Higher Rates Of Preterm Birth Research Articles

Perinatal Outcomes in Early and Late Gestational Diabetes Mellitus After Treatment From 24-28 Weeks' Gestation: A TOBOGM Secondary Analysis.

In most gestational diabetes mellitus (GDM) studies, cohorts have included women combined into study populations without regard to whether hyperglycemia was present earlier in pregnancy. In this study we sought to compare perinatal outcomes between groups: women with early GDM (EGDM group: diagnosis before 20 weeks but no treatment until 24-28 weeks if GDM still present), with late GDM (LGDM group: present only at 24-28 weeks), and with normoglycemia at 24-28 weeks (control subjects). This is a secondary analysis of a randomized controlled treatment trial where we studied, among women with risk factors, early (<20 weeks' gestation) GDM defined according to World Health Organization 2013 criteria. Those receiving early treatment for GDM treatment were excluded. GDM was treated if present at 24-28 weeks. The primary outcome was a composite of birth before 37 weeks' gestation, birth weight ≥4,500 g, birth trauma, neonatal respiratory distress, phototherapy, stillbirth/neonatal death, and shoulder dystocia. Comparisons included adjustment for age, ethnicity, BMI, site, smoking, primigravity, and education. Women with EGDM (n = 254) and LGDM (n = 467) had shorter pregnancy duration than control subjects (n = 2,339). BMI was lowest with LGDM. The composite was increased with EGDM (odds ratio [OR] 1.59, 95% CI 1.18-2.12)) but not LGDM (OR 1.19, 95% CI 0.94-1.50). Induction of labor was higher in both GDM groups. In comparisons with control subjects there were higher birth centile, higher preterm birth rate, and higher rate of neonatal jaundice for the EGDM group (but not the LGDM group). The greatest need for insulin and/or metformin was with EGDM. Adverse perinatal outcomes were increased with EGDM despite treatment from 24-28 weeks' gestation, suggesting the need to initiate treatment early, and more aggressively, to reduce the effects of exposure to the more severe maternal hyperglycemia from early pregnancy.

Female obesity increases the risk of preterm birth of single frozen-thawed euploid embryos: a retrospective cohort study.

Obesity has been associated with an increased risk of reproductive failure, especially preterm birth. As preimplantation genetic testing for aneuploidies (PGT-A) is increasingly used worldwide, however, it is still unclear whether body mass index (BMI) has an effect on the preterm birth rate in patients undergoing in vitro fertilization (IVF) with PGT-A when transferring a single euploid blastocyst. This retrospective, single-center cohort study included 851 women who underwent the first cycle of frozen-thawed single euploid blastocyst transfer with PGT-A between 2015 and 2020. The primary outcome was the preterm birth rate. Secondary outcomes were clinical pregnancy, miscarriage, ectopic pregnancy, pregnancy complications, and live birth. Patients were grouped by World Health Organization (WHO) BMI class: underweight (<18.5, n = 81), normal weight (18.5-24.9, n = 637), overweight (25-30, n = 108), and obese (≥30, n = 25). There was no difference in the clinical pregnancy, miscarriage, ectopic pregnancy, pregnancy complication, and live birth by BMI category. In multivariate logistic regression analysis, preterm birth rates were significantly higher in women with overweight (adjusted odds ratio [aOR] 3.18; 95% confidence interval [CI], 1.29-7.80, p = .012) and obese (aOR 1.49; 95% CI, 1.03-12.78, p = .027) compared with the normal weight reference group. Women with obesity experience a higher rate of preterm birth after euploid embryo transfer than women with a normal weight, suggesting that the negative impact of obesity on IVF and clinical outcomes may be related to other mechanisms than aneuploidy.

Exploring Risk Factors and Perinatal Outcomes of Preterm Birth in a Tertiary Care Hospital: A Comprehensive Analysis.

Background Preterm birth before 37 weeks of gestation is a global public health challenge, particularly in India, where the prevalence varies regionally. Understanding risk factors, such as maternal age and complications like hypertensive disorders, is vital. India's diverse healthcare landscape and regional disparities further complicate this issue. Preterm infants face increased mortality and morbidity risks like respiratory distress and intraventricular hemorrhage. This study in a tertiary care hospital aimed to analyze risk factors, assess perinatal outcomes, and contribute to the understanding of preterm birth in this complex context, providing valuable insights for maternal and child health strategies. Methods This retrospective cohort study was conducted at the Venkateshwara Institute of Medical Science, Rajabpur, over one year, extracting data from electronic health records. The study aimed to analyze risk factors associated with preterm delivery and assess perinatal outcomes. The study included diverse pregnancies, both singleton and multiple gestations, and employed sample size calculations to ensure statistical validity. Trained medical personnel collected extensive data on maternal characteristics, obstetric history, antenatal care, perinatal outcomes, and mode of delivery. Statistical analysis, utilizing SPSS (IBM, Chicago, USA), involved descriptive statistics, comparative analysis, chi-square tests, t-tests, Mann-Whitney U tests, and multivariate logistic regression models. Findings with a p-value <0.05 were considered significant. Results The study included 2042 deliveries, with a preterm birth prevalence of 14.2%. Multiparous women had higher preterm birth rates than primigravida (72.92% vs. 27.08%). Maternal age, history of preterm delivery, hypertensive disorders, inadequate antenatal care compliance, previous cesarean section, multiple gestations, antepartum hemorrhage (APH), polyhydramnios, oligohydramnios, and premature rupture of membranes (PROM) were significantly associated with preterm birth. Apgar scores at one minute and five minutes, neonatal complications, and mortality rates were notably worse among preterm births. Vaginal delivery rates were significantly lower in the preterm group (36.3%) compared to full-term deliveries (48.8%), with a higher rate of emergency cesarean sections (19.7% vs. 10.8%). Conclusion This study provides valuable insights into the risk factors and perinatal outcomes of preterm delivery at a tertiary care hospital, with precise values illustrating the extent of associations. The findings such as history of preterm delivery, hypertensive disorders, and inadequate antenatal care compliance as the most commonly associated conditions with preterm birthand management of such associated conditions may help reduce the rate of premature birth.

Pregnancy in Patients Receiving Home Dialysis.

Pregnancy is an important goal for many women with CKD or kidney failure, but important barriers exist, particularly as CKD stage progresses. Women with advanced CKD often have a limited fertility window and may miss their opportunity for a pregnancy if advised to defer until after kidney transplantation. Pregnancy rates in women with advanced kidney failure or receiving dialysis remain low, and despite the improved outcomes in recent years, these pregnancies remain high risk for both mother and baby with high rates of preterm birth due to both maternal and fetal complications. However, with increased experience and advances in models of care, this paradigm may be changing. Intensive hemodialysis regimens have been shown to improve both fertility and live birth rates. Increasing dialysis intensity and individualizing dialysis prescription to residual renal function, to achieve highly efficient clearances, has resulted in improved live birth rates, longer gestations, and higher birth weights. Intensive hemodialysis regimens, particularly nocturnal and home-based dialysis, are therefore a potential option for women with kidney failure desiring pregnancy. Global initiatives for the promotion and uptake of home-based dialysis are gaining momentum and may have advantages in this unique patient population. In this article, we review the epidemiology and outcomes of pregnancy in hemodialysis and peritoneal dialysis recipients. We discuss the role home-based therapies may play in helping women achieve more successful pregnancies and outline the principles and practicalities of management of dialysis in pregnancy with a focus on delivery of home modalities. The experience and perspectives of a patient are also shared.

Study of Different Breastfeeding Parameters by Using Breastfeeding Assessment Tools in Urban Tertiary Care Hospital

Background: In India, only 56% of mothers breastfeed exclusively for the first six months, as recommended. Given India’s extraordinarily high rates of preterm births, infant mortality, neonatal deaths and maternal fatalities, exclusive breastfeeding becomes even more crucial. There are many advantages of breastfeeding, but there are lots of barriers that need to be addressed. These problems need a proper objective assessment. Aims: To assess optimum positioning and attachment in mother-infant dyads, infant breastfeeding behaviour in the early neonatal period and early breastfeeding skills in mothers. Methods: A prospective cross-sectional study was conducted in the postnatal ward of a tertiary care hospital. In total, 208 full-term neonates (Age - 24 hours to 7 days) who were admitted to a postnatal ward of a tertiary care hospital and who were on direct breastfeeding were observed for breastfeeding. Objective assessment of breastfeeding was done by using the Bristol Breastfeeding Assessment Tool, Infant Breast-Feeding Assessment tool and LATCH tool. Statistical analysis was done by using SPSS version 25 with appropriate statistical tests. Result: For the BBAT tool, 110 (52.9%) infants were well supported while feeding and 118 (56.7%) had proper latching or attachment. For IBFAT Score Analysis, 109 (52.4%) infants were effective vigorous feeders and 95 (45.7%) and 4 (1.9%) were moderately effective feeders and poor feeders, respectively. For LATCH Score Analysis, 173 (83.2%) mother-infant dyads achieved a high score and 35 (16.8%) achieved moderate score. Conclusion: Objective assessment of breastfeeding by using these tools will help to identify the problem related to breastfeeding for both baby and mother. Addressing a particular problem in a timely manner will help the mother and the baby to establish, initiate and sustain exclusive breastfeeding. Caesarean-delivered mothers as well as primiparous mothers both needed more focused counselling for breastfeeding positioning, motivation for early initiation breastfeeding, a strong supportive relationship, adequate assistance during the early neonatal period for breastfeeding and proper guidance to sustain exclusive breastfeeding.

Pregnancy outcomes post-kidney transplantation across 23 years.

Pregnancy in kidney transplant recipients has become increasingly common. However, pregnancy carries higher risks to these patients compared to the general population. To describe pregnancy outcomes in kidney transplant recipients. We conducted a single-centre retrospective cohort study of kidney transplant recipients who delivered after 20 weeks gestation at a quaternary hospital in Victoria, Australia, between 2000 and 2022 inclusive. The study included 37 pregnancies from 27 patients, accounting for 38 infants. Over half of recorded pregnancies occurred in the past five years (56.8%, n = 21). There were high rates of pre-existing hypertension (75.7%, n = 28). Pregnancy-induced hypertension and pre-eclampsia were common antenatal complications (21.6%, n = 8 and 48.6%, n = 18 respectively). Soluble fms-like tyrosine kinase-1 / placental growth factor ratios were elevated in all patients who developed severe pre-eclampsia (16.2%, n = 6). The median gestational age at birth was 36.4 weeks (range 20-40.4, Q1 32.9, Q3 37.6) and 59.5% (n = 22) of births were preterm. Unplanned caesarean without labour was the most common mode of birth (35.1%, n = 13). The overall caesarean rate was 62.1% (n = 23). Post-partum haemorrhage complicated over half of pregnancies (56.8%, n = 21). Fifty percent (n = 19) of infants were admitted for neonatal care, in particular neonatal intensive care, and had low birthweights under 2500 g. While there was a transient deterioration in kidney function, there was no graft rejection within one year of birth. Clinicians should consider the high rates of pre-existing hypertension, preterm birth, and caesarean birth when counselling and managing pregnant kidney transplant recipients.

Evaluating the effect of maternal non-communicable disease on adverse pregnancy outcomes and birthweight in Pakistan, a facility based retrospective cohort study

Non-communicable diseases (NCDs) claim 74% of global lives, disproportionately affecting lower and middle-income countries like Pakistan. NCDs may increase the risk of preterm birth (PTB), caesarean section (CS), and low birthweight. This study aims to determine whether the high prevalence of NCDs in Pakistan play a role in the high rates of preterm births, and CS. This retrospective cohort study from Aga Khan University Hospital, Pakistan, investigated effects of pre-existing NCDs on pregnancy outcomes of 817 pregnant women. Medical records were used to generate odds ratios for the risk of PTB, labour outcome and birthweight in women with type 1 and type 2 diabetes, hypertension, asthma and thyroid disorders. Multinomial logistic regression and general linear models were used to adjust for confounding variables using IBM SPSS Statistics (v27). Type 2 diabetes significantly increased the risk of PTB and elective CS (both P < 0.05). Elective CS was significantly increased by hypertension and asthma (both, P < 0.05). Surprisingly, asthma halved the risk of PTB (P < 0.05), while type 1 diabetes significantly increased birthweight from 2832 to 3253g (P < 0.001). In conclusion, pre-existing NCDs increase the risk of negative pregnancy outcomes, including PTB, elective CS and birthweight. Asthma, however reduced PTB and justifies further investigation.

African immigrants' favorable preterm birth rates challenge genetic etiology of the Black-White disparity in preterm birth.

We examined over a million California birth records for 2010 through 2021 to investigate whether disparities in preterm birth (PTB) by nativity and race support the widely held but hitherto unsubstantiated belief that genetic differences explain the persistent Black-White disparity in PTB. We examined PTB rates and risk ratios among African-, Caribbean-, and U.S.-born Black women compared to U.S.-born White women. Multivariate analyses adjusted for maternal age, education, number of live births, delivery payer, trimester of prenatal care initiation, pre-pregnancy BMI, smoking, and prevalence of poverty in a woman's residence census tract; and for paternal education. In adjusted analyses, African-born Black women's PTB rates were no different from those of U.S.-born White women. The results add to prior evidence making a genetic etiology for the racial disparity in PTB unlikely. If genetic differences tied to "race" explained the Black-White disparity in PTB among U.S.-born women, the African immigrants in this study would have had higher rates of PTB, not the lower rates observed. Multiple explanations for the observed patterns and their implications are discussed. Failure to distinguish causes of PTB from causes of the racial disparity in PTB have likely contributed to erroneous attribution of the racial disparity to genetic differences. Based on the literature, unmeasured experiences of racism, including racism-related stress and adverse environmental exposures, are plausible explanations for the PTB disparity between Black and White U.S.-born women. The favorable birth outcomes of African-born Black immigrants may reflect less exposure to racism during sensitive life periods, e.g., childhood, when they were in African countries, where Black people are in the racial majority.

Review of the Assessment and Management of Perinatal Mood and Anxiety Disorders.

Perinatal mood and anxiety disorders (PMADs) are the most common complication of childbirth. When poorly controlled, they are associated with worse obstetric outcomes, such as higher rates of preterm birth and unplanned cesarean delivery. They are also associated with suicide, a leading cause of perinatal maternal death. This article provides an overview of evidence-based recommendations for screening, assessment, and management of PMADs, including suicide risk assessment and management and pharmacological and nonpharmacological treatment options compatible with pregnancy and lactation. Although specialized reproductive psychiatrists can provide expert guidance for the management of PMADs, their scarcity means that most patients will not have access to this expert care and instead will seek guidance from general psychiatrists. This article provides a clinical guide for generalists that is based on the best current evidence, including recently released treatment guidelines.

US County–Level Variation in Preterm Birth Rates, 2007-2019

Preterm birth is a leading cause of preventable neonatal morbidity and mortality. Preterm birth rates at the national level may mask important geographic variation in rates and trends at the county level. To estimate age-standardized preterm birth rates by US county from 2007 to 2019. This serial cross-sectional study used data from the National Center for Health Statistics composed of all live births in the US between 2007 and 2019. Data analyses were performed between March 22, 2022, and September 29, 2022. Age-standardized preterm birth (<37 weeks' gestation) and secondarily early preterm birth (<34 weeks' gestation) rates by county and year calculated with a validated small area estimation model (hierarchical bayesian spatiotemporal model) and percent change in preterm birth rates using log-linear regression models. Between 2007 and 2019, there were 51 044 482 live births in 2383 counties. In 2007, the national age-standardized preterm birth rate was 12.6 (95% CI, 12.6-12.7) per 100 live births. Preterm birth rates varied significantly among counties, with an absolute difference between the 90th and 10th percentile counties of 6.4 (95% CI, 6.2-6.7). The gap between the highest and lowest counties for preterm births was 20.7 per 100 live births in 2007. Several counties in the Southeast consistently had the highest preterm birth rates compared with counties in California and New England, which had the lowest preterm birth rates. Although there was no statistically significant change in preterm birth rates between 2007 and 2019 at the national level (percent change, -5.0%; 95% CI, -10.7% to 0.9%), increases occurred in 15.4% (95% CI, 14.1%-16.9%) of counties. The absolute and relative geographic inequalities were similar across all maternal age groups. Higher quartile of the Social Vulnerability Index was associated with higher preterm birth rates (quartile 4 vs quartile 1 risk ratio, 1.34; 95% CI, 1.31-1.36), which persisted across the study period. Similar patterns were observed for early preterm birth rates. In this serial cross-sectional study of county-level preterm and early preterm birth rates, substantial geographic disparities were observed, which were associated with place-based social disadvantage. Stability in aggregated rates of preterm birth at the national level masked increases in nearly 1 in 6 counties between 2007 and 2019.

Effects of maternal pulmonary arterial hypertension on fetal hemodynamics and maternal-fetal outcome in late pregnancy.

The aim of this study was to investigate the effects of maternal pulmonary arterial hypertension (PAH) on fetal hemodynamics in the third trimester and to identify hemodynamic indicators associated with adverse maternal and fetal outcomes. We recruited 48 pregnant women with PAH in the third trimester and 32 women with normal pregnancies as controls matched for age and gestational week. Fetal growth and hemodynamic parameters were assessed by two-dimensional and color Doppler. All cases were followed up until delivery and maternal and fetal outcomes were collected. High throughput sequencing method was used to determine differential miRNA patterns in plasma exposed to pulmonary arterial hypertension (PAH) in pregnant women. We then performed the validated of key differentially expressed miRNAs by real-time PCR. Compared with the normal and mild PAH groups, resistance index (RI), pulsatility index (PI) of the fetal umbilical artery (UA) and quantitative ductus venosus (QDV) blood flow were increased in subjects with moderate to severe PAH, while PI and the ratio of peak systolic velocity (PSV) to end-diastolic velocity (EDV) (S/D) of the middle cerebral artery (MCA) were decreased. Compared with the normal group, subjects in the mild and moderate PAH groups had lower neonatal weight, shorter neonatal height, and higher preterm birth rates. In addition, miRNA sequencing data showed that PAH affected the levels of 23 miRNAs in plasma. At the same time, we showed that PAH significantly decreased the level of miR-1255a and increased the level of miR-548ar-3p by real-time PCR. In the group of pregnant women with moderate to severe pulmonary hypertension, there was a higher proportion of preterm births and low birth weight babies. Hemodynamic changes in the fetal UA, MCA, and ductus venosus (DV) during late pregnancy were associated with adverse fetal outcomes. At the same time, miRNA sequencing results showed that miR-1255a and miR-548ar-3p may play an important role in the development of PAH.

Food environment index and preterm birth rate in the counties of the United States.

To determine the relationship between Food Environment Index (FEI) and Preterm Birth (PTB) rate at the county level of the United States of America (USA) (primary), while evaluating the interaction of multiple factors within a framework of sociodemographic, maternal health, maternal behavioral, and environmental factors. This is a population-based retrospective cohort ecological study from 2015-2018. The study compares the characteristics of the population of the counties of the USA. All counties with complete data on their PTB rate and the independent variables were included in the study. Independent variables with greater than 20% missing data were excluded from the study. Purposive sampling technique was applied. A total of 2983/3142 counties were included in the study. The median PTB rate of all counties was 9.90%. The highest PTB rate (23.3%) was in Tallapoosa County, Alabama and the lowest (3.4%) in San Juan County, Washington State. After adjusting for variables, PTB rate had a significant association with FEI (coefficient of correlation - 0.36, p < 0.01, 95% CI - 0.19 to - 0.04). Increase in the rate of unemployment, African American race, adult smoking, obesity, uninsured rate, sexually transmitted diseases (STD), high school education and air pollution was associated with an increase in PTB rate, while an increase in FEI and alcohol abuse rates was associated with a decrease in PTB rate. FEI can predict the PTB rate in USA counties after adjusting for sociodemographic, health, behavioral and environmental factors. Future studies are needed to confirm these associations and consider them when making policies to reduce PTBs.

Place-Based Strategies Addressing Neighborhood Environments to Improve Perinatal and Preterm Infant Outcomes.

Preterm birth (defined as birth <37 weeks of gestation) is a significant health concern globally, with lasting implications for individuals, families, and society. In the United States, high preterm birth rates among Black and low-income populations likely result from differences in environmental exposures. Structural racism and economic disadvantage have led to unequal distribution of polluting industrial sites and roadways across society as well as differential access to health-promoting resources which contribute to preterm birth risk. Once born, preterm infants remain at risk for numerous environmentally responsive adverse health outcomes that affect growth and development throughout childhood and adulthood. In this commentary, we describe associations of neighborhood environments with pregnancy and preterm infant health outcomes and propose strategies to address harmful exposures that affect families across the lifespan.

Why Causation Matters: Rethinking "Race" as a Risk Factor.

Although it is tempting to construe the correlation between Black "race" and higher rates of preterm birth as causal, this logic is flawed. Worse, the continued use of Black "race" as a risk factor for preterm birth is actively harmful. Using Black "race" as a risk factor suggests a causal relationship that does not exist and, critically, obscures what actually causes Black patients to be more vulnerable to poorer maternal and infant outcomes: anti-Black racism. Failing to name anti-Black racism as the root cause of Black patients' vulnerability conceals key pathways and tempts us to construe Black "race" as immutably related to higher rates of preterm birth. The result is that we overlook two highly treatable pathways-chronic stress and implicit bias-through which anti-Black racism negatively contributes to birth. Thus, clinicians may underuse important tools to reduce stress from racism and discrimination while missing opportunities to address implicit bias within their practices and institutions. Fortunately, researchers, physicians, clinicians, and medical staff can positively affect Black maternal and infant health by shifting our causal paradigm. By eliminating the use of Black "race" as a risk factor and naming anti-Black racism as the root cause of Black patients' vulnerability, we can practice anti-racist maternity care and take a critical step toward achieving birth equity.

Differences in Vaginal Progesterone Provision among Racial and Socioeconomic Groups

Objective: Preterm birth is the leading cause of perinatal morbidity and mortality and has been increasing in the United States. Short cervical length is a treatable risk factor for preterm birth. Non-Hispanic black and Hispanic women have significantly higher rates of preterm birth and disparities exist in the obstetrical care of these populations.

Obstetric and Perinatal Outcomes following Ovulation Induction and Unassisted Pregnancies in the Same Mother.

We aimed to assess whether ovulation induction treatments affect obstetric and neonatal outcomes. This was a historic cohort study of deliveries in a single university-affiliated medical center between November 2008 and January 2020. We included women who had one pregnancy following ovulation induction and one unassisted pregnancy. The obstetric and perinatal outcomes were compared between pregnancies following ovulation induction and unassisted pregnancies, so that each woman served as her own control. The primary outcome measure was birth weight. A total of 193 deliveries following ovulation induction and 193 deliveries after unassisted conception by the same women were compared. Ovulation induction pregnancies were characterized by a significantly younger maternal age and a higher rate of nulliparity (62.7 vs. 8.3%, p < 0.001). In pregnancies achieved by ovulation induction, we found a higher rate of preterm birth (8.3 vs. 4.1%, p = 0.02) and instrumental deliveries (8.8 vs. 2.1%, p = 0.005), while cesarean delivery rates were higher following unassisted pregnancies. Birth weight was significantly lower in ovulation induction pregnancies (3,167 ± 436 vs. 3,251 ± 460 g, p = 0.009), although the rate of small for gestational age neonates was similar between the groups. On multivariate analysis, birth weight remained significantly associated with ovulation induction after adjustment for confounders, while preterm birth did not. Pregnancies following ovulation induction treatments are associated with lower birth weight. This may be related to an altered placentation process following uterine exposure to supraphysiological hormonal levels. · Ovulation induction entails lower birthweight.. · This may relate to supraphysiological hormonal levels.. · Monitoring fetal growth is advised in such cases..

Maternal and neonatal outcomes in women with twin pregnancies based on gestational weight gain: An updated systematic review and meta-analysis.

This updated systematic review and meta-analysis aimed to assess maternal and fetal outcomes of pregnancies based on the Institute of Medicine (IOM) guidelines of gestational weight gain (GWG). PubMED, SCOPUS, EMBASE and Web of Science were searched up to 30th July 2022. All studies evaluating maternal and/or neonatal outcomes of twin pregnancies based on the IOM guidelines of gestational weight gain were included. Twenty two studies were included. Mothers with twin pregnancies experiencing inadequate GWG showed higher incidence of gestational diabetes with the risk ratio (RR) 1.22 95% CI (0.95,1.57), p=0.0005, i2= 69% and premature rupture of membrane (PROM) with RR 1.14 95% CI (0.99, 1.30), p=0.07; i2=0% that coincided with higher rates of preterm birth, low birth weight, small for gestational age (SGA) and admission to NICU in neonates. Mothers with excessive GWG had higher risk of developing gestational hypertension with RR 1.59 95% CI (1.22, 2.07), p=0.0006, i2=75% and extremely preterm delivery (<32 weeks). Within the limitations of this review, GWG was found to be a predictable risk factor for adverse maternal and neonatal outcomes of twin pregnancies.

Single cell profiling at the maternal–fetal interface reveals a deficiency of PD-L1+ non-immune cells in human spontaneous preterm labor

The mechanisms that underlie the timing of labor in humans are largely unknown. In most pregnancies, labor is initiated at term (≥ 37 weeks gestation), but in a signifiicant number of women spontaneous labor occurs preterm and is associated with increased perinatal mortality and morbidity. The objective of this study was to characterize the cells at the maternal–fetal interface (MFI) in term and preterm pregnancies in both the laboring and non-laboring state in Black women, who have among the highest preterm birth rates in the U.S. Using mass cytometry to obtain high-dimensional single-cell resolution, we identified 31 cell populations at the MFI, including 25 immune cell types and six non-immune cell types. Among the immune cells, maternal PD1+ CD8 T cell subsets were less abundant in term laboring compared to term non-laboring women. Among the non-immune cells, PD-L1+ maternal (stromal) and fetal (extravillous trophoblast) cells were less abundant in preterm laboring compared to term laboring women. Consistent with these observations, the expression of CD274, the gene encoding PD-L1, was significantly depressed and less responsive to fetal signaling molecules in cultured mesenchymal stromal cells from the decidua of preterm compared to term women. Overall, these results suggest that the PD1/PD-L1 pathway at the MFI may perturb the delicate balance between immune tolerance and rejection and contribute to the onset of spontaneous preterm labor.

Vitamin D deficiency in pregnancy and the risk of preterm birth: a nested case–control study

BackgroundEach year, an estimated 15 million babies are born preterm. Micronutrient deficiencies, including vitamin D deficiency (VDD), are common in many low- and middle-income countries (LMICs), and these conditions are often associated with adverse pregnancy outcomes. Bangladesh experiences a high prevalence of VDD. The country also has a high preterm birth (PTB) rate. Using data from a population-based pregnancy cohort, we estimated the burden of VDD during pregnancy and its association with PTB.MethodsPregnant women (N = 3,000) were enrolled after ultrasound confirmation of gestational age at 8–19 weeks of gestation. Trained health workers prospectively collected phenotypic and epidemiological data at scheduled home visits. Trained phlebotomists collected maternal blood samples at enrollment and 24 -28 weeks of gestation. Aliquots of serum were stored at -800 C. We conducted a nested case–control study with all PTB (n = 262) and a random sample of term births (n = 668). The outcome, PTB, was defined as live births < 37 weeks of gestation, based on ultrasound. The main exposure was vitamin D concentrations of 24–28 weeks maternal blood samples. The analysis was adjusted for other PTB risk factors. Women were categorized as VDD (lowest quartile of 25(OH)D; < = 30.25 nmol/L) or not deficient (upper-three quartiles of 25(OH)D; > 30.25 nmol/L). We used logistic regression to determine the association of VDD with PTB, adjusting for potential confounders.ResultsThe median and interquartile range of serum 25(OH)D was 38.0 nmol/L; 30.18 to 48.52 (nmol/L). After adjusting for co-variates, VDD was significantly associated with PTB [adjusted odds ratio (aOR) = 1.53, 95% confidence interval (CI) = 1.10 – 2.12]. The risk of PTB was also higher among women who were shorter (aOR = 1.81, 95% CI: 1.27–2.57), primiparous (aOR = 1.55, 95% CI = 1.12 – 2.12), passive smokers (aOR = 1.60, 95% CI = 1.09 – 2.34), and those who received iron supplementation during pregnancy (aOR = 1.66, 95% CI: 1.17, 2.37).ConclusionVDD is common in Bangladeshi pregnant women and is associated with an increased risk of PTB.

Long-term outcomes for children conceived by assisted reproductive technology

Worldwide, more than 10 million children have been born after Assisted Reproduction Technology (ART) and comprised up to 7.9% of children born in Europe and up to 5.1 % of children born in the US in 2018 (1, 2). The short-term outcome for children born after ART is well-known from numerous publications, with higher rates of preterm birth and low birth weight in children born after fresh embryo transfer and higher rates of large for gestational age and high birth weight in children born after frozen embryo transfer compared to children born after spontaneous conception (3, 4). Higher rates of birth defects in children born after ART have also been shown consistently over time (5). Studies on long-term health outcomes after ART are scarcer but suggest an increased risk of altered blood pressure and cardiovascular function in children born after ART. In this review we summarize long-term health outcomes in children born after ART and discuss if the increased health risks are associated with intrinsic maternal or paternal factors related to sub fertility or to the ART treatments per se. Finally, we speculate where the future will bring us with regards to ART treatment strategies and safety of the mother and child.