Percentage Of Preterm Deliveries Research Articles

The effectiveness and safety of intrauterine infusion of autologous regulatory T cells (Tregs) in patients with recurrent pregnancy loss and low levels of endometrial FoxP3+ cells: A retrospective cohort study.

Regulatory T cells (Tregs) are a specialized type of T cells that help maintain immune tolerance and homeostasis. The potential of Tregs cell-based therapies in treating diseases has been demonstrated in several clinical trials, which have shown promising outcomes and high safety in autoimmune diseases, transplant rejection, and graft-versus-host disease. However, their effectiveness and safety in improving endometrial receptivity and reducing pregnancy loss in human reproduction are unknown. The study used a retrospective design and included patients with recurrent pregnancy loss (RPL) and lower levels of endometrial FoxP3+ Tregs. Patients in the Tregs group (n=33) received intrauterine Tregs infusion three times during the follicular phase, while the control group (n=28) did not receive any intrauterine infusion. The intrauterine infusion of autologous Tregs increased the levels of FoxP3+ Tregs and CD56+ NK cells. Patients in the Treg group had higher live birth rates and lower miscarriage rates, especially early miscarriage rates. However, the two groups had no differences in the implantation rate, clinical pregnancy rate, and percentage of preterm delivery. The findings suggest that intrauterine Tregs infusion may be a potential therapeutic approach for RPL. Further research in larger clinical trials is needed to confirm these findings.

Do Anti-SARS-CoV-2 Monoclonal Antibodies Have an Impact on Pregnancy Outcome? A Systematic Review and Meta-Analysis.

Monoclonal antibodies (mAbs) have been used as a rescue strategy for pregnant women affected by COVID-19. To explore its impact on maternal-fetal health, we included all observational studies reporting maternal, fetal, delivery and neonatal outcomes in women who underwent mAbs infusion for COVID-19. Primary outcome was the percentage of preterm delivery. We used meta-analyses of proportions to combine data for maternal, fetal, delivery and neonatal outcome of women treated with mAbs for COVID-19 and reported pooled proportions and their 95% confidence intervals (CIs) for categorical variables or mean difference (MD) with their 95% confidence intervals for continuous variables. Preterm birth was observed in 22.8% of cases (95% CI 12.9-34.3). Fetal distress was reported in 4.2% (95% CI 1.6-8.2). Gestational hypertension and pre-eclampsia were observed in 3.0% (95% CI 0.8-6.8) and 3.4% (95% CI 0.8-7.5) of cases, respectively. Fetal growth restriction was observed in 3.2% of fetuses (95% CI 0.8-7.0). Secondary prophylaxis with mAbs is currently considered the best treatment option for people with mild to moderate COVID-19 disease. More attention should be paid to infants born from mothers who were treated with mAbs, for the risk of immunosuppression.

Maternal and neonatal outcomes in transverse and vertical skin incision for placenta previa

BackgroundPlacenta previa, a serious obstetric issue, should be managed by experienced teams. The safe and appropriate mode of delivery for placenta previa is by cesarean delivery. However, no studies were found comparing either maternal or neonatal outcomes for different skin incision in women with placenta previa. The aim of this study was to compare maternal and neonatal outcomes by skin incision types (transverse compared with vertical) in a large cohort of women with placenta previa who were undergoing cesarean delivery.MethodsThis was a retrospective cohort study carried out between January 2014 and June 2019. All pregnant women with placenta previa had confirmed by ultrasonologist before delivery and obstetrician at delivery. The primary outcome was the estimated blood loss during the surgery and within the first 24 hours postoperatively. Mean (standard deviation), median (interquartile range) or frequency (percentage) was reported to variables. Appropriate parametric and nonparametric tests were used to analyses.ResultsThe study included 1098 complete records, 332 (30.24%) cases in the vertical skin incision group and 766 (69.76%) cases in the transverse skin incision group. Those with vertical incision showed a higher percentage of preterm delivery, anterior placenta, abnormally invasive placenta, and history of previous cesarean delivery, and a lower percentage of first pregnancy, in vitro fertilization, and emergency cesarean delivery. After controlling for confounding factors, higher incidence of post-partum hemorrhage (OR 5.47, 95% CI 3.84–7.79), maternal intensive care unit (OR 4.30, 95% CI 2.86–6.45), transfusion (OR 5.97, 95% CI 4.15–8.58), and 5-min APGAR< 7 (OR 9.03, 95% CI 1.83–44.49), a more estimated blood loss (β 601.85, 95%CI 458.78–744.91), and a longer length of hospital stay after delivery (β 0.54, 95%CI 0.23–0.86) were found in the vertical skin incision group.ConclusionsOur data demonstrated that transverse skin incision group showed the better perinatal outcomes in women with placenta previa. Future collaborative studies are needed to be done by centers for placenta previa to have a better understanding of the characteristics and the outcomes of the disease in the choosing skin incision.

Oral dydrogesterone as an adjunctive therapy in the management of preterm labor: a randomized, double blinded, placebo\u2010controlled trial

BackgroundPreterm birth is a major challenge in obstetric and perinatal care. It is the leading cause of neonatal death. The primary aim of this study was to evaluate the efficacy of oral dydrogesterone on latency period in managing preterm labor. The secondary aims were to evaluate the gestational age at delivery, percentage of preterm delivery before 34 weeks and 37 weeks, time to recurrent uterine contraction, pregnancy outcomes, neonatal outcomes, compliance and side effects.MethodsThis was a randomized, double blinded, placebo-controlled trial. Forty-eight pregnant women with preterm labor, singleton pregnancy, and gestational age of 24–34 weeks were enrolled into the study. The study group received 10 mg of oral dydrogesterone three times per day and the control group received placebo. All pregnant women received standard treatment with tocolytic and antenatal corticosteroids.ResultsThe median latency periods were not significantly different between the dydrogesterone group (27.5 days) and placebo group (34 days, p = 0.45). Additionally, there were no differences in the gestational age at delivery, percentage of preterm delivery before 34 weeks and 37 weeks, pregnancy outcomes, neonatal outcomes, compliance and side effects. However, the time to the recurrence of uterine contractions in participants that had recurrent preterm labor was longer in the dydrogesterone group than in the placebo group (30.6 ± 12.3 vs 13.7 ± 5.0 days, p = 0.01).ConclusionsAdjunctive treatment with 30 mg of oral dydrogesterone could not prolong latency period in preterm labor when compared to placebo.Trial registrationClinicalTrials.gov (Clinical trials registration: NCT 03935152, registered on May 2,2019).

Intramuscular 17α-hydroxyprogesterone caproate to decrease preterm delivery in women with placenta praevia: a randomised controlled trial

We tested the hypothesis that 17α-hydroxyprogesterone caproate (17α-OHP-C) may decrease preterm delivery (PTD) in women with placenta praevia. This was a randomised controlled trial included 114 women with placenta praevia (between 24 and 28 weeks). They were randomly assigned to group I (17α-OHP-C) who received weekly injection of 17α-OHP-C (250 mg/IM) till completing 37 weeks’ gestation or group II (Non 17α-OHP-C). The percentage of placenta praevia patients went into PTD in the 17α-OHP-C group was significantly less in comparison to the PTD in the Non 17α-OHP-C group (∼37% vs. 63.5%, p = .004). Furthermore, the mean gestational age was significantly longer (36.7 ± 0.7 vs. 34.9 ± 1.2 weeks, p < .000), the mean number of bleeding attacks was significantly less and the mean birth weight was significantly higher (2841 ± 159 vs. 2561 ± 168 g, p < .000). In conclusion, maintenance tocolysis with intramuscular 17α-OHP-C in placenta praevia women appears beneficial in decreasing the number of bleeding attacks, the percentage of PTD and the neonatal ICU admission.IMPACT STATEMENTWhat is already known on this subject? Over the last two decades, a large number of studies indicated that placenta praevia is a major risk factor for preterm labour and prematurity with its neonatal complications. Increasing caesarean section rates had proportionally increased the incidence of placenta praevia.What do the results of this study add? Up to now, the effective and safe tocolytic agent among these patients is not established. The results of this study (prospective, randomised and controlled with calculated sample size) added a considerable support for hydroxyprogesterone caproate as an effective, safe and cheap tocolytic agent with excellent patient compliance.What are the implications of these findings for clinical practice and/or further research? Our findings may prompt researchers to conduct a large multicentre study to evaluate the prophylactic use of hydroxyprogesterone caproate to decrease preterm labour due to placenta praevia.

Evaluation of a new technique of prophylactic cervical cerclage simplified from the Shirodkar cerclage: A pilot study

IntroductionIn terms of prophylactic cerclage, the simplest and most commonly used technique is the McDonald cervical cerclage. Cervico-isthmic cerclage techniques may have better results, but are more difficult to achieve. A simplified Shirodkar technique would have the advantage of being “cervical high” while remaining easy to achieve. ObjectiveTo compare the results of high cervical cerclage, according to a simplified Shirodkar technique, with those of a classic McDonald cerclage, in the case of women at high risk of prematurity in an exploratory study. MethodsA comparative, retrospective study of prophylactic cerclage was conducted according to one or the other technique performed in a university hospital from 2006 to 2013. Women were included only if they had a history of at least two late miscarriages and/or premature delivery before 33 weeks. The primary outcome was the rate of delivery before 35 weeks. ResultsOur study involved 38 women: 24 in the McDonald cerclage group and 14 in the simplified Shirodkar cerclage group. The two groups were comparable for their obstetric and general characteristics. The percentage of preterm deliveries before 35 weeks was similar in both groups (7.1% and 25.0% in the Shirodkar and McDonald groups respectively; P=0.17). No significant difference was observed in the rate of surgical complications or hospitalizations during the pregnancies. ConclusionIn this study, we were unable to demonstrate an advantage to using the simplified Shirodkar technique – high cervical cerclage – compared with use of the McDonald technique – classical cerclage.

Pregnancy Outcomes in Women with Type 1 Diabetes Depending on the Different Modes of Insulin Therapy

The aim of the study was to evaluate the features of the effect of different modes of insulin therapy on pregnancy outcomes in women with type 1 diabetes mellitus (T1DM) with different levels of albuminuria. The study involved 155 women with T1DM during pregnancy, using various modes of insulin, and 42 infants born to women with T1DM. In order to identify a possible relationship between the level of proinflammatory cytokines and growth factors in pregnant women with T1DM and terms of delivery, we measured the daily urinary excretion of IL-1β, MCP-1, and TGF-β1 in 21 women at different trimesters of pregnancy. The use of continuous subcutaneous insulin infusion (CSII) in pregnant women with T1DM allows to prolong the pregnancy for 2–4 weeks as compared to the timing of delivery of pregnant women with T1DM receiving multiple subcutaneous injections of insulin (MPII). Pregnant women with MPII in 100% cases of the presence of microalbuminuria and proteinuria had premature delivery. Elevated levels of proinflammatory cytokines (IL-1β and MCP-1) and TGF-β1 may possibly serve as a predictor of pre-term delivery in pregnant women with diabetes type 1, starting with the early stages of pregnancy. The use of insulin by CSII in pregnant women with T1DM reduces the percentage of pre-term deliveries, regardless of the stage of diabetic nephropathy. It improves the condition of infants born at term in women with T1DM using a therapy with insulin pumps compared to that with MPII such as less common manifestation of diabetic fetopathy as macrosomia and hypoglycemia at birth, reducing the need for resuscitation in newborns.

Incidence of Maternal "Near-Miss" Events in a Tertiary Care Hospital of Central Gujarat, India.

Constant decline in maternal mortality ratio has given rise to the need of a new indicator. This search has motivated investigation of severe maternal morbidity-"maternal near-miss" (MNM) event. World Health Organization (WHO) defines MNM as "a woman who, being close to death, survives a complication that occurred during pregnancy, delivery or up to 42days after the end of her pregnancy". A hospital-based cross-sectional study was carried out at Sir Sayajirao General Hospital (SSGH), a tertiary care referral hospital in Vadodara, Central Gujarat, from May to September 2012. MNM events were identified according to either WHO or Mantel et al. criteria or both. During study period, 1929 live births, 18 maternal deaths and 46 "near-miss" cases were recorded. Among these 46 near-miss cases, 57 near-miss events were identified. Calculated MNM ratio was 23.85/1000 live births, MNM rate was 20.6/1000 obstetric admissions, the ratio of maternal death to MNM event was 1:2.6, and overall Mortality index was 28.1%. Among near-miss cases, percentage of preterm delivery was 42% and stillbirth rate was 35% (16/46). Out of 46 MNM, pregnancies were continued in 3 while 43 pregnancies were terminated. (25 live births, 16 stillbirths, 2 abortions). Identification of preventable factors and special preventive actions should be taken for management of complications in such near-miss cases.

MANAGEMENT OF PREGNANCY AND DELIVERY IN MULTIPLE PREGNANCY

The problem of multiple pregnancy management is of scientific and pragmatic interest, because in the last years, there is an increase of numbers of multiple pregnancies, especially due to wider use of assisted reproductive technologies. As a female organism has been evolutionally adapted to carriage of a single fetus, the multiple pregnancy is a classic model of fetoplacental insufficiency. Multiple pregnancy is a high risk pregnancy, with a high percentage of preterm deliveries, high perinatal mortality and infant morbidity. In pregnancy with two and more fetuses a certain observational algorithm is necessary that would allow timely performing of diagnostic and treatment activities, as well as taking adequante strategic decisions to ensure prolongation of pregnancy. The review deals with literature data summarizing a many years’ international experience of management of women with multiple pregnancies, as well as the results of the author’s own studies.

Elastography for predicting preterm delivery in patients with short cervical length at 18-22 weeks of gestation: a prospective observational study.

The aim of the study was to estimate the potential value of elastographic evaluation of the internal cervical os at 18-22 weeks of pregnancy in patients with short cervical length for prediction of preterm delivery (PTD). This prospective observational study included 109 patients with cervical length of ≤ 25 mm at 18-22 weeks scan. Stiffness of the internal cervical os was assessed by elastography. Elastographic assessment of the internal os was performed using a color map: red (soft), yellow (medium soft), blue (medium hard), and purple (hard). If two colors were visible in the region of the internal os, the softer option was noted. The following outcome measures were analyzed: percentage of PTDs in various categories of elastographic cervical assessment, sensitivity specificity negative predictive value (NPV), and positive predictive value (PPV) of elastography in predicting PTDs. Additionally ROC curves were constructed for elastography and cervical length for predicting PTDs. Forty-five cases of PTDs (< 37 weeks of pregnancy) were found in the studied population. The number of PTDs was significantly higher in the red group, than in the blue and purple groups. The sensitivity specificity NPV and PPV for the assessment of both, red and yellow internal os for predicting preterm delivery were 82.2%, 75.0%, 84.0% and 72.5% respectively The cut-off value for elastography suggested inclusion of both, red and yellow (warm) colors as predictors of PTD. Elastographic evaluation of the internal cervical os at 18-22 weeks of pregnancy in patients with short cervical length may be useful in predicting PTD.

Study of Clinical Profile of P. vivax Malaria in Pregnancy

Introduction: Malaria is a protozoa disease caused by the infection of red blood cells with the parasites of genus plasmodium and transmitted to man by certain species of female anopheles mosquitoes or by blood transfusion. There are two types of plasmodium genus are common in India. One is p. vivax and p. falciparam. Aims and Objectives: 1) To study various clinical manifestations and complications of p. vivax malaria during pregnancy. 2) To study morbid effect of p. vivax malaria on pregnancy. 3) To study differences of clinical manifestations between p. vivax and mixed malarial fever. Material and Methods: The study was carried out on 50 patients who were admitted in our institute. Written consent for participating in this study was taken of all patients. All patients were informed and explained about the study. Detailed history, clinical examinations, laboratory investigations and treatment given of all patients were collected. All patients are followed up to postpartum period to observe its postpartum complications. Results: In this study percentage of pre-term delivery ( 2.5kg. Conclusion: Most common presenting symptom was fever with chills and rigors (100% patients) followed by nausea and vomiting (92%) and headache (66%). Most common sign at the time of presentation was pallor (80%) followed by tachycardia (40%) and hypotension (20%). Most common complication associated with malaria in pregnancy is thrombocytopenia (82%).

Study of the Ophthalmic System of Babies Delivered to Transplant Recipients

The aim of the study was the analysis of ophthalmologic disorders in children born to mothers after liver transplantation (LTx) or renal transplantation (RTx) with the assessment of certain neonatal parameters. In the period between 01 January 2010 and 30 June 2012, ophthalmologic examinations were performed in 37 children born to mothers after LTx and 35 children after RTx, as well as 66 children from a control group, born at the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, from 01 January 2001 to 30 June 2012. Certain parameters of the neonatal period of the child and the mother were retrospectively analyzed. Good first-minute states of neonates were observed in 89.2% LTx and 97.1% RTx but in the fifth minute in more than 97% of neonates in both groups. In the LTx and RTx groups, the percentage of preterm deliveries was 48.8% (68.8% in the RTx and 43.2% in the LTx; P=0.0306). There were differences in the immunosuppressant drug therapy in monotherapy as well as two to three drug combinations between the two groups. Children from the LTx, RTx, and control groups had no ophthalmologic disorders in more than 80%. In the LTx and RTx groups, there were convergence insufficiency (6 of 72), strabismus (2 of 72), and hyperopia (2 of 72). The differences in disorders between LTx and RTx groups, as well as LTx+RTx and control groups, were not statistically significant (P=1.00 vs. 0.6206). Retinopathy of prematurity was diagnosed in only two neonates in the RTx group. Immunosuppressive treatment during pregnancy, regardless of kind, did not affect the ocular organ's development.

Descriptive analysis of maternal and neonatal characteristics in the maternity of the Dona Estefânia Hospital between 2005 and 2008.

Between 2005 and 2008 there were 8413 newborns at the maternity of the Hospital Dona Estefânia (HDE), comprising about 8% of the total number of newborns in Portugal in the same period. Fetal mortality (0,20%) met the goal of the Portuguese National Health Plan (NHP) and was at the lowest levels reported in the European Union. The percentage of preterm deliveries (8,1%) and caesareans (31,9%), however, are still above the goals established by the NHP, respectively, 4,9% and 24,8%. In newborns, the odds ratio of a low Apgar index at five minutes was 1,35 for each 100 g of birth weight less and 1,33 for each gestational week less. Average maternal age was 30,4 years old, with 3,8% being adolescents. About 22% were foreign mothers, a number well above the Portuguese national average of 9%. The percentage of preterm births and caesareans were lower among Chinese mothers and quite variable among nationalities. Weight at birth was found to correlate significantly with gestational age, type of pregnancy (twins/singleton), foetus gender, maternal parity and age at delivery. On average, when everything else remained constant, one additional gestational week translated into more 176 g; a twin newborn was, on average, 381 g lighter than a singleton, and a female newborn was, on average, 48 g lighter than a male. We present percentile tables of weight at birth by sex and gestational age (36-41 weeks) for newborns at the HDE.

Infant Morbidity and Mortality Attributable to Prenatal Smoking in the United States

Despite the continuing reduction in the incidence of smoking during pregnancy in the United States, prenatal smoking is still one of the most prevalent and preventable causes of infant morbidity and mortality. Two previous studies estimated that 5% to 6% of all infant deaths during 1995 to 1997 were due to prenatal smoking. In 2004, the Surgeon General's report concluded that there was sufficient evidence to show a clear association between prenatal smoking and several causes of infant morbidity and mortality. This study provides updated estimates of the percentage of preterm deliveries, term low-birth-weight deliveries <2500 g, and infant deaths because of smoking—individual outcomes identified in the Surgeon General's report as causally related to prenatal smoking in the United States. The updated estimates were based on the most recent and complete US vital statistical data. The US Linked Birth/Infant Death Data Set, 2002 birth cohort included a final sample of 3,352,756 singleton live births. Live birth outcomes were grouped into 5 delivery groups: very preterm (27 completed weeks of gestation), moderately preterm (28-33 completed weeks), late preterm (34-36 completed weeks), term low birth weight (≥37 completed weeks and <2500 g), sudden infant death syndrome (SIDS), and infant deaths from preterm-related causes. Multiple logistic regression models estimated the proportion of adverse birth outcomes attributable to prenatal smoking. Of the 3,352,756 singleton live infants delivered in 2002, 11.5% (n = 386,262) were exposed to prenatal smoking. The percentage of all infant deaths attributable to prenatal smoking was estimated to be 2.8% to 4.1 %. Prenatal smoking was associated with very (adjusted odds ratio [aOR], 1.5; 95% confidence interval [CI], 1.4-1.6); moderate (aOR, 1.4; 95% CI, 1.4-1.4); and late (aOR, 1.2; 95% CI, 1.2-1.3) preterm deliveries and term low-birth-weight deliveries (aOR, 2.3; 95% CI, 2.3-2.5) compared with term ≥2500 g deliveries. Prenatal smoking was also associated with SIDS (aOR, 2.7; 95% CI, 2.4-3.0) and preterm-related deaths (aOR, 1.5; 95% CI, 1.4-1.6). The percentage of adverse birth outcomes attributable to prenatal smoking and thereby, potentially avoidable was 5.3% to 7.7% of preterm deliveries, 13.1 % to 19.0% of term low-birth-weight deliveries, 23.2% to 33.6% of SIDS, and 5.0% to 7.3% of preterm-related deaths. Provided that rates of prenatal smoking continued to decline, estimates for the fraction of preterm-related deaths and SIDS deaths attributed to prenatal smoking in 2009 were slightly lower (4.4%-6.3% for preterm-related deaths and 20.2%-29.3% for SIDS deaths). These findings demonstrate that despite the continuing decline in rates of prenatal smoking, a substantial proportion of avoidable cases of infant morbidity and mortality is associated with prenatal smoking.

Effects of smoking cessation with voucher‐based contingency management on birth outcomes

This study examined whether smoking cessation using voucher-based contingency management (CM) improves birth outcomes. Data were combined from three controlled trials. Each of the trials was conducted in the same research clinic devoted to smoking and pregnancy. Participants (n=166) were pregnant women who participated in trials examining the efficacy of voucher-based CM for smoking cessation. Women were assigned to either a contingent condition, wherein they earned vouchers exchangeable for retail items by abstaining from smoking, or to a non-contingent condition where they received vouchers independent of smoking status. Birth outcomes were determined by review of hospital delivery records. Antepartum abstinence was greater in the contingent than non-contingent condition, with late-pregnancy abstinence being 34.1% versus 7.4% (P<0.001). Mean birth weight of infants born to mothers treated in the contingent condition was greater than infants born to mothers treated in the non-contingent condition (3295.6 ± 63.8 g versus 3093.6 ± 67.0 g, P = 0.03) and the percentage of low birth weight (<2500 g) deliveries was less (5.9% versus 18.5%, P = 0.02). No significant treatment effects were observed across three other outcomes investigated, although each was in the direction of improved outcomes in the contingent versus the non-contingent condition: mean gestational age (39.1 ± 0.2 weeks versus 38.5 ± 0.3 weeks, P = 0.06), percentage of preterm deliveries (5.9 versus 13.6, P = 0.09), and percentage of admissions to the neonatal intensive care unit (4.7% versus 13.8%, P = 0.06). These results provide evidence that smoking-cessation treatment with voucher-based CM may improve important birth outcomes.

Réseau sentinelle Audipog 2004–2005. Partie 1 : résultats des principaux indicateurs périnatals

Objective To present the principal perinatal indicators for 2004–2005, based on data from the Audipog sentinel network. Patients and methods The database for 2004 and 2005 covers 71,406 pregnancies from 86 maternity units throughout the year. We constructed a random subsample each year by including only the births occurring during a single month for each maternity ward. Our study therefore analyzes 6987 pregnancies in 2004 and 7648 pregnancies in 2005. Results The number of women working during pregnancy increased between 2004 and 2005 (62.3% versus 66.3%) ( p = 0.0008) as did the percentage with a postsecondary education (35.1% versus 41.9%) ( p < 0.0001). The percentage of amniocenteses declined (10.4% versus 7.9%) ( p < 0.0001). Use of prenatal care improved: more women had prenatal visits before week 14 (30.5% versus 33.9%) ( p = 0.0002), and fewer women had no prenatal care at all (1.1% versus 0.4%) ( p = 0.0003). The percentage of preterm deliveries was 6.4% in 2004 and 7% in 2005 ( p = 0.14) and the percentage of induced preterm deliveries was 37% in 2004 and 41.2% in 2005 ( p = 0.18). The cesarean rate was essentially stable (19 and 19.2%) and the rate of instrumental intervention in vaginal deliveries fell from 13.1% in 2004 to 11.2% in 2005 ( p = 0.0015). Discussion and conclusion The rates of cesarean and of preterm deliveries remained stable between 2004 and 2005, but the rate of induced preterm deliveries rose. These indicators are consistent with trends that began earlier.

Effect of supplementation of women in high-risk pregnancies with long-chain polyunsaturated fatty acids on pregnancy outcomes and growth measures at birth: a meta-analysis of randomized controlled trials

It is hypothesized that the intake of long-chain PUFA (LC-PUFA) throughout pregnancy could protect against pre-eclampsia, pregnancy-induced hypertension or intra-uterine growth retardation, and is essential for optimal neural development. The objective of the present study was to systematically evaluate the effect of LC-PUFA supplementation of high-risk pregnant women's diets on pregnancy outcomes and growth measures at birth. We searched MEDLINE, EMBASE, CINAHL and the Cochrane Library through March 2006 and references in reviewed articles for randomized controlled trials (RCT) comparing LC-PUFA supplementation with placebo or no supplementation in women with high-risk pregnancies. We found no evidence that supplementation influenced the duration of pregnancy or the percentage of preterm deliveries < 37 weeks of gestation. However, compared with controls, supplementation was associated with a significantly lower rate of early preterm delivery ( < 34 weeks of gestation) (two RCT; n 291; relative risk 0.39 (95 % CI 0.18, 0.84)). There was no significant difference in the infant birth weight, the rate of low birth weight ( < 2500 g or < 10th percentile) and the recurrence of intra-uterine growth retardation. Other pregnancy outcomes (for example, the rate of pregnancy-induced hypertension, the rate of pre-eclampsia and the rate of Caesarean section) were also similar in both groups. In conclusion, the present data suggest that supplementation with n-3 LC-PUFA in women with high-risk pregnancies reduced the risk of early preterm delivery in the fatty acid-supplemented group compared with the placebo group, while no other effects on pregnancy outcomes were detected.

RISK FACTORS FOR PLACENTAL MALARIA AND ITS EFFECT ON PREGNANCY OUTCOME IN YAOUNDE, CAMEROON

Between 1996 and 2001, the prevalence of placental malaria in pregnant women living in Yaounde, Cameroon and its effect on pregnancy outcome were evaluated with respect to gravidity and maternal age. Results showed that 19.9% of the women had placental malaria at delivery. After adjusting for relevant covariates, the major risk factor for placental malaria was an age < 25 years old. Placental malaria significantly increased the prevalence of anemia in women regardless of gravidity or age. In addition, the mean infant birth weight was lower and the percentage of pre-term deliveries (PTDs) and low birth weight (LBW) babies were higher in primigravidae and women < 20 years of age who had placental malaria. However, in a multivariate regression model taking relevant covariates into consideration, the major risk factor for PTDs was maternal anemia, and maternal anemia as well as first and second pregnancies were important risk factors for LBW babies.

Rates of and factors associated with recurrence of preterm delivery.

Information about risk of recurrent preterm delivery is useful to clinicians, researchers, and policy makers for counseling, generating etiologic leads, and measuring the related public health burden. To identify the rate of recurrence of preterm delivery in second pregnancies, factors associated with recurrence, and the percentage of preterm deliveries in women with a history of preterm delivery. Population-based cohort study of data from birth and fetal death certificates from the state of Georgia between 1980 and 1995. A total of 122 722 white and 56174 black women with first and second singleton deliveries at 20 to 44 weeks' gestation. Length of gestation (categorized as 20-31, 32-36, or > or =37 weeks) at second delivery compared with length of gestation at first delivery, by age and race. Most women whose first delivery was preterm subsequently had term deliveries. Of 1023 white women whose first delivery occurred at 20 to 31 weeks, 8.2% (95% confidence interval [CI], 6.6%-10.1%) delivered their second birth at 20 to 31 weeks and 20.1% (95% CI, 17.7%-22.8%) at 32 to 36 weeks. Of 1084 comparable black women, 13.4% (95 % CI, 11.4%-15.6%) delivered at 20 to 31 weeks and 23.4% (95% CI, 20.9%-26.1%) delivered at 32 to 36 weeks. Among women whose first delivery occurred at 32 to 36 weeks, all corresponding rates were lower than those whose first birth was at 20 to 31 weeks; the rates of second birth at 20 to 31 weeks were substantially lower (for white women, 1.9% [95% CI, 1.7%-2.2%]; for black women, 3.8% [95% CI, 3.4%-4.2%]). Compared with women aged 20 to 49 years at their second delivery, women younger than 18 years had twice the risk of recurrence of delivery at 20 to 31 weeks. Of all second deliveries at 20 to 31 weeks, 29.4% for white women and 37.8% for black women were preceded by a preterm delivery. Our data suggest that recurrence of preterm delivery contributes a notable portion of all preterm deliveries, especially at the shortest gestations.

Momento e freqüência das visitas de pré-natal: repercussões sobre os nascimentos pré-termo

O objetivo deste estudo foi determinar a eficácia da assistência pré-natal, com respeito às visitas (número e momento da primeira), sobre a idade gestacional e peso fetal ao nascimento. Avaliamos prospectivamente o efeito da assistência pré-natal sobre um grupo de 648 recém-nascidos no Hospital Universitário de Santa Maria de forma consecutiva, de gestações com idade entre 28 e 40 semanas. Os nascimentos de fetos pré-termo (< 37 semanas) corresponderam a 17,7% de todos os nascimentos; os recém-nascidos de baixo peso (< 2.500 g) a 20,5% e os recém-nascidos de muito baixo peso (< 1.000 g) a 2,8%. Quando a primeira visita pré-natal foi realizada antes da 12ªsemana de gestação, somente 5,1% dos neonatos nasceram antes da 37ª semana de idade gestacional ou tiveram peso ao nascimento < 2.500 g. Entretanto, quando a primeira visita foi realizada após a 28ª semana, a porcentagem de nascimentos pré-termo foi de 41,3% e o peso fetal inferior a 2.500 g, de 43,5%. Observou-se uma associação significante entre o aumento do número de visitas pré-natais, cuidados precoces e o decréscimo dos nascimentos pré-termo e de fetos de baixo peso. Concluímos que a maior freqüência de visitas pré-natais e a assistência precoce à gestante podem reduzir as taxas de nascimentos pré-termo e de fetos de baixo peso.