Preterm Birth Rate Research Articles

Changes in the characteristics and outcomes of high-risk pregnant women who delivered prior to and after China’s universal two-child policy: a real-world retrospective study, 2010–2021

BackgroundIn 2016, the “universal two-child” policy, allowing each couple to have two children, was introduced in China. The characteristic change of the long-term period after the implementation of the universal two-child policy was unclear. We studied trends in the obstetric characteristics and their potential impact on the rates of cesarean section and preterm birth in the era of China’s universal two-child policy.MethodsA tertiary center-based study (2010–2021) retrospectively focused single high-risk pregnancies who delivered from the one-child policy period (OCP, 2010–2015) to the universal two-child policy period (TCP, 2016–2021). A total of 39, 016 pregnancies were enrolled. Maternal demographics, complications, delivery mode and obstetric outcomes were analyzed. Furthermore, logistic regression analysis was used to explore the association between the cesarean section rate, preterm birth and implementation of the universal two-child policy, adjusting maternal age, parity, and fetal distress.ResultsUltimately a total of 39,016 pregnant women met the criteria and were included in this analysis. The proportion of women with advanced maternal age (AMA) increased from 14.6% in the OCP to 31.6% in the TCP. The number of multiparous women increased 2-fold in the TCP. In addition, the overall rate of cesarean section significantly decreased over the policy change, regardless of maternal age, whereas the risk of preterm birth significantly increased in the TCP. Adjusting for maternal age, parity and fetal distress, the universal two-child policy showed a significantly favorable impact on the cesarean section rate (RR 0.745, 95%CI (0.714–0.777), P < 0.001). Compared to the OCP group, a higher increase in fetal distress and premature rupture of membranes (PROM) were observed in the TCP group. In pregnancies with AMA, there was no increase in the risk of postpartum hemorrhage, whereas more women who younger than 35 years old suffered from postpartum hemorrhage in TCP. The logistic regression model showed that the universal two-child policy was positively associated with the risk of postpartum hemorrhage (RR: 1.135, 95%CI: 1.025–1.257, P = 0.015).ConclusionsAfter the implementation of the universal two-child policy in China, the rate of the cesarean section significantly decreased, especially for women under 35 years old. However, the overall risk of postpartum hemorrhage increased in women under 35 years old, while there was no change in women with AMA. Under the new population policy, the prevention of postpartum hemorrhage in the young women should not be neglected.

“MAMA’s is like a second mom:” Client and Staff Experiences in a Comprehensive Social Risk Care Management Program Within a Perinatal Medical Home

IntroductionAddressing persistent racial inequities in preterm birth requires innovative health care approaches. The Los Angeles County Maternity Assessment and Management Access Service Synergy Neighborhood program (MAMA’s) is a perinatal medical home program designed to alleviate the impacts of chronic stress by addressing social determinants of health. It reduced odds of preterm birth rates in Black participants, yet it is unclear which program components most contributed to this reduction. This study seeks to understand the experiences of staff and clients within the MAMA’s program to identify what factors decrease stress, how the program addresses racism and the challenges and opportunities of optimizing health during the COVID-19 pandemic.Methods21 staff and 34 clients completed semi-structured interviews from November 2020–December 2021. Separate interview guides for staff and clients explored experiences within the program, experiences during the COVID-19 pandemic, and how racism affects clients. Interviews were recorded and transcribed. Analysis used a phenomenologic framework. Coding was performed using grounded theory to identify themes.ResultsAnalysis revealed six key themes: Stressors clients face, barriers for undocumented, Latina, and Spanish-speaking clients, exceptional care, emotional support, naming and responding to racism and discrimination, and impacts of COVID-19 pandemic.DiscussionStaff and clients work together to address social needs in order to address chronic stress and racism in their lives, especially during the COVID-19 pandemic. Interviews revealed relationship building is a cornerstone of the program’s success and plays a significant role in alleviating chronic stress in this population.

Pregnancy in Patients Receiving Home Dialysis.

Pregnancy is an important goal for many women with CKD or kidney failure, but important barriers exist, particularly as CKD stage progresses. Women with advanced CKD often have a limited fertility window and may miss their opportunity for a pregnancy if advised to defer until after kidney transplantation. Pregnancy rates in women with advanced kidney failure or receiving dialysis remain low, and despite the improved outcomes in recent years, these pregnancies remain high risk for both mother and baby with high rates of preterm birth due to both maternal and fetal complications. However, with increased experience and advances in models of care, this paradigm may be changing. Intensive hemodialysis regimens have been shown to improve both fertility and live birth rates. Increasing dialysis intensity and individualizing dialysis prescription to residual renal function, to achieve highly efficient clearances, has resulted in improved live birth rates, longer gestations, and higher birth weights. Intensive hemodialysis regimens, particularly nocturnal and home-based dialysis, are therefore a potential option for women with kidney failure desiring pregnancy. Global initiatives for the promotion and uptake of home-based dialysis are gaining momentum and may have advantages in this unique patient population. In this article, we review the epidemiology and outcomes of pregnancy in hemodialysis and peritoneal dialysis recipients. We discuss the role home-based therapies may play in helping women achieve more successful pregnancies and outline the principles and practicalities of management of dialysis in pregnancy with a focus on delivery of home modalities. The experience and perspectives of a patient are also shared.

Combined effects of pre-pregnancy BMI and gestational weight gain on preterm birth: comparison between spontaneous and ART conception.

Inappropriate pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) are both linked to preterm birth (PTB); however, which one plays a dominant role in PTB risk is not yet sure. We aimed to evaluate the combined effect of pre-pregnancy BMI and GWG on the risk of PTB in singleton pregnancies conceived both spontaneously and through assisted reproductive technology (ART). The data included all mothers (n = 17,540,977) who had a live singleton birth from the US National Vital Statistics System (NVSS) 2015-2019. Logistic regression models, quantile-g-computation, and generalized additive model were used to analyze the combined association of pre-pregnancy BMI and GWG with PTB. The singleton PTB rate was significantly higher in ART pregnancies (11.5%) than in non-ART pregnancies (7.9%). When compared to those women with pre-pregnancy normal weight and GWG within Institute of Medicine (IOM) guidelines, the highest PTB risk was observed in non-ART women with pre-pregnancy underweight and GWG below IOM guidelines (aOR 2.56; 95% CI 2.53-2.60) and in ART women with pre-pregnancy obese and GWG below IOM guidelines (aOR 2.56; 95%CI 2.36-2.78). GWG dominated the combined effect with its joint effect coefficient of - 0.281 (P < 0.05) in non-ART women and - 0.108 (P < 0.05) in ART women. Inappropriate GWG played a dominant role in increasing the risk of PTB in both non-ART and ART populations. Counseling regarding pre-pregnancy BMI and especially GWG appears to be even more crucial for pregnancies conceived via ART, given their impact on PTB.

Assessing the Impact of COVID-19 Vaccination on Preterm Birth: A Systematic Review with Meta-Analysis.

During the coronavirus diseases 2019 (COVID-19) pandemic, the safety and efficacy of vaccination during pregnancy, particularly regarding the risk of preterm birth, have been a subject of concern. This systematic review aims to evaluate the impact of COVID-19 vaccination on preterm birth risk and to inform clinical practice and public health policies. Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a database search included PubMed, Embase, and Scopus, conducted up until October 2023. Inclusion criteria focused on studies that examined COVID-19 vaccination during pregnancy and its correlation with preterm birth, defined as a birth before 37 weeks of gestation. Six studies met these criteria, encompassing 35,612 patients. A quality assessment was performed using the Newcastle-Ottawa Scale and the Cochrane Collaboration's tool, with the risk of bias evaluated via a funnel plot analysis and an Egger's regression test. The studies demonstrated geographical diversity, mainly from Israel, Romania, and the United States, with a blend of prospective and retrospective designs. The patient cohort's mean age was 31.2 years, with common comorbidities such as gestational diabetes and obesity affecting 9.85% of the total population. The vaccination types varied across the studies, with BNT162b2 being the most used. The results indicated a low heterogeneity among the included studies, evidenced by a Cochran's Q statistic of 2.10 and an I2 statistic of 13%. The meta-analysis yielded a pooled odds ratio (OR) for a preterm birth risk post-vaccination of approximately 1.03 (95% CI: 0.82-1.30), suggesting no significant increase in preterm birth risk was associated with COVID-19 vaccination. Notable findings included a low preterm birth rate (as low as 0.6% and up to 6.1%) with minimal differences in neonatal outcomes, such as birth weight and APGAR (appearance, pulse, grimace, activity, and respiration) scores between vaccinated and unvaccinated groups. This study concludes that a COVID-19 vaccination during pregnancy does not significantly increase the risk of preterm birth. These findings are crucial for reassuring healthcare providers and pregnant women about the safety of COVID-19 vaccines and supporting their use in public health strategies during the pandemic.

Prevalence of hepatitis C among pregnant women in an Appalachian population.

The opioid crisis has adversely affected West Virginia's pregnant and infant populations. With high rates of opioid use disorder and neonatal abstinence syndrome, West Virginia has the highest rates of Hepatitis C (HCV) acute infection among pregnant women. To better understand how HCV impacts an already high-risk population, the study purpose was to (1) describe its prevalence among women receiving prenatal care at a single tertiary care clinic in Appalachia and compare with state and national rates, and (2) determine whether it is associated with preterm birth (gestation <37 weeks). Data were collected on a retrospective cohort of pregnant patients universally screened for HCV between 2017 and 2021. The study cohort had an HCV infection rate of 119/988 = 11.94% or 119.4 per 1000. This is five times the rate of 22.6 per 1000 live births in West Virginia in 2014 and 35 times the national rate of 3.4 per 1000 live births (MMWR Morb Mortal Wkly Rep 66, 2017 and 470). Viral loads were detected in 63 (6.38%) of patients. The study cohort with birth outcome data had high rates of tobacco use (326/720; 45.3%) and substance abuse (209/720; 29.0%). The preterm birth rate was 17.8% (128/720), almost double the national average (10.09%) (Natl Vital Stat Rep 70, 2021 and 1). There was no statistically significant difference in preterm birth between HCV-positive (15/92; 16.3%) and HCV-negative (113/628; 18.0%) patients. HCV infection in our population presents a significant public health issue and missed opportunity for treatment in a population with continuity of care challenges. These findings could be used to justify a pilot program for early postpartum referral for treatment.

Impacted fetal head extraction methods at second stage cesarean and subsequent preterm delivery: A multicenter study.

Second-stage cesarean delivery (CD) is associated with subsequent preterm birth (PTB). It has been suggested that an increased risk of PTB after second-stage cesarean delivery could be linked to a higher chance of cervical injury due to the extension of the uterine incision. Previous studies have shown that reverse breech extraction is associated with lower rates of uterine incision extensions compared to the "push" method. We aimed to investigate the association between the method of fetal extraction during second-stage CD and the rate of spontaneous PTB (sPTB), as well as other maternal and neonatal outcomes during the subsequent pregnancy. This was a multicenter retrospective cohort study. The study population included women in their first subsequent singleton delivery following a second-stage CD between 2004 and 2021. The main exposure of interest was the method of fetal extraction in the index CD ("push" method vs. reverse breech extraction). The primary outcome of this study was sPTB <37 weeks in the subsequent pregnancy. Secondary outcomes were overall PTB, trial of labor, and other adverse maternal and neonatal outcomes. Univariate analysis was followed by multiple logistic regression modeling. During the study period, 2969 index CD during second stage were performed, of those 583 met the inclusion criteria, of whom 234 (40.1%) had fetal extraction using the reverse breech extraction method, while 349 (59.9%) had the "push" method for extraction. In univariate analysis, women in those two groups had statistically similar rates of sPTB (3.7% vs. 3.0%; odds ratio [OR] 1.25, 95% CI: 0.49-3.19) and overall PTB (<37, <34 and <32 weeks), as well as other maternal, neonatal, and trial of labor outcomes. This was confirmed by multivariate analyses with an adjusted OR of 1.27 (95% CI: 0.43-3.71) for sPTB. Among women with a previous second-stage CD, no significant difference was observed in PTB rates in the subsequent pregnancies following the "push" method compared to the reverse breech extraction method.

Study of Different Breastfeeding Parameters by Using Breastfeeding Assessment Tools in Urban Tertiary Care Hospital

Background: In India, only 56% of mothers breastfeed exclusively for the first six months, as recommended. Given India’s extraordinarily high rates of preterm births, infant mortality, neonatal deaths and maternal fatalities, exclusive breastfeeding becomes even more crucial. There are many advantages of breastfeeding, but there are lots of barriers that need to be addressed. These problems need a proper objective assessment. Aims: To assess optimum positioning and attachment in mother-infant dyads, infant breastfeeding behaviour in the early neonatal period and early breastfeeding skills in mothers. Methods: A prospective cross-sectional study was conducted in the postnatal ward of a tertiary care hospital. In total, 208 full-term neonates (Age - 24 hours to 7 days) who were admitted to a postnatal ward of a tertiary care hospital and who were on direct breastfeeding were observed for breastfeeding. Objective assessment of breastfeeding was done by using the Bristol Breastfeeding Assessment Tool, Infant Breast-Feeding Assessment tool and LATCH tool. Statistical analysis was done by using SPSS version 25 with appropriate statistical tests. Result: For the BBAT tool, 110 (52.9%) infants were well supported while feeding and 118 (56.7%) had proper latching or attachment. For IBFAT Score Analysis, 109 (52.4%) infants were effective vigorous feeders and 95 (45.7%) and 4 (1.9%) were moderately effective feeders and poor feeders, respectively. For LATCH Score Analysis, 173 (83.2%) mother-infant dyads achieved a high score and 35 (16.8%) achieved moderate score. Conclusion: Objective assessment of breastfeeding by using these tools will help to identify the problem related to breastfeeding for both baby and mother. Addressing a particular problem in a timely manner will help the mother and the baby to establish, initiate and sustain exclusive breastfeeding. Caesarean-delivered mothers as well as primiparous mothers both needed more focused counselling for breastfeeding positioning, motivation for early initiation breastfeeding, a strong supportive relationship, adequate assistance during the early neonatal period for breastfeeding and proper guidance to sustain exclusive breastfeeding.

Impact of 2 years of COVID-19 pandemic on preterm birth: Experience from a tertiary center of obstetrics in western Germany.

To compare preterm birth rates and reasons before and during the COVID-19-pandemic using a monocentric, retrospective study. Univariate analysis identified differences in rates and reasons for preterm birth and neonatal outcomes between the pre-pandemic period (January 1, 2018 to December 31, 2019) and during the pandemic (January 1, 2020 to December 31, 2021) among all births at our tertiary obstetrical center, the University Hospital of Essen. The cohort consisted of 6086 deliveries with 593 liveborn preterm singletons. During the pandemic, the incidence of preterm birth decreased (10.7% vs. 8.6%; odds ratio [OR] 0.79; 95% confidence interval [CI] 0.66-0.93). Spontaneous preterm birth (43.2% vs. 52.3%; OR 1.47; 95% CI 1.05-2.03), and placenta accreta spectrum disorder (3.7% vs. 8.2%; OR 2.36; 95% CI 1.15-4.84) were more common reasons for preterm birth. Placental dysfunction was a less common reason (34.1% vs. 24.3%; OR 0.62; 95% CI 0.43-0.90). Incidences of preterm premature rupture of membranes (28.13% vs. 40.25%; OR 1.72; 95% CI 1.12-2.43) and oligo-/anhydramnios (3.98% vs. 7.88%; OR 2.06; 95% CI 1.02-4.21) increased. Iatrogenic preterm birth decreased (54.5% vs. 49.5%; OR 0.81; 95% CI 0.58-1.13). Stillbirth rates did not change significantly. Among term births, there were fewer spontaneous deliveries (71.0% vs. 65.8%; OR 0.78; 95% CI 0.69-0.88), and more elective (12.3% vs. 15.1%; OR 1.26; 95% CI 1.07-1.50) and unplanned (9.3% vs. 10.9%; OR 1.19; 95% CI 0.98-1.45) cesarean sections. During the pandemic, more term newborns were admitted to neonatal intensive care (1.4% vs. 2.5%; OR 1.86; 95% CI 1.20-2.88). Our results, in line with data from other high-income countries, suggest that the likely reason for the decreased preterm birth rates is the underdiagnosis of pregnancy complications.

Predictive value of cervical length in placenta previa totalis: a single-center experience

Aims: In our study, we aimed to scientifically assess the utility of measuring cervical length in predicting the risk of postpartum hemorrhage and the necessity for emergency preterm cesarean delivery in women diagnosed with placenta previa totalis. Methods: We conducted a retrospective study at a single medical center, comprising 48 pregnant women diagnosed with placenta previa totalis. Cervical length was precisely measured through transvaginal ultrasound. Patients were categorized based on cervical length (CL): CL &amp;gt;30mm, CL 25-30 mm, and CL &amp;lt;25 mm. Primary outcomes included preterm birth, postpartum hemorrhage, and emergency cesarean section. Results: Women with CL &amp;lt;25 mm exhibited a notably elevated risk of postpartum hemorrhage (60%) and emergency cesarean section (80%). While preterm birth rates displayed variations among groups, statistical significance remained elusive. APGAR scores demonstrated consistency across cervical length categories. Conclusion: Evaluation of cervical length holds promise as a valuable tool in the comprehensive management of placenta previa totalis. Women presenting with a cervical length less than 25 mm may warrant intensified monitoring and targeted interventions to mitigate adverse perinatal outcomes. Further research endeavors are imperative to corroborate these findings and advance the care provided for these intricate pregnancies.

Investigating ticagrelor in a preclinical pipeline as a novel therapeutic to prevent preterm birth.

Preterm birth is the leading cause of perinatal morbidity and mortality, and new therapies that delay preterm birth and improve neonatal outcomes are urgently needed. This study investigates whether ticagrelor inhibits uterine contractility and inflammation in preclinical in vitro, ex vivo (human) and in vivo (mouse) studies, to explore the potential of repurposing ticagrelor for the prevention of preterm birth. Preterm birth remains a significant global health challenge, affecting approximately 10% of pregnancies and resulting in one million deaths globally every year. Tocolytic agents, used to manage preterm labour, have considerable limitations including lack of efficacy, and adverse side effects, emphasising the urgent need for innovative solutions. Here, we explore repurposing an antiplatelet cardioprotective drug, ticagrelor, as a potential treatment to prevent preterm birth. Ticagrelor has demonstrated pleiotropic actions beyond platelet inhibition, including relaxant effects on smooth muscle cells and anti-inflammatory effects in models of diabetes and sepsis. As preterm birth is underscored by inflammatory processes triggering uterine contractions, these actions position ticagrelor as an attractive candidate for prevention or delay of preterm birth. Utilising primary human myometrial tissue, human myometrial cells, and a mouse model of preterm birth, we investigated ticagrelor's potential as a safe and effective therapy for preterm birth. We showed that ticagrelor did not reduce the frequency or strength of spontaneous muscle contractions of ex vivo myometrial tissue nor did it reduce in vitro inflammation-induced contractility in myometrial cells. Additionally, ticagrelor did not exhibit the anticipated anti-inflammatory effects in myometrial cell culture experiments. In our mouse model of preterm birth, ticagrelor neither improved the preterm birth rate or fetal survival outcomes. Gene expression of pro-inflammatory cytokines and contraction-associated proteins in postpartum mouse uteri were unaltered by ticagrelor. In conclusion, ticagrelor is not a strong candidate to continue investigations in clinical trial for the treatment of preterm labour and prevention of preterm birth.

Pregnancy outcomes post-kidney transplantation across 23 years.

Pregnancy in kidney transplant recipients has become increasingly common. However, pregnancy carries higher risks to these patients compared to the general population. To describe pregnancy outcomes in kidney transplant recipients. We conducted a single-centre retrospective cohort study of kidney transplant recipients who delivered after 20 weeks gestation at a quaternary hospital in Victoria, Australia, between 2000 and 2022 inclusive. The study included 37 pregnancies from 27 patients, accounting for 38 infants. Over half of recorded pregnancies occurred in the past five years (56.8%, n = 21). There were high rates of pre-existing hypertension (75.7%, n = 28). Pregnancy-induced hypertension and pre-eclampsia were common antenatal complications (21.6%, n = 8 and 48.6%, n = 18 respectively). Soluble fms-like tyrosine kinase-1 / placental growth factor ratios were elevated in all patients who developed severe pre-eclampsia (16.2%, n = 6). The median gestational age at birth was 36.4 weeks (range 20-40.4, Q1 32.9, Q3 37.6) and 59.5% (n = 22) of births were preterm. Unplanned caesarean without labour was the most common mode of birth (35.1%, n = 13). The overall caesarean rate was 62.1% (n = 23). Post-partum haemorrhage complicated over half of pregnancies (56.8%, n = 21). Fifty percent (n = 19) of infants were admitted for neonatal care, in particular neonatal intensive care, and had low birthweights under 2500 g. While there was a transient deterioration in kidney function, there was no graft rejection within one year of birth. Clinicians should consider the high rates of pre-existing hypertension, preterm birth, and caesarean birth when counselling and managing pregnant kidney transplant recipients.

Racial and ethnic disparities in preterm birth: a mediation analysis incorporating mixtures of polybrominated diphenyl ethers.

Racial and ethnic disparities persist in preterm birth (PTB) and gestational age (GA) at delivery in the United States. It remains unclear whether exposure to environmental chemicals contributes to these disparities. We applied recent methodologies incorporating environmental mixtures as mediators in causal mediation analysis to examine whether racial and ethnic disparities in GA at delivery and PTB may be partially explained by exposures to polybrominated diphenyl ethers (PBDEs), a class of chemicals used as flame retardants in the United States. Data from a multiracial/ethnic US cohort of 2008 individuals with low-risk singleton pregnancies were utilized, with plasma PBDE concentrations measured during early pregnancy. We performed mediation analyses incorporating three forms of mediators: (1) reducing all PBDEs to a weighted index, (2) selecting a PBDE congener, or (3) including all congeners simultaneously as multiple mediators, to evaluate whether PBDEs may contribute to the racial and ethnic disparities in PTB and GA at delivery, adjusted for potential confounders. Among the 2008 participants, 552 self-identified as non-Hispanic White, 504 self-identified as non-Hispanic Black, 568 self-identified as Hispanic, and 384 self-identified as Asian/Pacific Islander. The non-Hispanic Black individuals had the highest mean ∑PBDEs, the shortest mean GA at delivery, and the highest rate of PTB. Overall, the difference in GA at delivery comparing non-Hispanic Black to non-Hispanic White women was -0.30 (95% CI: -0.54, -0.05) weeks. This disparity reduced to -0.23 (95% CI: -0.49, 0.02) and -0.18 (95% CI: -0.46, 0.10) weeks if fixing everyone's weighted index of PBDEs to the median and the 25th percentile levels, respectively. The proportion of disparity mediated by the weighted index of PBDEs was 11.8%. No statistically significant mediation was found for PTB, other forms of mediator(s), or other racial and ethnic groups. PBDE mixtures may partially mediate the Black vs. White disparity in GA at delivery. While further validations are needed, lowering the PBDEs at the population level might help reduce this disparity.

Evaluating the effect of maternal non-communicable disease on adverse pregnancy outcomes and birthweight in Pakistan, a facility based retrospective cohort study

Non-communicable diseases (NCDs) claim 74% of global lives, disproportionately affecting lower and middle-income countries like Pakistan. NCDs may increase the risk of preterm birth (PTB), caesarean section (CS), and low birthweight. This study aims to determine whether the high prevalence of NCDs in Pakistan play a role in the high rates of preterm births, and CS. This retrospective cohort study from Aga Khan University Hospital, Pakistan, investigated effects of pre-existing NCDs on pregnancy outcomes of 817 pregnant women. Medical records were used to generate odds ratios for the risk of PTB, labour outcome and birthweight in women with type 1 and type 2 diabetes, hypertension, asthma and thyroid disorders. Multinomial logistic regression and general linear models were used to adjust for confounding variables using IBM SPSS Statistics (v27). Type 2 diabetes significantly increased the risk of PTB and elective CS (both P < 0.05). Elective CS was significantly increased by hypertension and asthma (both, P < 0.05). Surprisingly, asthma halved the risk of PTB (P < 0.05), while type 1 diabetes significantly increased birthweight from 2832 to 3253g (P < 0.001). In conclusion, pre-existing NCDs increase the risk of negative pregnancy outcomes, including PTB, elective CS and birthweight. Asthma, however reduced PTB and justifies further investigation.

African immigrants' favorable preterm birth rates challenge genetic etiology of the Black-White disparity in preterm birth.

We examined over a million California birth records for 2010 through 2021 to investigate whether disparities in preterm birth (PTB) by nativity and race support the widely held but hitherto unsubstantiated belief that genetic differences explain the persistent Black-White disparity in PTB. We examined PTB rates and risk ratios among African-, Caribbean-, and U.S.-born Black women compared to U.S.-born White women. Multivariate analyses adjusted for maternal age, education, number of live births, delivery payer, trimester of prenatal care initiation, pre-pregnancy BMI, smoking, and prevalence of poverty in a woman's residence census tract; and for paternal education. In adjusted analyses, African-born Black women's PTB rates were no different from those of U.S.-born White women. The results add to prior evidence making a genetic etiology for the racial disparity in PTB unlikely. If genetic differences tied to "race" explained the Black-White disparity in PTB among U.S.-born women, the African immigrants in this study would have had higher rates of PTB, not the lower rates observed. Multiple explanations for the observed patterns and their implications are discussed. Failure to distinguish causes of PTB from causes of the racial disparity in PTB have likely contributed to erroneous attribution of the racial disparity to genetic differences. Based on the literature, unmeasured experiences of racism, including racism-related stress and adverse environmental exposures, are plausible explanations for the PTB disparity between Black and White U.S.-born women. The favorable birth outcomes of African-born Black immigrants may reflect less exposure to racism during sensitive life periods, e.g., childhood, when they were in African countries, where Black people are in the racial majority.

Diving into CDC pregnancy data in the United States: longitudinal study and interactive application.

Preterm birth (PTB) is a major determinant of neonatal mortality, morbidity, and childhood disability. In this article, we present a longitudinal analysis of the risk factors associated with PTB and how they have varied over the years: starting from 1968 when the CDC first started, reporting the natality data, up until 2021. Along with this article, we are also releasing an RShiny web application that will allow for easy consumption of this voluminous dataset by the research community. Further, we hope this tool can aid clinicians in the understanding and prevention of PTB. This study used the CDC Natality data from 1968 to 2021 to analyze trends in PTB outcomes across the lens of various features, including race, maternal age, education, and interval length between pregnancies. Our interactive RShiny web application, CDC NatView, allows users to explore interactions between maternal risk factors and maternal morbidity conditions and the aforementioned features. Our study demonstrates how CDC data can be leveraged to conduct a longitudinal analysis of natality trends in the United States. Our key findings reveal an upward trend in late PTBs, which is concerning. Moreover, a significant disparity exists between African American and White populations in terms of PTB. These disparities persist in other areas, such as education, body-mass index, and access to prenatal care later in pregnancy. Another notable finding is the increase in maternal age over time. Additionally, we confirm that short interpregnancy intervals (IPIs) are a risk factor for PTBs. To facilitate the exploration of pregnancy risk factors, infections, and maternal morbidity, we developed an open-source RShiny tool called CDC NatView. This software offers a user-friendly interface to interact with and visualize the CDC natality data, which constitutes an invaluable resource. In conclusion, our study has shed light on the rise of late PTBs and the persistent disparities in PTB rates between African American and White populations in the US. The increase in maternal age and the confirmation of a short IPI as a risk factor for PTB are noteworthy findings. Our open-source tool, CDC NatView, can be a valuable resource for further exploration of the CDC natality data to enhance our understanding of pregnancy risk factors and the interaction of PTB outcomes and maternal morbidities.

A retrospective analysis of the safety of tacrolimus use and its optimal cut-off concentration during pregnancy in women with systemic lupus erythematosus: study from two Japanese tertiary referral centers

BackgroundTacrolimus is one of the major treatment options for systemic lupus erythematosus (SLE) and is considered to be a pregnancy-compatible medication. Since little is known about tacrolimus safety during pregnancy complicated by SLE, this study was designed.MethodsWe included SLE pregnant patients who were followed up at two Japanese tertiary referral centers. We performed multivariate logistic regression analysis to assess each adverse pregnancy outcome (APO) risk. Moreover, we assessed the influence of tacrolimus on the APO ratio in pregnant patients with lupus nephritis, and the impact of combined tacrolimus-aspirin therapy on the APO ratio relative to patients exclusively administered tacrolimus.ResultsOf the 124 pregnancies, 29 were exposed to tacrolimus. Multivariate analysis showed no statistical difference in APO ratio. (overall APO: adjusted odds ratio [aOR], 0.69; 95% confidence interval [CI], 0.23–2.03; p = 0.50; maternal APO: aOR, 1.17; 95% CI, 0.36–3.83; p = 0.80; neonatal APO: aOR, 1.10; 95% CI, 0.38–3.21; p = 0.86; PROMISSE APO: aOR, 0.50; 95% CI, 0.14–1.74; p = 0.27).Blood pressure and estimated glomerular filtration rate (eGFR) during pregnancy and after delivery did not differ between the two groups. Receiver operating characteristic (ROC) curve showed that tacrolimus concentration > 2.6 ng/ml was related to reduced preterm birth rate. (AUC = 0.85, 95% CI: 0.61–1.00, sensitivity: 93% and specificity: 75%).Regarding effect of tacrolimus on lupus nephritis during pregnancy, tacrolimus showed no increased risk of APO, blood pressure or eGFR during pregnancy and after delivery. (overall APO: OR, 1.00; 95% CI, 0.25–4.08; p = 0.98; maternal APO: OR 1.60, 95% CI, 0.39–6.64; p = 0.51; neonatal APO: OR, 0.71; 95% CI, 0.17–3.03; p = 0.65, PROMISSE APO: OR, 0.50; 95% CI, 0.08–3.22; p = 0.47).Tacrolimus-aspirin combination therapy showed a protective tendency against hypertensive disorders during pregnancy, preeclampsia and low birth weight.ConclusionsTacrolimus use during pregnancy with SLE and lupus nephritis showed no significant influence on APO, blood pressure, or renal function; therefore tacrolimus may be suitable for controlling lupus activity during pregnancy. In addition, when using tacrolimus during pregnancy, we should aim its trough concentration ≥ 2.6 ng/ml while paying careful attention to possible maternal side effects of tacrolimus.Trial registrationRetrospectively registered.

The effectiveness of vaginal progesterone to prevent preterm birth in singleton pregnant women with a short cervix at 18–32 weeks gestation

Objective: Short cervix is a risk factor for preterm birth. Currently, both international and domestic studies about progesterone’s effectiveness are limited to pregnant women at 18–24 weeks gestation. However, multiple studies indicated that cervical length was associated with preterm birth even before 32 weeks of gestation. Therefore, this study expanded the gestational week range to investigate whether progesterone can reduce the rate of preterm birth in singleton pregnant women with a short cervix at 18–32 weeks gestation. Methods: Pregnant women who underwent prenatal examination at Peking University First Hospital from January 2016 to August 2020 were prospectively followed. A total of 132 asymptomatic singleton pregnant women at 18–32 weeks gestation with a cervical length <25 mm were ultimately enrolled. According to the method of treatment, the participants were divided into progesterone group (80 patients) and control group (52 patients). The rate of preterm birth (PTB) at different stages was compared between two groups. Results: (1) There was no significant difference in the total preterm birth rate (18.8% vs. 21.2%, RR 0.886[0.442–1.777], p = 0.734). (2) Stratified analysis found that, for pregnant women at <24 weeks gestation, there was a significant difference in the rate of PTB at <32 weeks (2.8% vs. 33.3%, p = 0.021). For women at 24–28weeks gestation, significant difference was not found in the rate of PTB at <37 weeks gestation (25% vs. 42.9%, RR = 0.583[0.186–1.831], p = 0.682), neither for women at after 28 weeks(12.5% vs. 11.1%,1.12[0.27–4.59], p = 1). (3) Vaginal progesterone was not associated with low birth weight (13.8% vs. 19.2%, p = 0.4), or preterm birth-related complications such as respiratory distress syndrome (3.8% vs. 7.7%, p = 0.555), aspiration pneumonia (22.5% vs. 19.2%, p = 0.653) and sepsis (2.5% vs. 7.7%, p = 0.331). Conclusion: For pregnant women with a short cervix at 18–24 weeks gestation, the rate of preterm birth before 32 weeks could be significantly reduced. For women with a short cervix at 24–28 weeks gestation, the rate of preterm birth could be reduced, while there was no significant effect for pregnant women. Further studies with a larger sample size and randomized controlled researches are needed.

A comprehensive evaluation of pregnancy and newborn outcomes in Syrian refugees in Turkey.

The research was conducted to evaluate the birth and newborn outcomes of Syrian immigrant women according to maternal age groups and Vitamin D use. It was conducted retrospectively using the birth records of 2,866 Syrian migrant women, who had given birth at a tertiary center between January 2016 and May 2020. Demographic features, obstetric and neonatal outcomes were analyzed according to age groups and Vitamin D use. The mean age of the patients included in the study was 26.22 ± 5.90, the mean gestational age at birth was 38.06 ± 2.1 weeks, and the mean newborn birth weight was 3.151g. The mean hemoglobin value of the patients was 11.55 ± 1.54. While most of the patients were taking iron supplements (80.59%), Vitamin D (Vit D) supplement intake was 38.31%. The mean number of antenatal follow-ups was 3.40 ± 1.65. While the most common delivery method was normal vaginal delivery (61.93%), cesarean section rates were found to be 38.07%. The need for blood transfusion was significantly lower in the group that had received Vitamin D than that in the group that had not received it (2.00% vs. 8.94% p < 0.001). The rate of preterm birth was found to be 5.74% in the group that had received Vitamin D and 9.28% in the group that had not received it, which was significantly higher (p < 0.001). We have seen that maternal and fetal outcomes can be improved with hospital follow-up and adequate vitamin supplements in refugee pregnant women.

COVID-19 in pregnancy: prevalence, management, and outcomes in a single large health system

Objective This study assessed the prevalence of SARS-CoV-2 positivity in a cohort of pregnant patients served by a single health system. Treatments and outcomes are compared by maternal SARS-CoV-2 status and COVID-19 symptomatology. Methods This was a retrospective cohort study of patients with delivery outcomes from March 2020-December 2021. SARS-CoV-2 positivity was defined by patients who had a positive test or COVID-19 diagnosis during pregnancy. Descriptive analysis compared demographics, medical management during pregnancy, and both perinatal and non-obstetric outcomes by SARS-CoV-2/COVID-19 status (negative, positive-asymptomatic, and positive-symptomatic). Results Of 24,310 pregnancies, 94.6% were negative, 3.9% were positive-asymptomatic, and 1.5% were positive-symptomatic. Non-delivery hospitalizations were highest among positive-symptomatic patients (16.8%), followed by positive-asymptomatic patients (3.9%) and lastly negative patients (2.7%) (p < 0.001). Likewise, Intensive Care Unit (ICU) admissions during an antepartum or delivery admission were higher for positive-symptomatic patients (13.0%) compared to positive-asymptomatic patients or negative patients (0.7% and 0.5%, respectively, p < 0.001). The rate of preterm birth was significantly higher in positive-symptomatic patients compared to positive-asymptomatic and negative patients (15.7% vs. 9.5% and 9.8%, respectively, p = 0.002). There were no statistically significant differences in rates of miscarriage or intrauterine fetal demise. Maternal readmission, administration of corticosteroids for fetal lung maturity, birthweight, and neonatal intensive care unit (NICU) admission were significantly affected by SARS-CoV-2 status. Conclusion Pregnant patients testing positive for SARS-CoV-2 were mostly asymptomatic and identified during routine screening. Symptomatic patients were significantly more likely to require hospitalization and ICU admission with some increase in adverse perinatal outcomes.