Short Interpregnancy Interval Research Articles

Vitreous hemorrhage in a pregnant woman with a history of simultaneous pancreas and kidney transplantation: A case report

Pregnancy after simultaneous pancreas and kidney transplantation (SPKT) carries a high risk of maternal and fetal complications. We report the case of a 39-year-old woman with three consecutive pregnancies with favorable outcomes after SPKT. Within the first year of SPKT, the patient had a spontaneous pregnancy. At 32weeks of gestation, she underwent an emergency cesarean section (CS) due to severe preeclampsia and HELLP syndrome. The infant was of average birth weight and was transferred to the neonatal intensive care unit for further management. A second unplanned pregnancy occurred almost nine months after the first. The antenatal assessments for fetal growth, blood glucose, and blood pressure were normal throughout follow-up. Early in her pregnancy, the patient developed an uneventful retinopathy of the left eye. At 37weeks of gestation, she underwent an elective CS due to a short inter-pregnancy interval and delivered a healthy baby with an average birth weight. At the age of 39years, the patient had a third unplanned pregnancy. She was diagnosed with seronegative antiphospholipid syndrome. She suffered from bilateral vitreous hemorrhage and was managed successfully with a minimally invasive laser treatment combined with an intravitreal injection of anti-vascular endothelial growth factor during her third trimester. At 35weeks of gestation, the patient presented with labor pain and underwent an emergency CS and delivered a healthy baby with an average birth weight. Pregnancy after SPKT requires a multidisciplinary approach with a careful workup.

Role of short interpregnancy interval, birth mode, birth practices, and the postpartum vaginal microbiome in preterm birth.

There have been widely documented beneficial role of vaginal Lactobacillus species as an important biomarker for vaginal health and healthy pregnancy progression. When translating this to clinical settings, pregnant women with low proportions of Lactobacillus and commensurately high proportion of rich and highly diverse abnormal microbiota are most likely to encounter negative pregnancy outcome such as preterm birth and postpartum complications. However, multiple literatures have also addressed this notion that the absence of a Lactobacillus-dominated microbiota does not appear to directly imply to a diseased condition and may not be a major determinant of negative obstetric outcome. Caesarian delivery is notably a risk factor for preterm birth and postpartum endometritis, yet recent data shows a trend in the overuse of CS across several populations. Growing evidence suggest the potential role of vaginal/uterine cleaning practice during CS procedures in influencing postpartum infections, however there is a controversy that this practice is associated with increased rates of postpartum endometritis. The preponderance of bacterial vaginosis associated bacteria vagitype at postpartum which persist for a long period of time even after lochia regression in some women may suggest why short interpregnancy interval may pose a potential risk for preterm birth, especially multigravidas. While specifically linking a community of microbes in the female reproductive tract or an exact causative infectious agent to preterm birth and postpartum pathologies remains elusive, clinical attention should also be drawn to the potential contribution of other factors such as short interpregnancy interval, birth mode, birth practices and the postpartum vaginal microbiome in preterm birth which is explicitly described in this narrative review.

Interpregnancy interval in multiparas: does it impact the labor curve?

Both short and long interpregnancy intervals (IPI) are associated with adverse outcomes, however the impact of IPI on labor progression is unknown. We examined the impact of IPI on the labor curve, hypothesizing that those with a longer IPI would have a slower labor progression. This is a retrospective cohort study of multiparous patients with a history of one prior vaginal delivery admitted for induction of labor or spontaneous labor with a singleton gestation ≥37 weeks at a single academic medical center between 2004 and 2015. Repeated measures regression was used to construct labor curves which were compared between patients with a short IPI, defined as < 3 years since last delivery, and long IPI, defined as ≥3 years since last delivery. We chose this interval as it closely approximates the median birth interval in the USA. Interval-censored regression was used to estimate median duration of labor after 4-cm dilation stratified by type of labor (spontaneous versus induced). Multivariate analysis was used to adjust for potential confounders. Of the 1331 patients who were included in the analysis, 544 (41%) had a long IPI. Among the entire cohort, there were no significant differences in first stage progression between short and long IPI groups. The second stage was significantly shorter in patients with long IPI compared to those with short IPI (Table). In the stratified analysis, first stage progression varied between labor type. Long IPI was associated with a slower active phase among those being induced and quicker active phase among those in spontaneous labor (Figure). Second stage duration remained significantly shorter in the long IPI group regardless of labor type. The effect of IPI on first stage progression varies based on induction versus spontaneous labor. Regardless, a long IPI is consistently associated with a shorter second stage of labor, potentially secondary to improved physical fitness or muscle recovery with a longer IPI.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Interpregnancy Interval Effect on Perinatal Outcome- A Prospective Observational Study

Introduction: Spacing of birth is an important parameter affecting maternal and foetal health. Optimal birth spacing provides multiple benefits for both mother and her child. Both short and long Inter-Pregnancy Intervals (IPI) is associated with multiple adverse perinatal outcomes. Therefore, IPI is viewed as a potential modifiable risk factor for adverse foetal-maternal outcome. Aim: To study the association of IPIs with adverse maternal and foetal outcomes. Materials and Methods: This prospective observational study was conducted in R.G. Kar Medical College and Hospital, Kolkata, West Bengal, India for a period of 18 months from January 2019 to June 2020. All multigravida women with atleast three antenatal check-ups were included in the study. The subjects were divided in two groups: group A consisted of 86 subjects, who had &lt;2 year IPI and group B consisted of 87 subjects, who had ≥2 year IPI. These were compared on the basis of following sociodemographic characteristics: maternal age, Body Mass Index (BMI), contraceptive use, socio-economic status. Foetal outcome was assessed by gestational age at delivery, birth weight, Appearance, Pulse, Grimace, Activity and Respiration (APGAR) score, need for Neonatal Intensive Care Unit/Sick Neonatal Care Unit (NICU/SNCU) admission and perinatal morbidity and mortality. Data were collected and statistically analysed using Statistical Package for Social Science (SPSS) version 19.0 (SPSS Inc, Chicago, IL, USA). Chi-square test was used for categorical data and students t-test was used for continuous data. Statistical significance in all evaluations was defined as p-value &lt;0.05. Results: Contraception use were significantly less in women with short IPI (p=0.001). The incidence of anaemia (p=0.026), scar dehiscence in postcaesarean pregnancies (p=0.031) and Post Partum Haemorrhage (PPH) (p=0.041) were also higher in mothers with short IPI. In this group incidence of low-birthweight baby (p=0.039), preterm birth (p=0.041) and need for care of babies in NICU (p=0.043) were also higher and was statistically significant. Conclusion: Lack of contraceptive use significantly increases the risk of short IPI which increases the risk of preterm delivery, maternal anaemia PPH and scar rupture in post-CS pregnancy and therefore, has a serious impact on maternal morbidity. Low birth weight and NICU/SNCU admission being more in group A was a drain on the health expenditure.

Postpartum contraception in Australia: opportunities for increasing access in the primary care setting.

In Australia, 20% of pregnancies occur within the first year after birth and most are unintended. Both unintended pregnancies and short interpregnancy intervals (<12-18months) can have adverse effects on maternal, infant, and child health. Access to postpartum contraception reduces the risk of unintended pregnancies and short interpregnancy intervals, and supports women in pregnancy planning and birth spacing. In this forum article, we describe how postpartum contraception is currently provided in Australia and highlight opportunities for improving access in the primary care setting.

Эндотелиальная дисфункция при привычном невынашивании беременности: генетические факторы и факторы внешней среды

Objective. To examine the association between the carriage of endothelial dysfunction-related gene polymorphisms and recurrent pregnancy loss (RPL). Patients and methods. This case-control study included 87 patients who were divided into two groups. The study group consisted of 65 patients with a history of two or more consecutive pregnancy losses (2 to 11 losses). Primary RPL was detected in 20 patients, secondary in 26, and tertiary in 19. The control group consisted of 22 women with a history of three or more full-term births without episodes of miscarriage. The frequency of polymorphisms of the VEGFA -634G&gt;C and IL6 -174G&gt;C genes was determined by a ready-to-use real-time polymerase chain reaction (RT-PCR) test kits. Results. Carrying the VEGFA -634G&gt;C GC genotype increases the risk of RPL 4-fold (p = 0.0072) and the IL6 -174G&gt;C GC genotype – 3-fold (p = 0.028). Analysis of the impact of combinations of unfavorable genotypes showed that 65.0% of patients with primary RPL, 61.5% with secondary RPL, 63.2% with tertiary RPL, and 9% of healthy controls had a combination of GC VEGFA -634G&gt;C and CC IL6 -174G&gt;C. One of the key environmental factors determining the realization of susceptibility genes is age: the maximum age at the time of the first intended pregnancy was observed in patients with primary RPL (32.6 years vs. 25.5 years in the control group; p &lt; 0.05), with 9% of healthy controls having a combination of two genotypes associated with pregnancy loss. That is, successful pregnancy at a younger age is possible even when carrying multiple risk alleles. The birth interval length is also important for successful pregnancy: a short inter-pregnancy interval allows to carry out the reproductive function during the most favorable period of the reproductive system before the influence of genotypes predisposing to RPL begins. Other environmental factors leading to the realization of carriage of RPL risk alleles include a history of intrauterine interventions and sexually transmitted infections. Conclusion. Study of the VEGFA -634G&gt;C and IL6 -174G&gt;C gene polymorphisms may serve as an effective method to predict RPL. For patients carrying these unfavorable gene polymorphisms, it is especially important to perform the reproductive function in time, i.e., before the realization of environmental factors. Key words: recurrent pregnancy loss, VEGF, endothelial dysfunction, susceptibility genes

Short interpregnancy interval following a multifetal pregnancy: maternal and neonatal outcomes

Short interpregnancy interval following a multifetal pregnancy: maternal and neonatal outcomes

Magnitude of Modern Contraceptive Utilization and its Associated Factors Among Postpartum Women in Bench Sheko Zone, Southwest Ethiopia, 2021: Community-Based Cross-Sectional Study

Despite the significant benefit of postpartum modern contraceptives to avert the problems related to short interpregnancy intervals and unintended pregnancy, still the uptake remains low in Ethiopia. The aim of the study was to assess the magnitude of family planning use during the puerperium period and the factors associated with it in the Benchi Sheko zone of Southwest Ethiopia. From 10th March to 10th May/2021, 385 mothers were enrolled in a community-based cross-sectional study. Participants were nominated using simple random sampling. To collect the data, an interviewer-administered questionnaire was used. To identify the factors associated with the utilization of postpartum contraceptives, bivariate and multivariable logistic regression analyses were used. The statistical significance level was determined at p-value &lt; .05. The overall utilization of postpartum modern family planning utilization was 50.4% (95% CI: 45.3, 55.3). Maternal education (AOR = 2.26, 95% CI; 1.03–4.95), informed on family planning (AOR = 0.34, 95% CI; 0.13–0.91), counseled on contraceptives during Antenatal Care (ANC) (AOR = 1.82, 95% CI: 1.05–3.17), previous family planning utilization (AOR = 0.45, 95% CI: 0.28–0.73), counseled on contraceptives at the time of PNC (AOR = 1.70, 95% CI: 1.07–2.71), and resumption of sexual intercourse after delivery (AOR = 4.17, 95% CI: 1.57–11.08) were the major factors hindering the utilization of modern contraceptives. the overall magnitude of modern contraceptive utilization during the puerperium period was low. Having counseling, information, and previous experience in family planning, and time to sexual intercourse resumption were clinical predictors of family planning utilization. A concerted effort to incorporate contraceptive services into maternal, neonatal, and child health (MNCH) service units should strengthen much, and counseling gives due emphasis.

Effects of Short Interpregnancy Intervals on Adverse Pregnancy Outcomes - Haidian District, Beijing Municipality, China, 2017-2019.

Interpregnancy intervals (IPIs) that are either excessively long or short have been linked with an elevated risk of adverse perinatal outcomes. Presently, no pertinent guidelines have been established in China to provide clear direction with regard to optimal IPI. A brief interpregnancy interval may elevate the risk of miscarriage, postpartum hemorrhage, and fetal distress among expectant women. These results could inform prenatal consultations, guiding pregnant women towards an ideal interpregnancy interval of no less than 24 months.

Nonfulfillment of desired postpartum permanent contraception and resultant maternal and pregnancy health outcomes

Up to half of the patients requesting postpartum permanent contraception do not undergo the desired procedure. Although nonfulfillment of desired postpartum permanent contraception is associated with increased risk of pregnancy within 12 months of delivery, its long-term reproductive and maternal health outcomes are less clear. This study aimed to determine the association of fulfillment of postpartum permanent contraception with number and timing of subsequent pregnancies and maternal health outcomes. This was a retrospective single-center cohort chart review study of health outcomes in the 4 years following delivery (2016-2018) for 1331 patients with a documented contraceptive plan of female permanent contraception at time of postpartum discharge from 2012 to 2014. Rates of permanent contraception fulfillment within 90 days of delivery and clinical and demographic characteristics associated with permanent contraception were calculated. We determined number of and time to subsequent pregnancies, and diagnoses of medical comorbidities (hypertension, diabetes mellitus, depression, anxiety, asthma, anemia), sexually transmitted infection, and pregnancy comorbidities (preterm birth, gestational diabetes mellitus, gestational hypertension, preeclampsia, postpartum hemorrhage, low birthweight, intrauterine fetal demise) in the 4 years following delivery. Of the 1331 patients desiring permanent contraception postpartum, 588 (44.1%) had their requests fulfilled within 90 days of delivery and 743 (55.8%) did not. Patients who achieved permanent contraception fulfillment tended to have attended more outpatient prenatal visits, delivered via cesarean delivery, and were older, married, college-educated, and privately insured. Patients who received their desired postpartum permanent contraception were less likely to have subsequent intrauterine pregnancies (P<.001). In those who did not achieve permanent contraception, 22 (9.0%) subsequent pregnancies occurred within 6 months of previous deliveries, and 223 (91.0%) occurred after short interpregnancy intervals (within 18 months). Of 178 continued pregnancies, 26 (14.6%) were delivered preterm. There were no differences between the 2 groups in terms of ever attending an outpatient, preventive, or emergency room visit, or in most nonreproductive health outcomes investigated. Nonfulfillment of desired postpartum permanent contraception is associated with subsequent maternal reproductive and nonreproductive health ramifications. Given the barriers to permanent contraception, alternative plans for contraception should be discussed proactively if permanent contraception is not provided.

Interpregnancy interval and preterm delivery: An empirical comparison of between-persons and within-sibship designs.

Short interpregnancy interval has been associated with increased risk of preterm delivery; recent studies employing within-sibship designs suggest that this risk may be exaggerated. There are unresolved issues regarding properties of this design. To compare directly the results, for short intervals, of between-person and within-sibship analyses when applied to the same target population. Cross-sectional data are from the National Survey of Family Growth, a statistically representative survey of women and men in the USA, 2006-2015. Participants provided a complete pregnancy history including outcome, duration and ending date, enabling calculation of interval. Conventional analysis employed log-linear regression, controlling survey design, early life events, demographic variables, pregnancy intendedness, breastfeeding of the previous birth and obstetric history. Within-sibship analyses, utilising conditional log-linear regression, controlled the same variables, except those remaining static within each participant. Among participants with at least three live- or stillbirths, the percentage of pregnancies in each interval, and the percent of deliveries that were preterm following that interval were 9.2%, 14.6% for <6, and 14.7%, 15.4% for 6-11, versus 12.2%, 14.7% for 18-23 months. Among participants with at least three live- or stillborn infants, those in the within-sibship analysis had a higher risk profile than comparably parous, ineligible participants. In a between-participant analysis, among those included in within-sibship models, the adjusted risk ratios (vs 18-23 months) for preterm delivery for intervals <6 and 6-11 months were 0.74 (95% CI 0.63, 0.88) and 0.85 (95% CI 0.74, 0.98). The corresponding risk ratios were 0.56 (95% CI 0.14, 2.30) and 0.49 (95% CI 0.13, 1.80) for those ineligible for the within-sibship models. When comparable analyses were employed, the association between interval and preterm delivery was similar between participants included in the within-sibship analysis and those ineligible for the within-sibship analysis, but differed from those in the full cohort, perhaps due to different target populations.

Short interdelivery interval in modern obstetrics: Maternal and neonatal outcomes.

To investigate the maternal, neonatal outcomes of the patients with short interdelivery interval (IDI) considering initial pregnancy outcomes. Women with two consecutive deliveries between 2016 and 2020 were included in the study. The maternal and neonatal outcomes of both pregnancies were reviewed. The time interval between consecutive deliveries was calculated. The patients were divided into two groups in terms of IDI either less or more than 24 months. The number of patients with short IDI (≤24 months), and normal IDI was 1.915 and 1.370, respectively. About 15% of the women in both groups had at least one obstetric morbidity. The rates of uterine rupture, placenta previa, and peripartum hysterectomy were higher in women with short IDI. The number of patients with low birth weight, very low birth weight, and stillbirth was higher in the short IDI group. Patients with short interpregnancy intervals should be considered high-risk pregnancy. Adequate contraceptive methods should be used to prevent unintended pregnancies.

Independent and cumulative effects of risk factors associated with stillbirths in 50 low- and middle-income countries: Amulti-country cross-sectional study.

Early identification of high-risk pregnancies could reduce stillbirths, yet remains a challenge in low- and middle-income countries (LMICs). This study aims to estimate the associations between easily observable risk factors and stillbirths, and construct a risk score which could be adopted in LMICs to identify pregnancies with high risk of stillbirths. Using the most recent Demographic and Health Surveys from 50 low- and middle-income countries (LMICs) with available data between January 1, 2010 and December 31, 2021, we analysed a total of 22 factors associated with stillbirths in a series of single-adjusted and mutually adjusted logistic regression models. Upon identification of the risk factors with the strongest associations, we constructed a risk score on the basis of the magnitude of the β coefficient to examine the cumulative effects of risk factors on stillbirths. To assess whether the associations between risk scores and stillbirths were moderated by protective factors, we added an interaction term between the identified protective factor and risk scores to the regression model. We also conducted two setsof subgroup analyses for previous history of pregnancy and maternal age at pregnancy and four sets of supplementary analyses to test the robustness of the results. Among the 795,642 women identified for analysis with at least one pregnancy within the five years before the survey, the most recent pregnancy of 8968 (1.13%) ended as stillbirths. Using a mutually adjusted regression model, we found that the top factors showing the strongest associations with stillbirths were short maternal height (odds ratio [OR]: 1.99, 95% confidence interval [CI]: 1.48-2.67, P<0.001), interpregnancy interval less than six months (OR: 1.84, 95% CI: 1.42-2.38, P<0.001), previous stillbirth history (OR: 1.55, 95% CI: 1.07-2.26, P<0.020), low maternal education (OR: 1.50, 95% CI: 1.01-2.24, P=0.045), and lowest household wealth (OR: 1.32, 95% CI: 1.08-1.61, P=0.008). A female household head was a protective factor with an OR of 0.71 (95% CI: 0.55-0.90, P=0.005). Single-adjusted models, subgroup analyses, and sensitivity analyses showed generally consistent results. We also found that the odds of stillbirths increased with a larger risk score with a P trend <0.001. Compared with women without any risk factors, women with a risk score of 5 or more were 4.11 (95% CI: 2.83-5.97, P<0.001) times more likely to have their pregnancies ending up as stillbirths. However, these associations were weakened if the head of household was female. Our study suggested that short maternal height, low socioeconomic status, previous stillbirth history, low maternal education, and very short interpregnancy interval had the strongest associations with stillbirths. The construction of risk scores using easily observable risk factors could be an effective way to identify high-risk pregnancies in resource-poor settings. This research was supported by Sanming Project of Medicine in Shenzhen (NO. SZSM202111001) and China National Natural Science Foundation (NO. 72203119).

Effect of Short Inter-Pregnancy Interval on the Outcome of Vaginal Birth after Cesarean Section

Objective: To determine the effect of short inter-pregnancy interval on the outcome of vaginal birth after cesarean section.&#x0D; Study Design: Comparative cross-sectional study.&#x0D; Place and Duration of Study: Obstetrics and Gynecology Department, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Jan to Oct 2021.&#x0D; Methodology: A total of 400 pregnant females were selected for this study. For every consecutive pregnant woman with a previous cesarean section and short inter-pregnancy interval (&lt;18 months) recruited into the study, a suitable control with inter-pregnancy interval ≥18 months were recruited.&#x0D; Results: Only 107(53.5 %) females with short interpregnancy interval had a successful vaginal birth after cesarean section, whereas 143(71.5 %) females with &gt;18 months’ inter-pregnancy interval had a successful VBAC. In patients with a history of vaginal delivery, the success of vaginal birth after the cesarean section was significantly higher than in those without previous vaginal delivery or VBAC (p=0.005). 231 out of 250(92.4%) pregnant females with spontaneous onset of labour had a successful VBAC compared to those who had induction of labour, 19(7.6%) (p=0.005). Patients who needed augmentation during delivery had a higher rate of undergoing a cesarean section than VBAC (p=0.003). However, no significant difference was observed in the spontaneous onset of labour and the need for induction and augmentation of labour for the inter-pregnancy interval.&#x0D; Conclusion: Our study concluded that with increasing inter-pregnancy interval, the chances of a successful VBAC increase (p=0.001) with fewer reported complications.

Improving Access to and Quality of Postpartum Contraception Provision.

Sexual activity and fertility can resume shortly after childbirth, but there are barriers to contraceptive access in the postpartum period. Unintended pregnancy and short interpregnancy intervals (of less than one year) can increase the risk of obstetric and neonatal complications. The antenatal period presents an opportunity to discuss contraceptive options, many of which can be safely initiated immediately after childbirth. Successful delivery of a postpartum contraception program requires an adequate number of maternity staff trained to provide the full range of methods.

A STUDY ON THE PREVALENCE OF ANAEMIA AMONG PREGNANT WOMEN IN A TERTIARY CARE HOSPITAL IN KASHMIR VALLEY.

Introduction: Anaemia during pregnancy is a major health problem in South Asian countries and developing countries.World Health Organization (WHO) has dened anaemia in pregnancy as the haemoglobin less than 11g/dl. Predisposing factors of anaemia in pregnancy are young age, grandmultiparity, low socioeconomic status, illiteracy, ignorance and short interpregnancy interval. This study was done to know the prevalence and type of anaemia among pregnant women in Kashmir valley and study the factors that lead to the women being anaemic prior to pregnancy and gradually worsening of anaemia with each trimester. Materials And Method: A retrospective observational time based study was conducted from to mid October 2021 to mid January 2022 at Lalla Ded hospital , GMC Srinagar, Kashmir. Relevant patient data,ie. gestational age, parity, interpregnancy interval, same day haemoglobin estimation was collected from opd record register and analysed. The prevalence of anaemia was Results: 82.46%. moderate anaemia was most common (52.13%). The prevalence of anaemia was high among all the trimesters; 71.43% in rst trimester,86.5% in second trimester,80.5% in third trimester. Although the prevalence of anaemia was high in both primigravidae (76.72%) and multigravidae(85.51%), the prevalence of anaemia among primigravidae was less than multigravidae. Mild anaemia was more prevalent in primigravidas (24.66%) than multigravidas (19.56%) whereas moderate and severe anaemia was more in multigravidas. With interpregnancy interval of &lt; 1yr, there was high incidence of moderate anaemia (85.71%). Whereas it was 31.25% when interpregnancy interval was between 1-&lt;2yr. Conclusion: Most women enter pregnancy in an anaemic state, which is worsened as pregnancy progresses. Iron supplementation helps in decreasing the severity of anaemia, however the current measures are inadequate as high percentage of women in the third trimester suffer from anaemia(80.5%).Multiparity and interpregnancy interval &lt; 1 yr was found to be important risk factors for anaemia.

Immediate versus delayed postpartum insertion of contraceptive implant and IUD for contraception.

Immediate versus delayed postpartum insertion of contraceptive implant and IUD for contraception.

Prenatal exposure to nitrate from drinking water and the risk of preterm birth: A Danish nationwide cohort study.

Background:Evidence is emerging that preterm birth (PTB, birth before 37 completed weeks of gestation), a risk factor for neonatal mortality and future morbidity, may be induced by maternal nitrate () exposure from drinking water. The objective of this study is to assess the association between maternal exposure to nitrate and the risk of PTB in a nationwide study of liveborn singletons.Methods:We estimated maternal nitrate exposure from household tap water for 1,055,584 births in Denmark to Danish-born parents during 1991–2015 by linkage of individual home address(es) with nitrate concentrations from a national monitoring database. Nitrate exposure during pregnancy was modeled using four categories and continuously. Logistic models adjusted for sex, birth year, birth order, urbanicity, and maternal age, smoking, education, income, and employment, with generalized estimating equations were used to account for sibling clusters.Results:A total of 1,009,189 births were included, comprising 51,747 PTB. An increase in the risk of PTB was seen across categories of exposure (P < 0.001) with an odds ratio (OR) in the uppermost category (>25 mg/L nitrate) of 1.05 (95% confidence interval [CI] = 1.00, 1.10). Evidence of an exposure–response relationship was observed in models using continuous nitrate (OR = 1.01 [95% CI = 1.00, 1.03] per 10 mg/L nitrate). In sensitivity analyses, results were robust to the addition of variables for short inter-pregnancy interval (<1 year between births), maternal pre-pregnancy body mass index, paternal socioeconomic status and age, season of birth, and inclusion of post-term births. Results were virtually unchanged when the analysis was restricted to women exposed to less than the current European Union standard of 50 mg/L.Conclusion:We observed an increasing risk of PTB with increases in nitrate in household tap water. These findings add to a growing body of evidence of adverse effects from nitrate in drinking water at levels below current regulatory levels.

The synergistic effects of short inter-pregnancy interval and micronutrients deficiency on third-trimester depression.

ObjectiveTo explore the effect of inter-pregnancy interval (IPI) and micronutrients on depression in the third trimester of pregnancy.Materials and methodsA total of 5,951 eligible pregnant women were included in this single-center retrospective cohort study. Variables with potential effects on third-trimester depression were collected. These variables included: maternal factors [age, pregnancy interval, body mass index (BMI), BMI change, gravidity, native place, education, smoking, and alcohol consumption], previous delivery outcomes [preterm birth, preeclampsia, intrahepatic cholestasis of pregnancy (ICP), gestational diabetes mellitus (GDM), fetal growth restriction (FGR), and delivery mode], and micronutrients in early pregnancy (folic acid, 25-hydroxy vitamin D, vitamin B12, calcium, and ferritin). Univariate and multivariate analyses were used to screen the factors affecting the occurrence of depression. Based on these factors, the nomogram model was established. At the same time, the interaction between IPI and micronutrients was verified.ResultsThe incidence of depression in the third trimester of pregnancy was 4.3%. Univariate and multivariate analysis showed that there were five independent risk factors for third-trimester depression: gravidity, previous cesarean section delivery, folic acid, and vitamin D levels in early pregnancy and IPI. According to the multivariate logistic regression analysis, the prediction model and nomogram were established. The prediction cut-offs of the corresponding factors were calculated according to the Youden index. Finally, the synergistic effect of short IPI and micronutrient deficiency was verified.ConclusionThere is a synergistic effect between short IPI and micronutrient deficiency in early pregnancy, which can aggravate the occurrence of depression in late pregnancy.

Risk factor analysis in women who underwent trial of labor after cesarean section: a multicenter study in Germany

Objective:Rising caesarean delivery (CD) rates throughout the world are accompanied with high rates of severe maternal complications. The aim of the present study was to analyze the outcome of trial of labor after caesarean section (TOLAC) in a Western population and identify factors associated with the success of vaginal birth after caesarean section (VBAC).Material and Methods:A retrospective study was performed at two large obstetric departments in Germany from 2008 to 2018. Women with singleton pregnancies, a history of only one previous CD with a low transverse incision, a viable fetus in cephalic presentation, and gestational age >32 weeks were included in the study. The characteristics and outcome of successful VBAC and failed TOLAC were compared. A subgroup analysis addressed gestational age, interpregnancy interval, fetal macrosomia, body mass index, and maternal age.Results:Of 1,546 patients, 62.3% achieved VBAC while 37.7% had a secondary CD. Independent factors associated with the success of TOLAC were a history of vaginal birth in previous pregnancies (p<0.001) and the use of oxytocin (p<0.001), whereas preterm birth between gestational week 32 and 37 signified a higher risk of failed TOLAC (p=0.04). The success of VBAC did not differ significantly for patients older than 40 years of age, those with a shorter interpregnancy interval than 12 months, and fetal macrosomia with birth weight exceeding 4000 grams. Maternal and neonatal outcomes were poorer in women with failed TOLAC.Conclusion:Nearly two thirds of women with a history of CD achieve VBAC in Germany. Previous vaginal birth and the augmentation of labor with oxytocin are positively associated with the achievement of VBAC and no major perinatal complications. The decision to have a TOLAC should be encouraged in the majority of patients. Further studies are needed to evaluate the feasibility of TOLAC in preterm delivery.