Lower Odds Of Preterm Birth Research Articles

The Supplemental Nutrition Program for Women, Infants, and Children and Birth Outcomes Among Hispanic Mothers in California: A Sibling Control Design.

Participation in the Supplemental Nutrition Program for Women, Infants, and Children (WIC) during pregnancy appears to reduce risks of preterm birth and low birthweight. Many pregnant women who receive WIC benefits, however, also participate in Medicaid (Medi-Cal in California). This co-participation raises the question of whether WIC per se confers these perinatal health benefits. We use a unique, sibling-linked dataset of California births to estimate birth outcomes relating to program receipt (i.e., No WIC or Medi-Cal; WIC alone; Medi-Cal alone; and WIC and Medi-Cal). We also contribute to the literature by focusing on Hispanic mothers who represent the largest fraction of births in California, as well as the highest proportion of WIC recipients in the state. We specifically assessed the relation of differential program receipt on preterm birth (< 37weeks) and low birthweight (< 2500g). We restrict our analytic sample to births between 2007 and 2015 (n = 942,274). Our sibling-control results show lower odds of low birthweight (OR: 0.82, 95% CI: 0.77, 0.87) and preterm birth (OR: 0.87, 95% CI: 0.83, 0.90) when Hispanic mothers receive WIC benefits during pregnancy compared to when the mothers do not receive WIC benefits. While births associated with receipt of both WIC and Medi-Cal also exhibit lower odds of preterm birth (OR: 0.86, 95% CI: 0.79, 0.92), the protective findings do not extend to low birthweight. Our results extend previous work in other states and should stimulate additional research on whether participation in multiple means-tested programs reduce racial/ethnic disparities in adverse birth outcomes.

Neonatal outcomes of gestational diabetes mellitus (GDM) mothers: A cross-sectional study comparing medical nutritional therapy, metformin, and insulin treatments at a tertiary care centre

Gestational Diabetes Mellitus (GDM) poses a rising global health challenge, affecting 10-14.3% of pregnant women. This study aimed to investigate and compare neonatal outcomes among mothers with GDM treated with Medical Nutritional Therapy (MNT), metformin, and insulin at a tertiary care center. Understanding the impact of these treatments on neonatal outcomes is crucial for optimal care.Conducted at a tertiary care center in Chennai, India, this cross-sectional study included 160 GDM mothers identified through medical records from December 2021 to December 2023. Inclusion criteria covered women aged 18 and above, experiencing singleton pregnancies, diagnosed with GDM, and maintaining regular follow-up. Data analysis included birth weight, Apgar scores, neonatal hypoglycemia, and preterm birth rates. Multinomial logistic regression determined adjusted odds ratios.The study analyzed the distribution of perinatal factors among 160 neonates, revealing that 41.3% were delivered vaginally, while 58.8% were through cesarean section. The majority were preterm, with 118 being appropriate for gestational age.Neonatal Intensive Care Unit (ICU) admission was noted in 34.4% of cases, while 62.7% did not. Neonatal hypoglycemia was observed in 36.3% of cases, and seizures were present in 19.4%. Apgar scores were low in 23.8% of cases.A multinomial logistic analysis found that the Metformin, Insulin, and Metformin + Insulin groups had significantly higher odds of having a Cesarean section compared to the diet-only group. However, the Metformin group had lower odds of preterm birth, NICU admission, neonatal hypoglycemia, seizures, and AGA. The Metformin group had higher odds of LGA and Apgar score &amp;#60;7 at both the 1st and 5th minutes. No significant differences were found in the odds of preterm birth, NICU admission, or seizures between the diet-only and Metformin groups.This pioneering South Indian study of 160 neonates born to GDM mothers compared different treatment options. Metformin, alone or with insulin, showed comparable neonatal outcomes to insulin. Caution in GDM deliveries is recommended for optimal well-being. The study emphasizes the need for further research considering maternal outcomes as potential confounders to comprehensively understand GDM treatments and neonatal outcomes.

Continuous Glucose Monitoring for Management of Type 2 Diabetes and Perinatal Outcomes.

To evaluate the association between continuous glucose monitoring in pregnant people with type 2 diabetes and perinatal outcomes. This was a retrospective cohort study of pregnant people with type 2 diabetes who received prenatal care and delivered singleton, nonanomalous neonates at a single academic tertiary care center from November 1, 2019, to February 28, 2023. The primary outcome was a composite of neonatal morbidity, including hypoglycemia, hyperbilirubinemia, shoulder dystocia, large for gestational age at birth, preterm birth, neonatal intensive care unit (NICU) admission, or perinatal death. Demographics and outcomes were compared by type of monitoring (continuous glucose monitoring vs intermittent self-monitoring of blood glucose), and multivariable logistic regression estimated the association between continuous glucose monitoring use and perinatal outcomes. Of 360 pregnant people who met the inclusion criteria, 82 (22.7%) used continuous glucose monitoring. The mean gestational age at continuous glucose monitoring initiation was 21.3±6.4 weeks. The use of continuous glucose monitoring was associated with lower odds of the primary composite neonatal morbidity (65.9% continuous glucose monitoring vs 77.0% self-monitoring of blood glucose, adjusted odds ratio [aOR] 0.48, 95% CI, 0.24-0.94). Continuous glucose monitoring use was also associated with lower odds of preterm birth (13.4% vs 25.2%, aOR 0.48, 95% CI, 0.25-0.93) and NICU admission (33.8% vs 47.6%, aOR 0.36, 95% CI, 0.16-0.81). In pregnant people with type 2 diabetes, continuous glucose monitoring use was associated with less neonatal morbidity, fewer preterm births, and fewer NICU admissions.

Implementation of perinatal quality collaborative statewide initiative improves obstetrical opioid use disorder care and outcomes

BackgroundMaternal deaths resulting from opioid use disorder (OUD) have been rising across the United States​. OUD among pregnant persons is associated with adverse pregnancy outcomes including preterm birth along with racial disparities in optimal OUD care. ObjectiveWe aimed to evaluate whether the Illinois Perinatal Quality Collaborative’s (ILPQC) implementation of the Mothers and Newborns affected by Opioids – Obstetric quality improvement initiative was associated with improvement of OUD identification, provision of optimal OUD care for birthing patients, and reduction in racial gaps of optimal OUD care. Study DesignUsing a prospective cohort design, hospitals reported monthly key measures for all patients with OUD at delivery between July 2018 – December 2020. ILPQC facilitated collaborative learning opportunities, rapid-response data, and quality improvement (QI) support. Generalized linear mixed effects regression models were used to​ evaluate improvement in optimal OUD care including increases in linkages to medication assisted treatment, recovery treatment services and naloxone counseling across time​; and to determine whether optimal OUD care was associated with positive outcomes such as lower odds of preterm birth. ResultsNinety- one hospitals submitted data on 2,095 pregnant persons with OUD. For the primary outcomes, the rates of patients receiving Medication Assisted Treatment (MAT) and recovery treatment services improved across the initiative from 41 to 78% and 48 to 67% respectively. For the secondary outcomes, the receipt of recovery treatment services and both recovery treatment services / MAT provided prenatally before delivery admission was associated with lower odds of preterm birth (aOR (95% CI) 0.67 (0.50, 0.91) and 0.49 (0.31, 0.75), respectively). During the first quarter of the initiative, Black patients with OUD were less likely to be linked to MAT (23% vs. 48%); however, an increase in MAT rates across the initiative occurred for all patients, with the greatest improvement for Black patients with an associated reduction in this disparity gap with greater than 70% of both Black and White patients linked to MAT. ConclusionThe MNO-OB initiative is associated with improvements in optimal OUD care for pregnant patients across Illinois hospitals, while racial disparity in OUD care was reduced across the MNO OB initiative. The findings further implicate how optimal OUD care can improve pregnancy outcomes and close persistent racial gaps in pregnant individuals with OUD.

Heat Exposure, Preterm Birth, and the Role of Greenness in Australia

Preterm birth (PTB) is associated with adverse health outcomes. The outcomes of heat exposure during pregnancy and the moderating association of greenness with PTB remain understudied. To investigate associations between heat exposure, greenness, and PTB, as well as interactions between these factors. Included in this cohort study were births occurring in Sydney, New South Wales, Australia, between 2000 and 2020, retrieved from New South Wales Midwives Data Collection. Participants with incomplete or missing data on their residential address or those who resided outside of New South Wales during their pregnancy were excluded. Data were analyzed from March to October 2023. Greenness measured using normalized difference vegetation index (NDVI) and tree cover derived from satellite images. Daily extreme heat and nighttime extreme heat were defined as above the 95th percentile of community- and trimester-specific daily mean temperatures and nighttime temperatures. Logistic regression models estimated the independent association of extreme heat with PTB, adjusting for individual- and area-level covariates, season of conception, and long-term trend. An interaction term between extreme heat exposure and greenness was included to explore potential modification. With a significant interaction observed, the number of preventable heat-associated PTBs that were associated with greenness was estimated. A total of 1 225 722 births (median [IQR] age, 39 [38-40] weeks; 631 005 male [51.5%]) were included in the analysis, including 63 144 PTBs (median [IQR] age, 35 [34-36] weeks; 34 822 male [55.1%]). Compared with those without heat exposure, exposure to daily extreme heat and nighttime extreme heat in the third trimester was associated with increased risks of PTB, with an adjusted odds ratio (OR) of 1.61 (95% CI, 1.55-1.67) and 1.51 (95% CI, 1.46-1.56]), respectively (PTB rates: exposed, 4615 of 61 338 [7.5%] vs unexposed, 56 440 of 1 162 295 [4.9%] for daily extreme heat and 4332 of 61 337 [7.1%] vs 56 723 of 1 162 296 [4.9%] for nighttime extreme heat). Disparities in associations between extreme heat exposure and PTB were observed, with lower odds of PTB among pregnant individuals residing in greener areas. The associations between extreme heat exposure and PTB could be mitigated significantly by higher greenness. Improving NDVI and tree cover could reduce daily extreme heat-associated PTB by 13.7% (95% CI, 2.3%-15.1%) and 20.9% (95% CI, 5.8%-31.5%), respectively. For nighttime extreme heat-associated PTB, reductions were 13.0% (0.2%-15.4%) and 17.2% (4.1%-27.0%), respectively. Results of this large birth cohort study suggest that extreme heat exposure was adversely associated with PTB, with greenness playing a moderating role. Increasing greenness levels in residential communities could prevent heat-associated PTBs. These findings emphasize the importance of integrating heat mitigation strategies and improving green space in urban planning and public health interventions.

California's Comprehensive Perinatal Services Program and birth outcomes.

California's Medicaid (Medi-Cal) sponsors Comprehensive Perinatal Services Program (CPSP), a program with enhanced perinatal care for women (more education, nutritional supplements, and psychosocial counseling/support). Past evaluations of CPSP's effectiveness in birth outcomes were limited to pilot programs and yielded mixed results. We used 2012-2016 California's statewide data about singleton live births with any receipt of prenatal care (N = 2,385,811) to examine whether Medi-Cal with CPSP enrollment was associated with lower odds of preterm birth (PTB), spontaneous PTB, and low birthweight (LBW) than non-CPSP births. With three binary variables of PTB, spontaneous PTB, and LBW as the response variables, three multilevel logistic models were used to compare the outcomes of participants enrolled in Medi-Cal with CPSP against those with private insurance, adjusting for maternal factors and county-level covariates. Logistic models showed that participants enrolled to Medi-Cal with CPSP [n (%) = 89,009 (3.7)] had lower odds of PTB, spontaneous PTB and LBW, respectively, as compared with those with private insurance [n (%) = 1,133,140 (47.2)]. Within the Medi-Cal sub-population, the CPSP enrollment was associated with lower odds of PTB, SPTB and LBW than Medicaid beneficiaries without CPSP [n (%) = 967,094 (40.3)]. With statewide data, these findings revealed a robust link between CPSP enrollment and better birth outcomes. Expanding access to comprehensive prenatal services could be an important strategy to improve birth outcomes.

The effect of antenatal isoniazid preventive therapy on birth outcomes in Western Kenya.

BACKGROUND: Pregnant women living with HIV (WLHIV) are at high risk for TB. There are limited data to inform whether TB preventive therapy is safe in pregnancy.METHODS: We completed a retrospective study of antenatal and birth records of mother-infant dyads at two health care facilities in Kisumu, Kenya. Among pregnant WLHIV, we assessed the relationship of antenatal isoniazid preventive therapy (IPT) with birth outcomes (preterm birth, low birth weight [LBW], congenital anomalies, and perinatal death).RESULTS: Of 576 mother-infant pairs, most women were on antiretroviral therapy (574, 99.7%) with viral suppression (518, 89.9%) and one-quarter had IPT exposure during pregnancy (152, 26.4%). The prevalence of preterm birth was lower among women with antenatal IPT exposure (21% vs. 30%; P = 0.03). LBW, congenital anomaly and perinatal death were not associated with antenatal IPT; however, we observed a trend toward fewer composite poor birth outcomes among women taking antenatal IPT (26% vs 33%; P = 0.08). Controlling for maternal age and viral load, IPT use during pregnancy was associated with lower odds of preterm birth (aOR 0.62, 95% CI 0.40-0.98; P = 0.04).CONCLUSION: In a programmatic setting in Western Kenya, IPT use was not associated with adverse birth outcomes.

Abstract P241: Later Menarche Onset Portends Lower Risk of Preterm Birth: Results From the Boston Birth Cohort

Introduction: Age at menarche onset reflects many health aspects in women. Later age at menarche has been associated with lower risk of several cardiometabolic disease outcomes, including diabetes and various cardiovascular diseases. However, no studies have reported the association of maternal menarche age with risk of preterm birth (PTB)—a pregnancy outcome with significant racial disparities and cardiometabolic etiology. Hypothesis: Later age at menarche onset is associated with lower risk of PTB. Methods: We conducted a case-control study in the Boston Birth Cohort, including 2242 mothers with PTB [gestational age (GA) &lt;37 wks], and 6022 mothers with term birth (GA ≥37 wks). We used a maternal postpartum questionnaire (administered 24-72 hrs after delivery) to collect data on age at menarche, sociodemographic and lifestyle factors. We used medical records to ascertain GA. We used multivariable-adjusted logistic regression models and restricted cubic splines to examine the association between age at menarche and odds of PTB. Results: Of the 8264 mothers in our study, 46.9% identified as Black and 28.8% as Hispanic. Maternal age at delivery was 28.1y ±6.5y and age at menarche was 12.85y ±1.86y. Our multivariable-adjusted cubic spline suggested a linear dose-response association of age at menarche with odds of PTB and GA (Figure). Per 1-year later menarche onset of menarche was associated with 5% (95% CI: 2%-8%) lower odds of PTB, after adjustment for maternal place of birth, education, smoking status, Mediterranean diet score, and pre-pregnancy BMI. We found a similar pattern (5% lower odds per 1-year later, 95% CI: 1%-8%) in Black mothers. Conclusion: In a large cohort of racially and ethnically diverse women, later age at menarche is associated with lower risk for PTB. Our findings suggests that the origins of higher risk for PTB start early in life, before puberty, and appear to be independent of adiposity. Future studies are needed to identify mechanisms and points of intervention.

Birth equity on the front lines: Impact of a community-based doula program in Brooklyn, NY.

We assessed whether participation in Healthy Start Brooklyn's By My Side Birth Support Program-a maternal-health program providing community-based doula support during pregnancy, labor and delivery, and the early postpartum period-was associated with improved birth outcomes. By My Side takes a strength-based approach that aligns with the doula principles of respecting the client's autonomy, providing culturally appropriate care without judgment or conditions, and promoting informed decision making. Using a matched cohort design, birth certificate records for By My Side participants from 2010 through 2017 (n=603) were each matched to three controls who also lived in the program area (n=1809). Controls were matched on maternal age, race/ethnicity, education level, and trimester of prenatal-care initiation, using the simple random sampling method. The sample was restricted to singleton births. The odds of preterm birth, low birthweight, and cesarean birth were estimated, using conditional logistic regression. By My Side participants had lower odds of having a preterm birth (5.6% vs 11.9%, P < .0001) or a low-birthweight baby (5.8% vs 9.7%, P=.0031) than controls. There was no statistically significant difference in the odds of cesarean delivery. Participation in the By My Side Birth Support Program was associated with lower odds of preterm birth and low birthweight for participants, who were predominantly Black and Hispanic. Investing in doula services is an important way to address birth inequities among higher risk populations such as birthing people of color and those living in poverty. It could also help shape a new vision of the maternal-health system, placing the needs and well-being of birthing people at the center.

O85 - Do Women with an Existing Perinatal Mental Health Concern Benefit from Caseload Midwifery?

Women with a history or current perinatal mental health (PMH) disorders have an increased risk of adverse perinatal outcomes including preterm birth. Midwifery caseload practice (MCP) improves outcomes for women, including a 24% reduction in preterm birth rates. The Australian Clinical Practice Guidelines for PMH recommend MCP for women with PMH, though this is rarely implemented. Our aim was to compare obstetric and perinatal outcomes for women with a history of PMH between MCP and standard models of maternity care. Retrospective cohort study using routinely collected data of women with PMH between 1st January 2018 – 31st January 2021. We compared characteristics and outcomes between groups; adjusted for maternal age, gestational age, ethnicity, smoking, socioeconomic status, BMI, pregnancy complications and severity of mental health disorder. 3028 women with PMH, 352 (12%) received MCP. The commonest diagnosis was anxiety and depression (n=723, 23.9%). Women receiving MCP were younger (mean 30.9 vs 31.3, p=0.03), Caucasian (37.8 vs 27.1, p<0.001), from a postcode of advantaged (31.0% vs 20.2, p<0.001); less likely to smoke (5.1 vs 11.9, p<0.001) and lower BMI (mean 24.3 vs 26.5, p<0.001). Women in MCP had lower odds of preterm birth (adjOR 0.46, 95% CI 0.24-0.86), higher odds of vaginal birth (adjOR 2.55, 95% CI 1.93-3.36), breastfeeding at discharge (adj OR 3.06, 95% CI 2.10-4.55) with no difference in severe adverse neonatal outcome (adj OR 0.79, 95% CI 0.57-1.09). Evidence from this study demonstrates women with PMH who have continuity of midwifery care have improved outcomes compared to women with PMH who receive standard care. This provides further evidence that women are better together through midwifery continuity of care. Future RCTs for this group of women is needed to establish causation.

Does midwifery continuity of care make a difference to women with perinatal mental health conditions: A cohort study, from Australia

BackgroundPerinatal mental health (PMH) conditions are associated with an increased risk of adverse perinatal outcomes including preterm birth. Midwifery caseload group practice (continuity of care, MCP) improves perinatal outcomes including a 24 % reduction of preterm birth. The evidence is unclear whether MCP has the same effect for women with perinatal mental health conditions. AimTo compare perinatal outcomes in women with a mental health history between MCP and standard models of maternity care. The primary outcome measured the rates of preterm birth. MethodsA retrospective cohort study using routinely collected data of women with PMH conditions between 1st January 2018 – 31st January 2021 was conducted. We compared characteristics and outcomes between groups. Multivariate logistic regression models were performed adjusting for a-priori selected variables and factors that differ between models of care. ResultsThe cohort included 3028 women with PMH, 352 (11.6 %) received MCP. The most common diagnosis was anxiety and depression (n = 723, 23.9 %). Women receiving MCP were younger (mean 30.9 vs 31.3, p = 0.03), Caucasian (37.8 vs 27.1, p < 0.001), socio-economically advantaged (31.0 % vs 20.2, p < 0.001); less likely to smoke (5.1 vs 11.9, p < 0.001) and with lower BMI (mean 24.3 vs 26.5, p < 0.001) than those in the standard care group. Women in MCP had lower odds of preterm birth (adjOR 0.46, 95 % CI 0.24–0.86), higher odds of vaginal birth (adjOR 2.55, 95 % CI 1.93–3.36), breastfeeding at discharge (adj OR 3.06, 95 % CI 2.10–4.55) with no difference in severe adverse neonatal outcome (adj OR 0.79, 95 % CI 0.57–1.09). ConclusionsThis evidence supports MCP for women with PMH. Future RCTs on model of care for this group of women is needed to establish causation.

Associations between child and adolescent marriage and reproductive outcomes in Brazil, Ecuador, the United States and Canada

BackgroundAlthough marriage is associated with favourable reproductive outcomes among adult women, it is not known whether the marriage advantage applies to girls (< 18 years). The contribution of girl child marriage (< 18 years) to perinatal health is understudied in the Americas.MethodsNational singleton birth registrations were used to estimate the prevalence of girl child marriage among mothers in Brazil (2011–2018, N = 23,117,661), Ecuador (2014–2018, N = 1,519,168), the USA (2014–2018, N = 18,618,283) and Canada (2008–2018, N = 3,907,610). The joint associations between marital status and maternal age groups (< 18, 18–19 and 20–24 years) with preterm birth (< 37 weeks), small-for-gestational age (SGA < 10 percentile) and repeat birth were assessed with logistic regression.ResultsThe proportion of births to < 18-year-old mothers was 9.9% in Ecuador, 8.9% in Brazil, 1.5% in the United States and 0.9% in Canada, and marriage prevalence among < 18-year-old mothers was 3.0%, 4.8%, 3.7% and 1.7%, respectively. In fully-adjusted models, marriage was associated with lower odds of preterm birth and SGA among 20–24-year-old mothers in the four countries. Compared to unmarried 20–24-year-old women, married and unmarried < 18-year-old girls had higher odds of preterm birth in the four countries, and slightly higher odds of SGA in Brazil and Ecuador but not in the USA and Canada. In comparisons within age groups, the odds of repeat birth among < 18-year-old married mothers exceeded that of their unmarried counterparts in Ecuador [AOR: 1.99, 95%CI: 1.82, 2.18], the USA [AOR: 2.96, 95%CI: 2.79, 3.14], and Canada [AOR: 2.17, 95%CI: 1.67, 2.82], although minimally in Brazil [AOR: 1.09, 95%CI: 1.07, 1.11].ConclusionsThe prevalence of births to < 18-year-old mothers varies considerably in the Americas. Girl child marriage was differentially associated with perinatal health indicators across countries, suggesting context-specific mechanisms.

Nativity-Related Disparities in Preterm Birth and Cardiovascular Risk in a Multiracial U.S. Cohort

Having a preterm birth is associated with future cardiovascular risk. Non-Hispanic Black women have higher rates of preterm birth than non-Hispanic White and Hispanic women, but nativity-related disparities in preterm birth are not well understood. Data from 6,096 women in the Boston Birth Cohort: non-Hispanic Black (2,699), non-Hispanic White (997), or Hispanic (2,400), were analyzed in June 2021. Differences in cardiovascular risk factors were assessed. The association of preterm birth with nativity and duration of U.S. residence were investigated using multivariable logistic regression. U.S.-born women in all 3 racial-ethnic groups had a higher prevalence of obesity, smoking, and severe stress than foreign-born women. Foreign-born non-Hispanic Black and Hispanic women had lower odds of preterm birth than U.S.-born counterparts (non-Hispanic Black: AOR=0.79, 95% CI=0.65, 0.97; Hispanic: AOR=0.72, 95% CI=0.56, 0.93). In all the 3 groups, foreign-born women with shorter (<10 years) duration of U.S. residence had lower odds of preterm birth than the U.S.-born women (non-Hispanic Black: AOR=0.57, 95% CI=0.43, 0.75; Hispanic: AOR=0.72, 95% CI=0.55, 0.94; non-Hispanic White: AOR=0.46, 95% CI=0.25, 0.85), whereas the odds of preterm birth in foreign-born women with ≥10 years of residence were not significantly different. Foreign-born women had better cardiovascular risk profiles in all groups and lower odds of preterm birth in non-Hispanic Black and Hispanic groups. In all the 3 groups, a shorter duration of U.S. residence was associated with lower odds of preterm birth. Further studies are needed to understand the biological and social determinants underlying these nativity-related disparities and the impact of acculturation.

Genital Mycoplasmas and Biomarkers of Inflammation and Their Association With Spontaneous Preterm Birth and Preterm Prelabor Rupture of Membranes: A Systematic Review and Meta-Analysis.

Genital mycoplasmas (GM), such as Mycoplasma hominis, Mycoplasma genitalium, Ureaplasma parvum, and Ureaplasma urealyticum are commonly associated with spontaneous preterm labor (SPTL), spontaneous preterm birth (PTB), and preterm prelabor rupture of membranes (PPROM). This study determined the association between GM and such adverse pregnancy outcomes. We searched for studies published 1980–2019 in MEDLINE, EMBASE, and Web of Science. Studies were eligible when GM was detected during pregnancy. We included 93 and 51 studies in determining the prevalence and the inflammatory biomarkers associated with GM, respectively, using the “metafor” package within R. The protocol was registered with PROSPERO (registration no. CRD42016047297). Women with the studied adverse pregnancy outcomes had significantly higher odds of presence with GM compared to women who delivered at term. For PTB, the odds ratios were: M. hominis (OR: 2.25; CI: 1.35–3.75; I2: 44%), M. genitalium (OR: 2.04; CIL 1.18–3.53; I2: 20%), U. parvum (OR: 1.75; CI: 1.47–2.07; I2: 0%), U. urealyticum (OR: 1.50; CI: 1.08–2.07; I2: 58%). SPTL had significantly higher odds with M. hominis (OR: 1.96; CI: 1.19–3.23; I2: 1%) or U. urealyticum (OR: 2.37; CI: 1.20–4.70; I2: 76%) compared to women without SPTL. Women with PPROM had significantly higher odds with M. hominis (OR: 2.09; CI: 1.42–3.08; I2: 0%) than women without PPROM. However, our subgroup analysis based on the diagnostic test and the sample used for detecting GM showed a higher prevalence of GM in maternal samples than in fetal samples. GM presence of the cervix and vagina was associated with lower odds of PTB and preterm labor (PTL). In contrast, GM presence in the AF, fetal membrane, and placenta was associated with increased odds of PTB and PTL. However, genital mycoplasmas may not elicit the massive inflammation required to trigger PTB. In conclusion, GM presence in the fetal tissues was associated with significantly increased odds of PTB and PTL.

Physical Activity in Pregnancy was Favorably Associated with Maternal And Offspring Health Indices

Regular physical activity (PA) in pregnancy can benefit the pregnant woman through a shorter birth and a shorter recovery period. The study aimed to investigate the effect of PA in pregnancy, on maternal and offspring health indicators. Population-based data were obtained from a national database that included anthropometric and physical fitness data of almost all Greek children 8 to 9 years. Α random sample of 5,125 dyads of mothers-children was evaluated. Telephone interviews were carried out with the use of a standardized questionnaire for the collection of maternal lifestyle factors. Children born to mothers who participated in the recommended PA levels had lower odds (OR=0.78, 95% CI: 0.69-0.95) to be overweight/obese in childhood. Adequate PA levels in pregnancy were found to be associated with lower odds of preterm birth by 61% (OR = 0.39, 95% CI: 0.17-0.87), and alcohol consumption in pregnancy by 62% (OR = 0.38, 95% CI: 0.27-0.56) as compared to the inadequate level of PA. Also, mothers with adequate PA in pregnancy had decreased odds for excessive GWG and final BMI by almost 40% in comparison to those with inadequate PA levels. PA in pregnancy does seem to be related to offspring health indicators (e.g. obesity at 8 years) and is associated with a more favorable maternal health profile.

Abstract 11530: Cardiovascular Risk Profile and Preterm Birth by Maternal Nativity in Racially Diverse, Urban, Low Income Women in the United States

Introduction: Preterm Birth (PTB) is an independent risk factor for future cardiovascular disease (CVD). Nativity-related disparities in CVD risk profile and risk of PTB have been shown among non-Hispanic Black (NHB) women; however, studies exploring these disparities among women of other races are limited. We hypothesized that foreign-born NHB, White, and Hispanic women will have better CVD risk profile and lower risk of PTB compared to their US-born counterparts. Methods: We utilized data from 6096 women with mean age 27.5(±6.3) years in the Boston Birth Cohort who self-identified as NHB (2699), White (997), or Hispanic (2400). We examined differences in sociodemographic characteristics and CVD risk factors such as smoking, obesity, and hypertension by nativity status. Using multivariable logistic regression models, we examined the association of nativity and length of U.S. residence with PTB by race. Results: Of the total sample, 27.2% delivered preterm (29.1%, 29.8%, and 24.1% among NHB, White, and Hispanic women, respectively). Compared to foreign-born women, US-born women in each of the three racial groups were younger and more likely to be obese, single, smoke in pregnancy, and report severe stress. After adjusting for sociodemographic characteristics and CVD risk factors, foreign-born NHB women had lower odds of PTB compared to U.S-born NHB women (adjusted odds ratio, aOR: 0.79; 95%CI: 0.65-0.97). Similarly, foreign-born Hispanic women had lower odds of PTB compared to U.S-born Hispanic women (aOR: 0.72; 95%CI: 0.56-0.93). In all 3 racial groups, shorter (&lt;10 years), but not longer (≥10 years) length of U.S. residence was associated with lower odds of PTB. (Figure) Conclusions: US-born women in all three racial groups had a higher prevalence of CVD risk factors including smoking, obesity, and stress, compared to foreign-born women. The “foreign-born advantage” which is protective of PTB was not observed among foreign-born women with ≥10 years of U.S. stay.

Mid-thigh circumference as an indicator of nutritional status to predict adverse pregnancy outcomes among HIV-infected and HIV-uninfected women in Malawi

BackgroundHigh rates of adverse pregnancy outcomes globally raise the need to understand risk factors and develop preventative interventions. The Pregnancy Outcomes in the Era of Universal Antiretroviral Treatment in Sub-Saharan Africa (POISE Study) was a prospective, observational cohort study conducted from 2016 to 2017 in Blantyre, Malawi. We examine the associations between indicators of nutritional status, specifically mid-thigh circumference (MTC) and body-mass index (BMI), and adverse pregnancy outcomes, low birth weight (LBW), preterm birth (PTB), and small-for-gestational age (SGA), in a cohort of HIV-infected and HIV-uninfected women.MethodsSociodemographic, clinical, laboratory, and maternal height, weight and MTC data were collected immediately before or after delivery at the Queen Elizabeth Central Hospital (QEHC) and 4 affiliated health centers in Blantyre, Malawi. LBW was defined as birth weight < 2.5 kg; PTB as gestational age < 37 weeks using Ballard score; and SGA as birth weight < 10th percentile for gestational age. Descriptive, stratified, and multivariable logistic regression were conducted using R.ResultsData from 1298 women were analyzed: 614 HIV-infected and 684 HIV-uninfected. MTC was inversely associated with LBW (adjusted odds ratio [aOR] = 0.95, p = 0.03) and PTB (aOR 0.92, p < 0.001), after controlling for HIV status, age, socioeconomic status and hemoglobin. The association between MTC and SGA was (aOR 0.99, p = 0.53). Similarly, higher BMI was significantly associated with lower odds of PTB (aOR 0.90, p < 0.001), LBW (aOR 0.93, p = 0.05), and SGA (aOR 0.95, p = 0.04).ConclusionsWe observed an inverse relationship between MTC and adverse pregnancy outcomes in Malawi irrespective of HIV infection. MTC performs comparably to BMI; the ease of measuring MTC could make it a practical tool in resource-constrained settings for identification of women at risk of adverse pregnancy outcomes.

A pilot study of glyphosate, and preterm birth among blacks and whites

BACKGROUND AND AIM: Glyphosate was first registered as an herbicide in the United States in 1974. It has since been linked to birth defects in animal models. Additionally, in vitro studies suggest that glyphosate has anti-androgenic and anti-estrogenic activities including the ability to interfere with aromatase activity. One observational human study found a statistically significant correlation between higher maternal glyphosate levels and shortened gestational length. However, no studies have investigated potential race-disparities in gestational glyphosate exposure or effects. METHODS: A nested case control pilot study enrolled 26 women with a preterm birth (37 weeks completed gestation) and 26 term births matched by race from a larger cohort study. Second trimester urine samples, collected at 18-22 weeks of gestation, were analyzed for specific-gravity corrected glyphosate using liquid chromatography-tandem mass spectrometry. Logistic regression was used to estimate the association between gestational urinary glyphosate concentrations and preterm birth, adjusted for age, race, body mass index, season of specimen collection, education level and reported organic food consumption. RESULTS:Geometric mean glyphosate concentrations were 0.07 ng/mL (95% CI: 0.04-0.13) for preterm and 0.06 ng/mL for term births (95% CI: 0.03-0.10). Fewer term whites (n=4, 31%) were in the middle (range: 0.04-0.11 ng/mL) and highest (range: 0.17-1.25 ng/mL) tertiles of glyphosate exposure than term Blacks (n=7, 54%), although the difference was not statistically significant (p=0.43). Higher urinary glyphosate was associated with lower odds of preterm birth (odds ratio=0.75, 95% confidence interval 0.16-3.68), adjusted for covariates, although also not statistically significant. The odds varied by race, with OR=0.60 (95% CI: 0.11-3.4) among whites and OR=1.40 (95% CI: 0.28-7.02) among Blacks, although the interaction was not statistically significant. CONCLUSIONS:Glyphosate exposure varied by maternal race with elevated exposure in Blacks. There was no association found between urinary glyphosate levels and preterm birth, suggesting that glyphosate may not be a preterm birth risk factor. KEYWORDS: Glyphosate, Pregnancy Outcomes, Risk Assessment, Exposure assessment-biomarkers of exposure

Associations Between Gestational Environmental Phenols and Preterm Birth; a Nested Case-Control Study

BACKGROUND AND AIM: Studies report associations between environmental phenols exposure and preterm birth (PTB). There is significant racial disparity in PTB rates yet little data to characterize the effects of phenol exposure by race. To begin to address this data gap we conducted a case-control pilot study, nested within a larger U.S. investigation. METHODS: We enrolled 26 women with a PTB (37 weeks completed gestation) and 26 women with a term delivery, matched by race (non-Hispanic Blacks and non-Hispanic whites). Participants provided urine specimens at 18-22 weeks gestation, completed a questionnaire, and allowed access to hospital records. We measured ten environmental phenols in urine, including methyl- (MP), ethyl- (EP), propyl- (PP), and butylparabens (BP), benzophenones 1 (BZP-1) and 2 (BZP-2), pentachlorophenol, triclosan, and bisphenols A (BPA) and S (BPS), using liquid chromatography-tandem mass spectrometry. After specific gravity correction, we estimated associations between environmental phenols and PTB using logistic regression, adjusted for race, age, body mass index, and education. We tested interactions by race. RESULTS:Urinary BZP-1 (difference=12.01 ng/mL; P=0.001) and BZP-2 (difference=162.24 ng/mL; P=0.01) concentrations were greater among whites, and pentachlorophenol (difference=0.40 ng/mL; P=0.01) and BPS (difference=0.40 ng/mL; P=0.01) were greater among Blacks. Higher urinary BP was associated with greater odds of PTB (odd ratio (OR)=1.32; 95%CI:0.95-2.43), while higher urinary BZP-1 (OR=0.96; 95%CI:0.91-0.99), pentachlorophenol (OR=0.62; 95%CI:0.18-2.01), triclosan (OR=0.98; 95%CI:0.97-0.99), and BPS (OR=0.75; 95%CI:0.35-1.47) were associated with lower odds of PTB, although some confidence intervals were imprecise. We detected an interaction for race (P=0.08), such that Blacks had lower PTB odds (OR=0.70; 95%CI:0.29-1.02) than whites (OR=0.97; 95%CI:0.92-1.00) in association with higher BZP-1. CONCLUSIONS:In this pilot study, exposure to environmental phenols differed by race and individual phenols demonstrated variable associations with PTB risk. It does not appear that exposure to environmental phenols was associated with a greater risk of PTB in either Black or white mothers. KEYWORDS: Phenols, Environmental disparities, birth outcomes

Residential proximity to tree canopy and preterm birth in Black women

There are marked racial disparities in obstetrical outcomes, with the incidence of preterm birth being the highest among non-Hispanic Black women. The presence of green space, such as forests and parks, is now widely viewed as a health-promoting characteristic of residential environments. This study aimed to examine the association between the proximity of tree canopies to a prenatal residential address and the rates of preterm birth among non-Hispanic Black women in Milwaukee, Wisconsin. This was a retrospective, case-control study utilizing hospital pregnancy records of self-identified non-Hispanic Black women. The addresses of the women, who delivered from 2011 to 2019, were geocoded to characterize the percentage of tree canopy surrounding the prenatal address using the National Land Cover Database. Circular residential buffers of 100, 150, 250, and 500 m were used to assess the exposure to tree canopy coverage in proximity to a prenatal address. Univariable and multivariable analyses were conducted to determine whether tree canopy percentage at 4 different proximity buffers, examined both in means and quartiles, was associated with preterm birth (birth at <37 weeks' gestation). Of the 2771 non-Hispanic Black women included in the study, 333 (12.0%) experienced preterm births. Less tree canopy coverage was significantly (P < .05) associated with preterm birth, irrespective of whether the coverage was quantified as a mean or by quartile. In the unadjusted and adjusted models, which adjusted for sociodemographic and clinical risk factors for preterm birth, a 10% increase in tree canopy coverage was associated with lower odds of preterm birth at all 4 buffers examined. When examining the green space by quartile, higher quartiles were associated with lower odds of preterm birth at the 100-, 150-, and 250 m buffers, but not at the 500 m buffer. A higher percentage of tree canopy coverage in close proximity to the prenatal residential address is associated with lower odds of preterm birth among non-Hispanic Black women. These findings suggest that access to neighborhood green space is an important factor associated with preterm birth.