Preterm Birth Research Articles

Association between cellular immune and preeclampsia and preterm birth: a Mendelian randomization study

Emerging evidences have highlighted immune-inflammatory imbalances as a critical driver of the pathogenesis for preeclampsia (PE) and preterm birth (PB), but the impact of specific immune factors on the diseases is largely unknown. Our aim was to determine whether these immune cells are causally associated with the onset of PE or PB. Drawing on publicly available genetic data, we applied Mendelian randomization analysis to probe the causal link of 731 immune traits (7 panels: TBNK panel, Regulatory T cells panel, Maturation stages of T-cell panel, Dendritic cell panel, B-cell panel, Monocyte panel and Myeloid cell pane) with the risk of preeclampsia and preterm birth. The inverse variance weighting method (IVW) acted as the primary analysis to estimate the validity of causality, and sensitivity analyses were conducted to assessment of heterogeneity and pleiotropy. After adjusting for P-values for FDR method, CD27 on CD24+ CD27+ B cell, CD80 on plasmacytoid Dendritic Cell, CD33+ HLA DR+ CD14dim Absolute Count, CD33+ HLA DR+ CD14- Absolute Count, CD33+ HLA DR+ Absolute Count were remarkably causally involved in increased risk of PE, while HLA DR on Dendritic Cell exerted a protective causation against PE (PFDR < 0.05). Moreover, we determined that CD45 on CD33dim HLA DR- in myeloid cells decreased PB risk, whereas CD11b on Granulocytic Myeloid-Derived Suppressor Cells had the opposite effect on PB (FFDR < 0.2). This study provided genetic evidence for causal relationships between immune cell traits and PE and PB, offering potential candidate immunophenotypes for future studies on the etiology of pregnancy complications.

Maternal hair lead and cytokine pro-inflammatory effects in preterm birth

This case-control study analyzed the lead (Pb), interleukin 6 (IL-6), and tumor necrosis factor alpha (TNF-α) levels in pregnant women with preterm birth (PTB) in Central Java, Indonesia. Hair samples from 72 pregnant women were collected non-invasively. The prenatal exposure to Pb was determined with the total reflection X-ray fluorescence (TXRF) method. Serum IL-6 and TNF-α were examined using enzyme-linked immunosorbent assays (ELISA). The Pb concentration in hair was slightly higher in women with PTB than those without PTB; however, this difference was not statistically significant. An elevated hair Pb level was not associated with increased PTB risk (OR 24.69, 95% CI 0.93–653.82, p&amp;gt;0.05). A serum TNF-α level ≥27 pg/ml, a serum IL-6 level ≥9 pg/ml, and the spouse’s smoking frequency were significantly associated with increased PTB risk (TNF-α OR 42.25, 95% CI 5.26–339.61; IL-6 OR 22.33, 95% CI 3.12–158.54; spouse’s smoking frequency OR 1.28, 95% CI 1.09–1.5), while the maternal hemoglobin concentration significantly decreased PTB risk (OR 0.43, 95% CI 0.2–0.927). This study demonstrates that maternal hair Pb concentration has no significant relationship with PTB. Serum TNF-α, IL-6, and the spouse’s smoking frequency potentially increased PTB risk, while the maternal hemoglobin level is a protective factor.

Adverse Fetomaternal Outcomes in Obese Pregnant Women with Gestational Hypertension

Objective: To determine the incidence of adverse fetomaternal outcomes of gestational hypertension in pregnant obese women. Methodology: The six-month descriptive observational study at Liaqat Memorial Hospital, Kohat, with 127obesepregnantwomenaged15-45.Participantswere selectedbasedonsingletonpregnancy more than 24 weeks gestation according to scan or LMP and a blood pressure of &gt;140/90 mmHg on two different occasions without proteinuria, or a single reading of BP of 160/110mmHg with a BMI over 30 kg/m². Baseline data (maternal age, parity, BMI gestational age, education, socioeconomic status, family income, and residence) were collected. Fetomaternal complications were recorded by following up the patients till delivery. Results: The study included obese pregnant women with an average age of 33.2± 1.5 years and a mean BMI of 31.2 ± 5.6. Most participants had a median parity of 3, with a majority belonging to urban areas (51.1%) , having middle socioeconomic status (48.8% ). The adverse fetal outcomes ranged from preterm birth (16.4%),fetal growth restriction (12.6%),fetal hypoxia (8.9%)andlastlyperinataldeath(5.2%).Theadversematernaloutcomeswerepostpartumhemorrhage (16.4%), placental abruption (8.3%) , ecclempsia (7.2%) , HELLPsyndrome (4.1%) and maternal mortality (3.1%). Adverse maternal and fetal outcomes preterm labor postpartum hemorrhage, eclampsia, and placental abruption, fetal growth restriction and intrauterine fetal death outcomes being significantly higher in moderate gestational hypertension compared to mild gestational hypertension p=0.023, p=0.030, p=0.020, p=0.011, p=0.035 and p=0.022) respectively and adverse outcome placental abruption, eclampsia, and fetal growth restriction being significantly higher in class II obesity when compared to class I (p value= p=0.045 p=0.041 p=0.038)respectively Conclusion: Adverse fetomaternal outcomes are significantly affected by the severity of gestational hypertension andclass of obesity.Prenatal identification ofrisk factors in these women couldlowermaternal and fetal morbidity and mortality rates, underscoring the importance of an effective prenatal care system. Keywords: Obesity, Maternal Health, Fetal Growth Retardation, Pre- Eclampsia, Premature Birth

A novel approach for imbalanced instance handling toward better preterm birth classification

A novel approach for imbalanced instance handling toward better preterm birth classification

Protocol for a randomized controlled trial to evaluate the effectiveness of a telehealth group intervention to reduce perinatal depressive symptoms

BackgroundPerinatal depression and anxiety (PDA) affect approximately 20 % of individuals and are associated with adverse outcomes, including preterm birth, low birth weight, and impaired cognitive development of the child. Telehealth may reduce access barriers to needed mental health services. However, lack of disseminated, standardized study protocols aimed at investigating the role of telehealth in reducing PDA symptoms limits the ability to compare findings across studies. The purpose of this paper is to provide a conceptual framework and a randomized controlled trial protocol (RCT) for use in future studies. Methods and analysisAn RCT was designed to evaluate the effectiveness of a group videoconference intervention (VCI) to reduce PDA symptoms across pregnancy and postpartum period. Participants are randomly assigned to study groups: VCI + standard of care, or attention control (AC) + standard of care. Both groups have weekly one-hour group videoconference sessions for 9 weeks. The VCI groups are facilitated by a mental health professional using a manualized program based on mindfulness-based practices and cognitive behavioral therapy (MBCT). The AC groups are facilitated by a registered nurse using a manualized program for childbirth and parenting education. The primary outcomes are depressive symptoms as measured by the Edinburgh Postnatal Depression Scale (EPDS) and anxiety symptoms as measured by the Generalized Anxiety Disorder (GAD-7). ConclusionThis RCT study protocol can be used as a standard approach to improve the ability to compare findings across studies, applied in any setting (e.g., rural or urban), and adapted to diverse communities.Trial Registration:ClinicalTrials.govNCT03932760

Prenatal exposure to per- and polyfluoroalkyl substances (PFAS) and their influence on inflammatory biomarkers in pregnancy: Findings from the LIFECODES cohort

BackgroundPer- and polyfluoroalkyl substances (PFAS) are fluorinated chemicals linked to adverse pregnancy and birth outcomes. However, the underlying mechanisms, specifically their effects on maternal inflammatory processes, are not well characterized. ObjectiveWe examined associations between prenatal PFAS exposure and repeated measures of inflammatory biomarkers, including C-reactive protein (CRP) and four cytokines [Interleukin-10 (IL-10), IL-1β, IL-6, and tumor necrosis factor-α (TNF-α)]. MethodsWe analyzed data from 469 pregnant women in a nested case-control study of preterm birth at Brigham and Women’s Hospital in Boston, Massachusetts (2006–2008). We measured nine PFAS in early pregnancy plasma samples (median gestation: 10 weeks), with inflammatory biomarkers measured at median gestations of 10, 18, 26, and 35 weeks. We used linear mixed effects models for repeated measures and multivariable regression for visit-specific analysis to examine associations between each PFAS and inflammation biomarker, adjusting for maternal demographics, pre-pregnancy BMI, and parity. We examined PFAS mixture effects using sum of all PFAS (∑PFAS) and quantile-based g-computation approaches. ResultsWe observed consistent inverse associations between most PFAS and cytokines, specifically IL-10, IL-6, and TNF-α, in both single pollutant and mixture analyses. For example, an interquartile range increase in perfluorooctanesulfonic acid was associated with −10.87 (95% CI: −19.75, −0.99), −13.91 (95% CI: −24.11, −2.34), and −8.63 (95% CI: −14.51, −2.35) percent change in IL-10, IL-6, and TNF-α levels, respectively. Fetal sex, maternal race, and visit-specific analyses showed associations between most PFAS and cytokines were generally stronger in mid-pregnancy and among women who delivered males or identified as African American. ConclusionsThe observed suppression of both regulatory (IL-10) and pro-inflammatory (TNF-α) cytokines suggests that PFAS may alter maternal inflammatory processes or immune functions during pregnancy. Further research is needed to understand the effects of both legacy and newer PFAS on inflammatory pathways and their broader clinical implications.

Influenza Activity and Preterm Birth in the Atlanta Metropolitan Area: A Time-Series Analysis from 2010 to 2017.

Annual influenza epidemics lead to substantial public health burden, and pregnant people are vulnerable to severe outcomes. Influenza during pregnancy is hypothesized to increase risk of adverse birth outcomes, but population-based epidemiologic evidence remains limited and inconsistent. We conducted a time-series analysis to estimate short-term associations between community-level seasonal influenza activity and daily counts of preterm births in Atlanta, United States from October 17th, 2010 to July 10th, 2017. We defined weekly influenza exposures four ways: (1) percent test-positive from virologic surveillance, (2) percent of patients with symptoms of influenza-like illness (ILI) in outpatient settings, (3) a composite measure of percent test-positive and ILI, and (4) influenza hospitalization rates. We used Poisson log-linear models to estimate associations, adjusting for time-varying confounders and ongoing at-risk pregnancies. We further examined associations by influenza type and exposure lags, and effect modification by maternal characteristics. We studied a total of 316,253 births. We found consistent positive associations between influenza activity and preterm birth across different exposure measures and exposure lags. An interquartile range increase in composite measure of ILI activity and percent test-positive was associated with a 1.014 (95% confidence interval: 1.001, 1.027) increase in preterm birth during the same week. In stratified analyses, associations were more pronounced among married, non-Black, and Hispanic pregnant people. Periods of high influenza activity were associated with increased risk of preterm birth.

Development and Testing of the Comprehensive Prenatal Care Index: Relationship With Preterm Birth and Small for Gestational Age Across Racial and Ethnic Groups.

Preterm birth and small for gestational age (SGA) are significant public health concerns in the United States, with pronounced disparities across racial and ethnic groups. Traditional prenatal care adequacy indices have limitations in fully capturing their multifaceted nature. Our study introduces the Comprehensive Prenatal Care Index (CPCI) to provide a more holistic assessment of prenatal care by integrating key elements of prenatal counseling and health promotion. This cross-sectional study used the Pregnancy Risk Assessment Monitoring System 2016-2021 data. The CPCI was developed based on a comprehensive literature review, incorporating components such as timing, frequency, and content of prenatal visits. The index was validated using Item Response Theory (IRT) and compared with the Kotelchuck and Kessner Indices. The study included 139,181 pregnant women. The CPCI demonstrated strong internal consistency (Cronbach's α, 0.75; ω total, 0.81). IRT analysis confirmed the index's ability to capture variability in the quality of prenatal care, with item difficulty parameters ranging from -2.93 to +2.10. CPCI scores were significantly associated with reduced odds of adverse birth outcomes. Adequate CPCI care was linked to a 63% reduction in the odds of preterm birth among non-Hispanic White women, with similar reductions observed in Hispanic women (odds ratio [OR], 0.59) and Asian women (OR, 0.38). For SGA, adequate care was protective among non-Hispanic White (OR, 0.86) and Hispanic women (OR, 0.82) but showed mixed results in other groups. The CPCI provides a more inclusive measure of the quality of prenatal care compared with traditional indices. The study's findings suggest a significant role of comprehensive prenatal care in reducing adverse birth outcomes and addressing racial and ethnic disparities. Future research should focus on refining the CPCI and exploring its applicability in diverse populations to inform targeted and culturally sensitive prenatal care strategies.

Factors Influencing Nasoalveolar Molding Treatment Completion and Noncompletion in Infants with Cleft Lip and Palate.

Identify sociodemographic factors and comorbidities predictive of nasoalveolar molding (NAM) treatment completion and noncompletion in infants with cleft lip with or without (+/-) cleft palate in a rural-suburban population. Retrospective cohort study. Tertiary medical center. Infants diagnosed with cleft lip +/- cleft palate who initiated NAM treatment between 2013 and 2023. Forty-seven patients met inclusion criteria. Prevalence of NAM treatment completion, defined as continued attendance of NAM appointments until initial lip repair surgery. NAM treatment noncompletion rate of 23.4%. Noncomplete NAM treatment was associated with greater additional unscheduled NAM visits (P < .001); increased days inpatient after birth (P < .001); NICU admission (P < .001); public insurance (P = .007); preterm birth (P = .008); history of social work visits (P = .024); increased comorbidities (P = .028); non-Caucasian race (P = .034); and presence of siblings (P = .036). Associated comorbidities included use of feeding tube (P < .001); and conditions related with renal (P < .001); cardiac (P = .004); failure to thrive (P = .009); syndromes (P = .009); orthopedic (P = .011); pulmonary (P = .022); and ophthalmologic systems (P = .041). Increased overall health complexity, public insurance status, and need for social work support were identified as factors associated with NAM noncompletion. These variables can help identify patients at risk of noncompletion and empower providers to supply individualized support and resources.

Adverse outcomes associated with progressive intrahepatic cholestasis of pregnancy.

To assess the association between increasing bile acid levels in pregnancies with cholestasis and adverse outcomes. This is a retrospective cohort study of singleton, non-anomalous gestations complicated by cholestasis delivering at a single academic medical center from 2005-2019. We compared rates of adverse outcomes in pregnancies complicated by mild cholestasis (initial total bile acid (TBA) < 40 μmol/L and peak TBA < 40 μmol/L), progressive cholestasis (initial TBA < 40 μmol/L and peak TBA ≥ 40 μmol/L), and severe cholestasis (initial TBA ≥ 40 μmol/L). Our primary outcome was a composite adverse outcome including spontaneous preterm labor and delivery, umbilical artery pH < 7.20, 5-min Apgar < 7, cesarean delivery for non-reassuring fetal heart rate tracing, meconium-stained amniotic fluid, and neonatal ICU admission. Analyses were performed using mild cholestasis as the base comparator and a second analysis using severe cholestasis as the base comparator. Of the 1182 pregnancies complicated by cholestasis, 732 (61.9%) had mild cholestasis, 78 (6.6%) had progressive cholestasis, and 372 (31.5%) had severe cholestasis. After adjusting for confounders including gestational age at diagnosis and using mild cholestasis as the base comparator, both progressive and severe cholestasis were associated with the composite adverse outcome (progressive ICP OR 1.70; 95% CI 1.04-2.78 and severe ICP OR 1.60; 95% CI 1.24-2.06). When using progressive cholestasis as the base comparator, there were no statistically significant differences in the primary or secondary outcomes between progressive cholestasis and severe cholestasis. This study highlights the significance of monitoring peak bile acid levels and that some cases of cholestasis may progress in pregnancy and the adverse associations are better reflected by the peak total bile acid level and not the cholestasis severity at initial diagnosis.

Maternal Cannabis Use Disorder and Neonatal Health Outcomes: A Data Linkage Study.

We tested for the potential associations between maternal antenatal cannabis use disorders (CUD) and neonatal health outcomes using large linked administrative data. Population-based retrospective cohort study. The study was conducted in New South Wales, Australia. A total of 215 879 singleton live births. Generalised linear models (GLMs) fitted using log-binomial regression to estimate risk ratios (RRs) with the corresponding 95% confidence intervals (95% CI). Additionally, we conducted a propensity score matching (PSM) analysis. The outcomes include preterm births (PTB), low birth weight (LBW), small for gestational age (SGA), 5-min lower Apgar scores and admission to the neonatal intensive care unit (NICU). In unmatched analyses, antenatal CUD was associated with increased risks for all adverse neonatal outcomes (adjusted risk ratio [RR] ranging from 1.47 [95% CI: 1.01, 2.14] for 5-min lower APGAR scores to 2.58 [95% CI 2.28, 2.91] for PTB). In PSM analyses, we observed slightly attenuated risks of PTB (RR = 1.98 [1.70, 2.31]), LBW (RR = 2.46 [2.13, 2.84]), SGA (RR = 1.84 [1.44, 2.35]) and admission to NICU (RR = 1.91 [1.49, 2.45]) after matching by covariates. However, we found no significant association between antenatal CUD and 5-min low APGAR scores (RR = 1.47 [0.94, 2.30]). We found that maternal antenatal exposure to CUD is associated with a range of adverse neonatal outcomes. This study highlights that targeted interventions focusing on antenatal counselling are recommended to mitigate risks associated with maternal cannabis use.

Impact of Kangaroo mother care plus massage therapy on growth of preterm low birth weight infants at discharge

Background: To assess the impact of kangaroo mother care plus massage therapy on growth of preterm low birth weight infants at discharge. Methods: This randomized controlled trial was conducted in Department of Neonatology in Bangabandhu Sheikh Mujib Medical University over a period of 15 months from March 2022 to June 2023. Total 122 newborns were admitted in neonatal intensive care unit (NICU) of BSMMU during the study period with birth weight 800g to &lt;2000g and gestational age 28 weeks to &lt;34 weeks were enrolled in the study after getting informed written consent from parents or caregiver. Infants with major congenital anomalies were excluded from this study. All data were analyzed by statistical package for social sciences (SPSS) version 25 (IBM, USA). Results: Total 122 newborns were admitted in neonatal intensive care unit (NICU) of BSMMU during the study period with birth weight 800g to &lt;2000 g. Among them, 80 infants fulfilled inclusion criteria. Growth was significantly better in KMC plus massage therapy group. Mean weight gain per kg per day in KMC plus massage therapy group was 13.34±10.20 g and it was nearly half in KMC group 6.18±11.84 g only (p-value-0.01). Increase in length was 0.95±0.62 cm in KMC plus massage therapy group vs KMC group 0.66±0.49 cm (p-value-0.04). Increase in OFC was 0.59±0.29 cm in KMC plus massage therapy group vs KMC group 0.42±0.33 cm at discharge (p-value-0.03). Hospital stay in KMC group was 6.36±3.52 days, alternatively it was more 8.33±2.39 days in KMC plus massage therapy group. The dissimilarity was statistically significant (p-value-0.01) Study implication: Massage therapy potentiates benefits of kangaroo mother care in respect to better growth, so massage can be added along with KMC for better outcome. Conclusions: Massage therapy added to KMC is more effective than KMC alone in improving growth, although it did not affect the hospital stay.

Patient-Reported Pregnancy Outcomes and Survival in Women with Aortic Valve and/or Aortic Root Replacement.

Background: Our objective was to investigate patient-reported maternal and perinatal outcomes and survival among women undergoing aortic valve and/or aortic root replacement (AVR/ARR). Methods: This was a single-center observational study of U.S. women identified in our surgical/obstetric databases who underwent AVR/ARR between 1967 and 2019. Available, consenting patients participated in a telephone survey detailing patient-reported outcomes. The status of remaining individuals was verified through the Alabama Department of Public Health. Date of death, immediate and underlying cause of death, and death location were abstracted from death certificates. Results: Of 317 patients, 72 were confirmed living, 86 were deceased, and 159 were of unknown status. Mean age at first aortic valve replacement was 43 years. Of patients with known status (n = 158), 33% were Black, and the majority received a mechanical valve (58%). Of 57 participants completing the survey, reported complications included miscarriage (30%), preterm birth (12%), preeclampsia (14%), antepartum maternal intensive care unit admissions (6%), and congenital heart disease in the neonate (8%). Most pregnancies preceded AVR (78%). Among 86 decedents, the average age of death was 52.5 years; the average time from AVR/ARR to death was 7 years. Of those who died, a higher proportion were Black (75%) and had aortic insufficiency (72%). Conclusions: Patients who underwent aortic valve surgery report high rates of maternal and perinatal complications, and death certificate data confirm high rates of racial disparities and death within a decade of surgery. Interventions are urgently needed to improve maternal and perinatal outcomes in individuals with aortic valve disease and to eliminate preventable racial disparities.

Placenta Thickness Mediates the Association Between AKIP1 Methylation in Maternal Peripheral Blood and Full-Term Small for Gestational Age Neonates

Background/Objectives: A-kinase-interacting protein 1 (AKIP1) has been discovered to be a pivotal signaling adaptor in the regulation of human labor and associated with preterm birth, but its effect on fetal growth was still unclear. Meanwhile, the regulation role of DNA methylation (DNAm) on placental and fetal development has been demonstrated. Therefore, we aimed to investigate the association of AKIP1 DNAm in maternal peripheral blood with placental development and full-term small for gestational age (FT-SGA) neonates, and to explore whether placenta mediate the association between AKIP1 DNAm and FT-SGA; Methods: This study was a case–control study including 84 FT-SGAs and 84 FT-AGAs derived from the Shenzhen Birth Cohort Study. The DNA methylation analysis of CpG in the target region of the AKIP1 gene was measured by the Sequenom MassARRAY EpiTYPER approach. Multiple-variable logistic and linear regression analyses were used to estimate the association between the DNAm of three validated CpG sites in the AKIP1 gene, placental thickness, and FT-SGA. Mediation analysis was used to examine the mediation effect of placental development on the association between the DNAm of AKIP1 and FT-SGA. Results: For every increment in standard deviation in the DNAm of CpG4 (cg00061907) at AKIP1, the risk of FT-SGA elevated by 2.01-fold (aOR = 2.01, 95%CI = 1.39~3.01), and the thickness of the placenta significantly decreased by a 0.19 standard deviation (β = −0.19, 95%CI = −0.32~ −0.06). Placental thickness mediated the 22.96% of the effect of the DNAm of CpG4 at AKIP1 on the risk of FT-SGA with statistical significance. Conclusions: The findings in the present study suggested the mediating effect of placental thickness on the association of the DNAm of AKIP1 in maternal peripheral blood and the risk of FT-SGA, providing new evidence for the mechanism of maternal epigenetics in placental and fetal development.

Analysis of risk factors for very early preterm and early preterm birth in twins following invitro fertilization and intracytoplasmic sperm injection-assisted pregnancy: Aretrospective study.

To investigate the risk factors influencing very early preterm and early preterm births in twin pregnancies after invitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). This retrospective study analyzed 2042 twin pregnancies that underwent embryo transfer via IVF/ICSI at the Reproductive Center of Sir Run Run Shaw Hospital between January 2019 and December 2022. Spontaneous very early, early preterm, and provider-initiated preterm births were examined separately. Based on gestational age, participants were categorized into three groups: very early preterm birth (<28 weeks), early preterm birth (≥28 to <34 weeks), and ongoing pregnancy (≥34 weeks). Univariate analysis was conducted to assess general conditions, among the three groups. Multiple logistic regression analysis was performed to identify independent risk factors for very early and early spontaneous preterm birth in twin pregnancies. A total of 2042 twin pregnancies were included in the study, with birth rates of 4.36% (89 of 2042) <28 weeks, 12.14% (248 of 2042) ≥28 to <34 weeks, and 83.50% (1705 of 2042) ≥34 weeks. The primary cause of provider-initiated preterm birth <28 weeks was placental factors, while hypertensive disorders of pregnancy (31.11%) were the predominant cause for preterm births ≥28 to <34 weeks. Multiple logistic regression analysis identified the independent risk factors for births <28 weeks (P < 0.05) as cervical cerclage, history of late miscarriage or premature birth, uterine adhesions, primary infertility of polycystic ovary syndrome (PCOS), monochorionic pregnancies, history of cervical surgery, uterine malformations, body mass index ≥25 kg/m2, and uterine longitudinal axis lengths <3.6 cm. Cervical cerclage, main factors of infertility (PCOS), adenomyosis, and uterine longitudinal axis lengths <3.6 cm were identified as independent risk factors for ≥28 to 34 weeks (P < 0.05). It is crucial to consider risk factors during IVF/ICSI treatment because of the high incidence of very early and early preterm twin pregnancies, which can be identified early and properly managed.

Antenatal care strategies to improve perinatal and newborn outcomes.

Antenatal care strategies (ANC) play a pivotal role in ensuring a healthy gestational period for expectant mothers and promote optimal outcomes for their babies. Implementing these interventions can contribute to a supportive environment for pregnant women, resulting in positive perinatal and neonatal outcomes. We summarize evidence for a total of twenty-seven interventions pertaining to ANC from Every Newborn Series published in The Lancet 2014 by identifying the most recent systematic reviews, extracting data from each review, and conducting a sub group analysis for low-income and lower-middle-income countries (LICs/LMICs) for outcomes relevant to maternal and neonatal health. Findings from our paper suggest a paucity in evidence from LMICs, and consolidated efforts are required to narrow this gap to build on more inclusive evidence on antenatal care strategies. . Evidence from LMICs suggests that antenatal multiple micronutrient supplementation when compared to iron and folic acid, had a significant effect on stillbirth, small-for-gestational-age (SGA) and low birthweight (LBW). Vitamin D supplementation reduced the risks of preterm birth and LBW. High-dose calcium supplementation, when compared to placebo in pregnancy, lowered the likelihood of developing high blood pressure, pre-eclampsia and preterm birth. Antihypertensives significantly reduced the probability of developing severe hypertension, proteinuria/pre-eclampsia and severe pre-eclampsia. Metformin for GDM reduced the risk of neonatal death or serious morbidity composite. Cervical cerclage had no effect on stillbirth, preterm birth, or perinatal and neonatal mortality. Data for anti-D administration for rhesus alloimmunization was limited to HICs.

Lead exposure at the feto-maternal interface: A cause for concern for fetal membrane trophoblasts.

The integrity of fetal membranes enables biological functions that protect the fetus and maintain the pregnancy. Any compromise in fetal membrane function can predispose a pregnant woman to prelabor rupture of the membranes (pPROM) and subsequently to preterm birth (PTB). Epidemiologic data suggest that lead exposure during pregnancy is one of several risk factors associated with PTB and pPROM. This heavy metal can cross placental and fetal membrane barriers, disrupting homeostasis in these tissues. Autophagy contributes to the maintenance of fetal membrane homeostasis during gestation, and dysfunctional autophagy is associated with pPROM. In this study, we determined the mechanistic impact of lead-induced cellular changes, autophagy, senescence, and inflammation in chorion trophoblast cells (CTCs) and amnion epithelial cells (AECs) of the fetal membranes. Lead exposure in CTCs induced autophagy disfunction (increase in LC3B-II), augmented senescence (increased SA-β-galactosidase activity) and increased the release of inflammation. In AECs, lead exposure did effect autophagy, senescence, nor inflammation. The differential changes observed in CTCs and AECs after exposure to high lead concentrations may promote the weakening of fetal membranes and contribute to preterm rupture.

Maternal and perinatal outcomes of live births after uterus transplantation: A systematic review.

Uterus transplantation (UTx) is a treatment for absolute uterine factor infertility. The results of pregnancies of this complex infertility treatment should be established. The aim of the study was to systematically review maternal and neonatal outcomes in the pregnancies of women who have undergone UTx. The population of this review were women that have undergone UTx and delivered child(ren). Cesarean delivery after UTx were planned to be compared with studies reporting maternal mortality/morbidity and perinatal mortality/morbidity after delivery by elective cesarean section without UTx. Systematic literature searches were performed utilizing Medline, Embase, the Cochrane Library, Cinahl, PsycInfo, Web of Science, and clinicaltrials.gov for studies written in English language and published between January 1, 2010, and November 08, 2023. No study design limitation was applied. If no comparative studies were identified, we planned to report the outcomes from the case reports and case series. Included studies were assessed for risk of bias using a checklist for case series. The study protocol was registered with the International Platform of Registered Systematic Review and Meta-analysis Protocols (registration number: INPLASY202310052). Twenty-four articles were identified, containing data on 40 unique live births. Multiple publications including same cases were identified and clearly indicated. No comparative studies were identified. The certainty of evidence was very low, as all studies were either case reports (n = 15) or case series (n = 9). All deliveries were by cesarean section and 47.5% of them resulted in emergency cesarean sections. Out of the 21 elective cesarean sections, 52.4% were performed before 37 weeks' gestation. Historical comparison to population data on pregnancies delivered by cesarean section found a markedly increased risk for both the mother and child following cesarean section for UTx. Risks for placenta previa and preterm birth were notably high after UTx; however, some of the later may reflect the results of provider-initiated births. The maternal and perinatal outcomes of 40 live births post-UTx indicate that these pregnancies may be at high risk of maternal and perinatal complications. Aiming to delay elective cesarean section beyond 37 weeks' gestation could potentially reduce some of these risks. Registration of maternal and perinatal outcomes after UTx through quality registries are essential and obstetrical care guidelines for these women should be established.

Placental abruption and perinatal mortality in twins: novel insight into management at preterm versus term gestations.

Twins suffer a disproportionately higher burden of adverse perinatal outcomes than singletons. However, the degree to which preterm delivery shapes the relationship between abruption and perinatal mortality in twins is unknown. Through causal mediation decomposition, we examine how preterm delivery mediates the effect of abruption on perinatal mortality among twins using the US-matched multiple birth data (1995-2000). We estimated the hazard ratio (HR) from Cox models with gestational age as the timescale. We decomposed the total effect (TE) into counterfactual natural direct (NDE) and natural indirect (NIE) effects. 557,220 matched twin births, 1.3% (n = 7032) resulted in abruption with higher perinatal mortality rates than non-abruption births (143 versus 36 per 1000 births, respectively) and a 4.53-fold (95% confidence interval [CI]: 4.23, 4.82) increased hazard of perinatal mortality. HRs for NDE and NIE were 3.05 (95% CI: 2.84, 3.24) and 1.49 (95% CI: 1.49, 1.47, 1.50), respectively, and the proportion mediated (PM) was 41%. PM increased as the gestational age at delivery decreased. Associations persisted after correction for unmeasured confounders. The best strategies to improve perinatal delivery are delivery when abruption complicates twin pregnancies at term gestations and expectant management (avoiding early preterm delivery), if feasible, when abruption complicates twin pregnancies at preterm gestations.

Method for Identification and Bacterial Count Quantification in a Case of Ureaplasma Meningitis.

Intrauterine Ureaplasma infection is associated with chorioamnionitis and preterm birth. The difficulty of detecting Ureaplasma species by conventional culture methods makes definitive diagnosis of clinical infection challenging. Thus far, quantitative tests for Ureaplasma have been performed using adult cervical samples, amniotic fluid, and pediatric bronchial secretions, but quantification of bacterial count in central nervous system infections caused by Ureaplasma species has not been unreported. We report a case of culture-negative Ureaplasma meningitis in a preterm infant in whom novel techniques to identify this pathogen and quantify bacterial count were effective. We suspected meningitis based on a sustained reduction in cerebrospinal fluid (CSF) glucose levels. Multiple CSF cultures were sterile. We confirmed infection by Ureaplasma species using the melting temperature mapping method. Treatment with erythromycin and ciprofloxacin resulted in a gradual decrease in the bacterial count in the CSF to 0. Our study highlights the potential utility of the melting temperature mapping method as a new diagnostic tool for culture-negative Ureaplasma meningitis and establishes the utility of serial quantification of bacterial count to monitor response to therapy.