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Corbett GA, Moore R, Feehily C, Killeen SL, O'Brien E, Van Sinderen D, Matthews E, O'Flaherty R, Rudd PM, Saldova R, Walsh CJ, Lawton EM, MacIntyre DA, Corcoran S, Cotter PD, McAuliffe FM. Dietary amino acids, macronutrients, vaginal birth, and breastfeeding are associated with the vaginal microbiome in early pregnancy. Microbiol Spectr 2024:e0113024. [PMID: 39365058 DOI: 10.1128/spectrum.01130-24] [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: 06/24/2024] [Accepted: 07/29/2024] [Indexed: 10/05/2024] Open
Abstract
The vaginal microbiome is a key player in the etiology of spontaneous preterm birth. This study aimed to illustrate maternal environmental factors associated with vaginal microbiota composition and function in pregnancy. Women in healthy pregnancy had vaginal microbial sampling from the posterior vaginal fornix performed at 16 weeks gestation. After shotgun metagenomic sequencing, heatmaps of relative abundance data were generated. Community state type (CST) was assigned, and alpha diversity was calculated. Demography, obstetric history, well-being, exercise, and diet using food frequency questionnaires were collected and compared against microbial parameters. A total of 119 pregnant participants had vaginal metagenomic sequencing performed. Factors with strongest association with beta diversity were dietary lysine (adj-R2 0.113, P = 0.002), valine (adj-R2 0.096, P = 0.004), leucine (adj-R2 0.086, P = 0.003), and phenylalanine (adj-R2 0.085, P = 0.005, Fig. 2D). Previous vaginal delivery and breastfeeding were associated with vaginal beta diversity (adj-R2 0.048, P = 0.003; adj-R2 0.045, P = 0.004), accounting for 8.5% of taxonomy variation on redundancy analysis. Dietary fat, starch, and maltose were positively correlated with alpha diversity (fat +0.002 SD/g, P = 0.025; starch +0.002 SD/g, P = 0.043; maltose +0.440 SD/g, P = 0.013), particularly in secretor-positive women. Functional signature was associated with CST, maternal smoking, and dietary phenylalanine, accounting for 8.9%-11% of the variation in vaginal microbiome functional signature. Dietary amino acids, previous vaginal delivery, and breastfeeding history were associated with vaginal beta diversity. Functional signature of the vaginal microbiome differed with community state type, smoking, dietary phenylalanine, and vitamin K. Increased alpha diversity correlated with dietary fat and starch. These data provide a novel snapshot into the associations between maternal environment, nutrition, and the vaginal microbiome. IMPORTANCE This secondary analysis of the MicrobeMom randomized controlled trial reveals that dietary amino acids, macronutrients, previous vaginal birth, and breastfeeding have the strongest associations with vaginal taxonomy in early pregnancy. Function of the vaginal niche is associated mainly by species composition, but smoking, vitamin K, and phenylalanine also play a role. These associations provide an intriguing and novel insight into the association between host factors and diet on the vaginal microbiome in pregnancy and highlight the need for further investigation into the complex interactions between the diet, human gut, and vaginal microbiome.
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Affiliation(s)
- Gillian A Corbett
- UCD Perinatal Research Centre, UCD School of Medicine, University College Dublin, Dublin, Ireland
- National Maternity Hospital, Dublin 2, Ireland
| | - Rebecca Moore
- UCD Perinatal Research Centre, UCD School of Medicine, University College Dublin, Dublin, Ireland
| | - Conor Feehily
- School of Infection and Immunity, University of Glasgow, Glasgow, United Kingdom
| | - Sarah Louise Killeen
- UCD Perinatal Research Centre, UCD School of Medicine, University College Dublin, Dublin, Ireland
| | - Eileen O'Brien
- School of Biological, Health and Sports Sciences, Technological University Dublin, Dublin, Ireland
| | - Douwe Van Sinderen
- School of Microbiology, University College Cork, Cork, Ireland
- APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - Elizabeth Matthews
- GlycoScience Group, National Institute for Bioprocessing Research and Training (NIBRT), Dublin, Ireland
| | - Roisin O'Flaherty
- GlycoScience Group, National Institute for Bioprocessing Research and Training (NIBRT), Dublin, Ireland
- Department of Chemistry, Maynooth University, Maynooth, Ireland
| | - Pauline M Rudd
- GlycoScience Group, National Institute for Bioprocessing Research and Training (NIBRT), Dublin, Ireland
- Bioprocessing Technology Institute, AStar, Singapore, Singapore
| | - Radka Saldova
- GlycoScience Group, National Institute for Bioprocessing Research and Training (NIBRT), Dublin, Ireland
- College of Health and Agricultural Science (CHAS), UCD School of Medicine, University College Dublin, Dublin, Ireland
| | - Calum J Walsh
- Teagasc Food Research Centre, Moorepark, Cork, Ireland
- The Centre for Pathogen Genomics, Department of Microbiology & Immunology, Doherty Institute for Infection & Immunity, University of Melbourne, Melbourne, Victoria, Australia
| | | | - David A MacIntyre
- Division of the Institute of Reproductive and Developmental Biology, Department of Metabolism, Digestion, and Reproduction, March of Dimes Prematurity Research Centre, Imperial College London, London, United Kingdom
| | - Siobhan Corcoran
- UCD Perinatal Research Centre, UCD School of Medicine, University College Dublin, Dublin, Ireland
- National Maternity Hospital, Dublin 2, Ireland
| | - Paul D Cotter
- APC Microbiome Ireland, University College Cork, Cork, Ireland
- Teagasc Food Research Centre, Moorepark, Cork, Ireland
| | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, UCD School of Medicine, University College Dublin, Dublin, Ireland
- National Maternity Hospital, Dublin 2, Ireland
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Huang X, Zhou Y, Liu B, Huang Y, Wang M, Li N, Li B. Prediction model for spontaneous preterm birth less than 32 weeks of gestation in low-risk women with mid-trimester short cervical length: a retrospective cohort study. BMC Pregnancy Childbirth 2024; 24:621. [PMID: 39354430 PMCID: PMC11443884 DOI: 10.1186/s12884-024-06822-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Accepted: 09/11/2024] [Indexed: 10/03/2024] Open
Abstract
BACKGROUND A short cervix in mid-trimester pregnancy is a risk factor for spontaneous preterm birth. However, there is currently a lack of predictive models and classification systems for predicting spontaneous preterm birth in these patients, especially those without additional risk factors for spontaneous preterm birth. METHODS A retrospective observational cohort study of low-risk singleton pregnant women with a short cervix (≤ 25 mm) measured by transvaginal ultrasonography between 22 and 24 weeks was conducted. A multivariate logistic regression model for spontaneous preterm birth < 32 weeks in low-risk pregnant women with a short cervix was constructed. Moreover, we developed a nomogram to visualize the prediction model and stratified patients into three risk groups (low-, intermediate-, and high-risk groups) based on the total score obtained from the nomogram model. RESULTS Between 2020 and 2022, 213 low-risk women with a short cervix in mid-trimester pregnancy were enrolled in the study. Univariate logistic analysis revealed that a high body mass index, a history of three or more miscarriages, multiparity, a short cervical length, leukocytosis, and an elevated C-reactive protein level were associated with spontaneous preterm birth < 32 weeks, but multivariate analysis revealed that multiparity (OR, 3.31; 95% CI, 1.13-9.68), leukocytosis (OR, 3.96; 95% CI, 1.24-12.61) and a short cervical length (OR, 0.88; 95% CI, 0.82-0.94) were independent predictors of sPTB < 32 weeks. The model incorporating these three predictors displayed good discrimination and calibration, and the area under the ROC curve of this model was as high as 0.815 (95% CI, 0.700-0.931). Patients were stratified into low- (195 patients), intermediate- (14 patients) and high-risk (4 patients) groups according to the model, corresponding to patients with scores ≤ 120, 121-146, and > 146, respectively. The predicted probabilities of spontaneous preterm birth < 32 weeks for these groups were 6.38, 40.62, and 71.88%, respectively. CONCLUSIONS A noninvasive and efficient model to predict the occurrence of spontaneous preterm birth < 32 weeks in low-risk singleton pregnant women with a short cervix and a classification system were constructed in this study and can provide insight into the optimal management strategy for patients with different risk stratifications according to the score chart.
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Affiliation(s)
- Xiaoxiu Huang
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Xueshi Rd No. 1, Hangzhou, 310006, Zhejiang, People's Republic of China
| | - Yimin Zhou
- Department of Ultrasound, Women's Hospital, Zhejiang University School of Medicine, Xueshi Rd No. 1, Hangzhou, 310006, Zhejiang, People's Republic of China
| | - Bingqing Liu
- Department of Women's Health, Women's Hospital, Zhejiang University School of Medicine, Xueshi Rd No. 1, Hangzhou, 310006, Zhejiang, People's Republic of China
| | - Yuhui Huang
- School of Public Health, Zhejiang University, Hangtang Rd No. 866, Hangzhou, 310006, Zhejiang, People's Republic of China
| | - Mengni Wang
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Xueshi Rd No. 1, Hangzhou, 310006, Zhejiang, People's Republic of China
| | - Na Li
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Xueshi Rd No. 1, Hangzhou, 310006, Zhejiang, People's Republic of China
| | - Baohua Li
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Xueshi Rd No. 1, Hangzhou, 310006, Zhejiang, People's Republic of China.
- Zhejiang Key Laboratory of Maternal and Infant Health, Hangzhou, Zhejiang Province, People's Republic of China.
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Murosko DC, Radack J, Barreto A, Passarella M, Formanowski B, McGann C, Nelin T, Paul K, Peña MM, Salazar EG, Burris HH, Handley SC, Montoya-Williams D, Lorch SA. County-level Structural Vulnerabilities in Maternal Health and Geographic Variation in Infant Mortality. J Pediatr 2024:114274. [PMID: 39216622 DOI: 10.1016/j.jpeds.2024.114274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 07/15/2024] [Accepted: 08/26/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVE To evaluate whether community factors that differentially affect the health of pregnant people contribute to geographic differences in infant mortality across the United States. STUDY DESIGN This retrospective cohort study sought to characterize the association of a novel composite measure of county-level maternal structural vulnerabilities, the Maternal Vulnerability Index (MVI), with risk of infant death. We evaluated 11,456,232 singleton infants born at 22 0/7 through 44 6/7 weeks' gestation from 2012 to 2014. Using county-level MVI, which ranges from 0-100, multivariable mixed effects logistic regression models quantified associations per 20-point increment in MVI, with odds of death clustered at the county level and adjusted for state, maternal, and infant covariates. Secondary analyses stratified by the social, physical, and health exposures that comprise the overall MVI score. Outcome was also stratified by cause of death. RESULTS Odds of death were higher among infants from counties with the greatest maternal vulnerability (0.62% in highest quintile vs 0.32% in lowest quintile, [p<0.001]). Odds of death increased 6% per 20-point increment in MVI (aOR: 1.06, 95% CI 1.04, 1.07). The effect estimate was highest with theme of mental health and substance use (aOR 1.08; 95% CI 1.06, 1.09). Increasing vulnerability was associated with six of seven causes of death. CONCLUSIONS Community-level social, physical, and healthcare determinants indicative of maternal vulnerability may explain some of the geographic variation in infant death, regardless of cause of death. Interventions targeted to county-specific maternal vulnerabilities may reduce infant mortality.
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Affiliation(s)
- Daria C Murosko
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania.
| | - Josh Radack
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Alejandra Barreto
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Molly Passarella
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Brielle Formanowski
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Carolyn McGann
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Timothy Nelin
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania
| | - Kathryn Paul
- Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Michelle-Marie Peña
- Division of Neonatology, Children's Healthcare of Atlanta and Emory University School of Medicine. Atlanta, GA
| | - Elizabeth G Salazar
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania
| | - Heather H Burris
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sara C Handley
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Diana Montoya-Williams
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Scott A Lorch
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Cowan KN, Krajewski AK, Jimenez MP, Luben TJ, Messer LC, Rappazzo KM. Examining modification of the associations between air pollution and birth outcomes by neighborhood deprivation in a North Carolina birth cohort, 2011-2015. FRONTIERS IN REPRODUCTIVE HEALTH 2024; 6:1304749. [PMID: 39055124 PMCID: PMC11269152 DOI: 10.3389/frph.2024.1304749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 06/17/2024] [Indexed: 07/27/2024] Open
Abstract
Background Evidence from studies of air pollutants and birth outcomes suggests an association, but uncertainties around geographical variability and modifying factors still remain. As neighborhood-level social characteristics are associated with birth outcomes, we assess whether neighborhood deprivation level is an effect measure modifier on the association between air pollution and birth outcomes in a North Carolina birth cohort. Methods Using birth certificate data, all North Carolina residential singleton live births from 1 January 2011 to 31 December 2015 with gestational ages of 20-44 weeks (n = 566,799) were examined for birth defect diagnoses and preterm birth. Exposures were daily average fine particulate matter (PM2.5), daily 8-h maximum nitrogen dioxide (NO2), and daily 8-h maximum ozone (O3) modeled concentrations, and the modifier of interest was the neighborhood deprivation index (NDI). Linear binomial models were used to estimate the prevalence differences and 95% confidence intervals (CI) for the association between ambient air pollution and birth defect diagnoses. Modified Poisson regression models were used to estimate risk differences (RDs) and 95% CIs for air pollution and preterm birth. Models were stratified by the neighborhood deprivation index group (low, medium, or high) to assess potential modification by NDI. Results Approximately 3.1% of the study population had at least one birth defect and 8.18% were born preterm. For preterm birth, associations with PM2.5 and O3 did not follow a conclusive pattern and there was no evidence of modification by NDI. The associations between NO2 and preterm birth were generally negative across exposure windows except for a positive association with NO2 and preterm birth for high NDI [RD: 34.70 (95% CI 4.84-64.56)] for entire pregnancy exposure. There was no evidence of associations between pollutants examined and birth defects. Conclusions There may be differences in the association between NO2 exposure and preterm birth by NDI but we did not observe any evidence of associations for birth defects. Our results support the public health protection afforded by reductions in air pollution, even in areas of neighborhood deprivation, but future research conducted in areas with higher levels of air pollution and evaluating the potential for modification by neighborhood deprivation level would be informative.
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Affiliation(s)
- Kristen N. Cowan
- Oak Ridge Institute for Science and Education (ORISE), US EPA, Research Triangle Park, NC, United States
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Alison K. Krajewski
- Office of Research and Development, Center for Public Health & Environmental Assessment, United States Environmental Protection Agency,Research Triangle Park, NC, United States
| | - Monica P. Jimenez
- Oak Ridge Institute for Science and Education (ORISE), US EPA, Research Triangle Park, NC, United States
| | - Thomas J. Luben
- Office of Research and Development, Center for Public Health & Environmental Assessment, United States Environmental Protection Agency,Research Triangle Park, NC, United States
| | - Lynne C. Messer
- Departments of Community Health and Health Promotion and Epidemiology, OHSU-PSU School of Public Health, Portland, OR, United States
| | - Kristen M. Rappazzo
- Office of Research and Development, Center for Public Health & Environmental Assessment, United States Environmental Protection Agency,Research Triangle Park, NC, United States
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Chen S, Wang W, Yan G, Liu M, Li M, Chen P, Ma Q, Zhang J, Tang Y, Zhou L, You D. Amniotic Fluid Proteomics Analysis and In Vitro Validation to Identify Potential Biomarkers of Preterm Birth. Reprod Sci 2024; 31:2032-2042. [PMID: 38453771 PMCID: PMC11217130 DOI: 10.1007/s43032-024-01457-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/08/2024] [Indexed: 03/09/2024]
Abstract
This study aimed to investigate the regulation of amniotic fibroblast (AFC) function by vitamin K-dependent protein Z (PROZ) during preterm birth (PTB) and its potential role in adverse pregnancy outcomes. Proteomic samples were collected from amniotic fluid in the second trimester, and AFC were isolated from the amniotic membrane and cultured in vitro. The expression of extracellular and intracellular PROZ in AFC was modulated, and their biological properties and functions were evaluated. Clinical analysis revealed a significant upregulation of PROZ expression in amniotic fluid from preterm pregnant women. In vitro experiments demonstrated that PROZ stimulated AFC migration, enhanced their proliferative capacity, and reduced collagen secretion. Overexpression of PROZ further enhanced cell migration and proliferation, while knockdown of PROZ had the opposite effect. PROZ plays a crucial role in promoting the proliferation and migration of amniotic membrane fibroblasts. Increased PROZ expression in amniotic fluid is associated with the occurrence of PTB. These findings shed light on the potential involvement of PROZ in adverse pregnancy outcomes and provide a basis for further research on its regulatory mechanisms during PTB.
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Affiliation(s)
- Siguo Chen
- Yunnan Provincial Key Laboratory of Public Health and Biosafety & School of Public Health, Kunming Medical University, Kunming, Yunnan, 650000, China
| | - Weizhou Wang
- Department of Orthopedics, The First Affiliated Hospital of Kunming Medical University, Kunming, 650032, Yunnan, China
| | - Guanghong Yan
- Yunnan Provincial Key Laboratory of Public Health and Biosafety & School of Public Health, Kunming Medical University, Kunming, Yunnan, 650000, China
| | - Mengmei Liu
- Yunnan Provincial Key Laboratory of Public Health and Biosafety & School of Public Health, Kunming Medical University, Kunming, Yunnan, 650000, China
| | - Min Li
- Yunnan Provincial Key Laboratory of Public Health and Biosafety & School of Public Health, Kunming Medical University, Kunming, Yunnan, 650000, China
| | - Ping Chen
- Yunnan Provincial Key Laboratory of Public Health and Biosafety & School of Public Health, Kunming Medical University, Kunming, Yunnan, 650000, China
| | - Qingyan Ma
- Yunnan Provincial Key Laboratory of Public Health and Biosafety & School of Public Health, Kunming Medical University, Kunming, Yunnan, 650000, China
| | - Jinman Zhang
- Department of Medical Genetics, First People's Hospital of Yunnan Province, Kunming, 650034, Yunnan, China
| | - Ying Tang
- The Electron Microscopy Laboratory, Science and Technology Achievement Incubation Center, Kunming Medical University, Kunming, 650000, Yunnan, China
| | - Linglin Zhou
- Department of Obstetrics, Gejiu City People's Hospital, Gejiu, 661000, Yunnan, China
| | - Dingyun You
- Yunnan Provincial Key Laboratory of Public Health and Biosafety & School of Public Health, Kunming Medical University, Kunming, Yunnan, 650000, China.
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Kim S, Brennan PA, Slavich GM, Hertzberg V, Kelly U, Dunlop AL. Black-white differences in chronic stress exposures to predict preterm birth: interpretable, race/ethnicity-specific machine learning model. BMC Pregnancy Childbirth 2024; 24:438. [PMID: 38909177 PMCID: PMC11193905 DOI: 10.1186/s12884-024-06613-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 05/29/2024] [Indexed: 06/24/2024] Open
Abstract
BACKGROUND Differential exposure to chronic stressors by race/ethnicity may help explain Black-White inequalities in rates of preterm birth. However, researchers have not investigated the cumulative, interactive, and population-specific nature of chronic stressor exposures and their possible nonlinear associations with preterm birth. Models capable of computing such high-dimensional associations that could differ by race/ethnicity are needed. We developed machine learning models of chronic stressors to both predict preterm birth more accurately and identify chronic stressors and other risk factors driving preterm birth risk among non-Hispanic Black and non-Hispanic White pregnant women. METHODS Multivariate Adaptive Regression Splines (MARS) models were developed for preterm birth prediction for non-Hispanic Black, non-Hispanic White, and combined study samples derived from the CDC's Pregnancy Risk Assessment Monitoring System data (2012-2017). For each sample population, MARS models were trained and tested using 5-fold cross-validation. For each population, the Area Under the ROC Curve (AUC) was used to evaluate model performance, and variable importance for preterm birth prediction was computed. RESULTS Among 81,892 non-Hispanic Black and 277,963 non-Hispanic White live births (weighted sample), the best-performing MARS models showed high accuracy (AUC: 0.754-0.765) and similar-or-better performance for race/ethnicity-specific models compared to the combined model. The number of prenatal care visits, premature rupture of membrane, and medical conditions were more important than other variables in predicting preterm birth across the populations. Chronic stressors (e.g., low maternal education and intimate partner violence) and their correlates predicted preterm birth only for non-Hispanic Black women. CONCLUSIONS Our study findings reinforce that such mid or upstream determinants of health as chronic stressors should be targeted to reduce excess preterm birth risk among non-Hispanic Black women and ultimately narrow the persistent Black-White gap in preterm birth in the U.S.
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Affiliation(s)
- Sangmi Kim
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA.
| | | | - George M Slavich
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Vicki Hertzberg
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Ursula Kelly
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
- Atlanta VA Health Care System, Atlanta, GA, USA
| | - Anne L Dunlop
- Department of Gynecology and Obstetrics, School of Medicine, Emory University, Atlanta, GA, USA
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Zhou X, Fang J, Wu Y, Gao J, Chen X, Wang A, Shu C. Risk factors for maternal near-miss in an undeveloped province in south-central China, 2012-2022. BMC Public Health 2024; 24:1526. [PMID: 38844895 PMCID: PMC11157777 DOI: 10.1186/s12889-024-18970-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 05/27/2024] [Indexed: 06/09/2024] Open
Abstract
OBJECTIVE To explore the risk factors for maternal near-miss (MNM) using the WHO near-miss approach. METHODS Data were obtained from the Maternal Near-Miss Surveillance System in Hunan Province, China, 2012-2022. Multivariate logistic regression analysis (method: Forward, Wald, α = 0.05) and adjusted odds ratios (aORs) were used to identify risk factors for MNM. RESULTS Our study included 780,359 women with 731,185 live births, a total of 2461 (0.32%) MNMs, 777,846 (99.68%) non-MNMs, and 52 (0.006%) maternal deaths were identified. The MNM ratio was 3.37‰ (95%CI: 3.23-3.50). Coagulation/hematological dysfunction was the most common cause of MNM (75.66%). Results of multivariate logistic regression analysis showed risk factors for MNM: maternal age > = 30 years old (aOR > 1, P < 0.05), unmarried women (aOR = 2.21, 95%CI: 1.71-2.85), number of pregnancies > = 2 (aOR > 1, P < 0.05), nulliparity (aOR = 1.51, 95%CI: 1.32-1.72) or parity > = 3 (aOR = 1.95, 95%CI: 1.50-2.55), prenatal examinations < 5 times (aOR = 1.13, 95%CI: 1.01-1.27), and number of cesarean sections was 1 (aOR = 1.83, 95%CI: 1.64-2.04) or > = 2 (aOR = 2.48, 95%CI: 1.99-3.09). CONCLUSION The MNM ratio was relatively low in Hunan Province. Advanced maternal age, unmarried status, a high number of pregnancies, nulliparity or high parity, a low number of prenatal examinations, and cesarean sections were risk factors for MNM. Our study is essential for improving the quality of maternal health care and preventing MNM.
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Affiliation(s)
- Xu Zhou
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan Province, China
| | - Junqun Fang
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan Province, China
| | - Yinglan Wu
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan Province, China.
| | - Jie Gao
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan Province, China
| | - Xiaoying Chen
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan Province, China.
| | - Aihua Wang
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan Province, China
| | - Chuqiang Shu
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan Province, China
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Kudo R, Iwama N, Hamada H, Tomita H, Tagami K, Kumagai N, Sato N, Izumi S, Sakurai K, Watanabe Z, Ishikuro M, Obara T, Tatsuta N, Hoshiai T, Metoki H, Saito M, Sugawara J, Kuriyama S, Arima T, Yaegashi N. Maternal birth weight is an indicator of preterm delivery: the Japan environment and children's study. J Dev Orig Health Dis 2024; 15:e11. [PMID: 38773803 DOI: 10.1017/s2040174424000126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2024]
Abstract
This study aimed to investigate the association between maternal birth weight (MBW) with preterm delivery (PTD) in the Japanese population. To this end, a total of 78,972 Japanese pregnant women were included in a prospective birth cohort study. Multiple logistic regression and multinominal logistic regression models were applied to investigate the associations of MBW with PTD (delivery from 22 to < 37 weeks of gestation), early PTD (delivery from 22 to < 34 weeks), and late PTD (delivery from 34 to < 37 weeks). The results showed that MBW was inversely associated with PTD, early PTD, and late PTD (p-for-trend < 0.0001, 0.0014, and < 0.0001, respectively). The adjusted odds ratios per each 500 g of MBW decrease were 1.167 (95% confidence interval [CI]: 1.118-1.218) for PTD, 1.174 (95% CI: 1.070-1.287) for early PTD and 1.151 (95% CI: 1.098-1.206) for late PTD. The effect size of the association of MBW with early PTD was similar to that with late PTD. This study demonstrated for the first time an association of a low MBW with PTD, early PTD, and late PTD in a Japanese nationwide cohort.
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Affiliation(s)
- Rie Kudo
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Noriyuki Iwama
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan
- Division of Molecular Epidemiology, Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Hirotaka Hamada
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hasumi Tomita
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazuma Tagami
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Natsumi Kumagai
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Naoto Sato
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Seiya Izumi
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kasumi Sakurai
- Environment and Genome Research Center, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Zen Watanabe
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Mami Ishikuro
- Division of Molecular Epidemiology, Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
- Division of Molecular Epidemiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Taku Obara
- Division of Molecular Epidemiology, Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
- Division of Molecular Epidemiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Nozomi Tatsuta
- Environment and Genome Research Center, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tetsuro Hoshiai
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hirohito Metoki
- Division of Public Health, Hygiene and Epidemiology, Tohoku Medical Pharmaceutical University, Sendai, Japan
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Miyagi, Japan
| | - Masatoshi Saito
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Maternal and Fetal Therapeutics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Junichi Sugawara
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan
- Environment and Genome Research Center, Tohoku University Graduate School of Medicine, Sendai, Japan
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Miyagi, Japan
| | - Shinichi Kuriyama
- Division of Molecular Epidemiology, Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
- Division of Molecular Epidemiology, Tohoku University Graduate School of Medicine, Sendai, Japan
- International Research Institute of Disaster Science, Tohoku University, Sendai, Japan
| | - Takahiro Arima
- Environment and Genome Research Center, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Nobuo Yaegashi
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan
- Environment and Genome Research Center, Tohoku University Graduate School of Medicine, Sendai, Japan
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Miyagi, Japan
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9
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Hochberg A, Wertheimer A, Zlatkin R, Sapir O, Krispin E, Schohat T, Altman E, Ben-Haroush A, Shufaro Y. Poor Response to Gonadotropin Stimulation and Perinatal Outcomes in Fresh In Vitro Fertilization Embryo Transfer Cycles-A Retrospective Cohort Study. J Clin Med 2024; 13:2985. [PMID: 38792525 PMCID: PMC11121972 DOI: 10.3390/jcm13102985] [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: 03/10/2024] [Revised: 05/03/2024] [Accepted: 05/17/2024] [Indexed: 05/26/2024] Open
Abstract
Objective: The objective was to examine the association between poor ovarian response to gonadotropin stimulation for in vitro fertilization (IVF) and adverse perinatal outcomes in singleton gestations in young patients. Methods: This was a retrospective cohort study including women aged 17-39 who underwent fresh embryo transfer and delivered a singleton neonate at a single center (pre-implantation genetic testing excluded) (2007-2022). Patients were classified as one of the following categories: poor responders-daily follicle-stimulating hormone (FSH) ≥ 150 IU yielding ≤ 3 retrieved oocytes; normal responders-4-15 oocytes; and high responders with ≥16 oocytes. The primary outcome was a composite of pre-eclampsia (mild or severe), small-for-gestational-age, gestational diabetes mellitus, and preterm birth (<37 weeks). We compared maternal and neonatal outcomes between the three groups. Multivariable logistic regression was used to control for confounders. Results: Overall, 507 women met the inclusion criteria. Of them, there were 44 (8.68%) poor responders, 342 (67.46%) normal responders, and 121 (23.87%) high responders. Poor responders, compared to normal and high responders, were characterized by a higher maternal age (34.64 ± 4.01 vs. 31.4 ± 5.04 vs. 30.01 ± 4.93, p < 0.001, respectively) and total FSH dosage (3028.41 ± 1792.05 IU vs. 2375.11 ± 1394.05 IU vs. 1869.31 ± 1089.63 IU, p < 0.001). The perinatal outcomes examined, including cesarean delivery (CD) rate and the composite outcome, were comparable between groups. Using multivariable logistic regression and adjusting for ovarian response group, maternal age, nulliparity, and estradiol level and endometrial thickness before ovulation triggering, poor response was not associated with CD rate or the composite outcome, with maternal age associated with CD (p = 0.005), and nulliparity with the composite outcome (p = 0.007). Similar results were obtained when comparing poor responders to each other group separately or to all other responders. Conclusions: Poor ovarian response is not associated with increased adverse maternal or neonatal outcomes.
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Affiliation(s)
- Alyssa Hochberg
- IVF and Infertility Unit, Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva 4941492, Israel (O.S.); (Y.S.)
- The Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Avital Wertheimer
- IVF and Infertility Unit, Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva 4941492, Israel (O.S.); (Y.S.)
- The Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Rita Zlatkin
- IVF and Infertility Unit, Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva 4941492, Israel (O.S.); (Y.S.)
- The Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Onit Sapir
- IVF and Infertility Unit, Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva 4941492, Israel (O.S.); (Y.S.)
- The Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Eyal Krispin
- IVF and Infertility Unit, Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva 4941492, Israel (O.S.); (Y.S.)
- The Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Tzippy Schohat
- IVF and Infertility Unit, Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva 4941492, Israel (O.S.); (Y.S.)
- The Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Eran Altman
- IVF and Infertility Unit, Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva 4941492, Israel (O.S.); (Y.S.)
- The Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Avi Ben-Haroush
- IVF and Infertility Unit, Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva 4941492, Israel (O.S.); (Y.S.)
- The Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Yoel Shufaro
- IVF and Infertility Unit, Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva 4941492, Israel (O.S.); (Y.S.)
- The Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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10
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Wu B, Shabanova V, Taylor S, Hawley NL. Pre-pregnancy BMI, rate of gestational weight gain, and preterm birth among US Pacific Islander individuals. Obesity (Silver Spring) 2024; 32:798-809. [PMID: 38304993 PMCID: PMC10965383 DOI: 10.1002/oby.23979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/08/2023] [Accepted: 12/01/2023] [Indexed: 02/03/2024]
Abstract
OBJECTIVE The objective of this study was to examine the association between rate of gestational weight gain (GWG) and preterm birth (PTB) classified by pre-pregnancy BMI among Pacific Islander individuals in the United States. METHODS Pacific Islander mothers (n = 55,975) and singleton infants (22-41 gestational weeks) without congenital anomalies were included using data from the National Center for Health Statistics (2014-2018). PTB was compared by pre-pregnancy BMI among women in each stratum of rate of GWG using Cox proportional hazards models. RESULTS Compared with mothers with a rate of GWG within the guidelines, mothers with a rate of GWG below the guidelines and either pre-pregnancy underweight (adjusted hazard ratio [aHR] = 1.84, 95% CI: 1.10-3.06), healthy weight (aHR = 1.38, 95% CI: 1.15-1.65), obesity class I (aHR = 1.22, 95% CI: 0.97-1.52), or obesity class II (aHR = 1.43, 95% CI: 1.05-1.96) had an increased risk of PTB; mothers with a rate of GWG above the guidelines and either pre-pregnancy underweight (aHR = 1.57, 95% CI: 0.92-2.69) or obesity class II (aHR = 1.31, 95% CI: 0.98-1.76) had an increased risk of PTB. CONCLUSIONS The association between rate of GWG below or above the guidelines and PTB differs by pre-pregnancy BMI among Pacific Islander individuals.
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Affiliation(s)
- Bohao Wu
- Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Veronika Shabanova
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
- Department of Biostatistics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Sarah Taylor
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Nicola L Hawley
- Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, Connecticut, USA
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11
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Sananmuang T, Mankong K, Chokeshaiusaha K. Multilayer perceptron and support vector regression models for feline parturition date prediction. Heliyon 2024; 10:e27992. [PMID: 38533015 PMCID: PMC10963322 DOI: 10.1016/j.heliyon.2024.e27992] [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] [Received: 12/21/2022] [Revised: 01/24/2024] [Accepted: 03/10/2024] [Indexed: 03/28/2024] Open
Abstract
A crucial challenge in feline obstetric care is the accurate prediction of the parturition date during late pregnancy. The classic simple linear regression (SLR) model, which employed the fetal biparietal diameter (BPD) as the single input feature, was frequently applied for such prediction with limited accuracy. Since Multilayer Perceptron (MLP) and Support Vector Regression (SVR) are now two of the most potent scientific regression models, this study, for the first time, introduced such models as the new promising tools for feline parturition date prediction. The following features were candidate inputs for our models: biparietal diameter (BPD), litter size, and maternal weight. We observed and compared the performance results for each model. As the best-performed model, MLP delivered the highest coefficient score (0.972 ± 0.006), lowest mean absolute error score (1.110 ± 0.060), and lowest mean squared error score (1.540 ± 0.141), respectively. For the first time in this study, BPD, litter size, and maternal weight were considered the essential features for the innovative MLP and SVR modeling. With the optimized model parameters and the described analytical platform, further verification of these advanced models in feline obstetric practices is feasible.
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Affiliation(s)
- Thanida Sananmuang
- Faculty of Veterinary Medicine, Rajamangala University of Technology Tawan-Ok, Chonburi, Thailand
| | | | - Kaj Chokeshaiusaha
- Faculty of Veterinary Medicine, Rajamangala University of Technology Tawan-Ok, Chonburi, Thailand
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12
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Ortelan N, de Almeida MF, Pinto Júnior EP, Bispo N, Fiaccone RL, Falcão IR, Rocha ADS, Ramos D, Paixão ES, de Cássia Ribeiro-Silva R, Rodrigues LC, Barreto ML, Ichihara MYT. Evaluating the relationship between conditional cash transfer programme on preterm births: a retrospective longitudinal study using the 100 million Brazilian cohort. BMC Public Health 2024; 24:713. [PMID: 38443875 PMCID: PMC10916064 DOI: 10.1186/s12889-024-18152-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 02/19/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Preterm births increase mortality and morbidity during childhood and later life, which is closely associated with poverty and the quality of prenatal care. Therefore, income redistribution and poverty reduction initiatives may be valuable in preventing this outcome. We assessed whether receipt of the Brazilian conditional cash transfer programme - Bolsa Familia Programme, the largest in the world - reduces the occurrence of preterm births, including their severity categories, and explored how this association differs according to prenatal care and the quality of Bolsa Familia Programme management. METHODS A retrospective cohort study was performed involving the first live singleton births to mothersenrolled in the 100 Million Brazilian Cohort from 2004 to 2015, who had at least one child before cohort enrollment. Only the first birth during the cohort period was included, but born from 2012 onward. A deterministic linkage with the Bolsa Familia Programme payroll dataset and a similarity linkage with the Brazilian Live Birth Information System were performed. The exposed group consisted of newborns to mothers who received Bolsa Familia from conception to delivery. Our outcomes were infants born with a gestational age < 37 weeks: (i) all preterm births, (ii) moderate-to-late (32-36), (iii) severe (28-31), and (iv) extreme (< 28) preterm births compared to at-term newborns. We combined propensity score-based methods and weighted logistic regressions to compare newborns to mothers who did and did not receive Bolsa Familia, controlling for socioeconomic conditions. We also estimated these effects separately, according to the adequacy of prenatal care and the index of quality of Bolsa Familia Programme management. RESULTS 1,031,053 infants were analyzed; 65.9% of the mothers were beneficiaries. Bolsa Familia Programme was not associated with all sets of preterm births, moderate-to-late, and severe preterm births, but was associated with a reduction in extreme preterm births (weighted OR: 0.69; 95%CI: 0.63-0.76). This reduction can also be observed among mothers receiving adequate prenatal care (weighted OR: 0.66; 95%CI: 0.59-0.74) and living in better Bolsa Familia management municipalities (weighted OR: 0.56; 95%CI: 0.43-0.74). CONCLUSIONS An income transfer programme for pregnant women of low-socioeconomic status, conditional to attending prenatal care appointments, has been associated with a reduction in extremely preterm births. These programmes could be essential in achieving Sustainable Development Goals.
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Affiliation(s)
- Naiá Ortelan
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ-BA), Salvador, Bahia, Brazil.
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation. Edifício Tecnocentro, Rua Mundo, 121, Trobogy, Salvador, Bahia, 41745-715, Brazil.
| | | | - Elzo Pereira Pinto Júnior
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ-BA), Salvador, Bahia, Brazil
| | - Nivea Bispo
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ-BA), Salvador, Bahia, Brazil
- Institute of Mathematics and Statistics, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
| | - Rosemeire L Fiaccone
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ-BA), Salvador, Bahia, Brazil
- Institute of Mathematics and Statistics, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
| | - Ila Rocha Falcão
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ-BA), Salvador, Bahia, Brazil
| | - Aline Dos Santos Rocha
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ-BA), Salvador, Bahia, Brazil
| | - Dandara Ramos
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ-BA), Salvador, Bahia, Brazil
- Collective Health Institute, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
| | - Enny S Paixão
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ-BA), Salvador, Bahia, Brazil
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Rita de Cássia Ribeiro-Silva
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ-BA), Salvador, Bahia, Brazil
- School of Nutrition, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
| | - Laura C Rodrigues
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ-BA), Salvador, Bahia, Brazil
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Mauricio L Barreto
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ-BA), Salvador, Bahia, Brazil
- Collective Health Institute, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
| | - Maria Yury T Ichihara
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ-BA), Salvador, Bahia, Brazil
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13
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Kashani-Ligumsky L, Neiger R, Segal E, Cohen R, Lopian M. Is Parity a Risk Factor for Late Preterm Birth? Results from a Large Cohort Study. J Clin Med 2024; 13:429. [PMID: 38256563 PMCID: PMC10816547 DOI: 10.3390/jcm13020429] [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: 11/27/2023] [Revised: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
Most preterm births occur in the late preterm period. While prematurity-related adverse outcomes are significantly diminished when birth occurs during this period, these infants are still at increased risk of complications. Parity affects the incidence of obstetric complications. The purpose of this study was to determine whether parity impacts the risk of spontaneous late preterm birth (SLPTB) and associated complications. A retrospective observational cohort study was conducted. Patients were divided into three study groups according to parity. The primary outcome was the rate of SLPTB in each group. Secondary outcomes were unplanned cesarean delivery (UCD), prolonged third stage of labor respiratory distress syndrome (RDS), transient tachypnea of the newborn (TTN), intraventricular hemorrhage (IVH), neonatal hypoglycemia, duration of NICU admission, neonatal death, and composite adverse neonatal outcome (CANO). Primiparas were more likely to have SLPTB, UCD, and CANO compared to multiparas (2.6% vs. 1.9% OR 1.5 [1.3-1.7] p < 0.01) (4.1% vs. 1.3% OR 2.7 [1.2, 5.9] p < 0.01) (8.5% vs. 4.2 OR 2.1 [1.3-3.5] p = 0.002) and grandmultiparas (2.6% vs. 1.7% OR 1.4 [1.2-1.5] p < 0.001) 8.5% vs. 4.4% OR 2.0 [1.1, 3.8], p = 0.01) but no difference in UCD compared to grandmultiparas (4.1% vs. 3.3% OR 1.2 [0.6-2.7] p = 0.28). Primiparas are at increased risk of SLPTB and UCD, and this is accompanied by an increased risk of adverse neonatal outcomes.
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Affiliation(s)
- Lior Kashani-Ligumsky
- Department of Obstetrics and Gynecology, Mayanei Hayeshua Medical Center, Bnei Brak 51544, Israel; (L.K.-L.); (R.C.)
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Ran Neiger
- Department of Obstetrics and Gynecology, University of South Carolina, Columbia, SC 29208, USA;
| | - Ella Segal
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Ronnie Cohen
- Department of Obstetrics and Gynecology, Mayanei Hayeshua Medical Center, Bnei Brak 51544, Israel; (L.K.-L.); (R.C.)
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Miriam Lopian
- Department of Obstetrics and Gynecology, Mayanei Hayeshua Medical Center, Bnei Brak 51544, Israel; (L.K.-L.); (R.C.)
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
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14
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Yang X, Zhong Q, Li L, Chen Y, Tang C, Liu T, Luo S, Xiong J, Wang L. Development and validation of a prediction model on spontaneous preterm birth in twin pregnancy: a retrospective cohort study. Reprod Health 2023; 20:187. [PMID: 38129929 PMCID: PMC10740254 DOI: 10.1186/s12978-023-01728-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND This study was conducted to develop and validate an individualized prediction model for spontaneous preterm birth (sPTB) in twin pregnancies. METHODS This a retrospective cohort study included 3845 patients who gave birth at the Chongqing Maternal and Child Health Hospital from January 2017 to December 2022. Both univariable and multivariable logistic regression analyses were performed to find factors associated with sPTB. The associations were estimated using the odds ratio (OR) and the 95% confidence interval (CI). Model performance was estimated using sensitivity, specificity, accuracy, area under the receiver operating characteristic curve (AUC) and decision curve analysis (DCA). RESULTS A total of 1313 and 564 cases were included in the training and testing sets, respectively. In the training set, univariate and multivariate logistic regression analysis indicated that age ≥ 35 years (OR, 2.28; 95% CI 1.67-3.13), pre-pregnancy underweight (OR, 2.36; 95% CI 1.60-3.47), pre-pregnancy overweight (OR, 1.67; 95% CI 1.09-2.56), and obesity (OR, 10.45; 95% CI, 3.91-27.87), nulliparity (OR, 0.58; 95% CI 0.41-0.82), pre-pregnancy diabetes (OR, 5.81; 95% CI 3.24-10.39), pre-pregnancy hypertension (OR, 2.79; 95% CI 1.44-5.41), and cervical incompetence (OR, 5.12; 95% CI 3.08-8.48) are independent risk factors for sPTB in twin pregnancies. The AUC of the training and validation set was 0.71 (95% CI 0.68-0.74) and 0.68 (95% CI 0.64-0.73), respectively. And then we integrated those risk factors to construct the nomogram. CONCLUSIONS The nomogram developed for predicting the risk of sPTB in pregnant women with twins demonstrated good performance. The prediction nomogram serves as a practical tool by including all necessary predictors that are readily accessible to practitioners.
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Affiliation(s)
- Xiaofeng Yang
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children, No.120 Longshan Road, Yubei District, Chongqing, 401147, China
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, No.120 Longshan Road, Yubei District, Chongqing, 401147, China
| | - Qimei Zhong
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children, No.120 Longshan Road, Yubei District, Chongqing, 401147, China
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, No.120 Longshan Road, Yubei District, Chongqing, 401147, China
| | - Li Li
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children, No.120 Longshan Road, Yubei District, Chongqing, 401147, China
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, No.120 Longshan Road, Yubei District, Chongqing, 401147, China
| | - Ya Chen
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children, No.120 Longshan Road, Yubei District, Chongqing, 401147, China
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, No.120 Longshan Road, Yubei District, Chongqing, 401147, China
| | - Chunyan Tang
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children, No.120 Longshan Road, Yubei District, Chongqing, 401147, China
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, No.120 Longshan Road, Yubei District, Chongqing, 401147, China
| | - Ting Liu
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children, No.120 Longshan Road, Yubei District, Chongqing, 401147, China
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, No.120 Longshan Road, Yubei District, Chongqing, 401147, China
| | - Shujuan Luo
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children, No.120 Longshan Road, Yubei District, Chongqing, 401147, China
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, No.120 Longshan Road, Yubei District, Chongqing, 401147, China
| | - Jing Xiong
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children, No.120 Longshan Road, Yubei District, Chongqing, 401147, China
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, No.120 Longshan Road, Yubei District, Chongqing, 401147, China
| | - Lan Wang
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children, No.120 Longshan Road, Yubei District, Chongqing, 401147, China.
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, No.120 Longshan Road, Yubei District, Chongqing, 401147, China.
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15
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Mitta K, Tsakiridis I, Kapetanios G, Pavlaki A, Tarnanidis E, Dagklis T, Athanasiadis A, Mamopoulos A. Mode of Delivery and Neonatal Outcomes of Preterm Deliveries: A Retrospective Study in Greece. MEDICINA (KAUNAS, LITHUANIA) 2023; 60:10. [PMID: 38276044 PMCID: PMC10820495 DOI: 10.3390/medicina60010010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/02/2023] [Accepted: 12/19/2023] [Indexed: 01/27/2024]
Abstract
Background and Objectives: Preterm birth is a significant concern in obstetrics and neonatology since preterm neonates are at higher risk of various health complications and may require specialized care. The optimal mode of delivery in preterm birth is a matter of debate. This study aimed to evaluate the mode of delivery in preterm neonates and the associated neonatal outcomes. Material and Methods: This was a retrospective cohort study including all preterm neonates born between January 2010 and December 2020 at the 3rd Department of Obstetrics & Gynecology of Aristotle University of Thessaloniki, Greece. The mode of delivery in relation to gestational age groups and the cause of preterm birth were analyzed. Neonatal outcomes were also evaluated according to gestational age, indication and mode of delivery. Results: A total of 1167 preterm neonates were included in the study; the majority of them were delivered via cesarean section (76.1%). Most of the preterm neonates (n = 715; 61.3%) were delivered at 32+0-36+6 weeks, while cesarean section was the most common mode of delivery after 28+0 weeks. Furthermore, spontaneous onset of labor (OR: 6.038; 95% CI: 3.163-11.527; p < 0.001), multiple gestation (OR: 1.782; 95% CI: 1.165-2.227; p = 0.008) and fetal distress (OR: 5.326; 95% CI: 2.796-10.144; p < 0.001) were the main causes of preterm delivery at 32+0-36+6 weeks. The overall mortality rate was 8.1% among premature neonates. Regarding morbidity, 919 (78.7%) neonates were diagnosed with respiratory disorders, 129 (11.1%) with intraventricular hemorrhage and 30 (2.6%) with necrotizing enterocolitis. Early gestational age at delivery was the main risk factor of neonatal morbidity and mortality. Notably, the mode of delivery did not have any impact on neonatal survival (OR: 1.317; 95% CI: 0.759-2.284; p = 0.328), but preterm neonates born via cesarean section were at higher risk of respiratory disorders, compared to those born via vaginal delivery (OR: 2.208; 95% CI: 1.574-3.097; p < 0.001). Conclusions: Most preterm deliveries occurred in the moderate-to-late preterm period via cesarean section. Early gestational age at delivery was the main prognostic factor of neonatal morbidity and mortality, while the mode of delivery did not have any impact on neonatal survival. Future research on the mode of delivery of the preterm neonates is warranted to establish definitive answers for each particular gestational age.
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Affiliation(s)
- Kyriaki Mitta
- Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (K.M.); (G.K.); (E.T.); (T.D.); (A.A.); (A.M.)
| | - Ioannis Tsakiridis
- Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (K.M.); (G.K.); (E.T.); (T.D.); (A.A.); (A.M.)
| | - Georgios Kapetanios
- Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (K.M.); (G.K.); (E.T.); (T.D.); (A.A.); (A.M.)
| | - Antigoni Pavlaki
- Neonatal Intensive Care Unit, Hippokrateio General Hospital of Thessaloniki, 541 24 Thessaloniki, Greece;
| | - Efthymios Tarnanidis
- Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (K.M.); (G.K.); (E.T.); (T.D.); (A.A.); (A.M.)
| | - Themistoklis Dagklis
- Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (K.M.); (G.K.); (E.T.); (T.D.); (A.A.); (A.M.)
| | - Apostolos Athanasiadis
- Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (K.M.); (G.K.); (E.T.); (T.D.); (A.A.); (A.M.)
| | - Apostolos Mamopoulos
- Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (K.M.); (G.K.); (E.T.); (T.D.); (A.A.); (A.M.)
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Danieli-Gruber S, Levy H, Gomez R, Houri O, Geron Y, Hadar E. Optimizing the timing of antenatal corticosteroid administration prior to anticipated preterm birth: A retrospective cohort study. Int J Gynaecol Obstet 2023; 163:931-939. [PMID: 37254627 DOI: 10.1002/ijgo.14893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 04/18/2023] [Accepted: 05/10/2023] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To examine suboptimal antenatal corticosteroid (ACS) administration based on indications and maternal-obstetrical factors. METHODS Women who prematurely delivered (24 + 0 to 36 + 6 gestational weeks) a viable neonate following ACS treatment between 2012 and 2019 were identified by a retrospective database review. The cohort was divided into patients in whom ACS administration was optimally timed (≥24 h to ≤7 days) or suboptimally timed (>7 days). The groups were compared for ACS indications and maternal, obstetrical, and neonatal parameters. RESULTS The cohort included 399 women. ACS timing was optimal in 233 patients (58%) and was associated with nulliparity (109 [46.8%] vs. 54 [32.5%], P = 0.004) and preterm premature rupture of membranes (89 [38.2%] vs. 45 [27.1%], P = 0.021). Suboptimal timing was associated with chronic hypertension (22 [9.4%] vs. 36 [21.7%], P < 0.001) and asymptomatic cervical shortening (23 [9.9%] vs. 26 [15.7%], P = 0.020). Optimal ACS timing was associated with higher neonatal intensive care unit admission (135 [58%] vs. 71 [42.8%], P = 0.003). On multivariate analysis, the adjusted odds ratio (aOR) of neonatal intensive care unit admission was 0.69 (95% confidence interval [CI], 0.58-0.83, P < 0.001) and 0.99 (95% CI, 0.99-1, P = 0.003) when adjusted for gestational age and birth weight, respectively. When adjusting for maternal age, the aOR for suboptimal ACS administraion due to chronic hypertension was 2.65 (95% CI, 1.49-4.72; P < 0.001). CONCLUSION Optimal timing of ACS varies based on different maternal characteristics and clinical indications. In the presence of certain parameters physicians tend to administer ACS suboptimally, diminishing its beneficial effect.
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Affiliation(s)
- Shir Danieli-Gruber
- Helen Schneider Hospital for Women, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hillah Levy
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rachel Gomez
- Helen Schneider Hospital for Women, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ohad Houri
- Helen Schneider Hospital for Women, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yossi Geron
- Helen Schneider Hospital for Women, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Hadar
- Helen Schneider Hospital for Women, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Chang TY, Wang LK, Kuo YH, Chen CY, Pai TW, Chen CP. Interferon-stimulated gene 15 polymorphisms are associated with spontaneous preterm birth in Taiwanese women. Am J Reprod Immunol 2023; 90:e13790. [PMID: 38009059 DOI: 10.1111/aji.13790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 09/22/2023] [Accepted: 10/09/2023] [Indexed: 11/28/2023] Open
Abstract
PROBLEM Immune and inflammatory responses are known to be major causes of preterm birth (PTB). The maternal genetic background plays an important role in the development of PTB. Interferon-stimulated gene 15 (ISG15) is an interferon-induced protein which can modulate immune cell activation and function. We aim to study if polymorphisms in the ISG15 gene are associated with spontaneous PTB (sPTB) risk in Taiwanese women. METHOD OF STUDY ISG15 rs4615788 C/G, rs1921 G/A, and rs8997 A/G polymorphisms were genotyped in a hospital-based study of 112 women with sPTB and 1120 term controls. The plasma concentrations of ISG15 were determined by enzyme-linked immunosorbent assay. RESULTS We found the ISG15 rs1921 G-rs8997 A haplotype was associated with decreased risk for PTB (χ2 = 6.26, p = .01, pc = .04). The A/G genotype of ISG15 rs8997 polymorphism might have the potential to confer reduced risk of PTB women (χ2 = 4.09, p = .04, pc = .08). Spontaneous PTB women displayed higher plasma ISG15 levels compared to term controls (p < .001). The plasma ISG15 levels among pregnant women with rs8997 A/G genotype were found significantly lower compared to G/G genotype (p = .03). CONCLUSIONS Women with the ISG15 rs1921 G-rs8997 A haplotype may associate with spontaneous PTB. These findings provide new insights into the etiology of preterm birth.
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Affiliation(s)
- Tzu-Yang Chang
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan
| | - Liang-Kai Wang
- Division of High Risk Pregnancy, MacKay Memorial Hospital, Taipei, Taiwan
| | - Yi-Hsiu Kuo
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chia-Yu Chen
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan
| | - Tun-Wen Pai
- Department of Computer Science and Information Engineering, National Taipei University of Technology, Taipei, Taiwan
| | - Chie-Pein Chen
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan
- Division of High Risk Pregnancy, MacKay Memorial Hospital, Taipei, Taiwan
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Biyik I, Soysal C, Ince OUO, Durmus S, Oztas E, Keskin N, Isiklar OO, Karaagac OH, Gelisgen R, Uzun H. Prediction of Preterm Delivery Using Serum Ischemia Modified Albumin, Biglycan, and Decorin Levels in Women with Threatened Preterm Labor. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2023; 45:e754-e763. [PMID: 38141595 DOI: 10.1055/s-0043-1772593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2023] Open
Abstract
OBJECTIVE The serum ischemia modified albumin (IMA), biglycan, and decorin levels of pregnant women who were hospitalized for threatened preterm labor were measured. METHODS Fifty-one consecutive pregnant women with a single pregnancy between the 24th and 36th weeks with a diagnosis of threatened preterm labor were included in the present prospective cohort study. RESULTS As a result of multivariate logistic regression analysis for predicting preterm delivery within 24 hours, 48 hours, 7 days, 14 days, ≤ 35 gestational weeks, and ≤ 37 gestational weeks after admission, area under the curve (AUC) (95% confidence interval [CI[) values were 0.95 (0.89-1.00), 0.93 (0.86-0.99), 0.91 (0.83-0.98), 0.92 (0.85-0.99), 0.82 (0.69-0.96), and 0.89 (0.80-0.98), respectively. In the present study, IMA and biglycan levels were found to be higher and decorin levels lower in women admitted to the hospital with threatened preterm labor and who gave preterm birth within 48 hours compared with those who gave birth after 48 hours. CONCLUSION In pregnant women admitted to the hospital with threatened preterm labor, the prediction preterm delivery of the combined model created by adding IMA, decorin, and biglycan in addition to the TVS CL measurement was higher than the TVS CL measurement alone. CLINICAL TRIAL REGISTRATION The present trial was registered at ClinicalTrials.gov, number NCT04451928.
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Affiliation(s)
- Ismail Biyik
- Department of Obstetrics and Gynecology, School of Medicine, Kutahya Health Sciences University, Kutahya, Turkey
| | - Cenk Soysal
- Department of Obstetrics and Gynecology, School of Medicine, Kutahya Health Sciences University, Kutahya, Turkey
| | - Ozlem Ulas Onur Ince
- Department of Obstetrics and Gynecology, School of Medicine, Kutahya Health Sciences University, Kutahya, Turkey
- Department of Statistics, Faculty of Arts and Sciences, Middle East Technical University, Ankara, Turkey
| | - Sinem Durmus
- Department of Medical Biochemistry, School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Efser Oztas
- Department of Obstetrics and Gynecology, School of Medicine, Kutahya Health Sciences University, Kutahya, Turkey
| | - Nadi Keskin
- Department of Obstetrics and Gynecology, School of Medicine, Kutahya Health Sciences University, Kutahya, Turkey
| | - Ozben Ozden Isiklar
- Department of Medical Biochemistry, School of Medicine, Kutahya Health Sciences University, Kutahya, Turkey
| | - Oğuz Han Karaagac
- Department of Obstetrics and Gynecology, School of Medicine, Kutahya Health Sciences University, Kutahya, Turkey
| | - Remise Gelisgen
- Department of Medical Biochemistry, School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Hafize Uzun
- Department of Medical Biochemistry, Faculty of Medicine, Istanbul Atlas University, Istanbul, Turkey
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Freisthler M, Winchester PW, Young HA, Haas DM. Perinatal health effects of herbicides exposures in the United States: the Heartland Study, a Midwestern birth cohort study. BMC Public Health 2023; 23:2308. [PMID: 37993831 PMCID: PMC10664386 DOI: 10.1186/s12889-023-17171-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 11/03/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND The objective of the Heartland Study is to address major knowledge gaps concerning the health effects of herbicides on maternal and infant health. To achieve this goal, a two-phased, prospective longitudinal cohort study is being conducted. Phase 1 is designed to evaluate associations between biomarkers of herbicide concentration and pregnancy/childbirth outcomes. Phase 2 is designed to evaluate potential associations between herbicide biomarkers and early childhood neurological development. METHODS People (target enrollment of 2,000) who are seeking prenatal care, are ages 18 or older, and are ≤ 20 + 6 weeks gestation will be eligible for recruitment. The Heartland Study will utilize a combination of questionnaire data and biospecimen collections to meet the study objectives. One prenatal urine and buccal sample will be collected per trimester to assess the impact of herbicide concentration levels on pregnancy outcomes. Infant buccal specimens will be collected post-delivery. All questionnaires will be collected by trained study staff and clinic staff will remain blinded to all individual level research data. All data will be stored in a secure REDCap database. Hospitals in the agriculturally intensive states in the Midwestern region will be recruited as study sites. Currently participating clinical sites include Indiana University School of Medicine- affiliated Hospitals in Indianapolis, Indiana; Franciscan Health Center in Indianapolis, Indiana; Gundersen Lutheran Medical Center in La Crosse, Wisconsin, and University of Iowa in Iowa City, Iowa. An anticipated 30% of the total enrollment will be recruited from rural areas to evaluate herbicide concentrations among those pregnant people residing in the rural Midwest. Perinatal outcomes (e.g. birth outcomes, preterm birth, preeclampsia, etc.) will be extracted by trained study teams and analyzed for their relationship to herbicide concentration levels using appropriate multivariable models. DISCUSSION Though decades of study have shown that environmental chemicals may have important impacts on the health of parents and infants, there is a paucity of prospective longitudinal data on reproductive impacts of herbicides. The recent, rapid increases in herbicide use across agricultural regions of the United States necessitate further research into the human health effects of these chemicals, particularly in pregnant people. The Heartland Study provides an invaluable opportunity to evaluate health impacts of herbicides during pregnancy and beyond. TRIAL REGISTRATION The study is registered at clinicaltrials.gov, NCT05492708 with initial registration and release 05 August, 2022.
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Affiliation(s)
- Marlaina Freisthler
- Department of Environmental and Occupational Health, Milken Institute of Public Health, George Washington University, 950 New Hampshire Ave NW #2, Washington, DC, 20052, USA
| | - Paul W Winchester
- Neonatal-Perinatal Medicine, Riley Children's Hospital, Indiana University School of Medicine, 699 Riley Hospital Dr RR 208, Indianapolis, IN, 46202, USA
- Franciscan Health, Indianapolis, 8111 South Emerson Avenue, Indianapolis, IN, 46237, USA
| | - Heather A Young
- Department of Epidemiology, Milken Institute for Public Health, George Washington University, 950 New Hampshire Ave NW #2, Washington, DC, 20052, USA
| | - David M Haas
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, 550 N. University Blvd, Indianapolis, IN, UH2440, USA.
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Torremante P, Berge NK, Weiss C. Reducing the Rate of Premature Births through Early Diagnosis and Pregnancy-Adapted Treatment of Hypothyroidism. Geburtshilfe Frauenheilkd 2023; 83:1361-1370. [PMID: 38024217 PMCID: PMC10631574 DOI: 10.1055/a-2103-8143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 05/31/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction The aim of this study was to determine the extent to which regular monitoring of maternal free thyroxine level and pregnancy-adapted L-thyroxine replacement therapy before and during pregnancy in patients with existing or newly diagnosed latent and manifest hypothyroidism as well as hypothyroxinemia can influence the rate of premature births. Materials and Methods This is a retrospective cohort study assessing 1440 pseudonymized survey questionnaires to evaluate the risks of premature birth with two study groups from the same medical practice, and a nationally recruited control group. Study group A (n = 360) had already been taking L-thyroxine prior to conception, study group B (n = 580) started taking it after conception. Both study groups had a maximum gestational age of 12 + 0 GW. In the study groups, TSH and free thyroxine levels were determined regularly for dose adjustment purposes. The aim was to keep the free thyroxine level in the euthyroid hyperthyroxinemic range within the pregnancy adapted reference range. The control group (n = 500) had taken L-thyroxine during pregnancy according to criteria that were not known, as the questionnaire did not include any questions regarding this matter. Taking other risk factors into account, the influence of pregnancy-adapted L-thyroxine replacement therapy on the rate of premature births was determined using logistic regression analysis. Results Compared with the control group, the premature birth rate was 70% lower (p < 0.0001) in study group A and 42% lower in study group B (p = 0.0086), while the odds ratio, at 3.46, was particularly significant in study group A. High blood pressure (odds ratio 5.21), body mass index per kg/m 2 (odds ratio 0.91) and S. p. premature birth were identified as other independent risk factors. Conclusion The results show an association between more intensive thyroid diagnostics and pregnancy-adapted L-thyroxine replacement therapy and a decrease in premature births. Further studies should be conducted to confirm these results.
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Affiliation(s)
- Pompilio Torremante
- Frauenarzt/Spezielle Geburtshilfe und Perinatalmedizin, Ochsenhausen, Germany
| | - Nils Kristian Berge
- Abteilung für Medizinische Statistik, Biomathematik und Informationsverarbeitung, Universitätsmedizin Mannheim, Ruprecht-Karls-Universität Heidelberg Medizinische
Fakultät Mannheim, Mannheim, Germany
| | - Christel Weiss
- Abteilung für Medizinische Statistik, Biomathematik und Informationsverarbeitung, Universitätsmedizin Mannheim, Ruprecht-Karls-Universität Heidelberg Medizinische
Fakultät Mannheim, Mannheim, Germany
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Ytterberg K, Jacobsson B, Flatley C, Juodakis J, Nilsson S, Solé-Navais P. Exploring the association of parity and its interaction with history of preterm delivery on gestational duration. Ann Epidemiol 2023; 87:S1047-2797(23)00170-9. [PMID: 37714417 DOI: 10.1016/j.annepidem.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 09/08/2023] [Accepted: 09/09/2023] [Indexed: 09/17/2023]
Abstract
PURPOSE Preterm delivery is a major cause of child mortality. While the relationship between parity and preterm delivery is known, its association with gestational duration and variability remains underexplored. Differences in variance may suggest interaction with other well-established risk factors. METHODS With 1.1 million spontaneous deliveries (1990-2012) from the Swedish Medical Birth Register, we assessed while accounting for potential confounders the effects of parity on the mean and variance of gestational duration, and its possible interactions with history of preterm delivery. Pedigrees allowed to account for nonobserved, shared confounders using linear mixed models. RESULTS Parity has a modest association with mean gestational duration, but a large effect on its variance. For example, the first pregnancy had the shortest mean gestational duration, 0.29 days shorter (95% CI: -0.33, -0.25) than the second, and the largest variance (σ2 = 135 days2). Accounting for shared unobserved confounders highlighted a group effect bias, likely linked to the mothers' total number of offspring. Parity interacts with other risk factors, including previous preterm delivery where the magnitude of its effect increases with parity (up to 4.6 days effect difference). CONCLUSIONS Nonshared factors across a mother's pregnancies highlight parity's importance to gain insight into the mechanisms governing the timing of delivery.
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Affiliation(s)
- Karin Ytterberg
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Bo Jacobsson
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Genetics and Bioinformatics, Division of Health Data and Digitalization, Norwegian Institute of Public Health, Oslo, Norway
| | - Christopher Flatley
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Julius Juodakis
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Staffan Nilsson
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Pol Solé-Navais
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Wagijo MA, Crone M, Zwicht BBV, van Lith J, Billings DL, Rijnders M. Contributions of CenteringPregnancy to women's health behaviours, health literacy, and health care use in the Netherlands. Prev Med Rep 2023; 35:102244. [PMID: 37415970 PMCID: PMC10320596 DOI: 10.1016/j.pmedr.2023.102244] [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] [Received: 12/09/2022] [Revised: 05/11/2023] [Accepted: 05/11/2023] [Indexed: 07/08/2023] Open
Abstract
The objective of this study was to assess the effects of CenteringPregnancy (CP) in the Netherlands on different health outcomes. A stepped wedged cluster randomized trial was used, including 2132 women of approximately 12 weeks of gestation, from thirteen primary care midwifery centres in and around Leiden, Netherlands. Data collection was done through self-administered questionnaires. Multilevel intention-to-treat analysis and propensity score matching for the entire group and separately for nulliparous- and multiparous women were employed. The main outcomes were: health behaviour, health literacy, psychological outcomes, health care use, and satisfaction with care. Women's participation in CP is associated with lower alcohol consumption after birth (OR = 0.59, 95 %CI 0.42-0.84), greater consistency with norms for healthy eating and physical activity (β = 0.19, 95 %CI 0.02-0.37), and higher knowledge about pregnancy (β = 0.05, 95 %CI 0.01-0.08). Compared to the control group, nulliparous women who participating in CP reported better compliance to the norm for healthy eating and physical activity (β = 0.28, 95 %CI0.06-0.51)) and multiparous CP participants consumed less alcohol after giving birth (OR = 0.42, 95 %CI 0.23-0.78). Health care use and satisfaction rates were significantly higher among CP participants. A non-significant trend toward lower smoking rates was documented among CP participants. Overall, the results of this study reveal a positive (postpartum) impact on fostering healthy behaviours among participants.
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Affiliation(s)
- Mary-ann Wagijo
- Department of Public Health and Primary Care, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Mathilde Crone
- Department of Public Health and Primary Care, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Birgit Bruinsma-van Zwicht
- Department of Obstetrics, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Jan van Lith
- Department of Obstetrics, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Deborah L. Billings
- Group Care Global, 6520 Wissahickon Ave., Philadelphia, PA 19119, USA
- University of South Carolina (Columbia, SC) / University of North Carolina, Chapel Hill, NC, USA
| | - Marlies Rijnders
- Department of Child Health, TNO, PO Box 22152301 CE, Leiden, The Netherlands
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Combs CA, Zupancic JAF, Walker M, Shi J. Prediction and Prevention of Preterm Birth: Secondary Analysis of a Randomized Intervention Trial. J Clin Med 2023; 12:5459. [PMID: 37685526 PMCID: PMC10487576 DOI: 10.3390/jcm12175459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/11/2023] [Accepted: 08/18/2023] [Indexed: 09/10/2023] Open
Abstract
Our objective was to evaluate whether pregnancy is prolonged by the use of a proteomics-based maternal serum screening test followed by treatment interventions. This is a secondary analysis of the PREVENT-PTB randomized trial comparing screening with the PreTRM test versus no screening. The primary trial analysis found no significant between-group difference in the preterm birth rate. Rather than considering a dichotomous outcome (preterm versus term), we treated gestational age at birth as a continuous variable using survival analysis. We also evaluated between-group difference in NICU length of stay and duration of respiratory support. Results indicated that pregnancy was significantly prolonged in subjects screened with the PreTRM test compared to controls (adjusted hazard ratio 0.53, 95% confidence interval 0.36-0.78, p < 0.01). Newborns of screened subjects had significantly shorter NICU stays but no significant decrease in duration of respiratory support. In the PreTRM screen-positive group, interventions that were associated with pregnancy prolongation included care management and low-dose aspirin but not 17-hydroxyprogesterone caproate. We conclude that screening with the PreTRM test followed by interventions for screen-positive pregnancies may prolong pregnancy and reduce NICU LOS, but these observations need to be confirmed by additional research.
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Affiliation(s)
- C. Andrew Combs
- Pediatrix Center for Research, Education, Quality & Safety, Sunrise, FL 33323, USA
| | - John A. F. Zupancic
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
| | | | - Jing Shi
- Statistics Consultant, Carlsbad, CA 92009, USA
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Lv D, Zhang YL, Xie Y, Ye F, Zhang XL, Xu HZ, Sun YN, Li FF, He MZ, Fan Y, Li W, Zeng WJ, Chen SH, Feng L, Lin XG, Deng DR. New Interpretation of Neonatal Outcomes by Phenotypically Classified Preterm Syndrome: A Retrospective Cohort Study. Curr Med Sci 2023; 43:811-821. [PMID: 37558866 DOI: 10.1007/s11596-023-2769-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 06/08/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVE The global aim to lower preterm birth rates has been hampered by the insufficient and incomplete understanding of its etiology, classification, and diagnosis. This study was designed to evaluate the association of phenotypically classified preterm syndromes with neonatal outcomes; to what extent would these outcomes be modified after the obstetric interventions, including use of glucocorticoid, magnesium sulfate, and progesterone. METHODS This was a retrospective cohort study conducted at Tongji Hospital (composed of Main Branch, Optical Valley Branch and Sino-French New City Branch) in Wuhan. A total of 900 pregnant women and 1064 neonates were retrospectively enrolled. The outcomes were the distribution of different phenotypes among parturition signs and pathway to delivery, the association of phenotypically classified clusters with short-term unfavorable neonatal outcomes, and to what extent these outcomes could be modified by obstetric interventions. RESULTS Eight clusters were identified using two-step cluster analysis, including premature rupture of fetal membranes (PPROM) phenotype, abnormal amniotic fluid (AF) phenotype, placenta previa phenotype, mixed condition phenotype, fetal distress phenotype, preeclampsia-eclampsia & hemolysis, elevated liver enzymes, and low platelets syndrome (PE-E&HELLP) phenotype, multiple fetus phenotype, and no main condition phenotype. Except for no main condition phenotype, the other phenotypes were associated with one or more complications, which conforms to the clinical practice. Compared with no main condition phenotype, some phenotypes were significantly associated with short-term adverse neonatal outcomes. Abnormal AF phenotype, mixed condition phenotype, PE-E&HELLP phenotype, and multiple fetus phenotype were risk factors for neonatal small-for gestation age (SGA); placenta previa phenotype was not associated with adverse outcomes except low APGAR score being 0-7 at one min; mixed condition phenotype was associated with low APGAR scores, SGA, mechanical ventilation, and grade HI-W intraventricular hemorrhage (IVH); fetal distress phenotype was frequently associated with neonatal SGA and mechanical ventilation; PE-E&HELLP phenotype was correlated with low APGAR score being 0-7 at one min, SGA and neonatal intensive care unit (NICU) admission; multiple fetus phenotype was not a risk factor for the outcomes included except for SGA. Not all neonates benefited from obstetric interventions included in this study. CONCLUSION Our research disclosed the independent risk of different preterm phenotypes for adverse pregnancy outcomes. This study is devoted to putting forward the paradigm of classifying preterm birth phenotypically, with the ultimate purpose of defining preterm phenotypes based on multi-center studies and diving into the underlying mechanisms.
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Affiliation(s)
- Dan Lv
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yan-Ling Zhang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yin Xie
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Fang Ye
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xiao-Lei Zhang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - He-Ze Xu
- Department of Obstetrics and Gynaecology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Ya-Nan Sun
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Fan-Fan Li
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Meng-Zhou He
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yao Fan
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Wei Li
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Wan-Jiang Zeng
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Su-Hua Chen
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Ling Feng
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xing-Guang Lin
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
| | - Dong-Rui Deng
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Costello EK, DiGiulio DB, Robaczewska A, Symul L, Wong RJ, Shaw GM, Stevenson DK, Holmes SP, Kwon DS, Relman DA. Abrupt perturbation and delayed recovery of the vaginal ecosystem following childbirth. Nat Commun 2023; 14:4141. [PMID: 37438386 PMCID: PMC10338445 DOI: 10.1038/s41467-023-39849-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 06/28/2023] [Indexed: 07/14/2023] Open
Abstract
The vaginal ecosystem is closely tied to human health and reproductive outcomes, yet its dynamics in the wake of childbirth remain poorly characterized. Here, we profile the vaginal microbiota and cytokine milieu of participants sampled longitudinally throughout pregnancy and for at least one year postpartum. We show that delivery, regardless of mode, is associated with a vaginal pro-inflammatory cytokine response and the loss of Lactobacillus dominance. By contrast, neither the progression of gestation nor the approach of labor strongly altered the vaginal ecosystem. At 9.5-months postpartum-the latest timepoint at which cytokines were assessed-elevated inflammation coincided with vaginal bacterial communities that had remained perturbed (highly diverse) from the time of delivery. Time-to-event analysis indicated a one-year postpartum probability of transitioning to Lactobacillus dominance of 49.4%. As diversity and inflammation declined during the postpartum period, dominance by L. crispatus, the quintessential health-associated commensal, failed to return: its prevalence before, immediately after, and one year after delivery was 41%, 4%, and 9%, respectively. Revisiting our pre-delivery data, we found that a prior live birth was associated with a lower odds of L. crispatus dominance in pregnant participants-an outcome modestly tempered by a longer ( > 18-month) interpregnancy interval. Our results suggest that reproductive history and childbirth in particular remodel the vaginal ecosystem and that the timing and degree of recovery from delivery may help determine the subsequent health of the woman and of future pregnancies.
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Affiliation(s)
- Elizabeth K Costello
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA.
| | - Daniel B DiGiulio
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Anna Robaczewska
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Laura Symul
- Department of Statistics, Stanford University, Stanford, CA, 94305, USA
| | - Ronald J Wong
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Gary M Shaw
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - David K Stevenson
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Susan P Holmes
- Department of Statistics, Stanford University, Stanford, CA, 94305, USA
| | - Douglas S Kwon
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, 02139, USA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - David A Relman
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA.
- Department of Microbiology & Immunology, Stanford University School of Medicine, Stanford, CA, 94305, USA.
- Section of Infectious Diseases, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, 94304, USA.
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26
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Mekic N, Selimovic A, Cosickic A, Mehmedovic M, Hadzic D, Zulic E, Mustafic S, Serak A. Predictors of adverse short-term outcomes in late preterm infants. BMC Pediatr 2023; 23:298. [PMID: 37328827 PMCID: PMC10276478 DOI: 10.1186/s12887-023-04112-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 06/05/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Infants born between 34 weeks and 36 weeks and 6 days of gestation are defined as late preterm infants (LPIs), and they account for approximately 74% of all premature births. Preterm birth (PB) remains the leading cause of infant mortality and morbidity worldwide. AIM To analyse short-term morbidity and mortality and identify predictors of adverse outcomes in late preterm infants. PATIENTS AND METHODS In this retrospective study, we evaluated adverse short-term outcomes of LPIs admitted to the Intensive Care Unit (ICU), Clinic for Children's Diseases, University Clinical Center Tuzla, between 01.01.2020 and 31.12.2022. The analysed data included sex, gestational age, parity, birth weight, Apgar score (i.e., assessment of vitality at birth in the first and fifth minutes after birth), and length of hospitalization in NICU, as well as short-term outcome data. Maternal risk factors we observed were: age of mother, parity, maternal morbidity during pregnancy, complications and treatment during pregnancy. LPIs with major anatomic malformations were excluded from the study. Logistic regression analysis was used to identify risk factors for neonatal morbidity among LPIs. RESULTS We analysed data from 154 late preterm newborns, most of whom were male (60%), delivered by caesarean Sect. (68.2%) and from nulliparous mothers (63.6%). Respiratory complications were the most common outcome among all subgroups, followed by CNS morbidity, infections and jaundice requiring phototherapy. The rate of almost all of the complications in the late-preterm group decreased as gestational age increased from 34 to 36 weeks. Birth weight (OR: 1,2; 95% CI: 0,9 - 2,3; p = 0,0313) and male sex (OR: 2,5; 95% CI: 1,1-5,4; p = 0,0204) were significantly and independently associated with an increased risk for respiratory morbidity, and gestational weeks and male sex were associated with infectious morbidity. None of the risk factors analysed herein were predictors of CNS morbidity in LPIs. CONCLUSION A younger gestational age at birth is associated with a greater risk of short-term complications among LPIs, thus highlighting the need for increased knowledge about the epidemiology of these late preterm births. Understanding the risks of late preterm birth is critical to optimizing clinical decision-making, enhancing the cost-effectiveness of endeavours to delay delivery during the late preterm period, and reducing neonatal morbidity.
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Affiliation(s)
- Nina Mekic
- Pediatric Department, Health and Educational Medical Center Tuzla, Tuzla, Bosnia and Herzegovina.
| | - Amela Selimovic
- Clinic for Children's Diseases Tuzla, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Almira Cosickic
- Clinic for Children's Diseases Tuzla, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Majda Mehmedovic
- Clinic for Internal Medicine, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Devleta Hadzic
- Clinic for Children's Diseases Tuzla, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Evlijana Zulic
- Clinic for Children's Diseases Tuzla, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Sehveta Mustafic
- Polyclinic for Laboratory Diagnostics University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Amra Serak
- Pediatric Department, Health and Educational Medical Center Tuzla, Tuzla, Bosnia and Herzegovina
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Szyszka M, Rzońca E, Rychlewicz S, Bączek G, Ślęzak D, Rzońca P. Association between Parity and Preterm Birth-Retrospective Analysis from a Single Center in Poland. Healthcare (Basel) 2023; 11:1763. [PMID: 37372882 DOI: 10.3390/healthcare11121763] [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: 05/18/2023] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
Preterm births and parity are two medical areas that seem to be entirely different from each other. The aim of this study was to analyze the relationships between parity and maternal and neonatal outcomes associated with preterm birth. This study involved a retrospective analysis of electronic medical records from St. Sophia Hospital in Warsaw (Poland). This study was conducted among women who gave birth to preterm infants between 1 January 2017 and 31 December 2021. A total of 2043 cases of preterm births were included in the final analysis. A higher odds ratio of preterm birth in primiparas was found in women living in a city/town (OR = 1.56) and having secondary (OR = 1.46) and higher education (OR = 1.82). Multiparas who gave birth to preterm infants were more frequently diagnosed with gestational diabetes (19.69%) than primiparas. Multiparas were more likely to give birth to preterm infants who received an Apgar score of ≤7 both at 1 and 5 min after birth (25.80% and 15.34%). The results of our study emphasize the differences between primiparas and multiparas who give birth to preterm infants. Knowledge of these differences is essential to improve the perinatal care provided to mothers and their infants.
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Affiliation(s)
- Monika Szyszka
- Department of Human Anatomy, Faculty of Health Sciences, Medical University of Warsaw, 02-004 Warsaw, Poland
| | - Ewa Rzońca
- Department of Obstetrics and Gynecology Didactics, Faculty of Health Sciences, Medical University of Warsaw, 00-575 Warsaw, Poland
| | - Sylwia Rychlewicz
- St. Sophia's Specialist Hospital, Żelazna Medical Center, 01-004 Warsaw, Poland
| | - Grażyna Bączek
- Department of Obstetrics and Gynecology Didactics, Faculty of Health Sciences, Medical University of Warsaw, 00-575 Warsaw, Poland
| | - Daniel Ślęzak
- Department of Medical Rescue, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Patryk Rzońca
- Department of Human Anatomy, Faculty of Health Sciences, Medical University of Warsaw, 02-004 Warsaw, Poland
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28
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Zewdu D, Tantu T. Preterm Birth Among Intrapartum Cesarean Deliveries at Public Hospitals in Southern Ethiopia: A Multicenter Retrospective Analysis of Risk Factors. Int J Womens Health 2023; 15:869-879. [PMID: 37283992 PMCID: PMC10239637 DOI: 10.2147/ijwh.s398830] [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] [Received: 12/02/2022] [Accepted: 05/27/2023] [Indexed: 06/08/2023] Open
Abstract
Purpose Although the underlying causes for preterm birth are thought to be multifactorial irrespective of delivery mode, no study investigated its risk factors amongst cesarean deliveries (CD). Thus, we aimed to identify potential risk factors for the occurrence of preterm birth (PTB) among intrapartum CD. Methods Data from 1659 singleton intrapartum CDs were retrospectively recruited using medical records and an obstetric database. Gestational age was calculated using the last menstrual period (LMP) and ultrasound report of early onset pregnancy. A multivariable logistic regression analysis was performed to identify potential risk factors associated with PTB. Odds ratios (ORs) and 95% confidence intervals (95% CI) were used. Statistical analysis was performed using SPSS version 26.0. Results In this study, the prevalence of PTB among intrapartum CD was 6.1% (95% CI: 4.9, 7.2%). In the multivariable logistic regression model; grand parity ≥5 (adjusted odds ratio (AOR) = 2.43, 95% CI: 1.72-4.73), maternal age <20 years (AOR=2.63, 95% CI, 1.03-6.71), maternal age ≥35 years (AOR=3.83, 95% CI, 1.49-5.35), cesarean section scar ≥2 (AOR=4.86, 95% CI: 2.68-8.94), antepartum hemorrhage (AOR=4.37, 95% CI: 2.22-8.63), pregnancy-induced hypertension (AOR=2.92, 95% CI: 1.41-6.04), and premature rupture of membranes (AOR=4.56; 95% CI: 1.95-10.65) were significantly associated with PTB. Conclusion The current study showed an association between PTB and a multitude of obstetric variables, including grand parity ≥5, CS scar ≥2, antepartum hemorrhage, pregnancy-induced hypertension, and premature rupture of the membrane. Understanding these factors could help to implement improved quality of obstetric and neonatal care to increase survival and reduce morbidity among preterm birth.
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Affiliation(s)
- Dereje Zewdu
- Department of Anesthesia, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Temesgen Tantu
- Department of Obstetrics and Gynecology, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
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29
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Espinosa CA, Khan W, Khanam R, Das S, Khalid J, Pervin J, Kasaro MP, Contrepois K, Chang AL, Phongpreecha T, Michael B, Ellenberger M, Mehmood U, Hotwani A, Nizar A, Kabir F, Wong RJ, Becker M, Berson E, Culos A, De Francesco D, Mataraso S, Ravindra N, Thuraiappah M, Xenochristou M, Stelzer IA, Marić I, Dutta A, Raqib R, Ahmed S, Rahman S, Hasan ASMT, Ali SM, Juma MH, Rahman M, Aktar S, Deb S, Price JT, Wise PH, Winn VD, Druzin ML, Gibbs RS, Darmstadt GL, Murray JC, Stringer JSA, Gaudilliere B, Snyder MP, Angst MS, Rahman A, Baqui AH, Jehan F, Nisar MI, Vwalika B, Sazawal S, Shaw GM, Stevenson DK, Aghaeepour N. Multiomic signals associated with maternal epidemiological factors contributing to preterm birth in low- and middle-income countries. SCIENCE ADVANCES 2023; 9:eade7692. [PMID: 37224249 PMCID: PMC10208584 DOI: 10.1126/sciadv.ade7692] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 04/20/2023] [Indexed: 05/26/2023]
Abstract
Preterm birth (PTB) is the leading cause of death in children under five, yet comprehensive studies are hindered by its multiple complex etiologies. Epidemiological associations between PTB and maternal characteristics have been previously described. This work used multiomic profiling and multivariate modeling to investigate the biological signatures of these characteristics. Maternal covariates were collected during pregnancy from 13,841 pregnant women across five sites. Plasma samples from 231 participants were analyzed to generate proteomic, metabolomic, and lipidomic datasets. Machine learning models showed robust performance for the prediction of PTB (AUROC = 0.70), time-to-delivery (r = 0.65), maternal age (r = 0.59), gravidity (r = 0.56), and BMI (r = 0.81). Time-to-delivery biological correlates included fetal-associated proteins (e.g., ALPP, AFP, and PGF) and immune proteins (e.g., PD-L1, CCL28, and LIFR). Maternal age negatively correlated with collagen COL9A1, gravidity with endothelial NOS and inflammatory chemokine CXCL13, and BMI with leptin and structural protein FABP4. These results provide an integrated view of epidemiological factors associated with PTB and identify biological signatures of clinical covariates affecting this disease.
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Affiliation(s)
- Camilo A. Espinosa
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA
| | - Waqasuddin Khan
- Department of Pediatrics and Child Health, Faculty of Health Sciences, Medical College, The Aga Khan University, Karachi, Pakistan
| | - Rasheda Khanam
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sayan Das
- Centre for Public Health Kinetics, New Delhi, Delhi, India
| | - Javairia Khalid
- Department of Pediatrics and Child Health, Faculty of Health Sciences, Medical College, The Aga Khan University, Karachi, Pakistan
| | - Jesmin Pervin
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Margaret P. Kasaro
- University of North Carolina Global Projects Zambia, Lusaka, Zambia
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Kévin Contrepois
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - Alan L. Chang
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA
| | - Thanaphong Phongpreecha
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Basil Michael
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - Mathew Ellenberger
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - Usma Mehmood
- Department of Pediatrics and Child Health, Faculty of Health Sciences, Medical College, The Aga Khan University, Karachi, Pakistan
| | - Aneeta Hotwani
- Department of Pediatrics and Child Health, Faculty of Health Sciences, Medical College, The Aga Khan University, Karachi, Pakistan
| | - Ambreen Nizar
- Department of Pediatrics and Child Health, Faculty of Health Sciences, Medical College, The Aga Khan University, Karachi, Pakistan
| | - Furqan Kabir
- Department of Pediatrics and Child Health, Faculty of Health Sciences, Medical College, The Aga Khan University, Karachi, Pakistan
| | - Ronald J. Wong
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Martin Becker
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA
| | - Eloise Berson
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Anthony Culos
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA
- Department of Computer Science, Columbia University, New York, NY, USA
| | - Davide De Francesco
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA
| | - Samson Mataraso
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA
| | - Neal Ravindra
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA
| | - Melan Thuraiappah
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA
| | - Maria Xenochristou
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA
| | - Ina A. Stelzer
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Ivana Marić
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Arup Dutta
- Centre for Public Health Kinetics, New Delhi, Delhi, India
| | - Rubhana Raqib
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | | | | | - Said M. Ali
- Public Health Laboratory—Ivo de Carneri, Pemba, Zanzibar, Tanzania
| | - Mohamed H. Juma
- Public Health Laboratory—Ivo de Carneri, Pemba, Zanzibar, Tanzania
| | - Monjur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Shaki Aktar
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Saikat Deb
- Centre for Public Health Kinetics, New Delhi, Delhi, India
- Public Health Laboratory—Ivo de Carneri, Pemba, Zanzibar, Tanzania
| | - Joan T. Price
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
- Department of Obstetrics and Gynaecology, University of Zambia School of Medicine, Lusaka, Zambia
| | - Paul H. Wise
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Virginia D. Winn
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Maurice L. Druzin
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Ronald S. Gibbs
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Gary L. Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Jeffrey S. A. Stringer
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Brice Gaudilliere
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Michael P. Snyder
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - Martin S. Angst
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Anisur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Abdullah H. Baqui
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Fyezah Jehan
- Department of Pediatrics and Child Health, Faculty of Health Sciences, Medical College, The Aga Khan University, Karachi, Pakistan
| | - Muhammad Imran Nisar
- Department of Pediatrics and Child Health, Faculty of Health Sciences, Medical College, The Aga Khan University, Karachi, Pakistan
| | - Bellington Vwalika
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
- Department of Obstetrics and Gynaecology, University of Zambia School of Medicine, Lusaka, Zambia
| | - Sunil Sazawal
- Centre for Public Health Kinetics, New Delhi, Delhi, India
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Gary M. Shaw
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - David K. Stevenson
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Nima Aghaeepour
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA
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McFarlin BL, Liu Y, Villegas-Downs M, Mohammadi M, Simpson DG, Han A, O'Brien WD. Predicting Spontaneous Pre-term Birth Risk Is Improved When Quantitative Ultrasound Data Are Included With Historical Clinical Data. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:1145-1152. [PMID: 36740462 DOI: 10.1016/j.ultrasmedbio.2022.12.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 12/13/2022] [Accepted: 12/26/2022] [Indexed: 05/11/2023]
Abstract
OBJECTIVE Predicting women at risk for spontaneous pre-term birth (sPTB) has been medically challenging because of the lack of signs and symptoms of pre-term birth until interventions are too late. We hypothesized that prediction of the sPTB risk level is enhanced when using both historical clinical (HC) data and quantitative ultrasound (QUS) data compared with using only HC data. HC data defined herein included birth history prior to that of the current pregnancy as well as, from the current pregnancy, a clinical cervical length assessment and physical examination data. METHODS The study population included 248 full-term births (FTBs) and 26 sPTBs. QUS scans (Siemens S2000 and MC9-4) were performed by registered diagnostic medical sonographers using a standard cervical length approach. Two cervical QUS scans were conducted at 20 ± 2 and 24 ± 2 wk of gestation. Multiple QUS features were evaluated from calibrated raw radiofrequency backscattered ultrasonic signals. Two statistical models designed to determine sPTB risk were compared: (i) HC data alone and (ii) combined HC and QUS data. Model comparisons included a likelihood ratio test, cross-validated receiver operating characteristic area under the curve, sensitivity and specificity. The study's birth outcomes were only FTBs and sPTBs; medically induced pre-term births were not included. DISCUSSION Combined HC and QUS data identified women at risk of sPTB with better AUC (0.68, 95% confidence interval [CI]: 0.57-0.78) compared with HC data alone (0.53, 95% CI: 0.40-0.66) and HC data + cervical length at 18-20 wk of gestation (average AUC = 0.51, 95% CI: 0.38-0.64). A likelihood ratio test for significance of QUS features in the classification model was highly statistically significant (p < 0.01). CONCLUSION Even with only 26 sPTBs among 274 births, value was added in predicting sPTB when QUS data were included with HC data.
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Affiliation(s)
- Barbara L McFarlin
- Department of Human Development Nursing Science, UIC College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - Yuxuan Liu
- Department of Statistics, University of Illinois Urbana-Champaign, Champaign, IL, USA
| | - Michelle Villegas-Downs
- Department of Human Development Nursing Science, UIC College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - Mehrdad Mohammadi
- Department of Statistics, University of Illinois Urbana-Champaign, Champaign, IL, USA
| | - Douglas G Simpson
- Department of Statistics, University of Illinois Urbana-Champaign, Champaign, IL, USA
| | - Aiguo Han
- Bioacoustics Research Laboratory, Department of Electrical and Computer Engineering, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - William D O'Brien
- Bioacoustics Research Laboratory, Department of Electrical and Computer Engineering, University of Illinois Urbana-Champaign, Urbana, IL, USA.
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Salazar EG, Montoya-Williams D, Passarella M, McGann C, Paul K, Murosko D, Peña MM, Ortiz R, Burris HH, Lorch SA, Handley SC. County-Level Maternal Vulnerability and Preterm Birth in the US. JAMA Netw Open 2023; 6:e2315306. [PMID: 37227724 PMCID: PMC10214038 DOI: 10.1001/jamanetworkopen.2023.15306] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/11/2023] [Indexed: 05/26/2023] Open
Abstract
Importance Appreciation for the effects of neighborhood conditions and community factors on perinatal health is increasing. However, community-level indices specific to maternal health and associations with preterm birth (PTB) have not been assessed. Objective To examine the association of the Maternal Vulnerability Index (MVI), a novel county-level index designed to quantify maternal vulnerability to adverse health outcomes, with PTB. Design, Setting, and Participants This retrospective cohort study used US Vital Statistics data from January 1 to December 31, 2018. Participants included 3 659 099 singleton births at 22 plus 0/7 to 44 plus 6/7 weeks of gestation born in the US. Analyses were conducted from December 1, 2021, through March 31, 2023. Exposure The MVI, a composite measure of 43 area-level indicators, categorized into 6 themes reflecting physical, social, and health care landscapes. Overall MVI and theme were stratified by quintile (very low to very high) by maternal county of residence. Main Outcomes and Measures The primary outcome was PTB (gestational age <37 weeks). Secondary outcomes were PTB categories: extreme (gestational age ≤28 weeks), very (gestational age 29-31 weeks), moderate (gestational age 32-33 weeks), and late (gestational age 34-36 weeks). Multivariable logistic regression quantified associations of MVI, overall and by theme, with PTB, overall and by PTB category. Results Among 3 659 099 births, 298 847 (8.2%) were preterm (male, 51.1%; female, 48.9%). Maternal race and ethnicity included 0.8% American Indian or Alaska Native, 6.8% Asian or Pacific Islander, 23.6% Hispanic, 14.5% non-Hispanic Black, 52.1% non-Hispanic White, and 2.2% with more than 1 race. Compared with full-term births, MVI was higher for PTBs across all themes. Very high MVI was associated with increased PTB in unadjusted (odds ratio [OR], 1.50 [95% CI, 1.45-1.56]) and adjusted (OR, 1.07 [95% CI, 1.01-1.13]) analyses. In adjusted analyses of PTB categories, MVI had the largest association with extreme PTB (adjusted OR, 1.18 [95% CI, 1.07-1.29]). Higher MVI in the themes of physical health, mental health and substance abuse, and general health care remained associated with PTB overall in adjusted models. While the physical health and socioeconomic determinant themes were associated with extreme PTB, physical health, mental health and substance abuse, and general health care themes were associated with late PTB. Conclusions and Relevance The findings of this cohort study suggest that MVI was associated with PTB even after adjustment for individual-level confounders. The MVI is a useful measure for county-level PTB risk that may have policy implications for counties working to lower preterm rates and improve perinatal outcomes.
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Affiliation(s)
- Elizabeth G. Salazar
- Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania
| | - Diana Montoya-Williams
- Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Molly Passarella
- Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Carolyn McGann
- Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kathryn Paul
- Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Daria Murosko
- Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Michelle-Marie Peña
- Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania
- Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Robin Ortiz
- Department of Pediatrics, Institute for Excellence in Health Equity, NYU Grossman School of Medicine, New York, New York
- Department of Population Health, Institute for Excellence in Health Equity, NYU Grossman School of Medicine, New York, New York
| | - Heather H. Burris
- Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Scott A. Lorch
- Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sara C. Handley
- Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Lee M, Pöhlmann A, Abou-Dakn M, David M. Acculturation Experiences and Preterm Birth in Berlin: Does Acculturative Stress Contribute to Preterm Birth? J Immigr Minor Health 2023:10.1007/s10903-023-01480-7. [PMID: 37081192 DOI: 10.1007/s10903-023-01480-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2023] [Indexed: 04/22/2023]
Abstract
Acculturation and acculturative stress are potential risk factors for adverse perinatal outcomes. This study investigates whether and how acculturative stress affects preterm birth (PTB) in a sample of migrant women in Berlin. We interviewed 955 women who recently gave birth using standardized questionnaires (Frankfurt Acculturation Scale and Acculturative Stress Index). Multivariable logistic regression analyses assessed the effects of acculturation and acculturative stress on PTB. Women with migrant backgrounds did not have significantly higher PTB rates than German natives. First-generation migrants experienced higher acculturative stress levels than second-generation migrants, 38.8% vs. 13.2%. Acculturative stress could not be identified as a risk factor for PTB in our sample. These results need to be considered in the context of an international city and the wide use of antenatal care services in our population, which could be responsible for similarly good perinatal outcomes and highlights the potential of good access to perinatal care for vulnerable groups.
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Affiliation(s)
- Marlene Lee
- Department of Gynecology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität Zu Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Anna Pöhlmann
- Institute of Biometry and Clinical Epidemiology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität Zu Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany
| | - Michael Abou-Dakn
- Department of Gynecology and Obstetrics, St. Joseph Krankenhaus Berlin Tempelhof, Wüsthoffstraße 15, 112102, Berlin, Germany
| | - Matthias David
- Department of Gynecology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität Zu Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
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Jin H, Zhang Y, Fan Z, Wang X, Rui C, Xing S, Dong H, Wang Q, Tao F, Zhu Y. Identification of novel cell-free RNAs in maternal plasma as preterm biomarkers in combination with placental RNA profiles. J Transl Med 2023; 21:256. [PMID: 37046301 PMCID: PMC10100253 DOI: 10.1186/s12967-023-04083-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 03/25/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Preterm birth (PTB) is the main driver of newborn deaths. The identification of pregnancies at risk of PTB remains challenging, as the incomplete understanding of molecular mechanisms associated with PTB. Although several transcriptome studies have been done on the placenta and plasma from PTB women, a comprehensive description of the RNA profiles from plasma and placenta associated with PTB remains lacking. METHODS Candidate markers with consistent trends in the placenta and plasma were identified by implementing differential expression analysis using placental tissue and maternal plasma RNA-seq datasets, and then validated by RT-qPCR in an independent cohort. In combination with bioinformatics analysis tools, we set up two protein-protein interaction networks of the significant PTB-related modules. The support vector machine (SVM) model was used to verify the prediction potential of cell free RNAs (cfRNAs) in plasma for PTB and late PTB. RESULTS We identified 15 genes with consistent regulatory trends in placenta and plasma of PTB while the full term birth (FTB) acts as a control. Subsequently, we verified seven cfRNAs in an independent cohort by RT-qPCR in maternal plasma. The cfRNA ARHGEF28 showed consistence in the experimental validation and performed excellently in prediction of PTB in the model. The AUC achieved 0.990 for whole PTB and 0.986 for late PTB. CONCLUSIONS In a comparison of PTB versus FTB, the combined investigation of placental and plasma RNA profiles has shown a further understanding of the mechanism of PTB. Then, the cfRNA identified has the capacity of predicting whole PTB and late PTB.
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Affiliation(s)
- Heyue Jin
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, Anhui, China
- MOE Key Laboratory of Population Health Across Life Cycle, No 81 Meishan Road, Hefei, Anhui, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, Hefei, Anhui, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, Anhui, China
| | - Yimin Zhang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, Anhui, China
- MOE Key Laboratory of Population Health Across Life Cycle, No 81 Meishan Road, Hefei, Anhui, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, Hefei, Anhui, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, Anhui, China
| | - Zhigang Fan
- Department of Neonatology, Ma'anshan Maternal and Child Health Hospital, Ma'anshan, Anhui, China
| | - Xianyan Wang
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei, Anhui, China
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Hefei, Anhui, China
| | - Chen Rui
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei, Anhui, China
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Hefei, Anhui, China
| | - Shaozhen Xing
- MOE Key Laboratory of Bioinformatics, Center for Synthetic and Systems Biology, School of Life Sciences, Tsinghua University, Beijing, China
| | - Hongmei Dong
- Department of Obstetrics, Ma'anshan Maternal and Child Health Hospital, Ma'anshan, Anhui, China
| | - Qunan Wang
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei, Anhui, China.
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Hefei, Anhui, China.
| | - Fangbiao Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, Anhui, China.
- MOE Key Laboratory of Population Health Across Life Cycle, No 81 Meishan Road, Hefei, Anhui, China.
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, Hefei, Anhui, China.
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, Anhui, China.
| | - Yumin Zhu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, Anhui, China.
- MOE Key Laboratory of Population Health Across Life Cycle, No 81 Meishan Road, Hefei, Anhui, China.
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, Hefei, Anhui, China.
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, Anhui, China.
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Weiner CP, Zhou H, Cuckle H, Syngelaki A, Nicolaides KH, Weiss ML, Dong Y. Maternal Plasma RNA in First Trimester Nullipara for the Prediction of Spontaneous Preterm Birth ≤ 32 Weeks: Validation Study. Biomedicines 2023; 11:biomedicines11041149. [PMID: 37189767 DOI: 10.3390/biomedicines11041149] [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: 02/27/2023] [Revised: 03/31/2023] [Accepted: 04/10/2023] [Indexed: 05/17/2023] Open
Abstract
The first-trimester prediction of spontaneous preterm birth (sPTB) has been elusive, and current screening is heavily dependent on obstetric history. However, nullipara lack a relevant history and are at higher risk for spontaneous (s)PTB ≤ 32 weeks compared to multipara. No available objective first-trimester screening test has proven a fair predictor of sPTB ≤ 32 weeks. We questioned whether a panel of maternal plasma cell-free (PCF) RNAs (PSME2, NAMPT, APOA1, APOA4, and Hsa-Let-7g) previously validated at 16-20 weeks for the prediction of sPTB ≤ 32 weeks might be useful in first-trimester nullipara. Sixty (60) nulliparous women (40 with sPTB ≤ 32 weeks) who were free of comorbidities were randomly selected from the King's College Fetal Medicine Research Institute biobank. Total PCF RNA was extracted and the expression of panel RNAs was quantitated by qRT-PCR. The analysis employed, primarily, multiple regression with the main outcome being the prediction of subsequent sPTB ≤ 32 weeks. The test performance was judged by the area under the curve (AUC) using a single threshold cut point with observed detection rates (DRs) at three fixed false positive rates (FPR). The mean gestation was 12.9 ± 0.5 weeks (range 12.0-14.1 weeks). Two RNAs were differentially expressed in women destined for sPTB ≤ 32 weeks: APOA1 (p < 0.001) and PSME2 (p = 0.05). APOA1 testing at 11-14 weeks predicted sPTB ≤ 32 weeks with fair to good accuracy. The best predictive model generated an AUC of 0.79 (95% CI 0.66-0.91) with observed DRs of 41%, 61%, and 79% for FPRs of 10%, 20%, and 30%, including crown-rump length, maternal weight, race, tobacco use, and age.
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Affiliation(s)
- Carl P Weiner
- Department of Obstetrics and Gynecology, University of Kansas Medical Center, Kansas City, KS 66160, USA
- Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, KS 66160, USA
- Rosetta Signaling Laboratory LLC, Phoenix, AZ 85018, USA
| | - Helen Zhou
- Department of Obstetrics and Gynecology, University of Kansas Medical Center, Kansas City, KS 66160, USA
- Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Howard Cuckle
- Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv 69978, Israel
| | - Argyro Syngelaki
- Fetal Medicine Research Institute, King's College Hospital, London SE5 9RS, UK
| | - Kypros H Nicolaides
- Fetal Medicine Research Institute, King's College Hospital, London SE5 9RS, UK
| | - Mark L Weiss
- Departments of Anatomy and Physiology & Midwest Institute of Comparative Stem Cell Biology, Kansas State University, Manhattan, KS 66503, USA
| | - Yafeng Dong
- Department of Obstetrics and Gynecology, University of Kansas Medical Center, Kansas City, KS 66160, USA
- Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, KS 66160, USA
- Rosetta Signaling Laboratory LLC, Phoenix, AZ 85018, USA
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Hipwell AE, Tung I, Sherlock P, Tang X, McKee K, McGrath M, Alshawabkeh A, Bastain T, Breton CV, Cowell W, Dabelea D, Duarte CS, Dunlop AL, Ferrera A, Herbstman JB, Hockett CW, Karagas MR, Keenan K, Krafty RT, Monk C, Nozadi SS, O'Connor TG, Oken E, Osmundson SS, Schantz S, Wright R, Comstock SS. Impact of sedentary behavior and emotional support on prenatal psychological distress and birth outcomes during the COVID-19 pandemic. Psychol Med 2023; 53:1-14. [PMID: 36883203 PMCID: PMC10485176 DOI: 10.1017/s0033291723000314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 12/06/2022] [Accepted: 01/30/2023] [Indexed: 03/09/2023]
Abstract
Abstract. BACKGROUND Studies have reported mixed findings regarding the impact of the coronavirus disease 2019 (COVID-19) pandemic on pregnant women and birth outcomes. This study used a quasi-experimental design to account for potential confounding by sociodemographic characteristics. METHODS Data were drawn from 16 prenatal cohorts participating in the Environmental influences on Child Health Outcomes (ECHO) program. Women exposed to the pandemic (delivered between 12 March 2020 and 30 May 2021) (n = 501) were propensity-score matched on maternal age, race and ethnicity, and child assigned sex at birth with 501 women who delivered before 11 March 2020. Participants reported on perceived stress, depressive symptoms, sedentary behavior, and emotional support during pregnancy. Infant gestational age (GA) at birth and birthweight were gathered from medical record abstraction or maternal report. RESULTS After adjusting for propensity matching and covariates (maternal education, public assistance, employment status, prepregnancy body mass index), results showed a small effect of pandemic exposure on shorter GA at birth, but no effect on birthweight adjusted for GA. Women who were pregnant during the pandemic reported higher levels of prenatal stress and depressive symptoms, but neither mediated the association between pandemic exposure and GA. Sedentary behavior and emotional support were each associated with prenatal stress and depressive symptoms in opposite directions, but no moderation effects were revealed. CONCLUSIONS There was no strong evidence for an association between pandemic exposure and adverse birth outcomes. Furthermore, results highlight the importance of reducing maternal sedentary behavior and encouraging emotional support for optimizing maternal health regardless of pandemic conditions.
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Affiliation(s)
- Alison E. Hipwell
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Irene Tung
- Department of Psychology, California State University Dominguez Hills, Carson, CA, USA
| | - Phillip Sherlock
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Xiaodan Tang
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Kim McKee
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Monica McGrath
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | | | - Tracy Bastain
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Carrie V. Breton
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Whitney Cowell
- Department of Pediatrics, Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Anne L. Dunlop
- Department of Gynecology & Obstetrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Assiamira Ferrera
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Julie B. Herbstman
- Department of Environmental Health Sciences, Columbia Mailman School of Public Health, New York, NY, USA
| | - Christine W. Hockett
- Department of Pediatrics, Avera Research Institute, South Dakota School of Medicine, Vermillion, SD, USA
| | - Margaret R. Karagas
- Department of Epidemiology, Geisel School of Medicine, Dartmouth, Lebanon, NH, USA
| | - Kate Keenan
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Robert T. Krafty
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA
| | - Catherine Monk
- Departments of Obstetrics & Gynecology, and Psychiatry, Columbia University Medical Center, New York State Psychiatric Institute, New York, NY, USA
| | - Sara S. Nozadi
- Community Environmental Health Program, Health Sciences Center, University of New Mexico, Albuquerque, NM, USA
| | - Thomas G. O'Connor
- Departments of Psychiatry, Psychology, Neuroscience, and Obstetrics and Gynecology, University of Rochester, Rochester, NY, USA
| | - Emily Oken
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Sarah S. Osmundson
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Susan Schantz
- Beckman Institute for Advanced Science and Technology, Urbana, IL, USA
| | | | - Sarah S. Comstock
- Department of Food Science & Human Nutrition, Michigan State University, East Lansing, MI, USA
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Thomas MP, Ammann G, Onyebeke C, Gomez TK, Lobis S, Li W, Huynh M. Birth equity on the front lines: Impact of a community-based doula program in Brooklyn, NY. Birth 2023; 50:138-150. [PMID: 36625505 DOI: 10.1111/birt.12701] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 05/08/2022] [Accepted: 12/01/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND We assessed whether participation in Healthy Start Brooklyn's By My Side Birth Support Program-a maternal-health program providing community-based doula support during pregnancy, labor and delivery, and the early postpartum period-was associated with improved birth outcomes. By My Side takes a strength-based approach that aligns with the doula principles of respecting the client's autonomy, providing culturally appropriate care without judgment or conditions, and promoting informed decision making. METHODS Using a matched cohort design, birth certificate records for By My Side participants from 2010 through 2017 (n = 603) were each matched to three controls who also lived in the program area (n = 1809). Controls were matched on maternal age, race/ethnicity, education level, and trimester of prenatal-care initiation, using the simple random sampling method. The sample was restricted to singleton births. The odds of preterm birth, low birthweight, and cesarean birth were estimated, using conditional logistic regression. RESULTS By My Side participants had lower odds of having a preterm birth (5.6% vs 11.9%, P < .0001) or a low-birthweight baby (5.8% vs 9.7%, P = .0031) than controls. There was no statistically significant difference in the odds of cesarean delivery. CONCLUSION Participation in the By My Side Birth Support Program was associated with lower odds of preterm birth and low birthweight for participants, who were predominantly Black and Hispanic. Investing in doula services is an important way to address birth inequities among higher risk populations such as birthing people of color and those living in poverty. It could also help shape a new vision of the maternal-health system, placing the needs and well-being of birthing people at the center.
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Affiliation(s)
- Mary-Powel Thomas
- Healthy Start Brooklyn, New York City Department of Health and Mental Hygiene, Brooklyn, NY, USA
| | - Gabriela Ammann
- By My Side Birth Support Program, New York City Department of Health and Mental Hygiene, Brooklyn, NY, USA
| | - Chinelo Onyebeke
- Statistical Analysis and Reporting Unit, New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Tanya K Gomez
- Office of the First Deputy Commissioner and Chief Equity Officer, New York City Department of Health and Mental Hygiene, Queens, NY, USA
| | - Samantha Lobis
- Formerly with New York City Department of Health and Mental Hygiene, Brooklyn, NY, USA
| | - Wenhui Li
- Statistical Analysis and Reporting Unit, New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Mary Huynh
- Office of Vital Statistics, New York City Department of Health and Mental Hygiene, New York, NY, USA
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Gill P, Melamed N, Barrett J, Casper RF. A decrease in endometrial thickness before embryo transfer is not associated with preterm birth and placenta-mediated pregnancy complications. Reprod Biomed Online 2023; 46:283-288. [PMID: 36535879 DOI: 10.1016/j.rbmo.2022.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/11/2022] [Accepted: 11/15/2022] [Indexed: 11/25/2022]
Abstract
RESEARCH QUESTION Does a decrease in endometrial thickness (compaction ≥10%) before embryo transfer prognosticate the risk for preterm birth and placenta-mediated pregnancy complications among IVF pregnancies? DESIGN Retrospective cohort study at a large private fertility practice. Patients with a singleton live birth after a fresh or frozen embryo transfer between 2016 and 2019 were included. The primary outcome was preterm birth (delivery before 37 weeks gestational age). Secondary outcomes included gestational hypertension, pre-eclampsia, intrauterine growth restriction and placental abruption. RESULTS Of the 252 patients that met the study criteria, 122 (48%) demonstrated endometrial compaction (≥10%) and 130 (52%) did not. Age, body mass index (BMI), parity, history of preterm birth or history of pre-existing maternal conditions between the compaction and no-compaction groups were not significantly different. The overall prevalence of placenta-mediated complications across all participants was 25% (n = 62). The number of preterm births between the compaction and no-compaction groups (13% and 6%, respectively, P = 0.09) as well as the prevalence of placenta-mediated complications (29.5% and 20%, respectively, P = 0.08) were not significantly different. Findings for the primary outcome (preterm birth) persisted even after adjustment for potential confounding variables, including maternal age, parity, BMI, embryo score and type of embryo transfer (fresh versus frozen) (adjusted OR 1.86, 95% CI 0.64 to 5.38). CONCLUSIONS Endometrial compaction (or decrease in endometrial thickness) before embryo transfer is not associated with preterm birth or placenta-mediated pregnancy complications.
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Affiliation(s)
- Pavan Gill
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto Ontario, Canada.
| | - Nir Melamed
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto Ontario, Canada
| | - Jon Barrett
- Department of Obstetrics and Gynaecology, McMaster University, Hamilton Ontario, Canada
| | - Robert F Casper
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto Ontario, Canada; Trio Fertility, Toronto Ontario, Canada
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Guerby P, Girard M, Marcoux G, Beaudoin A, Pasquier JC, Bujold E. Midtrimester Cervical Length in Low-Risk Nulliparous Women for the Prediction of Spontaneous Preterm Birth: Should We Consider a New Definition of Short Cervix? Am J Perinatol 2023; 40:187-193. [PMID: 33940643 DOI: 10.1055/s-0041-1728818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The study aimed to estimate the predictive value of midtrimester cervical length (CL) and the optimal cut-off of CL that should be applied with asymptomatic nulliparous women for the prediction of spontaneous preterm birth (sPTB). STUDY DESIGN This is a prospective cohort study of asymptomatic nulliparous women with a singleton gestation. Participants underwent CL measurement by transvaginal ultrasound between 20 and 24 weeks of gestation. The participants and their health care providers remained blinded to the results of CL measurement. The primary outcomes were sPTB before 35 weeks and sPTB before 37 weeks. Receiver operating characteristics (ROC) curve analyses were performed. Analyses were repeated by using multiples of median (MoM) of CL adjusted for gestational age. RESULTS Of 796 participants, the mean midtrimester CL was 40 ± 6 mm with a 1st, 5th, and 10th percentile of 25, 29, and 32 mm, respectively. ROC curve analyses suggest that a cut-off of 30 mm was the optimal CL to predict sPTB before 35 weeks (area under the ROC curve [AUC]: 0.70, 95% confidence interval [CI]: 0.56-0.85) and before 37 weeks (AUC: 0.70, 95% CI: 0.59-0.80). Midtrimester CL <30 mm could detect 35% of all sPTB before 35 weeks at a false-positive rate of 5% (relative risk: 9.1, 95% CI: 3.5-23.5, p < 0.001). We observed similar results using a cut-off of CL <0.75 MoM adjusted for gestational age. CONCLUSION A midtrimester CL cut-off of 30 mm (instead of 25 mm), or CL less than 0.75 MoM, should be used to identify nulliparous women at high risk of sPTB. KEY POINTS · The optimal CL cut-off for the prediction of sPTB is 30 mm in nulliparous women.. · In nulliparous women, a midtrimester CL < 30 mm is highly associated with sPTB before 35 and 37 weeks.. · A midtrimester of CL <30 mm (5th percentile) should define a short cervix in asymptomatic nulliparous women..
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Affiliation(s)
- Paul Guerby
- Research Center, CHU de Québec-Université Laval, Québec, Canada
| | - Mario Girard
- Research Center, CHU de Québec-Université Laval, Québec, Canada
| | | | - Annie Beaudoin
- Research Center, CHU de Québec-Université Laval, Québec, Canada
| | - Jean-Charles Pasquier
- Department of Obstetrics and Gynecology, Université de Sherbrooke, Faculté de Médecine et des Sciences de la Santé 3001, Sherbrooke, Quebec, Canada
| | - Emmanuel Bujold
- Research Center, CHU de Québec-Université Laval, Québec, Canada.,Department of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Québec, Canada
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Patxot M, Stojanov M, Ojavee SE, Gobert RP, Kutalik Z, Gavillet M, Baud D, Robinson MR. Haematological changes from conception to childbirth: An indicator of major pregnancy complications. Eur J Haematol 2022; 109:566-575. [PMID: 36059200 PMCID: PMC9825915 DOI: 10.1111/ejh.13844] [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] [Received: 05/04/2022] [Revised: 07/26/2022] [Accepted: 07/29/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND About 800 women die every day worldwide from pregnancy-related complications, including excessive blood loss, infections and high-blood pressure (World Health Organization, 2019). To improve screening for high-risk pregnancies, we set out to identify patterns of maternal hematological changes associated with future pregnancy complications. METHODS Using mixed effects models, we established changes in 14 complete blood count (CBC) parameters for 1710 healthy pregnancies and compared them to measurements from 98 pregnancy-induced hypertension, 106 gestational diabetes and 339 postpartum hemorrhage cases. RESULTS Results show interindividual variations, but good individual repeatability in CBC values during physiological pregnancies, allowing the identification of specific alterations in women with obstetric complications. For example, in women with uncomplicated pregnancies, haemoglobin count decreases of 0.12 g/L (95% CI -0.16, -0.09) significantly per gestation week (p value <.001). Interestingly, this decrease is three times more pronounced in women who will develop pregnancy-induced hypertension, with an additional decrease of 0.39 g/L (95% CI -0.51, -0.26). We also confirm that obstetric complications and white CBC predict the likelihood of giving birth earlier during pregnancy. CONCLUSION We provide a comprehensive description of the associations between haematological changes through pregnancy and three major obstetric complications to support strategies for prevention, early-diagnosis and maternal care.
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Affiliation(s)
- Marion Patxot
- Department of Computational BiologyUniversity of LausanneLausanneSwitzerland,Swiss Institute of BioinformaticsLausanneSwitzerland
| | - Miloš Stojanov
- Materno‐fetal and Obstetrics Research Unit, Department of Obstetrics and GynecologyCentre Hospitalier Universitaire VaudoisLausanneSwitzerland
| | - Sven Erik Ojavee
- Department of Computational BiologyUniversity of LausanneLausanneSwitzerland,Swiss Institute of BioinformaticsLausanneSwitzerland
| | | | - Zoltán Kutalik
- Department of Computational BiologyUniversity of LausanneLausanneSwitzerland,Swiss Institute of BioinformaticsLausanneSwitzerland,Statistical GeneticsUniversity Center for Primary Care and Public HealthLausanneSwitzerland
| | - Mathilde Gavillet
- Service and Central Laboratory of Haematology, Department of Oncology and Department of Laboratories and PathologyCentre Hospitalier Universitaire VaudoisLausanneSwitzerland
| | - David Baud
- Materno‐fetal and Obstetrics Research Unit, Department of Obstetrics and GynecologyCentre Hospitalier Universitaire VaudoisLausanneSwitzerland
| | - Matthew R. Robinson
- Medical GenomicsInstitute of Science and Technology AustriaKlosterneuburgAustria
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40
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Ho N, Liu CZ, Tanaka K, Lehner C, Sekar R, Amoako AA. The association between induction of labour in nulliparous women at term and subsequent spontaneous preterm birth: a retrospective cohort study. J Perinat Med 2022; 50:926-932. [PMID: 35436047 DOI: 10.1515/jpm-2021-0111] [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: 03/01/2021] [Accepted: 03/23/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To evaluate the rate of subsequent spontaneous preterm birth in patients with previous induction of labour at term compared to women with previous spontaneous labour at term. METHODS This was a retrospective cohort study of all women with consecutive births at the Royal Brisbane and Women's Hospital between 2014 and 2018. All nulliparous women with a singleton pregnancy and induction of labour at term or in spontaneous labour at term in the index pregnancy were included. Data was extracted from electronic medical records. The outcome of spontaneous preterm birth in the subsequent pregnancy was compared between patients with previous term induction of labour and in previous term spontaneous labour. RESULTS A total of 907 patients with consecutive births met the inclusion criteria; of which 269 (29.7%) had a term induction of labour and 638 (70.3%) had a term spontaneous labour in the index pregnancy. The overall subsequent spontaneous preterm birth rate was 2.3%. Nulliparous women who underwent term induction of labour were less likely to have a subsequent preterm birth compared to nulliparous women in term spontaneous labour (0.74 vs. 2.98%; odds ratio [OR], 0.25; 95% confidence interval, 0.06-1.07; p=0.0496) in the index pregnancy. This however was not significant once adjusted for confounders (adjusted OR, 0.29; p=0.10). Spontaneous preterm birth was associated with a previous spontaneous labour compared to induction of labour between 37 to 37+6 and 38 to 38+6 weeks (adjusted OR 0.18 and 0.21; p=0.02 and 0.004 respectively). CONCLUSIONS Term induction of labour does not increase the risk of subsequent spontaneous preterm birth compared to spontaneous labour at term in nulliparous women. Further research is needed to validate these findings in a larger cohort of women and to evaluate the effect of elective IOL among low-risk nulliparous women.
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Affiliation(s)
- Nicole Ho
- Department of Obstetrics & Gynaecology, The Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Cathy Z Liu
- Department of Obstetrics & Gynaecology, The Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Keisuke Tanaka
- Department of Obstetrics & Gynaecology, The Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Christoph Lehner
- Department of Obstetrics & Gynaecology, The Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,Centre for Advanced Prenatal Care, The Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Renuka Sekar
- Department of Obstetrics & Gynaecology, The Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,Centre for Advanced Prenatal Care, The Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Akwasi A Amoako
- Faculty of Medicine, University of Queensland, Brisbane, Australia.,Department of Obstetrics & Gynaecology, Teaching & Research, Level 6 Ned Hanlon Building, The Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Brisbane, QLD 4029, Australia
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Ramos IF, Ross KM, Rinne GR, Somers JA, Mancuso RA, Hobel CJ, Coussons-Read M, Dunkel Schetter C. Pregnancy anxiety, placental corticotropin-releasing hormone and length of gestation. Biol Psychol 2022; 172:108376. [PMID: 35667479 PMCID: PMC10022399 DOI: 10.1016/j.biopsycho.2022.108376] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 05/29/2022] [Accepted: 05/31/2022] [Indexed: 12/20/2022]
Abstract
OBJECTIVE High pregnancy anxiety is a consistent predictor of earlier labor and delivery. Placental corticotropin-releasing hormone (pCRH) predicts earlier delivery consistently and it has been identified as a biological mediator of the association between pregnancy anxiety and gestational length. However, studies have not examined whether changes in pregnancy anxiety are associated with earlier birth as mediated by changes in pCRH during pregnancy. Accordingly, this study tests whether linear changes in pregnancy anxiety are associated with length of gestation indirectly through nonlinear increases in pCRH over pregnancy. METHODS A sample of pregnant women (n=233) completed prenatal assessments in early pregnancy, second trimester, and third trimester that included a 4-item assessment of pregnancy anxiety and collection of blood samples assayed for pCRH using radioimmunoassay. Length of gestation was abstracted from medical records after birth. RESULTS Increases in pregnancy anxiety from early pregnancy to third trimester predicted shorted length of gestation, as did nonlinear increases in pCRH over pregnancy. However, there was no evidence of an indirect effect of changes in pregnancy anxiety on length of gestation via changes in pCRH. CONCLUSIONS These results indicate that linear changes in pregnancy anxiety and nonlinear changes in pCRH during pregnancy are independent risk factors for shortened gestational length. This study adds to a small but growing body of work on biopsychological processes in pregnancy and length of gestation. Modeling changes in psychological and biological processes during pregnancy could provide more insight into understanding risk for adverse pregnancy outcomes.
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Hini JD, Kayem G, Quibel T, Berveiller P, De Carne Carnavale C, Delorme P. Risk of preterm delivery after medically indicated termination of pregnancy with induced vaginal delivery: a case-control study. J OBSTET GYNAECOL 2022; 42:1693-1702. [PMID: 35653800 DOI: 10.1080/01443615.2022.2071147] [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: 10/18/2022]
Abstract
We investigated whether nonsurgical termination of pregnancy after 14 weeks of gestation increases the risk of preterm delivery in a subsequent pregnancy. We conducted a two-centre retrospective case-control study. Patients who underwent non-surgical termination of pregnancy after 14 weeks of gestation between 2012 and 2015 and who gave birth after 14 weeks of gestation to a live-born singleton infant were included. Control patients were those who gave birth after 37 weeks of gestation (the same month as a case patient) and had a second delivery of a singleton foetus after 14 weeks of gestation. The primary outcome was preterm delivery during the second pregnancy period. We included 151 cases and 302 controls and observed 13 (8.6%) preterm births during the second pregnancy in the case group versus 8 (2.6%) (odds ratio: 3.62; 95% confidence interval: 1.40-8.65, p < .001) in the control group. This result remained significant after multivariate analysis. Impact statementWhat is already known about this topic? Many studies have evaluated the association between first-trimester surgical or non-surgical termination of pregnancy and the risk of preterm birth in the subsequent pregnancy. However, no study has evaluated the association between second- or third-trimester non-surgical termination of pregnancy due to foetal disease and the risk of preterm birth in the subsequent pregnancy. A small number of studies have included a small proportion of patients who previously underwent non-surgical termination of pregnancy after 14 weeks of gestation and later experienced first-trimester termination during their second pregnancy. These studies focussed on the impact of the interpregnancy interval or pharmacological induction of labour on the risk of preterm delivery in the subsequent pregnancy.What did the results of this study add? This is the first study to specifically evaluate the association between second- and third-trimester non-surgical terminations of pregnancy and the risk of preterm birth in the subsequent pregnancy. When compared with term birth, nonsurgical termination of pregnancy was associated with the risk of spontaneous preterm birth and hospitalisation in the neonatal intensive care unit in the subsequent pregnancy.What are the implications of these findings for clinical practice and further research? Further studies are required to confirm our results, but information delivered to patients with a late termination of pregnancy and during their pregnancy follow-up for the subsequent pregnancy could be modified to provide this information.
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Affiliation(s)
- Jean-Daniel Hini
- Department of Obstetrics and Gynecology, Trousseau Hospital, AP-HP, Paris, France.,Sorbonne Université, Paris, France
| | - Gilles Kayem
- Department of Obstetrics and Gynecology, Trousseau Hospital, AP-HP, Paris, France.,Sorbonne Université, Paris, France
| | - Thibaud Quibel
- Department of Obstetrics and Gynecology, Poissy-Saint Germain en Laye Hospital Center, Poissy, France
| | - Paul Berveiller
- Department of Obstetrics and Gynecology, Poissy-Saint Germain en Laye Hospital Center, Poissy, France
| | | | - Pierre Delorme
- Department of Obstetrics and Gynecology, Trousseau Hospital, AP-HP, Paris, France.,Sorbonne Université, Paris, France
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Mohapatra V, Saraogi S, Misra S. Demographic Profile, Etiology, and Perinatal Outcome Associated With Preterm Birth in a Tertiary Hospital of Eastern India: A Retrospective Study. Cureus 2022; 14:e26066. [PMID: 35865435 PMCID: PMC9293265 DOI: 10.7759/cureus.26066] [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] [Accepted: 06/18/2022] [Indexed: 11/13/2022] Open
Abstract
Background Preterm birth (PB), defined as birth occurring at less than 37 weeks of gestation, is a leading cause of perinatal mortality and morbidity in the world. Objectives This study aimed to evaluate the socio-demographic characteristics and etiological factors associated with preterm birth and consequent adverse perinatal outcomes retrospectively at a tertiary care hospital. Methods A single-centre retrospective observational study was conducted in the department of Obstetrics & Gynaecology, Fakir Mohan Medical College & Hospital, Balasore, Odisha, India, from April 2019 to March 2020. Data were retrieved from the antenatal ward admission register, case files, theatre records, and neonatal care unit records and reviewed. Descriptive statistics were used to describe data. Chi-square test and student's t-test were used to find significance of difference between variables. Results The incidence of preterm birth in the study population was 5.52%. The mean gestational age of preterm deliveries was 34.39 ± 1.92 weeks. The bulk of the women hailed from a rural background and belonged to the lower socioeconomic strata. About 47.29% of the women were nulliparous and spontaneous preterm birth was noted in 70.40%. Premature rupture of membranes (PROM), anaemia, intrauterine growth restriction (IUGR), preeclampsia, and eclampsia were the most common adverse pregnancy conditions prevalent in these women. Preterm deliveries comprised 31.21% of all neonatal intensive care unit (NICU) admissions. Respiratory distress syndrome, birth asphyxia, neonatal sepsis, and jaundice were the most common complications. Neonatal death occurred in 51 (9.21%) preterm infants with birth asphyxia being the commonest cause of such deaths. Maternal factors and adverse neonatal outcome variables were compared between the spontaneous and iatrogenic/medically indicated preterm birth groups. Preeclampsia, IUGR, and cesarean section were more significantly associated with the iatrogenic group. Conclusion Our study provides a general overview of the associated etiological factors and perinatal health concerns associated with preterm birth in a rural/semi-urban setting in Eastern India. The findings might provide essential data for taking steps toward the prevention and management of preterm birth from a developing country's perspective.
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Affiliation(s)
- Vandana Mohapatra
- Department of Obstetrics and Gynaecology, Fakir Mohan Medical College & Hospital, Balasore, IND
| | - Sujata Saraogi
- Department of Paediatrics, Fakir Mohan Medical College & Hospital, Balasore, IND
| | - Sujata Misra
- Department of Obstetrics and Gynaecology, Fakir Mohan Medical College & Hospital, Balasore, IND
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Mitselou N, Stephansson O, Melén E, Ludvigsson JF. Exposure to Allergen-Specific Immunotherapy in Pregnancy and Risk of Congenital Malformations and Other Adverse Pregnancy Outcomes. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:1635-1641.e2. [PMID: 35487856 DOI: 10.1016/j.jaip.2022.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/28/2022] [Accepted: 03/02/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Owing to insufficient data, current guidelines recommend against initiating allergen-specific immunotherapy (AIT) during pregnancy but suggest that well-tolerated ongoing immunotherapy may be continued. OBJECTIVE To evaluate the safety of AIT in pregnancy, especially the risk for congenital malformations. METHODS This nationwide Swedish cohort study identified pregnancies exposed to AIT, both subcutaneous and sublingual, through the Swedish Medical Birth register and the Prescribed Drug Register between 2005 and 2014. Information on congenital malformations in offspring was retrieved from the National Patient Register. Using the personal identity number, we linked data between registers. Using logistic regression, we calculated odds ratios (ORs) with 95% CIs for congenital malformations and other adverse pregnancy outcomes after adjusting for potential confounders. RESULTS From 2005 to 2014, we identified 924,790 singleton pregnancies. Among these, 743 pregnancies had been exposed to AIT 3 months before conception up until gestational week 22. Allergen-specific immunotherapy in pregnancy was not linked to congenital malformations (OR = 0.90; 95% CI, 0.63-1.27) or other adverse pregnancy outcomes (preterm birth: OR = 0.98; 95% CI, 0.71-1.35; stillbirth: OR = 0.79; 95% CI, 0.26-2.47; or cesarean delivery: OR = 0.91; 95% CI, 0.76-1.09). Stratification by route of immunotherapy, subcutaneous or sublingual, resulted in similar ORs. Restricting the pregnancy cohort to women with asthma or pulmonary disease, nulliparous women, births in 2012 to 2014, or Swedish-born women yielded similar results. CONCLUSIONS This nationwide study found no evidence of congenital malformations or other adverse pregnancy outcomes in women treated with AIT in pregnancy.
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Affiliation(s)
- Niki Mitselou
- Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
| | - Olof Stephansson
- Department of Medicine, Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden; Department of Women's Health, Karolinska University Hospital, Stockholm, Sweden
| | - Erik Melén
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Science and Education Södersjukhuset, Stockholm, Sweden; Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Jonas F Ludvigsson
- Department of Pediatrics, Örebro University Hospital, Örebro, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY
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Raab R, Hoffmann J, Spies M, Geyer K, Meyer D, Günther J, Hauner H. Are pre- and early pregnancy lifestyle factors associated with the risk of preterm birth? A secondary cohort analysis of the cluster-randomised GeliS trial. BMC Pregnancy Childbirth 2022; 22:230. [PMID: 35313852 PMCID: PMC8935257 DOI: 10.1186/s12884-022-04513-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 02/22/2022] [Indexed: 11/30/2022] Open
Abstract
Background Maternal lifestyle is discussed as a modifiable determinant in the prevention of preterm birth. However, previous research on associations between individual lifestyle factors and preterm birth risk is inconclusive. In this secondary analysis, we investigated the associations between several modifiable antenatal lifestyle factors and the odds of preterm birth. Methods This secondary cohort analysis used data from the cluster-randomised controlled “healthy living in pregnancy” (GeliS) trial. Data were collected from early pregnancy to birth with maternity records, validated questionnaires and birth protocols. Women with complete datasets for all covariates were eligible for analysis. Multivariate logistic regression models, adjusted for recognised risk factors, were fitted to determine whether dietary quality, assessed with a healthy eating index (HEI), physical activity (PA) levels and antenatal anxiety/distress influenced the odds of preterm birth. Moreover, the combined association between pre-pregnancy body mass index (BMI) and HEI on the odds of preterm birth was explored. The independent associations of individual dietary components and types of PA on prematurity were assessed by adjusted logistic regression models. Results Overall, 1738 women were included in the analysis. A low HEI significantly increased the odds of preterm birth (OR 1.54 (CI 1.04 – 2.30), p = 0.033), while no associations with either low PA levels or antenatal anxiety/distress were observed. BMI significantly interacted with HEI on the association with prematurity (p = 0.036). Energy % from protein and the intake of average portions of vegetables and cereals were significantly negatively associated with the odds of preterm birth. There was no significant evidence of an association between different types of PA and prematurity. Conclusions This cohort analysis revealed that low dietary quality in early pregnancy may increase the chance of giving birth prematurely, while healthier dietary choices may help to prevent preterm birth. More research on pre- and early pregnancy modifiable lifestyle factors is warranted. Trial registration This trial is registered with the Clinical Trial Registry ClinicalTrials.gov (NCT01958307). Registration date 09 October 2013, retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04513-5.
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Affiliation(s)
- Roxana Raab
- Institute of Nutritional Medicine, School of Medicine, Else Kröner-Fresenius-Centre for Nutritional Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, 80992, Munich, Germany
| | - Julia Hoffmann
- Institute of Nutritional Medicine, School of Medicine, Else Kröner-Fresenius-Centre for Nutritional Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, 80992, Munich, Germany.,European Foundation for the Care of Newborn Infants, Hofmannstrasse 7a, 81379, Munich, Germany
| | - Monika Spies
- Institute of Nutritional Medicine, School of Medicine, Else Kröner-Fresenius-Centre for Nutritional Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, 80992, Munich, Germany
| | - Kristina Geyer
- Institute of Nutritional Medicine, School of Medicine, Else Kröner-Fresenius-Centre for Nutritional Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, 80992, Munich, Germany
| | - Dorothy Meyer
- Institute of Nutritional Medicine, School of Medicine, Else Kröner-Fresenius-Centre for Nutritional Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, 80992, Munich, Germany
| | - Julia Günther
- Institute of Nutritional Medicine, School of Medicine, Else Kröner-Fresenius-Centre for Nutritional Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, 80992, Munich, Germany
| | - Hans Hauner
- Institute of Nutritional Medicine, School of Medicine, Else Kröner-Fresenius-Centre for Nutritional Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, 80992, Munich, Germany.
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Frequency and Molecular Characterization of Staphylococcus aureus from Placenta of Mothers with Term and Preterm Deliveries. Life (Basel) 2022; 12:life12020257. [PMID: 35207545 PMCID: PMC8879889 DOI: 10.3390/life12020257] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 02/04/2022] [Indexed: 01/02/2023] Open
Abstract
Globally, prematurity is the leading cause of neonatal mortality (babies in the first four weeks of life) and now the second leading cause of mortality after pneumonia in children under age five. The neonatal gut microbial colonization is crucial in the human life cycle. Placental microbiota transmits from the gut microbiota plays a significant role in association with kinship. Simultaneously, this transition is being made from mother to infant. This comparative study explored the diversity of microbiota associated with term and preterm neonates by evaluating the placental samples. The study found that 16/68 (23.5%) full-term placental samples were positive for S. aureus; on the other hand, 4/16 (25%) preterm placental samples confirmed culture growth for S. aureus. Antimicrobial susceptibility patterns showed that Staphylococcusaureus (S. aureus) isolates from both types of samples were resistant to Ofloxacin, Trimethoprim-sulfamethoxazole, Oxacillin, and Cefoxitin. However, Methicillin-Resistant Staphylococcus aureus (MRSA) detection was 43.75% in full-term and 75% in preterm placental samples. Moreover, two isolates were positive for both mecA and PVL virulent genes, and the rest were positive only for the mecA gene. Interestingly few isolates lacked both characteristic MRSA genes, mecA and PVL. Notably, resistances were more inclined towards preterm samples for antimicrobial susceptibility and MRSA screening. It may be concluded that there is a significant presence of S. aureus in the placenta of mothers with term and preterm deliveries which might be responsible for preterm deliveries. Therefore, judicious use of antibiotics during pregnancies may help prevent preterm births.
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Jarmund AH, Giskeødegård GF, Ryssdal M, Steinkjer B, Stokkeland LMT, Madssen TS, Stafne SN, Stridsklev S, Moholdt T, Heimstad R, Vanky E, Iversen AC. Cytokine Patterns in Maternal Serum From First Trimester to Term and Beyond. Front Immunol 2021; 12:752660. [PMID: 34721426 PMCID: PMC8552528 DOI: 10.3389/fimmu.2021.752660] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 09/22/2021] [Indexed: 12/29/2022] Open
Abstract
Pregnancy implies delicate immunological balance between two individuals, with constant changes and adaptions in response to maternal capacity and fetal demands. We performed cytokine profiling of 1149 longitudinal serum samples from 707 pregnant women to map immunological changes from first trimester to term and beyond. The serum levels of 22 cytokines and C-reactive protein (CRP) followed diverse but characteristic trajectories throughout pregnancy, consistent with staged immunological adaptions. Eotaxin showed a particularly robust decrease throughout pregnancy. A strong surge in cytokine levels developed when pregnancies progressed beyond term and the increase was amplified as labor approached. Maternal obesity, smoking and pregnancies with large fetuses showed sustained increase in distinct cytokines throughout pregnancy. Multiparous women had increased cytokine levels in the first trimester compared to nulliparous women with higher cytokine levels in the third trimester. Fetal sex affected first trimester cytokine levels with increased levels in pregnancies with a female fetus. These findings unravel important immunological dynamics of pregnancy, demonstrate how both maternal and fetal factors influence maternal systemic cytokines, and serve as a comprehensive reference for cytokine profiles in normal pregnancies.
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Affiliation(s)
- Anders Hagen Jarmund
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Centre of Molecular Inflammation Research (CEMIR), Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Guro Fanneløb Giskeødegård
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Mariell Ryssdal
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Centre of Molecular Inflammation Research (CEMIR), Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Bjørg Steinkjer
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Centre of Molecular Inflammation Research (CEMIR), Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Live Marie Tobiesen Stokkeland
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Centre of Molecular Inflammation Research (CEMIR), Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Torfinn Støve Madssen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Signe Nilssen Stafne
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Clinical Services, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Solhild Stridsklev
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Trine Moholdt
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Women’s Health, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Runa Heimstad
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Eszter Vanky
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Ann-Charlotte Iversen
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Centre of Molecular Inflammation Research (CEMIR), Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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Poor Adherence to the WHO Guidelines on Feeding Practices Increases the Risk for Respiratory Infections in Surinamese Preschool Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010739. [PMID: 34682480 PMCID: PMC8536009 DOI: 10.3390/ijerph182010739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 10/01/2021] [Accepted: 10/05/2021] [Indexed: 10/26/2022]
Abstract
Poor feeding practices in infants and young children may lead to malnutrition, which, in turn, is associated with an increased risk of infectious diseases, such as respiratory tract infections (RTIs), a leading cause of under-five mortality. We explored the association between RTIs and the WHO infant and young child feeding (IYCF) indicators: minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD), among infants and preschool children in Suriname. A validated pediatric food frequency questionnaire was used and data on RTIs, defined as clinical care for fever with respiratory symptoms, bronchitis, or pneumonia were obtained. Associations between feeding indicators and RTIs were explored using hierarchical logistic regression. Of 763 children aged 10-33 months, 51.7% achieved the MDD, 88.5% the MMF, and 46.5% the MAD. Furthermore, 73% of all children experienced at least one upper and/or lower RTI. Children meeting the MDD and MAD had significantly lower odds on RTIs (OR 0.53; 95%CI: 0.37-0.74, p < 0.001; OR 0.55; 95%CI: 0.39-0.78, p < 0.001, respectively). The covariates parity and household income were independently associated with RTIs. In conclusion, MDD and MAD were associated with (upper) RTIs. Whether these indicators can be used as predictors for increased risk for RTIs should be assessed in future prospective studies.
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Rydze RT, Wang S, Schoyer KD. Preterm birth: is it the patient or the process? Fertil Steril 2021; 115:583-584. [PMID: 33712102 DOI: 10.1016/j.fertnstert.2021.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 01/11/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Robert T Rydze
- Department of Obstetrics and Gynecology, Division of Reproductive Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Shunping Wang
- Department of Obstetrics and Gynecology, Division of Reproductive Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kate D Schoyer
- Department of Obstetrics and Gynecology, Division of Reproductive Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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Kayiga H, Achanda Genevive D, Amuge PM, Byamugisha J, Nakimuli A, Jones A. Incidence, associated risk factors, and the ideal mode of delivery following preterm labour between 24 to 28 weeks of gestation in a low resource setting. PLoS One 2021; 16:e0254801. [PMID: 34293031 PMCID: PMC8297859 DOI: 10.1371/journal.pone.0254801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 07/05/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Preterm labour, between 24 to 28 weeks of gestation, remains prevalent in low resource settings. There is evidence of improved survival after 24 weeks though the ideal mode of delivery remains unclear. There are no clear management protocols to guide patient management. We sought to determine the incidence of preterm labour occurring between 24 to 28 weeks, its associated risk factors and the preferred mode of delivery in a low resource setting with the aim of streamlining patient care. METHODS Between February 2020 and September 2020, we prospectively followed 392 women with preterm labour between 24 to 28 weeks of gestation and their newborns from admission to discharge at Kawempe National Referral hospital in Kampala, Uganda. The primary outcome was perinatal mortality associated with the different modes of delivery. Secondary outcomes included neonatal and maternal infections, admission to the Neonatal Special Care Unit (SCU), need for neonatal resuscitation, preterm birth and maternal death. Chi-square test was used to assess the association between perinatal mortality and categorical variables such as parity, mode of delivery, employment status, age, antepartum hemorrhage, digital vaginal examination, and admission to Special Care unit. Multivariate logistic regression was used to assess the association between comparative outcomes of the different modes of delivery and maternal and neonatal risk factors. RESULTS The incidence of preterm labour among women who delivered preterm babies between 24 to 28 weeks was 68.9% 95% CI 64.2-73.4). Preterm deliveries between 24 to 28 weeks contributed 20% of the all preterm deliveries and 2.5% of the total hospital deliveries. Preterm labour was independently associated with gravidity (p-value = 0.038), whether labour was medically induced (p-value <0.001), number of digital examinations (p-value <0.001), history of vaginal bleeding prior to onset of labour (p-value < 0.001), whether tocolytics were given (p-value < 0.001), whether an obstetric ultrasound scan was done (p-value <0.001 and number of babies carried (p-value < 0.001). At multivariate analysis; multiple pregnancy OR 15.45 (2.00-119.53), p-value < 0.001, presence of fever prior to admission OR 4.03 (95% CI .23-13.23), p-value = 0.002 and duration of drainage of liquor OR 0.16 (0.03-0.87), p-value = 0.034 were independently associated with preterm labour. The perinatal mortality rate in our study was 778 per 1000 live births. Of the 392 participants, 359 (91.5%), had vaginal delivery, 29 (7.3%) underwent Caesarean delivery and 4 (1%) had assisted vaginal delivery. Caesarean delivery was protective against perinatal mortality compared to vaginal delivery OR = 0.36, 95% CI 0.14-0.82, p-value = 0.017). The other protective factors included receiving antenatal corticosteroids OR = 0.57, 95% CI 0.33-0.98, p-value = 0.040, Doing 3-4 digital exams per day, OR = 0.41, 95% 0.18-0.91, p-value = 0.028) and hospital stay of > 7 days, p value = 0.001. Vaginal delivery was associated with maternal infections, postpartum hemorrhage, and admission to the Special Care Unit. CONCLUSION Caesarean delivery is the preferred mode of delivery for preterm deliveries between 24 to 28 weeks of gestation especially when labour is not established in low resource settings. It is associated with lesser adverse pregnancy outcomes when compared to vaginal delivery for remote gestation ages.
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Affiliation(s)
- Herbert Kayiga
- Department of Obstetrics and Gynecology, Makerere University College of Health Sciences, Kampala, Uganda
| | | | | | - Josaphat Byamugisha
- Department of Obstetrics and Gynecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Annettee Nakimuli
- Department of Obstetrics and Gynecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Andrew Jones
- University of Manchester, Manchester, United Kingdom
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