1
|
Walia A, Berger VK, Gonzalez JM, Sobhani NC. Mode of delivery and neonatal outcomes with early preterm severe preeclampsia: does fetal growth restriction matter? J Matern Fetal Neonatal Med 2023; 36:2208251. [PMID: 37137495 DOI: 10.1080/14767058.2023.2208251] [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: 05/05/2023]
Abstract
OBJECTIVE Severe preeclampsia diagnosed at or prior to 34 weeks is an indication for preterm delivery. Many patients with severe preeclampsia develop fetal growth restriction as a result of the placental dysfunction associated with both conditions. The ideal mode of delivery in cases of preterm severe preeclampsia with fetal growth restriction remains controversial, with providers often proceeding directly to cesarean delivery rather than attempting a trial of labor due to theoretic concerns about the harms of labor in the face of placental dysfunction. There are limited data supporting this approach. This study evaluates whether the presence of fetal growth restriction affects the ultimate mode of delivery or neonatal outcomes among pregnancies with severe preeclampsia undergoing induction of labor at or before 34 weeks. METHODS This was a retrospective cohort study of singletons with severe preeclampsia undergoing induction of labor ≤ 34 weeks at a single center between January 2015 and April 2022. The primary predictor was fetal growth restriction, defined as estimated fetal weight < 10th percentile for gestational age on ultrasound. Mode of delivery and neonatal outcomes were compared between those with and without fetal growth restriction using Fisher's exact and Kruskal-Wallis tests, and multivariate logistic regression was used to obtain adjusted odds ratios. RESULTS 159 patients were included (N = 117 without fetal growth restriction, N = 42 with fetal growth restriction). There was no difference in vaginal delivery between the groups (70% vs 67%, p = .70). While those with fetal growth restriction had a higher incidence of respiratory distress syndrome and longer neonatal hospital stay, these differences were not statistically significant after adjusting for gestational age at delivery. There were no significant differences in other neonatal outcomes, including Apgar score, cord blood gases, intraventricular hemorrhage, necrotizing enterocolitis, neonatal sepsis, and neonatal demise. CONCLUSION For pregnancies complicated by severe preeclampsia that require delivery ≤ 34 weeks, the likelihood of successful vaginal delivery following induction of labor does not differ based on presence of fetal growth restriction. Furthermore, fetal growth restriction is not an independent risk factor for adverse neonatal outcomes in this population. Induction of labor should be considered a reasonable approach and should be routinely offered to patients with concurrent preterm severe preeclampsia and fetal growth restriction.
Collapse
Affiliation(s)
- Anjali Walia
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Victoria K Berger
- Maternal and Fetal Medicine, Sutter West Bay Medical Group, San Francisco, CA, USA
| | - Juan M Gonzalez
- Division of Maternal-Fetal Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Nasim C Sobhani
- Division of Maternal-Fetal Medicine, University of California San Francisco, San Francisco, CA, USA
| |
Collapse
|
2
|
Li J, Zhu T, Liu G, Chen Y, Xing L, Tian Y, Liang F. Cesarean delivery was associated with low morbidity in very low birth weight infants: A retrospective cohort study. Medicine (Baltimore) 2023; 102:e33554. [PMID: 37083785 PMCID: PMC10118352 DOI: 10.1097/md.0000000000033554] [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: 12/05/2022] [Accepted: 03/28/2023] [Indexed: 04/22/2023] Open
Abstract
To estimate the relationship among the cesarean delivery (CD), mortality and morbidity in very low birth weight (VLBW) infants weighing less than 1500 g. This retrospective cohort study enrolled 242 VLBW infants delivered between the 24 to 31week of gestation from 2015 to 2021. We compared CD with vaginal delivery (VD). The primary outcome was a composite neonatal morbidity including bronchopulmonary dysplasia, intraventricular hemorrhage, periventricular leukomalacia, necrotizing enterocolitis, late-onset sepsis and retinopathy of prematurity. The secondary outcome included mortality within 28 days. A multivariate logistic regression was used and adjusted for birthweight, twin pregnancy and antenatal steroids intake. The overall CD rate was 80.6%. Compared with VD, a significantly lower composite neonatal morbidity was associated with CD (adjusted odds ratio, 0.33, 95% confidence interval, 0.12-0.90, P = .031). The relationship between CD and neonatal morbidity disappeared when the VLBW infants were stratified according to the gestational age. No significant difference was observed between the VD and CD cohorts regarding mortality. Compared with VD, CD was associated with a lower morbidity in VLBW infants. Further studies are required to clarify how this association is influenced by gestational age.
Collapse
Affiliation(s)
- Jianqiong Li
- Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, School of Medicine, Zhejiang University, Hangzhou, China
| | - Tingting Zhu
- Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, School of Medicine, Zhejiang University, Hangzhou, China
| | - Gu Liu
- Department of Neonatology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yuyang Chen
- Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, School of Medicine, Zhejiang University, Hangzhou, China
| | - Linli Xing
- Hangzhou Xixi Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yichao Tian
- Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, School of Medicine, Zhejiang University, Hangzhou, China
| | - Fengbing Liang
- Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, School of Medicine, Zhejiang University, Hangzhou, China
| |
Collapse
|
3
|
Arslan HC, Corbacıoglu Esmer A, Akca A, Arslan K. The effect of middle cerebral artery peak systolic velocity on prognosis in early and late-onset fetal growth restriction. J Perinat Med 2022; 51:559-563. [PMID: 36282729 DOI: 10.1515/jpm-2022-0305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 09/18/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES We aim to investigate the utility of MCA PSV Doppler in determining the perinatal mortality and morbidity in serial Doppler measurements from the time of diagnosis to the delivery of complicated cases with fetal growth restriction (FGR). METHODS At 24-38 weeks of gestation, 65 pregnant women diagnosed with FGR were included in the study. The fetal biometry measurements, MCA PI, and MCA PSV Doppler evaluation of the cases formed at the diagnosis and the delivery were recorded. Gestational weeks, birth weights, APGAR scores, cord pH values, NICU (neonatal intensive care unit) admission, NICU duration of stay, and perinatal morbidity parameters such as RDS (respiratory distress syndrome), BPD (Bronchopulmonary dysplasia), NEC (necrotizing enterocolitis), sepsis and perinatal mortality were compared. The patients were divided into two groups: early and late-onset fetal growth restriction. Perinatal morbidity and mortality were accepted as adverse perinatal outcomes. RESULTS MCA PSV above the 95th percentile at the diagnosis and delivery time was seen at a significantly higher rate with adverse perinatal outcomes. CONCLUSIONS This study shows that evaluating MCA PSV with Doppler can be a helpful diagnostic method for early diagnosis of restriction and hypoxic fetuses. Also, it may be used in clinics as a noninvasive method to predict neonatal prognosis.
Collapse
Affiliation(s)
- Hale Cetin Arslan
- Clinic of Obstetrics and Gynecology, University of Health Sciences Turkey, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | | | - Aysu Akca
- Clinic of Obstetrics and Gynecology, University of Health Sciences Turkey, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Kadir Arslan
- Clinic of Anesthesiology and Reanimation, University of Health Sciences Turkey, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
4
|
Luca A, Vinturache A, Ilea C, Avasiloaiei A, Paduraru L, Carauleanu A, Sripcariu I, Socolov D. Birth trauma in preterm spontaneous vaginal and cesarean section deliveries: A 10-years retrospective study. PLoS One 2022; 17:e0275726. [PMID: 36251717 PMCID: PMC9576096 DOI: 10.1371/journal.pone.0275726] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 09/22/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE We compared birth injuries for spontaneous vaginal (VD) and caesarean section (CS) deliveries in preterm and term pregnancies. METHODS A retrospective cohort study was conducted in a single tertiary center, between January 1st, 2007, and December 31st, 2017. The study included 62330 singleton pregnancies delivered after 24 0/7 weeks gestation. Multivariable analyses compared trauma at birth, birth hypoxia and birth asphyxia in term and preterm deliveries, stratified by mode of birth, VD versus CS. Main outcome measure was trauma at birth including intracranial laceration and haemorrhage, injuries to scalp, injuries to central and peripheral nervous system, fractures to skeleton, facial and eye injury. RESULTS The incidence of preterm deliveries was 10.9%. Delivery of preterm babies by CS increased from 37.0% in 2007 to 60.0% in 2017. The overall incidence of all birth trauma was 16.2%. When stratified by mode of delivery, birth trauma was recorded in 23.4% of spontaneous vaginal deliveries and 7.5% of CS deliveries (aOR 3.3, 95%CI 3.1-3.5). When considered all types of birth trauma, incidence of trauma at birth was higher after 28 weeks gestation in VD compared to CS (28-31 weeks, aOR 1.7, 95% CI 1.3-2.3; 32-36 weeks, aOR 4.2, 95% CI 3.6-4.9; >37 weeks, aOR 3.3, 95% CI 3.1-3.5). There was no difference in the incidence of birth trauma before 28 weeks gestation between VD and CS (aOR 0.8, 95% CI 0.5-1.2). Regarding overall life-threatening birth trauma or injuries at birth with severe consequences such as cerebral and intraventricular haemorrhage, cranial and brachial nerve injury, fractures of long bones and clavicle, eye and facial injury, there was no difference in vaginal preterm deliveries compared to CS deliveries (p > 0.05 for all). CONCLUSION CS is not protective of injury at birth. When all types of birth trauma are considered, these are more common in spontaneous VD, thus favoring CS as preferred method of delivery to avoid trauma at birth. However, when stratified by severity of birth trauma, preterm babies delivered vaginally are not at higher risk of major birth trauma than those delivered by CS.
Collapse
Affiliation(s)
- Alina Luca
- Department of Obstetrics & Gynecology, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania
- CuzaVoda Maternity University Hospital, Iasi, Romania
| | - Angela Vinturache
- Department of Obstetrics and Gynecology, University of Alberta & Department of Nuroscience, University of Lethbridge, Alberta, Canada
- Department of Obstetrics & Gynecology, Grande Prairie Regional Hospital, Alberta, Canada
- * E-mail:
| | - Ciprian Ilea
- Department of Obstetrics & Gynecology, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania
- CuzaVoda Maternity University Hospital, Iasi, Romania
| | - Andreea Avasiloaiei
- Department of Obstetrics & Gynecology, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania
- CuzaVoda Maternity University Hospital, Iasi, Romania
| | - Luminita Paduraru
- Department of Obstetrics & Gynecology, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania
- CuzaVoda Maternity University Hospital, Iasi, Romania
| | - Alexandru Carauleanu
- Department of Obstetrics & Gynecology, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania
- CuzaVoda Maternity University Hospital, Iasi, Romania
| | - Ioana Sripcariu
- Department of Obstetrics & Gynecology, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania
- CuzaVoda Maternity University Hospital, Iasi, Romania
| | - Demetra Socolov
- Department of Obstetrics & Gynecology, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania
- CuzaVoda Maternity University Hospital, Iasi, Romania
| |
Collapse
|
5
|
Rahman S, Ullah M, Ali A, Afridi N, Bashir H, Amjad Z, Jafri A, Jawaid A. Fetal Outcomes in Preterm Cesarean Sections. Cureus 2022; 14:e27607. [PMID: 36059308 PMCID: PMC9435399 DOI: 10.7759/cureus.27607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Neonatal mortality is a major challenge in low-middle-income countries. The current study was conducted to assess the association between preterm cesarean delivery and fetal outcomes. Methods A prospective study was conducted at the Combined Military Hospital in Peshawar, Pakistan, from October 1, 2020, to March 31, 2021. All women reporting to the hospital with a cephalic presentation and singleton pregnancies between the 27th and 34th weeks of gestation were included in the study. Pregnancies with an abnormal presentation, those diagnosed with a congenital abnormality, and those with indications for growth restriction or preterm delivery were excluded from the study. We also excluded infants delivered via vacuum or forceps. The outcomes of interest in this study included neonatal death prior to discharge, neonatal respiratory distress, sepsis, intraventricular hemorrhage (IVH), seizure, subdural hemorrhage (SDH), or appearance, pulse, grimace, activity, and respiration (APGAR) test score of less than 7 at five minutes. Maternal features including diabetes, hypertension and gestational age of delivery, parity, previous cesarean sections (CS), and last pregnancy outcomes were documented in a predefined pro forma. Results Our sample size consisted of 288 women, who were classified into two groups. Group A comprised 144 women who gave birth vaginally and group B consisted of 144 women who underwent CS. It was observed that women who underwent cesareans had a higher likelihood of a history of hypertension and related pathologies. It was also observed that these women had a greater likelihood of being of higher age compared to women who underwent vaginal deliveries. Neonates of women who had CS were at a greater risk of presenting with respiratory distress than those who had spontaneous vaginal deliveries. Conclusion Based on our findings, respiratory distress was significantly more common in babies of women who delivered via CS. However, there was no difference in neonatal outcomes in terms of IVH, seizures, SDH, and APGAR score of <7.
Collapse
|
6
|
The impact of maternal asthma on the preterm infants' gut metabolome and microbiome (MAP study). Sci Rep 2022; 12:6437. [PMID: 35440708 PMCID: PMC9018729 DOI: 10.1038/s41598-022-10276-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/30/2022] [Indexed: 11/20/2022] Open
Abstract
Preterm infants are at a greater risk for the development of asthma and atopic disease, which can lead to lifelong negative health consequences. This may be due, in part, to alterations that occur in the gut microbiome and metabolome during their stay in the Neonatal Intensive Care Unit (NICU). To explore the differential roles of family history (i.e., predisposition due to maternal asthma diagnosis) and hospital-related environmental and clinical factors that alter microbial exposures early in life, we considered a unique cohort of preterm infants born ≤ 34 weeks gestational age from two local level III NICUs, as part of the MAP (Microbiome, Atopic disease, and Prematurity) Study. From MAP participants, we chose a sub-cohort of infants whose mothers had a history of asthma and matched gestational age and sex to infants of mothers without a history of asthma diagnosis (control). We performed a prospective, paired metagenomic and metabolomic analysis of stool and milk feed samples collected at birth, 2 weeks, and 6 weeks postnatal age. Although there were clinical factors associated with shifts in the diversity and composition of stool-associated bacterial communities, maternal asthma diagnosis did not play an observable role in shaping the infant gut microbiome during the study period. There were significant differences, however, in the metabolite profile between the maternal asthma and control groups at 6 weeks postnatal age. The most notable changes occurred in the linoleic acid spectral network, which plays a role in inflammatory and immune pathways, suggesting early metabolomic changes in the gut of preterm infants born to mothers with a history of asthma. Our pilot study suggests that a history of maternal asthma alters a preterm infants’ metabolomic pathways in the gut, as early as the first 6 weeks of life.
Collapse
|
7
|
Predictors of respiratory distress syndrome, sepsis and mortality among preterm neonates admitted to neonatal intensive care unit in northern Ethiopia. J Pediatr Nurs 2022; 63:e113-e120. [PMID: 34649733 DOI: 10.1016/j.pedn.2021.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 09/26/2021] [Accepted: 09/30/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE We aim to identify the predictors of respiratory distress syndrome, neonatal sepsis and mortality among preterm neonates admitted to neonatal intensive care unit at Ayder Comprehensive Specialized Hospital, northern Ethiopia. MATERIALS AND METHODS An institutional-based retrospective cross-sectional study was conducted on 816 preterm neonates. An association between variables was decided at p-value ≤0.05, or AOR, 95% CI. RESULTS Neonatal sepsis was significantly associated with cesarean section (AOR = 0.62, CI (0.43-0.91)), male (AOR = 1.6, CI (1.12-2.28)), 4-6 APGAR score at 1-min (AOR = 1.67, CI (1.15-2.42)) and hospitalization for more than 14 days (AOR = 2.62, CI (1.5-4.58)) days. Also, the determinants of respiratory distress syndrome were compound fetal presentation (AOR = 2.17, CI (1-4.71)), < 28 weeks of gestational age (AOR = 3.32, CI (1.07-10.22)), 28-31 6/7 weeks of gestational age (AOR = 4.19, CI (2.39-7.33)), 1-1.49 kg birth weight (AOR = 4.22, CI (1.79-9.93)) and 4-6 APGAR score at 1-min (AOR = 2.22, CI (1.54-3.19)). Respiratory distress syndrome (AOR =12, CI (5.42-26.94)) and perinatal asphyxia (AOR = 3.42, CI (1.64-7.11)) were also associated with preterm neonatal mortality. CONCLUSION The predictors of respiratory distress syndrome were fetal presentation, gestational age, birth weight and 1st minute APGAR score. Also, neonatal sepsis was significantly associated with mode of delivery, sex, 1st minute APGAR score, respiratory distress syndrome and duration of hospitalization. Lastly, the predictors of mortality were respiratory distress syndrome, 1st minute APGAR score and perinatal asphyxia. PRACTICE IMPLICATIONS It will give clues to mobilize resources towards the main predictors of comorbidity and mortality in preterms in the health care settings.
Collapse
|
8
|
Survival and mortality of preterm neonates in a neonatal intensive care unit in Northern Ethiopia: a retrospective cohort study. Sci Rep 2022; 12:600. [PMID: 35022458 PMCID: PMC8755721 DOI: 10.1038/s41598-021-04521-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 12/24/2021] [Indexed: 02/07/2023] Open
Abstract
The purpose of this study was to assess the predictors of preterm neonatal survival in a neonatal intensive care unit (NICU). A cohort study was conducted retrospectively on 1017 preterm neonates using medical records from January 2014 through December 2018. The Kaplan–Meier model was used to estimate mean survival time and cumulative survival probability. Furthermore, Multivariable Cox regression analysis was run to identify predictors of preterm neonatal mortality using an adjusted hazard ratio (AHR) at P < 0.05 and 95% confidence interval (CI). During the follow-up period in the NICU, the mean survival time of the preterm neonates was 47 (95% CI (43.19–48.95)) days. Compound presentation (AHR = 2.29, 95% CI (1.23–4.24)), perinatal asphyxia (AHR = 2.83, 95% CI (1.75–4.58)), respiratory distress syndrome (AHR = 3.01, 95% CI (1.80–5.01)), 1-min APGAR score (AHR = 0.78, 95% CI (0.62–0.98)), and birth weight (AHR = 0.32, 95% CI (0.17–0.58)) were found to be significant predictors of time to preterm neonatal mortality. In conclusion, the survival probability of preterm neonates showed a considerable decrement in the first week of life. Fetal presentation, gestational age, birth weight, 1-min APGAR score, perinatal asphyxia and respiratory distress syndrome found as independent predictors of preterm neonatal mortality.
Collapse
|
9
|
Kollia M, Iacovidou N, Iliodromiti Z, Pouliakis A, Sokou R, Mougiou V, Boutsikou M, Politou M, Boutsikou T, Valsami S. Primary hemostasis in fetal growth restricted neonates studied via PFA-100 in cord blood samples. Front Pediatr 2022; 10:946932. [PMID: 36160789 PMCID: PMC9492943 DOI: 10.3389/fped.2022.946932] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/01/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Platelet function of fetal growth restricted (FGR) neonates remains a field of debate. Platelet function analyzer (PFA-100) offers a quantitative in vitro assessment of primary, platelet-related hemostasis. Our aim was to examine platelet function using PFA-100 in FGR neonates and associate our results with perinatal parameters. METHODS PFA-100 was applied on 74 FGR neonates, 48 full-term (>37 weeks' gestation) and 26 preterm neonates (<37 weeks). The control group consisted of 118 healthy neonates. Two closure times (CTs) with COL/EPI and COL/ADP cartridges were determined on cord blood samples for each subject. Statistical analysis was performed by SAS 9.4. The statistical significance level was set at 0.05 and all tests were two-tailed. RESULTS COL/EPI CTs were prolonged in FGR (median 132 s, IQR 95-181 s) compared with control neonates (median 112.5 s, IQR 93-145 s), p = 0.04. Median COL/EPI CT for term and preterm FGR neonates was 126 s (IQR 90-157 s) and 137 s (IQR 104-203), respectively (p = 0.001), and COL/ADP CT was 70 s (IQR 62-80 s) for term and 75 s (IQR 68-82 s) for preterm FGR neonates (p = 0.08). Among FGR neonates, COL/EPI CT was related with delivery time (with preterm neonates exhibiting prolonged COL/EPI CTs), p = 0.05. No correlation was proved between both CTs and hematological parameters in FGR neonates. CONCLUSION FGR neonates showed impaired platelet function via PFA-100, with preterm FGR neonates confronting the greatest risk. Prolonged COL/EPI CTs in FGR neonates seemed to be independent of hematological parameters and could warn for closer evaluation during the first days of their lives.
Collapse
Affiliation(s)
- Maria Kollia
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nicoletta Iacovidou
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Zoi Iliodromiti
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Abraham Pouliakis
- 2nd Department of Pathology, "Attikon" University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Rozeta Sokou
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasiliki Mougiou
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Boutsikou
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Marianna Politou
- Haematology Laboratory-Blood Bank, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodora Boutsikou
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Serena Valsami
- Haematology Laboratory-Blood Bank, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
10
|
Norman JE, Lawton J, Stock SJ, Siassakos D, Norrie J, Hallowell N, Chowdhry S, Hart RI, Odd D, Brewin J, Culshaw L, Lee-Davey C, Tebbutt H, Whyte S. Feasibility and design of a trial regarding the optimal mode of delivery for preterm birth: the CASSAVA multiple methods study. Health Technol Assess 2021; 25:1-102. [PMID: 34751645 DOI: 10.3310/hta25610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Around 60,000 babies are born preterm (prior to 37 weeks' gestation) each year in the UK. There is little evidence on the optimal birth mode (vaginal or caesarean section). OBJECTIVE The overall aim of the CASSAVA project was to determine if a trial to define the optimal mode of preterm birth could be carried out and, if so, determine what sort of trial could be conducted and how it could best be performed. We aimed to determine the specific groups of preterm women and babies for whom there are uncertainties about the best planned mode of birth, and if there would be willingness to recruit to, and participate in, a randomised trial to address some, but not all, of these uncertainties. This project was conducted in response to a Heath Technology Assessment programme commissioning call (17/22 'Mode of delivery for preterm infants'). METHODS We conducted clinician and patient surveys (n = 224 and n = 379, respectively) to identify current practice and opinion, and a consensus survey and Delphi workshop (n = 76 and n = 22 participants, respectively) to inform the design of a hypothetical clinical trial. The protocol for this clinical trial/vignette was used in telephone interviews with clinicians (n = 24) and in focus groups with potential participants (n = 13). RESULTS Planned sample size and data saturation was achieved for all groups except for focus groups with participants, as this had to be curtailed because of the COVID-19 pandemic and data saturation was not achieved. There was broad agreement from parents and health-care professionals that a trial is needed. The clinician survey demonstrated a variety of practice and opinion. The parent survey suggested that women and their families generally preferred vaginal birth at later gestations and caesarean section for preterm infants. The interactive workshop and Delphi consensus process confirmed the need for more evidence (hence the case for a trial) and provided rich information on what a future trial should entail. It was agreed that any trial should address the areas with most uncertainty, including the management of women at 26-32 weeks' gestation, with either spontaneous preterm labour (cephalic presentation) or where preterm birth was medically indicated. Clear themes around the challenges inherent in conducting any trial emerged, including the concept of equipoise itself. Specific issues were as follows: different clinicians and participants would be in equipoise for each clinical scenario, effective conduct of the trial would require appropriate resources and expertise within the hospital conducting the trial, potential participants would welcome information on the trial well before the onset of labour and minority ethnic groups would require tailored approaches. CONCLUSION Given the lack of evidence and the variation of practice and opinion in this area, and having listened to clinicians and potential participants, we conclude that a trial should be conducted and the outlined challenges resolved. FUTURE WORK The CASSAVA project could be used to inform the design of a randomised trial and indicates how such a trial could be carried out. Any future trial would benefit from a pilot with qualitative input and a study within a trial to inform optimal recruitment. LIMITATIONS Certainty that a trial could be conducted can be determined only when it is attempted. TRIAL REGISTRATION Current Controlled Trials ISRCTN12295730. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 61. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Jane E Norman
- Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Julia Lawton
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Sarah J Stock
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | - John Norrie
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - Nina Hallowell
- Ethox Centre and Wellcome Centre for Ethics & Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Ruth I Hart
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - David Odd
- Division of Population Medicine, School of Medicine, University of Cardiff, Cardiff, UK
| | | | | | | | | | - Sonia Whyte
- Tommy's Centre for Maternal and Fetal Health, MRC Centre for Maternal and Fetal Health, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
11
|
Cesarean section was not associated with mortality or morbidities advantage in very low birth weight infants: a nationwide cohort study. Sci Rep 2021; 11:20264. [PMID: 34642372 PMCID: PMC8511270 DOI: 10.1038/s41598-021-99563-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 09/07/2021] [Indexed: 11/28/2022] Open
Abstract
This study investigated the role of cesarean section (CS) in mortality and morbidity of very-low-birth-weight infants (VLBWIs) weighing less than 1500 g. This nationwide prospective cohort study of the Korean Neonatal Network consisted of 9,286 VLBWIs at 23–34 gestational weeks (GW) of age between 2013 and 2017. The VLBWIs were stratified into 23–24, 25–26, 27–28 and 29–34 GW, and the mortality and morbidity were compared according to the mode of delivery. The total CS rate was 78%, and was directly proportional to gestational age. The CS rate was the lowest at 61% in case of infants born at 23–24 GW and the highest at 84% in VLBWIs delivered at 29–34 GW. Contrary to the significantly lower total mortality (12%) and morbidities including sepsis (21%) associated with CS than vaginal delivery (VD) (16% and 24%, respectively), the mortality in the 25–26 GW (26%) and sepsis in the 27–28 GW (25%) and 29–34 GW (12%) groups were significantly higher in CS than in VD (21%, 20% and 8%, respectively). In multivariate analyses, the adjusted odds ratios (ORs) for mortality (OR 1.06, 95% CI 0.89–1.25) and morbidity including sepsis (OR 1.12, 95% CI 0.98–1.27) were not significantly reduced with CS compared with VD. The adjusted ORs for respiratory distress syndrome (1.89, 95% CI 1.59–2.23) and symptomatic patent ductus arteriosus (1.21, 95% CI 1.08–1.37) were significantly increased with CS than VD. In summary, CS was not associated with any survival or morbidity advantage in VLBWIs. These findings indicate that routine CS in VLBWIs without obstetric indications is contraindicated.
Collapse
|
12
|
Yu HY, Has P, Clark MA, Esposito M, Rouse DJ, Werner EF. Association between Respiratory Morbidity and Labor in Pregnancies with Gestational Diabetes Mellitus. Am J Perinatol 2021; 38:313-318. [PMID: 32892330 DOI: 10.1055/s-0040-1716483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study aimed to the assess risk of respiratory morbidity in neonates born to women with gestational diabetes mellitus (GDM) delivered after labor compared with those delivered without exposure to labor. STUDY DESIGN This is a secondary analysis of a prospective single-center cohort study of singleton pregnancies complicated by GDM. Neonates who were liveborn and delivered at ≥34 weeks' gestation were included. The primary outcome was respiratory morbidity defined as respiratory distress syndrome (RDS) or transient tachypnea of the newborn (TTN) resulting in neonatal intensive care unit (NICU) admission. Neonates born after labor (either spontaneous or induced) were compared with those delivered by cesarean delivery without labor. Associations between labor and neonatal morbidities were estimated using logistic regression. Covariates were adjusted for if they differed significantly between neonates exposed to and not exposed to labor (p < 0.05) and there was biologic plausibility that they would affect neonatal respiratory morbidity. RESULTS Of the 581 neonates meeting study inclusion criteria, 23.2% delivered without exposure to labor. Those who did and did not experience labor delivered at similar gestational ages (38.6 vs. 38.4 weeks). Thirty-six neonates (6.2%) developed RDS or TTN and were admitted to the NICU. Exposure to labor was associated with a lower frequency of respiratory morbidity requiring admission to NICU, 4.9% (22/446) versus 10.4% (14/135) (p = 0.04). After adjusting for parity, body mass index, birth weight, gestational weight gain more than Institute of Medicine guidelines, race, and exposure to labor were associated with an adjusted odds ratio of 0.41 (95% confidence interval: 0.18-0.89). CONCLUSION Exposure to labor was associated with decreased odds of respiratory morbidity in neonates born to mothers with GDM. Limiting elective cesarean in this population can reduce health care costs and optimize neonatal health. KEY POINTS · Labor is associated with less respiratory morbidity.. · We should limit elective cesarean delivery with GDM.. · This approach could reduce health care costs..
Collapse
Affiliation(s)
- Hope Y Yu
- Department of Obstetrics and Gynecology, Women & Infants Hospital of Rhode Island, Warren Alpert Medical School, Brown University, Providence, Rhode Island.,Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Phinnara Has
- Department of Obstetrics and Gynecology, Women & Infants Hospital of Rhode Island, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Melissa A Clark
- Department of Obstetrics and Gynecology, Women & Infants Hospital of Rhode Island, Warren Alpert Medical School, Brown University, Providence, Rhode Island.,Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island
| | - Matthew Esposito
- Department of Obstetrics and Gynecology, Women & Infants Hospital of Rhode Island, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Dwight J Rouse
- Department of Obstetrics and Gynecology, Women & Infants Hospital of Rhode Island, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Erika F Werner
- Department of Obstetrics and Gynecology, Women & Infants Hospital of Rhode Island, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| |
Collapse
|
13
|
AlQurashi MA. Impact of Mode of Delivery on the Survival Rate of Very Low Birth Weight Infants: A Single-Center Experience. Cureus 2020; 12:e11918. [PMID: 33304710 PMCID: PMC7721068 DOI: 10.7759/cureus.11918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Worldwide cesarean birth had increased over the past three decades and in the USA, the overall rate of cesarean birth has increased from 23.8% in 1989 to 31.9% in 2018. Moreover, the substantial increase of preterm infants delivered by cesarean section had reached anywhere from 45% to 72% for gestational age <33 weeks. There is a considerable debate on whether cesarean section confers a survival advantage for preterm infants. Published data on the relationship between mode of delivery and survival rate were inconsistent and there is a lack of large randomized controlled trials (RCTs) that have investigated this important clinical concern. Thus, the aim of this study is to evaluate the impact of cesarean section on the survival rate of very low birth weight (VLBW) infants. METHODS This was a retrospective cohort study of ≤32 weeks VLBW infants born alive and admitted to Neonatal Intensive Care Unit (NICU) at King Abdulaziz Medical City-Jeddah (KAMC-Jeddah) between January 1, 1994, and December 31, 2019. The primary outcome of interest was the survival rate to discharge of VLBW infants delivered by cesarean section compared to delivered vaginally. Relevant demographic and clinical variables were assessed and its association to survival to discharge of VLBW infants were analyzed. RESULTS Of the 1055 ≤32 weeks VLBW infants included in the study, 559 (53%) were delivered by cesarean section, and 496 (47%) were delivered vaginally. Cesarean delivery had increased from 44.2% to 66% between 1994-1998 and 2014-2019, respectively. The rise of cesarean delivery compared with the vaginal delivery was more profound for gestational age ≤26 weeks and birth weight ≤800 g. The VLBW infants delivered by cesarean section had a higher survival rate when compared to infants delivered vaginally (87.29% vs 71.77%, P<0.001). The survival advantage was statistically significant in extremely low birth weight (ELBW) infants (801-1000 g) and infants with birth weight ≤800 g, 86.73% vs 73.62%, P=0.018 and 58.02% vs 40.52, P=0.001, respectively. Moreover, VLBW infants ≤26 weeks gestational age delivered by cesarean section had a higher survival rate of 69.15% vs 44.5%, P<0.001. CONCLUSION This study demonstrates that cesarean birth is associated with higher survival for VLBW infants with birth weight ≤800 g and ELBW infants and gestational age ≤26 weeks compared to vaginal birth.
Collapse
Affiliation(s)
- Mansour A AlQurashi
- Neonatology Division, Department of Pediatrics, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, SAU.,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU.,Research and Development, King Abdullah International Medical Research Center, Jeddah, SAU
| |
Collapse
|
14
|
Jamshed S, Khan F, Chohan SK, Bano Z, Shahnawaz S, Anwar A, Hashmi AA. Frequency of Normal Birth Length and Its Determinants: A Cross-Sectional Study in Newborns. Cureus 2020; 12:e10556. [PMID: 33101803 PMCID: PMC7575309 DOI: 10.7759/cureus.10556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Objectives There are several factors that may affect the length and height of the infant. Maternal factors include a wide array of factors (anthropometric, hematological, or genetic), which can affect newborn health determinants. The objective of this study was to evaluate the frequency of normal birth length and its determinants in newborns. Methods This retrospective cross-sectional study was carried out at the Obstetrics and Gynaecological Department of Hamdard Hospital, Karachi, Pakistan, from March 1, 2019, to August 31, 2019. The relevant data were gathered by trained data collectors with the help of a structured questionnaire designed specifically for the study after taking written informed consent from all the participants. Data analysis was performed using Statistical Package for Social Sciences Version 20. Binary logistic regression was applied to develop a risk assessment model for the study outcome. Results Out of 195 pregnant mothers, 57 (29.2%) had low birth weight infants. Mean age of mothers was 29.29±5.22 years, 142 (72.8%) had BMI of 25.0 or more, 102 (52.3%) had hemoglobin between 10 to 11 mg/dL, 172 (88.2%) used to take vitamin C and iron during pregnancy, 136 (69.7%) consumed extra meals during pregnancy, and only 5 (2.6%) were tobacco smokers/chewers. Hundred (51.3%) newborns had normal birth length, i.e., >48 cm. The mother's mid-arm circumference > 22 cm (adjusted odds ratio [AOR]: 4.719; 95% CI: 2.337-9.527; p<0.001), consumption of extra meals during pregnancy (AOR: 3.947; 95% CI: 1.627-9.574; p=0.002), hemoglobin > 11 mg/dL (AOR: 4.314; 95% CI: 1.779-10.463; p=0.001), and adequate rest during pregnancy (AOR: 3.798; 95% CI: 1.464-9.848; p=0.006) were significantly associated with normal birth length of the infants, i.e., >48 cm. Conclusions Mother's mid-arm circumference > 22 cm, consumption of extra meals during pregnancy, hemoglobin > 11 mg/dL, and adequate rest during pregnancy were found to be significant predictors of normal birth length of the infants.
Collapse
Affiliation(s)
- Saira Jamshed
- Obstetrics and Gynecology, Hamdard University Hospital, Karachi, PAK
| | - Farah Khan
- Obstetrics and Gynecology, Hamdard University Hospital, Karachi, PAK
| | | | - Zakia Bano
- Obstetrics and Gynecology, Dar-Ul-Sehat Hospital, Karachi, PAK
| | - Shizra Shahnawaz
- Obstetrics and Gynecology, Jinnah Postgraduate Medical Center, Karachi, PAK
| | - Adnan Anwar
- Physiology, Al-Tibri Medical College, Karachi, PAK.,Stereotactic Radiosurgery/Radiation Oncology, Al-Tibri Medical College, Karachi, PAK
| | - Atif A Hashmi
- Pathology, Liaquat National Hospital and Medical College, Karachi, PAK
| |
Collapse
|
15
|
Eze P, Lawani LO, Chikezie RU, Ukaegbe CI, Iyoke CA. Perinatal outcomes of babies delivered by second-stage Caesarean section versus vacuum extraction in a resource-poor setting, Nigeria - a retrospective analysis. BMC Pregnancy Childbirth 2020; 20:298. [PMID: 32410592 PMCID: PMC7227301 DOI: 10.1186/s12884-020-02995-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 05/06/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND To evaluate the perinatal status of neonates delivered by assisted vaginal delivery (AVD) versus second-stage caesarean birth (CS). METHODS A 5-year retrospective study was conducted in a tertiary hospital. Data was analyzed with IBM SPSS® version 25.0 statistical software using descriptive/inferential statistics. RESULTS A total of 559 births met the inclusion criteria; AVD (211; 37.7%) and second-stage CS (348; 62.3%). Over 80% of the women were aged 20-34 years: 185 (87.7%) for the AVD group, and 301 (86.5%) for the second-stage CS group. More than half of the women were parous: 106 (50.2%) for the AVD group, and 184 (52.9%) for the second-stage CS group. The commonest indication for intervention in both groups is delayed second stage: 178 (84.4%) in the AVD group, and 239 (68.9%) in the second-stage CS group. There was a statistically significant difference in decision to delivery interval (DDI) between both groups: 197 (93.4%) women in the AVD group had DDI of less than 30 min and 21 women (6.0%) in the CS group had a DDI of less than 30 min (p < 0.001). During the DDI, there were 3 (1.4%) intra-uterine foetal deaths (IUFD) in the AVD and 19 (5.5%) in the CS group (p = 0.023). After adjusting for co-variates, there were statistically significant differences between the AVD and CS groups in the foetal death during DDI (p = 0.029) and perinatal deaths (p = 0.040); but no statistically significant differences in severe perinatal outcomes (p = 0.811), APGAR scores at 5th minutes (p = 0.355), and admission into the NICU (p = 0.946). After adjusting for co-variates, use of AVD was significantly associated with the level of experience of the care provider, with resident (junior) doctors less likely to opt for AVD than CS (aOR = 0.45, 95% CI: 0.29-0.70). CONCLUSION Second-stage CS when compared with AVD was not associated with improved perinatal outcomes. AVD is a practical option for reducing the rising Caesarean delivery rates without compromising the clinical status of the newborn.
Collapse
Affiliation(s)
- Paul Eze
- Medecins Sans Frontieres OCBA, Barcelona, Spain
- Centre for Global Health Research, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Lucky Osaheni Lawani
- Department of Obstetrics & Gynecology, Federal Teaching Hospital, Abakaliki, Nigeria
| | | | | | | |
Collapse
|
16
|
Maternal profile according to Mediterranean diet adherence and small for gestational age and preterm newborn outcomes. Public Health Nutr 2020; 24:1372-1384. [PMID: 32345384 DOI: 10.1017/s1368980019004993] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The objective was to evaluate maternal Mediterranean diet (MD) pattern adherence during pregnancy and its association with small for gestational age (SGA) and preterm birth. A secondary objective of the current study was to describe the sociodemographic, lifestyle and obstetric profile of the mothers studied as well as the most relevant paternal and newborn characteristics. DESIGN The current study is a two-phase retrospective population-based study of maternal dietary habits during pregnancy and their effect on newborn size and prematurity. The descriptive first phase examined maternal dietary habits during pregnancy along with the maternal sociodemographic, lifestyle and obstetric profile in a cross-sectional period study. In the second phase, newborn outcomes were evaluated in a nested case-control study. Adherence to MD during pregnancy was measured with the Spanish version of Kidmed index. SETTING Obstetrics ward of the La Fe Hospital in Valencia. PARTICIPANTS All mother-child pairs admitted after delivery during a 12-month period starting from January 2018 were assessed for eligibility. A total of 1118 provided complete outcome data after signing informed consent. RESULTS 14·5 % met the criteria of poor adherence (PA); 34·8 %, medium adherence (MA); and 50·7 %, optimal adherence (OA). Medium adherence to MD was associated in the adjusted scenarios with a higher risk of giving birth to a preterm newborn. No association was found between MD adherence and SGA. CONCLUSIONS Early intervention programmes geared towards pregnant women, where women were aided in reaching OA to MD, might reduce the risk of preterm newborn.
Collapse
|
17
|
Ahmed SI, Hasan SMT, Khan MA, Ahmed T. Effect of Maternal Exposure to Seasons during the Second and Third Trimesters of Pregnancy on Infant Birth Weight in Rural Bangladesh. Curr Dev Nutr 2020; 4:nzaa016. [PMID: 32154502 PMCID: PMC7054232 DOI: 10.1093/cdn/nzaa016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 12/19/2019] [Accepted: 01/31/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Pregnant women belonging to agricultural communities of low- and middle-income countries often face seasonal food insecurity and energy stress. OBJECTIVES We aimed to investigate the effect of maternal exposure to different seasons during the second and third trimesters of pregnancy on infant birth weight in rural Bangladesh. METHODS Information on 3831 singleton live births was obtained from the electronic databases of Matlab Health and Demographic Surveillance System and Matlab hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh. We collected information on all term births from July 2011 to June 2015 and excluded congenital anomalies and observations with missing data. Each year was divided into 3 distinct seasons: the post-aman harvest period (January-April), the height of the monsoon (May-August), and the post-aus harvest period (September-December). Seasonal exposure was measured in weeks, and multivariable linear regression models were fitted to determine the independent effect of each week of exposure of different seasons during the second and third trimesters of pregnancy on birth weight. RESULTS We observed peak birth weight in the post-aman harvest season, especially among infants born in March (mean ± SD: 2930.5 ± 462.1 g), and the lowest birth weight in the month of July (2830.6 ± 385.4 g) during the monsoon season. Regression analysis showed that exposure to the post-aman harvest season during the third trimester, and the post-aus harvest period during the second trimester of pregnancy had significant positive effects on birth weight. In the final adjusted model, each week of exposure to the post-aman harvest season during the third trimester was associated with a 6.3-g (95% CI: 1.6, 10.9 g; P = 0.008) increase in birth weight. CONCLUSIONS Infants born to women who were exposed to the post-aman harvest season for the entire third trimester (14 wk) were associated with 88.2-g higher weight at birth. Further investigations into the complex interplay between seasonal energy stress, maternal, and fetal nutrition and measures to alleviate it are warranted.
Collapse
Affiliation(s)
- Syed Imran Ahmed
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | - S M Tafsir Hasan
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | - Md Alfazal Khan
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| |
Collapse
|
18
|
Jarde A, Feng YY, Viaje KA, Shah PS, McDonald SD. Vaginal birth vs caesarean section for extremely preterm vertex infants: a systematic review and meta-analyses. Arch Gynecol Obstet 2019; 301:447-458. [DOI: 10.1007/s00404-019-05417-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 12/07/2019] [Indexed: 11/30/2022]
|
19
|
Mode of delivery and pregnancy outcomes in preterm birth: a secondary analysis of the WHO Global and Multi-country Surveys. Sci Rep 2019; 9:15556. [PMID: 31664121 PMCID: PMC6820722 DOI: 10.1038/s41598-019-52015-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 10/12/2019] [Indexed: 11/12/2022] Open
Abstract
Many studies have been conducted to examine whether Caesarean Section (CS) or vaginal birth (VB) was optimal for better maternal and neonatal outcomes in preterm births. However, findings remain unclear. Therefore, this secondary analysis of World Health Organization Global Survey (GS) and Multi-country Survey (MCS) databases was conducted to investigate outcomes of preterm birth by mode of delivery. Our sample were women with singleton neonates (15,471 of 237 facilities from 21 countries in GS; and 15,053 of 239 facilities from 21 countries in MCS) delivered between 22 and <37 weeks of gestation. We assessed association between mode of delivery and pregnancy outcomes in singleton preterm births by multilevel logistic regression adjusted for hierarchical data. The prevalences of women with preterm birth delivered by CS were 31.0% and 36.7% in GS and MCS, respectively. Compared with VB, CS was associated with significantly increased odds of maternal intensive care unit admission, maternal near miss, and neonatal intensive care unit admission but significantly decreased odds of fresh stillbirth, and perinatal death. However, since the information on justification for mode of delivery (MOD) were not available, our results of the potential benefits and harms of CS should be carefully considered when deciding MOD in preterm births.
Collapse
|
20
|
Englund-Ögge L, Brantsæter AL, Juodakis J, Haugen M, Meltzer HM, Jacobsson B, Sengpiel V. Associations between maternal dietary patterns and infant birth weight, small and large for gestational age in the Norwegian Mother and Child Cohort Study. Eur J Clin Nutr 2019; 73:1270-1282. [PMID: 30459338 PMCID: PMC6760641 DOI: 10.1038/s41430-018-0356-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 06/16/2018] [Accepted: 10/01/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND/OBJECTIVES To assess whether quality of maternal diet affects birth weight and the risk of small for gestational age (SGA) and/or large for gestational age (LGA) babies. SUBJECTS/METHODS This study is based on the Norwegian Mother and Child Cohort Study (MoBa) and includes 65,904 pregnant women who answered a validated food frequency questionnaire at mid-pregnancy. Three maternal dietary patterns were extracted based on characteristics of food items in each pattern. From these we created four non-overlapping groups: "high prudent," "high Western," "high traditional," and "mixed". We obtained information about birth weight from the Norwegian Medical Birth Registry and calculated birth weight z-scores, SGA, and LGA according to an ultrasound-based, population-based, and a customized growth standards. Associations were studied by linear and multiple logistic regression. RESULTS Compared to the high Western group, the high prudent group was associated with lower birth weight (βultrasound z-scores -0.041 (95% confidence interval (CI): -0.068, -0.013)) and the high traditional group with higher birth weight (βultrasound 0.067 (95% CI: 0.040, 0.094)) for all three growth standards. The high prudent pattern was associated with increased SGA risk (SGAultrasound odds ratio (OR) 1.25 (95% CI: 1.02, 1.54)) and decreased LGA risk (LGApopulation OR 0.84 (95% CI: 0.75, 0.94)), while the high traditional group on the contrary was associated with decreased SGA (SGAcustomized OR 0.92 (95% CI: 0.84, 0.99)) and increased LGA risk (LGApopulation OR 1.12 (95% CI: 1.02, 1.24)). CONCLUSIONS Food quality was associated with birth weight in this well-nourished Norwegian population. Food quality may affect a woman's risk of giving birth to a SGA or LGA baby.
Collapse
Grants
- N01ES75558 NIEHS NIH HHS
- U01 NS047537 NINDS NIH HHS
- The Norwegian Research Council (FUGE 183220/S10, FRIMEDKLI-05 ES236011). NIH/NIEHS (contract no N01-ES-75558), NIH/NINDS (grant no.1 UO1 NS 047537- 01 and grant no.2 UO1 NS 047537-06A1)
- The Norwegian Research Council (FUGE 183220/S10, FRIMEDKLI-05 ES236011), the Jane and Dan Olsson Foundation, the Swedish Medical Society (SLS 2008-21198) and Swedish government grants to researchers in public health service (ALFGBG-2863, ALFGBG-11522). The Norwegian Mother and Child Cohort Study are supported by the Norwegian Ministry of Health and Care Services and the Ministry of Education and Research, NIH/NIEHS (contract no N01-ES-75558), NIH/NINDS (grant no.1 UO1 NS 047537- 01 and grant no.2 UO1 NS 047537-06A1).The Gothenburg Medical Society Grants.
- the Norwegian Research Council (FUGE 183220/S10, FRIMEDKLI-05 ES236011), the Jane and Dan Olsson Foundation, the Swedish Medical Society (SLS 2008-21198) and Swedish government grants to researchers in public health service (ALFGBG-2863, ALFGBG-11522). The Norwegian Mother and Child Cohort Study are supported by the Norwegian Ministry of Health and Care Services and the Ministry of Education and Research, NIH/NIEHS (contract no N01-ES-75558), NIH/NINDS (grant no.1 UO1 NS 047537- 01 and grant no.2 UO1 NS 047537-06A1).
Collapse
Affiliation(s)
- Linda Englund-Ögge
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden.
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
| | - Anne Lise Brantsæter
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Julius Juodakis
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Margareta Haugen
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Helle Margrete Meltzer
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Bo Jacobsson
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Domain of Health Data and Digitalisation, Norwegian Institute of Public Health, Oslo, Norway
| | - Verena Sengpiel
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| |
Collapse
|
21
|
The association of maternal dietary folate intake and folic acid supplementation with small-for-gestational-age births: a cross-sectional study in Northwest China. Br J Nutr 2019; 122:459-467. [DOI: 10.1017/s0007114519001272] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
AbstractThe effect of maternal folate intake on small-for-gestational-age (SGA) births remains inconclusive. The present study aimed to investigate the associations of maternal folate intake from diet and supplements with the risk of SGA births using data from a cross-sectional study in Shaanxi Province of Northwest China. A total of 7307 women who were within 12 months (median 3; 10th–90th percentile 0–7) after delivery were included. Two-level models were adopted to examine the associations of folate (dietary folate, supplemental folic acid and total folate) intake with the risk of SGA births and birth weight Z score, controlling for a minimum set of confounders that were identified in a directed acyclic graph. Results showed that a higher supplemental folic acid intake during the first trimester was negatively associated with the risk of SGA births (≤60 d v. non-use: OR 0·80; 95 % CI 0·66, 0·96; >60 d v. non-use: OR 0·78; 95 % CI 0·65, 0·94; Ptrend = 0·010; per 10-d increase: OR 0·97; 95 % CI 0·95, 0·99). A higher total folate intake during pregnancy was associated with a reduced risk of SGA births (highest tertile v. lowest tertile: OR 0·77; 95 % CI 0·64, 0·94; Ptrend = 0·010; per one-unit increase in the log-transformed value: OR 0·81; 95 % CI 0·69, 0·95). A similar pattern was observed for the birth weight Z score. Our study suggested that folic acid supplementation during the first trimester and a higher total folate intake during pregnancy were associated with a reduced risk of SGA births.
Collapse
|
22
|
Gluck O, Tairy D, Bar J, Barda G. The impact of mode of delivery on neonatal outcome in preterm births. J Matern Fetal Neonatal Med 2019; 34:1183-1189. [PMID: 31154888 DOI: 10.1080/14767058.2019.1627319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION To evaluate the impact of mode of delivery on the outcome of neonates born before 34 weeks of gestation. MATERIAL AND METHODS This is a retrospective cohort study of all singleton live neonates born between 24.1 and 34.0 weeks of gestation at our institute between January 2009 and July 2017. Maternal and pregnancy characteristics, as well as the neonatal outcome, were compared between vaginal delivery (VD) and cesarean delivery (CD). RESULTS Of 475 preterm births, 223 (46.9%) were delivered vaginally and 252 (53.1%) were delivered by CD. Women who delivered vaginally were younger, (29.6 ± 6 versus 31.2 ± 6 years, p = .003), had lower rate of hypertensive disorders (9.9 versus 36.1%, p < .001), and diabetes mellitus (0.4 versus 4.4%, p = .006), and had higher rate of drug abuse (4.9 versus 1.6%, p = .006), as compared to those who delivered by CD. Neonates who were born by VD had higher birth weight (1716 ± 595 versus 1443 ± 507, p < .001) and a lower rate of Small for gestational age (7.2 versus 19.4%, p < .001) than those who were born by CD. Although VD neonates had higher Apgar score, as compared with CD, the neonatal composite outcome was similar between the two modes of deliveries. These findings were consistent in subgroups analysis according to gestational age (GA). By logistic regression analysis, only the administration of betamethasone up to 1 week prior to delivery (aOR = 0.59, 95% CI 0.38-0.92, p = .001) and GA at delivery (aOR = 0.74 95% CI 0.64-0.84, p = .004) were found to be independently protective against composite neonatal outcome. CONCLUSIONS It seems that neonatal outcome is not affected by the mode of delivery.
Collapse
Affiliation(s)
- Ohad Gluck
- Department of Obstetrics & Gynecology, the Edith Wolfson Medical Center affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Tairy
- Department of Obstetrics & Gynecology, the Edith Wolfson Medical Center affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Bar
- Department of Obstetrics & Gynecology, the Edith Wolfson Medical Center affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Giulia Barda
- Department of Obstetrics & Gynecology, the Edith Wolfson Medical Center affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
23
|
Cesarean section and the risk of neonatal respiratory distress syndrome: a meta-analysis. Arch Gynecol Obstet 2019; 300:503-517. [PMID: 31187205 DOI: 10.1007/s00404-019-05208-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 05/30/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To explore the association between cesarean section (CS) and the risk of neonatal respiratory distress syndrome (RDS). METHODS We searched PubMed, Web of Science, and ClinicalTrials.gov database for studies related to the association between CS and the risk of neonatal RDS up to 25 August 2018. The pooled odds ratios (ORs) with 95% confidence intervals (CIs) were estimated using a random-effects model (REM). RESULTS A total of 26 studies from 25 available articles were included in this meta-analysis. For the association between CS and the risk of neonatal RDS, the pooled OR was 1.76 (95% CI 1.48-2.09). The pooled OR of the risk of neonatal RDS was 2.38 (95% CI 1.89-2.99) for elective CS and 1.85 (95% CI 1.34-2.56) for emergency CS. CONCLUSION This meta-analysis suggested that CS, elective CS, and emergency CS were associated with an increased risk of neonatal RDS.
Collapse
|
24
|
Schmidt S, Norman M, Misselwitz B, Piedvache A, Huusom LD, Varendi H, Barros H, Cammu H, Blondel B, Dudenhausen J, Zeitlin J, Weber T. Mode of delivery and mortality and morbidity for very preterm singleton infants in a breech position: A European cohort study. Eur J Obstet Gynecol Reprod Biol 2019; 234:96-102. [PMID: 30682601 DOI: 10.1016/j.ejogrb.2019.01.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 12/29/2018] [Accepted: 01/03/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Caesarean section (CS) may reduce mortality and morbidity for very preterm breech infants, but evidence is inconclusive. We evaluated neonatal outcomes for singleton breech infants by mode of delivery in a European cohort. STUDY DESIGN Data come from the EPICE population-based cohort of very preterm births in 19 regions in 11 European countries (7770 live births). The study population was singleton spontaneous-onset breech births at 24-31 weeks gestational age (GA) without antenatal medical complications requiring caesarean delivery (N = 572). Mixed-effects regression models adjusting for maternal and pregnancy covariates and propensity score matching was used to examine the effect of (1) CS and (2) a unit policy of systematic CS for breech presentation by GA. The primary outcome was a composite of in-hospital mortality, intraventricular haemorrhage grades III & IV or cystic periventricular leukomalacia. Secondary outcomes were each component separately, five minute Apgar score below seven and mortality within six hours of delivery. RESULTS 64.4% of infants were delivered by CS with a range across regions from 41% to 100%; these infants had higher GA and were more likely to be small for gestational age, receive antenatal steroids, and have mothers who were hospitalised for more than one day before delivery compared to those delivered vaginally. CS was associated with lower risks of all outcomes in mixed-effects adjusted models (odds ratio (OR) for the composite outcome: 0.50, 95% confidence interval (CI): 0.30-0.81), but not in propensity score matched models (OR: 0.72, 95% CI: 0.41; 1.29). A systematic CS policy was associated with lower mortality and morbidity in unadjusted, but not adjusted models (OR for composite outcome: 0.76, 95% CI: 0.44; 1.28). 35% of births 24-25 weeks were delivered by CS and protective effects were consistently stronger, but not statistically significant. CONCLUSIONS Point estimates indicated protective effects of caesarean delivery for very preterm breech infants in conventional statistical models. However, analyses using propensity scores and based on unit policies did not confirm statistically significant associations. Prospective large-scale studies are needed to establish best practice and could be implemented in European regions where vaginal delivery remains an option.
Collapse
Affiliation(s)
- Stephan Schmidt
- Department of Obstetrics, University Hospital, Philipps University, Marburg, D-35043, Germany
| | - Mikael Norman
- Department of Clinical Science, Intervention & Technology, Karolinska Institutet, Stockholm, Sweden; Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | | | | | - Lene D Huusom
- Department of Obstetrics, Hvidovre University Hospital, Hvidovre, Denmark
| | - Heili Varendi
- University of Tartu, Tartu University Hospital, Tartu, Estonia
| | - Henrique Barros
- EPIUnit-Institute of Public Health, University of Porto, Porto, Portugal
| | - Hendrik Cammu
- H Cammu, Study centre of Perinatal Epidemiology & Vrije Universiteit Brussel, Belgium
| | - Béatrice Blondel
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | | | - Jennifer Zeitlin
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France.
| | - Tom Weber
- Department of Obstetrics, Hvidovre University Hospital, Hvidovre, Denmark
| |
Collapse
|
25
|
Wampach L, Heintz-Buschart A, Fritz JV, Ramiro-Garcia J, Habier J, Herold M, Narayanasamy S, Kaysen A, Hogan AH, Bindl L, Bottu J, Halder R, Sjöqvist C, May P, Andersson AF, de Beaufort C, Wilmes P. Birth mode is associated with earliest strain-conferred gut microbiome functions and immunostimulatory potential. Nat Commun 2018; 9:5091. [PMID: 30504906 PMCID: PMC6269548 DOI: 10.1038/s41467-018-07631-x] [Citation(s) in RCA: 159] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 11/13/2018] [Indexed: 01/07/2023] Open
Abstract
The rate of caesarean section delivery (CSD) is increasing worldwide. It remains unclear whether disruption of mother-to-neonate transmission of microbiota through CSD occurs and whether it affects human physiology. Here we perform metagenomic analysis of earliest gut microbial community structures and functions. We identify differences in encoded functions between microbiomes of vaginally delivered (VD) and CSD neonates. Several functional pathways are over-represented in VD neonates, including lipopolysaccharide (LPS) biosynthesis. We link these enriched functions to individual-specific strains, which are transmitted from mothers to neonates in case of VD. The stimulation of primary human immune cells with LPS isolated from early stool samples of VD neonates results in higher levels of tumour necrosis factor (TNF-α) and interleukin 18 (IL-18). Accordingly, the observed levels of TNF-α and IL-18 in neonatal blood plasma are higher after VD. Taken together, our results support that CSD disrupts mother-to-neonate transmission of specific microbial strains, linked functional repertoires and immune-stimulatory potential during a critical window for neonatal immune system priming.
Collapse
Affiliation(s)
- Linda Wampach
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, avenue des Hauts-Fourneaux 7, 4362, Esch-sur-Alzette, Luxembourg
- Laboratoire National de Santé, rue Louis Rech 1, 3555, Dudelange, Luxembourg
| | - Anna Heintz-Buschart
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, avenue des Hauts-Fourneaux 7, 4362, Esch-sur-Alzette, Luxembourg
- German Centre for Integrative Biodiversity Research (iDiv) Halle-Jena-Leipzig, Deutscher Platz 5e, 04103, Leipzig, Germany
- Helmholtz Centre for Environmental Research GmbH - UFZ, Theodor-Lieser-Str. 4, 06120, Halle (Saale), Germany
| | - Joëlle V Fritz
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, avenue des Hauts-Fourneaux 7, 4362, Esch-sur-Alzette, Luxembourg
- Centre Hospitalier de Luxembourg, rue Nicolas Ernest Barblé 4, 1210, Luxembourg, Luxembourg
| | - Javier Ramiro-Garcia
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, avenue des Hauts-Fourneaux 7, 4362, Esch-sur-Alzette, Luxembourg
| | - Janine Habier
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, avenue des Hauts-Fourneaux 7, 4362, Esch-sur-Alzette, Luxembourg
| | - Malte Herold
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, avenue des Hauts-Fourneaux 7, 4362, Esch-sur-Alzette, Luxembourg
| | - Shaman Narayanasamy
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, avenue des Hauts-Fourneaux 7, 4362, Esch-sur-Alzette, Luxembourg
- Megeno S.A., avenue des Hauts-Fourneaux 9, 4362, Esch-sur-Alzette, Luxembourg
| | - Anne Kaysen
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, avenue des Hauts-Fourneaux 7, 4362, Esch-sur-Alzette, Luxembourg
- Centre Hospitalier de Luxembourg, rue Nicolas Ernest Barblé 4, 1210, Luxembourg, Luxembourg
| | - Angela H Hogan
- Integrated BioBank of Luxembourg, rue Louis Rech 1, 3555, Dudelange, Luxembourg
| | - Lutz Bindl
- Centre Hospitalier de Luxembourg, rue Nicolas Ernest Barblé 4, 1210, Luxembourg, Luxembourg
| | - Jean Bottu
- Centre Hospitalier de Luxembourg, rue Nicolas Ernest Barblé 4, 1210, Luxembourg, Luxembourg
| | - Rashi Halder
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, avenue des Hauts-Fourneaux 7, 4362, Esch-sur-Alzette, Luxembourg
| | - Conny Sjöqvist
- KTH Royal Institute of Technology, Science for Life Laboratory, School of Biotechnology, Division of Gene Technology, Tomtebodavägen 23a, 17165, Solna, Sweden
- Environmental and Marine Biology, Åbo Akademi University, Tykistökatu 6, 20520, Turku, Finland
| | - Patrick May
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, avenue des Hauts-Fourneaux 7, 4362, Esch-sur-Alzette, Luxembourg
| | - Anders F Andersson
- KTH Royal Institute of Technology, Science for Life Laboratory, School of Biotechnology, Division of Gene Technology, Tomtebodavägen 23a, 17165, Solna, Sweden
| | - Carine de Beaufort
- Centre Hospitalier de Luxembourg, rue Nicolas Ernest Barblé 4, 1210, Luxembourg, Luxembourg
| | - Paul Wilmes
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, avenue des Hauts-Fourneaux 7, 4362, Esch-sur-Alzette, Luxembourg.
| |
Collapse
|
26
|
Effect of Adherence to a Mediterranean Diet and Olive Oil Intake during Pregnancy on Risk of Small for Gestational Age Infants. Nutrients 2018; 10:nu10091234. [PMID: 30189597 PMCID: PMC6164545 DOI: 10.3390/nu10091234] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 08/28/2018] [Accepted: 08/28/2018] [Indexed: 12/25/2022] Open
Abstract
To quantify the effect of a Mediterranean dietary pattern, as well as the consumption of olive oil (OO), on the risk of having a small for gestational age infants (SGA), a matched case-control study was conducted in Spain. Dietary intake during pregnancy was assessed using a validated food frequency questionnaire. Three indices were used to evaluate the adherence to Mediterranean diet (MD) (Predimed, Trichopoulou and Panagiotakos). Crude odds ratios (cOR) and adjusted odds ratios (aOR) and their 95% confidence intervals (CI) were estimated using conditional logistic regression models. Results were stratified by severity of SGA: moderate (percentiles 6–10), and severe (percentiles ≤5). For moderate, four or more points in the Predimed´s index was associated with a 41% reduction of having SGA compared with women with a score ≤3, aOR = 0.59 (95% CI 0.38–0.98); for severe, the reduction in risk was not statistically significant. Similar results were found when the other MD indexes were used. An intake of OO above 5 g/day was associated with a lower risk of SGA (aOR = 0.53, 95% CI 0.34–0.85); statistical significance was observed for moderate SGA (aOR = 0.53, 95% CI 0.30–0.96), but not for severe SGA (aOR = 0.51, 95% CI 0.24–1.07), although the magnitude of ORs were quite similar. Adherence to a MD and OO intake is associated with a reduced risk of SGA.
Collapse
|
27
|
Grondin-Depraetre L, Soussoko M, Gisbert S, Morel O, Bertholdt C. [Maternal outcomes in case of cesarean before 32weeks of gestation: A retrospective observational study]. ACTA ACUST UNITED AC 2018; 46:653-657. [PMID: 30174174 DOI: 10.1016/j.gofs.2018.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVES In recent years, active neonatal care in case of prematurity leads to an increase of cesarean delivery rate. Data remains sparse on maternal morbidity induced by preterm cesareans and especially before 32 weeks of gestation. The main aim of this study was to evaluate per-partum maternal morbidity in case of cesarean performed before 32 week of gestation. As secondary objectives, we assessed post-partum maternal morbidity and factors associated with maternal morbidity. METHODS This is a retrospective single-center study conducted in a tertiary care unit between 2014 and 2016 including cesareans performed before 32 week of gestation in the study period. The primary outcome was a composite criterion of per partum maternal morbidity including post-partum hemorrhage, blood transfusion, general anesthesia, surgical wounds and maternal death. The secondary outcome was the post-partum maternal morbidity, defined by a composite criterion including hospitalization more than 7 days, infectious disease, wall and digestive complication and venous thromboembolic disease. RESULTS Two hundred and eleven women were included. Maternal morbidity occurred in 21.3% in per partum and in 20.4% in post-partum. The factors associated with per partum morbidity were low-lying placenta (OR=4.40 [1.01-19.09]) and non-fetal indication of cesarean (OR=2.10[1.01-4.42]). The factors associated with post-partum morbidity were twin-pregnancy (OR=2.90 [1.12-7.54]), general anesthesia (OR=4.19 [1.68-10.49]) and non-cephalic fetal presentation (OR= 2.70 [1.23-5.93]). CONCLUSION The maternal morbidity of cesareans before 32 week of gestation is more than 20%. This study confirms the high maternal morbidity associated with caesareans performed before 32 weeks of gestation.
Collapse
Affiliation(s)
- L Grondin-Depraetre
- Pôle de gynécologie-obstétrique, maternité régionale universitaire, CHRU de Nancy, 10, rue du Docteur-Heydenreich, 54000 Nancy, France
| | - M Soussoko
- Pôle de gynécologie-obstétrique, maternité régionale universitaire, CHRU de Nancy, 10, rue du Docteur-Heydenreich, 54000 Nancy, France
| | - S Gisbert
- Pôle de gynécologie-obstétrique, maternité régionale universitaire, CHRU de Nancy, 10, rue du Docteur-Heydenreich, 54000 Nancy, France
| | - O Morel
- Pôle de gynécologie-obstétrique, maternité régionale universitaire, CHRU de Nancy, 10, rue du Docteur-Heydenreich, 54000 Nancy, France; Unité Inserm U1254, 1, allée du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - C Bertholdt
- Pôle de gynécologie-obstétrique, maternité régionale universitaire, CHRU de Nancy, 10, rue du Docteur-Heydenreich, 54000 Nancy, France; Unité Inserm U1254, 1, allée du Morvan, 54500 Vandœuvre-lès-Nancy, France.
| |
Collapse
|
28
|
Wang X, Zhu J, Guo C, Shi H, Wu D, Sun F, Shen L, Ge P, Wang J, Hu X, Chen J, Yu G. Growth of infants and young children born small for gestational age: growth restriction accompanied by overweight. J Int Med Res 2018; 46:3765-3777. [PMID: 30009651 PMCID: PMC6136010 DOI: 10.1177/0300060518779305] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objectives To compare growth profiles of children born small for gestational age (SGA)
with those born the appropriate size for gestational age (AGA), and examine
expected growth patterns for SGA in early childhood. Methods A survey on 23,871 SGA children was conducted in Shanghai. Data were
collected at 1, 2, 4, 6, 8, 10, 12, 18, 24, 36, 48, and 60 months of age
(+30 days). A check-up included assessments of weight, height, and head
circumference. Results At 5 years old, weight, height, and head circumference were lower in SGA
children compared with AGA children. The proportions of overweight and
obesity of SGA children at 4 to 18 months after birth were significantly
higher than those in AGA children, with higher proportions in boys than in
girls. There was no correlation between overweight at 5 years old and
overweight before 2 years old in SGA children. Conclusions Children born SGA remain shorter and lighter, with a smaller head
circumference at 5 years old compared with AGA children. At 4 to 18 months
after birth, there is a high incidence of overweight and obesity in SGA
children. Overweight and obesity in SGA boys are more serious than those in
SGA girls.
Collapse
Affiliation(s)
- Xiulian Wang
- 1 Department of Child Health Care, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jianzhen Zhu
- 2 China hospital development Institute, Shanghai Jiao Tong University, Shanghai, China
| | - Chong Guo
- 3 Department of Child Health Care, Fujian Maternity and Children Health Hospital, Teaching Hospital of Fujian Medical University, Fuzhou, China
| | - Huiqing Shi
- 1 Department of Child Health Care, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Dan Wu
- 1 Department of Child Health Care, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Fanfan Sun
- 1 Department of Child Health Care, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Li Shen
- 4 School of Public Health, Shanghai Jiao Tong University, Shanghai, China
| | - Pin Ge
- 3 Department of Child Health Care, Fujian Maternity and Children Health Hospital, Teaching Hospital of Fujian Medical University, Fuzhou, China
| | - Jian Wang
- 5 Department of Child Health Care, Jing'an District maternal and child healthcare center, Shanghai, China
| | - Xiangying Hu
- 5 Department of Child Health Care, Jing'an District maternal and child healthcare center, Shanghai, China
| | - Jinjin Chen
- 1 Department of Child Health Care, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Guangjun Yu
- 1 Department of Child Health Care, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| |
Collapse
|
29
|
Salcedo-Bellido I, Martínez-Galiano JM, Olmedo-Requena R, Mozas-Moreno J, Bueno-Cavanillas A, Jimenez-Moleon JJ, Delgado-Rodríguez M. Association between Vitamin Intake during Pregnancy and Risk of Small for Gestational Age. Nutrients 2017; 9:E1277. [PMID: 29168736 PMCID: PMC5748728 DOI: 10.3390/nu9121277] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 11/17/2017] [Accepted: 11/21/2017] [Indexed: 01/01/2023] Open
Abstract
Pregnancy increases the requirements of certain nutrients, such as vitamins, to provide nutrition for the newborn. The aim was to analyze the association between dietary intake of vitamins during pregnancy and risk of having a small for gestational age (SGA) newborn. A matched case-control study was conducted (518 cases and 518 controls of pregnant women) in Spain. Dietary vitamin intake during pregnancy was assessed using a validated food frequency questionnaire, categorized into quintiles. Odds ratios (ORs) and their 95% confidence intervals (CI) were estimated with conditional regression logistic models. A protective association was observed between maternal dietary intake of vitamins A and D and SGA. For vitamin B3 and B6, the observed protective effect was maintained after adjusting for potential confounding factors. For vitamin B9, we found only an effect in quintiles 3 and 4 (OR = 0.64; 95% CI, 0.41-1.00; OR = 0.58; 95% CI, 0.37-0.91). Protective effect for vitamin B12 was observed in 4th and 5th quintiles (OR = 0.61; 95% CI, 0.39-0.95; OR = 0.68; 95% CI, 0.43-1.04). No associations were detected between dietary intake of vitamins B2, E and C intake and SGA. Our results suggest a positive association between dietary vitamin intake during pregnancy and the weight of the newborn, although more studies are necessary and there could be a ceiling effect for higher intakes of some vitamins cannot be discarded.
Collapse
Affiliation(s)
- Inmaculada Salcedo-Bellido
- Department of Preventive Medicine and Public Health, School of Medicine, University of Granada, 18016 Granada, Spain.
- Ciber de Epidemiología y Salud Pública CIBERESP, 28029 Madrid, Spain.
- Instituto de Investigación Biosanitaria de Granada ibs.GRANADA, Complejo Hospitalario Universitario de Granada/Universidad de Granada, 18012 Granada, Spain.
| | - Juan Miguel Martínez-Galiano
- Ciber de Epidemiología y Salud Pública CIBERESP, 28029 Madrid, Spain.
- Department of Nursing, University of Jaen, 23071 Jaen, Spain.
- Public Health System of Andalusia, 23400 Jaen, Spain.
- University of Jaén, Campus de Las Lagunillas s/n, Building B3 Office 413, 23071 Jaén, Spain.
| | - Rocío Olmedo-Requena
- Department of Preventive Medicine and Public Health, School of Medicine, University of Granada, 18016 Granada, Spain.
- Ciber de Epidemiología y Salud Pública CIBERESP, 28029 Madrid, Spain.
- Instituto de Investigación Biosanitaria de Granada ibs.GRANADA, Complejo Hospitalario Universitario de Granada/Universidad de Granada, 18012 Granada, Spain.
| | - Juan Mozas-Moreno
- Ciber de Epidemiología y Salud Pública CIBERESP, 28029 Madrid, Spain.
- Obstetric and Gynecology Unit, Virgen de las Nieves Universitary Hospital, 18014 Granada, Spain.
| | - Aurora Bueno-Cavanillas
- Department of Preventive Medicine and Public Health, School of Medicine, University of Granada, 18016 Granada, Spain.
- Ciber de Epidemiología y Salud Pública CIBERESP, 28029 Madrid, Spain.
- Instituto de Investigación Biosanitaria de Granada ibs.GRANADA, Complejo Hospitalario Universitario de Granada/Universidad de Granada, 18012 Granada, Spain.
| | - Jose J Jimenez-Moleon
- Department of Preventive Medicine and Public Health, School of Medicine, University of Granada, 18016 Granada, Spain.
- Ciber de Epidemiología y Salud Pública CIBERESP, 28029 Madrid, Spain.
- Instituto de Investigación Biosanitaria de Granada ibs.GRANADA, Complejo Hospitalario Universitario de Granada/Universidad de Granada, 18012 Granada, Spain.
| | - Miguel Delgado-Rodríguez
- Ciber de Epidemiología y Salud Pública CIBERESP, 28029 Madrid, Spain.
- Division of Preventive Medicine, University of Jaen, 23071 Jaen, Spain.
| |
Collapse
|
30
|
Vivatkusol Y, Thavaramara T, Phaloprakarn C. Inappropriate gestational weight gain among teenage pregnancies: prevalence and pregnancy outcomes. Int J Womens Health 2017; 9:347-352. [PMID: 28553147 PMCID: PMC5439718 DOI: 10.2147/ijwh.s128941] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To study the prevalence and pregnancy outcomes of inappropriate gestational weight gain (GWG) among teenage pregnant women. METHODS A retrospective descriptive study was conducted on 2,165 teenage pregnant women who attended our antenatal clinic between January 2007 and August 2015. Adverse pregnancy outcomes, including maternal and neonatal outcomes of women with inappropriate GWG, including underweight and overweight, were studied and compared with those of women with appropriate GWG. RESULTS Complete data of 1,943 women were obtained. Among these women, the mean age was 17.4±1.4 years and mean body mass index at first visit was 19.1±3.0 kg/m2. The prevalence of inappropriate GWG was 61.7%. Underweight women were more likely to experience anemia and preterm delivery, whereas overweight women required more cesarean sections because of cephalopelvic disproportion and preeclampsia, compared to women with appropriate weight gain (all P<0.001). The rates of gestational diabetes mellitus among women who were underweight, overweight, or appropriate weight were not significantly different. CONCLUSION More than 60% of teenage pregnancies showed inappropriate GWG. GWG had a significant impact on pregnancy outcomes.
Collapse
Affiliation(s)
- Yada Vivatkusol
- Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Thaovalai Thavaramara
- Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Chadakarn Phaloprakarn
- Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| |
Collapse
|
31
|
Humberg A, Härtel C, Paul P, Hanke K, Bossung V, Hartz A, Fasel L, Rausch TK, Rody A, Herting E, Göpel W. Delivery mode and intraventricular hemorrhage risk in very-low-birth-weight infants: Observational data of the German Neonatal Network. Eur J Obstet Gynecol Reprod Biol 2017; 212:144-149. [PMID: 28363188 DOI: 10.1016/j.ejogrb.2017.03.032] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 03/21/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Very-low-birth-weight infants (VLBWI) are frequently delivered by cesarean section (CS). However, it is unclear at what gestational age the benefits of spontaneous delivery outweigh the perinatal risks, i.e. intraventricular hemorrhage (IVH) or death. OBJECTIVES To assess the short-term outcome of VLBWI on IVH according to mode of delivery in a population-based cohort of the German Neonatal Network (GNN). STUDY DESIGN A total cohort of 2203 singleton VLBWI with a birth weight <1500g and gestational age between 22 0/7 and 36 6/7 weeks born and discharged between 1st of January 2009 and 31st of December 2015 was available for analysis. VLBWI were stratified into three categories according to mode of delivery: (1) planned cesarean section (n=1381), (2) vaginal delivery (n=632) and (3) emergency cesarean section (n=190). Outcome was assessed in univariate and logistic regression analyses. RESULTS Prevalence of IVH was significantly higher in the vaginal delivery (VD) (26.6%) and emergency CS group (31.1%) as compared to planned CS (17.2%), respectively. In a logistic regression analysis including known risk factors for IVH, vaginal delivery (OR 1.725 [1.325-2.202], p≤0.001) and emergency cesarean section (OR 1.916 [1.338-2.746], p≤0.001) were independently associated with IVH risk. In the subgroup of infants >30 weeks of gestation prevalence for IVH was not significantly different in VD and planned CS (5.3% vs. 4.4%). CONCLUSIONS Our observational data demonstrate that elective cesarean section is associated with a reduced risk of IVH in preterm infants <30 weeks gestational age when presenting with preterm labor.
Collapse
Affiliation(s)
- Alexander Humberg
- Department of Pediatrics, University Hospital of Schleswig-Holstein, Campus Luebeck, Germany.
| | - Christoph Härtel
- Department of Pediatrics, University Hospital of Schleswig-Holstein, Campus Luebeck, Germany
| | - Pia Paul
- Department of Pediatrics, University Hospital of Schleswig-Holstein, Campus Luebeck, Germany
| | - Kathrin Hanke
- Department of Pediatrics, University Hospital of Schleswig-Holstein, Campus Luebeck, Germany
| | - Verena Bossung
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Luebeck, Germany
| | - Annika Hartz
- Department of Pediatrics, University Hospital of Schleswig-Holstein, Campus Luebeck, Germany
| | - Laura Fasel
- Department of Pediatrics, University Hospital of Schleswig-Holstein, Campus Luebeck, Germany
| | - Tanja K Rausch
- Department of Pediatrics, University Hospital of Schleswig-Holstein, Campus Luebeck, Germany; Institute of Medical Biometry and Statistics, University of Luebeck, University Medical Center of Schleswig-Holstein, Campus Luebeck, Germany
| | - Achim Rody
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Luebeck, Germany
| | - Egbert Herting
- Department of Pediatrics, University Hospital of Schleswig-Holstein, Campus Luebeck, Germany
| | - Wolfgang Göpel
- Department of Pediatrics, University Hospital of Schleswig-Holstein, Campus Luebeck, Germany
| | | |
Collapse
|
32
|
Effect of delivery mode on neonatal outcome among preterm infants: an observational study. Wien Klin Wochenschr 2016; 129:612-617. [PMID: 28004267 PMCID: PMC5599430 DOI: 10.1007/s00508-016-1150-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 11/30/2016] [Indexed: 11/25/2022]
Abstract
Background The optimal mode of delivery as a predictor for outcomes in preterm infants is under debate. The purpose of this study was to evaluate the effect of the delivery mode on neonatal outcome among preterm infants in different birthweight categories. Methods A retrospective analysis of singleton preterm deliveries from 23 + 0 to 33 + 6 gestational weeks was performed. Infants were categorized based on birthweight as large for gestational age (LGA), appropriate for gestational age (AGA) and small for gestational age (SGA). The Apgar score at 5 min served as the main outcome parameter. A sensitivity analysis was performed to adjust for maternal age, parity and fetal malformations as potential confounders. Results Out of 1320 singleton preterm infants, 970 (73.5%) were delivered by cesarean section and 350 (26.5%) were delivered vaginally. The AGA infants between 23 + 0 and 27 + 6 weeks showed better outcomes after cesarean section (p < 0.01 from 23 + 0–24 + 6; p = 0.03 from 25 + 0–27 + 6), whereas AGA infants between 31 + 0 and 33 + 6 gestational weeks showed better outcomes after vaginal delivery (p = 0.02). Cesarean section was beneficial in extremely and very preterm SGA infants (p = 0.01 from 25 + 0–27 + 6; p = 0.02 from 28 + 0–30 + 6). The sensitivity analysis showed no confounding effect of other variables. Conclusion There is a benefit from cesarean section in AGA preterm infants until 28 weeks of gestation and in SGA preterm infants until 31 weeks of gestation. Vaginal delivery should be chosen for moderately preterm AGA infants.
Collapse
|
33
|
Kurek Eken M, Tüten A, Özkaya E, Karatekin G, Karateke A. Major determinants of survival and length of stay in the neonatal intensive care unit of newborns from women with premature preterm rupture of membranes. J Matern Fetal Neonatal Med 2016; 30:1972-1975. [PMID: 27624140 DOI: 10.1080/14767058.2016.1235696] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To assess the predictors of outcome in terms of length of stay in the neonatal intensive care unit (NICU) and survival of neonates from women with preterm premature rupture of membranes (PPROM). METHODS A population-based retrospective study including 331 singleton pregnant women with PPROM at 24-34 gestational weeks between January 2013 and December 2015 was conducted. Gestational age at delivery, birth weight, route of delivery, newborn gender, maternal age, oligohydramnios, premature retinopathy (ROP), necrotising enterocolitis (NEC), sepsis, fetal growth retardation (FGR), intracranial hemorrhagia (ICH), bronchopulmonary dysplasia (BPD), respiratory distress syndrome (RDS), primary pulmonary hypertension (PPH), congenital cardiac disease (CCD), patent ductus arteriosus (PDA), use of cortisol (betamethasone) and maternal complications including gestational diabetes, preeclampsia and chorioamnionitis were used to predict neonatal outcomes in terms of length of stay in the NICU and survival. RESULTS In linear regression analyses, birth weight, ROP, CCD, BPD, PDA, NEC and preeclampsia were significant confounders for length of stay in the NICU. Among them, birth weight was the most powerful confounder for prolongation of the NICU stay (t: -6.43; p < 0.001). In multivariate logistic regression analyses, birth weight, PDA, ROP and PPH were significantly correlated with neonatal survival. PPH was the most powerful confounder in neonatal survival (β: 7.22; p = 0.005). CONCLUSION Prematurity-related complications are the most important problems for which precautions should be taken. Therefore, premature deliveries should be avoided to prevent infection and to prolong the latent period in cases of PPROM in order to decrease prematurity-related outcomes.
Collapse
Affiliation(s)
- Meryem Kurek Eken
- a Department of Obstetric and Gynecology , Adnan Menderes University , Aydın , Turkey
| | - Abdülhamit Tüten
- b Department of Neonatology , Zeynep Kamil Maternity and Children Hospital , İstanbul , Turkey , and
| | - Enis Özkaya
- c Department of Obstetric and Gynecology , Zeynep Kamil Maternity and Children Hospital , Istanbul , Turkey
| | - Güner Karatekin
- b Department of Neonatology , Zeynep Kamil Maternity and Children Hospital , İstanbul , Turkey , and
| | - Ateş Karateke
- c Department of Obstetric and Gynecology , Zeynep Kamil Maternity and Children Hospital , Istanbul , Turkey
| |
Collapse
|
34
|
McGillick EV, Orgeig S, Williams MT, Morrison JL. Risk of Respiratory Distress Syndrome and Efficacy of Glucocorticoids. Reprod Sci 2016; 23:1459-1472. [DOI: 10.1177/1933719116660842] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Erin V. McGillick
- Early Origins of Adult Health Research Group, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
- Molecular and Evolutionary Physiology of the Lung Laboratory, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Sandra Orgeig
- Molecular and Evolutionary Physiology of the Lung Laboratory, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Marie T. Williams
- Health and Alliance for Research in Exercise, Nutrition and Activity (ARENA), School of Health Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Janna L. Morrison
- Early Origins of Adult Health Research Group, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| |
Collapse
|
35
|
Singh R, Shah B, Allred EN, Grzybowski M, Martin CR, Leviton A. The antecedents and correlates of necrotizing enterocolitis and spontaneous intestinal perforation among infants born before the 28th week of gestation. J Neonatal Perinatal Med 2016; 9:159-170. [PMID: 27197933 DOI: 10.3233/npm-16915100] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To identify antecedents of "medical" necrotizing enterocolitis (mNEC), "surgical" NEC (sNEC), and spontaneous intestinal perforation (SIP) in newborns delivered before 28 weeks gestation. STUDY DESIGN Prospective multicenter cohort study. During study period, 2002- 2004, women delivering before 28 weeks gestation at one of 14 participating institutions were enrolled. Well defined antenatal and postnatal variables were collected. Bivariate analyses were performed to identify candidates for developing multinomial multivariable time-oriented logistic regression models. RESULTS Of the 1320 infants, 5% had mNEC, 6% had sNEC, and 4% had SIP. Antecedents of mNEC included mother's identification as Black, consumption of aspirin during the pregnancy, and vaginal bleeding after the 12th week of gestation. For sNEC the antecedents were maternal self- support, obesity and anemia during the pregnancy, birth before the 24th week, birth weight ≤750gm, and receipt of fresh frozen plasma (FFP) during the first postnatal week. An infant was at increased risk of SIP if the placenta had increased syncytial knots, birth occurred before the 24th week, and received FFP during the first week. CONCLUSIONS Maternal and neonatal characteristics might help identify at-risk ELGANs for NEC and SIP, who then may potentially benefit from targeted preventive strategies.
Collapse
MESH Headings
- Adult
- Aspirin/adverse effects
- Birth Weight
- Enterocolitis, Necrotizing/diagnosis
- Enterocolitis, Necrotizing/etiology
- Enterocolitis, Necrotizing/therapy
- Female
- Gestational Age
- Humans
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases/epidemiology
- Infant, Very Low Birth Weight
- Intestinal Perforation/diagnosis
- Intestinal Perforation/etiology
- Intestinal Perforation/therapy
- Mothers
- Placenta/physiopathology
- Pregnancy
- Prenatal Exposure Delayed Effects
- Prospective Studies
- Risk Factors
- Rupture, Spontaneous/diagnosis
- Rupture, Spontaneous/etiology
- Rupture, Spontaneous/therapy
- United States/epidemiology
- Uterine Hemorrhage
Collapse
Affiliation(s)
- R Singh
- Department of Pediatrics, Baystate Children's Hospital, Springfield, MA, USA
- Tufts University School of Medicine, Boston, MA, USA
| | - B Shah
- Department of Pediatrics, Baystate Children's Hospital, Springfield, MA, USA
- Tufts University School of Medicine, Boston, MA, USA
| | - E N Allred
- Department of Neurology, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - M Grzybowski
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - C R Martin
- Harvard Medical School, Boston, MA, USA
- Department of Pediatrics, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - A Leviton
- Department of Neurology, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| |
Collapse
|
36
|
Salmasi L, Capobianco E. Use of instrumental variables in electronic health record-driven models. Stat Methods Med Res 2016; 27:608-621. [PMID: 27055764 DOI: 10.1177/0962280216641154] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Precision medicine presents various methodological challenges whose assessment requires the consideration of multiple factors. In particular, the data multitude in the Electronic Health Records poses interoperability issues and requires novel inference strategies. A problem, though apparently a paradox, is that highly specific treatments and a variety of outcomes may hardly match with consistent observations (i.e., large samples). Why is it the case? Owing to the heterogeneity of Electronic Health Records, models for the evaluation of treatment effects need to be selected, and in some cases, the use of instrumental variables might be necessary. We studied the recently defined person-centered treatment effects in cancer and C-section contexts from Electronic Health Record sources and identified as an instrument the distance of patients from hospitals. We present first the rationale for using such instrument and then its model implementation. While for cancer patients consideration of distance turns out to be a penalty, implying a negative effect on the probability of receiving surgery, a positive effect is instead found in C-section due to higher propensity of scheduling delivery. Overall, the estimated person-centered treatment effects reveal a high degree of heterogeneity, whose interpretation remains context-dependent. With regard to the use of instruments in light of our two case studies, our suggestion is that this process requires ad hoc variable selection for both covariates and instruments and additional testing to ensure validity.
Collapse
Affiliation(s)
- Luca Salmasi
- 1 Department of Political Science, University of Perugia, Perugia, Italy
| | - Enrico Capobianco
- 2 Center for Computational Science, University of Miami, Coral Gables, Florida, USA.,3 Laboratory of Integrative Systems Medicine, Institute of Clinical Physiology, CNR, Pisa, IT
| |
Collapse
|
37
|
Association Between Low Dairy Intake During Pregnancy and Risk of Small-for-Gestational-Age Infants. Matern Child Health J 2016; 20:1296-304. [DOI: 10.1007/s10995-016-1931-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
38
|
Turitz AL, Friedman AM, Gyamfi-Bannerman C. Trial of labor after cesarean versus repeat cesarean in women with small-for-gestational age neonates: a secondary analysis. J Matern Fetal Neonatal Med 2015; 29:3051-5. [DOI: 10.3109/14767058.2015.1114084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Amy L. Turitz
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, USA
| | - Alexander M. Friedman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, USA
| | - Cynthia Gyamfi-Bannerman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, USA
| |
Collapse
|
39
|
Bannister-Tyrrell M, Patterson JA, Ford JB, Morris JM, Nicholl MC, Roberts CL. Variation in hospital caesarean section rates for preterm births. Aust N Z J Obstet Gynaecol 2015. [PMID: 26223538 DOI: 10.1111/ajo.12351] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Evidence about optimal mode of delivery for preterm birth is lacking, and there is thought to be considerable variation in practice. OBJECTIVE To assess whether variation in hospital preterm caesarean section rates (Robson Classification Group 10) and outcomes are explained by casemix, labour or hospital characteristics. MATERIALS AND METHODS Population-based cohort study in NSW, 2007-2011. Births were categorised according to degree of prematurity and hospital service capability: 26-31, 32-33 and 34-36 weeks' gestation. Hospital preterm caesarean rates were investigated using multilevel logistic regression models, progressively adjusting for casemix, labour and hospital factors. The association between hospital caesarean rates, and severe maternal and neonatal morbidity rates was assessed. RESULTS At 26-31 weeks' gestation, the caesarean rate was 55.2% (seven hospitals, range 43.4-58.4%); 50.9% at 32-33 weeks (12 hospitals, 43.4-58.1%); and 36.4% at 34-36 weeks (51 hospitals, 17.4-48.3%). At 26-31 weeks and 32-33 weeks' gestation, 81% and 59% of the variation between hospitals was explained with no hospital significantly different from the state average after adjustment. At 34-36 weeks' gestation, although 59% of the variation was explained, substantial unexplained variation persisted. Hospital caesarean rates were not associated with severe maternal morbidity rates at any gestational age. At 26-31 weeks' gestation, medium and high caesarean rates were associated with higher severe neonatal morbidity rates, but there was no evidence of this association ≥32 weeks. CONCLUSION Both casemix and practice differences contributed to the variation in hospital caesarean rates. Low preterm caesarean rates were not associated with worse outcomes.
Collapse
Affiliation(s)
- Melanie Bannister-Tyrrell
- Clinical and Population Perinatal Health Research, Kolling Institute, University of Sydney, St Leonards, NSW, Australia
| | - Jillian A Patterson
- Clinical and Population Perinatal Health Research, Kolling Institute, University of Sydney, St Leonards, NSW, Australia
| | - Jane B Ford
- Clinical and Population Perinatal Health Research, Kolling Institute, University of Sydney, St Leonards, NSW, Australia
| | - Jonathan M Morris
- Kolling Institute, University of Sydney, St Leonards, NSW, Australia
| | - Michael C Nicholl
- Department of Obstetrics and Gynaecology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Christine L Roberts
- Clinical and Population Perinatal Health Research, Kolling Institute, University of Sydney, St Leonards, NSW, Australia
| |
Collapse
|
40
|
Abstract
Management and decision whether to begin intensive care for very preterm infants below 26 WG and at borderline viability remains controversial, and survival rates for these children vary greatly and justify discussion with regards to literature data and according to the experience of others countries. If active management is more difficult with very preterm infants 24-25 WG, mortality is increased comparing with newborns of more than 26 WG. This is partly explained by limitations of active neonatal intensive care. Nevertheless, neurocomportemental and cognitive results are not so unfavorable. This justifies a human, medical, and ethical multidiciplinary discussion including the parents' wishes for an active resuscitation or a palliative management. Using the only criteria of gestational age is not a reliable tool to predict survival and neurodevelopmental outcome of preterm infants. It is very important to identify other prenatal factors such prenatal corticosteroid administration, gender, fetal estimated weight, amniotic fluid and absent/reverse end diastolic flow umbilical doppler. Implication and listening the parents' preferences are essential after individual information, objective and a honest counseling including mortality, morbidity and risks of neurocomportmental impairments. Birth and counseling should be done in reference maternofetal center with obstetricians and neonatalogist specialized in this topic. A real difficulty is to consider the route of delivery and the possibility that caesarean section could improve survival rates. Induction of labour is very often a high risk of failure and route of delivery remains controversial and this is a real question in order to improve survival rates. Literature is poor and conflicting without randomized trials. Caesarean section presents maternal risks such as pathologic placentation, haemorrhage delivery and increasing risks for the subsequent gestation. So, if it is not a good idea to recommend a systematic caesarean delivery, it is not ethical to refuse this route of delivery only because of the gestational age even in extremely premature birth.
Collapse
Affiliation(s)
- N Winer
- Service de gynécologie-obstétrique, hôpital Mère-Enfant, CHU de Nantes, 38, boulevard Jean-Monnet, 44093 Nantes cedex, France.
| | - C Flamant
- Service de réanimation et médecine néonatale, hôpital Mère-Enfant, CHU de Nantes, 38, boulevard Jean-Monnet, 44093 Nantes cedex, France
| |
Collapse
|
41
|
Impaired Neonatal Outcome after Emergency Cerclage Adds Controversy to Prolongation of Pregnancy. PLoS One 2015; 10:e0129104. [PMID: 26121653 PMCID: PMC4488141 DOI: 10.1371/journal.pone.0129104] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 05/05/2015] [Indexed: 11/19/2022] Open
Abstract
Objective Emergency cervical cerclage is one of the treatment options for the reduction of preterm birth. The aim of this study is to assess neonatal outcome after cerclage with special focus on adverse effects in very low birth weight infants. Study Design Retrospective cohort study. Classification of cerclages in history-indicated (HIC, n = 38), ultrasound-indicated (UIC, n = 29) and emergency/ physical examination-indicated (PEIC, n = 33) cerclage. Descriptive analysis of pregnancy and neonatal outcome (admission to NICU, duration of hospitalization, respiratory outcome (intubation, CPAP, FiO2max), neonatal complications (ROP, IVH)). Statistical comparison of perinatal parameters and outcome of neonates <1500 g after cerclage with a birth weight matched control group. Results Neonates <1500 g after PEIC show significantly impaired outcome, i.e. prolonged respiratory support (total ventilation in days, CPAP, FiO2max) and higher rates of neonatal complications (IVH ≥ II, ROP ≥ 2). Placental pathologic evaluation revealed a significantly higher rate of chorioamnionitis (CAM) after PEIC. Neonates <1500 g after UIC or HIC show no significant difference in neonatal complications or CAM. Conclusions In our study PEIC is associated with adverse neonatal outcome in infants <1500 g. The high incidence of CAM indicates a potential inflammatory factor in the pathogenesis. Large well-designed RCTs are required to give conclusive answers to the question whether to prolong or to deliver.
Collapse
|
42
|
|
43
|
Abstract
The fetus to newborn transition is a complex physiologic process that requires close monitoring. Approximately 10% of all newborns require some support in facilitating a successful transition after delivery. Clinicians should be aware of the physiologic processes and pay close regard to the newborn's cardiopulmonary transition at birth to provide appropriate treatment and therapies as required. Trained Personnel in the Neonatal Resuscitation program should be available at the delivery for all newborns to ensure that immediate and appropriate care is provided to achieve the best possible outcomes for those babies not smoothly transitioning to extrauterine life.
Collapse
|
44
|
Gut microbiota biomodulators, when the stork comes by the scalpel. Clin Chim Acta 2015; 451:88-96. [PMID: 25668229 DOI: 10.1016/j.cca.2015.01.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 01/22/2015] [Accepted: 01/25/2015] [Indexed: 02/07/2023]
Abstract
The microbial communities that reside in the human gut (microbiota) and their impact on human health and disease are nowadays one of the most exciting new areas of research. A well-balanced microbial intestinal colonization in early postnatal life is necessary for the development of appropriate innate and adaptive immune responses and to establish immune homeostasis later in life. Although the composition and functional characteristics of a 'healthy' gut microbiota remain to be elucidated, perturbations in the microbial colonization of an infant's gastrointestinal tract have been associated with an increased risk of short- and long-term immunologically mediated diseases. Emerging evidence suggests that gut microbiota biomodulators, such as probiotics, prebiotics, synbiotics, and postbiotics may support disease prevention in infants who tend to have a delayed and/or aberrant initial colonization with reduced microbiota diversity (delivery by caesarean section, premature delivery, and excessive use of perinatal antibiotics). Under these dysbiosis conditions probiotics could act as 'surrogate' colonizers to prevent immune-mediated diseases. This review focuses on the influence of delivery mode on the colonization of the infant gastro-intestinal tract. In particular, it examines the manipulation of the gut microbiota composition through the use of gut microbiota biomodulators, in the management of aberrant initial gut colonization and subsequent consequences for the health of the offspring.
Collapse
|
45
|
Zou L, Wang X, Ruan Y, Li G, Chen Y, Zhang W. Preterm birth and neonatal mortality in China in 2011. Int J Gynaecol Obstet 2014; 127:243-7. [PMID: 25132529 DOI: 10.1016/j.ijgo.2014.06.018] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2013] [Revised: 06/09/2014] [Accepted: 07/29/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To determine the incidence of preterm birth, its regional distribution, and associated neonatal mortality in mainland China. METHODS In a multicenter, hospital-based investigation of preterm birth, 2011 data were obtained from the seven administrative regions of mainland China. Between one and three subcenters were randomly selected for each administrative region, followed by secondary and tertiary hospitals within the chosen subcenters. Data were obtained from women's medical records, and obstetric and perinatal events were summarized. RESULTS Data for 107,905 deliveries were analyzed, which included 7769 (7.1%) preterm births (occurring between 28 and 37 weeks of pregnancy). The incidence varied among regions. Late preterm birth (between 34 and 37 weeks) accounted for 5495 (70.7%) of preterm births. The neonatal mortality rate was 33 deaths per 1000 live preterm births. Of the 254 neonatal deaths, 147 (57.9%) occurred after very preterm birth (between 28 and 32 weeks). Overall, 4519 (58.2%) preterm births occurred by cesarean. CONCLUSION The distribution of preterm birth across China is unbalanced, and neonatal mortality associated with preterm birth is high.
Collapse
Affiliation(s)
- Liying Zou
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Xin Wang
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Yan Ruan
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Guanghui Li
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Yi Chen
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Weiyuan Zhang
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China.
| |
Collapse
|
46
|
Gunnink SF, Vlug R, Fijnvandraat K, van der Bom JG, Stanworth SJ, Lopriore E. Neonatal thrombocytopenia: etiology, management and outcome. Expert Rev Hematol 2014; 7:387-95. [PMID: 24665958 DOI: 10.1586/17474086.2014.902301] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Thrombocytopenia is a very common hematological abnormality found in newborns, especially in preterm neonates. Two subgroups can be distinguished: early thrombocytopenia, occurring within the first 72 hours of life, and late thrombocytopenia, occurring after the first 72 hours of life. Early thrombocytopenia is associated with intrauterine growth restriction, whereas late thrombocytopenia is caused mainly by sepsis and necrotizing enterocolitis (NEC). Platelet transfusions are the hallmark of the treatment of neonatal thrombocytopenia. Most of these transfusions are prophylactic, which means they are given in the absence of bleeding. However, the efficacy of these transfusions in preventing bleeding has never been proven. In addition, risks of platelet transfusion seem to be more pronounced in preterm neonates. Because of lack of data, platelet transfusion guidelines differ widely between countries. This review summarizes the current understanding of etiology and management of neonatal thrombocytopenia.
Collapse
|
47
|
Åberg K, Norman M, Ekéus C. Preterm birth by vacuum extraction and neonatal outcome: a population-based cohort study. BMC Pregnancy Childbirth 2014; 14:42. [PMID: 24450413 PMCID: PMC3900732 DOI: 10.1186/1471-2393-14-42] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 01/20/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Very few studies have investigated the neonatal outcomes after vacuum extraction delivery (VE) in the preterm period and the results of these studies are inconclusive. The objective of this study was to describe the use of VE for preterm delivery in Sweden and to compare rates of neonatal complications after preterm delivery by VE to those found after cesarean section during labor (CS) or unassisted vaginal delivery (VD). METHODS Data was obtained from Swedish national registers. In a population-based cohort from 1999 to 2010, all live-born, singleton preterm infants in a non-breech presentation at birth, born after onset of labor (either spontaneously, by induction, or by rupture of membranes) by VD, CS, or VE were included, leaving a study population of 40,764 infants. Logistic regression analyses were used to calculate adjusted odds ratios (AOR), using unassisted vaginal delivery as reference group. RESULTS VE was used in 5.7% of the preterm deliveries, with lower rates in earlier gestations. Overall, intracranial hemorrhage (ICH) occurred in 1.51%, extracranial hemorrhage (ECH) in 0.64%, and brachial plexus injury in 0.13% of infants. Infants delivered by VE had higher risks for ICH (AOR = 1.84 (95% CI: 1.09-3.12)), ECH (AOR = 4.48 (95% CI: 2.84-7.07)) and brachial plexus injury (AOR = 6.21 (95% CI: 2.22-17.4)), while infants delivered by CS during labor had no increased risk for these complications, as compared to VD. CONCLUSION While rates of neonatal complications after VE are generally low, higher odds ratios for intra- and extracranial hemorrhages and brachial plexus injuries after VE, compared with other modes of delivery, support a continued cautious use of VE for preterm delivery.
Collapse
Affiliation(s)
- Katarina Åberg
- Department of Women’s and Children’s Health, Division of Reproductive Health, Karolinska Institutet, Retzius väg 13, 171 77 Stockholm, Sweden
| | - Mikael Norman
- Department of Clinical Science, Intervention and Technology, Division of Pediatrics, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia Ekéus
- Department of Women’s and Children’s Health, Division of Reproductive Health, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
48
|
Health outcomes for vaginal compared with cesarean delivery of appropriately grown preterm neonates. Obstet Gynecol 2013; 121:1195-1200. [PMID: 23812452 DOI: 10.1097/aog.0b013e3182918a7e] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the association between route of delivery and neonatal outcomes in a large, diverse cohort of preterm, appropriate-for-gestational-age neonates. METHODS This is a retrospective cohort study examining New York City birth data for 1995-2003 linked to hospital discharge data. Data were limited to singleton, live-born, cephalic neonates delivered between 24 and 34 weeks of gestation. Exclusion criteria included congenital anomalies, forceps or vacuum assistance, birth weight missing, less than 500 g, or not appropriate for gestational age. Any neonatal diagnosis of intraventricular hemorrhage, seizure, sepsis, subdural hemorrhage, respiratory distress, 5-minute Apgar score less than 7, or neonatal death was considered significant. Associations between method of delivery and neonatal morbidities were estimated using logistic regression. RESULTS Of 20,231 neonates meeting study criteria, 69.3% were delivered vaginally and 30.7% were delivered by cesarean. After controlling for maternal age, ethnicity, education, primary payer, prepregnancy weight, gestational age, diabetes, and hypertension, cesarean delivery compared with vaginal delivery was associated with increased odds of respiratory distress (39.2% compared with 25.6%, adjusted odds ratio [OR] 1.74, 95% confidence interval [CI] 1.61-1.89) and 5-minute Apgar score less than 7 (10.7% compared with 5.8%, adjusted OR 2.04, 95% CI 1.77-2.35). CONCLUSION In this preterm cohort, cesarean delivery was not protective against poor outcomes and in fact was associated with increased risk of respiratory distress and low Apgar score compared with vaginal delivery.
Collapse
|
49
|
In Reply. Obstet Gynecol 2012. [DOI: 10.1097/aog.0b013e3182772c8a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
50
|
Mode of delivery and neonatal outcomes in preterm, small-for-gestational-age newborns. Obstet Gynecol 2012; 120:1479; author reply 1479. [PMID: 23168778 DOI: 10.1097/aog.0b013e3182772be7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|