied using a standardized data collection and online data management system. Newborns had anthropometric and clinical examinations using standardized methods and identical equipment and were followed up until hospital discharge. The main study outcomes were clusters of preterm phenotypes and for each cluster, we analyzed signs of presentation at hospital admission, admission rates for neonatal intensive care for 7 days or more, and neonatal mortality rates. Twelve preterm birth clusters were identified using our conceptual framework. Eleven consisted of combinations of conditions known to be associated with preterm birth, 10 of which were dominated by a single condition. However, the most common single cluster (30.0% of the total preterm cases; n = 1747) was not associated with any severe maternal, fetal, or placental condition that was clinically detectable based on the information available; within this cluster, many cases were caregiver initiated. Only 22% (n = 1284) of all the preterm births occurred spontaneously without any of these severe conditions. Maternal presentation on hospital admission, newborn anthropometry, and risk for death before hospital discharge or admission for 7 or more days to a neonatal intensive care unit, none of which were used to construct the clusters, also differed according to the identified

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

    Directory of Open Access Journals (Sweden)

    Namrata Bhatia

    2015-08-01

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

  13. Periodontal disease treatment and risk of preterm birth: a systematic review and meta-analysis.

    Science.gov (United States)

    Rosa, Maria Inês da; Pires, Patrícia Duarte Simões; Medeiros, Lidia Rosi; Edelweiss, Maria Isabel; Martínez-Mesa, Jeovany

    2012-10-01

    The events leading to preterm birth are still not completely understood. A quantitative systematic review was performed to estimate the effects of periodontal care during pregnancy on preventing preterm birth and low birth weight. The meta-analysis included randomized trials with pregnant women with a diagnosis of periodontal disease before 20 weeks of gestation. Relative risk (RR) with 95% confidence intervals (95%CI) was calculated. We evaluated the reduction in preterm and low birth weight. Thirteen trials were included, comparing 3,576 women in intervention groups with 3,412 women receiving usual care. The meta-analysis of the effects of periodontal disease treatment during pregnancy indicated a non-significant reduction in preterm births (RR = 0.90; 95%CI: 0.68-1.19) and low birth weights (RR = 0.92; 95%CI: 0.71-1.20). The creation and examination of a funnel plot revealed clear evidence of publication bias. In summary, primary periodontal care during pregnancy cannot be considered an efficient way of reducing the incidence of preterm birth.

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

    Directory of Open Access Journals (Sweden)

    Einarsdóttir Kristjana

    2013-02-01

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

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

    Science.gov (United States)

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

    2017-03-01

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

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

    Directory of Open Access Journals (Sweden)

    Yun-Ping Zhang

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

  17. Maternal resolution of grief after preterm birth: implications for infant attachment security.

    Science.gov (United States)

    Shah, Prachi E; Clements, Melissa; Poehlmann, Julie

    2011-02-01

    This study explored the association between mothers' unresolved grief regarding their infant's preterm birth and infant-mother attachment security. We hypothesized that mothers with unresolved grief would be more likely to have insecurely attached infants at 16 months and that this association would be partially mediated by maternal interaction quality. This longitudinal study focused on 74 preterm infants (age of infants. The present analysis included assessment of neonatal and socioeconomic risks at NICU discharge; maternal depression, Reaction to Preterm Birth Interview findings, and quality of parenting at a postterm age of 9 months; and infant-mother attachment at postterm age of 16 months. Associations among findings of grief resolution with the Reaction to Preterm Birth Interview, quality of parenting interactions, and attachment security were explored by using relative risk ratios and logistic and multivariate regression models. The relative risk of developing insecure attachment when mothers had unresolved grief was 1.59 (95% confidence interval: 1.03-2.44). Controlling for covariates (adjusted odds ratio: 2.94), maternal feelings of resolved grief regarding the preterm birth experience were associated with secure infant-mother attachment at 16 months. Maternal grief resolution and interaction quality were independent predictors of attachment security. Maternal grief resolution regarding the experience of preterm birth and the quality of maternal interactions have important implications for emerging attachment security for infants born prematurely.

  18. Association between ambient fine particulate matter and preterm birth or term low birth weight: An updated systematic review and meta-analysis

    International Nuclear Information System (INIS)

    Li, Xiangyu; Huang, Shuqiong; Jiao, Anqi; Yang, Xuhao; Yun, Junfeng; Wang, Yuxin; Xue, Xiaowei; Chu, Yuanyuan; Liu, Feifei; Liu, Yisi; Ren, Meng

    2017-01-01

    An increasing number of studies have been conducted to determine a possible linkage between maternal exposure to ambient fine particulate matter and effects on the developing human fetus that can lead to adverse birth outcomes, but, the present results are not consistent. A total of 23 studies published before July 2016 were collected and analyzed and the mean value of reported exposure to fine particulate matter (PM 2.5 ) ranged from 1.82 to 22.11 We found a significantly increased risk of preterm birth with interquartile range increase in PM 2.5 exposure throughout pregnancy (odds ratio (OR) = 1.03; 95% conditional independence (CI): 1.01–1.05). The pooled OR for the association between PM 2.5 exposure, per interquartile range increment, and term low birth weight throughout pregnancy was 1.03 (95% CI: 1.02–1.03). The pooled ORs for the association between PM 2.5 exposure per 10 increment, and term low birth weight and preterm birth were 1.05 (95% CI: 0.98–1.12) and 1.02 (95% CI: 0.93–1.12), respectively throughout pregnancy. There is a significant heterogeneity in most meta-analyses, except for pooled OR per interquartile range increase for term low birth weight throughout pregnancy. We here show that maternal exposure to fine particulate air pollution increases the risk of preterm birth and term low birth weight. However, the effect of exposure time needs to be further explored. In the future, prospective cohort studies and personal exposure measurements needs to be more widely utilized to better characterize the relationship between ambient fine particulate exposure and adverse birth outcomes. - Highlights: • The results had shorter intervals indicate and smaller heterogeneity by using IQR increment increase as selected standard. • The manuscript included the latest research results and updated the previous systematic review and meta-analysis. - Meta-analysis of preterm birth and term low birth weight of PM 2.5

  19. Low birthweight and preterm birth in young people with special educational needs: a magnetic resonance imaging analysis

    Directory of Open Access Journals (Sweden)

    Owens David GC

    2008-01-01

    Full Text Available Abstract Background Although neuroanatomical and cognitive sequelae of low birthweight and preterm birth have been investigated, little is understood as to the likely prevalence of a history of low birthweight or preterm birth, or neuroanatomical correlates of such a history, within the special educational needs population. Our aim was to address these issues in a sample of young people receiving additional learning support. Methods One hundred and thirty-seven participants aged 13–22 years, receiving additional learning support, were recruited via their schools or colleges and underwent structural magnetic resonance imaging (MRI. Obstetric records, available in 98 cases, included birthweight and gestational data in 90 and 95 cases, respectively. Both qualitative and quantitative voxel-based analyses of MRI data were conducted. Results A history of low birthweight and preterm birth was present in 13.3% and 13.7% of cases, respectively. Low birthweight and preterm birth were associated with specific qualitative anomalies, including enlargement of subarachnoid cisterns and thinning of the corpus callosum. Low birthweight was associated with reduced grey matter density (GMD in the superior temporal gyrus (STG bilaterally, left inferior temporal gyrus and left insula. Prematurity of birth was associated with reduced GMD in the STG bilaterally, right inferior frontal gyrus and left cerebellar hemisphere. Comparison of subjects with no history of low birthweight or preterm birth with a previously defined control sample of cognitively unimpaired adolescents (n = 72 demonstrated significantly greater scores for several anomalies, including thinning of the corpus callosum, loss of white matter and abnormalities of shape of the lateral ventricles. Conclusion Although a two-fold increased prevalence of a history of low birthweight and preterm birth exists within the special educational needs population, other aetiological factors must be considered for

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

    Science.gov (United States)

    Ramaeker, Devon M; Simhan, Hyagriv N

    2012-03-01

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

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

    Science.gov (United States)

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

    2015-10-01

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

  2. Pregnancy-specific stress, preterm birth, and gestational age among high-risk young women.

    Science.gov (United States)

    Cole-Lewis, Heather J; Kershaw, Trace S; Earnshaw, Valerie A; Yonkers, Kimberly Ann; Lin, Haiqun; Ickovics, Jeannette R

    2014-09-01

    There is evidence that pregnancy-specific stress is associated with preterm birth. The purpose of this study is to examine the association between change in pregnancy-specific stress over the course of pregnancy and birth outcomes (i.e., preterm birth and gestational age) in an understudied but vulnerable group using a theoretically derived model. Multivariate linear and logistic regression techniques were used to examine the association between pregnancy-specific stress (measured in second and third trimester) and length of gestation (i.e., preterm birth and gestational age) among a sample of 920 Black and/or Latina adolescent and young women. Second trimester pregnancy-specific stress was not associated with preterm birth or gestational age. Third trimester pregnancy-specific stress was associated with preterm birth but not with gestational age. Change in pregnancy-specific stress between second and third trimester was significantly associated with increased likelihood of preterm delivery and shortened gestational age, even after controlling for important biological, behavioral, psychological, interpersonal, and sociocultural risk factors. Findings emphasize the importance of measuring pregnancy-specific stress across pregnancy, as the longitudinal change from second to third trimester was significantly associated with length of gestation measured both as a dichotomous variable (preterm birth) and a continuous variable (gestational age). Furthermore, this is the first study to observe the association of pregnancy-specific stress with length of gestation in this understudied population-unique in age, race, and ethnicity. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

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

    Directory of Open Access Journals (Sweden)

    Iyoke CA

    2014-10-01

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

  4. Magnesium sulphate for women at risk of preterm birth for neuroprotection of the fetus

    NARCIS (Netherlands)

    Doyle, Lex W.; Crowther, Caroline A.; Middleton, Philippa; Marret, Stephane; Rouse, Dwight

    2009-01-01

    Background Epidemiological and basic science evidence suggests that magnesium sulphate before birth may be neuroprotective for the fetus. Objectives To assess the effects of magnesium sulphate as a neuroprotective agent when given to women considered at risk of preterm birth. Search strategy We

  5. A functional approach to cerebral visual impairments in very preterm/very-low-birth-weight children

    NARCIS (Netherlands)

    Geldof, C.J.A.; van Wassenaer-Leemhuis, A.G.; Dik, M.; Kok, J.H.; Oosterlaan, J.

    2015-01-01

    Background:Cerebral visual impairment (CVI) is a major cause of visual impairment, with very preterm birth/very low birth weight (VP/VLBW) being a major risk factor. There is no generally accepted definition of CVI. This study aims to investigate the usefulness of an empirically-based functional

  6. A functional approach to cerebral visual impairments in very preterm/very-low-birth-weight children

    NARCIS (Netherlands)

    Geldof, Christiaan J. A.; van Wassenaer-Leemhuis, Aleid G.; Dik, Marjolein; Kok, Joke H.; Oosterlaan, Jaap

    2015-01-01

    Cerebral visual impairment (CVI) is a major cause of visual impairment, with very preterm birth/very low birth weight (VP/VLBW) being a major risk factor. There is no generally accepted definition of CVI. This study aims to investigate the usefulness of an empirically-based functional definition of

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

    NARCIS (Netherlands)

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

    2013-01-01

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

  8. Social representations of premature birth from the perspective of individuals born preterm in the 1990s.

    Science.gov (United States)

    Leavy, Pía; Violeta Prina, Martina; Martínez Cáceres, María José; Bauer, Gabriela

    2015-01-01

    Prematurity is a public health problem that calls to focus on its causes and consequences through a trans disciplinary approach. There are no studies analyzing premature birth from the perspective of individuals born preterm. To identify social representations associated with premature birth of individuals born preterm in the 1990s in Argentina. Twelve focus groups were conducted with individuals born preterm with a birth weightparents' memories and experiences, overprotection body, education, relationship with the medical practice and knowledge. The methodology used allowed to create a space for mutual recognition and reflection for participants. Prematurity is a significant element, especially in those who suffered major sequelae. Adolescents and youth give a warning on the negative effects caused by overprotective parents and reveal the possibility of redefining the challenges associated with their history of premature birth.

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

    Science.gov (United States)

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

    2008-03-01

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

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

    Directory of Open Access Journals (Sweden)

    Irina A Buhimschi

    2008-04-01

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

  11. Spatial and temporal patterns in preterm birth in the United States.

    Science.gov (United States)

    Byrnes, John; Mahoney, Richard; Quaintance, Cele; Gould, Jeffrey B; Carmichael, Suzan; Shaw, Gary M; Showen, Amy; Phibbs, Ciaran; Stevenson, David K; Wise, Paul H

    2015-06-01

    Despite years of research, the etiologies of preterm birth remain unclear. In order to help generate new research hypotheses, this study explored spatial and temporal patterns of preterm birth in a large, total-population dataset. Data on 145 million US births in 3,000 counties from the Natality Files of the National Center for Health Statistics for 1971-2011 were examined. State trends in early (birth rates were compared. K-means cluster analyses were conducted to identify gestational age distribution patterns for all US counties over time. A weak association was observed between state trends in birth rates and the initial absolute birth rate. Significant associations were observed between trends in birth rates and between white and African American births. Periodicity was observed in county-level trends in birth rates. Cluster analyses identified periods of significant heterogeneity and homogeneity in gestational age distributional trends for US counties. The observed geographic and temporal patterns suggest periodicity and complex, shared influences among preterm birth rates in the United States. These patterns could provide insight into promising hypotheses for further research.

  12. Preventing preterm births: trends and potential reductions with current interventionsin 39 very high human development index countries

    Science.gov (United States)

    Chang, Hannah H.; Larson, Jim; Blencowe, Hannah; Spong, Catherine Y.; Howson, Christopher P.; Cairns-Smith, Sarah; Lackritz, Eve M.; Lee, Shoo K.; Mason, Elizabeth; Serazin, Andrew C.; Walani, Salimah; Simpson, Joe Leigh; Lawn, Joy E.

    2013-01-01

    Summary Background Each year,1.1 million babies die from prematurity, andmany survivors are disabled. Worldwide, 15 million babies are preterm(10,000 births, country-by-country analyses were performed based on target population, incremental coverage increase,and intervention efficacy. Cost savings were estimated based on reported costs for preterm care in the USAadjusted usingWorld Bank purchasing power parity. Findings From 2010, even if all VHHDI countries achieved annual preterm birth rate reductions of the best performers, (Sweden and Netherlands), 2000-2010 or 2005-2010(Lithuania, Estonia)), rates would experience a relative reduction of<5% by 2015 on average across the 39 countries.Our analysis of preterm birth rise 1998-2004 in USA suggests half the change is unexplained, but important drivers includeinductions/cesareandelivery and ART.For all 39 VHHDI countries, five interventionsmodeling at high coveragepredicted 5%preterm birth rate relative reduction from 9.59 to 9.07% of live births:smoking cessation (0.01 rate reduction), decreasing multiple embryo transfers during assisted reproductive technologies (0.06), cervical cerclage (0.15), progesterone supplementation (0.01), and reduction of non-medically indicated labour induction or caesarean delivery (0.29).These translate to 58,000 preterm births averted and total annual economic cost savings of ~US$ 3 billion. Interpretation Even with optimal coverage of current interventions, many being complex to implement, the estimated potential reduction in preterm birth is tiny. Hence we recommenda conservative target of 5% preterm birth rate relative reductionby 2015. Our findings highlight the urgent need for discovery research into underlying mechanisms of preterm birth, and developmentof innovative interventions. Furthermore, the highest preterm birth rates occur in low-income settings where the causes of prematurity may differand have simpler solutions, such as birth spacing and treatment of infections in

  13. Effect of periodontal treatment on preterm birth rate: a systematic review of meta-analyses.

    Science.gov (United States)

    López, Néstor J; Uribe, Sergio; Martinez, Benjamín

    2015-02-01

    Preterm birth is a major cause of neonatal morbidity and mortality in both developed and developing countries. Preterm birth is a highly complex syndrome that includes distinct clinical subtypes in which many different causes may be involved. The results of epidemiological, molecular, microbiological and animal-model studies support a positive association between maternal periodontal disease and preterm birth. However, the results of intervention studies carried out to determine the effect of periodontal treatment on reducing the risk of preterm birth are controversial. This systematic review critically analyzes the methodological issues of meta-analyses of the studies to determine the effect of periodontal treatment to reduce preterm birth. The quality of the individual randomized clinical trials selected is of highest relevance for a systematic review. This article describes the methodological features that should be identified a priori and assessed individually to determine the quality of a randomized controlled trial performed to evaluate the effect of periodontal treatment on pregnancy outcomes. The AMSTAR and the PRISMA checklist tools were used to assess the quality of the six meta-analyses selected, and the bias domain of the Cochrane Collaboration's Tool was applied to evaluate each of the trials included in the meta-analyses. In addition, the methodological characteristics of each clinical trial were assessed. The majority of the trials included in the meta-analyses have significant methodological flaws that threaten their internal validity. The lack of effect of periodontal treatment on preterm birth rate concluded by four meta-analyses, and the positive effect of treatment for reducing preterm birth risk concluded by the remaining two meta-analyses are not based on consistent scientific evidence. Well-conducted randomized controlled trials using rigorous methodology, including appropriate definition of the exposure, adequate control of confounders for

  14. Preterm birth and structural brain alterations in early adulthood

    Directory of Open Access Journals (Sweden)

    Chiara Nosarti

    2014-01-01

    Full Text Available Alterations in cortical development and impaired neurodevelopmental outcomes have been described following very preterm (VPT birth in childhood and adolescence, but only a few studies to date have investigated grey matter (GM and white matter (WM maturation in VPT samples in early adult life. Using voxel-based morphometry (VBM we studied regional GM and WM volumes in 68 VPT-born individuals (mean gestational age 30 weeks and 43 term-born controls aged 19–20 years, and their association with cognitive outcomes (Hayling Sentence Completion Test, Controlled Oral Word Association Test, Visual Reproduction test of the Wechsler Memory Scale-Revised and gestational age. Structural MRI data were obtained with a 1.5 Tesla system and analysed using the VBM8 toolbox in SPM8 with a customized study-specific template. Similarly to results obtained at adolescent assessment, VPT young adults compared to controls demonstrated reduced GM volume in temporal, frontal, insular and occipital areas, thalamus, caudate nucleus and putamen. Increases in GM volume were noted in medial/anterior frontal gyrus. Smaller subcortical WM volume in the VPT group was observed in temporal, parietal and frontal regions, and in a cluster centred on posterior corpus callosum/thalamus/fornix. Larger subcortical WM volume was found predominantly in posterior brain regions, in areas beneath the parahippocampal and occipital gyri and in cerebellum. Gestational age was associated with GM and WM volumes in areas where VPT individuals demonstrated GM and WM volumetric alterations, especially in temporal, parietal and occipital regions. VPT participants scored lower than controls on measures of IQ, executive function and non-verbal memory. When investigating GM and WM alterations and cognitive outcome scores, subcortical WM volume in an area beneath the left inferior frontal gyrus accounted for 14% of the variance of full-scale IQ (F = 12.9, p < 0.0001. WM volume in posterior corpus

  15. Family cohesion, acculturation, maternal cortisol, and preterm birth in Mexican-American women

    Directory of Open Access Journals (Sweden)

    Ruiz RJ

    2013-05-01

    Full Text Available R Jeanne Ruiz,1 Rita H Pickler,2 C Nathan Marti,3 Nancy Jallo41College of Nursing, The Ohio State University, Columbus, OH, USA; 2Department of Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; 3Abacist Analytics, Austin, TX, USA; 4School of Nursing, Virginia Commonwealth University, Richmond, VA, USAObjective: To examine the potential moderating effects of family cohesion and acculturation on the physiological stress response (cortisol as a predictor of preterm birth (PTB in pregnant Mexican-American women.Methods: The sample included 470 participants; 33 had preterm births. All participants were self-identified as Mexican-American. In this cross-sectional study, family cohesion was measured by a self-report questionnaire. Acculturation was measured by self-report questionnaire as well as by years in the United States and country of birth. Stress was measured by serum cortisol. All measures were obtained at 22—24 weeks gestation. Additional data including history of PTB were obtained from the health record. Data analysis was primarily conducted using logistic regression.Results: The relationship between stress and PTB was predicted by family cohesion (estimate/standard error [E/SE] = —2.46, P = 0.014 and acculturation (E/SE = 2.56, P = 0.011. In addition, there was an interaction between family cohesion and history of previous PTB (E/SE = —2.12, P = 0.035.Conclusion: Results indicate that the impact of cortisol on PTB is predicted by acculturation and family cohesion such that higher levels of cortisol in conjunction with higher levels of acculturation and lower levels of family cohesion are associated with increased risk of PTB. In addition, low family cohesion in combination with a history of PTB was associated with higher levels of PTB. Assessment of family cohesion, including problem solving, adherence to family decisions, family shared space, and activity, should be included as part of prenatal

  16. Psychosocial Stress and Preterm Birth: The Impact of Parity and Race.

    Science.gov (United States)

    Wheeler, Sarahn; Maxson, Pamela; Truong, Tracy; Swamy, Geeta

    2018-03-29

    Objectives Studies examining risk factors for preterm birth (PTB) such as psychosocial stress are often focused on women with a history of PTB; however, most preterm babies are born to women with no history of preterm birth. Our objective was to determine if the relationship between psychosocial stress and PTB is altered by parity. Non-Hispanic black (NHB) women have increased psychosocial stress and PTB; therefore, we further aimed to determine if race alters the relationship between psychosocial stress, parity, and PTB. Methods We performed a secondary analysis of the Healthy Pregnancy, Healthy Baby Study comparing pregnant women who were primiparous (first pregnancy), multiparous with history of preterm birth, or multiparous with history of term birth. Perceived stress, perceived racism, interpersonal support, John Henryism and self-efficacy were measured using validated instruments. Logistic regression was used to model the effect of psychosocial stress on PTB stratified by parity and race. Results The analysis entire cohort included 1606 subjects, 426 were primiparous, 268 had a history of presterm birth, and 912 had a history of term birth. In women with a history of term birth, higher self-efficacy was associated with lower odds of spontaneous PTB, and this association was amplified in NHB women. In women with a history of spontaneous PTB, John Henryism Active Coping was associated with lower odds of spontaneous PTB in the index pregnancy. Conclusions for Practice The relationship between psychosocial stress and PTB may be mediated by parity and race.

  17. Setting research priorities to reduce global mortality from preterm birth and low birth weight by 2015.

    Science.gov (United States)

    Bahl, Rajiv; Martines, Jose; Bhandari, Nita; Biloglav, Zrinka; Edmond, Karen; Iyengar, Sharad; Kramer, Michael; Lawn, Joy E; Manandhar, D S; Mori, Rintaro; Rasmussen, Kathleen M; Sachdev, H P S; Singhal, Nalini; Tomlinson, Mark; Victora, Cesar; Williams, Anthony F; Chan, Kit Yee; Rudan, Igor

    2012-06-01

    This paper aims to identify health research priorities that could improve the rate of progress in reducing global neonatal mortality from preterm birth and low birth weight (PB/LBW), as set out in the UN's Millennium Development Goal 4. We applied the Child Health and Nutrition Research Initiative (CHNRI) methodology for setting priorities in health research investments. In the process coordinated by the World Health Organization in 2007-2008, 21 researchers with interest in child, maternal and newborn health suggested 82 research ideas that spanned across the broad spectrum of epidemiological research, health policy and systems research, improvement of existing interventions and development of new interventions. The 82 research questions were then assessed for answerability, effectiveness, deliverability, maximum potential for mortality reduction and the effect on equity using the CHNRI method. The top 10 identified research priorities were dominated by health systems and policy research questions (eg, identification of LBW infants born at home within 24-48 hours of birth for additional care; approaches to improve quality of care of LBW infants in health facilities; identification of barriers to optimal home care practices including care seeking; and approaches to increase the use of antenatal corticosteriods in preterm labor and to improve access to hospital care for LBW infants). These were followed by priorities for improvement of the existing interventions (eg, early initiation of breastfeeding, including feeding mode and techniques for those unable to suckle directly from the breast; improved cord care, such as chlorhexidine application; and alternative methods to Kangaroo Mother Care (KMC) to keep LBW infants warm in community settings). The highest-ranked epidemiological question suggested improving criteria for identifying LBW infants who need to be cared for in a hospital. Among the new interventions, the greatest support was shown for the development of

  18. Heightened risk of preterm birth and growth restriction after a first-born son.

    Science.gov (United States)

    Bruckner, Tim A; Mayo, Jonathan A; Gould, Jeffrey B; Stevenson, David K; Lewis, David B; Shaw, Gary M; Carmichael, Suzan L

    2015-10-01

    In Scandinavia, delivery of a first-born son elevates the risk of preterm delivery and intrauterine growth restriction of the next-born infant. External validity of these results remains unclear. We test this hypothesis for preterm delivery and growth restriction using the linked California birth cohort file. We examined the hypothesis separately by race and/or ethnicity. We retrieved data on 2,852,976 births to 1,426,488 mothers with at least two live births. Our within-mother tests applied Cox proportional hazards (preterm delivery, defined as less than 37 weeks gestation) and linear regression models (birth weight for gestational age percentiles). For non-Hispanic whites, Hispanics, Asians, and American Indian and/or Alaska Natives, analyses indicate heightened risk of preterm delivery and growth restriction after a first-born male. The race-specific hazard ratios for preterm delivery range from 1.07 to 1.18. Regression coefficients for birth weight for gestational age percentile range from -0.73 to -1.49. The 95% confidence intervals for all these estimates do not contain the null. By contrast, we could not reject the null for non-Hispanic black mothers. Whereas California findings generally support those from Scandinavia, the null results among non-Hispanic black mothers suggest that we do not detect adverse outcomes after a first-born male in all racial and/or ethnic groups. Copyright © 2015 Elsevier Inc. All rights reserved.

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

    DEFF Research Database (Denmark)

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

    2007-01-01

    Objective The main purpose of this study was to identify possible associations between medicines used in pregnancy and preterm deliveries using data mining as a screening tool. Settings Prospective cohort study. Methods We used data mining to identify possible correlates between preterm delivery...... 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...... further studies. Data mining, especially with additional refinements, may be a valuable and very efficient tool to screen large databases for relevant information which can be used in clinical and public health research....

  20. Preterm birth and low birth weight continue to increase the risk of asthma from age 7 to 43.

    Science.gov (United States)

    Matheson, Melanie C; D Olhaberriague, Ana López-Polín; Burgess, John A; Giles, Graham G; Hopper, John L; Johns, David P; Abramson, Michael J; Walters, E Haydn; Dharmage, Shyamali C

    2017-08-01

    Perinatal events can influence the development of asthma in childhood but current evidence is contradictory concerning the effects on life-time asthma risk. To assess the relationship between birth characteristics and asthma from childhood to adulthood. All available birth records for the Tasmanian Longitudinal Health Study (TAHS) cohort, born in 1961 were obtained from the Tasmanian State Archives and Tasmanian hospitals. Low birth weight (LBW) was defined as less than 2500 grams. Preterm birth was defined as delivery before 37 weeks' gestation. Small for gestational age (SGA) was defined as a birth weight below the 10 th percentile for a given gestational age. Multivariate logistic and cox regression were used to examine associations between birth characteristics and lifetime risk of current and incident asthma, adjusting for confounders. The prevalence of LBW was 5.2%, SGA was 13.8% and preterm was 3.3%. LBW (OR = 1.65, 95%CI 1.12,2.44) and preterm birth (OR = 1.81, 95%CI 0.99, 3.31) were both associated with an increased risk of current asthma between the ages of 7 to 43 years. There was no association between SGA and current asthma risk. However, SGA was associated with incident asthma (HR = 1.32, 95%CI 1.00, 1.74), and there was an interaction with sex (p value = 0.08), with males having a greater risk of incident asthma (HR = 1.70, 95%CI 1.16-2.49) than females (HR = 1.04, 95%CI 0.70-1.54). Preterm birth and LBW were associated with an increased risk of current asthma into middle-age. These findings are the first to demonstrate the continuing impact of these characteristics on asthma risk into middle-age.

  1. Periodontal conditions, low birth weight and preterm birth among postpartum mothers in two tertiary health facilities in Uganda.

    Science.gov (United States)

    Muwazi, Louis; Rwenyonyi, Charles Mugisha; Nkamba, Moses; Kutesa, Annet; Kagawa, Mike; Mugyenyi, Godfrey; Kwizera, Godfrey; Okullo, Isaac

    2014-04-28

    Literature reports have indicated an increase in research evidence suggesting association between periodontal disease and the risk of pre-term birth (PTB) and low birth weight (LBW). Periodontal diseases in Uganda have been documented as a public health problem, but their association to adverse pregnancy outcomes is unknown. This study was conducted to assess the association between periodontital diseases in postpartum mothers and PTB and LBW of babies in Mulago and Mbarara referral hospitals. This was a cross sectional study using medical records, clinical examination and oral interview of mothers at the two tertiary health facilities. Mothers with singleton babies from Mulago (n = 300) and Mbarara Hospital (n = 100) were recruited for the study. The women were clinically examined for periodontal disease by 2 trained and calibrated dentists. Data on PTB and LBW were retrieved from medical records. The data were analyzed to determine the relationship between the four parameters for periodontal disease (bleeding gingiva, periodontal pockets, gingival recession and calculus with plaque deposits) and the adverse pregnancy outcomes. Frequency distribution was used to describe the data. Bivariate and multivariate analyses were used to study the association between the periodontal diseases and adverse pregnancy outcomes. Approximately 26% and 29% of the postpartum mothers examined had bleeding gingiva and periodontal pockets of 4 mm or more deep, respectively. Advanced periodontitis i.e. pocket depth ≥ 6 mm was recorded in 13 (3.6%) of the mothers. Calculus with plaque deposits were recorded in 86% (n = 343) of the mothers. Gingival recession was recorded in 9.0% of the mothers and significantly and directly related to birth weight (p Periodontal conditions of postpartum mothers in this study were found to be better than previously reported amongst the Ugandan population. Bivariate analysis showed a significant association only between gingival

  2. Changes in quality of life into adulthood after very preterm birth and/or very low birth weight in the Netherlands

    NARCIS (Netherlands)

    Lunenburg, A.; Pal, S.M. van der; Dommelen, P. van. der; Pal-de Bruin, K.M. van der; Bennebroek Gravenhorst, J.; Verrips, G.H.W.

    2013-01-01

    It is important to know the impact of Very Preterm (VP) birth or Very Low Birth Weight (VLBW). The purpose of this study is to evaluate changes in Health-Related Quality of Life (HRQoL) of adults born VP or with a VLBW, between age 19 and age 28. Methods The 1983 nationwide Dutch Project On Preterm

  3. Preterm birth and cerebral palsy. Predictive value of pregnancy complications, mode of delivery, and Apgar scores

    DEFF Research Database (Denmark)

    Topp, Monica Wedell; Langhoff-Roos, J; Uldall, P

    1997-01-01

    BACKGROUND: Preterm infants are at 8 times higher risk than term infants for pre- and perinatal brain damage, resulting in cerebral palsy. In this paper we have analysed the influence of prenatal and birth-related risk factors on cerebral palsy in preterm infants. METHODS: In a register-based study.......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 Pregnancy...

  4. Maternal bereavement and the risk of preterm delivery: the importance of gestational age and of the precursor of preterm birth.

    Science.gov (United States)

    László, K D; Li, J; Olsen, J; Vestergaard, M; Obel, C; Cnattingius, S

    2016-04-01

    Maternal stress during pregnancy may increase the risk of preterm delivery (PD), but the associations between stress and subtypes of PD are not clear. We investigated maternal loss of a close relative and risks of very and moderately PD (information on death of women's family members (children, partner, siblings, parents), birth outcomes and maternal characteristics from nationwide registries. Overall, the death of a close family member the year before pregnancy or in the first 36 weeks of pregnancy was associated with a 7% increased risk of PD [95% confidence interval (CI) 1.04-1.10]. The highest hazard ratios (HR) for PD were found for death of an older child [HR (95% CI) 1.20 (1.10-1.31)] and for death of a partner [HR (95% CI) 1.31 (1.03-1.66)]. These losses were associated with higher risks of very preterm [HR (95% CI) 1.61 (1.29-2.01) and 2.07 (1.15-3.74), respectively] than of moderately preterm [HR (95% CI) 1.14 (1.03-1.26) and 1.22 (0.94-1.58), respectively] delivery. There were no substantial differences in the association between death of a child or partner and the risk of spontaneous v. medically indicated PD. Death of a close family member the year before or during pregnancy was associated with an increased risk of PD, especially very PD. Possible mechanisms include both spontaneous and medically indicated preterm birth.

  5. Antenatal steroids in preterm labour for the prevention of neonatal deaths due to complications of preterm birth.

    Science.gov (United States)

    Mwansa-Kambafwile, Judith; Cousens, Simon; Hansen, Thomas; Lawn, Joy E

    2010-04-01

    In high-income countries, administration of antenatal steroids is standard care for women with anticipated preterm labour. However, although >1 million deaths due to preterm birth occur annually, antenatal steroids are not routine practice in low-income countries where most of these deaths occur. To review the evidence for and estimate the effect on cause-specific neonatal mortality of administration of antenatal steroids to women with anticipated preterm labour, with additional analysis for the effect in low- and middle-income countries. We conducted systematic reviews using standardized abstraction forms. Quality of evidence was assessed using an adapted GRADE approach. Existing meta-analyses were reviewed for relevance to low/middle-income countries, and new meta-analysis was performed. We identified 44 studies, including 18 randomised control trials (RCTs) (14 in high-income countries) in a Cochrane meta-analysis, which suggested that antenatal steroids decrease neonatal mortality among preterm infants (preterm babies currently receive little or no medical care. It is plausible that antenatal steroids may be of even greater effect when tested in these settings. Based on high-grade evidence, antenatal steroid therapy is very effective in preventing neonatal mortality and morbidity, yet remains at low coverage in low/middle-income countries. If fully scaled up, this intervention could save up to 500 000 neonatal lives annually.

  6. Preterm Birth and Necrotizing Enterocolitis Alter Gut Colonization in Pigs

    DEFF Research Database (Denmark)

    Cilieborg, Malene S.; Boye, Mette; Mølbak, Lars

    2011-01-01

    perfringens predisposes to NEC. By using terminal-RFLP and FISH, we characterized the gut microbiota of preterm, caesarean-delivered, formula-fed pigs (n = 44) with or without NEC and of formula- or colostrum-fed term, and vaginally born pigs (n = 13). A different microbiota with high C. perfringens abundance......Necrotizing enterocolitis (NEC) in preterm neonates is dependent on bacterial colonization, but it remains unclear whether a particular microbiota or specific pathogens are involved. We hypothesized that gut colonization differs between preterm and term neonates and that overgrowth of Clostridium...

  7. Human milk oligosaccharide effects on intestinal function and inflammation after preterm birth in pigs

    DEFF Research Database (Denmark)

    Rasmussen, Stine O.; Martin, Lena; Østergaard, Mette V.

    2017-01-01

    (IF) improves intestinal function, bacterial colonization and NEC resistance immediately after preterm birth, as tested in a preterm pig model. Mixtures of HMOs were investigated in intestinal epithelial cells and in preterm pigs (n=112) fed IF supplemented without (CON) or with a mixture of four HMOs...... (4-HMO) or >25 HMOs (25-HMO, 5-10 g/L given for 5 or 11 days). The 25-HMO blend decreased cell proliferation and both HMO blends decreased lipopolysaccharide-induced interleukin-8 secretion in IPEC-J2 cells, relative to control (P

  8. Starting the conversation: community perspectives on preterm birth and kangaroo mother care in southern Malawi.

    Science.gov (United States)

    Lydon, Megan; Longwe, Monica; Likomwa, Dyson; Lwesha, Victoria; Chimtembo, Lydia; Donohue, Pamela; Guenther, Tanya; Valsangar, Bina

    2018-06-01

    Despite introduction of Kangaroo Mother Care (KMC) in Malawi over a decade ago, preterm birth remains the leading cause of neonatal mortality. Although KMC is initiated in the health care facility, robust community follow-up is critical for survival and optimal development of preterm and low birth weight infants post-discharge. The objective of this qualitative study was to gain insight into community and health worker understanding, attitudes, beliefs and practices around preterm and low birth weight babies and KMC in Malawi. A total of 152 participants were interviewed in two districts in southern Malawi, Machinga and Thyolo, in April 2015. Focus group discussions (groups = 11, n = 132) were conducted with pregnant women, community members and women who have practiced KMC. In-depth interviews (n = 20) were conducted with fathers who have practiced KMC, community and religious leaders, and health workers. Purposive and snowball sampling were employed to identify participants. Thematic content analysis was conducted. KMC mothers and fathers only learned about KMC and care for preterm newborns after delivery of a child in need of this care. Men typically were not included in KMC counseling due to societal gender roles. Health facilities were the main source of information on KMC, however informal networks among women provided some degree of knowledge exchange. Community leaders were regarded as major facilitators of health information, conveners, key influencers, and policy-makers. Religious leaders were regarded as advocates and emotional support for families with preterm infants. Finally, while many participants initially had negative feelings towards preterm births and KMC, the large majority saw a shift in their perceptions through health counseling, peer modeling, and personal success with KMC. The findings offer several opportunities to improve KMC implementation including 1) earlier introduction of KMC to pregnant women and their families that are

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

    Science.gov (United States)

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

    2011-01-01

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

  10. Continuous versus bolus intragastric tube feeding for preterm and low birth weight infants with gastro-oesophageal reflux disease.

    Science.gov (United States)

    Richards, Robyn; Foster, Jann P; Psaila, Kim

    2014-07-17

    Gastro-oesophageal reflux disease is a particularly common condition in preterm and low birth weight infants. These infants are also more likely to have excessive regurgitation, as they do not have a fully developed antireflux mechanism. Preterm and low birth weight infants who are unable to suck oral feeds are required to be fed via an intragastric tube for varying lengths of time. Intragastric tube feeding can be delivered by the intermittent bolus or continuous feeding method. Use of continuous or intermittent bolus intragastric feeding may have a positive or negative effect on the incidence or severity of gastro-oesophageal reflux disease. To determine whether continuous or intermittent bolus intragastric tube feeding reduces the number of episodes and the duration of gastro-oesophageal reflux disease (GORD) in preterm and low birth weight infants.We intended to perform subgroup analyses for gestational age; birth weight; age in days from birth at full enteral feeding via intragastric tube (breast vs bottle); frequency of intermittent bolus feed; and type of medication for treatment of GORD (only if medication prescribed and given similarly to both intervention groups). We used the standard search strategy of the Cochrane Neonatal Group as described in The Cochrane Library (www.thecochranelibrary.com) to search for randomised controlled trials (RCTs) in the Cochrane Central Register of Controlled Trials (CENTRAL) (2013, Issue 9), MEDLINE (1966 to September 2013), EMBASE (1980 to September 2013) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1982 to September 2013). We also searched previous reviews, including cross-references, abstracts and conference and symposia proceedings of the Perinatal Society of Australia and New Zealand and the Pediatric Academic Societies (American Pediatric Society/Society for Pediatric Research and European Society for Paediatric Research) from 1990 to 2012. Published and unpublished RCTs and quasi

  11. Maternal air pollution exposure and preterm birth in Wuxi, China: Effect modification by maternal age.

    Science.gov (United States)

    Han, Yingying; Jiang, Panhua; Dong, Tianyu; Ding, Xinliang; Chen, Ting; Villanger, Gro Dehli; Aase, Heidi; Huang, Lu; Xia, Yankai

    2018-08-15

    Numerous studies have investigated prenatal air pollution and shown that air pollutants have adverse effect on birth outcomes. However, which trimester was the most sensitive and whether the effect was related to maternal age is still ambiguous. This study aims to explore the association between maternal air pollution exposure during pregnancy and preterm birth, and if this relationship is modified by maternal age. In this retrospective cohort study, we examine the causal relationship of prenatal exposure to air pollutants including particulate matters, which are less than 10 µm (PM 10 ), and ozone (O 3 ), which is one of the gaseous pollutants, on preterm birth by gestational age. A total of 6693 pregnant women were recruited from Wuxi Maternal and Child Health Care Hospital. The participants were dichotomized into child-bearing age group ( = 35 years old) in order to analyze the effect modification by maternal age. Logistic and linear regression models were performed to assess the risk for preterm birth (gestational age air pollution exposure. With adjustment for covariates, the highest level of PM 10 exposure significantly increased the risk of preterm birth by 1.42-fold (95% CI: 1.10, 1.85) compared those with the lowest level in the second trimester. Trimester-specific PM 10 exposure was positively associated with gestational age, whereas O 3 exposure was associated with gestational age in the early pregnancy. When stratified by maternal age, PM 10 exposure was significantly associated with an increased risk of preterm birth only in the advanced age group during pregnancy (OR:2.15, 95% CI: 1.13, 4.07). The results suggested that PM 10 exposure associated with preterm birth was modified by advanced maternal age (OR interaction = 2.00, 95% CI: 1.02, 3.91, P interaction = 0.032). Prenatal air pollution exposure would increase risk of preterm birth and reduced gestational age. Thus, more attention should be paid to the effects of ambient air pollution

  12. Preterm Birth Associated With Group B Streptococcus Maternal Colonization Worldwide: Systematic Review and Meta-analyses.

    Science.gov (United States)

    Bianchi-Jassir, Fiorella; Seale, Anna C; Kohli-Lynch, Maya; Lawn, Joy E; Baker, Carol J; Bartlett, Linda; Cutland, Clare; Gravett, Michael G; Heath, Paul T; Ip, Margaret; Le Doare, Kirsty; Madhi, Shabir A; Saha, Samir K; Schrag, Stephanie; Sobanjo-Ter Meulen, Ajoke; Vekemans, Johan; Rubens, Craig E

    2017-11-06

    Preterm birth complications are the leading cause of deaths among children birth in order to inform estimates of the burden of GBS. We conducted systematic literature reviews (PubMed/Medline, Embase, Latin American and Caribbean Health Sciences Literature [LILACS], World Health Organization Library Information System [WHOLIS], and Scopus) and sought unpublished data from investigator groups on the association of preterm birth (birth with maternal GBS colonization to be 1.21 (95% confidence interval [CI], .99-1.48; P = .061) in cohort and cross-sectional studies, and the odds ratio to be 1.85 (95% CI, 1.24-2.77; P = .003) in case-control studies. Preterm birth was associated with GBS bacteriuria in cohort studies (RR, 1.98 [95% CI, 1.45-2.69]; P birth is associated with maternal GBS colonization, especially where there is evidence of ascending infection (bacteriuria). Several biases reduce the chance of detecting an effect. Equally, however, results, including evidence for the association, may be due to confounding, which is rarely addressed in studies. Assessment of any effect on preterm delivery should be included in future maternal GBS vaccine trials. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.

  13. Progestogens to prevent preterm birth in twin pregnancies: an individual participant data meta-analysis of randomized trials

    Directory of Open Access Journals (Sweden)

    Schuit Ewoud

    2012-03-01

    Full Text Available Abstract Background 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. Methods/design We propose an individual participant data meta-analysis of high quality randomized, double-blind, placebo-controlled trials of progestogen treatment in women with a twin pregnancy. The primary outcome will be adverse perinatal outcome (a composite measure of perinatal mortality and significant neonatal morbidity. Missing data will be imputed within each original study, before data of the individual studies are pooled. The effects of 17-hydroxyprogesterone caproate or vaginal progesterone treatment in women with twin pregnancies will be estimated by means of a random effects log-binomial model. Analyses will be adjusted for variables used in stratified randomization as appropriate. Pre-specified subgroup analysis will be performed to explore the effect of progestogen treatment in high-risk groups. Discussion Combining individual patient data from different randomized trials has potential to provide valuable, clinically useful information regarding the benefits and potential harms of progestogens in women with twin pregnancy overall and in relevant subgroups.

  14. Low birthweight and preterm birth rates 1 year before and after the Irish workplace smoking ban.

    Science.gov (United States)

    Kabir, Z; Clarke, V; Conroy, R; McNamee, E; Daly, S; Clancy, L

    2009-12-01

    It is well-established that maternal smoking has adverse birth outcomes (low birthweight, LBW, and preterm births). The comprehensive Irish workplace smoking ban was successfully introduced in March 2004. We examined LBW and preterm birth rates 1 year before and after the workplace smoking ban in Dublin. A cross-sectional observational study analysing routinely collected data using the Euroking K2 maternity system. Coombe University Maternal Hospital. Only singleton live births were included for analyses (7593 and 7648, in 2003 and 2005, respectively). Detailed gestational and clinical characteristics were collected and analysed using multivariable logistic regression analyses and subgroup analyses. Maternal smoking rates, mean birthweights, and adjusted odds ratios (ORs) of LBW and preterm births in 2005 versus 2003. There was a 25% decreased risk of preterm births (OR, 0.75; 95% CI, 0.59-0.96), a 43% increased risk of LBW (OR, 1.43; 95% CI, 1.10-1.85), and a 12% fall in maternal smoking rates (from 23.4 to 20.6%) in 2005 relative to 2003. Such patterns were significantly maintained when specific subgroups were also analysed. Mean birthweights decreased in 2005, but were not significant (P=0.99). There was a marginal increase in smoking cessation before pregnancy in 2005 (P=0.047). Significant declines in preterm births and in maternal smoking rates after the smoking ban are welcome signs. However, the increased LBW birth risks might reflect a secular trend, as observed in many industrialised nations, and merits further investigations.

  15. Effect of maternal age on the risk of preterm birth: A large cohort study.

    Science.gov (United States)

    Fuchs, Florent; Monet, Barbara; Ducruet, Thierry; Chaillet, Nils; Audibert, Francois

    2018-01-01

    Maternal age at pregnancy is increasing worldwide as well as preterm birth. However, the association between prematurity and advanced maternal age remains controversial. To evaluate the impact of maternal age on the occurrence of preterm birth after controlling for multiple known confounders in a large birth cohort. Retrospective cohort study using data from the QUARISMA study, a large Canadian randomized controlled trial, which collected data from 184,000 births in 32 hospitals. Inclusion criteria were maternal age over 20 years. Exclusion criteria were multiple pregnancy, fetal malformation and intra-uterine fetal death. Five maternal age categories were defined and compared for maternal characteristics, gestational and obstetric complications, and risk factors for prematurity. Risk factors for preterm birth births were included in the study. Chronic hypertension, assisted reproduction techniques, pre-gestational diabetes, invasive procedure in pregnancy, gestational diabetes and placenta praevia were linearly associated with increasing maternal age whereas hypertensive disorders of pregnancy followed a "U" shaped distribution according to maternal age. Crude rates of preterm birth before 37 weeks followed a "U" shaped curve with a nadir at 5.7% for the group of 30-34 years. In multivariate analysis, the adjusted odds ratio (aOR) of prematurity stratified by age group followed a "U" shaped distribution with an aOR of 1.08 (95%CI; 1.01-1.15) for 20-24 years, and 1.20 (95% CI; 1.06-1.36) for 40 years and older. Confounders found to have the greatest impact were placenta praevia, hypertensive complications, and maternal medical history. Even after adjustment for confounders, advanced maternal age (40 years and over) was associated with preterm birth. A maternal age of 30-34 years was associated with the lowest risk of prematurity.

  16. The Matrix Metalloproteases and Endothelin-1 in Infection-Associated Preterm Birth

    Directory of Open Access Journals (Sweden)

    Nicole S. Olgun

    2010-01-01

    Full Text Available Preterm birth (PTB is clinically defined as any delivery which occurs before the completion of 37 weeks of gestation, and is currently the most important problem in obstetrics. In the United States, PTB accounts for 12-13% of all live births, and, with the exception of fetuses suffering from anomalies, is the primary cause of perinatal mortality. While the risk factors for PTB are numerous, the single most common cause is intrauterine infection. As there is currently no FDA-approved therapy for infection-associated PTB, understanding the pathogenesis of preterm labor (PTL and delivery should be given high priority. The matrix metalloproteinases (MMPs are a family of enzymes that have been implicated in normal parturition as well as infection-triggered rupture of membranes and preterm birth. Several lines of evidence also suggest a role for endothelin-1 (ET-1 in infection-associated preterm delivery. This paper focuses on the evidence that the MMPs and ET-1 act in the same molecular pathway in preterm birth.

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

    Science.gov (United States)

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

    2017-09-01

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

  18. Family functioning, burden and parenting stress 2 years after very preterm birth.

    Science.gov (United States)

    Treyvaud, Karli; Doyle, Lex W; Lee, Katherine J; Roberts, Gehan; Cheong, Jeanie L Y; Inder, Terrie E; Anderson, Peter J

    2011-06-01

    Examining rates of difficulties in family functioning following very preterm birth has been a relatively neglected area of research. To examine family functioning, burden and parenting stress in families with very preterm compared with term born children, and investigate influences of parental mental health problems and child neurodevelopmental disability on family outcomes in families with preterm children. Participants were 184 very preterm and 71 term children and their parents. Parents completed the Family Assessment Device, Parenting Stress Index and Impact on Family questionnaires when their children were 2 years old (corrected for prematurity). Parental mental health and social risk information were also collected. Children were assessed for neurodevelopmental disability. Families with very preterm children reported poorer family functioning (p=.03) compared with families with term born children, with less evidence for differences between families with very preterm and term born children in parenting stress and family burden. Within very preterm families, parental mental health problems were associated with higher levels of parenting stress (p=.001), and parents of children with a neurodevelopmental disability were more likely to report higher family burden (p=.04). For families with very preterm children, parental mental health symptoms and child neurodevelopmental disability may identify families at risk of greater stress and burden who may benefit from additional support. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  19. Undiagnosed coeliac disease in a father does not influence birthweight and preterm birth.

    LENUS (Irish Health Repository)

    Khashan, Ali S

    2012-01-31

    There is conflicting evidence regarding the effect of coeliac disease (CD) in the father on birthweight and preterm birth. We investigated the association between paternal CD and birthweight and preterm birth. Medical records of all singleton live-born children in Denmark between 1 January 1979 and 31 December 2004 were linked to information about parents\\' diseases. Fathers who were diagnosed with CD were then identified. Fathers with CD were considered treated if they were diagnosed before pregnancy and untreated if they were diagnosed after the date of conception. The outcome measures were: birthweight, small-for-gestational age (birthweight<10th centile for gestational age) and preterm birth (<37 weeks). We compared the offspring of men without CD (n = 1 472 352) and offspring of those with CD [untreated (n = 138) and treated (n = 473)]. There was no significant association between untreated CD in the father and birthweight (adjusted mean difference = -3 g; [95% CI -46, 40]) or preterm birth (adjusted odds ratio (OR) = 0.86, [95% CI 0.53, 1.37]) (compared with no CD). There was some evidence for an association between treated paternal CD and birthweight (adjusted mean difference = -81 g; [95% CI -161, -3]), but not preterm birth (adjusted OR = 1.76, [95% CI 0.95, 3.26]). Untreated paternal CD was not associated with an increased risk of reduced birthweight, or of preterm birth. There was some evidence that diagnosis and presumed treatment of paternal CD with a gluten-free diet is associated with reduced birthweight.

  20. Impact of obstetric history on the risk of spontaneous preterm birth in singleton and multiple pregnancies: a systematic review

    NARCIS (Netherlands)

    Kazemier, B. M.; Buijs, P. E.; Mignini, L.; Limpens, J.; de Groot, C. J. M.; Mol, B. W. J.; von Dadelszen, P.; Magee, L.; Sawchuck, D.; Gao, E.; Oude Rengerink, K.; Zamora, J.; Fox, C.; Daniels, J.; Khan, K. S.; Thangaratinam, S.; Meads, C.

    2014-01-01

    Information about the recurrence of spontaneous preterm birth in subsequent twin/singleton pregnancies is scattered. To quantify the risk of recurrence of spontaneous preterm birth in different subtypes of subsequent pregnancies. An electronic literature search in OVID MEDLINE and EMBASE,

  1. Cervical length measurement for the prediction of preterm birth in multiple pregnancies: a systematic review and bivariate meta-analysis

    NARCIS (Netherlands)

    Lim, A. C.; Hegeman, M. A. [=Maud A.; Huis In 't Veld, M. A.; Opmeer, B. C.; Bruinse, H. W.; Mol, B. W. J.

    2011-01-01

    To review the literature on cervical length as a predictor of preterm birth in asymptomatic women with a multiple pregnancy. We searched MEDLINE, Embase and reference lists of included articles to identify all studies that reported on the accuracy of cervical length for predicting preterm birth in

  2. Developmental exposure of mice to dioxin promotes transgenerational testicular inflammation and an increased risk of preterm birth in unexposed mating partners.

    Directory of Open Access Journals (Sweden)

    Kaylon L Bruner-Tran

    Full Text Available TCDD (2,3,7,8-tetrachlorodibenzo-p-dioxin, commonly known as dioxin is a ubiquitous environmental contaminant and known endocrine disruptor. Using a mouse model, we previously found that adult female mice exposed in utero to TCDD (F1 generation as well as multiple subsequent generations (F2-F4 exhibited reduced fertility and an increased incidence of spontaneous preterm birth. Additional studies revealed that male F1 mice with a similar in utero/developmental TCDD exposure also exhibited diminished fertility and conferred an increased risk of preterm birth to their unexposed mating partners. Herein, we extend these previous observations, reporting that reduced fertility in male F1 mice is linked to testicular inflammation which coincides with apoptosis of developing spermatocytes, sub-fertility and an increased risk of preterm birth in their unexposed mating partners. Significantly, in the absence of additional toxicant exposure, testicular inflammation and reduced fertility persisted in F2 and F3 males and their control mating partners also frequently exhibited spontaneous preterm birth. Although a steady, global decline in male fertility has been noted over the last few decades, the reasons for these changes have not been firmly established. Likewise, the PTB rate in the U.S. and other countries has paralleled industrial development, suggesting a possible relationship between environmental toxicant exposure and adverse pregnancy outcomes. Most current clinical strategies to prevent preterm birth are focused solely on the mother and have yielded limited benefits. In contrast, our studies strongly suggest that the preconception testicular health of the father is a critical determinant of pregnancy outcomes in mice. Future clinical studies should examine the potential contribution of the male to gestation length in women and whether efforts to reduce the incidence of preterm birth should be initiated in both parents prior to pregnancy.

  3. Global report on preterm birth and stillbirth (4 of 7): delivery of interventions.

    Science.gov (United States)

    Victora, Cesar G; Rubens, Craig E

    2010-02-23

    The efficacious interventions identified in the previous article of this report will fail unless they are delivered at high and equitable coverage. This article discusses critical delivery constraints and strategies. Achieving universal coverage entails addressing major barriers at many levels. An overarching constraint is the lack of political will, resulting from the dearth of preterm birth and stillbirth data and the lack of visibility. Other barriers exist at the household and community levels, such as insufficient demand for interventions or sociocultural barriers; at the health services level, such as a lack of resources and trained healthcare providers; and at the health sector policy and management level, such as poorly functioning, centralized systems. Additional constraints involve weak governance and accountability, political instability, and challenges in the physical environment. Scaling up maternal, newborn and child health interventions requires strengthening health systems, but there is also a role for focused, targeted interventions. Choosing a strategy involves identifying appropriate channels for reaching high coverage, which depends on many factors such as access to and attendance at healthcare facilities. Delivery channels vary, and may include facility- and community-based healthcare providers, mass media campaigns, and community-based approaches and marketing strategies. Issues related to scaling up are discussed in the context of four interventions that may be given to mothers at different stages throughout pregnancy or to newborns: (1) detection and treatment of syphilis; (2) emergency Cesarean section; (3) newborn resuscitation; and (4) kangaroo mother care. Systematic reviews of the literature and large-scale implementation studies are analyzed for each intervention. Equitable and successful scale-up of preterm birth and stillbirth interventions will require addressing multiple barriers, and utilizing multiple delivery approaches and

  4. Global report on preterm birth and stillbirth (4 of 7: delivery of interventions

    Directory of Open Access Journals (Sweden)

    Rubens Craig E

    2010-02-01

    Full Text Available Abstract Background The efficacious interventions identified in the previous article of this report will fail unless they are delivered at high and equitable coverage. This article discusses critical delivery constraints and strategies. Barriers to scaling up interventions Achieving universal coverage entails addressing major barriers at many levels. An overarching constraint is the lack of political will, resulting from the dearth of preterm birth and stillbirth data and the lack of visibility. Other barriers exist at the household and community levels, such as insufficient demand for interventions or sociocultural barriers; at the health services level, such as a lack of resources and trained healthcare providers; and at the health sector policy and management level, such as poorly functioning, centralized systems. Additional constraints involve weak governance and accountability, political instability, and challenges in the physical environment. Strategies and examples Scaling up maternal, newborn and child health interventions requires strengthening health systems, but there is also a role for focused, targeted interventions. Choosing a strategy involves identifying appropriate channels for reaching high coverage, which depends on many factors such as access to and attendance at healthcare facilities. Delivery channels vary, and may include facility- and community-based healthcare providers, mass media campaigns, and community-based approaches and marketing strategies. Issues related to scaling up are discussed in the context of four interventions that may be given to mothers at different stages throughout pregnancy or to newborns: (1 detection and treatment of syphilis; (2 emergency Cesarean section; (3 newborn resuscitation; and (4 kangaroo mother care. Systematic reviews of the literature and large-scale implementation studies are analyzed for each intervention. Conclusion Equitable and successful scale-up of preterm birth and stillbirth

  5. Pregnant Women in Sport Climbing - Is there a Higher Risk for Preterm Birth?

    Science.gov (United States)

    Drastig, Jan; Hillebrandt, David; Rath, Werner; Küpper, Thomas

    2017-02-01

    Sport climbing is a popular recreational sport with an increasing proportion of female athletes. International recommendations emphasize the physical and mental benefits of regular sport activity during any uncomplicated pregnancy. In this context, sport climbing is associated with a high risk potential.The aim of this study was to examine if there is a higher risk for preterm birth in active climbing athletes.Original manuscript.A retrospective self-report online survey in the German language collected data between September 2012 and November 2013. In addition to anthropometric and demographic data, data on climbing experience, preferred climbing discipline, skill level and changes of climbing habits during pregnancy, known risk factors for preterm birth and information on delivery and the newborn were requested. The rate of preterm birth of the survey was tested with Fisher's exact test with information from the German Federal Statistical Office.Sample size was 32. 72% had a university degree, 81% were primiparous, all were singleton pregnancies. A 33 rd questionnaire was excluded because of described preeclampsia. Age ranged between 21 and 39 years, climbing experience before pregnancy between 2 and 24 years, and skill level before pregnancy between 4 and 7 on the UIAA scale (International Climbing and Mountaineering Federation). Half of the women climbed until the 36 th week and 90% adjusted their climbing habits mostly by reducing climbing difficulty and doing more top roping. 2 preterm births in the 36 th week of gestation were found (2 from 15, p=0.36). According to the data from the German Federal Statistical Office, 8.9% births in the year 2013 in Germany were preterm.This is the first study investigating the risk of preterm birth in recreational sport climbing athletes. No significantly higher proportion of preterm birth could be found. Limitations are small sample size and high social status of participants. What is known about the subject: Sport

  6. Optimizing Nutrition in Preterm Low Birth Weight Infants—Consensus Summary

    Directory of Open Access Journals (Sweden)

    R. Kishore Kumar

    2017-05-01

    Full Text Available Preterm birth survivors are at a higher risk of growth and developmental disabilities compared to their term counterparts. Development of strategies to lower the complications of preterm birth forms the rising need of the hour. Appropriate nutrition is essential for the growth and development of preterm infants. Early administration of optimal nutrition to preterm birth survivors lowers the risk of adverse health outcomes and improves cognition in adulthood. A group of neonatologists, pediatricians, and nutrition experts convened to discuss and frame evidence-based recommendations for optimizing nutrition in preterm low birth weight (LBW infants. The following were the primary recommendations of the panel: (1 enteral feeding is safe and may be preferred to parenteral nutrition due to the complications associated with the latter; however, parenteral nutrition may be a useful adjunct to enteral feeding in some critical cases; (2 early, fast, or continuous enteral feeding yields better outcomes compared to late, slow, or intermittent feeding, respectively; (3 routine use of nasogastric tubes is not advisable; (4 preterm infants can be fed while on ventilator or continuous positive airway pressure; (5 routine evaluation of gastric residuals and abdominal girth should be avoided; (6 expressed breast milk (EBM is the first choice for feeding preterm infants due to its beneficial effects on cardiovascular, neurological, bone health, and growth outcomes; the second choice is donor pasteurized human milk; (7 EBM or donor milk may be fortified with human milk fortifiers, without increasing the osmolality of the milk, to meet the high protein requirements of preterm infants; (8 standard fortification is effective and safe but does not fulfill the high protein needs; (9 use of targeted and adjustable fortification, where possible, helps provide optimal nutrition; (10 optimizing weight gain in preterm infants prevents long-term cardiovascular complications

  7. Small-for-gestational age and preterm birth across generations: a population-based study of Illinois births.

    Science.gov (United States)

    Castrillio, Stephanie M; Rankin, Kristin M; David, Richard J; Collins, James W

    2014-12-01

    Small for gestational age (weight for gestational age mothers (1956-1976) with appended US census income information. Former SGA White mothers (N = 8,993) had a twofold greater infant SGA frequency than former non-SGA White mothers (N = 101,312); 14.4 versus 6.9 %, RR = 2.1 (2.0-2.2). Former SGA African American (N = 4,861) mothers had a SGA birth frequency of 25.7 % compared to 16.1 % for former non-SGA mothers (N = 28,090); RR = 1.5 (1.5-1.6). The adjusted (controlling for maternal age, education, marital status, parity, prenatal care usage, cigarette smoking, and hypertension) RR (95 % CI) of infant SGA for former SGA (compared to non-SGA) White and African-American mothers equaled 2.0 (1.9-2.1 and 1.5 (1.5-1.6), respectively. The adjusted RR (95 % CI) of infant preterm birth for former preterm (compared to term) White and African-American mothers were 1.1 (1.0-1.2). The findings were minimally changed among mothers with a lifelong residence in impoverished or affluent neighborhoods. In both races, approximately 8 % of SGA births were attributable to maternal SGA. There is a transgenerational association of SGA but not preterm birth among non-Hispanic Whites and African-Americans. In both races, a similar proportion of SGA births are attributable to maternal SGA.

  8. The early use of appropriate prophylactic antibiotics in susceptible women for the prevention of preterm birth of infectious etiology

    DEFF Research Database (Denmark)

    Joergensen, Jan Stener; Weile, Louise Katrine Kjær; Lamont, Ronald F

    2014-01-01

    of preterm birth so it is logical to consider the use of antibiotics for the prevention of preterm birth. AREAS COVERED: Infection and antibiotics in the etiology, prediction and prevention of preterm birth. EXPERT OPINION: Antibiotics for the prevention of preterm birth have addressed different risk groups......, diagnostic methods, degrees of abnormal flora, antibiotic dose regimens, routes of administration, host susceptibilities, host response, gestational age at time of treatment, outcome parameters and definitions of success and outcomes. To address this confusion, a number of systematic reviews....../meta-analyses have been conducted but none has simultaneously addressed the optimal choice of agent, patient and timing of intervention. We conclude that inappropriate antibiotics used in inappropriate women at inappropriately late gestations do not reduce preterm birth. Conversely, a focused systematic review...

  9. Metropolitan isolation segregation and Black-White disparities in very preterm birth: a test of mediating pathways and variance explained.

    Science.gov (United States)

    Kramer, Michael R; Cooper, Hannah L; Drews-Botsch, Carolyn D; Waller, Lance A; Hogue, Carol R

    2010-12-01

    Residential isolation segregation (a measure of residential inter-racial exposure) has been associated with rates of preterm birth (births (32-36 weeks) raise questions about whether this association is similar across gestational ages, and through what pathways it might be mediated. Hierarchical Bayesian models were fit to answer three questions: is the isolation-prematurity association similar for very and moderately preterm birth; is this association mediated by maternal chronic disease, socioeconomic status, or metropolitan area crime and poverty rates; and how much of the geographic variation in Black-White very preterm birth disparities is explained by isolation segregation? Singleton births to Black and White women in 231 U.S. metropolitan statistical areas in 2000-2002 were analyzed and isolation segregation was calculated for each. We found that among Black women, isolation is associated with very preterm birth and moderately preterm birth. The association may be partially mediated by individual level socioeconomic characteristics and metropolitan level violent crime rates. There is no association between segregation and prematurity among White women. Isolation segregation explains 28% of the geographic variation in Black-White very preterm birth disparities. Our findings highlight the importance of isolation segregation for the high-burden outcome of very preterm birth, but unexplained excess risk for prematurity among Black women is substantial. Copyright © 2010 Elsevier Ltd. All rights reserved.

  10. Do the causes of infertility play a direct role in the aetiology of preterm birth?

    Science.gov (United States)

    Messerlian, Carmen; Platt, Robert W; Ata, Baris; Tan, Seang-Lin; Basso, Olga

    2015-03-01

    It is well established that singletons born of assisted reproductive technology are at higher risk of preterm birth and other adverse outcomes. What remains unclear is whether the increased risk is attributable to the effects of the treatment alone or whether the underlying causes of infertility also play a role. The aim of this study was to examine whether any of the six categories of causes of infertility were associated with a direct effect on preterm birth using causal mediation analysis. We assembled a hospital-based cohort of births delivered at a large tertiary care hospital in Montreal, Canada between 2001 and 2007. Causes of infertility were ascertained through a clinical database and medical chart abstraction. We employed marginal structural models (MSM) to estimate the controlled direct effect of each cause of infertility on preterm birth compared with couples without the cause under examination. The final study cohort comprised 18,598 singleton and twin pregnancies, including 1689 in couples with ascertained infertility. MSM results suggested no significant direct effect for any of the six categories of causes. However, power was limited in smaller subgroup analyses, and a possible direct effect for uterine abnormalities (e.g. fibroids and malformations) could not be ruled out. In this cohort, most of the increased risk of preterm birth appeared to be explained by maternal characteristics (such as age, body mass index, and education) and by assisted reproduction. If these findings are corroborated, physicians should consider these risks when counselling patients. © 2015 John Wiley & Sons Ltd.

  11. Antenatal corticosteroids trial in preterm births to increase neonatal survival in developing countries: study protocol.

    Science.gov (United States)

    Althabe, Fernando; Belizán, José M; Mazzoni, Agustina; Berrueta, Mabel; Hemingway-Foday, Jay; Koso-Thomas, Marion; McClure, Elizabeth; Chomba, Elwyn; Garces, Ana; Goudar, Shivaprasad; Kodkany, Bhalchandra; Saleem, Sarah; Pasha, Omrana; Patel, Archana; Esamai, Fabian; Carlo, Waldemar A; Krebs, Nancy F; Derman, Richard J; Goldenberg, Robert L; Hibberd, Patricia; Liechty, Edward A; Wright, Linda L; Bergel, Eduardo F; Jobe, Alan H; Buekens, Pierre

    2012-09-19

    Preterm birth is a major cause of neonatal mortality, responsible for 28% of neonatal deaths overall. The administration of antenatal corticosteroids to women at high risk of preterm birth is a powerful perinatal intervention to reduce neonatal mortality in resource rich environments. The effect of antenatal steroids to reduce mortality and morbidity among preterm infants in hospital settings in developed countries with high utilization is well established, yet they are not routinely used in developing countries. The impact of increasing antenatal steroid use in hospital or community settings with low utilization rates and high infant mortality among premature infants due to lack of specialized services has not been well researched. There is currently no clear evidence about the safety of antenatal corticosteroid use for community-level births. We hypothesize that a multi country, two-arm, parallel cluster randomized controlled trial to evaluate whether a multifaceted intervention to increase the use of antenatal corticosteroids, including components to improve the identification of pregnancies at high risk of preterm birth and providing and facilitating the appropriate use of steroids, will reduce neonatal mortality at 28 days of life in preterm newborns, compared with the standard delivery of care in selected populations of six countries. 102 clusters in Argentina, Guatemala, Kenya, India, Pakistan, and Zambia will be randomized, and around 60,000 women and newborns will be enrolled. Kits containing vials of dexamethasone, syringes, gloves, and instructions for administration will be distributed. Improving the identification of women at high risk of preterm birth will be done by (1) diffusing recommendations for antenatal corticosteroids use to health providers, (2) training health providers on identification of women at high risk of preterm birth, (3) providing reminders to health providers on the use of the kits, and (4) using a color-coded tape to measure

  12. Antenatal corticosteroids trial in preterm births to increase neonatal survival in developing countries: study protocol

    Directory of Open Access Journals (Sweden)

    Althabe Fernando

    2012-09-01

    Full Text Available Abstract Background Preterm birth is a major cause of neonatal mortality, responsible for 28% of neonatal deaths overall. The administration of antenatal corticosteroids to women at high risk of preterm birth is a powerful perinatal intervention to reduce neonatal mortality in resource rich environments. The effect of antenatal steroids to reduce mortality and morbidity among preterm infants in hospital settings in developed countries with high utilization is well established, yet they are not routinely used in developing countries. The impact of increasing antenatal steroid use in hospital or community settings with low utilization rates and high infant mortality among premature infants due to lack of specialized services has not been well researched. There is currently no clear evidence about the safety of antenatal corticosteroid use for community-level births. Methods We hypothesize that a multi country, two-arm, parallel cluster randomized controlled trial to evaluate whether a multifaceted intervention to increase the use of antenatal corticosteroids, including components to improve the identification of pregnancies at high risk of preterm birth and providing and facilitating the appropriate use of steroids, will reduce neonatal mortality at 28 days of life in preterm newborns, compared with the standard delivery of care in selected populations of six countries. 102 clusters in Argentina, Guatemala, Kenya, India, Pakistan, and Zambia will be randomized, and around 60,000 women and newborns will be enrolled. Kits containing vials of dexamethasone, syringes, gloves, and instructions for administration will be distributed. Improving the identification of women at high risk of preterm birth will be done by (1 diffusing recommendations for antenatal corticosteroids use to health providers, (2 training health providers on identification of women at high risk of preterm birth, (3 providing reminders to health providers on the use of the kits, and

  13. Risk Factors for Preterm Birth among HIV-Infected Tanzanian Women: A Prospective Study

    Directory of Open Access Journals (Sweden)

    Rachel M. Zack

    2014-01-01

    Full Text Available Premature delivery, a significant cause of child mortality and morbidity worldwide, is particularly prevalent in the developing world. As HIV is highly prevalent in much of sub-Saharan Africa, it is important to determine risk factors for prematurity among HIV-positive pregnancies. The aims of this study were to identify risk factors of preterm (<37 weeks and very preterm (<34 weeks birth among a cohort of 927 HIV positive women living in Dar es Salaam, Tanzania, who enrolled in the Tanzania Vitamin and HIV Infection Trial between 1995 and 1997. Multivariable relative risk regression models were used to determine the association of potential maternal risk factors with premature and very premature delivery. High rates of preterm (24% and very preterm birth (9% were found. Risk factors (adjusted RR (95% CI for preterm birth were mother <20 years (1.46 (1.10, 1.95, maternal illiteracy (1.54 (1.10, 2.16, malaria (1.42 (1.11, 1.81, Entamoeba coli (1.49 (1.04, 2.15, no or low pregnancy weight gain, and HIV disease stage ≥2 (1.41 (1.12, 1.50. Interventions to reduce pregnancies in women under 20, prevent and treat malaria, reduce Entamoeba coli infection, and promote weight gain in pregnant women may have a protective effect on prematurity.

  14. Infertility and preterm delivery, birthweight, and Caesarean section: a study within the Danish National Birth Cohort

    DEFF Research Database (Denmark)

    Basso, Olga; Baird, Donna D.

    2003-01-01

    , longitudinal studies enrolling couples irrespective of infertility treatment. METHODS: We used data from the Danish National Birth Cohort: 55 906 singleton live births from women who reported their waiting time to pregnancy (TTP) and other covariates in an interview during the 2nd trimester of pregnancy....... RESULTS: A TTP >1 year was associated with an increased risk of all outcomes studied, including preterm birth [odds ratios and 95% confidence intervals were 1.5 (1.2, 1.8) among primiparas and 1.9 (1.5, 2.4) among multiparas]. Odds ratios for preterm remained elevated after adjustment for covariates....... Among couples with a TTP >1 year, infertility treatment was associated with added risk only among multiparas. CONCLUSION: Infertile women are at higher risk of adverse birth outcomes even if they conceive without treatment. With >10% of babies born to infertile couples, it is important to consider...

  15. Determinants of the competing outcomes of intrauterine infection, abruption, or spontaneous preterm birth after preterm premature rupture of membranes.

    Science.gov (United States)

    Hackney, David N; Kuo, Kelly; Petersen, Rebecca J; Lappen, Justin R

    2016-01-01

    Patients with PPROM are at risk for a variety of outcomes, including chorioamnionitis (CA), placental abruption (PA), or preterm labor (PTL). Competing risk regression can analyze a cohort's risk of individual outcomes while accounting for ongoing deliveries secondary to competing events. A secondary analysis of the subjects from MFMU BEAM study of neuroprotection after preterm birth (BEAM) with conservative PPROM management. Deliveries were categorized as: PA, CA, PTL, "elective" or "indicated". The association between outcomes of PA, CA or PTL and clinical predictors of twins, ethnicity, parity, gestational age at rupture, bleeding, contractions, cervical dilation, preterm birth history, weight, and genitourinary infections were evaluated via competing risk regression. 1970 subjects were included. The significance and directionality of predictors varied according to specific outcomes. Patients with twins had an increased PTL hazard (1.85) though reductions in CA- (0.66) or PA-specific (0.56) hazards. Decreased latency in African-Americans was almost entirely due to an increased CA hazard (1.44) without a significant association with PTL. Increasing gestational age at membrane rupture was associated with a decreasing hazard of CA although increasing hazard of PTL. For patients with PPROM, the hazards associated with different clinical predictors vary according to exact outcomes.

  16. Plastic bags for prevention of hypothermia in preterm and low birth weight infants.

    Science.gov (United States)

    Leadford, Alicia E; Warren, Jamie B; Manasyan, Albert; Chomba, Elwyn; Salas, Ariel A; Schelonka, Robert; Carlo, Waldemar A

    2013-07-01

    Hypothermia contributes to neonatal mortality and morbidity, especially in preterm and low birth weight infants in developing countries. Plastic bags covering the trunk and extremities of very low birth weight infants reduces hypothermia. This technique has not been studied in larger infants or in many resource-limited settings. The objective was to determine if placing preterm and low birth weight infants inside a plastic bag at birth maintains normothermia. Infants at 26 to 36 weeks' gestational age and/or with a birth weight of 1000 to 2500 g born at the University Teaching Hospital in Lusaka, Zambia, were randomized by using a 1:1 allocation and parallel design to standard thermoregulation (blanket or radiant warmer) care or to standard thermoregulation care plus placement inside a plastic bag at birth. The primary outcome measure was axillary temperature in the World Health Organization-defined normal range (36.5-37.5°C) at 1 hour after birth. A total of 104 infants were randomized. At 1 hour after birth, infants randomized to plastic bag (n = 49) were more likely to have a temperature in the normal range as compared with infants in the standard thermoregulation care group (n = 55; 59.2% vs 32.7%; relative risk 1.81; 95% confidence interval 1.16-2.81; P = .007). The temperature at 1 hour after birth in the infants randomized to plastic bag was 36.5 ± 0.5°C compared with 36.1 ± 0.6°C in standard care infants (P 38.0°C) did not occur in any infant. Placement of preterm/low birth weight infants inside a plastic bag at birth compared with standard thermoregulation care reduced hypothermia without resulting in hyperthermia, and is a low-cost, low-technology tool for resource-limited settings.

  17. Basic Information Processing Abilities at 11 years Account for Deficits in IQ Associated with Preterm Birth.

    Science.gov (United States)

    Rose, Susan A; Feldman, Judith F; Jankowski, Jeffery J; Van Rossem, Ronan

    2011-07-01

    Although it is well established that preterms as a group do poorly relative to their full-term peers on tests of global cognitive functioning, the basis for this relative deficiency is less understood. The present paper examines preterm deficits in core cognitive abilities and determines their role in mediating preterm/full-term differences in IQ. The performance of 11-year-old children born preterm (birth weight <1750g) and their full-term controls were compared on a large battery of 15 tasks, covering four basic cognitive domains -- memory, attention, speed of processing and representational competence. The validity of these four domains was established using latent variables and confirmatory factor analysis (CFA). Preterms showed pervasive deficits within and across domains. Additionally, preterm deficits in IQ were completely mediated by these four cognitive domains in a structural equation model involving a cascade from elementary abilities (attention and speed), to more complex abilities (memory and representational competence), to IQ. The similarity of findings to those obtained with this cohort in infancy and toddlerhood suggest that preterm deficits persist - across time, across task, and from the non-verbal to the verbal period.

  18. A debate about ultrasound and anatomic aspects of the cervix in spontaneous preterm birth.

    Science.gov (United States)

    Bohîlțea, R E; Munteanu, O; Turcan, N; Baros, A; Bodean, O; Voicu, D; Cîrstoiu, M M

    2016-01-01

    Preterm birth is the legal first global cause of neonatal death. The cervix has two roles: it has to stay closed to allow the fetus to undergo a normal development during gestation, and at term, the cervix has to dilate under the pressure of uterine contractions to allow the delivery. The purpose of this article is to establish if the ultrasound measured length of the cervix and its appearance are predictive for the spontaneous preterm birth. Cervical insufficiency can be described by painless cervical dilatation leading to pregnancy losses/ births, with no other risk factors present. During gestation, the physiological softening of the cervix is determined by the extracellular matrix components, particular decorin, and thrombospondin 2. The direction of the collagen fibers remains the same - circumferential direction, but the collagen solubility increases. Therefore, during pregnancy, the cervical tissue is more hydrated and has higher collagen extractability than non-pregnant tissue. Women with cervical incompetence have increased levels of smooth muscle cells than normal pregnant women, the number of elastic fibers is low, and also the concentration of hydroxyproline is decreased. Transvaginal ultrasound is the suitable gold standard exam that can offer essential information about the cervical length and state of the internal os in early asymptomatic stage of cervical insufficiency for predicting and preventing preterm birth. In our experience, a transvaginal ultrasound screening for the measurement of the cervix is required. We consider that the proper gestational age for the prediction of a preterm birth is at 18-22 weeks of gestation for the general population and earlier for patients with a history of preterm birth. Just from an observational point of view, we concluded with the fact that the cerclage of the cervix is unnecessary if the cervical length is above 2 cm and if the internal cervical os is closed. In the absence of funneling, the probability of

  19. Estimated number of preterm births and low birth weight children born in the United States due to maternal binge drinking.

    Science.gov (United States)

    Truong, Khoa D; Reifsnider, Odette S; Mayorga, Maria E; Spitler, Hugh

    2013-05-01

    The objective of this study was to estimate the aggregate burden of maternal binge drinking on preterm birth (PTB) and low birth weight (LBW) across American sociodemographic groups in 2008. To estimate the aggregate burden of maternal binge drinking on preterm birth (PTB) and low birth weight (LBW) across American sociodemographic groups in 2008. A simulation model was developed to estimate the number of PTB and LBW cases due to maternal binge drinking. Data inputs for the model included number of births and rates of preterm and LBW from the National Center for Health Statistics; female population by childbearing age groups from the U.S. Census; increased relative risks of preterm and LBW deliveries due to maternal binge drinking extracted from the literature; and adjusted prevalence of binge drinking among pregnant women estimated in a multivariate logistic regression model using Behavioral Risk Factor Surveillance System survey. The most conservative estimates attributed maternal binge drinking to 8,701 (95% CI: 7,804-9,598) PTBs (1.75% of all PTBs) and 5,627 (95% CI 5,121-6,133) LBW deliveries in 2008, with 3,708 (95% CI: 3,375-4,041) cases of both PTB and LBW. The estimated rate of PTB due to maternal binge drinking was 1.57% among all PTBs to White women, 0.69% among Black women, 3.31% among Hispanic women, and 2.35% among other races. Compared to other age groups, women ages 40-44 had the highest adjusted binge drinking rate and highest PTB rate due to maternal binge drinking (4.33%). Maternal binge drinking contributed significantly to PTB and LBW differentially across sociodemographic groups.

  20. Early weight changes after birth and serum high-molecular-weight adiponectin level in preterm infants.

    Science.gov (United States)

    Yoshida, Tomohide; Nagasaki, Hiraku; Asato, Yoshihide; Ohta, Takao

    2011-12-01

    Extra-uterine growth retardation (EUGR) is associated with an increased risk for cardiometabolic diseases later in life. The aim of the present study was to examine the relationship between early weight change after birth in preterm infants and adiponectin (adn) multimeric complexes. Subjects included 28 preterm infants born between weeks 24 and 33 of gestation. Serum adn multimeric complexes and the anthropometric parameters were measured in preterm infants at birth and at corrected term. Bodyweight (BW) decreased during the first week of life, with birthweight restored at approximately 19 days after birth. Nineteen of the subjects had EUGR at corrected term. Total (T)-adn, high-molecular-weight (H)-adn, and the ratio of H-adn to T-adn (H/T-adn) were significantly elevated at corrected term than at birth. Postmenstrual age, birthweight, birth length and lowest BW after birth were positively correlated with H-adn and H/T-adn. Weight reduction after birth was negatively correlated with H-adn. Age to restore birthweight was negatively correlated with T-adn, H-adn and H/T-adn. Stepwise multiple regression analysis indicated age to restore birthweight as the major predictor of T-adn and H-adn. Early weight changes after birth may alter serum adn level in preterm infants at corrected term. The appropriate nutritional support in the early postnatal period could reduce the prevalence of EUGR and the future risk for cardiometabolic diseases. © 2011 The Authors. Pediatrics International © 2011 Japan Pediatric Society.

  1. Association between maternal comorbidity and preterm birth by severity and clinical subtype: retrospective cohort study.

    Science.gov (United States)

    Auger, Nathalie; Le, Thi Uyen Nhi; Park, Alison L; Luo, Zhong-Cheng

    2011-10-04

    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. 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 (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 PTBs. 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.

  2. Nitrosatable Drug Exposure during Pregnancy and Preterm and Small-for-Gestational-Age Births.

    Science.gov (United States)

    Vuong, Ann M; Shinde, Mayura U; Brender, Jean D; Shipp, Eva M; Huber, John C; Zheng, Qi; McDonald, Thomas J; Sharkey, Joseph R; Hoyt, Adrienne T; Werler, Martha M; Kelley, Katherine E; Langlois, Peter H; Canfield, Mark A

    2015-01-01

    Nitrosatable drugs react with nitrite in the stomach to form N-nitroso compounds, observed in animal models to result in adverse pregnancy outcomes, such as birth defects and reduced fetal weight. Previous studies examining prenatal exposure to medications classified as nitrosatable have reported an increased risk of preterm births (PTBs) and small-for-gestational-age (SGA) infants. Using data from mothers (controls) of babies without major birth defects from the National Birth Defects Prevention Study, prenatal nitrosatable drug usage by trimester and month of gestation was examined in relation to PTBs and SGA infants. Positive associations were observed with nitrosatable drug use and PTBs, with the strongest relationship with second trimester exposure (adjusted hazard ratio [aHR] 1.37, [95% confidence interval (CI) 1.10, 1.70]). Of the nitrosatable functional groups, secondary amines were the most notable, with a higher association among women with second (aHR 1.37, [95% CI 1.05, 1.79]) and third (aHR 1.34, [95% CI 1.02, 1.76]) trimester exposure compared with women with no prenatal nitrosatable drug use. Among SGA infants, a borderline association was noted with amide exposure during the third trimester (adjusted odds ratio 1.43 [95% confidence interval [CI] 1.00, 2.05]). Prenatal exposure to nitrosatable drugs during the second and third trimester of pregnancy, particularly secondary amines, might increase the risk of PTBs. However, prenatal exposure to nitrosatable drugs was not associated with SGA infants, with the exception of amide drugs. © 2014 John Wiley & Sons Ltd.

  3. Relationship between periodontal disease and preterm low birth ...

    African Journals Online (AJOL)

    Introduction: 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 ...

  4. [Description and evaluation of creative thinking in preterm low birth weight infants].

    Science.gov (United States)

    Parisi, L; Di Filippo, T; Firrigno, L; La Grutta, S; Testa, D; Roccella, M

    2007-04-01

    Since the 1950s, the problem of how to evaluate creativity has been addressed in studies on the definition of measurement criteria and on the relationship between intelligence and creative thinking. Many revealed cognitive and relational disorders in preterm infants, particularly in preterm very low birth weight infants (birth weight 2500 g. The test battery included: Torrance Test of Creative Thinking (TCTT); WISC-R intelligence test; Goodenough Human Figure Drawing Test. Statistical analysis (Mann-Whitney U test) showed a statistically significant difference (P>0.05) between the 2 groups; scores for figure originality, figure fluidity and figure elaboration were consistently higher in the control group. Within the low birth weight group, there was a significant correlation (Spearman r) between verbal IQ and verbal fluidity and verbal flexibility subscale scores and between IQ performance and figure elaboration. Scores on the figure drawing tests showed higher creative ability in the control group. In children born preterm with low birth weight, emotive dynamics and flow of affection may influence the channels of communication between child and family. The low figure originality subscale scores support the hypothesis that psychodynamic and relational factors (worry about the preterm condition, overprotective behaviour by parents and others) could lead to diminished autonomy, flexibility and manipulatory interest in the child.

  5. Pessary placement in the prevention of preterm birth in multiple pregnancies: a propensity score analysis

    NARCIS (Netherlands)

    Monfrance, Maurice J. M.; Schuit, Ewoud; Groenwold, Rolf H.; Oudijk, Martijn A.; de Graaf, Irene M.; Bax, Caroline J.; Bekedam, Dick J.; Mol, Ben Willem; Langenveld, Josje

    2016-01-01

    In asymptomatic women with a multiple pregnancy and short cervix prophylactic use of a cervical pessary might reduce preterm birth. We assessed the possible treatment effects of pessary use in pregnancy duration and for poor perinatal outcome. This cohort study was performed between December 2012

  6. Pessary placement in the prevention of preterm birth in multiple pregnancies : a propensity score analysis

    NARCIS (Netherlands)

    Monfrance, Maurice J M; Schuit, Ewoud; Groenwold, Rolf H; Oudijk, Martijn A; de Graaf, Irene M; Bax, Caroline J; Bekedam, Dick J; Mol, Ben Willem; Langenveld, Josje

    OBJECTIVE: In asymptomatic women with a multiple pregnancy and short cervix prophylactic use of a cervical pessary might reduce preterm birth. We assessed the possible treatment effects of pessary use in pregnancy duration and for poor perinatal outcome. STUDY DESIGN: This cohort study was performed

  7. Use of Progesterone Treatment for the Prevention of Recurrent Preterm Birth: Identification of Obstacles to Change

    NARCIS (Netherlands)

    Lim, Arianne C.; Goossens, Astrid; Ravelli, Anita C. J.; Boer, Kees; Bruinse, Hein W.; Mol, Ben Willem J.

    2010-01-01

    Progesterone treatment has proven to be effective in preventing recurrent preterm birth. The use of progesterone varies widely between different obstetric clinics in the Netherlands. The study aimed to identify factors that hamper or facilitate the use of progesterone to create an implementation

  8. Asthma in children in relation to pre-term birth and fetal growth restriction

    NARCIS (Netherlands)

    Koshy, Gibby; Akrouf, Kafya A. S.; Kelly, Yvonne; Delpisheh, Ali; Brabin, Bernard J.

    2013-01-01

    To assess the impact of parental asthma on risk of pre-term birth (PTB) and intrauterine growth restriction, and their subsequent association with childhood asthma. Three sequential cross-sectional surveys were conducted in 1993 (3,746), 1998 (1,964) and 2006 (1,074) in the same 15 schools among

  9. Candidate gene linkage approach to identify DNA variants that predispose to preterm birth

    DEFF Research Database (Denmark)

    Bream, Elise N A; Leppellere, Cara R; Cooper, Margaret E

    2013-01-01

    Background:The aim of this study was to identify genetic variants contributing to preterm birth (PTB) using a linkage candidate gene approach.Methods:We studied 99 single-nucleotide polymorphisms (SNPs) for 33 genes in 257 families with PTBs segregating. Nonparametric and parametric analyses were...... through the infant and/or the mother in the etiology of PTB....

  10. Nifedipine versus atosiban for threatened preterm birth (APOSTEL III): a multicentre, randomised controlled trial

    NARCIS (Netherlands)

    van Vliet, Elvira O. G.; Nijman, Tobias A. J.; Schuit, Ewoud; Heida, Karst Y.; Opmeer, Brent C.; Kok, Marjolein; Gyselaers, Wilfried; Porath, Martina M.; Woiski, Mallory; Bax, Caroline J.; Bloemenkamp, Kitty W. M.; Scheepers, Hubertina C. J.; Jacquemyn, Yves; van Beek, Erik; Duvekot, Johannes J.; Franssen, Maureen T. M.; Papatsonis, Dimitri N.; Kok, Joke H.; van der Post, Joris A. M.; Franx, Arie; Mol, Ben W.; Oudijk, Martijn A.

    2016-01-01

    In women with threatened preterm birth, delay of delivery by 48 h allows antenatal corticosteroids to improve neonatal outcomes. For this reason, tocolytics are often administered for 48 h; however, there is no consensus about which drug results in the best maternal and neonatal outcomes. In the

  11. Nifedipine versus atosiban for threatened preterm birth (APOSTEL III) : A multicentre, randomised controlled trial

    NARCIS (Netherlands)

    Van Vliet, Elvira O G; Nijman, Tobias A J; Schuit, Ewoud; Heida, Karst Y.; Opmeer, Brent C.; Kok, Marjolein; Gyselaers, Wilfried; Porath, Martina M.; Woiski, Mallory; Bax, Caroline J.; Bloemenkamp, Kitty W M; Scheepers, Hubertina C J; Jacquemyn, Yves; Beek, Erik Van; Duvekot, Johannes J.; Franssen, Maureen T M; Papatsonis, Dimitri N.; Kok, Joke H.; Van Der Post, Joris A M; Franx, Arie; Mol, Ben W.; Oudijk, Martijn A.

    2016-01-01

    Background In women with threatened preterm birth, delay of delivery by 48 h allows antenatal corticosteroids to improve neonatal outcomes. For this reason, tocolytics are often administered for 48 h; however, there is no consensus about which drug results in the best maternal and neonatal outcomes.

  12. Nifedipine versus atosiban for threatened preterm birth (APOSTEL III) : a multicentre, randomised controlled trial

    NARCIS (Netherlands)

    van Vliet, Elvira O. G.; Nijman, Tobias A. J.; Schuit, Ewoud; Heida, Karst Y.; Opmeer, Brent C.; Kok, Marjolein; Gyselaers, Wilfried; Porath, Martina M.; Woiski, Mallory; Bax, Caroline J.; Bloemenkamp, Kitty W. M.; Scheepers, Hubertina C. J.; Jacquemyn, Yves; van Beek, Erik; Duvekot, Johannes J.; Franssen, Maureen T. M.; Papatsonis, Dimitri N.; Kok, Joke H.; van der Post, Joris A. M.; Franx, Arie; Mol, Ben W.; Oudijk, Martijn A.

    2016-01-01

    Background In women with threatened preterm birth, delay of delivery by 48 h allows antenatal corticosteroids to improve neonatal outcomes. For this reason, tocolytics are often administered for 48 h; however, there is no consensus about which drug results in the best maternal and neonatal outcomes.

  13. Nifedipine versus atosiban for threatened preterm birth (APOSTEL III): a multicentre, randomised controlled trial

    NARCIS (Netherlands)

    Vliet, E.O. van; Nijman, T.A.; Schuit, E.; Heida, K.Y.; Opmeer, B.C.; Kok, M. de; Gyselaers, W.; Porath, M.M.; Woiski, M.D.; Bax, C.J.; Bloemenkamp, K.W.; Scheepers, H.C.; Jacquemyn, Y.; Beek, E. van; Duvekot, J.J.; Franssen, M.T.; Papatsonis, D.N.; Kok, J.H.; Post, J.A. van der; Franx, A.; Mol, B.W.; Oudijk, M.A.

    2016-01-01

    BACKGROUND: In women with threatened preterm birth, delay of delivery by 48 h allows antenatal corticosteroids to improve neonatal outcomes. For this reason, tocolytics are often administered for 48 h; however, there is no consensus about which drug results in the best maternal and neonatal

  14. Reduced renal length and volume 20 years after very preterm birth

    NARCIS (Netherlands)

    M.G. Keijzer-Veen (Mandy); A.S. Devos (Annick); M. Meradji (Morteza); F.W. Dekker (Friedo); J. Nauta (Jeroen); A.J. van der Heijden (Bert)

    2010-01-01

    textabstractIntrauterine growth retardation is presumed to be associated with decreased renal size and impaired renal function as a result of stunted kidney development and nephron deficit. To study whether very preterm birth also affects renal size at young adulthood, we sonographically measured

  15. The relationship between maternal periodontitis and preterm low birth weight: A case-control study

    Directory of Open Access Journals (Sweden)

    Satheesh Mannem

    2011-01-01

    Full Text Available Background: The relationship between periodontal diseases in pregnancy and children born prematurely or with low birth weight has been increasingly investigated, showing positive and negative results, respectively. Objective: To evaluate the association between Maternal Periodontitis and Preterm delivery or Low Birth Weight. Materials and Methods: In this case-control study, 104 pregnant women without systemic disease or other risk factors for preterm labor were chosen. The control group (n = 52 had term labor (infants ≥37 weeks and the case group (n = 52 had preterm labor (infants <37 weeks. Plaque index, bleeding index, and birth weight were measured. Results: The data of plaque index (cases 1.21±0.56; controls 0.63±0.31, bleeding index (cases, 2.08±0.62; controls, 1.52±0.61, birth weight (cases, 2.01±0.36; controls 2.87±0.32, and Probing Pocket Depth (PPD ≥4mm and Clinical Attachment Level (CAL ≥3mm in at least 4 teeth (odds ratio 137.50, P value < 0.0001 revealed a statistically significant difference between the two groups P< 0.05. Conclusions: A noticeable relationship between periodontal health and duration of pregnancy; periodontal disease could be a risk factor for preterm labor. Oral hygiene maintenance should be a part of prenatal care protocol.

  16. The Peculiarities of Observation of Preterm Babies with Very Low Birth Weight

    Directory of Open Access Journals (Sweden)

    S.V. Alifanova

    2015-10-01

    Full Text Available The article presents the results of follow-up of 59 preterm babies with very low birth weight during the first year of life. It was found that the most frequent causes of disability are cerebral palsy, retinopathy of prematurity, sensorineural deafness, congenital malformations. The main tasks and the algorithm of observation of these children in policlinic are described.

  17. Hearing loss by week of gestation and birth weight in very preterm neonates

    NARCIS (Netherlands)

    Dommelen, P. van; Verkerk, P.H.; Straaten, H.L. van; Steiner, K.; et al.,

    2015-01-01

    OBJECTIVE: To gain insight into health and related costs associated with very preterm births, one needs accurate information about the prevalence of the disabling conditions, including neonatal hearing loss (NHL). STUDY DESIGN: We assessed the prevalence of NHL by week of gestation and categories of

  18. Hearing loss by week of gestation and birth weight in very preterm neonates

    NARCIS (Netherlands)

    Dommelen, P. van; Verkerk, P.H.; Straaten, H.L. van

    2015-01-01

    Objective To gain insight into health and related costs associated with very preterm births, one needs accurate information about the prevalence of the disabling conditions, including neonatal hearing loss (NHL). Study design We assessed the prevalence of NHL by week of gestation and categories of

  19. Ethnic disparities in the risk of adverse neonatal outcome after spontaneous preterm birth

    NARCIS (Netherlands)

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

    2012-01-01

    Objective. To describe ethnic disparities in the risk of spontaneous preterm birth and related adverse neonatal outcome. Design. Nationwide prospective cohort study. Setting. The Netherlands, 19992007. Population. Nine hundred and sixty-nine thousand, four hundred and ninety-one singleton

  20. Maternal selenium status during early gestation and risk for preterm birth

    NARCIS (Netherlands)

    Rayman, M.P.; Wijnen, H.A.; Vader, H.; Kooistra, L.; Pop, V.

    2011-01-01

    Background Preterm birth occurs in 5%-13% of pregnancies. It is a leading cause of perinatal mortality and morbidity and has adverse long-term consequences for the health of the child. Because of the role selenium plays in attenuating inflammation, and because low concentrations of selenium have

  1. Maternal selenium status during early gestation and risk for preterm birth

    NARCIS (Netherlands)

    Rayman, Margaret P.; Wijnen, Hennie; Vader, Huib; Kooistra, Libbe; Pop, Victor

    2011-01-01

    Background: Preterm birth occurs in 5%-13% of pregnancies. It is a leading cause of perinatal mortality and morbidity and has adverse long-term consequences for the health of the child. Because of the role selenium plays in attenuating inflammation, and because low concentrations of selenium have

  2. Contribution of Congenital Anomalies to Preterm Birth Risk in the Netherlands: poster presentation

    NARCIS (Netherlands)

    Mohangoo1, A.; Lanting, C.; Bennebroek Gravenhorst, J.; Verloove-Vanhorick, P.; Buitendijk, S.

    2010-01-01

    Objective: To asses the extents to which congenital anomalies affect risk of preterm birth. Methods: For the present study, we analysed data on 1,972,058 newborns registered in the Netherlands Perinatal Registry database (inclusion criteria 16 weeks of gestation). Logistic regression techniques were

  3. Shift work, long working hours and preterm birth: a systematic review and meta-analysis

    NARCIS (Netherlands)

    van Melick, M. J. G. J.; Van Beukering, M. D. M.; Mol, B. W.; Frings-Dresen, M. H. W.; Hulshof, C. T. J.

    2014-01-01

    Specific physical activities or working conditions are suspected for increasing the risk of preterm birth (PTB). The aim of this meta-analysis is to review and summarize the pre-existing evidence on the effect of shift work or long working hours on the risk of PTB. We conducted a systematic search

  4. Growth of preterm low birth weight infants until 24 months corrected age: effect of maternal hypertension

    Directory of Open Access Journals (Sweden)

    Alice M. Kiy

    2015-05-01

    Conclusion: Preterm low birth weight born infants to hypertensive mothers have an increased risk of overweight at 24 months CA. Being born small for gestational age and inadequate growth in the 1st year of life are risk factors for growth disorders at 24 months CA.

  5. Preterm birth in singleton and multiple pregnancies : evaluation of costs and perinatal outcomes

    NARCIS (Netherlands)

    van Baaren, Gert J.; Peelen, Myrthe J. C. S.; Schuit, Ewoud; van der Post, Joris A. M.; Mol, Ben W. J.; Kok, Marjolein; Hajenius, Petra J.

    Objective: To estimate costs of preterm birth in singleton and multiple pregnancies. Study design: Cost analysis based on data from a prospective cohort study and three multicentre randomised controlled trials (2006-2012) in a Dutch nationwide consortium for women's health research. Women with

  6. Exposure to firework chemicals from production factories in pregnant women and risk of preterm birth occurrence in Liuyang, China.

    Science.gov (United States)

    Li, Xun; Tan, Hongzhuan; Luo, Meiling; Wu, Xinrui; Huang, Xin; Zhou, Shujin; Shen, Lin; He, Yue; Liu, Yi; Hu, Li; Chen, Mengshi; Hu, Shimin; Wen, Shi Wu

    2018-01-01

    In the production of fireworks, various pollutants including particles of metals and organic compounds are released into the environment. Although the adverse effects of these air pollutants are known, the impact on pregnant women residing in this area remains to be determined. The aim of this study was to examine the association between maternal exposure to fireworks production chemicals and frequency of preterm birth in Liuyang, China. Maternal exposure to fireworks production was estimated at the residential district level and assessed using factory density, which was defined as the number of fireworks factories per 1000 residents in each district. The association of maternal exposure to particulates released from fireworks production plants with frequency of preterm birth was determined using data obtained from a cohort study conducted in Liuyang, China. Data were analyzed utilizing linear regression and logistic regression. There was no significant association between factory density and spontaneous preterm or medically induced preterm birth. Unexpectedly, pregnant women residing in areas with higher density of fireworks factories were at a reduced risk of preterm premature rupture of membranes (PPROM). Data demonstrated that residential density of fireworks factories appeared to be negatively correlated with preterm birth rate as evidenced by PPROM. At present, it is difficult to reconcile the inverse relationship between firework chemical exposure and frequency of preterm births as ambient particulate inhalation is known to adversely affect preterm birth occurrence.

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

    DEFF Research Database (Denmark)

    Pinborg, A; Ortoft, G; Loft, A

    2015-01-01

    for the height of the cervical cone or the severity of the cervical intraepithelial neoplasia (CIN) or the time window between diagnosis of CIN and ART treatment. The finding on an increased risk of VPTB in ART twin pregnancies after dysplasia without conization may be random as we found no other increased risk......STUDY QUESTION: Does cervical conization add an additional risk of preterm birth (PTB) in assisted reproduction technology (ART) singleton and twin pregnancies? SUMMARY ANSWER: Cervical conization doubles the risk of preterm and very PTB in ART twin pregnancies. WHAT IS KNOWN ALREADY: ART...... and cervical conization are both risk factors for PTB. STUDY DESIGN, SIZE, DURATION: 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...

  8. Reproductive outcomes in adolescents who had a previous birth or an induced abortion compared to adolescents' first pregnancies

    Directory of Open Access Journals (Sweden)

    Wenzlaff Paul

    2008-01-01

    Full Text Available Abstract Background Recently, attention has been focused on subsequent pregnancies among teenage mothers. Previous studies that compared the reproductive outcomes of teenage nulliparae and multiparae often did not consider the adolescents' reproductive histories. Thus, the authors compared the risks for adverse reproductive outcomes of adolescent nulliparae to teenagers who either have had an induced abortion or a previous birth. Methods In this retrospective cohort study we used perinatal data prospectively collected by obstetricians and midwives from 1990–1999 (participation rate 87–98% of all hospitals in Lower Saxony, Germany. From the 9742 eligible births among adolescents, women with multiple births, >1 previous pregnancies, or a previous spontaneous miscarriage were deleted and 8857 women Results In bivariate logistic regression analyses, compared to nulliparous teenagers, adolescents with a previous birth had higher risks for perinatal [OR = 2.08, CI = 1.11,3.89] and neonatal [OR = 4.31, CI = 1.77,10.52] mortality and adolescents with a previous abortion had higher risks for stillbirths [OR = 3.31, CI = 1.01,10.88] and preterm births [OR = 2.21, CI = 1.07,4.58]. After adjusting for maternal nationality, partner status, smoking, prenatal care and pre-pregnancy BMI, adolescents with a previous birth were at higher risk for perinatal [OR = 2.35, CI = 1.14,4.86] and neonatal mortality [OR = 4.70, CI = 1.60,13.81] and adolescents with a previous abortion had a higher risk for very low birthweight infants [OR = 2.74, CI = 1.06,7.09] than nulliparous teenagers. Conclusion The results suggest that teenagers who give birth twice as adolescents have worse outcomes in their second pregnancy compared to those teenagers who are giving birth for the first time. The prevention of the second pregnancy during adolescence is an important public health objective and should be addressed by health care providers who attend the first birth or the abortion

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

    Science.gov (United States)

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

    2016-01-01

    Preterm birth is a dire complication of pregnancy that poses huge long-term medical and financial burdens for affected children, their families, and the health care system. The aim of the present study was to identify characteristics associated with preterm births at the Lagos University Teaching Hospital (LUTH), Lagos, Nigeria from 2011 to 2013. We obtained Information from 5,561 maternal, fetal/neonatal and obstetric records from the labor ward. We excluded delivery at less than 22 weeks (0.25%), post-term birth at ≥42 weeks gestation (1.3%), and unknown gestation (1.4%). Additionally, we excluded records of multiple births (5.4%) and stillbirths (8.3%) leaving 4,691 records of singleton live-births for analysis. Logistic regression analysis was performed comparing preterm birth (22-36 weeks gestation) to term birth (37-41 weeks gestation). Multiple variable models adjusting for maternal age, parity, fetal position, delivery method and booking status were also evaluated. Multinomial regression was used to identify characteristics associated with preterm birth (PTB) defined as early PTB (22-31 weeks gestation), moderate PTB (32-34 weeks gestation), late PTB (35-36 weeks gestation), compared to term birth (37-41 completed weeks gestation). From our data, 16.8% of the singleton live-birth deliveries were preterm (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) = 20.8), moderate (OR = 8.68), and late (OR = 2.15). PTB and risks for PTB remain high in Nigeria. We recommend that any high risk

  10. Intraocular pressure in very low birth weight preterm infants and its association with postconceptional age

    Directory of Open Access Journals (Sweden)

    Rodrigo L. Lindenmeyer

    2012-11-01

    Full Text Available OBJECTIVE: To evaluate intraocular pressure in very low birth weight preterm infants and correlate it with postconceptional age. METHODS: The intraocular pressure in a prospective cohort of very low birth weight premature infants (defined as a birth weight <1,500 g and gestational age <32 weeks admitted to Hospital de Clínicas de Porto Alegre , Brazil was evaluated weekly. The evaluated outcome was the variation in the intraocular pressure following changes in the postconceptional age (defined as the gestational age at birth plus the age in weeks at the time of examination in the weeks following preterm birth. Mixed-effects models were used for the statistical analysis to determine the intraocular pressure variation according to postconceptional age, and means and 10th and 90th percentiles were calculated for the intraocular pressure values. RESULTS: Fifty preterm infants with a mean gestational age of 29.7 ± 1.6 weeks and a mean birth weight of 1,127.7 ± 222.7 g were evaluated. The mean intraocular pressure for the entire cohort considering both eyes was 14.9 ± 4.5 mmHg, and 13.5% of all recorded intraocular pressure values were greater than 20 mmHg. The analysis revealed a mean reduction in the intraocular pressure of 0.29 mmHg for each increase in postconceptional age (p = 0.047; 95% CI: -0.58 to -0.0035. The mean intraocular pressure (P10-P90 decreased from 16.3 mmHg (10.5222.16 at 26.3 weeks to 13.1 mmHg (7.28-18.92 at 37.6 weeks of postconceptional age. CONCLUSIONS: The mean intraocular pressure in very low birth weight preterm infants was 14.9 ± 4.5 mmHg. This value decreased 0.29 mmHg per week as the postconceptional age increased.

  11. Preterm birth-associated cost of early intervention services: an analysis by gestational age.

    Science.gov (United States)

    Clements, Karen M; Barfield, Wanda D; Ayadi, M Femi; Wilber, Nancy

    2007-04-01

    Characterizing the cost of preterm birth is important in assessing the impact of increasing prematurity rates and evaluating the cost-effectiveness of therapies to prevent preterm delivery. To assess early intervention costs that are associated with preterm births, we estimated the program cost of early intervention services for children who were born in Massachusetts, by gestational age at birth. Using the Pregnancy to Early Life Longitudinal Data Set, birth certificates for infants who were born in Massachusetts between July 1999 and June 2000 were linked to early intervention claims through 2003. We determined total program costs, in 2003 dollars, of early intervention and mean cost per surviving infant by gestational age. Costs by plurality, eligibility criteria, provider discipline, and annual costs for children's first 3 years also were examined. Overall, 14,033 of 76,901 surviving infants received early intervention services. Program costs totaled almost $66 million, with mean cost per surviving infant of $857. Mean cost per infant was highest for children who were 24 to 31 weeks' gestational age ($5393) and higher for infants who were 32 to 36 weeks' gestational age ($1578) compared with those who were born at term ($725). Cost per surviving infant generally decreased with increasing gestational age. Among children in early intervention, mean cost per child was higher for preterm infants than for term infants. At each gestational age, mean cost per surviving infant was higher for multiples than for singletons, and annual early intervention costs were higher for toddlers than for infants. Compared with their term counterparts, preterm infants incurred higher early intervention costs. This information along with data on birth trends will inform budget forecasting for early intervention programs. Costs that are associated with early childhood developmental services must be included when considering the long-term costs of prematurity.

  12. Attitudes of Swedish midwives towards management of extremely preterm labour and birth.

    Science.gov (United States)

    Danerek, Margaretha; Maršál, Karel; Cuttini, Marina; Lingman, Göran; Nilstun, Tore; Dykes, Anna-Karin

    2012-12-01

    the aim of the study was to ascertain the attitudes of Swedish midwives towards management of very preterm labour and birth and to compare the attitudes of midwives at university hospitals with those at general hospitals. this cross-sectional descriptive and comparative study used an anonymous self-administrated questionnaire for data collection. Descriptive and analytic statistics were carried out for analysis. the answers from midwives (n=259) were collected in a prospective SWEMID study. the midwives had experience of working on delivery wards in maternity units with neonatal intensive care units (NICU) in Sweden. in the management of very preterm labour and birth, midwives agreed to initiate interventions concerning steroid prophylaxis at 23 gestational weeks (GW), caesarean section for preterm labour only at 25 GW, when to give information to the neonatologist before birth at 23 GW, and when to suggest transfer to NICU at 23 GW. Midwives at university hospitals were prone to start interventions at an earlier gestational age than the midwives at general hospitals. Midwives at university hospitals seemed to be more willing to disclose information to the parents. midwives with experience of handling very preterm births at 21-28 GW develop a positive attitude to interventions at an earlier gestational age as compared to midwives without such experience. based on these results we suggest more communication and transfer of information about the advances in perinatal care and exchange of knowledge between the staff at general and university hospitals. Establishment of platforms for inter-professional discussions about ethically difficult situations in perinatal care, might benefit the management of very preterm labour and birth. Copyright © 2011 Elsevier Ltd. All rights reserved.

  13. The associations of birth intervals with small-for-gestational-age, preterm, and neonatal and infant mortality: a meta-analysis

    Science.gov (United States)

    2013-01-01

    Background Short and long birth intervals have previously been linked to adverse neonatal outcomes. However, much of the existing literature uses cross-sectional studies, from which deriving causal inference is complex. We examine the association between short/long birth intervals and adverse neonatal outcomes by calculating and meta-analyzing associations using original data from cohort studies conducted in low-and middle-income countries (LMIC). Methods We identified five cohort studies. Adjusted odds ratios (aOR) were calculated for each study, with birth interval as the exposure and small-for-gestational-age (SGA) and/or preterm birth, and neonatal and infant mortality as outcomes. The associations were controlled for potential confounders and meta-analyzed. Results Birth interval of shorter than 18 months had statistically significant increased odds of SGA (pooled aOR: 1.51, 95% CI: 1.31-1.75), preterm (pooled aOR: 1.58, 95% CI: 1.19-2.10) and infant mortality (pooled aOR: 1.83, 95% CI: 1.19-2.81) after controlling for potential confounding factors (reference 36-gestational-age, and preterm-SGA. Birth interval over 60 months had increased risk of SGA (pooled aOR: 1.22, 95% CI: 1.07-1.39) and term-SGA (pooled aOR: 1.14, 95% CI: 1.03-1.27), but was not associated with other outcomes. Conclusions Birth intervals shorter than 18 months are significantly associated with SGA, preterm birth and death in the first year of life. Lack of access to family planning interventions thus contributes to the burden of adverse birth outcomes and infant mortality in LMICs. Programs and policies must assess ways to provide equitable access to reproductive health interventions to mothers before or soon after delivering a child, but also address underlying socioeconomic factors that may modify and worsen the effect of short intervals. PMID:24564484

  14. Short term effect of air pollution, noise and heat waves on preterm births in Madrid (Spain).

    Science.gov (United States)

    Arroyo, Virginia; Díaz, Julio; Ortiz, Cristina; Carmona, Rocío; Sáez, Marc; Linares, Cristina

    2016-02-01

    Preterm birth (PTB) refers to delivery before 37 weeks of gestation and represents the leading cause of early-life mortality and morbidity in developed countries. PTB can lead to serious infant health outcomes. The etiology of PTB remains uncertain, but epidemiologic studies have consistently shown elevated risks with different environmental variables as traffic-related air pollution (TRAP). The aim of the study was to evaluate with time series methodology the short-term effect of air pollutants, noise levels and ambient temperature on the number of births and preterm births occurred in Madrid City during the 2001-2009 period. A time-series analysis was performed to assess the short term impact of daily mean concentrations (µg/m(3)) of PM2.5 and PM10, O3 and NO2. Measurements of Acoustic Pollution in dB(A) analyzed were: Leqd, equivalent diurnal noise level and Leqn, equivalent nocturnal noise level. Maximum and Minimum daily temperature (°C), mean Humidity in the air (%) and Atmospheric Pressure (HPa), were included too. Linear trends, seasonality, as well as the autoregressive nature of the series itself were controlled. We added as covariate the day of the week too. Autoregressive over-dispersed Poisson regression models were performed and the environmental variables were included with short-term lags (from 0 to 7 days) in reference to the date of birth. Firstly, simple models for the total number of births and preterm births were done separately. In a second stage, a model for total births adjusted for preterm births was performed. A total of 298,705 births were analyzed. The results of the final models were expressed in relative risks (RRs) for interquartile increase. We observed evidence of a short term effect at Lag 0, for the following environmental variables analyzed, PM2.5 (RR: 1.020; 95% CI:(1.008 1.032)) and O3 (RR: 1.012; 95% CI:(1.002 1.022)) concentrations and Leqd (RR: 1.139; 95% CI:( (1.124 1.154)) for the total number of births, and besides

  15. [The influence of previous pregnancy terminations, miscarriages and still-births on the incidence of babies with low birth weight and premature births as well as a somatic classification of newborns].

    Science.gov (United States)

    Voigt, M; Olbertz, D; Fusch, C; Krafczyk, D; Briese, V; Schneider, K T M

    2008-02-01

    The influence of previous interruptions, miscarriages and IUFD on the IUGR and preterm rate as well as on the somatic staging (gestational age and birth weight) of the new born is a subject of controversial discussion in the literature. The present paper attempts to quantify these risks of the medical history. 2 282 412 singleton pregnancies of the period 1995 to 2000 were evaluated from the German Perinatal Database. For the analysis 1 065 202 pregnancies (46.7 %) of those mothers without any live birth in the medical history were assessed. To exclude any influence from previous abortions patients with previous miscarriages and IUFDs were excluded. The control collective were new borns whose mothers had suffered neither from miscarriages nor from abortions or IUFD. Previous interruptions, miscarriages and IUFD influence the rate of new borns with low birth weight and increase the rate of prematurity. With increasing numbers of isolated or combined risks in the medical history, the rate of newborns with a low birth weight or with prematurity is increased. The lowest risk was found after one interruption, the highest rate with two or more IUFDs. Interruptions, miscarriages or IUFD are not risk factors for IUGR or SGA. Previous interruptions, miscarriages and IUFD are relevant risk factors for prematurity and are related with low birth weight of the new borns. Pregnant women with such risk factors have to been considered as risk pregnancies and need intensive surveillance.

  16. Preterm Birth Reduces Nutrient Absorption With Limited Effect on Immune Gene Expression and Gut Colonization in Pigs

    DEFF Research Database (Denmark)

    Østergaard, Mette V; Cilieborg, Malene S.; Skovgaard, Kerstin

    2015-01-01

    The primary risk factors for necrotizing enterocolitis (NEC) are preterm birth, enteral feeding, and gut colonization. It is unclear whether feeding and colonization induce excessive expression of immune genes that lead to NEC. Using a pig model, we hypothesized that reduced gestational age would...... upregulate immune-related genes and cause bacterial imbalance after birth. Preterm (85%-92% gestation, n = 53) and near-term (95%-99% gestation, n = 69) pigs were delivered by cesarean section and euthanized at birth or after 2 days of infant formula or bovine colostrum feeding. At birth, preterm delivery...... reduced 5 of 30 intestinal genes related to nutrient absorption and innate immunity, relative to near-term pigs, whereas 2 genes were upregulated. Preterm birth also reduced ex vivo intestinal glucose and leucine uptake (40%-50%), but failed to increase cytokine secretions from intestinal explants...

  17. Periodontal disease and oral health-related behavior as factors associated with preterm birth: a case-control study in south-eastern Brazil.

    Science.gov (United States)

    Macedo, J F; Ribeiro, R A; Machado, F C; Assis, N M S P; Alves, R T; Oliveira, A S; Ribeiro, L C

    2014-08-01

    Several studies have suggested a link between periodontal disease and preterm birth, but the mechanism of how this occurs remains controversial. Therefore, this study aimed to investigate whether periodontal disease, defined according to two commonly used clinical definitions, is associated with preterm birth and to examine the association regarding oral health-related behaviors during pregnancy. This case-control study included women 18-40 years of age. Demographic and socio-economic data, information on current and previous pregnancies, and data on dental health-related behaviors and periodontal clinical parameters were collected within 48 h postpartum. Periodontal disease was assessed according to two definitions: four or more teeth with at least one site showing a probing depth of ≥ 4 mm and clinical attachment level of ≥ 3 mm (Definition 1); or at least one site with probing depth and clinical attachment level of ≥ 4 mm (Definition 2). The chi-square test was used to examine differences in the proportion of categorical variables. Bivariate analysis was performed to analyze the proportion of preterm births with respect to independent variables. Multiple logistic regression analyses were used to assess the association between periodontal disease and preterm birth. Odds ratios (ORs) were calculated with a 95% confidence interval (95% CI). A total of 296 postpartum women met the inclusion criteria. The case group included 74 women who delivered a preterm neonate (Periodontal disease according to Definition 1 was not associated with fewer weeks of gestation (adjusted OR (OR adjusted ) = 1.62; 95% CI = 0.80-3.29; p = 0.178). However, a significant association was found between periodontal disease, according to Definition 2, and preterm birth (OR adjusted = 1.98; 95% CI = 1.14-3.43; p = 0.015). Increased appetite and a low number of daily toothbrushings were associated with preterm birth, regardless of the definition of periodontal disease used. Periodontal

  18. Particulate Matter Exposure and Preterm Birth: Estimates of U.S. Attributable Burden and Economic Costs.

    Science.gov (United States)

    Trasande, Leonardo; Malecha, Patrick; Attina, Teresa M

    2016-12-01

    Preterm birth (PTB) rates (11.4% in 2013) in the United States remain high and are a substantial cause of morbidity. Studies of prenatal exposure have associated particulate matter ≤ 2.5 μm in diameter (PM2.5) and other ambient air pollutants with adverse birth outcomes; yet, to our knowledge, burden and costs of PM2.5-attributable PTB have not been estimated in the United States. We aimed to estimate burden of PTB in the United States and economic costs attributable to PM2.5 exposure in 2010. Annual deciles of PM2.5 were obtained from the U.S. Environmental Protection Agency. We converted PTB odds ratio (OR), identified in a previous meta-analysis (1.15 per 10 μg/m3 for our base case, 1.07-1.16 for low- and high-end scenarios) to relative risk (RRs), to obtain an estimate that better represents the true relative risk. A reference level (RL) of 8.8 μg/m3 was applied. We then used the RR estimates and county-level PTB prevalence to quantify PM2.5-attributable PTB. Direct medical costs were obtained from the 2007 Institute of Medicine report, and lost economic productivity (LEP) was estimated using a meta-analysis of PTB-associated IQ loss, and well-established relationships of IQ loss with LEP. All costs were calculated using 2010 dollars. An estimated 3.32% of PTBs nationally (corresponding to 15,808 PTBs) in 2010 could be attributed to PM2.5 (PM2.5 > 8.8 μg/m3). Attributable PTBs cost were estimated at $5.09 billion [sensitivity analysis (SA): $2.43-9.66 B], of which $760 million were spent for medical care (SA: $362 M-1.44 B). The estimated PM2.5 attributable fraction (AF) of PTB was highest in urban counties, with highest AFs in the Ohio Valley and the southern United States. PM2.5 may contribute substantially to burden and costs of PTB in the United States, and considerable health and economic benefits could be achieved through environmental regulatory interventions that reduce PM2.5 exposure in pregnancy. Citation: Trasande L, Malecha P, Attina TM. 2016

  19. The incidence of histological chorioamnionitis in IVF/GIFT preterm births.

    Science.gov (United States)

    Williams, H; Jeffery, H

    1994-08-01

    A retrospective case control study was designed to investigate the role of subclinical infection as a risk factor for the high rate of preterm deliveries in IVF/GIFT pregnancies. The cases and the controls were identified from the records of consecutive livebirths of preclampsia and antepartum haemorrhage. As a marker of subclinical infection, the incidence of histological chorioamnionitis (HCA) in the 2 groups (as defined by the standardized, semiquantitative method of Benirschke) was compared. The matched variables did not differ significantly between the IVF/GIFT group and the control group. No significant difference in the incidence of HCA was detected between IVF/GIFT and control groups for singletons or twins. Overall 24% of IVF/GIFT and 30% of controls showed evidence of HCA, odds ratio (95% confidence intervals), 0.72 (0.40-1.31). This study showed no evidence that the incidence of HCA, is significantly increased in IVF/GIFT preterm births compared with other matched, preterm births. Therefore, we conclude that subclinical infection/inflammation cannot explain the 4-fold increase in preterm births in the IVF/GIFT population.

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

    Directory of Open Access Journals (Sweden)

    Naomi Tamura

    2018-02-01

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

  1. Memory function and hippocampal volumes in preterm born very-low-birth-weight (VLBW) young adults.

    Science.gov (United States)

    Aanes, Synne; Bjuland, Knut Jørgen; Skranes, Jon; Løhaugen, Gro C C

    2015-01-15

    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.

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

    Science.gov (United States)

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

    2015-11-01

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

  3. Screening to prevent spontaneous preterm birth: systematic reviews of accuracy and effectiveness literature with economic modelling.

    Science.gov (United States)

    Honest, H; Forbes, C A; Durée, K H; Norman, G; Duffy, S B; Tsourapas, A; Roberts, T E; Barton, P M; Jowett, S M; Hyde, C J; Khan, K S

    2009-09-01

    To identify combinations of tests and treatments to predict and prevent spontaneous preterm birth. Searches were run on the following databases up to September 2005 inclusive: MEDLINE, EMBASE, DARE, the Cochrane Library (CENTRAL and Cochrane Pregnancy and Childbirth Group trials register) and MEDION. We also contacted experts including the Cochrane Pregnancy and Childbirth Group and checked reference lists of review articles and papers that were eligible for inclusion. Two series of systematic reviews were performed: (1) accuracy of tests for the prediction of spontaneous preterm birth in asymptomatic women in early pregnancy and in women symptomatic with threatened preterm labour in later pregnancy; (2) effectiveness of interventions with potential to reduce cases of spontaneous preterm birth in asymptomatic women in early pregnancy and to reduce spontaneous preterm birth or improve neonatal outcome in women with a viable pregnancy symptomatic of threatened preterm labour. For the health economic evaluation, a model-based analysis incorporated the combined effect of tests and treatments and their cost-effectiveness. Of the 22 tests reviewed for accuracy, the quality of studies and accuracy of tests was generally poor. Only a few tests had LR+ > 5. In asymptomatic women these were ultrasonographic cervical length measurement and cervicovaginal prolactin and fetal fibronectin screening for predicting spontaneous preterm birth before 34 weeks. In this group, tests with LR- 5 were absence of fetal breathing movements, cervical length and funnelling, amniotic fluid interleukin-6 (IL-6), serum CRP for predicting birth within 2-7 days of testing, and matrix metalloprotease-9, amniotic fluid IL-6, cervicovaginal fetal fibronectin and cervicovaginal human chorionic gonadotrophin (hCG) for predicting birth before 34 or 37 weeks. In this group, tests with LR- asymptomatic women. Non-steroidal anti-inflammatory agents were the most effective tocolytic agent for reducing

  4. 15 million preterm births annually: what has changed this year?

    Directory of Open Access Journals (Sweden)

    Kinney Mary V

    2012-11-01

    Full Text Available Abstract Each year, more than 1 in 10 of the world’s babies are born preterm, resulting in 15 million babies born too soon. World Prematurity Day, November 17, is a global effort to raise awareness about prematurity. This past year, there has been increased awareness of the problem, through new data and evidence, global partnership and country champions. Actions to improve care would save hundreds of thousands of babies born too soon from death and disability. Accelerated prevention requires urgent research breakthroughs.

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

    Directory of Open Access Journals (Sweden)

    Sukru Yildiz

    2013-08-01

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

  6. Preterm labor and premature birth: Are you at risk?

    Science.gov (United States)

    ... and premature birth, including: Connective tissue disorders, like Ehlers-Danlos syndromes (also called EDS) and vascular Ehlers-Danlos syndrome (also called vEDS). Connective tissue is tissue that ...

  7. The association between parity, infant gender, higher level of paternal education and preterm birth in Pakistan: a cohort study

    Directory of Open Access Journals (Sweden)

    Shaikh Kiran

    2011-11-01

    Full Text Available Abstract Background High rates of antenatal depression and preterm birth have been reported in Pakistan. Self reported maternal stress and depression have been associated with preterm birth; however findings are inconsistent. Cortisol is a biological marker of stress and depression, and its measurement may assist in understanding the influence of self reported maternal stress and depression on preterm birth. Methods In a prospective cohort study pregnant women between 28 to 30 weeks of gestation from the Aga Khan Hospital for Women and Children completed the A-Z Stress Scale and the Centre for Epidemiology Studies Depression Scale to assess stress and depression respectively, and had a blood cortisol level drawn. Women were followed up after delivery to determine birth outcomes. Correlation coefficients and Wilcoxon rank sum test was used to assess relationship between preterm birth, stress, depression and cortisol. Logistic regression analysis was used to determine the key factors predictive of preterm birth. Results 132 pregnant women participated of whom 125 pregnant women had both questionnaire and cortisol level data and an additional seven had questionnaire data only. Almost 20% of pregnant women (19·7%, 95% CI 13·3-27·5 experienced a high level of stress and nearly twice as many (40·9%, 95% CI 32·4-49·8% experienced depressive symptoms. The median of cortisol level was 27·40 ug/dl (IQR 22·5-34·2. The preterm birth rate was 11·4% (95% CI 6·5-18. There was no relationship between cortisol values and stress scale or depression. There was a significant positive relationship between maternal depression and stress. Preterm birth was associated with higher parity, past delivery of a male infant, and higher levels of paternal education. Insufficient numbers of preterm births were available to warrant the development of a multivariable logistic regression model. Conclusions Preterm birth was associated with higher parity, past delivery

  8. The association between parity, infant gender, higher level of paternal education and preterm birth in Pakistan: a cohort study.

    Science.gov (United States)

    Shaikh, Kiran; Premji, Shahirose S; Rose, Marianne S; Kazi, Ambreen; Khowaja, Shaneela; Tough, Suzanne

    2011-11-02

    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. 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. 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. Preterm birth was associated with higher parity, past delivery of a male infant, and higher levels of paternal education. There

  9. Cervical HSV-2 infection causes cervical remodeling and increases risk for ascending infection and preterm birth

    Science.gov (United States)

    McGee, Devin; Poncil, Sharra; Patterson, Amanda

    2017-01-01

    Preterm birth (PTB), or birth before 37 weeks gestation, is the leading cause of neonatal mortality worldwide. Cervical viral infections have been established as risk factors for PTB in women, although the mechanism leading to increased risk is unknown. Using a mouse model of pregnancy, we determined that intra-vaginal HSV2 infection caused increased rates of preterm birth following an intra-vaginal bacterial infection. HSV2 infection resulted in histological changes in the cervix mimicking cervical ripening, including significant collagen remodeling and increased hyaluronic acid synthesis. Viral infection also caused aberrant expression of estrogen and progesterone receptor in the cervical epithelium. Further analysis using human ectocervical cells demonstrated a role for Src kinase in virus-mediated changes in estrogen receptor and hyaluronic acid expression. In conclusion, HSV2 affects proteins involved in tissue hormone responsiveness, causes significant changes reminiscent of premature cervical ripening, and increases risk of preterm birth. Studies such as this improve our chances of identifying clinical interventions in the future. PMID:29190738

  10. Comparison of maternal omentin-1 levels and genetic variability between spontaneous term and preterm births.

    Science.gov (United States)

    Šplíchal, Zbyněk; Zlámal, Filip; Máchal, Jan; Lipková, Jolana; Pavlová, Tereza; Hodická, Zuzana; Ventruba, Pavel; Vašků, Anna; Bienertová-Vašků, Julie

    2018-07-01

    To determine maternal omentin-1 levels and genetic variability in the omentin-1 gene in women with spontaneous term and preterm births (PTBs). Maternal serum omentin-1 levels and the role of the omentin-1 Val109Asp (rs2274907) polymorphism were evaluated in 32 women with spontaneous term birth (sTB) and 30 women with spontaneous preterm birth (sPTB) including women with (n = 16) and without (n = 14) preterm premature rupture of membranes (PPROM). Maternal omentin-1 levels were significantly lower in women with sPTBs compared to term births during the hospitalization period (p = .015). However, maternal omentin-1 levels were similar in women with sPTBs with and without PPROM (p = .990). Furthermore, the omentin-1 Val109Asp polymorphism was found to have no significant effect on omentin-1 serum levels. In addition, no significant differences in genotype distributions and allelic frequencies between sTB and sPTB were established. High omentin-1 levels in normal sTBs compared to PTBs without significant differences between cases with and without PPROM suggest that omentin-1 plays a potential role in the pathophysiology of PTB but not in the PPROM mechanism itself.

  11. Periconceptional multivitamin use and risk of preterm or small-for-gestational-age births in the Danish National Birth Cohort.

    Science.gov (United States)

    Catov, Janet M; Bodnar, Lisa M; Olsen, Jorn; Olsen, Sjurdur; Nohr, Ellen A

    2011-09-01

    The intake of periconceptional multivitamins may decrease the risk of preterm births (PTBs) or small-for-gestational-age (SGA) births. We related the timing and frequency of periconceptional multivitamin use to SGA births and PTBs and its clinical presentations (ie, preterm labor, premature rupture of membranes, and medical induction). Women in the Danish National Birth Cohort (n = 35,897) reported the number of weeks of multivitamin use during a 12-wk periconceptional period. Cox regression was used to estimate the relation between any multivitamin use and PTBs (2 SDs below the mean on the basis of fetal growth curves). The timing (preconception and postconception) and frequency of use were also analyzed. Regular users (4-6 wk) and partial users (1-3 wk) in each period were compared with nonusers. The association between periconceptional multivitamin use and PTBs varied according to prepregnancy overweight status (P-interaction = 0.07). Regular preconception and postconception multivitamin use in women with a prepregnancy BMI (in kg/m(2)) PTBs in nonoverweight women.

  12. Early corticosteroid treatment does not affect severity of unconjugated hyperbilirubinemia in extreme low birth weight preterm infants

    NARCIS (Netherlands)

    Hulzebos, Christian V.; Bos, Arend F.; Anttila, Eija; Hallman, Mikko; Verkade, Henkjan J.

    Aim: To determine the relationship between early postnatal dexamethasone (DXM) treatment and the severity of hyperbilirubinemia in extreme low birth weight (ELBW) preterm infants. Methods: In 54 ELBW preterm infants, total serum bilirubin concentrations (TSB) and phototherapy (PT) data during the

  13. Investigating the variations in survival rates for very preterm infants in 10 European regions : the MOSAIC birth cohort

    NARCIS (Netherlands)

    Draper, E. S.; Zeitlin, J.; Fenton, A. C.; Weber, T.; Gerrits, J.; Martens, G.; Misselwitz, B.; Breart, G.

    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 10 geographically defined European regions during 2003, followed to discharge home from hospital. Participants:

  14. Hot Executive Function Following Moderate-to-Late Preterm Birth: Altered Delay Discounting at 4 Years of Age

    Science.gov (United States)

    Hodel, Amanda S.; Brumbaugh, Jane E.; Morris, Alyssa R.; Thomas, Kathleen M.

    2016-01-01

    Interest in monitoring long-term neurodevelopmental outcomes of children born moderate-to-late preterm (32-36 weeks gestation) is increasing. Moderate-to-late preterm birth has a negative impact on academic achievement, which may relate to differential development of executive function (EF). Prior studies reporting deficits in EF in preterm…

  15. Born too soon: care before and between pregnancy to prevent preterm births: from evidence to action.

    Science.gov (United States)

    Dean, Sohni V; Mason, Elizabeth; Howson, Christopher P; Lassi, Zohra S; Imam, Ayesha M; Bhutta, Zulfiqar A

    2013-01-01

    Providing care to adolescent girls and women before and between pregnancies improves their own health and wellbeing, as well as pregnancy and newborn outcomes, and can also reduce the rates of preterm birth. This paper has reviewed the evidence-based interventions and services for preventing preterm births, reported the findings from research priority exercise, and prescribed actions for taking this call further. Certain factors in the preconception period have been shown to increase the risk for prematurity and, therefore, preconception care services for all women of reproductive age should address these risk factors through preventing adolescent pregnancy, preventing unintended pregnancies, promoting optimal birth spacing, optimizing pre-pregnancy weight and nutritional status (including a folic acid-containing multivitamin supplement) and ensuring that all adolescent girls have received complete vaccination. Preconception care must also address risk factors that may be applicable to only some women. These include screening for and management of chronic diseases, especially diabetes; sexually-transmitted infections; tobacco and smoke exposure; mental health disorders, notably depression; and intimate partner violence. The approach to research in preconception care to prevent preterm births should include a cycle of development and delivery research that evaluates how best to scale up coverage of existing evidence-based interventions, epidemiologic research that assesses the impact of implementing these interventions and discovery science that better elucidates the complex causal pathway of preterm birth and helps to develop new screening and intervention tools. In addition to research, policy and financial investment is crucial to increasing opportunities to implement preconception care, and rates of prematurity should be included as a tracking indicator in global and national maternal child health assessments.

  16. Mechanisms leading to increased risk of preterm birth in growth-restricted guinea pig pregnancies.

    Science.gov (United States)

    Palliser, Hannah K; Kelleher, Meredith A; Welsh, Toni N; Zakar, Tamas; Hirst, Jonathan J

    2014-02-01

    Intrauterine growth restriction (IUGR) is a risk factor for preterm labor; however, the mechanisms of the relationship remain unknown. Prostaglandin (PG), key stimulants of labor, availability is regulated by the synthetic enzymes, prostaglandin endoperoxidases 1 and 2 (PTGS1 and 2), and the metabolizing enzyme, 15-hydroxyprostaglandin dehydrogenase (HPGD). We hypothesized that IUGR increases susceptibility to preterm labor due to the changing balance of synthetic and metabolizing enzymes and hence greater PG availability. We have tested this hypothesis using a surgically induced IUGR model in guinea pigs, which results in significantly shorter gestation. Myometrium, amnion, chorion, and placentas were collected from sham operated or IUGR pregnancies, and PTGS1 and HPGD protein expression were quantified throughout late gestation (>62 days) and labor. The PTGS1 expression was significantly upregulated in the myometrium of IUGR animals, and chorionic HPGD expression was markedly decreased (P production over metabolism in IUGR pregnancies leads to a greater susceptibility to preterm birth.

  17. Second trimester cervical length and risk of preterm birth in women with twin gestations treated with 17-α hydroxyprogesterone caproate.

    LENUS (Irish Health Repository)

    Durnwald, Celeste P

    2010-12-01

    To compare rates of preterm birth before 35 weeks based on cervical length measurement at 16-20 weeks in women with twin gestations who received 17-α hydroxyprogesterone caproate (17OHPC) or placebo.

  18. Predictive accuracy of changes in transvaginal sonographic cervical length over time for preterm birth: a systematic review and metaanalysis.

    Science.gov (United States)

    Conde-Agudelo, Agustin; Romero, Roberto

    2015-12-01

    To determine the accuracy of changes in transvaginal sonographic cervical length over time in predicting preterm birth in women with singleton and twin gestations. PubMed, Embase, Cinahl, Lilacs, and Medion (all from inception to June 30, 2015), bibliographies, Google scholar, and conference proceedings. Cohort or cross-sectional studies reporting on the predictive accuracy for preterm birth of changes in cervical length over time. Two reviewers independently selected studies, assessed the risk of bias, and extracted the data. Summary receiver-operating characteristic curves, pooled sensitivities and specificities, and summary likelihood ratios were generated. Fourteen studies met the inclusion criteria, of which 7 provided data on singleton gestations (3374 women) and 8 on twin gestations (1024 women). Among women with singleton gestations, the shortening of cervical length over time had a low predictive accuracy for preterm birth at predictive accuracy for preterm birth at predictive accuracies for preterm birth of cervical length shortening over time and the single initial and/or final cervical length measurement in 8 of 11 studies that provided data for making these comparisons. In the largest and highest-quality study, a single measurement of cervical length obtained at 24 or 28 weeks of gestation was significantly more predictive of preterm birth than any decrease in cervical length between these gestational ages. Change in transvaginal sonographic cervical length over time is not a clinically useful test to predict preterm birth in women with singleton or twin gestations. A single cervical length measurement obtained between 18 and 24 weeks of gestation appears to be a better test to predict preterm birth than changes in cervical length over time. Published by Elsevier Inc.

  19. Association of the gut microbiota mobilome with hospital location and birth weight in preterm infants.

    Science.gov (United States)

    Ravi, Anuradha; Estensmo, Eva Lena F; Abée-Lund, Trine M L'; Foley, Steven L; Allgaier, Bernhard; Martin, Camilia R; Claud, Erika C; Rudi, Knut

    2017-11-01

    BackgroundThe preterm infant gut microbiota is vulnerable to different biotic and abiotic factors. Although the development of this microbiota has been extensively studied, the mobilome-i.e. the mobile genetic elements (MGEs) in the gut microbiota-has not been considered. Therefore, the aim of this study was to investigate the association of the mobilome with birth weight and hospital location in the preterm infant gut microbiota.MethodsThe data set consists of fecal samples from 62 preterm infants with and without necrotizing enterocolitis (NEC) from three different hospitals. We analyzed the gut microbiome by using 16S rRNA amplicon sequencing, shot-gun metagenome sequencing, and quantitative PCR. Predictive models and other data analyses were performed using MATLAB and QIIME.ResultSThe microbiota composition was significantly different between NEC-positive and NEC-negative infants and significantly different between hospitals. An operational taxanomic unit (OTU) showed strong positive and negative correlation with NEC and birth weight, respectively, whereas none showed significance for mode of delivery. Metagenome analyses revealed high levels of conjugative plasmids with MGEs and virulence genes. Results from quantitative PCR showed that the plasmid signature genes were significantly different between hospitals and in NEC-positive infants.ConclusionOur results point toward an association of the mobilome with hospital location in preterm infants.

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

    Science.gov (United States)

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

    2008-07-08

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

  1. Oxidative stress damage as a detrimental factor in preterm birth pathology.

    Science.gov (United States)

    Menon, Ramkumar

    2014-01-01

    Normal term and spontaneous preterm births (PTB) are documented to be associated with oxidative stress (OS), and imbalances in the redox system (balance between pro- and antioxidant) have been reported in the maternal-fetal intrauterine compartments. The exact mechanism of labor initiation either at term or preterm by OS is still unclear, and this lack of understanding can partially be blamed for failure of antioxidant supplementation trials in PTB prevention. Based on recent findings from our laboratory, we postulate heterogeneity in host OS response. The physiologic (at term) and pathophysiologic (preterm) pathways of labor are not mediated by OS alone but by OS-induced damage to intrauterine tissues, especially fetal membranes of the placenta. OS damage affects all major cellular elements in the fetal cells, and this damage promotes fetal cell senescence (aging). The aging of the fetal cells is predominated by p38 mitogen activated kinase (p38MAPK) pathways. Senescing cells generate biomolecular signals that are uterotonic, triggering labor process. The aging of fetal cells is normal at term. However, aging is premature in PTB, especially in those PTBs complicated by preterm premature rupture of the membranes, where elements of redox imbalances and OS damage are more dominant. We postulate that fetal cell senescence signals generated by OS damage are likely triggers for labor. This review highlights the mechanisms involved in senescence development at term and preterm by OS damage and provides insight into novel fetal signals of labor initiation pathways.

  2. Oxidative stress damage as a detrimental factor in preterm birth pathology

    Directory of Open Access Journals (Sweden)

    Ramkumar eMenon

    2014-11-01

    Full Text Available Normal term and spontaneous preterm births (PTB are documented to be associated with oxidative stress (OS, and imbalances in the redox system (balance between pro- and antioxidant have been reported in the maternal-fetal intrauterine compartments. The exact mechanism of labor initiation either at term or preterm by OS is still unclear, and this lack of understanding can partially be blamed for failure of antioxidant supplementation trials in PTB prevention. Based on recent findings from our laboratory, we postulate heterogeneity in host OS response. The physiologic (at term and pathophysiologic (preterm pathways of labor are not mediated by OS alone but by OS-induced damage to intrauterine tissues, especially fetal membranes of the placenta. OS damage affects all major cellular elements in the fetal cells, and this damage promotes fetal cell senescence (aging. The aging of the fetal cells are predominated by p38 mitogen activated kinase (p38MAPK pathways. Senescing cells generate biomolecular signals that are uterotonic, triggering labor process. The aging of fetal cells is normal at term. However, aging is premature in PTB, especially in those PTBs complicated by preterm premature rupture of the membranes (pPROM, where elements of redox imbalances and OS damage are more dominant. We postulate that fetal cell senescence signals generated by OS damage are likely triggers for labor. This review highlights the mechanisms involved in senescence development at term and preterm by OS damage and provides insight into novel fetal signals of labor initiation pathways.

  3. Maternal obesity and neonatal mortality according to subtypes of preterm birth

    DEFF Research Database (Denmark)

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

    2007-01-01

    : Compared with infants of mothers who were at a normal weight before pregnancy (BMI of 18.5 or more but less than 25), neonatal mortality was increased in infants of mothers who were overweight (BMI of 25 or more but less than 30) or obese (BMI of 30 or more) (adjusted hazard ratios 1.7, CI 1.2-2.5, and 1.......6, CI 1.0-2.4, respectively). For preterm infants (n=3,934, 136 deaths), neonatal mortality in infants born after preterm premature rupture of membranes (PROM) was significantly increased if they were born to an overweight or obese mother (adjusted hazard ratios 3.5, CI 1.4-8.7, and 5.7, CI 2.......2-14.8). There were no associations between high BMI and neonatal mortality in infants born after spontaneous preterm birth without preterm PROM or in infants born after induced preterm delivery. CONCLUSION: High maternal weight seems to increase the risk of neonatal mortality, especially in infants born after...

  4. Genetic Associations with Gestational Duration and Spontaneous Preterm Birth

    DEFF Research Database (Denmark)

    Zhang, G.; Feenstra, B.; Bacelis, J.

    2017-01-01

    . METHODS: We performed a genomewide association study in a discovery set of samples obtained from 43,568 women of European ancestry using gestational duration as a continuous trait and term or preterm (... of 8643 women) to test for replication of genomic loci that had significant genomewide association (Pdiscovery set. RESULTS: In the discovery and replication data sets, four loci (EBF1, EEFSEC, AGTR2, and WNT4) were...... significantly associated with gestational duration. Functional analysis showed that an implicated variant in WNT4 alters the binding of the estrogen receptor. The association between variants in ADCY5 and RAP2C and gestational duration had suggestive significance in the discovery set and significant evidence...

  5. Effect of Hurricane Katrina on Low Birth Weight and Preterm Deliveries in African American Women in Louisiana, Mississippi, and Alabama

    Directory of Open Access Journals (Sweden)

    Chau-Kuang Chen

    2012-04-01

    Full Text Available Using three modeling techniques (GLR, GEP, and GM, the effect of Hurricane Katrina on low birth weight and preterm delivery babies for African American women is examined in Louisiana, Mississippi and Alabama. The study results indicate that risk factors associated with low birth weight and preterm delivery for American African women include unemployment and percent of mothers between the ages of 15-19. Among White women, ages 15-19, risk factors included poverty rate, median household income, and total birth rate. The GMs performed accurate predictions with increasing low birth weight and preterm delivery trends for African American women in the Gulf Coast states and other U.S. states, and decreasing low birth weight and preterm delivery trends for their White counterparts in the same state locations. Data presented between 2007-2010 show low birth weight and preterm delivery for White women as a decreasing tendency while adverse birth outcomes for African American women exhibited a monotonically increasing trend. The empirical findings suggest that health disparities will continue to exist in the foreseeable future, if no effective intervention is taken. The models identify risk factors that contribute to adverse birth outcomes and offer some insight into strategies and programs to address and ameliorate these effects.

  6. Maternal serum lead level during pregnancy is positively correlated with risk of preterm birth in a Chinese population

    International Nuclear Information System (INIS)

    Li, Jun; Wang, Hua; Hao, Jia-Hu; Chen, Yuan-Hua; Liu, Lu; Yu, Zhen; Fu, Lin; Tao, Fang-Biao; Xu, De-Xiang

    2017-01-01

    Lead (Pb) is a well-known developmental toxicant. The aim of the present study was to analyze the association between maternal serum Pb level and risk of preterm birth in a population-based birth cohort study. The present study analyzed a sub-study of the China-Anhui Birth Cohort that recruited 3125 eligible mother-and-singleton-offspring pairs. Maternal serum Pb level was measured by graphite furnace atomic absorption spectrometry. All subjects were classified into three groups by tertile division according to serum Pb level: Low-Pb (L-Pb, <1.18 μg/dl), Medium-Pb (M-Pb, 1.18–1.70 μg/dl), and High-Pb (H-Pb, ≥1.71 μg/dl). The rate of preterm birth was 2.8% among subjects with L-Pb, 6.1% among subjects with M-Pb, and 8.1% among subjects with H-Pb, respectively. After controlling confounding factors, the adjusted OR for preterm birth was 2.33 (95%CI: 1.49, 3.65) among subjects with M-Pb and 3.09 (95%CI: 2.01, 4.76) among subjects with H-Pb. Of interest, maternal Pb exposure in early gestational stage than in middle gestational stage was more susceptible to preterm birth. Moreover, maternal serum Pb level was only associated with increased risk of late preterm birth. The present study provides evidence that maternal serum Pb level during pregnancy is positively associated with risk of preterm birth in a Chinese population. - Highlights: • Environmental Pb exposure during pregnancy elevates risk of preterm birth. • Environmental Pb exposure during pregnancy elevates risk of moderate and late preterm birth. • Environmental Pb exposure at early or middle gestational stage elevates risk of preterm birth. - Maternal serum Pb level during pregnancy is positively associated with risk of preterm birth in a Chinese population.

  7. Inattention and development of toddlers born in preterm and with low birth weight.

    Science.gov (United States)

    Huang, June-Hui; Huang, Huei-Lin; Chen, Hsiu-Lin; Lin, Lung-Chang; Tseng, Hsing-I; Kao, Tsung-Jen

    2012-07-01

    The objective of this study was to examine the impact of low birth weight and preterm birth on a toddler's inattention and development, including cognitive, language, motor, social-emotional and adaptive behaviors. A total of 105 toddlers enrolled for the study; they were divided into four groups: 40 full-term and normal birth weight (NBW, birth weight greater than 2500 g) toddlers, 24 moderate birth weight (MLBW, birth weight between 2499 and 1500 g) toddlers, 20 very to extremely low birth weight (V-ELBW, 12 between 1000 and 1499 g and 8 lower than 1000 g) toddlers, and 21 term toddlers who were recruited from a clinic of developmental delay as the developmental delay at risk (DDR) group. The Bayley Scales of Infant and Toddler Development-Third Edition (BSID-III) and Disruptive Behavior Rating Scale-Toddler were used. The findings were as follows: (1) DDR group performed worst in BSID-III; (2) although there were no statistical differences among the NBW, MLBW, and V-ELBW groups in BSID-III, the lower the birth weight, the lower the average performance, especially in language, adaptive social behavior, and adaptive practical behavior; and (3) comparing the inattention score, the DDR group was the poorest, normal and V-ELBW groups were the best, and MLBW group was in the middle. In conclusion, low birth weight and preterm delivery affected children's inattention and development of language, adaptive social behavior, and adaptive practical behavior. Copyright © 2012. Published by Elsevier B.V.

  8. Inattention and development of toddlers born in preterm and with low birth weight

    Directory of Open Access Journals (Sweden)

    June-Hui Huang

    2012-07-01

    Full Text Available The objective of this study was to examine the impact of low birth weight and preterm birth on a toddler's inattention and development, including cognitive, language, motor, social–emotional and adaptive behaviors. A total of 105 toddlers enrolled for the study; they were divided into four groups: 40 full-term and normal birth weight (NBW, birth weight greater than 2500 g toddlers, 24 moderate birth weight (MLBW, birth weight between 2499 and 1500 g toddlers, 20 very to extremely low birth weight (V-ELBW, 12 between 1000 and 1499 g and 8 lower than 1000 g toddlers, and 21 term toddlers who were recruited from a clinic of developmental delay as the developmental delay at risk (DDR group. The Bayley Scales of Infant and Toddler Development—Third Edition (BSID-III and Disruptive Behavior Rating Scale—Toddler were used. The findings were as follows: (1 DDR group performed worst in BSID-III; (2 although there were no statistical differences among the NBW, MLBW, and V-ELBW groups in BSID-III, the lower the birth weight, the lower the average performance, especially in language, adaptive social behavior, and adaptive practical behavior; and (3 comparing the inattention score, the DDR group was the poorest, normal and V-ELBW groups were the best, and MLBW group was in the middle. In conclusion, low birth weight and preterm delivery affected children's inattention and development of language, adaptive social behavior, and adaptive practical behavior.

  9. Black-white preterm birth disparity: a marker of inequality

    Science.gov (United States)

    Purpose. The racial disparity in preterrn birth (PTB) is a persistent feature of perinatal epidemiology, inconsistently modeled in the literature. Rather than include race as an explanatory variable, or employ race-stratified models, we sought to directly model the PTB disparity ...

  10. Thymic size at birth in preterm infants with severe respiratory ...

    African Journals Online (AJOL)

    The only maternal and postnatal factors influencing CT/T ratio were the presence of pre-eclamptic toxaemia (PET) and birth by caesarean section (CS), but these factors did not influence likelihood of survival. Factors found to be not associated with thymic size were antenatal steroid administration, maternal HIV status, ...

  11. Unexpected: an interpretive description of parental traumas? associated with preterm birth

    OpenAIRE

    Lasiuk, Gerri C; Comeau, Thea; Newburn-Cook, Christine

    2013-01-01

    Background 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...

  12. Area-level poverty and preterm birth risk: A population-based multilevel analysis

    Directory of Open Access Journals (Sweden)

    Muglia Louis A

    2008-09-01

    Full Text Available Abstract Background Preterm birth is a complex disease with etiologic influences from a variety of social, environmental, hormonal, genetic, and other factors. The purpose of this study was to utilize a large population-based birth registry to estimate the independent effect of county-level poverty on preterm birth risk. To accomplish this, we used a multilevel logistic regression approach to account for multiple co-existent individual-level variables and county-level poverty rate. Methods Population-based study utilizing Missouri's birth certificate database (1989–1997. We conducted a multilevel logistic regression analysis to estimate the effect of county-level poverty on PTB risk. Of 634,994 births nested within 115 counties in Missouri, two levels were considered. Individual-level variables included demographics factors, prenatal care, health-related behavioral risk factors, and medical risk factors. The area-level variable included the percentage of the population within each county living below the poverty line (US census data, 1990. Counties were divided into quartiles of poverty; the first quartile (lowest rate of poverty was the reference group. Results PTB th quartile (4.9%, p adjOR 1.18 (95% CI 1.03, 1.35, with a similar effect at earlier gestational ages (adjOR 1.27 (95% CI 1.06, 1.52. Conclusion Women residing in socioeconomically deprived areas are at increased risk of preterm birth, above other underlying risk factors. Although the risk increase is modest, it affects a large number of pregnancies.

  13. Diurnal Cortisol Patterns and Dexamethasone Suppression Test Responses in Healthy Young Adults Born Preterm at Very Low Birth Weight.

    Directory of Open Access Journals (Sweden)

    Nina Kaseva

    Full Text Available Early life stress, such as painful and stressful procedures during neonatal intensive care after preterm birth, can permanently affect physiological, hormonal and neurobiological systems. This may contribute to altered programming of the hypothalamic-pituitary-adrenal axis (HPAA and provoke changes in HPAA function with long-term health impacts. Previous studies suggest a lower HPAA response to stress in young adults born preterm compared with controls born at term. We assessed whether these differences in HPAA stress responsiveness are reflected in everyday life HPAA functioning, i.e. in diurnal salivary cortisol patterns, and reactivity to a low-dose dexamethasone suppression test (DST, in unimpaired young adults born preterm at very low birth weight (VLBW; <1500 g.The participants were recruited from the Helsinki Study of Very Low Birth Weight Adults cohort study. At mean age 23.3 years (2.1 SD, 49 VLBW and 36 controls born at term participated in the study. For cortisol analyzes, saliva samples were collected on two consecutive days at 0, 15, 30 and 60 min after wake-up, at 12:00 h, 17:00 h and 22:00 h. After the last salivary sample of the first study day the participants were instructed to take a 0.5 mg dexamethasone tablet.With mixed-effects model no difference was seen in overall diurnal salivary cortisol between VLBW and control groups [13.9% (95% CI: -11.6, 47.0, P = 0.31]. Salivary cortisol increased similarly after awakening in both VLBW and control participants [mean difference -2.9% (29.2, 33.0, P = 0.85]. Also reactivity to the low-dose DST (awakening cortisol ratio day2/day1 was similar between VLBW and control groups [-1.1% (-53.5, 103.8, P = 0.97].Diurnal cortisol patterns and reactivity to a low-dose DST in young adulthood were not associated with preterm birth.

  14. Variability in urinary phthalate metabolite levels across pregnancy and sensitive windows of exposure for the risk of preterm birth

    Science.gov (United States)

    Ferguson, Kelly K.; McElrath, Thomas F.; Ko, Yi-An; Mukherjee, Bhramar; Meeker, John D.

    2014-01-01

    Background Preterm birth is a significant public health problem, affecting over 1 in 10 live births and contributing largely to infant mortality and morbidity. Everyday exposure to environmental chemicals such as phthalates could contribute, and may be modifiable. In the present study we examine variability in phthalate exposure across gestation and identify windows of susceptibility for the relationship with preterm birth. Methods Women were recruited early in pregnancy as part of a prospective, longitudinal birth cohort at the Brigham and Women’s Hospital in Boston, Massachusetts. Urine samples were collected at up to 4 time points during gestation for phthalate measurement, and birth outcomes were recorded at delivery. From this population we selected all 130 cases of preterm birth, defined as delivery before 37 weeks completed gestation, as well as 352 random controls. Results Urinary phthalate metabolite levels were moderately variable over pregnancy, but levels measured at multiple time points were associated with increased odds of preterm birth. Adjusted odds ratios (aOR) for spontaneous preterm birth were strongest in association with phthalate metabolite concentrations measured at the beginning of the third trimester (aOR for summed di-2-ethylhexyl phthalate metabolites [∑DEHP]=1.33, 95% confidence interval [CI]=1.02, 1.73). Odds ratios for placental preterm birth, defined as delivery with presentation of preeclampsia or intrauterine growth restriction, were slightly elevated in the first trimester for DEHP metabolites (aOR for ∑DEHP=1.33, 95% CI=0.99, 1.78). Conclusions Pregnant women with exposure to phthalates both early and late in pregnancy are at increased risk of delivering preterm, but mechanisms may differ based on etiology. PMID:24934852

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

    Directory of Open Access Journals (Sweden)

    S. J. Kroese

    2017-01-01

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

  16. Periodontal infection as a risk factor for preterm low birth weight

    Directory of Open Access Journals (Sweden)

    Gandhimadhi D

    2010-01-01

    Full Text Available Introduction: There is an overwhelming body of evidence strongly suggesting that periodontal infection may have a significant negative impact on pregnancy outcome in some women. The aim of this study was to determine the association, if any, between periodontal disease and preterm low birth weight. Materials and Methods : A total of 211 mothers between the ages of 17 and 35 were grouped into two categories based on the gestational age and weight of the baby as cases (< 37 weeks, < 2500 g and controls (>37 weeks, >2500 g. Relevant obstetric history and information on other primary risk factors for preterm low birth weight were obtained. Investigation reports on blood group, Rh factor and hemoglobin (Hb were also gathered. Oral assessments included: simplified oral hygiene index (OHI-S, gingival bleeding index, probing pocket depth and clinical attachment level (CAL. Results: Cases had significantly more attachment loss and probing pocket depth, poor oral hygiene, more percentage of sites with attachment loss (Extent and more mean attachment loss per site (Severity and less Hb than controls. The number of visits for prenatal care and the percentage of sites with CAL≥2mm (Extent 2 remained significant when compared to other variables. Conclusion: The study indicated that periodontal disease is a contributing factor for preterm low birth weight.

  17. When Parents Ask ... about Preterm Birth, Breastfeeding Success, Breast Cancer, or Waterbirth.

    Science.gov (United States)

    Moore, Mary Lou

    2003-01-01

    IN THIS COLUMN, THE AUTHOR REVIEWS RESEARCH ON FOUR SEPARATE TOPICS: the prevention of preterm birth, the effect of epidurals on breastfeeding success, the possible protective effect of lactation on breast cancer, and laboring in water. In two separate studies-a multisite study in the United States and a second study from Brazil-natural progesterone was shown to significantly reduce the incidence of preterm birth in women at high risk. A third study conducted in the United Kingdom examined the effect of clindamycin on preventing infection that can lead to preterm birth. A group of studies related to lactation found that early breastfeeding was more successful in women who did not have epidural anesthesia. In a Korean study, the lifetime duration of breastfeeding was associated with a significant reduction in breast cancer. Concerning waterbirth, Swiss researchers found that, when a woman labored in water, she regulated both water temperature and bathing duration to ensure that her body temperature and that of the fetus remained within a normal physiological range.

  18. Pulmonary outcome in former preterm, very low birth weight children with bronchopulmonary dysplasia: a case-control follow-up at school age.

    Science.gov (United States)

    Vom Hove, Maike; Prenzel, Freerk; Uhlig, Holm H; Robel-Tillig, Eva

    2014-01-01

    To assess and compare long-term pulmonary outcomes in former preterm-born, very low birth weight (VLBW) children with and without bronchopulmonary dysplasia (BPD) born in the surfactant era. Pulmonary function tests (ie, spirometry, body plethysmography, and gas transfer testing) were performed in children with a history of VLBW and BPD (n = 28) and compared with a matched preterm-born VLBW control group (n = 28). Medical history was evaluated by questionnaire. At time of follow-up (mean age, 9.5 years), respiratory symptoms (36% vs 8%) and receipt of asthma medication (21% vs 0%) were significantly more frequent in the preterm-born children with previous BPD than in those with no history of BPD. The children with a history of BPD had significantly lower values for forced expiratory volume in 1 second (z-score -1.27 vs -0.4; P = .008), forced vital capacity (z-score -1.39 vs -0.71 z-score; P = .022), and forced expiratory flow rate at 50% of forced vital capacity (z-score -2.21 vs -1.04; P = .048) compared with the preterm control group. Preterm-born children with a history of BPD are significantly more likely to have lung function abnormalities, such as airway obstruction and respiratory symptoms, at school age compared with preterm-born children without BPD. Copyright © 2014 Mosby, Inc. All rights reserved.

  19. PRETERM BIRTH AND FUTURE MATERNAL BLOOD PRESSURE, INFLAMMATION AND INTIMAL MEDIAL THICKNESS: THE CARDIA STUDY

    Science.gov (United States)

    Catov, Janet M; Lewis, Cora E; Lee, Minjae; Wellons, Melissa F; Gunderson, Erica P

    2013-01-01

    Preterm birth (PTB, PTBs (n=226) had higher mean systolic blood pressures (SBP) before pregnancy (106 vs. 105 mmHg, respectively; p=0.03). Systolic and diastolic blood pressure increased more rapidly over 20 years compared to women with term births (p<0.01 time interaction) even after removing women with self-reported hypertension in pregnancy. Women with PTB vs. term births had similar mean IMT adjusted for age, BMI, race, lifestyle and cardiovascular risk factors. CRP and IL-6 did not differ according to PTB. Women with PTB, regardless of hypertension during pregnancy, had higher blood pressure after pregnancy compared to women with term births. In the U.S. where rates of PTB are high and race disparities persist, PTB may identify women with higher blood pressure the years after pregnancy. PMID:23319540

  20. Transcriptome signature identifies distinct cervical pathways induced in lipopolysaccharide-mediated preterm birth.

    Science.gov (United States)

    Willcockson, Alexandra R; Nandu, Tulip; Liu, Cheuk-Lun; Nallasamy, Shanmugasundaram; Kraus, W Lee; Mahendroo, Mala

    2018-03-01

    With half a million babies born preterm each year in the USA and about 15 million worldwide, preterm birth (PTB) remains a global health issue. Preterm birth is a primary cause of infant morbidity and mortality and can impact lives long past infancy. The fact that there are numerous, and many currently unidentified, etiologies of PTB has hindered development of tools for risk evaluation and preventative therapies. Infection is estimated to be involved in nearly 40% of PTBs of known etiology; therefore, understanding how infection-mediated inflammation alters the cervical milieu and leads to preterm tissue biomechanical changes are questions of interest. Using RNA-seq, we identified enrichment of components involved in inflammasome activation and unique proteases in the mouse cervix during lipopolysaccharide (LPS)-mediated PTB and not physiologically at term before labor. Despite transcriptional induction of inflammasome components, there was no evidence of functional activation based on assessment of mature IL1B and IL18 proteins. The increased transcription of proteases that target both elastic fibers and collagen and concentration of myeloid-derived cells capable of protease synthesis in the cervical stroma support the structural disruption of elastic fibers as a functional output of protease activity. The recent demonstration that elastic fibers contribute to the biomechanical function of the pregnant cervix suggests their protease-induced disruption in the infection model of LPS-mediated PTB and may contribute to premature loss of mechanical competency and preterm delivery. Collectively, the transcriptomics and ultrastructural data provide new insights into the distinct mechanisms of premature cervical remodeling in response to infection.

  1. Preterm Birth, Age at School Entry and Long Term Educational Achievement.

    Science.gov (United States)

    Odd, David; Evans, David; Emond, Alan

    2016-01-01

    To investigate if the detrimental impact of year of entering education in preterm infants persists into adolescence. Preterm infants are often enrolled in school a year earlier than would be expected if this decision is based on their actual date of birth rather than their due date. Initially these infants appear to do disproportionately worse than those who do not 'skip' a year. However, it is unclear if this effect remains as the infants grow, to have an important effect on long term achievements in education. A cohort study, drawn from the Avon Longitudinal Study of Parents and Children (ALSPAC). The exposure measurement was gestational age (defined as preterm (birth (DOB), their expected date of delivery (EDD), or their expected date of delivery and year of school entry. After matching for DOB, preterm infants had an increased odds of SEN (OR 1.57 (1.33-1.86)) and the association remained after adjusting for potential confounders (OR 1.39 (1.14-1.68)). The association remained in the analysis matching for EDD (fully adjusted OR 1.43 (1.17-1.74)) but attenuated after restricting to those infants who were enrolled in school in the same year as the control infants (fully adjusted OR 1.21 (0.97-1.52)). There was less evidence for an impact of prematurity on the KS4 score (Matched for DOB; OR 1.10 (0.91 to 1.34), matched for EDD OR 1.17 (0.96 to 1.42) and EDD and same year of schooling, OR 1.00 (0.80 to 1.26)). This modifiable effect of going to school a year earlier than predicted by their due date appears to have measurable consequences for ex-preterm infants in adolescence and is likely to limit adulthood opportunities.

  2. Risks of Preterm Premature Rupture of Membranes and Preterm Birth Post Fetoscopy Based on Location of Trocar Insertion Site.

    Science.gov (United States)

    Chmait, Ramen H; Chon, Andrew H; Korst, Lisa M; Llanes, Arlyn; Kontopoulos, Eftichia V; Quintero, Ruben A

    2018-07-01

     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.

  3. Association of Vac A- and Cag A-specific Helicobacter pylori strain infection with spontaneous preterm birth.

    Science.gov (United States)

    Yang, Seung Woo; Kwon, Han Sung; Sohn, In Sook; Kim, Young Ju; Hwang, Han Sung

    2017-04-01

    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.

  4. Brain caspase-3 and intestinal FABP responses in preterm and term rats submitted to birth asphyxia

    Directory of Open Access Journals (Sweden)

    R.L. Figueira

    2016-01-01

    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.

  5. Correlation among periodontal health status, maternal age and pre-term low birth weight.

    Science.gov (United States)

    Capasso, Francesca; Vozza, Iole; Capuccio, Veronica; Vestri, Anna Rita; Polimeni, Antonella; Ottolenghi, Livia

    2016-08-01

    To assess correlations between periodontal status, maternal age and adverse pregnancy outcomes, such as pre-term and low birth weight in a sample of pregnant women. Study population was represented by outpatient pregnant women, gestational age > 26 weeks. Medical history questionnaires were administered to all participants who underwent clinical evaluation; clinical obstetric outcome records were collected after delivery. A questionnaire was administered regarding personal information, socio-economic status, oral hygiene habits, and oral health conditions. A clinical oral examination was performed to collect Simplified Oral Hygiene Index (OHI-S) and Community Periodontal Index (CPI). Pregnancy outcome records included: delivery week, kind and causes of delivery, any relevant complications, and birth weight. Descriptive statistics were used to depict the data from the questionnaire while the relationship between delivery week, birth weight, maternal age and periodontal status was evaluated through multivariate tests of significance. 88 pregnant women were enrolled in the study. The results showed a statistically significant correlation (Pperiodontal disease and adverse pregnancy outcomes. No statistical correlation was found among pre-term and low birth weight, smoking, ethnicity and educational level of mothers. The results highlight the importance of including a routine oral and periodontal health examination in pregnant women older than 40 years of age. The correlation between periodontal status and adverse pregnancy outcomes in older mothers indicates the need for routine oral health examination and periodontal status assessment and care in pregnant women older than 40 years of age.

  6. Socio-Emotional Development Following Very Preterm Birth: Pathways to Psychopathology.

    Science.gov (United States)

    Montagna, Anita; Nosarti, Chiara

    2016-01-01

    Very preterm birth (VPT; 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 etiology 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.

  7. Socio-emotional development following very preterm birth: pathways to psychopathology

    Directory of Open Access Journals (Sweden)

    Anita eMontagna

    2016-02-01

    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.

  8. Vaginal progesterone to prevent preterm birth in pregnant women with a sonographic short cervix: clinical and public health implications.

    Science.gov (United States)

    Conde-Agudelo, Agustin; Romero, Roberto

    2016-02-01

    Vaginal progesterone administration to women with a sonographic short cervix is an efficacious and safe intervention used to prevent preterm birth and neonatal morbidity and mortality. The clinical and public health implications of this approach in the United States have been critically appraised and compared to other therapeutic interventions in obstetrics. Vaginal progesterone administration to women with a transvaginal sonographic cervical length (CL) ≤25 mm before 25 weeks of gestation is associated with a significant and substantial reduction of the risk for preterm birth from effects have been achieved in women with a singleton gestation, with or without a history of spontaneous preterm birth, and did not differ significantly as a function of CL (effectiveness and decision analyses have shown that the combination of universal transvaginal CL screening and vaginal progesterone administration to women with a short cervix is a cost-effective intervention that prevents preterm birth and associated perinatal morbidity and mortality. Universal assessment of CL and treatment with vaginal progesterone for singleton gestations in the United States would result in an annual reduction of approximately 30,000 preterm births before 34 weeks of gestation and of 17,500 cases of major neonatal morbidity or neonatal mortality. In summary, there is compelling evidence to recommend universal transvaginal CL screening at 18-24 weeks of gestation in women with a singleton gestation and to offer vaginal progesterone to those with a CL ≤25 mm, regardless of the history of spontaneous preterm birth, with the goal of preventing preterm birth and neonatal morbidity and mortality. Published by Elsevier Inc.

  9. Factors associated with preterm delivery and low birth weight: a study from rural Maharashtra, India [version 1; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Anand Ahankari

    2017-01-01

    Full Text Available Background Although preterm delivery and low birth weight (LBW have been studied in India, findings may not be generalisable to rural areas such as the Marathwada region of Maharashtra state. There is limited information available on maternal and child health indicators from this region. We aimed to present some local estimates of preterm delivery and LBW in the Osmanabad district of Marathwada and assess available maternal risk factors.   Methods The study used routinely collected data on all in-hospital births in the maternity department of Halo Medical Foundation’s hospital from 1st January 2008 to 31st December 2014. Multivariable logistic regression analysis provided odds ratios (OR with 95% confidence intervals (CI for preterm delivery and LBW according to each maternal risk factor.   Results We analysed 655 live births, of which 6.1% were preterm deliveries. Of the full term births (N=615, 13.8% were LBW (<2.5 kilograms at birth. The odds of preterm delivery were three times higher (OR=3.23, 95% CI 1.36 to 7.65 and the odds of LBW were double (OR=2.03, 95% CI 1.14 to 3.60 among women <22 years of age compared with older women. The odds of both preterm delivery and LBW were reduced in multigravida compared with primigravida women regardless of age. Anaemia (Hb<11g/dl, which was prevalent in 91% of women tested, was not significantly related to these birth outcomes.   Conclusions The odds of preterm delivery and LBW were much higher in mothers under 22 years of age in this rural Indian population. Future studies should explore other related risk factors and the reasons for poor birth outcomes in younger mothers in this population, to inform the design of appropriate public health policies that address this issue.

  10. Traffic-Related Air Pollution and Risk of Preterm Birth in the San Joaquin Valley of California

    Science.gov (United States)

    Padula, Amy M.; Mortimer, Kathleen M.; Tager, Ira B.; Hammond, S. Katharine; Lurmann, Frederick W.; Yang, Wei; Stevenson, David K.; Shaw, Gary M.

    2014-01-01

    We evaluated associations between traffic-related air pollution during pregnancy and preterm birth in births in four counties in California during years 2000–2006. We used logistic regression to examine the association between the highest quartile of ambient air pollutants (carbon monoxide, nitrogen dioxide, particulate matter <10 and 2.5 μm) and traffic density during pregnancy and each of five levels of prematurity based on gestational age at birth (20–23, 24–27, 28–31, 32–33 and 34–36 weeks) versus term (37–42 weeks). We examined trimester averages and the last month and last 6 weeks of pregnancy. Models were adjusted for birth weight, maternal age, race/ethnicity, education, prenatal care and birth costs payment. Neighborhood socioeconomic status was evaluated as a potential effect modifier. There were increased odds ratios for early preterm birth for those exposed to the highest quartile of each pollutant during the second trimester and the end of pregnancy (adjusted odds ratios: 1.4– 2.8). Associations were stronger among mothers living in low socioeconomic status neighborhoods (adjusted odds ratios: 2.1–4.3). We observed exposure-response associations for multiple pollutant exposures and early preterm birth. Inverse associations during the first trimester were observed. The results confirm associations between traffic-related air pollution and prematurity, particularly among very early preterm births and low socioeconomic status neighborhoods. PMID:25453347

  11. Association between maternal comorbidity and preterm birth by severity and clinical subtype: retrospective cohort study

    Directory of Open Access Journals (Sweden)

    Le Thi

    2011-10-01

    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.

  12. Appearances of diffuse excessive high signal intensity (DEHSI) on MR imaging following preterm birth

    International Nuclear Information System (INIS)

    Hart, Anthony R.; Smith, Michael F.; Rigby, Alan S.; Wallis, Lauren I.; Whitby, Elspeth H.

    2010-01-01

    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.)

  13. Association between preterm birth and thoracic musculoskeletal static alterations in adolescents

    Directory of Open Access Journals (Sweden)

    Kessey M. B. Garcia

    2015-02-01

    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.

  14. A study of neonatal outcome associated with preterm birth in a tertiary care hospital

    International Nuclear Information System (INIS)

    Iqbal, I.; Azhar, I.A.

    2013-01-01

    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)

  15. Appearances of diffuse excessive high signal intensity (DEHSI) on MR imaging following preterm birth

    Energy Technology Data Exchange (ETDEWEB)

    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)

    2010-08-15

    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.)

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

    Directory of Open Access Journals (Sweden)

    Manalee Vishnu Surve

    2016-09-01

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

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

    Science.gov (United States)

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

    2016-01-01

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

  18. Treatment with magnesium sulphate in pre-term birth

    DEFF Research Database (Denmark)

    Wolf, Hans; Hegaard, H K; Greisen, G

    2012-01-01

    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...

  19. Socio-economic inequality in preterm birth: a comparative study of the Nordic countries from 1981 to 2000

    DEFF Research Database (Denmark)

    Petersen, Christina B; Mortensen, Laust H; Morgen, Camilla S

    2009-01-01

    During the 1980s and 1990s, there were large social and structural changes within the Nordic countries. Here we examine time changes in risks of preterm birth by maternal educational attainment in Denmark, Finland, Norway and Sweden. Information on gestational age and maternal socio-economic posi......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 (12 years of education, mothers with...

  20. Rapid multiplex high resolution melting method to analyze inflammatory related SNPs in preterm birth

    Directory of Open Access Journals (Sweden)

    Pereyra Silvana

    2012-01-01

    Full Text Available Abstract Background Complex traits like cancer, diabetes, obesity or schizophrenia arise from an intricate interaction between genetic and environmental factors. Complex disorders often cluster in families without a clear-cut pattern of inheritance. Genomic wide association studies focus on the detection of tens or hundreds individual markers contributing to complex diseases. In order to test if a subset of single nucleotide polymorphisms (SNPs from candidate genes are associated to a condition of interest in a particular individual or group of people, new techniques are needed. High-resolution melting (HRM analysis is a new method in which polymerase chain reaction (PCR and mutations scanning are carried out simultaneously in a closed tube, making the procedure fast, inexpensive and easy. Preterm birth (PTB is considered a complex disease, where genetic and environmental factors interact to carry out the delivery of a newborn before 37 weeks of gestation. It is accepted that inflammation plays an important role in pregnancy and PTB. Methods Here, we used real time-PCR followed by HRM analysis to simultaneously identify several gene variations involved in inflammatory pathways on preterm labor. SNPs from TLR4, IL6, IL1 beta and IL12RB genes were analyzed in a case-control study. The results were confirmed either by sequencing or by PCR followed by restriction fragment length polymorphism. Results We were able to simultaneously recognize the variations of four genes with similar accuracy than other methods. In order to obtain non-overlapping melting temperatures, the key step in this strategy was primer design. Genotypic frequencies found for each SNP are in concordance with those previously described in similar populations. None of the studied SNPs were associated with PTB. Conclusions Several gene variations related to the same inflammatory pathway were screened through a new flexible, fast and non expensive method with the purpose of analyzing

  1. Density of Stromal Cells and Macrophages Associated With Collagen Remodeling in the Human Cervix in Preterm and Term Birth.

    Science.gov (United States)

    Dubicke, Aurelija; Ekman-Ordeberg, Gunvor; Mazurek, Patricia; Miller, Lindsay; Yellon, Steven M

    2016-05-01

    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.

  2. Intestinal microbiota is different in women with preterm birth: results from terminal restriction fragment length polymorphism analysis.

    Directory of Open Access Journals (Sweden)

    Arihiro Shiozaki

    Full Text Available Preterm birth is a leading cause of perinatal morbidity and mortality. Studies using a cultivation method or molecular identification have shown that bacterial vaginosis is one of the risk factors for preterm birth. However, an association between preterm birth and intestinal microbiota has not been reported using molecular techniques, although the vaginal microbiota changes during pregnancy. Our aim here was to clarify the difference in intestinal and vaginal microbiota between women with preterm birth and women without preterm labor. 16S ribosomal ribonucleic acid genes were amplified from fecal and vaginal DNA by polymerase chain reaction. Using terminal restriction fragment length polymorphism (T-RFLP, we compared the levels of operational taxonomic units of both intestinal and vaginal flora among three groups: pregnant women who delivered term babies without preterm labor (non-PTL group (n = 20, those who had preterm labor but delivered term babies (PTL group (n = 11, and those who had preterm birth (PTB group (n = 10. Significantly low levels of Clostridium subcluster XVIII, Clostridium cluster IV, Clostridium subcluster XIVa, and Bacteroides, and a significantly high level of Lactobacillales were observed in the intestinal microbiota in the PTB group compared with those in the non-PTL group. The levels of Clostridium subcluster XVIII and Clostridium subcluster XIVa in the PTB group were significantly lower than those in the PTL group, and these levels in the PTL group were significantly lower than those in non-PTL group. However, there were no significant differences in vaginal microbiota among the three groups. Intestinal microbiota in the PTB group was found to differ from that in the non-PTL group using the T-RFLP method.

  3. Intestinal microbiota is different in women with preterm birth: results from terminal restriction fragment length polymorphism analysis.

    Science.gov (United States)

    Shiozaki, Arihiro; Yoneda, Satoshi; Yoneda, Noriko; Yonezawa, Rika; Matsubayashi, Takamichi; Seo, Genichiro; Saito, Shigeru

    2014-01-01

    Preterm birth is a leading cause of perinatal morbidity and mortality. Studies using a cultivation method or molecular identification have shown that bacterial vaginosis is one of the risk factors for preterm birth. However, an association between preterm birth and intestinal microbiota has not been reported using molecular techniques, although the vaginal microbiota changes during pregnancy. Our aim here was to clarify the difference in intestinal and vaginal microbiota between women with preterm birth and women without preterm labor. 16S ribosomal ribonucleic acid genes were amplified from fecal and vaginal DNA by polymerase chain reaction. Using terminal restriction fragment length polymorphism (T-RFLP), we compared the levels of operational taxonomic units of both intestinal and vaginal flora among three groups: pregnant women who delivered term babies without preterm labor (non-PTL group) (n = 20), those who had preterm labor but delivered term babies (PTL group) (n = 11), and those who had preterm birth (PTB group) (n = 10). Significantly low levels of Clostridium subcluster XVIII, Clostridium cluster IV, Clostridium subcluster XIVa, and Bacteroides, and a significantly high level of Lactobacillales were observed in the intestinal microbiota in the PTB group compared with those in the non-PTL group. The levels of Clostridium subcluster XVIII and Clostridium subcluster XIVa in the PTB group were significantly lower than those in the PTL group, and these levels in the PTL group were significantly lower than those in non-PTL group. However, there were no significant differences in vaginal microbiota among the three groups. Intestinal microbiota in the PTB group was found to differ from that in the non-PTL group using the T-RFLP method.

  4. Area-level poverty and preterm birth risk: A population-based multilevel analysis

    Science.gov (United States)

    DeFranco, Emily A; Lian, Min; Muglia, Louis A; Schootman, Mario

    2008-01-01

    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 rate of PTB poverty and increased through the 4th quartile (4.9%), p poverty was significantly associated with PTB risk. PTB risk (poverty, adjusted odds ratio (adjOR) 1.18 (95% CI 1.03, 1.35), with a similar effect at earlier gestational ages (birth, above other underlying risk factors. Although the risk increase is modest, it affects a large number of pregnancies. PMID:18793437

  5. The effects of preterm birth on mother-infant interaction and attachment during the infant's first two years.

    Science.gov (United States)

    Korja, Riikka; Latva, Reija; Lehtonen, Liisa

    2012-02-01

    Early mother-infant relationships in preterm populations were evaluated in the context of a systematic review of the literature. A systematic search of three electronic databases (PsychINFO, PubMed and Cochrane Library) was undertaken. Three studies of maternal attachment, 18 studies of mother-preterm infant interaction and eight studies of infant attachment were included. Studies of preterm infant attachment were also evaluated using a meta-analysis. Studies of mother-preterm infant interactions showed that the differences in maternal interaction behavior between mothers of preterm infants and mothers of full-term infants seem to be most evident during the first six months of life. Differences in the preterm infant's interaction behavior seem also to continue for six months after birth. However, five of 18 studies showed an equal or even higher quality of mother-infant interaction in groups of preterm compared to groups of full-term infants. Studies of maternal and infant attachment indicated that preterm infants and their mothers are not at higher risk of insecure attachment than full-term infants and their mothers. The mother-preterm infant relationship is complex, and some relational patterns forecast greater psychological risk than others. It is important to decrease maternal stress and early separation in every possible way during hospitalization as well as after discharge. © 2012 The Authors Acta Obstetricia et Gynecologica Scandinavica© 2012 Nordic Federation of Societies of Obstetrics and Gynecology.

  6. Traffic-related air pollution and risk of preterm birth in the San Joaquin Valley of California.

    Science.gov (United States)

    Padula, Amy M; Mortimer, Kathleen M; Tager, Ira B; Hammond, S Katharine; Lurmann, Frederick W; Yang, Wei; Stevenson, David K; Shaw, Gary M

    2014-12-01

    To evaluate associations between traffic-related air pollution during pregnancy and preterm birth in births in four counties in California during years 2000 to 2006. We used logistic regression to examine the association between the highest quartile of ambient air pollutants (carbon monoxide, nitrogen dioxide, particulate matter prematurity based on gestational age at birth (20-23, 24-27, 28-31, 32-33, and 34-36 weeks) versus term (37-42 weeks). We examined trimester averages and the last month and the last 6 weeks of pregnancy. Models were adjusted for birthweight, maternal age, race/ethnicity, education, prenatal care, and birth costs payment. Neighborhood socioeconomic status (SES) was evaluated as a potential effect modifier. There were increased odds ratios (ORs) for early preterm birth for those exposed to the highest quartile of each pollutant during the second trimester and the end of pregnancy (adjusted OR, 1.4-2.8). Associations were stronger among mothers living in low SES neighborhoods (adjusted OR, 2.1-4.3). We observed exposure-response associations for multiple pollutant exposures and early preterm birth. Inverse associations during the first trimester were observed. The results confirm associations between traffic-related air pollution and prematurity, particularly among very early preterm births and low SES neighborhoods.

  7. Preventing preterm births: analysis of trends and potential reductions with interventions in 39 countries with very high human development index.

    Science.gov (United States)

    Chang, Hannah H; Larson, Jim; Blencowe, Hannah; Spong, Catherine Y; Howson, Christopher P; Cairns-Smith, Sarah; Lackritz, Eve M; Lee, Shoo K; Mason, Elizabeth; Serazin, Andrew C; Walani, Salimah; Simpson, Joe Leigh; Lawn, Joy E

    2013-01-19

    Every year, 1·1 million babies die from prematurity, and many survivors are disabled. Worldwide, 15 million babies are born preterm (rates in almost all countries with reliable data. The understanding of drivers and potential benefit of preventive interventions for preterm births is poor. We examined trends and estimate the potential reduction in preterm births for countries with very high human development index (VHHDI) if present evidence-based interventions were widely implemented. This analysis is to inform a rate reduction target for Born Too Soon. Countries were assessed for inclusion based on availability and quality of preterm prevalence data (2000-10), and trend analyses with projections undertaken. We analysed drivers of rate increases in the USA, 1989-2004. For 39 countries with VHHDI with more than 10,000 births, we did country-by-country analyses based on target population, incremental coverage increase, and intervention efficacy. We estimated cost savings on the basis of reported costs for preterm care in the USA adjusted using World Bank purchasing power parity. From 2010, even if all countries with VHHDI achieved annual preterm birth rate reductions of the best performers for 1990-2010 (Estonia and Croatia), 2000-10 (Sweden and Netherlands), or 2005-10 (Lithuania, Estonia), rates would experience a relative reduction of less than 5% by 2015 on average across the 39 countries. Our analysis of preterm birth rise 1989-2004 in USA suggests half the change is unexplained, but important drivers include non-medically indicated labour induction and caesarean delivery and assisted reproductive technologies. For all 39 countries with VHHDI, five interventions modelling at high coverage predicted a 5% relative reduction of preterm birth rate from 9·59% to 9·07% of livebirths: smoking cessation (0·01 rate reduction), decreasing multiple embryo transfers during assisted reproductive technologies (0·06), cervical cerclage (0·15), progesterone

  8. Investigating the variations in survival rates for very preterm infants in ten European regions: the MOSAIC birth cohort

    DEFF Research Database (Denmark)

    Draper, Elizabeth S; Zeitlin, Jennifer; Fenton, Alan C

    2008-01-01

    OBJECTIVE: To investigate the variation in the survival rate and the mortality rates for very preterm infants across Europe. DESIGN: A prospective birth cohort of very preterm infants for ten geographically defined European regions during 2003 followed to discharge home from hospital. PARTICIPANTS...... to directly compare international statistics for mortality in very preterm infants, data collection needs to be standardised. We believe that the standard point of comparison should be using all those infants alive at the onset of labour as the denominator for comparisons of mortality rates for very preterm...... for NIC. For babies rates to discharge from NIC for very preterm deliveries and in the timing of death across the MOSAIC regions. In order...

  9. Association of prior HPV vaccination with reduced preterm birth: A population based study.

    Science.gov (United States)

    Lawton, Beverley; Howe, Anna S; Turner, Nikki; Filoche, Sara; Slatter, Tania; Devenish, Celia; Hung, Noelyn Anne

    2018-01-02

    Emerging evidence suggests that HPV infection is associated with negative pregnancy outcomes such as preterm birth (PTB), and pre-eclampsia. We aimed to determine if prior HPV vaccination reduced adverse pregnancy outcomes. A New Zealand population-based retrospective study linking first pregnancy outcome data (2008-2014 n = 35,646) with prior quadrivalent HPV vaccination status. Primary outcomes were likelihood (odds ratios, ORs) of PTB, pre-eclampsia, and stillbirth. Exposure groups were based on HPV vaccination. Adjusted ORs were calculated for each outcome, controlling for mother's age at delivery, ethnicity, socioeconomic status, health board region at time of delivery, and body mass index and smoking status at time of registration with maternity care provider. Mother's mean age at delivery was 19 (SD 2.1) years. Of 34,994 the pregnancies included in the final study analyses 62.3% of women were unvaccinated, 11.0% vaccinated with one or two doses and 27.7% vaccinated with three doses prior to pregnancy. PTB (OR: 0.87; CI 0.78, 0.96)) was significantly lower for women who previously received the HPV vaccine. A dose response effect was found with each successive dose received decreasing the likelihood of PTB. No associations between the vaccinated and unvaccinated groups were shown for pre-eclampsia or stillbirth. Prior receipt of the quadrivalent HPV vaccine was associated with a significant reduction in PTB (13%); suggesting that HPV vaccination may be effective in reducing PTB. The potential global public health impact is considerable and there is urgency to undertake further research to replicate and explore these findings. Copyright © 2017 Elsevier Ltd. All rights reserved.

  10. The impact of maternal celiac disease on birthweight and preterm birth: a Danish population-based cohort study.

    LENUS (Irish Health Repository)

    Khashan, A S

    2012-01-31

    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.

  11. Preterm birth and reduced birthweight in first and second teenage pregnancies: a register-based cohort study.

    LENUS (Irish Health Repository)

    Khashan, Ali S

    2010-01-01

    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.

  12. Preterm birth and reduced birthweight in first and second teenage pregnancies: a register-based cohort study

    Directory of Open Access Journals (Sweden)

    Baker Philip N

    2010-07-01

    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.

  13. Cognition, behavior and social competence of preterm low birth weight children at school age

    Directory of Open Access Journals (Sweden)

    Rachel Gick Fan

    2013-07-01

    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.

  14. Social disadvantage and the black-white disparity in spontaneous preterm delivery among California births.

    Directory of Open Access Journals (Sweden)

    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.

  15. Maternal periodontal disease and preterm birth: A case-control study

    Directory of Open Access Journals (Sweden)

    Pushpalatha Govindaraju

    2015-01-01

    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.

  16. Resveratrol protects from lipopolysaccharide-induced inflammation in the uterus and prevents experimental preterm birth.

    Science.gov (United States)

    Bariani, María Victoria; Correa, Fernando; Leishman, Emma; Domínguez Rubio, Ana Paula; Arias, Andreína; Stern, Aníbal; Bradshaw, Heather B; Franchi, Ana María

    2017-08-01

    pregnant BALB/c mice with resveratrol prevented the LPS-induced preterm birth in 64% of the cases, whereas only 15% of mice with LPS alone escaped preterm birth. Treatment with resveratrol resulted in a reduced NOS activity (P resveratrol reduced the expression of LPS-induced pro-inflammatory agents such as iNOS (P resveratrol administration resulted in changes in the uterine endocannabinoid profiling altered by LPS. N/A. Since our experimental design involves the use of mice, the extrapolation of the results presented here to humans is limited. Our findings provide evidence for the tocolytic effects of resveratrol. Dr Ana María Franchi was funded by Agencia Nacional para la Promoción Científica y Tecnológica (PICT 2013/0097) and by Consejo Nacional de Investigaciones Científicas y Técnicas (PIP 2012/0061). Dr Heather B. Bradshaw was funded by NIH (DA006668). The authors have no competing interests. © The Author 2017. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com

  17. Maternal Vitamin D Insufficiency Early in Pregnancy Is Associated with Increased Risk of Preterm Birth in Ethnic Minority Women in Canada.

    Science.gov (United States)

    Tabatabaei, Negar; Auger, Nathalie; Herba, Catherine M; Wei, Shuqin; Allard, Catherine; Fink, Guy D; Fraser, William D

    2017-06-01

    Background: Maternal vitamin D insufficiency (plasma 25-hydroxyvitamin D [25(OH)D] rates of preterm and spontaneous preterm births. Objective: We explored the relation between maternal plasma 25(OH)D concentration in the first trimester (8-14 wk of gestation) and the risk of preterm and spontaneous preterm births (birth (distribution of vitamin D status between cases and controls for 8 ethnic minority subgroups. We explored the association between maternal plasma 25(OH)D concentration and preterm and spontaneous preterm births with the use of splines in logistic regression by ethnicity. Results: The distributions of maternal vitamin D status (75 nmol/L) were different in preterm and spontaneous preterm birth cases compared with controls but only in women of ethnic minority ( P- trend = 0.003 and 0.024, respectively). Among ethnic subgroups, sub-Saharan Africans ( P -trend = 0.030) and Arab-West Asians ( P -trend = 0.045) showed an inverse relation between maternal vitamin D status and the risk of preterm birth. Maternal plasma 25(OH)D concentrations of 30 nmol/L were associated with 4.05 times the risk of preterm birth in the total ethnic minority population (95% CI: 1.16, 14.12; P = 0.028) relative to participants with a concentration of 75 nmol/L. In contrast, there was no such association among nonethnic women (OR: 0.94; 95% CI: 0.48, 1.82; P = 0.85). There was no association when we considered only spontaneous preterm births in the total ethnic minority population (OR: 1.75; 95% CI: 0.39, 7.79; P = 0.46). Conclusion: Vitamin D insufficiency is associated with an increased risk of preterm birth in ethnic minority women in Canada. © 2017 American Society for Nutrition.

  18. Association of light-to-moderate alcohol drinking in pregnancy with preterm birth and birth weight

    DEFF Research Database (Denmark)

    Strandberg-Larsen, Katrine; Poulsen, Gry; Bech, Bodil Hammer

    2017-01-01

    Women who drink light-to-moderately during pregnancy have been observed to have lower risk of unfavourable pregnancy outcomes than abstainers. This has been suggested to be a result of bias. In a pooled sample, including 193 747 live-born singletons from nine European cohorts, we examined...... alcohol. This decreased to 39% in 2000–2004, and 14% in 2005–2011. Before 2000, every additional drink was associated with reduced mean birth weight, whereas in 2005–2011, the mean birth weight increased with increasing intake. The period-specific associations between low-to-moderate drinking and birth...

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

    Directory of Open Access Journals (Sweden)

    Digna R Velez

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

  20. Treatment of vaginal candidiasis for the prevention of preterm birth: a systematic review and meta-analysis.

    Science.gov (United States)

    Roberts, Christine L; Algert, Charles S; Rickard, Kristen L; Morris, Jonathan M

    2015-03-21

    Recognition that ascending infection leads to preterm birth has led to a number of studies that have evaluated the treatment of vaginal infections in pregnancy to reduce preterm birth rates. However, the role of candidiasis is relatively unexplored. Our aim was to undertake a systematic review and meta-analysis to assess whether treatment of pregnant women with vulvovaginal candidiasis reduces preterm birth rates and other adverse birth outcomes. We undertook a systematic review and meta-analysis of published randomised controlled trials (RCTs) in which pregnant women were treated for vulvovaginal candidiasis (compared to placebo or no treatment) and where preterm birth was reported as an outcome. Trials were identified by searching the Cochrane Central Register of Controlled Trials, Medline and Embase databases to January 2014. Trial eligibility and outcomes were pre-specified. Two reviewers independently assessed the studies against the agreed criteria and extracted relevant data using a standard data extraction form. Meta-analysis was used to calculate pooled rate ratios (RR) and 95% confidence intervals (CI) using a fixed-effects model. There were two eligible RCTs both among women with asymptomatic candidiasis, with a total of 685 women randomised. Both trials compared treatment with usual care (no screening for, or treatment of, asymptomatic candidiasis). Data from one trial involved a post-hoc subgroup analysis (n = 586) of a larger trial of treatment of 4,429 women with asymptomatic infections in pregnancy and the other was a pilot study (n = 99). There was a significant reduction in spontaneous preterm births in treated compared with untreated women (meta-analysis RR = 0.36, 95% CI = 0.17 to 0.75). Other outcomes were reported by one or neither trial. This systematic review found two trials comparing the treatment of asymptomatic vaginal candidiasis in pregnancy for the outcome of preterm birth. Although the effect estimate suggests that

  1. Intimate partner violence during pregnancy and its association with preterm birth and low birth weight in Tanzania: A prospective cohort study

    Science.gov (United States)

    Mushi, Declare; Meyrowitsch, Dan Wolf; Manongi, Rachel; Rogathi, Jane Januarius; Gammeltoft, Tine; Rasch, Vibeke

    2017-01-01

    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 exposure to violence during pregnancy, and after delivery to estimate gestation age at delivery and birth weight. Logistic regression analysis was performed to assess the association between exposure to IPV during pregnancy and PTB and LBW while adjusting for possible confounders. In addition, stratified 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%: 1.3–6.5) and LBW (AOR = 3.2; CI 95%: 1.3–7.7). Women with previous adverse pregnancy outcomes and exposure to physical IPV had a further increased risk of PTB (AOR = 4.5; CI 95%: 1.5–13.7) and LBW (AOR = 4.8; CI 95%: 1.6–14.8) compared to those without previous history of adverse outcome. Conclusion Women who are exposed to IPV during pregnancy are at increased risk of PTB and LBW. The risk is even stronger if the women additionally have suffered a previous adverse pregnancy outcome. Interventions addressing IPV are urgently needed to prevent occurrence and reoccurrence of PTB and LBW. PMID:28235031

  2. The influence of multiple birth and bereavement on maternal and family outcomes 2 and 7years after very preterm birth.

    Science.gov (United States)

    Treyvaud, Karli; Aldana, Andrea C; Scratch, Shannon E; Ure, Alexandra M; Pace, Carmen C; Doyle, Lex W; Anderson, Peter J

    2016-09-01

    Psychological distress has been reported by mothers of infants born very preterm (VPT) and by mothers of multiples (twins and triplets). This study examined the influence of i) multiple birth and ii) bereavement associated with a multifetal pregnancy, on mental health, parenting stress and family functioning for mothers of children born VPT across early childhood. Participants were 162 mothers of 194 infants (129 singletons, 65 multiples) born at family functioning were assessed using the Parenting Stress Index and Family Assessment Device. Maternal mental health, stress and family functioning were similar in mothers of VPT singletons and multiples. However compared with mothers who had not experienced bereavement, mothers who had were 3.6 times [95% confidence interval (95% CI) 1.05, 12.5] more likely to report elevated anxiety symptoms and 3.6 times [95% CI 1.05, 12.3] more likely to report elevated depressive symptoms when their VPT child was seven years old. The results of this study highlight the need for monitoring and offering ongoing support to bereaved mothers with surviving VPT children. However, within the context of VPT birth, multiple birth does not increase the risk for maternal psychological distress in early childhood. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  3. Preterm Labor

    Science.gov (United States)

    Preterm labor is labor that starts before 37 completed weeks of pregnancy. It can lead to premature birth. Premature babies may face serious health risks. Symptoms of preterm labor include Contractions every 10 minutes or more often ...

  4. Parental occupation and preterm births: a nationwide epidemiological study in Sweden.

    Science.gov (United States)

    Li, Xinjun; Sundquist, Jan; Kane, Kimberly; Jin, Qianren; Sundquist, Kristina

    2010-11-01

    The hypothesis was that some occupations could lead to preterm birth (PTB) because of potential exposures to various agents. The objective in this nationwide follow-up study was to analyse the association between PTB and parental occupational groups, controlling for potential confounders. Data from the Swedish Medical Birth Register, in which all children born in Sweden from 1990 onward are registered with their parents, were linked to census data. Inclusion criteria for the study population were employment (both women and men) and age >20 years (women). There were 816,743 first singleton live births from 1990 to 2004, of whom 43,956 were PTBs. A total of 7659 of the 43,956 PTBs were very PTBs. Odds ratios (ORs) with 95% confidence intervals were calculated separately for mothers and fathers to estimate the odds of PTB and very PTB in 51 occupational groups (reference groups: mothers or fathers who were 'Technical, science research-related workers and physicians') and by family income level. Women and men with low family incomes had increased ORs of PTB and very PTB. Significantly increased ORs of PTB (including very PTB) were found in four maternal and nine paternal occupational groups after accounting for family income, geographic region of residence, civil status, smoking habits, maternal age at infant's birth and period of birth. Further studies should examine specific agents in those parental occupations that were associated with increased odds of PTB and very PTB. © 2010 Blackwell Publishing Ltd.

  5. Treatment of asymptomatic vaginal candidiasis in pregnancy to prevent preterm birth: an open-label pilot randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Rickard Kristen

    2011-03-01

    Full Text Available Abstract Background Although the connection between ascending infection and preterm birth is undisputed, research focused on finding effective treatments has been disappointing. However evidence that eradication of Candida in pregnancy may reduce the risk of preterm birth is emerging. We conducted a pilot study to assess the feasibility of conducting a large randomized controlled trial to determine whether treatment of asymptomatic candidiasis in early pregnancy reduces the incidence of preterm birth. Methods We used a prospective, randomized, open-label, blinded-endpoint (PROBE study design. Pregnant women presenting at Candida were randomized to 6-days of clotrimazole vaginal pessaries (100mg or usual care (screening result is not revealed, no treatment. The primary outcomes were the rate of asymptomatic vaginal candidiasis, participation and follow-up. The proposed primary trial outcome of spontaneous preterm birth Results Of 779 women approached, 500 (64% participated in candidiasis screening, and 98 (19.6% had asymptomatic vaginal candidiasis and were randomized to clotrimazole or usual care. Women were not inconvenienced by participation in the study, laboratory testing and medication dispensing were problem-free, and the follow-up rate was 99%. There was a tendency towards a reduction in spontaneous preterm birth among women with asymptomatic candidiasis who were treated with clotrimazole RR = 0.33, 95%CI 0.04-3.03. Conclusions A large, adequately powered, randomized trial of clotrimazole to prevent preterm birth in women with asymptomatic candidiasis is both feasible and warranted. Trial registration Australia and New Zealand Clinical Trials Register (ANZCTR: ACTRN12609001052224

  6. The effects of maternal depression, anxiety, and perceived stress during pregnancy on preterm birth: A systematic review.

    Science.gov (United States)

    Staneva, Aleksandra; Bogossian, Fiona; Pritchard, Margo; Wittkowski, Anja

    2015-09-01

    Experiencing psychological distress such as depression, anxiety, and/or perceived stress during pregnancy may increase the risk for adverse birth outcomes, including preterm birth. Clarifying the association between exposure and outcome may improve the understanding of risk factors for prematurity and guide future clinical and research practices. The aims of the present review were to outline the evidence on the risk of preterm associated with antenatal depression, anxiety, and stress. Four electronic database searches were conducted to identify quantitative population-based, multi-centre, cohort studies and randomised-controlled trial studies focusing on the association between antenatal depression, anxiety, and stress, and preterm birth published in English between 1980 and 2013. Of 1469 electronically retrieved articles, 39 peer-reviewed studies met the final selection criteria and were included in this review following the PRISMA and MOOSE review guidelines. Information was extracted on study characteristics; depression, anxiety and perceived stress were examined as separate and combined exposures. There is strong evidence that antenatal distress during the pregnancy increases the likelihood of preterm birth. Complex paths of significant interactions between depression, anxiety and stress, risk factors and preterm birth were indicated in both direct and indirect ways. The effects of pregnancy distress were associated with spontaneous but not with medically indicated preterm birth. Health practitioners engaged in providing perinatal care to women, such as obstetricians, midwives, nurses, and mental health specialists need to provide appropriate support to women experiencing psychological distress in order to improve outcomes for both mothers and infants. Copyright © 2015 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  7. Use of plastic bags to prevent hypothermia at birth in preterm infants--do they work at lower gestations?

    Science.gov (United States)

    Ibrahim, C P H; Yoxall, C W

    2009-02-01

    Hypothermia at birth is strongly associated with mortality and morbidity in preterm infants. Occlusive wrapping of preterm infants during resuscitation, including polythene bags have been shown to prevent hypothermia. To evaluate the effectiveness of the introduction of polythene bags at resuscitation of infants born below 30 weeks gestation in a large tertiary neonatal centre. Retrospective audit of admission temperatures of all infants born below 30 weeks gestation for two years before and two years after the introduction of polythene bags. Hypothermia was defined as admission axillary temperature bags. The main reduction in hypothermia was seen in infants born above 28 weeks gestation (19.4% vs. 3.9%, p = 0.017). There was no significant effect in infants born between 28 weeks and 30 weeks (29.3% vs. 24.8%, p = 0.58). Polythene bags are effective in reducing the incidence of hypothermia at admission in infants born below 30 weeks gestation. The benefit in infants born below 28 weeks gestation was only marginal. This is in contrast to previously published studies. This may be related to the comparatively low incidence of hypothermia at the study centre even prior to introduction of polythene bags.

  8. Developmental outcome of low birth-weight and preterm newborns: a re-view of current evidence

    Directory of Open Access Journals (Sweden)

    Farin Soleimani

    2013-12-01

    Full Text Available Low birth weight (LBW and preterm birth are one the most important causes of death in the world and therefore are considered as one of the major health problems. Global statistics demonstrates an increase in the prevalence of low birth weight in the developing countries. Low birth weight infants are exposed to complications such as major neurosensory impairements, cerebral palsy, cognitive and language delays, neuromotor developmental delay, blindness and hearing loss, behavioral and psychosocial disorders, learning difficulties and dysfunction in scholastic performances. The majority of infant's death and developmental disorders were due to disorders relating to prematurity and unspecified low birth weight. Infants weighing less than 2500 g, is a major determinant of both neonatal and infant mortality rates and, together with congenital anomalies (e.g., cardiac, central nervous system, and respiratory, contributes significantly to childhood morbidity. Various studies indicate that low birth weight infants are suffering from physiological and psychosocial disabilities, two to three times more than the other children. At school age, preterm and low birth weight infants have poorer physical growth, cognitive function, and school performance. These disadvantages appear to persist into adulthood and therefore have broad implications for society. Although the survival rates have increased dramatically and the incidence of morbidities has decreased, the complications are still considered to be associated with economical and social burdens. Most children with Low birth weight suffer from multiple disabilities. Therefore, they need special and consistent care. On demand of reducing the infant mortality rate, the need to decrease the complications in low birth weight and preterm infants should be considered by the policy makers in health care system. In this review article, we assessed current evidences on developmental outcomes of low birth weight and

  9. Ureaplasma parvum genotype, combined vaginal colonisation with Candida albicans, and spontaneous preterm birth in an Australian cohort of pregnant women.

    Science.gov (United States)

    Payne, Matthew S; Ireland, Demelza J; Watts, Rory; Nathan, Elizabeth A; Furfaro, Lucy L; Kemp, Matthew W; Keelan, Jeffrey A; Newnham, John P

    2016-10-18

    Detection of Ureaplasma, Mycoplasma and Candida spp. in the vagina during pregnancy has previously been associated with preterm birth (PTB). However, the prevalence of these microorganisms and the associated obstetric risks (likely to be population-specific) have not been determined in Australian women; furthermore, in the case of Ureaplasma spp., very few studies have attempted characterisation at the species level and none have examined genotype/serovar status to further refine risk assessment. In order to address these issues we sampled the vaginal fluid of 191 pregnant Australian women at three time points in pregnancy. Culture methods were used for detection of Ureaplasma spp. and Candida spp., and real-time PCR was used for speciation of U. parvum and U. urealyticum, non-albicans Candida spp., Mycoplasma hominis and Mycoplasma genitalium. High-resolution melt PCR was used to genotype U. parvum. Data on various lifestyle factors (including sex during pregnancy and smoking), antimicrobial use and pregnancy outcome were collected on all participants. Chi-square tests were used to assess the association of vaginal microorganisms with PTB. Detection of Ureaplasma spp. was higher among spontaneous PTB cases, specifically in the presence of U. parvum [77 % preterm (95 % confidence interval (CI) 50-100 %) vs. 36 % term (CI: 29-43 %), p = 0.004], but not U. urealyticum. The association with PTB strengthened when U. parvum genotype SV6 was detected (54 % preterm (CI: 22-85 %) vs. 15 % term (CI: 10-20 %), p = 0.002); this genotype was also present in 80 % (4/5) of cases of PTB Ureaplasma spp. in the vagina confers an increased risk of spontaneous PTB, findings which may be useful in risk assessment for identifying women who would benefit from antimicrobial treatment.

  10. Sex ratio at birth in India, its relation to birth order, sex of previous children and use of indigenous medicine.

    Directory of Open Access Journals (Sweden)

    Samiksha Manchanda

    Full Text Available OBJECTIVE: Sex-ratio at birth in families with previous girls is worse than those with a boy. Our aim was to prospectively study in a large maternal and child unit sex-ratio against previous birth sex and use of traditional medicines for sex selection. MAIN OUTCOME MEASURES: Sex-ratio among mothers in families with a previous girl and in those with a previous boy, prevalence of indigenous medicine use and sex-ratio in those using medicines for sex selection. RESULTS: Overall there were 806 girls to 1000 boys. The sex-ratio was 720:1000 if there was one previous girl and 178:1000 if there were two previous girls. In second children of families with a previous boy 1017 girls were born per 1000 boys. Sex-ratio in those with one previous girl, who were taking traditional medicines for sex selection, was 928:1000. CONCLUSION: Evidence from the second children clearly shows the sex-ratio is being manipulated by human interventions. More mothers with previous girls tend to use traditional medicines for sex selection, in their subsequent pregnancies. Those taking such medication do not seem to be helped according to expectations. They seem to rely on this method and so are less likely use more definitive methods like sex selective abortions. This is the first such prospective investigation of sex ratio in second children looked at against the sex of previous children. More studies are needed to confirm the findings.

  11. The treatment of bacterial vaginosis in pregnancy with clindamycin to reduce the risk of infection-related preterm birth

    DEFF Research Database (Denmark)

    Lamont, Ronald F.; Keelan, Jeffrey A.; Larsson, Per G.

    2017-01-01

    and Gynecology advised against the use of clindamycin for the treatment of bacterial vaginosis in pregnancy to reduce the risk of spontaneous preterm birth based on lack of evidence of efficacy. We believe that the evidence for the use of clindamycin for this indication is robust and that this recommendation...... was reached erroneously on the basis of flawed inclusion criteria: the inclusion of an unpublished study with poorly diagnosed bacterial vaginosis and the exclusion of an important pivotal study on the use of clindamycin in early pregnancy for the prevention of preterm birth. Had these errors been corrected...

  12. Vaginal progesterone combined with cervical pessary: A chance for pregnancies at risk for preterm birth?

    Science.gov (United States)

    Stricker, Nathanael; Timmesfeld, Nina; Kyvernitakis, Ioannis; Goerges, Janina; Arabin, Birgit

    2016-06-01

    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

  13. A randomized, controlled trial of the effectiveness of an early-intervention program in reducing parenting stress after preterm birth.

    Science.gov (United States)

    Kaaresen, Per Ivar; Rønning, John A; Ulvund, Stein Erik; Dahl, Lauritz B

    2006-07-01

    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

  14. Maternal Risk Factors for Preterm Birth in Murmansk County, Russia: A Registry-Based Study.

    Science.gov (United States)

    Usynina, Anna A; Postoev, Vitaly A; Grjibovski, Andrej M; Krettek, Alexandra; Nieboer, Evert; Odland, Jon Øyvind; Anda, Erik Eik

    2016-09-01

    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 (<18 years) or older (≥35 years) mothers, graduates of vocational schools, underweight, overweight/obese mothers, and smokers were at higher risk of moderate-to-late PTB. Secondary education, alcohol abuse, diabetes mellitus, or gestational diabetes were strongly associated with moderate-to-late and very PTB. The observed prevalence of PTB (6.9%) in 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.

  15. Rate of gestational weight gain, pre-pregnancy body mass index and preterm birth subtypes: a retrospective cohort study from Peru.

    Science.gov (United States)

    Carnero, A M; Mejía, C R; García, P J

    2012-07-01

    To examine the shape (functional form) of the association between the rate of gestational weight gain, pre-pregnancy body mass index (BMI), and preterm birth and its subtypes.   Retrospective cohort study.   National reference obstetric centre in Lima, Peru.   Pregnant women who delivered singleton babies during the period 2006-2009, resident in Lima, and beginning prenatal care at ≤ 12 weeks of gestation (n=8964).   Data were collected from the centre database. The main analyses consisted of logistic regression with fractional polynomial modelling.   Preterm birth and its subtypes.   Preterm birth occurred in 12.2% of women, being mostly idiopathic (85.7%). The rate of gestational weight gain was independently associated with preterm birth, and the shape of this association varied by pre-pregnancy BMI. In women who were underweight, the association was linear (per 0.1 kg/week increase) and protective (OR 0.88; 95% CI 0.82-1.00). In women of normal weight or who were overweight, the association was U-shaped: the odds of delivering preterm increased exponentially with rates 0.66 kg/week, and 0.50 kg/week, respectively. In women who were obese, the association was linear, but non-significant (OR 1.01; 95% CI 0.95-1.06). The association described for preterm birth closely resembled that of idiopathic preterm birth, although the latter was stronger. The rate of gestational weight gain was not associated with indicated preterm birth or preterm prelabour rupture of membranes.   In Peruvian pregnant women starting prenatal care at ≤ 12 weeks of gestation, the rate of gestational weight gain is independently associated with preterm birth, mainly because of its association with idiopathic preterm birth, and the shape of both associations varies by pre-pregnancy BMI. © 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG.

  16. Early term and late preterm birth are associated with poorer school performance at age 5 years: a cohort study.

    Science.gov (United States)

    Quigley, Maria A; Poulsen, Gry; Boyle, Elaine; Wolke, Dieter; Field, David; Alfirevic, Zarko; Kurinczuk, Jennifer J

    2012-05-01

    To compare school performance at age 5 years in children born at full term (39-41 weeks gestation) with those born at early term (37-38 weeks gestation), late preterm (34-36 weeks gestation), moderately preterm (32-33 weeks gestation) and very preterm (2000-2001 and attending school in England in 2006. School performance was measured using the foundation stage profile (FSP), a statutory assessment by teachers at the end of the child's first school year. The FSP comprises 13 assessment scales (scored from 1 to 9). Children who achieve an average of 6 points per scale and at least 6 in certain scales are classified as 'reaching a good level of overall achievement'. Fifty-one per cent of full term children had not reached a good level of overall achievement; this proportion increased with prematurity (55% in early term, 59% in late preterm, 63% in moderately preterm and 66% in very preterm children). Compared with full term children, an elevated risk remained after adjustment, even in early term (adjusted RR 1.05, 95% 1.00 to 1.11) and late preterm children (adjusted RR 1.12, 95% CI 1.04 to 1.22). Similar effects were noted for 'not working securely' in mathematical development, physical development and creative development. The effects of late preterm and early term birth were small in comparison with other risk factors. Late preterm and early term birth are associated with an increased risk of poorer educational achievement at age 5 years.

  17. Kangaroo position: Immediate effects on the physiological variables of preterm and low birth weight newborns

    Directory of Open Access Journals (Sweden)

    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.

  18. The administration of 100% oxygen and respiratory drive in very preterm infants at birth.

    Directory of Open Access Journals (Sweden)

    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.

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

    Science.gov (United States)

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

    2015-01-01

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

  20. Spontaneous preterm birth and single nucleotide gene polymorphisms: a recent update

    Directory of Open Access Journals (Sweden)

    Ishfaq A. Sheikh

    2016-10-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Kai P. Law

    2015-05-01

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

  2. Mother's Emotional and Posttraumatic Reactions after a Preterm Birth: The Mother-Infant Interaction Is at Stake 12 Months after Birth.

    Science.gov (United States)

    Petit, Anne-Cécile; Eutrope, Julien; Thierry, Aurore; Bednarek, Nathalie; Aupetit, Laurence; Saad, Stéphanie; Vulliez, Lauriane; Sibertin-Blanc, Daniel; Nezelof, Sylvie; Rolland, Anne-Catherine

    2016-01-01

    Very preterm infants are known to be at risk of developmental disabilities and behavioural disorders. This condition is supposed to alter mother-infant interactions. Here we hypothesize that the parental coping with the very preterm birth may greatly influence mother-infant interactions. 100 dyads were included in 3 university hospitals in France. Preterm babies at higher risk of neurodevelopmental sequelae (PRI>10) were excluded to target the maternal determinants of mother-infant interaction. We report the follow-up of this cohort during 1 year after very preterm birth, with regular assessment of infant somatic state, mother psychological state and the assessment of mother-infant interaction at 12 months by validated scales (mPPQ, HADS, EPDS, PRI, DDST and PIPE). We show that the intensity of post-traumatic reaction of the mother 6 months after birth is negatively correlated with the quality of mother-infant interaction at 12 months. Moreover, the anxious and depressive symptoms of the mother 6 and 12 months after birth are also correlated with the quality of mother-infant interaction at 12 months. By contrast, this interaction is not influenced by the initial affective state of the mother in the 2 weeks following birth. In this particular population of infants at low risk of sequelae, we also show that the quality of mother-infant interaction is not correlated with the assessment of the infant in the neonatal period but is correlated with the fine motor skills of the baby 12 months after birth. This study suggests that mothers' psychological condition has to be monitored during the first year of very preterm infants' follow-up. It also suggests that parental interventions have to be proposed when a post-traumatic, anxious or depressive reaction is suspected.

  3. Mother's Emotional and Posttraumatic Reactions after a Preterm Birth: The Mother-Infant Interaction Is at Stake 12 Months after Birth.

    Directory of Open Access Journals (Sweden)

    Anne-Cécile Petit

    Full Text Available Very preterm infants are known to be at risk of developmental disabilities and behavioural disorders. This condition is supposed to alter mother-infant interactions. Here we hypothesize that the parental coping with the very preterm birth may greatly influence mother-infant interactions.100 dyads were included in 3 university hospitals in France. Preterm babies at higher risk of neurodevelopmental sequelae (PRI>10 were excluded to target the maternal determinants of mother-infant interaction. We report the follow-up of this cohort during 1 year after very preterm birth, with regular assessment of infant somatic state, mother psychological state and the assessment of mother-infant interaction at 12 months by validated scales (mPPQ, HADS, EPDS, PRI, DDST and PIPE.We show that the intensity of post-traumatic reaction of the mother 6 months after birth is negatively correlated with the quality of mother-infant interaction at 12 months. Moreover, the anxious and depressive symptoms of the mother 6 and 12 months after birth are also correlated with the quality of mother-infant interaction at 12 months. By contrast, this interaction is not influenced by the initial affective state of the mother in the 2 weeks following birth. In this particular population of infants at low risk of sequelae, we also show that the quality of mother-infant interaction is not correlated with the assessment of the infant in the neonatal period but is correlated with the fine motor skills of the baby 12 months after birth.This study suggests that mothers' psychological condition has to be monitored during the first year of very preterm infants' follow-up. It also suggests that parental interventions have to be proposed when a post-traumatic, anxious or depressive reaction is suspected.

  4. Pre-term birth and low birth weight following preimplantation genetic diagnosis: analysis of 88 010 singleton live births following PGD and IVF cycles.

    Science.gov (United States)

    Sunkara, Sesh Kamal; Antonisamy, Belavendra; Selliah, Hepsy Y; Kamath, Mohan S

    2017-02-01

    Is PGD associated with the risk of adverse perinatal outcomes such as pre-term birth (PTB) and low birth weight (LBW)? There was no increase in the risk of adverse perinatal outcomes of PTB, and LBW following PGD compared with autologous IVF. Pregnancies resulting from ART are associated with a higher risk of pregnancy complications compared with spontaneously conceived pregnancies. The possible reason of adverse obstetric outcomes following ART has been attributed to the underlying infertility itself and embryo specific epigenetic modifications due to the IVF techniques. It is of interest whether interventions such as embryo biopsy as performed in PGD affect perinatal outcomes. Anonymous data were obtained from the Human Fertilization and Embryology Authority (HFEA), the statutory regulator of ART in the UK. The HFEA has collected data prospectively on all ART performed in the UK since 1991. Data from 1996 to 2011 involving a total of 88 010 singleton live births were analysed including 87 571 following autologous stimulated IVF ± ICSI and 439 following PGD cycles. Data on all women undergoing either a stimulated fresh IVF ± ICSI treatment cycle or a PGD cycle during the period from 1996 to 2011 were analysed to compare perinatal outcomes of PTB and LBW among singleton live births. Logistic regression analysis was performed adjusting for female age category, year of treatment, previous IVF cycles, infertility diagnosis, number of oocytes retrieved, whether IVF or ICSI was used and day of embryo transfer. There was no increase in the risk of PTB and LBW following PGD versus autologous stimulated IVF ± ICSI treatment, unadjusted odds of PTB (odds ratio (OR) 0.68, 95% CI: 0.46-0.99) and LBW (OR 0.56, 95% CI: 0.37-0.85). After adjusting for the potential confounders, there was again no increase in the risk of the adverse perinatal outcomes following PGD: PTB (adjusted odds ratio (aOR) 0.66, 95% CI: 0.45-0.98) and LBW (aOR 0.58, 95% CI: 0.38-0.88). Although the

  5. Racial/Ethnic Inequities in Low Birth Weight and Preterm Birth: The Role of Multiple Forms of Stress.

    Science.gov (United States)

    Almeida, Joanna; Bécares, Laia; Erbetta, Kristin; Bettegowda, Vani R; Ahluwalia, Indu B

    2018-02-13

    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 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.

  6. Alcohol consumption among first-time mothers and the risk of preterm birth: a cohort study.

    Science.gov (United States)

    Dale, Maria T G; Bakketeig, Leiv S; Magnus, Per

    2016-04-01

    Our aim was to explore the association between alcohol consumption, before and during pregnancy, and the risk of preterm birth among 46,252 primiparous mothers. We obtained information on alcohol consumption from questionnaire responses at pregnancy week 15 from the prospective, observational Norwegian Mother and Child Cohort Study. Data on preterm birth, categorized as delivery before gestation week 37, were retrieved from the Medical Birth Registry of Norway. Among the participants, 91% consumed alcohol before pregnancy and fewer than 20% reported consuming alcohol during pregnancy. The adjusted odds ratio (aOR) for preterm birth associated with prepregnancy alcohol consumption was 0.81 (95% confidence interval [CI], 0.70-0.95). We did not find a risk reduction for overall drinking during pregnancy, aOR = 1.03 (95% CI, 0.90-1.19). However, dose-response analyses showed tendencies toward adverse effects when drinking 1-3 times per month during the first 15 weeks of pregnancy, aOR = 1.51 (95% CI, 1.14-2.00). We did not find any effects of alcohol consumption during pregnancy, whereas pre-pregnancy drinking was associated with reduced risk of preterm birth. Residual confounding may have influenced the risk estimates, especially before pregnancy, as nondrinkers have lower socioeconomic status and well-being than drinkers. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Exploration of preterm birth rates associated with different models of antenatal midwifery care in Scotland: Unmatched retrospective cohort analysis.

    Science.gov (United States)

    Symon, Andrew; Winter, Clare; Cochrane, Lynda

    2015-06-01

    preterm birth represents a significant personal, clinical, organisational and financial burden. Strategies to reduce the preterm birth rate have had limited success. Limited evidence indicates that certain antenatal care models may offer some protection, although the causal mechanism is not understood. We sought to compare preterm birth rates for mixed-risk pregnant women accessing antenatal care organised at a freestanding midwifery unit (FMU) and mixed-risk pregnant women attending an obstetric unit (OU) with related community-based antenatal care. unmatched retrospective 4-year Scottish cohort analysis (2008-2011) of mixed-risk pregnant women accessing (i) FMU antenatal care (n=1107); (ii) combined community-based and OU antenatal care (n=7567). Data were accessed via the Information and Statistics Division of the NHS in Scotland. Aggregates analysis and binary logistic regression were used to compare the cohorts׳ rates of preterm birth; and of spontaneous labour onset, use of pharmacological analgesia, unassisted vertex birth, and low birth weight. Odds ratios were adjusted for age, parity, deprivation score and smoking status in pregnancy. after adjustment the 'mixed risk' FMU cohort had a statistically significantly reduced risk of preterm birth (5.1% [n=57] versus 7.7% [n=583]; AOR 0.73 [95% CI 0.55-0.98]; p=0.034). Differences in these secondary outcome measures were also statistically significant: spontaneous labour onset (FMU 83.9% versus OU 74.6%; AOR 1.74 [95% CI 1.46-2.08]; pbirth weight was not statistically significant after adjustment for other variables. There was no significant difference in the rate of perinatal or neonatal death. given this study׳s methodological limitations, we can only claim associations between the care model and or chosen outcomes. Although both cohorts were mixed risk, differences in risk levels could have contributed to these findings. Nevertheless, the significant difference in preterm birth rates in this study

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

    DEFF Research Database (Denmark)

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

    2013-01-01

    The aim of the study is to investigate the association between gestational age, birth size, and the long-term risk of maternal diabetes. We conducted a nation-wide prospective follow-up study of the cohort of all Danish women with a singleton delivery in 1982/1983 (index delivery) and no history...

  9. The relative proportion of preterm births complicated by premature rupture of membranes in multifetal gestations: a population-based study.

    Science.gov (United States)

    Pakrashi, Tarita; Defranco, Emily A

    2013-01-01

    To compare the relative contribution of premature rupture of membranes (PROM) to preterm births in singleton compared with multifetal gestations. A population-based retrospective cohort study of 291,782 nonanomalous live births in the state of Ohio from January 1, 2006, to December 31, 2007, identified through birth certificate data. Frequency of PROM was compared between singleton and multifetal gestations and then stratified by gestational age at birth. Multivariate regression analysis estimated the risk of PROM by plurality in each gestational age group, accounting for influential risk factors. The frequency of PROM increased with increasing plurality of gestation. The relative proportion of preterm birth < 37 weeks complicated by PROM increased with gestational plurality 13.2% singletons, 16.8% twins, 20.0% triplets, 19.6% quadruplets, and 100% for higher-order multiples (p < 0.001). The frequency of PROM increased with earlier gestational age at birth, regardless of plurality. The increased risk of PROM in multifetal gestation persisted even after adjustment for influential concomitant risk factors. The proportion of preterm birth attributable to PROM increases by plurality of gestation, with its most significant contribution in higher-order multiples and at earliest gestational ages when outcomes are the poorest. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  10. Outdoor air pollution, preterm birth, and low birth weight: analysis of the world health organization global survey on maternal and perinatal health.

    Science.gov (United States)

    Fleischer, Nancy L; Merialdi, Mario; van Donkelaar, Aaron; Vadillo-Ortega, Felipe; Martin, Randall V; Betran, Ana Pilar; Souza, João Paulo

    2014-04-01

    Inhaling fine particles (particulate matter with diameter ≤ 2.5 μm; PM2.5) can induce oxidative stress and inflammation, and may contribute to onset of preterm labor and other adverse perinatal outcomes. We examined whether outdoor PM2.5 was associated with adverse birth outcomes among 22 countries in the World Health Organization Global Survey on Maternal and Perinatal Health from 2004 through 2008. Long-term average (2001-2006) estimates of outdoor PM2.5 were assigned to 50-km-radius circular buffers around each health clinic where births occurred. We used generalized estimating equations to determine associations between clinic-level PM2.5 levels and preterm birth and low birth weight at the individual level, adjusting for seasonality and potential confounders at individual, clinic, and country levels. Country-specific associations were also investigated. Across all countries, adjusting for seasonality, PM2.5 was not associated with preterm birth, but was associated with low birth weight [odds ratio (OR) = 1.22; 95% CI: 1.07, 1.39 for fourth quartile of PM2.5 (> 20.2 μg/m3) compared with the first quartile (levels of air pollution may be of concern for both outcomes.

  11. The impact of low-dose aspirin on preterm birth: secondary analysis of a randomized controlled trial.

    Science.gov (United States)

    Allshouse, A A; Jessel, R H; Heyborne, K D

    2016-06-01

    The objective of this study is to determine whether low-dose aspirin (LDA) reduced the rate of preterm birth (PTB) in a cohort of women at high risk for preeclampsia. Secondary analysis of the Maternal-Fetal Medicine Units High-Risk Aspirin trial. Preterm births were categorized by phenotype: indicated, spontaneous or due to preterm premature rupture of membranes (PPROMs). Of 1789 randomized women, 30.5% delivered before 37 weeks (18.5% indicated, 5.8% spontaneous and 6.2% following preterm PPROMs). Among women randomized to LDA, we observed a trend favoring fewer PTBs due to spontaneous preterm labor and preterm PPROMs, odds ratio (OR: 0.826 (0.620, 1.099)); the incidence of indicated PTBs appeared unchanged, OR: 0.999 (0.787, 1.268). Although not reaching significance, we observed an effect size similar to other studies of both low- and high-risk women. These results support findings from other studies assessing LDA as a PTB prevention strategy.

  12. Association between prenatal care utilization and risk of preterm birth among Chinese women.

    Science.gov (United States)

    Zhang, Bin; Yang, Rong; Liang, Sheng-Wen; Wang, Jing; Chang, Jen Jen; Hu, Ke; Dong, Guang-Hui; Hu, Rong-Hua; Flick, Louise H; Zhang, Yi-Ming; Zhang, Dan; Li, Qing-Jie; Zheng, Tong-Zhang; Xu, Shun-Qing; Yang, Shao-Ping; Qian, Zheng-Min

    2017-08-01

    It is recognized that prenatal care plays an important role in reducing adverse birth. Chinese pregnant women with medical condition were required to seek additional health care based on the recommended at least 5 times health care visits. This study was to estimate the association between prenatal care utilization (PCU) and preterm birth (PTB), and to investigate if medical conditions during pregnancy modified the association. This population-based case control study sampled women with PTB as cases; one control for each case was randomly selected from women with term births. The Electronic Perinatal Health Care Information System (EPHCIS) and a questionnaire were used for data collection. The PCU was measured by a renewed Prenatal Care Utilization (APNCU) index. Logistic regression models were used to estimate odds ratios (OR) and the 95% confidence interval (95% CI). Totally, 2393 women with PTBs and 4263 women with term births were collected. In this study, 695 (10.5%) women experienced inadequate prenatal care, and 5131 (77.1%) received adequate plus prenatal care. Inadequate PCU was associated with PTB (adjusted OR: 1.41, 95% CI: 1.32-1.84); the similar positive association was found between adequate plus PCU and PTB. Among women with medical conditions, these associations still existed; but among women without medical conditions, the association between inadequate PCU and PTB disappeared. Our data suggests that women receiving inappropriate PCU are at an increased risk of having PTB, but it does depend on whether the woman has a medical condition during pregnancy.

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

    Science.gov (United States)

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

    2016-02-01

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

  14. Parental bonding after preterm birth: child and parent perspectives in the Helsinki study of very low birth weight adults.

    Science.gov (United States)

    Pyhälä, Riikka; Räikkönen, Katri; Pesonen, Anu-Katriina; Heinonen, Kati; Lahti, Jari; Hovi, Petteri; Strang-Karlsson, Sonja; Andersson, Sture; Eriksson, Johan G; Järvenpää, Anna-Liisa; Kajantie, Eero

    2011-02-01

    To examine whether parenting behavior recalled by very low birth weight (VLBW) adults or their parents differs from that of term-born control subjects or their parents. A total of 164 VLBW and 172 control adults (mean age 22.5 years, SD 2.2) assessed retrospectively the parenting behavior of their parents by the Parental Bonding Instrument, which includes dimensions of care, protectiveness, and authoritarianism. A subgroup of 190 mothers and 154 fathers assessed their own parenting behavior by the Parent Behavior Inventory, which includes dimensions of supportive and hostile parenting. The VLBW women assessed their mothers as more protective and authoritarian than the control women. The VLBW and control men did not differ from each other. Both mothers and fathers of the VLBW adults assessed their own parenting as more supportive than those of the control subjects. Preterm birth at VLBW may promote a more protective, as well as more supportive, parenting style. Copyright © 2011 Mosby, Inc. All rights reserved.

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

    DEFF Research Database (Denmark)

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

    2014-01-01

    OBJECTIVE: To assess indicators of fetal growth and risk of preterm birth in children of parents with rheumatoid arthritis (RA). METHODS: Through linkage of Danish national registries, we identified all children born in Denmark between 1977 and 2008. We used general linear regression models...... to estimate mean differences in indicators of fetal growth among children with a parent with RA compared to unexposed children. Odds ratios (ORs) and 95% confidence intervals (95% CIs) of preterm birth were calculated using a logistic regression model. RESULTS: Of the 1,917,723 children included, a total...... of 13,556 children were exposed to maternal RA or maternal preclinical RA. Children exposed to maternal RA (n = 2,101) had approximately similar length, head circumference, and abdominal circumference at birth compared with children of mothers without RA. Birth weight was 87 gm lower (mean difference...

  16. [The connection between maltreatment and preterm birth - in the light of psychomotor development at 2 years old].

    Science.gov (United States)

    Szele, Anna Szabina; Nagy, Beáta Erika

    2017-06-01

    Preterm children' development and harmful affecting factors to development are important aspects of public health, because in our country the number of preterm birth is very high. Description of psychomotor development of preterm children (Brunet-Lézine; Bayley-III) and connection between psychomotor development and maternal abuse history (own questionnaire). Extremely (psychomotor development quotients and higher development risk. Strong associations were found between maternal history of childhood abuse and the development quotients. We would like to draw attention to the importance of assessing preterm children, as well as to the importance of maltreatment and the severity of its consequences. With the early recognition of necessity for developmental interventions we can prevent problems in the future. Orv Hetil. 2017; 158(25): 976-983.

  17. High-risk of preterm birth and low birth weight after oocyte donation IVF: analysis of 133,785 live births.

    Science.gov (United States)

    Kamath, Mohan Shashikant; Antonisamy, Belavendra; Mascarenhas, Mariano; Sunkara, Sesh Kamal

    2017-09-01

    A higher risk of pregnancy complications occurs after assisted reproductive techniques compared with spontaneously conceived pregnancies. This is attributed to the underlying infertility and assisted reproduction technique procedures involved during treatment. It is a matter of interest whether use of donor oocytes affects perinatal outcomes compared with pregnancies after autologous IVF. Anonymized data were obtained from the Human Fertilization and Embryology Authority. The analysis included 5929 oocyte donation and 127,856 autologous IVF live births. Data from all women who underwent donor oocyte recipient or autologous IVF cycles, both followed with fresh embryo transfer, were analysed to compare perinatal outcomes of preterm birth (PTB) and low birthweight (LBW) after singleton and multiple live births. The risk of adverse perinatal outcomes after oocyte donation was increased: adjusted OR (aOR) 1.56, 99.5% CI 1.34 to 1.80 for PTB and aOR 1.43, 99.5% CI 1.24 to 1.66 for LBW were significantly higher after oocyte donation compared with autologous IVF singletons. The adjusted odds PTB (aOR 1.21, 99.5% CI 1.02 to 1.43) was significantly higher after oocyte donation compared with autologous IVF multiple births. Analysis of this large dataset suggests significantly higher risk of PTB and LBW after ooctye donation compared with autologous IVF pregnancies. Copyright © 2017 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

  18. Preterm birth, infant weight gain, and childhood asthma risk: a meta-analysis of 147,000 European children.

    Science.gov (United States)

    Sonnenschein-van der Voort, Agnes M M; Arends, Lidia R; de Jongste, Johan C; Annesi-Maesano, Isabella; Arshad, S Hasan; Barros, Henrique; Basterrechea, Mikel; Bisgaard, Hans; Chatzi, Leda; Corpeleijn, Eva; Correia, Sofia; Craig, Leone C; Devereux, Graham; Dogaru, Cristian; Dostal, Miroslav; Duchen, Karel; Eggesbø, Merete; van der Ent, C Kors; Fantini, Maria P; Forastiere, Francesco; Frey, Urs; Gehring, Ulrike; Gori, Davide; van der Gugten, Anne C; Hanke, Wojciech; Henderson, A John; Heude, Barbara; Iñiguez, Carmen; Inskip, Hazel M; Keil, Thomas; Kelleher, Cecily C; Kogevinas, Manolis; Kreiner-Møller, Eskil; Kuehni, Claudia E; Küpers, Leanne K; Lancz, Kinga; Larsen, Pernille S; Lau, Susanne; Ludvigsson, Johnny; Mommers, Monique; Nybo Andersen, Anne-Marie; Palkovicova, Lubica; Pike, Katharine C; Pizzi, Costanza; Polanska, Kinga; Porta, Daniela; Richiardi, Lorenzo; Roberts, Graham; Schmidt, Anne; Sram, Radim J; Sunyer, Jordi; Thijs, Carel; Torrent, Maties; Viljoen, Karien; Wijga, Alet H; Vrijheid, Martine; Jaddoe, Vincent W V; Duijts, Liesbeth

    2014-05-01

    Preterm birth, low birth weight, and infant catch-up growth seem associated with an increased risk of respiratory diseases in later life, but individual studies showed conflicting results. We performed an individual participant data meta-analysis for 147,252 children of 31 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). 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. 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 infant weight gain, we observed the highest risks of school-age asthma in children born preterm with high infant weight gain (odds ratio [OR], 4.47; 95% CI, 2.58-7.76). Preterm birth was positively associated with an increased risk of preschool wheezing (pooled odds ratio [pOR], 1.34; 95% CI, 1.25-1.43) and school-age asthma (pOR, 1.40; 95% CI, 1.18-1.67) independent of birth weight. Weaker effect estimates were observed for the associations of low birth weight adjusted for gestational age at birth with preschool wheezing (pOR, 1.10; 95% CI, 1.00-1.21) and school-age asthma (pOR, 1.13; 95% CI, 1.01-1.27). Younger gestational age at birth and higher infant weight gain were associated with childhood asthma outcomes. The associations of lower birth weight with childhood asthma were largely explained by gestational age at birth. Copyright © 2014 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights

  19. Preterm birth, infant weight gain, and childhood asthma risk: A meta-analysis of 147,000 European children

    Science.gov (United States)

    Sonnenschein-van der Voort, Agnes M.M.; Arends, Lidia R.; de Jongste, Johan C.; Annesi-Maesano, Isabella; Arshad, S. Hasan; Barros, Henrique; Basterrechea, Mikel; Bisgaard, Hans; Chatzi, Leda; Corpeleijn, Eva; Correia, Sofia; Craig, Leone C.; Devereux, Graham; Dogaru, Cristian; Dostal, Miroslav; Duchen, Karel; Eggesbø, Merete; van der Ent, C. Kors; Fantini, Maria P.; Forastiere, Francesco; Frey, Urs; Gehring, Ulrike; Gori, Davide; van der Gugten, Anne C.; Hanke, Wojciech; Henderson, A. John; Heude, Barbara; Iñiguez, Carmen; Inskip, Hazel M.; Keil, Thomas; Kelleher, Cecily C.; Kogevinas, Manolis; Kreiner-Møller, Eskil; Kuehni, Claudia E.; Küpers, Leanne K.; Lancz, Kinga; Larsen, Pernille S.; Lau, Susanne; Ludvigsson, Johnny; Mommers, Monique; Nybo Andersen, Anne-Marie; Palkovicova, Lubica; Pike, Katharine C.; Pizzi, Costanza; Polanska, Kinga; Porta, Daniela; Richiardi, Lorenzo; Roberts, Graham; Schmidt, Anne; Sram, Radim J.; Sunyer, Jordi; Thijs, Carel; Torrent, Maties; Viljoen, Karien; Wijga, Alet H.; Vrijheid, Martine; Jaddoe, Vincent W.V.; Duijts, Liesbeth

    2014-01-01

    Background Preterm birth, low birth weight, and infant catch-up growth seem associated with an increased risk of respiratory diseases in later life, but individual studies showed conflicting results. Objectives We performed an individual participant data meta-analysis for 147,252 children of 31 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 infant weight gain, we observed the highest risks of school-age asthma in children born preterm with high infant weight gain (odds ratio [OR], 4.47; 95% CI, 2.58-7.76). Preterm birth was positively associated with an increased risk of preschool wheezing (pooled odds ratio [pOR], 1.34; 95% CI, 1.25-1.43) and school-age asthma (pOR, 1.40; 95% CI, 1.18-1.67) independent of birth weight. Weaker effect estimates were observed for the associations of low birth weight adjusted for gestational age at birth with preschool wheezing (pOR, 1.10; 95% CI, 1.00-1.21) and school-age asthma (pOR, 1.13; 95% CI, 1.01-1.27). Conclusion Younger gestational age at birth and higher infant weight gain were associated with childhood asthma outcomes. The associations of lower birth weight with childhood asthma were largely explained by gestational age at birth. PMID:24529685

  20. The vaginal microbiome, vaginal anti-microbial defence mechanisms and the clinical challenge of reducing infection-related preterm birth.

    Science.gov (United States)

    Witkin, S S

    2015-01-01

    Ascending bacterial infection is implicated in about 40-50% of preterm births. The human vaginal microbiota in most women is dominated by lactobacilli. In women whose vaginal microbiota is not lactobacilli-dominated anti-bacterial defence mechanisms are reduced. The enhanced proliferation of pathogenic bacteria plus degradation of the cervical barrier increase bacterial passage into the endometrium and amniotic cavity and trigger preterm myometrial contractions. Evaluation of protocols to detect the absence of lactobaciili dominance in pregnant women by self-measuring vaginal pH, coupled with measures to promote growth of lactobacilli are novel prevention strategies that may reduce the occurrence of preterm birth in low-resource areas. © 2014 Royal College of Obstetricians and Gynaecologists.

  1. [Mortality in the first 24h of very low birth weight preterm infants in the Northeast of Brazil].

    Science.gov (United States)

    Castro, Eveline Campos Monteiro de; Leite, Álvaro Jorge Madeiro; Guinsburg, Ruth

    2016-01-01

    To evaluate factors associated with neonatal death within 24 hours after birth in very low birth weight preterm newborns. Prospective cohort of live births with gestational age of 23(0/7)-31(6/7) 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. 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 vitality at birth and a worse infrastructure of the hospital where the birth occurred. Copyright © 2015 Sociedade de Pediatria de São Paulo. Publicado por Elsevier Editora Ltda. All rights reserved.

  2. Ethnic and racial disparities in the risk of preterm birth: a systematic review and meta-analysis

    NARCIS (Netherlands)

    Schaaf, Jelle M.; Liem, Sophie M. S.; Mol, Ben Willem J.; Abu-Hanna, Ameen; Ravelli, Anita C. J.

    2013-01-01

    The aim of this study is to present a systematic review of available literature on the effect of maternal ethnicity (Africans/blacks, Asians, Hispanics, others) on the risk of preterm birth (PTB). Studies investigating ethnicity (or race) as a risk factor for PTB were included if performing

  3. Polymorphisms in NR5A2, gene encoding liver receptor homolog-1 are associated with preterm birth

    DEFF Research Database (Denmark)

    Kaluarachchi, D. C.; Momany, A. M.; Busch, T. D.

    2016-01-01

    Preterm birth (PTB) is a major cause of neonatal mortality and morbidity. There is strong evidence of genetic susceptibility. Objective of this study was to identify genetic variants contributing to PTB.Methods:Genotyping was performed for 24 single nucleotide polymorphisms (SNPs) in 4 candidate...

  4. Limited effects of preterm birth and the first enteral nutrition on cerebellum morphology and gene expression in piglets

    DEFF Research Database (Denmark)

    Bergström, Anders; Kaalund, Sanne S.; Skovgaard, Kerstin

    2016-01-01

    three ages but the proportion of white matter increased postnatally, relative to term pigs. Early initiation of enteral nutrition had limited structural or molecular effects. The Sonic Hedgehog pathway was unaffected by preterm birth. Few differences in expression of the selected genes were found...

  5. Meta-analysis of neurobehavioral outcomes in very preterm and/or very low birth weight children

    NARCIS (Netherlands)

    C.S.H. Aarnoudse-Moens (Cornelieke); N. Weisglas-Kuperus (Nynke); J.B. van Goudoever (Hans); J. Oosterlaan (Jaap)

    2009-01-01

    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,

  6. The role of immunonutrients in the prevention of necrotizing enterocolitis in preterm very low birth weight infants

    DEFF Research Database (Denmark)

    Zhou, Ping; Li, Yanqi; Ma, Li-Ya

    2015-01-01

    Necrotizing enterocolitis (NEC) is a critical intestinal emergency condition, which mainly occurs in preterm very low birth weight (PVLBW) infants. Despite remarkable advances in the care of PVLBW infants, with considerable improvement of the survival rate in recent decades, the incidence of NEC...

  7. Prospective validation of a prognostic model for respiratory syncytial virus bronchiolitis in late preterm infants: a multicenter birth cohort study

    NARCIS (Netherlands)

    Blanken, M.O.; Koffijberg, H.; Nibbelke, E.E.; Rovers, M.M.; Bont, L.; Liem, K.D.; et al.,

    2013-01-01

    OBJECTIVES: This study aimed to update and validate a prediction rule for respiratory syncytial virus (RSV) hospitalization in preterm infants 33-35 weeks gestational age (WGA). STUDY DESIGN: The RISK study consisted of 2 multicenter prospective birth cohorts in 41 hospitals. Risk factors were

  8. Cervical length measurement for the prediction of preterm birth in multiple pregnancies : a systematic review and bivariate meta-analysis

    NARCIS (Netherlands)

    Lim, A. C.; Hegeman, M. A.; In 't Veld, M. A. Huis; Opmeer, B. C.; Bruinse, H. W.; Mol, B. W. J.

    Objectives To review the literature on cervical length as a predictor of preterm birth in asymptomatic women with a multiple pregnancy. Methods We searched MEDLINE, Embase and reference lists of included articles to identify all studies that reported on the accuracy of cervical length for predicting

  9. Spatial-temporal modeling of the association between air pollution exposure and preterm birth: identifying critical windows of exposure.

    Science.gov (United States)

    Warren, Joshua; Fuentes, Montserrat; Herring, Amy; Langlois, Peter

    2012-12-01

    Exposure to high levels of air pollution during the pregnancy is associated with increased probability of preterm birth (PTB), a major cause of infant morbidity and mortality. New statistical methodology is required to specifically determine when a particular pollutant impacts the PTB outcome, to determine the role of different pollutants, and to characterize the spatial variability in these results. We develop a new Bayesian spatial model for PTB which identifies susceptible windows throughout the pregnancy jointly for multiple pollutants (PM(2.5) , ozone) while allowing these windows to vary continuously across space and time. We geo-code vital record birth data from Texas (2002-2004) and link them with standard pollution monitoring data and a newly introduced EPA product of calibrated air pollution model output. We apply the fully spatial model to a region of 13 counties in eastern Texas consisting of highly urban as well as rural areas. Our results indicate significant signal in the first two trimesters of pregnancy with different pollutants leading to different critical windows. Introducing the spatial aspect uncovers critical windows previously unidentified when space is ignored. A proper inference procedure is introduced to correctly analyze these windows. © 2012, The International Biometric Society.

  10. Blood glucose levels within 7 days after birth in preterm infants according to gestational age

    Directory of Open Access Journals (Sweden)

    Ju Young Yoon

    2015-12-01

    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.

  11. Very Preterm Birth and Parents' Quality of Life 27 Years Later.

    Science.gov (United States)

    Wolke, Dieter; Baumann, Nicole; Busch, Barbara; Bartmann, Peter

    2017-09-01

    Parents of preterm children experience increased distress early in their children's lives. Whether the quality of life of parents of preterm children is comparable to that of parents of term children by the time their offspring reach adulthood is unknown. What precursors in their offspring's childhood predict parental quality of life? A prospective whole-population study in Germany followed very preterm (VP) (parents (VP or VLBW: N = 219; term: N = 227) from birth to adulthood. Parental quality of life was evaluated with the World Health Organization Quality of Life assessment and the Satisfaction with Life questionnaire when their offspring were adults (mean age 27.3 years, 95% confidence interval [CI]: 27.2 to 27.3). Childhood standard assessments of VP or VLBW and term offspring included neurosensory disability, academic achievement, mental health, and parent-child and peer relationships. Overall quality of life of parents of VP or VLBW adults was found to be comparable to parents of term individuals ( P > .05). Parental quality of life was not predicted by their children being born VP or VLBW, experiencing disability, academic achievement, or the parent-child relationship in childhood but by their offspring's mental health (B = 0.15, 95% CI: 0.08 to 0.22) and peer relationships (B = 0.09, 95% CI: 0.02 to 0.16) in childhood. As a testament to resilience, parents of VP or VLBW adults had quality of life comparable to parents of term adults. Support and interventions to improve mental health and peer relationships in all children are likely to improve parents' quality of life. Copyright © 2017 by the American Academy of Pediatrics.

  12. Probiotics, prebiotics infant formula use in preterm or low birth weight infants: a systematic review

    Science.gov (United States)

    2012-01-01

    Background Previous reviews (2005 to 2009) on preterm infants given probiotics or prebiotics with breast milk or mixed feeds focused on prevention of Necrotizing Enterocolitis, sepsis and diarrhea. This review assessed if probiotics, prebiotics led to improved growth and clinical outcomes in formula fed preterm infants. Methods Cochrane methodology was followed using randomized controlled trials (RCTs) which compared preterm formula containing probiotic(s) or prebiotic(s) to conventional preterm formula in preterm infants. The mean difference (MD) and corresponding 95% confidence intervals (CI) were reported for continuous outcomes, risk ratio (RR) and corresponding 95% CI for dichotomous outcomes. Heterogeneity was assessed by visual inspection of forest plots and a chi2 test. An I2 test assessed inconsistencies across studies. I2> 50% represented substantial heterogeneity. Results Four probiotics studies (N=212), 4 prebiotics studies (N=126) were included. Probiotics: There were no significant differences in weight gain (MD 1.96, 95% CI: -2.64 to 6.56, 2 studies, n=34) or in maximal enteral feed (MD 35.20, 95% CI: -7.61 to 78.02, 2 studies, n=34), number of stools per day increased significantly in probiotic group (MD 1.60, 95% CI: 1.20 to 2.00, 1 study, n=20). Prebiotics: Galacto-oligosaccharide / Fructo-oligosaccharide (GOS/FOS) yielded no significant difference in weight gain (MD 0.04, 95% CI: -2.65 to 2.73, 2 studies, n=50), GOS/FOS yielded no significant differences in length gain (MD 0.01, 95% CI: -0.03 to 0.04, 2 studies, n=50). There were no significant differences in head growth (MD −0.01, 95% CI: -0.02 to 0.00, 2 studies, n=76) or age at full enteral feed (MD −0.79, 95% CI: -2.20 to 0.61, 2 studies, n=86). Stool frequency increased significantly in prebiotic group (MD 0.80, 95% CI: 0.48 to 1.1, 2 studies, n=86). GOS/FOS and FOS yielded higher bifidobacteria counts in prebiotics group (MD 2.10, 95% CI: 0.96 to 3.24, n=27) and (MD 0.48, 95% CI: 0

  13. The temperament of pre-term, low birth weight infants and its potential biological substrates.

    Science.gov (United States)

    Weiss, Sandra J; Jonn-Seed, Mary St; Wilson, Peggy

    2004-12-01

    Temperament profiles of pre-term, low birth weight (LBW) infants were assessed at 6 months of age using standardized norms from the Revised Infant Temperament Questionnaire (RITQ). The contributions of perinatal risk, ethnicity, and gender to various temperament dimensions were examined. The sample included 152 infants with a mean birth weight of 1687 g and a mean gestational age of 31 weeks. Eighty percent of the infants were classified as having temperaments that were difficult to manage. Irregularity of the infants' biorhythms, slowness in their ability to adapt to changes, and distractibility were the most problematic.