Association of maternal serum homocysteine concentration levels in late stage of pregnancy with preterm births: a nested case–control study

Purpose: To investigate the relationship between maternal serum homocysteine (Hcy) levels in the late stage of pregnancy and preterm birth. Other relevant biochemical parameters were measured to establish the normal reference interval of serum Hcy in both women in the late stage of pregnancy and neonates.

Materials and methods: The nested case–control study included 300 singleton pregnant women with preterm births between June 2013 and May 2015 and their premature delivered babies as a preterm group. Blood sample within three days before delivery was collected. Simultaneously, 300 healthy pregnant women admitted during the same time, and singleton mature neonates who had gestational week-matched blood sample were age-matched as a control group.

Results: Maternal serum levels of Hcy, total triglycerides, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), uric acid (UA), free fatty acids (FAA) and superoxide dismutase (SOD) were all higher in the preterm group than in the control group except high-density lipoprotein cholesterol (HDL-C). Serum levels of Hcy, TC, LDL-C, UA, FAA and SOD were higher in prematurely delivered neonates than in the control group except for HDL-C. The body weight of prematurely delivered neonates was negatively correlated with the maternal serum levels of Hcy and UA before delivery.

Conclusions: Higher maternal serum Hcy levels were associated with preterm birth and neonatal body weight. Elevated maternal serum levels of Hcy might serve as a biomarker for preterm birth prediction.     

Owning the birth experience: what factors influence women’s vaginal birth after caesarean decision?

Objective: Our quantitative analysis examined what factors influence pregnant women to choose a vaginal birth after a caesarean (VBAC).

Background: There is growing concern over the high rates of caesarean section; much of the high rate is driven by repeat caesareans. A trial of labour after a previous caesarean is an option for many women increasingly supported by medical literature.

Methods: Survey data from 173 pregnant women who had had only one birth by caesarean were analysed using a hierarchical binary logistic regression model.

Results: Desire for the experience of a vaginal birth strongly predicted choice of VBAC; however, this relationship was dampened among women with a high (versus low) powerful others (e.g. doctors and nurses) locus of control. Prior reason for a caesarean section and practical factors also play a role.

Conclusion: Women may be more likely to choose VBAC if they are encouraged to believe that they can help control the outcome, especially if their desire for a vaginal birth experience is high.     

An examination of the factors affecting intestinal wall integrity in newborns at birth

Background: An understanding of the factors that influence intestinal wall integrity during the transition from fetal to neonatal life is important to elucidate and minimize potential contributions to the development of intestinal pathologies in vulnerable newborns.

Objective: To assess the factors affecting intestinal wall integrity of late preterm and term newborns at birth.

Methods: The concentrations of serum intestinal fatty acid-binding protein (I-FABP) as biomarker of intestinal wall injury, superoxide dismutase (SOD), and glutathione peroxidase (Gpx) as parameters of oxidative stress, and blood gas analyses were measured in the arterial cord blood of 80 newborns, delivered by spontaneous vaginal delivery (labor group) or elective cesarean delivery (non-labor group).

Results: Compared with the non-labor group, I-FABP, SOD, and Gpx levels were significantly higher in the labor group. I-FABP concentration was inversely correlated with pH and BE and positively correlated with SOD and Gpx concentrations, second stage of labor duration, and active pushing time.

Conclusions: This study demonstrates that oxidative stress at birth and prolonged second stage of labor may lead to the intestinal injury, which is reflected in increased serum concentration of I-FABP.     

The Janus face of maternal serum relaxin: a facilitator of birth,might it also induce preterm birth?

Objective: Preterm birth is a major cause of neonatal morbidity and mortality in the developed world. In order to better understand the pathophysiological pathway of this condition, the role of genetic factors and/or inflammation-associated molecules, as well as of socioeconomic parameters, is therefore under intense investigation. The purpose of this review study was to examine the potential role of maternal serum relaxin levels in the etiology of preterm birth.

Methods: Electronic databases (Pubmed, Embase, Cochrane Library) were searched for previously published research studies that investigated the biological role of relaxin and the mechanisms in which this hormone is involved during pregnancy and labor.

Results: It is evident that while relaxin is an essential endometrial/decidual angiogentic factor playing a vital role in maternal accommodation of pregnancy, elevated levels of this hormone could well be associated with preterm birth.

Conclusions: There are strong indications that maternal serum hyperrelaxinemia correlates with an increased risk of preterm birth.     

Clinical significance of primary symptoms in women with placental abruption

Background: To evaluate the clinical significance of primary symptoms in women with placental abruption.

Methods: A retrospective study of 273 cases of placental abruption was performed. The subjects were classified into two groups according to primary symptoms: 210 cases of the vaginal bleeding group and 63 cases of the abdominal pain group. The clinical features, maternal and neonatal outcomes were compared between two groups.

Results: The incidence of preeclampsia and preterm birth in the vaginal bleeding group was significantly lower than abdominal pain group, while the incidence of premature rupture of membrane (PROM) in the former group was higher than that in the latter group. Both fetal and maternal outcomes were significantly poorer in the abdominal pain group than in the vaginal bleeding group in terms of rate of abnormal fetal heart monitoring (FHR), concealed abruption, abruption area over 50%, uteroplacental apoplexy, volume of postpartum hemorrhage, rate of blood transfusion, neonatal asphyxia and acidemia.

Conclusions: Primary symptoms of placental abruption were associated with preterm birth, preeclampsia and PROM, which could predict pregnancy outcomes effectively.     

Incidence and risk factors of postnatal growth restriction in preterm infants

Aim: Preterm infants are often significantly underweight at the time of hospital discharge. Growth impairment during early infancy can have permanent detrimental effects. We aimed to evaluate the incidence and risk factors of postnatal growth restriction (PNGR) in preterm infants.

Methods: This prospective study included 124 preterm infants in neonatal intensive care unit between January 2015 and June 2016.

Results: Of 140 preterm infants screened, postnatal growth retardation was detected in 46 babies (37%). Low gestational age was independent risk factors for PNGR.

Conclusion: Clinicians should be aware of the presence of this morbidity when caring for preterm infants and to provide optimal enteral nutrition.     

The influence of psychological factors on postpartum weight retention 12 months post-birth

Background

During the first postpartum year 20% of women retain excessive weight from pregnancy (postpartum weight retention; PPWR), which predicts long-term overweight/obesity.

Objective

The aim of this study was to explore the associations between psychological factors (depression, anxiety and stress symptoms and body attitudes) in late gestation and at 12-months postpartum with PPWR one-year post-birth.

Methods

Pregnant women (N = 176) completed questionnaires in early–mid pregnancy (Time 1; mean (SD) = 16.97 (1.35) weeks), late pregnancy (Time 2; mean (SD) = 33.33 (2.05) weeks), and one year postpartum (Time 3; mean (SD) = 53.12 (3.34) weeks). Women provided demographic characteristics, height and pre-pregnancy weight at Time 1. At Times 2 and 3, weight, depressive, anxiety and stress symptoms and body attitudes (salience of weight and shape, attractiveness, feeling fat, and strength and fitness) were assessed in addition to physiological, socio-contextual and lifestyle factors. Gestational weight gain and PPWR were calculated. Hierarchical linear regression models were conducted to explore variance in 12-month PPWR.

Results

Overall, models explained 26–39% variance in PPWR. Gestational weight gain in late pregnancy and low attractiveness at 12 months postpartum were the only variables associated significantly with 12-month PPWR.

Conclusion

While psychological factors did not appear to be important direct contributors to PPWR at 12 months, the overall contribution of all variables suggests that such factors may be implicated in a small and incremental way. Exploration of the interactions between variables will help unpack potential mechanisms of the development of PPWR at 12 months post-birth.     

Fine tuning fear of childbirth: the relationship between Childbirth Fear Questionnaire subscales and demographic and reproductive variables

Objective: The objective of the current study was to investigate the relationship between the newly developed Childbirth Fear Questionnaire (CFQ) and demographic and reproductive variables.

Background: The CFQ was developed in an effort to improve measurement and understanding of women’s childbirth fears. To our knowledge the CFQ is the only multidimensional measure of childbirth fears in which (a) multiple domains of childbirth fear are assessed and (b) individual subscales have been psychometrically developed.

Methods: Participants were 643 pregnant women residing in English-speaking countries, recruited via online forums. Participants completed a set of questionnaires, including the multidimensional CFQ, via an online survey. Given the differences in childbirth fear between nulliparous and multiparous women, findings are stratified by parity.

Results: Gestational age was largely unrelated to fear of childbirth. Age, income and education were negatively related to fear of childbirth. Assisted vaginal delivery and episiotomy in a previous pregnancy were positively associated with a fear of pain. Self-reported history of traumatic vaginal birth was associated with higher scores on all aspects of fear of childbirth. History of caesarean birth was not generally associated with increased childbirth fears, but women with a prior, self-reported traumatic caesarean birth reported more fear of future caesarean births.

Conclusions: Findings are consistent with previous reports of fear of childbirth. However, the CFQ provides increased specificity with respect to women’s childbirth fears. This information is relevant to both education and treatment planning for pregnant women and women wishing to reproduce.     

Maternal and perinatal outcomes in pregnant women with type 1 diabetes treated with continuous subcutaneous insulin infusion and real time continuous glucose monitoring in two specialized centers in Medellin,Colombia

Objective: We assessed maternal and perinatal outcomes in pregnant women with type 1 diabetes, treated with continuous subcutaneous insulin infusion and real time continuous glucose monitoring.

Methods: This is a retrospective study, analyzing the basal characteristics, glycemic control, maternal and perinatal outcomes of pregnant women with type 1 diabetes, who were on an insulin pump with continuous glucose monitoring between 2011 and 2015.

Results: Fourteen patients were included. The median age was 33 and disease duration 12 years. Indications for therapy were mainly poor glycemic control and severe hypoglycemia. The median A1c decrease was 1.02% between the first and third trimester. Pregnancies were associated with complications: 7.1% of the patients had diabetic ketoacidosis, 7.1% had an abortion, 28.5% gestational hypertension and 12.2% preeclampsia. The median gestational age at birth was 37 weeks and four days; the frequency of preterm birth was 7.1% and macrosomia 21.4%. There were no congenital malformations or perinatal death.

Conclusions: Baseline characteristics and results of patients in this study were similar to those reported in the previous literature. Continuous subcutaneous insulin infusion with continuous glucose monitoring is an alternative treatment option for pregnant women with type 1 diabetes before or during pregnancy.     

Increased human leukocyte antigen-G expression at the maternal–fetal interface is associated with preterm birth

Objective: The maternal–fetal interface must modulate immune function to allow tolerance of fetal cells while still reacting to pathogens to suppress infection. Human leukocyte antigen-G (HLA-G) is a class Ib major histocompatibility complex protein involved in maternal–fetal tolerance. We posited that alterations in placental HLA-G expression predispose women to preterm birth. The aim of this study was to compare HLA-G expression in the maternal–fetal interface of term versus preterm human placentas.

Methods: We performed a cross-sectional study of specimens from the basal plate of the human placenta from women enrolled in a tissue specimen and clinical data consortium. Immunohistochemistry with digital microscopic analysis was used to quantify HLA-G protein expression in the basal plate from preterm and term placentas.

Results: Preterm birth <37 weeks occurred in 29.5% of 149 singleton pregnancies. HLA-G-positive cells occupied one-third of the basal plates, and the HLA-G-positive area was increased by 14% in placentas from preterm births than in those from term births (32.1% in term placentas versus 36.6% in preterm placentas).

Conclusion: Although HLA-G is required for maternal tolerance of the semi-allogeneic fetus, higher levels of HLA-G expression at the maternal–fetal interface is associated with preterm birth.     

Women’s views on anxiety in pregnancy and the use of anxiety instruments: a qualitative study

Objective: To explore women’s experience of anxiety in pregnancy and views on the use of anxiety instruments in antenatal care.

Background: Anxiety in pregnancy is associated with adverse birth outcomes, developmental and behavioural problems in infants and postnatal depression. Despite recommendations for routine psychological assessment in pregnancy, the optimal methods to identify anxiety in pregnancy have not been confirmed.

Methods: A qualitative study using two focus group discussions was undertaken. Focus group one included women in a community setting and focus group two included women in a hospital clinic setting who had received additional support for anxiety in pregnancy. Participants were women who had given birth within the past nine months and considered themselves to have been anxious during their pregnancy.

Results: Three main themes were identified using template analysis: sources of support, administration of anxiety instruments and the use of instruments to prompt discussion. Women stated that anxiety instruments could help them to identify their anxious feelings and prompt a discussion around those feelings. However, they expressed concerns surrounding the administration of anxiety instruments and questioned how useful they would be in helping women access help and support.

Conclusions: The introduction of anxiety instruments in antenatal care may present an opportunity to discuss women’s emotional health and anxieties. Providing women with sufficient time to discuss their anxious feelings, identified by such instruments, could facilitate access to additional support.     

Magnesium sulfate for neuroprotection in the setting of chorioamnionitis

Purpose: We examined the effects of magnesium on premature neonatal outcomes complicated by chorioamnionitis.

Materials and methods: We conducted a secondary analysis of data from the BEAM Trial, an RCT to determine if antenatal magnesium decreases the incidence of CP in preterm birth. We compared the effect of magnesium sulfate by the presence or absence of chorioamnionitis. Outcomes examined include CP, IVH, NEC, BPD, and assessments of mental and motor disability. Logistic regression was used to estimate adjusted odds ratios of each outcome.

Results: About 1944 women were included in this analysis of which 228 were diagnosed with chorioamnionitis. Demographic characteristics were similar between women randomized to receive magnesium or placebo. Magnesium therapy demonstrated no significant reduction in CP in the presence of chorioamnionitis (OR 0.76, CI: 0.19–2.76) but does demonstrate benefit in the absence of chorioamnionitis (OR 0.52, CI: 0.31–0.86).

Conclusions: Antenatal magnesium did not show a clear neuroprotective effect in the setting of chorioamnionitis.     

Personality and labor: a retrospective study of the relationship between personality traits and birthing experiences

Objective: In the current study, we explored the relationship between a woman’s personality, epidural use and perceptions of the labour and birth experience.

Background: Having a positive birthing experience is relevant to predicting a range of important outcomes including mother–infant bonding, fertility rates and delivery interventions. However, limited research has addressed the kinds of individual differences that may affect a woman’s subjective birthing experience.

Methods: One hundred and twenty-five women were surveyed about subjective aspects of the labour and birthing experience of their first-born child, including use of epidural, perceived pain, anxiety, self-capacity and positive experiences. The women also completed the Big Five personality inventory, which measures five dimensions of stable personality characteristics.

Results: Results show that four of the Big Five personality traits were found to correlate to the four different aspects of the labour and birth experience, and that these relationships were largely moderated by a woman’s decision to have an epidural.

Conclusion: These findings add to the limited body of research on the relationships between personality and the labour experience. They also highlight the importance of considering pain management decisions in understanding this relationship. Future research in this area may provide a new way for doctors, midwives and doulas to tailor support and intervention for women during the birthing process based on individual differences to help more women have positive birthing experiences.     

Type-2 diabetes mellitus: does prenatal care affect outcomes?

Objective: To determine if prenatal care affects adverse perinatal outcomes in pregnant women with Type-2 diabetes mellitus (T2DM).

Study design: This was a retrospective cohort study of pregnant women with pregestational diabetes mellitus pregnancies in the state of California between 1997 and 2006, using vital statistics data linked to birth certificates. Women were stratified by time of presentation to care and we compared those who presented in the first trimester, third trimester, and those who had no prenatal care prior to delivery. Perinatal outcomes looked at included: preeclampsia, macrosomia, preterm delivery, cesarean delivery, and intrauterine fetal demise (IUFD). The two groups were compared with chi-squared testing to determine statistical significance.

Results: In women with pregestational diabetes those who presented at time of delivery had an 11.3% risk of IUFD compared to 0.9% in those who presented in the first trimester. There was also an increased rate of preterm birth in the late presentation cohort (29.4% at time of delivery versus 21.0% in the first trimester). After adjusting for possible confounding variables using logistic regression models, rates of IUFD and preterm delivery were still found to be statistically significant with adjusted odds ratios of 11.37 (95% CI: 6.10–21.16) and 1.55 (95% CI: 1.03–2.32), respectively. There were no differences in rates of macrosomia or preeclampsia between the three cohorts.

Conclusions: Treatment of T2DM throughout pregnancy leads to improved maternal and neonatal outcomes.     

Correlation between allopregnanolone levels and depressive symptoms during late menopausal transition and early postmenopause

Objectives: This observational, cross-sectional study included 140 women with climacteric symptoms. The aim of the study was to evaluate the correlation between the presence and severity of depressive symptoms and allopregnanolone levels in women during late menopausal transition and early postmenopause.

Methods: The study group was divided into two groups: 45 women in late menopausal transition and 95 early postmenopausal women. We evaluated Kupperman index, Hamilton scale and serum follicle-stimulating hormone, luteinizing hormone, 17β-estradiol, prolactin, total testosterone, dehydroepiandrosterone sulfate and allopregnanolone levels.

Results: We found that serum allopregnanolone concentration was lower in early postmenopausal women compared to women in late menopausal transition; that there was a correlation between serum allopregnanolone levels in early postmenopausal women and time since last menstruation, intensity of climacteric symptoms, and intensity of depression symptoms and that there was a correlation between serum allopregnanolone levels and several depression symptoms presence (shallow sleep and symptoms of the digestive tract in women during late menopause transition; feelings of guilt, sleep disorders and general somatic symptoms in early postmenopausal women).

Conclusion: We concluded that reproductive aging is characterized by a reduction of allopregnanolone circulating levels that correlate to Hamilton depression index in early postmenopause and presence of specific depressive symptoms during late menopausal transition and early postmenopause.     

Risk factors for spontaneous localized intestinal perforation in the preterm infant

Purpose: The aim of this study was to investigate prenatal and postnatal risk factors for spontaneous intestinal perforation (SIP) in preterm infants.

Material and methods: Matched case-control study of 62 preterm infants (matching based on gender, gestational age and birth weight) who developed a SIP over a period of 20 years in a single NICU. Univariate and multivariate logistic regression analysis were performed.

Results: Prenatal risk factors were not significantly different between cases and controls. Patients exposed to surfactant and inotropic agents have an increased risk for SIP. No initiation of feeding before development of SIP and IVH ≥ grade 3 were also associated with an increased risk for SIP. In multivariate analysis inotropic agents, lack of initiation of feeding and IVH ≥ grade 3 remained significant risk factors (OR 5.58 (95% CI 1.14–27.22), 0.29 (95% CI 0.09–0.88), 15.2 (95% CI 1.09–211.55) respectively).

Conclusions: The study found that patients with SIP are more likely to have been exposed to inotropic agents and to have developed IVH ≥ grade 3. They were also less likely to have been fed. These risk factors most likely reflect the severity of illness of preterm infants and an increased vulnerability for developing SIP.     

The development of the Slade–Pais Expectations of Childbirth Scale (SPECS)*

Objective: To develop a valid and reliable English language-based scale to measure pregnant women’s expectations of childbirth.

Background: During pregnancy, most women think about their forthcoming childbirth, and develop expectations of how they think this experience will be. Women with adverse expectations of childbirth have been found to have more negative actual experiences. Measuring expectations is therefore important. Existing measures are limited in their established psychometric properties.

Methods: Items were generated from semi-structured interviews with 18 pregnant women to explore their expectations of their forthcoming childbirth. Content analysis was used to analyse interview data and scale items were developed using the constructs extracted. A population sample of 148 pregnant women completed the initial 85-item version of the Slade–Pais Expectations of Childbirth Scale (SPECS) and the State Trait Anxiety Inventory.

Results: Principal components analysis of the SPECS identified six underlying components labelled ‘coping and robustness to pain’, ‘staff and service responsive to needs’, ‘fear’, ‘out of control and embarrassed’, ‘perceptions of partner’s coping’ and ‘positive anticipation of birth’. Items with poor psychometric properties were excluded. A final 50-item version of the SPECS showed acceptable internal reliability and good content and construct validity.

Conclusion: The SPECS shows promising psychometric robustness for use both as a research and clinical tool. It can be used as a total score, as a shortened scale focussed only on expectations of self, or as a series of subscales covering all domains.     

Serum stromal-derived-factor-1 (CXCL12) and its alpha chemokine receptor (CXCR4) as biomarkers in neonatal sepsis

Background: Neonatal sepsis remains one of the leading causes of morbidity and mortality both among term and preterm infants. Advances in neonatal care improved survival and reduced complications in preterm infants. Chemokines are chemotactic cytokines that give directional guidance for leukocyte migration during inflammatory process. The chemokine CXCL12 and its receptor CXCR4 are now known to play an important role in inflammatory states. However, its value as a biomarker in neonatal sepsis is unclear.

Objectives: To assess the value of measuring the serum levels of alpha-chemokine receptor type 4 (CXCR-4) and stromal-derived-factor-1 (CXCL12) in diagnosis of late onset neonatal sepsis.

Subject and methods: Serum levels of CXCL12 and CXCR4 were determined in 38 full term neonates, 23 cases of late onset sepsis (13 males and 10 female), and 15 healthy neonates as control (six males and nine females) by ELISA technique and flow-cytometry.

Results: Serum levels of CXCR4 and CXCL12 were significantly higher in neonates with late onset sepsis compared with the non-septic ones. The sensitivity, the specificity, and the overall accuracy of CXCL12 were 100%. The sensitivity of CXCR4 was 87%; the specificity was 80% and the overall accuracy was 84%.

Conclusions: Serum CXCR4 and CXCL12 levels increase significantly in septic neonates and they are valuable marker in diagnosis of neonatal sepsis. Serum concentrations of both chemokines represent promising novel biomarkers for neonatal sepsis.     

Peer support workers’ experiences of supporting women with postnatal depression: a constant comparative exploration

Objective: To explore the lived experiences of peer support workers (PSWs) during their intervention with mothers suffering from postnatal depression (PND).

Background: Postnatal depression is a major public health concern affecting approximately 13% of women worldwide. There is evidence within recent literature that peer support may have a positive effect upon women suffering with PND.

Methods: Written data from the PSW’s logbooks, interviews and supervisory sessions was collected and thematically analysed.

Results: Data were analysed using a constant comparative method and four key themes emerged. These were: changing perspectives of the PSW, their personal self-analysis and recognition, concern about the abandonment of the women that they had been supporting and self-recovery from postnatal depression.

Conclusion: Findings indicate that PSWs choose to offer support based upon their own experiences, rejecting formal counselling therapies. This study found that peer-designed interventions do appear to have some merit.     

Proteomic profile of serum of pregnant women carring a fetus with Down syndrome using nano uplc Q-tof ms/ms technology

Introduction: Prenatal diagnosis of Down syndrome (DS) is based on the calculated risk of maternal age, biochemical and ultrasonographic markers and recently by cfDNA. Differences in proteomic profiles may give an opportunity to find new biomarkers.

Objective: Characterize proteome of serum of mothers carrying DS fetus.

Material and methods: Blood serum samples of three groups of women were obtained, (a) 10 non-pregnant, (b) 10 pregnant with healthy fetus by ultrasound evaluation, (c) nine pregnant with DS fetus. Sample preparation was as follows: Albumin/IgG depletion, desalting, and trypsin digestion; the process was performed in nanoUPLC MS/MS. Data analysis was made with Mass Lynx 4.1 and ProteinLynx Global Server 3.0, peptide and protein recognition by MASCOT algorithm and UNIPROT-Swissprot database.

Results: Each group showed different protein profiles. Some proteins were shared between groups. Only sera from pregnant women showed proteins related to immune and clot pathways. Mothers with DS fetus had 42 specific proteins.

Conclusions: We found a different serum protein profile in mothers carrying DS fetuses that do not reflect expression of genes in the extra chromosome. Further studies will be necessary to establish the role of these proteins in aneuploid fetus and analyze their possible use as potential biomarkers.