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Pedretti MK, Dickinson JE, Doherty DA, Newnham JP. Routine transabdominal cervical length screening in mid-pregnancy for the prevention of preterm birth: Is it good enough to use as a screening test? Aust N Z J Obstet Gynaecol 2024. [PMID: 38982861 DOI: 10.1111/ajo.13859] [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: 04/20/2024] [Accepted: 06/16/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND Preterm birth (PTB) is a major pregnancy complication. There is evidence that a short cervical length in mid-pregnancy may predict women at increased risk of PTB. AIMS To evaluate the utility of population-based, transabdominal cervical length (TACL) measurement screening in mid-pregnancy for PTB prediction in women. MATERIALS AND METHODS A transabdominal approach was initially performed, with a transvaginal (TVCL) approach offered when the TACL was <35 mm, could not be accurately measured, or the pregnancy had risk factors for PTB. TACL was compared to the directly related TVCL, when both were performed at the same assessment. Women with risk factors of PTB were included when they had both TACL and TVCL measurements performed at the same visit. RESULTS Data were provided for 9355 singleton pregnancies from 13 participating imaging centres. A transabdominal approach was used in 9006 (96.3%), including 682 (7.3%) TVCL combined with TACL. There were 349 (3.7%) women who had TVCL only. The median TACL was longer (40 mm) than the TVCL (38 mm). In 682 paired TACL and TVCL measurements, TACL <35 mm correctly identified 96.2% of pregnancies with TVCL <25 mm, compared with 65.4% of cases when using a TACL <30 mm. A TVCL <25 mm occurred in 59 (0.6%) women. A TACL <35 mm was associated with birth <37 weeks of gestation in 12.1% of women and birth <32 weeks of gestation in 3.9%. CONCLUSIONS Universal TACL is a feasible option for population screening of cervical length in a low-risk population, progressing to TVCL if the TACL is <35 mm or the cervix cannot be transabdominally accurately measured.
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Affiliation(s)
- Michelle K Pedretti
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
- Department of Ultrasound, King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Jan E Dickinson
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
- Maternal Fetal Medicine Service, King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Dorota A Doherty
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
| | - John P Newnham
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
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Pfeiffer AF, Clark RE, Sullivan J, Rizvi SAA, Byrne JJ, Boyd AR. Sigmoid volvulus in pregnancy: A rare case report. Int J Gynaecol Obstet 2024; 165:1285-1287. [PMID: 38226725 DOI: 10.1002/ijgo.15384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/18/2023] [Accepted: 01/02/2024] [Indexed: 01/17/2024]
Abstract
SynopsisSigmoid volvulus in pregnancy is a surgical emergency that requires speedy diagnosis and definitive treatment at an appropriate level of care center as it may provoke preterm labor.
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Affiliation(s)
- Alixandria F Pfeiffer
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Reece E Clark
- Department of Obstetrics and Gynecology, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Jana Sullivan
- Department of Obstetrics and Gynecology, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Syed A A Rizvi
- College of Biomedical Sciences, Larkin University, Miami, Florida, USA
| | - John J Byrne
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Angela R Boyd
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Health San Antonio, San Antonio, Texas, USA
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Enyew HD, Hailu AB, Mereta ST. Effect of a chimney-fitted improved stove on pregnancy outcomes in Northwest Ethiopia: a randomized controlled trial. BMC Pregnancy Childbirth 2024; 24:192. [PMID: 38475748 PMCID: PMC10936082 DOI: 10.1186/s12884-024-06363-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 02/22/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Exposure to household air pollution during pregnancy has been linked to adverse pregnancy outcomes. Improved stove was implemented in Ethiopia to reduce this exposure and related health problems. However, the effects of improved stove interventions on pregnancy outcomes remains uncertain. METHOD Individually randomized stove replacement trial was conducted among 422 households in six low-income rural kebeles of Northwestern Ethiopia. Pregnant women without known health conditions were recruited at ≤ 24 weeks gestation and randomized to an intervention or control group with a 1:1 ratio. A baseline survey was collected and a balance test was done. Two-sided independent samples t-test for continuous outcomes and chi-square for categorical variables were used to compare the effect of the intervention between the groups. Mean differences with 95% CIs were calculated and a p-value of < 0.05 was considered statistically significant. RESULT In this study, the mean birth weight was 3065 g (SD = 453) among the intervention group and not statistically different from 2995 g (SD = 541) of control group. After adjusting for covariates, infants born from intervention group weighed 55 g more [95% CI: - 43 to 170) than infants born from the control group, but the difference was not statistically significant (P = 0.274). The respective percentages for low birth weight were 8% and 10.3% for intervention and control groups respectively (P = 0.346). However, the average gestational age at delivery was higher among improved stove users (38 weeks (SD = 8.2) compared to control groups 36.5 weeks (SD = 9.6) with statistically significant difference at 0.91 weeks (95% CI: 0.52 to 1.30 weeks, p < 0.001). The corresponding difference in risk ratio for preterm birth is 0.94 (95% CI:0.92 to 0.97; p < 0.001). The percentages for maternal complications, stillbirth, and miscarriage in the intervention group were not statistically different from the control group. CONCLUSIONS While the increase in average birth weight among babies born to mothers using improved stoves was not statistically significant, babies had a longer gestational age on average, offering valuable health benefits. However, the study didn't find a significant impact on other pregnancy outcomes like stillbirth, miscarriage, or maternal complications. TRIAL REGISTRATION The study was registered at the Pan African Clinical Trial Registry website under the code PACTR202111534227089, ( https://pactr.samrc.ac.za/ (Identifier). The first trial registration date was (11/11/2021).
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Affiliation(s)
- Habtamu Demelash Enyew
- College of Health Sciences, Department of Public Health, Debre Tabor University, Debre Tabor, Ethiopia.
- Institution of Health, Department of Environmental Health Science and Technology, Jimma University, Jimma, Ethiopia.
| | - Abebe Beyene Hailu
- Institution of Health, Department of Environmental Health Science and Technology, Jimma University, Jimma, Ethiopia
| | - Seid Tiku Mereta
- Institution of Health, Department of Environmental Health Science and Technology, Jimma University, Jimma, Ethiopia
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Stylianou-Riga P, Boutsikou T, Kouis P, Michailidou K, Kinni P, Sokou R, Iliodromiti Z, Pitsios C, Yiallouros PK, Iacovidou N. Epidemiology, risk factors, clinical presentation and complications of late-onset neonatal sepsis among preterm neonates in Cyprus: a prospective case-control study. BMC Pediatr 2024; 24:50. [PMID: 38229029 DOI: 10.1186/s12887-023-04359-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 10/12/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Late-onset neonatal sepsis (LOS) is common in preterm neonates, with increasing incidence in recent years. In the present study, we examined the epidemiology, clinical presentation, and complications of LOS in Cyprus and quantified possible risk factors for the development of this condition. METHODS The study subjects were preterm neonates admitted in the Neonatal Intensive Care Unit (NICU) of Archbishop Makarios III Hospital, the only neonatal tertiary centre in Cyprus. A prospective, case-control study was designed, and carried out between April 2017-October 2018. Depending on blood culture results, preterm neonates were classified as "Confirmed LOS": positive blood culture - microorganism isolated and LOS symptoms, "Unconfirmed LOS": negative blood culture and LOS symptoms, and "Controls" group: negative blood culture and absence of LOS symptoms. Comparisons between the 3 groups were performed and the associations between demographic, clinical and treatment characteristics with the likelihood of LOS were assessed using univariate and multivariate logistic regression. RESULTS A total of 350 preterm neonates were included in the study and the incidence of LOS was 41.1%. 79 (22.6%) and 65 (18.6%) neonates were classified as "Confirmed LOS", and "unconfirmed LOS" cases respectively while 206 (58.9%) served as controls. The rate of confirmed LOS ranged from 12.2% in moderate to late preterm neonates to 78.6% in extremely preterm neonates. In the multivariate model, we demonstrated an independent association between LOS and duration of hospitalization (OR: 1.06, 95%CI: 1.01-1.10), duration of ventilation (OR: 1.23, 95%CI: 1.07-1.43) and necrotising enterocolitis (OR: 3.41, 95%CI: 1.13-10.25). CONCLUSIONS The present study highlights the epidemiology of LOS in preterm neonates in Cyprus and its association with the duration of ventilation and hospitalization as well as with necrotizing enterocolitis. Establishment of protocols for the prevention of nosocomial infections during hospitalization in the NICUs and mechanical ventilation of preterm neonates is recommended.
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Affiliation(s)
- Paraskevi Stylianou-Riga
- Neonatal Intensive Care Unit, "Archbishop Makarios III" Hospital, Nicosia, Cyprus.
- Respiratory Physiology Laboratory, Medical School, University of Cyprus Shakolas Educational Center of Clinical, Medicine Palaios Dromos Lefkosias Lemesou 215/6, Aglantzia, Nicosia, 2029, Cyprus.
- Neonatal Department, Medical School, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | - Theodora Boutsikou
- Neonatal Department, Medical School, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Panayiotis Kouis
- Respiratory Physiology Laboratory, Medical School, University of Cyprus Shakolas Educational Center of Clinical, Medicine Palaios Dromos Lefkosias Lemesou 215/6, Aglantzia, Nicosia, 2029, Cyprus
| | | | - Paraskevi Kinni
- Respiratory Physiology Laboratory, Medical School, University of Cyprus Shakolas Educational Center of Clinical, Medicine Palaios Dromos Lefkosias Lemesou 215/6, Aglantzia, Nicosia, 2029, Cyprus
| | - Rozeta Sokou
- Neonatal Department, Medical School, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Zoi Iliodromiti
- Neonatal Department, Medical School, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Constantinos Pitsios
- Respiratory Physiology Laboratory, Medical School, University of Cyprus Shakolas Educational Center of Clinical, Medicine Palaios Dromos Lefkosias Lemesou 215/6, Aglantzia, Nicosia, 2029, Cyprus
| | - Panayiotis K Yiallouros
- Respiratory Physiology Laboratory, Medical School, University of Cyprus Shakolas Educational Center of Clinical, Medicine Palaios Dromos Lefkosias Lemesou 215/6, Aglantzia, Nicosia, 2029, Cyprus
| | - Nicoletta Iacovidou
- Neonatal Department, Medical School, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Sridhar S, Mol BW, Hodges R, Palmer KR, Sundram S, de Carvalho Pacagnella R, Souza RT, Barbosa-Junior F, Mackin D, Said J, Rolnik D, Malhotra A. Feasibility of a pregnancy intervention mimicking viral transmission mitigation measures on the incidence of preterm birth in high-risk pregnant women enrolled in antenatal clinics in Melbourne, Australia: protocol for a pilot, randomised trial. BMJ Open 2023; 13:e075703. [PMID: 38154903 PMCID: PMC10759123 DOI: 10.1136/bmjopen-2023-075703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 11/23/2023] [Indexed: 12/30/2023] Open
Abstract
INTRODUCTION Preterm birth is a leading cause of perinatal morbidity and mortality. During the COVID-19 pandemic, reduction in rates of preterm birth in women exposed to viral mitigation measures was reported by multiple studies. In addition, others and we observed a more pronounced reduction of preterm birth in women who had previously experienced a preterm birth. The aim of this pilot study is to establish the feasibility of a lifestyle intervention based on viral mitigation measures in high-risk pregnancies, with the ultimate aim to reduce the incidence of preterm birth. METHODS AND ANALYSIS One hundred pregnant women, enrolled in antenatal clinics at two tertiary maternity centres in Melbourne, Australia, who have had a previous preterm birth between 22 and 34 weeks gestation will be recruited. This is a two-arm, parallel group, open-label randomised controlled feasibility trial: 50 women will be randomised to the intervention group, where they will be requested to comply with a set of lifestyle changes (similar to the viral mitigation measures observed during the pandemic). Another 50 women will be randomised to the control group, where they will undergo standard pregnancy care. The primary outcome of this trial is feasibility, which will be assessed by measuring patient eligibility rate, recruitment rate, compliance rate and data completion rate. Secondary outcomes include incidence of preterm birth, maternal satisfaction, maternal quality of life and other pregnancy outcomes. Standard methods in statistical analysis for randomised controlled trials on an intention to treat basis will be followed. ETHICS AND DISSEMINATION This trial has been approved by the Monash Human Research Ethics Committee; approval reference number RES-22-0000-122A. Study findings will be reported and submitted to peer-reviewed journals for publication, and presentation at conferences. TRIAL REGISTRATION NUMBER ACTRN12622000753752; Pre-results.
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Affiliation(s)
- Shivadharshini Sridhar
- Department of Obstetrics and Gynaecology, Monash Medical Centre Clayton, Clayton, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, Monash Medical Centre Clayton, Clayton, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Ryan Hodges
- Department of Obstetrics and Gynaecology, Monash Medical Centre Clayton, Clayton, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Kirsten R Palmer
- Department of Obstetrics and Gynaecology, Monash Medical Centre Clayton, Clayton, Victoria, Australia
- Obstetrics and Gynaecology, Monash University School of Clinical Sciences at Monash Health, Clayton, Victoria, Australia
| | - Suresh Sundram
- Department of Psychiatry, Monash University, Clayton, Victoria, Australia
- Mental Health Program, Monash Medical Centre Clayton, Clayton, Victoria, Australia
| | | | - Renato T Souza
- Department of Obstetrics and Gynaecology, University of Campinas Institute of Biology, Campinas, Brazil
| | | | - David Mackin
- Department of Maternal Fetal Medicine, Sunshine Hospital, St Albans, Victoria, Australia
| | - Joanne Said
- Department of Maternal Fetal Medicine, Sunshine Hospital, St Albans, Victoria, Australia
- The University of Melbourne, Melbourne, Victoria, Australia
| | - Daniel Rolnik
- Department of Obstetrics and Gynaecology, Monash Medical Centre Clayton, Clayton, Victoria, Australia
- Monash University, Clayton, Victoria, Australia
| | - Atul Malhotra
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
- Monash Children's Hospital, Clayton, Victoria, Australia
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Di Salvo L, Cade T, Sheehan P, Georgiou HM, Di Quinzio M, Brennecke SP. Identification of biochemical biomarkers associated with premature cervical shortening in high-risk, asymptomatic pregnant women: a retrospective data analysis. J OBSTET GYNAECOL 2023; 43:2212299. [PMID: 37178334 DOI: 10.1080/01443615.2023.2212299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Reliably predicting spontaneous preterm birth remains challenging, therefore it persists as a major contributor to perinatal morbidity and mortality. The use of biomarkers to predict premature cervical shortening, a recognised risk factor for spontaneous preterm birth, is yet to be fully explored in current literature. This study evaluates seven cervicovaginal biochemical biomarkers as possible predictors of premature cervical shortening. Asymptomatic, high-risk women (n = 131) presenting to a specialised preterm birth prevention clinic were analysed through a retrospective data analysis. Cervicovaginal biochemical biomarker concentrations were obtained, and the shortest cervical length measurement, up to 28 weeks' gestation, was recorded. Associations between biomarker concentration and cervical length were then analysed. Of the seven biochemical biomarkers, Interleukin-1 Receptor Antagonist and Extracellular Matrix Protein-1 had statistically significant relationships with cervical shortening below 25 mm. Further investigation is required to validate these findings and any downstream clinical utility, with intentions to improve perinatal outcomes.IMPACT STATEMENTWhat is already known on this subject? Preterm birth is a major cause of perinatal morbidity and mortality. A woman's risk of delivering preterm is currently stratified using historical risk factors, mid-gestation cervical length, and biochemical biomarkers such as foetal fibronectin.What do the results of this study add? In a cohort of high-risk, asymptomatic pregnant women, two cervicovaginal biochemical biomarkers, Interleukin-1 Receptor Antagonist and Extracellular Matrix Protein-1, displayed associations with premature cervical shortening.What are the implications of these findings for clinical practice and/or further research? Further investigation into the possible clinical utility of these biochemical biomarkers is warranted, with a view to improving preterm birth prediction and antenatal resource utilisation, thereby reducing the burden of preterm birth and its sequelae in a cost-effective manner.
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Affiliation(s)
- Lauren Di Salvo
- Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia
- Department of Maternal-Fetal Medicine, Pregnancy Research Centre, Royal Women's Hospital, Melbourne, Australia
| | - Thomas Cade
- Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia
- Department of Maternal-Fetal Medicine, Pregnancy Research Centre, Royal Women's Hospital, Melbourne, Australia
| | - Penelope Sheehan
- Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia
- Department of Maternal-Fetal Medicine, Pregnancy Research Centre, Royal Women's Hospital, Melbourne, Australia
| | - Harry M Georgiou
- Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia
- Department of Maternal-Fetal Medicine, Pregnancy Research Centre, Royal Women's Hospital, Melbourne, Australia
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Melbourne, Australia
| | - Megan Di Quinzio
- Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Melbourne, Australia
| | - Shaun P Brennecke
- Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia
- Department of Maternal-Fetal Medicine, Pregnancy Research Centre, Royal Women's Hospital, Melbourne, Australia
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Eyeberu A, Alemu A, Debella A, Mussa I. Is intimate partner violence and obstetrics characteristics of pregnant women associated with preterm birth in Ethiopia? Umbrella review on preterm birth. Reprod Health 2023; 20:168. [PMID: 37978546 PMCID: PMC10656915 DOI: 10.1186/s12978-023-01716-7] [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: 08/18/2023] [Accepted: 11/10/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Preterm birth is a significant contributor to newborns morbidity and mortality. Despite the availability of highly effective and powerful interventions, the burden of preterm birth has not decreased. Given the relevance of the topic to clinical decision-making, strong conclusive and supporting evidence emanating from the umbrella review is required. To this end, this umbrella review study sought to determine the association between intimate partner violence and obstetrics characteristics of women with preterm birth in Ethiopia. METHODS Six systematic review and meta-analysis studies searched across multiple databases were included in this umbrella review. The quality of the included systematic review and meta-analysis studies was evaluated using the Assessment of Multiple Systematic Reviews (AMSTAR-2) checklist. STATA version 18 was used for the statistical analysis. A random-effects model was used to calculate the overall effect measurement. RESULTS A total of 114 observational studies in the six systematic review and meta-analysis studies involving 75,624 pregnant women were included in this comprehensive analysis. The preterm birth rate among mothers in Ethiopia was 11% (95% CI 10-13%; I2 = 98.08). Preterm birth was significantly associated with intimate partner violence (POR: 2.32; 95% CI 1.74-2.90), multiple pregnancies (POR: 3.36; 95% CI 2.41-4.32), pregnancy-induced hypertension (POR: 4.13; 95% CI 3.17-5.10), anemia (POR: 2.76; 95% CI 1.97-3.56), and premature rupture of pregnancy (POR: 5.1; 95% CI 3.45-6.75). CONCLUSIONS More than one out of ten pregnant women experienced preterm birth in Ethiopia. Intimate partner violence is significantly associated with preterm birth. Furthermore, multiple pregnancies, pregnancy-induced hypertension, anemia, and premature rupture of the membrane were significant predictors of preterm birth. Therefore, policymakers should consider further instigations and implementations of policies and strategies closely related to reductions of intimate partner violence. It is also crucial to the early identification and treatment of high-risk pregnancies.
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Affiliation(s)
- Addis Eyeberu
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
| | - Addisu Alemu
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Adera Debella
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Ibsa Mussa
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Smith Hughes C, Butrick E, Namutundu J, Olwanda E, Otieno P, Waiswa P, Walker D, Kahn JG. Cost analysis of an intrapartum quality improvement package for improving preterm survival and reinforcing best practices in Kenya and Uganda. PLoS One 2023; 18:e0287309. [PMID: 37352149 PMCID: PMC10289453 DOI: 10.1371/journal.pone.0287309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 06/02/2023] [Indexed: 06/25/2023] Open
Abstract
INTRODUCTION Preterm birth is a leading cause of under-5 mortality, with the greatest burden in lower-resource settings. Strategies to improve preterm survival have been tested, but strategy costs are less understood. We estimate costs of a highly effective Preterm Birth Initiative (PTBi) intrapartum intervention package (data strengthening, WHO Safe Childbirth Checklist, simulation and team training, quality improvement collaboratives) and active control (data strengthening, Safe Childbirth Checklist). METHODS In our analysis, we estimated costs incremental to current cost of intrapartum care (in 2020 $US) for the PTBi intervention package and active control in Kenya and Uganda. We costed the intervention package and control in two scenarios: 1) non-research implementation costs as observed in the PTBi study (Scenario 1, mix of public and private inputs), and 2) hypothetical costs for a model of implementation into Ministry of Health programming (Scenario 2, mostly public inputs). Using a healthcare system perspective, we employed micro-costing of personnel, supplies, physical space, and travel, including 3 sequential phases: program planning/adaptation (9 months); high-intensity implementation (15 months); lower-intensity maintenance (annual). One-way sensitivity analyses explored the effects of uncertainty in Scenario 2. RESULTS Scenario 1 PTBi package total costs were $1.11M in Kenya ($48.13/birth) and $0.74M in Uganda ($17.19/birtth). Scenario 2 total costs were $0.86M in Kenya ($23.91/birth) and $0.28M in Uganda ($5.47/birth); annual maintenance phase costs per birth were $16.36 in Kenya and $3.47 in Uganda. In each scenario and country, personnel made up at least 72% of total PTBi package costs. Total Scenario 2 costs in Uganda were consistently one-third those of Kenya, largely driven by differences in facility delivery volume and personnel salaries. CONCLUSIONS If taken up and implemented, the PTBi package has the potential to save preterm lives, with potential steady-state (maintenance) costs that would be roughly 5-15% of total per-birth healthcare costs in Uganda and Kenya.
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Affiliation(s)
- Carolyn Smith Hughes
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Elizabeth Butrick
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, United States of America
| | | | | | | | - Peter Waiswa
- School of Public Health, Makerere University, Kampala, Uganda
| | - Dilys Walker
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - James G. Kahn
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, United States of America
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Sullivan KS, Richardson S, Ross A, Cederbaum JA, Pflieger J, Abramovitz L, Bukowinski A, Stander V. Pre- and Perinatal Risk Factors for Child Maltreatment in Military Families Across the First Two Years of Life. CHILD MALTREATMENT 2023; 28:209-220. [PMID: 35427204 DOI: 10.1177/10775595221088198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Military families are exposed to a unique constellation of risk factors, which may impact maltreatment outcomes. The present study examined prospective relationships between demographic, health, birth-related, and military-specific risk factors identified prior to a child's birth on their risk for maltreatment in the first two years of life. Data from the Millennium Cohort Study, Department of Defense (DoD) operational records and Family Advocacy Program data on met-criteria maltreatment, and Birth and Infant Health Research program data on suspected maltreatment were linked for 9076 service member parents. Discrete time survival analysis showed that preterm birth increased risk of maltreatment while parents' older age, physical health, and service in the Navy or Air Force decreased risk. Building on DoD's New Parent Support Program, findings suggest the need for universal and targeted prevention efforts, beginning during pregnancy, which limit or eliminate risk factors for maltreatment in military families.
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Affiliation(s)
| | - Sabrina Richardson
- Leidos, Inc., San Diego, CA, USA
- Center for Deployment Health Research, 115252Naval Health Research Center, San Diego, CA, USA
| | - Abigail Ross
- Graduate School of Social Service, 5923Fordham University, New York, NY, USA
| | - Julie A Cederbaum
- Suzanne Dworak-Peck School of Social Work, 5116University of Southern California, Los Angeles, CA, USA
| | - Jacqueline Pflieger
- Leidos, Inc., San Diego, CA, USA
- Center for Deployment Health Research, 115252Naval Health Research Center, San Diego, CA, USA
| | - Lisa Abramovitz
- Leidos, Inc., San Diego, CA, USA
- Center for Deployment Health Research, 115252Naval Health Research Center, San Diego, CA, USA
| | - Anna Bukowinski
- Leidos, Inc., San Diego, CA, USA
- Center for Deployment Health Research, 115252Naval Health Research Center, San Diego, CA, USA
| | - Valerie Stander
- Center for Deployment Health Research, 115252Naval Health Research Center, San Diego, CA, USA
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Xiao L, Feng J, Zhang W, Pan J, Wang M, Zhang C, Li L, Su X, Yao P. Autism-like behavior of murine offspring induced by prenatal exposure to progestin is associated with gastrointestinal dysfunction due to claudin-1 suppression. FEBS J 2023. [PMID: 36855792 DOI: 10.1111/febs.16761] [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: 09/20/2022] [Revised: 01/06/2023] [Accepted: 02/23/2023] [Indexed: 03/02/2023]
Abstract
Autism spectrum disorders (ASD) are associated with the contribution of many prenatal risk factors; in particular, the sex hormone progestin and vitamin D receptor (VDR) are associated with gastrointestinal (GI) symptoms in ASD development, although the related mechanism remains unclear. We investigated the possible role and mechanism of progestin 17-hydroxyprogesterone caproate (17-OHPC) exposure-induced GI dysfunction and autism-like behaviours (ALB) in mouse offspring. An intestine-specific VDR-deficient mouse model was established for prenatal treatment, while transplantation of haematopoietic stem cells (HSCT) with related gene manipulation was used for postnatal treatment for 17-OHPC exposure-induced GI dysfunction and ALB in mouse offspring. The in vivo mouse experiments found that VDR deficiency mimics prenatal 17-OHPC exposure-mediated GI dysfunction, but has no effect on 17-OHPC-mediated autism-like behaviours (ALB) in mouse offspring. Furthermore, prenatal 17-OHPC exposure induces CLDN1 suppression in intestine epithelial cells, and transplantation of HSCT with CLDN1 expression ameliorates prenatal 17-OHPC exposure-mediated GI dysfunction, but has no effect on 17-OHPC-mediated ALB in offspring. In conclusion, prenatal 17-OHPC exposure triggers GI dysfunction in autism-like mouse offspring via CLDN1 suppression, providing a possible explanation for the involvement of CLDN1 and VDR in prenatal 17-OHPC exposure-mediated GI dysfunction with ASD.
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Affiliation(s)
- Li Xiao
- Department of Pediatrics, Affiliated Foshan Maternity & Child Healthcare Hospital, The Second School of Clinical Medicine of Southern Medical University, Foshan, China
| | - Jianqing Feng
- Hainan Women and Children's Medical Center, Haikou, China
| | - Wanhua Zhang
- Department of Pediatrics, Affiliated Foshan Maternity & Child Healthcare Hospital, The Second School of Clinical Medicine of Southern Medical University, Foshan, China
| | - Jie Pan
- Hainan Women and Children's Medical Center, Haikou, China
| | - Min Wang
- Hainan Women and Children's Medical Center, Haikou, China
| | - Cheng Zhang
- College of Liberal Arts and Sciences, Long Island University (Post), Brookville, NY, USA
| | - Ling Li
- Hainan Women and Children's Medical Center, Haikou, China
| | - Xi Su
- Department of Pediatrics, Affiliated Foshan Maternity & Child Healthcare Hospital, The Second School of Clinical Medicine of Southern Medical University, Foshan, China
| | - Paul Yao
- Department of Pediatrics, Affiliated Foshan Maternity & Child Healthcare Hospital, The Second School of Clinical Medicine of Southern Medical University, Foshan, China.,Hainan Women and Children's Medical Center, Haikou, China
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11
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Garite TJ, Manuck TA. Should case management be considered a component of obstetrical interventions for pregnancies at risk of preterm birth? Am J Obstet Gynecol 2022; 228:430-437. [PMID: 36130634 PMCID: PMC10024643 DOI: 10.1016/j.ajog.2022.09.022] [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: 02/16/2022] [Revised: 08/11/2022] [Accepted: 09/14/2022] [Indexed: 11/24/2022]
Abstract
Preterm birth remains the leading cause of morbidity and mortality among nonanomalous neonates in the United States. Unfortunately, preterm birth rates remain high despite current medical interventions such as progestogen supplementation and cerclage placement. Case management, which encompasses coordinated care aimed at providing a more comprehensive and supportive environment, is a key component in improving health and reducing costs in other areas of medicine. However, it has not made its way into the general lexicon and practice of obstetrical care. Case management intended for decreasing prematurity or ameliorating its consequences may include specialty clinics, social services, coordination of specialty services such as nutrition counseling, home visits or frequent phone calls by specially trained personnel, and other elements described herein. It is not currently included in nor is it advocated for as a recommended prematurity prevention approach in the American College of Obstetricians and Gynecologists or Society for Maternal-Fetal Medicine guidelines for medically indicated or spontaneous preterm birth prevention. Our review of existing evidence finds consistent reductions or trends toward reductions in preterm birth with case management, particularly among individuals with high a priori risk of preterm birth across systematic reviews, metaanalyses, and randomized controlled studies. These findings suggest that case management has substantial potential to improve the environmental, behavioral, social, and psychological factors with patients at risk of preterm birth.
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Affiliation(s)
- Thomas J Garite
- Sera Prognostics, Salt Lake City, UT; University of California Irvine, Irvine, CA.
| | - Tracy A Manuck
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, The University of North Carolina at Chapel Hill, Chapel Hill, NC; Institute for Environmental Health Solutions, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC
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12
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Dunleavy JEM, Dinh DT, Filby CE, Green E, Hofstee P, Pini T, Rivers N, Skerrett-Byrne DA, Wijayarathna R, Winstanley YE, Zhou W, Richani D. Reproductive biology research down under: highlights from the Australian and New Zealand Annual Meeting of the Society for Reproductive Biology, 2021. Reprod Fertil Dev 2022; 34:855-866. [PMID: 35836362 DOI: 10.1071/rd22115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 06/17/2022] [Indexed: 11/23/2022] Open
Abstract
Against the backdrop of a global pandemic, the Society for Reproductive Biology (SRB) 2021 meeting reunited the Australian and New Zealand reproductive research community for the first time since 2019 and was the first virtual SRB meeting. Despite the recent global research disruptions, the conference revealed significant advancements in reproductive research, the importance of which span human health, agriculture, and conservation. A core theme was novel technologies, including the use of medical microrobots for therapeutic and sperm delivery, diagnostic hyperspectral imaging, and hydrogel condoms with potential beyond contraception. The importance of challenging the contraceptive status quo was further highlighted with innovations in gene therapies, non-hormonal female contraceptives, epigenetic semen analysis, and in applying evolutionary theory to suppress pest population reproduction. How best to support pregnancies, particularly in the context of global trends of increasing maternal age, was also discussed, with several promising therapies for improved outcomes in assisted reproductive technology, pre-eclampsia, and pre-term birth prevention. The unique insights gained via non-model species was another key focus and presented research emphasised the importance of studying diverse systems to understand fundamental aspects of reproductive biology and evolution. Finally, the meeting highlighted how to effectively translate reproductive research into policy and industry practice.
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Affiliation(s)
- Jessica E M Dunleavy
- School of BioSciences, Faculty of Science, The University of Melbourne, Parkville, Vic. 3010, Australia
| | - Doan Thao Dinh
- Robinson Research Institute, School of Biomedicine, Faculty of Health Sciences, The University of Adelaide, Adelaide, SA 5006, Australia
| | - Caitlin E Filby
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Vic. 3168, Australia; and Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Clayton, Vic. 3168, Australia
| | - Ella Green
- Robinson Research Institute and Adelaide Medical School, The University of Adelaide, Adelaide, SA 5006, Australia
| | - Pierre Hofstee
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Taylor Pini
- School of Veterinary Science, The University of Queensland, Gatton, Qld 4343, Australia
| | - Nicola Rivers
- Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Clayton, Vic. 3168, Australia
| | - David A Skerrett-Byrne
- School of Environmental and Life Sciences, College of Engineering, Science and Environment, The University of Newcastle, Callaghan, NSW 2308, Australia; and Infertility and Reproduction Research Program, Hunter Medical Research Institute, New Lambton, NSW 2305, Australia
| | - Rukmali Wijayarathna
- Centre for Reproductive Health, Hudson Institute of Medical Research, Clayton, Vic. 3168, Australia; and Department of Molecular and Translational Sciences, School of Clinical Sciences, Monash University, Clayton, Vic. 3800, Australia
| | - Yasmyn E Winstanley
- Robinson Research Institute, School of Biomedicine, Faculty of Health Sciences, The University of Adelaide, Adelaide, SA 5006, Australia
| | - Wei Zhou
- Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Vic. 3010, Australia; and Gynaecology Research Centre, Royal Women's Hospital, Parkville, Vic. 3052, Australia
| | - Dulama Richani
- Fertility & Research Centre, School of Women's and Children's Health, University of New South Wales, Sydney, NSW 2031, Australia
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13
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Understanding and Reducing Persistent Racial Disparities in Preterm Birth: a Model of Stress-Induced Developmental Plasticity. Reprod Sci 2022; 29:2051-2059. [PMID: 35298790 DOI: 10.1007/s43032-022-00903-4] [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: 11/27/2021] [Accepted: 02/27/2022] [Indexed: 10/18/2022]
Abstract
Preterm birth is a leading cause of neonatal mortality and is characterized by substantial racial disparities in the US. Despite efforts to reduce preterm birth, rates have risen and racial disparities persist. Maternal stress is a risk factor for preterm birth; however, often, it is treated as a secondary variable rather than a primary target for intervention. Stress is known to affect several biological processes leading to downstream sequelae. Here, we present a model of stress-induced developmental plasticity where maternal stress is a key environmental cue impacting the length of gestation and therefore a primary target for intervention. Black women experience disproportionate and unique maternal stressors related to perceived racism and discrimination. It is therefore not surprising that Black women have disproportionate rates of preterm birth. The downstream effects of racism on preterm birth pathophysiology may reflect an appropriate response to stressors through the highly conserved maternal-fetal-placental neuroendocrine stress axis. This environmentally sensitive system mediates both maternal stress and the timing of birth and is a mechanism by which developmental plasticity occurs. Fortunately, stress does not appear to be an all-or-none variable. Evidence suggests that developmental plasticity is dynamic, functioning on a continuum. Therefore, simple, stress-reducing interventions that support pregnant women may tangibly reduce rates of preterm birth and improve birth outcomes for all women, particularly Black women.
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14
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Pedretti MK, Doherty DA, Dickinson JE. The perceptions of obstetric care providers about cervical length screening for preterm birth prevention. Aust N Z J Obstet Gynaecol 2022; 62:650-657. [PMID: 35285013 DOI: 10.1111/ajo.13514] [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: 10/02/2021] [Accepted: 02/25/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Routine cervical length (CL) measurement at the mid-pregnancy ultrasound is a central recommendation of the Western Australian Preterm Birth Prevention Initiative (Initiative). AIM To evaluate the perceptions and changes in practice of Western Australian obstetric care providers regarding routine CL screening for preterm birth (PTB) prevention following the Initiative introduction. METHODS Two self-administered questionnaires were completed by providers from a range of practices. The first was during site visits with the Initiative Outreach team in 2015-2016. The questionnaire was re-issued in 2021 via online dissemination. Participant demographic data and opinions on CL screening for PTB prevention were collected. RESULTS Two hundred and fourteen providers participated in 2015-2016 and 109 in 2021. In both surveys, providers were more likely to discuss transvaginal CL screening with high-risk women (48.1%, 76.1%; P < 0.001) compared with low-risk (7.5%, 18.3%; P = 0.002) and the importance of CL screening (13.5%, 40.4%; P < 0.001), in 2015-2016 and 2021, respectively. Responses relating to CL screening, including what constitutes a short cervix on ultrasound were varied. A transabdominal CL <35 mm was classified as short by 46.2% and 37.6% and <25 mm on transvaginal ultrasound by 49.1% and 64.2%, in the respective surveys. Most providers ceased progesterone (68.6%, 75.2%) at >28 weeks gestation. CONCLUSIONS Providers focused on women with overt PTB risk factors, rather than a universal CL screening approach. Although there was improvement between the surveys, the definition of what constitutes a short cervix on ultrasound and how to treat and monitor women with a short CL remained varied.
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Affiliation(s)
- Michelle K Pedretti
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia.,Department of Ultrasound, King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Dorota A Doherty
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia.,Women and Infants Research Foundation (WIRF), Perth, Western Australia, Australia
| | - Jan E Dickinson
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
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15
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Ghelichkhani S, Masoumi SZ, Shirzadeh AA, Khazaei S, Shahbazi F. Evaluation of maternal risk factors for preterm delivery in Fatemieh Hospital of Hamadan, Iran, 2019: A case-control study. J Family Med Prim Care 2021; 10:3832-3837. [PMID: 34934688 PMCID: PMC8653452 DOI: 10.4103/jfmpc.jfmpc_1032_21] [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: 02/21/2021] [Revised: 04/15/2021] [Accepted: 07/30/2021] [Indexed: 11/04/2022] Open
Abstract
Background The present study aimed to evaluate maternal risk factors of preterm delivery in Fatemieh Hospital in Hamadan, Iran, 2019. Methods In this case-control study, 7,478 hospital files of live-born neonates and their mothers in Hamadan Fatemieh Hospital in 2019 were examined. According to statistical estimates, 261 preterm deliveries and 736 term deliveries were studied. Information files of neonates and mothers were used to complete the study questionnaire. The data were compared in two separate groups and logistic regression was performed to estimate the crude relationship between demographic and clinical characteristics of term and preterm delivery. Results The mean age of women was 27.89 ± 6.48 years. Analysis of data revealed that academic education (OR: 2.02, P = 0.014), age group 25-34 years (OR: 1.5, P = 0.016), age of 35 years and above (OR: 1.66, P = 0.018), previous history of preterm delivery (OR: 5.3, P < 0.001), history of abortion (OR: 1.67, P = 0.004), history of surgery (OR: 1.54, P = 0.007), history of infertility (P = 0.016), and a history of cesarean (OR: 2.11, P < 0.001) were potentially associated with a higher odds of preterm delivery (P < 0.2). Conclusion Based on the results, it is important to identify potential risk factors of preterm delivery in mothers and corrective interventions in strengthening consultation and education of pregnant women during pregnancy. Such a measure helps select the type of delivery and strengthen prenatal care in identifying mothers in high-risk groups and performing timely interventions.
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Affiliation(s)
- Samereh Ghelichkhani
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Seyedeh Zahra Masoumi
- Department of Midwifery and Reproductive Health, Mother and Child Care Research Center, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Azam Ali Shirzadeh
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Salman Khazaei
- Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Fatemeh Shahbazi
- Department of Epidemiology and Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
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16
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Mukhopadhyay S, Underwood MA. Phenotyping preterm infants at birth to predict infection risk. Pediatr Res 2021; 90:508-509. [PMID: 34099853 DOI: 10.1038/s41390-021-01603-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 03/31/2021] [Accepted: 05/24/2021] [Indexed: 01/29/2023]
Affiliation(s)
- Sagori Mukhopadhyay
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA. .,Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Mark A Underwood
- Division of Neonatology, Department of Pediatrics, University of California, Davis School of Medicine, Sacramento, CA, USA
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17
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Rocha TAH, de Thomaz EBAF, de Almeida DG, da Silva NC, Queiroz RCDS, Andrade L, Facchini LA, Sartori MLL, Costa DB, Campos MAG, da Silva AAM, Staton C, Vissoci JRN. Data-driven risk stratification for preterm birth in Brazil: a population-based study to develop of a machine learning risk assessment approach. LANCET REGIONAL HEALTH. AMERICAS 2021; 3:100053. [PMID: 36777406 PMCID: PMC9904131 DOI: 10.1016/j.lana.2021.100053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 08/01/2021] [Accepted: 08/03/2021] [Indexed: 10/20/2022]
Abstract
Background Preterm birth (PTB) is a growing health issue worldwide, currently considered the leading cause of newborn deaths. To address this challenge, the present work aims to develop an algorithm capable of accurately predicting the week of delivery supporting the identification of a PTB in Brazil. Methods This a population-based study analyzing data from 3,876,666 mothers with live births distributed across the 3,929 Brazilian municipalities. Using indicators comprising delivery characteristics, primary care work processes, and physical infrastructure, and sociodemographic data we applied a machine learning-based approach to estimate the week of delivery at the point of care level. We tested six algorithms: eXtreme Gradient Boosting, Elastic Net, Quantile Ordinal Regression - LASSO, Linear Regression, Ridge Regression and Decision Tree. We used the root-mean-square error (RMSE) as a precision. Findings All models obtained RMSE indexes close to each other. The lower levels of RMSE were obtained using the eXtreme Gradient Boosting approach which was able to estimate the week of delivery within a 2.09 window 95%IC (2.090-2.097). The five most important variables to predict the week of delivery were: number of previous deliveries through Cesarean-Section, number of prenatal consultations, age of the mother, existence of ultrasound exam available in the care network, and proportion of primary care teams in the municipality registering the oral care consultation. Interpretation Using simple data describing the prenatal care offered, as well as minimal characteristics of the pregnant, our approach was capable of achieving a relevant predictive performance regarding the week of delivery. Funding Bill and Melinda Gates Foundation, and National Council for Scientific and Technological Development - Brazil, (Conselho Nacional de Desenvolvimento Científico e Tecnológico - CNPQ acronym in portuguese) Support of the research project named: Data-Driven Risk Stratification for Preterm Birth in Brazil: Development of a Machine Learning-Based Innovation for Health Care- Grant: OPP1202186.
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Affiliation(s)
- Thiago Augusto Hernandes Rocha
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America,Corresponding author: Thiago Augusto Hernandes Rocha, Duke University
| | | | | | - Núbia Cristina da Silva
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | | | - Luciano Andrade
- Department of Nursing, State University of the West of Parana, Foz do Iguaçu, Parana, Brazil
| | - Luiz Augusto Facchini
- Department of Social Medicine, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | | | - Dalton Breno Costa
- The Federal University of Health Sciences of Porto Alegre. Porto Alegre, Rio Grande do Sul, Brazil
| | | | | | - Catherine Staton
- Duke Emergency Medicine, Duke University Medical Center, Durham, NC USA. Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - João Ricardo Nickenig Vissoci
- Duke Emergency Medicine, Duke University Medical Center, Durham, NC USA. Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
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18
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Hines LA, Spry EA, Moreno-Betancur M, Mohamad Husin H, Becker D, Middleton M, Craig JM, Doyle LW, Olsson CA, Patton G. Cannabis and tobacco use prior to pregnancy and subsequent offspring birth outcomes: a 20-year intergenerational prospective cohort study. Sci Rep 2021; 11:16826. [PMID: 34413325 PMCID: PMC8376878 DOI: 10.1038/s41598-021-95460-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/20/2021] [Indexed: 11/15/2022] Open
Abstract
There is increasing evidence that the life-course origins of health and development begin before conception. We examined associations between timing and frequency of preconception cannabis and tobacco use and next generation preterm birth (PTB), low birth weight (LBW) and small for gestational age. 665 participants in a general population cohort were repeatedly assessed on tobacco and cannabis use between ages 14-29 years, before pregnancy. Associations were estimated using logistic regression. Preconception parent (either maternal or paternal) daily cannabis use age 15-17 was associated with sixfold increases in the odds of offspring PTB (aOR 6.65, 95% CI 1.92, 23.09), and offspring LBW (aOR 5.84, 95% CI 1.70-20.08), after adjusting for baseline sociodemographic factors, parent sex, offspring sex, family socioeconomic status, parent mental health at baseline, and concurrent tobacco use. There was little evidence of associations with preconception parental cannabis use at other ages or preconception parental tobacco use. Findings support the hypothesis that the early life origins of growth begin before conception and provide a compelling rationale for prevention of frequent use during adolescence. This is pertinent given liberalisation of cannabis policy.
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Affiliation(s)
- Lindsey A Hines
- Centre for Academic Mental Health, Population Health Sciences Institute, University of Bristol, Bristol, UK.
- MRC Integrative Epidemiology Unit, Population Health Sciences Institute, University of Bristol, Bristol, UK.
| | - Elizabeth A Spry
- Centre for Social and Early Emotional Development, Faculty of Health, Deakin University, Melbourne, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Australia
| | - Margarita Moreno-Betancur
- University of Melbourne, Melbourne, Australia
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Australia
| | - Hanafi Mohamad Husin
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Australia
| | - Denise Becker
- Biostatistics Unit, Faculty of Health, Deakin University, Melbourne, Australia
| | - Melissa Middleton
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Australia
| | - Jeffrey M Craig
- Centre for Molecular and Medical Research, Deakin University School of Medicine, Geelong, Australia
| | - Lex W Doyle
- Department of Obstetrics and Gynaecology, The Royal Women's Hospital, University of Melbourne, Melbourne, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paedatrics, University of Melbourne, Melbourne, Australia
| | - Craig A Olsson
- Centre for Social and Early Emotional Development, Faculty of Health, Deakin University, Melbourne, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Australia
| | - George Patton
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Australia
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19
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Zhang Y, Xu C, Tang Z, Guo D, Yao R, Zhao H, Chen Z, Ni X. Furin is involved in uterine activation for labor. FASEB J 2021; 35:e21565. [PMID: 33864414 DOI: 10.1096/fj.202002128rr] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 12/21/2022]
Abstract
The uterus undergoes distinct molecular and functional changes during pregnancy and parturition. These processes are associated with the dramatic changes in various proteins. Given that the maturation and activation of many proteins require proteolytic processing by proprotein convertases (PCs), we sought to explore the role of PCs in uterine activation for labor. First, we found that furin was the most dramatically increased PC member in myometrial tissues from the pregnant women after onset of labor at term. Using the model of cultured human myometrial smooth muscle cells (HMSMCs), we showed that furin inhibitor CMK, D6R treatment and furin siRNA transfection suppressed contractility. Inhibition of furin activity or interfering furin expression decreased connexin 43 (CX43), prostaglandin (PG) endoperoxide synthase-2 (COX-2) and PGF2α receptor (FP) expression and NF-κB activation. In mouse model, administration of furin inhibitors prolonged gestational length. However, D6R treatment did not affect RU38486- and lipopolysaccharides (LPS)-induced preterm birth. Furthermore, D6R and furin siRNA treatment reduced the release of soluble form of tumor necrosis factor (TNF)-related weak inducer of apoptosis (TWEAK), while furin overexpression led to an increase in soluble TWEAK release in cultured HMSMCs. D6R treatment decreased TWEAK level in blood of pregnant mice. TWEAK treatment promoted contractility and NF-κB activation, while TWEAK receptor fibroblast growth factor-inducible 14 (FN14) antagonist treatment inhibited contractility and NF-κB activation in HMSMCs. In pregnant mice, administration of FN14 antagonist prolonged gestational length. Our data suggest that furin can act as a stimulator for uterine activation for labor at term. TWEAK is one of the potential substrates which mediate furin regulation of parturition initiation.
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Affiliation(s)
- Youyi Zhang
- Department of Gynecology and Obstetrics, Research Center for Molecular Metabolomics, Xiangya Hospital Central South University, Changsha, China.,Department of Physiology, Second Military Medical University, Shanghai, China.,Department of Gynecology and Obstetrics, General Hospital of Western Theater Command of PLA, Chengdu, China
| | - Chen Xu
- Department of Physiology and Pathophysiology, Shanghai Medical School of Fundan University, Shanghai, China
| | - Zhengshan Tang
- Department of Gynecology and Obstetrics, Research Center for Molecular Metabolomics, Xiangya Hospital Central South University, Changsha, China
| | - Dewei Guo
- Department of Gynecology and Obstetrics, Research Center for Molecular Metabolomics, Xiangya Hospital Central South University, Changsha, China
| | - Ruojin Yao
- Department of Gynecology and Obstetrics, Research Center for Molecular Metabolomics, Xiangya Hospital Central South University, Changsha, China
| | - Huina Zhao
- Department of Gynecology and Obstetrics, Changhai Hospital, Shanghai, China.,Department of Gynecology and Obstetrics, Shanghai Seventh People's Hospital, Shanghai, China
| | - Zixi Chen
- Department of Physiology, Second Military Medical University, Shanghai, China
| | - Xin Ni
- Department of Gynecology and Obstetrics, Research Center for Molecular Metabolomics, Xiangya Hospital Central South University, Changsha, China.,Department of Physiology, Second Military Medical University, Shanghai, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital Central South University, Changsha, China
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20
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The amniotic fluid cell-free transcriptome in spontaneous preterm labor. Sci Rep 2021; 11:13481. [PMID: 34188072 PMCID: PMC8242007 DOI: 10.1038/s41598-021-92439-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 06/03/2021] [Indexed: 02/03/2023] Open
Abstract
The amniotic fluid (AF) cell-free RNA was shown to reflect physiological and pathological processes in pregnancy, but its value in the prediction of spontaneous preterm delivery is unknown. Herein we profiled cell-free RNA in AF samples collected from women who underwent transabdominal amniocentesis after an episode of spontaneous preterm labor and subsequently delivered within 24 h (n = 10) or later (n = 28) in gestation. Expression of known placental single-cell RNA-Seq signatures was quantified in AF cell-free RNA and compared between the groups. Random forest models were applied to predict time-to-delivery after amniocentesis. There were 2385 genes differentially expressed in AF samples of women who delivered within 24 h of amniocentesis compared to gestational age-matched samples from women who delivered after 24 h of amniocentesis. Genes with cell-free RNA changes were associated with immune and inflammatory processes related to the onset of labor, and the expression of placental single-cell RNA-Seq signatures of immune cells was increased with imminent delivery. AF transcriptomic prediction models captured these effects and predicted delivery within 24 h of amniocentesis (AUROC = 0.81). These results may inform the development of biomarkers for spontaneous preterm birth.
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21
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Adane AA, Bailey HD, Marriott R, Farrant BM, White SW, Shepherd CCJ. Disparities in severe neonatal morbidity and mortality between Aboriginal and non-Aboriginal births in Western Australia: a decomposition analysis. J Epidemiol Community Health 2021; 75:1187-1194. [PMID: 34006585 DOI: 10.1136/jech-2020-214507] [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: 05/06/2020] [Revised: 05/05/2021] [Accepted: 05/08/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND The health disadvantages faced by Australian Aboriginal peoples are evidenced in early life, although few studies have focused on the reasons for population-level inequalities in more severe adverse outcomes. This study aimed to examine the scale of disparity in severe neonatal morbidity (SNM) and mortality between Aboriginal and non-Aboriginal births and quantify the relative contributions of important maternal and infant factors. METHOD A retrospective cohort study with singleton live births (≥32 weeks' gestation) was conducted using Western Australia linked whole population datasets, from 1999 to 2015. Aboriginal status was determined based on the mothers' self-reported ethnic origin. An Australian validated indicator was adapted to identify neonates with SNM. The Oaxaca-Blinder method was employed to calculate the contribution of each maternal and infant factor to the disparity in SNM and mortality. RESULTS Analyses included 425 070 births, with 15 967 (3.8%) SNM and mortality cases. The disparity in SNM and mortality between Aboriginal and non-Aboriginal births was 2.9 percentage points (95% CI 2.6 to 3.2). About 71% of this gap was explained by differences in modelled factors including maternal area of residence (23.8%), gestational age (22.2%), maternal age (7.5%) and antenatal smoking (7.2%). CONCLUSIONS There is a considerable disparity in SNM and mortality between Aboriginal and non-Aboriginal births in Western Australia with the majority of this related to differences in maternal sociodemographic factors, antenatal smoking and gestational age. Public health programmes targeting these factors may contribute to a reduction in early life health differentials and benefit Aboriginal population health through the life course.
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Affiliation(s)
- Akilew A Adane
- Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia .,Ngangk Yira Research Centre for Aboriginal Health and Social Equity, Murdoch University, Murdoch, Western Australia, Australia
| | - Helen D Bailey
- Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Rhonda Marriott
- Ngangk Yira Research Centre for Aboriginal Health and Social Equity, Murdoch University, Murdoch, Western Australia, Australia
| | - Brad M Farrant
- Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Scott W White
- Division of Obstetrics and Gynaecology, The University of Western Australia, Nedlands, Western Australia, Australia.,Maternal Fetal Medicine Service, King Edward Memorial Hospital for Women Perth, Subiaco, Western Australia, Australia
| | - Carrington C J Shepherd
- Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia.,Ngangk Yira Research Centre for Aboriginal Health and Social Equity, Murdoch University, Murdoch, Western Australia, Australia.,Curtin Medical School, Curtin University, Bentley, Western Australia, Australia
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22
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Paes LS, Carvalho FH, Araujo Júnior E, Feitosa HN. Assessment of morbidity and mortality in newborns with late prematurity: experience of a reference maternity in the northeast of Brazil. Minerva Obstet Gynecol 2021; 74:270-278. [PMID: 33876899 DOI: 10.23736/s2724-606x.21.04734-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Late preterm infants show high rates of adverse perinatal outcomes. The aim of this study is to assess the morbidity and mortality of newborns (NBs) with late preterm birth in a reference maternity hospital in northeastern Brazil. METHODS Retrospective cohort study from March 1 to July 15, 2017. A total of 204 NBs with gestational age between 34 and 36 weeks and six days were evaluated and compared to 205 full-term NBs (39 and 40 weeks and six days). Perinatal outcomes including neonatal morbidity were evaluated. The Student's t and ANOVA tests were used for normal variables, and the Wilcoxon, Mann-Whitney and Kruskal-Wallis tests for non-normal variables. RESULTS Late preterm infants showed significant higher rates of hypothermia, hypoglycemia, respiratory distress syndrome, jaundice in need of phototherapy (67.6%), admission to the neonatal intensive care unit (ICU), and difficulty breastfeeding compared to full-term NBs (p<0.001). Respiratory distress was the main indication for the admission of late preterm infants (p<0.001) to neonatal ICU. Late preterm infants had a longer hospital stay (6.9 vs. 3.7 days, p<0.001). There were three deaths in the group of late preterm NBs, and none in the group of term NBs. CONCLUSIONS Late preterm NBs presented higher rates of morbidity and mortality when compared to full-term NBs.
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Affiliation(s)
- Liliana S Paes
- Department of Maternal and Child Health, Federal University of Ceará (UFC), Fortaleza-CE, Brazil
| | - Francisco H Carvalho
- Department of Maternal and Child Health, Federal University of Ceará (UFC), Fortaleza-CE, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil -
| | - Helvécio N Feitosa
- Department of Maternal and Child Health, Federal University of Ceará (UFC), Fortaleza-CE, Brazil
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23
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Orefice R, Smythe J, Doherty DA, Lim B. Preventing early births in a regional tertiary maternity unit: Evaluating preterm and early term birth rates before and after implementation of the Preterm Birth Prevention Initiative in the Australian Capital Territory. Aust N Z J Obstet Gynaecol 2021; 61:693-699. [PMID: 33759176 DOI: 10.1111/ajo.13328] [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: 07/28/2020] [Accepted: 02/03/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND A multifaceted preterm birth (PTB) prevention initiative was launched in the Australian Capital Territory (ACT) in 2019. The aim of this initiative was to safely lower the rate of early births across the ACT and the surrounding areas in New South Wales. Modelled on the Western Australian PTB Prevention Initiative, the program included new clinical guidelines and a new PTB prevention clinic at the main tertiary hospital. AIM To evaluate the initiative and its effects on preterm and early term birth rates at the main tertiary hospital after 16 months of implementation. MATERIALS AND METHODS A before and after intervention study was conducted. Rates of preterm and early term birth before (previous five years) and after 16 months of implementation of the ACT PTB Prevention Initiative were evaluated. RESULTS At the main tertiary hospital in The Canberra Hospital, the rate of PTB was significantly reduced by 10% after 16 months of implementation of the initiative. Rates of PTB were lower than any of the preceding five years and resulted in 45 averted or delayed PTBs. The number of planned early term births with no medical indication was significantly reduced by 34.5% and resulted in 77 averted or delayed early term births. CONCLUSIONS The multifaceted PTB Prevention Initiative safely lowered the rates of early birth in the ACT context. These results highlight the importance of prioritising early birth prevention, education, research and expanding the initiative nationwide.
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Affiliation(s)
- Roberto Orefice
- Centenary Hospital for Women and Children, Canberra Health Services, Canberra, Australian Capital Territory, Australia.,Australian National University, Canberra, Australian Capital Territory, Australia
| | - Julia Smythe
- Centenary Hospital for Women and Children, Canberra Health Services, Canberra, Australian Capital Territory, Australia
| | - Dorota A Doherty
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
| | - Boon Lim
- Centenary Hospital for Women and Children, Canberra Health Services, Canberra, Australian Capital Territory, Australia.,Australian National University, Canberra, Australian Capital Territory, Australia
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24
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Egesa WI, Odoch S, Odong RJ, Nakalema G, Asiimwe D, Ekuk E, Twesigemukama S, Turyasiima M, Lokengama RK, Waibi WM, Abdirashid S, Kajoba D, Kumbakulu PK. Germinal Matrix-Intraventricular Hemorrhage: A Tale of Preterm Infants. Int J Pediatr 2021; 2021:6622598. [PMID: 33815512 PMCID: PMC7987455 DOI: 10.1155/2021/6622598] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 02/26/2021] [Indexed: 12/15/2022] Open
Abstract
Germinal matrix-intraventricular hemorrhage (GM-IVH) is a common intracranial complication in preterm infants, especially those born before 32 weeks of gestation and very-low-birth-weight infants. Hemorrhage originates in the fragile capillary network of the subependymal germinal matrix of the developing brain and may disrupt the ependymal lining and progress into the lateral cerebral ventricle. GM-IVH is associated with increased mortality and abnormal neurodevelopmental outcomes such as posthemorrhagic hydrocephalus, cerebral palsy, epilepsy, severe cognitive impairment, and visual and hearing impairment. Most affected neonates are asymptomatic, and thus, diagnosis is usually made using real-time transfontanellar ultrasound. The present review provides a synopsis of the pathogenesis, grading, incidence, risk factors, and diagnosis of GM-IVH in preterm neonates. We explore brief literature related to outcomes, management interventions, and pharmacological and nonpharmacological prevention strategies for GM-IVH and posthemorrhagic hydrocephalus.
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Affiliation(s)
- Walufu Ivan Egesa
- Department of Paediatrics and Child Health, Faculty of Clinical Medicine and Dentistry, Kampala International University, Uganda
| | - Simon Odoch
- Department of Paediatrics and Child Health, Faculty of Clinical Medicine and Dentistry, Kampala International University, Uganda
| | - Richard Justin Odong
- Department of Paediatrics and Child Health, Faculty of Clinical Medicine and Dentistry, Kampala International University, Uganda
| | - Gloria Nakalema
- Department of Paediatrics and Child Health, Faculty of Clinical Medicine and Dentistry, Kampala International University, Uganda
| | - Daniel Asiimwe
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University, Uganda
| | - Eddymond Ekuk
- Department of Surgery, Faculty of Medicine, Mbarara University of Science and Technology, Uganda
| | - Sabinah Twesigemukama
- Department of Paediatrics and Child Health, Faculty of Clinical Medicine and Dentistry, Kampala International University, Uganda
| | - Munanura Turyasiima
- Department of Paediatrics and Child Health, Faculty of Clinical Medicine and Dentistry, Kampala International University, Uganda
| | - Rachel Kwambele Lokengama
- Department of Paediatrics and Child Health, Faculty of Clinical Medicine and Dentistry, Kampala International University, Uganda
| | - William Mugowa Waibi
- Department of Paediatrics and Child Health, Faculty of Clinical Medicine and Dentistry, Kampala International University, Uganda
| | - Said Abdirashid
- Department of Paediatrics and Child Health, Faculty of Clinical Medicine and Dentistry, Kampala International University, Uganda
| | - Dickson Kajoba
- Department of Paediatrics and Child Health, Faculty of Clinical Medicine and Dentistry, Kampala International University, Uganda
| | - Patrick Kumbowi Kumbakulu
- Department of Paediatrics and Child Health, Faculty of Clinical Medicine and Dentistry, Kampala International University, Uganda
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25
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Eleje GU, Eke AC, Ikechebelu JI, Ezebialu IU, Okam PC, Ilika CP. Cervical stitch (cerclage) in combination with other treatments for preventing spontaneous preterm birth in singleton pregnancies. Cochrane Database Syst Rev 2020; 9:CD012871. [PMID: 32970845 PMCID: PMC8094629 DOI: 10.1002/14651858.cd012871.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Preterm birth (PTB) remains the foremost global cause of perinatal morbidity and mortality. Thus, the prevention of spontaneous PTB still remains of critical importance. In an attempt to prevent PTB in singleton pregnancies, cervical cerclage, in combination with other treatments, has been advocated. This is because, cervical cerclage is an intervention that is commonly recommended in women with a short cervix at high risk of preterm birth but, despite this, many women still deliver prematurely, as the biological mechanism is incompletely understood. Additionally, previous Cochrane Reviews have been published on the effectiveness of cervical cerclage in singleton and multiple pregnancies, however, none has evaluated the effectiveness of using cervical cerclage in combination with other treatments. OBJECTIVES To assess whether antibiotics administration, vaginal pessary, reinforcing or second cerclage placement, tocolytic, progesterone, or other interventions at the time of cervical cerclage placement prolong singleton gestation in women at high risk of pregnancy loss based on prior history and/or ultrasound finding of 'short cervix' and/or physical examination. History-indicated cerclage is defined as a cerclage placed usually between 12 and 15 weeks gestation based solely on poor prior obstetrical history, e.g. multiple second trimester losses due to painless dilatation. Ultrasound-indicated cerclage is defined as a cerclage placed usually between 16 and 23 weeks gestation for transvaginal ultrasound cervical length < 20 mm in a woman without cervical dilatation. Physical exam-indicated cerclage is defined as a cerclage placed usually between 16 and 23 weeks gestation because of cervical dilatation of one or more centimetres detected on physical (manual) examination. SEARCH METHODS We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP) (26 September 2019), and reference lists of retrieved studies. SELECTION CRITERIA We included published, unpublished or ongoing randomised controlled trial (RCTs). Studies using a cluster-RCT design were also eligible for inclusion in this review but none were identified. We excluded quasi-RCTs (e.g. those randomised by date of birth or hospital number) and studies using a cross-over design. We also excluded studies that specified addition of the combination therapy after cervical cerclage because the woman subsequently became symptomatic. We included studies comparing cervical cerclage in combination with one, two or more interventions with cervical cerclage alone in singleton pregnancies. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles and abstracts of all retrieved articles, selected studies for inclusion, extracted data, assessed risk of bias, and evaluated the certainty of the evidence for this review's main outcomes. Data were checked for accuracy. Standard Cochrane review methods were used throughout. MAIN RESULTS We identified two studies (involving a total of 73 women) comparing cervical cerclage alone to a different comparator. We also identified three ongoing studies (one investigating vaginal progesterone after cerclage, and two investigating cerclage plus pessary). One study (20 women), conducted in the UK, comparing cervical cerclage in combination with a tocolytic (salbutamol) with cervical cerclage alone in women with singleton pregnancy did not provide any useable data for this review. The other study (involving 53 women, with data from 50 women) took place in the USA and compared cervical cerclage in combination with a tocolytic (indomethacin) and antibiotics (cefazolin or clindamycin) versus cervical cerclage alone - this study did provide useable data for this review (and the study authors also provided additional data on request) but meta-analyses were not possible. This study was generally at a low risk of bias, apart from issues relating to blinding. We downgraded the certainty of evidence for serious risk of bias and imprecision (few participants, few events and wide 95% confidence intervals). Cervical cerclage in combination with an antibiotic and tocolytic versus cervical cerclage alone (one study, 50 women/babies) We are unclear about the effect of cervical cerclage in combination with antibiotics and a tocolytic compared with cervical cerclage alone on the risk of serious neonatal morbidity (RR 0.62, 95% CI 0.31 to 1.24; very low-certainty evidence); perinatal loss (data for miscarriage and stillbirth only - data not available for neonatal death) (RR 0.46, 95% CI 0.13 to 1.64; very low-certainty evidence) or preterm birth < 34 completed weeks of pregnancy (RR 0.78, 95% CI 0.44 to 1.40; very low-certainty evidence). There were no stillbirths (intrauterine death at 24 or more weeks). The trial authors did not report on the numbers of babies discharged home healthy (without obvious pathology) or on the risk of neonatal death. AUTHORS' CONCLUSIONS Currently, there is insufficient evidence to evaluate the effect of combining a tocolytic (indomethacin) and antibiotics (cefazolin/clindamycin) with cervical cerclage compared with cervical cerclage alone for preventing spontaneous PTB in women with singleton pregnancies. Future studies should recruit sufficient numbers of women to provide meaningful results and should measure neonatal death and numbers of babies discharged home healthy, as well as other important outcomes listed in this review. We did not identify any studies looking at other treatments in combination with cervical cerclage. Future research needs to focus on the role of other interventions such as vaginal support pessary, reinforcing or second cervical cerclage placement, 17-alpha-hydroxyprogesterone caproate or dydrogesterone or vaginal micronised progesterone, omega-3 long chain polyunsaturated fatty acid supplementation and bed rest.
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Affiliation(s)
- George U Eleje
- Effective Care Research Unit, Department of Obstetrics and Gynaecology, Faculty of Medicine, College of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus, PMB 5001, Nnewi, Nigeria
| | - Ahizechukwu C Eke
- Division of Maternal Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Joseph I Ikechebelu
- Department of Obstetrics/Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
| | - Ifeanyichukwu U Ezebialu
- Department of Obstetrics and Gynaecology, Faculty of Clinical medicine, College of Medicine, Anambra State University Amaku, Awka, Nigeria
| | - Princeston C Okam
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
| | - Chito P Ilika
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
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26
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Ghosh C, Wojtowycz M. Effect of gestational disorders on preterm birth, low birthweight, and NICU admission. Arch Gynecol Obstet 2020; 303:419-426. [PMID: 32897400 DOI: 10.1007/s00404-020-05760-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 08/24/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Many modifiable maternal behaviors and experiences before and during pregnancy are associated with adverse health outcomes. The relationship between a number of maternal and gestational disorders and perinatal outcomes (preterm birth, low birth weight and neonatal intensive care unit (NICU)) admission in the Central New York population is determined using the Statewide Perinatal Data System, in a retrospective population-based cohort study. METHODS Singleton births excluding newborns with congenital anomalies among 165,739 women between 2004 and 2012 are included in this study. Multivariable logistic regression analysis is used to estimate odds ratios (OR) and 95% confidence intervals (CI) adjusted for maternal age, race, education, employment, parity, body mass index, smoking, drug use, depression, abortions, gender of child, prenatal care, and hospital level. RESULTS Previous preterm birth and vaginal bleeding are independent high-risk factors for all three perinatal outcomes, pre-pregnancy diabetes (OR 4.95, 95% CI 4.34, 5.64) for preterm birth and (OR 7.45, 95% CI 6.58, 8.44) for NICU admission; and gestational hypertension (OR 4.35, 95% CI 4.03, 4.70) for low birth weight. Among infections, bacterial vaginosis is retained in the multivariable model as a risk factor for preterm and low birth weight while hepatitis C is a risk factor for NICU admission. CONCLUSIONS Our findings suggest the continued importance of addressing the need to provide preconception and inter conception care for women since many modifiable risk factors are correlated and need to be addressed well before the woman becomes pregnant.
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Affiliation(s)
- Chaitali Ghosh
- Department of Mathematics, SUNY College At Buffalo, A257 Buckham Hall, 1300 Elmwood Avenue, Buffalo, NY, 14222, USA.
- Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, 766 Irving Avenue, Syracuse, NY, 13210, USA.
| | - Martha Wojtowycz
- Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, 766 Irving Avenue, Syracuse, NY, 13210, USA
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27
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Vitner D, Barrett J, Katherine W, White SW, Newnham JP. Community-based, population-focused preterm birth prevention programs - a review. Arch Gynecol Obstet 2020; 302:1317-1328. [PMID: 32875346 DOI: 10.1007/s00404-020-05759-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 08/24/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Preterm birth (PTB) is the leading cause of perinatal morbidity and mortality worldwide. Being born too early contributes to approximately 70% of neonatal mortality and approximately half of long-term neurodevelopmental disabilities. Various PTB prevention programs have been described going back more than 30 years, and some have described possible success in decreasing the rate of PTB. In addition, there are also PTB prenatal care clinics in many parts of the world, each with the singular goal of reducing the PTB rate in their region. Interventions can be directed at all women for primary prevention and reducing the risk of PTB or used to mitigate risk in women identified to be at increased risk. METHODS A Medline and ClinicalTrials.gov ( www.clinicaltrials.gov ) search was performed (1982-2018), using preterm birth prevention program as the primary medical subject heading, reporting randomized clinical trials, quasi-experimental trials, and analytic studies (including retrospective and prospective cohort studies). We also searched Google for preterm birth prevention programs and prenatal care clinics published on-line. RESULTS Some prevention programs have reported success in lowering rates of PTB, principally using historical controls although the majority were not followed by improved outcomes. CONCLUSION Increasing knowledge and the use of social media to enhance education should now enable greater effectiveness of new programs. Development of regional and national PTB prevention programs should now be considered.
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Affiliation(s)
- Dana Vitner
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. .,Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
| | - Jon Barrett
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,Alliance for the Prevention of Preterm Birth and Stillbirth, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Wendy Katherine
- Alliance for the Prevention of Preterm Birth and Stillbirth, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Scott W White
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
| | - John P Newnham
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
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28
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LaBella AL, Abraham A, Pichkar Y, Fong SL, Zhang G, Muglia LJ, Abbot P, Rokas A, Capra JA. Accounting for diverse evolutionary forces reveals mosaic patterns of selection on human preterm birth loci. Nat Commun 2020; 11:3731. [PMID: 32709900 PMCID: PMC7382462 DOI: 10.1038/s41467-020-17258-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 06/19/2020] [Indexed: 02/02/2023] Open
Abstract
Currently, there is no comprehensive framework to evaluate the evolutionary forces acting on genomic regions associated with human complex traits and contextualize the relationship between evolution and molecular function. Here, we develop an approach to test for signatures of diverse evolutionary forces on trait-associated genomic regions. We apply our method to regions associated with spontaneous preterm birth (sPTB), a complex disorder of global health concern. We find that sPTB-associated regions harbor diverse evolutionary signatures including conservation, excess population differentiation, accelerated evolution, and balanced polymorphism. Furthermore, we integrate evolutionary context with molecular evidence to hypothesize how these regions contribute to sPTB risk. Finally, we observe enrichment in signatures of diverse evolutionary forces in sPTB-associated regions compared to genomic background. By quantifying multiple evolutionary forces acting on sPTB-associated regions, our approach improves understanding of both functional roles and the mosaic of evolutionary forces acting on loci. Our work provides a blueprint for investigating evolutionary pressures on complex traits.
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Affiliation(s)
- Abigail L LaBella
- Department of Biological Sciences, Vanderbilt University, Nashville, TN, 37235, USA
| | - Abin Abraham
- Vanderbilt Genetics Institute, Vanderbilt University, Nashville, TN, 37235, USA
- Vanderbilt University Medical Center, Vanderbilt University, Nashville, TN, 37232, USA
| | - Yakov Pichkar
- Department of Biological Sciences, Vanderbilt University, Nashville, TN, 37235, USA
| | - Sarah L Fong
- Vanderbilt Genetics Institute, Vanderbilt University, Nashville, TN, 37235, USA
| | - Ge Zhang
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
- The Center for Prevention of Preterm Birth, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
- March of Dimes Prematurity Research Center Ohio Collaborative, Cincinnati, OH, 45267, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, 45267, USA
| | - Louis J Muglia
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
- The Center for Prevention of Preterm Birth, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
- March of Dimes Prematurity Research Center Ohio Collaborative, Cincinnati, OH, 45267, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, 45267, USA
| | - Patrick Abbot
- Department of Biological Sciences, Vanderbilt University, Nashville, TN, 37235, USA
| | - Antonis Rokas
- Department of Biological Sciences, Vanderbilt University, Nashville, TN, 37235, USA.
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN, 37235, USA.
| | - John A Capra
- Department of Biological Sciences, Vanderbilt University, Nashville, TN, 37235, USA.
- Departments of Biomedical Informatics and Computer Science, Vanderbilt Genetics Institute, Center for Structural Biology, Vanderbilt University, Nashville, TN, 37235, USA.
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29
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Pervin J, Rahman SM, Rahman M, Aktar S, Rahman A. Association between antenatal care visit and preterm birth: a cohort study in rural Bangladesh. BMJ Open 2020; 10:e036699. [PMID: 32709651 PMCID: PMC7380851 DOI: 10.1136/bmjopen-2019-036699] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Strengthening the antenatal care programme is suggested as one of the public health strategies to reduce preterm birth burden at a population level. However, the evidence so far available is inconclusive. OBJECTIVES To evaluate the association between antenatal care (ANC) visit and preterm birth; and also to explore to what extent the increased usage of ANC after the initiation of the Maternal, Neonatal and Child Health (MNCH) project in Matlab, Bangladesh, contributed to the reduction of preterm birth. SETTING This population-based cohort study was conducted in Matlab, a subdistrict under Chandpur. The analysis was based on data collected from 2005 to 2009. In 2007, an MNCH project was initiated in the area that strengthened the ongoing ANC services. PARTICIPANTS In total, 12 980 live births with their mothers during the study period were included in the analysis. ANALYSIS We performed logistic regression with generalised estimating equation models to evaluate the associations. OUTCOME MEASURES Preterm birth. RESULTS The number of ANC visits was associated with preterm birth in a dose-dependent way (p for linear trend <0.001). The adjusted odds of preterm birth were 2.4-times higher (OR 2.37, 95% CI 2.07 to 2.70) among women who received ≤1 ANC compared with women who received ≥3 ANC. We observed a significant reduction of preterm birth rates (OR 0.69, 95% CI 0.61 to 0.77) in the period after (2008 to 2009) MNCH project initiation in comparison to the period before (2005 to 2006). Controlling for ANC visits substantially attenuated this observed effect of the MNCH project on preterm birth (OR 0.88, 95% CI 0.77 to 0.99) (Sobel test of mediation p<0.001). CONCLUSIONS ANC visits are associated with decreased occurrences of preterm births. Strengthening the ANC services should be prioritised in countries with high preterm birth rates to reduce the preterm birth burden at the population level.
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Affiliation(s)
- Jesmin Pervin
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Syed Moshfiqur Rahman
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - 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
| | - Anisur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
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30
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Choi SJ, Kwak DW, Kil K, Kim SC, Kwon JY, Kim YH, Na S, Bae JG, Cha HH, Shim JY, Oh KY, Lee KA, Kim SM, Cho IA, Lee SM, Cho GJ, Jo YS, Choi GY, Choi SK, Hur SE, Hwang HS, Kim YJ. Vaginal compared with intramuscular progestogen for preventing preterm birth in high-risk pregnant women (VICTORIA study): a multicentre, open-label randomised trial and meta-analysis. BJOG 2020; 127:1646-1654. [PMID: 32536019 DOI: 10.1111/1471-0528.16365] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare the efficacy of two types of progestogen therapy for preventing preterm birth (PTB) and to review the relevant literature. DESIGN A multicentre, randomised, open-label, equivalence trial and a meta-analysis. SETTING Tertiary referral hospitals in South Korea. POPULATION Pregnant women with a history of spontaneous PTB or short cervical length (<25 mm). METHODS Eligible women were screened and randomised at 16-22 weeks of gestation to receive either 200 mg of vaginal micronised progesterone daily (vaginal group) or an intramuscular injection of 250 mg 17α-hydroxyprogesterone caproate weekly (IM group). Stratified randomisation was carried out according to participating centres and indications for progestogen therapy. This trial was registered at ClinicalTrials.gov (NCT02304237). MAIN OUTCOME MEASURE Preterm birth (PTB) before 37 weeks of gestation. RESULTS A total of 266 women were randomly assigned and a total of 247 women (119 and 128 women in the vaginal and IM groups, respectively) were available for the intention-to-treat analysis. Risks of PTB before 37 weeks of gestation did not significantly differ between the two groups (22.7 versus 25.8%, P = 0.571). The difference in PTB risk between the two groups was 3.1% (95% CI -7.6 to 13.8%), which was within the equivalence margin of 15%. The meta-analysis results showed no significant differences in the risk of PTB between the vaginal and IM progestogen treatments. CONCLUSION Compared with vaginal progesterone, treatment with intramuscular progestin might increase the risk of PTB before 37 weeks of gestation by as much as 13.8%, or reduce the risk by as much as 7.6%, in women with a history of spontaneous PTB or with short cervical length. TWEETABLE ABSTRACT Vaginal and intramuscular progestogen showed equivalent efficacy for preventing preterm birth before 37 weeks of gestation.
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Affiliation(s)
- S-J Choi
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - D W Kwak
- Ajou University School of Medicine, Suwon, Korea
| | - K Kil
- Yeouido St Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - S-C Kim
- Pusan National University College of Medicine, Pusan, Korea
| | - J-Y Kwon
- Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Y H Kim
- Chonnam National University Medical School, Gwangju, Korea
| | - S Na
- Kangwon National University Hospital, School of Medicine Kangwon National University, Chuncheon, Korea
| | - J-G Bae
- Keimyung University School of Medicine, Daegu, Korea
| | - H-H Cha
- Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - J-Y Shim
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - K Y Oh
- School of Medicine, Eulji University, Daejeon, Korea
| | - K A Lee
- Kyung Hee University School of Medicine, Seoul, Korea
| | - S M Kim
- Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - I A Cho
- Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - S M Lee
- Seoul National University College of Medicine, Seoul, Korea
| | - G J Cho
- Korea University College of Medicine, Seoul, Korea
| | - Y S Jo
- St Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - G Y Choi
- Soonchunhyang University Seoul Hospital, College of Medicine, Soonchunhyang University, Seoul, Korea
| | - S K Choi
- College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - S E Hur
- Konyang University Hospital, Daejeon, Korea
| | - H S Hwang
- Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea
| | - Y J Kim
- College of Medicine, Ewha Womans University, Seoul, Korea
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Newnham JP, White SW, Lee HS, Arrese CA, Watts JC, Pedretti MK, Dickinson JE, Doherty DA. The elements of success in a comprehensive state-wide program to safely reduce the rate of preterm birth. PLoS One 2020; 15:e0234033. [PMID: 32497072 PMCID: PMC7272053 DOI: 10.1371/journal.pone.0234033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 05/18/2020] [Indexed: 11/18/2022] Open
Abstract
Background In 2014, a whole-of-population and multi-faceted preterm birth prevention program was introduced in Western Australia with the single aim of safely lowering the rate of preterm birth. The program included new clinical guidelines, print and social media, and a dedicated new clinic. In the first full calendar year the rate of preterm birth fell by 7.6% and the reduction extended from the 28–31 week gestational age group upwards. Objective The objective of this study was to evaluate outcomes in greater depth and to also include the first three years of the program. Study design This was a prospective population-based cohort study of perinatal outcomes in singleton pregnancies before and after commencement of the program. Results There was a significant reduction in preterm birth in the tertiary center which extended from 28 weeks gestation onwards and was ongoing. In non-tertiary centers there was an initial reduction, but this was not sustained past the first year. The greatest reduction was observed in pregnancies classified at first attendance as low risk. No benefit was observed in the private sector, but a significant reduction was seen in the remote region of the Kimberley where the program was first launched and vaginal progesterone had been made free-of-charge. Conclusion Preterm birth rates can be safely reduced by a multi-faceted and whole-of-population program but the effectiveness requires continuing effort and will be greatest where the strategies are most targeted.
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Affiliation(s)
- John P Newnham
- Maternal Fetal Medicine Service, King Edward Memorial Hospital, Perth, Western Australia, Australia.,Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
| | - Scott W White
- Maternal Fetal Medicine Service, King Edward Memorial Hospital, Perth, Western Australia, Australia.,Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
| | - Han-Shin Lee
- Maternal Fetal Medicine Service, King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Catherine A Arrese
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
| | - Jared C Watts
- Department of Obstetrics and Gynaecology, WA Country Health Service, Kimberley, Western Australia, Australia.,Rural Clinical School of Western Australia, The University of Western Australia, Broome, Western Australia, Australia
| | - Michelle K Pedretti
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia.,Department of Ultrasound, King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Jan E Dickinson
- Maternal Fetal Medicine Service, King Edward Memorial Hospital, Perth, Western Australia, Australia.,Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
| | - Dorota A Doherty
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
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Batura R, Colbourn T. A stitch in time: narrative review of interventions to reduce preterm births in Malawi. Int Health 2020; 12:213-221. [PMID: 31867622 PMCID: PMC7320425 DOI: 10.1093/inthealth/ihz101] [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: 08/06/2019] [Revised: 08/14/2019] [Accepted: 12/16/2019] [Indexed: 11/13/2022] Open
Abstract
Background The rising rate of preterm births (PTBs) is a global concern, and Malawi has a high rate of PTBs (10.5%). The resulting neonatal and under-5 mortality, morbidity and lifelong disability represent a significant loss of human potential affecting individuals, families and society as a whole. This study aims to review the literature to determine the risk factors for PTB in Malawi and to identify effective interventions to prevent PTBs. Methods A literature search yielded 22 studies that were categorized according to risk factors implicated for PTBs and health interventions to reduce the risks. Results The study has shown that maternal pregnancy factors, infections, nutrition, anaemia and young maternal age are the main causes and risk factors of PTBs in Malawi. The literature revealed no evidence of community-based interventions for reducing the rates of PTBs in Malawi. Conclusions Any successful effort to reduce the rate of PTBs will require a multisector, multilevel strategy targeted at the community, homes and individuals as a package to improve the education, nutrition and reproductive health of girls and women as well as focus on improving the delivery of antenatal services in the community.
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Affiliation(s)
- Rekha Batura
- UCL Institute for Global Health, 30 Guilford Street, London WC1N 1EH, UK
| | - Tim Colbourn
- UCL Institute for Global Health, 30 Guilford Street, London WC1N 1EH, UK
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Adu-Bonsaffoh K, Oppong SA, Dassah ET, Seffah JD. Challenges in preterm birth research: Ghanaian perspective. Placenta 2020; 98:24-28. [PMID: 33039028 DOI: 10.1016/j.placenta.2020.04.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 04/25/2020] [Accepted: 04/27/2020] [Indexed: 01/30/2023]
Abstract
Preterm birth is highly prevalent in Ghana. It is a major public health concern because of the high burden as well as the associated immediate and long-term consequences including increased healthcare cost. Studies conducted in high-income countries may not be sufficiently generalizable in our context. Locally generated evidence-based interventions will be indispensable in improving the clinical management and prevention of preterm birth in the country. However, there are limited published literature on preterm birth and prematurity in the country. This review seeks to discuss the major challenges associated with preterm birth research in Ghana and proposes evidence-based strategies to improve biomedical and epidemiological research on preterm birth and prematurity. The limited high quality preterm birth research is partly attributable to a variety of challenges related to accurate gestational age estimation, research training, capacity and support including funding, efficient ethics committees, local and international collaboration as well as effective health management information systems. Other related challenges include unavailability of reliable internet connectivity, poor compensation for researchers and lack of conductive research environment. There is the need to expedite advocacy on implementation of practical interventions and strategies aimed at increasing high quality research in the area of preterm birth and prematurity in the country. A paradigm shift in preterm birth research with appropriate integration of concerted multidisciplinary research groups should be constituted to put basic science research to clinical practice as well as the prevention of preterm birth in the country.
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Affiliation(s)
- K Adu-Bonsaffoh
- Department of Obstetrics and Gynecology, School of Medicine and Dentistry, University of Ghana, Accra, Ghana.
| | - S A Oppong
- Department of Obstetrics and Gynecology, School of Medicine and Dentistry, University of Ghana, Accra, Ghana
| | - E T Dassah
- School of Public Health, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana; Department of Obstetrics & Gynecology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - J D Seffah
- Department of Obstetrics and Gynecology, School of Medicine and Dentistry, University of Ghana, Accra, Ghana
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Karnati S, Kollikonda S, Abu-Shaweesh J. Late preterm infants - Changing trends and continuing challenges. Int J Pediatr Adolesc Med 2020; 7:36-44. [PMID: 32373701 PMCID: PMC7193066 DOI: 10.1016/j.ijpam.2020.02.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Late preterm infants, defined as newborns born between 340/7-366/7 weeks of gestational age, constitute a unique group among all premature neonates. Often overlooked because of their size when compared to very premature infants, this population is still vulnerable because of physiological and structural immaturity. Comprising nearly 75% of babies born less than 37 weeks of gestation, late preterm infants are at increased risk for morbidities involving nearly every organ system as well as higher risk of mortality when compared to term neonates. Neurodevelopmental impairment has especially been a concern for these infants. Due to various reasons, the rate of late preterm births continue to rise worldwide. Caring for this high risk population contributes a significant financial burden to health systems. This article reviews recent trends in regarding rate of late preterm births, common morbidities and long term outcomes with special attention to neurodevelopmental outcomes.
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Affiliation(s)
- Sreenivas Karnati
- Department of Pediatrics, Cleveland Clinic Children’s, Cleveland, OH, USA
| | - Swapna Kollikonda
- Department of Obstetrics and Gynecology, Women’s Health Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jalal Abu-Shaweesh
- Department of Pediatrics, Cleveland Clinic Children’s, Cleveland, OH, USA
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Impact of erythrocyte long-chain omega-3 polyunsaturated fatty acid levels in early pregnancy on birth outcomes: findings from a Belgian cohort study. J Perinatol 2020; 40:488-496. [PMID: 31913325 DOI: 10.1038/s41372-019-0573-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 11/15/2019] [Accepted: 12/18/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To examine the association between maternal erythrocyte long-chain omega-3 PUFA (n-3 LCPUFA), measured in early pregnancy, and pregnancy and birth outcomes. STUDY DESIGN One hundred and eight healthy women with a singleton pregnancy were included. Erythrocyte fatty acids were analyzed using gas chromatography. Gestational length, birth anthropometric measures, and pregnancy-associated complications were collected from hospital medical records. RESULTS We observed significant positive associations between maternal docosahexaenoic acid (DHA) levels (p = 0.024) and omega-3 index values (p = 0.021) and gestational length in adjusted linear regression models. Each point in maternal DHA level was associated with 2.19 days longer gestational duration (β = 2.19; 95% CI 0.29-4.09). No consistent associations were found between n-3 PUFA levels and composite pregnancy outcome. CONCLUSION These findings suggest that the gestational length is positively affected by maternal n-3 LCPUFA status as soon as the early stages of pregnancy.
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Leow SM, Di Quinzio MKW, Ng ZL, Grant C, Amitay T, Wei Y, Hod M, Sheehan PM, Brennecke SP, Arbel N, Georgiou HM. Preterm birth prediction in asymptomatic women at mid-gestation using a panel of novel protein biomarkers: the Prediction of PreTerm Labor (PPeTaL) study. Am J Obstet Gynecol MFM 2020; 2:100084. [PMID: 33345955 DOI: 10.1016/j.ajogmf.2019.100084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 12/12/2019] [Accepted: 12/23/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Accurate prediction of spontaneous preterm labor/preterm birth in asymptomatic women remains an elusive clinical challenge because of the multi-etiological nature of preterm birth. OBJECTIVE The aim of this study was to develop and validate an immunoassay-based, multi-biomarker test to predict spontaneous preterm birth. MATERIALS AND METHODS This was an observational cohort study of women delivering from December 2017 to February 2019 at 2 maternity hospitals in Melbourne, Australia. Cervicovaginal fluid samples were collected from asymptomatic women at gestational week 16+0-24+0, and biomarker concentrations were quantified by enzyme-linked immunosorbent assay. Women were assigned to a training cohort (n = 136) and a validation cohort (n = 150) based on chronological delivery dates. RESULTS Seven candidate biomarkers representing key pathways in utero-cervical remodeling were discovered by high-throughput bioinformatic search, and their significance in both in vivo and in vitro studies was assessed. Using a combination of the biomarkers for the first 136 women allocated to the training cohort, we developed an algorithm to stratify term birth (n = 124) and spontaneous preterm birth (n = 12) samples with a sensitivity of 100% (95% confidence interval, 76-100%) and a specificity of 74% (95% confidence interval, 66-81%). The algorithm was further validated in a subsequent cohort of 150 women (n = 139 term birth and n = 11 preterm birth), achieving a sensitivity of 91% (95% confidence interval, 62-100%) and a specificity of 78% (95% confidence interval, 70-84%). CONCLUSION We have identified a panel of biomarkers that yield clinically useful diagnostic values when combined in a multiplex algorithm. The early identification of asymptomatic women at risk for preterm birth would allow women to be triaged to specialist clinics for further assessment and appropriate preventive treatment.
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Affiliation(s)
| | - Megan K W Di Quinzio
- Department of Obstetrics and Gynecology University of Melbourne, Australia; Department of Obstetrics and Gynecology, Mercy Hospital for Women, Heidelberg VIC, Australia
| | | | - Claire Grant
- Department of Maternal-Fetal Medicine, Pregnancy Research Centre, Royal Women's Hospital, Parkville VIC, Australia
| | - Tal Amitay
- Carmentix Australia Pty Ltd, Collingwood VIC, Australia
| | | | | | - Penelope M Sheehan
- Department of Obstetrics and Gynecology University of Melbourne, Australia; Department of Maternal-Fetal Medicine, Pregnancy Research Centre, Royal Women's Hospital, Parkville VIC, Australia
| | - Shaun P Brennecke
- Department of Obstetrics and Gynecology University of Melbourne, Australia; Department of Maternal-Fetal Medicine, Pregnancy Research Centre, Royal Women's Hospital, Parkville VIC, Australia
| | - Nir Arbel
- Carmentix Pte Ltd, Singapore; Carmentix Australia Pty Ltd, Collingwood VIC, Australia
| | - Harry M Georgiou
- Department of Obstetrics and Gynecology University of Melbourne, Australia; Department of Obstetrics and Gynecology, Mercy Hospital for Women, Heidelberg VIC, Australia; Department of Maternal-Fetal Medicine, Pregnancy Research Centre, Royal Women's Hospital, Parkville VIC, Australia.
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Egorov V, Rosen T, van Raalte H, Kurtenoks V. Cervical Characterization with Tactile-Ultrasound Probe. OPEN JOURNAL OF OBSTETRICS AND GYNECOLOGY 2020; 10:85-99. [PMID: 32133244 PMCID: PMC7055710 DOI: 10.4236/ojog.2020.101008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Premature cervical softening and shortening may be considered an early mechanical failure that predisposes to preterm birth. Preliminary clinical studies demonstrate that cervical elastography may be able to quantify this phenomenon and predict spontaneous preterm delivery. OBJECTIVE To explore a new approach for cervix elasticity and length measurements with tactile-ultrasound probe. METHODS Cervix probe has tactile array and ultrasound transducer designed to apply controllable load to cervix and acquire stress-strain data for calculation of cervical elasticity (Young's modulus) and cervical length for four cervix sectors. Average values, standard deviations, intraclass correlation coefficients and the 95% limits of agreement (Bland-Altman plots) were estimated. RESULTS Ten non-pregnant and ten pregnant women were examined with the probe. The study with non-pregnant women demonstrated a reliable acquisition of the tactile signals. The ultrasound signals had a prolonged appearance; identification of the internal os of the cervix in these signals was not reliable. The study with pregnant women with the gestational age of 25.4 ± 2.3 weeks demonstrated reliable data acquisition with real-time visualization of the ultrasound signals. Average values for cervical elasticity and standard deviations of 19.7 ± 15.4 kPa and length of 30.7 ± 6.6 mm were calculated based on two measurements per 4 sectors. Measurement repeatability calculated as intraclass correlation coefficients between two measurements at the same cervix sector on pregnant women was found to be 0.97 for cervical elasticity and 0.93 for the cervical length. The 95% limits of agreement of 1) cervical elasticity were from -22.4% to +14.9%, and 2) cervical length from -13.3% to +16.5%. CONCLUSIONS This study demonstrated clinically acceptable measurement performance and reproducibility. The availability of stress-strain data allowed the computation of cervical elasticity and length. This approach has the potential to provide cervical markers to predict spontaneous preterm delivery.
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Affiliation(s)
| | - Todd Rosen
- Department of Obstetrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Kumari S, Garg N, Kumar A, Guru PKI, Ansari S, Anwar S, Singh KP, Kumari P, Mishra PK, Gupta BK, Nehar S, Sharma AK, Raziuddin M, Sohail M. Maternal and severe anaemia in delivering women is associated with risk of preterm and low birth weight: A cross sectional study from Jharkhand, India. One Health 2019; 8:100098. [PMID: 31485474 PMCID: PMC6715890 DOI: 10.1016/j.onehlt.2019.100098] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 07/23/2019] [Accepted: 07/23/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Haemoglobin content is the well accepted indicator for anaemia assessment. The high prevalence of anaemia, maternal health care issues and adverse delivery outcome in Jharkhand, we investigated whether delivering women with anaemia would present a modifiable risk of preterm (PTB) and low birth weight (LBW). METHODS A facility-based cross-sectional study involving pregnant women, with screening for pregnancy endpoints and haemoglobin assay, were conducted. Anaemia was classified according to World Health Organization's definition of anaemia in pregnancy. Confounding variables were adjusted in a logistic model. The adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were used for analyzing the association among maternal anaemia, PTB and LBW. RESULTS We observed a high prevalence of anaemia (78.45%) in delivering women, whereas high prevalence of preterm birth (34.75%) and LBW (32.81%) in delivering women overall. In the adjusted analysis, overall anaemia in pregnancy was strongly associated with preterm birth (OR, 3.42; 95% CI, 1.98-5.88; P ≤ .0001) as compared to LBW (OR, 1.12; 95% CI, 0.65-1.61; P = .0003). The risk of PTB and LBW were dependent on the stratification of the anaemia group, as the strongest association was observed in severe (OR, 4.86) followed by mild (OR, 3.66) and moderate (OR, 3.18) anaemia in PTB; whereas risk of LBW was found in severe (OR, 2.5) followed by moderate (OR, 1.11) and mild (OR, 0.57) anaemia. The risk of PTB and LBW across six pregnancy haemoglobin groups were compared, haemoglobin of 10-10.9 g/dl (OR, 1.25) and ≤ 8 g/dl (OR, 1.03) have shown association with PTB and LBW, respectively. However, high haemoglobin concentration was not associated with either PTB or LBW. CONCLUSIONS Anaemia in delivering women was associated with an elevated risk of PTB and LBW and the risk increased with the severity of anaemia in pregnant women.
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Affiliation(s)
- Shweta Kumari
- Research Laboratory, University Department of Zoology, Vinoba Bhave University, Hazaribag, Jharkhand, India
| | - Neelima Garg
- Centre for Tribal Health and Biotechnology Foundation, New Delhi, India
| | - Amod Kumar
- Research Laboratory, University Department of Zoology, Vinoba Bhave University, Hazaribag, Jharkhand, India
| | - Pawas Kumar Indra Guru
- Research Laboratory, University Department of Zoology, Vinoba Bhave University, Hazaribag, Jharkhand, India
| | - Sharafat Ansari
- Research Laboratory, University Department of Zoology, Vinoba Bhave University, Hazaribag, Jharkhand, India
| | - Shadab Anwar
- SLS, Jawaharlal Nehru University, New-Delhi, India
- Centre for Tribal Health and Biotechnology Foundation, New Delhi, India
| | - Krishn Pratap Singh
- Research Laboratory, University Department of Zoology, Vinoba Bhave University, Hazaribag, Jharkhand, India
- Centre for Tribal Health and Biotechnology Foundation, New Delhi, India
| | - Priti Kumari
- Research Laboratory, University Department of Zoology, Vinoba Bhave University, Hazaribag, Jharkhand, India
- Centre for Tribal Health and Biotechnology Foundation, New Delhi, India
| | - Prashant Kumar Mishra
- University Department of Biotechnology, Vinoba Bhave University, Hazaribag, Jharkhand, India
| | - Birendra Kumar Gupta
- Research Laboratory, University Department of Zoology, Vinoba Bhave University, Hazaribag, Jharkhand, India
| | - Shamshun Nehar
- Department of Zoology, Ranchi University, Ranchi, Jharkhand, India
| | - Ajay Kumar Sharma
- Research Laboratory, University Department of Zoology, Vinoba Bhave University, Hazaribag, Jharkhand, India
| | - Mohammad Raziuddin
- Research Laboratory, University Department of Zoology, Vinoba Bhave University, Hazaribag, Jharkhand, India
| | - Mohammad Sohail
- Research Laboratory, University Department of Zoology, Vinoba Bhave University, Hazaribag, Jharkhand, India
- Centre for Tribal Health and Biotechnology Foundation, New Delhi, India
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Stewart DL, Barfield WD. Updates on an At-Risk Population: Late-Preterm and Early-Term Infants. Pediatrics 2019; 144:peds.2019-2760. [PMID: 31636141 DOI: 10.1542/peds.2019-2760] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The American Academy of Pediatrics published a clinical report on late-preterm (LPT) infants in 2007 that was largely based on a summary of a 2005 workshop convened by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, at which a change in terminology from "near term" to "late preterm" was proposed. This paradigm-shifting recommendation had a remarkable impact: federal agencies (the Centers for Disease Control and Prevention), professional societies (the American Academy of Pediatrics and American College of Obstetricians and Gynecologists), and organizations (March of Dimes) initiated nationwide monitoring and educational plans that had a significant effect on decreasing the rates of iatrogenic LPT deliveries. However, there is now an evolving concern. After nearly a decade of steady decreases in the LPT birth rate that largely contributed to the decline in total US preterm birth rates, the birth rate in LPT infants has been inching upward since 2015. In addition, evidence revealed by strong population health research demonstrates that being born as an early-term infant poses a significant risk to an infant's survival, growth, and development. In this report, we summarize the initial progress and discuss the potential reasons for the current trends in LPT and early-term birth rates and propose research recommendations.
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Affiliation(s)
- Dan L Stewart
- School of Medicine, University of Louisville, Louisville, Kentucky; and
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Pillay T. Parent-Carer Education: Reducing the Risks for Neonatal and Infant Mortality. NEONATAL MEDICINE 2019. [DOI: 10.5772/intechopen.82786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Abstract
Rates of bronchopulmonary dysplasia (BPD) are increasing. After preterm birth, there are important developmental periods in which neonates are more vulnerable to stressful events. These periods are opportunities for pharmacologic interventions. Many drugs remain inadequately tested and no new drugs have been approved in more than 25 years for BPD prevention or therapy. More progress is needed in defining appropriate end points based on the pathophysiology of BPD and postdischarge chronic pulmonary insufficiency of prematurity and to develop effective new drugs. In addition, much work is needed to better define perinatal factors, early postnatal findings, and physiologic phenotypes or endotypes.
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Hobel CJ, Dolan SM, Hindoyan NA, Zhong N, Menon R. History of the establishment of the Preterm Birth international collaborative (PREBIC). Placenta 2019; 79:3-20. [PMID: 31047707 DOI: 10.1016/j.placenta.2019.03.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 03/16/2019] [Accepted: 03/20/2019] [Indexed: 01/25/2023]
Abstract
INTRODUCTION The primary aim of PREBIC is to assess the underlying mechanisms and developing strategies for preterm birth (PTB) prevention. MATERIALS AND METHODS We used concept mapping and logic models to track goals. This paper reviews our progress over 13 years using working group activities, research developments, guest speakers, and publications. RESULTS Using interactions between genetics, environment, and behaviors we identified complex interactions between biological systems. PREBIC determined that epidemiology and biomarkers should be an initial focus. In 2005, we initiated presentations by young investigators, yearly satellite meetings, working groups including nutrition and inflammation, assessment of clinical trials, and accepted an invitation by the WHO to begin yearly meetings in Geneva. DISCUSSION PREBIC used epidemiology to identify PTB factors and complex pathways. Candidate genes are associated with the environment, behavior (stress), obesity, inflammation and insulin resistance. Epigenetic changes and production of proteins can be used as biomarkers to define risk. Subsequently, we found risk factors for PTB that were also associated with the risk of cardiovascular disease (CVD) of the mother. Tanz et al. (2017) found that a history of PTB is independently predictive of CVD later in life and suggested that a modest proportion of PTB-CVD association was accounted by CVD risk factors, many of which have been identified in this paper. CONCLUSION Our findings support a relationship between genes, environment, behaviors and risk of CVD in women. The next several years must assess which factors are modifiable early in life and before pregnancy to prevent PTB.
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Affiliation(s)
- Calvin J Hobel
- Departments of OB/GYN & Pediatrics, Cedars-Sinai Medical Center, 8635 West 3rd St. Suite 160W, Los Angeles, CA, 90048, USA; David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, 90095-1740, USA.
| | - Siobhan M Dolan
- Department of Obstetrics & Gynecology and Women's Health, Montefiore Medical Center/Albert Einstein College of Medicine, 1695 Eastchester Road Suite 301, Bronx, NY, 10461, USA.
| | - Niree A Hindoyan
- Department of Medicine, Cedars-Sinai Medical Center, 8730 Alden Drive Room W215, Los Angeles, CA, 90048, USA.
| | - Nanbert Zhong
- Developmental Genetics Laboratory, Department of Human Genetics, New York State Institute for Basic Research in Developmental Disabilities, 1050 Forest Hill Road, Staten Island, NY, 10314, USA.
| | - Ramkumar Menon
- Department of Obstetrics and Gynecology, Maternal-Fetal Medicine, Perinatal Research Division, University of Texas Medical Branch MRB 11.138, 301 University Blvd, Galveston, TX, 7755-1062, USA.
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Hart R. Generational Health Impact of PCOS on Women and their Children. Med Sci (Basel) 2019; 7:medsci7030049. [PMID: 30889922 PMCID: PMC6473601 DOI: 10.3390/medsci7030049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 03/08/2019] [Accepted: 03/12/2019] [Indexed: 12/28/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is a metabolic disorder with reproductive consequences. Hence, the synergy of the dual maternal challenges of difficulties with conception, set on a background of metabolic disorder and inflammation, understandably leads to increased obstetric risk for the woman. Furthermore, she is more likely than her peers to require assistance with conception, either through induction of ovulation with the attendant risk of a multiple gestation, or in vitro fertilization (IVF) with its recognized increased obstetric risk for woman and her child. The increased obstetric risk for a woman with PCOS is manifested with an increased rate of miscarriage, gestational diabetes, hypertensive disorder and premature delivery. These obstetric complications are due to impairment of placental function, systemic inflammation and metabolic disorder and are markers for the woman herself of her predisposition to cardiometabolic disorder in later life. Consequently, it is inevitable that this environment may induce changes in the fetus during pregnancy, leading to an intergenerational risk from maternal PCOS.
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Affiliation(s)
- Roger Hart
- Division of Obstetrics and Gynaecology, Medical School, University of Western Australia, Perth, WA 6008, Australia.
- Fertility Specialists of Western Australia, Bethesda Hospital, 25 Queenslea Drive, Claremont, WA 6010, Australia.
- Division of Obstetrics & Gynaecology, King Edward Memorial Hospital, Subiaco, Perth, WA 6008, Australia.
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Mulualem G, Wondim A, Woretaw A. The effect of pregnancy induced hypertension and multiple pregnancies on preterm birth in Ethiopia: a systematic review and meta-analysis. BMC Res Notes 2019; 12:91. [PMID: 30777132 PMCID: PMC6380048 DOI: 10.1186/s13104-019-4128-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 02/11/2019] [Indexed: 11/15/2022] Open
Abstract
Objective This systematic review and meta-analysis aimed to estimate the overall pooled prevalence of preterm birth and the effect of pregnancy induced hypertension (PIH) and multiple pregnancies on preterm birth in Ethiopia. Result A total of 9 studies with 27,119 participants were included in this systematic review and meta-analysis. The pooled prevalence of preterm birth among mothers who gave births in Ethiopia was found to be 13.32% (95% CI = 7.99, 18.660). Preterm birth was found to be higher among mothers who had pregnancy induced hypertension with odds ratio of 4.69 (95% CI = 2.32, 9.49) and multiple pregnancy with odds ratio of 2.40 (95% CI = 1.06, 5.45) as compared to the counterparts. In subgroup analysis by region, the prevalence of preterm birth was found to be 12.63% (95% CI = 3.26, 22) in Amhara and 10.18% (95% CI = 6.04, 14.32) in Oromia region. Electronic supplementary material The online version of this article (10.1186/s13104-019-4128-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Getaneh Mulualem
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, P.O.BOX: 196, Gondar, Ethiopia.
| | - Amare Wondim
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, P.O.BOX: 196, Gondar, Ethiopia
| | - Abere Woretaw
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, P.O.BOX: 196, Gondar, Ethiopia
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Development of a mucoinert progesterone nanosuspension for safer and more effective prevention of preterm birth. J Control Release 2019; 295:74-86. [PMID: 30597245 PMCID: PMC6398330 DOI: 10.1016/j.jconrel.2018.12.046] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 12/19/2018] [Accepted: 12/27/2018] [Indexed: 02/03/2023]
Abstract
Preterm birth (PTB) is a significant global problem, but few therapeutic options exist. Vaginal progesterone supplementation has been demonstrated to reduce PTB rates in women with a sonographic short cervix, yet there has been little investigation into the most effective dose or delivery form. Further, vaginal products like progesterone gel often contain excipients that cause local toxicity, irritation, and leakage. Here, we describe the development and characterization of a mucoinert vaginal progesterone nanosuspension formulation for improved drug delivery to the female reproductive tract. We compare the pharmacokinetics and pharmacodynamics to the clinical comparator progesterone gel in pregnant mice and demonstrate increased vaginal absorption and biodistribution via the uterine first-pass effect. Importantly, the unique plasma progesterone double peak observed in humans, reflecting recirculation from the uterus, was also observed in pregnant mice with vaginal dosing. We adapted a mouse model of progesterone withdrawal that was previously believed to be incompatible with testing the efficacy of exogenous progestins, and are first to demonstrate efficacy in preventing preterm birth with vaginal progesterone in this model. Further, improved vaginal progesterone delivery by the nanosuspension led to increased efficacy in PTB prevention. Additionally, we identified histological and transcriptional evidence of cervical and uterine toxicity with a single vaginal administration of the clinical gel that are absent after dosing with the mucoinert nanosuspension formulation. We demonstrate that a progesterone formulation that is designed for improved vaginal progesterone absorption and vaginal biocompatibility could be more effective for PTB prevention.
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Garry DJ, Baker DA, Persad MD, Peresleni T, Kocis C, Demishev M. Progesterone effects on vaginal cytokines in women with a history of preterm birth. PLoS One 2018; 13:e0209346. [PMID: 30596707 PMCID: PMC6312274 DOI: 10.1371/journal.pone.0209346] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 12/04/2018] [Indexed: 11/24/2022] Open
Abstract
Objective To determine the effect of intramuscular progesterone on the vaginal immune response of pregnant women with a history of prior preterm birth. Methods A prospective, cohort study of women at 11–16 weeks gestation, ≥18 years of age, and carrying a singleton pregnancy was conducted from June 2016 to August 2017 after IRB approval. Women in the progesterone arm had a history of preterm birth and received weekly intramuscular 17-hydroxyprogesterone caproate. Controls comprised of women with healthy, uncomplicated pregnancies. Excluded were women with vaginitis, diabetes mellitus, hypertension, or other chronic diseases affecting the immune response. A vaginal wash was performed at enrollment, at 26–28 weeks, and at 35–36 weeks gestation. Samples underwent semi-quantitative detection of human inflammatory markers. Immunofluorescence pixel density data was analyzed and a P value <0.05 was considered significant. Results There were 39 women included, 10 with a prior preterm birth and 29 controls. The baseline demographics and pregnancy outcomes for both groups were similar in age, parity, race, BMI, gestational age at delivery, mode of delivery, and birth weight. Enrollment cytokines in women with a prior preterm birth, including IL-1 alpha (39.2±25.1% versus 26.1±13.2%; P = 0.04), IL-1 beta (47.9±26.4% versus 24.9±17%; P<0.01), IL-2 (16.7±9.3% versus 11.3±6.3%; P = 0.03), and IL-13 (16.9±12.4% versus 8.2±7.4%; P = 0.01) were significantly elevated compared to controls. In the third trimester the cytokine densities for IL-1 alpha (26.0±18.2% versus 22.3±12.0%; P = 0.49), IL-1 beta (31.8±15.9% versus 33.1±16.8%; P = 0.84), IL-2 (10.0±8.4% versus 10.9±5.9%; P = 0.71), and IL-13 (9.1±5.9% versus 10.0±6.5%; P = 0.71) were all statistically similar between the progesterone arm and controls, respectively. Conclusion There is an increased cytokine presence in vaginal washings of women at risk for preterm birth which appears to be modified following the administration of 17- hydroxyprogesterone caproate to levels similar to healthy controls.
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Affiliation(s)
- David J. Garry
- Department of Obstetrics & Gynecology and Reproductive Medicine, Stony Brook Medicine, Stony Brook, NY, United States of America
- * E-mail:
| | - David A. Baker
- Department of Obstetrics & Gynecology and Reproductive Medicine, Stony Brook Medicine, Stony Brook, NY, United States of America
| | - Malini D. Persad
- Department of Obstetrics & Gynecology and Reproductive Medicine, Stony Brook Medicine, Stony Brook, NY, United States of America
| | - Tatyana Peresleni
- Department of Obstetrics & Gynecology and Reproductive Medicine, Stony Brook Medicine, Stony Brook, NY, United States of America
| | - Christina Kocis
- Department of Obstetrics & Gynecology and Reproductive Medicine, Stony Brook Medicine, Stony Brook, NY, United States of America
| | - Michael Demishev
- Department of Obstetrics & Gynecology and Reproductive Medicine, Stony Brook Medicine, Stony Brook, NY, United States of America
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Zhong Q, Lu C, Zhang W, Zheng X, Deng Q. Preterm birth and ambient temperature: Strong association during night-time and warm seasons. J Therm Biol 2018; 78:381-390. [DOI: 10.1016/j.jtherbio.2018.11.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 11/03/2018] [Accepted: 11/05/2018] [Indexed: 11/29/2022]
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Zuber PLF, Moran AC, Chou D, Renaud F, Halleux C, Peña-Rosas JP, Viswanathan K, Lackritz E, Jakob R, Mason E, Lamprianou S, Guillard-Maure C. Mapping the landscape of global programmes to evaluate health interventions in pregnancy: the need for harmonised approaches, standards and tools. BMJ Glob Health 2018; 3:e001053. [PMID: 30364289 PMCID: PMC6195154 DOI: 10.1136/bmjgh-2018-001053] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 09/11/2018] [Indexed: 01/31/2023] Open
Abstract
Pregnant women and their babies are among the populations most vulnerable to untoward health outcomes. Yet current standards for evaluating health interventions cannot be met during pregnancy because of lack of adequate evidence. The situation is even more concerning in low-income and middle-income countries, where the need for effective interventions is the greatest. Meeting the Sustainable Development Goals for health will require strengthened attention to maternal and child health. In this paper we examine ongoing initiatives aimed at improving the assessment of maternal interventions. We review current methodologies to monitor outcomes of maternal interventions and identify where harmonisation is needed. Based on this analysis we identify settings where different minimal data sets should be considered taking into consideration the clinical realities. Stronger coordination mechanisms and a roadmap to support harmonised monitoring of maternal interventions across programmes and partners, working on improving pregnancy and early childhood health events, will greatly enhance ability to generate evidence-based policies.
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Affiliation(s)
- Patrick L F Zuber
- Safety and Vigilance, Department of Essential Medicines and Health Products, World Health Organization, Geneva, Switzerland
| | - Allisyn C Moran
- Department of Epidemiology, Monitoring and Evaluation, Department of Child and Adolescent Health and Development, World Health Organization, Geneva, Switzerland
| | - Doris Chou
- Adolescents and at-Risk Populations, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Françoise Renaud
- Strategic Information and Planning, Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
| | - Christine Halleux
- Intervention and Implementation Research, Special Programme for Research and Training in Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Juan Pablo Peña-Rosas
- Evidence and Programme Guidance, Department of Nutrition for Health and Development, World Health Organization, Geneva, Switzerland
| | - Kavitha Viswanathan
- Global Platform for Measurement and Accountability, Department of Information, Evidence and Research, World Health Organization, Geneva, Switzerland
| | - Eve Lackritz
- High Threat Pathogens, Department of Infectious Hazard Management, World Health Organization, Geneva, Switzerland
| | - Robert Jakob
- Data Standards and Informatics, Department of Information, Evidence and Research, World Health Organization, Geneva, Switzerland
| | | | - Smaragda Lamprianou
- Safety and Vigilance, Department of Essential Medicines and Health Products, World Health Organization, Geneva, Switzerland
| | - Christine Guillard-Maure
- Safety and Vigilance, Department of Essential Medicines and Health Products, World Health Organization, Geneva, Switzerland
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Su D, Samson K, Garg A, Hanson C, Anderson Berry AL, Lin G, Qu M. Birth history as a predictor of adverse birth outcomes: Evidence from state vital statistics data. Prev Med Rep 2018; 11:63-68. [PMID: 29984140 PMCID: PMC6030394 DOI: 10.1016/j.pmedr.2018.05.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 05/09/2018] [Accepted: 05/11/2018] [Indexed: 11/22/2022] Open
Abstract
One of the most important predictors of preterm births (PTBs) or low-birth-weight births (LBWBs) is whether a mother has had a history of these birth outcomes. This study examined how different characterizations of birth history (e.g., any previous incidence of PTBs or LBWBs, immediate previous birth that was preterm or of low birth weight, and number of previous PTBs or LBWBs) were associated with PTBs or LBWBs. Based on birth records (n = 98,776) reported to the vital statistics electronic registration system in Nebraska from 2005 to 2014, mothers with a history of PTBs or LBWBs were more likely to have recurrences of these outcomes than those who did not have any history of PTBs or LBWBs. The adjusted odds ratios for recurrent PTBs ranged from 2.82 (95% CI: 2.62, 3.04) to 5.54 (95% CI: 4.67, 6.57) depending on how previous incidence of PTBs or LBWBs were characterized. The corresponding adjusted odds ratio for LBWBs ranged from 1.58 (95% CI: 1.43, 1.74) to 6.75 (95% CI: 4.96, 9.17). Relative to other measures used to characterize birth history, the use of number of previous PTBs or LBWBs allows for identifying mothers most vulnerable to recurrences of these birth outcomes. To help identify mothers at risk for future PTBs or LBWBs, it is beneficial to develop state-wide surveillance of reoccurrences for adverse birth outcomes which is feasible by integrating all separated birth records for the same mother using vital statistics data.
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Affiliation(s)
- Dejun Su
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, United States
- Corresponding author at: 984340 Nebraska Medical Center, Omaha, NE 68198-4340, United States.
| | - Kaeli Samson
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, United States
| | - Ashvita Garg
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, United States
| | - Corrine Hanson
- College of Allied Health Professions, University of Nebraska Medical Center, United States
| | - Ann L. Anderson Berry
- Department of Pediatrics, College of Medicine, University of Nebraska Medical Center, United States
| | - Ge Lin
- Department of Environmental and Occupational Health, School of Community Health Sciences, University of Nevada, Las Vegas, United States
| | - Ming Qu
- Epidemiology and Health Informatics Unit, Division of Public Health, Nebraska Department of Health and Human Services, United States
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Gestational bisphenol S impairs placental endocrine function and the fusogenic trophoblast signaling pathway. Arch Toxicol 2018; 92:1861-1876. [PMID: 29550860 DOI: 10.1007/s00204-018-2191-2] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 03/13/2018] [Indexed: 02/07/2023]
Abstract
Exposure to bisphenolic chemicals during pregnancy occurs in > 90% of pregnancies. Bisphenolic compounds can cross the placental barrier reaching fetal circulation. However, the effects of emerging bisphenolic compounds, such as bisphenol S (BPS), on placental function remain untested. The aim was to determine if bisphenol A (BPA) or BPS, at an environmentally relevant dose, impairs placental function. Pregnant sheep were randomly distributed into three treatment groups (n = 7-8/group): control, BPA, and BPS. All animals received daily injections of corn oil (control), BPA, or BPS (0.5 mg/kg; s.c.; internal fetal doses were ~ 2.6 ng/mL unconjugated BPA and ~ 7.7 ng/mL of BPS) from gestational day 30-100. After a 20-day washout period, placentas were weighed and placentomes collected. Placental endocrine function was assessed on biweekly maternal blood samples. Gestational exposure to BPS, but not BPA, reduced maternal circulating pregnancy-associated glycoproteins without change in placental weight or placental stereology. BPS-exposed placentas had 50% lower e-cadherin protein expression, ~ 20% fewer binucleate cells, and ~ threefold higher glial cell missing-1 protein expression. BPA placentas were not affected highlighting the intrinsic differences among bisphenolic chemicals. This is the first study to demonstrate that gestational BPS can result in placental endocrine dysfunction and points to a dysregulation in the fusogenic trophoblast signaling pathway.
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