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Journal of Pregnancy 2012
Topics: Female; Humans; Pregnancy; Premature Birth
PubMed: 22550589
DOI: 10.1155/2012/610364 -
BJOG : An International Journal of... Jan 2023To describe the rates of and risk factors associated with iatrogenic and spontaneous preterm birth and the variation in rates between hospitals.
OBJECTIVE
To describe the rates of and risk factors associated with iatrogenic and spontaneous preterm birth and the variation in rates between hospitals.
DESIGN
Cohort study using electronic health records.
SETTING
English National Health Service.
POPULATION
Singleton births between 1 April 2015 and 31 March 2017.
METHODS
Multivariable Poisson regression models were used to estimate adjusted risk ratios (adjRR) to measure association with maternal demographic and clinical risk factors.
MAIN OUTCOME MEASURES
Preterm births (<37 weeks of gestation) were defined as iatrogenic or spontaneous according to mode of onset of labour.
RESULTS
Of the births, 6.1% were preterm and of these, 52.8% were iatrogenic. The proportion of preterm births that were iatrogenic increased after 32 weeks. Both sub-groups were associated with previous preterm birth, extremes of maternal age, socio-economic deprivation and smoking. Iatrogenic preterm birth was associated with higher body mass index (BMI) (BMI >40 kg/m adjRR 1.59, 95% CI 1.50-1.69) and previous caesarean (adjRR 1.88, 95% CI 1.83-1.95). Spontaneous preterm birth was less common in women with a higher BMI (BMI >40 kg/m adjRR 0.77, 95% CI 0.70-0.84) and in women with a previous caesarean (adjRR 0.87, 95% CI 0.83-0.90). More variation between NHS hospital trusts was observed in rates of iatrogenic, compared with spontaneous, preterm births.
CONCLUSIONS
Just over half of all preterm births resulted from iatrogenic intervention. Iatrogenic births have overlapping but different patterns of maternal demographic and clinical risk factors to spontaneous preterm births. Iatrogenic and spontaneous sub-groups should therefore be measured and monitored separately, as well as in aggregate, to facilitate different prevention strategies. This is feasible using routinely acquired hospital data.
Topics: Pregnancy; Infant, Newborn; Female; Humans; Premature Birth; Gestational Age; Cohort Studies; State Medicine; Risk Factors; Iatrogenic Disease
PubMed: 36073305
DOI: 10.1111/1471-0528.17291 -
American Journal of Obstetrics and... Nov 2012Spontaneous preterm birth is a heterogeneous phenotype. A multitude of pathophysiologic pathways culminate in the final common denominator of cervical softening,... (Review)
Review
Spontaneous preterm birth is a heterogeneous phenotype. A multitude of pathophysiologic pathways culminate in the final common denominator of cervical softening, shortening, and dilation that leads to preterm birth. A precise description of specific microstructural changes to the cervix is imperative if we are to identify the causative upstream molecular processes and resultant biomechanical events that are associated with each unique pathway. Currently, however, we have no reliable clinical tools for quantitative and objective evaluation, which likely contributes to the reason the singleton spontaneous preterm birth rate has not changed appreciably in >100 years. Fortunately, promising techniques to evaluate tissue hydration, collagen structure, and/or tissue elasticity are emerging. These will add to the body of knowledge about the cervix and facilitate the coordination of molecular studies and ultimately lead to novel approaches to preterm birth prediction and, finally, prevention.
Topics: Animals; Cervical Length Measurement; Cervix Uteri; Elasticity Imaging Techniques; Electric Impedance; Female; Humans; Mice; Pregnancy; Premature Birth; Rats
PubMed: 22717270
DOI: 10.1016/j.ajog.2012.05.015 -
The Cochrane Database of Systematic... Oct 2015Identification of pregnancies that are higher risk than average is important to allow the possibility of interventions aimed at preventing adverse outcomes like preterm... (Review)
Review
BACKGROUND
Identification of pregnancies that are higher risk than average is important to allow the possibility of interventions aimed at preventing adverse outcomes like preterm birth. Many scoring systems designed to classify the risk of a number of poor pregnancy outcomes (e.g. perinatal mortality, low birthweight, and preterm birth) have been developed, but they have usually been introduced without evaluation of their utility and validity.
OBJECTIVES
To determine whether the use of a risk-screening tool designed to predict preterm birth (in combination with appropriate consequent interventions) reduces the incidence of preterm birth and very preterm birth, and associated adverse outcomes.
SEARCH METHODS
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 June 2015).
SELECTION CRITERIA
All randomised or quasi-randomised (including cluster-randomised) or controlled clinical trials that compared the incidence of preterm birth between groups that used a risk-scoring instrument to predict preterm birth with those who used an alternative instrument, or no instrument; or that compared the use of the same instrument at different gestations. The reports may have been published in peer reviewed or non-peer reviewed publications, or not published, and written in any language.
DATA COLLECTION AND ANALYSIS
All review authors planned to independently assess for inclusion all the potential studies we identified as a result of the search strategy. However, we did not identify any eligible studies.
MAIN RESULTS
Searching revealed no trials of the use of risk-scoring systems for preventing preterm birth.
AUTHORS' CONCLUSIONS
The role of risk-scoring systems in the prevention of preterm birth is unknown.There is a need for prospective studies that evaluate the use of a risk-screening tool designed to predict preterm birth (in combination with appropriate consequent interventions) to prevent preterm birth, including qualitative and/or quantitative evaluation of their impact on women's well-being. If these prove promising, they should be followed by an adequately powered, well-designed randomised controlled trial.
Topics: Female; Humans; Pregnancy; Pregnancy, High-Risk; Premature Birth; Risk Assessment
PubMed: 26490698
DOI: 10.1002/14651858.CD004902.pub5 -
International Journal of Epidemiology Jun 2022Research documents social and economic antecedents of adverse birth outcomes, which may include involuntary job loss. Previous work on job loss and adverse birth...
BACKGROUND
Research documents social and economic antecedents of adverse birth outcomes, which may include involuntary job loss. Previous work on job loss and adverse birth outcomes, however, lacks high-quality individual data on, and variation in, plausibly exogenous job loss during pregnancy and therefore cannot rule out strong confounding.
METHODS
We analysed unique linked registries in Denmark, from 1980 to 2017, to examine whether a father's involuntary job loss during his spouse's pregnancy increases the risk of a low-weight (i.e. <2500 grams) and/or preterm (i.e. <37 weeks of gestational age) birth. We applied a matched-sibling design to 743 574 sibling pairs.
RESULTS
Results indicate an increased risk of a low-weight birth among infants exposed in utero to fathers' unexpected job loss [odds ratio (OR) = 1.37, 95% confidence interval (CI): 1.07, 1.75]. Sex-specific analyses show that this result holds for males (OR = 1.70, 95% CI: 1.14, 2.53) but not females (OR = 1.24, 95% CI: 0.80, 1.91). We find no relation with preterm birth.
CONCLUSIONS
Findings support the inference that a father's unexpected job loss adversely affects the course of pregnancy, especially among males exposed in utero.
Topics: Female; Gestational Age; Humans; Infant; Infant, Low Birth Weight; Infant, Newborn; Male; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Premature Birth; Siblings
PubMed: 34508593
DOI: 10.1093/ije/dyab180 -
International Journal of Molecular... Jul 2021Preterm birth (PTB) refers to the birth of infants before 37 weeks of gestation and is a challenging issue worldwide. Evidence reveals that PTB is a multifactorial... (Review)
Review
Preterm birth (PTB) refers to the birth of infants before 37 weeks of gestation and is a challenging issue worldwide. Evidence reveals that PTB is a multifactorial dysregulation mediated by a complex molecular mechanism. Thus, a better understanding of the complex molecular mechanisms underlying PTB is a prerequisite to explore effective therapeutic approaches. During early pregnancy, various physiological and metabolic changes occur as a result of endocrine and immune metabolism. The microbiota controls the physiological and metabolic mechanism of the host homeostasis, and dysbiosis of maternal microbial homeostasis dysregulates the mechanistic of fetal developmental processes and directly affects the birth outcome. Accumulating evidence indicates that metabolic dysregulation in the maternal or fetal membranes stimulates the inflammatory cytokines, which may positively progress the PTB. Although labour is regarded as an inflammatory process, it is still unclear how microbial dysbiosis could regulate the molecular mechanism of PTB. In this review based on recent research, we focused on both the pathological and therapeutic contribution of microbiota-generated metabolites to PTB and the possible molecular mechanisms.
Topics: Adolescent; Adult; Dysbiosis; Extraembryonic Membranes; Female; Gestational Age; Humans; Infant, Newborn; Microbiota; Pregnancy; Premature Birth; Risk Factors; Young Adult
PubMed: 34360908
DOI: 10.3390/ijms22158145 -
Developmental Medicine and Child... Mar 2018This study examined whether late-preterm birth (34+0 to 36+6wks+d gestational age) was associated with neurocognitive deficit in young adulthood, and whether small for...
AIM
This study examined whether late-preterm birth (34+0 to 36+6wks+d gestational age) was associated with neurocognitive deficit in young adulthood, and whether small for gestational age (SGA) birth amplified any adversity.
METHOD
Participants derived from the prospective regional cohort study, the Arvo Ylppö Longitudinal Study (n=786; 398 females, 388 males) (mean age 25y 4mo, SD 8mo), born 1985 to 1986 late-preterm (n=119; 21 SGA, <-2 SD) and at term (37+0 to 41+6wks+d; n=667; 28 SGA) underwent tests of intelligence, executive functioning, attention, and memory, and reported their education.
RESULTS
Those born late-preterm scored -3.71 (95% confidence interval [CI] -6.71 to -0.72) and -3.11 (95% CI -6.01 to -0.22) points lower on Full-scale and Verbal IQ than peers born at term. Compared with those born at term and appropriate for gestational age (≥-2 to <2 SD) Full-scale, Verbal, and Performance IQ scores of those born late-preterm and SGA were -9.45 to -11.84 points lower. After adjustments, differences were rendered non-significant, except that scores in Full-scale and Performance IQ remained lower among those born late-preterm and SGA.
INTERPRETATION
Late-preterm birth, per se, may not increase the risk of poorer neurocognitive functioning in adulthood. But the double burden of being born late-preterm and SGA seems to increase this risk.
WHAT THIS PAPER ADDS
Late-preterm birth did not increase the risk of poorer neurocognitive functioning in adulthood. But the double burden of being born late-preterm and being small for gestational age did increase this risk.
Topics: Adult; Cognition Disorders; Cohort Studies; Female; Gestational Age; Humans; Infant, Small for Gestational Age; Intelligence; Intelligence Tests; Longitudinal Studies; Male; Neuropsychological Tests; Premature Birth; Young Adult
PubMed: 29178266
DOI: 10.1111/dmcn.13616 -
International Journal of Molecular... Aug 2021Antimicrobial peptides (AMPs) are short cationic amphipathic peptides with a wide range of antimicrobial properties and play an important role in the maintenance of... (Review)
Review
Antimicrobial peptides (AMPs) are short cationic amphipathic peptides with a wide range of antimicrobial properties and play an important role in the maintenance of immune homeostasis by modulating immune responses in the reproductive tract. As intra-amniotic infection and microbial dysbiosis emerge as common causes of preterm births (PTBs), a better understanding of the AMPs involved in the development of PTB is essential. The altered expression of AMPs has been reported in PTB-related clinical presentations, such as preterm labor, intra-amniotic infection/inflammation, premature rupture of membranes, and cervical insufficiency. Moreover, it was previously reported that dysregulation of AMPs may affect the pregnancy prognosis. This review aims to describe the expression of AMPs associated with PTBs and to provide new perspectives on the role of AMPs in PTB.
Topics: Female; Humans; Infant, Newborn; Pore Forming Cytotoxic Proteins; Pregnancy; Premature Birth
PubMed: 34445608
DOI: 10.3390/ijms22168905 -
Medicina Oral, Patologia Oral Y Cirugia... Sep 2008The aim of this paper is to descibe the pathogenic mechanisms that could explain the relationship between periodontitis and adverse pregnancy outcomes, and to review the... (Review)
Review
The aim of this paper is to descibe the pathogenic mechanisms that could explain the relationship between periodontitis and adverse pregnancy outcomes, and to review the evidence from systematic reviews and interventional studies, regarding the association between the clinical indicators of periodontitis and the incidence of low birth weight or preterm births. Preterm birth and low birth weight are world wide leading perinatal problems and have evident public health implications, due to the fact that their incidence doesn't decrease in spite of the many attempts at their prevention. Both intrauterus infections and bacterial vaginosis of the mother are well known risk factors, but distant infections, even subclinicals, may also produce preterm births. Periodontitis is a chronic infection by anaerobic gram-negative organisms and may produce local and systemic infection, so a possible association between periodontitis and adverse pregnancy outcomes has been suggested. Since 1996, a number of studies have investigated the potential relationship between periodontitis and preterm and low birth weight. However, results have been controversial and more research is needed in order to confirm or discard this association.
Topics: Female; Humans; Infant, Low Birth Weight; Infant, Newborn; Periodontitis; Pregnancy; Pregnancy Complications; Premature Birth
PubMed: 18758408
DOI: No ID Found -
Archives of Gynecology and Obstetrics Apr 2023To investigate the perinatal outcomes of singleton pregnant women with Müllerian anomalies (MuAs).
PURPOSE
To investigate the perinatal outcomes of singleton pregnant women with Müllerian anomalies (MuAs).
METHODS
A retrospective cohort study was conducted on singleton pregnant women with MuAs who delivered at the West China Second University Hospital between January 1, 2009 and December 31, 2020.
RESULTS
Four hundred fifty-seven cases of MuAs were identified, with an incidence of 0.40%. The most common anomaly was a septate uterus (38.7%). Compared to the control group, the MuAs group had significantly higher incidences of perinatal complications, including preterm deliveries (PTDs) (27.4 vs. 9.8%, P < 0.001), preterm premature rupture of membranes (PPROM) (29.1 vs. 22.5%, P = 0.001), malpresentation (34.4 vs. 5.6%, P < 0.001), abruptio placentae (4.6 vs. 1.2%, P < 0.001), placental accreta/increta (19.7 vs. 11.8%, P < 0.001), and uterine rupture (2.8 vs. 1.6%, P = 0.035). The rates of in vitro fertilization and embryo transfer (IVF-ET), foetal growth restriction (FGR), and low birth weight were also significantly higher in the MuAs group (8.3 vs. 4.5%, P < 0.001; 2.6 vs. 0.9%, P = 0.001; 3.1 vs. 1.7%, P = 0.033, respectively). In the MuAs group, the incidence of PPROM was high in cases with unicornuate uterus (31.5%), and malpresentation was as high as 42.4 and 37.0% in cases with septate and didelphys uteri, respectively.
CONCLUSION
The data suggest that pregnancy with MuAs may increase adverse perinatal outcomes, which calls for intensive supervision during pregnancy and delivery to reduce maternal and foetal complications. Individualized considerations should be emphasized according to the different categories of MuAs in pregnancies.
Topics: Infant, Newborn; Pregnancy; Female; Humans; Pregnancy Outcome; Retrospective Studies; Premature Birth; Placenta
PubMed: 35426514
DOI: 10.1007/s00404-022-06557-6