Higher Rates Of Preterm Birth Research Articles

55: Neonatal mortality rates in the neonatal intensive care unit at kamuzu central hospital in malawi

Neonatal mortality has increased from 37% to 46% worldwide among all causes of under-five mortality from 2010 to 2015. The highest burden of mortality occurs in resource-limited settings, specifically sub-Saharan Africa. No previous studies have evaluated neonatal mortality in Malawi, the country with the highest preterm birth rate at ∼20%, over a year-long period. We aimed to evaluate the neonatal mortality rate and causes of death in a large, tertiary referral hospital, Kamuzu Central Hospital (KCH), in Lilongwe, Malawi. A prospective, observational study was performed in which 123 clinical and demographic variables were collected on all neonates admitted to and treated in the KCH NICU from October 2017 to October 2018. Patients were excluded from data analysis only if they had any known congenital anomaly reported. 2137 newborns were included, of which 86 patient records lacked information regarding the final outcome and were excluded. Of the 2051 patients included in the analysis, 497 patients died (24.2% mortality). Mortality data was stratified by birth weight (Figure 1A), and evaluated with the rate of new admissions per month to the NICU (Figure 1B). Notably, the mortality rate was lowest in January 2018 (17.7%). We examined when mortality occurred (Figure 1C) and found most deaths occurred at 24-48 hours of life. The most common mortality causes were evaluated in those that died in the first 24 hours from birth (Figure 2A) compared to those who died >24 hours after birth (Figure 2B) with the leading cause being prematurity followed by asphyxia and then neonatal sepsis. This is the largest cohort of neonates in Malawi to be prospectively studied and the first study to evaluate neonatal outcomes over a 12-month period assessing for seasonal variation. Mortality was highest in neonates weighing < 1000g. Patients between 1200-1600g at birth had higher baseline mortality than those weighing more, highlighting a specific population to target for interventions to improve neonatal outcomes. Overall, our findings provide a framework to direct future improvements.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

A stitch in time: narrative review of interventions to reduce preterm births in Malawi.

BackgroundThe rising rate of preterm births (PTBs) is a global concern, and Malawi has a high rate of PTBs (10.5%). The resulting neonatal and under-5 mortality, morbidity and lifelong disability represent a significant loss of human potential affecting individuals, families and society as a whole. This study aims to review the literature to determine the risk factors for PTB in Malawi and to identify effective interventions to prevent PTBs.MethodsA literature search yielded 22 studies that were categorized according to risk factors implicated for PTBs and health interventions to reduce the risks.ResultsThe study has shown that maternal pregnancy factors, infections, nutrition, anaemia and young maternal age are the main causes and risk factors of PTBs in Malawi. The literature revealed no evidence of community-based interventions for reducing the rates of PTBs in Malawi.ConclusionsAny successful effort to reduce the rate of PTBs will require a multisector, multilevel strategy targeted at the community, homes and individuals as a package to improve the education, nutrition and reproductive health of girls and women as well as focus on improving the delivery of antenatal services in the community.

Outcomes of twin neonates and association with chorionicity and modes of conception

Objective To investigate the pregnancy and neonatal outcomes in twin pregnancies and the association with chorionicity and modes of conception in order to provide evidence for early prevention and reduction of complications and life quality improvement of twin neonates. Methods This study retrospectively enrolled 756 women with twin pregnancies who gave birth at Peking University Third Hospital from January 1, 2014 to December 31, 2015. Clinical features of the mothers and newborns were collected, the pregnancy and neonatal outcomes were analyzed. Impacts of chorionicity and different modes of conception on the outcomes were also evaluated. Two independent-sample t test and Chi-square test were used as statistical methods. Results Twin pregnancies accounted for 6.7% (756/11 169) of all deliveries in the hospital during the study period and the preterm birth rate was 59.4% (449/756). Twenty five women underwent fetal reduction (3.3%, 25/756) and intrauterine death occurred in 85 pregnancies (11.2%, 85/756). Eventually 1 400 babies were born alive (92.6%, 1 400/1 512). Subgroup analysis suggested that compared with dichorionic diamniotic (DCDA) pregnancies, monochorionic diamniotic (MCDA) cases showed younger maternal age at conception [(30.5±4.2) vs (32.9±4.0) years, t=-7.412], smaller gestational age at delivery [(34.1±3.1) vs (35.7±2.2) weeks, t=-7.325] and higher preterm birth rate [78.4% (174/222) vs 51.5% (263/511), χ2=46.554], all P<0.05. Moreover, the incidence of neonatal complications, including respiratory distress syndrome [18.3% (40/219) vs 8.0% (21/261), χ2=11.210], neonatal pneumonia [18.3% (40/219) vs 8.8% (23/261), χ2=9.331] and sepsis [6.8% (15/219) vs 1.5% (4/261), χ2=8.854], etc. was higher in the MCDA group than those in the DCDA group, resulting in a higher mortality rate [7.8% (17/219) vs 1.1% (3/261), χ2=13.042] in the MCDA pregnancies, all P<0.05. Compared with spontaneously conceived twin pregnancies, women underwent in vitro fertilization-embryo transfer were older at conception [(33.4±3.8) vs (30.6±4.4) years, t=-6.095], delivered at a greater gestational age [(35.8±2.1) vs (35.2±2.6) weeks, t=-2.452] and had a lower preterm birth rate [49.2% (206/419) vs 63.5% (54/85), χ2=5.838] in the DCDA group, all P<0.05. No significant differences in the incidence of neonatal diseases were observed between the two subgroups. Conclusions The incidence of preterm birth is high in twin pregnancies. Compared with DCDA twin pregnancies, MCDA twin pregnancies are associated with more adverse outcomes due to higher incidence of neonatal diseases. In vitro fertilization-embryo transfer does not increase the incidence of preterm birth and the neonatal outcomes were comparable to those of spontaneously conceived ones. Key words: Pregnancy, twin; Pregnancy outcome; Premature birth; Infant, newborn, diseases; Incidence; Fertilization in vitro; Embryo transfer

Reducing the Risk of Preterm Birth by Ambulatory Risk Factor Management.

The preterm birth rate in Germany has remained unchanged at 8-9% since 2009. Preterm birth is the most common cause of neonatal morbidity and mortality. In the absence of a causal treatment, it is important to lower the risk of preterm birth by preventive measures in prenatal outpatient care. This review is based on pertinent publications from the years 2000-2019 that were retrieved by a selective search in PubMed. The clinical risk factors for preterm birth-known mainly from retrospective cohort studies-include previous preterm birth (adjusted odds ratio [aOR]: 3.6), multiple pregnancy (relative risk [RR]: 7.7), nicotine consumption (aOR: 1.7), and a short uterine cervix, i.e., <25 mm in the second trimester (aOR: 6.9). In women with a short cervix, vaginally administered progesterone significantly lowers the preterm birth rate (22.5% vs. 14.1% for birth before 33 weeks of gestation, RR: 0.62; 95% confidence interval [0.47; 0.81]). Nicotine abstinence is associated with a lower pre- term birth rate as well (aOR: 0.91; [0.88; 0,.94]), while working more than 40 hours per week (aOR: 1.25; [1,.01; 1,.54]) and heavy lifting during pregnancy (hazard ratio [HR]: 1.43; [1.13; 1.80]) are associated with a higher preterm birth rate. Avoidance of physical exertion, or bed rest, in the face of impending preterm birth does not lower the preterm birth rate, but it does increase the risk of complications, such as thromboembolism. The meticulous assessment and elimination of treatable risk factors at the outset of ambulatory prenatal care can help lower the preterm birth rate. Further velopment of causally directed treat- ments (e.g., changes of relevant environmental and epigenetic factors).

Fertility treatments and offspring pediatric infectious morbidities: results of a population-based cohort with a median follow-up of 10 years

To study the association between mode of conception and offspring infectious morbidity risk. Population-based cohort study. Regional university medical center. All singleton infants born between the years 1991 and 2014 and discharged alive from the hospital. Follow-up time in the study was calculated from birth to an event, defined as the first offspring hospitalization with any infectious morbidity. All infectious diagnoses were compared between the study groups, and a multivariable survival model was created to study the association between mode of conception and offspring pediatric hospitalization with infectious morbidity, and adjusting for confounding or clinically significant variables. First offspring pediatric hospitalization with infectious morbidity. During the study period, 242,187 newborns met the inclusion criteria: 2,603 (1.1%) of which were conceived after undergoing IVF, 1,172 (0.7%) after ovulation induction (OI), and 237,863 (98.3%) were conceived spontaneously. Mothers receiving fertility treatments were older and with higher rates of preterm births and low birthweights. The hospitalizations rates per 1,000 person years of follow-up were 16.34/1,000 person years, 11.61/1,000 person years, and 10.19/1,000 person years, among the IVF, OI, and spontaneously conceived offspring, respectively. The adjusted hazard ratios were 1.26 (95% confidence interval 1.13-1.42) and 1.14 (95% confidence interval 1.00-1.38), for the IVF and OI compared with the spontaneously conceived offspring, respectively. The model adjusted for preterm delivery, birthweight, maternal age, hypertension, diabetes, and cesarean section. Higher risk for infectious morbidity was found among offspring conceived after fertility treatments compared with spontaneously conceived offspring.

Adverse birth outcomes in Guangdong province, China, 2014–2017: a spatiotemporal analysis of 2.9 million births

ObjectivesAdverse birth outcomes pose a great threat to the public health and bring a heavy burden of disease in China. A comprehensive examination of the temporal and spatial trends of...

Analysis of big data for prediction of provider-initiated preterm birth and spontaneous premature deliveries and ranking the predictive features.

High rate of preterm birth (birth before 37 weeks of gestation) in the world, its negative outcomes for pregnant women and newborns necessitate to predict preterm birth and identify its main risk factors. Premature deliveries have been divided into provider-initiated (with medical intervention for early terminating the pregnancy) and spontaneous preterm birth (without any intervention) categories in the previous studies. The main aim of this study is proposing methods for prediction of provider-initiated preterm birth and spontaneous premature deliveries and ranking the predictive features. Data from national databank of Maternal and neonatal records (IMAN registry) is used in the study. The collected data have information about more than 1,400,000 deliveries with 112 features. Among them, 116,080 preterm births have occurred (from which 11,799 and 104,281 cases belong to provider-initiated preterm birth and spontaneous premature delivery, respectively). The data can be considered as big data due to its large number of data records, large number of the features and unbalanced distribution of the data between three classes of term, provider-initiated and spontaneous preterm birth. Therefore, we need to analyze data based on big data algorithms. In this paper, Map Reduce-based machine learning algorithms named MR-PB-PFS are proposed for this purpose. Map phase use parallel feature selection and classification methods to score the features. Reduce phase aggregates the feature scores obtained in Map phase and assign final scores to the features. Moreover, the classifiers trained in Map phase are aggregated based on two different ensemble rules in Reduce phase. Experimental results show that the best performance of the proposed models for preterm birth prediction is accuracy of 81% and the area under the receiver operating characteristic curve (AUC) of 68%. Top features for predicting term, provider-initiated preterm and spontaneous premature birth identified in this study are having pregnancy risk factors, having gestational diabetes, having cardiovascular disease, maternal underlying diseases, and mother age. Chronic blood pressure is a high rank feature for preterm birth prediction and father nationality is highly important for discriminating provider-initiated from spontaneous premature delivery. Identifying the pregnant women with high risk of spontaneous premature or therapeutic preterm delivery in our proposed model can help them to: (1) reduce the probability of premature birth with monitoring and management of the main risk factors and/or (2) educate them to care from the premature newborn. Management and monitoring top features discriminating term, provider-initiated preterm and spontaneous premature birth or their associated factors can reduce preterm labor or its negative outcomes.

Pregnancy following kidney transplantation - impact on mother and graft function and focus on childrens\u2019 longitudinal development

BackgroundPregnancy after kidney transplantation has been considered as high risk for maternal and fetal complications. After careful patient selection successful pregnancies are described. Little is known about fetal outcomes and data is particularly scarce on childrens´ early development up to two years when born to kidney/−pancreas transplant recipients.Here, we analyzed maternal and fetal risk and evaluated graft function during pregnancy in transplanted women. We aimed to identify factors affecting the outcomes of mothers and their grafts during pregnancy and of children up to 2 years after delivery/ birth.MethodsAll consecutive pregnancies in kidney/ kidney-pancreas recipients with live-born children from 2002 to 2016 were evaluated in two transplant centers (Charité Berlin/ University Tuebingen). All data was gathered from medical records. Impact of pregnancy on obstetrical risks, graft function and fetal development was evaluated. Additionally, for the first time development of children, including physical examination and assessment of neurological function were evaluated at 12 and 24 months.ResultsThirty-two pregnancies in 28 patients with a median duration of 34 gestational weeks (range, 24–38) were analyzed. 13 patients (46.4%) developed deterioration of kidney graft function > 10 ml/min during pregnancy. In majority, caesarean section was performed (75%). Twenty-five (78.1%) children were born prematurely, thereof (16%) < 28 weeks. Almost 70% had low birth weights (LBW) (< 2.500 g); median birth weight was 2.030 g. General health and physical constitution of children were unremarkable with normal development in 94% at 12 and 24 months of corrected age, respectively.ConclusionDespite the high rate of preterm birth and LBW, development up to two years was age-appropriate in this cohort. Due to low absolute numbers, increasing efforts in centralized counseling, diagnostics and committed specialist support are required. Decisive treatment of these high-risk patients in specialized units leading to better performance of these patients (mother/ fetus) is deemed superior. In order to confirm this, prospective studies on neonatal and pediatric outcomes with a standard-of-care comparator arm will be conducted.

Trauma in pregnancy and severe adverse perinatal outcomes

Background Trauma, including accidental and violent trauma, is a rare but severe complication of pregnancy. The incidence of adverse perinatal outcomes in pregnancies affected by traumatic injury has not been well-studied. Objective We sought to characterize the association between traumatic injury during pregnancy and severe adverse perinatal outcomes in a large population. Study design We performed a retrospective cohort study of California Birth Registry data from 2007 to 2011. ICD-9 diagnosis and procedure codes were used to categorize patients into trauma and non-trauma cohorts and to assess the prevalence of severe adverse fetal and neonatal outcomes. Chi-square tests were used to characterize maternal demographics and perform univariate analyses, and logistic regression was used to control for potential confounders. Results Of 2,406,605 singleton nonanomalous pregnancies, 1262 (0.05%) experienced trauma prior to delivery. The rate of composite perinatal outcomes was higher in pregnancies with trauma compared to those without (3.1 versus 0.87%, p < .001). Trauma was associated with higher occurrences of preterm birth <37 weeks, preterm birth <32 weeks, very low birth weight and neonatal death. Fetal demise at any gestational age was more common among trauma patients (1.9 versus 0.53%, p < .001), though this difference was not statistically significant among term fetuses (0.28 versus 0.14%, p = .21). A difference in composite adverse perinatal outcomes was seen even after controlling for important maternal characteristics (aOR 3.2, 95% CI). Trauma patients with severe morbidity compared to those without had higher rates of preterm birth <37 weeks, preterm birth <32 weeks, and composite severe perinatal outcomes. Conclusion Trauma in pregnant women is associated with an increased risk of severe adverse perinatal outcomes, including fetal and neonatal demise. Prevalence of fetal demise is not different between trauma and non-trauma mothers when looking at term fetuses only, suggesting that the greatest risk of fetal demise in the setting of trauma occurs in the preterm period. These data can be used to counsel patients and to inform more detailed research into the mechanisms of trauma in pregnancy outcomes.

Maternal Health in the Aftermath of Hurricanes Irma and Maria in Puerto Rico

OPS 11: Health effects of climate change in low- and middle-income countries, Room 114, Floor 1, August 27, 2019, 10:30 AM - 12:00 PM Background: Prior to Hurricane Maria, Puerto Rico had 200+ hazardous waste sites, significant contamination of water resources, and marked disparities in reproductive health, including higher rates of preterm birth, low birthweight, and infant mortality compared to the mainland US. Since 2010, the Puerto Rico Testsite for Exploring Contamination Threats (PROTECT) Center has been investigating prenatal environmental exposures and preterm birth on the island. When Maria struck Puerto Rico in September 2017, there were 102 pregnant PROTECT participants. Previous research suggests that pregnant women who experience a natural disaster are at higher risk of adverse birth outcomes. Methods: In Fall 2018, we administered a questionnaire to identify hurricane-related sources of stress and environmental exposures to women who were pregnant during Maria or who became pregnant in the aftermath (n=176). Demographic and health data were obtained from the PROTECT database. Results: Women who continued participation or enrolled in PROTECT after Maria had slightly higher income and education compared to previous participants. Currently, 122 women have completed the questionnaire, 7 declined, 2 are pending, and 45 were unreachable. On average, respondents were without electricity for 108 days, and 88% reported use of a power generator during the emergency. In the aftermath of the hurricane, 10% of women reported having asthma during pregnancy and 16% indicated having problems completing their prenatal visits. 24% indicated living in a place other than their pre-hurricane residence, 65% indicated damages to their property, and 31% reported living with stagnant water near or inside their homes. Conclusions: Analysis of questionnaire data in relation to hurricane-related exposures and stress, as well as birth outcomes, is in progress. This work, along with ongoing community engagement efforts, will identify ways to minimize the impact of future natural disasters on maternal and child health in Puerto Rico.

Reducing Inequities in Adverse Birth Outcomes among African American Women in the United States: A Focus on the Life Course Perspective

Adverse birth outcomes are the leading cause of death among infants globally, and the second leading cause of infant deaths in the United States. African-American women have disproportionately higher rates of preterm birth, low birth weight, and infant mortality compared to other racial groups. This is due in part to social inequities, as well as differential exposures to and experience of risk and protective factors before, during, and after pregnancy. The life course perspective framework posits that adverse birth outcomes are not primarily due to experiences during pregnancy, but experiences (environmental exposures, biological, social and behavioral factors, as well as life experiences) across the life course. These experiences negatively affect birth outcomes in current and future generations. Reducing the adverse birth outcome gap between African Americans and other racial groups requires not only increasing access to prenatal care, but also addressing the differential cumulative impact of social inequities and early life disadvantages experienced by the former. It is therefore critically important to focus on the life course perspective when framing solutions to bridge racial disparities in adverse birth outcomes.

Risk of preterm birth in the subsequent pregnancy following caesarean section at full cervical dilatation compared with mid-cavity instrumental delivery.

Expediting delivery in the second stage of labour often involves a choice between a caesarean section at full dilatation or mid-cavity instrumental delivery. Accumulating evidence suggests that the mode of delivery may influence the risk of preterm birth in the subsequent pregnancy. To directly compare first birth caesarean section at full dilatation with mid-cavity instrumental delivery for the risk of preterm birth in the subsequent pregnancy (second birth). A further aim was to identify predictive factors associated with these index modes of delivery. This is a retrospective cohort study involving three maternity hospitals in western Sydney over the period of 2006-2017. Inclusion criteria were nulliparous women with a singleton term cephalic first birth delivered by caesarean section at full dilatation or mid-cavity instrumental delivery, and whose second birth also occurred under our care. Data were analysed separately for first and second births. There were 425 caesarean section at full dilatation and 874 mid-cavity instrumental cases which met inclusion criteria. The risk of preterm birth in the second birth was 5.7% compared to 3.2%, respectively (risk ratio 1.76; 95% CI 1.04-3.00; P=0.035). After excluding causes of preterm birth not related to previous mode of delivery, the risk of spontaneous preterm birth was 4.3% compared to 2.0%, respectively (risk ratio 2.18; 1.14-4.19; P=0.019). Caesarean section at full dilatation is associated with a significantly higher rate of preterm birth in the subsequent pregnancy compared to a mid-cavity instrumental delivery. This should be considered in second-stage mid-cavity decision-making.

Corrigendum: Gestational age and birth weight variations in young children with language impairment at an early communication intervention clinic.

No abstract available.

Cervical length should be measured for women with placenta previa: cohort study

Objectives To study the relevance between cervical length (CL) and different maternal/neonatal outcomes in pregnancies complicated with placenta previa/accreta. Methods Three hundred twenty-eight women, who had medically free singleton live pregnancies with the diagnosis of placenta previa and/or accreta, were included and divided regarding their CL into two groups. Threatened preterm labor, maternal tocolysis, multiple gestations, polyhydramnios, ruptured fetal membranes, fetal complications, history of cervical conization, and the presence of cervical cerclage were the exclusion criteria. Demographic data, obstetric history, as well as, the courses of the complicated pregnancies were collected and statistically analyzed. Results The short CL group had significantly less distance between the placenta and the internal cervical os (p-value < .001) Also, they showed more ultrasound parameters of complete placenta previa with anterior location (p-value < .001 and .003 respectively) and placental adherence (21.8 versus 41.1%). Women with short cervix had significantly higher rates of preterm birth, antepartum hemorrhage, emergency cesarean sections, intraoperative estimated blood loss, massive bleeding, prevalence of placental adherence and cesarean hysterectomy (p-value < .001 for the entire outcomes). Multivariable binary logistic regression showed that CL (<30 mm) was a significant independent risk factor in prediction of severe hemorrhage, PTB, emergency CS, placental adherence, cesarean hysterectomy (p-value < .001 for adverse maternal outcomes) and low cord Ph (p-value = .016). Conclusions Assessment of the cervical length could be a crucial step in the work-up and decision making for pregnancies complicated with abnormally situated and/or adherent placenta as it is strongly associated with a wide range of maternal and neonatal morbidities.

Obstetric outcomes for women with severe mental illness: 10years of experience in a tertiary multidisciplinary antenatal clinic.

This study aims to describe 10years of antenatal care and outcomes for women with a severe mental illness (SMI). A retrospective cohort study of 420 completed pregnancy records over the last 10years (2007-2017). Findings were compared to the Western Australian (WA) pregnancy data. Antenatal attendance, demographic, obstetric, neonatal and psychosocial variables were analysed using t tests, χ2, ANOVA and odds ratio (OR). Overall, women with a SMI had high rates of comorbidity (47%), antenatal complications, and preterm birth at 12.6% compared to WA mothers (p < 0.001). Those with schizophrenia were at highest risk with increased risk of threatened preterm labour OR 8.25 (95% CI 4.64-14.65), gestational diabetes OR 3.59 (95% CI 2.18-5.91) and reduced likelihood of a spontaneous vaginal birth OR 0.46 (95% CI 0.29-0.71). Late presentation and antenatal attendance for women with SMI were significantly associated with maternal substance use, psychiatric admission during pregnancy, and child welfare involvement. Women with schizophrenia had significantly lower attendance rates at scheduled antenatal care (ANC) appointments than those with bipolar disease (87.1% vs 94%, p = 0.003). Obstetric outcomes are poorer for women with SMI compared to the general population. They have higher rates of medical comorbidities, lifestyle and psychosocial risks factors that are known to contribute to poor obstetric outcomes. Effective delivery of regular and appropriate ANC is essential in addressing these multifactorial risks. Targeted strategies addressing comprehensive medical management, preterm birth prevention, lifestyle modifications and increased psychosocial support could improve both short- and long-term outcomes for these women and their children.

Barriers and enablers for practicing kangaroo mother care (KMC) in rural Sindh, Pakistan.

BackgroundMore than 2.5 million newborns die each year, accounting for 47% of children dying worldwide before their age of five years. Complications of preterm birth are the leading cause of death among newborns. Pakistan is amongst the top ten countries with highest preterm birth rate per 1000 live births. Globally, Every Newborn Action Plan (ENAP) has emphasized on Kangaroo Mother Care (KMC) as an essential component of neonatal health initiatives.Materials and methodsWe conducted this qualitative study with 12 in-depth interviews (IDIs) and 14 focus group discussion (FGD) sessions, in two health facilities of Sindh, Pakistan during October-December 2016, to understand the key barriers and enablers to a mother's ability to practice KMC and the feasibility of implementing and improving these practices.ResultsThe findings revealed that community stakeholders were generally aware of health issues especially related to maternal and neonatal health. Both the health care providers and managers were supportive of implementing KMC in their respective health facilities as well as for continuous use of KMC at household level. In order to initiate KMC at facility level, study respondents emphasized on ensuring availability of equipment, supplies, water-sanitation facility, modified patient ward (e.g., curtain, separate room) and quality of services as well as training of health providers as critical prerequisites. Also in order to continue practicing KMC at household level, engaging the community and establishing functional referral linkage between community and facilities were focused issues in facility and community level FGDs and IDIs.ConclusionThe study participants considered it feasible to initiate KMC practice at health facility and to continue practicing at home after returning from facility. Ensuring facility readiness to initiate KMC, improving capacity of health providers both at facility and community levels, coupled with focusing on community mobilization strategy, targeting specific audiences, may help policy makers and program planners to initiate KMC at health facility and keep KMC practice continued at household level.

Birth outcomes in Aboriginal mother-infant pairs from the Northern Territory, Australia, who received 23-valent polysaccharide pneumococcal vaccination during pregnancy, 2006-2011: The PneuMum randomised controlled trial.

Pregnant women and infants <6months old have a high baseline risk for pneumococcal disease compared to the general population, particularly among Indigenous populations living in poverty and low-resource settings. Efficacy trials of pneumococcal vaccination in pregnancy examining adverse birth outcomes are lacking. We report adverse birth events as secondary outcomes from the 'PneuMum' randomised controlled trial of 23-valent pneumococcal polysaccharide vaccination (23vPPV) in pregnancy (August 2006-January 2011). Australian Aboriginal women aged 17-39years with singleton uncomplicated pregnancies were randomised (1:2 ratio) to receive 23vPPV or no 23vPPV in pregnancy at 30-36weeks gestation. We compared risks of stillbirth, preterm birth, low birthweight (LBW), and small for gestational age (SGA) between vaccinated and unvaccinated pregnant women. Cox proportional hazard ratios (HRs) were calculated on an intention-to-treat basis. Among 227 enrolled participants, 75 (33%) received 23vPPV in pregnancy. Risk differences in adverse birth outcomes between 23vPPV vaccinated and unvaccinated pregnant women were; preterm birth 9% vs 4% (HR 2.79; 95% CI 0.94-8.32) P=0.07; LBW 9% vs 5% (HR 2.09; 95% CI 0.76-5.78) P=0.15; and SGA 15% vs 17% (HR 1.02; 95% CI 0.50-2.06) P=0.96. There were no stillbirths. We found a numerically higher rate of preterm births among women who received 23vPPV in pregnancy compared to unvaccinated pregnant women. Although further investigation with larger participant numbers is needed to better evaluate this safety signal, the contribution of safety results from smaller studies using appropriate data analysis methodologies is critical, particularly as more clinical trials in pneumococcal vaccination in pregnancy are progressing.

Emotional distress in mothers of early-preterm infants, late-preterm infants, and full-term infants in Malawi

BackgroundMothers of preterm infants, early or late, report more distress than mothers of full-term infants. Malawi has the highest preterm birth rate in the world, but nothing is known about the relation of preterm birth to maternal mental health. PurposeTo compare emotional distress among mothers of early-preterm, late-preterm, and full-term infants. MethodsWe recruited 28 mothers of early-preterm, 29 mothers of late-preterm, and 28 mothers of full-term infants. Emotional distress was assessed 24-72 hr following birth. One-way ANOVA and regression analysis were used to compare the three groups. FindingsMothers of early-preterm infants reported more distress symptoms than mothers of full-term infants, and scores of mothers of late-preterm infants fell between the other two groups. Having a support person present was associated with lower symptoms and caesarean birth was associated with more symptoms. DiscussionPromoting maternal mental health is important following preterm birth and health care providers need to support mothers.

Risk of preterm delivery in singletons conceived by in vitro fertilization

To evaluate the preterm delivery and other obstetrics complications similar in singleton pregnancies achieved through IVF compared to spontaneous pregnancies. Retrospective case-control study included 1663 women with singleton pregnancies following IVF-ICSI (study group) and 3326 women with singleton spontaneous pregnancies (control group) who delivered between January 2015 and January 2018 at the Peking University Third Hospital. The control group matched 1:2 by age, BMI, parity, and gravidity. Maternal outcomes included preterm delivery and complications. There was significantly higher incidence of gestational diabetes, hypertensive disorders, and placenta previa in IVF-ICSI pregnancies versus controls (p < .05). IVF-ICSI resulted in significantly higher rate of preterm birth than in spontaneous pregnancies (p < .05) and the difference remained significant for deliveries that occurred before 28, 32, and 34 weeks gestation (p < .05). Multivariate logistic regression analysis revealed that female-factor infertility, hypertensive disorder, placenta previa, and PROM were significant prognostic factors associated with increased risk of prematurity. IVF-ICSI is associated with increased risk of obstetric complications including preterm delivery in singleton pregnancies. Female-factor infertility is an independent prognostic factor for preterm birth. This information is important for patient counseling and helps to refine the recommendation to optimize maternal health before embarking on fertility treatments.

Lipidomics Profiles are Related to Preterm Birth and Depressive Symptoms in Pregnant African American Women

African American women have a higher preterm birth rate (PTB, birth before 37 weeks) compared to non‐Hispanic white women. Exposure to chronic stressors has been related to higher rates of PTB (Latendresse et al. 2009 &amp; Misra et al. 2010). This project is a part of a larger research study to investigate the social and biological mechanisms responsible for higher PTB and other pregnancy complications in African American women. We hypothesized that the lipidomic profiles will be related to gestational age at birth and depressive symptoms among pregnant African American women. Thirty women were recruited at the prenatal clinic site in Metropolitan Detroit. Women completed the questionnaires and plasma samples were collected between 8 to 16 weeks of gestation. The lipidomic profiles were determined by “shotgun” Orbitrap high resolution/accurate mass spectrometry. Plasma triglycerides, glycerolipids, phospholipids, sphingolipids, sterols, fatty acids, and signaling lipids were measured. The data were analyzed by multivariate analysis, Principal Component Analysis (PCA), Orthogonal Projections to Latent Structures (OPLS), and OPLS Discriminant Analysis (OPLS‐DA) using SIMCA P+ software. PCA was used to identify the outliers and patterns in the data. OPLS DA score plot showed good separation and groupings of PTB and full‐term birth. The corresponding S‐plot, loading plot, and Variable Importance for the Projection (VIP) plot/list were used to identify the lipids responsible for the groupings. We identified a panel of lipid markers of PTB. Higher levels of triglycerides species TG (53:5), TG (53:4), TG (54:5), TG (54:6), TG (52:6) and TG (52:4) and lower levels of phospholipid species PC (37:1), PC (41:6) and PC (39:3) were associated with PTB. Plasma lipidomics profiles showed a good correlation with the Center for Epidemiologic Studies Depression Scale (CES‐D) scores in the OPLS model. There was a clear separation in the OPLS DA score plot between women with CES‐D scores ≥ 23 compared to women with CES‐D scores &lt; 23. Phosphatidylcholine PC (37:1) levels were also lower among women with CES‐D scores ≥ 23 compared to women with CES‐D scores &lt; 23 pointing toward a possible connection between depressive symptoms and PTB. We also investigated the differences in lipidomics profiles based on Body Mass Index (BMI). Although the overweight pregnant women group (pre‐pregnancy BMI &gt;25 kg/m2) showed higher levels of triglycerides, there was no clear overlap with the PTB model. Our data suggest the role of specific triglycerides and phosphatidylcholines in PTB. Further investigation of the association of PTB and depressive symptoms with lipidomics profiles and phospholipid metabolism in a larger sample of pregnant African American women may lead to the identification of non‐invasive lipid biomarkers of PTB and intervention strategies for these women.Support or Funding InformationR01 MD011575, Social Stressors and Inflammation: A Mixed Methods Approach to Preterm Birth. National Institute on Minority Health and Health DisparitiesThis abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.