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Braveman P, Heck K, Dominguez TP, Marchi K, Burke W, Holm N. African immigrants' favorable preterm birth rates challenge genetic etiology of the Black-White disparity in preterm birth. Front Public Health 2024; 11:1321331. [PMID: 38239790 PMCID: PMC10794556 DOI: 10.3389/fpubh.2023.1321331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 12/07/2023] [Indexed: 01/22/2024] Open
Abstract
Background We examined over a million California birth records for 2010 through 2021 to investigate whether disparities in preterm birth (PTB) by nativity and race support the widely held but hitherto unsubstantiated belief that genetic differences explain the persistent Black-White disparity in PTB. Methods We examined PTB rates and risk ratios among African-, Caribbean-, and U.S.-born Black women compared to U.S.-born White women. Multivariate analyses adjusted for maternal age, education, number of live births, delivery payer, trimester of prenatal care initiation, pre-pregnancy BMI, smoking, and prevalence of poverty in a woman's residence census tract; and for paternal education. Results In adjusted analyses, African-born Black women's PTB rates were no different from those of U.S.-born White women. Discussion The results add to prior evidence making a genetic etiology for the racial disparity in PTB unlikely. If genetic differences tied to "race" explained the Black-White disparity in PTB among U.S.-born women, the African immigrants in this study would have had higher rates of PTB, not the lower rates observed. Multiple explanations for the observed patterns and their implications are discussed. Failure to distinguish causes of PTB from causes of the racial disparity in PTB have likely contributed to erroneous attribution of the racial disparity to genetic differences. Based on the literature, unmeasured experiences of racism, including racism-related stress and adverse environmental exposures, are plausible explanations for the PTB disparity between Black and White U.S.-born women. The favorable birth outcomes of African-born Black immigrants may reflect less exposure to racism during sensitive life periods, e.g., childhood, when they were in African countries, where Black people are in the racial majority.
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Affiliation(s)
- Paula Braveman
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Katherine Heck
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Tyan Parker Dominguez
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States
| | - Kristen Marchi
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Wylie Burke
- Department of Bioethics and Humanities, University of Washington, Seattle, Washington, DC, United States
| | - Nicole Holm
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, United States
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Jamaluddine Z, Sharara E, Helou V, El Rashidi N, Safadi G, El-Helou N, Ghattas H, Sato M, Blencowe H, Campbell OMR. Effects of size at birth on health, growth and developmental outcomes in children up to age 18: an umbrella review. Arch Dis Child 2023; 108:956-969. [PMID: 37339859 DOI: 10.1136/archdischild-2022-324884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 05/04/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Size at birth, an indicator of intrauterine growth, has been studied extensively in relation to subsequent health, growth and developmental outcomes. Our umbrella review synthesises evidence from systematic reviews and meta-analyses on the effects of size at birth on subsequent health, growth and development in children and adolescents up to age 18, and identifies gaps. METHODS We searched five databases from inception to mid-July 2021 to identify eligible systematic reviews and meta-analyses. For each meta-analysis, we extracted data on the exposures and outcomes measured and the strength of the association. FINDINGS We screened 16 641 articles and identified 302 systematic reviews. The literature operationalised size at birth (birth weight and/or gestation) in 12 ways. There were 1041 meta-analyses of associations between size at birth and 67 outcomes. Thirteen outcomes had no meta-analysis.Small size at birth was examined for 50 outcomes and was associated with over half of these (32 of 50); continuous/post-term/large size at birth was examined for 35 outcomes and was consistently associated with 11 of the 35 outcomes. Seventy-three meta-analyses (in 11 reviews) compared risks by size for gestational age (GA), stratified by preterm and term. Prematurity mechanisms were the key aetiologies linked to mortality and cognitive development, while intrauterine growth restriction (IUGR), manifesting as small for GA, was primarily linked to underweight and stunting. INTERPRETATION Future reviews should use methodologically sound comparators to further understand aetiological mechanisms linking IUGR and prematurity to subsequent outcomes. Future research should focus on understudied exposures (large size at birth and size at birth stratified by gestation), gaps in outcomes (specifically those without reviews or meta-analysis and stratified by age group of children) and neglected populations. PROSPERO REGISTRATION NUMBER CRD42021268843.
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Affiliation(s)
- Zeina Jamaluddine
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Eman Sharara
- Center for Research On Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Vanessa Helou
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Nadine El Rashidi
- Center for Research On Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Gloria Safadi
- Center for Research On Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Nehmat El-Helou
- Center for Research On Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Hala Ghattas
- Center for Research On Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Miho Sato
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Hannah Blencowe
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Oona M R Campbell
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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3
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Sangah AB, Jabeen S, Hunde MZ, Devi S, Mumtaz H, Shaikh SS. Maternal and fetal outcomes of SLE in pregnancy: a literature review. J OBSTET GYNAECOL 2023; 43:2205513. [PMID: 37154805 DOI: 10.1080/01443615.2023.2205513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Systemic Lupus Erythematosus (SLE) is an auto-immune disease in which the immune system assaults its tissues. We aimed to analyse the maternal and foetal outcomes during pregnancy in SLE mothers. A literature search was conducted by two investigators to assess SLE's outcomes on maternal and foetal during pregnancies. We searched PubMed/Medline, Embase, and Google scholar to collect evidence from different research studies, draw the conclusion, and report it. In our investigation, we found out that SLE could cause a spectrum of complications during pregnancy, not only for the mother but also for the foetus. It could affect fertility and cause difficult pregnancies for the couple as well which includes certain complications such as: preterm labour and delivery, high blood pressure (preeclampsia), placental insufficiency, miscarriage or stillbirth, whereas in the foetus SLE can cause mortality, preterm birth, and neonatal lupus (a temporary condition in the baby caused by SLE-related antibodies) and structural abnormalities. The literature suggests that SLE could prove fatal for the foetus and induce many complications in the mother. However, this could be avoided if pregnancy is planned right from the start and proper management is provided to the mother during pregnancy and delivery.p.
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Affiliation(s)
- Abdul Basit Sangah
- Liaquat National Hospital and Medical College Karachi, Karachi, Pakistan
| | - Sidra Jabeen
- Liaquat National Hospital and Medical College Karachi, Karachi, Pakistan
| | | | - Sunita Devi
- Liaquat National Hospital and Medical College Karachi, Karachi, Pakistan
| | - Hassan Mumtaz
- Senior Clinical Research Associate, Maroof International Hospital, Public Health Scholar, Health Services Academy, Islamabad, Pakistan
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Yoshida-Montezuma Y, Kirkwood D, Sivapathasundaram B, Keown-Stoneman CDG, de Souza RJ, To T, Borkhoff CM, Birken CS, Maguire JL, Brown HK, Anderson LN. Late preterm birth and growth trajectories during childhood: a linked retrospective cohort study. BMC Pediatr 2023; 23:450. [PMID: 37684561 PMCID: PMC10485950 DOI: 10.1186/s12887-023-04257-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 08/18/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Evidence suggests that accelerated postnatal growth in children is detrimental for adult cardiovascular health. It is unclear whether children born late preterm (34-36 weeks) compared to full term (≥ 39 weeks), have different growth trajectories. Our objective was to evaluate the association between gestational age groups and growth trajectories of children born between 2006-2014 and followed to 2021 in Ontario, Canada. METHODS We conducted a retrospective cohort study of children from singleton births in TARGet Kids! primary care network with repeated measures of weight and height/length from birth to 14 years, who were linked to health administrative databases. Piecewise linear mixed models were used to model weight (kg/month) and height (cm/month) trajectories with knots at 3, 12, and 84 months. Analyses were conducted based on chronological age. RESULTS There were 4423 children included with a mean of 11 weight and height measures per child. The mean age at the last visit was 5.9 years (Standard Deviation: 3.1). Generally, the more preterm, the lower the mean value of weight and height until early adolescence. Differences in mean weight and height for very/moderate preterm and late preterm compared to full term were evident until 12 months of age. Weight trajectories were similar between children born late preterm and full term with small differences from 84-168 months (mean difference (MD) -0.04 kg/month, 95% CI -0.06, -0.03). Children born late preterm had faster height gain from 0-3 months (MD 0.70 cm/month, 95% CI 0.42, 0.97) and 3-12 months (MD 0.17 cm/month, 95% CI 0.11, 0.22). CONCLUSIONS Compared to full term, children born late preterm had lower average weight and height from birth to 14 years, had a slightly slower rate of weight gain after 84 months and a faster rate of height gain from 0-12 months. Follow-up is needed to determine if growth differences are associated with long-term disease risk.
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Affiliation(s)
- Yulika Yoshida-Montezuma
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street W, Hamilton, ON, L8S 4L8, Canada
| | | | | | - Charles D G Keown-Stoneman
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
| | - Russell J de Souza
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street W, Hamilton, ON, L8S 4L8, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Population Health Research Institute, Hamilton Health Sciences Corporation, Hamilton, ON, Canada
| | - Teresa To
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- ICES, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
| | - Cornelia M Borkhoff
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
- Women's College Research Institute, Toronto, ON, Canada
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Catherine S Birken
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Pediatrics, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Jonathon L Maguire
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
- Population Health Research Institute, Hamilton Health Sciences Corporation, Hamilton, ON, Canada
- Department of Pediatrics, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Hilary K Brown
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- ICES, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Women's College Research Institute, Toronto, ON, Canada
- Department of Health & Society, University of Toronto Scarborough, Toronto, ON, Canada
| | - Laura N Anderson
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street W, Hamilton, ON, L8S 4L8, Canada.
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada.
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Mohammed RHA, Mumtaz H, Sangah AB, Shaikh SS, Nasir N, Jabeen S. Pregnancy in lupus: an updated consensus to guide best practice strategies. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2022. [DOI: 10.1186/s43166-022-00167-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Abstract
Background
Systemic lupus erythematosus is a multifaceted chronic relapsing autoimmune disease of unknown etiology. The disease has always been a serious diagnosis in women being a multisystem pathology that is classically encountered during the childbearing age posing serious systemic comorbidities with a potential impact on the functional performance, psychosocial status, and survival. In this article, we review critical issues related to the decision to conceive in female with lupus highlighting the impact of the diagnosis and disease activity status on the mother and the fetus, attempting to suggest a consensus to guide safe decision making for pregnancy with SLE.
Main body
The pleomorphic dysregulated immune nature of lupus in the presence of uncontrolled disease carries a higher risk of complicated pregnancy. Therefore, SLE pregnancies should be well planned and are usually encouraged if the disease is inactive (at least 6 months prior to conception) to ensure immune quiescence towards a safer outcome.
Conclusion
With the proper implementation of preconception counseling strategy, choice of the correct timing of conception, close monitoring of SLE flares with tight control, and the appreciation of the value of multidisciplinary management to best practice most young women with SLE can carry on successful pregnancies with favorable outcome.
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The amniotic fluid proteome predicts imminent preterm delivery in asymptomatic women with a short cervix. Sci Rep 2022; 12:11781. [PMID: 35821507 PMCID: PMC9276779 DOI: 10.1038/s41598-022-15392-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 06/23/2022] [Indexed: 11/09/2022] Open
Abstract
Preterm birth, the leading cause of perinatal morbidity and mortality, is associated with increased risk of short- and long-term adverse outcomes. For women identified as at risk for preterm birth attributable to a sonographic short cervix, the determination of imminent delivery is crucial for patient management. The current study aimed to identify amniotic fluid (AF) proteins that could predict imminent delivery in asymptomatic patients with a short cervix. This retrospective cohort study included women enrolled between May 2002 and September 2015 who were diagnosed with a sonographic short cervix (< 25 mm) at 16–32 weeks of gestation. Amniocenteses were performed to exclude intra-amniotic infection; none of the women included had clinical signs of infection or labor at the time of amniocentesis. An aptamer-based multiplex platform was used to profile 1310 AF proteins, and the differential protein abundance between women who delivered within two weeks from amniocentesis, and those who did not, was determined. The analysis included adjustment for quantitative cervical length and control of the false-positive rate at 10%. The area under the receiver operating characteristic curve was calculated to determine whether protein abundance in combination with cervical length improved the prediction of imminent preterm delivery as compared to cervical length alone. Of the 1,310 proteins profiled in AF, 17 were differentially abundant in women destined to deliver within two weeks of amniocentesis independently of the cervical length (adjusted p-value < 0.10). The decreased abundance of SNAP25 and the increased abundance of GPI, PTPN11, OLR1, ENO1, GAPDH, CHI3L1, RETN, CSF3, LCN2, CXCL1, CXCL8, PGLYRP1, LDHB, IL6, MMP8, and PRTN3 were associated with an increased risk of imminent delivery (odds ratio > 1.5 for each). The sensitivity at a 10% false-positive rate for the prediction of imminent delivery by a quantitative cervical length alone was 38%, yet it increased to 79% when combined with the abundance of four AF proteins (CXCL8, SNAP25, PTPN11, and MMP8). Neutrophil-mediated immunity, neutrophil activation, granulocyte activation, myeloid leukocyte activation, and myeloid leukocyte-mediated immunity were biological processes impacted by protein dysregulation in women destined to deliver within two weeks of diagnosis. The combination of AF protein abundance and quantitative cervical length improves prediction of the timing of delivery compared to cervical length alone, among women with a sonographic short cervix.
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Yoshida-Montezuma Y, Sivapathasundaram B, Brown HK, Keown-Stoneman C, de Souza RJ, To T, Borkhoff CM, Birken CS, Maguire JL, Anderson LN. Association of Late Preterm Birth and Size for Gestational Age With Cardiometabolic Risk in Childhood. JAMA Netw Open 2022; 5:e2214379. [PMID: 35622362 PMCID: PMC9142868 DOI: 10.1001/jamanetworkopen.2022.14379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE The long-term cardiometabolic consequences of late preterm birth (34-36 weeks' gestation) are not well understood. OBJECTIVE To assess whether late preterm birth and size for gestational age are associated with cardiometabolic risk (CMR) in childhood. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study included 1742 children born in Ontario, Canada, between April 1, 2006, and September 30, 2014, and followed up until September 30, 2019. Data from children enrolled in The Applied Research Group for Kids (TARGet Kids!) primary care practice-based research network were linked to administrative health care data at ICES (formerly known as the Institute for Clinical Evaluative Sciences). Participants were excluded if they had conditions affecting growth (eg, failure to thrive or cystic fibrosis), any acute or chronic conditions (other than asthma and high-functioning autism), severe developmental delay, or families who were unable to communicate in English. EXPOSURES Late preterm birth, gestational age as a continuous measure, and size for gestational age. MAIN OUTCOMES AND MEASURES The primary outcome was composite CMR score (overall age- and sex-standardized z score of CMR components, including waist circumference, log triglyceride level, glucose level, systolic blood pressure, and high-density lipoprotein cholesterol level). Secondary outcomes were the individual CMR components. Multivariable linear regression analysis was used to separately evaluate the associations of late preterm birth, continuous gestational age, and size for gestational age with CMR at ages 3 to 12 years. RESULTS Among 2440 eligible children, 1742 (mean [SD] age, 5.6 [2.2] years; 951 boys [54.6%]) were included in the final cohort. Overall, 87 children (5.0%) were born moderately preterm (<34 weeks' gestation), 145 (8.3%) were born late preterm (34-36 weeks' gestation), 455 (26.1%) were born early term (37-38 weeks' gestation), and 1055 (60.6%) were born full term (≥39 weeks' gestation). Compared with children born full term, those born moderately preterm (adjusted β = 0.50; 95% CI, 0.24-0.75) and late preterm (adjusted β = 0.27; 95% CI, 0.06-0.47) had higher CMR scores. Each additional gestational week was associated with a 0.06 U (adjusted β; 95% CI, -0.08 to -0.03 U) decrease in CMR. CONCLUSIONS AND RELEVANCE In this study, children born late preterm and moderately preterm had higher CMR. These results suggest that screening and early-life interventions for these children may prevent cardiometabolic outcomes.
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Affiliation(s)
- Yulika Yoshida-Montezuma
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Branavan Sivapathasundaram
- ICES (formerly the Institute for Clinical Evaluative Sciences), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Hilary K. Brown
- ICES (formerly the Institute for Clinical Evaluative Sciences), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada
- Women’s College Research Institute, Toronto, Ontario, Canada
| | - Charles Keown-Stoneman
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Russell J. de Souza
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Population Health Research Institute, Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada
| | - Teresa To
- ICES (formerly the Institute for Clinical Evaluative Sciences), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Cornelia M. Borkhoff
- Women’s College Research Institute, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Catherine S. Birken
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jonathon L. Maguire
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, St Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Laura N. Anderson
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
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Yoshida‐Montezuma Y, Stone E, Iftikhar S, De Rubeis V, Andreacchi AT, Keown‐Stoneman C, Mbuagbaw L, Brown HK, de Souza RJ, Anderson LN. The association between late preterm birth and cardiometabolic conditions across the life course: A systematic review and meta-analysis. Paediatr Perinat Epidemiol 2022; 36:264-275. [PMID: 34806197 PMCID: PMC9299497 DOI: 10.1111/ppe.12831] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 09/23/2021] [Accepted: 09/26/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The effect of being born late preterm (34-36 weeks gestation) on cardiometabolic outcomes across the life course is unclear. OBJECTIVES To systematically review the association between being born late preterm (spontaneous or indicated), compared to the term and cardiometabolic outcomes in children and adults. DATA SOURCES EMBASE(Ovid), MEDLINE(Ovid), CINAHL. STUDY SELECTION AND DATA EXTRACTION Observational studies up to July 2021 were included. Study characteristics, gestational age, cardiometabolic outcomes, risk ratios (RRs), odds ratios (ORs), hazard ratios (HRs), mean differences and 95% confidence intervals (CIs) were extracted. SYNTHESIS We pooled converted RRs using random-effects meta-analyses for diabetes, hypertension, ischemic heart disease (IHD) and body mass index (BMI) with subgroups for children and adults. The risk of bias was assessed using the Newcastle-Ottawa scale and certainty of the evidence was assessed using the grading of recommendations, assessment, development and evaluation (GRADE) approach. RESULTS Forty-one studies were included (41,203,468 total participants; median: 5.0% late preterm). Late preterm birth was associated with increased diabetes (RR 1.24, 95% CI 1.17, 1.32; nine studies; n = 6,056,511; incidence 0.9%; I2 51%; low certainty) and hypertension (RR 1.21, 95% CI 1.13, 1.30; 11 studies; n = 3,983,141; incidence 3.4%; I2 64%; low certainty) in children and adults combined. Late preterm birth was associated with decreased BMI z-scores in children (standard mean difference -0.38; 95% CI -0.67, -0.09; five studies; n = 32,602; proportion late preterm 8.3%; I2 96%; very low certainty). There was insufficient evidence that late preterm birth was associated with increased IHD risk in adults (HR 1.20, 95% CI 0.89, 1.62; four studies; n = 2,706,806; incidence 0.3%; I2 87%; very low certainty). CONCLUSIONS Late preterm birth was associated with an increased risk of diabetes and hypertension. The certainty of the evidence was low or very low. Inconsistencies in late preterm and term definitions, confounding variables and outcome age limited the comparability of studies.
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Affiliation(s)
- Yulika Yoshida‐Montezuma
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
| | - Erica Stone
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
| | - Saman Iftikhar
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
| | - Vanessa De Rubeis
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
| | - Alessandra T. Andreacchi
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
| | - Charles Keown‐Stoneman
- Li Ka Shing Knowledge InstituteSt. Michael’s HospitalTorontoOntarioCanada,Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada,Biostatistics UnitFather Sean O’Sullivan Research CentreSt Joseph’s Healthcare HamiltonHamiltonOntarioCanada,Centre for the Development of Best Practices in HealthYaoundéCameroon,Department of Global HealthStellenbosch UniversityStellenboschSouth Africa
| | - Hilary K. Brown
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada,Department of Health & SocietyUniversity of Toronto ScarboroughTorontoOntarioCanada,Women’s College Research InstituteTorontoOntarioCanada
| | - Russell J. de Souza
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada,Population Health Research InstituteHamilton Health Sciences CorporationHamiltonOntarioCanada
| | - Laura N. Anderson
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada,Child Health Evaluative SciencesThe Hospital for Sick ChildrenTorontoOntarioCanada
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9
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Najjarzadeh M, Abbasalizadeh S, Mohammad‐Alizadeh‐Charandabi S, Asghari‐Jafarabadi M, Mirghafourvand M. Perceived stress and its predictors in women with threatened preterm labour: A cross-sectional study. Nurs Open 2022; 9:210-221. [PMID: 34553513 PMCID: PMC8685874 DOI: 10.1002/nop2.1055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/30/2021] [Accepted: 09/01/2021] [Indexed: 12/07/2022] Open
Abstract
AIM To determine prevalence and predictors of perceived stress in women with threatened preterm labour. DESIGN Cross-sectional. METHODS We recruited 409 women with threatened preterm labour, hospitalized at two tertiary hospitals. We assessed their socio-demographic and obstetrics characteristics, and their perceived stress, perceived social support, experience of violence using validated scales. Multiple linear regression was used to determine the predictors. RESULTS Data from all recruited women were analysed. Most of them had borderline (36%) or high (42%) level stress. Overall, 17 predictors were identified explaining 89.5% of variation in the stress score. Predictors of the higher stress score included: urban living, experience of sexual and psychological violence, perceived insufficient social support, experience of vaginal bleeding during current pregnancy, abnormal results in initial pregnancy tests, having multiple roles at home, being less than 28 weeks pregnant, being parous, sleep disorders, history of health problems, insufficient income and unwanted pregnancy.
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Affiliation(s)
- Maryam Najjarzadeh
- Students’ Research CommitteeFaculty of Nursing and MidwiferyTabriz University of Medical SciencesTabrizIran
| | - Shamsi Abbasalizadeh
- Women's Reproductive Health Research CenterTabriz University of Medical SciencesTabrizIran
| | - Sakineh Mohammad‐Alizadeh‐Charandabi
- Department of MidwiferyFaculty of Nursing and MidwiferySocial Determinants of Health Research CenterTabriz University of Medical SciencesTabrizIran
| | - Mohammad Asghari‐Jafarabadi
- Department of Statistics and EpidemiologyFaculty of HealthRoad Traffic Injury Research CenterTabriz University of Medical SciencesTabrizIran
| | - Mojgan Mirghafourvand
- Clinical Research Development UnitImam Reza General HospitalTabriz University of Medical SciencesTabrizIran
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10
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Braveman P, Dominguez TP, Burke W, Dolan SM, Stevenson DK, Jackson FM, Collins JW, Driscoll DA, Haley T, Acker J, Shaw GM, McCabe ERB, Hay WW, Thornburg K, Acevedo-Garcia D, Cordero JF, Wise PH, Legaz G, Rashied-Henry K, Frost J, Verbiest S, Waddell L. Explaining the Black-White Disparity in Preterm Birth: A Consensus Statement From a Multi-Disciplinary Scientific Work Group Convened by the March of Dimes. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:684207. [PMID: 36303973 PMCID: PMC9580804 DOI: 10.3389/frph.2021.684207] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/06/2021] [Indexed: 11/30/2022] Open
Abstract
In 2017–2019, the March of Dimes convened a workgroup with biomedical, clinical, and epidemiologic expertise to review knowledge of the causes of the persistent Black-White disparity in preterm birth (PTB). Multiple databases were searched to identify hypothesized causes examined in peer-reviewed literature, 33 hypothesized causes were reviewed for whether they plausibly affect PTB and either occur more/less frequently and/or have a larger/smaller effect size among Black women vs. White women. While definitive proof is lacking for most potential causes, most are biologically plausible. No single downstream or midstream factor explains the disparity or its social patterning, however, many likely play limited roles, e.g., while genetic factors likely contribute to PTB, they explain at most a small fraction of the disparity. Research links most hypothesized midstream causes, including socioeconomic factors and stress, with the disparity through their influence on the hypothesized downstream factors. Socioeconomic factors alone cannot explain the disparity's social patterning. Chronic stress could affect PTB through neuroendocrine and immune mechanisms leading to inflammation and immune dysfunction, stress could alter a woman's microbiota, immune response to infection, chronic disease risks, and behaviors, and trigger epigenetic changes influencing PTB risk. As an upstream factor, racism in multiple forms has repeatedly been linked with the plausible midstream/downstream factors, including socioeconomic disadvantage, stress, and toxic exposures. Racism is the only factor identified that directly or indirectly could explain the racial disparities in the plausible midstream/downstream causes and the observed social patterning. Historical and contemporary systemic racism can explain the racial disparities in socioeconomic opportunities that differentially expose African Americans to lifelong financial stress and associated health-harming conditions. Segregation places Black women in stressful surroundings and exposes them to environmental hazards. Race-based discriminatory treatment is a pervasive stressor for Black women of all socioeconomic levels, considering both incidents and the constant vigilance needed to prepare oneself for potential incidents. Racism is a highly plausible, major upstream contributor to the Black-White disparity in PTB through multiple pathways and biological mechanisms. While much is unknown, existing knowledge and core values (equity, justice) support addressing racism in efforts to eliminate the racial disparity in PTB.
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Affiliation(s)
- Paula Braveman
- School of Medicine, University of California, San Francisco, San Francisco, CA, United States
- *Correspondence: Paula Braveman
| | - Tyan Parker Dominguez
- USC Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States
| | - Wylie Burke
- University of Washington School of Medicine, Seattle, WA, United States
| | - Siobhan M. Dolan
- Albert Einstein College of Medicine, New York, NY, United States
| | | | | | - James W. Collins
- Northwestern University School of Medicine, Chicago, IL, United States
| | - Deborah A. Driscoll
- University of Pennsylvania School of Medicine, Philadelphia, PA, United States
| | - Terinney Haley
- School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Julia Acker
- School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Gary M. Shaw
- Stanford University School of Medicine, Stanford, CA, United States
| | - Edward R. B. McCabe
- David Geffen School of Medicine at University of California, Los Angeles, CA, United States
| | | | - Kent Thornburg
- School of Medicine, Oregon State University, Portland, OR, United States
| | | | - José F. Cordero
- University of Georgia College of Public Health, Athens, GA, United States
| | - Paul H. Wise
- Stanford University School of Medicine, Stanford, CA, United States
| | - Gina Legaz
- March of Dimes, White Plains, NY, United States
| | | | | | - Sarah Verbiest
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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11
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Raja R, Mukherjee I, Sarkar BK. A Machine Learning-Based Prediction Model for Preterm Birth in Rural India. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:6665573. [PMID: 34234931 PMCID: PMC8219409 DOI: 10.1155/2021/6665573] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 01/21/2023]
Abstract
Preterm birth (PTB) in a pregnant woman is the most serious issue in the field of Gynaecology and Obstetrics, especially in rural India. In recent years, various clinical prediction models for PTB have been developed to improve the accuracy of learning models. However, to the best of the authors' knowledge, most of them suffer from selecting the most accurate features from the medical dataset in linear time. The present paper attempts to design a machine learning model named as risk prediction conceptual model (RPCM) for the prediction of PTB. In this paper, a feature selection approach is proposed based on the notion of entropy. The novel approach is used to find the best maternal features (responsible for PTB) from the obstetrical dataset and aims to predict the classifier's accuracy at the highest level. The paper first deals with the review of PTB cases (which is neglected in many developing countries including India). Next, we collect obstetrical data from the Community Health Centre of rural areas (Kamdara, Jharkhand). The suggested approach is then applied on collected data to identify the excellent maternal features (text-based symptoms) present in pregnant women in order to classify all birth cases into term birth and PTB. The machine learning part of the model is implemented using three different classifiers, namely, decision tree (DT), logistic regression (LR), and support vector machine (SVM) for PTB prediction. The performance of the classifiers is measured in terms of accuracy, specificity, and sensitivity. Finally, the SVM classifier generates an accuracy of 90.9%, which is higher than other learning classifiers used in this study.
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Affiliation(s)
- Rakesh Raja
- Department of Computer Science & Engineering, Birla Institute of Technology, Mesra, Ranchi, India
| | - Indrajit Mukherjee
- Department of Computer Science & Engineering, Birla Institute of Technology, Mesra, Ranchi, India
| | - Bikash Kanti Sarkar
- Department of Computer Science & Engineering, Birla Institute of Technology, Mesra, Ranchi, India
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12
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Duan J, Ma D, Wen X, Guo Q, Gao J, Zhang G, Xu K, Zhang L. Hydroxychloroquine prophylaxis for preeclampsia, hypertension and prematurity in pregnant patients with systemic lupus erythematosus: A meta-analysis. Lupus 2021; 30:1163-1174. [PMID: 33853420 DOI: 10.1177/09612033211007199] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES This meta-analysis aimed to evaluate the effectiveness of HCQ in improving the maternal and fetal outcomes in pregnancies with SLE. METHODS A literature search was conducted using PubMed, MEDLINE, EMBASE, and the Cochrane database for relevant English language articles, and Wanfang, CNKI and VIP for Chinese articles, from the databases' inception to April 30, 2020. These studies compared the maternal and/or fetal outcomes between pregnant patients with SLE who were administered HCQ during pregnancy (HCQ+ group) and those who were not administered HCQ (HCQ- group). Two investigators extracted the data and assessed the quality using the Newcastle-Ottawa Scale (NOS) and GRADE criteria independently. Odds ratio (OR) and 95% confidence intervals (CIs) were calculated. All statistical analyses were conducted using the Stata 12.0 software. RESULTS Nine studies involving 1132 pregnancies were included in the study (3 case controls, 2 prospective cohorts, 4 retrospective cohorts). Preeclampsia, gestational hypertension, and prematurity were significantly lower in the HCQ+ group than in the HCQ- group (OR 0.35, 95% CI 0.21-0.59), (OR 0.41, 95% CI 0.19-0.89) and (OR 0.55, 95% CI 0.36-0.86), respectively. There were no significant differences in the rates of HELLP Syndrome (OR 0.88, 95% CI 0.19-3.96), gestational diabetes (OR 2.3, 95% CI 0.44-12.12), thrombotic events (OR 0.26, 95% CI 0.05-1.51), spontaneous abortion (OR 1.77, 95% CI 0.96-3.26), premature rupture of membranes (OR 0.58, 95% CI 0.24-1.39), oligohydramnios (OR 0.90, 95% CI 0.38-2.14), live birth (OR 1.22, 95% CI 0.60-2.47), stillbirth (OR 1.00, 95% CI 0.50-2.00), congenital malformation (OR 0.53, 95% CI 0.14-2.04), low birth weight (OR 0.77, 95% CI 0.43-1.39), intrauterine distress (OR 1.07, 95% CI 0.41-2.76,), intrauterine growth restriction (OR 0.57, 95% CI 0.06-5.43), or five-minute APGAR score <7 (OR 0.72, 95% CI 0.20-2.58) between the two groups. CONCLUSIONS HCQ treatment during pregnancy could reduce the risk of preeclampsia, pregnancy hypertension and prematurity in SLE patients. The certainty of evidence is high but majority of the studies included are retrospective studies and not randomized controlled trials. Therefore, the multidisciplinary management of pregnant patients with SLE should promote HCQ use, irrespective of disease activity or severity.
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Affiliation(s)
- Jiaoniu Duan
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, China
| | - Dan Ma
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, China.,Tongji Shanxi Hospital, Tongji Medical College, Huazhong University of Science and Technology, Taiyuan, China
| | - Xiaoting Wen
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, China
| | - Qianyu Guo
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, China.,Tongji Shanxi Hospital, Tongji Medical College, Huazhong University of Science and Technology, Taiyuan, China
| | - Jinfang Gao
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, China.,Tongji Shanxi Hospital, Tongji Medical College, Huazhong University of Science and Technology, Taiyuan, China
| | - Gailian Zhang
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, China
| | - Ke Xu
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, China
| | - Liyun Zhang
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, China
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13
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Piske M, Qiu AQ, Maan EJ, Sauvé LJ, Forbes JC, Alimenti A, Janssen PA, Money DM, Côté HCF. Preterm Birth and Antiretroviral Exposure in Infants HIV-exposed Uninfected. Pediatr Infect Dis J 2021; 40:245-250. [PMID: 33480662 DOI: 10.1097/inf.0000000000002984] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Infants HIV-exposed and uninfected (IHEU) who are born to women living with HIV are at an increased risk of preterm birth (PTB). Antenatal exposure to certain maternal antiretroviral therapy (ART) regimens has been associated with PTB, although existing studies in this domain are limited and report discordant findings. We determined odds of PTB among IHEU by antenatal ART regimens and timing of exposure, adjusting for maternal risk factors. METHODS We retrospectively studied IHEU born in British Columbia (BC), Canada between 1990 and 2012 utilizing provincial health administrative databases. We included data from a control group of infants HIV-unexposed and uninfected (IHUU) matched ~3:1 for each IHEU on age, sex and geocode. RESULTS A total of 411 IHEU and 1224 IHUU were included in univariable analysis. PTB was more frequent among IHEU (20%) compared with IHUU (7%). IHEU were more often antenatally exposed to alcohol, tobacco, as well as prescription, nonprescription, and illicit drugs (IHEU: 36%, 8% and 35%; vs. IHUU: 3%, 1% and 9%, respectively). After adjusting for maternal substance use and smoking exposure, IHEU remained at increased odds of PTB [adjusted odds ratio (aOR) (95% CI): 2.66; (1.73, 4.08)] compared with matched IHUU controls. ART-exposed IHEU (excluding those with NRTIs only ART) had lower adjusted odds of PTB compared with IHEU with no maternal ART exposure, regardless of regimen [aOR range: 0.16-0.29 (0.02-0.95)]. Odds of PTB between IHEU exposed to ART from conception compared with IHEU exposed to ART postconception did not differ [aOR: 0.91 (0.47, 1.76)]; however, both groups experienced lower odds of PTB compared with IHEU with no maternal ART [preconception: aOR: 0.28 (0.08, 0.89); postconception: aOR 0.30 (0.11, 0.83)]. CONCLUSIONS BC IHEU were over twice as likely to be born preterm compared with demographically matched controls. Maternal substance use in pregnancy modulated this risk; however, we found no adverse associations of PTB with exposure to antenatal ART.
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Affiliation(s)
- Micah Piske
- From the Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Annie Q Qiu
- BC Women's Hospital, Vancouver, British Columbia
| | - Evelyn J Maan
- BC Women's Hospital, Vancouver, British Columbia
- Women's Health Research Institute, Vancouver, British Columbia
| | - Laura J Sauvé
- BC Women's Hospital, Vancouver, British Columbia
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
| | - John C Forbes
- BC Women's Hospital, Vancouver, British Columbia
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
| | - Ariane Alimenti
- BC Women's Hospital, Vancouver, British Columbia
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
| | - Patricia A Janssen
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia
- Women's Health Research Institute, Vancouver, British Columbia
| | - Deborah M Money
- BC Women's Hospital, Vancouver, British Columbia
- Women's Health Research Institute, Vancouver, British Columbia
- Department of Obstetrics, University of British Columbia, Vancouver, British Columbia
| | - Hélène C F Côté
- From the Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Women's Health Research Institute, Vancouver, British Columbia
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14
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Davidesko S, Wainstock T, Sheiner E, Pariente G. Long-Term Infectious Morbidity of Premature Infants: Is There a Critical Threshold? J Clin Med 2020; 9:jcm9093008. [PMID: 32961963 PMCID: PMC7563528 DOI: 10.3390/jcm9093008] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/07/2020] [Accepted: 09/16/2020] [Indexed: 01/16/2023] Open
Abstract
In this study, we sought to ascertain a relationship between gestational age at birth and infectious morbidity of the offspring via population-based cohort analysis comparing the long-term incidence of infectious morbidity in infants born preterm and stratified by extremity of prematurity (extreme preterm birth: 24 + 0–27 + 6, very preterm birth: 28 + 0–31 + 6, moderate to late preterm birth: 32 + 0−36 + 6 weeks of gestation, and term deliveries). Infectious morbidity included hospitalizations involving a predefined set of International Classification of Diseases 9 (ICD9) codes, as recorded in hospital records. A Kaplan–Meier survival curve compared cumulative incidence of infectious-related morbidity. A Cox proportional hazards model controlled for confounders and time to event. The study included 220,594 patients: 125 (0.1%) extreme preterm births, 784 (0.4%) very preterm births, 13,323 (6.0%) moderate to late preterm births, and 206,362 term deliveries. Offspring born preterm had significantly more infection-related hospitalizations (18.4%, 19.8%, 14.9%, and 11.0% for the aforementioned stratification, respectively, p < 0.001). Multivariate analysis found being born very or late to moderate preterm was independently associated with long-term infectious morbidity (adjusted hazard ratio (aHR) 1.5, 95% confidence interval (CI) 1.27–1.77 and aHR 1.23, 95% CI 1.17–1.3, respectively, p < 0.001). A comparable risk of long-term infectious morbidity was found in the two groups of premature births prior to 32 weeks gestation. In our population, a cutoff from 32 weeks and below demarks a significant increase in the risk of long-term infectious morbidity of the offspring.
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Affiliation(s)
- Sharon Davidesko
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel; (E.S.); (G.P.)
- Correspondence: ; Tel.: +972-5-4683-7362
| | - Tamar Wainstock
- The Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel;
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel; (E.S.); (G.P.)
| | - Gali Pariente
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel; (E.S.); (G.P.)
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15
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Porter L, van Heugten K, Champion P. The risk of low risk: First time motherhood, prematurity and dyadic well-being. Infant Ment Health J 2020; 41:836-849. [PMID: 32573015 DOI: 10.1002/imhj.21875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Premature birth has a well-documented impact on infants, mothers and their dyadic interactions. First time motherhood in the context of low risk premature birth-relatively unexplored in the literature-is a specific experience that sits at the nexus of premature infancy, motherhood and the processes that underpin dyadic connection. This qualitative study analyzed semistructured interviews with first time mothers of low risk premature babies. Findings were generated in response to research questions concerning mothers' meaning-making, bonding and identity. Findings demonstrated that maternal meaning-making emerged from a dyadic framework. When mothers or their infants were considered outside of a dyadic context, surplus suffering inadvertently occurred. Findings have important implications for infant mental health practice in medical settings, for postnatal support in the aftermath of premature birth, and for understanding the meaning of risk.
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Affiliation(s)
- Lauren Porter
- Student Health and Counselling, Massey University, Wellington, New Zealand
| | - Kate van Heugten
- Human Services and Social Work, University of Canterbury, Christchurch, New Zealand
| | - Patricia Champion
- Department of Health Sciences, University of Canterbury, Christchurch, New Zealand
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16
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Bhatti G, Romero R, Rice GE, Fitzgerald W, Pacora P, Gomez-Lopez N, Kavdia M, Tarca AL, Margolis L. Compartmentalized profiling of amniotic fluid cytokines in women with preterm labor. PLoS One 2020; 15:e0227881. [PMID: 31945128 PMCID: PMC6964819 DOI: 10.1371/journal.pone.0227881] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 12/31/2019] [Indexed: 12/14/2022] Open
Abstract
Objective Amniotic fluid cytokines have been implicated in the mechanisms of preterm labor and birth. Cytokines can be packaged within or on the surface of extracellular vesicles. The main aim of this study was to test whether the protein abundance internal to and on the surface of extracellular vesicles changes in the presence of sterile intra-amniotic inflammation and proven intra-amniotic infection in women with preterm labor as compared to the women with preterm labor without either intra-amniotic inflammation or proven intra-amniotic infection. Study design Women who had an episode of preterm labor and underwent an amniocentesis for the diagnosis of intra-amniotic infection or intra-amniotic inflammation were classified into three groups: 1) preterm labor without either intra-amniotic inflammation or proven intra-amniotic infection, 2) preterm labor with sterile intra-amniotic inflammation, and 3) preterm labor with intra-amniotic infection. The concentrations of 38 proteins were determined on the extracellular vesicle surface, within the vesicles, and in the soluble fraction of amniotic fluid. Results 1) Intra-amniotic inflammation, regardless of detected microbes, was associated with an increased abundance of amniotic fluid cytokines on the extracellular vesicle surface, within vesicles, and in the soluble fraction. These changes were most prominent in women with proven intra-amniotic infection. 2) Cytokine changes on the surface of extracellular vesicles were correlated with those determined in the soluble fraction; yet the magnitude of the increase was significantly different between these compartments. 3) The performance of prediction models of early preterm delivery based on measurements on the extracellular vesicle surface was equivalent to those based on the soluble fraction. Conclusions Differential packaging of amniotic fluid cytokines in extracellular vesicles during preterm labor with sterile intra-amniotic inflammation or proven intra-amniotic infection is reported herein for the first time. The current study provides insights into the biology of the intra-amniotic fluid ad may aid in the development of biomarkers for obstetrical disease.
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Affiliation(s)
- Gaurav Bhatti
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit Michigan, United States of America
- Department of Biomedical Engineering, Wayne State University College of Engineering, Detroit, Michigan, United States of America
| | - Roberto Romero
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit Michigan, United States of America
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, United States of America
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan, United States of America
- Detroit Medical Center, Detroit, Michigan, United States of America
- Department of Obstetrics and Gynecology, Florida International University, Miami, Florida, United States of America
- * E-mail: (RR); (GER); (ALT)
| | - Gregory Edward Rice
- Centre for Clinical Research, University of Queensland, Herston, Queensland, Australia
- * E-mail: (RR); (GER); (ALT)
| | - Wendy Fitzgerald
- Section on Intercellular Interactions, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, United States of America
| | - Percy Pacora
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit Michigan, United States of America
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Nardhy Gomez-Lopez
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit Michigan, United States of America
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
- Department of Biochemistry, Microbiology, and Immunology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Mahendra Kavdia
- Department of Biomedical Engineering, Wayne State University College of Engineering, Detroit, Michigan, United States of America
| | - Adi L. Tarca
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit Michigan, United States of America
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
- Department of Computer Science, Wayne State University College of Engineering, Detroit, Michigan, United States of America
- * E-mail: (RR); (GER); (ALT)
| | - Leonid Margolis
- Section on Intercellular Interactions, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, United States of America
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17
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Steiner L, Diesner SC, Voitl P. Risk of infection in the first year of life in preterm children: An Austrian observational study. PLoS One 2019; 14:e0224766. [PMID: 31816626 PMCID: PMC6901347 DOI: 10.1371/journal.pone.0224766] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 10/21/2019] [Indexed: 11/18/2022] Open
Abstract
Newborns, especially preterm infants, have an immature immune system, which, in combination with the required medical interventions necessary for keeping the neonate alive may lead to an increased risk of infection. Even after reaching stability and adapting to the environment, preterm infants have adverse prognoses regarding infections and long-term outcomes compared to their full-term counterparts. The objective of this study was to research differences in the number and severity of infections between preterm and full-term infants during their first year of life. To answer this question, a monocentric prospective study was conducted in a pediatric practice in Vienna, including 71 full-term infants and 72 preterm infants who were observed during their first year of life regarding occurring infections. In respective samples, there was a significantly higher total number of infections in preterm (mean 6.01 ± 3.90) compared to full-term infants (3.85 ± 1.72) during the observation period of one year. Particularly the count of respiratory and severe infections was considerably higher in preterm infants. Otorhinolaryngeal infections were the most frequent of all types of infections in both groups. The pregnancy period, number of siblings, and length of the postnatal hospital stay, were observed as significantly influencing factors which affected the total number of infections. The group of early term infants (37+0 weeks to 38+6) was not significantly different to late term babies (>39+0). The acquired knowledge about the increased risk of infections should lead to a more extensive care for preterm infants, with the objective of reducing the rates of complications, morbidity and mortality in this vulnerable age group in the future.
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Affiliation(s)
- Laura Steiner
- First Vienna Pediatric Medical Center, Vienna, Austria
| | | | - Peter Voitl
- First Vienna Pediatric Medical Center, Vienna, Austria
- Sigmund Freud University Vienna, Vienna, Austria
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18
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Xiang H, Tao Y, Zhang B, Liang C, Li Z, Feng L, Qi J, Pan W, Tong J, Yan S, Tao F. Protective effect of high zinc levels on preterm birth induced by mercury exposure during pregnancy: A birth cohort study in China. J Trace Elem Med Biol 2019; 55:71-77. [PMID: 31345369 DOI: 10.1016/j.jtemb.2019.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 06/09/2019] [Accepted: 06/11/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The aims of our study were to determine whether prenatal mercury levels are associated with the risk of preterm birth (PTB) and whether high maternal serum zinc (Zn) levels alleviate any negative effects of maternal mercury (Hg) exposure regarding PTB. METHODS Serum concentrations of Zn and Hg were measured in 3025 pregnant women from the Ma'anshan Birth Cohort. Before the collection of blood samples, they underwent examinations via the completion of questionnaires. The delivery records of the women were obtained from a series of medical records. We divided the study population into tertiles according to the participants' Hg levels: the low-Hg group (the first tertile, <0.30 μg/L), the medium-Hg group (the second tertile, 0.30-0.43 μg/L) and the high-Hg group (the third tertile, ≥0.43 μg/L). The associations of Hg exposure with both the risk of PTB and gestational age (weeks) at birth were estimated using a binary logistic regression model and multivariable linear regression analysis, respectively. Afterwards, we conducted a repeated analyses test after the participants were stratified according to their Zn levels, using the 75th percentile division method. RESULTS Overall, the medians and the interquartile ranges of Hg and Zn in the second trimester were 0.36 (0.27, 0.48) μg/L and 812.34 (731.26, 896.59) μg/L, respectively. Hg levels were associated with PTB [adjusted odds ratio (OR) and 95% confidence interval (95% CI): 1.91 (1.17, 3.12) for the third tertile vs. the first tertile of the serum Hg levels]. In the stratification analysis of the participants in the low-Zn group, the high-Hg group exhibited a significant odds ratio of PTB [adjusted OR (95% CI): 1.87 (1.08, 3.24)], compared to the low-Hg group. However, in the participants from the high-Zn group, the high-Hg group exhibited a non-significant OR of PTB [adjusted OR (95% CI): 2.32 (0.73, 7.42)]. In the multivariate linear regression analysis, gestational age (weeks) at delivery was significantly and inversely associated with the ln-transformed Hg concentrations [adjusted β (95% CI): -0.16 (-0.26, -0.06)]. Similarly, after the stratification analysis in the high-Zn group, there were no significant associations between PTB and the Hg levels [adjusted β (95% CI): -0.12 (-0.33, 0.09)]. CONCLUSION Prenatal Hg exposure adversely affected PTB, and high Zn levels alleviate this effect, which indicates that a more stringent control of Hg and a sufficient intake of Zn are necessary to help birth outcomes.
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Affiliation(s)
- Haiyun Xiang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Yiran Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Baoli Zhang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Chunmei Liang
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, China
| | - Zhijuan Li
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Lanlan Feng
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Juan Qi
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Wan Pan
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Juan Tong
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Shuangqin Yan
- Ma'anshan Maternal and Child Health (MCH) Center, Ma'anshan, China
| | - Fangbiao Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, China.
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Giannì ML, Bezze E, Colombo L, Rossetti C, Pesenti N, Roggero P, Sannino P, Muscolo S, Plevani L, Mosca F. Complementary Feeding Practices in a Cohort of Italian Late Preterm Infants. Nutrients 2018; 10:nu10121861. [PMID: 30513799 PMCID: PMC6316424 DOI: 10.3390/nu10121861] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 11/22/2018] [Accepted: 11/24/2018] [Indexed: 12/30/2022] Open
Abstract
Limited data are available on complementary feeding in preterm infants, who show increased nutritional needs and are at risk of altered postnatal growth. The aim of this study was to investigate the timing and content of complementary feeding in a cohort of late preterm infants. We conducted a prospective, observational study, including mothers who had given birth to infants admitted to level I or II of care with a gestational age between 34 and 36 weeks. Mothers were contacted at 3, 6 and 12 months after delivery by phone calls and were asked about their infant’s mode of feeding and the timing and schedule of the introduction of different solid foods types. A total of 49 mothers and 57 infants completed the study. The mean postnatal age of the introduction of complementary foods was 5.7 ± 0.7 months. Low energy and/or low protein-dense foods were first introduced in most infants. Fruit as the first type of complementary food in the infant’s diet was associated with a 1.6-month advance in initiating complementary feeding. The present findings provide further insight into complementary feeding practices in late preterm infants and underline the need for specific recommendations addressing this vulnerable population.
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Affiliation(s)
- Maria L Giannì
- Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, via Commenda 12, 20122 Milan, Italy.
- Department of Clinical Sciences and Community Health, University of Milan, Via San Barnaba 8, 20122 Milan, Italy.
| | - Elena Bezze
- Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, via Commenda 12, 20122 Milan, Italy.
| | - Lorenzo Colombo
- Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, via Commenda 12, 20122 Milan, Italy.
| | - Camilla Rossetti
- Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, via Commenda 12, 20122 Milan, Italy.
| | - Nicola Pesenti
- Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, via Commenda 12, 20122 Milan, Italy.
| | - Paola Roggero
- Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, via Commenda 12, 20122 Milan, Italy.
- Department of Clinical Sciences and Community Health, University of Milan, Via San Barnaba 8, 20122 Milan, Italy.
| | - Patrizio Sannino
- S.I.T.R.A. Basic Education Sector, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 28, 20122 Milan, Italy.
| | - Salvatore Muscolo
- Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, via Commenda 12, 20122 Milan, Italy.
| | - Laura Plevani
- Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, via Commenda 12, 20122 Milan, Italy.
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, via Commenda 12, 20122 Milan, Italy.
- Department of Clinical Sciences and Community Health, University of Milan, Via San Barnaba 8, 20122 Milan, Italy.
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20
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Savić D, Simović A, Marković S, Kostić G, Vuletić B, Radivojević S, Lišanin M, Igrutinović Z, Pavlović R. The Role of Presepsin Obtained from Tracheal Aspirates in the Diagnosis of Early Onset Pneumonia in Intubated Newborns. Indian J Pediatr 2018; 85:968-973. [PMID: 29654571 DOI: 10.1007/s12098-018-2676-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 04/02/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To investigate the role of presepsin obtained from tracheal aspirate of intubated newborns in the diagnosis of early neonatal pneumonia. METHODS A cross-sectional observational study was performed on 60 intubated newborns during the two-year period. Tracheal aspirate for examination was taken in aseptic conditions in usual toilets, by lavage with 2 ml of 0.9% NaCl in Mucus suction set. On the same day, presepsin (blood) was measured. RESULTS There were 34 newborns in the examined group (with pneumonia) and 26 in the control group. Patient groups were similar regarding demographic characteristics related to gender and Apgar score. The coefficients of simple linear correlation revealed the statistically significant connection between presepsin (from tracheal aspirate) and birth body weight, presepsin (plasma), maternal infection and pneumonia. Significant differences in the values of presepsin (from tracheal aspirate) (p < 0.001) and birth body weight (p = 0.036) were found. CONCLUSIONS In intubated newborns, measurements of presepsin obtained from tracheal aspirate suggested that it can be used as a complementary marker in diagnosing early onset neonatal pneumonia.
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Affiliation(s)
- Dragana Savić
- Faculty of Medical Sciences, Department of Pediatrics, University of Kragujevac, Kragujevac, Serbia
- Pediatric Clinic, Clinical Center Kragujevac, Kragujevac, Serbia
| | - Aleksandra Simović
- Faculty of Medical Sciences, Department of Pediatrics, University of Kragujevac, Kragujevac, Serbia
- Pediatric Clinic, Clinical Center Kragujevac, Kragujevac, Serbia
| | - Slavica Marković
- Faculty of Medical Sciences, Department of Pediatrics, University of Kragujevac, Kragujevac, Serbia
- Pediatric Clinic, Clinical Center Kragujevac, Kragujevac, Serbia
| | - Gordana Kostić
- Faculty of Medical Sciences, Department of Pediatrics, University of Kragujevac, Kragujevac, Serbia
- Pediatric Clinic, Clinical Center Kragujevac, Kragujevac, Serbia
| | - Biljana Vuletić
- Faculty of Medical Sciences, Department of Pediatrics, University of Kragujevac, Kragujevac, Serbia
- Pediatric Clinic, Clinical Center Kragujevac, Kragujevac, Serbia
| | - Snezana Radivojević
- Laboratory Diagnostic Service, Clinical Center Kragujevac, Kragujevac, Serbia
| | - Marina Lišanin
- Laboratory Diagnostic Service, Clinical Center Kragujevac, Kragujevac, Serbia
| | - Zoran Igrutinović
- Faculty of Medical Sciences, Department of Pediatrics, University of Kragujevac, Kragujevac, Serbia
- Pediatric Clinic, Clinical Center Kragujevac, Kragujevac, Serbia
| | - Radisa Pavlović
- Faculty of Medical Sciences, Department of Clinical Pharmacy, University of Kragujevac, Kragujevac, Serbia.
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Wennerstrom A, Haywood C, Wallace M, Sugarman M, Walker A, Bonner T, Sutton Y, Keller BL, Lewis M, Springgate B, Theall K. Creating Safe Spaces: A Community Health Worker-Academic Partnered Approach to Addressing Intimate Partner Violence. Ethn Dis 2018; 28:317-324. [PMID: 30202184 DOI: 10.18865/ed.28.s2.317] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Intimate partner violence (IPV) is a persistent public health problem in the United States, with an estimated one in three women experiencing rape, physical violence, and/or stalking by an intimate partner within her lifetime. Non-Hispanic Black women disproportionately experience IPV, but there has been limited success in implementing culturally appropriate prevention programs and services for members of this population. Community health workers (CHWs) are trusted members of under-resourced communities who provide reliable health information and improve the cultural appropriateness of service delivery and may be a vital resource for developing new IPV interventions. Guided by the principles of community partnered participatory research, we developed the CHW-led Safe Spaces project, which aimed to establish a strong academic-community partnership to focus on issues related to experiences of IPV and the prevention of IPV in New Orleans. In this article, we describe the development of our partnership including the formation of an advisory board, creation of a broad-based stakeholder coalition, offering a community partnered participatory research training, conducting IPV education and outreach, and establishing a research agenda. Our processes are replicable and lessons learned may be relevant to other groups seeking to address IPV by leveraging the strengths of community-academic collaborations and CHWs.
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Affiliation(s)
| | | | - Maeve Wallace
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | | | - Ashlee Walker
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | | | - Yana Sutton
- Kali Red's Initiative: Take Back Your Life Foundation, New Orleans, LA
| | | | - Marva Lewis
- Tulane University School of Social Work, New Orleans, LA
| | | | - Katherine Theall
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
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22
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Jiang Y, Xia W, Zhang B, Pan X, Liu W, Jin S, Huo W, Liu H, Peng Y, Sun X, Zhang H, Zhou A, Xu S, Li Y. Predictors of thallium exposure and its relation with preterm birth. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2018; 233:971-976. [PMID: 29033178 DOI: 10.1016/j.envpol.2017.09.080] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 09/21/2017] [Accepted: 09/25/2017] [Indexed: 06/07/2023]
Abstract
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.
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Affiliation(s)
- Yangqian Jiang
- Key Laboratory of Environment and Health (Huazhong University of Science and Technology), Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Wei Xia
- Key Laboratory of Environment and Health (Huazhong University of Science and Technology), Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Bin Zhang
- Women and Children Medical and Healthcare Center of Wuhan, Wuhan 430015, Hubei, China
| | - Xinyun Pan
- Key Laboratory of Environment and Health (Huazhong University of Science and Technology), Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Wenyu Liu
- Key Laboratory of Environment and Health (Huazhong University of Science and Technology), Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Shuna Jin
- Key Laboratory of Environment and Health (Huazhong University of Science and Technology), Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Wenqian Huo
- Key Laboratory of Environment and Health (Huazhong University of Science and Technology), Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Hongxiu Liu
- Key Laboratory of Environment and Health (Huazhong University of Science and Technology), Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Yang Peng
- Key Laboratory of Environment and Health (Huazhong University of Science and Technology), Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Xiaojie Sun
- Key Laboratory of Environment and Health (Huazhong University of Science and Technology), Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Hongling Zhang
- College of Health Science and Nursing, Wuhan Polytechnic University, Wuhan 430023, Hubei, China
| | - Aifen Zhou
- Women and Children Medical and Healthcare Center of Wuhan, Wuhan 430015, Hubei, China
| | - Shunqing Xu
- Key Laboratory of Environment and Health (Huazhong University of Science and Technology), Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Yuanyuan Li
- Key Laboratory of Environment and Health (Huazhong University of Science and Technology), Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China.
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23
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Slogrove AL, Becquet R, Chadwick EG, Côté HCF, Essajee S, Hazra R, Leroy V, Mahy M, Murenga M, Wambui Mwangi J, Oyiengo L, Rollins N, Penazzato M, Seage GR, Serghides L, Vicari M, Powis KM. Surviving and Thriving-Shifting the Public Health Response to HIV-Exposed Uninfected Children: Report of the 3rd HIV-Exposed Uninfected Child Workshop. Front Pediatr 2018; 6:157. [PMID: 29900165 PMCID: PMC5989128 DOI: 10.3389/fped.2018.00157] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 05/10/2018] [Indexed: 11/15/2022] Open
Abstract
Great gains were achieved with the introduction of the United Nations' Millennium Development Goals, including improved child survival. Transition to the Sustainable Development Goals (SDGs) focused on surviving, thriving, and transforming, representing an important shift to a broader public health goal, the achievement of which holds the promise of longer-term individual and societal benefits. A similar shift is needed with respect to outcomes for infants born to women living with HIV (WLHIV). Programming to prevent vertical HIV transmission has been successful in increasingly achieving a goal of HIV-free survival for infants born to WLHIV. Unfortunately, HIV-exposed uninfected (HEU) children are not achieving comparable health and developmental outcomes compared with children born to HIV-uninfected women under similar socioeconomic circumstances. The 3rd HEU Child Workshop, held as a satellite session of the International AIDS Society's 9th IAS Conference in Paris in July 2017, provided a venue to discuss HEU child health and development disparities. A summary of the Workshop proceedings follows, providing current scientific findings, emphasizing the gap in systems for long-term monitoring, and highlighting the public health need to establish a strategic plan to better quantify the short and longer-term health and developmental outcomes of HEU children.
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Affiliation(s)
- Amy L Slogrove
- Department of Paediatrics & Child Health, Stellenbosch University, Cape Town, South Africa
| | - Renaud Becquet
- Bordeaux Population Health Research Center, Institut National de la Santé et de la Recherche Médicale, University of Bordeaux, Bordeaux, France
| | - Ellen G Chadwick
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Hélène C F Côté
- Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, BC, Canada
| | | | - Rohan Hazra
- Maternal and Pediatric Infectious Disease Branch, Eunice Kennedy Shriver National Institute of Child Health and Health and Human Development, National Institute of Health, Bethesda, MD, United States
| | - Valériane Leroy
- French Institute of Health and Medical Research, Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - Mary Mahy
- Strategic Information Department, UNAIDS, Geneva, Switzerland
| | | | | | | | - Nigel Rollins
- HIV Department, World Health Organization, Geneva, Switzerland
| | | | - George R Seage
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Lena Serghides
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.,Department of Immunology and Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada.,Women's College Research Institute, Toronto, ON, Canada
| | - Marissa Vicari
- Collaborative Initiative for Paediatric HIV Education and Research, International AIDS Society, Geneva, Switzerland
| | - Kathleen M Powis
- Departments of Internal Medicine and Pediatrics, Masschusetts General Hospital, Boston, MA, United States.,Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, United States
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24
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Grometto A, Pizzo B, Strozzi MC, Gazzolo F, Gazzolo D. Cerebral NIRS patterns in late preterm and very preterm infants becoming late preterm. J Matern Fetal Neonatal Med 2017; 32:1124-1129. [PMID: 29157051 DOI: 10.1080/14767058.2017.1401605] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Near Infrared Spectroscopy (NIRS) has been proposed as a useful, noninvasive monitoring technique providing reliable information about central nervous system (CNS) oximetry and function. Recently, brain damage has been reconsidered as a dynamic process evolving over the weeks of gestation. We therefore investigated NIRS cerebral pattern differences between healthy late preterm infants (LPTo) and very preterm infants becoming late preterm (LPT). METHODS We conducted an observational study in 40 healthy late preterm infants, matched for gestational age at monitoring, of whom 20 where LPTo and 20 LPT. Clinical, diagnostic and laboratory monitoring procedures and cerebral oximetry (crSO2) and function (cFTOE) were recorded on admission into the study. RESULTS No significant differences (p > .05, for all) were found between groups regarding clinical, diagnostic or laboratory parameters. Higher crSO2 and lower cFTOE (p < .001, for both) were found in the LPTo group. CONCLUSIONS Our results, showing impaired oximetry and function of CNS in LPT, offer additional support to NIRS parameters as a useful tool for longitudinal CNS monitoring of very preterm infants becoming LPT. Future studies correlating NIRS variables and long-term neurological outcome in LPT are needed to elucidate the concept of dynamic brain damage pathogenesis.
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Affiliation(s)
- Alice Grometto
- a Faculty of Biology , University of Pavia , Pavia , Italy.,b Department of Maternal, Fetal and Neonatal Medicine , C. Arrigo Children's Hospital , Alessandria , Italy
| | - Benedetta Pizzo
- b Department of Maternal, Fetal and Neonatal Medicine , C. Arrigo Children's Hospital , Alessandria , Italy.,c Faculty of Biology , University of Oriental Piedmont , Alessandria , Italy
| | - Maria Chiara Strozzi
- b Department of Maternal, Fetal and Neonatal Medicine , C. Arrigo Children's Hospital , Alessandria , Italy
| | - Francesca Gazzolo
- c Faculty of Biology , University of Oriental Piedmont , Alessandria , Italy
| | - Diego Gazzolo
- b Department of Maternal, Fetal and Neonatal Medicine , C. Arrigo Children's Hospital , Alessandria , Italy.,d Neonatal Intensive Care Unit , "G d'Annunzio" University of Chieti , Chieti , Italy
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25
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Risk of Mortality into Adulthood According to Gestational Age at Birth. J Pediatr 2017; 190:185-191.e1. [PMID: 29144243 DOI: 10.1016/j.jpeds.2017.07.051] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 07/12/2017] [Accepted: 07/28/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To quantify the independent risks of neonatal (0-28 days), postneonatal (29-364 days), 1- to 5- and 6- to 30-year mortality by gestational age and investigate changes in survival over time in an Australian birth cohort. STUDY DESIGN Maternal and birth related Western Australian population data (1980-2010) were linked to the state mortality data using a retrospective cohort study design involving 722 399 live-born singletons infants. RESULTS When compared with 39- to 41-week born infants, the adjusted risk ratio for neonatal mortality was 124.8 (95% CI 102.9-151.3) for 24-31 weeks of gestation, 3.4 (95% CI 2.4-4.7) for 35-36 weeks of gestation, and 1.4 (95% CI 1.1-1.8) for 37-38 weeks of gestation. For 24-31 weeks of gestation infants, the adjusted hazard ratio for postneonatal mortality (29-364 days) was 13.9 (95% CI 10.9-17.6), for 1- to 5-year mortality 1.4 (95% CI 0.7-3.0) and for 6- to 30-year mortality 1.3 (95% CI 0.8-2.3). The risk of neonatal and postneonatal mortality for those born preterm decreased over time. CONCLUSIONS In Western Australia, late preterm and early term infants experienced higher risk of neonatal and postneonatal mortality when compared with their full-term peers. There was insufficient evidence to show that gestational length was independently associated with mortality beyond 1 year of age. Neonatal and postneonatal mortality improved with each decade of the study period.
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26
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Physical Growth, Morbidity Profile and Mortality Among Healthy Late Preterm Neonates. Indian Pediatr 2017; 54:629-634. [PMID: 28607209 DOI: 10.1007/s13312-017-1123-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the physical growth outcomes, morbidity profile and mortality at an age of 12 months among late preterm (34 0/7to 36 6/7) neonates to term (37 0/7to 41 6/7) neonates. STUDY DESIGN Prospective cohort study. SETTING A tertiary care center of Northern India during 2014-2015. PARTICIPANTS 200 apparently healthy late preterms and term infants, followed up to 12 months of age. MAIN OUTCOME MEASURES Physical growth parameters, morbidity profile and mortality. RESULTS At mean age of 12 months, mean (SD) weight, length and head circumference of late preterms were 7.4 (0.8) kg, 69.2 (2.5) cm and 43.0 (1.1) cm, respectively; which were significantly lower than that of the full term infants [8.7 (1.6) kg, 72.2 (3.1) cm and 44.2 (1.1) cm] (P< 0.001). On univariate analysis, late preterm group was associated with higher odds (95% CI) of being underweight [5.6 (3.4, 5.5)], stunted [3.5 (2.1, 5.8)] and wasted [3.6 (1.9, 6.9)]. On multivariate analysis, only adjusted odds of late preterms becoming underweight by one year was significant [OR 4.1; 95% CI (1.6, 10.4)]. Feeding difficulties, jaundice and re-hospitalization rates were significantly higher in the late preterm group. The median (IQR) episodes per baby for late preterms as compared to terms for diarrhea [1.84 (0,3) vs 1.14 (0,2) (P <0.001)], and fever [1.33 (0,2) vs. 0.95 (0,2) (P = 0.01)] were higher. CONCLUSION Healthy late preterms are at significantly higher risk of being underweight in the first year of life, in addition to having significantly higher morbidity.
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Poole KL, McDonald SD, Griffith LE, Hutton EK. Association of external cephalic version before term with late preterm birth. Acta Obstet Gynecol Scand 2017; 96:998-1005. [PMID: 28414857 DOI: 10.1111/aogs.13153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 04/08/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION While evidence suggests that beginning an external cephalic version (ECV) before term (340/7 to 366/7 weeks) compared with after term may be associated with an increase in late preterm birth (340/7 to 366/7 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. MATERIAL AND METHODS Secondary analysis of data collected from the international, multicenter Early ECV trials. We evaluated the relation between ECV exposure and late preterm birth (340/7 to 366/7 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. RESULT 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). CONCLUSION 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.
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Affiliation(s)
- Kristie L Poole
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Sarah D McDonald
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.,Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
| | - Lauren E Griffith
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Eileen K Hutton
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.,Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
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Wei S, Lai K, Yang Z, Zeng K. Systemic lupus erythematosus and risk of preterm birth: a systematic review and meta-analysis of observational studies. Lupus 2017; 26:563-571. [PMID: 28121241 DOI: 10.1177/0961203316686704] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We performed a meta-analysis to identify the association between systemic lupus erythematosus (SLE) and preterm birth. In this study, we studied the effects of SLE, SLE disease activity, a history of nephritis and active nephritis on preterm birth. Searches were conducted before 20 May 2016 of PubMed, Embase, Medline and Cochrane Library of literature and article reference lists. Eleven observational case-control studies and thirteen cohort studies met the inclusion criteria. The pooled relative risk (RR) for the risk of preterm birth in SLE patients versus controls was 2.05 (95% confidence interval (CI): 1.72-3.32); for active SLE patients versus inactive was 2.98 (95% CI: 2.32-3.83); for SLE patients with a history of lupus nephritis versus those without nephritis it was 1.62 (95% CI: 1.35-1.95); and for SLE patients with active nephritis versus those with quiescent nephritis it was 1.78 (95% CI: 1.17-2.70). In summary, this study identified a significant association in the above results. This association was more significant in active SLE patients versus inactive. With respect to SLE itself, active inflammation (such as disease activity) may be more hazardous for the management of the pregnancy. This suggests that it is essential to control disease activity in order to achieve a better outcome of SLE pregnancy.
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Affiliation(s)
- S Wei
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, PR China
| | - K Lai
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, PR China
| | - Z Yang
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, PR China
| | - K Zeng
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, PR China
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Giannì ML, Consonni D, Liotto N, Roggero P, Morlacchi L, Piemontese P, Menis C, Mosca F. Does Human Milk Modulate Body Composition in Late Preterm Infants at Term-Corrected Age? Nutrients 2016; 8:nu8100664. [PMID: 27782098 PMCID: PMC5084050 DOI: 10.3390/nu8100664] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 10/04/2016] [Accepted: 10/18/2016] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Late preterm infants account for the majority of preterm births and are at risk of altered body composition. Because body composition modulates later health outcomes and human milk is recommended as the normal method for infant feeding, we sought to investigate whether human milk feeding in early life can modulate body composition development in late preterm infants; (2) Methods: Neonatal, anthropometric and feeding data of 284 late preterm infants were collected. Body composition was evaluated at term-corrected age by air displacement plethysmography. The effect of human milk feeding on fat-free mass and fat mass content was evaluated using multiple linear regression analysis; (3) Results: Human milk was fed to 68% of the infants. According to multiple regression analysis, being fed any human milk at discharge and at term-corrected and being fed exclusively human milk at term-corrected age were positively associated with fat-free mass content(β = −47.9, 95% confidence interval (CI) = −95.7; −0.18; p = 0.049; β = −89.6, 95% CI = −131.5; −47.7; p < 0.0001; β = −104.1, 95% CI = −151.4; −56.7, p < 0.0001); (4) Conclusion: Human milk feeding appears to be associated with fat-free mass deposition in late preterm infants. Healthcare professionals should direct efforts toward promoting and supporting breastfeeding in these vulnerable infants.
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Affiliation(s)
- Maria Lorella Giannì
- Fondazione I.R.C.C.S. Ca Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, Department of Clinical Science and Community Health, University of Milan, Via Commenda 12, 20122 Milano, Italy.
| | - Dario Consonni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Epidemiology Unit, Via San Barnaba 8, 20122 Milan, Italy.
| | - Nadia Liotto
- Fondazione I.R.C.C.S. Ca Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, Department of Clinical Science and Community Health, University of Milan, Via Commenda 12, 20122 Milano, Italy.
| | - Paola Roggero
- Fondazione I.R.C.C.S. Ca Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, Department of Clinical Science and Community Health, University of Milan, Via Commenda 12, 20122 Milano, Italy.
| | - Laura Morlacchi
- Fondazione I.R.C.C.S. Ca Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, Department of Clinical Science and Community Health, University of Milan, Via Commenda 12, 20122 Milano, Italy.
| | - Pasqua Piemontese
- Fondazione I.R.C.C.S. Ca Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, Department of Clinical Science and Community Health, University of Milan, Via Commenda 12, 20122 Milano, Italy.
| | - Camilla Menis
- Fondazione I.R.C.C.S. Ca Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, Department of Clinical Science and Community Health, University of Milan, Via Commenda 12, 20122 Milano, Italy.
| | - Fabio Mosca
- Fondazione I.R.C.C.S. Ca Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, Department of Clinical Science and Community Health, University of Milan, Via Commenda 12, 20122 Milano, Italy.
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Wong CH, Chen CP, Wang KG, Sun FJ, Chen CY. Comparison of two cervical cerclages for the prevention of preterm birth and neonatal complications. J Matern Fetal Neonatal Med 2016; 30:551-555. [PMID: 27072547 DOI: 10.1080/14767058.2016.1177818] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To investigate the outcomes of singleton pregnant women with cervical insufficiency undergoing two different cervical cerclages. METHODS This is a retrospective cohort study of women who underwent a history- or ultrasound-indicated cerclage (either Shirodkar or McDonald) at a tertiary referral center from 2002 to 2014. Outcome parameters (delivery age, postoperative cervical length, preterm premature rupture of membranes, preterm delivery rate and neonatal complications) were compared between the two cerclage procedures. Multivariate logistic regression analysis was applied to control for significant variables of preterm birth. Kaplan-Meier survival analysis was used to demonstrate delivery age to percentage of term delivery by cerclage type. RESULTS Ninety-four cases were initially included. After excluding cases not meeting the study criteria, 60 pregnancies (Shirodkar 36 and McDonald 24) were recruited for analysis. The mean delivery age in the Shirodkar group was more advanced than that in the McDonald group (37.1 ± 3.3 versus 34.8 ± 4.9 weeks, p = 0.039). There were significantly fewer deliveries <37 gestational weeks in the Shirodkar group than in the McDonald group (30.6% versus 58.3%, p = 0.033) but no significant differences in deliveries <28, 32 and 34 gestational weeks. No significant differences were found in neonatal complications except for respiratory distress syndrome (5.6% in Shirodkar versus 29.2% in McDonald, p = 0.023). CONCLUSION In the setting of history-indicated or ultrasound-indicated cerclage, Shirodkar was superior to McDonald in the prevention of late preterm birth and neonatal respiratory distress syndrome.
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Affiliation(s)
- Chian-Huey Wong
- a Department of Obstetrics and Gynecology , Mackay Memorial Hospital , Taipei , Taiwan
| | - Chie-Pein Chen
- a Department of Obstetrics and Gynecology , Mackay Memorial Hospital , Taipei , Taiwan
| | - Kuo-Gon Wang
- a Department of Obstetrics and Gynecology , Mackay Memorial Hospital , Taipei , Taiwan
| | - Fang-Ju Sun
- b Department of Medical Research , Mackay Memorial Hospital , Taipei , Taiwan , and
| | - Chen-Yu Chen
- a Department of Obstetrics and Gynecology , Mackay Memorial Hospital , Taipei , Taiwan.,c Department of Medicine , Mackay Medical College , New Taipei City , Taiwan
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Giannì ML, Roggero P, Liotto N, Taroni F, Polimeni A, Morlacchi L, Piemontese P, Consonni D, Mosca F. Body composition in late preterm infants according to percentile at birth. Pediatr Res 2016; 79:710-5. [PMID: 26717003 DOI: 10.1038/pr.2015.273] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 10/12/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND The data on body composition of late preterm infants, evaluated according to percentile at birth, are scarce. The study aimed to investigate body composition of late preterm infants, according to percentile at birth, and to compare their body composition with that of term newborns. METHODS A total of 122 (99 appropriate and 23 small for gestational age (SGA)) late preterm infants underwent growth and body composition assessment using an air displacement plethysmography system on the fifth day of life and at term. The reference group was composed of 42 healthy, term, breast-fed infants. RESULTS At birth, appropriate and SGA late preterm infants had lower fat mass and fat-free mass indexes than term newborns. The fat mass and fat-free mass content increased significantly throughout the study, irrespective of percentile at birth. At term, fat mass index, but not fat-free mass index, was higher in both appropriate and SGA late preterm infants than in term newborns. CONCLUSION Late preterm infants, irrespective of their percentile at birth, show postnatal growth characterized by predominant fat mass accretion. The potential long-term health clinical implications of these findings need to be further elucidated.
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Affiliation(s)
- Maria Lorella Giannì
- Neonatal Intensive Care Unit, Department of Clinical Science and Community Health, Fondazione IRCCS "Ca' Granda" Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Paola Roggero
- Neonatal Intensive Care Unit, Department of Clinical Science and Community Health, Fondazione IRCCS "Ca' Granda" Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Nadia Liotto
- Neonatal Intensive Care Unit, Department of Clinical Science and Community Health, Fondazione IRCCS "Ca' Granda" Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Francesca Taroni
- Neonatal Intensive Care Unit, Department of Clinical Science and Community Health, Fondazione IRCCS "Ca' Granda" Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Antonio Polimeni
- Neonatal Intensive Care Unit, Department of Clinical Science and Community Health, Fondazione IRCCS "Ca' Granda" Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Laura Morlacchi
- Neonatal Intensive Care Unit, Department of Clinical Science and Community Health, Fondazione IRCCS "Ca' Granda" Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Pasqua Piemontese
- Neonatal Intensive Care Unit, Department of Clinical Science and Community Health, Fondazione IRCCS "Ca' Granda" Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Dario Consonni
- Epidemiology Unit, Department of Clinical Science and Community Health, Fondazione IRCCS "Ca' Granda" Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Department of Clinical Science and Community Health, Fondazione IRCCS "Ca' Granda" Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
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Asztalos EV, Hannah ME, Hutton EK, Willan AR, Allen AC, Armson BA, Gafni A, Joseph K, Ohlsson A, Ross S, Sanchez JJ, Mangoff K, Barrett JF. Twin Birth Study: 2-year neurodevelopmental follow-up of the randomized trial of planned cesarean or planned vaginal delivery for twin pregnancy. Am J Obstet Gynecol 2016; 214:371.e1-371.e19. [PMID: 26830380 DOI: 10.1016/j.ajog.2015.12.051] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 12/13/2015] [Accepted: 12/29/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND The Twin Birth Study randomized women with uncomplicated pregnancies, between 32(0/7)-38(6/7) weeks' gestation where the first twin was in cephalic presentation, to a policy of either a planned cesarean or planned vaginal delivery. The primary analysis showed that planned cesarean delivery did not increase or decrease the risk of fetal/neonatal death or serious neonatal morbidity as compared with planned vaginal delivery. OBJECTIVE This study presents the secondary outcome of death or neurodevelopmental delay at 2 years of age. STUDY DESIGN A total of 4603 children from the initial cohort of 5565 fetuses/infants (83%) contributed to the outcome of death or neurodevelopmental delay. Surviving children were screened using the Ages and Stages Questionnaire with abnormal scores validated by a clinical neurodevelopmental assessment. The effect of planned cesarean vs planned vaginal delivery on death or neurodevelopmental delay was quantified using a logistic model to control for stratification variables and using generalized estimating equations to account for the nonindependence of twin births. RESULTS Baseline maternal, pregnancy, and infant characteristics were similar. Mean age at assessment was 26 months. There was no significant difference in the outcome of death or neurodevelopmental delay: 5.99% in the planned cesarean vs 5.83% in the planned vaginal delivery group (odds ratio, 1.04; 95% confidence interval, 0.77-1.41; P = .79). CONCLUSION A policy of planned cesarean delivery provides no benefit to children at 2 years of age compared with a policy of planned vaginal delivery in uncomplicated twin pregnancies between 32(0/7)-38(6/7)weeks' gestation where the first twin is in cephalic presentation.
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Giannì ML, Roggero P, Piemontese P, Liotto N, Orsi A, Amato O, Taroni F, Morlacchi L, Consonni D, Mosca F. Is nutritional support needed in late preterm infants? BMC Pediatr 2015; 15:194. [PMID: 26597280 PMCID: PMC4657334 DOI: 10.1186/s12887-015-0511-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 11/17/2015] [Indexed: 11/10/2022] Open
Abstract
Background Late preterm birth accounts for 70 % of all preterm births. While the impact of feeding problems in very preterm infants has been widely investigated, data on late preterm infants’ feeding issues are scarce. The aim of the present study was to investigate the need of nutritional support during hospital stay in a cohort of late preterm infants and to identify the factors that most contribute to its occurrence. Methods We analyzed the medical records of late preterm infants, born 2011–2013, admitted to a single institution. Neonatal data, the need for nutritional support, defined as the need for parenteral nutrition or intravenous fluids or tube feeding, and the feeding status at discharge were retrieved. The occurrence of respiratory distress syndrome, congenital malformations/chromosomal diseases, cardiac diseases, sepsis, hypoglycemia, poor feeding and the need for surgical intervention were also collected. Results A total of 1768 late preterm infants were included. Among the 592 infants requiring a nutritional support, 228 developed a respiratory distress syndrome, two developed a sepsis, one presented with a cardiac disease, 24 underwent a surgical intervention, eight had a chromosomal disease/congenital malformation, 80 had hypoglycemia. In addition, 100 infants required nutritional support due to poor feeding and 149 were born small for gestational age. Birth weight ≤2000 g (adjusted OR = 12.2, 95 % CI 7.5-19.9, p < 0.0001), gestational age of 34 weeks (adjusted OR = 4.08, 95 % CI 2.8-5.9, p < 0.0001), being small for gestational age (adjusted OR = 2.17, 95 % CI 2.8-5.9, p=0.001), having a respiratory distress syndrome (adjusted OR = 79.6, 95 % CI 47.2-134.3, p < 0.0001) and the need of surgical intervention (adjusted OR = 49.4, 95 % CI 13.9-174.5, p < 0.0001) were associated with a higher risk of need of nutritional support during hospital stay. Conclusions Late preterm infants are at relatively high risk of requiring nutritional support during hospital stay, especially if they have a birth weight ≤2000 g, a gestational age of 34 weeks, are born small for gestational age, develop a respiratory distress syndrome and require a surgical intervention. The present findings add to the knowledge of late preterm infants’ feeding issues and may contribute to tailoring nutritional approaches for these infants.
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Affiliation(s)
- Maria Lorella Giannì
- Department of Clinical Science and Community Health, Neonatal Intensive Care Unit, Fondazione I.R.C.C.S. Ca' Granda Ospedale Maggiore Policlinico, University of Milan, via Commenda 12, 20122, Milano, Italy.
| | - Paola Roggero
- Department of Clinical Science and Community Health, Neonatal Intensive Care Unit, Fondazione I.R.C.C.S. Ca' Granda Ospedale Maggiore Policlinico, University of Milan, via Commenda 12, 20122, Milano, Italy.
| | - Pasqua Piemontese
- Department of Clinical Science and Community Health, Neonatal Intensive Care Unit, Fondazione I.R.C.C.S. Ca' Granda Ospedale Maggiore Policlinico, University of Milan, via Commenda 12, 20122, Milano, Italy.
| | - Nadia Liotto
- Department of Clinical Science and Community Health, Neonatal Intensive Care Unit, Fondazione I.R.C.C.S. Ca' Granda Ospedale Maggiore Policlinico, University of Milan, via Commenda 12, 20122, Milano, Italy.
| | - Anna Orsi
- Department of Clinical Science and Community Health, Neonatal Intensive Care Unit, Fondazione I.R.C.C.S. Ca' Granda Ospedale Maggiore Policlinico, University of Milan, via Commenda 12, 20122, Milano, Italy.
| | - Orsola Amato
- Department of Clinical Science and Community Health, Neonatal Intensive Care Unit, Fondazione I.R.C.C.S. Ca' Granda Ospedale Maggiore Policlinico, University of Milan, via Commenda 12, 20122, Milano, Italy.
| | - Francesca Taroni
- Department of Clinical Science and Community Health, Neonatal Intensive Care Unit, Fondazione I.R.C.C.S. Ca' Granda Ospedale Maggiore Policlinico, University of Milan, via Commenda 12, 20122, Milano, Italy.
| | - Laura Morlacchi
- Department of Clinical Science and Community Health, Neonatal Intensive Care Unit, Fondazione I.R.C.C.S. Ca' Granda Ospedale Maggiore Policlinico, University of Milan, via Commenda 12, 20122, Milano, Italy.
| | - Dario Consonni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Epidemiology Unit, Via San Barnaba 8, 20122, Milan, Italy.
| | - Fabio Mosca
- Department of Clinical Science and Community Health, Neonatal Intensive Care Unit, Fondazione I.R.C.C.S. Ca' Granda Ospedale Maggiore Policlinico, University of Milan, via Commenda 12, 20122, Milano, Italy.
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Abstract
PURPOSE OF REVIEW To provide an overview of the literature regarding medical and developmental risks for moderate to late preterm infants (32-36 weeks gestation), with particular attention to the pediatrician's role in care during both inpatient and outpatient periods. RECENT FINDINGS Although the risks of medical issues and developmental delays decrease with increasing gestational age, research suggests that infants born after 32 weeks' gestation often exhibit significant morbidities associated with prematurity. These infants, often referred to as 'macro preemies', have been found to be at a greater risk for medical complications secondary to immature organ systems including impairments in temperature regulation, respiratory functioning, feeding coordination, bilirubin excretion, glucose control, and infection susceptibility. Recent studies of macro preemies also suggest a higher incidence of significant deficits noted in gross and fine motor skills, speech and communication, and learning and behavior compared to their full-term counterparts. Without careful attention from birth, macro preemie infants could be susceptible to both medical issues and developmental delays. SUMMARY Physicians should be aware of the research regarding increased medical and developmental risks for all infants born before term in order to provide their patients with comprehensive medical and neurodevelopmental follow-up care.
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Autoimmune connective tissue diseases. Best Pract Res Clin Obstet Gynaecol 2015; 29:658-70. [DOI: 10.1016/j.bpobgyn.2015.03.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 03/02/2015] [Accepted: 03/06/2015] [Indexed: 11/17/2022]
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One-year neurodevelopmental outcome of very and late preterm infants: Risk factors and correlation with maternal stress. Infant Behav Dev 2015; 39:11-20. [DOI: 10.1016/j.infbeh.2015.01.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 11/25/2014] [Accepted: 01/03/2015] [Indexed: 11/21/2022]
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van der Ven AJ, van Os MA, Kleinrouweler CE, de Groot CJM, Haak MC, Mol BWJ, Pajkrt E, Kazemier BM. Is cervical length associated with maternal characteristics? Eur J Obstet Gynecol Reprod Biol 2015; 188:12-6. [PMID: 25770842 DOI: 10.1016/j.ejogrb.2015.02.032] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 12/24/2014] [Accepted: 02/19/2015] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Women with a mid-trimester short cervical length (CL) are at increased risk for preterm delivery. Consequently, CL measurement is a potential screening tool to identify women at risk for preterm birth. Our objective was to assess possible associations between CL and maternal characteristics. STUDY DESIGN A nationwide screening study was performed in which CL was measured during the standard anomaly scan among low risk women with a singleton pregnancy. Data on maternal height, pre-pregnancy weight, ethnicity, parity and gestational age at the time of the CL measurement were collected from January 2010 to December 2012. Univariable and multivariable linear regression analyses were performed to assess the relationship between CL and maternal characteristics. RESULTS We included 5092 women. The mean CL was 44.3mm. No association was found between CL and maternal height or gestational age of the measurement. Maternal weight was associated with CL (p=0.007, adjusted R(2) 0.03). Separate analysis for BMI did not change these results. Ethnicity, known in 2702 out of 5092 women, was associated with CL (mean CL in Caucasian women 45.0mm, Asian 43.9mm, Mediterranean 43.1mm, and African 41.8mm, p=0.003), as well as parity (mean CL multiparous 45.3mm, nulliparous 43.5mm, p<0.0001). CONCLUSION Shorter mid-trimester cervical length is associated with higher maternal weight, younger maternal age, nulliparity and non-Caucasian ethnicity, but not with maternal height.
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Affiliation(s)
- A J van der Ven
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands.
| | - M A van Os
- Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands.
| | - C E Kleinrouweler
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands.
| | - C J M de Groot
- Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands.
| | - M C Haak
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, The Netherlands.
| | - B W J Mol
- The Robinson Institute, School of Paediatrics and Reproductive Health, University of Adelaide, 5000 SA, Australia.
| | - E Pajkrt
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands.
| | - B M Kazemier
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands.
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Cole-Lewis HJ, Kershaw TS, Earnshaw VA, Yonkers KA, Lin H, Ickovics JR. Pregnancy-specific stress, preterm birth, and gestational age among high-risk young women. Health Psychol 2014; 33:1033-45. [PMID: 24447189 PMCID: PMC4104268 DOI: 10.1037/a0034586] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Quinello C, Silveira-Lessa AL, Ceccon MEJR, Cianciarullo MA, Carneiro-Sampaio M, Palmeira P. Phenotypic Differences in Leucocyte Populations among Healthy Preterm and Full-Term Newborns. Scand J Immunol 2014; 80:57-70. [DOI: 10.1111/sji.12183] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 04/07/2014] [Indexed: 01/12/2023]
Affiliation(s)
- C. Quinello
- Department of Pediatrics; Faculdade de Medicina da Universidade de São Paulo; São Paulo Brazil
- Laboratory of Medical Investigation (LIM-36); Instituto da Criança; Hospital das Clínicas; São Paulo Brazil
| | - A. L. Silveira-Lessa
- Laboratory of Medical Investigation (LIM-36); Instituto da Criança; Hospital das Clínicas; São Paulo Brazil
- Department of Parasitology; Instituto de Ciências Biomédicas da Universidade de São Paulo; São Paulo Brazil
| | - M. E. J. R. Ceccon
- Department of Pediatrics; Faculdade de Medicina da Universidade de São Paulo; São Paulo Brazil
| | - M. A. Cianciarullo
- Department of Pediatrics; Faculdade de Medicina da Universidade de São Paulo; São Paulo Brazil
| | - M. Carneiro-Sampaio
- Department of Pediatrics; Faculdade de Medicina da Universidade de São Paulo; São Paulo Brazil
- Laboratory of Medical Investigation (LIM-36); Instituto da Criança; Hospital das Clínicas; São Paulo Brazil
| | - P. Palmeira
- Department of Pediatrics; Faculdade de Medicina da Universidade de São Paulo; São Paulo Brazil
- Laboratory of Medical Investigation (LIM-36); Instituto da Criança; Hospital das Clínicas; São Paulo Brazil
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Aly H, Hoffman H, El-Dib M, Said L, Mohamed M. Factor affecting length of stay in late preterm infants: an US national database study. J Matern Fetal Neonatal Med 2014; 28:598-604. [PMID: 24853492 DOI: 10.3109/14767058.2014.927428] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Late preterm infants are the fastest growing segment of the premature infant population in the United States. However, it is not known if demographic and clinical factors can impact the length of hospital stay (LOS) in this population. The objectives of this study are to determine the following: (a) factors associated with a LOS > 3 d and (b) whether there is any difference in risks between infants born at 33-34 versus 35-36 weeks. METHODS Utilizing the Nationwide Inpatient Sample Database, a de-identified dataset produced by the Healthcare Cost and Utilization Project, analysis of 81 913 infants born at 33-36 weeks from 2007 to 2008 was conducted. LOS outcome was defined as ≤3 and >3 d. Bivariable and multivariable logistic regression was used to evaluate predictors of LOS among this population. RESULTS Only 42.7% of infants were discharged home within three days. Factors associated with a LOS > 3 d included gestational age of <35 weeks (RR = 1.63; CI: 1.58-1.68), birth weight of < 2500 g (RR = 1.36; CI: 1.33-1.39), male sex (RR = 1.06; CI: 1.05-1.07), delivery via C-section (RR = 1.46; CI: 1.41-1.51) and multiple gestation (RR = 1.08; 95% CI: 1.06-1.09). Other significant factors included race, birth region, primary insurance payer and clinical complications. In the adjusted interaction model, these variables have more impact on longer LOS in the 35-36 weeks group (p < 0.0001). CONCLUSION Birth region in addition to gestational age, birth weight, gender, mode of delivery, multiple gestation and primary insurance payer affect LOS in late preterm infants. These variables are more critical for the 35-36 week population.
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Affiliation(s)
- Hany Aly
- Department of Neonatology, The George Washington University and Children's National Medical Center , Washington, DC , USA and
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Abstract
PURPOSE OF REVIEW In spite of the advances made in the management of pregnancies in women with systemic lupus erythematosus (SLE), maternal complications and adverse fetal outcomes still exceed the rate of pregnancy complications in the general population. An intriguing question relates to the observation that pregnancy loss, intrauterine growth restriction (IUGR), preterm birth, and preeclampsia remain major complications in SLE pregnancies, not substantially altered by improved therapy and monitoring. RECENT FINDINGS From the review of the recent literature on the pathogenesis of pregnancy loss, IUGR, preeclampsia, and prematurity, it appears that clinical or subclinical inflammation, presence of autoantibodies, hormonal dysfunction, and immune alterations of lupus contribute to pregnancy complications. Impairment of early placenta development leads to poor vascularization, resulting in placental ischemia and subsequent endothelial damage. Depending on the extent of the pathological process, pregnancy loss, IUGR, and preeclampsia can develop. SUMMARY Early recognition of pregnancy complications is desirable in order to prevent their development or to prompt intervention that improves the outcomes. Several biomarkers have been investigated for their ability to predict complications at an early stage of pregnancy. However, up to date only lupus anticoagulant has emerged as a consistent predictor for adverse pregnancy outcomes.
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Naver KV, Grinsted J, Larsen SO, Hedley PL, Jørgensen FS, Christiansen M, Nilas L. Increased risk of preterm delivery and pre-eclampsia in women with polycystic ovary syndrome and hyperandrogenaemia. BJOG 2014; 121:575-81. [PMID: 24418062 DOI: 10.1111/1471-0528.12558] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To study the risk of adverse pregnancy outcomes in women with polycystic ovary syndrome (PCOS), and to examine the role of hyperandrogenaemia. DESIGN Cohort study. SETTING Singleton pregnancies in women with PCOS identified at a private fertility clinic during 1997-2010 and a background population including all singleton deliveries at Hvidovre Hospital, Denmark, in 2005. POPULATION A cohort of 459 women with PCOS and a background population of 5409 women. METHODS Obstetric outcomes were extracted from national Danish registries and odds ratios (ORs) were calculated by multiple logistic regression analysis, adjusting for age, parity, and body mass index. MAIN OUTCOME MEASURES Risk of pre-eclampsia, preterm delivery, and small for gestational age offspring in the entire PCOS population and in a subsample with hyperandrogenaemia. RESULTS Women with PCOS had an increased risk of preterm delivery <37 weeks of gestation (OR 2.28; 95% confidence interval, 95% CI, 1.51-3.45; P < 0.0001). The elevated risk was confined to hyperandrogenic women with PCOS: preterm delivery before 37 weeks of gestation (OR 2.78; 95% CI 1.62-4.77; P < 0.0001), and was not seen in normoandrogenic women with PCOS (OR 1.35; 95% CI 0.54-3.39; P = 0.52). The overall risk of pre-eclampsia was not elevated (OR 1.69; 95% CI 0.99-2.88; P = 0.05) compared with the background population, but was significantly increased in the hyperandrogenic subsample (OR 2.41; 95% CI 1.26-4.58; P < 0.001). The risk of small for gestational age offspring was similar in all groups. CONCLUSION Women with PCOS had an increased risk of preterm delivery compared with the background population. The increased risk was confined to hyperandrogenic women with PCOS who had a two-fold increased risk of preterm delivery and pre-eclampsia.
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Affiliation(s)
- K V Naver
- Department of Obstetrics and Gynaecology, Hvidovre University Hospital, University of Copenhagen, Hvidovre, Denmark
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Coussons-Read ME. Effects of prenatal stress on pregnancy and human development: mechanisms and pathways. Obstet Med 2013; 6:52-57. [PMID: 27757157 DOI: 10.1177/1753495x12473751] [Citation(s) in RCA: 166] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2012] [Indexed: 11/16/2022] Open
Abstract
A growing body of research shows that prenatal stress can have significant effects on pregnancy, maternal health and human development across the lifespan. These effects may occur directly through the influence of prenatal stress-related physiological changes on the developing fetus, or indirectly through the effects of prenatal stress on maternal health and pregnancy outcome which, in turn, affect infant health and development. Animal and human studies suggest that activation of the maternal stress response and resulting changes in endocrine and inflammatory activity play a role in the aetiology of these effects. Ongoing research is focusing on clarifying these mechanisms, understanding the role of racial and cultural factors in these effects, and examining the epigenetic and transgenerational influences of prenatal stress.
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Affiliation(s)
- Mary E Coussons-Read
- The University of Colorado, Colarado Springs and The Colorado School of Public Health, 1420 Austin Bluffs Parkway, Colorado Springs, CO 80918, USA
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Morag I, Bart O, Raz R, Shayevitz S, Simchen MJ, Strauss T, Zangen S, Kuint J, Gabis L. Developmental characteristics of late preterm infants at six and twelve months: a prospective study. Infant Behav Dev 2013; 36:451-6. [PMID: 23644422 DOI: 10.1016/j.infbeh.2013.03.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 12/09/2012] [Accepted: 03/26/2013] [Indexed: 11/19/2022]
Abstract
AIM To longitudinally assess the neurodevelopmental outcomes of late preterm infants (LPI) through the first year of life and to investigate for perinatal conditions that may affect developmental outcomes. METHODS The study population comprised of 124 LPI, born in a single Israeli inborn center over an eight months period. Thirty-three term infants (TI) were recruited for comparison. Alberta Infant Motor Scale (AIMS) for gross motor evaluation was performed at 6 months of age and the Griffiths Mental Development Scales (GMDS) were performed at 12 months (chronological age). Maternal and neonatal covariates, potentially associated with low developmental scores, were analyzed by multivariate logistic regression models. RESULTS At chronological age of 6 and 12 months, LPI performed significantly lower than TI on all subscales, but when scores were corrected for post conception age, developmental scores were similar in the two groups. In a multivariate model of logistic regression, male gender, emergent cesarean section and higher maternal education (>14 years) were found to be associated with increased risk for lower developmental scores at 12 month of age in LPI. CONCLUSIONS LPI do not complete their neurodevelopmental maturation by the first year of life. Males and those born after emergent cesarean section (CS) are at increased risk for lower developmental scores. Correction of age to term birth in LPI may still be needed at this age.
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Affiliation(s)
- Iris Morag
- Department of Neonatology, The Edmond and Lily Safra Children's Hospital, Sheba, Tel Hashomer, Israel
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Baroutis G, Mousiolis A, Mesogitis S, Costalos C, Antsaklis A. Preterm birth trends in Greece, 1980-2008: a rising concern. Acta Obstet Gynecol Scand 2013; 92:575-82. [PMID: 23360152 DOI: 10.1111/aogs.12089] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 12/27/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To identify preterm birth trends in Greece. DESIGN Retrospective epidemiological study. SETTING Women giving birth in Greece from 1980 to 2008. POPULATION Live births beyond the 24th gestational week. METHODS Data acquisition from the Hellenic Vital Statistics records. Statistical analysis of preterm birth rate among neonates estimated for each year. MAIN OUTCOME MEASURES Total number of births and preterm births, as well as rate of preterm birth by gestational week. Stillbirth rates by gestational age. RESULTS 3 218 463 births occurred during the period under study, 151 594 (4.7%) of which were preterm. A steep rise in preterm births was noted during the final years of the study, reaching 9.6% in 2008. This was mainly due to the "late preterm" sub-group (34(+0) -36(+6) gestational weeks). The rates of stillbirth fell in a constant way regardless of the maturity index. CONCLUSIONS Although preterm birth etiology is multifactorial, the selective rise in the "late preterm" group possibly was due to an increase in medical reasons necessitating a preterm delivery, changes in obstetric practice, or both. Further studies are needed to estimate the precise effect of each contributing factor.
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Affiliation(s)
- Georgios Baroutis
- Neonatal Department, Alexandra Hospital, University of Athens, Athens, Greece
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Clowse MEB, Wallace DJ, Weisman M, James A, Criscione-Schreiber LG, Pisetsky DS. Predictors of preterm birth in patients with mild systemic lupus erythematosus. Ann Rheum Dis 2013; 72:1536-9. [PMID: 23361085 DOI: 10.1136/annrheumdis-2012-202449] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE While increased disease activity is the best predictor of preterm birth in women with systemic lupus erythematosus (SLE), even women with low disease activity are at increased risk of this complication. Biomarkers that would identify at-risk pregnancies could allow interventions to prevent preterm birth. METHOD Measures of SLE activity, inflammation, placental health and renal function between 20 and 28 weeks gestation (mid-gestation) were correlated to preterm birth and gestational age at delivery in a prospective cohort of pregnant women with SLE. RESULT Of the 40 pregnancies in 39 women, all with mild-moderate SLE disease, 9 (23.7%) of the 38 live births were delivered preterm. Low C4 was the only marker of SLE activity associated with younger gestational age at delivery. Elevated ferritin and lower oestradiol correlated with younger gestational age at delivery. Renal function remained normal during all pregnancies at mid-gestation and did not correlate with preterm birth. Higher serum uric acid, however, correlated with younger gestational age at delivery. CONCLUSIONS In women with SLE with mild-moderate disease activity, ferritin, oestradiol and uric acid levels at mid-gestation may predict preterm birth. These markers may prove to be clinically useful in identifying pregnancies at particularly high risk for adverse outcomes.
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Affiliation(s)
- Megan E B Clowse
- Department of Medicine, Duke University Medical Center, , Durham, NC 27710, USA.
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Giannì ML, Roggero P, Liotto N, Amato O, Piemontese P, Morniroli D, Bracco B, Mosca F. Postnatal catch-up fat after late preterm birth. Pediatr Res 2012; 72:637-40. [PMID: 23011446 DOI: 10.1038/pr.2012.128] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Late preterm birth accounts for 70% of preterm births. The aim of the study was to investigate the postnatal weight gain and weight gain composition changes in a cohort of late preterm infants. METHODS A total of 49 late preterm infants (mean birth weight 2,496 ± 330 g and gestational age 35.2 ± 0.7 wks) underwent growth and body composition assessment by an air displacement plethysmography system on the fifth day of life, at term, and at 1 and 3 mo of corrected age. The reference group was composed of 40 healthy, full-term, breast-fed infants. RESULTS The late preterm infants showed a Δ fat mass gain between birth and term-corrected age equal to 182%. As compared with full-term infants, at term and 1 mo of corrected age mean weight (3,396 ± 390 vs. 3,074 ± 409 g and 4,521 ± 398 vs. 4,235 ± 673 g, respectively) and percentage of fat mass (16.1 ± 4.6 vs. 8.9 ± 2.9 and 22.6 ± 4.2 vs. 17.4 ± 4.0, respectively) were significantly higher in late preterm infants, whereas no difference among groups was found at 3 mo. CONCLUSION Rapid postnatal catch-up fat was found in these infants. Further studies are needed to investigate whether this short-term increase in fat mass may modulate the risk of chronic diseases or represent an adaptive mechanism to extrauterine life.
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Affiliation(s)
- Maria L Giannì
- Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi, Milano, Italy
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Singer D. [Long-term survival of preterm neonates]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2012; 55:568-75. [PMID: 22441527 DOI: 10.1007/s00103-012-1453-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
In view of the increased survival rate of very preterm neonates, several longitudinal studies were done to assess the quality of life of the survivors. They revealed a fairly constant rate of 25-30% of sensorineural and/or motor impairment. Beyond those "major handicaps," further problems may arise in every single period of life, which, albeit less severe, add to the burden of prematurity. These include growth retardation and cognitive delay in the school age, affected psychosocial behavior during adolescence, and the "metabolic syndrome" of formerly malnourished fetuses in adulthood. Thus, the epidemiologic studies not only confirmed the role of regionalization in the quality of perinatology, but also supported a more farsighted approach to the sequelae of prematurity. Like in young adults who grew up with congenital heart defects, also in former preterm neonates, appropriate medical care has to be provided for an increasing number of long-term survivors. Moreover, the life-long effects of metabolic imprinting in growth-retarded fetuses underline the primary-preventive role of perinatal medicine, extending far beyond the "baby" stage of human development.
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Affiliation(s)
- D Singer
- Sektion Neonatologie und Pädiatrische Intensivmedizin, Zentrum für Geburtshilfe, Kinder- und Jugendmedizin, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
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The underestimation of immaturity in late preterm infants. Arch Gynecol Obstet 2012; 286:619-26. [PMID: 22562386 DOI: 10.1007/s00404-012-2366-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Accepted: 04/23/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE Late preterm infants with gestational ages between 34 0/7 and 36 6/7 weeks are known to be at higher risk of mortality and morbidity than term newborns. This study aims to investigate the nature and frequency of neonatological complications in the late preterm population resulting in neonatal intensive care unit admissions as well as to draw obstetrical conclusions from the results. METHODS Neonatological outcomes of 893 consecutively born late preterm infants were evaluated and classified by the frequency of occurrence in relation to potential maternal or fetal risk factors. RESULTS Out of 893 late preterm infants, 528 (59.1 %) required intensive neonatal care. The incidence of apnea and bradycardia, the occurrence of feeding difficulties and the requirement of continuous positive airway pressure (CPAP) were inversely proportional to gestational age (p < 0.001). Gestational diabetes of the mother was more frequently associated with hypoglycemia (p < 0.001), but showed a reduced risk of hypothermia (p < 0.001). Small for gestational age neonates had a significantly lower rate of respiratory disorders (p < 0.001), but were more often affected by feeding difficulties (p < 0.01). Normal vaginal delivery had a significant advantage with regard to the necessity of CPAP (p < 0.01) and the occurrence of feeding difficulties (p < 0.05). Infants born by cesarean section were at higher risk of hypoglycemia (p < 0.001), but at lower risk of hyperbilirubinemia (p < 0.001). CONCLUSIONS The high risk of a problematic neonatological outcome in late preterms requires fundamental reconsideration. All efforts to prolong a pregnancy should be made beyond the 34th week of gestation.
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The occurrence of preterm delivery is linked to pregnancy-specific distress and elevated inflammatory markers across gestation. Brain Behav Immun 2012; 26:650-9. [PMID: 22426431 PMCID: PMC4462138 DOI: 10.1016/j.bbi.2012.02.009] [Citation(s) in RCA: 127] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2011] [Revised: 02/15/2012] [Accepted: 02/29/2012] [Indexed: 11/21/2022] Open
Abstract
There is mounting evidence that stress during pregnancy can have detrimental effects on gestation and birth. Existing studies indicate that prenatal stress may increase levels of circulating inflammatory markers that are associated with prematurity and pregnancy complications, suggesting that stress-related changes in the cytokine milieu may increase the risk of poor pregnancy outcome. Previous studies, however, have not clearly connected stress during pregnancy to changes in inflammatory mediators and, in turn, to clinically-relevant outcomes such as premature delivery. The present study sought to directly connect prenatal stress and changes in inflammatory markers to preterm delivery and gestational age at birth (GAB). A sample of 173 women was recruited during the first trimester of pregnancy and followed through delivery. Overall stress, pregnancy-specific distress, and inflammatory markers were assessed early and later in pregnancy, and the predictive value of these measures for preterm birth and GAB was determined. There were significant differences in pregnancy-specific distress, IL-6, and TNF-α between women who delivered prematurely versus those who delivered at term, and elevated levels of pregnancy-specific distress, IL-6, and TNF-α were predictive of shortened GAB overall. Importantly, in many cases, the effects of overall stress and pregnancy-specific distress on GAB were mediated by levels of circulating inflammatory markers. Collectively, these data provide strong evidence that prenatal stress experiences can affect the timing of parturition via alterations in circulating inflammatory mediators, and underscore the need for ongoing research aimed at further understanding the mechanisms and effects of prenatal stress on maternal and infant health.
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