Moderate Preterm Birth Research Articles

Growth Trajectory at 24 Months of Preterm Infants after Discharge: A Longitudinal Study in Indonesia.

Maintaining optimal growth of preterm infants after hospital discharge remains a challenge. There has been no data on the long-term growth trajectory of preterm infants in Indonesia. We aimed to describe the growth trajectory of preterm infants up to 24 months of corrected age and its variation among gestational age groups. A longitudinal study was conducted in Cipto Mangunkusumo Hospital, Jakarta from 2018 to 2020. All preterm infants who were discharged during the study period were included. Growth trajectory analysis used weight-for-age (WAZ), length-for-age (LAZ), and weight-for-length (WFL) z-score of 3-month time intervals across gestational age groups using repeated measure ANOVA and generalized estimating equation regression. Length trajectory was specifically reported as a stunted proportion. Among 306 preterm infants included, most were moderate preterm (49.67%) and low birth weight (69.93%). Overall WAZ at 0 month were in the median of the curve, then decreased at 3 months, but consistently increased slowly until 24 months. The WAZ trends were unique across gestational age groups, but statistically similar (p = 0.263). The proportion of stunted gradually decreases to 13.40% at 24 months, mostly among the moderate preterm group in the first 6 months (p<0.001) but then becomes similar at 24 months. All subjects were in the normal range for WFL but had variations in trends across gestational age groups (p<0.001). Growth trajectory differed between weight, length, and weight-for-length in the first 24 months and varied among gestational age groups. Close follow-up is crucial to ensure optimal growth after NICU discharge.

Secular variation and risk factors of preterm birth in Hainan, the Free Trade Port in China from 2010 to 2021

ObjectivesPreterm delivery rates have increased obviously worldwide over the past decade, yet reliable epidemiological studies on the incidence of preterm birth and temporal trends are not available in Hainan, The Free Trade Port in China. We aimed to describe the rate of preterm birth and trends between 2010 and 2021 and to primarily explore risk factors associated with preterm birth in Hainan, China.MethodsThis was an observational study was based on data from the Hainan Provincial Birth Certificate System (HPBCS) for live births between 1 January 2010 and 31 December 2021. We included pregnancies resulting in at least one live birth, with newborns born at a gestational age of 28 weeks or greater, or with a birth weight of 1000 g or more. The outcome were preterm birth rates and their trends over time. Potential risk factors were collected, including infant gender, maternal age, paternal age, maternal ethnicity, paternal ethnicity, home address, and single or multiple pregnancies. The logistic regression model was used to assess the relationship between preterm birth and potential risk factors.ResultsA total of 1,537,239 live births and 86,328 preterm births were investigated, giving a total preterm birth rate of 5.62%. The overall preterm birth rate increased from 4.47% in 2010 to 7.12% in 2021 (compound annual growth rate [CAGR] 4.32). The CAGR of late preterm birth is consistent with the overall preterm birth rate (4.32%). The fastest growth is observed in the rate of very preterm births (5.53%), while the rate of moderate preterm births exhibits the slowest growth (3.87%). Infant gender, multiple pregnancy, home address, parental age, and ethnicity had significant effects on preterm birth.ConclusionThe preterm birth rate was increasing year by year from 2010 to 2021 in Hainan, The Free Trade Port in China. Incidence of preterm births in Hainan Province in relation to multiple pregnancies, infant sex, parental age, parental race and residential address.

Cumulative live birth rate of a blastocyst versus cleavage stage embryo transfer policy during in vitro fertilisation in women with a good prognosis: multicentre randomised controlled trial

ObjectivesTo evaluate whether embryo transfers at blastocyst stage improve the cumulative live birth rate after oocyte retrieval, including both fresh and frozen-thawed transfers, and whether the risk of obstetric and...

Secular Trends in Preterm Birth Rates: Uncovering the Primary Challenge for Perinatal Medicine in Greece.

Preterm labour is a serious pregnancy complication that is the primary cause of infant mortality, with detrimental impacts on the offspring and the mother in the short as well as the long term. This study aims to comprehensively present the time trends of national preterm birth rates (PBRs) in Greece. Official national data regarding live births in Greece were acquired from the Hellenic Statistical Authority, and the annual total PBRand rates for gestational age groups were computed per 100 total live births spanning from 1980 to 2022. Time trends were analyzed through joinpoint regression analysis, and annual percent changes (APC) and average annual percent change (AAPC) were calculated with a 95% confidence interval (95% CI). Following a steady decline from 4.66% in 1980 to a historic low of 2.77% in 1991 with an APC of -5.1 (-6.2 to -4.2), the PBR exhibited a dramatic increase during 1991-2011 with an APC of 7.3 (6.9 to 7.8). Subsequently, between 2011 and 2022, the rise in PBR was attenuated, showing a slight statistically non-significant upward trend (APC = 0.5, 95% CI: -0.6 to 1.5). This led to a historical high of 12.07% in 2018, 4.4 times higher than that in 1991, and eventually, the PBR reached 11.90% in 2022. From 1991 to 2022, there were sharper increases in the rates of moderate (32-33 weeks) and late (34-36 weeks) preterm births, with AAPCs of 4.9 (3.5-6.4) and 5.8 (5.3-6.3), respectively. In contrast, the rates of extremely (<28 weeks) and very (28-31 weeks) preterm births saw slower growth, with AAPCs of 2.2 (1.7-2.7) and 0.7 (0.5-1.0), respectively. The PBR in Greece more than quadrupled during 1991-2022, mainly due to increases in moderate and late preterm births. Although its rise has markedly decelerated since 2011, amidst the country's economic recession, the PBR is alarmingly higher than those in all other European and developed nations. More than one in nine neonates is born prematurely in the Greek population, posing challenges in implementing evidence-based prevention strategies and perinatal care.

Prenatal exposure to Benzo[a]pyrene affects maternal–fetal outcomes via placental apoptosis

Prenatal exposure to Benzo[a]pyrene (BaP) has been suggested to increase the risk of adverse pregnancy outcomes. However, the role of placental apoptosis on BaP reproductive toxicity is poorly understood. We conducted a maternal animal model of C57BL/6 wild-type (WT) and transformation-related protein 53 (Trp53) heterozygous knockout (p53KO) mice, as well as a nested case–control study involving 83 women with PB and 82 term birth from a birth cohort on prenatal exposure to BaP and preterm birth (PB). Pregnant WT and p53KO mice were randomly allocated to BaP treatment and control groups, intraperitoneally injected of low (7.8 mg/kg), medium (35 mg/kg), and high (78 mg/kg) doses of 3,4-BaP per day and equal volume of vegetable oil, from gestational day 10.5 until delivery. Results show that high-dose BaP treatment increased the incidence of preterm birth in WT mice. The number of fetal deaths and resorptions increased with increasing doses of BaP exposure in mice. Notably, significant reductions in maternal and birth weights, increases in placental weights, and decrease in the number of livebirths were observed in higher-dose BaP groups in dose-dependent manner. We additionally observed elevated p53-mediated placental apoptosis in higher BaP exposure groups, with altered expression levels of p53 and Bax/Bcl-2. In case–control study, the expression level of MMP2 was increased among women with high BaP exposure and associated with the increased risk of all PB and moderate PB. Our study provides the first evidence of BaP-induced reproductive toxicity and its adverse effects on maternal–fetal outcomes in both animal and population studies.

Mediating role of gestational weight gain in the relationship between socioeconomic status and preterm birth: a Chinese population-based study

BackgroundThe modifiable mechanisms underlying the association between socioeconomic status (SES) and preterm birth remain unclear. This study aimed to investigate the relationship between preterm birth and maternal SES or gestational weight gain (GWG), as well as the role of GWG in mediating SES disparities in preterm birth.MethodsData was from a hospital-based sub-study of physical growth and development survey for Chinese newborns with various gestational ages. Singleton newborns aged from 24 to 42weeks’ gestation and their mothers were included. Using information from maternal questionnaire, a composite SES was constructed with parental education and family annual income. GWG as mediator was calculated by deducting pre-pregnancy weight from maternal weight at delivery. Logistic regression model was adopted to investigate the association of preterm birth with SES or GWG. Causal mediation analysis was performed to measure mediating effect of GWG on the pathway from SES to preterm birth.ResultsAfter controlling for potential confounders, risk of preterm birth was reduced by 12.4% (OR = 0.876, 95%CI:0.855–0.879) for per one-kilogram increase of GWG, and risk of preterm birth was reduced by 24% (OR = 0.760, 95%CI: 0.717–0.806) for per one-unit increase of SES score. Mediation analysis supported a significant association between higher SES and decreased risk of preterm partly through higher GWG, in which estimated proportion mediated by GWG was 13.04% (95%CI: 11.89–16.25). GWG also played a significant role as a mediator when socioeconomic status was indicated by maternal education, paternal education or family income. GWG mediated approximately 11.03% (95% CI: 8.56–18.25) of the total effect of SES on very preterm birth, which was greater than that for moderate preterm birth (6.72%, 95%CI: 2.72–31.52) and late preterm birth (9.04%, 95%CI: 5.24–24.04). A series of sensitive analysis confirmed the robustness of association of interest.ConclusionIncreased GWG and higher socioeconomic status are strongly associated with a lower risk of preterm birth. GWG mediates socioeconomic disparities in preterm birth, most notably in very preterm birth. Understanding this mechanism will aid in the development of interventions and policy for maternal and child health care.

Growth and respiratory status at 3 years of age after moderate preterm, late preterm and early term births: the Japan Environment and Children’s Study

ObjectiveTo assess the association between gestational age at birth and the risk of growth failure and respiratory symptoms at 3 years of age.DesignCohort study using the Japan Environment and Children’s...

Trophectoderm biopsy is associated with lower risks of moderate to extreme prematurity and low birthweights: a national registry cohort study of singleton livebirths from frozen-thawed blastocyst transfers

BackgroundTrophectoderm biopsy has become the mainstay assisted reproductive technique performed for preimplantation genetic testing, accounting for 43.8% of embryo transfer cycles in the US in 2019 alone. Despite its prevalence, data on the obstetric and perinatal outcomes post trophectoderm biopsy remains sparse and mixed. ObjectiveThis study aimed to examine the risks of adverse perinatal outcomes in birth weights and prematurity after transfers of vitrified-thawed blastocyst with trophectoderm biopsy for preimplantation genetic testing. Study DesignThis was a retrospective observational cohort study of 45,712 singleton live births resulting from autologous vitrified-thawed blastocyst transfer cycles with or without trophectoderm biopsy for preimplantation genetic testing, reported by participating member clinics to the Society for Assisted Reproductive Technology national registry between 2014 and 2017. Adverse perinatal outcomes of preterm births and low birth weights were analyzed. Multivariable regression analyses were performed to control for covariates. Comparing the trophectoderm biopsy (n=21,584) and no trophectoderm biopsy (n=24,128) groups, adjusted odds ratios were calculated for the outcomes of small for gestational age, large for gestational age, low birth weight < 2,500 g, very low birth weight < 1,500 g, extremely low birth weight < 1,000 g, late preterm births < 37 weeks, moderate preterm births < 34 weeks, and extremely preterm births < 28 weeks. ResultsWomen in the trophectoderm biopsy group were older and more likely to have prior pregnancies, deliveries, and history of spontaneous abortions. Tobacco use, diminished ovarian reserve, and recurrent pregnancy loss were also more prevalent in the trophectoderm biopsy group. Trophectoderm biopsy was not associated with small-for-gestational-age (aOR 0.97, 95% CI 0.85-1.12, p-value 0.72) or large-for-gestational-age newborns (aOR 1.10, 95% CI 0.99-1.22, p-value 0.09). Risks of preterm births < 37 weeks gestation were similar between the biopsy and non-biopsy groups (aOR 0.93, 95% CI 0.85-1.02, p-value 0.11). Trophectoderm biopsy was associated with a significantly lower risk of low birthweight < 2,500 g (aOR 0.80, 95% CI 0.70-0.92, p-value <0.001), very low birthweight < 1,500 g (aOR 0.62, 95% CI 0.46-0.83, p-value <0.001), extremely low birthweight < 1,000 g (aOR 0.48, 95% CI 0.31-0.74, p-value <0.001), moderate preterm birth < 34 weeks (aOR 0.76, 95% CI 0.64-0.91, p-value 0.003), and extreme preterm birth < 28 weeks (aOR 0.63, 95% CI 0.43-0.92, p-value 0.017). ConclusionTrophectoderm biopsy is not associated with increased risks of small for gestational age, large for gestational age, or late preterm birth. Risks of low birthweight, very low birthweight, and extremely low birthweight from moderate and extreme preterm births are lower after trophectoderm biopsy, possibly by selecting against confined placental mosaicism or inducing placental epigenetic changes, the mechanisms of which warrant further investigation.

Characterization of Angiogenic, Matrix Remodeling, and Antimicrobial Factors in Preterm and Full-Term Human Umbilical Cords.

Little is known about morphogenetic changes in the umbilical cord during the maturation process. Extracellular matrix remodeling, angiogenesis, progenitor activity, and immunomodulation are represented by specific markers; therefore, the aim of this study was to determine the expression of matrix metalloproteinase-2 (MMP2), tissue inhibitor of metalloproteinases-2 (TIMP2), CD34, vascular endothelial growth factor (VEGF), and human β-defensin 2 (HBD2) in preterm and full-term human umbilical cord tissue. Samples of umbilical cord tissue were obtained from 17 patients and divided into two groups: very preterm and moderate preterm birth umbilical cords; late preterm birth and full-term birth umbilical cords. Routine histology examination was conducted. Marker-positive cells were detected using the immunohistochemistry method. The number of positive structures was counted semi-quantitatively using microscopy. Statistical analysis was carried out using the SPSS Statistics 29 program. Extraembryonic mesenchyme cells are the most active cell producers, expressing MMP2, TIMP2, VEGF, and HBD2 at notable levels in preterm and full-term umbilical cord tissue. Statistically significant differences in the expression of CD34, MMP2, and TIMP2 between the two patient groups were found. The expression of VEGF was similar in both patient groups, with the highest number of VEGF-positive cells seen in the extraembryonic mesenchyme. The expression of HBD2 was the highest in the extraembryonic mesenchyme and the amniotic epithelium, where mostly moderate numbers of HBD2-positive cells were detected. Extracellular matrix remodeling in preterm and term umbilical cords is strongly regulated, and tissue factors MMP2 and TIMP2 take part in this process. The expression of VEGF is not affected by the umbilical cord's age; however, individual patient factors can affect the production of VEGF. Numerous CD34-positive cells in the endothelium of the umbilical arteries suggest a significant role of progenitor cells in very preterm and moderate preterm birth umbilical cords. Antimicrobial activity provided by HBD2 is essential and constant in preterm and full-term umbilical cords.

Association between maternal zinc intake and preterm birth in Gansu Province in 2010-2012

To analyze the association between maternal dietary zinc levels at different stages and preterm birth. The subjects were from the 2010-2012 birth cohort of Maternal and Child Health Hospital of Gansu Province, and a total of 10 179 pregnant women were included in the final study. Dietary information before and during pregnancy was collected through semi-quantitative food frequency questionnaire, and daily zinc intake in each period was estimated according to the frequency of consumption and portion size of food items using the Chinese Standard Tables of Food Consumption. Logistic regression was used to analyze the OR value of preterm birth under different maternal dietary zinc levels. The detection rate of preterm birth was 10.0%, of which 81.8% were moderate preterm, 18.3% were very preterm, 33.2% were medically indicated preterm and 66.8% were spontaneous preterm birth. After adjusting for general conditions such as maternal age, education level, and history of preterm birth, compared with the group with the highest zinc intake before and during pregnancy, those with low zinc intake before or during pregnancy had a significantly higher risk of moderate, very, and spontaneous preterm birth. After further controlled of folic acid and fiber intake during pregnancy, compared with the group with the highest zinc intake before and during pregnancy, the risk of very preterm birth(OR=2.04, 95%CI 1.07-3.90) and spontaneous preterm birth(OR=1.38, 95%CI 1.01-1.88) was significantly increased in those with the lowest zinc intake during the third trimester. For pregnant women aged≥30 years(OR=1.55, 95%CI 1.12-2.13) and normal or less normal weight gain during pregnancy(OR=1.51, 95%CI 1.15-1.97), insufficient zinc intake was significantly associated with preterm birth. Maternal low dietary zinc intake during the third trimester was associated with very premature and spontaneous preterm birth.

Does Screening Ultrasound Timing in Developmental Dysplasia of the Hip Need to be Adjusted for Moderate Preterm and Near-term Infants: A Prospective Study.

An initial screening ultrasound is essential for patients at higher risk of developmental dysplasia of the hip (DDH) due to breech presentation or a family history of DDH. The American Academy of Pediatrics recommends screening ultrasounds to be performed after 6 weeks of age to reduce the rate of false positives. However, there is limited evidence regarding whether these screening ultrasounds need to be adjusted for gestational age in prematurity. The purpose of this study was to evaluate the influence of moderate preterm and near-term births on screening hip ultrasounds for high-risk DDH populations. We identified all prospectively enrolled patients in a single-center database referred for screening hip ultrasound for DDH. We included those hips referred for risk factors of DDH, including breech presentation, family history of DDH, or hip click, and excluded those with known dysplasia or referral for hip instability. Each ultrasound was measured by a pediatric radiologist to determine the alpha angle and femoral head coverage. Patients were classified as "premature" if born at <37 weeks gestation or "full term" if born at ≥37 weeks gestation. All patients underwent screening hip ultrasound between 5 and 8 weeks of age. Sonographic markers of dysplasia and the incidences of abnormal ultrasound and Pavlik harness treatment were compared between cohorts. Significance was set at P <0.05. A total of 244 hips in 122 patients were included, 58 hips in the premature cohort and 186 hips in the full-term cohort. The premature cohort had a significantly decreased gestational age compared with the full-term cohort (35.4 ± 1.1 vs 38.5 ± 1.1wk, respectively, P < 0.001). However, there was no difference between premature and full-term cohorts in sex distribution (69% vs 75%, females, P = 0.39), unadjusted age at the time of ultrasound (6.6 ± 0.7 vs 6.8±0.7wk, respectively, P = 0.07), or referral reason (P = 0.14). On hip ultrasound, there was no difference between premature and full-term cohorts with respect to alpha angle (62.6 ± 3.3 vs 62.2 ± 5.3 degrees, P = 0.41), femoral head coverage (54.9 ± 6.3 vs 55.1 ± 10.6, P = 0.19), rate of abnormal ultrasound (18.3% vs 20.7%, respectively, P = 0.68), or the rate of Pavlik harness treatment (0% vs 5.3%, respectively, P = 0.12). There was no significant difference in alpha angle or femoral head coverage between premature and full-term patients at 5 to 8 weeks of unadjusted age. This preliminary data suggests that screening ultrasounds can be performed without adjusting for prematurity. Level II, prognostic study.

Neurodevelopmental outcomes at age 3 years after moderate preterm, late preterm and early term birth: the Japan Environment and Children’s Study

ObjectiveTo assess the association between gestational age classification at birth and the risk of neurodevelopmental impairments at age 3 years.DesignCohort study using the Japan Environment and Children’s Study database.PatientsA total...

The paradoxical influence of the COVID-19 lockdown period on different types of preterm births in Alberta: a provincial study.

The objective of this study was to determine if the COVID-19 pandemic impacted different types of preterm birth rates in Alberta, Canada. A population-based, retrospective, cohort study was conducted from March 15, 2015 to December 31, 2020 using provincial data. The primary exposure was the COVID-19 lockdown period, and the primary outcome was the incidence of preterm birth (<37 weeks gestational age). Multivariable analyses in the complete lockdown and overall lockdown (partial and complete lockdown) periods were performed to test the association between the year of birth and preterm birth status and were adjusted for various independent variables. Preterm birth status was adjusted for various confounding factors. Following the analysis of n = 41,187 mothers and their singleton infants, we found that the lockdown due to COVID-19 had no impact in reducing the overall preterm birth rate. However, a paradoxical influence was observed with an increase of extremely low preterm births in the overall lockdown period, and a decrease in moderate preterm births during the complete lockdown period. The results of this study demonstrated that there was a decrease in moderate and increase in extremely low preterm birth rates as a result of the COVID-19 lockdown. However, the COVID-19 lockdown did not impact the very preterm and late preterm birth rate in Alberta.

COVID-19 lockdown related to decrease in premature birth rate and increase in birth weight in metropolitan France.

The worldwide rate of preterm birth (PTB) has been increasing over the last two decades. COVID-19 lockdowns provide a unique opportunity to assess the effects of socioenvironmental and lifestyle factors on premature birth and birth weight. We explored the effects of COVID-19 lockdowns on the PTB rate and birth weight at a nationwide scale in France until one year after their occurrence. This national retrospective observational study evaluated the rate of PTB and birth weight in France from January 2016 to December 2020. Data were obtained from the national Programme Médicalisé des Systèmes d'Information database. The rates of global and sub-categories of PTB were tested. The birth weight was studied before and after lockdown for all live births, for term and premature neonates, and for each category of low birth weight (LBW) by a stratified analysis. Data from 2,949,372 births from January 2016 to December 2019, including 228,857 PTB, were compared to those of 699,344 births and 51,886 PTB from January to December 2020. The national rate of PTB decreased significantly from 7.7% to 7.3%, when compared with the 2016-2019 period. This decrease was persistent up to 9 months later. It was observed only for moderate PTB, whereas very PTB and extremely PTB remained stable. The national mean birth weight for full-term babies increased after the lockdown and was still observable up to 8 months later (+0.16%, p < 0.0001). The proportion of children with LBW also decreased 2 months after lockdown (-0.15%; p = 0.02). For VLBW, the difference only appeared over the 6-month post-lockdown period (-0.06%; p = 0.006). This nationwide study shows a significant reduction in prematurity and a significant increase in birth weight in France after the lockdown for a period of time not limited to the lockdown itself. A more in-depth study of the factors determining these variations may help to drive PTB prevention policies.

Low-Dose Aspirin Use in Pregnancy and the Risk of Preterm Birth: A Swedish Register-Based Cohort Study

ABSTRACT Evidence has shown that low-dose aspirin can reduce the risk of preeclampsia in women with risk factors; more recent evidence has shown that aspirin may also be useful for the prevention of spontaneous preterm birth, even among women without risk factors for preeclampsia. However, there are fewer studies examining the effectiveness of low-dose aspirin in this population, and the studies that have been done have generally been statistically underpowered. This study was meant to address this limitation in a large population of women who had previously experienced preterm birth, assessing whether low-dose aspirin treatment was associated with a lower risk for preterm birth. This study was a register-based cohort study performed using several different Swedish registries. The sample included all women with a first and second singleton birth between 2006 and 2019 and with a preterm birth in the first pregnancy. The primary outcome assessed was preterm birth during the second pregnancy, and secondary outcomes included assessment of preterm birth by severity (moderate preterm was between 32 and 36 weeks' gestation, and severe preterm was less than 32 weeks' gestation) and onset (spontaneous or medically indicated). The variable of interest was low-dose aspirin exposure or at least 1 dispensed prescription of 75 to 160 mg aspirin. The analysis included 22,127 women with a preterm birth in their first pregnancy followed by a second recorded pregnancy. Of this sample, 3057 (14%) were prescribed low-dose aspirin during their second pregnancy. Recurrent preterm birth occurred in 3703 individuals, of whom 547 (15%) had used low-dose aspirin. After adjusting for confounding variables, the incidence of preterm birth was lower in those using low-dose aspirin, with a marginal relative risk (mRR) of 0.87 (95% confidence interval [CI], 0.77–0.99). However, there was no difference in risk for moderate or severe preterm birth (moderate group: mRR, 0.90 [95% CI, 0.78–1.03]; severe group: mRR, 0.75 [95% CI, 0.54–1.04]). In adjusted analyses, there were no statistically significant differences for either medically indicated or spontaneous preterm birth between individuals who used low-dose aspirin and those who did not. The study was limited by its retrospective nature. In addition, the authors acknowledge that a dispensed prescription for aspirin does not necessarily equate to consistent intake of low-dose aspirin throughout a pregnancy. In addition, the population for this study was limited to those who had already experienced a preterm birth, which could affect the generalizability of the results. Although limited differences were found, a small protective effect could not be ruled out, and randomized controlled trials to understand more fully the effect low-dose aspirin might have on preterm birth would be helpful. Further research should also focus on whether the benefits of aspirin use during pregnancy outweigh the potential risks, as well as what the lowest effective dose might be.

O-275 Becoming parents after hematopoietic stem cells transplantation: obstetrics outcomes of spontaneous pregnancies

Abstract Study question Are spontaneous pregnancies after hematopoietic stem cells transplantation (HSCT) of one of the two partners burdened with an increased risk of obstetric complications? Summary answer We found a higher risk of Intrauterine growth restriction (IUGR) and preterm delivery after both maternal and paternal HSCT and of pre-eclampsia after maternal HSCT. What is known already Conditioning therapies for HSCT are highly gonadotoxic and result in permanent amenorrhea or azoospermia in 70% of patients. Small cohorts of pregnancies after HSCT show an increased risk of complications such as dysfunctional placentation, IUGR or preterm birth. With no more than 9% of survivors reporting a spontaneous pregnancy and the others using of cryopreserved material or gametes donation, it is difficult to untangle the effect of assisted reproduction techniques, gametes donation, radiation on the uterus, and HSCT itself. Study design, size, duration This is a retrospective analysis of all spontaneous pregnancies among patients who underwent HSCT for haematological malignancies in a single national referral centre between 1990 and 2016. Obstetric and neonatal outcomes are reported to be compared to the expected incidence in the general population. All patients signed a general informed consent for the use of their anonymized data for research and we obtained the local ethics committee approval. Participants/materials, setting, methods We collected the outcome of 53 pregnancies in 30 women after HSCT and 33 pregnancies from 22 men after HSCT. The malignancies treated with HSCT were leukaemia (15 females and 14 males), severe aplastic anaemia (12 and 10), Hodgkin’s lymphoma (2 and 1) and myelofibrosis (1 and 1). The conditioning regimen included total body irradiation (TBI) in 20 women (66.7%) and 8 men (36.4%). All patients we included conceived spontaneously after HSCT. Main results and the role of chance We observed 53 pregnancies (52 singletons and 1 monochorionic diamniotic twin pregnancy) in women, 12±5.3 years after HSCT. Nine (16.9%) resulted in an early miscarriage. Of the other 44, 15 (34.1%) were uneventful and resulted in a healthy baby born at term. We observed 10 (22.7%) preterm deliveries: 4 very preterm births (1 at 29 and 3 at 31 weeks; 2 spontaneous 2 iatrogenic for pre-eclampsia); 5 moderate preterm births (32 weeks; 4 spontaneous and 1 iatrogenic for pre-eclampsia); 1 late preterm birth (36 weeks, iatrogenic for pre-eclampsia). The incidence of hypertensive disorders in all pregnancies was high (10, 22.7%). In 9 pregnancies (20.5%) there was evidence of IUGR, one of which resulted in an intrauterine foetal death at 35 weeks of gestation. Half of the patients delivered through caesarean section (20, 45.5%). We also reported 33 pregnancies fathered by 22 men who underwent HSCT 7.3±4.3 years earlier. Two pregnancies (6.1%) ended in an early miscarriage. Sixteen of the other 31 pregnancies (51.6%) were uneventful. In 12 cases (38.7%) there was evidence of IUGR, leading to 5 iatrogenic preterm births (16.1%). No maternal hypertensive disorder of pregnancy was reported. Limitations, reasons for caution While this is, as far as we know, the largest cohort of spontaneous pregnancies after HSCT present in the literature, the numerosity is still low and we cannot exclude larger numbers would have produced different results. Wider implications of the findings HSCT has consequences on reproduction, behind infertility. Pregnancies after HSCT should be followed in a high-risk setting, collecting data collaboratively. The next research effort should be focused on understanding the specific action of the different conditioning therapies used in females and males, to unveil the biological rationale behind these findings. Trial registration number not applicable

Does recurrent gestational diabetes mellitus increase the risk of preterm birth? A population-based cohort study

AimsTo investigate whether recurrent gestational diabetes mellitus (GDM) is associated with an increased risk of preterm birth. MethodsWe conducted a prospective population-based cohort study covering all live singleton births born to nulliparous and multiparous mothers aged 20 years and older in Qingdao, from 2018 to 2020 (n = 105,528). Preterm birth (<37 gestational weeks) was classified into moderate preterm birth (32–36 weeks of gestation) and very preterm birth (<32 weeks). Logistic regression analysis was performed to estimate the risk and severity of prematurity in relation to parity among mothers with previous GDM, current GDM, and recurrent GDM (previous and current GDM), using mothers without GDM as the reference group. Z-test and ratio of odds ratios (ROR) were used to determine subgroup differences. ResultsMaternal GDM increased the risk of preterm birth in both nullipara (ORadj = 1.28, 95 %CI: 1.14–1.45) and multipara (ORadj = 1.26, 95 %CI: 1.14–1.40). However, the risk of premature delivery in multiparous mothers with recurrent GDM and those with current GDM did not differ significantly, with a ROR of 0.89 (95 %CI: 0.71–1.12). The risk of recurrent GDM on preterm birth was most pronounced among multiparous mothers with pre-pregnancy BMI above 30 kg/m2 (ORadj = 2.18, 95 %CI: 1.25–3.82) as compared with those with current GDM alone (ROR = 2.20, 95 %CI: 1.07–4.52). The risk of GDM for moderate preterm birth was similar to that of overall preterm birth. In contrast, GDM was not associated with very preterm birth irrespective of parity (all P values > 0.05). ConclusionsMaternal GDM increased the risk of preterm birth in nullipara and multipara, whereas recurrent GDM was not associated with a further increase in the risk of prematurity in multiparous mothers. Maternal GDM did not contribute to very preterm birth irrespective of parity. Our findings can be useful for facilitating more targeted preventive strategies for adverse pregnancy outcomes.

Association between very advanced maternal age women with gestational diabetes mellitus and the risks of adverse infant outcomes: a cohort study from the NVSS 2014–2019

BackgroundTo evaluate the association between gestational diabetes mellitus (GDM) and infant outcomes in women of very advanced maternal age (vAMA) (≥45 years).MethodsThis cohort study utilized data from the National Vital Statistics System (NVSS) database (2014–2019) in the United States. Preterm birth was the primary outcome, which was subdivided into extremely preterm, very preterm, and moderate or late preterm. The secondary outcomes were neonatal intensive care unit (NICU) admission, low birthweight and small for gestational age. Univariate and multivariate logistic regression analyses were used to explore the association between GDM and infant outcomes among vAMA women. Subgroup analyses were performed based on race and use of infertility treatment. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated.ResultsA total of 52,544 vAMA pregnant women were included. All analysis made comparisons between women with vAMA and GDM and women with vAMA and no GDM. Women with GDM had a significantly higher risk of preterm birth than those without GDM (OR = 1.26, 95%CI = 1.18–1.36, P < 0.001). Compared with women without GDM, those with GDM had a significantly increased risk of moderate or late preterm birth (OR = 1.27, 95%CI = 1.18–1.37, P < 0.001); no significant association of GDM with extremely preterm birth and very preterm birth was observed. Women with GDM had a significantly greater risk of NICU admission than those without (OR = 1.33, 95%CI = 1.23–1.43, P < 0.001). GDM was associated with a significantly lower risk of low birthweight (OR = 0.91, 95%CI = 0.84–0.98, P = 0.010), and no significant association was found between GDM and small for gestational age (OR = 0.95, 95%CI = 0.87–1.03, P = 0.200) in vAMA women.ConclusionvAMA women with GDM had an increased risk of preterm birth, especially moderate or late preterm birth. NICU admission and low birthweight were also associated with GDM among vAMA women.

Extreme, moderate, late, and overall preterm birth by maternal race, ethnicity and nativity in US

Assess associations of maternal race, ethnicity and nativity (i.e. birthplace) with PTB both overall (<37 weeks) and stratified into late (34-<37 weeks), moderate (29-<34 weeks), and extremely preterm (< 29 weeks). This retrospective cohort study used restricted US National Vital Statistics data of singleton births from 2014-2018 (N=18,501,156). Individuals were grouped into 14 mutually exclusive categories that accounted for their intersectional race, ethnicity and nativity. For example, US-born non-Hispanic White (US-NHW) and foreign-born Hispanic Black (FB-HB). American Indian/Alaskan Native and Pacific Islander/Native Hawaiian individuals were grouped into an Indigenous category. Logistic regression models calculated the odds of PTB for each category and multinomial logistic regression models calculated the odds of PTB per category, with US-NHW as the reference. We adjusted for sociodemographic and medical comorbidities and ran Bonferroni-corrected pairwise comparisons. Adjusted predicted rates were calculated for each strata of PTB using predictive margins from regression models. All foreign-born individuals had lower rates of PTB overall and each category of PTB than their US-born counterparts, except for Indigenous individuals who had higher odds of PTB compared to US-born counterparts (Table 1, aOR 1.23, 95% CI 1.18-1.27). US-Born NHB (12.6%) and FB-Indigenous individuals (12.5%) had the highest adjusted predicted rates of PTB (Figure 1). Compared to the US-NHW population, all groups had significantly higher adjusted odds of PTB, except for the FB-NHW population. FB-HB individuals had lower odds of PTB than all US-born groups except for NHW individuals, but higher than FB-HW individuals. NHW individuals continue to have the lowest rates of PTB overall and each strata, regardless of nativity. Indigenous peoples’ risk of PTB is critical to study given high rates and sparse literature exploring their birth outcomes. The intersection of nativity and ethnicity may be protective for Hispanic Black populations, but racial disparities persist within immigrant groups.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

The single pregnancy predicting model of 1 minute Apgar score less than 7 after preterm birth: A retrospective study.

Preterm delivery is greatly associated with perinatal mortality and morbidity, while there is no objective way to identify high-risk newborns currently. This study aimed at discovering the risk factor for Apgar score less than 7 at 1 minute of preterm neonates born with vaginal delivery. A retrospective study was performed in single pregnancy women with a vaginal delivery before 37 weeks of gestation. All the preterm infants were categorized into three types: very preterm birth (28 to 32 weeks), moderate preterm birth (32 to 34 weeks) and late preterm birth (34 to 37 weeks). Risk factors were identified through logistic regression analysis in every category of newborns mentioned above. And the receiver operating characteristic analysis was used in continuous variables to determine the best threshold of the outcome. On the basis of the selected factors, the predicting models are created and its prognosticating ability is compared by the area under the curve. A nomogram was established for the proved best model. A total of 981 cases were investigated, of whom 55 were found with 1 min Apgar scores less than 7. The nomogram was set for the predicting model with larger area under the receiver operating characteristic curve, of which is 0.742(95% confidence interval = 0.670-0.805) in very preterm birth, with the variables of first and second labor stage(> = 1.6 hours), birthweight and MgSO4(magnesium sulfate), and is 0.807(95% confidence interval = 0.776-0.837) in late preterm birth, with the variables of second labor stage(> = 1.23 hours), birthweight, a history of previous cesarean delivery, fetal distress and placental abruption. The combination of first and second labor stage, newborn weight and MgSO4 use can predict 74.2% of 1 minute Apgar score < 7 in very preterm neonates. And 80.7% high-risk infants can be identified when second labor stage, newborn weight, VBAC (vaginal birth after cesarean) and the occur of placental abruption and fetal distress were combined in the predicting model for late preterm birth. These predicting models would bring out great assistance towards obstetricians and reduce unnecessary adverse fetal outcomes.