Impact of pre-pregnancy weight on the risk of premature rupture of membranes in Chinese women

Determinants for premature rupture of membranes: a prospective cohort study

BACKGROUND

Premature rupture of membranes (PROM) and preterm premature rupture of membranes (PPROM) are significant obstetric complications that can lead to adverse maternal and neonatal outcomes. There is an increased concern for various risk factors for PROM and PPROM, in the context of inconsistent findings. This study aimed to investigate determinants for PROM and PPROM.

METHODS

We conducted a prospective cohort study involving 5,500 pregnant women receiving prenatal care at Maternal and Child Health Hospital of Hubei Province. We collected data on demographic characteristics, reproductive history, medical history, behavior and lifestyle factors and pregnancy outcomes, utilizing univariate and multivariate modified Poisson regression analyses to identify determinants associated with PROM and PPROM. Subgroup analyses were conducted to compare differences between nulliparous and multiparous women because parity emerged as a significant confounder.

RESULTS

The overall incidence of PROM in our study was 14.38% (550/3,825), with PPROM accounting for 2.04% (78/3,825). Nulliparity (RR 2.16; 95% CI 1.71-2.74; P < 0.001), and higher education level (RR 1.19; 95% CI 1.00-1.42; P = 0.048) were identified as significant risk factors for PROM, while nulliparity (RR 2.39; 95% CI 1.26-4.52; P = 0.008), presence of uterine fibroids (RR 2.32; 95% CI 1.19-4.52; P = 0.013), and vaginal bleeding at early pregnancy (RR 1.61; 95% CI 1.02-2.56; P = 0.042) were identified as significant risk factors for PPROM. In the nulliparity subgroup, vaginal bleeding at early pregnancy (RR 2.01; 95% CI 1.23-3.27; P = 0.005) and presence of uterine fibroids (RR 2.17; 95% CI 1.03-4.55; P = 0.041) were identified as risk factors for PPROM. In the multiparity subgroup, allergic diseases (RR 7.72; 95% CI 1.60-37.31; P = 0.011), gestational hypertension (RR 5.10; 95% CI 1.05-24.80; P = 0.043) and regular exercise (RR 4.45; 95% CI 0.96-20.60; P = 0.057) were identified as risk factors for PPROM.

CONCLUSIONS

This prospective cohort study underscores the importance of parity, considered as a confounder when analyzing determinants for PROM and PPROM in future research. We also found that in nulliparous women, presence of uterine fibroids increased the risk of PPROM while regular exercise reduced the risk; in multiparous women, presence of uterine fibroids was not correlated while regular exercise increased the risk. While occupational stress exhibited preliminary associations, refined exposure metrics are needed to clarify its role. Future research should integrate biological mediators, objective measures and diverse cohorts to confirm the associations and optimize prevention strategies.

Initial and Longitudinal Trajectories in Hemoglobin Levels Predict the Prognosis of Patients With Premature Rupture of Membranes

PROBLEM

Premature rupture of membranes (PROM) can lead to adverse maternal and neonatal outcomes. Identifying predictors of length of hospital stay (LOS) in PROM patients can aid in improving management and prognosis.

METHOD OF STUDY

The Medical Information Mart for Intensive Care IV database was searched to acquire data on PROM individuals. A univariable analysis, LASSO regression, and multivariable generalized linear model (GLM) were adopted to identify factors closely related to LOS. Next, the change trends in the key variable over multiple time points were determined using a latent class trajectory model (LCTM). The association of these trajectories with LOS was analyzed using GLMs.

RESULTS

The retrospective study finally enrolled 868 samples. The significant factors included initial hemoglobin, chorioamnionitis, premature birth, and rupture to delivery interval <24 h. Notably, higher initial hemoglobin level was independently associated with shorter LOS (β = -0.599; 95% CI = [-0.846, -0.352]; p < 0.05). The stratified analysis confirmed this association in all subgroups except those with chorioamnionitis. The LCTM identified three hemoglobin trajectories. Compared to other trajectory groups, the "lowest, declining" group had longer LOS (p < 0.05).

CONCLUSIONS

PROM patients with lower initial hemoglobin levels and the "lowest, declining" trajectory group were linked to longer LOS. Monitoring and managing hemoglobin levels is important in improving patient outcomes.

Perinatal outcomes following abdominoplasty: a retrospective study and review of current literature

BACKGROUND

Abdominoplasty surgery is a common body contouring surgery to remove excess fat and skin and restore weakened or separated abdominal muscles caused by aging, pregnancy, or weight fluctuations. There is limited literature regarding patient and pregnancy outcomes after abdominoplasty.

OBJECTIVE

This study aimed to determine whether there was a correlation between adverse pregnancy outcomes and history of abdominoplasty.

STUDY DESIGN

Our study used a large federated deidentified national health research network with data sourced from 68 healthcare organizations within the United States (TriNetX; data accessed on August 19, 2022). All patients with a record of pregnancy were identified using the International Classification of Diseases, Ninth Revision and Tenth Revision, codes and were grouped into those with a history of abdominoplasty and those without. This study evaluated the perinatal outcomes of fetal growth restriction, abnormal umbilical artery Dopplers, gestational hypertension, preeclampsia, preterm delivery, preterm premature rupture of membranes, gestational diabetes mellitus, macrosomia, stillbirth, abnormal placentation, and wound disruption or infection occurring during a patient's pregnancy after abdominoplasty. Propensity matching was performed to account for potential confounders. An alpha level of <.05 was considered statistically significant.

RESULTS

Of the 44,737 patients meeting our criteria, 304 had a history of abdominoplasty, whereas 44,433 did not (control). Our study found that patients with a history of abdominoplasty had significantly higher gravidity, were largely located in the Southern and Midwest region, and had higher counts of vaginal deliveries and cesarean deliveries than the control cohort (Table 1). After propensity score matching, our study found a lower risk of preeclampsia and preterm premature rupture of membranes in patients with abdominoplasty (odds ratio, 0.46; 95% confidence interval, 0.32-0.67; P<.0001) (Table 2). Furthermore, abdominoplasty was associated with an increased risk of preterm delivery (odds ratio, 2.15; 95% confidence interval, 1.48-3.13; P=.0002) (Table 2). Lastly, this study did not find significant differences in the other perinatal outcomes (Table 2).

CONCLUSION

Our data suggest that abdominoplasty may be associated with a relative increase in the rates of preterm delivery and cesarean delivery and that other perinatal outcomes are not increased. This provides evidence that future desire for pregnancy need not be a relative contraindication to abdominoplasty.

Differences in cervical length during the second trimester among normal weight, overweight and obese women: A systematic review and meta-analysis

Objective

Maternal obesity has been previously linked to increased risk of preterm birth; however, the actual pathophysiology behind this observation remains unknown. Cervical length seems to differentiate among overweight, obese and extremely obese patients, compared to normal weight women. However, to date the actual association between body mass index and cervical length remains unknown. In this systematic review, accumulated evidence is presented to help establish clinical implementations and research perspectives.

Methods

We searched Medline, Scopus, the Cochrane Central Register of Controlled Trials CENTRAL, Google Scholar, and Clinicaltrials.gov databases from inception till February 2023. Observational studies that reported on women undergone ultrasound assessment of their cervical length during pregnancy were included, when there was data regarding their body mass index. Statistical meta-analysis was performed with RStudio. The quality of the included studies was assessed using the Newcastle-Ottawa Quality Assessment Scale (NOS).

Results

Overall, 20 studies were included in this systematic review and 12 in the meta-analysis. Compared to women with normal weight, underweight women were not associated with increased risk of CL < 15 mm or < 30 mm and their mean CL was comparable (MD -1.51; 95% CI -3.07, 0.05). Overweight women were found to have greater cervical length compared to women with normal weight (MD 1.87; 95% CI 0.52, 3.23) and had a lower risk of CL < 30 mm (OR 0.65; 95% CI 0.47, 0.90).

Conclusion

Further research into whether BMI is associated with cervical length in pregnant women is deemed necessary, with large, well-designed, prospective cohort studies with matched control group.