Risk Of Early Preterm Delivery Research Articles

The effect of chorionicity on maternal and neonatal outcomes in triplet pregnancies

ObjectiveTriplet gestations are associated with increased maternal, fetal, and neonatal complications particularly early and extreme preterm delivery. Identifying and interrupting the preterm delivery cascade could prevent the fetal, neonatal, and long-term childhood complications. The shared circulation and placental vascular anastomosis are responsible for the occurrence of twin-to-twin transfusion syndrome, selective fetal growth restriction as well as the higher risk of morbidity and mortality observed in mono and dichorionic compared to trichorionic triplet gestations.Thus, the aim of this study was to determine the effect of chorionicity on maternal, fetal, and neonatal outcomes of triplet pregnancies as it has not been fully ascertained. Study designA retrospective population-based cohort study of 125 parturient with triplets' pregnancy who delivered at a single tertiary hospital. Results98 trichorionic and 27 dichorionic gestations were included. Maternal demographic and obstetric characteristics as well as pregnancy and postpartum complications were similar in the two study groups. The median gestational age at delivery was lower among dichorionic than trichorionic triplet gestations (median 31 vs 33 weeks, p < 0.046). Early (<32 weeks) and extreme preterm delivery (<28 weeks) were more prevalent in the dichorionic than the trichorionic group (early − 56 % vs 34 %, p < 0.038; extreme − 33.3 % vs 8 %, p < 0.002). We found no difference in fetal or newborns' complications and characteristics between the groups. However, the rate of neonatal death was significantly higher in the dichorionic compared to trichorionic triplet gestations (22 % vs 7 %, p < 0.038).A multivariate logistic regression model to determine the variables that contribute to early preterm delivery in triplet gestations showed that women who experienced a past preterm delivery had an independently higher risk for early preterm delivery in the triplet gestation (adj. OR 5.91, 95 % CI 1.16–30.03). Neither maternal age nor chorionicity were found to be independent risk factors for early preterm delivery. ConclusionsDichorionic triplet gestations exhibit a higher rate of early (<32 weeks) and extreme (<28 weeks) preterm delivery and are more prone to neonatal death compared to trichorionic gestations. Past preterm delivery is an independent risk factor for early preterm delivery in a triplet gestation.

Thyroid dysfunction in pregnancy - a retrospective observational analysis of a Maltese cohort

BackgroundThyroid dysfunction is known to adversely affect pregnancy. This studyevaluates the prevalence of thyroid disorders and explores their associationwith pregnancy complications/comorbidities and modes of delivery in the Maltesepregnant population over a ten year period.DesignA population based observational study.MethodWe analysed data from the National Obstetrics Information Service of theDepartment of Health Informations and Research (NOIS) for all births deliveredin Malta between 2006 and 2016. Cases identified and recorded by NOIS to have had some form of thyroiddysfunction during pregnancy were confirmed by cross-referencing with laboratory results found in patients’medical records and/or iSOFT® database system. Using the Statistical Packagefor the Social sciences (SPSS®) demographic data, pastobstetric and medical history and obstetric outcomes were analysed forpregnancies with thyroid dysfunction and compared to data pertaining to pregnancies in euthyroid patients, that is those with no recorded thyroid dysfunction on NOIS. Chi square/Fisher'sexact test were used to compare categorical variables while ANOVA/Mann-WhitneyU test was used to compare continuous variables. Statistical significance wasdefined by a two-sided p value <0.05.ResultsData was available for 46,283 women (mean [SD] age = 29.2 [5.4] years).587 pregnancies (1.3%) suffered from thyroid dysfunction. Of these, 67.3% werehypothyroid, 3.2% had hyperthyroidism, 28.3% had isolated hypothyroxinaemia(IHT) while 1.2% had a history of thyroid carcinoma. Patients with IHT andhypothyroidism were older than euthyroid patients (p < 0.001). IHT and hypothyroid patients had astatistically significant higher body mass index (BMI) than euthyroid women(p=0.001 for hypothyroid women, p = 0.035 for IHT). Hypothyroid and IHT women were more likely to have had aprevious lower segment caesarean section (p=0.043, and 0.006respectively). Type 1 diabetes and gestational diabetes p = 0.012) were more common associatedcomorbidities in hypothyroid pregnancies. Offspring of patients with IHT had ahigher birth weight than those born to euthyroid patients (p=0.009). Patients with hyperthyroidism were found to havea significantly increased risk of early preterm delivery before 34 weeks ofgestation and were also more likely to have suspected intrauterine growthrestriction and low mean birth weight. We report no significantdifferences in past history of obstetric loss, antenatal complications, mode ofdelivery, gestational age at delivery and postpartum haemorrhage rates acrossthyroid categories.ConclusionsAvailable evidence suggests that thyroid dysfunction is more likely in thesetting of older age, and higher body mass index. Moreover, it impacts on neonatalbirth weight, rates of early preterm delivery and intrauterine growthrestriction.

Preconception leisure-time physical activity and family history of stroke and myocardial infarction associate with preterm delivery: findings from a Norwegian cohort

BackgroundPreterm birth poses short and long-term health consequences for mothers and offspring including cardiovascular disease sequelae. However, studies evaluating preexisting family history of cardiovascular disease and risk factors, such as physical activity, as they relate prospectively to risk of delivering preterm are lacking.ObjectivesTo evaluate whether preconception past-year weekly leisure-time physical activity or a family history of stroke or of myocardical infarction prior to age 60 years in first degree relatives associated, prospectively, with preterm delivery.DesignCohort study. Baseline data from Cohort Norway (1994–2003) health surveys were linked to the Medical Birth Registry of Norway for identification of all subsequent births (1994–2012). Logistic regression models provided odds ratios (OR) and 95% confidence intervals (CI) for preterm delivery (< 37 weeks gestation); multinomial logistic regression provided OR for early preterm (< 34 weeks) and late preterm (34 through to end of 36 weeks gestation) relative to term deliveries.ResultsMean (SD) length of time from baseline health survey participation to delivery was 5.6 (3.5) years. A family history of stroke associated with a 62% greater risk for late preterm deliveries (OR 1.62; CI 1.07–2.47), while a family history of myocardial infarction associated with a 66% greater risk of early preterm deliveries (OR 1.66; CI 1.11–2.49). Sensitivity analyses, removing pregnancies complicated by hypertensive disorders of pregnancy, diabetes mellitus, and stillbirth deliveries, gave similar results. Preconception vigorous physical activity of three or more hours relative to less than 1 h per week associated with increased risk of early preterm delivery (OR 1.52; 95% CI 1.01–2.30), but not late or total preterm deliveries. Light physical activity of three or more hours per week relative to less activity prior to pregnancy was not associated with early, late, or total preterm deliveries.ConclusionsResults suggest that family history of cardiovascular disease may help identify women at risk for preterm delivery. Further, research is needed regarding preconception and very early pregnancy vigorous physical activity and associated risks.

Periodontal disease and preterm birth: Findings from the 2015 Pelotas birth cohort study.

To verify the association between periodontal conditions and preterm birth. This study used data from the 2015 Pelotas Birth Cohort Study, Brazil. Pregnant women expected to give birth in 2015 were interviewed and dentally examined by a trained dentist, with periodontal measures collected in all teeth, six sites per tooth. Exposure was periodontal disease. Outcomes were preterm birth (all births <37weeks of gestational age) and early preterm birth (<34weeks). Analysis was carried out using Poisson regression according to a directed acyclic graph. A total of 2,474 women participated in the study. Incidence of preterm births was 10.2% and of early preterm births was 3.5%. Frequency of gingivitis was 21.7%, and periodontitis was 14.9%. Periodontitis was associated with a risk almost two times higher of having early preterm delivery compared with healthy pregnant women (RR 1.93; 95% CI 1.09-3.43). Presence of 5+ mm periodontal pocket with bleeding on probing was also associated with higher risk for early preterm delivery. The association between periodontal disease in pregnancy and the occurrence of preterm delivery is sensitive to the case definitions. Periodontal disease increased the risk of early preterm delivery.

Transferencia de embriones congelados y riesgo de parto prematuro: estudio de la cohorte española

IntroductionCurrent evidence suggest that perinatal outcomes of children of patients subjected to in vitro fertilisation (IVF) with fresh embryo transfer (ET) are worse compared to frozen embryo transfer (FET). There are doubts if the cause might be related to the technique of vitrification or ovarian stimulation performed in IVF. The aim of this study is to assess the risk of preterm delivery in patients undergoing IVF with fresh ET versus FET. Material and methodsRetrospective cohort study using data from the National Registry of Assisted Reproduction Techniques Activity - Registry of the Spanish Fertility Society (RNATRA) from 2010 to 2015, including women with a singleton pregnancy following autologous IVF (IVF-AO), or IVF with donation of oocytes (IVF-DO). ResultsA total of 371,308 cycles of IVF were performed, of which 263,306 followed IVF-AO (172,626 fresh ET, and 90,680 FET), and 108,002 underwent IVF-DO (57,944 fresh ET and 50,048 FET). The prevalence of preterm delivery was 12% in IVF-AO group and 18.6% in IVF-DO group. A decreased risk of early preterm delivery was observed after FET only in IVF-AO (OR: 0.87; 95% CI: 0.75-0.99), while an increased risk of late and moderate preterm delivery was found after FET, both in IVF-AO (OR: 1.12; 95% CI: 1.04-1.20) and IVF-DO (OR: 1.17; 95% CI: 1.08-1.26). ConclusionsBoth IVF-AO and IVF-DO have a high prevalence of preterm delivery. Cryopreservation is associated with a lower risk of early preterm delivery compared to fresh ET in patients undergoing IVF-AO; however, an increased risk of late and moderate preterm delivery was observed in both IVF-AO and IVF-DO. These findings should be analysed with caution due to methodological limitations.

Physical Exertion Immediately Before Early Preterm Delivery: A Case-Crossover Study.

Occupational exertion is associated with a higher risk of preterm delivery, although studies of leisure time activities generally document reduced risks. Less is known about the risk of preterm delivery immediately following episodes of moderate or heavy physical exertion. We conducted a case-crossover study of 722 women interviewed during their hospital stay for early preterm delivery, defined by a gestational age before 34 weeks, and after 20 weeks. Interviews occurred between March 2013 and December 2015 in seven hospitals in Lima, Peru. The incidence rate ratio (RR) of early preterm delivery was 5.82-fold higher (95% confidence interval [CI] = 4.29, 7.36) in the hour following moderate or heavy physical exertion compared with other times and returned to baseline in the hours thereafter. The RR of early preterm delivery within an hour of physical exertion was lower for exertion at moderate intensity (RR = 2.43; 95% CI = 1.50, 3.96) than at heavy intensity (RR = 23.62; 95% CI = 15.54, 35.91; P-homogeneity < 0.001). The RR of early preterm delivery was lower in the hour following moderate physical exertion among women who habitually engaged in physical exertion >3 times per week in the year before pregnancy (RR = 1.56; 95% CI = 0.81, 3.00) compared with more sedentary women (RR = 6.91; 95% CI = 3.20, 14.92; P-homogeneity = 0.003). Our study showed a heightened risk of early preterm delivery in the hour following moderate or heavy physical exertion.

Successful Management of Preterm Premature Rupture of Membrane in Second Trimester: A Case Report and Literature Review

The preterm premature rupture of membranes occurring in early pregnancy at less than 23 - 24 weeks (prior to fetal viability), has higher risk for early preterm delivery, and therefore, the poorer the prognosis with poor chance of neonatal survival and a high rate of severe, long-term neonatal morbidity among survivors. In such cases in absence of overt evidence of intrauterine infection at the time of diagnosis termination of pregnancy or expectant management is generally offered modality of treatment, the prior being commonly preffered. When expectant management is instituted, it is very rare that spontaneous resealing of the membranes occurs with the outcome that is equivocal to normal pregnancy. The presented case is an example of this rare happening. A 25-year-old, mangolian, primigravida at 20 weeks of pregnancy had spontaneous preterm premature rupture of membranes. After 8 days of expectant management, she had cessation of amniotic fluid leak and could continue pregnancy till term with normal feto-maternal outcome at 37 weeks of pregnancy. The risk of infection increases with prolongation of latency period but in this case, the latency period was prolonged for more than 16 weeks and there was no evidence of infection, with normal feto-maternal outcome at term. This is the first case of its kind happened in our hospital and deserves to be reported. It is expected that this article will reveal the possibility of resealing of spontaneous preterm premature rupture of membrane with proper expectant management.

Effects of Omega-3 Fatty Acids in Prevention of Early Preterm Delivery

Abstract Objective Preterm birth continues to be the one of the leading causes of infant deaths worldwide. There is a need for effective, easily available, safe and acceptable interventions to prevent preterm delivery, especially before 34 weeks of gestation. Omega-3 fatty acids such as EPA (eicosapentanoic acid) and DHA (docosahexanoic acid) are available as over the counter nutritional supplements, and are taken by women to improve pregnancy outcomes, without any clear recommendations. We undertook a systematic review to assess the effects of omega-3 fatty acids on early ( Methods We searched MEDLINE, EMBASE and Cochrane Library from inception to 2014 without any language restrictions. Study selection, quality assessment and data extraction were done by two independent reviewers. Results were summarized as relative risks and 95% confidence intervals for dichotomous outcomes and mean differences for continuous outcomes. Results Of the nine included trials (5980 women), six (4193 women) evaluated the effects of omega-3 fatty acids on early preterm delivery. The risk of early preterm delivery was reduced by 58% (RR 0.42; 95% CI 0.27–0.66; I2 = 0%; p = 0.0002) and any preterm delivery by 17% (RR 0.83; 95% CI 0.70–0.98; I2 = 0%; p = 0.03) with the intervention. There was a significant increase in the mean gestational age by 1.95 weeks (95% CI 0.42–3.48 weeks; I2 = 0.47; p = 0.01) and mean birth weight by 122.1 g (95% CI 47.4–196.8; I2 = 0.84; p = 0.001) in the intervention group compared to the controls. Subgroup analysis showed no significant differences in the effects between the groups according to the risk status, dose and timing of the intervention. Conclusion Omega-3 fatty acids are effective in preventing early and any preterm delivery. The intervention is simple and easily available and has the potential to influence population based strategies in the prevention of preterm birth.

Chorioamnionitis and Neurocognitive Development at Age 2 Years.

To evaluate whether chorioamnionitis is associated with decreased Bayley II scores at age 2 years. We conducted an observational cohort study of women and their offspring enrolled in the Eunice Kennedy Shriver National Institute of Child Health and Development's Maternal-Fetal Medicine Units Network multicenter, randomized controlled trial of magnesium for cerebral palsy prevention in pregnancies at high risk for early preterm delivery. We included nonanomalous singleton gestations and excluded pregnancies missing outcome or exposure data. Our primary exposure was chorioamnionitis, defined by the clinical diagnosis of chorioamnionitis and a maternal fever greater than 100°F. Our primary outcome was a Bayley II Mental Developmental Index score less than 70 or Psychomotor Developmental Index score less than 70 assessed at age 2 years. We also assessed Mental Developmental Index or Psychomotor Developmental Index score less than 85. We conducted bivariate analyses and fit a log-linear regression model, adjusting for related to Mental Developmental Index or Psychomotor Developmental Index score less than 70 or less than 85 with a detectable effect size estimated at a relative risk of 1.5 or greater. Of 1,574 patients in our analysis, 194 (12%) had chorioamnionitis and 1,366 (87%) had preterm premature rupture of membranes. The mean gestational age at delivery was 29 3/7 weeks. There were no significant differences in Mental Developmental Index score less than 70 (37 [19.1%] compared with 233 [17%], P=.45) or Psychomotor Developmental Index score less than 70 (29 [15%] compared with 195 [14%] P=.76) for children born to mothers with or without chorioamnionitis, respectively. After adjusting for confounders, there remained no difference in the proportion of abnormal scores in either group. However, neonates diagnosed with sepsis were found to have significantly decreased Mental Developmental Index scores. Exposure to chorioamnionitis was not associated with neurocognitive defects as measured by abnormal Bayley II scores.

Cribado de parto prematuro con progesterona salival

Preterm birth is the most frequent cause of perinatal morbidity and mortality, especially before 34 weeks. Current screening methods include medical history of preterm delivery and ultrasound assessment of cervix length during the second trimester of pregnancy, which give a detection rate of approximately 65% with a false positive rate of 10%. Vaginal progesterone therapy has proved to reduce the risk of early preterm delivery by 50% in patient under risk. This might suggest that preterm pregnancies have lower levels of progesterone compared to term pregnancies. Although, the prediction of prematurity using biomarkers, including plasma progesterone, has been researched for several years, none of them have proved to be associated with preterm delivery. However, measuring salivary progesterone has already been suggested to be a potential biomarker associated with prematurity in pregnancies at high risk of preterm delivery. Saliva is a fluid that reflects only the free fraction of the biologically active steroidal hormone, and thus is more representative measure than the total plasma progesterone, which is the one usually measured in laboratories. For these reasons, the aim of our study is to evaluate whether the assessment of salivary progesterone can be used as a screening test for prediction of preterm delivery less than 34 weeks in pregnant women who attended at our Fetal Medicine Unit at 11-14 and 20-25 weeks of gestation.

Effects of omega-3 fatty acids in prevention of early preterm delivery: a systematic review and meta-analysis of randomized studies

ObjectivePreterm birth continues to be the one of the leading causes of infant deaths worldwide. There is a need for effective, easily available, safe and acceptable interventions to prevent preterm delivery, especially before 34 weeks of gestation. Omega-3 fatty acids such as EPA (eicosapentanoic acid) and DHA (docosahexanoic acid) are available as over the counter nutritional supplements, and are taken by women to improve pregnancy outcomes, without any clear recommendations. We undertook a systematic review to assess the effects of omega-3 fatty acids on early (<34 weeks) and any (<37 weeks) preterm delivery. MethodsWe searched MEDLINE, EMBASE and Cochrane Library from inception to 2014 without any language restrictions. Study selection, quality assessment and data extraction were done by two independent reviewers. Results were summarized as relative risks and 95% confidence intervals for dichotomous outcomes and mean differences for continuous outcomes. ResultsOf the nine included trials (5980 women), six (4193 women) evaluated the effects of omega-3 fatty acids on early preterm delivery. The risk of early preterm delivery was reduced by 58% (RR 0.42; 95% CI 0.27–0.66; I2=0%; p=0.0002) and any preterm delivery by 17% (RR 0.83; 95% CI 0.70–0.98; I2=0%; p=0.03) with the intervention. There was a significant increase in the mean gestational age by 1.95 weeks (95% CI 0.42–3.48 weeks; I2=0.47; p=0.01) and mean birth weight by 122.1g (95% CI 47.4–196.8; I2=0.84; p=0.001) in the intervention group compared to the controls. Subgroup analysis showed no significant differences in the effects between the groups according to the risk status, dose and timing of the intervention. ConclusionOmega-3 fatty acids are effective in preventing early and any preterm delivery. The intervention is simple and easily available and has the potential to influence population based strategies in the prevention of preterm birth.

Fish oil supplementation improves pregnancy outcomes and size of the newborn: a meta-analysis of 21 randomized controlled trials

Objective: To observe the effects of fish oil on related pregnancy outcomes.Methods: A systematic search of the Medline, EMBASE and Cochrane’s library databases was conducted for the randomized controlled trials published till February 2015 that compared the effects of fish oil supplementation with a control diet in women during pregnancy.Results: Twenty-one studies comprising 10 802 pregnant women were included. Dietary fish oil was associated with a 5.8-day increase in gestational age of the newborn, a 22% reduced risk for early preterm delivery (risk ratio [RR] = 0.78, 95% CI: 0.64–0.95, p = 0.01) and a 10% reduction in preterm delivery (RR = 0.90, 95% CI 0.81–1.00, p = 0.05). Fish oil supplementation was associated with higher infantile birth weight (51.23 g), birth length (0.28 cm) and head circumference (0.09 cm), and a 23% lower risk of low birth weight. No benefit from fish oil supplementation was found with regard to risk of intrauterine growth restriction or stillbirth.Conclusions: Dietary fish oil during pregnancy was associated with reduced risk of preterm delivery and improved size of the newborn. Fish oil during pregnancy may be an effective prophylactic for preterm delivery.

Magnesium sulfate, chorioamnionitis, and neurodevelopment after preterm birth.

To assess the neuroprotective effect of magnesium sulfate (MgSO4 ) in preterm children exposed to chorioamnionitis. A secondary analysis of a multicentre randomised controlled trial of antenatal MgSO4 administered to women at risk of preterm birth for the prevention of cerebral palsy (CP). Singleton, non-anomalous pregnancies with clinical chorioamnionitis, delivering at ≥24weeks of gestation, were selected. Cases were exposed to antepartum MgSO4 ; controls received placebo. Multicentre randomised controlled trial. Singleton, non-anomalous pregnancies with clinical chorioamnionitis, delivering at ≥24weeks of gestation. All data were analysed by intention to treat. Univariate and multivariate analyses were performed. Primary outcome was a composite of stillbirth, death by the age of 1year, or moderate or severe CP by the age of 2years. Secondary outcomes included a composite neonatal outcome as well as neurodevelopmental delay, defined as Bayley II mental and psychomotor developmental indices <70 at the age of 2years. Subgroup analysis assessed these outcomes in children born at <28weeks of gestation. A total of 396 children were included, with 192 (48.5%) randomised to MgSO4 . Maternal and delivery characteristics were similar between the groups. The primary outcome occurred in 14.1% of children exposed to MgSO4 and 12.7% of children exposed to placebo (relative risk, RR 1.29; 95% CI 0.70-2.38). Rates of stillbirth, death, moderate-severe CP, and neurodevelopmental delay did not differ between groups. In the subgroup analysis of children born at <28weeks of gestation, there was no difference in the rates of the primary outcome, nor in the secondary outcomes assessed. [Correction added on 02 March 2016 after online publication: There were errors in statistical data analysis and these have been corrected throughout the article.] Among children at risk for early preterm delivery exposed to chorioamnionitis, antenatal administration of MgSO4 was not associated with improved neurodevelopmental outcome. We do not recommend any change in the guidelines on the administration of MgSO4 for neuroprotection based on this study. MgSO4 was not associated with improved neurodevelopmental outcome in setting of chorioamnionitis.

180: Value of magnesium sulfate for >12 hours to prevent cerebral palsy and death

Magnesium sulfate (MS) is standard of care for the prevention of moderate and severe cerebral palsy among women who are expected to deliver at less than 32 weeks of gestation. The recommended protocol is to stop MS after 12 hours if no sign of imminent delivery. Limited information exists as to whether longer courses of MS are associated with decreased risk for cerebral palsy and death in the children of women who deliver prior to 32 weeks of gestation. Our aim is to determine whether extended courses of MS in women at high risk for early preterm delivery are associated with decreased risk of cerebral palsy and death in their children.

10.1 Can essential fatty acids prevent early preterm delivery? A meta-analysis of evidence

BackgroundAmongst preterm babies, those delivered before 34 weeks gestations contribute disproportionately highly to prematurity related complications. There is a need for effective, acceptable, accessible and safe interventions to prevent early...

PMM.01 Can essential fatty acids prevent early preterm delivery? A meta-analysis of evidence

BackgroundAmongst preterm babies, those delivered before 34 weeks gestations contribute disproportionately highly to prematurity related complications. There is a need for effective, acceptable, accessible and safe interventions to prevent early...

First trimester maternal serum pregnancy-associated plasma protein-A is a predictive factor for early preterm delivery in normotensive pregnancies

In this study, we investigated whether the concentrations of pregnancy-associated plasma protein-A (PAPP-A) or free β-hCG (fβhCG) in the first trimester can identify women at increased risk of subsequent preterm delivery in the absence of hypertensive disorders. Preterm and early preterm deliveries are defined as those deliveries before completing 37 and 34 weeks, respectively. A total of 868 women were enrolled into this study. According to the level of the markers, the patients were evaluated in three groups: 1 – maternal serum level ≤5th percentile, 2 – between 5th and 95th percentiles, 3 – ≥95th percentile. In the group of patients with a PAPP-A level ≤5th percentile [≤0.35 multiples of the median (MoM)], mean gestational age (GA) at delivery, mean birth weight and the number of the cases with early preterm delivery were significantly lower than the others. Mean level of PAPP-A was significantly lower in cases with early preterm than term deliveries (0.58 ± 0.32 versus1.09 ± 0.69; p = 0.01). Maternal serum level of fβhCG did not show significant difference between these groups (0.84 ± 0.45 versus 1.17 ± 0.77; p = 0.15). Low levels of maternal serum PAPP-A (≤0.35 MoM) (Odds ratio = 7; 95% confidence interval 1.8–27.7; p = 0.0048) significantly predicted early preterm delivery in normotensive pregnancies. Women with low levels of PAPP-A at first trimester have a higher risk of early preterm delivery even in the absence of hypertensive disorders.

445: Maternal diet alters the offspring microbial gene catalogue as revealed by whole genome shotgun (WGS) sequencing in a primate model of obesity

catalogue as revealed by whole genome shotgun (WGS) sequencing in a primate model of obesity Radhika Ganu, Jun Ma, Antonio Frias, Diana Takahashi, Joseph Petrosino, Kevin Grove, James Versalovic, Kjersti Aagaard Baylor College of Medicine, Division of Maternal-Fetal Medicine, and Departments of Obstetrics and Gynecology, Molecular and Cell Biology, and the Bioinformatics Research Lab, Houston, TX, Oregon Health & Science University, Obstetrics and Gynecology, Portland, OR, Oregon Health & Science University, Oregon National Primate Research Center, Beaverton, OR, Baylor College of Medicine, Molecular Virology and Microbiology, Houston, TX, Baylor College of Medicine and Texas Children’s Hospital, Pathology & Immunology, Houston, TX OBJECTIVE: The infants microbiome (totality of microorganisms) is felt to be relatively sparse at birth. Based upon mode of delivery, gestational age, and breastfeeding it is thereafter variably populated. We have previously employed 16S-based metagenomics in our well-characterized primate model of maternal obesity, and observed that maternal diet additionally structures the offsprings microbiome. However, clear delineation of which species and microbial genes are influenced by the maternal diet has heretofor eluded us. Our study objective was to employ WGS metagenomics with metabolic pathway reconstruction to delineate not only which microbes are (or are not) present, but what these microbes are capable of doing. STUDY DESIGN: Age and weight-matched dams on control (13%) or HF (35%) diet yielded two distinct maternal cohorts emerged: obese HF diet sensitive [HFS] & lean HF resistant [HFR]. Based on the 16S-based analysis of over 200 comprehensive body site samples collected to date (placenta, oral, GI, fecal, GU) limited (n 12) samples for costly massively parallel WGS sequencing on the Illumina HiSeq (panel A). Binned microbial sequences were analyzed using MetaPhlAn (taxonomy abundance) and HuMAnN (pathway reconstruction). Significant features differentiating the groups were identified and ranked by Z-score corresponding to p-value. RESULTS: Consistent with maturation of the primate gut microbiome over the first year of life, maternal and juvenile gut microbiomes are distinguishable (Panel B). Juvenile gut microbiomes and associated metabolic pathways are significantly structured primarily by virtue of maternal diet, with a lesser contribution by maternal obesity (Panels C & D). CONCLUSION: High resolution metagenomics supports the notion that a highfat maternal diet in utero structures the offspring gut microbiome to 1 year of age; these are accompanied by significant alterations in bacterial metabolic gene catalogues. 446 Predictors of preterm delivery (PTD) after fetoscopic laser surgery (FLS) for twin twin transfusion syndrome (TTTS) Ramesha Papanna, Lovepreet Mann, Dana Block-Abraham, Irina Buhimschi, Michael Bebbington, Elisa Garcia, Nahla Khalek, Christopher Harman, Kenneth Moise Jr., Ahmet Baschat, Anthony Johnson Yale University, Ob/Gyn & Reprod. Sci., New Haven, CT, University of Maryland School of Medicine, Obstetrics, Gynecology and Reproductive Sciences, Baltimore, MD, University of Texas Health Science Center, Obstetrics, Gynecology and Reproductive Sciences, Houston, TX, The Children’s Hospital of Philadelphia, The Center for Fetal Diagnosis and Treatment, Philadelphia, PA OBJECTIVE: Despite the success of FLS for TTTS, PTD remains a critical contributor to adverse outcome. There is a paucity of data to explain the possible causes for PTD after FLS. Our objective is to identify the risk factors associated with preterm delivery after FLS. STUDY DESIGN: Prospectively collected data from 4 US fetal centers of 495 patients was centralized to an independent research center. Exclusion criteria were triplet pregnancies (n 24) and selective reduction for a failed FLS (n 12). Periand post-operative variables were collected and analyzed. Subgroups were created based on the median gestational age at delivery of 32 weeks (mean SD: 31.2 4.9w). Risk factors and outcomes were compared between these groups. Comparative statistics were performed using appropriate statistical analysis (statistical significance p 0.05). Multivariate logistic regression was performed on the significant factors on univariate analysis. RESULTS: Significant comparisons are shown in Table 1. There were no differences in peri-operative variables. On multivariate analysis, greater maternal age at procedure, iPPROM (occurring in 32%).and larger cannula diameter increased the risk for early PTD. iPPROM reduced the procedure to delivery interval by 22 days (Kaplan-Meier survival analysis; p 0.001) and the associated rate for 9,10 and 12 Fr cannulas were 16%, 30%,42%, respectively, and procedure-to-delivery intervals (days) were 83.4 34.6, 79.3 36, and 59.6 36.8, respectively (all 0.001). Pre-viable ( 24 weeks) delivery occurred in 10%, and was attributable to iPPROM in 30% and spontaneous preterm labor in 57%. CONCLUSION: Early preterm delivery remains a major complication of FLS. Cannulas size and the associated rate of iPPROM appear to be the significant contributors to preterm birth. Further research should focus on methods to prevent iPPROM and to improve instrumentation to decrease the size of the cannula and maintain better visualization during fetoscopy. Poster Session III Doppler Assess, Fetus, Prematurity, U/S, Med-Surg-Diseases www.AJOG.org

Effect of n‐3 Long‐chain Polyunsaturated Fatty Acid Intake during Pregnancy on Maternal, Infant, and Child Health Outcomes: A Systematic Review

Evidence from observational studies and randomised trials has suggested a potential association between intake of n-3 long-chain polyunsaturated fatty acids (LCPUFA) during pregnancy and certain pregnancy and birth outcomes. Marine foods (e.g. fatty sea fish, algae) and select freshwater fish contain pre-formed n-3 LCPUFA, which serve as precursors for bioactive molecules (e.g. prostaglandins) that influence a variety of biological processes. The main objective of this analysis was to summarise evidence of the effect of n-3 LCPUFA intake during pregnancy on select maternal and child health outcomes. Searches were performed in PubMed, EMBASE, and other electronic databases to identify trials where n-3 LCPUFA were provided to pregnant women for at least one trimester of pregnancy. Data were extracted into a standardised abstraction table and pooled analyses were conducted using RevMan software. Fifteen randomised controlled trials were eligible for inclusion in the meta-analysis, and 14 observational studies were included in the general review. n-3 LCPUFA supplementation during pregnancy resulted in a modest increase in birthweight (mean difference = 42.2 g; [95% CI 14.8, 69.7]) and no significant differences in birth length or head circumference. Women receiving n-3 LCPUFA had a 26% lower risk of early preterm delivery (<34 weeks) (RR = 0.74; [95% CI 0.58, 0.94]) and there was a suggestion of decreased risk of preterm delivery (RR = 0.91; [95% CI 0.82, 1.01]) and low birthweight (RR = 0.92; [95% CI 0.83, 1.02]). n-3 LCPUFA in pregnancy did not influence the occurrence of pre-eclampsia, high blood pressure, infant death, or stillbirth. Our review of observational studies revealed mixed findings, with several large studies reporting positive associations between fish intake and birthweight and several reporting no associations. In conclusion, n-3 LCPUFA supplementation during pregnancy resulted in a decreased risk of early preterm delivery and a modest increase in birthweight. More studies in low- and middle-income countries are needed to determine any effect of n-3 LCPUFA supplementation in resource-poor settings, where n-3 PUFA intake is likely low.

Predictive score for early preterm birth in decisions about emergency cervical cerclage in singleton pregnancies

To develop a simple score for assessing the risk of early preterm delivery before 32 weeks in women with singleton pregnancies receiving emergency cervical cerclage. Retrospective study. French tertiary care center from 1994 to 2006. A total of 134 pregnant women underwent emergency cervical cerclage procedure at 15-26 weeks. The analysis concerned 85 singleton pregnancies after exclusion of women with a dilated cervix without visible membranes, or presenting for revision of failed prophylactic cerclage, or who had either preterm premature rupture of membranes or clinical signs of chorioamnionitis. Multivariate logistic regression methods with rounded coefficients were used to develop a score to predict early preterm delivery before 32 weeks. Early preterm delivery before 32 weeks. The score, ranging from 0 to 15 points, was based on the following four criteria independently associated with early preterm delivery: obstetric history; cervical dilatation; membranes bulging into the vagina; and infection. Each score value was associated with a predicted probability of early preterm birth. The score and its associated early preterm probabilities may be a valuable tool to help physicians in advising women about the need for emergency cerclage.