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Revista Brasileira de Ginecologia E... 2024To ascertain how screening for preterm birth is performed among obstetricians working in public and private practice in a middle-income country.
OBJECTIVE
To ascertain how screening for preterm birth is performed among obstetricians working in public and private practice in a middle-income country.
METHODS
Cross-sectional study of 265 obstetrician-gynecologists employed at public and private facilities. An online questionnaire was administered, with items designed to collect data on prematurity screening and prevention practices.
RESULTS
The mean age of respondents was 44.5 years; 78.5% were female, and 97.7% had completed a medical residency program. Universal screening (i.e., by ultrasound measurement of cervical length) was carried out by only 11.3% of respondents in public practice; 43% request transvaginal ultrasound if the manual exam is abnormal, and 74.6% request it in pregnant women with risk factors for preterm birth. Conversely, 60.7% of respondents in private practice performed universal screening. This difference in screening practices between public and private practice was highly significant (p < 0.001). Nearly all respondents (90.6%) reported prescribing vaginal progesterone for short cervix.
CONCLUSION
In the setting of this study, universal ultrasound screening to prevent preterm birth was used by just over half of doctors in private practice. In public facilities, screening was even less common. Use of vaginal progesterone in cervical shortening was highly prevalent. There is an unmet need for formal protocols for screening and prevention of preterm birth in middle-income settings.
Topics: Humans; Cross-Sectional Studies; Female; Premature Birth; Adult; Pregnancy; Practice Patterns, Physicians'; Male; Obstetrics; Private Practice; Middle Aged; Surveys and Questionnaires
PubMed: 38765518
DOI: 10.61622/rbgo/2024rbgo32 -
European Journal of Obstetrics,... Jul 2024In singleton-pregnant women, abnormal maternal apolipoprotein levels have been confirmed as a risk factor for preterm birth. However, there are currently no studies on...
OBJECTIVE
In singleton-pregnant women, abnormal maternal apolipoprotein levels have been confirmed as a risk factor for preterm birth. However, there are currently no studies on the relationship of the related research in twin-pregnant women.
METHODS
This single-center retrospective study included 743 dichorionic twin-pregnant women who delivered between January 2019 and December 2020. Twins delivered before 37 weeks gestation were categorized as the preterm group, while those delivered at or after 37 weeks gestation were classified as the term group. Maternal serum apolipoprotein A1 (ApoA1) levels, apolipoprotein B (ApoB) levels, and the ApoB/ApoA1 ratio were measured in the first trimester(6-14 weeks), the second trimester(18-28 weeks) and the third trimester(after 28 weeks). We conducted SPSS analysis to evaluate the correlation between ApoA1 levels, ApoB levels, the ApoB/ApoA1 ratio and preterm birth.
RESULTS
Among the 743 included dichorionic twin-pregnant women, 53.57 % (398/743) delivered preterm. Compared with the term group, the ApoA1 levels in the third trimester were lower (p < 0.001), while the Apo B/ApoA1 ratio was higher in the second (p = 0.01) and third trimesters in the preterm group (p = 0.001). When preterm birth was categorized as iatrogenic and spontaneous preterm birth, the results were similar. In the analysis stratified by prepregnancy BMI, a higher risk of preterm birth was associated with low ApoA1 levels and a high Apo B/ApoA1 ratio in the second and third trimesters only among the subgroup of overweight/obese dichorionic twin-pregnant women.
CONCLUSIONS
Low ApoA1 levels and a high Apo B/ApoA1 ratio during the second and third trimesters were associated with a high incidence of preterm birth for overweight/obese dichorionic twin-pregnant women.
Topics: Humans; Female; Pregnancy; Retrospective Studies; Pregnancy, Twin; Premature Birth; Adult; Risk Factors; Apolipoprotein A-I; Apolipoproteins B
PubMed: 38761531
DOI: 10.1016/j.ejogrb.2024.05.013 -
Journal of Urban Health : Bulletin of... Jun 2024Police-related violence may be a source of chronic stress underlying entrenched racial inequities in reproductive health in the USA. Using publicly available data on...
Investigating the Black Birth Experience: A Race-Stratified Analysis of Preterm Birth Risk and Exposure to Metropolitan Statistical Area-Level Police-Related Deaths, US 2018-2019.
Police-related violence may be a source of chronic stress underlying entrenched racial inequities in reproductive health in the USA. Using publicly available data on police-related fatalities, we estimated total and victim race-specific rates of police-related fatalities (deaths per 100,000 population) in 2018-2019 for Metropolitan Statistical Areas (MSA) and counties within MSAs in the USA. Rates were linked to data on live births by maternal MSA and county of residence. We fit adjusted log-Poisson models with generalized estimating equations and cluster-robust standard errors to estimate the relative risk of preterm birth associated with the middle and highest tertiles of police-related fatalities compared to the lowest tertile. We included a test for heterogeneity by maternal race/ethnicity and additionally fit race/ethnicity-stratified models for associations with victim race/ethnicity-specific police-related fatality rates. Fully adjusted models indicated significant adverse associations between police-related fatality rates and relative risk of preterm birth for the total population, non-Hispanic Black, and non-Hispanic White groups separately. Results confirm the role of fatal police violence as a social determinant of population health outcomes and inequities, including preterm birth.
Topics: Humans; Police; Premature Birth; Female; United States; Black or African American; Pregnancy; Adult; White People; Violence; Infant, Newborn; Risk Factors
PubMed: 38753137
DOI: 10.1007/s11524-024-00871-x -
Environmental Health Perspectives May 2024There is a lack of research on the relationship between water fluoridation and pregnancy outcomes.
BACKGROUND
There is a lack of research on the relationship between water fluoridation and pregnancy outcomes.
OBJECTIVES
We assessed whether hypothetical interventions to reduce fluoride levels would improve birth outcomes in California.
METHODS
We linked California birth records from 2000 to 2018 to annual average fluoride levels by community water system. Fluoride levels were collected from consumer confidence reports using publicly available data and public record requests. We estimated the effects of a hypothetical intervention reducing water fluoride levels to (the current level recommended by the US Department of Health and Human Services) and (below the current recommendation) on birth weight, birth-weight-for-gestational age -scores, gestational age, preterm birth, small-for-gestational age, large-for-gestational age, and macrosomia using linear regression with natural cubic splines and G-computation. Inference was calculated using a clustered bootstrap with Wald-type confidence intervals. We evaluated race/ethnicity, health insurance type, fetal sex, and arsenic levels as potential effect modifiers.
RESULTS
Fluoride levels ranged from 0 to , with a median of . There was a small negative association on birth weight with the hypothetical intervention to reduce fluoride levels to [; 95% confidence interval (CI): , 0.0] and to (; 95% CI: , ). There were small negative associations with birth-weight-for-gestational-age -scores for both hypothetical interventions (: ; 95% CI: , 0.000 and : ; 95% CI: , 0.000). We also observed small negative associations for risk of large-for-gestational age for both the hypothetical interventions to [; 95% CI: , 0.000 and (; 95% CI: , 0.000)]. We did not observe any associations with preterm birth or with being small for gestational age for either hypothetical intervention. We did not observe any associations with risk of preterm birth or small-for-gestational age for either hypothetical intervention.
CONCLUSION
We estimated that a reduction in water fluoride levels would modestly decrease birth weight and birth-weight-for-gestational-age -scores in California. https://doi.org/10.1289/EHP13732.
Topics: California; Humans; Fluoridation; Female; Pregnancy; Pregnancy Outcome; Infant, Newborn; Fluorides; Birth Weight; Premature Birth; Adult; Gestational Age; Infant, Small for Gestational Age
PubMed: 38752991
DOI: 10.1289/EHP13732 -
MSystems Jun 2024The vaginal microbiome has been linked to negative health outcomes including preterm birth. Specific taxa, including spp., have been identified as risk factors for...
The vaginal microbiome has been linked to negative health outcomes including preterm birth. Specific taxa, including spp., have been identified as risk factors for these conditions. Historically, microbiome analysis methods have treated all spp. as one species, but the broad diversity of has become more apparent. We explore the diversity of clades and genomic species in the vaginal microbiome of pregnant women and their associations with microbiome composition and preterm birth. Relative abundance of clades and genomic species and other taxa was quantified in shotgun metagenomic sequencing data from three distinct cohorts of pregnant women. We also assessed the diversity and abundance of variants in 16S rRNA gene amplicon sequencing data from seven previously conducted studies in differing populations. Individual microbiomes often contained multiple variants, and the number of clades was associated with increased microbial load, or the ratio of non-human reads to human reads. Taxon co-occurrence patterns were largely consistent across clades and among cohorts. Some variants previously described as rare were prevalent in other cohorts, highlighting the importance of surveying a diverse set of populations to fully capture the diversity of . The diversity of both across populations and within individual vaginal microbiomes has long been unappreciated, as has been the intra-species diversity of many other members of the vaginal microbiome. The broad genomic diversity of has led to its reclassification as multiple species; here we demonstrate the diversity of found within and between vaginal microbiomes.IMPORTANCEThe present study shows that single microbiomes can contain all currently known species of and that multiple similar species can exist within the same environment. Furthermore, surveys of demographically distinct populations suggest that some species appear more commonly in certain populations. Further studies in broad and diverse populations will be necessary to fully understand the ecological roles of each sp., how they can co-exist, and their distinct impacts on microbial communities, preterm birth, and other health outcomes.
Topics: Humans; Female; Pregnancy; Premature Birth; Vagina; Microbiota; Gardnerella; RNA, Ribosomal, 16S; Adult; Genetic Variation
PubMed: 38752784
DOI: 10.1128/msystems.01339-23 -
Frontiers in Public Health 2024Preterm birth persists as a leading cause of infant mortality and morbidity despite decades of intervention effort. Intervention null effects may reflect failure to...
Preterm birth persists as a leading cause of infant mortality and morbidity despite decades of intervention effort. Intervention null effects may reflect failure to account for social determinants of health (SDH) or jointly acting risk factors. In some communities, persistent preterm birth trends and disparities have been consistently associated with SDH such as race/ethnicity, zip code, and housing conditions. Health authorities recommend conceptual frameworks for targeted action on SDH and precision public health approaches for preterm birth prevention. We document San Francisco, California's experience identifying the need, rationale, methods, and pilot work for developing a conceptual framework for preterm birth review (PTBR) in San Francisco. The PTBR conceptual framework is intended to enable essential public health services in San Francisco that prevent a range of preterm birth phenotypes by guiding plans for data collection, hypothesis testing, analytical methods, reports, and intervention strategy. Key elements of the PTBR conceptual framework are described including, 10 domains of SDH, 9 domains at the whole person level, such as lived experience and health behaviors, 8 domains at the within-person level, such as biomarkers and clinical measures, 18 preterm birth phenotypes, and the interconnections between domains. Assumptions for the PTBR conceptual framework were supported by a scoping review of literature on SDH effects on preterm birth, health authority consensus reports, and PTBR pilot data. Researcher and health authority interest in each of the domains warrants the framework to prompt systematic consideration of variables in each proposed domain. PTBR pilot data, illustrated in heatmaps, confirm the feasibility of data collection based on the framework, prevalence of co-occurring risk factors, potential for joint effects on specific preterm birth phenotypes, and opportunity for intervention to block SDH effects on preterm birth. The proposed PTBR conceptual framework has practical implications for specifying (1) population groups at risk, (2) grids or heatmap visualization of risk factors, (3) multi-level analyses, and (4) multi-component intervention design in terms of patterns of co-occurring risk factors. Lessons learned about PTBR data collection logistics, variable choice, and data management will be incorporated into future work to build PTBR infrastructure based on the PTBR conceptual framework.
Topics: Humans; San Francisco; Premature Birth; Social Determinants of Health; Female; Pregnancy; Risk Factors; Infant, Newborn; Pilot Projects
PubMed: 38751590
DOI: 10.3389/fpubh.2024.1332972 -
BMC Pregnancy and Childbirth May 2024Given the increasing incidence of negative outcomes during pregnancy, our research team conducted a dose-response systematic review and meta-analysis to investigate the... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Given the increasing incidence of negative outcomes during pregnancy, our research team conducted a dose-response systematic review and meta-analysis to investigate the relationship between ultra-processed foods (UPFs) consumption and common adverse pregnancy outcomes including gestational diabetes mellitus (GDM), preeclampsia (PE), preterm birth (PTB), low birth weight (LBW), and small for gestational age (SGA) infants. UPFs are described as formulations of food substances often modified by chemical processes and then assembled into ready-to-consume hyper-palatable food and drink products using flavors, colors, emulsifiers, and other cosmetic additives. Examples include savory snacks, reconstituted meat products, frozen meals that have already been made, and soft drinks.
METHODS
A comprehensive search was performed using the Scopus, PubMed, and Web of Science databases up to December 2023. We pooled relative risk (RR) and 95% confidence intervals (CI) using a random-effects model.
RESULTS
Our analysis (encompassing 54 studies with 552,686 individuals) revealed a significant association between UPFs intake and increased risks of GDM (RR = 1.19; 95% CI: 1.10, 1.27; I = 77.5%; p < 0.001; studies = 44; number of participants = 180,824), PE (RR = 1.28; 95% CI: 1.03, 1.59; I = 80.0%; p = 0.025; studies = 12; number of participants = 54,955), while no significant relationships were found for PTB, LBW and SGA infants. Importantly, a 100 g increment in UPFs intake was related to a 27% increase in GDM risk (RR = 1.27; 95% CI: 1.07, 1.51; I = 81.0%; p = 0.007; studies = 9; number of participants = 39,812). The non-linear dose-response analysis further indicated a positive, non-linear relationship between UPFs intake and GDM risk P = 0.034, P = 0.034), although no such relationship was observed for PE (P = 0.696, P = 0.812).
CONCLUSION
In summary, both prior to and during pregnancy, chronic and excessive intake of UPFs is associated with an increased risk of GDM and PE. However, further observational studies, particularly among diverse ethnic groups with precise UPFs consumption measurement tools, are imperative for a more comprehensive understanding.
Topics: Humans; Pregnancy; Female; Pregnancy Outcome; Diabetes, Gestational; Infant, Newborn; Fast Foods; Infant, Small for Gestational Age; Premature Birth; Pre-Eclampsia; Infant, Low Birth Weight; Pregnancy Complications; Food Handling; Food, Processed
PubMed: 38750456
DOI: 10.1186/s12884-024-06489-w -
BMC Pregnancy and Childbirth May 2024Preterm birth (PTB) contributes to nearly 11% of all deliveries in the world. The majority of spontaneous preterm birth (sPTB) remains unexplained. Risk factors include...
BACKGROUND
Preterm birth (PTB) contributes to nearly 11% of all deliveries in the world. The majority of spontaneous preterm birth (sPTB) remains unexplained. Risk factors include abnormal body mass index (BMI), short cervical length, comorbidities and many more. However, there is limited study on the association between body mass index, cervical length and preterm birth in Malaysia among low-risk women. Hence, we aim to examine the relationship between body mass index, cervical length and the risk of spontaneous preterm birth.
METHOD
In this prospective cohort study, pregnant women between 16 and 24 weeks who fulfilled the criteria were recruited. Women with history of preterm birth were excluded. Demographic and clinical data (age, BMI, ethnicity, education level and parity) were obtained. Cervical length was measured using transvaginal scan. Patients were then followed up till delivery to determine their delivery gestation and outcome of delivery.
RESULTS
Out of 153 women who participated in this study, 146 women had cervical length of more than 30 mm, six had cervical length between 25 mm and 30 mm and one had cervical length of 24 mm. There were nine (9) cases of sPTB, with all of them being late preterm with normal midtrimester cervical length. Almost half of them (44%) were overweight/obese. A significant association was found between age, cervical length, and parity compared to BMI. Nevertheless, no significant association was seen between the BMI and risk of sPTB.
CONCLUSION
This study demonstrates a higher BMI is associated with longer cervical length, but it is not necessarily protective against sPTB. Hence, we concluded there is a limited role in cervical length screening among low-risk women regardless of their BMI in predicting sPTB.
Topics: Humans; Female; Body Mass Index; Pregnancy; Premature Birth; Cervical Length Measurement; Adult; Prospective Studies; Cervix Uteri; Risk Factors; Malaysia; Young Adult; Obesity
PubMed: 38750414
DOI: 10.1186/s12884-024-06552-6 -
JMIR Research Protocols May 2024Premature birth poses significant health challenges globally, impacting infants, families, and society. Despite recognition of its contributing factors, efforts to... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Premature birth poses significant health challenges globally, impacting infants, families, and society. Despite recognition of its contributing factors, efforts to reduce its incidence have seen limited success. A notable gap exists in the awareness among women of childbearing age (WCA) regarding both the risks of premature birth and the preventative measures they can take. Research suggests that enhancing health beliefs and self-management efficacy in WCA could foster preventive health behaviors. Interactive webtoons offer an innovative, cost-effective avenue for delivering engaging, accessible health education aimed at preventing premature birth.
OBJECTIVE
This protocol describes a randomized controlled trial to assess the effectiveness and feasibility of a novel, self-guided, web-based intervention-Pregnancy Story I Didn't Know in Interactive Webtoon Series (PSIDK-iWebtoons)-designed to enhance self-management efficacy and promote behaviors preventing premature birth in WCA.
METHODS
Using an explanatory sequential mixed methods design, this study first conducts a quantitative analysis followed by a qualitative inquiry to evaluate outcomes and feasibility. Participants are randomly assigned to 2 groups: one accessing the PSIDK-iWebtoons and the other receiving Pregnancy Story I Didn't Know in Text-Based Information (PSIDK-Texts) over 3 weeks. We measure primary efficacy through the self-management self-efficacy scale for premature birth prevention (PBP), alongside secondary outcomes including perceptions of susceptibility, severity, benefits, and barriers based on the health belief model for PBP and PBP intention. Additional participant-reported outcomes are assessed at baseline, the postintervention time point, and the 4-week follow-up. The feasibility of the intervention is assessed after the end of the 3-week intervention period. Outcome analysis uses repeated measures ANOVA for quantitative data, while qualitative data are explored through content analysis of interviews with 30 participants.
RESULTS
The study received funding in June 2021 and institutional review board approval in October 2023. Both the PSIDK-iWebtoons and PSIDK-Texts interventions have been developed and pilot-tested from July to November 2023, with the main phase of quantitative data collection running from November 2023 to March 2024. Qualitative data collection commenced in February 2024 and will conclude in May 2024. Ongoing analyses include process evaluation and data interpretation.
CONCLUSIONS
This trial will lay foundational insights into the nexus of interactive web-based interventions and the improvement of knowledge and practices related to PBP among WCA. By demonstrating the efficacy and feasibility of a web-based, interactive educational tool, this study will contribute essential evidence to the discourse on accessible and scientifically robust digital platforms. Positive findings will underscore the importance of such interventions in fostering preventive health behaviors, thereby supporting community-wide efforts to mitigate the risk of premature births through informed self-management practices.
TRIAL REGISTRATION
Korea Disease Control and Prevention Agency (KDCA) KCT0008931; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=25857.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)
DERR1-10.2196/58326.
Topics: Humans; Premature Birth; Female; Pregnancy; Adult; Internet-Based Intervention; Young Adult; Randomized Controlled Trials as Topic
PubMed: 38748471
DOI: 10.2196/58326 -
Journal of Osteopathic Medicine May 2024The obesity epidemic in the United States is continuing to worsen. Obesity is a known risk factor for pregnancy morbidity. However, many studies use the patient's body...
CONTEXT
The obesity epidemic in the United States is continuing to worsen. Obesity is a known risk factor for pregnancy morbidity. However, many studies use the patient's body mass index (BMI) at the time of delivery, do not stratify by class of obesity, or utilize billing codes as the basis of their study, which are noted to be inaccurate.
OBJECTIVES
This study aims to investigate the prepregnancy BMI class specific risks for pregnancy and neonatal complications based on a prepregnancy BMI class.
METHODS
We conducted a retrospective cohort study of 40,256 pregnant women with 55,202 singleton births between October 16, 2007 and December 3, 2023. We assessed the risk of pregnancy and neonatal morbidity based on the maternal prepregnancy BMI category. The primary outcome was composite maternal morbidity, including hypertensive disorders of pregnancy (i.e., gestational hypertension [GHTN] and preeclampsia), and gestational diabetes mellitus (GDM), adjusted for pregestational diabetes mellitus and chronic hypertension (cHTN). Secondary maternal outcomes included preterm premature rupture of membranes (PPROM), preterm delivery (PTD<37 and <32 weeks), induction of labor (IOL), cesarean delivery (CD), and postpartum hemorrhage (PPH). Neonatal outcomes included a composite adverse outcome (including stillbirth, intraventricular hemorrhage (IVH), hypoglycemia, respiratory distress syndrome [RDS], APGAR [Appearance, Pulse, Grimace, Activity, and Respiration] <7 at 5 min, and neonatal intensive care unit [NICU] admission), birthweight, fetal growth restriction (FGR), and macrosomia.
RESULTS
Composite maternal morbidity (odds ratio [OR] 4.40, confidence interval [CI] 3.70-5.22 for class III obesity [BMI≥40.0 kg/m] compared with normal BMI), hypertensive disorders of pregnancy (HDP), GDM, PTD, IOL, CD, PPH, neonatal composite morbidity, hypoglycemia, RDS, APGAR<7 at 5 min, NICU admission, and macrosomia showed a significant increasing test of trend among BMI classes. Increased BMI was protective for FGR.
CONCLUSIONS
Our data provides BMI-class specific odds ratios (ORs) for adverse pregnancy outcomes. Increased BMI class significantly increases the risk of HDP, GDM, IOL, CD, composite adverse neonatal outcomes, and macrosomia, and decreases the risk of FGR. Attaining a healthier BMI category prior to conception may lower pregnancy morbidity.
PubMed: 38747407
DOI: 10.1515/jom-2024-0025