Physical activity and the risk of spontaneous preterm delivery

An epidemiologic case-control study exploring possible risk factors for preterm delivery was undertaken at Yale-New Haven Hospital during 1977. The study groups consisted of 175 mothers of singleton preterm infants and 313 mothers of singleton term infants. Analysis of questionnaire responses provided no evidence that employment, housework, child care and leisure-time physical activity during pregnancy increased the risk of preterm delivery. Women who participated in sports or physical fitness exercises during pregnancy were found to have a significantly decreased risk of preterm delivery as compared to those who were not similarly active; this finding suggests that certain forms of moderate physical activity may actually protect against preterm delivery.     

Predicting preterm delivery and lowering very preterm delivery rate.

The chances and quality of survival depend on gestational age at birth. Why has PTD not decreased during the last decade, in spite of all the known risk factors? Perinatal data bases tend to include biomedical risk factors and are assembled and analysed retrospectively. These data should form the basis for prediction, and risk factors such as stress, anxiety, inflammation (leading to elevated CRH with its role in PTD), short cervix etc, should be added when assessed prospectively. The goal is preconception and early prediction in pregnancy. Only with the implementation of efficient intervention will we lengthen pregnancies and lower the VPTD rate. More articles about the PTD and complications of preterm births should be published in the lay press. There is no room for pessimism: if everybody involved would do just a little in the right direction, the result would be enormous. Constant auditing of interventions is necessary. The most difficult to "cure" and most likely to relapse are stress, anxiety and social factors, and discrimination in obtaining basic health care. Long forgotten lessons of compassion with pregnant women have not yet been acknowledged as proven to change VPTD into PTD, but are available at no cost world wide.     

Physical exertion at work and the risk of preterm delivery and small-for-gestational-age birth

OBJECTIVE: To assess whether exposure to standing, lifting, night work, or long work hours during 3 periods of pregnancy are associated with an increased risk of preterm or small-for-gestational-age birth. METHODS: The Pregnancy, Infection and Nutrition study is a prospective cohort with a nested case-control component that was conducted through clinic and hospital settings in Central North Carolina. A total of 1,908 women pregnant with a singleton gestation were recruited during prenatal visits from January 1995 through April 2000 and provided information during telephone and face-to-face interviews about physical exertion for the 2 longest-held jobs during pregnancy. RESULTS: No significant elevations in preterm delivery were observed among women who lifted repeatedly or stood at least 30 hours per week, with no changes in risk estimates over the course of pregnancy. A 50% elevation in the risk of preterm delivery (relative risk 1.5, 95% confidence interval 1.0-2.0; first trimester) was observed among women who reported working at night (10:00 PM to 7:00 AM), whereas a 40% reduction in risk was observed among women working at least 46 hours per week (relative risk 0.6, 95% confidence interval 0.4-0.9; first trimester), regardless of period of exposure. No elevations in small-for-gestational-age birth were observed among women exposed to any of the 4 types of occupational exertion. CONCLUSION: Physically demanding work does not seem to be associated with adverse pregnancy outcomes, whereas working at night during pregnancy may increase the risk of preterm delivery. Studies to examine the effect of shift work on uterine activity would help to clarify the possibility of a causal effect on preterm birth.     

Stress and preterm delivery

Although widely criticized for its didactical inadequacy, the accepted form for medical postgraduate training is still the symposium. One of its great deficiencies is the inability for participants to put new (scientific) findings into a personal medical context by means of discussion and reflection. To meet the didactical demands an innovative approach to postgraduate education was developed and tested with gynaecologist as teachers and general practitioners as participants. The first results with five courses are very positive: in comparison to the symposium, the new approach stimulates internalisation of provided knowledge much more, information retention is much higher and the reactions of participants are overwhelmingly enthusiastic. A short outline of the didactic model and its procedures is provided.     

Bacterial vaginosis and preterm delivery

Bacterial vaginosis (BV) is an imbalance of vaginal flora. There is a statistical association between BV in early pregnancy and the occurrence of obstetric complications including preterm delivery. If screening and treatment of asymptomatic BV in patients at low risk are not recommended, the management of patients at high risk of prematurity is controversial. Using molecular tool, a rational and objective approach to the imbalance of vaginal flora, would reassess the relationship between VB and obstetric complications.     

Causes of preterm delivery

Although major advances have been made in both obstetric care of the high-risk patient and in neonatal care, prematurity and its consequences remain the major contributor to perinatal mortality. The identification of maternal or obstetric risk factors associated with preterm delivery has enhanced our ability to provide special obstetric care to gravidas at increased risk. The selective management of patients at increased risk for preterm delivery may ultimately reduce the incidence of preterm births. Maternal genital infections are also associated with preterm delivery. Further research is needed to explore the pathogenesis of preterm delivery associated with genital infections, since infections may represent a potentially preventable cause of prematurity.     

Bacterial vaginosis and preterm delivery: an open question

OBJECTIVE: To evaluate the prevalence of bacterial vaginosis in a population of Italian pregnant women and to study its association with adverse pregnancy outcomes, particularly preterm delivery. STUDY DESIGN: After giving informed consent, 598 women were consecutively enrolled at their first prenatal visit (13-18 weeks of gestation). The presence of bacterial vaginosis was assessed by Gram's method at 13-18 weeks of gestation (early bacterial vaginosis) and at 28-32 weeks of gestation (late bacterial vaginosis). Univariate and multiple logistic regression models of analysis were used to assess the statistical significance of the data. RESULTS: Preterm delivery occurred in 14.7% of pregnant women positivefor bacterial vaginosis at theirfirst prenatal visit and in 6.9% of healthy women (OR 1.6, CI 1.07-2.51). In patients with bacterial vaginosis, preterm delivery occurred more often in the 36th week of gestation (78.6%). CONCLUSION: The presence of bacterial vaginosis at an early gestational age is associated with preterm delivery, although in the study population the condition did not seem to be related to great prematurity.     

Adenomyosis and risk of preterm delivery

OBJECTIVE: To evaluate the risk of preterm delivery in patients with adenomyosis. DESIGN: A 1:2 nested case-control study. SETTING: Tertiary-care institution. POPULATION: A base cohort population of 2138 pregnant women who attended routine prenatal check-up between July 1999 and June 2005. METHODS: From this base cohort population, gravid women with singleton pregnancy who delivered prior to the completion of 37 weeks of gestation were identified and formed the study group. Singleton gravid women who had term delivery and who matched with age, body mass index, smoking, and status of previous preterm delivery were recruited concurrently and served as control group. Preterm delivery cases were further divided into spontaneous preterm delivery and preterm premature rupture of membranes (PPROM) cases. MAIN OUTCOME MEASURES: Risk analysis of preterm delivery between gravid women with and without adenomyosis. RESULTS: One-hundred and four preterm delivery case subjects and 208 control subjects were assessed. Overall, gravid women with adenomyosis were associated with significantly increased risk of preterm delivery (adjusted odds ratio 1.96, 95% CI 1.23-4.47, P=0.022). For subgroup analysis, gravid women with adenomyosis had an adjusted 1.84-fold risk of spontaneous preterm delivery (95% CI 1.32-4.31, P=0.012) and an adjusted 1.98-fold risk of PPROM (95% CI 1.39-3.15, P=0.017). CONCLUSIONS: Gravid women with adenomyosis were associated with increased risk of both spontaneous preterm delivery and PPROM. A common pathophysiological pathway may exist in these two disorders. Further in-depth biochemical and molecular studies are necessary to explore this phenomenon.     

Inflammatory bowel disease and preterm delivery

Background

The association between inflammatory bowel disease (IBD) and preterm delivery is controversial. Study size, quality, and design have been inconsistent, making it difficult to assess the relationship between IBD and preterm delivery.

Objective

Utilizing a systematic search of Pubmed for all relevant literature, this review seeks to clarify the correlation between IBD and preterm delivery and to assess the impact of disease activity and medication usage on this outcome.

Results

The available evidence is inadequate to make any robust claims about the association between IBD and preterm delivery. IBD in pregnant women may represent a risk for preterm delivery, and it is probable that IBD activity augments this risk. Many of the medications used to treat IBD also have a correlation with preterm delivery.

Conclusions

While an association between IBD and preterm delivery may exist, further well-designed prospective studies are necessary to determine how the course and management of disease may impact this outcome.