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Li A, Zhang L, Liu Q, Fang Z, Sun Y, Li S, Peng Y, Zhang M, Wang X. Proteomic analysis of amniotic fluid to identify potential targets predicting preterm delivery. BIOCHIMICA ET BIOPHYSICA ACTA. PROTEINS AND PROTEOMICS 2023; 1871:140879. [PMID: 36396099 DOI: 10.1016/j.bbapap.2022.140879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/04/2022] [Accepted: 11/11/2022] [Indexed: 11/16/2022]
Abstract
Preterm delivery is a common complication of pregnancy which leads to significant neonatal mortality and morbidity. Identifying predictive markers linked to spontaneous preterm delivery (SPTD) is important for effective treatment and prevention of PTD. To explore potential biomarkers related to SPTD, we performed proteomics analysis in amniotic fluid (AF). In total, we enrolled 30 pregnant women with singleton gestation who underwent clinically indicated amniocentesis at 15-24 weeks of gestation. LC-MS analysis was used to analyze the AF samples of 10 women with SPTD < 34 weeks after cervix cerclage (Preterm group), 10 women with term delivery (TD) ≥ 34 weeks after cervix cerclage (Term group), and 10 women who delivered at term (Normal group). ELISA validation was performed for candidate proteins in a second independent cohort. As a result, we identified 44 differentially expressed proteins (DEPs, P < 0.05) via proteomic analysis, and based on that, 9 primary pathways were also determined in SPTD. Results of the ELISA assay confirmed that the increased concentration of Serpin A1, decreased concentrations of Renin and IGFBP4 were significantly associated with SPTD at ≤34 weeks.
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Affiliation(s)
- Anna Li
- Key Laboratory of Birth Regulation and Control Technology of National Health Commission of China, Maternal and child health care hospital of Shandong province, Jinan 250014, Shandong, China
| | - Lin Zhang
- Key Laboratory of Birth Regulation and Control Technology of National Health Commission of China, Maternal and child health care hospital of Shandong province, Jinan 250014, Shandong, China
| | - Qunying Liu
- Key Laboratory of Birth Regulation and Control Technology of National Health Commission of China, Maternal and child health care hospital of Shandong province, Jinan 250014, Shandong, China
| | - Zhenya Fang
- Key Laboratory of Birth Regulation and Control Technology of National Health Commission of China, Maternal and child health care hospital of Shandong province, Jinan 250014, Shandong, China
| | - Yaqiong Sun
- Key Laboratory of Birth Regulation and Control Technology of National Health Commission of China, Maternal and child health care hospital of Shandong province, Jinan 250014, Shandong, China
| | - Shuxian Li
- Key Laboratory of Birth Regulation and Control Technology of National Health Commission of China, Maternal and child health care hospital of Shandong province, Jinan 250014, Shandong, China
| | - Yanjie Peng
- Key Laboratory of Birth Regulation and Control Technology of National Health Commission of China, Maternal and child health care hospital of Shandong province, Jinan 250014, Shandong, China
| | - Meihua Zhang
- Key Laboratory of Birth Regulation and Control Technology of National Health Commission of China, Maternal and child health care hospital of Shandong province, Jinan 250014, Shandong, China.
| | - Xietong Wang
- Key Laboratory of Birth Regulation and Control Technology of National Health Commission of China, Maternal and child health care hospital of Shandong province, Jinan 250014, Shandong, China; Department of Obstetrics and Gynecology, Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China.
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Nsugbe E. A cybernetic framework for predicting preterm and enhancing care strategies: A review. BIOMEDICAL ENGINEERING ADVANCES 2021. [DOI: 10.1016/j.bea.2021.100024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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3
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Hadgu FB, Gebretsadik LG, Mihretu HG, Berhe AH. Prevalence and Factors Associated with Neonatal Mortality at Ayder Comprehensive Specialized Hospital, Northern Ethiopia. A Cross-Sectional Study. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2020; 11:29-37. [PMID: 32095090 PMCID: PMC6995303 DOI: 10.2147/phmt.s235591] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 01/11/2020] [Indexed: 11/23/2022]
Abstract
Background The neonatal period is the most vulnerable time of human life for diseases. Neonatal morbidity and mortality are significant contributors to under-five morbidity and mortality in sub-Saharan Africa. Objective To assess prevalence and factors associated with neonatal mortality at Ayder Comprehensive Specialized Hospital. Methods A facility-based cross-sectional study was conducted on neonates admitted to the neonatal intensive care unit of Ayder Comprehensive Specialized Hospital from June 1, 2018 to May 30, 2019. Data were taken retrospectively from patient records during admission, discharge, and death certificate issue. The data were entered and analyzed using SPSS version 23. Descriptive and logistic regression analysis was done to describe and identify associated factors with neonatal mortality. P-values <0.05 were considered statistically significant. Results During the study period, 1785 neonates were seen and 1069 (60%) were males. Neonatal mortality rate was 298 (16.7%). Of all the deaths, 98.3% occurred during the first 7 days of age. Respiratory distress syndrome (AOR: 12.56; 95% CI: 6.40–24.66:), perinatal asphyxia (AOR: 19.64; 95% CI: 12.35–31.24), congenital anomaly (AOR: 2.42; 95% CI: (1.48–4.01), early neonatal sepsis (AOR: 3.68; 95% CI: 2.32–5.81), late onset sepsis (AOR: 8.9; 95% CI: 4.14–19.21), gestational age, 34–36+6 weeks (AOR: 0.09; 95% CI: 0.014–0.59), 3741+6 weeks (AOR: 0.025; 95% CI: 0.0030.218), >42 weeks (AOR: 0.039; 95% CI: 0.004–0.4250), parity (AOR: 0.64; 95% CI: 0.44–0.93) and hospital stay (AOR: 0.09; 95% CI: 0.05–0.14) were significantly associated with neonatal mortality. Neonates with a birth weight of less than 1500 g were at 49%, 70%, and 80% increased odds of mortality compared to those 1500-2499 g, 2500-3999 g, and more than 4000 g, respectively. Conclusion In this study neonatal mortality was significantly high. Neonatal mortality was highly associated with primipara, prematurity, low birth weight, perinatal asphyxia, respiratory distress syndrome, congenital anomaly, neonatal sepsis and duration of hospital stay. Many of those cases could be prevented by improving antenatal care follow up, emergency obstetric services, and the enhancement of neonatal resuscitation skills and management of sick neonates.
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Affiliation(s)
- Fikaden Berhe Hadgu
- Department of Pediatrics and Child Health, College of Health Sciences, Mekelle University, Tigray, Ethiopia
| | | | - Hagos Gidey Mihretu
- Department of Pediatrics and Child Health, College of Health Sciences, Mekelle University, Tigray, Ethiopia.,Department of Obstetrics and Gynecology, College of Health Sciences, Mekelle University, Tigray, Ethiopia
| | - Amanuel Hadgu Berhe
- Department of Pediatrics and Child Health, College of Health Sciences, Mekelle University, Tigray, Ethiopia
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Yang X, Meng T. Admission of full-term infants to the neonatal intensive care unit: a 9.5-year review in a tertiary teaching hospital. J Matern Fetal Neonatal Med 2019; 33:3003-3009. [PMID: 30624998 DOI: 10.1080/14767058.2019.1566901] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Xiuhua Yang
- Department of Obstetrics, The First Hospital of China Medical University, Shenyang, China
| | - Tao Meng
- Department of Obstetrics, The First Hospital of China Medical University, Shenyang, China
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Iskusnykh IY, Buddington RK, Chizhikov VV. Preterm birth disrupts cerebellar development by affecting granule cell proliferation program and Bergmann glia. Exp Neurol 2018; 306:209-221. [PMID: 29772246 PMCID: PMC6291230 DOI: 10.1016/j.expneurol.2018.05.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 05/09/2018] [Accepted: 05/12/2018] [Indexed: 01/17/2023]
Abstract
Preterm birth is a leading cause of long-term motor and cognitive deficits. Clinical studies suggest that some of these deficits result from disruption of cerebellar development, but the mechanisms that mediate cerebellar abnormalities in preterm infants are largely unknown. Furthermore, it remains unclear whether preterm birth and precocious exposure to the ex-utero environment directly disrupt cerebellar development or indirectly by increasing the probability of cerebellar injury, including that resulting from clinical interventions and protocols associated with the care of preterm infants. In this study, we analyzed the cerebellum of preterm pigs delivered via c-section at 91% term and raised for 10 days, until term-equivalent age. The pigs did not receive any treatments known or suspected to affect cerebellar development and had no evidence of brain damage. Term pigs sacrificed at birth were used as controls. Immunohistochemical analysis revealed that preterm birth did not affect either size or numbers of Purkinje cells or molecular layer interneurons at term-equivalent age. The number of granule cell precursors and Bergmann glial fibers, however, were reduced in preterm pigs. Preterm pigs had reduced proliferation but not differentiation of granule cells. qRT-PCR analysis of laser capture microdissected external granule cell layer showed that preterm pigs had a reduced expression of Ccnd1 (Cyclin D1), Ccnb1 (Cyclin B1), granule cell master regulatory transcription factor Atoh1, and signaling molecule Jag1. In vitro rescue experiments identified Jag1 as a central granule cell gene affected by preterm birth. Thus, preterm birth and precocious exposure to the ex-utero environment disrupt cerebellum by modulating expression of key cerebellar developmental genes, predominantly affecting development of granule precursors and Bergmann glia.
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Affiliation(s)
- Igor Y Iskusnykh
- Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | | | - Victor V Chizhikov
- Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis, TN 38163, USA.
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Gustafsson AM, Fransson E, Dubicke A, Hjelmstedt AK, Ekman-Ordeberg G, Silfverdal SA, Lange S, Jennische E, Bohlin K. Low levels of anti-secretory factor in placenta are associated with preterm birth and inflammation. Acta Obstet Gynecol Scand 2018; 97:349-356. [DOI: 10.1111/aogs.13282] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 12/10/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Anna M. Gustafsson
- Department of Clinical Science, Intervention and Technology; Karolinska Institutet; Stockholm Sweden
- Department of Neonatology; Karolinska University Hospital; Stockholm Sweden
- Department of Obstetrics; Karolinska University Hospital; Stockholm Sweden
| | - Emma Fransson
- Department of Microbiology, Tumor and Cell Biology; Karolinska Institutet; Stockholm Sweden
- Department of Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
| | - Aurelija Dubicke
- Department of Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
| | - Anna K. Hjelmstedt
- Department of Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
| | - Gunvor Ekman-Ordeberg
- Department of Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
| | | | - Stefan Lange
- Department of Medical Biochemistry and Cell Biology; Institute of Biomedicine; University of Gothenburg; Gothenburg Sweden
| | - Eva Jennische
- Department of Medical Biochemistry and Cell Biology; Institute of Biomedicine; University of Gothenburg; Gothenburg Sweden
| | - Kajsa Bohlin
- Department of Clinical Science, Intervention and Technology; Karolinska Institutet; Stockholm Sweden
- Department of Neonatology; Karolinska University Hospital; Stockholm Sweden
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Demisse AG, Alemu F, Gizaw MA, Tigabu Z. Patterns of admission and factors associated with neonatal mortality among neonates admitted to the neonatal intensive care unit of University of Gondar Hospital, Northwest Ethiopia. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2017; 8:57-64. [PMID: 29388628 PMCID: PMC5774602 DOI: 10.2147/phmt.s130309] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Introduction The neonatal period is a highly vulnerable time for an infant completing many of the physiologic adjustments required for life outside the uterus. As a result, there are high rates of morbidity and mortality. The three major causes of mortality in developing countries include prematurity, infection, and perinatal asphyxia. The aim of this study was to identify the patterns of neonatal admission and factors associated with mortality among neonates admitted at the Neonatal Intensive Care Unit (NICU) of University of Gondar Hospital. Materials and methods A retrospective cross-sectional study was conducted among all admitted neonates in the NICU of University of Gondar referral hospital from December 1, 2015 to August 31, 2016. Information was extracted retrospectively during admission from patient records and death certificates, using a pretested questionnaire. The data were entered and analyzed using SPSS version 20, and p-values <0.05 were considered statistically significant. Results A total of 769 neonates was included in the study. There were 448 (58.3%) male neonates, and 398 (51.8%) neonates were rural residents. More than two-thirds of the 587 deliveries (76.3%) were performed in tertiary hospitals. Neonatal morbidity included hypothermia 546 (71%), sepsis 522 (67.9%), prematurity 250 (34.9%), polycythemia 242 (31.5%), hypoglycemia 142 (18.5), meconium aspiration syndrome 113 (14.7%), and perinatal asphyxia 96 (12.5%). The overall mortality was 110 (14.3%; 95% confidence interval [CI]: 11.9-16.9) of which 69 (62.7%) deaths occurred in the first 24 hours of age. In the multivariate analysis, mortality was associated with perinatal asphyxia (adjusted odds ratio [AOR]: 5.97; 95% CI: 3.06-11.64), instrumental delivery (AOR: 2.99; 95% CI: 1.08-8.31), and early onset neonatal sepsis (AOR: 2.66; 95% CI: 1.62-6.11). Conclusion Hypothermia, sepsis, and prematurity were the main reasons for NICU admission. Neonates often died within the first 24 hours of age. Implementing a better referral link and timely intervention could decrease neonatal mortality and morbidities in Gondar, Ethiopia.
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Affiliation(s)
- Abayneh Girma Demisse
- School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Fentahun Alemu
- School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Mahlet Abayneh Gizaw
- School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Zemene Tigabu
- School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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Wong CH, Chen CP, Chang CC, Chen CY. Bio-functionalized magnetic nanoparticles for the immunoassay of fetal fibronectin: a feasibility study for the prediction of preterm birth. Sci Rep 2017; 7:42461. [PMID: 28198381 PMCID: PMC5309779 DOI: 10.1038/srep42461] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 01/11/2017] [Indexed: 01/09/2023] Open
Abstract
Preterm birth is an important cause of perinatal morbidity and mortality. Various biomarkers in cervicovaginal secretions related to preterm birth have been investigated, of which foetal fibronectin (fFN) shows the greatest potential because of its high negative predictive value. The immunomagnetic reduction (IMR) assay has emerged as a novel quantitative method to detect biomarkers. In this prospective case-control study, we analysed 33 samples of cervicovaginal secretions from pregnant women between 22 and 34 weeks of gestation at high risk of preterm birth. Seventeen samples were from women with term deliveries and 16 from those with preterm deliveries. The fFN concentration in each sample was measured using both an IMR assay and enzyme-linked immunosorbent assay (ELISA). The low detection limits of the IMR assay and ELISA were 0.0001 ng/mL and 0.789 ng/mL, respectively. The sensitivity and specificity of the IMR assay were 0.833 and 0.944, respectively, compared to 0.583 and 0.611 by ELISA. Our results suggest that measuring the concentration of fFN with the IMR assay is a good alternative method to accurately predict the risk of preterm birth.
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Affiliation(s)
- Chian-Huey Wong
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
| | - Chie-Pein Chen
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
| | - Chia-Chen Chang
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Chen-Yu Chen
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
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Rodríguez-Sánchez IP, Suárez-Caro S, Rivas-Solís F, Delgado-Enciso I, Sánchez-Chaparro MM, Gómez-Govea MA, Martínez-de-Villarreal LE, Valdez-Velazquez LL. Association of the polymorphism 12109g>A from the REN gene as a risk factor for preterm birth. J Renin Angiotensin Aldosterone Syst 2016; 17:1470320316678159. [PMID: 28019132 PMCID: PMC5843887 DOI: 10.1177/1470320316678159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 09/30/2016] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Preterm birth is the most important cause of neonatal mortality and morbidity. It is a multifactorial disease with different etiologies, including genetic factors. Genetic variability is represented by single nucleotide polymorphisms (SNPs) in genes of proteins involved in the contractile activity. We determine the association between SNP 12109G> A in REN associated with preterm birth and premature rupture of membrane. MATERIALS AND METHODS A study of cases ( N=112, 22-36 weeks of gestation; mean: 31, 95% confidence interval 30.7-32.2) and controls ( N=66; 38-40 weeks of gestation from the last menstrual period; mean: 39.8, 95% confidence interval 38.9-39.4) was performed. Genomic DNA was isolated in all patients from peripheral blood. The SNP 12109G> A ( Mbo I) in REN was typified by PCR-restriction fragment length polymorphism. RESULTS A significant difference in the case group for the SNP 12109G>A was observed. The A allele was increased in women with preterm birth (81% cases vs. 15% control, p<0.0000004). There was also a significant difference between genotypes, mainly an excess of G/A heterozygotes in women with preterm birth (60% cases vs. 23% controls). The phenotype 12109G> A has odds ratio 6.62 (95% confidence interval 3.14-14.15), which means a high risk of preterm birth/premature rupture of membrane in presence of allele A, both in homozygotes and in heterozygotes. CONCLUSION Allelic frequency of A of SNP 12109G>A was higher in women with preterm birth than in women with normal vaginal delivery and could be considered a risk factor.
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Affiliation(s)
- Irám P Rodríguez-Sánchez
- Genetics Department, ‘Dr. José Eleuterio González’ University Hospital, Universidad Autonoma de Nuevo León, Monterrey, Mexico
| | | | | | - Iván Delgado-Enciso
- Faculty of Medicine, Universidad de Colima, Mexico
- State Cancer Institute, Health Secretary de Colima, Mexico
| | - María M Sánchez-Chaparro
- Developmental Biology Unit, Laboratory of Immunology and Virology, Faculty of Biological Sciences, Universidad Autónoma de Nuevo León, San Nicolas de los Garza, Mexico
| | - Mayra A Gómez-Govea
- Faculty of Biological Sciences, Universidad Autónoma de Nuevo León, San Nicolás de los Garza, Mexico
| | - Laura E Martínez-de-Villarreal
- Genetics Department, ‘Dr. José Eleuterio González’ University Hospital, Universidad Autonoma de Nuevo León, Monterrey, Mexico
| | - Laura L Valdez-Velazquez
- Faculty of Chemical Sciences, Universidad de Colima, Coquimatlán, Mexico
- Faculty of Medicine, Universidad de Colima, Mexico
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Butali A, Ezeaka C, Ekhaguere O, Weathers N, Ladd J, Fajolu I, Esezobor C, Makwe C, Odusanya B, Anorlu R, Adeyemo W, Iroha E, Egri-Okwaji M, Adejumo P, Oyeneyin L, Abiodun M, Badejoko B, Ryckman K. Characteristics and risk factors of preterm births in a tertiary center in Lagos, Nigeria. Pan Afr Med J 2016; 24:1. [PMID: 27583065 PMCID: PMC4992393 DOI: 10.11604/pamj.2016.24.1.8382] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 03/20/2016] [Indexed: 11/25/2022] Open
Abstract
Introduction Preterm birth is a dire complication of pregnancy that poses huge long-term medical and financial burdens for affected children, their families, and the health care system. The aim of the present study was to identify characteristics associated with preterm births at the Lagos University Teaching Hospital (LUTH), Lagos, Nigeria from 2011 to 2013. Methods We obtained Information from 5,561 maternal, fetal/neonatal and obstetric records from the labor ward. We excluded delivery at less than 22 weeks (0.25%), post-term birth at ≥42 weeks gestation (1.3%), and unknown gestation (1.4%). Additionally, we excluded records of multiple births (5.4%) and stillbirths (8.3%) leaving 4,691 records of singleton live-births for analysis. Logistic regression analysis was performed comparing preterm birth (22-36 weeks gestation) to term birth (37-41 weeks gestation). Multiple variable models adjusting for maternal age, parity, fetal position, delivery method and booking status were also evaluated. Multinomial regression was used to identify characteristics associated with preterm birth (PTB) defined as early PTB (22-31 weeks gestation), moderate PTB (32-34 weeks gestation), late PTB (35-36 weeks gestation), compared to term birth (37-41 completed weeks gestation). Results From our data, 16.8% of the singleton live-birth deliveries were preterm (<37 weeks gestation). Of these, 4.7% were early (22-31 weeks), 4.5% were moderate (32-34 weeks) and 7.7% were late (35-36) PTBs. Older maternal age (≥35 years) [odds ratio (OR) = 1.41], hypertension (OR = 3.44) and rupture of membranes (OR = 4.03) were significantly associated with increased odds of PTB. Women being treated for the prevention of mother-to-child transmission of HIV were at a significantly decreased risk for PTB (OR = 0.70). Sixteen percent of women in this cohort were not registered for antenatal care in LUTH. These non-registered subjects had significantly greater odds of all categories of PTB, including early (odds ratio (OR) = 20.8), moderate (OR = 8.68), and late (OR = 2.15). Conclusion PTB and risks for PTB remain high in Nigeria. We recommend that any high risk pregnancy should be referred to a tertiary center for prenatal care in order to significantly reduce adverse birth outcomes such as PTBs.
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Affiliation(s)
- Azeez Butali
- Department of Oral Pathology, Radiology and Medicine, College of Dentistry, University of Iowa, IA, USA
| | - Chinyere Ezeaka
- Department of Pediatrics, College of Medicine, University of Lagos, Nigeria
| | | | | | - Jenna Ladd
- Department of Epidemiology, College of Public Health, University of Iowa, IA, USA
| | - Iretiola Fajolu
- Department of Pediatrics, College of Medicine, University of Lagos, Nigeria
| | | | - Christian Makwe
- Department of Obstetrics and Gynecology, College of Medicine, University of Lagos, Nigeria
| | - Bukola Odusanya
- Department of Pediatrics, College of Medicine, University of Lagos, Nigeria
| | - Rose Anorlu
- Department of Pediatrics, College of Medicine, University of Lagos, Nigeria
| | - Wasiu Adeyemo
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Lagos, Nigeria
| | - Edna Iroha
- Department of Pediatrics, College of Medicine, University of Lagos, Nigeria
| | | | | | - Lawal Oyeneyin
- Department of Obstetrics and Gynecology, Mother and Child Hospital Ondo, Ondo, Nigeria
| | - Moses Abiodun
- Department of Pediatrics, Mother and Child Hospital Ondo, Ondo, Nigeria
| | - Bolaji Badejoko
- Department of Pediatrics, Mother and Child Hospital Ondo, Ondo, Nigeria
| | - Kelli Ryckman
- Department of Epidemiology, College of Public Health, University of Iowa, IA, USA
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Lee SM, Romero R, Park JS, Chaemsaithong P, Jun JK, Yoon BH. A transcervical amniotic fluid collector: a new medical device for the assessment of amniotic fluid in patients with ruptured membranes. J Perinat Med 2015; 43:381-9. [PMID: 25372723 PMCID: PMC5898808 DOI: 10.1515/jpm-2014-0276] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 10/06/2014] [Indexed: 11/15/2022]
Abstract
AIM To describe a new device for the transcervical collection of amniotic fluid (AF) in patients with ruptured membranes, and to compare the concentration of proteins in fluid retrieved by transabdominal amniocentesis and the transcervical AF collector. STUDY DESIGN Paired AF samples were collected in patients with preterm prelabor rupture of membranes (PROM) (n=11) by transabdominal amniocentesis and with the transcervical AF collector (Yoon's AF Collector™). Three proteins known to have high concentrations in AF [α-fetoprotein (AFP), β-human chorionic gonadotrophin (β-hCG), and prolactin] were measured. RESULTS (1) There was a significant correlation between the concentrations of analytes in AF obtained by transabdominal amniocentesis and by the transcervical AF collector (r=0.94, P<0.001 for AFP; r=0.96, P<0.001 for β-hCG; r=0.72, P<0.05 for prolactin); (2) Bland-Altman plots showed no evidence of heteroscedasticity between transabdominal or transcervical AF concentrations of these markers. CONCLUSIONS There was a strong correlation between the concentrations of proteins in AF collected by amniocentesis or with the transcervical device.
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Affiliation(s)
- Seung Mi Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea,Department of Obstetrics and Gynecology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Roberto Romero
- Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD and Detroit, MI, USA,Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA,Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - Joong Shin Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Piya Chaemsaithong
- Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD and Detroit, MI, USA,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Jong Kwan Jun
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Bo Hyun Yoon
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
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Mistry HD, Kurlak LO, Young SD, Briley AL, Broughton Pipkin F, Baker PN, Poston L. Maternal selenium, copper and zinc concentrations in pregnancy associated with small-for-gestational-age infants. MATERNAL & CHILD NUTRITION 2014; 10:327-34. [PMID: 22784110 PMCID: PMC6860350 DOI: 10.1111/j.1740-8709.2012.00430.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Pregnancy during adolescence increases the risk of adverse pregnancy outcome, especially small-for-gestational-age (SGA) birth, which has been linked to micronutrient deficiencies. Smoking has been shown to be related to lower micronutrient concentrations. Different ethnicities have not been examined. We used a subset from a prospective observational study, the About Teenage Eating study consisting of 126 pregnant adolescents (14-18-year-olds) between 28 and 32 weeks gestation. Micronutrient status was assessed by inductively coupled mass spectrometry. Smoking was assessed by self-report and plasma cotinine, and SGA was defined as infants born <10th corrected birthweight centile. The main outcome measures were as follows: (1) maternal plasma selenium, copper and zinc concentrations in adolescent mothers giving birth to SGA vs. appropriate-for-gestational-age (AGA) infants; and (2) comparison of micronutrient concentrations between women of different ethnicities and smoking habits. The plasma selenium {mean ± standard deviation (SD) [95% confidence interval (CI)]} concentration was lower in the SGA [n = 19: 49.4 ± 7.3 (CI: 45.9, 52.9) µg L(-1)] compared with the AGA [n = 107: 65.1 ± 12.5 (CI: 62.7, 67.5) µg L(-1); P < 0.0001] group. Smoking mothers had a lower selenium concentration compared with non-smokers (P = 0.01) and Afro-Caribbean women had higher selenium concentrations compared with White Europeans (P = 0.02). Neither copper nor zinc concentrations varied between groups. Low plasma selenium concentration in adolescent mothers could contribute to the risk of delivering an SGA infant, possibly through lowering placental antioxidant defence, thus directly affecting fetal growth. Differences in plasma selenium between ethnicities may relate to variation in nutritional intake, requiring further investigation.
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Affiliation(s)
- Hiten D. Mistry
- Division of Women's Health, King's College London, Women's Health Academic Centre, KHP, London, UK
| | - Lesia O. Kurlak
- Department of Obstetrics & Gynaecology, School of Clinical Sciences, University of Nottingham, Nottingham, UK
| | - Scott D. Young
- School of Biosciences, Faculty of Science, University of Nottingham, Nottingham, UK
| | - Annette L. Briley
- Division of Women's Health, King's College London, Women's Health Academic Centre, KHP, London, UK
| | - Fiona Broughton Pipkin
- Department of Obstetrics & Gynaecology, School of Clinical Sciences, University of Nottingham, Nottingham, UK
| | - Philip N. Baker
- Departments of Obstetrics/Gynecology & Physiology, University of Alberta, Edmonton, Alberta, Canada
| | - Lucilla Poston
- Division of Women's Health, King's College London, Women's Health Academic Centre, KHP, London, UK
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Meinert M, Malmström A, Petersen AC, Eriksen GV, Uldbjerg N. Chorioamniontis in preterm delivery is associated with degradation of decorin and biglycan and depletion of hyaluronan in fetal membranes. Placenta 2014; 35:546-51. [PMID: 24920507 DOI: 10.1016/j.placenta.2014.05.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2012] [Revised: 05/05/2014] [Accepted: 05/06/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The proteoglycan decorin stabilizes collagen whereas biglycan and hyaluronan disrupt well-organized collagen. The aim was to determine the concentrations of these constituents in fetal membranes in relation to gestational age, preterm labour, PPROM and chorioamnionitis. STUDY DESIGN Preterm fetal membranes (24-34 weeks gestation) were obtained from elective caesarean deliveries (N = 4), from PPROM (N = 14), and from preterm labour (N = 14). Term fetal membranes from elective caesarean deliveries (N = 9) and spontaneous vaginal deliveries (N = 11) were used for comparison. Chorioamnionitis was assessed histologically. The proteoglycans were analysed using alcian blue precipitation, SDS-PAGE and immunostaining. Hyaluronan was estimated by a radioimmunoassay. RESULTS Preterm amniotic membranes with chorioamnionitis displayed a 8-fold decrease in hyaluronan concentration as well as a pronounced (88%) degradation of decorin and biglycan (p < 0.05). The amnion from preterm elective caesarean sections had higher decorin (3.2 vs. 1.7 μg/mg, p < 0.05) and lower biglycan (0.4 vs. 1.0 μg/mg, p < 0.05) concentrations as compared to similar term amnion (p < 0.05), whereas the hyaluronan concentrations were not associated with gestational age. Also the chorio-decidua from preterm caesarean sections had higher decorin concentrations (1.8 vs. 1.0 μg/mg, p < 0.05) whereas the biglycan concentration was unchanged. Labour (term as well as preterm) was characterized by increased hyaluronan and biglycan concentrations in the amnion (not statistically significant). CONCLUSION The biglycan/decorin balance increases during third trimester of pregnancy and during active labour. This relation might contribute to mechanical weakening of the membranes. Chorioamnionitis induces dramatic degradation of both proteoglycans and hyaluronan, which can explain the decreased biomechanical strength.
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Affiliation(s)
- M Meinert
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, 8200 Aarhus N, Denmark.
| | - A Malmström
- Department of Cell and Molecular Biology, Biomedical Center, C13, 221 84 Lund, Sweden
| | - A C Petersen
- Department of Pathology, Aalborg University Hospital, 9100 Aalborg, Denmark
| | - G V Eriksen
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - N Uldbjerg
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, 8200 Aarhus N, Denmark
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van den Broek NR, Jean-Baptiste R, Neilson JP. Factors associated with preterm, early preterm and late preterm birth in Malawi. PLoS One 2014; 9:e90128. [PMID: 24595186 PMCID: PMC3940843 DOI: 10.1371/journal.pone.0090128] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 01/26/2014] [Indexed: 11/19/2022] Open
Abstract
Background Assessment of risk factors for preterm birth in a population with high incidence of preterm birth and HIV infection. Methods Secondary analysis of data for 2,149 women included in a community based randomized placebo controlled trial for the prevention of preterm birth (APPLe trial (ISRCTN84023116) with gestational age at birth determined through ultrasound measurement in early pregnancy. Multivariate Logistic Regression analyses to obtain models for three outcome variables: all preterm, early preterm, and late preterm birth. Findings No statistical differences were noted for the prevalence of HIV infection (p = 0.30) or syphilis (p = 0.12) between women who delivered preterm versus term. BMI (Adjusted OR 0.91 (0.85–0.97); p = 0.005) and weight gain (Adjusted OR 0.89 (0.82–0.97); p = 0.006) had an independent, protective effect. Previous preterm birth doubled the odds of preterm birth (Adjusted OR 2.13 (1.198–3.80); p = 0.01). Persistent malaria (despite malaria prophylaxis) increased the risk of late preterm birth (Adjusted OR 1.99 (1.05–3.79); p = 0.04). Age <20 (Adjusted OR 1.73 (1.03–2.90); p = 0.04) and anemia (Adjusted OR 1.95 (1.08–3.52); p = 0.03) were associated with early preterm birth (<34 weeks). Conclusions Despite claims that HIV infection is an important cause of preterm birth in Africa, we found no evidence of an association in this population (unexposed to anti-retroviral treatment). Persistent malaria was associated with late preterm birth. Maternal undernourishment and anemia were independently associated with early preterm birth. The study did not assess whether the link was direct or whether a common precursor such as chronic infection was responsible for both maternal effects and early labour.
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Affiliation(s)
- Nynke R. van den Broek
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
- * E-mail:
| | - Rachel Jean-Baptiste
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
| | - James P. Neilson
- Department of Women's & Children's Health, Institute of Translational Medicine, University of Liverpool, United Kingdom
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Sania A, Spiegelman D, Rich-Edwards J, Okuma J, Kisenge R, Msamanga G, Urassa W, Fawzi WW. The contribution of preterm birth and intrauterine growth restriction to infant mortality in Tanzania. Paediatr Perinat Epidemiol 2014; 28:23-31. [PMID: 24117986 PMCID: PMC7893612 DOI: 10.1111/ppe.12085] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Our objectives were to examine the associations of neonatal and infant mortality with preterm birth and intrauterine growth restriction (IUGR), and to estimate the partial population attributable risk per cent (pPAR%) of neonatal and infant mortality due to preterm birth and IUGR. METHODS Participants were HIV-negative pregnant women and their infants enrolled in Dar es Salaam, Tanzania. Gestational age calculated from date of last menstrual period was used to define preterm, and small for gestational age (SGA) was used as proxy for IUGR. Survival of infants was ascertained at monthly follow-up visits. Cox proportional hazard models were used to estimate the associations of preterm and SGA with neonatal and infant mortality. RESULTS Study included 7225 singletons, of whom 15% were preterm and 21% were SGA; majority of preterm or SGA babies had birthweight ≥2500 g. Compared to term and appropriately sized babies (AGA), relative risks (RR) of neonatal mortality among preterm-AGA was 2.6 [95% CI 1.8, 3.9], RR among term-SGA was 2.3 [95% CI 1.6, 3.3], and the highest risk was among the preterm-SGA babies (RR 15.1 [95% CI 8.2, 27.7]). Risk associated with preterm was elevated throughout the infancy, and risk associated with SGA was elevated during the neonatal period only. The pPAR% of neonatal mortality for preterm was 22% [95% CI 17%, 26%] and for SGA it was 26% [95% CI 16%, 36%]. CONCLUSIONS Preterm and SGA birth substantially increased the risk of mortality. Interventions for prevention and management of these conditions are likely to reduce of infant mortality in Tanzania.
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Affiliation(s)
- Ayesha Sania
- Department of Epidemiology, Harvard School of Public Health, Boston, MA
| | - Donna Spiegelman
- Department of Epidemiology, Harvard School of Public Health, Boston, MA,Department of Biostatistics, Harvard School of Public Health, Boston, MA
| | - Janet Rich-Edwards
- Department of Epidemiology, Harvard School of Public Health, Boston, MA,The Connors Center for Women’s Health and Gender Biology, Brigham and Women’s Hospital, Boston, MA
| | - James Okuma
- Department of Nutrition, Harvard School of Public Health, Boston, MA
| | - Rodrick Kisenge
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Gernard Msamanga
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Willy Urassa
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Wafaie W. Fawzi
- Department of Epidemiology, Harvard School of Public Health, Boston, MA,Department of Nutrition, Harvard School of Public Health, Boston, MA,Global Health and Population, Harvard School of Public Health, Boston, MA
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Stumpf RM, Wilson BA, Rivera A, Yildirim S, Yeoman CJ, Polk JD, White BA, Leigh SR. The primate vaginal microbiome: comparative context and implications for human health and disease. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2013; 152 Suppl 57:119-34. [PMID: 24166771 DOI: 10.1002/ajpa.22395] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 08/31/2013] [Indexed: 12/12/2022]
Abstract
The primate body hosts trillions of microbes. Interactions between primate hosts and these microbes profoundly affect primate physiology, reproduction, health, survival, and ultimately, evolution. It is increasingly clear that primate health cannot be understood fully without knowledge of host-microbial interactions. Our goals here are to review what is known about microbiomes of the female reproductive tract and to explore several factors that influence variation within individuals, as well as within and between primate species. Much of our knowledge of microbial variation derives from studies of humans, and from microbes located in nonreproductive regions (e.g., the gut). We review work suggesting that the vaginal microbiota affects female health, fecundity, and pregnancy outcomes, demonstrating the selective potential for these agents. We explore the factors that correlate with microbial variation within species. Initial colonization by microbes depends on the manner of birth; most microbial variation is structured by estrogen levels that change with age (i.e., at puberty and menopause) and through the menstrual cycle. Microbial communities vary by location within the vagina and can depend on the sampling methods used (e.g., swab, lavage, or pap smear). Interindividual differences also exist, and while this variation is not completely understood, evidence points more to differences in estrogen levels, rather than differences in external physical environment. When comparing across species, reproductive-age humans show distinct microbial communities, generally dominated by Lactobacillus, unlike other primates. We develop evolutionary hypotheses to explain the marked differences in microbial communities. While much remains to be done to test these hypotheses, we argue that the ample variation in primate mating and reproductive behavior offers excellent opportunities to evaluate host-microbe coevolution and adaptation.
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Affiliation(s)
- Rebecca M Stumpf
- Department of Anthropology, University of Illinois, Urbana, IL; Institute for Genomic Biology, University of Illinois, Urbana, IL
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Osava RH, Silva FMBD, Vasconcellos de Oliveira SMJ, Tuesta EF, Amaral MCED. [Meconium-stained amniotic fluid and maternal and neonatal factors associated]. Rev Saude Publica 2013; 46:1023-9. [PMID: 23358619 DOI: 10.1590/s0034-89102013005000005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Accepted: 05/24/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To identify the frequency and maternal and neonatal factors associated with meconium-stained amniotic fluid at birth. METHODS Cross-sectional study carried out with 2,441 births at an in-hospital birth center in the city of São Paulo (Southeastern Brazil) in March and April, 2005. The association between meconium-stained amniotic fluid and the independent variables (maternal age, parity, previous c-section or not, gestational age, obstetric history, oxytocin use in the labor, cervical dilation at admission, mode of current delivery, newborn weight, Apgar score at the 1st and 5th minute) was expressed as prevalence ratio (PR). RESULTS Meconium-stained amniotic fluid was verified in 11.9% of the births; 68.2% of these were normal births and 38.8% c-sections. Meconium was associated with: primiparity (PR=1.49, 95%CI 1.29; 1.73), gestational age ≥ 41 weeks (PR = 5.05, 95%CI 1.93;13.25), oxytocin in labor (PR = 1.83, 95%CI 1.60; 2.10), c- section (PR = 2.65, 95%CI 2.17; 3.24) and Apgar scores < 7 at the 5th minute (PR = 2.96, 95%CI 2,94;2,99). Neonatal mortality was 1.6/1,000 live births. Meconium-stained amniotic fluid was found in 50% of neonatal deaths and it was associated with higher rates of surgical deliveries. CONCLUSIONS Oxytocin use, worse conditions of the newborn after the delivery and increased c-section rates were factors associated with meconium-stained amniotic fluid. Routine use of oxytocin in the intrapartum period could be evaluated due to its association with meconium-stained amniotic fluid.
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Affiliation(s)
- Ruth Hitomi Osava
- Curso de Obstetrícia, Escola de Artes, Ciências e Humanidades, Universidade de São Paulo, São Paulo, SP, Brasil
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Mathai S, Cutfield WS, Derraik JG, Dalziel SR, Harding JE, Robinson E, Biggs J, Jefferies C, Hofman PL. Insulin sensitivity and β-cell function in adults born preterm and their children. Diabetes 2012; 61:2479-83. [PMID: 22596051 PMCID: PMC3447901 DOI: 10.2337/db11-1672] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
We aimed to evaluate insulin secretion and insulin sensitivity in adults born preterm and their children. Subjects were adults born both preterm and at term, with their children aged 5-10 years born at term. Insulin sensitivity and secretion were assessed using hyperglycemic clamps in adults and frequently sampled intravenous glucose tolerance tests using Bergman minimal model in children. In total, 52 adults aged 34-38 years participated (31 born preterm, mean gestational age 33.3 weeks). Adults born preterm were less insulin sensitive than those born at term (19.0 ± 2.5 vs. 36.3 ± 5.2 mg · kg(-1) · min(-1)mU · L; P < 0.05) with compensatory increased first-phase insulin secretion (56.1 ± 8.5 vs. 25.3 ± 3.7 mU/L; P < 0.001) but similar disposition index indicating appropriate insulin secretion. These differences were independent of sex and remained when subjects born <32 weeks' gestation were excluded from analyses. In total, 61 children were studied (37 of preterm parents, mean age 7.9 ± 0.3 years). Children of parents born preterm had similar insulin sensitivity to children of parents born at term, but a correlation between parental and offspring insulin sensitivity was noted only among children of parents born preterm. In conclusion, adults born preterm have insulin resistance in midadulthood, but this was not associated with insulin resistance in their children.
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Affiliation(s)
- Sarah Mathai
- Liggins Institute, University of Auckland, Auckland, New Zealand
- National Research Centre for Growth and Development, University of Auckland, Auckland, New Zealand
| | - Wayne S. Cutfield
- Liggins Institute, University of Auckland, Auckland, New Zealand
- National Research Centre for Growth and Development, University of Auckland, Auckland, New Zealand
| | | | - Stuart R. Dalziel
- Children’s Emergency Department, Starship Children’s Hospital, Auckland, New Zealand
| | - Jane E. Harding
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Elizabeth Robinson
- Department of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | - Janene Biggs
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Craig Jefferies
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Paul L. Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand
- National Research Centre for Growth and Development, University of Auckland, Auckland, New Zealand
- Corresponding author: Paul L. Hofman,
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Sezik M, Antalyali M, Ozmen O, Haligur M, Koker A, Ozkaya O, Kosker M. Ultra-high dose of intra-amniotic or direct fetal intramuscular betamethasone for lung maturation in the preterm goat model. Eur J Obstet Gynecol Reprod Biol 2012; 164:15-23. [PMID: 22683022 DOI: 10.1016/j.ejogrb.2012.05.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Revised: 04/26/2012] [Accepted: 05/16/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To evaluate the effects of intra-amniotic (IA) and fetal injections of a single ultra-high dose of betamethasone (BM) 48 h before preterm delivery on neonatal pulmonary function, using an experimental goat model. STUDY DESIGN Eighteen date-mated singleton pregnant Hair goats were randomized into four groups. At gestational day 118 (alveolar phase, term 150-155 days) after obtaining a sample of amniotic fluid, fetuses in group 1 (n=5) received 8 mg/kg IA BM, and in group 2 (n=5) 4 mg/kg fetal IM BM. In group 3 (n=4) (0.3mg/kg/day) maternal BM was administered at day 118 and 119 with a 24h interval; control fetuses (n=4) received 1 mL/kg of IA saline at day 118. At gestational day 120, after obtaining second sample of amniotic fluids 18 kids were delivered by preterm cesarean section, entubated, weighed, and mechanically ventilated for 15 min. Arterial blood gas samples and deflation/inflation lung pressure-volume measurements were obtained. After sacrifice, lungs were removed, weighed, gross examined and processed for further histological and immunohistochemical (IHC) evaluations. On hematoxylin and eosin (HE) stained slides, presence and severity of lung emphysema was evaluated; slides stained for surfactant proteins, and caspases were used for semi-quantitative evaluation of lung maturation. Kruskal-Wallis, Mann-Whitney, Wilcoxon signed rank, and chi-square tests were used for comparisons. RESULTS IA BM was associated with increased number of stillbirths (60% vs. 0% in control) (p=0.06) and emphysematous changes. Bodyweight-adjusted pressure-volume measurements were improved after maternal, but not IA or fetal, BM (p=0.06). Following mechanical ventilation, arterial blood gas parameters did not significantly alter across maternal and fetal administrations. However, pH was significantly lower (p<0.05) and carbon dioxide partial pressure was higher (p<0.05) in the control group, indicating hypercapnic acidemia in non-treated pregnancies. None of the treatments induced measurable alterations in amniotic fluid lecithin/sphingomyelin (L/S) values. IA and fetal routes were associated with decreased surfactant protein expressions and increased apoptotic activity in alveolar and bronchio-alveolar epithelial cells. CONCLUSION Ultra-high dose IA and fetal IM BM is not superior to the standard dose and maternal way of administration in our experimental design.
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Affiliation(s)
- Mekin Sezik
- Suleyman Demirel University, Faculty of Medicine, Department of Obstetrics and Gynecology, Isparta, Turkey
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Chen CY, Chang CC, Yu C, Lin CW. Clinical application of surface plasmon resonance-based biosensors for fetal fibronectin detection. SENSORS 2012; 12:3879-90. [PMID: 22666007 PMCID: PMC3355388 DOI: 10.3390/s120403879] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Revised: 03/16/2012] [Accepted: 03/20/2012] [Indexed: 12/31/2022]
Abstract
Preterm birth is the leading cause of perinatal morbidity and mortality. Fetal fibronectin (fFN), a glycoprotein in the extracellular matrix of the amniotic membranes, is the most powerful biomarker for predicting the risk of preterm birth. Biosensors using the surface plasmon resonance (SPR) response are potentially useful in quantitatively measuring molecules. We established a standard calibration curve of SPR intensity against fFN concentration and used the SPR-based biosensor to detect fFN concentrations in the cervicovaginal secretions of pregnant women between 22 and 34 weeks of gestation. The calibration curve extends from 0.5 ng/mL to 100 ng/mL with an excellent correlation (R(2) = 0.985) based on standard fFN samples. A cutoff value of 50 ng/mL fFN concentration in commercial ELISA kits corresponds to a relative intensity of 17 arbitrary units (a.u.) in SPR. Thirty-two pregnant women were analyzed in our study. In 11 women, the SPR relative intensity was greater than or equal to 17 a.u., and in 21 women, the SPR relative intensity was less than 17 a.u. There were significant differences between the two groups in regular uterine contractions (p = 0.040), hospitalization for tocolysis (p = 0.049), and delivery weeks (p = 0.043). Our prospective study concluded that SPR-based biosensors can quantitatively measure fFN concentrations. These results reveal the potential utility of SPR-based biosensors in predicting the risk of preterm birth.
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Affiliation(s)
- Chen-Yu Chen
- Institute of Biomedical Engineering and College of Medicine, National Taiwan University, No. 1, Roosevelt Road, Taipei 10617, Taiwan; E-Mails: (C.-Y.C.); (C.-C.C.); (C.Y.)
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, No. 92, Section 2, Zhongshan N. Road, Taipei 10449, Taiwan
- Mackay Medicine, Nursing and Management College, No. 92, Shengjing Road, Taipei 112, Taiwan
| | - Chia-Chen Chang
- Institute of Biomedical Engineering and College of Medicine, National Taiwan University, No. 1, Roosevelt Road, Taipei 10617, Taiwan; E-Mails: (C.-Y.C.); (C.-C.C.); (C.Y.)
| | - Chun Yu
- Institute of Biomedical Engineering and College of Medicine, National Taiwan University, No. 1, Roosevelt Road, Taipei 10617, Taiwan; E-Mails: (C.-Y.C.); (C.-C.C.); (C.Y.)
| | - Chii-Wann Lin
- Institute of Biomedical Engineering and College of Medicine, National Taiwan University, No. 1, Roosevelt Road, Taipei 10617, Taiwan; E-Mails: (C.-Y.C.); (C.-C.C.); (C.Y.)
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +886-2-3366-5272; Fax: +886-2-3366-5268
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Mistry HD, Broughton Pipkin F, Redman CWG, Poston L. Selenium in reproductive health. Am J Obstet Gynecol 2012; 206:21-30. [PMID: 21963101 DOI: 10.1016/j.ajog.2011.07.034] [Citation(s) in RCA: 175] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Revised: 07/12/2011] [Accepted: 07/22/2011] [Indexed: 02/07/2023]
Abstract
Selenium is an essential trace element of importance to human biology and health. Increasing evidence suggests that this mineral plays an important role in normal growth and reproduction in animals and humans, and selenium supplementation is now recommended as part of public health policy in geographical areas with severe selenium deficiency in soil. This review addresses the biological functions of selenium followed by a detailed review of associations between selenium status and reproductive health. In many countries, selenium dietary intake falls below the recommended nutrient intakes and is inadequate to support maximal expression of the selenoenzymes. Numerous reports implicate selenium deficiency in several reproductive and obstetric complications including male and female infertility, miscarriage, preeclampsia, fetal growth restriction, preterm labor, gestational diabetes, and obstetric cholestasis. Currently, there is inadequate information from the available small intervention studies to inform public health strategies. Larger intervention trials are required to reinforce or refute a beneficial role of selenium supplementation in disorders of reproductive health.
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Affiliation(s)
- Hiten D Mistry
- Maternal and Fetal Research Unit, Division of Women's Health, King's College London, United Kingdom.
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Menon R, Dunlop AL, Kramer MR, Fortunato SJ, Hogue CJ. An overview of racial disparities in preterm birth rates: caused by infection or inflammatory response? Acta Obstet Gynecol Scand 2011; 90:1325-31. [PMID: 21615712 PMCID: PMC5573126 DOI: 10.1111/j.1600-0412.2011.01135.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Infection has been hypothesized to be one of the factors associated with spontaneous preterm birth (PTB) and with the racial disparity in rates of PTB between African American and Caucasian women. However, recent findings refute the generalizability of the role of infection and inflammation. African Americans have an increased incidence of PTB in the setting of intraamniotic infection, periodontal disease, and bacterial vaginosis compared to Caucasians. Herein we report variability in infection- and inflammation-related factors based on race/ethnicity. For African American women, an imbalance in the host proinflammatory response seems to contribute to infection-associated PTB, as evidenced by a greater presence of inflammatory mediators with limited or reduced presence of immune balancing factors. This may be attributed to differences in the genetic variants associated with PTB between African Americans and Caucasians. We argue that infection may not be a cause of racial disparity but in association with other risk factors such as stress, nutritional deficiency, and differences in genetic variations in PTB, pathways and their complex interactions may produce differential inflammatory responses that may contribute to racial disparity.
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Affiliation(s)
- Ramkumar Menon
- Department of Epidemiology, Women and Children's Center, Emory University Rollins School of Public Health, Atlanta, GA 30322, USA.
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Haldipur P, Bharti U, Alberti C, Sarkar C, Gulati G, Iyengar S, Gressens P, Mani S. Preterm delivery disrupts the developmental program of the cerebellum. PLoS One 2011; 6:e23449. [PMID: 21858122 PMCID: PMC3157376 DOI: 10.1371/journal.pone.0023449] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Accepted: 07/18/2011] [Indexed: 11/26/2022] Open
Abstract
A rapid growth in human cerebellar development occurs in the third trimester, which is impeded by preterm delivery. The goal of this study was to characterize the impact of preterm delivery on the developmental program of the human cerebellum. Still born infants, which meant that all development up to that age had taken place in-utero, were age paired with preterm delivery infants, who had survived in an ex-utero environment, which meant that their development had also taken place outside the uterus. The two groups were assessed on quantitative measures that included molecular markers of granule neuron, purkinje neuron and bergmann glia differentiation, as well as the expression of the sonic hedgehog signaling pathway, that is important for cerebellar growth. We report that premature birth and development in an ex-utero environment leads to a significant decrease in the thickness and an increase in the packing density of the cells within the external granular layer and the inner granular layer well, as a reduction in the density of bergmann glial fibres. In addition, this also leads to a reduced expression of sonic hedgehog in the purkinje layer. We conclude that the developmental program of the cerebellum is specifically modified by events that follow preterm delivery.
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Affiliation(s)
| | - Upasna Bharti
- National Brain Research Centre, Manesar, Haryana, India
| | - Corinne Alberti
- Inserm, CIE 5; Assistance publique - Hôpitaux de Paris, Robert Debré Hospital, Unité d'épidémiologie clinique, Paris, France
- Université Paris 7, Faculté de Médecine Denis Diderot, Paris, France
| | - Chitra Sarkar
- All India Institute of Medical Sciences, New Delhi, India
| | - Geetika Gulati
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Pierre Gressens
- Université Paris 7, Faculté de Médecine Denis Diderot, Paris, France
- Inserm, U676, Paris, France
- PremUP, Paris, France
| | - Shyamala Mani
- National Brain Research Centre, Manesar, Haryana, India
- * E-mail:
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O'Keane V, Lightman S, Marsh M, Pawlby S, Papadopoulos AS, Taylor A, Moore R, Patrick K. Increased pituitary-adrenal activation and shortened gestation in a sample of depressed pregnant women: a pilot study. J Affect Disord 2011; 130:300-5. [PMID: 21093926 DOI: 10.1016/j.jad.2010.10.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Revised: 10/07/2010] [Accepted: 10/07/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND Major depression (MD) is frequently accompanied by a relatively increased production of the stress hormone cortisol. During pregnancy corticotrophin releasing hormone (CRH) is secreted from the placenta and critically high levels of CRH are one of the key triggers for parturition. Maternal cortisol promotes the secretion of placental CRH. In this study, we examined the hypothesis that women suffering with MD in pregnancy would have relatively increased cortisol secretion, a time-advanced rise in placental CRH production and an earlier delivery of the baby. METHODS A group of medication-free pregnant women, free of know obstetric and medical complications, with (n=27) and without (n=38) MD were recruited. Blood concentrations of CRH, adrenocorticotrophic hormone (ACTH) and diurnal salivary cortisol concentrations were measured at fixed time points. RESULTS Maternal cortisol concentrations were highly correlated with placental CRH secretion for the entire group. Second trimester CRH concentrations and mean evening salivary cortisol concentrations were significantly higher in the depressed women. Although pregnancy length was shorter in the depressed women there were no statistical relationships between the stress hormone measures and pregnancy length. LIMITATIONS The sample size was small and highly selected. CONCLUSIONS These findings suggest that depressed pregnant women hypersecrete cortisol in a diurnal pattern similar to that typical of MD, and that this leads to a time-advanced rise in placental CRH secretion. Factors other than this stress-delivery mechanism may be contributing to the shortened pregnancy length in depressed women.
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Affiliation(s)
- V O'Keane
- Trinity Science Building, Tallaght Hospital (AMNCH), Dublin 24, Ireland.
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25
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McGready R, Wuthiekanun V, Ashley EA, Tan SO, Pimanpanarak M, Viladpai-Nguen SJ, Jesadapanpong W, Blacksell SD, Proux S, Day NP, Singhasivanon P, White NJ, Nosten F, Peacock SJ. Diagnostic and treatment difficulties of pyelonephritis in pregnancy in resource-limited settings. Am J Trop Med Hyg 2011; 83:1322-9. [PMID: 21118943 PMCID: PMC2990053 DOI: 10.4269/ajtmh.2010.10-0332] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Limited microbiology services impede adequate diagnosis and treatment of common infections such as pyelonephritis in resource-limited settings. Febrile pregnant women attending antenatal clinics at Shoklo Malaria Research Unit were offered urine dipstick, sediment microscopy, urine culture, and a 5-mL blood culture. The incidence of pyelonephritis was 11/1,000 deliveries (N = 53 in 4,819 pregnancies) between January 7, 2004 and May 17, 2006. Pyelonephritis accounted for 20.2% (41/203) of fever cases in pregnancy. Escherichia coli was the most commonly isolated pathogen: 87.5% (28/32) of organisms cultured. Susceptibility of E. coli to ampicillin (14%), cotrimoxazole (21%), and amoxicillin-clavulanic acid (48%) was very low. E. coli was susceptible to ceftriaxone and ciprofloxacin. The rate of extended spectrum β-lactamase (4.2%; 95% confidence interval = 0.7-19.5) was low. The rate and causes of pyelonephritis in pregnant refugee and migrant women were comparable with those described in developed countries. Diagnostic innovation in microbiology that permits affordable access is a high priority for resource-poor settings.
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Affiliation(s)
- Rose McGready
- Shoklo Malaria Research Unit, Mae Sot, Tak, Thailand.
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26
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Abstract
Prematurity and HIV present a complex challenge, with biologic underpinnings that are often confounded by a myriad of other factors that coexist in this high-risk population. Furthermore, many of the current management options designed to reduce mother-to-infant transmission, including antiretroviral therapy and cesarean birth, may each have an independent effect on prematurity. These issues notwithstanding, knowledge gained from randomized controlled trials and epidemiologic studies has made a significant impact on the approach to this challenging public health problem worldwide. This article discusses the significance, contribution, and management of perinatal transmission of HIV in prematurity.
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Affiliation(s)
- Julie Mirpuri
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive, Atlanta, GA, USA.
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27
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Tsekoura EA, Konstantinidou A, Papadopoulou S, Athanasiou S, Spanakis N, Kafetzis D, Antsaklis A, Tsakris A. Adenovirus genome in the placenta: association with histological chorioamnionitis and preterm birth. J Med Virol 2010; 82:1379-83. [DOI: 10.1002/jmv.21820] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Lawn JE, Gravett MG, Nunes TM, Rubens CE, Stanton C. Global report on preterm birth and stillbirth (1 of 7): definitions, description of the burden and opportunities to improve data. BMC Pregnancy Childbirth 2010; 10 Suppl 1:S1. [PMID: 20233382 PMCID: PMC2841772 DOI: 10.1186/1471-2393-10-s1-s1] [Citation(s) in RCA: 475] [Impact Index Per Article: 33.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION This is the first of seven articles from a preterm birth and stillbirth report. Presented here is an overview of the burden, an assessment of the quality of current estimates, review of trends, and recommendations to improve data. PRETERM BIRTH Few countries have reliable national preterm birth prevalence data. Globally, an estimated 13 million babies are born before 37 completed weeks of gestation annually. Rates are generally highest in low- and middle-income countries, and increasing in some middle- and high-income countries, particularly the Americas. Preterm birth is the leading direct cause of neonatal death (27%); more than one million preterm newborns die annually. Preterm birth is also the dominant risk factor for neonatal mortality, particularly for deaths due to infections. Long-term impairment is an increasing issue. STILLBIRTH Stillbirths are currently not included in Millennium Development Goal tracking and remain invisible in global policies. For international comparisons, stillbirths include late fetal deaths weighing more than 1000g or occurring after 28 weeks gestation. Only about 2% of all stillbirths are counted through vital registration and global estimates are based on household surveys or modelling. Two global estimation exercises reached a similar estimate of around three million annually; 99% occur in low- and middle-income countries. One million stillbirths occur during birth. Global stillbirth cause-of-death estimates are impeded by multiple, complex classification systems. RECOMMENDATIONS TO IMPROVE DATA (1) increase the capture and quality of pregnancy outcome data through household surveys, the main data source for countries with 75% of the global burden; (2) increase compliance with standard definitions of gestational age and stillbirth in routine data collection systems; (3) strengthen existing data collection mechanisms--especially vital registration and facility data--by instituting a standard death certificate for stillbirth and neonatal death linked to revised International Classification of Diseases coding; (4) validate a simple, standardized classification system for stillbirth cause-of-death; and (5) improve systems and tools to capture acute morbidity and long-term impairment outcomes following preterm birth. CONCLUSION Lack of adequate data hampers visibility, effective policies, and research. Immediate opportunities exist to improve data tracking and reduce the burden of preterm birth and stillbirth.
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Affiliation(s)
- Joy E Lawn
- Saving Newborn Lives/Save the Children, 11 South Way, Pinelands Cape Town, South Africa
| | - Michael G Gravett
- Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington USA
| | - Toni M Nunes
- Global Alliance to Prevent Prematurity and Stillbirth, an initiative of Seattle Children's, Seattle, Washington, USA
| | - Craig E Rubens
- Global Alliance to Prevent Prematurity and Stillbirth, an initiative of Seattle Children's, Seattle, Washington, USA
- Department of Pediatrics at University of Washington School of Medicine, Seattle, Washington, USA
| | - Cynthia Stanton
- Department of Population, Family and Reproductive Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Klingberg-Allvin M, Graner S, Phuc HD, Höjer B, Johansson A. Pregnancies and births among adolescents: a population-based prospective study in rural Vietnam. SEXUAL & REPRODUCTIVE HEALTHCARE 2009; 1:15-9. [PMID: 21122591 DOI: 10.1016/j.srhc.2009.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2009] [Revised: 08/28/2009] [Accepted: 09/22/2009] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To describe birth rates and pregnancy outcomes, specifically stillbirth, preterm delivery and low birth weight (LBW) in relation to socio-demographic characteristics, among adolescent women in a rural district in northern Vietnam. MATERIAL AND METHOD Within an epidemiological field laboratory, quarterly surveillance of 7767 adolescent women in the ages 15-19 during the period January 1999 to December 2005 was conducted. Birth rates were calculated and pregnancy outcomes were described in relation to background factors. RESULT A total of 1021 pregnancies were reported by 926 adolescent women during the period of whom 17% were below 18 years. The estimated adolescent birth rate during 1999-2005 was 27/1000 women-years. The incidence of stillbirth among all births was 19/1000 births. These were more likely to be delivered preterm. The incidence of preterm deliveries and LBW infants was 193 and 75 per 1000 live births, respectively. There were no differences in socio-demographic background for stillbirth, preterm delivery or LBW. CONCLUSION Adolescent birth rates were similar to those found in the recent Vietnamese DHS and considerably lower than the average for South-East Asia. Higher rates of stillbirth and preterm delivery were found than those previously reported for Vietnam, indicating the need for careful monitoring of adolescent pregnancies and their infants. Further research is needed to explore if and how much socio-demographic variables influence pregnancy outcome, comparing more differentiated groups, as a basis for interventions to assure access to adequate reproductive health care services for all women.
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Affiliation(s)
- Marie Klingberg-Allvin
- Department of Public Health Sciences, Division of International Health (IHCAR), Karolinska Institutet, Stockholm, Sweden.
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30
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Hofmeyr GJ. What (not) to do before delivery? Prevention of fetal meconium release and its consequences. Early Hum Dev 2009; 85:611-5. [PMID: 19822401 DOI: 10.1016/j.earlhumdev.2009.09.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Accepted: 09/24/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Meconium-stained amniotic fluid is a common occurrence which places the mother at risk of escalating obstetric interventions, and the baby at risk of meconium aspiration syndrome. METHODS The Cochrane Library was searched for interventions related to care before delivery with useful evidence on the outcomes 'meconium-stained amniotic fluid' and 'meconium aspiration syndrome'. FINDINGS Curtailment of post-term pregnancy reduces the occurrence of meconium-stained amniotic fluid, and meconium aspiration syndrome. Uterine stimulants, particularly misoprostol, are associated with occurrence of meconium-stained amniotic fluid. Amniotomy during labour may be a risk factor for meconium aspiration syndrome. There is little research evidence on the benefits or otherwise of obstetric interventions such as expedited delivery for meconium-stained liquor without other evidence of fetal distress. Amnioinfusion for meconium-stained amniotic fluid improves neonatal outcome only in settings with limited peripartum surveillance. There is insufficient evidence to support the use of amnioinfusion for meconium-stained liquor in settings with adequate peripartum surveillance.
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Affiliation(s)
- G J Hofmeyr
- Effective Care Research Unit, Eastern Cape Department of Health, University of the Witwatersrand, University of Fort Hare, South Africa.
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31
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Edmondson N, Bocking A, Machin G, Rizek R, Watson C, Keating S. The prevalence of chronic deciduitis in cases of preterm labor without clinical chorioamnionitis. Pediatr Dev Pathol 2009; 12:16-21. [PMID: 18171100 DOI: 10.2350/07-04-0270.1] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2007] [Accepted: 12/17/2007] [Indexed: 11/20/2022]
Abstract
Preterm labor is a major cause of perinatal mortality and morbidity, and in approximately 30% of cases a clinical cause is not identified. Acute chorioamnionitis is found histologically in a significant percentage of placentas from preterm deliveries, and the mother is often asymptomatic. Although such subclinical acute chorioamnionitis is known to play a role in preterm labor, this study explores the hypothesis that chronic deciduitis with plasma cells is seen more frequently in cases of preterm labor than in control placentas. Thirty-nine singleton placentas from patients with idiopathic preterm labor were examined microscopically and compared in a blinded fashion with 39 gestational age-matched control placentas. Cases of clinical acute chorioamnionitis and known chronic maternal diseases were excluded. Thirty-nine control singleton placentas were obtained from patients undergoing induction of labor for fetal structural abnormalities, excluding aneuploidy. The presence or absence of acute chorioamnionitis, acute fetal inflammatory response, chronic deciduitis, chronic villitis, infarction, and decidual vasculopathy was noted. Immunohistochemical staining was undertaken to further define leukocyte subtypes. Forty-one percent of cases and 15% of controls showed chronic deciduitis (P = 0.022). Forty-six percent of cases and 18% of controls showed histologic acute chorioamnionitis (P = 0.015). There were 8 cases demonstrating acute fetal inflammatory response but only 1 control (P = 0.029). Little difference was seen in the distribution of lymphocyte subsets between cases and control placentas. Our findings suggest that chronic deciduitis plays a role in the etiology of some cases of preterm labor.
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Affiliation(s)
- Nadeen Edmondson
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
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32
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Abstract
Recurrent preterm birth is frequently defined as two or more deliveries before 37 completed weeks of gestation. The recurrence rate varies as a function of the antecedent for preterm birth: spontaneous versus indicated. Spontaneous preterm birth is the result of either preterm labor with intact membranes or preterm prelabor rupture of the membranes. This article reviews the body of literature describing the risk of recurrence of spontaneous and indicated preterm birth. Also discussed are the factors which modify the risk for recurrent spontaneous preterm birth (a short sonographic cervical length and a positive cervicovaginal fetal fibronectin test). Patients with a history of an indicated preterm birth are at risk not only for recurrence of this subtype, but also for spontaneous preterm birth. Individuals of black origin have a higher rate of recurrent preterm birth.
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Affiliation(s)
- Shali Mazaki-Tovi
- Perinatology Research Branch, Intramural Division, NICHD/NIH/DHHS, Hutzel Women’s Hospital, Bethesda, MD, and Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University/Hutzel Women’s Hospital, Detroit, MI, USA
| | - Roberto Romero
- Perinatology Research Branch, Intramural Division, NICHD/NIH/DHHS, Hutzel Women’s Hospital, Bethesda, MD, and Detroit, MI, USA
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI, USA
| | - Juan Pedro Kusanovic
- Perinatology Research Branch, Intramural Division, NICHD/NIH/DHHS, Hutzel Women’s Hospital, Bethesda, MD, and Detroit, MI, USA
| | - Offer Erez
- Perinatology Research Branch, Intramural Division, NICHD/NIH/DHHS, Hutzel Women’s Hospital, Bethesda, MD, and Detroit, MI, USA
| | - Beth L. Pineles
- Perinatology Research Branch, Intramural Division, NICHD/NIH/DHHS, Hutzel Women’s Hospital, Bethesda, MD, and Detroit, MI, USA
| | - Francesca Gotsch
- Perinatology Research Branch, Intramural Division, NICHD/NIH/DHHS, Hutzel Women’s Hospital, Bethesda, MD, and Detroit, MI, USA
| | - Pooja Mittal
- Perinatology Research Branch, Intramural Division, NICHD/NIH/DHHS, Hutzel Women’s Hospital, Bethesda, MD, and Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University/Hutzel Women’s Hospital, Detroit, MI, USA
| | - Nandor Gabor Than
- Perinatology Research Branch, Intramural Division, NICHD/NIH/DHHS, Hutzel Women’s Hospital, Bethesda, MD, and Detroit, MI, USA
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Steer PJ. The epidemiology of preterm labour--why have advances not equated to reduced incidence? BJOG 2007; 113 Suppl 3:1-3. [PMID: 17206958 DOI: 10.1111/j.1471-0528.2006.01116.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The major burden of preterm birth is in the developing world, where most of the increasing death and morbidity is secondary to infectious diseases such as malaria, HIV, tuberculosis, bacterial vaginosis and intestinal parasites. In some developing countries, the growth of medical care has outstripped the growth of preventive public health, with an associated increase in iatrogenic preterm births. In developed countries, more than one-third of preterm births are medically indicated because of conditions such as fulminating pre-eclampsia or severe intrauterine growth restriction. Neither of these conditions is currently preventable. One in five preterm births is associated with multiple pregnancy, and these have been greatly increased by assisted reproduction techniques. The use of tocolytics has proved disappointing perhaps because inflammation rather than spontaneous uterine activity is increasingly recognised as the final common pathway. Inappropriate antibiotics used late in pregnancy are ineffective and may have adverse effects. Currently, the most promising interventions are public health related and include reducing the transmission of communicable diseases, improvements in the management of diabetes and reduction in harmful behaviours such as smoking and drug abuse.
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Affiliation(s)
- P J Steer
- Division of Surgery, Oncology, Reproductive Biology and Anaesthetics, Faculty of Medicine, Imperial College London, London, UK
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34
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Abstract
Birth in the human is particularly difficult compared with that in the other primates. Bipedalism has evolved over the past 6 or 7 million years, and has resulted in a small pelvis, adapted to the upright posture. In recent millennia, the increasing size of the fetal head at birth has made childbirth difficult. Haig has suggested that the mother and fetus do not have identical interests; the baby benefits from being large at birth, while it is easier for the mother to deliver a small baby. Many of the 500 000 maternal deaths per year around the world are due to obstructed labour, especially in Africa. Even in London, black African women have the highest caesarean section rates. Black African babies are on average smaller than white European babies, due mainly to earlier delivery. In a 13-year study of births in North West Thames, African babies were 2.5 times more likely to be born between 24 and 31 weeks inclusive than white European babies. Between 33 and 38 weeks of gestation, black African babies behaved in a more mature way, are more likely to pass meconium and have jaundice, but less likely to have respiratory problems leading to admission to the special care baby unit. Preterm black African babies have lower gestation-specific perinatal mortality than white European babies, while at term and beyond the reverse is true. Preterm birth may have evolved partly as a response to disproportion.
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Affiliation(s)
- P J Steer
- Division of Surgery, Oncology, Reproductive Biology and Anaesthetics, Faculty of Medicine, Imperial College London, London, UK.
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