Gestation Term Research Articles

Association of the distance travelled, and the call to hospital arrival time with early neonatal mortality in neonates born to mothers using emergency medical services at term gestation: a retrospective observational study

BackgroundMost neonatal deaths in India occur due to a lack of timely and proper care just before and during delivery. Timely availability of an ambulance for institutional delivery has led...

Association Between Laboratory Coagulation Parameters and Postpartum Hemorrhage in Preterm and Term Caesarean Section: A Retrospective Analysis.

Background: Deranged antepartum laboratory parameters may be risk factors for postpartum hemorrhage (PPH). However, whether this is also valid in women who give birth prematurely is currently unknown. Methods: We performed a retrospective single-center study to assess the role of antepartum hemoglobin, platelet count, fibrinogen, activated partial thromboplastin time, and prothrombin time as risk factors for PPH following caesarean section. We defined PPH as documented blood loss of at least 1 L and/or transfusion of red blood cell concentrates. We stratified the included patients according to gestational age: extremely preterm (gestational age < 28 weeks), very preterm (gestational age between 28 and 32 weeks), late and moderate preterm (gestational age between 32 and 37 weeks), and term (gestational age ≥ 37 weeks). Results: We included 1734 patients, 112 (6%) of whom had PPH. In total, 19 patients (10%) were in the extremely preterm group, 13 patients (10%) were in the very preterm group, 44 patients (9%) were in the late and moderate preterm group, and 36 patients (4%) were in the term group. Hemoglobin predicted PPH in all gestational age groups. Platelet count was associated with PPH in term, but not in preterm patients. Fibrinogen was associated with PPH in late prematurity but not in term patients and not in patients with early or extreme prematurity. Conclusions: Antepartum hemoglobin was the only factor predicting PPH in preterm and term caesarean sections. Platelet count and fibrinogen concentration were associated with PPH in term and late prematurity, respectively, but not in earlier stages of prematurity.

Perinatal Outcome in Women with Perception of Reduced Fetal Movements at Term Pregnancy - A Prospective Observational Study

Background: A significant reduction or sudden alteration in fetal movements is a potentially an important clinical symptom for induction, caesarean section, low neonatal Apgar score at delivery. In this context this study was conducted to evaluate the association between perception of reduced fetal movements and perinatal outcome in pregnant women with singleton term gestation. Methods: The present study was a prospective observational study done to evaluate the pregnancy outcomes in women presenting with perception of decreased fetal movements (PDFM). 154 women were enrolled out of which 77 were cases (with PDFM) and 77 were controls (without PDFM). Results: IUD was reported in 1.3% of the cases and none in controls. Induction of labor (IOL) was done in 78% cases and 41.6% controls and need for NICU admission was high in cases when compared to controls but not statistically significant. Conclusion: Decreased fetal movements warrant immediate evaluation as obstetric and perinatal outcomes are poor.

Novel, Group-Based Trajectories of Labor Progress in Nulliparous Women With Low-Risk Pregnancies

ObjectiveTo characterize labor progress among nulliparous women by applying group-based trajectory analysis and examining predictors of group membership. DesignRetrospective observational. SettingAn existing biobank and database from a birth hospital in Western Pennsylvania. ParticipantsNulliparous women with low-risk pregnancies at term gestation with singleton fetuses in vertex presentation (N = 401). MethodsWe characterized labor progress by applying group-based trajectory analysis. We conducted a multinomial logistic regression analysis to examine the relationships among labor trajectory groups and various demographic and clinical variables. ResultsWe identified three trajectories of labor in the group-based trajectory analyses: precipitously progressing (n = 76, 20.1%), average (n = 245, 59.1%), and slow progress (n = 80, 20.7%). Only gestational age at birth significantly predicted trajectory group membership, and an increased gestational age was associated with greater odds of belonging to the slower progress group (OR = 1.43, 95% CI [1.06, 1.92]). ConclusionWe identified multiple trajectories of labor progress in a sample of nulliparous women with low-risk pregnancies at term gestation. Gestational age may help predict the trajectory of labor.

Cardiovascular responses to heat and cold exposure are altered by preterm birth in guinea pigs.

Adversity early in life can modify the trajectory for disease risk extending decades beyond the event. Preterm birth produces persistent cardiovascular alterations that may appear maladaptive in adulthood. We have previously hypothesized that those born preterm may exhibit cardiovascular vulnerability in the climate change context. Further, this vulnerability may be present as early as childhood. We aimed to identify the early signs of cardiovascular dysfunction at childhood-equivalent age using our animal model of preterm birth. Using a whole-body thermal stress test, guinea pigs aged 35-d and 38-d (equivalent to 8-10-year-old children) and born at term or preterm gestations were exposed to progressive hyper- (TC = 41.5°C) and hypo-thermia (TC = 34°C; normothermia TC = 39°C). Comprehensive cardiovascular monitoring included ECG, blood pressure, microvascular perfusion, blood gas, and catecholamine profile, as well as skin and core body temperature. Preterm-born animals exhibited attenuated vascular responses to hyperthermic stress, and a significant elevation in systolic blood pressure in response to hypothermic stress. Such responses are similar to those observed in elderly populations and indicate the presence of cardiovascular dysfunction. This is the first study to demonstrate the impact of preterm birth on the cardiovascular response to both heat and cold stress. Further, this dysfunction has been observed at an earlier age than that achievable using traditional stress testing techniques. The present findings warrant further investigation.

Progress in growth monitoring for infants born at term and preterm gestations: are we there yet?

Progress in growth monitoring for infants born at term and preterm gestations: are we there yet?

The Effectiveness of Birthing Ball Gymnastics on Primigravida Maternity Gestational Age

One of the riskiest pregnancy conditions is post-term pregnancy, which is defined as a gestational age greater than the estimated day of delivery (HPL). This is because difficulties may arise for both the mother and the fetus, particularly when birthing is imminent. Birthing ball gymnastics is one complementary therapy that can help labor commence at full gestational age (term). The aim of the research was to evaluate the impact of birthing ball gymnastics on the gestational age of moms who were primigravidae. The study's quasi-experimental design, which included a treatment group and a control group, was randomized post-test only. The Midwife Independent Practice Place (TPMB) Sidoarjo served as the research site for five months, starting in February 2023 and ending in June 2023. Purposive sampling procedures were used in the study to collect samples from participants who satisfied the inclusion criteria. This resulted in the collection of 30 samples, 15 of which were treatment groups and 15 of which were control groups. Birthing ball exercises and birthing ball gymnastics are provided twice a week for 20 minutes to the treatment group starting at 32 weeks gestation. The control group, on the other hand, had no birthing ball gymnastics instruction and was assessed right away. Utilizing the chi square statistical test to analyze the data, the study's results (p value (0.000) &lt; 0.05) indicated that birthing ball gymnastics was effective in reducing primigravida maternity mothers' gestational age at the Midwife Independent Practice Place (TPMB) in Sidoarjo. In order to prevent the delivery process with post-term gestational age, it is envisaged that the installation of birthing ball gymnastics can be carried out in healthcare facilities such as hospitals, clinics, or Midwife Independent Practice Places (TPMD) for primigravida pregnant women.

Patient and provider perspectives on pain and other dimensions of anesthesia experience for cesarean delivery: A qualitative study.

There is a lack of evidence on the importance of pain or other aspects of clinical care in the overall patient experience and patient-centered outcomes in cesarean delivery. The purpose of this study was to discover patient priorities in cesarean delivery anesthesia experience, to compare patient and provider perspectives, and to explore attitudes on shared decision-making around anesthesia choices for cesarean delivery. Patients with recent cesarean deliveries and clinical care providers were approached using a purposeful sampling strategy for this prospective observational qualitative study. Patients were included if they were in the hospital within 72 hours of a cesarean delivery (scheduled or unscheduled), spoke English fluently, and had term gestation. Providers were included if they currently provide regular clinical care to patients having cesarean deliveries and have at least 3 years of practice experience. Semi-structured interviews were conducted using an interview guide. Interview transcripts were independently coded by three coders and qualitatively analyzed for major themes until thematic saturation was achieved. A total of 42 participants (20 patients and 22 providers) completed interviews. Five major themes emerged reflecting patient attitudes and beliefs toward cesarean delivery experience: 1) effective communication, education, and respect; 2) emotional support by care team; 3) intraoperative pain or discomfort; 4) varying acceptability around pain therapies; 5) stigma surrounding cesarean delivery. Five major themes emerged reflecting provider attitudes and beliefs toward cesarean delivery priorities: 1) complexity of pain responses; 2) multiple pain control strategies; 3) effective communication during emergency cesarean delivery; 4) patient psychological well-being during cesarean delivery; 5) barriers to observing the patients' birth plans. Patients and providers alike prioritize pain management, psychological well-being, and effective communication during cesarean delivery experiences. Patients emphasize relationships and trust in their cesarean experience, while clinicians emphasize clinical complexities and physical treatments. Our results guide future research in patient perspectives in cesarean deliveries.

Associations between maternal bacteremia during the peripartum period and early-onset neonatal sepsis: a retrospective cohort study

IntroductionEarly-onset neonatal sepsis (EONS) significantly impacts neonatal morbidity and mortality, with maternal bacteremia during the peripartum period being a potential risk factor. This study aims to explore the association between peripartum maternal bacteremia and EONS.MethodsA retrospective cohort study at the Women's Wellness and Research Center in Doha, Qatar (2015–2019) compared women with and without bacteremia, based on blood cultures taken from up to seven days before to 48 h after delivery, examining the association with EONS.ResultsAmong the 536 maternal blood cultures analyzed, 102 (19.0%) were positive. The most prevalent organisms were Group B streptococcus (GBS) (39.2%), followed by Escherichia coli (14.7%) and anaerobes (10.8%). Neonates from bacteremic mothers had lower birth weights (2913 ± 86 g vs. 3140 ± 745 g; MD 227.63 g; 95% CI 61.72 − 393.55; p = 0.007), required more resuscitation (27.5% vs. 13.2%; OR 2.48; 95% CI 1.48 − 4.17; p < 0.001), and received antibiotics for ≥ 7 days more frequently (41.2% vs. 16.6%; OR 3.51; 95% CI 2.20 − 5.62; p < 0.001) compared to those from non-bacteremic mothers. Maternal Gram-positive (GP) organisms were more commonly isolated in term gestation (67.9%) compared to Gram-negative (GN) (22.2%) and anaerobic bacteremias (9.9%). During intrapartum, GP bacteremia was predominant (67.1%) vs. GN (21.4%) and Anaerobes (11.4%), with GN bacteremia being more common in postpartum samples. Culture-proven EONS occurred in 0.75% of the cohort, affecting 3.9% of infants from bacteremic mothers vs. none in controls (OR 2.34; 95% CI 1.27 − 4.31; p < 0.001). Culture-negative EONS appeared in 14.7% of infants from bacteremic mothers vs. 7.8% in controls (OR 2.02; 95% CI, 1.05 − 3.88; p = 0.03). Among 40 cases of maternal GBS bacteremia, culture-proven GBS EONS occurred in 3 neonates (7.5%), all from mothers with negative GBS screening, compared to none in the control group. A strong association was found between EONS and maternal bacteremia due to any organism (aOR 2.34; 95% CI, 1.24 − 4.41; p = 0.009), GP bacteremia (aOR 3.66; 95% CI, 1.82 − 7.34; p < 0.001), or GBS (aOR 5.74; 95% CI, 2.57 − 12.81; p < 0.001). Bacteremia due to GN and Anaerobic organisms were not associated with EONS. Chorioamnionitis and antepartum fever were independent predictors for EONS associated with significant bacterial isolates.ConclusionThis study underscores the significant impact of maternal GP bacteremia, particularly from GBS, on EONS. The strong association highlights the need for vigilant monitoring and interventions in pregnancies complicated by bacteremia to reduce adverse neonatal outcomes.

A prospective study of clinical profile of premature rupture of membranes and its effect on maternal and perinatal outcome at term gestation in primigravida

Premature rupture of membranes (PROM) is defined as the spontaneous rupture of amniotic membranes with a release of amniotic fluid, before the onset of labor. If it occurs after 37 weeks of gestation, it is called as term PROM. The incidence of PROM worldwide varies between 5-10%.Out of which 80% occurs at term. In India, the incidence of PROM was reported as 7-12% in all labours.This study was a prospective, observational hospital based study which include the cases admitted to labour ward, Department of Obstetrics, District hospital, Tumakuru, Karnataka with Premature rupture of membranes or prelabor rupture of membranes (PROM) after fulfilling the inclusion and exclusion criteria. Out of 220 participants, about 60% (132) of subjects delivered vaginally and40%(88)of subjects underwent caesarean section. Among the 88 subjects who underwent caesarean section, the indications were fetal distress(34.09%), CPD(23%), failed induction (15.9%), non-progress of labour (23.86%). Among the study population, 10(4.54%) babies were with APGAR score &amp;#60;7 and 210(95.45%) babies were with APGAR score ≥7. The Premature rupture of membranes at term still remains as one of the challenging situation to the practicing obstetrician. It is still an important cause of maternal and perinatal morbidity.

Influence of gestational window on offspring vascular health in rodents with in utero exposure to electronic cigarettes.

Studies have shown cerebrovascular dysfunction in offspring with full-gestational electronic cigarette (Ecig) exposure, but little is known about how individual trimester exposure impacts offspring health. This study aimed to determine if there is a critical window during gestation that contributes to vascular and anxiety-like behavioural changes seen with full-term exposure. To test this, rats were time-mated, and the pregnant dams were randomly assigned to Ecig exposure during first trimester (gestational day, GD2-7), second trimester (GD8-14), third trimester (GD15-21) or full-term gestation (GD2-21). We also assessed the effect of maternal preconception exposure. Both male and female offspring from all maternal exposure conditions were compared to offspring from dams under ambient air (control) conditions. Ecig exposure consisted of 60-puffs/day (5days/week) using either 5 or 30watts for each respective exposure group. We found that maternal exposure to Ecig in the second and third trimesters resulted in a decrease (23-38%) in vascular reactivity of the middle cerebral artery (MCA) reactivity in 3- and 6-month-old offspring compared to Air offspring. Further, the severity of impairment was comparable to the full-term exposure (31-46%). Offspring also displayed changes in body composition, body mass, anxiety-like behaviour and locomotor activity, indicating that Ecigs influence neurodevelopment and metabolism. Maternal preconception exposure showed no impact on offspring body mass, anxiety-like behaviour, or vascular function. Thus, the critical exposure window where Ecig affects vascular development in offspring occurs during mid- to late-gestation in pregnancy, and both 5W and 30W exposure produce significant vascular dysfunction compared to Air. KEY POINTS: Exposure to electronic cigarettes (Ecigs) is known to increase risk factors for cardiovascular disease in both animals and humans. Maternal Ecig use during pregnancy in rodents is found to impair the vascular health of adolescent and adult offspring, but the critical gestation window for Ecig-induced vascular impairment is not known. This study demonstrates Ecig exposure during mid- and late-gestation (i.e. second or third trimester) results in impaired endothelial cell-mediated dilatation (i.e. middle cerebral artery reactivity) and alters anxiety-like behaviour in offspring. Maternal exposure prior to conception did not impact offspring's vascular or anxiety-like behavioural outcomes. Rodent models have been a reliable and useful predictor of inhalation-induced harm to humans. These data indicate maternal use of Ecigs during pregnancy should not be considered safe, and begin to inform clinicians and women about potential long-term harm to their offspring.

Evaluation of Statewide Program to Reduce Cesarean Deliveries Among Nulliparous Individuals With Singleton Pregnancies at Term Gestation in Vertex Presentation.

To evaluate the effect of statewide efforts to reduce nulliparous, term, singleton, vertex (NTSV) cesarean delivery rates in California. This was a population-based study of all NTSV births in California from 2015 to 2019. In 2015, all California hospitals with NTSV cesarean delivery rates above the 23.9% Healthy People 2020 target were invited to join a CMQCC (California Maternal Quality Care Collaborative)-sponsored, 3-year, multifaceted collaborative or a system-level quality collaborative to safely support vaginal birth. We examined the cesarean delivery rate overall and by participation or nonparticipation in a collaborative program. Secondarily, for hospitals that started with an NTSV cesarean delivery rate above 23.9%, we compared patient-level, hospital-level, and obstetric management characteristics between hospitals that met the Healthy People 2020 target (cesarean delivery rate below 23.9%) in 2019 and those that did not. There were 758,268 NTSV births at 238 hospitals. Annual mean NTSV cesarean delivery rates decreased among all racial and ethnic groups statewide and among all patients, regardless of payer, maternal age, or body mass index (BMI). The decrease in cesarean delivery was driven largely by a decrease in the frequency of cesarean delivery performed for labor dystocia (14.9% in 2015 to 12.8% in 2019) and from cesarean delivery before the onset of labor (4.2% in 2015 to 3.3% in 2019). For hospitals that started with an NTSV cesarean delivery rate above 23.9%, NTSV cesarean delivery rates among 80 hospitals participating in the CMQCC had a mean±SD decline of 6.9±5.9%, 13 hospitals participating in the system-level collaborative had a 5.0±4.5% decline, and those not participating in any collaborative had a 2.1±6.0% decline. In multivariable analysis, there was no association between meeting the Healthy People target and any of the hospital-level factors or aggregated patient-level characteristics. Rates of induction of labor increased in both groups and were not associated with a change in cesarean delivery rates. Hospitals in California between 2015 and 2019 with a wide variation in institutional and patient characteristics successfully reduced their NTSV cesarean delivery rates. Reduction in the NTSV cesarean delivery rate at hospitals that started above the Healthy People target was not associated with differences in patient characteristics but rather a reduction in cesarean deliveries for labor dystocia and cesarean deliveries performed before the onset of labor.

Gambaran Karakteristik Demografi Dan Perkembangan Pada Anak Usia 2-5 Tahun di Puskesmas Kesesi I

The development of children under five is an increasingly complex body structure and function that occurs in a regular and predictable pattern as a maturation process. Children's development can be assessed from their speech and language abilities, fine or gross motor skills, cognitive intelligence, and social or emotional abilities. This study aims to describe the demographic and developmental characteristics of stunted children aged 2-5 years at the Kesesi I health center. This research is a descriptive study. This sampling technique used total sampling, the population of this study was 38 children at the Kesesi I Community Health Center. This research instrument used the Pre-Developmental Screening Questionnaire (KPSP) which was recommended by the Ministry of Health of the Republic of Indonesia for use in this study, so validity and reliability tests were not carried out. . The data analysis used was univariate in the form of a percentage frequency distribution. The results of this study show that the average child at the Kesesi I Community Health Center is 42 months old. Male gender (71.1%), spontaneous birth (81.6%), term gestation (37-42 weeks) (81.6%), weight at birth with sufficient birth weight (2500-4000 grams) (89.5%), current BB in the normal category (68.4%), current TB in the normal category (60.5%) and (100%) children have a history of breastfeeding. The development of toddlers at the Kesesi I Community Health Center shows that (55%) of respondents have doubtful development. The conclusion obtained is that 55% of the demographic and developmental characteristics of stunted children aged 2-5 years at the Kesesi I Community Health Center have doubtful development.

Association between Prenatal Control and the Incidence of Preeclampsia in Ecuadorian Pregnant Women: A Cross-Sectional Study

Hypertensive disorders are one of the main complications that affect pregnancy, which makes them one of the most important causes of high maternal and fetal morbimortality. Approximately 80% of cases occur at term gestational age, while the remaining percentage begin at earlier gestational ages. Most cases of preeclampsia occur in healthy pregnant women. Therefore, it is important to establish the risk factors in prenatal control visits. Prenatal control is fundamental in which comprehensive surveillance of the pregnant woman is performed. It is known that hypertension in pregnancy is a frequent and potentially dangerous complication for the mother, fetus and newborn. For this reason, one of the objectives of prenatal care is to detect pre-pregnancy hypertension and pregnancy-induced hypertension syndrome (preeclampsia). A nationally representative sample of 20648 mothers from the National Health and Nutrition Survey 2018 (ENSANUT) was used. We used multicollinearity tests to rule out possible statistical modeling problems and a binary logistic linear regression model where Odds Ratio (OR) with their 95% confidence intervals (95% CI) were estimated for each of the independent variables. In addition, we used specificity tests to test the fit between our dependent and independent variables. Our results reveal that prenatal control reduced 2 times (OR= -2.0005; CI=-1.981;-2.055) the probability of suffering complications during pregnancy such as preeclampsia. This result is statistically significant (p&lt;0.05). It was also demonstrated that women from rural areas, with lower income and low schooling are more susceptible to suffer complications during pregnancy compared to the rest of the population. Preeclampsia-eclampsia continues to be one of the pathologies that has the greatest impact on maternal and perinatal morbidity and mortality, so work should continue to find ways to prevent its onset or modify its evolution, avoiding eclampsia or other severe forms of the disease. The results found in this study showed that adequate prenatal care (more than five visits starting in the first trimester of pregnancy) has an impact on the prevention of pregnancy complications such as preeclampsia, since identifying and avoiding it is one of the main purposes of prenatal care.

The Analysis of Premature Rupture of Membrane Outcomes: Comparison Between 34-36 Weeks and Term Gestation

The Analysis of Premature Rupture of Membrane Outcomes: Comparison Between 34-36 Weeks and Term Gestation

Looking beyond retinopathy of prematurity

A 2050 gm, 34 weeks gestational age term female with a family history of Osteogenesis Imperfect (OI) was referred for ROP Screening. She was on oxygen support for respiratory distress. On examination, both eye sclera showed blue-grey discoloration (Figure 1).

Acute pancreatitis and refractory hypercalcemia in the third trimester caused by parathyroid carcinoma

BackgroundHypercalcemia can be a rare contributor to acute pancreatitis (AP) in pregnancy. This is primarily due to primary hyperparathyroidism (PHPT), resulting from parathyroid carcinoma. We exhibited a case report to analyze the diagnosis and treatment during the onset of hypercalcemia-induced AP.Case presentationA 32-year-old primigravida presented with acute pancreatitis near full-term gestation. Following a cesarean delivery, there was a reduction in serum amylase and peripancreatic exudate, but her serum calcium concentrations persistently elevated over 4.0 mmol/L. Interventions to lower the hypercalcemia were only temporarily effective, until a high serum parathyroid hormone (PTH) concentration of 1404 pg/mL was detected. Ultrasound revealed a 31 mm × 24 mm hypoechoic oval nodule in the left lower lobe of the thyroid gland. She underwent a parathyroidectomy, resulting in a dramatic decrease in serum PTH level, from preoperative levels of 2051 pg/mL to 299 pg/mL just 20 minutes after removal. Similarly, her serum calcium declined from 3.82 mmol/L to 1.73 mmol/L within 24 hours postoperatively. The final histopathology suggested parathyroid carcinoma.ConclusionWhen refractory hypercalcemia is present, serum PTH levels should be measured to determine PHPT. Parathyroidectomy is the optimal strategy for alleviating hypercalcemia and clarifying the underlying pathology.

Transvaginal radiofrequency ablation: a therapeutic option for managing symptomatic uterine fibroids in women with reproductive desires

To evaluate whether transvaginal radiofrequency (RF) ablation of fibroids is a technique that can be offered to women with reproductive desires. Unicentric, prospective, observational study. University Hospital. Twenty-seven individuals who desired to become mothers after undergoing RF ablation for symptomatic fibroids. Transvaginal RF ablation for symptomatic fibroids with a maximum total volume of 145 cm3. The reduction in the size of the fibroids, improvement of symptoms, and reproductive outcomes during the 24 months after the ablation. For patients who achieved pregnancy, we assessed the type of conception, course of gestation, type of delivery, neonatal outcomes, and occurrence of both maternal and fetal complications. A statistically significant reduction in symptoms related to the fibroids 6 months after the ablation was demonstrated through the implementation of the Symptom Severity Scale. No patient required hospitalization after the procedure, and on average from the third day after intervention, they resumed their work activities without the need for analgesics. Among those patients who attempted pregnancy during the 24-month follow-up period, 73.68 % (14/19) achieved motherhood. There were no cases of uterine rupture, premature birth, or intrauterine fetal death. Radiofrequency ablation for fibroids seems to be a promising, safe, and low-complexity alternative that does not appear to interfere with the development of a normal term gestation.

Prenatal Exposure to Ambient Air Pollution and Cerebral Palsy

Air pollution is associated with structural brain changes, disruption of neurogenesis, and neurodevelopmental disorders. The association between prenatal exposure to ambient air pollution and risk of cerebral palsy (CP), which is the most common motor disability in childhood, has not been thoroughly investigated. To evaluate the associations between prenatal residential exposure to ambient air pollution and risk of CP among children born at term gestation in a population cohort in Ontario, Canada. Population-based cohort study in Ontario, Canada using linked, province-wide health administrative databases. Participants were singleton full term births (≥37 gestational weeks) born in Ontario hospitals between April 1, 2002, and March 31, 2017. Data were analyzed from January to December 2022. Weekly average concentrations of ambient fine particulate matter with a diameter 2.5 μm (PM2.5) or smaller, nitrogen dioxide (NO2), and ozone (O3) during pregnancy assigned by maternal residence reported at delivery from satellite-based estimates and ground-level monitoring data. CP cases were ascertained by a single inpatient hospitalization diagnosis or at least 2 outpatient diagnoses for children from birth to age 18 years. The present study included 1 587 935 mother-child pairs who reached term gestation, among whom 3170 (0.2%) children were diagnosed with CP. The study population had a mean (SD) maternal age of 30.1 (5.6) years and 811 745 infants (51.1%) were male. A per IQR increase (2.7 μg/m3) in prenatal ambient PM2.5 concentration was associated with a cumulative hazard ratio (CHR) of 1.12 (95% CI, 1.03-1.21) for CP. The CHR in male infants (1.14; 95% CI, 1.02-1.26) was higher compared with the CHR in female infants (1.08; 95% CI, 0.96-1.22). No specific window of susceptibility was found for prenatal PM2.5 exposure and CP in the study population. No associations or windows of susceptibility were found for prenatal NO2 or O3 exposure and CP risk. In this large cohort study of singleton full term births in Canada, prenatal ambient PM2.5 exposure was associated with an increased risk of CP in offspring. Further studies are needed to explore this association and its potential biological pathways, which could advance the identification of environmental risk factors of CP in early life.

Cardiac Development and Related Clinical Considerations

The anatomy, physiology, and hemodynamics of the premature heart vary along the range of gestational ages cared for in neonatal intensive care units, from 22 weeks to term gestation. Clinical management of the preterm neonate should account for this heterogenous development. This requires an understanding of the impact of ex utero stressors on immature and disorganized cardiac tissue, the different state of hemodynamics across intracardiac shunts impacting the natural transition from fetal to neonatal life, and the effects of intensive pharmacologic and non-pharmacologic interventions that have systemic consequences influencing cardiac function. This article provides a review of the increasing but still limited body of literature on the anatomy, hemodynamics, and electrophysiology of the preterm heart with relevant clinical considerations.