FIGO good practice recommendations on modifiable causes of iatrogenic preterm birth

Respiratory morbidity among offspring misclassified as growth restricted

OBJECTIVE

An ultrasound-based diagnosis implies that some fetuses suspected to be growth-restricted (FGR) are discovered at birth to be appropriately grown (appropriate for gestational age [AGA] birth weight, between the 10th and 90th percentile). These fetuses may thus be exposed to unnecessary medical interventions, including early labor induction. In this study, we have evaluated the long-term respiratory health of offspring misclassified as FGR.

STUDY DESIGN

A population-based cohort analysis was conducted, including deliveries of AGA singletons between 1991 and 2021 at a tertiary referral hospital. Incidence of morbidity due to various respiratory conditions was compared between AGA offspring with prenatal diagnosis of FGR, and those without a false diagnosis of FGR. The Kaplan-Meier approach was used to estimate cumulative morbidity incidence. The stratified Cox proportional-hazards model was used to control for confounders.

RESULTS

A total of 324,620 deliveries of AGA newborns were included in the analyses; 3249 of them (1.0%) were misclassified prenatally as FGR. The FGR subgroup delivered at an earlier gestational age (36.7 vs. 39.1 weeks, p < .001) and had more than 25% higher incidence of respiratory-related morbidity during childhood (33.2% vs. 26.5%), specifically related to asthma and obstructive sleep apnea (p < .001 for all). A higher cumulative morbidity rate due to respiratory conditions was observed in the Kaplan-Meier survival curve (log-rank p value < .001). This association between FGR and respiratory morbidity was independent of preterm delivery, maternal age, cesarean delivery, and child's birth year (adjusted hazard ratio = 1.14, 95% confidence interval: 1.07-1.21, p < .001), using a Cox proportional hazards model.

CONCLUSION

AGA newborns misclassified as FGR, are at an increased risk for long-term respiratory morbidity during childhood and adolescence.

The Role of Genetics in Preterm Birth

Preterm birth (PTB), defined as the birth of a child before 37 completed weeks gestation, affects approximately 11% of live births and is the leading cause of death in children under 5 years. PTB is a complex disease with multiple risk factors including genetic variation. Much research has aimed to establish the biological mechanisms underlying PTB often through identification of genetic markers for PTB risk. The objective of this review is to present a comprehensive and updated summary of the published data relating to the field of PTB genetics. A literature search in PubMed was conducted and English studies related to PTB genetics were included. Genetic studies have identified genes within inflammatory, immunological, tissue remodeling, endocrine, metabolic, and vascular pathways that may be involved in PTB. However, a substantial proportion of published data have been largely inconclusive and multiple studies had limited power to detect associations. On the contrary, a few large hypothesis-free approaches have identified and replicated multiple novel variants associated with PTB in different cohorts. Overall, attempts to predict PTB using single "-omics" datasets including genomic, transcriptomic, and epigenomic biomarkers have been mostly unsuccessful and have failed to translate to the clinical setting. Integration of data from multiple "-omics" datasets has yielded the most promising results.

Pregnancy outcomes in women with gestational hypertension and preeclampsia at Paropakar Maternity and Women's Hospital, Nepal: A retrospective study

INTRODUCTION

Gestational hypertension and preeclampsia are the most common types of hypertensive disorder in pregnancy and these conditions are associated with adverse maternal and fetal outcomes. This study aims to determine the differences in pregnancy outcomes in women with gestational hypertension and preeclampsia.

METHODS

A retrospective study was done at The Paropakar Maternity and Women's Hospital, a tertiary level hospital, in the Kathmandu, Nepal. Pregnant women who had given birth at the hospital between September 17 and December 18 of 2017 were included. Data were obtained from the non-digitalized hospital records. The adjusted odds ratio (AOR) and 95% confidence interval were computed using logistic regression analysis. Multivariable analysis of pregnancy outcomes (cesarean sections, low birth weight, and preterm birth) was adjusted for maternal age, parity, twin birth, gestational age, calcium supplementation, and maternal co-morbidity.

RESULTS

Preeclampsia was strongly associated with cesarean section compared to normal pregnancies (OR = 8.11, p<0.001). Whereas the odds of cesarean section among women with gestational hypertension was almost 2 times (OR = 1.89, p<0.001). Preterm birth was not significantly associated with gestational hypertension but was associated with preeclampsia (OR = 3.39, p<0.001). Gestational hypertension and preeclampsia were not associated with low birth weight.

CONCLUSION

In Nepal, women who develop preeclampsia seem at higher risk of having adverse pregnancy outcomes than women with gestational hypertension. These findings should be considered by national health authorities and other health organizations when setting new priorities to improve pregnancy outcomes.

Evaluation of the effects of COVID-19 disease and the trimester in which the disease is diagnosed on obstetric and neonatal outcomes: A retrospective cohort study

AIM

To evaluate the effects of COVID-19 disease and the trimester in which the disease is diagnosed on obstetric and neonatal outcomes.

METHODS

This retrospective cohort study was conducted with 358 patients who had or had not been diagnosed with COVID-19 during their pregnancy, had a miscarriage or had given birth.

RESULTS

COVID-19 disease during pregnancy was associated with higher maternal hypertensive disease, preterm birth, low birth weight, low first- and fifth-minute Apgar scores, and need for neonatal intensive care unit. The incidence of preterm birth, low birth weight, low first- and fifth-minute Apgar scores, and need for neonatal intensive care unit in those diagnosed with COVID-19 in the second trimester was significantly higher than those diagnosed with COVID-19 in other trimesters. The frequency of cesarean section was observed most in those diagnosed with COVID-19 in the 3rd trimester, while it was observed in those diagnosed with COVID-19 at least in the first trimester.

CONCLUSION

The presence of COVID-19 during pregnancy may be associated with an increased risk of iatrogenic preterm birth. The frequency of preterm birth in pregnant women diagnosed with COVID-19 in the second trimester is higher than in pregnant women diagnosed with COVID-19 in other trimesters. As the pregnancy trimester at the time of diagnosis progresses, the frequency of cesarean section increases. While the risk of maternal hypertensive disease increases more in pregnant women with COVID-19, the effect of the trimester in which COVID-19 was passed on the risk of maternal hypertensive disease is not observed.