Preterm Singleton Research Articles

Neonatal Intensive Care Variation in Medicaid-Insured Newborns: A Population-Based Study

To assess the contribution of maternal and newborn characteristics to variation in neonatal intensive care use across regions and hospitals. This was a retrospective population-based live birth cohort of newborn infants insured by Texas Medicaid in 2010-2014 with 2 subcohorts: very low birth weight (VLBW) singletons and late preterm singletons. Crude and risk-adjusted neonatal intensive care unit (NICU) admission rates, intensive and intermediate special care days, and imaging procedures were calculated across Neonatal Intensive Care Regions (n=21) and hospitals (n=100). Total Medicaid payments were calculated. Overall, 11.5% of live born, 91.7% of VLBW, and 37.6% of infants born late preterm were admitted to a NICU, receiving an average of 2days, 58days, and 5days of special care with payments per newborn inpatient episode of $5231, $128 075, and $10 837, respectively. There was little variation across regions and hospitals in VLBW NICU admissions but marked variation for NICU admissions in late preterm newborn infants and for special care days and imaging rates in all cohorts. The variation decreased slightly after health risk adjustment. There was moderate substitution of intermediate for intensive care days across hospitals (Pearson r VLBW -0.63 P<.001; late preterm newborn -0.53 P<.001). Across all risk groups, the variation in NICU use was poorly explained by differences in newborn illness levels and is likely to indicate varying practice styles. Although the "right" rates are uncertain, it is unlikely that all of these use patterns represent effective and efficient care.

Maternal hypertension and survival in singletons and twins born at 23-29 weeks: not just one answer….

To describe the association between maternal hypertension (chronic and gestational, MH) and mortality in very preterm singletons and twins, focusing on how estimates depend on gestational age (GA) and size at birth. We estimated relative risks of in-hospital death in 12,320 singletons (MH: 22.4%) and 4381 twins (MH: 10.6%) born at 23-29 weeks in the Italian Neonatal Network (89 hospitals, 2008-2016). Babies with MH had higher GA and were more frequently small-for-gestational age (SGA), especially singletons. In crude analyses, MH was associated with lower mortality in singletons. In multivariable analyses, the effects of GA and size differed between twins and singletons with and without MH. The best-fitting models included continuous birth weight (rather than SGA) and were stratified by GA. In these models, MH was associated with lower mortality in singletons-but not twins-born after week 25. In this cohort of very preterm infants, the association between MH and mortality differed between singletons and twins and across strata of GA at birth. These estimates cannot be interpreted causally, but suggest that, from a descriptive/predictive standpoint, singletons with MH born after week 25 have lower mortality than singletons born to women without MH.

Mode of delivery and mortality and morbidity for very preterm singleton infants in a breech position: A European cohort study

ObjectiveCaesarean section (CS) may reduce mortality and morbidity for very preterm breech infants, but evidence is inconclusive. We evaluated neonatal outcomes for singleton breech infants by mode of delivery in a European cohort. Study designData come from the EPICE population-based cohort of very preterm births in 19 regions in 11 European countries (7770 live births). The study population was singleton spontaneous-onset breech births at 24–31 weeks gestational age (GA) without antenatal medical complications requiring caesarean delivery (N = 572). Mixed-effects regression models adjusting for maternal and pregnancy covariates and propensity score matching was used to examine the effect of (1) CS and (2) a unit policy of systematic CS for breech presentation by GA. The primary outcome was a composite of in-hospital mortality, intraventricular haemorrhage grades III & IV or cystic periventricular leukomalacia. Secondary outcomes were each component separately, five minute Apgar score below seven and mortality within six hours of delivery. Results64.4% of infants were delivered by CS with a range across regions from 41% to 100%; these infants had higher GA and were more likely to be small for gestational age, receive antenatal steroids, and have mothers who were hospitalised for more than one day before delivery compared to those delivered vaginally. CS was associated with lower risks of all outcomes in mixed-effects adjusted models (odds ratio (OR) for the composite outcome: 0.50, 95% confidence interval (CI): 0.30-0.81), but not in propensity score matched models (OR: 0.72, 95% CI: 0.41; 1.29). A systematic CS policy was associated with lower mortality and morbidity in unadjusted, but not adjusted models (OR for composite outcome: 0.76, 95% CI: 0.44; 1.28). 35% of births 24–25 weeks were delivered by CS and protective effects were consistently stronger, but not statistically significant. ConclusionsPoint estimates indicated protective effects of caesarean delivery for very preterm breech infants in conventional statistical models. However, analyses using propensity scores and based on unit policies did not confirm statistically significant associations. Prospective large-scale studies are needed to establish best practice and could be implemented in European regions where vaginal delivery remains an option.

410: Neonatal hypoglycemia after corticosteroid exposure: what is the effect of plurality?

Antenatal corticosteroid (ACS) administration before anticipated preterm birth is one of the most important therapies available to improve neonatal outcomes. Nevertheless, this treatment is associated with increased risk of neonatal hypoglycemia. While the association between ACS and neonatal hypoglycemia has been investigated in singleton pregnancies, there is paucity of data regarding twin gestation. Thus, the aim of our study was to determine whether preterm twins who receive ACS are at increased risk for developing hypoglycemia. A retrospective cohort study of all preterm births of twins at a single tertiary center from 2011 to 2018. The primary outcome was neonatal hypoglycemia (<40 mg/dL) within the first 48 h of life. The study population included 3 groups: 1. twin neonates who received a course of ACS 1-7 days before birth (n=264); 2. preterm twins who did not receive ACS at that time interval (n=80) and 3. singletons receiving ACS 1-7 days before birth (n=277). The groups were matched for gestational age (GA) at delivery and birth weight. Non-parametric statistical methods as well as regression analysis were employed. Neonatal hypoglycemia was less common in the twin newborns who received a course of ACS close to delivery than in the singletons who received ACS (29.1% vs. 37.7%, p=0.01). The prevalence of neonatal hypoglycemia within 48 h of life did not differ significantly between twin pregnancies who received ACS and twin pregnancies who did not (29.1% vs. 26.6%, p=0.55). The three groups did not differ in the lowest neonatal blood glucose levels measured in the first or second day of life (p=0.08 and p=0.12, respectively), or through the entire hospitalization (p=0.06). Compared to singleton pregnancy, exposure to ACS in twin gestation was significantly associated with lower rate of neonatal hypoglycemia after adjustment for maternal age and BMI, gestational diabetes, GA at delivery, mode of delivery and birth weight (OR 0.67, 95% CI 0.46 - 0.98, p=0.04). To the best of our knowledge, this is the first study to examine the association between ACS exposure in preterm twins and neonatal hypoglycemia. Our findings suggest ACS administration in preterm twins is not associated with neonatal hypoglycemia. This is in contrast to the finding of neonatal hypoglycemia in late preterm singletons, and may be due to higher volume of distribution and a shorter half-life of betamethasone in twin pregnancies compared to singleton pregnancies.

Neonatal Outcomes of Very Preterm or Very Low Birth Weight Triplets.

To compare the neonatal outcomes of very preterm triplets with those of matched singletons using a large international cohort. A retrospective matched-cohort study of preterm triplets and singletons born between 2007 and 2013 in the International Network for Evaluation of Outcomes in neonates database countries and matched by gestational age, sex, and country of birth was conducted. The primary outcome was a composite of mortality or severe neonatal morbidity (severe neurologic injury, treated retinopathy of prematurity, and bronchopulmonary dysplasia). Unadjusted and adjusted odds ratios with 95% confidence intervals (CIs) were calculated for model 1 (maternal hypertension and birth weight z score) and model 2 (variables in model 1, antenatal steroids, and mode of birth). Models were fitted with generalizing estimating equations and random effects modeling to account for clustering. A total of 6079 triplets of 24 to 32 weeks' gestation or 500 to 1499 g birth weight and 18 232 matched singletons were included. There was no difference in the primary outcome between triplets and singletons (23.4% vs 24.0%, adjusted odds ratio: 0.91, 95% CI: 0.83-1.01 for model 1 and 1.00, 95% CI: 0.90-1.11 for model 2). Rates of severe neonatal morbidities did not differ significantly between triplets and singletons. The results were also similar for a subsample of the cohort (1648 triplets and 4944 matched singletons) born at 24 to 28 weeks' gestation. No significant differences were identified in mortality or major neonatal morbidities between triplets who were very low birth weight or very preterm and matched singletons.

Antenatal Corticosteroids and Clinical Outcomes of Preterm Singleton Neonates with Intrauterine Growth Restriction

Antenatal Corticosteroids and Clinical Outcomes of Preterm Singleton Neonates with Intrauterine Growth Restriction

Planned delivery route of preterm breech singletons, and neonatal and 2-year outcomes: a population-based cohort study.

To assess whether planned route of delivery is associated with perinatal and 2-year outcomes for preterm breech singletons. Prospective nationwide population-based EPIPAGE-2 cohort study. France, 2011. Three hundred and ninety women with breech singletons born at 26-34weeks of gestation after preterm labour or preterm prelabour rupture of membranes. Propensity-score analysis. Survival at discharge, survival at discharge without severe morbidity, and survival at 2years of corrected age without neurosensory impairment. Vaginal and caesarean deliveries were planned in 143 and 247 women, respectively. Neonates with planned vaginal delivery and planned caesarean delivery did not differ in survival (93.0 versus 95.7%, P=0.14), survival at discharge without severe morbidity (90.4 versus 89.9%, P=0.85), or survival at 2years without neurosensory impairment (86.6 versus 91.6%, P=0.11). After applying propensity scores and assigning inverse probability of treatment weighting, as compared with planned vaginal delivery, planned caesarean delivery was not associated with improved survival (odds ratio, OR1.31; 95% confidence interval, 95%CI 0.67-2.59), survival without severe morbidity (OR0.75, 95%CI 0.45-1.27), or survival at 2years without neurosensory impairment (OR1.04, 95%CI 0.60-1.80). Results were similar after matching on propensity score. No association between planned caesarean delivery and improved outcomes for preterm breech singletons born at 26-34weeks of gestation after preterm labour or preterm prelabour rupture of membranes was found. The route of delivery should be discussed with women, balancing neonatal outcomes with the higher risks of maternal morbidity associated with caesarean section performed at low gestational age.

Twins versus singleton pregnancies: outcomes in small for gestational age late preterm deliveries

Background: Compared to singleton pregnancies, small for gestational age (SGA) and twin gestations experience adverse maternal and neonatal outcomes. Specific data regarding outcomes in late preterm SGA twin gestations are lacking.Objective: This study sought to compare pregnancy outcomes of late preterm (≥34 and <37 weeks) SGA twins versus singletons. In addition, we sought to stratify the comparisons by <10 and <5 percentile categories.Study design: In this retrospective cohort of 1.85 million pregnancies, we identified 10,646 nonanomalous, SGA, late preterm singleton and twin pregnancies. Births at gestational ages <34 and ≥37 weeks were excluded. Multivariate regression analyses and Chi-squared test were used for statistical comparisons and a p-value of less than 0.05 was used to indicate statistical significance.Results: After controlling for race, education, parity, prenatal care, diabetes, and hypertensive disease, twin pregnancies were less likely to experience neonatal death (aOR 0.14; 95% CI 0.03–0.63; p = .01) and intrauterine fetal demise (IUFD) (aOR 0.16; 95% CI 0.08–0.31; p < .001) compared to SGA <10 percentile singletons. Cesarean rates were higher in SGA <10 [percentile twin pregnancies (aOR 3.40; 95% CI 3.01–3.90; p < .001) as were postpartum hemorrhage (aOR 2.01; 95% CI 1.52–2.67; p < .001) and transfusion (aOR 1.54; 95% CI 1.52–2.67; p = .024).Conclusion: Late preterm SGA twin pregnancies were more like to be complicated by cesarean delivery, postpartum hemorrhage, and maternal transfusion compared to singleton pregnancies. However, neonatal death and IUFD were less common in SGA twin gestations.

Being a mother of preterm multiples in the context of socioeconomic disadvantage: perceived stress and psychological symptoms

ObjectiveThis study aimed to examine the differences between mothers of preterm multiples and mothers of preterm singletons regarding perceived stress and maternal psychological symptoms, and to explore the putative adverse amplified effect of socioeconomic disadvantage. MethodNinety‐five mothers of 1‐year‐olds born preterm participated in this cross‐sectional study. Data collection was carried out in two public hospitals from Northern Portugal. To assess maternal perceived daily stress and psychological symptoms, mothers completed two questionnaires. Mothers reported on socioeconomic factors, including family poverty, parent unemployment, and low education, and two groups of family socioeconomic disadvantage were created. A child medical risk index was calculated. ResultsResults indicated that mothers of preterm multiples reported higher levels of stress than mothers of preterm singletons. Moreover, and specifically regarding psychological functioning, mothers of preterm multiples reported more symptoms than mothers of preterm singletons, but only when living in a context of socioeconomic adversity. ConclusionsThe results of the present study have important implications for practice. Mothers of preterm multiples are at higher risk to present mental health difficulties, in comparison to mothers of singletons, especially when exposed to socioeconomic adversities. The development of psychosocial intervention programs and public policies are of decisive importance in helping mothers of multiples adjust to parenthood.

Causal Relationship between Funisitis and Congenital Cerebral Palsy in Preterm Infants: A Direct or Indirect Effect?

Background: Premature delivery is the leading risk factor for congenital cerebral palsy (CCP). Intrauterine infection, leading to an inflammatory state, may link preterm birth and CCP. We evaluated the strength of the association between intrauterine infection and CCP, and determined if the effects of funisitis are directly or indirectly mediated. Methods: Using the U.S. Collaborative Perinatal Project (CPP) data (1959-1976), we performed a multivariate pathway analysis to evaluate the direct effects of funisitis on CPP, and the mediating effects of selected variables including Apgar score, severe infection during the neonatal period, and more specifically, gestational age. Findings: analysis was based on data from 4067 preterm singletons, with no evidence of central nervous system malformation. Infants were classified into 3 birth groups: extremely preterm (gestational age, 23-27 weeks), early preterm (28-33 weeks), and late preterm (34-36 weeks). size of the total, direct, and indirect effects of funisitis on CCP, and the 95% confidence interval (CI), were as follows: extremely preterm, 0·67 (95% CI, 0·49-0·80), 0·68 (95% CI, 0·45-0·84), and -0·01 (95% CI, - 0·17-0·14), respectively; and early preterm, 0·52 (95% CI, 0·44-0·59), 0·52 (95% CI, 0·44-0·60), and 0·00 (95% CI, -0·02-0·02), respectively. In the late preterm group, the direct effect of funisitis remained the dominant: total effect, 0·32 (95% CI, 0·27 to 0·37); direct effect, 0·30 (95% CI, 0·25 to 0·35); and indirect effect, 0·02 (95 % CI, 0·01 to 0·04). Interpretation: In preterm birth, especially in extremely preterm birth, intrauterine inflammation is an important risk factor for CCP and exerts a direct effect on the developing brain. Funding Statement: National Natural Science Foundation of China (NO. 81470201) and the Shanghai municipal health and family planning commission foundation of China (NO. 201740195). Declaration of Interests: authors have indicated they have no potential conflicts of interest to disclose. Ethics Approval Statement: authors state: The CPP study data have been de-identified and is publicly available. As such, ethics clearance was not required for the study.

Caesarean section is the safest mode of delivery for extremely preterm breech singleton infants: FOR: Caesarean delivery of extremely preterm breech singletons.

Caesarean section is the safest mode of delivery for extremely preterm breech singleton infants: FOR: Caesarean delivery of extremely preterm breech singletons.

Estimating neonatal length of stay for babies born very preterm

ObjectiveTo predict length of stay in neonatal care for all admissions of very preterm singleton babies.SettingAll neonatal units in England.PatientsSingleton babies born at 24–31 weeks gestational age from 2011 to...

Effect of delay in cord clamping 45 versus 60 s on very preterm singleton infants

BackgroundIn the range of timing suggested by American College of Obstetricians and Gynecologists 30 to 60 s, preterm infants may potentially derive more short and long-term benefits with delayed cord clamping (DCC) for at least 60 s. However, there are concerns with longer resuscitation delay in this vulnerable population. ObjectiveTo compare the clinical consequences of 45 versus 60 s delay in umbilical cord clamping in singleton infants born between 230/7 to 316/7 weeks gestation. Study designWe implemented DCC process in very preterm singleton infants, initially for 45 s and later, modified the policy to increase the delay to 60 s. We compared the infants born and received DCC (n = 60) during the 45 s study period (DCC-45 cohort), from Aug.19, 2013, to Aug.18, 2014 to the infants born and received DCC (n = 63) during the 60 s study period (DCC-60 cohort), from Feb.1, 2015, to Jan.31, 2016. ResultsThe incidence of necrotizing enterocolitis in DCC-60 cohort was 0% compared to 8% in the DCC-45 cohort (P = 0.02). Similarly, incidence of culture-positive sepsis was significantly lower in the DCC-60 cohort compared to DCC-45 cohort (8% versus 18%; P = 0.04). Incidence of mortality and other major morbidities were similar between both groups. Length of stay was significantly lower in DCC-60 cohort compared to DCC-45 cohort. ConclusionDCC for 60 s in very preterm singleton infants was safe, feasible and not associated with any adverse maternal or neonatal short-term outcomes compared to DCC for 45 s.

Epidemiological trends among preterm infants with apnea. A twelve-year database review

ObjectivesThis study sought to characterize trends in the diagnosis of apnea, associated comorbidities and complications, and 30-day readmission rates in preterm singleton infants. Subjects and methodsThe study design was a retrospective, longitudinal, observational study. 2003–2014 New York State Statewide Planning and Research Cooperative System and New York City Vital Statistics databases were merged identifying preterm live singleton births. Hospitalizations of preterm newborns with and without apnea were compared; multivariable logistic regression and log-linear Poisson regression models applied. ResultsOf 1,384,013 singleton births, 7.5% were identified as preterm. While relative risk of preterm birth rates declined (RR = 0.987, 95% CI = 0.982–0.991), the diagnosis of apnea increased significantly (RR = 1.069, 95% CI = 1.049–1.089). Multivariable analysis identified two apnea predictors, gastric reflux (OR = 3.19, 95% CI = 2.80–3.63) and early gestational age (OR = 0.83 for 1 week GA increase, 95% CI = 0.82–0.84). Preterm newborns with apnea were more likely to be readmitted within the first 30 days and total charges were 5.4 times higher. ConclusionsWhile the preterm birth rate has declined the rate of diagnosis of apnea with associated comorbidities and complications has increased. Given the additional findings of higher 30-day readmission rates and charges, more multidisciplinary research appears warranted to identify ways to optimize the quality of high risk newborn care.

Do late preterm twins face an increased neonatal morbidity compared with singletons?

Late preterm infants (born between 34 0/7 and 36 6/7 weeks of gestation) have been shown to have a higher morbidity and mortality than term infants. Furthermore, twins, both term and preterm, have a higher neonatal morbidity than singletons. The aim of our study was to examine if late preterm twins consequently have twice the neonatal morbidity when both risk factors prematurity and multiple pregnancy are present. A retrospective single-centre study was conducted to compare neonatal outcome of late preterm singletons and late preterm twins born between 34 0/7 and 36 6/7 weeks of gestation as well as term twins with a gestational age from 37 0/7 to 41 6/7 weeks. Primary outcome was length of hospitalisation. Secondary outcome was neonatal morbidity. A total of 845 infants were included. Late preterm twins (n = 243) were hospitalised significantly longer than term twins (n = 107) (13.5 ± 8.0 vs 6.29 ± 2.0 days, p <0.001) and late preterm singletons (n = 495) (13.5 ± 8.0 vs 12.6 ± 8.6 days, p = 0.011). Hyperbilirubinaemia occurred significantly more often in late preterm singletons than in late preterm twins (49.7 vs 29.2%; p<0.001). Otherwise, no significant differences were detected regarding neonatal morbidities or mortality of late preterm singletons and late preterm twins. Late preterm twins had a significantly higher incidence of most morbidities than term twins. Late preterm twins are hospitalised significantly longer than similar-aged singletons, but have otherwise similar neonatal morbidities. Hyperbilirubinaemia is less frequent in late preterm twins than late preterm singletons.

675: Does a history of spontaneous preterm birth (sPTB) of twins increase the risk of subsequent singleton sPTB?

It remains a conundrum whether gravidae with a history of a twin sPTB are at significant risk of sPTB in subsequent pregnancies. The aim of this study was to leverage a comprehensive perinatal database to evaluate the impact of prior sPTB of both singletons and twins on subsequent pregnancies. This is a retrospective cohort study utilizing a single center database of deliveries from August 2011 - June 2016. All deliveries were included as index pregnancies, including term and preterm deliveries and singleton and twin gestations. Prior history of singleton or twin sPTB was abstracted from the electronic medical record or solicited directly from subjects. Preterm deliveries were classified as spontaneous in the absence of documented indication for preterm delivery, and suspected indicated PTBs were excluded (e.g., preeclampsia, IUGR, or abnormalities of placentation). Of the 17,256 deliveries that occurred during the study period, 16,605 met inclusion criteria (16,379 singleton and 226 twin deliveries). Of the index singleton pregnancies, 1,083 (6.6%) delivered spontaneously preterm while 131 (58.0%) of index twin pregnancies delivered spontaneously preterm. Consistent with previous literature, women with a history of singleton sPTB were at greater risk for subsequent singleton sPTB (536/1017 (5.3%) vs. 248/1439 (17.2%); OR 3.72, 95% CI 3.16-4.37). Compared to women with a history of twin term birth, women with a history of twin sPTB trended towards but did not have a significant higher likelihood of delivering a subsequent singleton preterm (4/51 (7.8%) vs. 1/106 (0.94%); OR 8.94, 95% CI 0.97-82.17). Compared to women with a history of singleton term birth, women with a history of singleton sPTB were more likely to deliver twins spontaneously preterm (22/29 (75.9%) vs. 69/127 (54.3%); OR 2.64, 95% CI 1.05-6.63). Based on our results, a history of singleton sPTB increases the risk of subsequent twin sPTB. Our study did not show a significant increase in singleton sPTB among women with a history of twin sPTB. We speculate that women with a history of twin sPTB are unlikely to benefit from preterm birth prevention strategies in the setting of subsequent singleton pregnancy while women with a history of singleton sPTB with subsequent twins may benefit from prevention strategies.

Are risk factors for preterm and early-term live singleton birth the same? A population-based study in France

ObjectivesTo investigate whether risk factors for preterm (<37 weeks gestation) and early-term birth (37 and 38 weeks gestation) are similar.DesignNationally representative cross-sectional study of births.SettingFrance in 2010.ParticipantsLive singleton births (n=14...

720: Risk of preterm birth in a singleton pregnancy following prior preterm twin birth: a cohort study

A history of preterm birth (PTB) is a strong risk factor for PTB in future pregnancy. However, it remains unclear as whether prior PTB in twin pregnancy also increases the risk of PTB in a future singleton pregnancy. Our aim was to determine the risk of singleton PTB following previous twin PTB and identify factors that are predictive of PTB in the subsequent singleton pregnancy. A retrospective study of all women with a prior twin birth followed by a singleton birth who gave birth between 2000-2016 at two tertiary medical centers in Toronto, Ontario. We compared risk of singleton PTB between women who experienced preterm vs. term birth in the index twin pregnancy. The analysis was further stratified by gestational age at birth, indication for PTB and chorionicity in the index twin pregnancy. Unadjusted odds ratios and confidence intervals were calculated for each of the objectives. A total of 378 women met the study inclusion criteria, of whom 252 (66.7%) had PTB in the index twin pregnancy. The overall rate of PTB in the subsequent singleton pregnancy was 11.6% (44/378) and was significantly higher for women with prior twin PTB compared with women with prior term twin birth (17.5% vs. 6.3%, p= 0.003, OR 3.12, 95%-CI 1.42-6.85). The risk of PTB in the subsequent singleton pregnancy was related to the degree of prematurity in the index twin delivery (Figure). The association between previous twin PTB and subsequent singleton PTB was significant only for cases of prior spontaneous twin PTB (OR 3.27, 95%-CI 1.47-7.27) but not for cases of prior indicated twin PTB (OR 2.52, 95%-CI 0.86-7.38). Chorionicity in the index twin delivery did not affect the relationship between prior twin PTB and risk of future singleton PTB. History of preterm twin birth is associated with higher odds of subsequent preterm singleton birth, and the risk is related to the severity of prematurity in the index twin PTB.

The Mediterranean diet adherence by pregnant women delivering prematurely: association with size at birth and complications of prematurity

Background The Mediterranean diet (MD) is associated with decreased risk of metabolic syndrome and gestational diabetes due to the anti-inflammatory and antioxidative properties of its components. The aim was to investigate the potential association of MD adherence (MDA) during pregnancy by mothers delivering prematurely, with intrauterine growth as expressed by neonates’ anthropometry at birth and complications of prematurity. Participants and methods This is a single-center, prospective, observational cohort study of 82 women who delivered preterm singletons at post conceptional age (PCA) ≤ 34 weeks and their live-born neonates. Maternal and neonatal demographic and clinical data were recorded. All mothers filled in a food frequency questionnaire, and the MDA score was calculated. Based on 50th centile of MD score, participants were classified into high-MDA and low-MDA groups. Results The low-MDA mothers had significantly higher pregestational BMI and rates of overweight/obesity (odd ratios (OR) 3.5) and gestational hypertension/preeclampsia (OR 3.8). Neonates in the low-MDA group had significantly higher incidence of intrauterine growth restriction (IUGR) (OR 3.3) and lower z-scores of birth weight and BMI. Regarding prematurity-related complications, the low MDA-group was more likely to develop necrotizing enterocolitis, bronchopulmonary dysplasia, and retinopathy of prematurity (OR 3.2, 1.3, and 1.6, respectively), while they were less likely to develop respiratory distress syndrome (OR 0.49), although the differences were not statistically significant. However, adjustment for confounders revealed MDA as a significant independent predictor of hypertension/preeclampsia, IUGR, birth weight z-score, necrotizing enterocolitis, and bronchopulmonary dysplasia. Conclusions High MDA during pregnancy may favorably affect intrauterine growth and certain acute and chronic complications of prematurity as well as maternal hypertension/preeclampsia.

Being a mother of preterm multiples in the context of socioeconomic disadvantage: perceived stress and psychological symptoms

ObjectiveThis study aimed to examine the differences between mothers of preterm multiples and mothers of preterm singletons regarding perceived stress and maternal psychological symptoms, and to explore the putative adverse amplified effect of socioeconomic disadvantage. MethodNinety-five mothers of 1-year-olds born preterm participated in this cross-sectional study. Data collection was carried out in two public hospitals from Northern Portugal. To assess maternal perceived daily stress and psychological symptoms, mothers completed two questionnaires. Mothers reported on socioeconomic factors, including family poverty, parent unemployment, and low education, and two groups of family socioeconomic disadvantage were created. A child medical risk index was calculated. ResultsResults indicated that mothers of preterm multiples reported higher levels of stress than mothers of preterm singletons. Moreover, and specifically regarding psychological functioning, mothers of preterm multiples reported more symptoms than mothers of preterm singletons, but only when living in a context of socioeconomic adversity. ConclusionsThe results of the present study have important implications for practice. Mothers of preterm multiples are at higher risk to present mental health difficulties, in comparison to mothers of singletons, especially when exposed to socioeconomic adversities. The development of psychosocial intervention programs and public policies are of decisive importance in helping mothers of multiples adjust to parenthood.