Preterm Low Birth Research Articles

Intrinsically Autoregressive Spatiotemporal Models With Application to Aggregated Birth Outcomes

A class of hierarchical Bayesian models is proposed for adverse birth outcomes such as preterm birth, which are assumed to follow a conditional binomial distribution. The log-odds of an adverse outcome in a particular county, logit(pi), follow a linear model that includes observed covariates and normally-distributed random effects. Spatial dependence between neighboring regions is allowed for by including an intrinsically autoregressive (IAR) prior or an IAR convolution prior in the linear predictor. Temporal dependence is incorporated by including a temporal IAR term also. It is shown that the variance parameters underlying these random effects (IAR, convolution, convolution plus temporal IAR) are identifiable. The Deviance Information Criterion (DIC) is considered as a way to compare spatial hierarchical models. Simulations are performed to test whether the DIC can identify whether binomial outcomes come from a hierarchical model that includes different combinations of random and fixed effects. Having validated the DIC as a means of comparing models, we examine preterm birth and low birth weight counts in the state of Arkansas from 1994–2005. We find that preterm birth and low birth weight have different spatial patterns of risk, and that rates of low birth weight can be fit with a relatively simple model that includes a constant spatial effect for all periods, a linear trend, and three covariates (multiple birth, black mother, smoking). It is also found that the risks of each outcome are increasing over time, even with adjustment for covariates.

Pill use in the month before conception linked to risk of low birth weight preterm delivery

Women who use oral contraceptives just prior to conception may be more likely than nonusers to experience adverse birth outcomes according to a study of health records from the Canadian province of Saskatchewan.1 Those who used the pill within 30 days of their last menstrual period had elevated odds of preterm birth and low birth weight conditions that are associated with infant morbidity and mortality. The researchers examined records from Saskatchewan Health Databases which contain information on 99% of the provinces residents. They obtained data on physician services hospital stays and prescription drug use in the year prior to giving birth for a random sample of 50% of women who had a pregnancy between 1997 and 2000. these outcomes. In an analysis that adjusted for womens socioeconomic and chronic disease status pill use within 30 days of the last menstrual period was positively associated with the occurrence of very low and low birth weight (odds ratios 3.2 and 1.9 respectively) and preterm delivery (1.6). Use 2-3 months prior to the last menstrual period was not associated with adverse birth outcomes. (excerpt)

M1151 Influence of Inflammatory Bowel Disease On Pregnancy

Objective: evaluate the influence of inflammatory bowel disease (IBD) on pregnancy evolution and fetal alterations. Method: the protocols of patients with Crohn's disease (CD) and ulcerative colitis (UC), from 1984 and 2006, in fertile age, followed at the ambulatory of IBD, were reviewed. Patients were interviewed by the research medical doctor, to complete some issues not found in their protocols. Patients with others colitis, incomplete investigation, not in fertile age or without cognitive capacity were excluded from this study. Obstetric history before and after the beginning of symptoms related to IBD, clinical conditions of patients, drugs administered during pregnancy period, preterm delivery, low birth weight, stillbirth, congenital anomalies, spontaneous miscarriage, vaginal and cesarean delivery were investigated. Results: 416 pregnancies in 163 patients before the diagnosis of IBD and 140 pregnancies in 104 patients with IBD were evaluated (UC in 63 pregnancies and CD in 77 pregnancies). IBD was associated with increased preterm delivery (x2=6.7205, p=0.009). There was no statistical difference in low birth weight (x2=0.413 / p=0.5204), congenital anomalies (Fisher test: p=0.6447), stillbirth (Fisher: p=0.2245), spontaneous miscarriage (x2= 4.884, p=0.27), vaginal and cesarean delivery (x2= 1.7959, p=0.1802). There were 63 pregnancies in UC patients, with active disease in 28 and inactive in 35 pregnancies. There were 77 pregnancies in CD patients, with active disease in 57 and inactive in 20 patients. There was no difference between the groups of pregnancies in UC and CD, related to preterm delivery, low birth weight, congenital anomalies, stillbirth and spontaneous miscarriage (p > 0.0649). There was statistical difference in active and inactive disease groups in CD, related to preterm delivery and low birth weight (p < 0.0365). Distribution of alterations in fetus and activity of UC and CD is shown on table 1. Conclusions: preterm delivery rates were higher in pregnancies of CD patients, even with inactive disease during pregnancy. There was no influence of IBD on low birth weight, congenital anomalies, stillbirth and spontaneous miscarriage. Table 1. Distribution of alterations in fetus and activity of UC and CD.

M1152 Influence of Smoking Habits On the Mid-Term Clinical Outcome of New-Onset Crohn's Disease

Objective: evaluate the influence of inflammatory bowel disease (IBD) on pregnancy evolution and fetal alterations. Method: the protocols of patients with Crohn's disease (CD) and ulcerative colitis (UC), from 1984 and 2006, in fertile age, followed at the ambulatory of IBD, were reviewed. Patients were interviewed by the research medical doctor, to complete some issues not found in their protocols. Patients with others colitis, incomplete investigation, not in fertile age or without cognitive capacity were excluded from this study. Obstetric history before and after the beginning of symptoms related to IBD, clinical conditions of patients, drugs administered during pregnancy period, preterm delivery, low birth weight, stillbirth, congenital anomalies, spontaneous miscarriage, vaginal and cesarean delivery were investigated. Results: 416 pregnancies in 163 patients before the diagnosis of IBD and 140 pregnancies in 104 patients with IBD were evaluated (UC in 63 pregnancies and CD in 77 pregnancies). IBD was associated with increased preterm delivery (x2=6.7205, p=0.009). There was no statistical difference in low birth weight (x2=0.413 / p=0.5204), congenital anomalies (Fisher test: p=0.6447), stillbirth (Fisher: p=0.2245), spontaneous miscarriage (x2= 4.884, p=0.27), vaginal and cesarean delivery (x2= 1.7959, p=0.1802). There were 63 pregnancies in UC patients, with active disease in 28 and inactive in 35 pregnancies. There were 77 pregnancies in CD patients, with active disease in 57 and inactive in 20 patients. There was no difference between the groups of pregnancies in UC and CD, related to preterm delivery, low birth weight, congenital anomalies, stillbirth and spontaneous miscarriage (p > 0.0649). There was statistical difference in active and inactive disease groups in CD, related to preterm delivery and low birth weight (p < 0.0365). Distribution of alterations in fetus and activity of UC and CD is shown on table 1. Conclusions: preterm delivery rates were higher in pregnancies of CD patients, even with inactive disease during pregnancy. There was no influence of IBD on low birth weight, congenital anomalies, stillbirth and spontaneous miscarriage. Table 1. Distribution of alterations in fetus and activity of UC and CD.

Does Exposure to Antenatal Indomethacin have an Impact on the Neurodevelopmental Outcome in Preterm Very Low Birth Weight (Vlbw) Infants at 36 Months Adjusted Age?

Does Exposure to Antenatal Indomethacin have an Impact on the Neurodevelopmental Outcome in Preterm Very Low Birth Weight (Vlbw) Infants at 36 Months Adjusted Age?

Parity and Low Birth Weight or Preterm Birth: a Systematic Review and Meta-Analyses

Parity and Low Birth Weight or Preterm Birth: a Systematic Review and Meta-Analyses

Intention to Become Pregnant and Low Birth Weight and Preterm Birth: a Systematic Review

Increased stress, psychosocial problems, economic disadvantages, and lack of prenatal care are proposed to explain discrepancies in the outcome of unintended pregnancies. Studies of maternal intention and pregnancy outcomes have yielded varied results. Objective is to review studies of the risk of low birth weight (LBW)/preterm births (PTB) associated with unintended pregnancies ending in a live birth. We reviewed studies reporting on maternal intentions and outcomes from Medline, Embase, CINAHL, and bibliographies of identified articles. An unintended pregnancy was further classified as mistimed (not intended at that time) or unwanted (not desired at any time). Studies reporting an association between pregnancy intention and any of the outcomes were included. Study quality was assessed for biases in selection, exposure assessment, confounder adjustment, analyses, outcomes assessment, and attrition. Unadjusted and adjusted data from included studies were extracted by two reviewers. There were significantly increased odds of LBW among unintended pregnancies [odds ratio (OR) 1.36, 95% confidence interval (CI) 1.25, 1.48] ending in a live birth. Within the unintended category, mistimed (OR 1.31, 95% CI 1.13, 1.52) and unwanted (OR 1.51, 95% CI 1.29, 1.78) pregnancies were associated with LBW. There were statistically significantly increased odds of PTB among unintended (OR 1.31, 95% CI 1.09, 1.58), and unwanted (OR 1.50, 95% CI 1.41, 1.61) but not for mistimed (OR 1.36, 95% CI 0.96, 1.93) pregnancies. Unintended, unwanted, and mistimed pregnancies ending in a live birth are associated with a significantly increased risk of LBW and PTB.

Is Induced Abortion Associated with Low Birth Weight or Preterm Birth? a Systematic Review and Meta-Analyses

Is Induced Abortion Associated with Low Birth Weight or Preterm Birth? a Systematic Review and Meta-Analyses

Iron-deficiency anemia increases risk of preterm delivery.

In an inner-city sample of pregnant women, iron-deficiency anemia was associated with a higher risk of preterm delivery and low birth weight but not with small-for-gestational-age births. However, the prevalence of iron-deficiency anemia (3.5%) explained only a small proportion of preterm deliveries.

The use of progesterone and other progestational agents to prevent spontaneous preterm labour and preterm birth

Background: Preterm birth is the major cause of perinatal mortality and morbidity in the developed world, making a huge impact on healthcare costs. There is accumulating evidence that the prophylactic use of progestagens is able to reduce significantly the incidence of low birth weight and preterm birth. Objectives: to emphasise the importance of preterm birth; to review the role of progesterone in inducing myometrial quiescence which prevent preterm labour and preterm birth; to review the published literature and planned future research on the use of progestagens for the prevention of preterm birth. Methods: A review of the published literature using accepted search engines. Results/conclusions: Progestagens have been demonstrated to reduce the incidence of low birth weight and preterm birth. Many questions remain unanswered, particularly the long-term safety concerns and also whether the use of progestagens results in improved neonatal and childhood outcomes.

Motor Development in Very Preterm and Very Low Birth Weight Children

Outcome studies indicate that very preterm infants (≤32 weeks' gestation) and very low birth weight (VLBW) infants (≤1500 g) are at risk for delayed educational, social, and behavioral development. Findings from studies on motor development in such infants have been inconsistent but suggest that delayed motor development affects specific adaptive functions, including early exploratory behaviors, engagement in social activities, and handwriting skills. Investigators in the Netherlands …

Lifetime and During Pregnancy Experience of Violence and the Risk of Low Birth Weight and Preterm Birth

In order to assess the relationship between lifetime and during pregnancy experience of violence and low birth weight (LBW) and preterm birth outcomes, we designed a prospective cohort study in which the birth outcomes of women who experienced violence before their pregnancy or who experienced violence during pregnancy were compared to women who reported no lifetime experience of violence. We found that the risk of having a low birth weight or preterm baby was higher for women who did not experience violence. The proportion of women who had LBW babies was 7.1% for women who experienced violence during pregnancy, 7.8% for women who experienced violence before the current pregnancy, and 9.1% for nonexposed women. The proportion of preterm births was 3.5% for women exposed to violence during pregnancy, 8.5% for women exposed before the current pregnancy, and 9.7% for nonexposed women. However, married women who experienced violence had a higher proportion of LBW and preterm infants compared to the reference group of nonvictims of violence. Overall, women who experienced violence during pregnancy and before their current pregnancy did not have a greater proportion of LBW babies or preterm births. The findings suggest that married women in certain populations may experience more frequent or more severe experience of violence than unmarried women.

T05-P-04 Abuse and preterm delivery: a case report

Since the late 1970s empirical reports show maternal psychosocial distress as a significant predictor of spontaneous preterm birth even after data were adjusted for biological risk factors. Although little research has been conducted on women with histories of childhood sexual abuse, it's known that injuries resulting from physical abuse are associated with both low birth weight and preterm birth. The story of a 66 years old woman is an emblematic demonstration of this. She had two children by cesarean cut, even if she have ever had any sexuale intercourses with her husband because of her severe vaginism. During both her pregnancies she had preterm contractions that led to preterm deliveries: one of the baby didn’t survive because of his severe prematurity, the other one born at 31 weeks. She came to our attention for an ultrasound check. She had always refused any gynecologic visit, but now in her oldness she felt it was not too late to better her life. She told us she was abused by her father during all her childhood, but since now she have never been able to tell anyone the truth. Sexual abuse is a worldwide problem, and it's increasingly recognized as a potentially modifiable risk factor for adverse pregnancy outcomes. A comparison of the long-therm consequences of sexual abuse will provide perspective on the need for future research, prevention activities, and treatment of survivors.

Periodontal Disease as a Risk Factor for Adverse Pregnancy Outcomes: A Prospective Cohort Study

Aim: The aim of this study was to determine the association between periodontitis and the incidence of preterm birth (PB), low birth weight (LBW) and preterm low birth weight (PLBW) Material and Methods: One thousand and ninty-six women were enrolled. Periodontal data, pregnancy outcome variables and information on other factors that may influence adverse pregnancy outcomes were collected. Data were analysed using a logistic regression model. Results: The incidence of PB and LBW was 6.6% and 6.0%, respectively. The incidence of PLBW was 3.3%. PB was related to mother's age, systemic diseases, onset of prenatal care, previous PBs, complications of pregnancy, type of delivery, the presence of untreated caries and the presence of periodontitis (odds ratio 1.77, 95% confidence interval: 1.08–2.88). LBW was related to mother's smoking habits, ethnicity, systemic diseases, previous LBW babies, complications of pregnancy and type of delivery. PLBW was related to mother's age, onset of prenatal care, systemic diseases, previous LBW babies, complications of pregnancy and type of delivery. Conclusions: The factors involved in many cases of adverse pregnancy outcomes have still not being identified, although systemic infections may play a role. This study found a modest association between periodontitis and PB. Further research is required to establish whether periodontitis is a risk factor for PB and/or LBW.

Adverse Birth Outcome Among Mothers With Low Serum Cholesterol

Expectant mothers require cholesterol for both the hormonal and physical changes of early pregnancy, but it is not clear whether a given pregnancy is at risk if the maternal serum cholesterol falls below a particular level. This pilot study sought to determine whether low maternal serum cholesterol, defined as a total cholesterol (TC) level less than the 10th percentile (159 mg/dL at a mean gestational age of 17.6 weeks), is associated with adverse pregnancy outcomes. Mother-infant pairs were retrospectively chosen from a cohort of 9938 women referred for second-trimester serum screening. Eligible women ranged from 21 to 34 years of age and had no known major risk factors for a poor outcome. All infants were singletons and were born alive. TC values were adjusted for gestational age at screening. The study population included 118 women with low TC and 940 with higher TC levels. Outcomes were assessed using multivariate regression models. The prevalence of preterm delivery was 12.7% in low maternal serum cholesterol mothers and 5.0% in control subjects with mid-range total cholesterol levels. The association between low maternal serum cholesterol and preterm birth was noted only in white mothers. In black women, preterm delivery was associated only with high TC. Term infants of mothers with low maternal serum cholesterol weighed 150 g less on average than those born to control mothers; this was true for both whites and blacks. Low maternal serum cholesterol was not associated with an increased risk of congenital anomalies. There was a trend toward an increased risk of microcephaly in neonates whose mothers had low TC values.

FREEDOM OF BREATH, FOUNDATION OF LIFE

Perinatal asphyxia is the leading cause of neonatal mortality, cerebral palsy, and mental retardation worldwide and accounts for ∼1 million of the 4 million neonatal deaths that occur each year (World Health Organization, 2005). According to China's national maternal and children's health surveillance in 2005, neonatal mortality was 19 per 1000 live births. In China, the first top 3 causes of infant mortality are preterm birth and low birth weight, birth asphyxia, and pneumonia. In 2005 asphyxia accounted for 20.5% of deaths in children under the age of 5 years. On the basis of a national sample survey from China Disabled Persons' Foundation in 2003, there are 199 000 disabled children between 0 and 6 years old each year, 54.2% of whom are mentally disabled, primarily related to birth asphyxia. The Neonatal Resuscitation Program (NRP) was introduced to China in the 1990s to reduce mortality and morbidity caused by asphyxia. NRP training was held in cities such as Beijing and Shanghai, which helped to build the foundation of the NRP in China. To disseminate the NRP throughout China, a multidisciplinary partnership was established among the Chinese Ministry of Health, Chinese Perinatal Society, Chinese Nursing Association, American Academy of Pediatrics, and Johnson and Johnson Pediatric Institute. In July 2003, a task force that consists of representatives from all partners made a 5-year commitment to set up “Freedom of Breath, Foundation of Life: China Neonatal Resuscitation Program.” The objective was to ensure the presence of at least 1 trained health care professional at every delivery. It has been 3 years since the program launched, and many key accomplishments have been made: The Chinese version of the fourth and fifth editions of the NRP manual (created by American Academy of Pediatrics and American Heart Association) was published.Chinese NRP editions were made with Chinese cultural considerations to guide neonatal resuscitation practices in China.Since July 2004, many training sessions have been organized, including a national instructors training, provincial instructors training(s) in 30 provinces (there are a total of 30 provinces in China), and cascading trainings in cities, counties, and townships. To date, 18 240 health care professionals have been trained, among them obstetricians, pediatricians, nurses/midwives, and anesthetists. By the end of 2006, NRP training had covered 99.1% of health care institutions in cities and 59.8% in 20 target provinces.On September 20–23, 2006, the NRP Science Updates and Experience Sharing conference was held in Xian, capital city of Shaanxi in the northwest part of China. One hundred fifty health care professionals from 20 target provinces attended to learn of scientific updates from Drs Keenan and Niemeyer. Each province presented their training reports and summaries; a few of them were rewarded for their excellence of performance.Since the launch of the NRP, many provincial health bureaus included neonatal resuscitation skills into midwifery service licensing. By the end of 2007, it will become a nationwide regulation in midwifery service licensing. Starting in 2007, the Chinese NRP expanded its program elements to add neonatal mortality and morbidity evaluation. We believe the data collected from this evaluation would be valuable, not only to the Chinese NRP but also to the international NRP.

The Contribution of Birth Defects to Preterm Birth and Low Birth Weight

The Contribution of Birth Defects to Preterm Birth and Low Birth Weight

NNP02 The association between prenatal anxiety and spontaneous preterm birth and low birth weight

NNP02 The association between prenatal anxiety and spontaneous preterm birth and low birth weight

The differential effect of foreign‐born status on preterm birth: a Taiwan population‐based birth registry study

Whether foreign-born status confers a protective effect on preterm birth in Taiwan was investigated using singleton live birth data from the 2004 Taiwan Birth Registry (n = 211,946). Newborns of foreign-born mothers (FBMs) comprised 13.7% of the population. The preterm birth rate of newborns of FBMs (5.9%) was significantly lower than that of newborns of Taiwan-born mothers (TBMs) (8.0%) (P < 0.0001). After having adjusted for predisposing maternal factors or adverse pregnancy conditions, newborns of FBMs still had a lower risk in preterm birth than that of TBMs, with an odds ratio of 0.74 and 95% confidence interval between 0.71 and 0.79. Selection was hypothesised to explain the low preterm birth rate in FBMs.

Treatment of Periodontal Disease and the Risk of Preterm Birth

Background Maternal periodontal disease has been associated with an increased risk of preterm birth and low birth weight. We studied the effect of nonsurgical periodontal treatment on preterm birth. Methods We randomly assigned women between 13 and 17 weeks of gestation to undergo scaling and root planing either before 21 weeks (413 patients in the treatment group) or after delivery (410 patients in the control group). Patients in the treatment group also underwent monthly tooth polishing and received instruction in oral hygiene. The gestational age at the end of pregnancy was the prespecified primary outcome. Secondary outcomes were birth weight and the proportion of infants who were small for gestational age. Results In the follow-up analysis, preterm birth (before 37 weeks of gestation) occurred in 49 of 407 women (12.0%) in the treatment group (resulting in 44 live births) and in 52 of 405 women (12.8%) in the control group (resulting in 38 live births). Although periodontal treatment improved periodo...