Incidence Of PTB Research Articles

The use of cervical cerclage in asymptomatic twin pregnancies with cervical shortening or dilation: a twelve-year retrospective cohort study

BackgroundTo identify the effect and optimal time of cervical cerclage in asymptomatic twin pregnancies with cervical shortening or dilation.MethodsThis observational retrospective study enrolled all women with asymptomatic twin pregnancies who were diagnosed with asymptomatic cervical shortening or dilation at the Second Affiliated Hospital of Wenzhou Medical University between 2010 and 2022. Women included were allocated into the cerclage group (n = 36) and the no cerclage group (n = 22). The cerclage group was further divided into the cerclage group (< 24 weeks group) and the cerclage group (24–28 weeks group) according to the time of cerclage. The no cerclage group was further divided into no cerclage group (< 24 weeks group) and no cerclage group (24–28 weeks group) according to the time of ultrasound-indicated or physical exam indicated cerclage. The rates of PTB < 24, 28, 32 and 34 weeks of gestation, maternal and neonatal outcomes were compared among the groups.ResultsThe gestational age (GA) at delivery was higher (P = 0.005) and the interval time between the presentation of the indicated cerclage and delivery was longer in the cerclage group (P < 0.001). The rates of PTB before 28, 32, and 34 weeks of gestation, caesarean section and stillbirth were lower in the cerclage group (P < 0.05). The birthweight of the twins was higher in the cerclage group (P = 0.012). Admissions to the NICU were more frequent in pregnancies with no cerclage (P = 0.008). Subgroup analysis showed that the interval time between the presentation and delivery was longer in the cerclage group (< 24 weeks) (P < 0.001). The GA at delivery and the birthweight of the twins were significantly higher in the cerclage group (< 24 weeks) (P < 0.001). No differences were found in the GA at presentation, the GA at delivery, the interval time between the presentation to delivery and birthweight between the cerclage group (24–28 weeks group) and the control group (24–28 weeks group) (P > 0.05).ConclusionsCerclage appears to prolong the GA at delivery and the interval time between the presentation to delivery, and may reduce the incidence of PTB before 28, 32 and 34 weeks of gestation and adverse perinatal outcomes in asymptomatic twin pregnancies with cervical shortening or dilation. Cerclage before 24 weeks of gestation showed longer GA at delivery, longer interval time between the presentation to delivery and higher birthweight of the twins. The GA at presentation, the GA at delivery, the interval time between the presentation to delivery and birthweight in women with cerclage at 24–28 weeks were similar to those in women without cerclage at 24–28 weeks.

Is there any role for surgery in post-tuberculosis sequelae? A retrospective institutional analysis

Despite the development of novel drugs to tackle MDR tuberculosis, the incidence and prevalence of PTB remains significant. While majority of the patients completed treatment, they often come back with post-TB sequelae. Surgical advancements in the form of VATS and robotic surgery, management of post-tuberculosis sequelae such as chronic empyema and abscess is simpler. However, adhesions make the surgical field very challenging due to distortion in anatomy. Hence, we present this study so that we could share our institutional knowledge regarding the outcomes of surgery performed for post-tuberculosis sequelae.

Extracellular Vesicles-mediated recombinant IL-10 protects against ascending infection-associated preterm birth by reducing fetal inflammatory response.

Fetal inflammatory response mediated by the influx of immune cells and activation of pro-inflammatory transcription factor NF-κB in feto-maternal uterine tissues is the major determinant of infection-associated preterm birth (PTB, live births < 37 weeks of gestation). To reduce the incidence of PTB by minimizing inflammation, extracellular vesicles (EVs) were electroporetically engineered to contain anti-inflammatory cytokine interleukin (IL)-10 (eIL-10), and their efficacy was tested in an ascending model of infection (vaginal administration of E. coli) induced PTB in mouse models. EVs (size: 30-170 nm) derived from HEK293T cells were electroporated with recombinant IL-10 at 500 volts and 125 Ω, and 6 pulses to generate eIL-10. eIL-10 structural characters (electron microscopy, nanoparticle tracking analysis, ExoView [size and cargo content] and functional properties (co-treatment of macrophage cells with LPS and eIL-10) were assessed. To test efficacy, CD1 mice were vaginally inoculated with E. coli (1010CFU) and subsequently treated with either PBS, eIL-10 (500ng) or Gentamicin (10mg/kg) or a combination of eIL-10+gentamicin. Fetal inflammatory response in maternal and fetal tissues after the infection or treatment were conducted by suspension Cytometer Time of Flight (CyTOF) using a transgenic mouse model that express red fluorescent TdTomato (mT+) in fetal cells. Engineered EVs were structurally and functionally stable and showed reduced proinflammatory cytokine production from LPS challenged macrophage cells in vitro. Maternal administration of eIL-10 (10 µg/kg body weight) crossed feto-maternal barriers to delay E. coli-induced PTB to deliver live pups at term. Delay in PTB was associated with reduced feto-maternal uterine inflammation (immune cell infiltration and histologic chorioamnionitis, NF-κB activation, and proinflammatory cytokine production). eIL-10 administration was safe, stable, specific, delayed PTB by over 72 hrs and delivered live pups. The delivery of drugs using EVs overcomes the limitations of in-utero fetal interventions. Protecting IL-10 in EVs eliminates the need for the amniotic administration of recombinant IL-10 for its efficacy.

Preterm birth and its associated factors in coastal areas of eastern China: a multicenter retrospective study

Abstract Aim Preterm birth (PTB) is considered to be an important cause of neonatal mortality. However, most parts of China lack data or studies with large sample sizes to quantify the true burden of PTB. The current study aimed to determine the incidence of and factors associated with PTB in coastal areas of eastern China. Subject and methods This retrospective study included all eligible pregnant women who delivered in Lianyungang, Jiangsu Province, eastern China, between 1 July 2021 and 30 June 2022. Binary logistic regression was used to analyze the associated factors of PTB. Results A total of 29,807 pregnant women were included, and the incidence of PTB was found to be 5.1%. Multivariate regression analysis showed that pregnant women aged 18 years or younger (OR: 1.706, 95% CI: 1.207–2.409), who were 35 years or older (OR: 1.519, 95% CI: 1.312–1.760), or who had had a cesarean section delivery (OR: 1.542, 95% CI: 1.360–1.748), two or more perinatal births (OR: 14.557, 95% CI: 11.507–18.415), or four or more deliveries (OR: 1.614, 95% CI: 1.192–2.186) had a higher risk of PTB. Pregnant women with five or more prenatal visits (OR: 0.299, 95% CI: 0.241–0.372) had a lower risk of preterm delivery. In addition, pregnant women with hypertension (OR: 2.184, 95% CI: 1.666–2.863), preeclampsia (OR: 4.948, 95% CI: 3.014–8.124), gestational diabetes mellitus (OR: 1.610, 95% CI: 1.328–1.952), placenta previa (OR: 2.543, 95% CI: 1.836–3.523), or a history of PTB (OR: 9.028, 95% CI: 5.667–14.383) were more likely to have PTB. Conclusion The incidence of PTB was high and was affected by many factors. Early identification and management can reduce the incidence of PTB.

P-416 Age and Oocyte Donation: An Analysis of Pregnancy Outcomes in Women Under and Above 45

Abstract Study question Do Maternal and Neonatal Risks Increase among oocyte recipients &amp;gt; 45 years compared to younger oocyte recipients? Summary answer This study fails to demonstrate increased maternal and neonatal complications among oocyte recipients &amp;gt;45 years. A lower socioeconomic status is strongly related with those risks. What is known already Oocyte donation (OD) is an integral part of modern assisted reproductive care, and its prevalence has increased dramatically. Although OD is an effective fertility option for women with advanced age these pregnancies have higher risks of maternal and obstetric morbidity. Study design, size, duration This study is a retrospective big data cohort study that utilizes electronic data from Maccabi Healthcare Services, a 2.5-million patient integrated care organization, which represents 25% of the pregnant population in the country. The data used in this study was collected from 2000 through 2018. Participants/materials, setting, methods A total of 1433 OD pregnancies were divided into two groups according to maternal age at birth: 946 singleton gestations (335 of women &amp;gt; 45 and 611 of women ≤45) and 487 twin gestations (175 of women &amp;gt; 45 and 312 of women ≤45). The two groups were compared for maternal characteristics, perinatal outcomes including PTB and small for gestational age (SGA), and obstetric outcomes. Main results and the role of chance For singletons, mean maternal age at birth was 47.6 for women &amp;gt; 45 and 40.7 for women ≤45 (p &amp;lt; 0.001). The women &amp;gt; 45 group had significantly higher BMI and had higher birth weights (26.4 vs 25.6, p = 0.04 and 3011g vs 2920g, p = 0.04, respectively). The incidence of PTB &amp;lt;37 weeks, PTB &amp;lt;34 weeks and PTB &amp;lt;32 weeks among singletons was higher among the women ≤45 group (24.9% vs 18.5%, p = 0.05, 7.9% vs 4.5%, p = 0.04 and 4.9% vs 2.5%, p = 0.05, respectively). Multivariable logistic regression analysis for PTB &amp;lt;37 weeks and SGA in singletons demonstrated that maternal age &amp;lt;45 and low socioeconomic status (SES) were significant variables. For twin gestations, mean maternal age at birth was 47.3 for women &amp;gt; 45 and 40.2 for women ≤45 (p &amp;lt; 0.001). The women &amp;gt; 45 group had significantly lower SES and lower birth weights (6.8 vs 7.2 SES scale, p = 0.04 and 2119g vs 2256g, p = 0.01, respectively). multivariable logistic regression analysis for PTB &amp;lt;37 weeks in twins demonstrated that low SES and maternal smoking were significant variables. No differences were found between the groups among singletons and twin gestations regarding hypertension, diabetes, intrauterine fetal demise, malpresentation, post-partum hemorrhage, retained placentae and cesarean deliveries. Limitations, reasons for caution Underdiagnoses and missing information regarding indications leading to OD may have led to better understanding of the data. Wider implications of the findings OD pregnancies should be considered high-risk. Understanding the differences in complications among age groups can help healthcare providers provide more personalized and effective care to women who are considering oocyte donation. Comparative studies between different age groups can contribute to future practices and policies related to oocyte donation. Trial registration number 0046-18-BBL

Incidence of pulmonary tuberculosis in suburban Bissau, Guinea-Bissau between 2004 and 2020: a prospective cohort study.

Previous studies have found declining incidence of tuberculosis (TB) in Bissau, Guinea-Bissau. This study aimed to report incidence rates of TB for the period 2004-2020, stratifying by sex, smear-status, and HIV-status, as well as describe developments in TB case fatality rate and diagnostic delay. Data from the Bandim Health Project HDSS and the TB registry from Jan 1st, 2004 to Dec 31st, 2020 were used. Incidence rates were calculated for each year and for smear-positive, smear-negative, HIV-positive, HIV-negative, and unknown HIV-status. Incidence rate ratio and test for trend were done using a one-step Newton approximation to the log-linear Poisson regression coefficient. Overall TB incidence declined only slightly over the period from 294 per 100,000 in 2004 to 273 in 2020. TB/HIV coinfection declined from 108 in 2004 to 14 in 2020, as did incidence among females and smear-negative cases. Incidence of PTB in Bissau, Guinea-Bissau is declining slowly, if at all. TB incidence among females, smear-negative TB, TB case fatality rate, and TB/HIV coinfection and diagnostic delay are declining.

Early arrivals: association of maternal obstetric factors with preterm births and their survival in India

ObjectivesPreterm birth (PTB) increases the risk of various acute and chronic morbidities and premature mortality in children under 5 years of age. The present study examines the association between different maternal obstetric factors and PTB. In addition, this study estimates the risk of neonatal mortality among children born preterm. Study designRetrospective two-stage stratified sample design. MethodsThe weighted prevalence of PTB was estimated using data on 148,746 most recent institutional births from the National Family Health Survey (NFHS)-4, 2015–16. The Poisson regression model was used to investigate the association between maternal obstetric factors and PTB. Using Cox's proportional hazard model, the risk of neonatal mortality among PTBs was estimated. ResultsMaternal obstetric factors, such as minimal antenatal care, delivery complications, history of previous caesarean delivery and delivery at private health facilities, were significantly associated with an increased risk of PTB. The survival probability of preterm babies sharply declined in the first week of life and thereafter was found to stabilise. The risk of mortality in the first 28 days of life increased 2.5-fold if the baby was born preterm. Optimising antenatal care was found to lower the likelihood of PTB and improve their chances of survival. ConclusionAntenatal care services and delivery care practices in private facilities were strongly associated with the incidence and survival of PTB. Evaluating associations of history of caesarean births on future pregnancies can help understand their deleterious effects on PTB. Affordable, accessible and available antenatal care services, in both public and private facilities, can increase the survival rates of PTBs.

Incidence of pulmonary tuberculosis under the regular COVID-19 epidemic prevention and control in China

BackgroundThe COVID-19 pandemic has driven public health intervention strategies, including keeping social distance, wearing masks in crowded places, and having good health habits, to prevent the transmission of the novel coronavirus (SARS-CoV-2). However, it is unknown whether the use of these intervention strategies influences morbidity in other human infectious diseases, such as tuberculosis.MethodsIn this study, three prediction models were constructed to compare variations in PTB incidences after January 2020 without or with intervention includes strict and regular interventions, when the COVID-19 outbreak began in China. The non-interventional model was developed with an autoregressive integrated moving average (ARIMA) model that was trained with the monthly incidence of PTB in China from January 2005 to December 2019. The interventional model was established using an ARIMA model with a continuing intervention function that was trained with the monthly PTB incidence in China from January 2020 to December 2020.ResultsStarting with the assumption that no COVID-19 outbreak had occurred in China, PTB incidence was predicted, and then the actual incidence was compared with the predicted incidence. A remarkable overall decline in PTB incidence from January 2020 to December 2020 was observed, which was likely due to the potential influence of intervention policies for COVID-19. If the same intervention strategy is applied for the next 2 years, the monthly PTB incidence would reduce on average by about 1.03 per 100,000 people each month compared with the incidence predicted by the non-interventional model. The annual incidence estimated 59.15 under regular intervention per 100,000 in 2021, and the value would decline to 50.65 with strict interventions.ConclusionsOur models quantified the potential knock-on effect on PTB incidence of the intervention strategy used to control the transmission of COVID-19 in China. Combined with the feasibility of the strategies, these results suggested that continuous regular interventions would play important roles in the future prevention and control of PTB.

Retrospective study of pulmonary and extrapulmonary tuberculosis cases in Giza Governorate during the period of 2014\u20132018

BackgroundTuberculosis in Egypt is a main public health problem. Egypt is categorized among the mid-level incidence countries. The objective of this work is to study the epidemiology of TB in Giza Governorate during the period from 2014 to 2018.ResultsThis study revealed that the total number of TB cases in Giza Governorate during the period from 2014 to 2018 was 3357 (2035 males and 1322 females including 199 children) with the highest number of cases in 2017 (n=770 cases). The highest incidence occurred in the age group 18–65 years (86.3%%, 78.8%, 83.8%, 84.2%, and 87.1%) and male gender (56.8%, 62.8%, 59.9%, 61.3%, and 61.5%) during the study period, respectively, and in urban residence, the higher percentage occurred in PTB than EPTB in 2014, 2015, 2016, and 2018 (66.2%, 58.9%, 57.3%, and 55.5%), respectively, while the incidence of the extra PTB was higher than PTB in 2017 (51.6% versus 48.4%). The increased incidence of new cases (92.9%, 89.6%, 92.7%, 91.8%, and 92.9%) during the 5 studied years are smear-positive and cure outcome (86.3%, 87.7%, 88.7%, 83.4%, and 83.4%, respectively)ConclusionYoung, middle-aged male, and new smear-positive cases were highest in percentage. The highest percentage of PTB (66.2%) was registered in 2014, and the highest percentage of EPTB (51.6%) was registered in 2017. The increased percentage of cure outcome was during the period from 2014 to 2018 in Giza Governorate.

Impact of environmental factors on pulmonary tuberculosis in multi-levels industrial upgrading area of China

In the present paper, an association between the growth rate of PTB and the environmental impacting elements in the pearl river delta region and the closed industry related cities in China is studied. We summarized the characteristics of different industry characteristics in this region by three echelons of urban agglomerations conducted by K-means clustering model on the time series of their monthly AQI data. To determine the impact of environmental factors on the increase of PTB, the SMLR in GLM has been applied. We then measured the seasonal effect and suggest the spring to be the leading season which keep the highest possibility of the incidence of PTB. Besides giving the analysis by fixed meteorological factors, we presented a sensitive analysis with a variation of precipitation. The Genetic algorithms (GAs) is used to determine the “tolerant” interval and as the results, the width of “tolerant” almost keep a declining trend as the precipitation increasing except when the precipitation comes the interval [68,74]. In addition, with the precipitation increasing higher than 64 mm, the “tolerant” for the AQI values from the first and the second echelon both trend to decline, and a lenient environmental policy currently may easily cause a rapid development of PTB growth rate.

Perfluoroalkyl substances exposure in early pregnancy and preterm birth in singleton pregnancies: a prospective cohort study

BackgroundPreterm birth (PTB, < 37 completed weeks’ gestation) is one of the global public health concerns. Epidemiologic evidence on the potential impact of perfluoroalkyl substances (PFAS) on PTB is still limited and inconsistent. We aimed to investigate the associations between prenatal PFAS exposure and PTB among singleton live births.MethodsWe studied 2849 mother-infant pairs in the Shanghai Birth Cohort (SBC) from 2013 to 2016. Ten PFAS in maternal plasma in early pregnancy (gestational age, median (interquartile range): 15 (13–16) weeks) were measured. Primary outcomes were duration of gestation, PTB, spontaneous PTB and clinically indicated PTB. A linear regression model was used to assess the associations between ln-transformed PFAS and duration of gestation (in weeks). Logistic regression models were applied to estimate the relative risks of these outcomes.ResultsThe incidence of overall PTB was 4.8% (95% confidence limit: 4.0–5.6%, n = 136) in this study population. In the linear regression analyses, PFAS were not associated with the duration of gestation after controlling for potential confounders. In the multiple logistic models, no significant associations were observed between PFAS and overall PTB, spontaneous or indicated PTB.ConclusionIn this prospective cohort study, we did not observe significant associations between maternal plasma PFAS concentrations in early pregnancy and gestational length, overall PTB, spontaneous or indicated PTB.

Poor Embryo Quality Is Associated With A Higher Risk of Low Birthweight in Vitrified-Warmed Single Embryo Transfer Cycles.

BackgroundPrevious studies have reported the association between embryo quality and perinatal outcomes in fresh cycles, after cleavage-stage or blastocyst embryo transfer, and found no significant difference. However, in terms of vitrified-warmed embryo transfer cycles, the impact of embryo quality on neonatal and maternal outcomes has not been evaluated.ObjectivesTo explore the association between the quality of a single vitrified-warmed embryo and perinatal outcomes.MethodsThis retrospective study included 2403 live-born singletons derived from single vitrified-warmed embryo transfer cycles during January 2006 and July 2018. Neonatal and maternal outcomes were compared between singletons resulting from the use of single good quality embryo (GQE) (n = 1854) and single poor quality embryo (PQE) (n = 549) and analyzed in the group of cleavage-stage embryo transfer and the group of blastocyst transfer, respectively.ResultsA significantly higher risk of low birthweight (LBW, birthweight <2500 g) was observed in the singletons derived from the transfer of single PQE compared with those derived from the transfer of single GQE both in cleavage and blastocyst stages (cleavage-stage, AOR 2.62, 95% CI 1.27–5.37; blastocyst stage, AOR 1.98, 95% CI 1.06–3.70). An increased risk of preterm birth (PTB, gestational age <37 weeks) was also observed in singletons born after transfer of a PQE of cleavage-stage compared with those after a GQE of cleavage-stage (AOR 2.40, 95% CI 1.28–4.49). The transfer of single poor quality blastocyst was associated with a higher risk of placenta previa compared with the transfer of single good quality blastocyst (AOR 2.65, 95% CI 1.26–5.57). Other maternal complications, neonatal malformations, and neonatal complications were similar between compared groups.ConclusionIn vitrified-warmed cycles with single embryo transfer, poor embryo quality would result in a significantly higher risk of LBW, regardless of cleavage-stage or blastocyst embryo transfer. Meanwhile, the transfer of poor cleavage-stage embryo was also associated with an increased incidence of PTB.

A Strategy for Effective Tuberculosis Contact Tracing in Botswana

Botswana has witnessed the highest TB rates in the southern African countries, ranking the fourth after South Africa, Swaziland, and Zimbabwe. In 2012, the TB rate was, on average, 531/100 000 population. About 2 380 contacts out of a possible 8 110 (amounting to 29.30%) were traced nationally (Botswana 2011:8), indicating a potential gap of 5 730, which was yet to be traced in 2011. The TBCT strategies might be inadequate leading to absence of screening and treating TB contacts and reducing PTB related deaths. The purpose of this study was to describe utilisation of current TBCT and develop a strategy for a more effective TBCT in Botswana. Data were collected through a quantitative cross-sectional research design. The study further described the association between TBCT strategies and practices and determined the gaps, challenges, and needs in the TBCT. Results revealed under-tracing of contacts in the number of registered and enumerated TB contacts. The results further established the risk of mixing TB contacts and general patients. The differences in the perceptions and knowledge of the cause of TB, as well as poor utilisation of the current programmes by the PTB patients, denotes the need for aggressive awareness-raising and health promotion strategies. The results were used to develop an alternative plan, the IC-TBCT, which has the potential to trace all TB contacts. The approach encourages participation, active accountability and involvement of the beneficiaries in all efforts aiming at early contact identification and reducing the incidence of PTB.

Does Aerobic Vaginitis Have Adverse Pregnancy Outcomes? Prospective Observational Study

Background Aerobic vaginitis (AV) is an aberration within the balanced vaginal microbiota. Only few reports have documented the adverse pregnancy outcomes related to AV. Nonetheless, the exact role of AV in pregnancy and the potential benefit of its screening need further study. Our goal was to evaluate the association between aerobic vaginitis (AV) in late pregnancy and maternal and neonatal outcomes. Methods In this prospective observational study, a total of 600 singleton pregnant women with intact fetal membranes at a gestational age of 34-36 weeks were recruited (one hundred women with AV and 500 pregnant women without AV). The study protocol excluded patients with other forms of vaginal infection. Pregnancy outcomes were traced and documented. The primary outcome was the association between AV and preterm labor. The current study compared the maternal and neonatal outcomes among pregnant women with and without AV in unadjusted and adjusted analyses with the odds ratio (OR) and 95% confidence interval (CI) reported. Results There was an association between AV and with preterm birth (adjusted OR 3.06, 95% CI 1.58-5.95) and prelabor rupture of membranes (adjusted OR 6.17, 95% CI 3.24-11.7). For neonatal outcomes, AV was associated with a higher incidence of neonatal ICU admission (adjusted OR 2.19, 95% CI 1.1-4.34). Severe forms of AV significantly increased the incidence of PTB (p = 0.0014) and PROM (p = 0.0094) when compared to less severe forms of AV. Conclusion AV is common in late pregnancy and is linked to a diversity of adversative pregnancy outcomes including preterm birth, PROM, and neonatal ICU admission. Moreover, the incidence of PTB and PROM might further increase with the severity of AV. Clinicians should pay more consideration to vaginal microbiota assessment during pregnancy.

Trends in preterm birth: an academic center’s campaign to reduce the incidence

Objective To evaluate if the implementation of five protocols aimed at reducing the preterm birth rate were associated with a decrease in incidence of PTBs at an academic center. Methods This is an observational study of women with singleton gestations delivered at TJUH between 2004 and 2014. Primary outcome was the annual incidence of PTB <37 weeks at TJUH. Secondary outcome was the rate of change for PTBs at TJUH compared against that of the nation. Linear regression, Pearson correlation coefficients, and t-tests were used to analyze preterm birth rates over time. Results TJUH incidence of PTB < 37 weeks significantly decreased from 10.8% (n = 206) in 2004 to 9.1% (n = 169) in 2014 (p = .001). Linear regression showed a dramatically greater rate of decline at TJUH (0.32% per year, p = .001) compared to that of the USA (0.14% per year, p < .0001). Early PTBs (28–33 6/7 week) at TJUH had the steepest rate of decline at 0.13% per year (p = .001). Late PTBs (34–36 6/7 week) at TJUH were the only group to not have a significant rate of decline (p = .114). Conclusion The incidence of PTBs at TJUH decreased more than the USA national average in the study period, which may be due to early adoption of guidelines for prevention of PTB. Condensation The incidence of PTBs at TJUH decreased more than the USA national average in the study period, which may be due to early adoption of guidelines for prevention of PTB.

Paternal Environmental Toxicant Exposure and Risk of Adverse Pregnancy Outcomes.

Current clinical efforts to predict and prevent preterm birth are primarily focused on the mother and have made minimal progress in improving outcomes. However, recent data indicate that paternal factors can also influence timing of birth. Herein, we will review recent human and murine data examining the contribution of the father to pregnancy outcomes with an emphasis on environmental exposures that can negatively impact fertility and the timing of birth. Human epidemiology studies now clearly indicate that a variety of paternal factors (age, race, weight, smoking status) can influence sperm quality, birth timing and, in some studies, offspring health. Utilizing a mouse model, our data have 57demonstrated that developmental exposure to the environmental toxicant TCDD (2,3,7,8-tetrachlorodibenzo-p-dioxin) is associated with a transgenerational reduction in sperm number and quality and an increased risk of preterm birth in an unexposed partner. Toxicant exposure history can clearly influence sperm quality in men and mice. Murine data further indicate that exposures which negatively affect sperm quality also impair placental function, potentially leading to preterm birth and other adverse outcomes. Of particular concern, these changes have been linked to epigenetic alterations within the male germ cell which can then be transmitted across multiple generations. Since it is not possible to prevent an ancestral toxicant exposure in a human population, identifying lifestyle modifications that can be implemented during the preconception period to improve sperm quality should be explored for the therapeutic potential to reduce the incidence of PTB and its sequelae.

Spontaneous and iatrogenic preterm birth rates among unselected women in three consecutive pregnancies

ObjectiveTo assess the risk of sPTB and iPTB in women with three consecutive singleton pregnancies and the impact of the outcome of the 1st and 2nd pregnancy on the (recurrent) PTB risk in the 3rd pregnancy. Study designA nationwide retrospective cohort study using the population based longitudinal linked dataset of the Netherlands. We included all nulliparous women with three consecutive singleton pregnancies ending between 22 and 44 weeks of gestation between 1999 and 2009. We excluded congenital abnormalities and stillbirths. We compared the incidence of sPTB and iPTB in the three pregnancies (<37, <34 and <30 weeks). Logistic regression analysis was performed to predict PTB in the 3rd pregnancy, adjusting for maternal age, fetal gender, socio-economic status, hypertension, interpregnancy interval, artificial reproductive technology, and small for gestational age. Analyses were also performed stratified by prior PTB subtype, gestational age and combined outcome of the 1st and 2nd pregnancy. ResultsWe studied 52,978 women. PTB occurred in 7.0%, 3.7% and 3.4% in the 1st, 2nd and 3rd pregnancy, respectively. The outcome of the 2nd pregnancy is more predictive for PTB in the 3rd pregnancy then the outcome of the 1st pregnancy (sPTB aOR7.3 (95%CI 6.3–8.4) and iPTB (aOR 5.9 (95% CI 4.5–7.9) in 2nd pregnancy vs. sPTB aOR 3.0 (95% CI 2.6–3.4) and iPTB aOR 2.7 (95% CI 2.1–3.4) in the 1st pregnancy). In the prediction of sPTB in the 3rd pregnancy, sPTB in the 2nd pregnancy is most predictive (aOR8.2 (95% CI 7.1-9.6) and for prediction iPTB in the 3rd pregnancy, iPTB in the 2nd pregnancy is most predictive (aOR12.1 (95% CI 8.5–17.2). ConclusionWe studied a population with three subsequent singleton deliveries within 10 year. The incidence of PTB decreased with 50% from the 1st to the 2nd pregnancy, to then stay relative stable in the 3rd pregnancy. Compared to PTB in the 1st pregnancy, PTB in the 2nd pregnancy is more predictive for the occurrence of PTB in the 3rd pregnancy.

A description of the methods of the aspirin supplementation for pregnancy indicated risk reduction in nulliparas (ASPIRIN) study

BackgroundPreterm birth (PTB) remains the leading cause of neonatal mortality and long term disability throughout the world. Though complex in its origins, a growing body of evidence suggests that first trimester administration of low dose aspirin (LDA) may substantially reduce the rate of PTB.MethodsHypothesis: LDA initiated in the first trimester reduces the risk of preterm birth.Study Design Type: Prospective randomized, placebo-controlled, double-blinded multi-national clinical trial conducted in seven low and middle income countries. Trial will be individually randomized with one-to-one ratio (intervention/control)Population: Nulliparous women between the ages of 14 and 40, with a singleton pregnancy between 6 0/7 weeks and 13 6/7 weeks gestational age (GA) confirmed by ultrasound prior to enrollment, no more than two previous first trimester pregnancy losses, and no contraindications to aspirin.Intervention: Daily administration of low dose (81 mg) aspirin, initiated between 6 0/7 weeks and 13 6/7 weeks GA and continued to 36 0/7 weeks GA, compared to an identical appearing placebo. Compliance and outcomes will be assessed biweekly.OutcomesPrimary outcome: Incidence of PTB (birth prior to 37 0/7 weeks GA).Secondary outcomes Incidence of preeclampsia/eclampsia, small for gestational age and perinatal mortality.DiscussionThis study is unique as it will examine the impact of LDA early in pregnancy in low-middle income countries with preterm birth as a primary outcome. The importance of developing low-cost, high impact interventions in low-middle income countries is magnified as they are often unable to bear the financial costs of treating illness.Trial registrationClinicalTrials.gov identifier: NCT02409680 Date: March 30, 2015

Cervical length in adolescents versus adults

Purpose: Two of the known risk factors for spontaneous preterm birth (sPTB) are short cervical length (CL) ≤ 25 mm and adolescence (≤19 years). Our objective was to evaluate whether adolescent women have a higher incidence of short CL compared to their 20–24 year old counterparts.Materials and methods: Retrospective cohort of nulliparous singleton gestations undergoing universal second trimester transvaginal ultrasound (TVU) CL screening between January 2012 and June 2013. Adolescent women ≤19 years of age were compared to women 20–24 years of age. Primary outcomes were mean CL and incidence of CL ≤25 mm. Secondary outcomes were incidence of PTB <37 weeks, delivery mode, birth weight, and NICU admission.Results: One hundred and five adolescents and 236 women 20–24 years underwent TVU CL screening. There was no difference in mean CL (40.6 mm vs. 40.6 mm, p = 0.51) or incidence of CL ≤25 mm (1.0% vs. 1.7%; OR 0.56 [0.06–5.1]). After controlling for maternal differences, there still was no significant correlation between maternal age and CL. There was no significant difference in PTB, birth weight, or NICU admission between the groups. CL measurements did not significantly differ across all maternal ages (14–42 years).Conclusions: There is no difference in mean CL or incidence of CL ≤25 mm among adolescents compared to women 20–24 years.

Racial disparities in cervical length for prediction of preterm birth in a low risk population

Purpose: Racial minorities experience higher rates of spontaneous preterm birth (sPTB). Our objective was to evaluate whether there are racial discrepancies in the incidence of second trimester short cervical length (≤25 mm).Materials and methods: Retrospective cohort of women with singleton gestations without prior sPTB undergoing universal second trimester transvaginal ultrasound cervical length (CL) screening between January 2012 and December 2013. Black women were compared to non-Hispanic white women. Our primary outcome was the incidence of CL ≤25 mm. Secondary outcomes were incidence of PTB ≤37 weeks, delivery mode, birth weight and neonatal intensive care unit (NICU) admission.Results: Black women (n = 1092) differed from non-Hispanic white women (n = 659) with respect to maternal age (26.0 versus 30.7 years), gravidity (3.1 versus 2.1), prepregnancy BMI (29.6 versus 25.0 kg/m2), and smoking status (9.8% versus 16%), respectively (p < 0.001). Black women had higher incidence of CL ≤25 mm (1.9% versus 0.6%; OR: 3.21 [1.1–9.4]), rates of sPTB (8.5% versus 4.4%; aOR: 1.95 [1.1–3.4]), incidence of low birthweight infants (<2500 g, 8.3% versus 5.6%; aOR 1.80 [1.1–3.0]) and were more likely to have their infants admitted to the NICU (16% versus 11%; OR: 1.52 [1.0–2.3]).Conclusions: Black women had a 2.8-fold increased risk of CL ≤25 mm compared non-Hispanic white women in a low-risk population.