Prevalence Of Preterm Delivery Research Articles

Use of intravenous immunoglobulin in antiphospholipid antibody positive patients with high risk of miscarriage: a systematic review and meta-analysis.

The purpose of the present study was to evaluate whether intravenous immunoglobulin (IVIG) increases live birth rates and improves neonatal results in patients with antiphospholipid antibodies (aPL) at high-risk for miscarriage. Positivity of aPL in pregnant women is a high-risk factor for miscarriage, and IVIG treatment has emerged as a potential intervention. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was employed to search multiple electronic databases for articles published until August 20, 2023, including PubMed, Web of Science, Embase, Scopus and Medline. The inclusion criteria encompassed studies assessing the efficacy of IVIG in aPL-positive patients with a high risk of miscarriage. Relevant articles were assessed for the quality and data were extracted for analysis. Two independent reviewers performed study selection, data extraction, and quality assessments. The risk of bias was evaluated according to the Cochrane risk of bias tool. All analyses were conducted using Review Manager 5.3. This systematic review included nine randomized controlled trials, with 366 aPL-positive women at high risk of miscarriage. These studies included in this review were randomized controlled trials. The primary outcome measures were successful pregnancy outcomes and live birth rates. The secondary outcomes included obstetric complications, and neonatal outcomes (such as birth weight and live-birth rate). The comparison between the intervention and control groups revealed no significant differences in terms of obstetric complications and neonatal outcomes. The group receiving IVIG treatment had a higher prevalence of preterm deliveries than controls (OR = 2.05, I2 = 46%, 95% CI [0.58-5.24]), but also exhibited a partial improvement in live birth rates (OR = 2.86, I2 = 52%, 95% CI [1.04-7.90]), because it reduced the number of miscarriages (OR = 0.35, I2 = 52%, 95% CI [0.13-0.96]). Based on the available evidence, IVIG intervention appears to be a potentially effective approach for managing of aPL-positive pregnant women with high risk of miscarriage. While IVIG shows significant potential in tripling the chances of having a live-born child, further large-scale randomized controlled trials are necessary, preferably comparing IVIG with hydroxychloroquine or lifestyle and dietary interventions, to refine treatment protocols and ensure the most effective application.

Rate of preterm delivery and latency period in asymptomatic patients undergoing cerclage for very short cervix ≤10.0 mm

AimTo estimate the rate of preterm delivery (PTD) and mean latency period to delivery in asymptomatic women with no history of preterm delivery and cervical length (CL) ≤10.0 mm undergoing or not cerclage and who were not treated with vaginal progesterone. MethodsRetrospective analysis of asymptomatic patients with singleton pregnancies and no history of preterm delivery, with an incidental finding of a CL ≤10.0 mm measured with transvaginal ultrasound during the mid-trimester scan, 56 of them (63.6%) underwent cerclage placement and 32 (36.4%) did not, none of them received vaginal progesterone. Those with evidence of advanced dilation, prolapsing, membranes, ruptured membranes, or positive signs of infection were not candidates for cerclage placement were excluded from the analysis. Differences in the prevalence of preterm birth, mean gestational age at delivery, and mean latency from very short cervix identification to delivery between the two groups were calculated. Associations between cerclage and preterm delivery adjusted for maternal characteristics and fetal weight, were estimated. ResultsMedian (range) gestational age at time of CL measurement in the cerclage group was (weeks/days) 20w6d (17w5d–23w3d) vs. 21w5d (17w6d–23w6d) in the no-cerclage group (p=0.02). No differences in CL were observed between those who had a cerclage (5.9 mm (SD 3.1 mm)) vs. those who did not (6.5 mm (SD 3.2 mm); p=0.4). The prevalence of preterm delivery (PTD) in women with cerclage vs. women without cerclage was: PTD <37 weeks 31/56 (55.3%) vs. 28/32 (87.5%); adjusted (a) OR 0.17 (95% CI; 0.05-0.62 p=0.008); PTD ≤34 weeks 27/56 (48.2%) vs. 24/32 (75.0%); aOR 0.16 (95% CI 0.05-0.55; p=0.02); PTD ≤28 weeks 19/56 (33.9%) vs. 22/32 (68.7%); aOR 0.15 (95% CI 0.05-0.51; p=0.002). The mean (range) gestational age at delivery was 32w6d (19w1d–40w1d) for the cerclage group, and 28w1d (20w1d–40w2d) for the no-cerclage group (p =0.001). The median (range) latency from the time of CL measurement to delivery in the cerclage group was 84 (8-144) vs. 43 (1-146) days in the no-cerclage group (p=0.003). ConclusionAmong low-risk asymptomatic women with a very short cervix (≤10.0 mm) in the midtrimester scan, those treated with cerclage have increased latency to delivery and lower prevalence of preterm birth as compared to expectant management.

Risk factors associated with preterm birth among mothers delivered at Lira Regional Referral Hospital

BackgroundThe World Health Organization (WHO) defines Preterm Birth (PTB) as “a live birth taking place before the expected 37 weeks of gestation”. Annually, approximately 15 million infants are born prematurely, constituting significantly to infant mortality during the initial four weeks of life, responsible for 40% of deaths among children under the age of five. Evidently, preterm deliveries have contributed to 46% of admissions to the neonatal intensive care unit (NICU) at Lira Regional Referral Hospital (LRRH) over the past three years. Paradoxically, while the prevalence of preterm births remains high, there is a lack of documented information regarding the underlying risk factors. Consequently, the primary objective of this study was to assess the potential risk factors associated with preterm birth at LRRH.MethodsAn analytical cross-sectional research was undertaken at LRRH, employing a quantitative methodology. The study utilized secondary data obtained from a total of 590 comprehensive maternal medical records, of deliveries that occurred at the facility between April 2020 and July 2021. The collected data underwent analysis using STATA version 17 software. To identify predictors of preterm birth, a Logistic regression model was applied, yielding adjusted odds ratios (AOR) alongside 95% confidence intervals (CI). The significance level was set at p < 0.05 to establish statistical significance. Furthermore, assessments for multicollinearity and model fitness were conducted using the Variance Inflation Factor (VIF) and linktest, respectively.ResultsThe prevalence of preterm delivery among mothers who gave birth at LRRH stood at 35.8%. The outcomes of logistic regression analysis revealed that maternal employment status had a statistically significant association with preterm birth (AOR = 0.657, p = 0.037, 95%CI: 0.443–0.975); having a baby with low birth weight (AOR = 0.228, p < 0.001, 95% CI: 0.099–0.527) and experiencing preeclampsia (AOR = 0.142, p < 0.001, 95% CI: 0.088–0.229) were also identified as significant predictors of preterm birth in the study.Conclusions and recommendationsThe occurrence of preterm delivery is significantly higher (35.8%) among mothers who gave birth at LRRH when compared to the national average (13.6%). The prevalence of preterm birth among mothers was linked to factors such as employment status, delivery of low birth weight infants, and the presence of preeclampsia. Consequently, the research proposes a set of recommendations. Firstly, the Ministry of Health (MoH) should evaluate the present state of readiness within the healthcare system to effectively handle cases of preterm birth both within medical facilities and the community. Secondly, the Ministry of Gender, Labour, and Social Development should leverage Labor Officers to implement and uphold the regulations stipulated in the Employment Act and Labor Laws.

Pregnancy outcomes in ANCA-associated vasculitis patients: A systematic review and meta-analysis

ObjectiveAntineutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV), namely granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis and microscopic polyangiitis constitute a group of rare systemic vasculitides, affecting small vessels. Genders are equally affected, with symptoms most commonly presenting during and/or after the fifth decade of life, but AAV may also present in younger individuals. As advanced maternal age is becoming common and safe over the last decades, it is now more feasible for middle-aged women suffering from AAV to get pregnant. Although adverse pregnancy outcomes have been thoroughly investigated in other systemic diseases, the exact prevalence of pregnancy complications and unfavorable outcomes in pregnant women with AAV has not been systematically evaluated. MethodsWe researched PubMed, Scopus, Cochrane Library and Cinahl databases until September, 2022. Three blinded investigators extracted data and assessed the risk of bias. A random effects model was used for the analysis. The outcomes studied were pre-term delivery, intrauterine growth restriction (IUGR) neonates and disease flare. ResultsWe included six studies with 92 pregnancies in patients with AAV. The prevalence of pre-term delivery, IUGR neonates and disease flare were 18% (CI: 0.10–0.30, P=non-significant), 20% (CI: 0.11–0.33, P=non-significant) and 28% (CI: 0.09–0.59, P<0.01), respectively. ConclusionThe analysis demonstrated higher occurrence of adverse outcomes in pregnant women suffering from AAV accompanied by an increased risk of disease flare during pregnancy. These findings underline the importance of preconception counseling and the necessity of close monitoring in these patients similarly to other systemic inflammatory diseases.

Preterm Delivery and Neonatal Deaths among Anaemic Pregnant Women in the Bolgatanga Metropolis of Ghana.

Preterm deliveries and neonatal deaths as functions of anaemia in pregnancy are of major public health interest. However, data on the prevalence of preterm deliveries and their association with mortality in anaemic pregnant women in the study area are scanty. Thus, the study sought to investigate the prevalence of preterm delivery and neonatal deaths among anaemic pregnant women in the Bolgatanga Regional Hospital in the Upper East Region of Ghana during the past five years. A retrospective study design was adopted, and data were gathered between March and May 2016. Records of women who were anaemic during any trimester of their pregnancy and delivered in the hospital within the last five years were included in the study. In all, two hundred (200) cases were reviewed. Data on the sociodemographic characteristics, health status, and birth outcome of participants were captured, and analyses were conducted using SPSS version 21 while considering significant differences at p < 0.05. The study revealed that more than half of the anaemic women (52.5%, n = 105) had preterm deliveries, while neonatal mortality was 8.5% (n = 17). The proportion of mothers who received dietary or medical intervention for the treatment of anaemia and the number of attendances to antenatal clinics were comparable between preterm and normal-term mothers (p > 0.05). Mothers with preterm deliveries had a higher risk of neonatal mortality (AOR = 13.66, 95% CI = 1.65-113.30, and p=0.015). This study has shown that anaemia in pregnancy increases the risk of preterm delivery and neonatal death. It is recommended that extra care be given to pregnant women with anaemia, while further studies are conducted with a larger sample size to substantiate the claims made in this study.

Adolescent Pregnancy Outcomes and Risk Factors.

One of the major social and public health problems in the world is adolescent pregnancy. Adolescent pregnancy is strongly associated to less favorable results for both the mother and the newborn. We conducted this research to ascertain the impact of teenage age on neonatal outcomes and also observed the lifestyles of pregnant teenage girls. We conducted a study of 2434 mothers aged ≤19 years (n = 294) or 20-34 years (n = 2140) who gave birth in 2019-2020 at the Department of Gynaecology and Obstetrics of Louis Pasteur University Hospital in Košice. The data on mothers and newborn infants have been reported from the reports on mothers at childbirth. Women between the ages of 20 and 34 served as the reference group. The teenage mothers were more likely to become pregnant if they were unmarried (OR = 14.2; 95% CI = 9.3-21.6; p < 0.001) and had a basic education or lack of education (OR = 16.8; 95% CI = 11.5-24.6; p < 0.001). Additionally, they were more likely to smoke when pregnant (OR = 5.0; 95% CI = 3.8-6.6; p < 0.001). Low birth weight was more common in newborns born to adolescent mothers than in those born to adult mothers (p < 0.001). Our findings showed that infants of teenage mothers often had lower birth weights (-332.6 g, p < 0.001). Adolescent mothers were associated with lower Apgar scores at the first minute (p = 0.003). As compared with the control group, pregnant teenage girls had a greater prevalence of preterm deliveries in our research (p = 0.004). This study finds significant age-related disparities in neonatal outcomes between mothers. These results might be used to identify vulnerable groups who need special assistance and actions to reduce the probability of negative outcomes for such groups.

Predictive Value of Cervical Length Measurement on Transvaginal Ultrasonography in Determination of Preterm Delivery in a Nigerian South Western Tertiary Hospital

Introduction: There has been an upsurge in the prevalence of preterm delivery globally and short cervix has been strongly associated with it. However, studies have shown that when it is detected early in mid-second trimester, preventive measures could be taken to forestall pregnancy loss. Materials and Methods: This prospective cohort study was conducted among pregnant women who presented for mid-trimester anomaly ultrasound scan between 18 and 24 weeks at the University College Hospital (UCH), Ibadan. The cervical length was measured with ultrasound machine through the transvaginal route and the patients were subsequently followed up till delivery. Results: One hundred and seventy-seven pregnant women with an age range between 21 and 44 years were recruited for the study. The incidence rate of mid-pregnancy short cervical length among the patients was 7.9%. The preterm delivery rate was 14.1%, and the association between it and short cervical length was statistically significant. The positive predictive value for preterm delivery when the &lt;2.5 cm cervical length cut-off was used was 44%, the negative predictive value was 97.3%. Conclusion: The incidence of preterm delivery due to ultrasonographically detected short cervical length was significant among the women attending antenatal clinic in UCH, and there was a significant association with some of the risk factors such as previous preterm delivery and previous preterm premature rupture of membranes.

Association between isolated maternal hypothyroxinemia during the first trimester and adverse pregnancy outcomes in Southern Chinese women: a retrospective study of 7051 cases

BackgroundThe association between isolated maternal hypothyroxinemia (IMH) and adverse pregnancy outcomes is still controversial. This study aimed to evaluate the association between IMH during the first trimester and adverse pregnancy outcomes in southern Chinese women.MethodsThis was a hospital-based, retrospective cohort study. The records of 7051 women, including 1337 IMH women and 5714 euthyroid women who had a singleton pregnancy and accepted routine prenatal service at the Third Affiliated Hospital of Sun Yat-Sen University from January 2015 to September 2018, were extracted from the electronic medical records system in this study. Thyroid functions [thyroid-stimulating hormone (TSH), free thyroxine (fT4) and anti-thyroperoxidase autoantibody (TPO-Ab)] had to be measured before 13 weeks and 6 days of gestation. The chi-square test and multivariate logistic regression analysis were applied to evaluate the association between IMH during the first trimester and adverse pregnancy outcomes.ResultsPrepregnancy obesity [prepregnancy body mass index (preBMI) ≥ 25 kg/m2] was found to be more common in the IMH group (11.2% vs. 6.1%) (P < 0.05). The prevalence of gestational diabetes mellitus (GDM), postpartum haemorrhage (PPH), macrosomia and large for gestational age (LGA) was higher in the IMH group. However, after using multivariate logistic regression analysis to adjust for confounders (maternal age, educational levels and preBMI), only LGA was shown to be associated with an increased risk in IMH women [adjusted OR: 1.27 (95% CI 1.044–1.566)]. The prevalence of preterm delivery (either < 37 or < 34 weeks), gestational hypertension, preeclampsia, placenta previa, placental abruption, premature rupture of membrane (PROM), intrauterine growth restriction (IUGR), polyhydramnios, stillbirth, small for gestational age (SGA) and low Apgar score did not increase.ConclusionIMH during the first trimester did not increase any risk of adverse pregnancy outcomes in southern Chinese women except LGA.

Impact of Novel Coronavirus (COVID-19) on Pregnant Women: A Review

The novel coronavirus infection (COVID-19) is a global public health emergency. Since its outbreak in Wuhan, China in December 2019, the infection has spread at an alarming rate across the globe and humans have been locked down to their countries, cities and homes. As of now, the virus has affected over 20 million people globally and has inflicted over 7 lac deaths. Nevertheless, the recovery rate is improving with each passing day and over 14 million people have recuperated so far. The statistics indicate that nobody is immune to the disease as the virus continues to spread among all age groups, newborns to the elders, and all compartments including pregnant women. However, pregnant women may be more susceptible to this infection as they are, in general, highly vulnerable to respiratory infections. There is no evidence for vertical transmission of the COVID-19 virus among pregnant women, but an increased prevalence of preterm deliveries. Besides this, the COVID-19 may alter immune response at the maternal-fetal interface and affect the well-being of mothers as well as infants. Unfortunately, there is limited evidence available in the open literature regarding coronavirus infection during pregnancy and it now appears that certain pregnant women have been infected during the present 2019-nCoV pandemic. In this perspective, we study the impact of the COVID-19 infection on vertical transmission and fetal outcomes among pregnant women.

Chronic hypertension and risk of preterm delivery: National Longitudinal Study of Adolescents to Adult Health.

Chronic hypertension during pregnancy is associated with increased risk of adverse birth outcomes. In 2017, the American College of Cardiology and American Heart Association (ACC/AHA) lowered thresholds to classify hypertension in non-pregnant adults to SBP≥130mmHg and DBP≥80mmHg (ie stage I hypertension), resulting in an additional 4.5-million reproductive-aged women meeting criteria for hypertension. Little is known about effects of pre-pregnancy blood pressure (BP) in this range. To examine the effect of pre-pregnancy maternal BP on preterm delivery. We analysed the data from two waves of the National Longitudinal Study of Adolescent to Adult Health, including participants that had measured BP at Wave IV (2008-09) and a pregnancy that resulted in a singleton live birth between Waves IV and V (2016-18; n=2038). We categorised BP using ACC/AHA cut-offs: normal (SBP<120mmHg and DBP<80mmHg), elevated (SBP 120-129mmHg and DBP<80mmHg), hypertension stage I (SBP 130-139mmHg or DBP 80-89mmHg) and hypertension stage II (SBP≥140mmHg or DBP≥90mmHg). We estimated risk ratios (RR) with log-binomial regression adjusting for maternal demographics, anthropometrics and medication use. The prevalence of preterm delivery was 12.6%. A standard deviation (SD) increment in SBP (SD=12.2mmHg) and DBP (SD=9.3mmHg) was associated with a 14% (95% confidence interval [CI] 2, 27) and 20% (95% CI 4, 37) higher risk of preterm delivery. Compared to normotensive controls, stage I (RR 1.33, 95% CI 1.01, 1.74) and stage II (RR 1.34, 95% CI 0.89, 2.00) hypertension were associated with increased risk. We observed greater risk of preterm delivery among women with higher pre-pregnancy BP. Women with stage I hypertension during pregnancy may benefit from increased BP monitoring. Additional studies on the utility of foetal surveillance in this group are warranted.

Pregnant and Postpartum Women Requiring Intensive Care Treatment for COVID-19-First Data from the CRONOS-Registry.

(1) Background: Data on coronavirus 2 infection during pregnancy vary. We aimed to describe maternal characteristics and clinical presentation of SARS-CoV-2 positive women requiring intensive care treatment for COVID-19 during pregnancy and postpartum period based on data of a comprehensive German surveillance system in obstetric patients. (2) Methods: Data from COVID-19 Related Obstetric and Neonatal Outcome Study (CRONOS), a prospective multicenter registry for SARS-CoV-2 positive pregnant women, was analyzed with respect to ICU treatment. All women requiring intensive care treatment for COVID-19 were included and compared regarding maternal characteristics, course of disease, as well as maternal and neonatal outcomes. (3) Results: Of 2650 cases in CRONOS, 101 women (4%) had a documented ICU stay. Median maternal age was 33 (IQR, 30–36) years. COVID-19 was diagnosed at a median gestational age of 33 (IQR, 28–35) weeks. As the most invasive form of COVID-19 treatment interventions, patients received either continuous monitoring of vital signs without further treatment requirement (n = 6), insufflation of oxygen (n = 30), non-invasive ventilation (n = 22), invasive ventilation (n = 28), or escalation to extracorporeal membrane oxygenation (n = 15). No significant clinical differences were identified between patients receiving different forms of ventilatory support for COVID-19. Prevalence of preterm delivery was significantly higher in women receiving invasive respiratory treatments. Four women died of COVID-19 and six fetuses were stillborn. (4) Conclusions: Our cohort shows that progression of COVID-19 is rare in pregnant and postpartum women treated in the ICU. Preterm birth rate is high and COVID-19 requiring respiratory support increases the risk of poor maternal and neonatal outcome.

Effects of Covid-19 Pandemic on First and Second Trimester Pregnancies

Objective: Main purpose of this study is to determine the effects of pandemic disease COVID-19 on first and second trimester pregnancies. Study Design: Cross-sectional/Descriptive study Place and Duration: Study was conducted at Gynae and Obs department of Jinnah International Hospital, Abbottabad for duration of 10 months from January to October, 2021. Methods: Total ninety pregnant women of ages 18- 35 years were presented in this study. All the presented women had pandemic disease COVID-19. Women had first and second trimester pregnancies. Patients’ age, body mass index, parity, education status, socio-economic status and residency were calculated after taking informed written consent. Chi square and t-test was performed to differentiate between symptomatic and asymptomatic cases. Outcomes were assessed in terms of stress, depression among mothers and low birth weight of infants, perinatal death, preterm delivery, and C-section. Data was analyzed by SPSS 23.0 version. Results: Among 90 pregnant women 40 (44.4%) patients had first trimester pregnancies and 50 (55.6%) females had second trimester pregnancies. Mean age of the patients was 29.16±6.34 years and had mean BMI 22.13±5.16 kg/m2. Majority of the patients 52 (57.8%) had parity primipara. 44 (48.9%) patients were educated and majority of the patients were financially weak 62 (68.9%). 55 (61.1%) females were from urban areas. 54 (60%) females were symptomatic and 36 (40%) were asymptomatic. Frequency of depression among females was 68 (75.6%) and depression was found in 61 (67.8%) cases. Low birth weight was found in 22 (24.4%) cases, prevalence of preterm delivery was among 38 (42.2%) cases, number of C-section among cases was 47 (52.2%). Perinatal death was found in 7 (7.8%) cases. Majority of the patients with infants were instantly discharged after delivery 75 (83.3%) and 8 patients were admitted because of severity of pandemic disease. Conclusion: We determined in this study that Covid-19 among females with trimester first and second pregnancies were highly affected and had severity of psychotic disorders at start of disease but had lower adverse outcomes with low perinatal mortality. Majority of the females were recovered and discharged safely after delivery. Keywords: Pregnancy, Trimester, C-section, Coronavirus, Outcomes

Maternal Anemia during Pregnancy and Its Association with Preterm Birth

Objective: To determine the association of preterm delivery with maternal anemia in Tertiary Care Hospital, Karachi. Study Design: Prospective cohort study. Study Setting: Study was conducted at Department of Obstetrics and Gynecology of Aga Khan University Hospital Karachi, Pakistan. Duration of Study: Six months from 3rd September, 2018 to 3rd March, 2019. Subjects and Methods: Data was prospectively collected from 90 patients. 45 patients were in the anemic group and 45 patients were in the non anemic group. Quantitative data was presented as simple descriptive statistics giving mean and standard deviation and qualitative variables were presented as frequency and percentages. Effect modifiers were controlled through stratification. Post stratification chi square was applied and p-value of ≤0.05 was considered significant. RR &gt; 1 was considered significant. Results: In the anemic group, mean age of the patient was 28.82±3.65 years, gestational age at delivery was 36.97±2.58 weeks, booking hemoglobin was 9.79±0.84 g/dl, and delivery hemoglobin was found to be 9.73±1.19 g/dl. In the non-anemic group mean age of the patient was 29.57±5.83 years, gestational age at delivery 37.08±1.91 weeks, booking hemoglobin was 10.76±0.99 g/dl and delivery hemoglobin was found to be 10.75±1.12 g/dl. Moreover, frequency distribution of preterm status showed that out of 45 patients in anemic and non-anemic group, 35.6% and 46.7% had preterm status respectively. RR was 0.76. Conclusion: Prematurity is major cause of perinatal mortality. The findings of this study although shows prevalence of preterm delivery in both anemic and non-anemic pregnant women however results were not significant to support our hypothesis. Further research is needed with strategies to address the anemia status of expecting mothers. Key Words: Maternal anemia, preterm, anemia and non-anemic group.

Premature Birth in Women with Endometriosis: a Systematic Review and Meta-analysis.

The objective of this study is to verify the association between endometriosis and preterm birth through systematic review and meta-analysis. Is there an increased risk of premature birth in women with endometriosis compared to women without this diagnosis? The databases searched were PubMed, Medline, and LILACS in order to identify all studies published up to April 2020, using the keywords (prematurity OR preterm birth OR premature birth OR premature labor OR obstetric premature labor OR preterm labor OR premature obstetric labor) AND (endometriosis OR adenomyosis OR endometrioma OR endometriomas). A manual research was also performed through the analysis of theses, book chapters, reference references, guidelines, and reviews. All published prospective cohort studies that reported the prevalence of preterm delivery among women with endometriosis, adenomyosis, or endometrioma were included, comparing it to the control group of women without such diagnoses. The random-effects model, the calculation of relative risk, and the confidence interval of 95% were used to perform the meta-analysis. Three studies involving 10,111 patients were included. Compared to women without endometriosis, women with endometriosis present an increased risk of premature birth (RR: 2.68, 95% CI [1.19; 6.02], I2 = 91%). In the subgroup of women with spontaneous conception, endometriosis is also a risk factor for prematurity (RR: 3.26, 95% CI [2.09; 5.09], I2 = 0%, 2 studies, 682 participants). The evidence presented suggests that women with endometriosis should be alerted to a potential risk of preterm birth. PROSPERO registration number, CRD42020189451.

Unchanged Prevalence of Preeclampsia After Implementation of Prophylactic Aspirin for All Pregnant Women With Preexisting Diabetes: A Prospective Cohort Study.

To evaluate the prevalence of preeclampsia after implementation of prophylactic aspirin for all pregnant women with preexisting diabetes compared with the prevalence in a previous risk-based prophylaxis. A prospective observational cohort study of 410 consecutive pregnant women with preexisting diabetes categorized according to aspirin prophylaxis strategy, with the prevalence of preeclampsia as primary outcome. In total, 207 women were included after implementation of prophylactic aspirin for all pregnant women with preexisting diabetes in February 2018 (all-cohort). The 203 women included before this date, where aspirin prophylaxis was risk based and only prescribed to selected women (selected-cohort), were studied for comparison. Aspirin was prescribed at ∼10 gestational weeks for 88% (all-cohort) compared with 25% (selected-cohort). HbA1c, parity, chronic hypertension, home blood pressure, microalbuminuria/diabetic nephropathy, and smoking were similar in the two cohorts in early pregnancy. In the all-cohort, fewer women had type 2 diabetes (32% vs. 42%, respectively; P = 0.04) and BMI tended to be lower (P = 0.05). The prevalence of preeclampsia was similar (12% vs. 11%, P = 0.69) in the two cohorts, and this was also the case with stratification for diabetes type. Prevalence of preterm delivery <37 weeks (23% vs. 27%, P = 0.30), preterm preeclampsia (7% vs. 7%, P = 0.96), and infants large (40% vs. 32%, P = 0.07) and small (7% vs. 6%, P = 0.88) for gestational age was similar in the two cohorts. Implementation of prophylactic aspirin for all pregnant women with diabetes did not reduce the prevalence of preeclampsia compared with the previous risk-based prophylaxis in this cohort study.

Potentially modifiable risk factors of preterm delivery in women with type 1 and type 2 diabetes.

We aimed to identify potentially modifiable risk factors and causes for preterm delivery in women with type 1 or type 2 (pre-existing) diabetes. A secondary analysis of a prospective cohort study of 203 women with pre-existing diabetes (117 type 1 and 86 type 2 diabetes) was performed. Consecutive singleton pregnancies were included at the first antenatal visit between September 2015 and February 2018. In total, 27% (n = 55) of the 203 women delivered preterm at median 36 + 0weeks. When stratified by diabetes type, 33% of women with type 1 diabetes delivered preterm compared with 20% in women with type 2 diabetes (p = 0.04). Women delivering preterm were characterised by a higher prevalence of pre-existing kidney involvement (microalbuminuria or diabetic nephropathy) (16% vs 3%, p = 0.002), preeclampsia (26% vs 5%, p < 0.001), higher positive ultrasound estimated fetal weight deviation at 27 gestational weeks (2.7% vs -1.6% from the mean, p = 0.008), higher gestational weight gain (399g/week vs 329g/week, p = 0.01) and similar HbA1c levels in early pregnancy (51mmol/mol [6.8%] vs 49 [6.6%], p = 0.22) when compared with women delivering at term. Independent risk factors for preterm delivery were pre-existing kidney involvement (OR 12.71 [95% CI 3.0, 53.79]), higher gestational weight gain (per 100g/week, OR 1.25 [1.02, 1.54]), higher positive ultrasound estimated fetal weight deviation at 27 gestational weeks (% from the mean, OR 1.07 [1.03, 1.12]) and preeclampsia (OR 7.04 [2.34, 21.19]). Two-thirds of preterm deliveries were indicated and one-third were spontaneous. Several contributing factors to indicated preterm delivery were often present in each woman. The main indications were suspected fetal asphyxia (45%), hypertensive disorders (34%), fetal overgrowth (13%) and maternal indications (8%). Suspected fetal asphyxia mainly included falling insulin requirement and abnormal fetal haemodynamics. Presence of preeclampsia, higher positive ultrasound estimated fetal weight deviation at 27 gestational weeks and higher gestational weight gain were independent potentially modifiable risk factors for preterm delivery in this cohort of women with pre-existing diabetes. Indicated preterm delivery was common with suspected fetal asphyxia or preeclampsia as the most prevalent causes. Prospective studies evaluating whether modifying these predictors will reduce the prevalence of preterm delivery are warranted.

Maternal and Neonatal Outcomes of Syrian Adolescent Refugees and Local Adolescent Turkish Citizens: A Comparative Study at a Tertiary Care Maternity Hospital in Turkey

OBJECTIVE: In this study, we aim to compare the maternal and obstetric outcomes between local adolescent Turkish citizens and adolescent Syrian refugees admitted to a tertiary care center in Turkey. STUDY DESIGN: Between January 2014 and December 2019, a total of 57,049 births were performed in our hospital. The study included a total of 6,021 patients aged 19 years or younger pregnancy who gave birth at our hospital. Of this number, 5,164 (1,792 Syrian adolescent refugee cases and 3,372 local adolescent Turkish cases) were live singleton pregnancies. Our primary aim was to compare the maternal and obstetric outcomes between the two groups. RESULTS: In the pregnant refugee women, the maternal age was younger (p&lt;0.001). Hemoglobin and hematocrit levels are significantly lower in Syrian pregnant women (p&lt;0.001 and p&lt;0.001, respectively). Anemia was significantly higher in Syrian refugee pregnant women (p&lt;0.001). The double screening test and triple screening test were significantly lower in Syrian pregnant women (p&lt;0.001 and p&lt;0.001, respectively). Preterm birth rates and late preterm delivery prevalence (34-37 gestational weeks) were significantly higher in the adolescent Syrian immigrants' compared to the adolescent Turkish locals (p&lt;0.001 and p&lt;0.001, respectively). The average birth weight of the Syrian refugees was lower but the number of low birth weight babies was higher Turkish locals (p=0.010 and p=0.014, respectively). The preterm birth ratio and low birth weight ratio in Syrian adolescents has decreased over the years. CONCLUSION: Syrian adolescent refugees are particularly at risk of early pregnancy, high fertility rate, preterm birth, low birth weight, and anemia. Immigrant women should be provided with fertility, family planning, and training on behavior that protects reproductive health. Syrian pregnant women should be supported to receive services.

Risk Factors Associated with Preterm Delivery in Singleton Pregnancy in a Tertiary Care Hospital in South India: A Case Control Study.

BackgroundPreterm delivery is a major obstetric complication and a leading cause of neonatal mortality and morbidity. It is also associated with significant costs in terms of psychological and financial hardship, to the families.ObjectiveThe primary objective of this study was to determine the risk factors associated with all preterm deliveries in singleton pregnancy in a tertiary care hospital and the secondary objective was to determine the fetal outcomes among women with preterm delivery.Materials and MethodsA case control study was conducted between January 2019 and June 2019 in the Department of Obstetrics and Gynecology of a tertiary care center in Central Kerala, India. Women who delivered before 37 completed weeks of gestation were taken as cases and those who delivered at or after 37 weeks were considered as controls in a 1:1 ratio, approximately. Data regarding 191 cases and 200 controls were taken from delivery room records of the years 2016 to 2018 with the help of a predesigned checklist. Univariate and multivariate analysis were done to determine the magnitude of association between the exposure factors and preterm delivery.ResultsThe mean age of study participants among the cases was 29.3 ± 5.1 years and controls was 28.1 ± 4.4. Pregnancy induced hypertension (aOR = 14.60; 95% CI 4.8, 44.1; p<0.001), abnormal amniotic fluid volume (aOR = 10.68; 95% CI 3.46, 32.98; p<0.001), premature rupture of membranes (PROM) (aOR = 10.27; 95% CI 4.82, 21.86; p<0.001), previous history of preterm delivery (aOR = 4.12; 95% CI 1.22, 13.85; p<0.002), history of urinary tract infection (UTI) during pregnancy (aOR = 3.67; 95% CI 1.39, 9.68; p<0.002), systemic diseases (aOR = 2.78; 95% CI 1.28, 6.39; p<0.001), anaemia (aOR = 2.54; 95% CI 1.28, 5.03; p<0.004) were found to be the independent risk factors for preterm delivery. On analyzing the fetal outcomes, the average birth weight of preterm babies was 2 ± 0.6 kg compared to 3.1kg among term babies.ConclusionEarly detection and adequate treatment of various conditions like anaemia, pregnancy induced hypertension, UTI and systemic illness can help in reduction of the prevalence of preterm delivery.

Old Question Revisited: Are High-Protein Diets Safe in Pregnancy?

Background: A previous randomized dietary intervention in pregnant women from the 1970s, the Harlem Trial, reported retarded fetal growth and excesses of very early preterm births and neonatal deaths among those receiving high-protein supplementation. Due to ethical challenges, these findings have not been addressed in intervention settings. Exploring these findings in an observational setting requires large statistical power due to the low prevalence of these outcomes. The aim of this study was to investigate if the findings on high protein intake could be replicated in an observational setting by combining data from two large birth cohorts. Methods: Individual participant data on singleton pregnancies from the Danish National Birth Cohort (DNBC) (n = 60,141) and the Norwegian Mother, Father and Child Cohort Study (MoBa) (n = 66,302) were merged after a thorough harmonization process. Diet was recorded in mid-pregnancy and information on birth outcomes was extracted from national birth registries. Results: The prevalence of preterm delivery, low birth weight and fetal and neonatal deaths was 4.77%, 2.93%, 0.28% and 0.17%, respectively. Mean protein intake (standard deviation) was 89 g/day (23). Overall high protein intake (>100 g/day) was neither associated with low birth weight nor fetal or neonatal death. Mean birth weight was essentially unchanged at high protein intakes. A modest increased risk of preterm delivery [odds ratio (OR): 1.10 (95% confidence interval (CI): 1.01, 1.19)] was observed for high (>100 g/day) compared to moderate protein intake (80–90 g/day). This estimate was driven by late preterm deliveries (weeks 34 to <37) and greater risk was not observed at more extreme intakes. Very low (<60 g/day) compared to moderate protein intake was associated with higher risk of having low-birth weight infants [OR: 1.59 (95%CI: 1.25, 2.03)]. Conclusions: High protein intake was weakly associated with preterm delivery. Contrary to the results from the Harlem Trial, no indications of deleterious effects on fetal growth or perinatal mortality were observed.

Cervical Length at 28–32 Weeks of Gestation Predicts Preterm Birth

Abstract Objective: To evaluate the ability of cervical length (CL) at 28–32 weeks of gestation to predict spontaneous preterm delivery and preterm premature rupture of membranes (PPROM). Methods: It was a retrospective cohort study that vaginal ultrasonography at approximately 28–32 weeks of gestation was performed in 14,953 women between 17–49 years old with singleton pregnancies who delivered after 28 weeks of gestation at the Peking University First Hospital from June 2008 to December 2012. The pregnancy outcomes were followed and the relationship between the CL and preterm delivery or PPROM was assessed. The relative risk was calculated to assess group differences in the likelihood of an event occurring. Results: The overall prevalence of preterm delivery was 5.7% (858/14,953); the incidence for therapeutic preterm delivery was 2.1% (318/14,953), for spontaneous preterm delivery was 0.9% (133/14,953), and for PPROM was 2.7% (407/14,953). Excluding the 318 women who had therapeutic preterm delivery, the relative risk of preterm delivery for women with a CL between 25 mm and &lt;30 mm, between 15 mm and &lt;25 mm, and &lt;15 mm was 3.7, 9.3, and 30.2, respectively. The sensitivity, specificity, and positive and negative predictive values of CL ≤25 mm at 28–32 weeks of gestation as the cut-off value for predicting preterm delivery were 19.8%, 97.5%, 23.4%, and 96.9%, respectively. For preterm delivery before 35 weeks of gestation, the sensitivity, specificity, and positive and negative predictive values of a CL ≤ 25 mm at 28–32 weeks of gestation as the cut-off value were 30.0%, 97.2%, 11.8%, and 99.1%, respectively. In addition, women with PPROM (n = 407) had significantly shorter CL (31.9 ± 7.4) mm at 28–32 weeks of gestation compared that of women without PPROM (34.0 ± 8.3) mm. The incidence of PPROM in women with a CL≤25 mm at 28–32 weeks of gestation (19.4%, 79/407) was significantly lower than that for women with a CL &gt;25 mm (80.6%, 328/407, P &lt; 0.05). Conclusion: CL at 28–32 weeks of gestation can predict spontaneous preterm delivery, and is valuable for predicting PPROM.