Incidence Of Preterm Delivery Research Articles

1419-P: Pregravid Metabolic Syndrome and Risk of Adverse Outcomes in Pregnancy: A Preconception Cohort Study

Women with a history of adverse outcomes in pregnancy (including pre-term birth, delivery of a small-for-gestational-age (SGA) infant, preeclampsia, and gestational diabetes (GDM)) have a higher prevalence of metabolic syndrome (MetS) and cardiovascular disease, as compared to their peers. However, it is not known if MetS precedes the index pregnancy in women who develop these outcomes. Thus, we sought to evaluate the impact of pre-gravid MetS on the risk of adverse outcomes in pregnancy. In this prospective pre-conception cohort study, 1183 newly-married women underwent systematic assessment of cardiovascular risk factors (anthropometry, blood pressure, lipids, glucose) and then were followed across a subsequent pregnancy for the outcomes of interest. The women were stratified into two groups based on the presence (n=49) or absence (n=1134) of pre-gravid MetS (harmonized definition). The groups did not differ in length of gestation (p=0.31) or infant birthweight (p=0.21). Of note, women with pre-gravid MetS were more likely to have a Caesarean delivery (61.4% vs. 38.6%, p=0.003). However, there were no differences between the groups in the incidence of pre-term delivery, SGA, LGA, preeclampsia or GDM (Table). In conclusion, the increased lifetime risk of MetS observed in women with a history of these adverse pregnancy outcomes does not necessarily manifest prior to their pregnancy. Disclosure R. Retnakaran: Consultant; Self; Eli Lilly and Company, Novo Nordisk Inc., Sanofi. Research Support; Self; Boehringer Ingelheim International GmbH, Novo Nordisk Inc. S. Wen: None. H. Tan: None. C. Ye: None. M. Shen: None. G.N. Smith: None. M.C. Walker: None. Funding Canadian Institutes of Health Research

Randomized trial of nicotine inhaler for pregnant smokers

Smoking during pregnancy is a serious public health problem in need of better treatments. Nicotine replacement treatment (NRT) (patch or gum) has not been shown in randomized placebo-controlled trials to be efficacious for smoking cessation during pregnancy. However, the nicotine inhaler may have advantages over other NRTs as it replicates some of the sensory effects of smoking. The purpose of the study was examine the efficacy and safety of the nicotine inhaler for smoking cessation during pregnancy. We hypothesized that the nicotine inhaler compared to placebo would increase quit rates and reduce smoking during treatment and at the end of pregnancy, result in a higher birth weight and gestational age in the offspring, and reduce the incidence of preterm birth and low birth weight infants. We conducted a randomized, double-blind, placebo-controlled trial of the nicotine inhaler for smoking cessation during pregnancy. Pregnant women who smoked ≥5 cigarettes daily received behavioral counseling and random assignment to a 6-week treatment with nicotine or placebo inhaler, followed by a 6-week taper period. Throughout treatment, we assessed tobacco exposure biomarkers, cessation rates, and adverse events. We also obtained information on birth outcomes. The primary outcome was smoking cessation at 32-34 weeks gestation; secondary outcomes were smoking reduction, birth weight and gestational age, and the incidence of preterm birth or low birth weight infants. We compared treatment groups on these measures using t-tests, Fisher's exact tests, and multivariate linear and logistic regression. Participants in the placebo (n=67) and nicotine (n=70) groups were comparable on baseline characteristics, though women in the placebo group reported a higher motivation to quit (p=0.016). Biochemically-validated smoking cessation rates were similar with nicotine and placebo (after 6 weeks of treatment: 4% (3/70) vs. 3% (2/67), respectively, p< 0.99, and at 32-34 weeks gestation: 10% (7/70) vs. 18% (12/67), respectively, p=0.220). Cigarettes per day (CPD) decreased over time in both groups (p< 0.001), with the nicotine inhaler group having a greater decrease than the placebo group two (p=0.022) and six weeks after the quit date (p=0.042), but not at 32-34 weeks gestation (p=0.108). Serum cotinine levels, birth weight, gestational age and reductions in carbon monoxide did not differ by group. However, the incidence of preterm delivery was higher in the placebo than the nicotine group: 15% (10/67) vs. 4% (3/67), respectively, p=0.030). The incidence of delivering a low birth weight infant was also higher in the placebo than the nicotine group: 15% (10/67) vs. 6% (4/67), respectively, p=0.035, but not after adjusting for preterm delivery p=0.268. Although the nicotine inhaler group did not have a higher quit rate during pregnancy than the placebo group, the outcome of preterm delivery occurred less frequently in the nicotine group.

Increased incidence of obstetric and perinatal complications in pregnancies achieved using donor oocytes and single embryo transfer in young and healthy women. A prospective hospital-based matched cohort study

In this single-center matched-cohort study, women who underwent IVF/ICSI with donor oocytes between 2007 and 2014 (n = 259) were compared to women undergoing autologous cycles during the same time period (n = 515). The matching (1:2) took into consideration the women’s age, type of treatment (IVF/ICSI), and year of embryo transfer. All women were healthy and below 40 years of age at the time of IVF/ICSI, and the treatments were performed using a strict policy of single embryo transfer. Multiple logistic regression analysis, adjusted for body mass index (BMI), smoking, and parity, showed a four times increased risk of gestational hypertensive disorders (adjusted odds ratio, AOR 4.25; 95% confidence interval (CI), 2.61–6.92) and pre-eclampsia (AOR 3.99; 95% CI 2.27–7.00) in pregnancies achieved with donor oocytes. There was also a higher rate of cesarean section in women who gave birth after oocyte donation (AOR 1.69; 95% CI 1.22–2.35) and a higher risk of postpartum hemorrhage >1000 mL (AOR 1.59; 95% CI, 1.11–2.27). After further adjustment for preeclampsia in the logistic regression analysis, no additional increased perinatal risks were found. The incidence of preterm delivery, low weight at birth, need of neonatal intensive care, Apgar scores, and incidence of perinatal death were also similar between the groups.

To find incidence and factors associated with preterm birth at tertiary care teaching hospital

Introduction: Preterm birth is a global problem with prevalence ranging from 6 – 12% all over the world. Various risk factors associated with preterm births have been widely studied in developed countries and identified certain obstetric and non-obstetric factors that are correlated with occurrence of preterm births. The present study aimed to find incidence of preterm delivery in our institute and to identify the various factors associated with preterm birth. Material and Method: 100 consecutive women, who were willing to participate, with singleton live pregnancy and gestational age between 24 – 40 weeks admitted in labour room for delivery were included and monitored till delivery. Data were analyzed. Results: The incidence of preterm in our center was 19%. Prior history of preterm birth (OR 15) and abortions (OR 3.7), APH (OR 9.4118), Tobaco/alcohol use (OR 7.4063), UTI (OR 5.133) and illiteracy (OR 4.2115) were strongly associated with an increased risk of preterm labor. Other risk factors identified were maternal age &gt;35 years (OR 2.1), interpregnancy interval &lt;3 years (OR 3), inadequate ANC visit (OR 2.9951), unplanned pregnancy (OR 2.4136), PROM ((OR 2.9545) and anemia (OR 2.5714). Conclusion: Preterm delivery is still a challenging maternal health problem. Most of the factors found to be associated with preterm birth, are modifiable. Early identification of these factors and appropriate and innovative preventive intervention, customized individual’s need may prevent preterm births and improve foetal outcomes.

Modification of the Pre-conceptional Treatment Program at the Stage of Pregnancy Planning Regarding the Psychoemotional State of Women

The course of normal pregnancy is accompanied by significant changes in the functioning of almost all physiological systems and the tension of adaptive processes to new requirements, while the complicated period of pregnancy, is an extremely strong psycho-emotional factor.The objective: was to determine the structure and prevalence of the types of psychological component of gestational dominant (PCGD), taking into account psycho-emotional state in women, to assess its impact on reproductive loss and complicated pregnancy as well as to develop a modified complex of pre-conceptional treatment.Materials and methods. In order to solve the target tasks, we conducted an experimental psycho-diagnostic study and an in-depth clinical and laboratory-instrumental examination of 120 patients with a burdened reproductive history who underwent the preconceptional treatment on the basis of the Conscious Parenthood Center «Divia». The assessment of the psychological component of the gestational dominant was carried out by the method of «Pregnant woman attitude test» by I.V. Dobriakov, modified for pregnant patients, Spielberg’s and Beck’s tests were also used to assess the level of personal and reactive anxiety and signs of depression. The state of the vegetative nervous system was assessed on the basis of the main characteristics: vegetative tonus, vegetative index (SI) Kerdo), vegetative reactivity and vegetative maintenance of activity (orthostatic test). For the evaluation of the effectiveness of the proposed pre-bladder training from 120 women, where the type of PCGD was assessed, 70 patients with anxiety and depressive type of PCGD were identified, which formed two groups: the main (35 women) who received the proposed complex of psychological and medicamental correction, and the comparative group (35 patients), where the pre-conceptional treatment included traditional, in accordance with modern guidelines, – folate therapy.Results. Experimental and psychodiagnostic research allowed to establish a high percentage of unfavorable pregnancy types of PCGD, among which the most sufficient were anxiety and depression types. Most attention on the specifics of pregnancy course deserve differences in the incidence of preterm delivery, preeclampsia resistance to treatment and the proportion of labor activity anomalies and its medicamental correction, which 2.6 times prevailed in case of anxiety and depression types of psychological components of gestational dominant.Conclusion. The proposed pre-conceptional treatment, modified by a differentiated complex of psychological correction and a medicamental package with the inclusion of neuroprotectors and plant adapters, allowed not only to strengthen the adaptation mechanisms at the stage of pregnancy planning, but also to significantly reduce the proportion of gestational complications in the process of its monitoring.

An electrical scalpel conization versus Shimodaira-Taniguchi conization procedure for cervical intraepithelial neoplasia.

The incidence of cervical intraepithelial neoplasia(CIN) among reproductive-aged women has increased in Japan. Cervical conization is commonly applied for local cervical treatment to preserve fertility. The Shimodaira-Taniguchi (S-T) conization procedure is widely used in Japan. S-T conization uses a high-frequency current and a triangular probe with a linear excision electrode to remove cervical tissue as a single informative specimen. However, alternative of an electrosurgical scalpel (ES) has the advantage of adjusting the surgical margin to the transformation zone in order to preserve the maximum amount of healthy cervical tissue with good hemostasis. The aim of this study is to retrospectively analyze data regarding surgical margin status, perioperative adverse events, cervical stenosis, and preterm birth between S-T and ES.Between January 2009 and December 2014, the medical records of 1166 patients who were diagnosed as CIN II, III, or stage 1a1 cervical cancer and who were treated with conization in 7 hospitals in Gunma Prefecture, Japan were enrolled for this retrospective study. The clinicopathological data was analyzed to statistically compare outcome between S-T and ES conization.There was no difference for age or post-operative follow-up period between ES and S-T treatments. However, positive surgical margins were significantly less frequent in patients who were treated with S-T than in those treated with ES, resulting in a reduced incidence of re-treatment for S-T in comparison with ES patients. In perioperative adverse events, S-T had more patients who were administered antibiotics. The incidence of preterm delivery and cervical stenosis did not differ significantly between the groups.We demonstrate here that S-T is an alternative procedure for cervical conization with a low risk of recurrence and acceptably low rate of adverse events such as cervical stenosis and preterm delivery. The results of this study can provide useful information for future management of patient with cervical intraepithelial neoplasia.

Randomized trial of the efficacy of intravaginal ulinastatin administration for the prevention of preterm birth in women with a singleton pregnancy and both cervical shortening and inflammation of lower genital tract.

To assess the preventive effect on preterm birth of intravaginal ulinastatin (urinary trypsin inhibitor; UTI) administration during the mid-trimester in women with singleton pregnancy and both cervical shortening and lower genital infections. Pregnant women with a short cervical length < 25 mm between 16 and 26 weeks of gestation and who had been diagnosed with a lower genital infection were randomly assigned for intravaginal UTI administration or placebo. All of the women were screened for infection or inflammation of the lower genital tract, and women with negative results were excluded. Of the 92 patients with a short cervical length who were assessed for eligibility for this study, 86 singleton patients were enrolled. All patients were randomized to one of two treatment groups: patients administered UTI (n = 35) and placebo (n = 35). There were no differences between the two groups in the incidence of preterm delivery before 28, 30, 32, 34 and 37 weeks of gestation and in perinatal outcomes. For women diagnosed with a short cervical length < 25 mm) between 16 and 26 weeks of gestation and lower genital infection, who were at risk of preterm birth, administration of transvaginal UTI with vaginal irrigation showed no apparent benefit. Future research on the efficacy of UTI should evaluate modified modes of UTI application.

Abuse of pregnant women in the healthcare system

Objective: The purpose of this study was to determine the incidence of abuse in healthcare system during pregnancy and its impact on pregnancy outcomes.Materials and methods: A validated screening Norvold Abuse Questionnaire for the identification of female victims of four kinds of abuse: emotional, physical, sexual, and the abuse in the healthcare system was anonymously offered to all women in the first 2 days postpartum.Results: The study group consisted of 1018 women, 6.2% of which reported experiencing abuse in healthcare system during pregnancy. Affected women had a higher incidence of preterm delivery (OR 2.4; 95% CI 1.2–4.8) and cesarean section rate (OR 2.0; 95% CI 1.1–3.6). Sexual abuse and abuse in healthcare system during childhood were associated with abuse in healthcare system during pregnancy (OR 4.4; CI 95% 1.2–16.2 and OR 6.9; CI 95% 1.3–35.4, respectively).Conclusions: Our study indicates that as many as 6.2% of pregnant women experience abusive encounters with perinatal care providers. These pregnancies eventually end more often preterm and by cesarean section. This possibly causal relationship should be further explored.

Methods of gestational age assessment influence the observed association between antiretroviral therapy exposure, preterm delivery, and small-for-gestational age infants: a prospective study in Cape Town, South Africa

PurposeHeterogeneous findings exist on antiretroviral therapy (ART) use in pregnancy and preterm delivery (PTD) or infants born small-for-gestational age (SGA). Whether reported differences may be explained by methods used to ascertain gestational age (GA) has not been explored. MethodsWe enrolled consecutive pregnant women attending a large primary care antenatal clinic in South Africa. Public-sector midwives assessed GA by last menstrual period (LMP) and symphysis-fundal height (SFH). Separately, if clinical GA was less than 24 weeks, ultrasound (US) was performed by a research sonographer blinded to midwife assessments. In analysis, the impact of measurement error on the association between HIV/ART status and birth outcome by GA method was assessed, and factors associated with clinical GA underestimation or overestimation identified. ResultsIn 1787 women included overall, estimated PTD incidence was 36% by LMP, 17% by SFH, and 11% by US. PTD risk was higher for HIV-infected than HIV-uninfected women using US-GA (adjusted odds ratio [aOR] 1.95; 95% CI 1.10–3.46); for LMP/SFH-GA, the associations were smaller and not significant. These findings persisted after adjustment for age, parity, height, and previous PTD. PTD risk did not vary by timing of ART initiation (before or during pregnancy) for any method. Elevated BMI and older age were associated with decreased risk of underestimation by both LMP and SFH; HIV status and obesity were associated with increased risk of overestimation by SFH. There were no differences in SGA incidence across GA methods. ConclusionsFindings for an association between HIV/ART and birth outcomes are substantially influenced by GA assessment method. With growing public health interest in this association, future research efforts should seek to standardize optimal measures of gestation.

The relationship between lipid profiles in pregnancy and preterm delivery: a systematic review

Background: High-density lipoprotein (HDL), low-density lipoprotein (LDL), triglyceride (TG), and total cholesterol (TC) are associated with maternal hormonal changes which can lead to pregnancy complications. High lipid levels during pregnancy may be accompanied by an increased risk of spontaneous preterm labor. The purpose of this review was to determine the relationship between lipid profiles in pregnancy and preterm delivery.&#x0D; Methods: A systematic search was performed in PubMed, EMBASE, Web of Science, Scopus, and Science Direct databases to find cross-sectional, case-control, and cohort studies on the associations between lipid profiles in pregnancy and preterm delivery. The search results were limited to papers published during 2000-2018. The quality of the selected studies was assessed based on the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. Finally, a total of 25 eligible high-quality papers were reviewed.&#x0D; Results: A high maternal TG level in the first trimester of pregnancy was identified as a significant risk factor for preterm delivery. Low TG, HDL-cholesterol (HDL-C) and LDL-cholesterol (LDL-C) levels were uniquely associated with an increased risk of preterm delivery. High TC, TG, and LDL-C levels increased the risk of spontaneous preterm labor. A further association was found between high TG and TC levels and an elevated risk of preterm labor before 34 weeks of gestation. The risk of preterm labor before 34 weeks and during the 34th-37th weeks of gestation increased with increasing TG and TC levels. Moreover, overweight women who had a delivery before 34 weeks exhibited significant increases in TC and LDL concentrations during early pregnancy.&#x0D; Conclusion: Lipid metabolism undergoes complicated changes in pregnancy. Lipid levels (LDL, HDL, TC, and TG) above or below the normal range during pregnancy increase the risk of preterm delivery. Considering the significance of maternal lipid metabolism in the incidence of preterm delivery, lipid profile screening in early pregnancy can largely contribute to the prevention of preterm delivery. Further studies are warranted to meticulously examine the effects of lipid profile on preterm delivery.

Neurodevelopment of breastfed HIV-exposed uninfected and HIV-unexposed children in South Africa.

To assess neurodevelopment of breastfed HIV-exposed uninfected (HEU) and breastfed HIV-unexposed children in the context of universal maternal antiretroviral therapy (ART). Prospective study with antenatal enrolment and follow-up of breastfeeding HEU and HIV-unexposed mother-infant pairs through 12-18 months postpartum. Peri-urban community, Cape Town, South Africa. HEU (n = 215) and HIV-unexposed (n = 306) children. Cognitive, motor and language development at median 13 (interquartile range 12-14) months of age: continuous and dichotomous Bayley Scales of Infant and Toddler Development Third Edition (delay defined as composite score <85). Incidence of preterm delivery (<37 weeks) was similar among HEU and HIV-unexposed children (11 vs. 9%, P = 0.31; median gestation 39 weeks); 48% were boys. Median breastfeeding duration was shorter among HEU vs. HIV-unexposed children (6 vs. 10 months). All HIV-infected mothers initiated lifelong ART (tenofovir-emtricitabine-efavirenz) antenatally. HEU (vs. HIV-unexposed) children had higher odds of cognitive delay [odds ratio (OR) 2.28 (95% confidence interval (CI) 1.13-4.60)] and motor delay [OR 2.10 (95% CI 1.03-4.28)], but not language delay, in crude and adjusted analysis. Preterm delivery modified this relationship for motor development: compared with term HIV-unexposed children, term HEU children had similar odds of delay, preterm HIV-unexposed children had five-fold increased odds of delay (adjusted OR 4.73, 95% CI 1.32; 16.91) and preterm HEU children, 16-fold increased odds of delay (adjusted OR 16.35, 95% CI 5.19; 51.54). Young HEU children may be at increased risk for cognitive and motor delay despite universal maternal ART and breastfeeding; those born preterm may be particularly vulnerable.

Maternal serum arsenic level during pregnancy is positively associated with adverse pregnant outcomes in a Chinese population

Arsenic is an environmental toxicant. The association of gestational arsenic exposure with adverse pregnant outcomes remains controversial. This study was to investigate the association of serum As level with adverse pregnant outcomes in a large Chinese cohort population. Total 3194 mother-and-infant pairs were recruited from the China-Anhui Birth Cohort Study. Maternal serum arsenic (As) concentration was measured using hydride generation-atomic fluorescence spectrometry. Subjects were divided into L-As group and H-As group in accordance to the 75th percentile of serum As concentration. The associations of serum As level during gestation with adverse pregnant outcomes were analyzed. The incidence of small-for-gestational-age (SGA) newborns was elevated in H-As group compared to L-As group (9.9% vs 7.6%, P = .044). After controlling confounders and stratified analysis, the adjusted OR for SGA was significant only in girls with H-As but not in boys. Moreover, the incidence of preterm delivery (PTD) was elevated in H-As group compared to L-As group (7.0% vs 4.8%, P = .016). Further analysis found that the adjusted OR for moderate-to-late PTD was 1.47 (95%CI: 1.03, 2.09; P = .034) in H-As group as compared with L-As group. These results indicate that maternal serum As level during gestation is positively associated with adverse pregnant outcomes.

Impact of maternal depression on perinatal outcomes in hospitalized women-a prospective study.

Scarce data exists regarding the prevalence of antenatal depression in hospitalized pregnant women, and its effect on perinatal outcome. We aimed to estimate the risk of maternal depression among women hospitalized in a high-risk pregnancy department, and to evaluate its potential association with adverse perinatal outcome. A depression screening self-questionnaire-based prospective study was performed, in which hospitalized pregnant women who screened positive for depression were compared to those who screened negative. The Edinburgh Postnatal Depression Scale (EPDS) was used for antenatal depression screening. Pregnancy course and perinatal outcome were compared between the groups. A multivariate logistic regression model was constructed to control for clinically relevant confounders. During the study period, 279 women met the inclusion criteria. Among them, 28.3% (n = 79) screened positive for depression (≥ 10 points on the EPDS). In the univariate analysis, a significantly higher incidence of preterm delivery (< 37weeks), low birthweight (< 2500g), low Apgar scores (at 1 and 5min), and neonatal intensive care unit (NICU) admissions were noted among the screen positive group. In the multivariate regression model, controlled for maternal age, ethnicity, gestational diabetes mellitus, preeclampsia, past preterm delivery, and gestational age upon admission, maternal antenatal depression during hospitalization was noted as an independent risk factor for preterm delivery (adjusted OR 3.32, 95%CI 1.16-9.52, p = 0.026). Maternal antenatal depression during hospitalization is very common and appears to play a significant and independent role in the prediction of preterm delivery.

Outcomes of Pregnancy After Right Ventricular Outflow Tract Reconstruction With an Allograft Conduit

BackgroundThere is no published evidence on pregnancy after right ventricular outflow tract (RVOT) reconstruction with an allograft. ObjectivesThe aim of this study was to describe pregnancy outcomes in women with allografts in the RVOT position. MethodsA retrospective cohort study of consecutive female patients who received allografts in the RVOT position was conducted. All patients between 18 and 50 years of age were screened for cardiac, obstetric, and fetal outcomes of completed (≥20 weeks’ gestation) pregnancies. ResultsIn total, 196 women met the inclusion criteria, of whom 56 had 89 completed pregnancies. Information could be retrieved in 84 cases (94.4%). Mean maternal age was 29.6 ± 4.3 years, with 80 patients (95.2%) in New York Heart Association functional class I or II. The most common diagnosis was tetralogy of Fallot. All women survived pregnancy. There were 2 cases (2.4%) of heart failure (arrhythmic and diastolic dysfunction), 1 case (1.2%) of infection (chorioamnionitis), and 3 cases (3.6%) of pre-eclampsia. No other cardiac or obstetric events were reported. All children were born alive at a median gestational age of 38.4 weeks (interquartile range: 36.9 to 39.6 weeks), with a median birthweight of 2,930 g (interquartile range: 2,535 to 3,385 g). Seventeen (20.2%) were small for gestational age, and 20 (23.8%) were premature. Neonatal death was reported in 2 children (2.5%). Preconception pulmonary regurgitation was associated with an increased probability of pre-term labor (odds ratio: 2.610; 95% confidence interval: 1.318 to 5.172). Compared with the general Dutch population, pre-term delivery (25.0% vs. 7.4%, p < 0.001) and children small for gestational age (20.2% vs. 10.0%, p = 0.002) were more common. ConclusionsWomen in good cardiac health after RVOT reconstruction with allografts can safely experience pregnancy and labor. The higher incidence of pre-term delivery and children small for gestational age warrants special attention.

He Tamariki Kokoti Tau-Tackling Preterm: a\xa0data-linkage methodology to explore the clinical care pathway in preterm deliveries

BackgroundSignificant health inequities exist around maternal and infant health for Māori, the indigenous people of Aotearoa New Zealand – and in particular around a premature (preterm) delivery. Māori babies are more likely to be born preterm (8.1%, compared to an overall rate of 7.4%) and they are more likely to have a preterm death. An essential part of redressing these disparities is to examine the clinical care pathway and outcomes associated with preterm deliveries. This paper describes a protocol utilising national and local health collections to enable such a study.DesignThis is a retrospective cohort study comprising 5 years data pertaining to preterm deliveries from 2010 to 2014. These data are generated from linked national administrative and local health information collections to explore a range of neonatal outcomes and infant mortality in relation to the antenatal care pathway and known risk factors for preterm delivery. This study is being conducted within a Kaupapa Māori paradigm that dismisses victim blaming and seeks to intervene at structural levels to improve the health and wellbeing of Māori whānau (family).Significance of the studyOur data-linkage methodology optimises the utility of New Zealand health collections to address a significant health issue. Our findings will fill the information gaps around the burden of preterm delivery by quantifying the incidence of preterm delivery and adverse neonatal and infant outcomes in Aotearoa New Zealand. It will explore access to evidenced based care including use of steroids before birth, and appropriate place of delivery. The results from this study will inform maternity care services to improve management of preterm deliveries – both locally and internationally. This in turn will improve the preterm sequela by reducing the long-term health burden and health inequities.

Elevated systemic microbial translocation in pregnant HIV-infected women compared to HIV-uninfected women, and its inverse correlations with plasma progesterone levels

In HIV infection, increased adverse perinatal outcomes reported among HIV-associated pregnancies are not fully understood. Currently, microbial product translocation (MT) from a permeable mucosa is demonstrated as a driver of inflammation, and may contribute to preterm delivery in HIV. Here, our results showed that plasma LPS levels (a representative marker of MT) were increased in HIV-infected women in the first and second trimester. Progesterone levels were significantly decreased in HIV-infected subjects in the first trimester and second trimester. There were significant inverse correlations between plasma LPS and progesterone in the first and second trimester. These results suggested heightened systemic MT and decreased plasma progesterone levels in HIV-infected pregnant women may play a role in increased incidence of preterm delivery.

A systematic review and meta-analysis of velamentous cord insertion among singleton pregnancies and the risk of preterm delivery.

Observational studies have reported varying results about the association of velamentous cord insertion (VCI) with adverse pregnancy outcomes. To evaluate the risk of preterm delivery among singleton pregnancies complicated by VCI. Various databases were searched for English-language articles published up to February, 28, 2017, using keywords including VCI; abnormal placentation; abnormal cord insertions; adverse perinatal outcomes; and preterm birth. Outcome measures included preterm delivery; pre-eclampsia; cesarean delivery; fetal demise in utero (FDIU); and small for gestational age (SGA). Only studies involving VCI were included in the meta-analysis. Analyses were performed using RevMan version 5.3.5 (The Nordic Cochrane Centre, Copenhagen, Denmark). There were six studies included in the analysis. The VCI and control groups comprised 16295 and 1366485 women, respectively. An increased incidence of preterm delivery was found for the VCI group compared with the control group (11.8% vs 7.0%; adjusted odds ratio [aOR] 1.95, 95% confidence interval [CI] 1.85-2.04). A diagnosis of VCI was also associated with cesarean delivery (aOR 1.17, 95% CI 1.12-1.23), SGA (aOR 1.93, 95% CI 1.83-2.04), and FDIU (aOR 3.96, 95% CI 3.21-4.89). The presence of VCI was associated with adverse pregnancy outcomes.

Influent factors of gestational vitamin D deficiency and its relation to an increased risk of preterm delivery in Chinese population

Gestational vitamin D deficiency (VDD) has been linked with adverse pregnant outcomes. To investigate influent factors of gestational VDD and its relation to the incidence of preterm delivery, total 3598 eligible mother-and-singleton-offspring pairs were recruited. For serum 25(OH)D concentration, 941 pregnant women were sufficient, 1260 insufficient, and 1397 deficient. Further analysis showed that VDD was more prevalent in winter than in other seasons. Underweight but not overweight was a risk factor for gestational VDD. Multivitamin use reduced risk of gestational VDD. Interestingly, 8.23% delivered preterm infants among subjects with VDD (adjusted RR: 4.02; 95% CI: 2.33, 6.92) and 3.81% among subjects with gestational vitamin D insufficiency (VDI) (adjusted RR: 2.07; 95% CI: 1.16, 3.71). Moreover, 2.59% delivered early preterm infants among subjects with VDD (adjusted RR: 2.97; 95% CI: 1.41, 6.24) and 0.49% among subjects with VDI (adjusted RR: 0.54; 95% CI: 0.19, 1.51). The incidence of late preterm delivery was 5.64% among subjects with VDD (adjusted RR: 3.90; 95% CI: 2.26, 6.72) and 3.32% among subjects with VDI (adjusted RR: 2.09; 95% CI: 1.17, 3.74). In conclusion, pre-pregnancy BMI, seasonality and multivitamin use are influent factors of gestational vitamin D status. Gestational VDD is associated with an increased risk of preterm delivery in Chinese population.

Study of the neonatal outcomes in babies born to elderly mothers and young mothers

Background: More and more women are focusing on obtaining higher education and reaching career objectives. This has in turn, lead to delayed marriage and child birth at a later age. Advanced maternal age at birth has been found to be associated with preterm delivery, low birth weight, intrauterine fetal death and increased perinatal morbidity and mortality. The aim of our study was to know the neonatal outcome in elderly mothers and young mothers, and to compare the neonatal outcome of these two groups. Methods: Present study was a cross sectional, analytical case control study, done in babies delivered to mothers &gt;35 years and &lt;35 years. Information like period of gestation, birth weight, APGAR at 1 minute and 5 minutes, NICU admissions, neonatal outcome like respiratory distress, jaundice, convulsion, etc. were recorded in a proforma. Collected data was analysed using appropriate statistical tests.Results: In the present study, total sample size was 460 (230 cases and 230 controls). Incidence of preterm deliveries, Low birth weight, NICU admissions were significantly more in case group (babies born to mothers &gt;35 years) than the control group (babies born to mothers between 19 to 35 years).Conclusions: It was observed that low birth weight, prematurity and NICU admissions were more common in babies born to elderly mothers.

Maternal weight gain during pregnancy and outcomes for the newborn child and mother in Tulkarem and in camps: a retrospective cohort study

BackgroundExcessive gestational weight gain appears to be a risk factor for low and high birthweight, preterm delivery, gestational diabetes, pre-eclampsia, caesarean section, and post-partum haemorrhage). The objective of this study was to determine the association between gestational weight gain and pregnancy outcomes. MethodsThis retrospective cohort study was done at a primary health-care centre supported by the Palestinian Ministry of Health in Tulkarem (one of the main cities in northern occupied Palestinian territory) and in two United Nations Relief and Works Agency (UNRWA) primary health-care centres (in the Tulkarem and Nourshams Camps) in 2016. Patient files of women who had given birth were reviewed, and sociodemographic data, medical history, body-mass index (BMI), and gestational weight gain were recorded. We used SPSS version 20 for statistical analysis. Significance was set at a p value of less than 0·05. This study was approved by the Institutional Review Board committee at An-Najah National University, and permission was obtained from the Ministry of Health and the UNRWA. Findings771 patient files were reviewed (326 from Tulkarem City, 274 from Tulkarem Camp, and 171 from Nourshams Camp). The mean age of mothers at first visit was 26·5 years (SD 5·81), and 328 (43%) women had attended tertiary education. 341 (44%) women had a normal BMI at first visit, 254 (33%) women were overweight, and 147 (19%) women were obese. 283 (37%) women gained weight within recommended levels, and 213 (28%) women gained more than the recommended weight. 210 (27%) women had a caesarean section. The incidences of preterm delivery, gestational diabetes, pre-eclampsia, and post-partum haemorrhage were 9%, 6%, 2%, and 10%, respectively. 405 (53%) newborn babies were boys and 366 (48%) were girls, with an overall mean birthweight of 3313 g (SD 511·83). 37 (5%) neonates had low birthweight, and 60 (8%) neonates had high birthweight. Bivariate analysis showed a significant association between gestational weight gain and BMI at first visit, high birthweight, and post-partum haemorrhage (p<0·001). Multivariate logistic regression showed that women who gained weight above recommendations had a higher risk of giving birth to a baby with high birthweight (odds ratio 3·4, 95% CI 1·65–7·00), whereas women who gained less than recommended had a lower risk of developing post-partum haemorrhage (odds ratio 0·44, 95% CI 0·199–0.996). InterpretationGaining more than the recommended weight during pregnancy is consistently associated with negative maternal and infant outcomes. These effects could be avoided if improved individualised care were systematically implemented in both ministry of health and UNRWA clinics to support women preconceptionally, prenatally, and post partum. FundingNone.