Global, regional and national levels and trends of preterm birth rates for 1990 to 2014: protocol for development of World Health Organization estimates

Prevalence of unintended pregnancy in the MENA region: a systematic review and meta-analysis

BACKGROUND

Unintended pregnancies pose significant public health challenges globally, particularly in the Middle East and North Africa (MENA) region, where cultural, religious and societal factors play the most substantial role. This systematic review and meta-analysis investigated the pooled prevalence and factors associated with unintended pregnancies in the MENA region.

METHODS

We conducted a systematic review to identify relevant studies in Medical Literature Analysis and Retriaval System (MEDLINE), Embase and Scopus published on unintended pregnancies until July 2024. We included studies that were conducted on unintended pregnancy prevalence within MENA countries and employed suitable measurement tools. We analysed data from 40 studies involving 34 837 participants across the region, including Egypt, Iran, Saudi Arabia and Qatar. We used a random-effects model to estimate the pooled prevalence of unintended pregnancy.

RESULTS

In this meta-analysis, we found that the overall prevalence of unintended pregnancy was 27.0% (95% CI 25.0% to 30.0%) in the MENA region, and the certainty of the evidence was moderate. Saudi Arabia had the highest prevalence of unintended pregnancy at 32.0% (95% CI 27.0% to 38.0%). A lower prevalence, 10.0% (95% CI 8.0% to 14.0%), was found in the studies that used validated tools compared with non-validated tools to measure unintended pregnancy. Between 2006 and 2010, the prevalence was 34.0% (95% CI 28.0% to 40.0%), the highest compared to other time periods . Age, rural areas, education, employment, economic status, parity, gravidity, history of miscarriage, previous pregnancies or abortion, non-use or failure of contraception methods, limited antenatal care, were associated with unintended pregnancies.

CONCLUSION

Our findings suggest that the MENA region faces a substantial burden of unintended pregnancies, with variations among countries and over time. The results emphasise the need for evidence-based interventions to address this issue, focusing on factors associated with unintended pregnancy.

Prevalence, trends, and maternal risk factors of adverse birth outcomes from a hospital-based birth defects surveillance system in Kampala, Uganda, 2015-2022

BACKGROUND

Adverse birth outcomes (ABOs) cause significant infant morbidity and mortality in resource-limited settings. Many of the maternal risk factors associated with ABOs can be prevented. We present the prevalence, trends, and risk factors of selected ABOs from a hospital-based birth defects surveillance program in Kampala, Uganda.

METHODS

We analyzed data for all mothers with singleton deliveries collected from four urban hospitals between 2015 and 2022. Prevalence of preterm birth [PTB], low birth weight [LBW], small for gestational age [SGA], and stillbirth [SB] and maternal HIV seroprevalence were calculated among 222,427 births. SB was defined as infant born without life ≥ 28 weeks of gestation, LBW as term live birth weighing < 2500 g and PTB as live birth born < 37 weeks of gestation. Time trends of ABOs by maternal HIV status and age were computed using quasi-Poisson regression model and presented graphically. Risk factor associations were estimated using robust Poisson models adjusting for infant sex, hospital of delivery, and birth year.

RESULTS

Prevalence of PTB, LBW, SGA, and SB were 14.8%, 4.3%, 17.8%, and 3.1%, respectively. Maternal HIV seroprevalence was 7.7%. Compared to mothers aged 25-34 years, young adolescents 10-18 years was associated with PTB (adjusted risk ratio [aRR]: 1.44, 95% confidence interval (CI): 1.38-1.50); LBW (1.65,1.51-1.81); and SGA (1.18; 1.12-1.24). HIV seropositivity was associated with PTB (1.18; 1.14-1.22), LBW (1.54; 1.43-1.65), and SGA (1.28; 1.23-1.33). Compared to starting ANC in the first trimester, no antenatal care (ANC) was associated with PTB (2.44; 2.33-2.56), LBW (1.80; 1.55-2.09), SGA (1.37; 1.27-1.49), and SB (3.73; 3.32-4.15) and late attendance with LBW (1.09; 1.02-1.16), SGA (1.26; 1.22-1.30), and SB (1.09; 1.02-1.17). Our findings also indicate a rising trend in PTB among adolescent and young women aged 10-24 years, and a declining trend in LBW and SGA over time (ptrend < 0.05 for all).

CONCLUSIONS

Young maternal age, maternal HIV, and late or no ANC attendance were associated with ABO. Childbearing in the ages 25-34, preventing HIV in women, and supporting early and frequent ANC attendance are important in improving birth outcomes.

An exploration of the support received by mothers for kangaroo mother care practice along the health facility-community continuum in a sub-district of Northern Karnataka, India

INTRODUCTION

Early initiation with optimal duration of Kangaroo Mother Care (KMC), for all stable small babies (<2000grams at birth), is essential for accelerated reduction of neonatal mortality. The purpose of this paper is to explore the support received by mothers along the health facility-community continuum and its association with KMC practice.

METHODS

All live small babies aged >  4 weeks of life, who were residing in the Gangawati sub-district, were recruited on a rolling basis (Dec 2017-Sept 2018) to obtain the estimated sample size of 210. Mother-baby dyads were visited in their homes to collect information [knowledge, attitude, and support received] for KMC initiation and maintenance till required. Secondary data on KMC duration was obtained from the district-wide project database.

RESULTS

A total of 209 mothers with 227 small babies were interviewed (18 had twins). The mothers had a mean age of 23 (±4) years; and 7(±5) years of education, with 5 (±2) family members >  18 years in their households. More than half (51%) of the babies were female with a mean age of 35.6 (±7.5)days/ 4-6weeks and mean birth weight of 1693.6 (±221.4)grams irrespective of gestational age; 21.6% of whom were ≤ 1500g at birth. Most of the babies 205 (90.3%) were initiated on KMC at the health facility. The score obtained for KMC initiation [45%} and KMC maintenance support at the health facility [51.3%] was minimal. Multiple regression linear analysis showed that overall KMC support at the health facility was significantly higher for first-time mothers [β coefficient -1.54 (95% CI -2.87, -0.22)] and better knowledge scores on KMC [β coefficient 0.21 (05% CI 0.01, 0.42)]. KMC maintenance support was significantly higher for first-time mothers [β coeff -3.62 (95% CI -6.29, -0.96)] and for mothers whose babies had lower birth weights [β coeff -4.27 (95% CI -7.50, -1.05)].

CONCLUSION

Mothers require support to initiate and continue KMC along the health facility-community continuum (S1 Table). The role of support at home would require further exploration to determine its association with KMC practice.

Bloodstream infection in a neonatal intensive care unit: Epidemiology, Antifungal susceptibility and new drug delivered strategies

Bloodstream infection in neonates is a complicated disease and presents a major challenge both in diagnosis and in therapeutic intervention. The focus of the present study was to investigate the incidence, the species distribution and the risk factors associated with mortality of bloodstream infections in a neonatal intensive care unit (NICU) and evaluating the antifungal susceptibility of traditional antifungal drugs and three nanoparticle-based drug delivery systems based on nanoparticles. A total of 458 patients were evaluated, and 9.38 % were confirmed to have bloodstream infections through laboratory tests. The death rate was higher among neonates with fungal infections (66.7 %) compared to those with bacterial infections (5.4 %). Severe health conditions contributed to the increased mortality rate, especially gestational age <28 weeks and weight <1.000 g. Coagulase-negative staphylococci were the major pathogens (64.9 %) considering cases of neonatal sepsis. Candida albicans was the predominant causative agent among neonates with fungemia, although non-albicans species led to the highest mortality rates. In vitro antifungal activity evidenced resistance of C. tropicalis to fluconazole and voriconazole. Three nanoparticles were evaluated: chitosan-coated PLGA containing Amphotericin B, zein containing voriconazole and PLA containing voriconazole, and results were considered promising. The present findings demonstrate the importance of constant epidemiological surveillance in a NICU and the severity of fungal infection in neonates. The results suggest the potential of nanotechnology as an alternative in the treatment of fungal infection.

Adverse birth outcome and associated factors among mothers with antepartum hemorrhage in public hospitals Tigray, northern Ethiopia, 2020

BACKGROUND

Adverse birth outcome is a major public health problem in the world and in Ethiopia. Antepartum hemorrhage complicates 3-5% of pregnancies and is a primary cause of perinatal and maternal mortality worldwide. One in five of all preterm babies are born in association with antepartum hemorrhage. Preterm birth, low birth weight and asphyxiated babies are at high risk for mortality, morbidity and developmental problems Thus, the aim of this study was to assess adverse birth outcomes and associated factors among mothers with antepartum hemorrhage in Tigray public hospitals, northern Ethiopia.

METHODS

Institution based cross sectional study design was conducted from February to April 2020 among randomly selected 309 charts of mothers with chart completeness of 95.4%. A simple random sampling technique was used to select hospitals and charts of study participants. A Pretested check list was used to collect data. Data were analyzed using SPSS version 20. Logistic regression was computed and variables which have a P-value less than 0.2 on bivariable analysis were taken to multivariable analysis. A P-value of less than 0.05 and 95% confidence level was used as a cut-off point for statistical significance in multivariable analysis.

RESULTS

The magnitude of adverse birth outcome was 46.3% at 95% CI and 15.2% of the neonates were admitted to neonatal intensive care unit due to preterm birth and low birth weight. Rural residence [AOR = 2.16, 95%CI (1.069, 4.38)], three and below antenatal care follow-up visits [AOR = 6.6, 95%CI (3.345,13.10)], bad obstetric history [AOR = 2.8, 95%CI (1.044,7.691)], and having less than or equal 11 g/dl hemoglobin level at admission were [AOR = 3.7,95%Cl (1.93,6.914)] found as predictors of adverse birth outcome in this study.

CONCLUSION AND RECOMMENDATION

adverse birth outcomes were higher in magnitude and the higher public health problem in the Tigray region. Predictors could be minimized by strengthening antenatal care follow up, ensuring early arrival to health institution, and focusing on rural area.

Multi-institutional quality improvement algorithm for home nasogastric tube care for neonates

BACKGROUND

High-risk neonates continuing to need enteral nutrition, but otherwise medically ready for discharge home from the NICU, are often offered ongoing hospitalization for nasogastric tube (NGT) feeding, versus discharge after placement of gastrostomy tube. Our group developed an interdisciplinary algorithm to support a third option-discharge home with enteral nutrition via NGT. Our objective was to develop a cross-institutional and interdisciplinary pathway to optimize outcomes for neonates discharged with NGTs.

METHODS

A program to support home NGT feeding use was created, "Passport Home Program," based upon feedback from parents, nurses, speech-language pathologists, otolaryngologists, and neonatal intensivists, amongst others, spanning four hospitals across our health system.

RESULTS

Standardized educational materials for caregivers of neonates requiring ongoing NGT feeding on discharge were created and consist of an in-hospital curriculum with specific competency thresholds, including demonstrating NGT replacement and confirmation with pH test strips. A discharge kit, including a QR code for a video reviewing safe techniques for home NGT placement, is distributed, along with support staff contact information. Members of an emergency department were trained in neonatal NGT replacement in case of issues after business hours. Each patient is followed in a dedicated outpatient multi-disciplinary clinic.

DISCUSSION

This is an interdisciplinary and multi-institutional effort to standardize a pathway for neonates discharged home from the NICU with NGTs. This has the potential to lead to earlier discharge, better outcomes for patients and families, as well as lower costs. This best practice algorithm serves as an example pathway applicable across fields of medicine.

Determinants and outcomes of preterm births in Nigerian tertiary facilities

OBJECTIVE

To describe the incidence, and sociodemographic and clinical factors associated with preterm birth and perinatal mortality in Nigeria.

DESIGN

Secondary analysis of data collected through the Maternal Perinatal Database for Quality, Equity and Dignity (MPD-4-QED) Programme.

SETTING

Data from births in 54 referral-level hospitals across Nigeria between 1 September 2019 and 31 August 2020.

POPULATION

A total of 69 698 births.

METHODS

Multilevel modelling was used to determine the factors associated with preterm birth and perinatal mortality.

OUTCOME MEASURES

Preterm birth and preterm perinatal mortality.

RESULTS

Of 62 383 live births, 9547 were preterm (153 per 1000 live births). Maternal age (<20 years - adjusted odds ratio [aOR] 1.52, 95% CI 1.36-1.71; >35 years - aOR 1.23, 95% CI 1.16-1.30), no formal education (aOR 1.68, 95% CI 1.54-1.84), partner not gainfully employed (aOR 1.94, 95% CI 1.61-2.34) and no antenatal care (aOR 2.62, 95% CI 2.42-2.84) were associated with preterm births. Early neonatal mortality for preterm neonates was 47.2 per 1000 preterm live births (451/9547). Father's occupation (manual labour aOR 1.52, 95% CI 1.20-1.93), hypertensive disorders of pregnancy (aOR 1.37, 95% CI 1.02-1.83), no antenatal care (aOR 2.74, 95% CI 2.04-3.67), earlier gestation (28 to <32 weeks - aOR 2.94, 95% CI 2.15-4.10; 32 to <34 weeks - aOR 1.80, 95% CI 1.3-2.44) and birthweight <1000 g (aOR 21.35, 95% CI 12.54-36.33) were associated with preterm perinatal mortality.

CONCLUSIONS

Preterm birth and perinatal mortality in Nigeria are high. Efforts should be made to enhance access to quality health care during pregnancy, delivery and the neonatal period, and improve the parental socio-economic status.

Development and validation of the caregiver Burden from infant home NGT care instrument

OBJECTIVE

To design and validate an age and condition-specific health status instrument to best reflect the parental experience caring for these children with complex needs and home Nasogastric Tube (NGT) placement.

STUDY DESIGN

Combined Qualitative and Quantitative design, testing and implementation for item production and reduction, followed by formal validation by evaluating validity, reliability, and establishing a clinically meaningful change score.

SETTINGS

Tertiary care, multi-disciplinary aerodigestive center.

PARTICIPANTS

All caregivers whose infant met criteria for eligibility for discharge home from the NICU or Special Care Nursery (SCN) with NGT in place were offered inclusion in this group. Intervention/Exposure: Structured qualitative interviews of these caregivers to explore and define these concepts and domains, to item generate and then reduce, and then psychometric analyses.

METHODS

Structured, moderated qualitative interviews with parents/caregivers of children who have undergone home NGT care of their children for item creation, design, and then reduction. Reliability was assessed by Cronbach alpha analysis. Construct validity and clinically meaningful change score was assessed using various query methods.

MAIN OUTCOME MEASURES

Cronbach's alpha to assess reliability, a priori hypotheses validity analyses, and minimally important clinical difference calculation.

RESULTS

Scaled scores of this condition specific instrument ranged from 14 to 74 where higher scores indicate better QOL related to managing the NGT. Cronbach's alpha with all 14 items was 0.93. Validity was assessed by a self-assessment question to discriminate between change (95% CI: 8.5-14.1; p < 0.0001) as well as by other comparators to identify the instrument's ability to discriminate among populations where parents felt a difference in experience. The minimally important difference was calculated at 18 points.

CONCLUSION

This represents the initial validation of the first condition and age-specific health status instrument to assess parent experience of caring for infants requiring a home NGT for dysphagia.

Economic burden of adverse perinatal outcomes from births to age 5 years in high-income settings: a protocol for a systematic review

BACKGROUND

Adverse perinatal outcomes such as preterm, small for gestational age, low birth weight, congenital anomalies, stillbirth and neonatal death have devastating impacts on individuals, families and societies, with significant lifelong health implications. Despite extensive knowledge of the significant and lifelong health implications of adverse perinatal outcomes, information on the economic burden is limited. Estimating this burden will be crucial for designing cost-effective interventions to reduce perinatal morbidity and mortality. Thus, we will quantify the economic burden of adverse perinatal outcomes from births to age 5 years in high-income countries.

METHODS AND ANALYSIS

A systematic review of all primary studies published in English in peer-reviewed journals on the economic burden for at least one of the adverse perinatal outcomes in high-income countries from 2010 will be searched in databases-MEDLINE (Ovid), EconLit, CINAHL (EBSCO), Embase (Ovid) and Global Health (Ovid). We will also search using Google Scholar and snowballing of the references list of included articles. The search terms will include three main concepts-costs, adverse perinatal outcome(s) and settings. We will use the Consolidated Health Economics Evaluation Reporting Standards 2022 and 17 criteria from the critical appraisal of cost-of-illness studies to assess the quality of each study. We will report the findings based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses 2020 statement. Costs will be converted into a common currency (US dollar), and we will estimate the pooled cost and subgroup analysis will be done. The reference lists of included papers will be reviewed.

ETHICS AND DISSEMINATION

This systematic review will not involve human participants and requires no ethical approval. The results of this review will be published in a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42023400215.

Can Pre-Pregnancy Body Mass Index and Maternal Exercise Affect Birth and Neonatal Outcomes-A Cross Sectional Study

There has been a dramatic worldwide increase in the prevalence of obesity or overweight and physical inactivity in women of reproductive age. Growing evidence suggests that pre-pregnancy maternal abnormal body mass index (BMI) and lower physical activity level are associated with poor maternal health and perinatal outcomes. The aim of this study was to assess how self-perceived exercise and pre-pregnancy BMI are associated with preterm birth, low birth weight, and type of birth. We conducted a retrospective cross-sectional study of 394 Polish women in the postpartum period. We used a questionnaire with the structure of the medical interview. To analyze factors related to birth outcomes, we used the Pearson's Chi-squared test of independence and odds ratio (OR), with a corresponding 95% confidence interval (CI), followed by a multiple logistic regression. Women who reported being physically active before pregnancy (p = 0.00) and during pregnancy (p = 0.03) were more likely to give birth on time and had a lower incidence of very-premature and extremely premature births compared to inactive women. Importantly, they were more likely to have vaginal birth (p = 0.03). Pre-pregnancy BMI influenced the week of delivery, i.e., inadequate, too-high BMI contributed to an increase in the percentage of premature births [OR (95% CI) = 1.19 (1.06; 1.34)]. The findings indicate that promoting physical activity and weight management remains a priority in public health policy, and women of childbearing age should be encouraged to adopt or maintain an active and healthy lifestyle during pregnancy in order to avoid sedentary- and obesity-associated risks affecting birth and newborns' health.

Changes in preterm and extremely preterm birth rates in Japan after the introduction of obstetrical practice guidelines in 2008

AIM

Obstetrical guidelines were established in Japan in 2008, and obstetrical diagnoses and treatments were subsequently standardized nationally. We examined changes in the preterm birth rate (PTBR) and extremely preterm birth rate (EPTBR) following the introduction of such guidelines.

METHODS

Information on 50 706 432 live births in Japan between 1979 and 2021, including Japanese reproductive medicine, the childbearing age of pregnant women, and the employment status of reproductive-age women between 2007 and 2020, were obtained from the Japanese government and academic societies. Regression analysis was used to compare chronological changes nationally and those of eight Japanese regions. Regional and national average PTBRs and EPTBRs from 2007 to 2020 were compared by using a repeated measures analysis of variance.

RESULTS

From 1979 to 2007, PTBRs and EPTBRs in Japan increased significantly. However, from 2008, the national PTBR and EPTBR decreased until 2020 (p < 0.001) and 2019 (p = 0.02), respectively. From 2007 to 2020, overall PTBR and EPTBR were 5.68% and 0.255%, respectively. A significant difference in the PTBR and EPTBR existed between the eight Japanese regions. During this period, the number of pregnancies using assisted reproductive technology increased from 19 595 to 60 381, pregnant women became older, the employment rate of those of reproductive age increased, and nonregular employment was 54%, which was 2.5 times higher than for men.

CONCLUSIONS

In Japan, after obstetrical guidelines were enacted in 2008, PTRBs decreased significantly even under the pressure of increasing preterm births. Countermeasures may be necessary for regions showing high PTBRs.

Contribution of Preterm Birth to Mortality Among Neonates with Birth Defects

OBJECTIVE

To estimate the proportion of neonatal mortality risk attributable to preterm delivery among neonates with birth defects.

STUDY DESIGN

Using a statewide cohort of live born infants from the Texas Birth Defects Registry (1999-2014 deliveries), we estimated the population attributable fraction and 95% CI of neonatal mortality (death <28 days) attributable to prematurity (birth at <37 weeks vs ≥37 weeks) for 31 specific birth defects. To better understand the overall population burden, analyses were repeated for all birth defects combined.

RESULTS

Our analyses included 169 148 neonates with birth defects, of which 40 872 (24.2%) were delivered preterm. The estimated proportion of neonatal mortality attributable to prematurity varied by birth defect, ranging from 12.5% (95% CI: 8.7-16.1) for hypoplastic left heart syndrome to 71.9% (95% CI: 41.1-86.6) for anotia or microtia. Overall, the proportion was 51.7% (95% CI: 49.4-54.0) for all birth defects combined.

CONCLUSIONS

A large proportion of deaths among neonates with birth defects are attributable to preterm delivery. Our results highlight differences in this burden across common birth defects. Our findings may be helpful for prioritizing future work focused on better understanding the etiology of prematurity among neonates with birth defects and the mechanisms by which prematurity contributes to neonatal mortality in this population.

The role of chondrocyte-to-osteoblast trans-differentiation in fetal bone dysplasia of mice caused by prenatal exposure to dexamethasone

Maternal exposure to dexamethasone can cause developmental toxicity of long bones in offspring. However, the effect of dexamethasone on the trans-differentiation of growth plate chondrocytes into osteoblasts and its role in bone dysplasia of fetuses caused by prenatal dexamethasone exposure (PDE) remains unclear. In this study, pregnant mice were treated with different doses, stages, and courses of dexamethasone according to clinical practice to reveal the phenomenon. Further, growth plate chondrocytes were treated with dexamethasone in vitro to clarify the phenomenon and mechanism. The results showed that PDE caused dysplasia of fetal long bones in female and male mice, accompanied by the delayed formation of the primary ossification center and the widening hypertrophic zone of growth plate cartilage. Meanwhile, PDE increased the number of hypertrophic chondrocytes at growth plate cartilage and decreased the number of osteoblasts at the primary ossification center. Moreover, PDE significantly decreased the expression of osteogenic transcription factor Runx2 but increased the expression of hypertrophic chondrocytes marker Col10. These above phenomena were more significant in the high dose, early stage, and double courses of dexamethasone exposure groups, and the male fetal mice showed more obvious than the female fetal mice. In vitro, dexamethasone significantly inhibited the trans-differentiation of growth plate chondrocytes into osteoblasts, accompanied by a decrease in Runx2 expression and an increase in Col10 expression. In conclusion, this study revealed the phenomenon and mechanism of fetal bone dysplasia caused by PDE from the new perspective of trans-differentiation disorder of growth plate chondrocytes to osteoblasts.

Cognitive, Behavioral and Socioemotional Development in a Cohort of Preterm Infants at School Age: A Cross-Sectional Study

More than 50% of children who survive prematurity have an atypical course of development at school age, as environmental demands become more demanding. This study examines the effects of preterm birth on the cognitive, behavioral and socioemotional development of 185 children at ages five and seven years. Weaknesses were found in attention, working memory, processing speed and the ability to correctly interpret emotions at both ages five and seven. Significant correlations were found in regression and moderation models. These findings suggest that school-age children who were preterm infants are at increased risk of exhibiting impairments in several developmental domains that may affect their overall quality of life.

Effects of Formula Milk Feeding in Premature Infants: A Systematic Review

The preterm baby is born at a critical period for the growth and development of the gastrointestinal and neuromotor systems. Breast milk is the food of choice for infants during the first months of life, as it provides multiple short- and long-term benefits to preterm and sick newborns. Despite this, breastfeeding is often nutritionally insufficient, requiring the addition of fortifiers. In other cases, it is important to ensure the necessary nutrients and calories, which can be provided by formula milk or pasteurized and fortified donated human milk. However, the specific guidelines for the use of formula milk have not yet been determined. Therefore, a systematic search was considered necessary in order to identify the effects of feeding with formula milk in preterm infants. A systematic search in Scopus, Medline, Pubmed, Cinahl, ClinicalTrials and Web of Science with the terms Infant Formula and Infant Premature was conducted. A total of 18 articles were selected, of which, eight were experimental and ten were observational studies. Among the objectives of the analyzed investigations, we distinguished nine that compared the effects of feeding with formula milk, breast milk and donated human milk, five that evaluated the effects of different compositions of formula milk and/or fortifiers and four investigations that compared the effects of formula milk and donated human milk. In conclusion, when breast milk is insufficient or unavailable, formula milk is a good nutritional option, due to its higher caloric density and protein content. Nevertheless, the preterm infant's diet should incorporate breast milk to reduce the incidence of morbidities such as necrotizing enterocolitis and sepsis (related to hospital handling of fortifiers and formula milk).

Iatrogenic factors contributed to the high rate of preterm birth in a community hospital

BACKGROUND

Preterm birth (PTB) rates have been increased significantly in recent years, mostly due to obstetric intervention. This study presents the incidence of PTB in community hospitals by assessing the association between pregnancy complications and iatrogenic PTB.

METHODS

A total of 6,693 pregnancies were enrolled in the Wuxi Maternity and Child Health Care Hospital of Nanjing Medical University. They were divided into two groups (<35 and ≥35 years of age) to examine the effect of maternal age on PTB. Binary logistic and multiple linear regression analyses were used to assess the relationship between PTB and pregnancy complications.

RESULTS

This study provided the incidence of PTB and found that PP, PROM, and ICP increased the risk of PTB, indicating that pregnancy complications have led to the iatrogenic PTB and contributed to the high rate of PTB, especially in the group of advanced-age pregnant women. The prevalence of PTB was 9.53%. Placenta previa (PP), premature rupture of membranes (PROM), and intrahepatic cholestasis of pregnancy (ICP) were significantly associated with PTB. Among all the risk factors, hypertension, disease in pregnancy, premature PROM, and PP were observed as independent key factors for iatrogenic PTBs. In the advanced-age group, PP and pPROM increased the risk of PTB.

CONCLUSIONS

It is often necessary to terminate a pregnancy in community hospitals to balance the safety of the fetus and the maternal comorbid symptoms, which has led to nosocomial premature delivery. Therefore, high-risk pregnancies should be carefully evaluated and comprehensively treated with caution to balance the preterm rate and the safety of the pregnant woman and fetus, and the pros and cons of the outcomes, which has brought a challenge to an obstetrician to reduce the proportion of iatrogenic PTB.

Association between intimate partner violence during pregnancy and risk of preterm birth

Background

Preterm birth is a risk factor for child survival in both the short and long term. In Zimbabwe, the prevalence of preterm birth is rising, and there are growing concerns about the adverse consequences. This study explored the association between intimate partner violence (IPV) during pregnancy and preterm birth in Zimbabwe.

Methods

Using data from the 2015 Zimbabwe Demographic and Health Survey, we applied propensity score matching to estimate the effect of IPV during pregnancy on preterm birth among women of reproductive age (15–49 years). A total of 4833 pregnant women who gave birth during the five years preceding the survey were analysed.

Results

We successfully matched 79 women who were exposed to IPV during pregnancy to 372 unexposed during pregnancy. Using the matched sample, the probability of preterm delivery was significantly higher among women who were exposed to IPV during pregnancy than those who were not exposed. The findings showed that 7 out of 79 (8.9%) of women exposed to IPV during pregnancy experienced preterm delivery, and 11 out of 372 (3.0%) of those who were not exposed to IPV during pregnancy experienced preterm delivery. In the urban areas, those exposed to IPV during pregnancy were almost five times more likely to experience preterm delivery (OR = 4.8, 95% CI 2.0–11.6), but the association was not significantly different among women in rural areas.

Conclusion

The findings showed that women exposed to IPV during pregnancy were at increased risk of preterm birth. Some of the risk factors associated with IPV were urban residence, low economic status and unemployment. Effective policies and programmes are required to address the issue of IPV in Zimbabwe.

Development of Polydiacetylene-Based Testosterone Detection as a Model Sensing Platform for Water-Insoluble Hormone Analytes

We have developed a polydiacetylene (PDA)-based sensing platform to detect testosterone (T) as a potential biomarker of preterm birth. The insolubility of the steroid hormone in water, where PDA assemblies are dispersed, poses a major issue, since they can hardly interact with each other. To overcome this challenge, acetonitrile was used as a suitable solvent. In addition, to minimize false signals of PDA assemblies caused by the solvent, a mixture of acetonitrile and distilled water was selected. To prove a concept of PDA-based sensing platform for targeting T hormone, we conjugated anti-T antibodies to surface of PDA assemblies to induce selective binding between T and anti-T antibodies. The fluorescence sensory signaling of the PDA-anti-T antibody conjugate was selectively generated for T, over 3.4 times higher sensitivity of the signaling compared to that from other sex steroid hormones studied (β-estradiol and progesterone).

Effects of Dietary Patterns during Pregnancy on Preterm Birth: A Birth Cohort Study in Shanghai

The objective of this study was to analyse representative dietary patterns during pregnancy in Shanghai and explore the effects of dietary patterns during pregnancy on preterm birth. Data were derived from the ‘Iodine Status in Pregnancy and Offspring Health Cohort’ (ISPOHC) study. Multistage, stratified random sampling was used to select survey participants from 16 districts in Shanghai, which were divided into five sampling areas; 40–70 pregnant women were selected from each area. A total of 4361 pregnant women and their offspring were involved in the study. The male-to-female ratio of the babies was 1.04:1, and the incidence of single preterm birth was 4.2%. Three dietary patterns were extracted by factor analysis: a ‘Vegetarian Pattern’, an ‘Animal Food Pattern’ (AFP), and a ‘Dairy and Egg Pattern’. These patterns explained 40.513% of the variance in dietary intake. Binary logistic regression, which was used to analyse the association between birth outcomes and scores measuring maternal dietary patterns, found only the AFP was a significant risk factor for preterm birth. Higher AFP scores were positively associated with preterm birth (Q2 vs. Q1 OR = 1.487, 95% CI: 1.002–2.207; Q3 vs. Q1 OR = 1.885, 95% CI: 1.291–2.754). After adjusting for other potential contributors, a higher AFP score was still a significant risk factor for preterm birth (Q2 vs. Q1 OR = 1.470, 95% CI: 0.990–2.183; Q3 vs. Q1 OR = 1.899, 95% CI: 1.299–2.776). The incidence of preterm birth was 4.2%. A higher score of AFP was significantly associated with a higher risk of preterm birth. The animal food intake of pregnant women should be reasonably consumed during pregnancy.

Adverse birth outcomes and associated factors among mothers who delivered in Bale zone hospitals, Oromia Region, Southeast Ethiopia

Objective

Adverse birth outcomes, which include stillbirth, preterm birth, low birthweight, congenital abnormalities, and stillbirth, are the leading cause of neonatal and infant mortality worldwide. We assessed adverse birth outcomes and associated factors among mothers who gave birth in Bale zone hospitals, Oromia, Southeast Ethiopia.

Methods

We used systematic random sampling in this cross-sectional study. We identified factors associated with adverse birth outcomes using bivariate analysis and multivariable logistic regression analysis.

Results

The proportion of adverse birth outcomes among participants was 21%. Of 576 births, 70 (12.2%) were low birthweight, 49 (8.5%) were preterm birth, 45 (7.8%) were stillbirth, and 18 (3.1%) infants had congenital anomalies. Inadequate antenatal care (adjusted odds ratio [AOR] = 6.58, 95% confidence interval [CI] 3.25–13.32), multiple pregnancy (AOR  =  4.74, 95% CI 1.55–14.45), premature rupture of membranes in the current pregnancy (AOR = 2.31, 95% CI 1.26–4.21), hemoglobin level  < 11 g/dL (AOR = 3.22, 95% CI 1.85–5.58), and mid-upper arm circumference less than 23 cm (AOR = 5.93, 95% CI 3.49–10.08) were all significantly associated with adverse birth outcomes.

Conclusions

Approximately one in five study participants had adverse birth outcomes. Increasing antenatal care uptake, ferrous supplementation during pregnancy, and improving the quality of maternal health services are recommended.

Exaggerated Cardiac Contractile Response to Hypoxia in Adults Born Preterm

Individuals born prematurely have smaller hearts, cardiac limitations to exercise, and increased overall cardiometabolic risk. The cardiac effects of acute hypoxia exposure as another physiologic stressor remain under explored. The purpose of this study was to determine the effects of hypoxia on ventricular function in adults born preterm. Adults born moderately to extremely preterm (≤32 weeks gestation or <1500 g, N = 32) and born at term (N = 18) underwent cardiac magnetic resonance imaging under normoxic (21% O₂) and hypoxic (12% O₂) conditions to assess cardiovascular function. In normoxia, cardiac function parameters were similar between groups. During hypoxia, the right ventricular (RV) contractile response was significantly greater in participants born premature, demonstrated by greater increases in RV ejection fraction (EF) (p = 0.002), ventricular-vascular coupling (VVC) (p = 0.004), and strain (p < 0.0001) measures compared to term-born participants, respectively. Left ventricular contractile reserve was similar to term-born participants. Adults born preterm exhibit an exaggerated contractile response to acute hypoxia, particularly in the RV. This suggests that adults born preterm may have contractile reserve, despite the lack of volume reserve identified in previous exercise studies. However, this exaggerated and hyper-adapted response may also increase their risk for late RV failure.

Prevalence of and characteristics associated with operative vaginal birth at Mizan-Tepi University Teaching Hospital

Background

To observe prevalence, characteristics and outcomes associated with operative vaginal birth (OVB).

Methods

We compared spontaneous vaginal birth with OVB.

Results

Of 993 women, 759 (76.4%) experienced vaginal birth; 716 were spontaneous (94.3%), 14 (1.8%) underwent forceps-assisted birth and 29 (3.8%) had vacuum assistance. In a multivariable model of OVB (forceps and vacuum), compared with a midwife, general practitioners (OR 5.6, p = 0.04) and integrated emergency surgical officers (OR 42.8, p = 0.001) were more likely to attend. Women experiencing OVB were more likely to receive local anesthesia (OR 3.0, p = 0.009).

Conclusion

OVB is used sparingly but safely at Mizan-Tepi University Teaching Hospital.

Shear wave dispersion as a potential biomarker for cervical remodeling during pregnancy: evidence from a non-human primate model

Shear wave dispersion (variation of phase velocity with frequency) occurs in tissues with layered and anisotropic microstructure and viscous components, such as the uterine cervix. This phenomenon, mostly overlooked in previous applications of cervical Shear Wave Elasticity Imaging (SWEI) for preterm birth risk assessment, is expected to change drastically during pregnancy due to cervical remodeling. Here we demonstrate the potential of SWEI-based descriptors of dispersion as potential biomarkers for cervical remodeling during pregnancy. First, we performed a simulation-based pre-selection of two SWEI-based dispersion descriptors: the ratio R of group velocities computed with particle-velocity and particle-displacement, and the slope S of the phase velocity vs. frequency. The pre-selection consisted of comparing the contrast-to-noise ratio (CNR) of dispersion descriptors in materials with different degrees of dispersion with respect to a low-dispersive medium. Shear waves induced in these media by SWEI were simulated with a finite-element model of Zener viscoelastic solids. The pre-selection also considered two denoising strategies to improve CNR: a low-pass filter with automatic frequency cutoff determination, and singular value decomposition of shear wave displacements. After pre-selection, the descriptor-denoising combination that produced the largest CNR was applied to SWEI cervix data from 18 pregnant Rhesus macaques acquired at weeks 10 (mid-pregnancy stage) and 23 (late pregnancy stage) of the 24.5-week full pregnancy. A maximum likelihood linear mixed-effects model (LME) was used to evaluate the dependence of the dispersion descriptor on pregnancy stage, maternal age, parity and other experimental factors. The pre-selection study showed that descriptor S combined with singular value decomposition produced a CNR 11.6 times larger than the other descriptor and denoising strategy combinations. In the Non-Human Primates (NHP) study, the LME model showed that descriptor S significantly decreased from mid to late pregnancy (-0.37 ± 0.07 m/s-kHz per week, p <0.00001) with respect to the base value of 15.5 ± 1.9 m/s-kHz. This change was more significant than changes in other SWEI features such as the group velocity previously reported. Also, S varied significantly between the anterior and posterior portions of the cervix (p =0.02) and with maternal age (p =0.008). Given the potential of shear wave dispersion to track cervical remodeling, we will extend its application to ongoing longitudinal human studies.

Re-evaluation of gestational age as a predictor for subsequent preterm birth

BACKGROUND

To evaluate gestational age as a predictor of subsequent preterm birth.

MATERIALS AND METHODS

This was a retrospective birth cohort study to evaluate gestational age as a predictor of subsequent preterm birth. Participants were mothers who gave birth to their first two children in Western Australia, 1980-2015 (N = 255,151 mothers). For each week of final gestational age of the first birth, we calculated relative risks (RR) and absolute risks (AR) of subsequent preterm birth defined as final gestational age before 28, 32, 34 and <37 weeks. Risks were unadjusted to preserve risk factor profiles at each week of gestation.

RESULTS

The relative risks of second birth before 28, 32, and 34 weeks' gestation were all approximately twenty times higher for mothers whose first birth had a gestational age of 22 to 30 weeks compared to those whose first birth was at 40 weeks' gestation. The absolute risks of second birth before 28, 32, and 34 weeks' gestation for these mothers had upper confidence limits that were all less than 16.74%. The absolute risk of second birth before 37 weeks was highest at 32.11% (95% CI: 30.27, 34.02) for mothers whose first birth was 22 to 30 weeks' gestation. For all gestational ages of the first child, the lowest quartile and median gestational age of the second birth were at least 36 weeks and at least 38 weeks, respectively. Sensitivity and positive predictive values were all below 35%.

CONCLUSION

Relative risks of early subsequent birth increased markedly with decreasing gestational age of the first birth. However, absolute risks of clinically significant preterm birth (<28 weeks, <32 weeks, <34 weeks), sensitivity and positive predictive values remained low. Early gestational age is a strong risk factor but a poor predictor of subsequent preterm birth.

Incidence and trend of preterm birth in China, 1990-2016: a systematic review and meta-analysis

OBJECTIVES

To update the WHO estimate of preterm birth rate in China in 1990-2016 and to further explore variations by geographic regions and years of occurrence.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Pubmed, Embase, Cochrane Library and Sinomed databases were searched from 1990 to 2018.

ELIGIBILITY CRITERIA

Studies were included if they provided preterm birth data with at least 500 total births. Reviews, case-control studies, intervention studies and studies with insufficient information or published before 1990 were excluded. We estimated pooled incidence of preterm birth by a random effects model, and preterm birth rate in different year, region and by livebirths or all births in subgroup analyses.

RESULTS

Our search identified 3945 records. After the removal of duplicates and screening of titles and abstracts, we reviewed 254 studies in full text and excluded 182, leaving 72 new studies. They were combined with the 82 studies included in the WHO report (154 studies, 187 data sets in total for the meta-analysis), including 24 039 084 births from 1990 to 2016. The pooled incidence of preterm birth in China was 6.09% (95% CI 5.86% to 6.31%) but has been steadily increasing from 5.36% (95% CI 4.89% to 5.84%) in 1990-1994 to 7.04% (95% CI 6.09% to 7.99%) in 2015-2016. The annual rate of increase was about 1.05% (95% CI 0.85% to 1.21%). Northwest China appeared to have the highest preterm birth rate (7.3%, 95% CI 4.92% to 9.68% from 1990 to 2016).

CONCLUSIONS

The incidence of preterm birth in China has been rising gradually in the past three decades. It was 7% in 2016. Preterm birth rate varied by region with the West having the highest occurrence.

Lipidomic Biomarkers of Extracellular Vesicles for the Prediction of Preterm Birth in the Early Second Trimester

Preterm birth is the leading cause of infant death worldwide and results in a high societal economic burden associated with newborn care. Recent studies have shown that extracellular vesicles (EVs) play an important role in fetal development during pregnancy. Lipids in EVs related to preterm birth remain undefined. Here, we fully investigated differences in lipids in plasma, microvesicles (MVs), and exosomes (Exos) between 27 preterm and 66 full-term pregnant women in the early second trimester (12-24 weeks) using an untargeted lipidomics approach. Independent of other characteristics of samples, we detected 97, 58, and 10 differential features (retention time (RT) and m/z) with identification in plasma, MVs, and Exos, respectively. A panel of five lipids from MVs has an area under the receiver operating characteristic curve (AUC) of 0.87 for the prediction of preterm birth. One lipid of the panel (PS (34:0)) was validated in an additional 83 plasma samples (41 preterm and 42 full-term deliveries) by the pseudotargeted lipidomics method (AUC = 0.71). Our results provide useful information about the early prediction of preterm birth, as well as a better understanding of the underlying mechanisms and intervention of preterm birth. The MS data have been deposited in the CNSA (https://db.cngb.org/cnsa/) of CNGBdb with accession code CNP0001076.

Adverse events associated with the use of recommended vaccines during pregnancy: An overview of systematic reviews

INTRODUCTION

Maternal immunization is aimed at reducing morbidity and mortality in pregnant women and their newborns. Updated evidence synthesis of maternal-fetal outcomes is constantly needed to ensure that the risk-benefit of vaccination during pregnancy remains positive.

METHODS

An overview of systematic reviews (OoSRs) was performed. We searched The Cochrane Library, MEDLINE and EMBASE for SRs including recommended vaccines for maternal immunization reporting the following: abortion, stillbirth, chorioamnionitis, congenital anomalies, microcephaly, neonatal death, neonatal infection, preterm birth (PTB), low birth weight (LBW), maternal death and small for gestational age (SGA) from 2010 to April 2019. Quality and overlap of SRs was assessed.

RESULTS

Seventeen SRs were identified, eight of them included meta-analysis; quality was high in three SRs, moderate in six SRs, low in two SRs, and critically low in six SRs. Stillbirth and PTB were the most frequently reported outcomes by 15 and 13 SRs, respectively, followed by abortion (9 SRs), congenital anomalies (9 SRs), SGA (8 SRs), neonatal death (8 SRs), LBW (4 SRs), chorioamnionitis (3 SRs), maternal death (1 SR). SRs included mainly observational evidence for influenza and Tdap vaccines (11 SRs and 4 SRs, respectively); limited evidence was found for hepatitis (1 SR), yellow fever (1 SR), and meningococcal (1 SR) vaccines. Most of the SRs found no effect. Eight SRs found benefit/protection of influenza vaccine (for stillbirth, neonatal death, preterm birth, LBW), or Tdap vaccine (for preterm birth and SGA); one found a probable risk (chorioamnionitis/Tdap). The SRs for Hepatitis B, meningococcal and yellow fever vaccines were inconclusive.

CONCLUSIONS

Definite risks were not identified for any vaccine and outcome; however better evidence is needed for all outcomes and vaccines. The available evidence in the SRs to support vaccine safety was based mainly on observational data. More RCTs with adequate reporting of maternal-fetal outcomes and larger high-quality observational studies are needed.

Risk of singleton preterm birth after prior twin preterm birth: a systematic review and meta-analysis

OBJECTIVE DATA

The purpose of this study was to conduct a systematic review and meta-analyses of literature regarding the risk of preterm birth in singleton pregnancies after a preterm twin birth.

STUDY

We conducted a literature search of Embase, Ovid Medline, and Cochrane from inception until February 28, 2019. Studies that evaluated women with a previous twin birth followed by a singleton birth were included.

STUDY APPRAISAL AND SYNTHESIS METHODS

Data were abstracted in duplicate, and summary odds ratios and confidence intervals were calculated with the use of random effects model. Risk of bias was assessed with the use of the Newcastle-Ottawa Scale, and quality of evidence was evaluated with the use of the Grades of Recommendation, Assessment, Development, and Evaluation approach. The primary outcome was a preterm singleton birth (<37 weeks gestational age); secondary outcomes included risk of late preterm birth (34-36+6 weeks gestation), preterm birth between 30 and 33+6 weeks gestation, and preterm birth at <30 weeks gestation. Subanalysis of risk of singleton preterm birth after spontaneous twin birth was also performed. A priori, the protocol was developed and registered with PROSPERO (2016; registration number: CRD42017053382).

RESULTS

We included 8 cohort studies at low risk-of-bias met inclusion criteria for the systematic review and 6 for the meta-analysis. Compared with women with previous term twin births, women who had previous preterm (<37 weeks gestation) twin births were at increased odds of preterm singleton birth in subsequent pregnancy (odds ratio, 4.34; 95% confidence interval, 2.83-6.65). Gestational age at birth of previous twin pregnancy was an effect modifier. Compared with previous term twin births, the odd ratios of subsequent preterm singleton birth were 2.13 (95% confidence interval, 1.21-3.74) if twins were born between 34 and 36+6 weeks gestation, 5.18 (95% confidence interval, 2.78-9.64) if twins were born between 30 and 33+6 weeks gestation, and 9.78 (95% confidence interval, 4.99-18.98) if twins were born at <30 weeks gestation. A similar trend was seen for the risk of singleton preterm birth after spontaneous twin preterm birth.

CONCLUSION

A history of preterm twin birth is associated with higher odds of subsequent preterm singleton birth. The odds increase with decreasing gestational age of previous twin birth.

Early Pulmonary Vascular Disease in Young Adults Born Preterm

Rationale: Premature birth affects 10% of live births in the United States and is associated with alveolar simplification and altered pulmonary microvascular development. However, little is known about the long-term impact prematurity has on the pulmonary vasculature.Objectives: Determine the long-term effects of prematurity on right ventricular and pulmonary vascular hemodynamics.Methods: Preterm subjects (n = 11) were recruited from the Newborn Lung Project, a prospectively followed cohort at the University of Wisconsin-Madison, born preterm with very low birth weight (≤1,500 g; average gestational age, 28 wk) between 1988 and 1991. Control subjects (n = 10) from the same birth years were recruited from the general population. All subjects had no known adult cardiopulmonary disease. Right heart catheterization was performed to assess right ventricular and pulmonary vascular hemodynamics at rest and during hypoxic and exercise stress.Measurements and Main Results: Preterm subjects had higher mean pulmonary arterial pressures (mPAPs), with 27% (3 of 11) meeting criteria for borderline pulmonary hypertension (mPAP, 19-24 mm Hg) and 18% (2 of 11) meeting criteria for overt pulmonary hypertension (mPAP ≥ 25 mm Hg). Pulmonary vascular resistance and elastance were higher at rest and during exercise, suggesting a stiffer vascular bed. Preterm subjects were significantly less able to augment cardiac index or right ventricular stroke work during exercise. Among neonatal characteristics, total ventilatory support days was the strongest predictor of adult pulmonary pressure.Conclusions: Young adults born preterm demonstrate early pulmonary vascular disease, characterized by elevated pulmonary pressures, a stiffer pulmonary vascular bed, and right ventricular dysfunction, consistent with an increased risk of developing pulmonary hypertension.

Association of Maternal History of Neonatal Death With Subsequent Neonatal Death in India

IMPORTANCE

Among the United Nations' Sustainable Development Goals is to reduce the neonatal mortality rate to 12 per 1000 live births by 2030. Identifying high-risk pregnancies can help achieve this target in low-resource countries, such as India, which accounts for one-fourth of global neonatal deaths.

OBJECTIVE

To analyze the association of maternal history of neonatal death with subsequent neonatal mortality.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study included a nationally representative sample of singleton live births from multiparous women. Data were obtained from the 2016 National Family Health Survey in India. Data were analyzed from November 2018 to January 2020.

EXPOSURES

Maternal history of neonatal death and a comprehensive set of covariates, including socioeconomic environment, maternal anthropometry, and pregnancy care.

MAIN OUTCOMES AND MEASURES

Subsequent neonatal mortality. Population-attributable risk associated with history of neonatal death was calculated, and sensitivity analyses were performed.

RESULTS

The overall study population consisted of 127 336 singleton live births from multiparous women aged 15 to 49 (mean [SD] age, 28.8 [5.2] years) years when the survey was undertaken. In our analytic sample, 11 101 (8.7%) mothers had a history of neonatal death, and 506 of 2224 total neonatal deaths (22.8%) were attributed to women with history of neonatal death. The prevalence of history of neonatal death differed by selected covariates and across states or union territories. Maternal history of neonatal death was associated with significantly higher odds of neonatal mortality (adjusted odds ratio, 2.23; 95% CI, 1.96-2.55), and this remained consistent across different subgroups. The population-attributable risk associated with maternal history of neonatal death was 11.8%. Stronger associations were found for maternal history of multiple neonatal deaths (adjusted odds ratio, 3.50; 95% CI, 2.78-4.41) and in respect to the risk of mortality in early neonatal period (ie, 0-2 completed days) (adjusted odds ratio, 2.45; 95% CI, 2.09-2.86).

CONCLUSIONS AND RELEVANCE

These findings suggest that maternal history of neonatal death is a potentially useful risk factor to identify women and neonates who may need extended and enhanced pregnancy care.

Perfil antropométrico e metabólico de adolescentes nascidos prematuros em município do Oeste do Paraná

RESUMO Objetivo Relacionar o grau de prematuridade e adequação de peso ao nascer ao perfil lipídico, glicêmico, pressórico e antropométrico de adolescentes nascidos prematuros. Métodos Estudo transversal. Amostra com 50 adolescentes nascidos prematuros – idade gestacional menor que 37 semanas – classificados com base na idade gestacional e peso ao nascer: Adequado para Idade Gestacional (AIG), Pequeno para Idade Gestacional (PIG) e Grande para Idade Gestacional (GIG). Avaliaram-se medidas antropométricas; Pressão Arterial (PA); glicose, Colesterol Total (CT), Triglicerídeos (TG), coletados por punção digital. Análise por estatística descritiva, teste de associação exato de Fisher e análise de variância (ANOVA), considerando 5% de significância. Resultados 8% apresentaram Síndrome Metabólica (SM). 70% foram classificados como AIG, 30% apresentaram excesso de peso. 6% nasceu prematuro extremo e muito prematuro (14%). O grau de prematuridade associou-se significativamente a PA (p=0,027) e mostrou tendência à associação com o TG (p=0,05). Conclusão e implicações para a prática Os níveis pressóricos são influenciados pelo grau de prematuridade; foi evidenciado tendência a TG aumentados. Prematuros têm maior vulnerabilidade para desenvolver SM, alterações pressóricas e possíveis alterações na homeostase glicêmica devido à alteração de TG, indicando a necessidade de seguimento na infância e adolescência atentando ao seu maior risco para doenças cardiovasculares.

Prepregnancy Overweight and Obesity Are Associated with an Increased Risk of Preterm Birth in Chinese Women

INTRODUCTION

The association between obesity before pregnancy and preterm birth varies with age and ethnicity.

OBJECTIVE

To study the association between early body mass index (BMI) and risk of preterm birth in Chinese women.

METHODS

This was a hospital-based retrospective cohort study including 36,596 Chinese women who gave birth to a live singleton infant from 2015 to 2018. Women were classified as underweight (BMI <18.5), normal weight (BMI 18.5 to <23), overweight (BMI 23 to <27.5), or obese (BMI ≥27.5) according to the most recent criteria for Asian women. Multivariate log-binomial regression models were used to estimate the relative risks (RRs) and 95% confidence intervals (95% CIs) for preterm birth among different groups.

RESULTS

Compared to women with normal weight, women with overweight or obesity before pregnancy had an increased risk of preterm birth; the RRs and 95% CIs were 1.22 (95% CI: 1.08-1.37) and 1.30 (95% CI: 1.01-1.69), respectively. The greatest risk of extremely preterm birth was observed in obese women. The estimators were robust when considering the maternal age and rate of gestational weight gain (GWG) during pregnancy.

CONCLUSIONS

Women with overweight and obesity had an increased risk of preterm birth regardless of GWG in early pregnancy. Our study suggests that it is beneficial to lose weight before conception for both overweight and obese women who plan to become pregnant.

Appendectomy in Third Trimester of Pregnancy and Birth Outcomes: A Propensity Score Analysis of a 6-Year Cohort Study Using Administrative Claims Data

INTRODUCTION

While there is evidence of obstetric and neonatal outcomes from non-obstetric surgery during pregnancy, surgery during the third trimester of gestation has not been evaluated as a prognostic factor for those outcomes. The objective of this study was to determine whether appendectomies during the third trimester are associated with adverse neonatal outcomes, in comparison with appendectomies during the first two trimesters, based on national administrative data in Colombia.

METHODS

A retrospective cohort study was performed using administrative health records. It included all women who had live births and who underwent an appendectomy during any stage of pregnancy, between the years 2011 and 2016, and who belonged to Colombia's contributory health system. The main outcome was preterm birth. Birth weight and 1-min and 5-min Apgar scores were also measured, as well as outcomes used to identify neonatal near-miss cases. Propensity score matching was used in order to balance baseline characteristics (age, weeks of gestation, obstetric comorbidity index, and region and year the procedure was performed). Relative risks were estimated with Poisson regressions.

RESULTS

This study included a total of 2507 women in Colombia's contributory health system who underwent an appendectomy during pregnancy. Appendectomy was performed on 885 women (35.30%) in their first trimester, 1205 women (48.07%) in their second trimester, and 417 women (16.63%) in their third trimester. For the entire population, the preterm birth rate was 11.85 per 100 appendectomies. With the matched sample, this study found that women in their third trimester had a 1.65 greater risk of preterm birth [95% CI, 1.118-2.423], a 3.43 greater risk of birth at gestational ages < 33 weeks [95% CI, 1.363 to 8.625], 2.083 greater risk of weight under 1750 g [95% CI, 1.056-4.109], and a mean difference of - 0.247 [95% CI, - .382 to - .112] in the 1-min Apgar score and - .168^a [95% CI, - .276 to - .060] in the 5-min Apgar. No differences were found in birth weight or Apgar scores < 7.

CONCLUSIONS

In Colombia's contributory health system, women who undergo appendectomies in their third trimester have a greater risk of preterm birth, birth weight under 1750 g, birth at gestational ages less than 33 weeks, and decreased 1-min and 5-min Apgar scores.

Association between violence during pregnancy and preterm birth and low birth weight in Colombia: Analysis of the demographic and health survey

To explore the association between low birth weight and preterm birth with violence during pregnancy, we conducted a cross-sectional study by using the 2010 Colombian Demographic and Health Survey. We conducted bivariate analyses, binomial logistic regression, and stratified models by age, and 14,520 women were included. There was no association between violence and low birth weight. Nonetheless, an association with preterm birth in women aged over 35 was observed (OR 1.98, 95%CI 1.23, 3.17). Prenatal care appeared to be a protective factor for both outcomes. This research unexpectedly showed that supplementation with folic acid and iron was associated with preterm birth.

Epidemiology of late preterm and early term births - An international perspective

Late preterm (34-36 weeks of gestational age (GA)), and early term (37-38 weeks GA) birth rates among singleton live births vary from 3% to 6% and from 15% to 31%, respectively, across countries, although data from low- and middle-income countries are sparse. Countries with high preterm birth rates are more likely to have high early term birth rates; many risk factors are shared, including pregnancy complications (hypertension, diabetes), medical practices (provider-initiated delivery, assisted reproduction), maternal socio-demographic and lifestyle characteristics and environmental factors. Exceptions include nulliparity and inflammation which increase risks for preterm, but not early term birth. Birth before 39 weeks GA is associated with adverse child health outcomes across a wide range of settings. International rate variations suggest that reductions in early delivery are achievable; implementation of best practice guidelines for obstetrical interventions and public health policies targeting population risk factors could contribute to prevention of both late preterm and early term births.

Global, regional, and national estimates of levels of preterm birth in 2014: a systematic review and modelling analysis

BACKGROUND

Preterm birth is the leading cause of death in children younger than 5 years worldwide. Although preterm survival rates have increased in high-income countries, preterm newborns still die because of a lack of adequate newborn care in many low-income and middle-income countries. We estimated global, regional, and national rates of preterm birth in 2014, with trends over time for some selected countries.

METHODS

We systematically searched for data on preterm birth for 194 WHO Member States from 1990 to 2014 in databases of national civil registration and vital statistics (CRVS). We also searched for population-representative surveys and research studies for countries with no or limited CRVS data. For 38 countries with high-quality data for preterm births in 2014, data are reported directly. For countries with at least three data points between 1990 and 2014, we used a linear mixed regression model to estimate preterm birth rates. We also calculated regional and global estimates of preterm birth for 2014.

FINDINGS

We identified 1241 data points across 107 countries. The estimated global preterm birth rate for 2014 was 10·6% (uncertainty interval 9·0-12·0), equating to an estimated 14·84 million (12·65 million-16·73 million) live preterm births in 2014. 12· 0 million (81·1%) of these preterm births occurred in Asia and sub-Saharan Africa. Regional preterm birth rates for 2014 ranged from 13·4% (6·3-30·9) in North Africa to 8·7% (6·3-13·3) in Europe. India, China, Nigeria, Bangladesh, and Indonesia accounted for 57·9 million (41×4%) of 139·9 million livebirths and 6·6 million (44×6%) of preterm births globally in 2014. Of the 38 countries with high-quality data, preterm birth rates have increased since 2000 in 26 countries and decreased in 12 countries. Globally, we estimated that the preterm birth rate was 9×8% (8×3-10×9) in 2000, and 10×6% (9×0-12×0) in 2014.

INTERPRETATION

Preterm birth remains a crucial issue in child mortality and improving quality of maternal and newborn care. To better understand the epidemiology of preterm birth, the quality and volume of data needs to be improved, including standardisation of definitions, measurement, and reporting.

FUNDING

WHO and the March of Dimes.

The association between whole blood concentrations of heavy metals in pregnant women and premature births: The Japan Environment and Children's Study (JECS)

BACKGROUND

Heavy metals are widely distributed in the environment. Recent reports have demonstrated the risk of preterm birth following heavy metal exposure. Preterm births are classified as early and late, depending on the duration of pregnancy, and are associated with increased risk of congenital illnesses such as heart failure, asthma, etc. Particularly, early preterm births carry a higher risk of mortality; however, the differential effects of heavy metal exposure on early and late preterm births are unknown.

OBJECTIVES

To analyze the association between maternal whole blood concentrations of heavy metals, such as cadmium (Cd), lead (Pb), mercury (Hg), selenium (Se), and manganese (Mn) that are common toxicants in Japan, and early and late preterm births.

METHODS

The data of 14,847 pregnant women who were participants of the Japan Environment and Children's Study were used. Data of the self-questionnaire pertaining to the first trimester (T1), second/third trimester (T2), and medical records after delivery were analyzed. We divided preterm birth into two groups: early preterm (22 to < 34 weeks) and late preterm (34 to < 37 weeks). Maternal blood samples for measuring heavy metal concentrations were collected in T2 (pregnancy weeks: 14-39). The participants were classified into four quartiles (Q1-Q4) according to increasing heavy metal levels.

RESULTS

The rate of preterm birth was 4.5%. After controlling for confounding factors, such as age, pre-pregnancy body mass index, smoking, partner's smoking, drinking habits, gravidity, parity, number of cesarean deliveries, uterine infections, household income, educational levels, and sex of infant, Cd levels were found, by multivariable logistic regression analysis, to be significantly associated with early preterm birth (p = 0.002), with odds ratio for early preterm birth of 1.91 (95% confidence interval: 1.12-3.27, P = 0.018) in subjects of Q4 compared with in subjects with term birth (≧ 37 weeks).

CONCLUSION

Maternal blood Cd levels during pregnancy are positively associated with the risk of early preterm birth among Japanese women. Identification of the main source of maternal Cd exposure may contribute to the prevention of early preterm births and health maintenance of mothers and their infants in the future.

Determinants of preterm birth at Jimma University Medical Center, southwest Ethiopia

Background

Preterm birth is the second leading cause of death next to pneumonia in children aged <5 years and the single-most important cause of death in the first month of life. Research examining determinants of preterm birth in Ethiopia is limited. Therefore, this study aimed to determine risk factors associated with preterm births at Jimma University Medical Center in southwest Ethiopia.

Methods

This unmatched case–control study was conducted from March 15 to April 1, 2017 from medical records of mothers and newborns delivered at Jimma University Medical Center from January 1 to December 30, 2016. Data were extracted using a structured checklist for cases (preterm) and controls (term) by reviewing maternal and newborn medical records using a simple random-sampling technique. Risk factors for preterm delivery were determined using bivariate and multivariate logistic regression models. Statistically significant associations were declared at P<0.05.

Results

The present study evaluated 218 maternal and newborn cases and 438 controls. Risk factors identified were history of previous preterm birth (AOR 6.4, 95% CI 2.9–13.9), preeclampsia (AOR 6.6, 95% CI 3.3–13.4), premature membrane rupture (AOR 11.7, 95% CI 6.2–21.9), antenatal care of fewer than four visits (AOR 4.8, 95% CI 1.2–19), birth interval <2 years (AOR 2.7, 95% CI 1.7–4.5), and multiple pregnancies (AOR 4.5, 95% CI 2.4–8.5).

Conclusion

History of previous preterm births, preeclampsia, premature membrane rapture, antenatal care of fewer than four visits, birth interval <2 years, and multiple pregnancies were found to have a possible causal relationship with preterm births. Therefore, similar further studies should be conducted to generate more population-based evidence on determinants of preterm births.

S-adenosyl methionine regulates calcium channels and inhibits uterine smooth muscle contraction in rats with infectious premature delivery through the transient receptor protein 3/protein kinase Cβ/C-kinase-activated protein phosphatase-1 inhibitor of 17 kDa signaling pathway

The aim of the present study was to investigate the effects of S-adenosyl methionine (SAMe) on infectious premature inflammatory factors and uterine contraction, and to further explore its mechanism of action via the transient receptor protein 3 (TRPC3)/protein kinase Cβ (PKCβ)/C-kinase-activated protein phosphatase-1 inhibitor of 17 kDa (CPI-17) signaling pathway, following intervention by a TRPC3 inhibitor. A rat model of premature delivery induced by lipopolysaccharide (LPS) was established. Following treatment with SAMe and inhibiting TRPC3 expression, rat serum and uterus were isolated. Hematoxylin and eosin staining was used to observe the histopathological changes in the uterus. Uterine muscle strips in vitro were selected to measure the changes in muscle tension. ELISA was utilized to measure the changes in serum inflammatory factor and oxidative stress indexes. Immunohistochemistry, western blot assay and reverse transcription-quantitative polymerase chain reaction were applied to detect calcium channel protein expression in the uterus. Western blot analysis was employed to measure the expression of TRPC3/PKCβ/CPI-17 signaling pathway-related proteins. TRPC3 was highly expressed in the uterus of rat models of premature delivery induced by LPS. Following treatment with SAMe, inflammatory cell infiltration markedly reduced in the uterus and the tension of in vitro uterine muscle strips significantly decreased. SAMe treatment suppressed inflammatory reaction and oxidative stress, and diminished L-type and T-type calcium channel protein expression. TRPC3/PKCβ/CPI-17 signaling pathway-related protein expression was also reduced. When TRPC3 expression was suppressed, the effects of SAMe against inflammation and oxidative stress were diminished. TRPC3/PKCβ/CPI-17 signaling pathway-related protein expression significantly increased. SAMe was able to reduce inflammatory reaction and oxidative stress in the uterus of rat model of infectious premature delivery induced by LPS, prolong delivery time, reduce the mortality rate of offspring rats, and serve a therapeutic role. This effect is likely achieved via the regulation of uterine contractions and childbirth through the TRPC3/PKCβ/CPI-17 signaling pathway.

The development of progesterone-loaded nanofibers using pressurized gyration: A novel approach to vaginal delivery for the prevention of pre-term birth

Recent evidence has continued to support the applicability of progesterone in preventing preterm birth, hence the development of an appropriate vaginal delivery system for this drug would be of considerable interest. Here, we describe the development of progesterone-loaded bioadhesive nanofibers using pressurized gyration for potential incorporation into a vaginal insert, with a particular view to addressing the challenges of incorporating a poorly water-soluble drug into a hydrophilic nanofiber carrier. Polyethylene oxide and carboxymethyl cellulose were chosen as polymers to develop the carrier systems, based on previous evidence of their yielding mucoadhesive nanofibers using the pressurized gyration technique. The fabrication parameters such as solvent system, initial drug loading and polymer composition were varied to facilitate optimisation of fiber structure and efficiency of drug incorporation. Such studies resulted in the formation of nanofibers with satisfactory surface appearance, diameters in the region of 400 nm and loading of up to 25% progesterone. Thermal and spectroscopic analyses indicated that the drug was incorporated in a nanocrystalline state. Release from the drug-loaded fibers indicated comparable rates of progesterone dissolution to that of Cyclogest, a commercially available progesterone pessary, allowing release over a period of hours. Overall, the study has shown that pressurized gyration may produce bioadhesive progesterone-loaded nanofibers which have satisfactory loading of a poorly water-soluble drug as well as having suitable structural and release properties. The technique is also capable of producing fibers at a yield commensurate with practical applicability, hence we believe that the approach shows considerable promise for the development of progesterone dosage forms for vaginal application.

The effect of a short course of moderate pressure sunflower oil massage on the weight gain velocity and length of NICU stay in preterm infants

OBJECTIVE

The aim of this study was to evaluate the efficacy of five-day course of sunflower oil massage with moderate pressure on the weight gain and length of NICU stay in preterm infants.

METHODS

Forty-four healthy preterm infants with a corrected gestational age of 30-36 weeks at the time of the study, were randomly assigned to the study group receiving body massage with sunflower oil and the control group receiving only routine NICU care. The massage was performed three times per day, each session including three consecutive five-minute stages, for five days. The primary outcome was to evaluate the efficacy of a short course of moderate pressure sunflower oil massage on the weight gain velocity. The secondary outcome was to compare the length of NICU stay between the two groups.

RESULTS

During the study period, the increase in the average daily and fifth-day weight gain was significant in the intervention group. The length of NICU stay was shorter in the intervention group significantly.

CONCLUSION

Our findings suggest that even a short course of body massage with sunflower oil for only five days increases preterm infants' weight gain and decreases their duration of NICU stay significantly.