Low pre-pregnancy body mass index and risk of medically indicated versus spontaneous preterm singleton birth

Objective(s)

There were three primary objectives of this study: (1) to estimate the risk of preterm and very preterm birth by severity of low pre-pregnancy body mass index (BMI), (2) to determine if the risk in preterm and very preterm birth by severity of low pre-pregnancy BMI differs for spontaneous versus medically indicated preterm delivery, and finally (3) to determine if there is a difference in the risk for preterm and very preterm birth by severity of low pre-pregnancy BMI across gradations of gestational weight gain.

Study design

This study utilized the Missouri maternally linked cohort files from 1989 to 1997. After restricting analyses to singleton live births (gestational age 20–44 weeks) and women with either a low or normal BMI, the final study population consisted of 437,403 births. Pre-pregnancy BMI was categorized as normal (19.5–24.9), mild thinness (17.0–18.5), moderate thinness (16.0–16.9) and severe thinness (≤15.9). Statistical analyses included chi-square tests and logistic regression with generalized estimating equations (GEE).

Results

Underweight mothers were more likely to experience a preterm delivery. For all preterm births, the risk among underweight mothers increased with ascending underweight severity (p < 0.01). Higher risk estimates were observed for spontaneous than for medically indicated preterm birth. For each BMI category, extreme risk values for spontaneous preterm births were observed among women with very low gestational weight gain (<0.12 kg/week). Severely thin mothers with very low and very high pregnancy weight gain were at the greatest risk for spontaneous preterm birth. By contrast, underweight women with moderate gestational weight gain (0.23–0.68 kg/week) had the lowest risk for spontaneous preterm birth with the sole exception of moderately underweight gravidas.

Conclusions

These findings suggest that women with low or normal pre-pregnancy BMI should be counseled to maintain a moderate level of gestational weight gain (0.23–0.68 kg/week) in order to reduce their risk for preterm birth. Further, our observation that severity of low pre-pregnancy BMI was associated directly (in a dose–response pattern) with preterm birth highlights the importance of preconceptional counseling for women—specifically the importance of women achieving or maintaining a normal weight status prior to pregnancy.     

Headache and adverse pregnancy outcomes: a prospective study

Objective

To investigate the association between headache, namely migraine and tension-type headache, and adverse pregnancy outcome.

Study design

Prospective cohort study conducted in three tertiary care centres in Italy: 376 pregnant women suffering from headache and 326 non-headache pregnant women as controls were recruited. The diagnosis of headache was made at the beginning of pregnancy, according to the criteria of the International Classification of Headache Disorders (ICHD-II). Women were followed up until delivery, and gestational age at delivery, mode of delivery, indications for operative delivery or caesarean section, birth weight, and centile of neonatal weight at birth were carefully recorded. Main outcome measures of the study were: preterm delivery, newborns small for gestational age, and foetal losses. Odds ratios and 95% confidence intervals were calculated.

Results

The incidence of preterm delivery (Adj OR, 95% CI 2.74, 1.27–5.91) was significantly higher in women suffering from headache than in controls. There was no statistically significant difference in small for gestational age newborns between the groups. Fewer women in the headache group had preterm elective caesarean section or induction of labour, than did controls, indicating a higher chance of spontaneous preterm delivery. Multivariate analysis showed that the association between headache, either migraine or tension-type, and adverse perinatal outcomes was statistically significant regardless of pre-eclampsia.

Conclusions

Women with headache should be considered at risk for adverse perinatal outcomes and should, therefore, be included in a high-risk pregnancy protocol of care throughout pregnancy.     

Do placental histologic findings of chorion-decidual hemorrhage or inflammation in spontaneous preterm birth influence outcomes in the subsequent pregnancy?

Introduction

Spontaneous preterm birth (SPTB) is the common endpoint of different underlying etiologies, including chorion-decidual bleeding and inflammation. However, specific histologic findings from a prior pregnancy do not always inform clinical management in subsequent pregnancies secondary to few prior studies having evaluated the relationship between prior pregnancy pathology and subsequent outcomes in patients with SPTB.

Methods

Included subjects had: 1) a SPTB with available placental pathology and 2) a subsequent consecutive delivery at >20 weeks gestational age at our institution. For included subjects archived placenta and membrane paraffin blocks from the index SPTB were cut, stained with Prussian Blue and evaluated by a perinatal pathologist for the presence of hemosiderin. The association between histologic findings and subsequent pregnancy outcomes were evaluated through logistic and linear regression.

Results

A total of 131 subjects were included, of whom 39.7% had a recurrent SPTB. Funisitis at the time of preterm delivery significantly increased the risk of early (<34 weeks) recurrent preterm birth (OR 3.38, p = 0.016), though this may have been confounded by gestational age at delivery. Several histologic features were significantly associated with reductions in birth weight in the subsequent pregnancies, even if they did not increase the risk of recurrent preterm birth.

Discussion

The presence of chorion-decidual bleeding or inflammation in a prior pregnancy can signal an increased risk in a future pregnancy beyond the recurrent risk of SPTB itself.

Conclusions

Placental histologic findings after SPTB maybe associated with differences in birth weight in a subsequent pregnancy.     

Possible association between maternal recurrent orofacial herpes in pregnancy and a lower rate of preterm birth

Objective.?To study the possible association between orofacial herpes during pregnancy and pregnancy complications including preterm birth and low birth weight, since the results of previous studies are inconsistent.

Method.?The population-based large data set of the Hungarian Case-Control Surveillance System of Congenital Abnormalities was used; pregnancies in mothers with and without recurrent orofacial herpes were compared.

Results.?Of 38 151 newborn infants, 572 (1.5%) had mothers with recurrent orofacial herpes during pregnancy, while 37 577 had mothers with no orofacial herpes. Pregnant women with recurrent orofacial herpes had a higher prevalence of severe nausea and vomiting, threatened preterm delivery, and placental disorders but a lower prevalence of preeclampsia. Mothers with recurrent orofacial herpes during pregnancy also had a somewhat longer (0.4 weeks) gestation (adjusted t = 2.7; p = 0.006) and an obviously lower proportion of preterm births (3.5% vs. 9.3%; adjusted POR with 95% CI = 0.42, 0.27–0.65). However, there was no significant difference in the mean birth weight and rate of low birth weight infants between the two study groups.

Conclusion.?Recurrent orofacial herpes during pregnancy is associated with a smaller proportion of preterm births.     

Influence of mode of delivery on neonatal mortality and morbidity in spontaneous preterm breech delivery

Objective

To study the association between mode of delivery and neonatal outcome in singleton pregnancy with breech presentation and preterm birth, due to premature labour (PTL) and/or preterm premature rupture of the membranes (pPROM).

Design and methods

Information on preterm (gestational week 25–36) singleton births in breech presentation in Sweden during 1990–2002 was obtained from the Swedish Medical Birth Registry and the Swedish Hospital Discharge Registry. The study groups included 1975 caesarean and 699 vaginal deliveries with a diagnosis of PTL or pPROM, without pregnancy complications implying a high risk of fetal compromise. The rates of infant respiratory distress syndrome (IRDS), intraventricular haemorrhage (IVH), low Apgar scores, and neonatal deaths were compared between infants delivered vaginally and by caesarean section. Odds ratios were calculated with adjustment for gestational age, year of birth, maternal age and parity.

Results

The risk of neonatal death and the risk of an Apgar score below 5 min postnatally were both lower after caesarean delivery (OR 0.4; 95% CI 0.2–0.7, and OR 0.4; 95% CI 0.3–0.7, respectively), whereas the risk of IRDS was increased (OR 2.1; 95% CI 1.4–3.2). A diagnosis of IRDS was not associated with mortality (OR 0.8; 95% CI 0.5–1.5). IVH was not associated with mode of delivery (OR 1.2; 95% CI 0.5–2.8).

Conclusion

The lower neonatal mortality after CS supports a policy of caesarean delivery of the preterm breech.     

Use of oxytocin to prevent haemorrhage at caesarean section--a survey of practice in the United Kingdom

Objective

Preterm birth remains one of the most challenging areas in obstetrics. The pathogenesis of preterm labor is multifactorial and research on preterm birth has focused principally on infection and inflammatory markers. Recently the focus has turned to potential genetic factors influencing preterm birth. Uteroplacental insufficiency and thrombotic vasculopathy are considered part of the pathogenesis of preterm labor. Investigating the gene expression in the maternal/fetal interface seems of importance to expand our knowledge of the pathophysiology of preterm birth. The renin–angiotensin system (RAS) appears to play an important role in fetal/placental development and uteroplacental circulation. Hence, the aim of this study was to investigate angiotensin converting enzyme (ACE) activity and I/D polymorphisms in the ACE gene in mothers and infants with appropriately grown infants in relation to preterm birth and infant birth weight.

Study design

We conducted a cross-sectional study of 113 term pregnancies (≥37 weeks) and 18 preterm pregnancies (<37 weeks). Umbilical cord bloods (venous and arterial) were obtained from the placenta immediately after delivery for serum ACE activity, ACE genotype analysis of the I/D polymorphism and the acid-base status. Maternal venous samples were obtained just after delivery for analysis of ACE activity and ACE genotype.

Results

The distribution of the maternal ACE genotypes was similar for preterm and term births as was maternal ACE activity. Preterm infants were more likely to be of the DD genotype than term infants (7/18 (39%) vs. 11/83 (13%), p = 0.02) (adjusted p = 0.04). There was no correlation between ACE activity and birth weight (r² 0.00, p = 0.82).

Conclusions

These findings suggest that the ACE genotype of the infant may influence the risk of preterm birth among appropriately grown fetuses.     

Possible association between maternal recurrent orofacial herpes in pregnancy and a lower rate of preterm birth.

OBJECTIVE: To study the possible association between orofacial herpes during pregnancy and pregnancy complications including preterm birth and low birth weight, since the results of previous studies are inconsistent. METHOD: The population-based large data set of the Hungarian Case-Control Surveillance System of Congenital Abnormalities was used; pregnancies in mothers with and without recurrent orofacial herpes were compared. RESULTS. Of 38,151 newborn infants, 572 (1.5%) had mothers with recurrent orofacial herpes during pregnancy, while 37 577 had mothers with no orofacial herpes. Pregnant women with recurrent orofacial herpes had a higher prevalence of severe nausea and vomiting, threatened preterm delivery, and placental disorders but a lower prevalence of preeclampsia. Mothers with recurrent orofacial herpes during pregnancy also had a somewhat longer (0.4 weeks) gestation (adjusted t = 2.7; p = 0.006) and an obviously lower proportion of preterm births (3.5% vs. 9.3%; adjusted POR with 95% CI = 0.42, 0.27-0.65). However, there was no significant difference in the mean birth weight and rate of low birth weight infants between the two study groups. CONCLUSION: Recurrent orofacial herpes during pregnancy is associated with a smaller proportion of preterm births.     

Maternal age ≥45 years and maternal and perinatal outcomes: A review of the evidence

Objective

to examine the evidence in relation to very advanced maternal age (≥45 years) and maternal and perinatal outcomes in high-income countries.

Background

this review was conducted against a background of increasing fertility options for women aged ≥=45 years and rising birth rates among this group of women.

Methods

established health databases including SCOPUS, MEDLINE, CINAHL, EMBASE and Maternity and Infant Care were searched for journal papers, published 2001–2011, that examined very advanced maternal age (VAMA) and maternal and perinatal outcomes. Further searches were based on references found in located articles. Keywords included a search term for maternal age ≥45 years (very advanced maternal age, pregnancy aged 45 years and older) and a search term for maternal complications (caesarian section, hypertension, pre-eclampsia, gestational diabetes) and/or adverse perinatal outcome (preterm birth, low birth weight, small for gestational age, stillbirth, perinatal death). Of 164 retrieved publications, 10 met inclusion criteria.

Data extraction

data were extracted and organised under the following headings: maternal age ≥45 years; maternal characteristics such as parity and use of artificial reproductive technology (ART); and pre-existing maternal conditions, such as diabetes and hypertension. Additional headings included: gestational conditions, such as pre-eclampsia and gestational diabetes (GDM); and perinatal outcomes, including fetal/infant demise; gestational age and weight. Study quality was assessed by using the Critical Appraisal Skills Programme (CASP) guidelines.

Findings

this review produced three main findings: (1) increased rates of stillbirth, perinatal death, preterm birth and low birth weight among women ≥45 years; (2) increased rates of pre-existing hypertension and pregnancy complications such as GDM, gestational hypertension (GH), pre-eclampsia and interventions such as caesarian section; and (3) a trend of favourable outcomes, even at extremely advanced maternal age (50–65 years), for healthy women who had been screened to exclude pre-existing disease.

Key conclusions

although there is strong evidence of an association between very advanced maternal age and adverse maternal and perinatal outcomes, the absolute rate of stillbirth/perinatal death remains low, at less than 10 per 1000 births in most high-income countries. Therefore, although women in this age group encounter greater pregnancy risk, most will achieve a successful pregnancy outcome. Best outcomes appear to be linked to pre-existing maternal health, and pregnancy care at tertiary centres may also contribute. This information should be used to counsel women aged ≥45 years who are contemplating pregnancy.     

Are active labour and mode of delivery still a challenge for extremely low birth weight infants? Experience at a tertiary care hospital

Objective

This study was to evaluate the impact of mode of delivery and timing of caesarean section in extremely preterm births, below 28 weeks of gestation, on long-term survival and psychomotor outcomes.

Study design

This was a single-centre retrospective cohort study of 84 cases of extremely low birth weight infants with complete maternal, obstetrical and neonatological information. Mortality and survival with neurological disabilities at 18 months of life were considered outcome measures.

Results

Forty percent of deliveries were at or less than 25 weeks of gestation and birth weight was ≤500 g in 14% of all infants. The overall survival rate was 54.8% with a prevalence of neuromotor impairment with disability among the survivors of 26.1%. After adjustment using multiple logistic regression, only extreme prematurity (≤25 weeks) and birth weight below 500 g had significant effects on survival (p < 0.05), regardless of mode and timing of delivery.

Conclusions

Mode of delivery and labour seem not to play a significant role in adverse neonatal outcomes, either mortality or neuro-developmental impairment, in extremely low birth weight infants.     

Cell-free fetal DNA and adverse outcome in low risk pregnancies

Objective

To analyze in a large prospective cohort study of low risk pregnancies whether cell-free fetal (cff) DNA in maternal plasma of the second trimester might be associated with the development of preeclampsia, preterm delivery, and small for gestational age.

Study design

A subset of a large prospective cohort study in serological RhD negative pregnant women with RHD positive fetuses was used. Cff DNA was determined through the detection of RHD specific sequences with real-time PCR.

Results

In 611 pregnancies, rates of 7.2% preeclampsia, 1.6% preterm birth ≤32, 2.9% ≤34, and 12.4% ≤37 weeks of gestation, 5.7% of small for gestational age <5th percentile, and 8.2% <10th percentile were observed. For none of these risk groups an association with cff DNA could be established.

Conclusion

Cff DNA in maternal plasma of the second trimester was not found to be a marker for an adverse pregnancy outcome in low risk pregnancies.     

Possible association of folic acid supplementation during pregnancy with reduction of preterm birth: a population-based study

Objective

Periconceptional folic acid or multivitamin supplementation is recommended for prospective pregnant women to prevent neural-tube defects. The question is whether it is worth continuing these supplementations after the first trimester of pregnancy or not. Thus the possible fetal growth promoting and/or preterm birth reducing effect of vitamin supplements in the second and mainly in the third trimester was studied.

Study design

Comparison of birth outcomes of singletons born to primiparous pregnant women with prospectively and medically recorded vitamin supplement in the population-based data set of the Hungarian Case-Control Surveillance of Congenital Abnormalities (HCCSCA), 1980–1996 contained 6293, 169, and 311 primiparae with folic acid alone, multivitamins and folic acid + multivitamin supplementation, respectively, and their data were compared to the data of 7319 pregnant women without folic acid and folic acid-containing multivitamin supplementation as reference.

Results

Mean gestational age was 0.3 week longer and mean birth weight was by 37 g higher in the group of folic acid alone, than in the reference group (39.2 weeks; 3216 g). The rate of preterm births (7.6%) was significantly lower compared with the reference sample (11.8%), but the rate of low birth weight newborns did not show significant reduction. Folic acid alone in the third trimester associated with 0.6 week longer gestational age and a more significant reduction in the rate of preterm births (4.8%).

Conclusions

Minor increase in mean birth weight after high dose of folic acid supplementation during pregnancy would not be expected to result in too large babies; however, the significant reduction in the rate of preterm births may have great public health benefit.     

Does young maternal age increase the risk of adverse obstetric,fetal and neonatal outcomes: A cohort study

Objective

To determine whether young maternal age is associated with increased risks of adverse obstetric, fetal and perinatal outcomes.

Study design

Register-based study using the data from a computerized database of a University Hospital for the years 1994–2001. The study population included 8514 primiparous women aged less than 31 who delivered a singleton infant. Using maternal age as a continuous variable, crude and adjusted relative risks (RRs) were estimated for each maternal and perinatal outcome.

Results

Crude and adjusted RRs of anaemia during pregnancy and fetal death consistently increased with younger maternal age. After adjustment for confounding factors, RRs (95% confidence interval) of fetal death and anaemia were respectively 1.37 (1.09–1.70) and 1.27 (1.15–1.40) for a 16-year-old compared to a 20-year-old mother. Younger mothers had significantly decreased risks of obstetric complications (preeclampsia, caesarean section, operative vaginal delivery and post-partum haemorrhage). Higher prevalence of prematurity and low birth weight in infants born to teenagers were not attributable to young maternal age after adjustment for confounding factors.

Conclusion

In our population, younger maternal age was significantly and consistently associated to greater risks of fetal death and anaemia and to lower risks of adverse obstetric outcomes.     

High environmental temperature and preterm birth: A review of the evidence

Objective

to examine the evidence in relation to preterm birth and high environmental temperature.

Background

this review was conducted against a background of global warming and an escalation in the frequency and severity of hot weather together with a rising preterm birth rate.

Methods

electronic health databases such as: SCOPUS, MEDLINE, CINAHL, EMBASE and Maternity and Infant Care were searched for research articles, that examined preterm birth and high environmental temperature. Further searches were based on the reference lists of located articles. Keywords included a search term for preterm birth (preterm birth, preterm, premature, <37 weeks, gestation) and a search term for hot weather (heatwaves, heat-waves, global warming, climate change, extreme heat, hot weather, high temperature, ambient temperature). A total of 159 papers were retrieved in this way. Of these publications, eight met inclusion criteria.

Data extraction

data were extracted and organised under the following headings: study design; dataset and sample; gestational age and effect of environmental heat on preterm birth. Critical Appraisal Skills Programme (CASP) guidelines were used to appraise study quality.

Findings

in this review, the weight of evidence supported an association between high environmental temperature and preterm birth. However, the degree of association varied considerably, and it is not clear what factors influence this relationship. Differing definitions of preterm birth may also add to lack of clarity.

Key conclusions

preterm birth is an increasingly common and debilitating condition that affects a substantial portion of infants. Rates appear to be linked to high environmental temperature, and more especially heat stress, which may be experienced during extreme heat or following a sudden rise in temperature. When this happens, the body may be unable to adapt quickly to the change. As global warming continues, the incidence of high environmental temperature and dramatic temperature changes are also increasing. This situation makes it important that research effort is directed to understanding the degree of association and the mechanism by which high temperature and temperature increases impact on preterm birth. Research is also warranted into the development of more effective cooling practices to ameliorate the effects of heat stress. In the meantime, it is important that pregnant women are advised to take special precautions to avoid heat stress and to keep cool when there are sudden increases in temperature.     

The effects of gestational transient thyrotoxicosis on the perinatal outcomes: a case–control study

Purpose

To study the effects of gestational transient thyrotoxicosis (GTT) on pregnancy outcomes.

Methods

This case–control study retrospectively analyzed 7976 women with singleton pregnancies whose thyroid function was measured before 16 weeks of gestation and who delivered at ≥22 weeks of pregnancy. GTT was defined as hyperthyroidism (free thyroxine [FT4] level: ≥95th percentile) in the early pregnancy, which normalized in mid-pregnancy without thyroid-stimulating hormone receptor antibodies. Using data extracted from electronic records, we examined the association between GTT and the pregnancy outcomes (preterm delivery, gestational age at delivery, pregnancy induced hypertension (PIH), preeclampsia, placental abruption, caesarian section, birth weight, low birth weight, Apgar score, cord pH, stillbirth at gestational week ≥22, and neonatal death). We classified the cases into quartiles according to their FT4 values during the early pregnancy and investigated the association with the gestational age at delivery.

Results

Two hundred and eight cases of GTT and 6317 cases with normal thyroid assessments were reviewed. GTT was associated with hyperemesis gravidarum, but not with stillbirth, preterm delivery, PIH, preeclampsia, placental abruption, or low birth weight. The gestation period was shorter in patients with GTT than in those with a normal thyroid function (38.69 ± 1.79 vs. 39.07 ± 1.64 weeks, p < 0.01). Higher FT4 levels during the early pregnancy were associated with earlier delivery (p = 0.02).

Conclusions

GTT was associated with a lower gestational age at delivery but not with adverse pregnancy outcomes. There was a negative correlation between the FT4 values in the early pregnancy and the gestational period.

     

The possible preterm birth preventive effect of ampicillin during pregnancy

Objective: To study the possible association between oral ampicillin treatment during pregnancy and pregnancy complications, in addition to birth outcomes, particularly preterm birth. Methods: We evaluated newborn infants without congenital abnormalities born to mothers with or without ampicillin treatment during pregnancy in the population-based large data set of the Hungarian Case-Control Surveillance of Congenital Abnormalities. Results: Of 38,151 newborn infants, 2,630 (6.9%) had mothers with ampicillin treatment during pregnancy. Some pregnancy complications, particularly preeclampsia, showed a higher prevalence in pregnant women with ampicillin treatment. Mean gestational age was slightly longer (0.2 week) but it resulted in a significant reduction in the prevalence of preterm birth (7.1 vs 9.3%; adjusted POR with 95% CI: 0.8, 0.7–0.9). The preterm birth preventive effect of ampicillin was most obvious after the use of the drug in the first trimester of pregnancy. Similar difference was not seen in the reduction of low birth weight. The rate of preterm birth was lower in newborn infants born to mothers with acute infectious diseases of both the genitourinary and respiratory systems if they were treated by ampicillin. Conclusions: Ampicillin treatment, particularly in the first trimester of gestation, can reduce the proportion of preterm birth in pregnant women with acute infectious diseases of the genitourinary and respiratory system.     

Exposure to life-threatening stressful situations and the risk of preterm birth and low birth weight

Objective

To evaluate the association between exposure to life-threatening rocket attacks and the risks of preterm birth (PTB) and low birth weight (LBW).

Methods

The present retrospective cohort study compared the outcomes of 1851 births by women exposed to rocket attacks and 2979 births by unexposed women. The timing, frequency, and intensity of exposure were calculated for each trimester and for the entire pregnancy period. Demographic and medical data were abstracted from the patients’ records.

Results

The rates of PTB and LBW were higher among exposed than unexposed women (PTB: 9.1% versus 6.8%, P = 0.004; LBW: 7.6% versus 5.8%, P = 0.02). The rate of infants who were small for gestational age did not differ between the groups. After controlling for potential confounders, the risks for PTB and LBW remained significantly higher in the exposed group (PTB: adjusted odds ratio 1.3 [95% confidence interval, 1.1–1.7]; LBW: adjusted odds ratio 1.3 [95% confidence interval, 1.03–1.7]). There was no linear association between the intensity of exposure and the risk of PTB or LBW.

Conclusion

Maternal exposure to intermittent but repeated life-threatening rocket attacks for a prolonged period might be associated with increased risks of PTB and LBW.     

Association between maternal panic disorders and pregnancy complications and delivery outcomes

BACKGROUND: The objective of the study was to evaluate the possible association between panic disorders during pregnancy and pregnancy complications, as well as birth outcomes: gestational age and birth weight, as well as preterm birth/low birthweight in newborns. METHODOLOGY: Comparison of newborn infants (without any defects) born to mothers with or without panic disorder in the population-based large data set of the Hungarian Case-Control Surveillance System of Congenital Abnormalities. Main outcome measures were medically recorded pregnancy complications, as well as gestational age and birth weight, proportion of preterm birth and low birthweight. PRINCIPAL FINDINGS: Of 38,151 controls, 187 (0.5%) had mothers with panic disorders during pregnancy. Among pregnancy complications, anemia and polyhydramnion showed a higher prevalence in women with panic disorder. There was a higher proportion of males among newborn infants born to mothers with panic diseases compared to newborn infants of mothers without panic disorders. Pregnant women with panic disorders had a shorter (0.4 week) gestational age (adjusted t = 2.3; p = 0.02) and a larger proportion of preterm births (17.1% versus 9.1%) (adjusted POR with 95% CI = 1.9, 1.3-2.8). However, there was no significant difference in the mean birth weight and rate of low birthweight between the two study groups. CONCLUSION: Panic disorders during pregnancy were associated with anemia, a shorter gestational age and a larger proportion of preterm birth. Further studies are needed to confirm and explain or disprove the male excess among newborn infants born to mothers with panic disorders.     

Identifying risk factors for very preterm birth: A reference for clinicians

Objective

to provide an accessible list of individual and population-based risk factors associated with very preterm birth to assist care providers in planning appropriate pregnancy care.

Design

a population-based case-control study.

Setting

Victoria, Australia.

Participants

women were recruited from April 2002 to 2004. Cases had a singleton birth between 20 and 31+6 weeks gestation and controls were a random selection of women having a birth of at least 37 weeks gestation in the same time period as the cases.

Measurements and findings

structured interviews were conducted within a few weeks postpartum with 603 cases and 796 controls. Data were collected on sociodemographic factors; obstetric and gynaecological history; and maternal health problems, both pre-existing and occurring during the index pregnancy. Risk factors were calculated.

Key conclusions

when correlated, risk factors were grouped as either lifestyle or maternal health factors. The majority of the risks were obstetric or gynaecological factors. Risks occurring in pregnancy may precipitate preterm birth.

Implications for practice

knowing the risk factors for very preterm birth is likely to be helpful for pregnancy care providers. The development of a risk factor checklist based on the findings presented here may enable more informed planning of care and timely intervention.     

Mycoplasma genitalium and preterm delivery at an urban community health center

Objective

To determine the prepartum prevalence of cervical Mycoplasma genitalium colonization and evaluate prospectively whether colonization is associated with preterm delivery among women from a racial/ethnic minority background with a high risk of delivering a low birth weight newborn and a high prevalence of sexually transmitted infections.

Methods

In a prospective cohort study at an urban community health center in Roxbury, MA, USA, 100 women receiving routine prenatal care for singleton pregnancies were enrolled between August 2010 and December 2011. Endocervical samples were tested for M. genitalium, and delivery data were collected.

Results

The prevalence of M. genitalium colonization at the first prenatal visit was 8.4%. The incidence of low birth weight was 16.7%. The incidence of preterm delivery among women who were known to have a live birth was 16.7%. The incidence of preterm delivery did not differ with respect to M. genitalium colonization. The crude odds ratio for preterm delivery among women with M. genitalium colonization versus those without was 1.27 (95% confidence interval, 0.02–14.78).

Conclusion

M. genitalium colonization was not associated with preterm delivery among women with a high incidence of low birth weight newborns and preterm delivery, and a high prevalence of sexually transmitted infections.     

Fetal growth in women with homozygous sickle cell disease: an observational study

Objectives

To assess fetal growth and whether lower birthweight to mothers with homozygous sickle cell (SS) disease is related to maternal body composition or to clinical events in pregnancy.

Study design

A prospective study of 41 pregnant women with SS disease and 41 women with a normal (AA) phenotype attending the antenatal clinic, University Hospital of the West Indies, Kingston, Jamaica. Maternal anthropometry, body composition and fetal sonographic measurements were assessed at 15, 25, and 35 weeks’ gestation from December 2005 to April 2008. Birth measurements were performed within 24 h of delivery. Differences between maternal genotypes and between their offspring were assessed using 2-sample t-tests. Multiple linear regression was used to control for baby's gender and gestational age at delivery. Fetal growth was compared in SS mothers with and without admission for sickle-related complications including bone pain crisis, acute chest syndrome, pregnancy-induced hypertension and urinary tract infection.

Results

Mothers with SS disease had lower weight, body fat, fat mass and lean body mass throughout pregnancy but correlation with birth size did not reach statistical significance. Sonographically, babies of SS mothers had smaller abdominal circumference, femoral length and a lower estimated fetal weight at 35 weeks. Birth measurements confirm lower birthweight, crown–heel length and head circumference but the differences were no longer significant after adjustment for baby gender and gestational age at delivery. Bone pain crisis in pregnancy was associated with a significantly reduced crown–heel length at birth.

Conclusion

Lower birthweight in babies of mothers with SS disease is largely the result of the lower gestational age. Fetal sonography showed no growth differences by maternal genotype until 35 weeks’ gestation and a reduced crown–heel length in offspring of SS mothers was associated with bone pain crises in pregnancy.