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Al-Saleh I, Elkhatib R, Alnuwaysir H, Aldhalaan H, Alismail E, Binmanee A, Hawari A, Alhazzani F, Jabr MB, Mohamed G. Exposure of preterm neonates receiving total parenteral nutrition to phthalates and its impact on neurodevelopment at the age of 2 months. Sci Rep 2023; 13:6969. [PMID: 37117441 PMCID: PMC10141929 DOI: 10.1038/s41598-023-33715-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 04/18/2023] [Indexed: 04/30/2023] Open
Abstract
This prospective study assessed the exposure to phthalates of preterm neonates who received total parenteral nutrition (TPN) during their stay in the neonatal intensive care unit (NICU) and the risk of neurodevelopment delays at the age of 2 months. Our study recruited 33 preterm neonates who required TPN upon NICU admission. Urine samples for analyzing phthalate metabolites were obtained at admission and then daily until the last day of receiving TPN. Phthalates in the daily TPN received by the preterm neonates were analyzed. The neurodevelopment of the neonates was assessed using the Ages and Stages Questionnaire Edition 3 (ASQ-3). Diethyl phthalate and butyl benzyl phthalate were found in all TPN samples, while 27% and 83% contained dibutyl phthalate and di-(2-ethylhexyl) phthalate (DEHP), respectively. Yet, the daily dose of each phthalate that our preterm neonates received from TPN was much lower than the recommended tolerable limit. Urinary levels of monobenzyl phthalate and four metabolites of DEHP [i.e., mono-(2-ethylhexyl) phthalate (MEHP), mono-(2-ethyl-5-hydroxyhexyl) phthalate, mono-(2-ethyl-5-oxohexyl) phthalate (MEOHP), and mono-(2-ethyl-5-carboxypentyl) phthalate (MECPP)] and the sum of four DEHP metabolites (∑4DEHP) increased significantly in preterm neonates before discharge. However, these levels were not correlated with their phthalate parent compounds in TPN, suggesting other sources of exposure in the NICU. At 2 months, we found that urinary levels of mono-iso-butyl phthalate (MiBP), MECPP, MEHP, and ∑4DEHP were inversely related to fine motor skills. After adjusting for head circumference, the inverse relationships remained significant, suggesting direct effects from phthalates. Given the extreme vulnerability of our population, it is critical to minimize exposure to phthalates during their NICU stay.
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Affiliation(s)
- Iman Al-Saleh
- King Faisal Specialist Hospital and Research Centre, Environmental Health Program (MBC#03), P.O. Box: 3354, Riyadh, 11211, Saudi Arabia.
| | - Rola Elkhatib
- King Faisal Specialist Hospital and Research Centre, Environmental Health Program (MBC#03), P.O. Box: 3354, Riyadh, 11211, Saudi Arabia
| | - Hissah Alnuwaysir
- King Faisal Specialist Hospital and Research Centre, Environmental Health Program (MBC#03), P.O. Box: 3354, Riyadh, 11211, Saudi Arabia
| | - Hesham Aldhalaan
- Center for Autism Research, King Faisal Specialist Hospital and Research Centre, P.O. Box: 3354, Riyadh, 11211, Saudi Arabia
| | - Eiman Alismail
- Center for Autism Research, King Faisal Specialist Hospital and Research Centre, P.O. Box: 3354, Riyadh, 11211, Saudi Arabia
| | - Abdulaziz Binmanee
- Neonatal Critical Care Section, Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, P.O. Box: 3354, Riyadh, 11211, Saudi Arabia
| | - Amal Hawari
- Neonatal Critical Care Section, Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, P.O. Box: 3354, Riyadh, 11211, Saudi Arabia
| | - Fahad Alhazzani
- Neonatal Critical Care Section, Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, P.O. Box: 3354, Riyadh, 11211, Saudi Arabia
| | - Mohammad Bin Jabr
- Neonatal Critical Care Section, Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, P.O. Box: 3354, Riyadh, 11211, Saudi Arabia
| | - Gamal Mohamed
- Biostatistics, Epidemiology and Scientific Computing Department, King Faisal Specialist Hospital and Research Centre, P.O. Box: 3354, Riyadh, 11211, Saudi Arabia
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Uyan Hendem D, Oluklu D, Menekse Beser D, Besimoglu B, Goncu Ayhan S, Sahin D. Role of cervical sliding sign in predicting preterm delivery in pregnancies complicated with preterm premature rupture of membranes. Int J Gynaecol Obstet 2023; 160:886-891. [PMID: 35942714 DOI: 10.1002/ijgo.14384] [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: 05/27/2022] [Revised: 07/08/2022] [Accepted: 07/28/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To investigate the effect of cervical sliding sign (CSS) to predict preterm delivery in patients with premature rupture of membranes. METHODS This prospective cohort study included 88 pregnant women between 240/7 and 366/7 weeks of gestation who were complicated with preterm premature rupture of membranes (PPROM) between June 2020 and January 2022. We measured the cervical length (CL) and applied pressure to the anterior fornix of the cervix with the transvaginal probe to investigate the CSS, which is defined as the sliding of the anterior lip of the cervix on the posterior lip. RESULTS The time between PPROM and delivery was significantly shorter in the CSS+ group (P < 0.001). Receiver operating characteristic curve analysis was performed for CSS with regard to predicting delivery within 7 days following PPROM (area under the curve, 0.749 [95% confidence interval, 0.642-0.857], P < 0.001). On logistic regression analysis, CL <25 mm increased the predictive accuracy of delivery within 7 days following PPROM 1.91-fold, and CSS increased the predictive accuracy of delivery within 7 days following PPROM 10.71-fold. CONCLUSION CSS is an effective sonographic marker in predicting preterm delivery and provides better information of oncoming preterm delivery in patients with PPROM than CL measurement.
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Affiliation(s)
- Derya Uyan Hendem
- Division of Perinatology, Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Deniz Oluklu
- Division of Perinatology, Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Dilek Menekse Beser
- Division of Perinatology, Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Berchan Besimoglu
- Division of Perinatology, Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Sule Goncu Ayhan
- Division of Perinatology, Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Dilek Sahin
- Division of Perinatology, Department of Obstetrics and Gynecology, University of Health Sciences, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
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Muacevic A, Adler JR, Sharma DK, Wasnik P, Wanjari MB. Unwanted Teenage Pregnancy and Its Complications: A Narrative Review. Cureus 2022; 14:e32662. [PMID: 36686124 PMCID: PMC9848684 DOI: 10.7759/cureus.32662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 12/18/2022] [Indexed: 12/23/2022] Open
Abstract
Teenage pregnancy may have a huge negative social and medical influence on mothers' and children's health globally. Compared to adult primigravida, young women experience more harmful perinatal problems, such as premature births, neonatal fatalities and stillbirths, and the delivery of children with low birth weight. With negative perinatal outcomes, in India, teenage pregnancy is still a widespread and important public health issue that needs urgent attention. One of the main causes of mortality for females between the ages of 15 and 19 is pregnancy and delivery problems. The health of young women in India is, therefore, seriously threatened by adolescent pregnancies. Neonatal and maternal difficulties are more common when a teen gets pregnant. To bring about change, avert problems, and lower the risk of maternal death, specialized antenatal care (ANC) and health education are crucial. In India, teenage pregnancy is very high. To prevent this, there is a need to focus on teenage education regarding safe sexual practices and pregnancy complications.
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Wang C, Yu G, Menon R, Zhong N, Qiao C, Cai J, Wang W, Zhang H, Liu M, Sun K, Kan H, Zhang J. Acute and chronic maternal exposure to fine particulate matter and prelabor rupture of the fetal membranes: A nation-wide survey in China. ENVIRONMENT INTERNATIONAL 2022; 170:107561. [PMID: 36209598 DOI: 10.1016/j.envint.2022.107561] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 09/30/2022] [Accepted: 10/02/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Prelabor rupture of the fetal membranes (PROM) is a major contributor to adverse perinatal outcomes. Some epidemiologic studies explored the association between maternal PM2.5 exposure and PROM but failed to treat the labor induction and prelabor cesarean section as censored observations. OBJECTIVE We aimed to evaluated whether acute and chronic maternal ambient PM2.5 exposure may increase the risk of PROM in China. METHODS This study was based on the China Labor and Delivery Survey, a nationwide multicenter investigation. Included in the current analysis were 45,879 singleton spontaneous births in 96 hospitals in mainland China from 2015 to 2017. Outcomes were PROM, preterm PROM (<37 weeks' gestation) and term PROM (≥37 weeks' gestation). Daily concentration of PM2.5 at 1 km spatial resolution was estimated by gap-filling model. Generalized linear mixed model and mixed effects Cox model were applied to assess the associations of acute (from 0 to 4 days before delivery) and chronic (average gestational and trimester-specific) ambient PM2.5 exposure with outcomes, respectively. RESULTS Significant associations were found between acute PM2.5 exposures (per interquartile range increase) and the risk of preterm PROM (OR = 1.11; 95 % CI: 1.03, 1.19 for PM2.5 on delivery day; OR = 1.10; 95 % CI: 1.02, 1.18 for PM2.5 1 day before delivery) but not for term PROM. An interquartile range increase in PM2.5 during the second trimester was associated with elevated risks of PROM (HR = 1.14; 95 % CI: 1.07, 1.22), preterm PROM (HR = 1.22; 95 % CI: 1.02, 1.45) and term PROM (HR = 1.13; 95 % CI: 1.06, 1.22), respectively. Women who were less educated, obese, or gave birth in a cold season appeared to be more sensitive to ambient PM2.5 exposure. CONCLUSION Our findings suggest that both acute and chronic maternal exposures to ambient PM2.5 during pregnancy are risk factors for PROM.
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Affiliation(s)
- Cuiping Wang
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guoqi Yu
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ramkumar Menon
- Department of Obstetrics and Gynecology/Cell Biology at the University Texas Medical Branch at Galveston, TX, U.S.A
| | - Nanbert Zhong
- The New York State Institute for Basic Research in Developmental Disabilities, Staten Island, NY, U.S.A
| | - Chong Qiao
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jing Cai
- School of Public Health, Shanghai Institute of Infectious Disease and Biosecurity, Key Lab of Public Health Safety of the Ministry of Education and Key Lab of Health Technology Assessment of the Ministry of Health, Fudan University, Shanghai 200032, China
| | - Weidong Wang
- School of Public Health, Shanghai Institute of Infectious Disease and Biosecurity, Key Lab of Public Health Safety of the Ministry of Education and Key Lab of Health Technology Assessment of the Ministry of Health, Fudan University, Shanghai 200032, China
| | - Huijuan Zhang
- Department of Pathology, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ming Liu
- Department of Obstetrics, Shanghai Oriental Hospital, Tongji University, Shanghai, China
| | - Kang Sun
- Center for Reproductive Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haidong Kan
- School of Public Health, Shanghai Institute of Infectious Disease and Biosecurity, Key Lab of Public Health Safety of the Ministry of Education and Key Lab of Health Technology Assessment of the Ministry of Health, Fudan University, Shanghai 200032, China; Children's Hospital of Fudan University, National Center for Children's Health, Shanghai, China.
| | - Jun Zhang
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Maheshwari MV, Khalid N, Patel PD, Alghareeb R, Hussain A. Maternal and Neonatal Outcomes of Adolescent Pregnancy: A Narrative Review. Cureus 2022; 14:e25921. [PMID: 35844352 PMCID: PMC9282583 DOI: 10.7759/cureus.25921] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2022] [Indexed: 12/04/2022] Open
Abstract
Adolescent pregnancy is the pregnancy of girls aged 10-19 years, leading to many maternal and neonatal adverse effects. These pregnancies have been a global concern for many decades and yet are still prevailing. This article has reviewed the significant determinants of adolescent pregnancy and various maternal adverse effects, including preeclampsia, preterm premature rupture of the membrane (PPROM), maternal anemia, sexually transmitted diseases, postpartum depression, and maternal deaths, and adverse neonatal outcomes, including low birth weight (LBW), prematurity, stillbirths, early neonatal demise, and low Apgar score. Various pathophysiologic events that lead to such adverse consequences have been briefly discussed in the article and how such occurrences can be overcome. This article has also emphasized the need to implement various modalities such as sex education, availability of contraceptives, and bringing community-level awareness to lower the prevalence of adolescent pregnancy.
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Zhai Y, Wang B, Qin L, Luo B, Xie Y, Hu H, Du H, Li Z. Smog and risk of maternal and fetal birth outcomes: A retrospective study in Baoding, China. Open Med (Wars) 2022; 17:1007-1018. [PMID: 35733622 PMCID: PMC9164291 DOI: 10.1515/med-2022-0489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 03/30/2022] [Accepted: 04/20/2022] [Indexed: 11/15/2022] Open
Abstract
Abstract
Pregnant women are more susceptible to smog pollution than the general population. This study focused on the association between smog and birth outcomes, considering both pregnant mothers and their offspring. In this retrospective study, conducted in Baoding between 2013 and 2016, we enrolled 842 participants. Birth outcomes were low birth weight (LBW), pregnancy-induced hypertension (PIH), gestational diabetes mellitus (GDM), and premature rupture of membranes (PROM). The overall prevalence of LBW, PIH, GDM, and PROM was 8.2%, 14.8%, 16.5%, and 12.1%, respectively. Compared with lower pollution level, higher pollution level of fine particulate matter (particulate matter with aerodynamics diameter <2.5 μm) (PM2.5), inhalable particle (particulate matter with aerodynamics diameter <10 μm) (PM10), and CO increased the risk of term with LBW. PM2.5, PM10, and NO2 increased the risk of PIH during different trimesters, while PM10 increased the risk of PROM during trimester 3. In conclusion, smog significantly affects the risk of adverse birth outcomes by different exposure time windows.
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Affiliation(s)
- Yijing Zhai
- Department of Nutrition, Hebei Key Laboratory of Nutrition and Health, The First Hospital of Hebei Medical University , Shijiazhuang , 050031 , China
| | - Bei Wang
- Department of Nutrition, Hebei Key Laboratory of Nutrition and Health, The First Hospital of Hebei Medical University , Shijiazhuang , 050031 , China
| | - Liqiang Qin
- Department of Nutrition and Food Hygiene, School of Public Health, Soochow University , Suzhou , 215000 , China
| | - Bin Luo
- Department of Nutrition, Hebei Key Laboratory of Nutrition and Health, The First Hospital of Hebei Medical University , Shijiazhuang , 050031 , China
| | - Ying Xie
- Department of Nutrition, Hebei Key Laboratory of Nutrition and Health, The First Hospital of Hebei Medical University , Shijiazhuang , 050031 , China
| | - Huanyu Hu
- Department of Nutrition, Hebei Key Laboratory of Nutrition and Health, The First Hospital of Hebei Medical University , Shijiazhuang , 050031 , China
| | - Hongzhen Du
- Department of Nutrition, Hebei Key Laboratory of Nutrition and Health, The First Hospital of Hebei Medical University , Shijiazhuang , 050031 , China
| | - Zengning Li
- Department of Nutrition, Hebei Key Laboratory of Nutrition and Health, The First Hospital of Hebei Medical University , Shijiazhuang , 050031 , China
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Wu J, Feng L, Zhang H, Guo L, Pérez-Escamilla R, Hu Y. The Inconsistency Between Women's Preference and Actual Mode of Delivery in China: Findings From a Prospective Cohort Study. Front Public Health 2022; 10:782784. [PMID: 35433620 PMCID: PMC9005775 DOI: 10.3389/fpubh.2022.782784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 03/09/2022] [Indexed: 11/13/2022] Open
Abstract
Background Previous studies have found that the rates of cesarean preference were much lower than the actual rates of cesarean births in China. We aimed to observe this inconsistency between preferred and actual modes of delivery and the factors associated with the inconsistency. Methods We conducted a prospective cohort study at the maternity hospital with the largest number of deliveries in Beijing. We collected data through a questionnaire applied in the outpatient department, and medical records from the hospital's information system. Unconditional logistic regression was used to identify factors influencing the inconsistency between preferred and actual delivery mode. Results The rates of actual cesarean section and of cesarean preference were 41 and 17%, respectively (χ2 = 82.9, P < 0.0001). The overall inconsistency rate was 31%, with 119 women preferred vaginal delivery but experienced cesarean section, accounting for 67% women undergoing cesarean section. Risk factors for this inconsistency between preferred vaginal delivery and actual cesarean section included: maternal obesity, receiving assisted reproduction, having an abnormal amniotic fluid volume, and fetal distress. Pre-labor rupture of membranes was a unique factor associated with such inconsistency between cesarean section preference and vaginal delivery at delivery. Conclusions The inconsistent rate between preferred delivery at late pregnancy and actual delivery is high in China. Further research is needed to understand how to lower cesarean rates in China, taking maternal preferences for vaginal deliveries into account.
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Affiliation(s)
- Jing Wu
- School of Agroforestry & Medicine, the Open University of China, Beijing, China
| | - Li Feng
- School of Agroforestry & Medicine, the Open University of China, Beijing, China
| | - Hongwei Zhang
- Obstetrics Department, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Li Guo
- Obstetrics Department, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | | | - Yifei Hu
- Department of Child, Adolescent health and Maternal health, School of Public Health, Capital Medical University, Beijing, China
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Wang Y, Song J, Zhang X, Kang W, Li W, Yue Y, Zhang S, Xu F, Wang X, Zhu C. The Impact of Different Degrees of Intraventricular Hemorrhage on Mortality and Neurological Outcomes in Very Preterm Infants: A Prospective Cohort Study. Front Neurol 2022; 13:853417. [PMID: 35386416 PMCID: PMC8978798 DOI: 10.3389/fneur.2022.853417] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/23/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveIntraventricular hemorrhage (IVH) is a common complication in preterm infants and is related to neurodevelopmental outcomes. Infants with severe IVH are at higher risk of adverse neurological outcomes and death, but the effect of low-grade IVH remains controversial. The purpose of this study was to evaluate the impact of different degrees of IVH on mortality and neurodevelopmental outcomes in very preterm infants.MethodsPreterm infants with a gestational age of <30 weeks admitted to neonatal intensive care units were included. Cerebral ultrasound was examined repeatedly until discharge or death. All infants were followed up to 18–24 months of corrected age. The impact of different grades of IVH on death and neurodevelopmental disability was assessed by multiple logistic regression.ResultsA total of 1,079 preterm infants were included, and 380 (35.2%) infants had grade I-II IVH, 74 (6.9%) infants had grade III-IV IVH, and 625 (57.9%) infants did not have IVH. The mortality in the non-IVH, I-II IVH, and III-IV IVH groups was 20.1, 19.7, and 55.2%, respectively (p < 0.05), and the incidence of neurodevelopmental disabilities was 13.9, 16.1, and 43.3%, respectively (p < 0.05), at 18–24 months of corrected age. After adjusting for confounding factors, preterm infants with III-IV IVH had higher rates of cerebral palsy [26.7 vs. 2.4%, OR = 6.10, 95% CI (1.840–20.231), p = 0.003], disability [43.3 vs. 13.9%, OR = 2.49, 95% CI (1.059–5.873), p = 0.037], death [55.2 vs. 20.1%, OR = 3.84, 95% CI (2.090–7.067), p < 0.001], and disability + death [73.7 vs. 28.7%, OR = 4.77, 95% CI (2.518–9.021), p < 0.001] compared to those without IVH. However, the mortality and the incidence of neurodevelopmental disability in infants with I-II IVH were similar to those without IVH (p > 0.05).ConclusionsSevere IVH but not mild IVH increased the risk of mortality and neurodevelopmental disability in very preterm infants.
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Affiliation(s)
- Yong Wang
- Henan Key Laboratory of Child Brain Injury and Henan Pediatric Clinical Research Center, Institute of Neuroscience and Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Juan Song
- Henan Key Laboratory of Child Brain Injury and Henan Pediatric Clinical Research Center, Institute of Neuroscience and Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaoli Zhang
- Henan Key Laboratory of Child Brain Injury and Henan Pediatric Clinical Research Center, Institute of Neuroscience and Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wenqing Kang
- Department of Neonatology, Children's Hospital of Zhengzhou University, Zhengzhou, China
| | - Wenhua Li
- Henan Key Laboratory of Child Brain Injury and Henan Pediatric Clinical Research Center, Institute of Neuroscience and Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuyang Yue
- Henan Key Laboratory of Child Brain Injury and Henan Pediatric Clinical Research Center, Institute of Neuroscience and Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shan Zhang
- Henan Key Laboratory of Child Brain Injury and Henan Pediatric Clinical Research Center, Institute of Neuroscience and Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Falin Xu
- Henan Key Laboratory of Child Brain Injury and Henan Pediatric Clinical Research Center, Institute of Neuroscience and Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaoyang Wang
- Henan Key Laboratory of Child Brain Injury and Henan Pediatric Clinical Research Center, Institute of Neuroscience and Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Center for Perinatal Medicine and Health, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Changlian Zhu
- Henan Key Laboratory of Child Brain Injury and Henan Pediatric Clinical Research Center, Institute of Neuroscience and Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
- *Correspondence: Changlian Zhu ;
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Xiong Z, Pei S, Zhu Z. Four kinds of tocolytic therapy for preterm delivery: Systematic review and network meta-analysis. J Clin Pharm Ther 2022; 47:1036-1048. [PMID: 35304748 DOI: 10.1111/jcpt.13641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/10/2022] [Accepted: 02/23/2022] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Premature birth affects more than 15 million infants, as well as mothers and families around the world. With the relaxation of the two-child policy, the problem of premature birth has become relatively prominent in China. According to statistics, China had a birth population of 15.23 million in 2018, with a considerably large number of premature births. This study aims to evaluate the efficacy and safety of tocolysis in the treatment of preterm delivery, provide clinical evidence for medical staff and promote the self-management of patients with premature births. METHODS Four English databases (PubMed, Embase, Cochrane Library and Web of Science) were retrieved by computer, the retrieval time was from the establishment of each database to November 2021, and the randomized controlled trials for the treatment of preterm delivery were screened according to the pre-set natriuretic exclusion criteria. After literature screening, data selection and risk of bias evaluation were independently conducted by two researchers. R 4.1.1 and Stata 17.0 software were used for statistical analysis. RESULTS AND DISCUSSION A total of 44 RCTs were included, including 6939 patients. The results of network meta-analysis reveal that in terms of effectiveness, indomethacin was the most effective intervention measure, followed by nifedipine, and the difference was statistically significant; regarding safety, nifedipine was the safest intervention measure, followed by indomethacin, and the difference was statistically significant; and in respect of adverse reactions, ritodrine had the highest probability, and the difference was statistically significant. WHAT IS NEW AND CONCLUSION Nifedipine may be better for delayed delivery and less likely to produce adverse pregnancy outcomes, followed by indomethacin. Limited by the number and quality of recipient studies, the aforementioned conclusions need to be verified through more high-quality studies. At the same time, the focus should be on patients with twin pregnancy and patients with clinical manifestations of extreme preterm delivery.
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Affiliation(s)
- Zhihui Xiong
- Department of Obstetrics, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Shuping Pei
- Department of Obstetrics, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Zhen Zhu
- Department of Obstetrics, Tongde Hospital of Zhejiang Province, Hangzhou, China
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Saito-Abe M, Yamamoto-Hanada K, Pak K, Sato M, Irahara M, Mezawa H, Sasaki H, Nishizato M, Ishitsuka K, Konishi M, Yang L, Ohya Y, Suzuki K. Association of Maternal History of Allergic Features with Preterm Pregnancy Outcomes in the Japan Environment and Children's Study. Int Arch Allergy Immunol 2021; 182:650-662. [PMID: 33601376 DOI: 10.1159/000513749] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 12/14/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Previous studies have reported that maternal asthma increases the risk of preterm birth. We hypothesized that inflammatory reactions caused by allergic diseases might affect the uterine environment and, subsequently, perinatal outcomes. The objective of this study was to examine the associations between allergic features among mothers and preterm pregnancy outcomes in a nationwide birth cohort. METHODS We analyzed data from pregnant women obtained from the Japanese Environment and Children's Study (JECS), a nationwide general birth cohort study. We used binomial and multinomial logistic regression models to examine the associations between maternal allergic features and preterm birth, threatened preterm labor (TPL), and preterm premature rupture of the membrane (PPROM). RESULTS A total of 97,683 pregnant women were included. Prevalence of preterm birth, TPL, and PPROM was 4.7, 19.6, and 1.2%, respectively. Maternal history of allergic diseases (asthma, allergic rhinitis, allergic conjunctivitis, food allergy, drug allergy, and contact dermatitis) increased the risk of TPL(adjusted odds ratio [aOR] = 1.11 [95% CI: 1.06-1.17], aOR = 1.12 [1.08-1.16], aOR = 1.10 [1.04-1.16], aOR = 1.17 [1.09-1.26], aOR = 1.35 [1.23-1.48], and aOR = 1.34 [1.20-1.49], respectively). Although some maternal allergic features showed a negative association with preterm birth, the variables affecting preterm birth differed according to the gestational age of the fetus (22-33 weeks vs. 34-36 weeks). There were no significant associations between maternal allergic features and PPROM. CONCLUSION Maternal allergic disease, except atopic dermatitis, may increase the risk of TPL. Comorbidity of maternal allergic disorders and perinatal adverse outcomes require further investigation.
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Affiliation(s)
- Mayko Saito-Abe
- Medical Support Center for the Japan Environment and Children's Study, National Center for Child Health and Development, Tokyo, Japan, .,Department of Health and Psychosocial Medicine, Aichi Medical University School of Medicine, Nagakute, Japan,
| | - Kiwako Yamamoto-Hanada
- Medical Support Center for the Japan Environment and Children's Study, National Center for Child Health and Development, Tokyo, Japan
| | - Kyongsun Pak
- Division of Biostatistics, Department of Data Management, Center for Clinical Research, National Center for Child Health and Development, Tokyo, Japan
| | - Miori Sato
- Medical Support Center for the Japan Environment and Children's Study, National Center for Child Health and Development, Tokyo, Japan.,Department of Health and Psychosocial Medicine, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Makoto Irahara
- Medical Support Center for the Japan Environment and Children's Study, National Center for Child Health and Development, Tokyo, Japan
| | - Hidetoshi Mezawa
- Medical Support Center for the Japan Environment and Children's Study, National Center for Child Health and Development, Tokyo, Japan
| | - Hatoko Sasaki
- Medical Support Center for the Japan Environment and Children's Study, National Center for Child Health and Development, Tokyo, Japan
| | - Minaho Nishizato
- Medical Support Center for the Japan Environment and Children's Study, National Center for Child Health and Development, Tokyo, Japan
| | - Kazue Ishitsuka
- Medical Support Center for the Japan Environment and Children's Study, National Center for Child Health and Development, Tokyo, Japan
| | - Mizuho Konishi
- Medical Support Center for the Japan Environment and Children's Study, National Center for Child Health and Development, Tokyo, Japan
| | - Limin Yang
- Medical Support Center for the Japan Environment and Children's Study, National Center for Child Health and Development, Tokyo, Japan
| | - Yukihiro Ohya
- Medical Support Center for the Japan Environment and Children's Study, National Center for Child Health and Development, Tokyo, Japan
| | - Kohta Suzuki
- Department of Health and Psychosocial Medicine, Aichi Medical University School of Medicine, Nagakute, Japan
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