BirthStats: percentage of preterm births, United States and selected European countries, 2004

The Impact of CenteringPregnancy Group Prenatal Care on Birth Outcomes in Medicaid Eligible Women

Background: CenteringPregnancy group prenatal care (GPNC) has been shown to reduce rates of preterm birth (PTB). We evaluated the impact of GPNC on spontaneous PTB (sPTB) as a first step in exploring the possible mechanism by which GPNC may decrease rates of PTB. We also evaluated whether attending more than five GPNC sessions affected PTB risk and examined all differences by race/ethnicity. Materials and Methods: We conducted a retrospective cohort study among women delivering at a single institution between April 2009 and March 2014. Birth outcome data from vital statistics records were appended to patient records, and detailed chart abstraction was used to determine spontaneous versus indicated PTB. The association between GPNC and attending more than five GPNC sessions and birth outcomes (i.e., PTB, sPTB, low birth weight [LBW], and neonatal intensive care unit [NICU] admissions) was analyzed using generalized estimating equation log binomial regression models. We examined effect modification of the associations by race/ethnicity. Results: The analysis included 1,292 women in GPNC and 8,703 in traditional individual prenatal care (IPNC). After controlling for potential confounders, the risk of PTB (risk ratio [RR] 0.38; 95% confidence interval [CI] 0.31-0.47), sPTB (RR 0.49; 95% CI 0.38-0.63), LBW (RR 0.46; 95% CI 0.37-0.56), and NICU admissions (RR 0.46; 95% CI 0.37-0.57) was lower in GPNC compared to IPNC women. Results differed by maternal race/ethnicity, with the strongest associations among non-Hispanic white mothers and the weakest associations among Hispanic mothers, especially for sPTB. Similarly, the risk of PTB, LBW, and NICU admissions was lower among GPNC women who attended more than five sessions. Conclusion: Participation in GPNC demonstrated a decreased risk for sPTB, as well as other adverse birth outcomes. In addition, participation in more than five GPNC sessions demonstrated a decreased risk for adverse birth outcomes. Prospective longitudinal studies are needed to further explore mechanisms associated with these findings.

Periodontitis, cardiovascular disease and pregnancy outcome--focal infection revisited?

Over the last two decades there has been a renewed interest around the possible effects of periodontal disease on both cardiovascular health and pregnancy outcome (among other diseases), a topic which has interested science for hundreds of years. These have led to a range of studies, workshops and consensus documents being published, with corresponding coverage in general and professional media. In this article the authors summarise the history and supporting theories behind such associations, whether clinical studies have been able to confirm these and what this might mean for general practitioners who are questioned on this topic by patients.

Short-term respiratory outcomes in late preterm infants

Objective

To evaluate short-term respiratory outcomes in late preterm infants (LPI) compared with those of term infants (TI).

Methods

A retrospective study conducted in a single third level Italian centre (2005–2009) to analyse the incidence and risk factors of composite respiratory morbidity (CRM), the need for adjunctive therapies (surfactant therapy, inhaled nitric oxide, pleural drainage), the highest level of respiratory support (mechanical ventilation – MV, nasal continuous positive airway pressure – N-CPAP, nasal oxygen) and the duration of pressure support (hours in N-CPAP and/or MV).

Results

During the study period 14,515 infants were delivered. There were 856 (5.9%) LPI and 12,948 (89.2%) TI. CRM affected 105 LPI (12.4%), and 121 TI (0.9%), with an overall rate of 1.6%. Eighty-four LPI (9.8%) and 73 TI (0.56%) received respiratory support, of which 13 LPI (1.5%) and 16 TI (0.12%) were ventilated. The adjusted OR for developing CRM significantly increased from 3.3 (95% CI 2.0-5.5) at 37 weeks to 40.8 (95% CI 19.7-84.9%) at 34 weeks. The adjusted OR for the need of MV significantly increased from 3.4 (95% CI 1.2-10) at 37 weeks to 34.4 (95% CI 6.7-180.6%) at 34 weeks. Median duration of pressure support was significantly higher at 37 weeks (66.6 h vs 40.5 h). Twin pregnancies were related to a higher risk of CRM (OR 4.3, 95% CI 2.6-7.3), but not independent of gestational age (GA). Cesarean section (CS) was associated with higher risk of CRM independently of GA, but the OR was lower in CS with labour (2.2, 95% CI 1.4-3.4 vs 3.0, 95% CI 2.1-4.2).

Conclusions

In this single third level care study late preterm births, pulmonary diseases and supportive respiratory interventions were lower than previously documented. LPI are at a higher risk of developing pulmonary disease than TI. Infants born from elective cesarean sections, late preterm twins in particular and 37 weekers too might benefit from preventive intervention.

Imaging modalities to assess structural birth defects in mutant mouse models

Assessment of structural birth defects (SBDs) in animal models usually entails conducting detailed necropsy for anatomical defects followed by histological analysis for tissue defects. Recent advances in new imaging technologies have provided the means for rapid phenotyping of SBDs, such as using ultra-high frequency ultrasound biomicroscopy, optical coherence tomography, micro-CT, and micro-MRI. These imaging modalities allow the detailed assessment of organ/tissue structure, and with ultrasound biomicroscopy, structure and function of the cardiovascular system also can be assessed noninvasively, allowing the longitudinal tracking of the fetus in utero. In this review, we briefly discuss the application of these state-of-the-art imaging technologies for phenotyping of SBDs in rodent embryos and fetuses, showing how these imaging modalities may be used for the detection of a wide variety of SBDs.