Greater Risk Of Preterm Birth Research Articles

Periodontal Disease and Pregnancy Outcomes

An increasing number of studies are confirming an association between periodontal disease (PD) and adverse outcomes in pregnancy. PD places pregnant women at greater risk for preterm birth than alcohol consumption or smoking. This underscores the importance of offering dental screening to women who are pregnant or contemplating pregnancy and the need for physicians who provide obstetric care to be aware of the possible connection between poor dental health and poor pregnancy outcomes.

Migration to western industrialised countries and perinatal health: A systematic review

Influxes of migrant women of childbearing age to receiving countries have made their perinatal health status a key priority for many governments. The international research collaboration Reproductive Outcomes And Migration (ROAM) reviewed published studies to assess whether migrants in western industrialised countries have consistently poorer perinatal health than receiving-country women. A systematic review of literature from Medline, Health Star, Embase and PsychInfo from 1995 to 2008 included studies of migrant women/infants related to pregnancy or birth. Studies were excluded if there was no cross-border movement or comparison group or if the receiving country was not western and industrialised. Studies were assessed for quality, analysed descriptively and meta-analysed when possible. We identified 133 reports (>20,000,000 migrants), only 23 of which could be meta-analysed. Migrants were described primarily by geographic origin; other relevant aspects (e.g., time in country, language fluency) were rarely studied. Migrants' results for preterm birth, low birthweight and health-promoting behaviour were as good or better as those for receiving-country women in >or=50% of all studies. Meta-analyses found that Asian, North African and sub-Saharan African migrants were at greater risk of feto-infant mortality than 'majority' receiving populations, and Asian and sub-Saharan African migrants at greater risk of preterm birth. The migration literature is extensive, but the heterogeneity of the study designs and definitions of migrants limits the conclusions that can be drawn. Research that uses clear, specific migrant definitions, adjusts for relevant risk factors and includes other aspects of migrant experience is needed to confirm and understand these associations.

The contribution of maternal race/ethnicity and fetal sex to prematurity in twins

The contribution of male fetal sex to twin preterm birth (PTB) rates was evaluated in the United States. The 2002 National Center for Health Statistics Natality database was analyzed for fetal sex and twin gestations based on birth sex for MM and FF pairs (M, male; F, female). Multivariable Cox proportional hazards regression was applied to estimate the hazard ratio for PTB with adjustments for known risks. Thirty-three thousand nine hundred twenty-six pairs were analyzed. PTBs between 20-36 completed weeks occurred in 59.1% MM pairs and 57.5% FF pairs. MM sex was an independent risk factor for PTB. This effect was greatest for deliveries between 20-29 weeks (hazard ratio, 1.224; 95% CI, 1.113-1.346). The effect was most pronounced in non-Hispanic white MM pairs. In the United States, MM pairs are at greater risk for PTB. Race and ethnicity modulate sex effects. Further studies are needed to understand potential mechanisms.

Are women who have had a preterm twin delivery at greater risk of preterm birth in a subsequent singleton pregnancy?

Are women who have had a preterm twin delivery at greater risk of preterm birth in a subsequent singleton pregnancy?

Are women who have had a preterm twin delivery at greater risk of preterm birth in a subsequent singleton pregnancy?

Are women who have had a preterm twin delivery at greater risk of preterm birth in a subsequent singleton pregnancy?

Are women who have had a preterm twin delivery at greater risk of preterm birth in a subsequent singleton pregnancy?

The purpose of this study was to determine whether preterm birth of twins is associated with an increased risk of preterm birth in a subsequent singleton pregnancy. All patients who delivered a twin gestation and a subsequent singleton pregnancy at Northwestern Memorial Hospital during a 10-year period were identified. We used a cohort study design, comparing the outcomes of the singleton pregnancies in women with preterm twin deliveries to those pregnancies with term twin deliveries. One hundred sixty-seven women delivered twins followed by a singleton pregnancy. Women whose twin delivery was preterm (n = 99) were more likely than those who had delivered a term twin pregnancy (n = 68) to deliver a subsequent preterm singleton pregnancy (13.1% vs 2.9%; odds ratio, 5.0; 95% CI, 1.1, 22.9). Preterm birth of twins is associated with an increased risk of preterm delivery in a subsequent singleton pregnancy.

Medical Therapy and Birth Outcomes in Women With Crohn's Disease: What Should We Tell Our Patients?

It is not surprising that women with inflammatory bowel disease (IBD) have a greater risk of an adverse pregnancy outcome. Although it is ideal to be in remission during conception and pregnancy, women often flare during this critical time. Paradoxically, while pregnant, women often stop the medications that have worked so well to maintain remission due to the fear that these drugs may harm the fetus. Many women with IBD find it especially difficult to continue 6-mercaptopurine (6-MP) and azathioprine (AZA) during pregnancy. There have been a number of studies of IBD and pregnancy but none have successfully separated out the effects of disease activity and drug therapy on pregnancy outcomes. The study by Norgard et al. in this issue of the American Journal of Gastroenterology is the first to combine the power of two national data registries of hospitalizations, outpatient visits, and births with a national prescription database. The authors have detailed information on 900 babies born to mothers with Crohn's disease as well as information on every IBD drug prescribed during pregnancy from 1996 to 2004. The worrisome results here are the greater risk of preterm birth and congenital abnormalities among patients prescribed AZA/6-MP throughout their pregnancies. However, although the authors have accurate information on drug exposure during pregnancy, their measures of disease activity cannot be as accurate due to the nature of this database study. Only a prospective pregnancy registry of IBD patients can adequately differentiate the effects of disease activity and medication use on adverse pregnancy outcomes.

Association of Sociodemographic Variables With Risk for Very Preterm Birth in Twins

Objective: To assess the influence of maternal race, age, marital status, and education on risk for earlier and later preterm births in twin pregnancies. Methods: We analyzed 8109 white and 1906 black liveborn twin pregnancies in the Missouri Linked Sibship files for the years 1978–1990, using contingency tables and multiple logistic regression. Results: Black twin gestations had 1.61-fold (95% confidence interval [CI] 1.46, 1.76) greater risk than whites for preterm birth before 34 weeks’ gestation. However, there was no race difference after 33 weeks. Among whites, teen age, unmarried status, and education fewer than 12 years were independently associated with risk for delivery before 34 weeks in multivariate analysis (odds ratios [OR] 1.28–1.51, each P ≤ .001). These associations were diminished or absent for preterm births after 33 weeks’ gestation. White unmarried teen mothers with fewer than 12 years of education had 1.83-fold (95% CI 1.39, 2.40) greater risk for preterm birth before 34 weeks’ gestation compared with white married women more than 19 years of age with at least 12 years of education. In blacks, this difference was 1.47-fold (95% CI 1.13, 1.92). In both races, these differences were absent after 33 weeks’ gestation. Conclusion: Traditional sociodemographic risk factors were present for twin preterm birth, but mainly before 34 weeks’ gestation. This, together with previous data from Missouri Linked Sibship files, indicates that dominant pathogenic mechanisms of early preterm birth in twin gestations are likely to be different from those causing later preterm twin birth. Therefore, gestational age should be accounted for in future studies seeking to identify predictive factors or biomechanisms for twin preterm birth.

OUTCOMES OF TEENAGE PREGNANCY IN A MILITARY POPULATION. † 1695

OBJECTIVE: To determine and compare the use of prenatal care, incidence of pregnancy complications, and selected pregnancy outcomes (i.e., incidence of prematurity, low birth weight, and survival) in adolescent mothers with that of older mothers in a military population with access to a tertiary care center. METHODS: We reviewed data from the neonatal data base of a military tertiary care center, for the time period 1990-1994. All singleton births ≥ 20 weeks estimated gestational age (EGA) or ≥ 500 grams were included. All maternal transfers were excluded. Mothers were divided by age into four groups: 1) 13-17 years, 2) 18-19 years, 3) 20-29 years, and 4) ≥ 30 years. Use of prenatal care was assessed by the Kessner index. Data was analyzed by chisquare, t-test, Mann-Whitney U, logistical regression techniques, and One-way ANOVA with Bonferroni correction.RESULTS: There were 7017 infants included in the study (240 in Group 1; 629 in Group 2; 4474 in Group 3; 1674 in Group 4). Utilization of prenatal care was significantly improved as maternal age increased for each successive age group. Hispanic mothers utilized prenatal care less adequately than black and white mothers. Of the nine pregnancy complications reviewed, the only difference noted was a higher incidence of diabetes in Group 4 when compared to the other three groups. There was no difference between Group 1 and each of the other three groups in the incidence of prematurity, low birth weight infants, or infant survival. However, Group 2 had a significantly greater risk of preterm birth at < 33 weeks EGA than Group 3, and Group 4 had a significantly greater risk of preterm birth at < 37 weeks than Group 3. Additionally, rates for birthweight < 2500 grams were significantly greater in Group 2 when compared to Groups 3 and 4. Admission rates to higher level of neonatal care were no different between groups.