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Park H, Hong S, Yoo HN, Kim YM, Lee SJ, Park KH. The Identification of Immune-Related Plasma Proteins Associated with Spontaneous Preterm Delivery and Intra-Amniotic Infection in Women with Premature Cervical Dilation or an Asymptomatic Short Cervix. J Korean Med Sci 2020; 35:e26. [PMID: 32080985 PMCID: PMC7036344 DOI: 10.3346/jkms.2020.35.e26] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 12/22/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND We aimed to investigate whether various immune-related plasma proteins, alone or in combination with conventional clinical risk factors, can predict spontaneous preterm delivery (SPTD) and intra-amniotic infection in women with premature cervical dilation or a short cervix (≤ 25 mm). METHODS This retrospective study included 80 asymptomatic women with premature cervical dilation (n = 50) or a short cervix (n = 30), who underwent amniocentesis at 17-29 weeks. Amniotic fluid (AF) was cultured, and maternal plasma was assayed for interleukin (IL)-6, matrix metalloproteinase (MMP)-9, tissue inhibitor of metalloproteinases (TIMP)-1, and complements C3a and C5a, using enzyme-linked immunosorbent assay (ELISA) kits. The primary outcome measures were SPTD at < 32 weeks and positive AF cultures. RESULTS The plasma levels of IL-6, C3a, and C5a, but not of MMP-9 and TIMP-1, were significantly higher in women with SPTD at < 32 weeks than in those who delivered at ≥ 32 weeks. The women who delivered at < 32 weeks had more advanced cervical dilatation, and higher rates of antibiotic and tocolytic administration and were less likely to be given vaginal progesterone than those who delivered at ≥ 32 weeks. Using a stepwise regression analysis, a combined prediction model was developed, which included the plasma IL-6 and C3a levels, and cervical dilatation (area under the curve [AUC], 0.901). The AUC for this model was significantly greater than that for any single variable included in the predictive model. In the univariate analysis, plasma IL-6 level was the only significant predictor of intra-amniotic infection. CONCLUSION In women with premature cervical dilation or a short cervix, maternal plasma IL-6, C3a, and C5a levels could be useful non-invasive predictors of SPTD at < 32 weeks. A combination of these biomarkers and conventional clinical factors may clearly improve the predictability for SPTD, as compared with the biomarkers alone. An increased plasma level of IL-6 predicted intra-amniotic infection.
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Affiliation(s)
- Hyunsoo Park
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Subeen Hong
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Ha Na Yoo
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Yu Mi Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Se Jin Lee
- Department of Obstetrics and Gynecology, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Kyo Hoon Park
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
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Park HS, Kwon H, Kwak DW, Kim MY, Seol HJ, Hong JS, Shim JY, Choi SK, Hwang HS, Oh MJ, Cho GJ, Kim K, Oh SY. Addition of Cervical Elastography May Increase Preterm Delivery Prediction Performance in Pregnant Women with Short Cervix: a Prospective Study. J Korean Med Sci 2019; 34:e68. [PMID: 30863266 PMCID: PMC6406042 DOI: 10.3346/jkms.2019.34.e68] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 02/15/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND We investigated whether there is a difference in elastographic parameters between pregnancies with and without spontaneous preterm delivery (sPTD) in women with a short cervix (≤ 25 mm), and examined the ability of elastographic parameters to predict sPTD in those women. METHODS E-CervixTM (WS80A; Samsung Medison, Seoul, Korea) elastography was used to examine the cervical strain. Elastographic parameters were compared between pregnancies with and without sPTD. Diagnostic performance of elastographic parameters to predict sPTD ≤ 37 weeks, both alone and in combination with other parameters, was compared with that of cervical length (CL) using area under receiver operating characteristic curve (AUC) analysis. RESULTS A total of 130 women were included. Median gestational age (GA) at examination was 24.4 weeks (interquartile range, 21.4-28.9), and the prevalence of sPTD was 20.0% (26/130). Both the elastographic parameters and CL did not show statistical difference between those with and without sPTD. However, when only patients with CL ≥ 1.5 cm (n = 110) were included in the analysis, there was a significant difference between two groups in elasticity contrast index (ECI) within 0.5/1.0/1.5 cm from the cervical canal (P < 0.05) which is one of elastographic parameters generated by E-Cervix. When AUC analysis was performed in women with CL ≥ 1.5 cm, the combination of parameters (CL + pre-pregnancy body mass index + GA at exam + ECI within 0.5/1.0/1.5 cm) showed a significantly higher AUC than CL alone (P < 0.05). CONCLUSION An addition of cervical elastography may improve the ability to predict sPTD in women with a short CL between 1.5 and 2.5 cm.
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Affiliation(s)
- Hyun Soo Park
- Department of Obstetrics and Gynecology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Hayan Kwon
- Department of Obstetrics and Gynecology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Dong Wook Kwak
- Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea
- Department of Obstetrics and Gynecology, Ajou University Hospotal, Ajou University School of Medicine, Suwon, Korea
| | - Moon Young Kim
- Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea
| | - Hyun-Joo Seol
- Department of Obstetrics and Gynecology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Joon-Seok Hong
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae-Yoon Shim
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sae-Kyung Choi
- Department of Obstetrics and Gynecology, The Catholic University of Korea Incheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Han-Sung Hwang
- Department of Obstetrics and Gynecology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Min Jeong Oh
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Geum Joon Cho
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Kunwoo Kim
- Department of Obstetrics and Gynecology, Hamchoon Women's Clinic, Seoul, Korea
| | - Soo-young Oh
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Kwak MY, Lee SM, Lee TH, Eun SJ, Lee JY, Kim Y. Accessibility of Prenatal Care Can Affect Inequitable Health Outcomes of Pregnant Women Living in Obstetric Care Underserved Areas: a Nationwide Population-Based Study. J Korean Med Sci 2019; 34:e8. [PMID: 30618515 PMCID: PMC6318447 DOI: 10.3346/jkms.2019.34.e8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 10/11/2018] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND As of 2011, among 250 administrative districts in Korea, 54 districts did not have obstetrics and gynecology clinics or hospitals providing prenatal care and delivery services. The Korean government designated 38 regions among 54 districts as "Obstetric Care Underserved Areas (OCUA)." However, little is known there are any differences in pregnancy, prenatal care, and outcomes of women dwelling in OCUA compared to women in other areas. The purposes of this study were to compare the pregnancy related indicators (PRIs) and adequacy of prenatal care between OCUA region and non-OCUA region. METHODS Using National Health Insurance database in Korea from January 1, 2012 to December 31, 2014, we constructed the whole dataset of women who terminated pregnancy including delivery and abortion. We assessed incidence rate of 17 PRIs and adequacy of prenatal care. All indicators were compared between OCUA group and non-OCUA group. RESULTS The women dwelling in OCUA regions were more likely to get abortion (4.6% in OCUA vs. 3.6% in non-OCUA) and receive inadequate prenatal care (7.2% vs. 4.4%). Regarding abortion rate, there were significant regional differences in abortion rate. The highest abortion rate was 10.3% and the lowest region was 1.2%. Among 38 OCUA regions, 29 regions' abortion rates were higher than the national average of abortion rate (3.56%) and there were 10 regions in which abortion rates were higher than 7.0%. In addition, some PRIs such as acute pyelonephritis and transfusion in obstetric hemorrhage were more worse in OCUA regions compared to non-OCUA regions. CONCLUSION PRIs are different according to the regions where women are living. The Korean government should make an effort reducing these gaps of obstetric cares between OCUA and non-OCUA.
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Affiliation(s)
- Mi Young Kwak
- Center for Public Health, National Medical Center, Seoul, Korea
| | - Seung Mi Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Tae Ho Lee
- Center for Public Health, National Medical Center, Seoul, Korea
| | - Sang Jun Eun
- Department of Preventive Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jin Yong Lee
- Public Health Medical Service, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
- Institute of Health Policy and Management, Medical Research Center, Seoul National University, Seoul, Korea
| | - Yoon Kim
- Institute of Health Policy and Management, Medical Research Center, Seoul National University, Seoul, Korea
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea
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Kim YM, Park KH, Park H, Yoo HN, Kook SY, Jeon SJ. Complement C3a, But Not C5a, Levels in Amniotic Fluid Are Associated with Intra-amniotic Infection and/or Inflammation and Preterm Delivery in Women with Cervical Insufficiency or an Asymptomatic Short Cervix (≤ 25 mm). J Korean Med Sci 2018; 33:e220. [PMID: 30140190 PMCID: PMC6105771 DOI: 10.3346/jkms.2018.33.e220] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 06/04/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND We aimed to estimate whether elevated levels of complement C3a and C5a in amniotic fluid (AF) are independently associated with increased risks of intra-amniotic infection and/or inflammation (IAI) and spontaneous preterm delivery (SPTD) in women with cervical insufficiency or a short cervix (≤ 25 mm). METHODS We conducted a retrospective cohort study of 96 consecutive women with cervical insufficiency (n = 62) or a short cervix (n = 34) at 17 to 27 weeks, and who underwent an amniocentesis. AF was cultured and analyzed for C3a and C5a by enzyme-linked immunosorbent assay kits. The primary outcome measures were IAI (defined as a positive AF culture and/or an elevated AF interleukin-6 level [≥ 7.6 ng/mL]) and SPTD at < 32 weeks. RESULTS In multivariable analysis, AF level of C3a was the only variable significantly associated with IAI, whereas C5a level in AF and serum C-reactive protein level were not associated with IAI. Using SPTD at < 32 weeks as the outcome variable in logistic regression, elevated AF levels of C3a were associated with increased risk of SPTD at < 32 weeks after adjusting for other baseline confounders, whereas elevated AF levels of C5a were not. CONCLUSION In women with cervical insufficiency or a short cervix, elevated AF level of C3a, but not C5a, is independently associated with increased risks of IAI and SPTD at < 32 weeks. These findings suggest that subclinical IAI or SPTD in the context of cervical insufficiency is related to activation of complement system in AF.
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Affiliation(s)
- Yu Mi Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Kyo Hoon Park
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- Center for High Risk Pregnancy and Neonate, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hyunsoo Park
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- Center for High Risk Pregnancy and Neonate, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Ha-Na Yoo
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Song Yi Kook
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- Center for High Risk Pregnancy and Neonate, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Se Jeong Jeon
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- Center for High Risk Pregnancy and Neonate, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Hauspurg A, Ying W, Hubel CA, Michos ED, Ouyang P. Adverse pregnancy outcomes and future maternal cardiovascular disease. Clin Cardiol 2018; 41:239-246. [PMID: 29446836 DOI: 10.1002/clc.22887] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 01/03/2018] [Indexed: 12/25/2022] Open
Abstract
Cardiovascular disease (CVD) remains the leading cause of death in women. Although traditional risk factors increase later-life CVD, pregnancy-associated complications additionally influence future CVD risk in women. Recent guidelines for the prevention of CVD in women have added adverse pregnancy outcomes as major CVD risk factors. Studies have shown that women with a history of preeclampsia, gestational diabetes, preterm delivery, and delivery of a small-for-gestational-age infant have an increased risk of developing cardiometabolic risk factors and subsequent CVD. A history of multiple adverse pregnancy outcomes further increases this risk. It has been suggested that these pregnancy complications may unmask preexisting elevated CVD risk; however, whether the pathophysiologic changes underlying these conditions directly result in long-term cardiovascular damage is unclear. The purpose of this review was to highlight the associations between adverse pregnancy outcomes and future CVD, and to emphasize the importance of considering pregnancy history in assessing a woman's CVD risk. Targeted efforts to initiate screening and risk-reduction strategies in women with prior history of pregnancy complications, particularly lifestyle modification, may help decrease the burden of CVD in women.
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Affiliation(s)
- Alisse Hauspurg
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Wendy Ying
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Carl A Hubel
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Erin D Michos
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Pamela Ouyang
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Mojibyan M, Karimi M, Bidaki R, Rafiee P, Zare A. Exposure to Second-hand Smoke During Pregnancy and Preterm Delivery. Int J High Risk Behav Addict 2013; 1:149-53. [PMID: 24971254 PMCID: PMC4070123 DOI: 10.5812/ijhrba.7630] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 12/21/2012] [Accepted: 01/01/2013] [Indexed: 11/16/2022]
Abstract
Background Prematurity is an issue related to increasing the neonatal morbidity and mortality and smoking pregnant women cause the risk of low birth weight and prematurity increase, compared to non-smoking ones. Objectives This study investigates second-hand smoke (SHS) exposure’s effects over pregnant women on gestational age and birth weight. Materials and Methods In this descriptive-analytic study, 205 women referred to both public and private hospitals in the third trimester were questioned about second-hand smoke (SHS) exposure during pregnancy. In addition to birth weight and gestational age, other variables including mother’s education and job and sex of the newborns were also assessed. Results Of all 205 women, 43 (20.97%) women exposed to SHS during pregnancy and 162 (79.02%) women did not. In SHS exposure group, 11 infant (25.6%) and in non- SHS exposure group, 17 infant (10.5%), were born prematurely (< 37 weeks) (P = 0.01). Also birth weight of newborn in non-SHS exposure group was 118 gram more than other group but the differences were not significant (P = 0.09). Conclusions Our findings showed that the secondhand smoke (SHS) exposure of pregnant women may be significantly associated with early preterm delivery.
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Affiliation(s)
- Mahdiyeh Mojibyan
- Department of Gynecology, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, IR Iran
| | - Mehran Karimi
- Department of Pediatrics, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, IR Iran
- Corresponding author: Mehran Karimi, Department of Pediatrics, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, IR Iran, Tel.: +98-351 8244258, Fax: +98-3518224100, E-mail:
| | - Reza Bidaki
- Department of Psychiatry, Rafsanjan University of Medical Sciences, Rafsanjan, IR Iran
| | - Parivash Rafiee
- General practitioner, School of medicine , Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, IR Iran
| | - Asghar Zare
- Health Center of Yazd Province, Shahid Sadoughi University of Medical Sciences, Yazd, IR Iran
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Borna S, Mirzamoradi M, Abdollahi A, Milani F, Pouransari P. Applying Maternal Serum and Amniotic Fluid CRP Concentrations, and Cervical Length to Predict Preterm Delivery. J Family Reprod Health 2013; 7:1-5. [PMID: 24971095 PMCID: PMC4064741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
OBJECTIVE To investigate the clinical advantage of several prognostic factors for predicting preterm delivery. MATERIALS AND METHODS Eighty and six patients with a singleton pregnancy admitted to Vali-Asr hospital underwent genetic amniocentesis between the 15th and 23th weeks were included in this study. Maternal serum C-reactive protein (CRP), transvaginal sonographic measurement of cervical length (CL),were examined on genetic amniocentesis time. Receiver-operating characteristic (ROC) analysis was performed to determine the efficacy of maternal serum and amniotic fluid CRP levels in predicting women with preterm delivery. Correlation between each factor and the duration of pregnancy was investigated. RESULTS The prevalence of spontaneous preterm delivery before 37 weeks of gestation was 11%. ROC analysis revealed that maternal serum CRP level was the parameter, which had a significant power in the prediction of preterm delivery. The optimum cut-off level was 1.2 mg/L. The sensitivity and specificity were 95.1% and 91.8%, respectively. The positive predictive value for CL length with the cut off value of 25 mm was 72.1%. No statistically significant difference correlation observed between CL and the duration of pregnancy or amniotic fluid and maternal serum CRP levels. CONCLUSION The maternal serum CRP level has a good sensitivity and specificity in the prediction of preterm delivery and this may be helpful in predicting preterm delivery during genetic amniocentesis. Maternal serum CRP measurement is a safe, simple clinically useful, cost effective, non invasive method, that may assist clinicians in evaluation for high-risk patients and determine strategies for the prevention of preterm delivery.
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Affiliation(s)
- Sedigheh Borna
- Department of Obstetrics & Gynecology, Vali-e-asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoomeh Mirzamoradi
- Department of Obstetrics & Gynecology, Mahdiyeh Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Abdollahi
- Department of pathology, Vali-e-asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Foruzan Milani
- Department of Obstetrics & Gynecology, Rasht University of Medical Sciences, Rasht, Iran
| | - Parichehr Pouransari
- Department of Obstetrics & Gynecology, Royan Institute Research and Clinical Center for Infertility, Tehran, Iran
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Nelson K, Lohsoonthorn V, Williams MA. Preterm Delivery Risk in Relation to Maternal Occupational and Leisure Time Physical Activity Among Thai Women. ASIAN BIOMED 2009; 3:267-277. [PMID: 23997840 PMCID: PMC3756907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Little is known about the relationship between maternal occupational physical exertion and leisure time physical activity (LTPA) with preterm delivery (PTD) among Thai women, a population that differs in many respects from women in Western countries. OBJECTIVES To evaluate associations of maternal occupational physical exertion and LTPA with PTD in aggregate and in subgroups (i.e., spontaneous preterm labor, preterm premature rupture of membrane, medically indicated preterm delivery, moderate preterm delivery [gestational age 32-36 weeks], and very preterm delivery [<32 weeks]) among Thai women. METHODS This case-control study included 467 PTD cases and 467 term controls. Maternal occupational exertion during pregnancy, as well as habitual engagement in LTPA before and during pregnancy was assessed using a structured questionnaire administered after delivery. Logistic regression procedures were used to examine relationships between both occupational and leisure time physical activity and PTD. RESULTS After controlling for potential confounders, women who reported heavy physical occupational exertion during pregnancy, compared with other women, had a 2.42-fold increased risk of PTD overall [OR=2.42, 95% CI: 1.15, 5.09]. Very PTD [OR=4.57, 95% CI: 1.65, 12.64] and medically indicated PTD [OR=3.79, 95% CI: 1.54, 9.32] were particularly strongly associated with heavy occupational exertion. Maternal participation in LTPA before pregnancy was associated with a 24% reduction in PTD risk overall [OR=0.76, 95% CI: 0.57, 1.00], though no similar pattern in risk reduction was observed for LTPA performed during the first 6 months of pregnancy [OR=0.96, 95% CI: 0.68, 1.36]. CONCLUSION Consistent with some previous reports, we noted that heavy occupational physical exertion is associated with at least a doubling in PTD risk. Patterns of associations of PTD risk with LTPA were less well delineated in this Thai population.
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Affiliation(s)
- Kailey Nelson
- Multidisciplinary International Research Training Program, Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, Washington, USA
| | - Vitool Lohsoonthorn
- Multidisciplinary International Research Training Program, Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, Washington, USA
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Michelle A. Williams
- Multidisciplinary International Research Training Program, Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, Washington, USA
- Center for Perinatal Studies, Swedish Medical Center, Seattle, Washington, USA
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