Odds Of Preterm Delivery Research Articles

Risks of Placental Abruption and Preterm Delivery in Patients Undergoing Assisted Reproduction

Patients using assisted reproductive technology (ART) may need additional counseling about the increased risks of placental abruption and preterm delivery. Further investigation into the potential additive risk of ART and placental abruption is needed. To ascertain the risk of placental abruption in patients who conceived with ART and to evaluate if placental abruption and ART conception are associated with an increased risk of preterm delivery (<37 weeks' gestation) over and above the risks conferred by each factor alone. This cross-sectional study used data from the National Inpatient Sample, which includes data from all-payer hospital inpatient discharges from 48 states across the US. Participants included women aged 15 to 54 years who delivered from 2000 through 2019. Data were analyzed from January 17 to April 18, 2024. Pregnancies conceived with ART. Risks of placental abruption and preterm delivery in ART conception compared with spontaneous conceptions. Associations were expressed as odds ratios (ORs) and 95% CIs derived from weighted logistic regression models before and after adjusting for confounders. The relative excess risk due to interaction (RERI) of the risk of preterm delivery based on ART conception and placental abruption was also assessed. Of 78 901 058 deliveries, the mean (SD) maternal age was 27.9 (6.0) years, and 9 212 117 patients (11.7%) were Black individuals, 14 878 539 (18.9%) were Hispanic individuals, 34 899 594 (44.2%) were White individuals, and 19 910 807 (25.2%) were individuals of other races and ethnicities. Of the total hospital deliveries, 98.2% were singleton pregnancies, 68.8% were vaginal deliveries, and 52.1% were covered by private insurance. The risks of placental abruption among spontaneous and ART conceptions were 11 and 17 per 1000 hospital discharges, respectively. After adjusting for confounders, the adjusted OR (AOR) of placental abruption was 1.42 (95% CI, 1.34-1.51) in ART pregnancies compared with spontaneous conceptions, with increased odds in White women (AOR, 1.42; 95% CI, 1.31-1.53) compared with Black women (AOR, 1.16; 95% CI, 0.93-1.44). The odds of preterm delivery were significantly higher in pregnancies conceived by ART compared with spontaneous conceptions (AOR, 1.46; 95% CI, 1.42-1.51). The risk of preterm delivery increased when patients had both ART conception and placental abruption (RERI, 2.0; 95% CI, 0.5-3.5). In this cross-sectional study, patients who conceived using ART and developed placental abruption had a greater risk of preterm delivery compared with spontaneous conception without placental abruption. These findings have implications for counseling patients who seek infertility treatment and obstetrical management of ART pregnancies.

ECD - Pregnancy outcomes of a birth cohort. Are adolescent mothers really at more risk?

ABSTRACT This sub-study within the JAKIDS longitudinal cohort study compares medical and psychosocial outcomes of pregnancy in younger adolescent mothers (<16 years), older adolescent mothers (16–19 years) and adult mothers (>19 years) in Jamaica. Participants were recruited from July to September 2011 and included 9521 mother–infant dyads; mean maternal age 26.0 years (SD 6.8). Adolescent mothers represented 19.1% (n = 1822) of the sample – 1704 older adolescent mothers (17.9%) and 118 younger adolescent mothers (1.2%). Participants completed interviewer-administered questionnaires regarding their sexual and reproductive health history, feelings about the current pregnancy, and presence of anxious and depressive symptoms. Data on delivery and perinatal and neonatal outcomes were extracted from hospital charts. Younger adolescent mothers were more likely to deliver preterm (p < 0.001) and low birth weight infants (p < 0.001) than older adolescent and adult mothers. Younger adolescent mothers had lower levels of antenatal anxiety regarding the pregnancy and its outcome (p < 0.001) while prevalence of elevated depressive symptoms antenatally (EPDS ≥11) was similar across age groups. Older adolescent mothers with significant depressive symptoms had increased odds of preterm delivery. These findings call for close antenatal monitoring of younger adolescent mothers and highlight the need for psychological services for all mothers.

Autoimmune Hepatitis and Obstetrical Outcomes: A Nationwide Assessment.

Previous research identified AIH as linked to unfavorable obstetrical outcomes in a US nationwide retrospective study from 2012-2016. Our aim is to update the literature and strengthen the AIH-pregnancy outcomes relationship. Using the National Inpatient Sample database in the US, from 2016 to 2020, we compared pregnant females with a diagnosis of AIH to those with and without other chronic liver diseases (CLD), using ICD-10-CM codes. Baseline characteristics were analyzed using T-test and Chi-Square, and multivariate regression was used to estimate the differences in maternal outcomes adjusted for age, race, insurance status, geographical location, hospital characteristics, and comorbid conditions. Out of 19,392,328 hospitalizations for pregnant females ≥ 18years old from 2016 to 2020, 1095 had AIH, 179,655 had CLD, and 19,206,696 had no CLD. No mortality was observed among individuals with AIH. When compared to individuals without CLD, AIH was associated with an82% increase in the odds of preterm delivery (AIH: 8% vs. Without CLD: 5%, adjusted Odds Ratio = 1.82, 95% CI 1.06-3.14), with no significant differences in gestational diabetes mellitus, hypertensive complications, and postpartum hemorrhage, and a 0.6day longer hospital stay. Furthermore, there were no significant differences in outcomes between AIH and CLD. Our study reinforces the association of AIH with adverse obstetrical outcomes (e.g., preterm delivery), however, we found that there is no difference in GDM and hypertensive complications, as suggested in prior studies. Therefore, further investigations are needed to clarify the association between AIH and these obstetrical complications.

Mother's age at menarche is associated with odds of preterm delivery: A case-control study.

There is a secular trend towards earlier age of menarche in the US and globally. Earlier age at menarche (AAM) has been associated with metabolic disorders that increase risk for preterm delivery (PTD), yet no studies in the US have investigated whether AAM influences risk of PTD. This study tested the hypothesis that AAM is associated with PTD. A case-control study. The Boston Medical Center (BMC) in Boston, Massachusetts. 8264 mother-newborn dyads enrolled at birth at BMC between 1998 and 2019, of which 2242 mothers had PTD (cases) and 6022 did not have PTD (controls). Multivariable-adjusted logistic regression models and restricted cubic splines were used to examine the association between AAM and risk of PTD. The combined impact of AAM and age at delivery on the risk of PTD was also examined. Preterm delivery and gestational age (GA) was defined by maternal last menstrual period and early ultrasound documented in medical records. Maternal age at delivery was 28.1 ± 6.5 years and AAM was 12.85 ± 1.86 years. Multivariable-adjusted cubic spline suggested an inverse dose-response association of AAM with odds of PTD and, consistently, a positive association with GA. A 1-year earlier AAM was associated with 5% (95% CI 2%-8%) higher odds of PTD, after adjustment for maternal year of birth, parity, maternal place of birth, education, smoking status and Mediterranean-style diet score. The association between AAM and PTD was stronger among older mothers whose age at delivery was ≥35 years. Earlier AAM is associated with higher odds for PTD, and this association is stronger among women at advanced reproductive age.

S881 Impact of Inflammatory Bowel Disease on Maternal and Fetal Outcomes

Introduction: Inflammatory bowel disease is a disease of young age and incidence is highest during the reproductive years and current estimates are that only one quarter of female IBD patients will conceive. Due to increased incidence of IBD during reproductive years, many studies are performed to assess the impact of IBD on fertility and pregnancy outcomes, but the results from these studies are conflicting. The aim of our study was to assess the burden of adverse maternal and fetal outcomes in IBD patients. Methods: Using National inpatient sample (NIS) database from 2016 to 2018.All patients above age 15 with diagnosis of pregnancy including live or still birth after 20 weeks of gestation with a secondary diagnosis of Ulcerative colitis or Crohn Disease were included in the study. Maternal outcomes of interest were gestational diabetes (GDM), Gestational hypertension and its complications including Pre-eclampsia, Eclampsia and HELLP syndrome and Postpartum hemorrhage. Fetal outcomes studied were fetal growth restriction (FGR), large for gestational age infants (LGA), preterm birth and fetal death. Subgroup analysis was performed on UC and CD patients.The secondary outcomes were length of stay, maternal death, total hospital charges. Results: Multivariable logistic regression analysis was conducted after adjusting for patient and hospital level confounders. Pregnant ladies with IBD had more odds of GDM (AOR 1.55 95% CI 1.04-2.3, P-value 0.02), Gestational hypertension associated complications (AOR 1.35 95% CI 1.06-1.72, P-value 0.01) and postpartum hemorrhage (AOR 1.04 95% CI 0.84-1.29, P-value 0.68). Pregnancies with co-existent IBD lead to FGR (AOR 1.27 95%CI 1-1.63, P-value 0.05), as well more odds of pre-term delivery (< 37 weeks) and LGA infants (AOR, 1.41 95% CI 1.13-1.76 P-value 0.003, AOR 1.05 95% CI 0.79-1.40 P-value 0.69 respectively). IBD was also associated with higher odds of fetal death (AOR 3.21 95% CI 1.72-6.00 P-value < 0.01). Similar results were seen on subgroup analysis of UC and CD. Conclusion: Patients with IBD, CD and UC has worse maternal and fetal outcomes as well increased resource utilization. As IBD is disease of young population and majority of the patients are diagnosed in their 20s and 30s which coincides with the peak fertility period, and it is seen that woman with IBD voluntarily avoid pregnancy due to fear of worse outcomes. We suggest that women who have moderate to severe disease should get pre-conceptional counselling and treated aggressively to obtain remission.Table 1.: Maternal and Fetal outcomes in Inflammatory bowel disease , Ulcerative Colitis and Crohn Disease, Adjusted Analysis.

Using principal component analysis to examine associations of early pregnancy inflammatory biomarker profiles and adverse birth outcomes

Inflammation as a risk factor for preterm birth is well-established. The primary objective of this analysis was to examine whether individual cytokines versus a composite indicator of mid-pregnancy inflammation are significantly associated with risk for adverse birth outcomes. A multi-site prospective study was conducted in a socio-demographically diverse cohort of 610 pregnant participants. At a study visit between 12 and 20 6/7 weeks' gestation, low-grade inflammation was measured via log-transformed serum concentrations of the biomarkers IFN-γ, IL-10, IL-13, IL-6, IL-8, TNF-α, and CRP. Principal component analysis (PCA) was used to identify underlying dimensions of inflammatory activity from the seven biomarkers measured. Gestational age and birth weight at delivery were obtained from medical chart review. The associations between inflammatory profiles and birth outcomes were assessed via linear and logistic regression models. Results were compared with those from individual inflammatory biomarkers, and model fit was assessed using Akaike's Information Criterion (AIC). Principal component analysis analysis yielded a two-factor solution, with the first factor (IF1) composed of IL-8, IL-10, IL-13, IFN-ɣ, and TNF-α, and the second factor (IF2) containing IL-6 and CRP. When adjusted for race, education, BMI, smoking status, gestational age at time of blood draw, and study site, a one standard deviation (SD) increase in IF1 remained significantly associated with a decrease in standardized gestational age (β=-.13, 95% CI: -.21, -.05) and an increase in odds of preterm delivery (OR=1.46, 95% CI: 1.13, 1.88) (Table 3). A one SD increase in IF2 was similarly associated with a decrease in standardized gestational age at delivery (β=-.13, 95% CI: -.23, -.04) and an increase in odds of preterm delivery (OR: 1.46, 95% CI: 1.04, 2.05). Neither IF1 nor IF2 was associated with measures of fetal growth. AIC identified that IL-6 was a slightly better fit for length of gestation compared to either composite measure, though all performed similarly. Independent of known sociodemographic risk factors, an elevated mid-pregnancy inflammatory profile was associated with a nearly 50% increase in odds of preterm delivery. The composite performed similarly to IL-6. These results suggest that maternal low-grade inflammation is a risk factor for preterm delivery, and that mid-pregnancy inflammatory biomarkers may be useful in predicting risk for preterm delivery.

Preterm delivery risk in infertile women who conceived after reproductive surgery: natural conception versus IVF/ICSI.

Is preterm delivery an infertility treatment-related adverse outcome in infertile women who conceived after reproductive surgery? Compared with matched fertile women, preterm delivery appears to be a modest infertility treatment-related adverse outcome in infertile women who have reproductive surgery then conceived naturally or after IVF/ICSI. Most observational studies have shown that women who receive any infertility treatment are more likely to deliver preterm than do fertile women. However, studies on the outcome of pregnancies in infertile women who conceive naturally after reproductive surgery are scarce. This was a single-centre historical two-part study: cohort and matched cohort study. Anonymized data of 761 infertile women who conceived after reproductive surgery and 758 fertile women were obtained by linking three computerized databases from 1 July 2012 to 31 December 2015. In the cohort study, we evaluated the association between the mode of conception and preterm delivery <37 and <32 gestational weeks in 703 infertile women, with a singleton pregnancy who conceived after reproductive surgery, using logistic regression adjusted for relevant co-variates to calculate the adjusted odds ratio with a 95% CI. In the matched cohort study, we evaluated preterm delivery as infertility treatment-related adverse outcome using the propensity score (PS) method. The matched cohort comprised 758 infertile women and 758 fertile women with a twin or singleton pregnancy. Infertile women conceived after reproductive surgery either naturally or through IVF/ICSI. Infertile and fertile women were matched using PS matching. Infertile and fertile women were matched for pre-defined risk factors for preterm delivery. Three infertile women out of an original 761 were not included in the analysis because they lacked all required matching variables. We performed a 1:1 matching with an optimal matching algorithm with a caliper width of the linear predictor of 0.1 standard deviations. The effect of reproductive surgery on preterm delivery was evaluated in the PS-matched sample using Pearson's χ2 test and presented as the odds ratio (OR) with 95% CI. All women delivered at the Department of Perinatology, University Medical Centre Ljubljana, Slovenia. Among 761 infertile women who conceived after reproductive surgery, 428 (56.2%) women conceived naturally and 333 (43.8%) conceived after IVF/ICSI. The incidence of twin pregnancies was significantly lower after natural conception (2.6% vs 14.1%). Among the 703 infertile women with a singleton pregnancy, 417 (59.3%) conceived naturally and 286 (40.7%) conceived after IVF/ICSI. Adjusted for maternal age and parity in infertile women with singleton pregnancies, IVF/ICSI showed a moderate association with preterm delivery <32 weeks. Compared with natural conception after reproductive surgery, the odds for preterm delivery after IVF/ICSI was 1.07 (95% CI 0.63-1.81) <37 weeks and 2.25 (95% CI 0.80-6.34) <32 weeks. Preterm delivery appears to be a modest infertility treatment-related adverse outcome. Compared with fertile women in the PS-matched sample, infertile women who conceived after reproductive surgery either naturally or after IVF/ICSI the odds of preterm delivery <37 weeks were 1.31 (95% CI 0.97-1.78) and odds of preterm delivery <32 weeks were 1.57 (95% CI 0.78-3.18). However, none of the estimations were statistically significant. The main limitations of the study were the retrospective design, the heterogeneity of the types of reproductive surgery performed and underlying reproductive pathologies. The low number of preterm deliveries in the present study might influence the precision of estimations. The present study aims to alter the prevailing opinion that reproductive surgery should only be considered preceding IVF to increase implantation and pregnancy rates after IVF. It implies that in selected infertile women who have had reproductive surgery, a high rate of natural conception, a low rate of multiple pregnancies, and a modest infertility treatment-related effect on preterm delivery should be the reasons to encourage natural conception after reproductive surgery. Furthermore, by allowing for natural conception, we can avoid a high-cost invasive medical procedure. The study received no funding. We have no competing interest to declare. N/A.

Systematic Review and Meta-Analysis of Surgical Interventions of Adnexal Masses in Pregnancy

Study Objective To compare maternal and fetal outcomes in laparoscopy versus laparotomy in the surgical management of adnexal masses in pregnancy. Design Systematic Review and Meta-Analysis. 8027 titles and abstracts were screened, followed by 691 full articles. Ten retrospective studies were included in the meta-analysis. Setting N/A Patients or Participants N/A Interventions N/A Measurements and Main Results 287 women underwent laparoscopy and 496 underwent laparotomy. The median age undergoing laparoscopy versus laparotomy was similar (27.7 years and 27.3 years, respectively, p=0.80), as was the mean gestational age at time of surgery (16.0 weeks in laparoscopy and 15.6 weeks in laparotomy, p=0.59). The median size of the mass was 7.8 cm in laparoscopy and 9.1 cm in laparotomy (p=0.07). The most common pathology was dermoid (36%) and the overall risk of malignancy was 1%. Women undergoing laparoscopy were less likely to have a preterm delivery (OR 0.72 [0.33, 1.45]). However, laparoscopy was more likely to result in spontaneous abortion (OR 1.67 [0.67, 4.33]). Operative time was increased by 12.6 minutes in laparoscopy as compared to laparotomy (median 76.6 minutes vs 64.0 minutes, p=0.05). The Estimated blood loss (EBL) was lower in laparoscopy by 26.6 mL (median 48.9 mL for laparoscopy versus 75.5 mL for laparotomy, p=0.05). The median length of hospital stay (LOS) was 2.8 days for those undergoing laparoscopy versus 5.8 days for laparotomy (p Conclusion Laparoscopy for the surgical management of adnexal masses is associated with a lower EBL and reduced LOS. There is no statistically significant difference in the odds of preterm delivery or spontaneous abortion in laparoscopy as compared to laparotomy. Additional surgical complications and fetal outcomes of interest were not compared due to heterogeneity of the included articles. Laparoscopy is a safe alternative to laparotomy for the surgical management of adnexal masses in pregnancy.

The Impact of Occupational Activities During Pregnancy on Pregnancy Outcomes: A Systematic Review and Metaanalysis

Abstract Backgroud An increasing number of studies suggest that exposure to physically demanding work during pregnancy could be associated with increased risks of adverse pregnancy outcomes, but the results remain conflicted and inconclusive. Objective To examine the influence of occupational activities during pregnancy on maternal and fetal health outcomes. Data sources Five electronic databases and three gray literature sources were searched up to March 15, 2019. Methods Of Study Selection Studies of all designs (except case studies and reviews) were included, which contained information on the relevant population (women who engaged in paid work during pregnancy), occupational exposures (heavy lifting, prolonged standing, prolonged walking, prolonged bending, and heavy physical workload), comparator (no exposure to the listed physical work demands), and outcomes (preterm birth, low birth weight, small for gestational age, miscarriage, gestational hypertension, pre-eclampsia, gestational diabetes mellitus, stillbirth, and intrauterine growth restriction). Tabulation, Integration, And Results Eighty observational studies (N=853,149) were included. ‘Low’ to ‘very low’ certainty evidence revealed that lifting objects ≥ 11 kilograms (kg) was associated with an increased odds ratio (OR) of miscarriage (OR: 1.31, 95% CI: 1.08 to 1.58, I2=79%), and pre-eclampsia (OR: 1.35, 95% CI: 1.07 to 1.71, I2=0%). Lifting objects for a combined weight of > 100kg per day was associated with an increased odds of preterm delivery (OR: 1.31, 95% CI: 1.11 to 1.56, I2=0%) and having a low-birth-weight neonate (OR: 2.08, 95% CI: 1.06 to 4.11, I2=73%). Prolonged standing was associated with increased odds of preterm delivery (OR: 1.11, 95% CI: 1.02 to 1.22, I2=30%), and having a small-for-gestational-age neonate (OR: 1.17, 95% CI: 1.01 to 1.35, I2=41%. A heavy physical workload was associated with increased odds of preterm delivery (OR: 1.23, 95% CI: 1.07 to 1.41, I2=32%), and having a low-birth-weight neonate (OR: 1.79, 95% CI: 1.11 to 2.87, I2=87%). All other associations were not statistically significant. Dose-response analysis showed women standing more than 2.5 hours per day (versus no standing) had a 10% increase in the odds of having a preterm delivery. Conclusion Physically demanding work during pregnancy is associated with an increased risk of adverse pregnancy outcomes.

Endometrial preparation before the transfer of single, vitrified-warmed, euploid blastocysts: does the duration of estradiol treatment influence clinical outcome?

To investigate whether the duration of estrogen administration before euploid embryo transfer affects clinical outcome. Retrospective cohort study. Private, academic fertility center. Patients (n = 1,439) undergoing autologous freeze-only invitro fertilization with preimplantation genetic testing (PGT) followed by endometrial preparation with estrogen and progesterone in a frozen, euploid blastocyst transfer cycle. None. Primary outcome was live birth, and secondary outcomes included implantation, clinical pregnancy, early pregnancy loss, live birth, infant birthweight, low birth weight, infant gestational age at delivery, and preterm birth. The duration of estrogen administration (mean: 17.5 ± 2.9days; range: 10-36days) before frozen embryo transfer did not impact implantation (odds ratio [OR] 0.99; 95% confidence interval [CI], 0.95-1.03), clinical pregnancy (OR 0.98; 95% CI, 0.94-1.01), early pregnancy loss (OR 1.03; 95% CI, 0.95-1.12), or live birth (OR 0.99; 95% CI, 0.95-1.03). The duration of estrogen exposure did not affect infant birthweight (in grams) (β= -10.65 ± 8.91) or the odds of low birth weight (OR 0.87; 95% CI, 0.68-1.13). For every additional day of estrogen administration, we observed a reduction in gestational age at delivery (in weeks) (β= -0.07 ± 0.03), but the odds of preterm delivery were not affected (OR 1.05; 95% CI, 0.95-1.17). Variation in the duration of estradiol supplementation before progesterone initiation does not impact frozen, euploid blastocyst transfer outcome. The duration of estrogen administration was inversely correlated with gestational age at delivery, but this did not translate into an increase in preterm delivery. Further studies are required on the downstream effects of endometrial preparation on the placental-endometrium interface.

Maternal dietary patterns during pregnancy and preterm delivery: a large prospective cohort study in China

BackgroundEvidence about the associations between maternal dietary patterns and preterm delivery is scarce in Eastern countries. The purpose of this study was to examine the associations between maternal dietary patterns during pregnancy and preterm delivery in a Chinese population.MethodsA total of 7352 mothers were included in the Born in Guangzhou Cohort Study, a prospective study in China. A validated self-administered food frequency questionnaire (FFQ) was used to assess maternal diet at 24–27 weeks of gestation. Dietary patterns were identified by cluster analysis. Gestational age was obtained from routine medical records. Preterm delivery was defined as delivery before 37 completed weeks of gestation, and was further classified into spontaneous and iatrogenic preterm delivery, and also early/moderate and late preterm delivery. Associations between dietary patterns and preterm delivery outcomes were assessed using logistic regression analyses.ResultsSix dietary patterns were identified, including ‘Milk’, ‘Cereals, eggs, and Cantonese soups’, ‘Meats’, ‘Fruits, nuts, and Cantonese desserts’, ‘Vegetables’, and ‘Varied’. There were 351 (4.8%) preterm deliveries in this study population. Among those of preterm delivery, 16.2 and 83.8% were early/moderate and late preterm delivery, respectively. Compared with women of ‘Vegetables’ pattern, those of ‘Milk’ pattern had greater odds of overall preterm delivery (adjusted odds ratio [OR] 1.59, 95% confidence interval [CI] 1.11, 2.29, p < 0.05), spontaneous preterm delivery (adjusted OR 1.73, 95% CI 1.14, 2.62, p < 0.05) and late preterm delivery (adjusted OR 1.73, 95% CI 1.08, 2.62, p < 0.05); those of ‘Cereals, eggs, and Cantonese soups’ and ‘Fruits, nuts, and Cantonese desserts’ patterns had greater odds of late preterm delivery (adjusted OR 1.54, 95% CI 1.01, 2.35 for ‘Cereals, eggs, and Cantonese soups’, adjusted OR 1.61, 95% CI 1.04, 2.50 for ‘Fruits, nuts, and Cantonese desserts’, respectively).ConclusionMaternal diet with frequent consumption of milk and less frequent consumption of vegetables during pregnancy might be associated with increased odds of preterm delivery. Future interventions should investigate whether increasing vegetable intake reduces preterm deliveries.

Factors associated with preterm delivery and low birth weight: a study from rural Maharashtra, India

Background: Although preterm delivery and low birth weight (LBW) have been studied in India, findings may not be generalisable to rural areas such as the Marathwada region of Maharashtra state. There is limited information available on maternal and child health indicators from this region. We aimed to present some local estimates of preterm delivery and LBW in the Osmanabad district of Marathwada and assess available maternal risk factors. Methods: The study used routinely collected data on all in-hospital births in the maternity department of Halo Medical Foundation’s hospital from 1 st January 2008 to 31 st December 2014. Multivariable logistic regression analysis provided odds ratios (OR) with 95% confidence intervals (CI) for preterm delivery and LBW according to each maternal risk factor. Results: We analysed 655 live births, of which 6.1% were preterm deliveries. Of the full term births (N=615), 13.8% were LBW (<2.5 kilograms at birth). The odds of preterm delivery were three times higher (OR=3.23, 95% CI 1.36 to 7.65) and the odds of LBW were double (OR=2.03, 95% CI 1.14 to 3.60) among women <22 years of age compared with older women. The odds of both preterm delivery and LBW were reduced in multigravida compared with primigravida women regardless of age. Anaemia (Hb<11g/dl), which was prevalent in 91% of women tested, was not significantly related to these birth outcomes. Conclusions: The odds of preterm delivery and LBW were much higher in mothers under 22 years of age in this rural Indian population. Future studies should explore other related risk factors and the reasons for poor birth outcomes in younger mothers in this population, to inform the design of appropriate public health policies that address this issue.

Factors associated with preterm delivery and low birth weight: a study from rural Maharashtra, India.

Background: Although preterm delivery and low birth weight (LBW) have been studied in India, findings may not be generalisable to rural areas such as the Marathwada region of Maharashtra state. There is limited information available on maternal and child health indicators from this region. We aimed to present some local estimates of preterm delivery and LBW in the Osmanabad district of Marathwada and assess available maternal risk factors. Methods: The study used routinely collected data on all in-hospital births in the maternity department of Halo Medical Foundation's hospital from 1 st January 2008 to 31 st December 2014. Multivariable logistic regression analysis provided odds ratios (OR) with 95% confidence intervals (CI) for preterm delivery and LBW according to each maternal risk factor. Results: We analysed 655 live births, of which 6.1% were preterm deliveries. Of the full term births (N=615), 13.8% were LBW (<2.5 kilograms at birth). The odds of preterm delivery were three times higher (OR=3.23, 95% CI 1.36 to 7.65) and the odds of LBW were double (OR=2.03, 95% CI 1.14 to 3.60) among women <22 years of age compared with older women. The odds of both preterm delivery and LBW were reduced in multigravida compared with primigravida women regardless of age. Anaemia (Hb<11g/dl), which was prevalent in 91% of women tested, was not significantly related to these birth outcomes. Conclusions: The odds of preterm delivery and LBW were much higher in mothers under 22 years of age in this rural Indian population. Future studies should explore other related risk factors and the reasons for poor birth outcomes in younger mothers in this population, to inform the design of appropriate public health policies that address this issue.

Association of methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism with preterm delivery and placental abruption: a systematic review and meta-analysis.

The aim of this study was to summarize evidence on the association between methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism and odds of preterm delivery and placental abruption. PubMed, EMBASE, CBM (Chinese Biomedical Database) and CNKI (Chinese National Knowledge Infrastructure) were searched to identify eligible studies published in English or Chinese before 12 August 2014. The pooled odds ratios (ORs) with 95% confidence intervals were estimated for the association of MTHFR C677T polymorphism with preterm delivery and placental abruption using random effects models. A total of 22 studies that met inclusion and exclusion criteria were included in this meta-analysis. Regardless of the genetic model tested we found no statistically significant association of MTHFR C677T polymorphism with preterm delivery or placental abruption. Funnel plots inspections, Begg's test and Egger's test did not show evidence of publication bias. This meta-analysis demonstrated that overall there was no association of MTHFR C677T polymorphism with preterm delivery or placental abruption.

Pregnancy outcomes after laparoscopic sleeve gastrectomy among obese patients

ObjectiveTo analyze pregnancy outcomes after laparoscopic sleeve gastrectomy (LSG) according to body mass index (BMI) at conception and the interval between LSG and pregnancy. MethodsIn a retrospective study, data were obtained for all women who became pregnant after LSG at a center in France between December 2001 and December 2011. Frequencies of perinatal events according to BMI at conception and the interval between LSG and pregnancy were compared. ResultsA total of 63 pregnancies occurring in 54 patients were included, among which 52 (83%) occurred after the first postoperative year and 26 (41%) in women who remained obese. Compared with women who were no longer obese at conception, women who were still obese delivered neonates of significantly lower gestational age at birth (P=0.02) and birth weight (P=0.001). Odds of preterm delivery were also increased (odds ratio 4.37, 95% confidence interval 1.17–16.27; P=0.03). Maternal and neonatal outcomes according to the interval between LSG and pregnancy did not differ significantly. ConclusionWomen who remain obese following LSG are at increased risk of adverse outcomes, including low gestational age at birth, low birth weight, and preterm delivery, and should be regarded as a risk group.

Obstetric outcomes in adolescent pregnancies: a racial/ethnic comparison

Objective: To examine obstetric outcomes for adolescents among the major US racial/ethnic groups.Methods: This is a retrospective cohort study of singleton births to nulliparous women aged 12 to 19 years from 1988 to 2008. The prevalence of preterm delivery, cesarean delivery, preeclampsia, gestational diabetes, low birth weight and low Apgar score were compared across African-American, Asian, Latina and White adolescents.Results: 1865 adolescents were included in the analysis. Differences between racial/ethnic groups for rates of preterm delivery, cesarean delivery and gestational diabetes were statistically significant at p < 0.05. African Americans had lower odds of preterm delivery (OR = 0.58, 95% CI [0.38–0.90]) and gestational diabetes (OR = 0.17, 95% CI [0.05–0.55]) than White adolescents. White adolescents had increased odds of cesarean delivery compared to African-American (OR = 0.69, 95% CI [0.48–0.98]), Latina (OR = 0.62, 95% CI [0.41–0.94]) and Asian adolescents (OR = 0.41, 95% CI [0.25–0.68]). Although not statistically significant, White adolescents also had higher odds of low Apgar score. In the multivariate analysis, non-White adolescents continued to have improved outcomes, except in the case of low birth weight.Conclusions: African-American, Asian and Latina adolescents may have similar or decreased risk of obstetric complications compared to White adolescents.

A case–control study of the risk of adverse perinatal outcomes due to tuberculosis during pregnancy

We conducted a case–control study at three main inner-city hospitals in Birmingham, UK between 2004 and 2006, to determine the risk of adverse perinatal outcomes in pregnant women with tuberculosis (TB) (n = 24), compared with healthy pregnant controls (n = 72). The incidence of TB was 62/100,000 pregnancies, with 54.2% cases having pulmonary TB (41.7% extra-pulmonary; 4.2% both). Infants of mothers with TB had a significantly lower mean birth weight compared with controls (2,735 g vs 3,135 g; p = 0.03). Mean birth weight was lower in pulmonary TB than in the extra-pulmonary TB. Multivariate analysis showed that low birth weight was associated with pre-term delivery (p < 0.001). We conclude that pregnant women with TB are at higher risk of low birth weight due to higher odds of pre-term delivery.

Human Immunodeficiency Virus Infection in Advanced Maternal Age Gravidas

Our study compares perinatal outcomes among HIV(+) versus HIV(-) advanced maternal aged (AMA) women. A retrospective cohort study of AMA deliveries from 2000 to 2009 was performed. HIV(+) (group A) women were compared to temporally matched HIV(-) (group B) women. Demographics, medical comorbidities, HIV treatment, and delivery data were collected. SAS was used for data analysis with p<0.05 considered significant. Seventy-one patients per study group were reviewed; for group A, the mean CD4 count near delivery was 507±363; 75% (34/45) had viral load ≤400 in the third trimester and 58% were on a protease inhibitor regimen. HIV(+) women had significantly higher preterm delivery (PTD) <37 weeks (A: 40.85%, B: 16.90%, p=0.0016). Logistic regression performed revealed that the odds of PTD was 2.83 (CI 1.22-6.54) for HIV(+) and 4.02 (CI 1.27-12.72) for drug use independent of other factors. The pathophysiology of PTD among HIV(+) AMA women warrants prospective examination to better define the causal relationship.

Innate immune system gene polymorphisms in maternal and child genotype and risk of preterm delivery

Objective. There is little information about the combination of genetic variability in pregnant women and their children in relation to the risk of preterm delivery (PTD). In a sub-cohort of 487 non-Hispanic white and 288 African-American mother/child pairs, the Pregnancy Outcomes and Community Health Study assessed 10 functional polymorphisms in 9 genes involved in innate immune function.Methods. Race-stratified weighted logistic regression models were used to calculate odds ratios for genotype and PTD/PTD subtypes. Polymorphisms significantly associated with PTD/PTD subtypes were tested for mother/child genotype interactions.Results. Three maternal polymorphisms (IL-1 receptor antagonist intron two repeat (IL-1RN), matrix metalloproteinase- −C1562T, and TNF receptor two M196R (TNFR2)) and three child polymorphisms (IL1-RN, tumor necrosis factor-alpha −G308A, and TNFR2) were associated with PTD, but associations varied by PTD subtype and race. Two interactions were detected for maternal and child genotype. Among non-Hispanic white women, the odds of PTD was higher when both mother and child carried the IL-1RN allele two (additive interaction p < 0.05). Among African-American women, the odds of PTD were higher when both mother and child carried the TNFR2 R allele (multiplicative interaction p < 0.05).Conclusion. These results highlight the importance of assessing both maternal and child genotype in relation to PTD risk.

Antiretroviral therapy in pregnancy: Balancing the risk of preterm delivery with prevention of mother-to-child HIV transmission

Highly active antiretroviral therapy (HAART) for pregnant HIV-positive women reduces the risk of mother-to-child transmission, but is associated with an increased risk of preterm delivery (<37 weeks gestation). We aimed to quantify the incremental risk-benefit ratio for HAART compared with zidovudine monotherapy with respect to these outcomes. Two-stage Monte Carlo simulation methods were used to estimate the risk-benefit ratio for HAART in pregnancy. Estimates of mother-to-child transmission and preterm delivery rates were obtained from UK and Ireland surveillance data collected through the National Study of HIV in Pregnancy and Childhood. At a population level, HAART was associated with a more than sevenfold reduction in mother-to-child transmission compared with zidovudine monotherapy (adjusted odds ratio [AOR] 0.13, 95% confidence interval [CI] 0.06-0.27), but with a 1.4-fold increased odds of preterm delivery (AOR 1.43, 95% CI 1.10-1.86) and twofold increased odds of severe preterm delivery (<32 weeks; AOR 2.06, 95% CI 1.09-3.88). The incremental risk-benefit ratio for HAART in pregnancy compared with monotherapy was 0.63 (95% simulation interval 0.06-1.96) additional preterm births and 0.23 (95% simulation interval -0.02-0.88) severe preterm births for each infection prevented. It is estimated that for every 100 HIV transmissions prevented through the use of HAART (rather than monotherapy), 63 additional preterm deliveries would occur, including 23 at <32 weeks gestation. Interpretation of these ratios is context-dependent and requires additional information about morbidity, mortality and costs associated with the outcomes.