Pregnancy Intendedness,Maternal Psychosocial Factors and Preterm Birth

Objectives: This study examined associations between reported pregnancy intendedness and several maternal psychosocial factors in relation to preterm birth (<37 weeks' completed gestation). Methods: Women were recruited into a prospective cohort study between the 24th and 29th weeks of pregnancy in central North Carolina from 1996 to 2000. Prior to delivery, participants responded to questions about pregnancy intendedness, life events impacts, depressive symptoms, and coping style. Results: Women who reported not intending their pregnancy had increased odds of reporting low, medium and high levels of perceived stress during pregnancy (OR = 1.4 [95% CI: 1.1, 1.9], OR = 2.2 [95% CI: 1.7, 2.8], and OR = 3.4 [95% CI: 2.6, 4.5], respectively, relative to very low), medium and high levels of depressive symptoms (OR = 2.2 [95% CI: 1.8, 2.9] and OR = 3.1 [95% CI: 2.4, 3.9], respectively), and medium and high levels of several coping styles. Reporting not intending the pregnancy was not associated with increased risk of preterm birth (Risk Ratio [RR] = 1.0, 95% CI: 0.8, 1.1), but reporting the highest quartile of perceived stress (RR = 1.6, 95% CI: 1.1, 2.3) and the highest tertile of distancing coping style (compared with lowest quartile) was associated with preterm birth (RR = 1.4, 95% CI: 1.1, 1.9). Interactions between pregnancy intendedness and the psychosocial variables perceived stress, depression or coping style did not modify the psychosocial variable's associations with preterm birth. Conclusions: Pregnancy intendedness remains an important concept in the reproductive health literature integrally tied to indicators of maternal mental health, but not necessarily to pregnancy outcomes.     

大气污染对低出生体重和早产影响的Meta分析

目的 研究各主要大气污染物对低出生体重(LSW)和早产的影响.方法 通过计算机检索收集国内外1999-2009年公开发表的有关大气污染对不良妊娠结局影响的相关文献14篇,按照制定的纳入排除标准对文献进行筛选,利用Stata9.0的Meta模块对人选文献进行异质性检验和相应的效应值合并.采用Meta分析获得的合并OR值作为最终的合并效应值.结果 建立各主要污染物与低出生体重和早产的暴露.反应关系,其中PM10浓度每升高50μg/m3,所对应的低出生体重及早产发生的合并OR值分别为1.07(95%CI:1.024～1.119,P＜0.01)、1.217(95%CI:1.045～1.415,P＜0.05);SO2浓度每升高43λg/m3(15 ppb),所对应的低出生体重或早产发生的合并OR值分别为1.137(95%CI:1.047～1.235,P＜0.05)、1.163(95%CI:1.082～1.250,P＜0.01);NO2每升高21μg/m3(10 ppb),所对应的低出生体重发生的合并OR值为1.03(95%CI:1.008～1.054,P＜0.01);CO每升高1.25 mg/m3(1 ppm),所对应的低出生体重发生的合并OR值为1.066(95%C1:1.016～1.117,P＜0.01);NO2以及CO对早产影响的合并效应值无统计学意义(P＞0.05).结论 本研究综合定量分析的结果 表明,大气污染能够增加低出生体重和早产发生的危险,妊娠期妇女有必要采取有效的措施减少大气污染的暴露.     

Racial/Ethnic Inequities in Low Birth Weight and Preterm Birth: The Role of Multiple Forms of Stress

Introduction Racial/ethnic inequities in low birth weight (LBW) and preterm birth (PTB) persist in the United States. Research has identified numerous risk factors for adverse birth outcomes; however, they do not fully explain the occurrence of, or inequalities in PTB/LBW. Stress has been proposed as one explanation for differences in LBW and PTB by race/ethnicity. Methods Using the Pregnancy Risk Assessment Monitoring System (PRAMS) data from 2012 to 2013 for 21 states and one city (n?=?15,915) we used Poisson regression to estimate the association between acute, financial and relationship stressors and LBW and PTB, and to examine the contribution of these stressors individually and simultaneously to racial/ethnic differences in LBW and PTB. Results Adjusting for age and race/ethnicity, acute (p?<?0.001), financial (p?<?0.001) and relationship (p?<?0.05) stressors were associated with increased risk of LBW, but only acute (p?<?0.05) and financial (p?<?0.01) stress increased risk of PTB. Across all models, non-Hispanic blacks had higher risk of LBW and PTB relative to non-Hispanic whites (IRR 1.87, 95% CI 1.55, 2.27 and IRR 1.46, 95% CI 1.18, 1.79). Accounting for the effects of stressors attenuated the risk of LBW and PTB by 17 and 22% respectively, but did not fully explain the increased likelihood of LBW and PTB among non-Hispanic blacks. Discussion Results of this study demonstrate that stress may increase the risk of LBW and PTB. While stressors may contribute to racial/ethnic differences in LBW and PTB, they do not fully explain them. Mitigating stress during pregnancy may help promote healthier birth outcomes and reduce racial/ethnic inequities in LBW and PTB.     

The Association Between Major Birth Defects and Preterm Birth

Objective To evaluate the association between preterm birth and major birth defects by maternal and infant characteristics and specific types of birth defects. Study Design We pooled data for 1995–2000 from 13 states with population-based birth defects surveillance systems, representing about 30% of all U.S. births. Analyses were limited to singleton, live births from 24–44 weeks gestational age. Results Overall, birth defects were more than twice as common among preterm births (24–36 weeks) compared with term births (37–41 weeks gestation) (prevalence ratio [PR] = 2.65, 95% confidence interval [CI] 2.62–2.68), and approximately 8% of preterm births had a birth defect. Birth defects were over five times more likely among very preterm births (24–31 weeks gestation) compared with term births (PR = 5.25, 95% CI 5.15–5.35), with about 16% of very preterm births having a birth defect. Defects most strongly associated with very preterm birth included central nervous system defects (PR = 16.23, 95% CI 15.49–17.00) and cardiovascular defects (PR = 9.29, 95% CI 9.03–9.56). Conclusions Birth defects contribute to the occurrence of preterm birth. Research to identify shared causal pathways and risk factors could suggest appropriate interventions to reduce both preterm birth and birth defects.     

Maternal Chlamydia trachomatis Infections and Preterm Birth: The Impact of Early Detection and Eradication During Pregnancy

The risks for preterm birth are heterogeneous and there remains much to elucidate regarding etiology of this adverse perinatal outcome. Antenatal infection with Chlamydia trachomatis, a highly prevalent sexually-transmitted infection, may convey a higher risk of preterm birth. Early detection and eradication of this sexually-transmitted infection without recurrent/persistent infection during pregnancy may serve as an intervention that reduces the risk of preterm birth. The objective of this study was to characterize the association between early antenatal detection and eradication of maternal C. trachomatis infection and the likelihood of preterm birth among pregnant women in an urban county. A retrospective cohort study was conducted in Hamilton County, Ohio (2006–2011) to evaluate the risk of preterm birth among women with maternal C. trachomatis infections detected and eradicated at or before 20 weeks gestation—the intervention group. Infected women whose infections were detected after 20 weeks gestation or persistent during the pregnancy represented the reference group. The study population contained 3,354 pregnant women with documented C. trachomatis infections. The relative risk for moderate to late spontaneous preterm birth (32–36 weeks gestation) was 0.54 (95 % CI 0.37–0.80) for women in the intervention group who were 19 years of age and younger. Pregnant adolescents benefited the most from early detection and eradication of antenatal C. trachomatis infections through a reduction in the risk of PTB at 32–36 weeks gestation. This finding suggests the importance of early antenatal detection and effective treatment of C. trachomatis.     

Stress and Preterm Birth: Neuroendocrine,Immune/Inflammatory,and Vascular Mechanisms

A growing literature suggests that maternal psychological and social stress is a significant and independent risk factor for a range of adverse reproductive outcomes including preterm birth. Several issues remain to be addressed about stress and vulnerability to stress during pregnancy. Of these, perhaps one of the most important questions relates to biologic plausibility. Parturition, the process that results in birth, is a biological phenomenon. Very little empirical research to date, however, has examined the role of biological processes, if any, as mediators of the relationship between stress and preterm birth. In this paper we discuss the maternal, placental, and fetal neuroendocrine, immune/inflammatory, and vascular processes that may bridge the experience of social adversity before and during pregnancy and the biological outcome of preterm birth.     

Choriodecidual Infection and Preterm Birth

Of all U.S. births, 11% occur preterm. These infants are responsible for the majority of perinatal mortality and morbidity. Infants at highest risk are those born weighing < 1000 g and those born at < 28 weeks gestation. Recent evidence suggests that the majority of these preterm births are caused by bacterial infections of the chorioamnion, with the organisms originating in the vagina. The mechanisms leading to preterm labor and rupture of membranes involve an inflammatory response involving increased production of cytokines, prostaglandins, and metalloproteases. Results of treatment trials to eradicate the infection and reduce preterm birth have been mixed.     

空气污染对早产和低出生体重影响的流行病学研究现况

空气污染对不良妊娠结局的影响研究日益被国内外的专家所关注,空气污染物与早产和低出生体重的研究有待进一步开展。该文就近年来有关空气污染物(可吸入颗粒物、细颗粒物、CO、NO2、SO2等)对早产和低出生体重影响的流行病学研究进行了综述,为控制空气污染和减少不良妊娠结局的发生以及进一步探索其可能的机制提供有益的参考。     

Low Birth Weight and Preterm Birth Among Arab-American Women in Ohio

Maternal and Child Health Journal - There is limited evidence about prevalence and odds of adverse birth outcomes among Arab American women in the United States. We estimated the prevalence of low...     

Intention to Become Pregnant and Low Birth Weight and Preterm Birth: A Systematic Review

Increased stress, psychosocial problems, economic disadvantages, and lack of prenatal care are proposed to explain discrepancies in the outcome of unintended pregnancies. Studies of maternal intention and pregnancy outcomes have yielded varied results. Objective is to review studies of the risk of low birth weight (LBW)/preterm births (PTB) associated with unintended pregnancies ending in a live birth. We reviewed studies reporting on maternal intentions and outcomes from Medline, Embase, CINAHL, and bibliographies of identified articles. An unintended pregnancy was further classified as mistimed (not intended at that time) or unwanted (not desired at any time). Studies reporting an association between pregnancy intention and any of the outcomes were included. Study quality was assessed for biases in selection, exposure assessment, confounder adjustment, analyses, outcomes assessment, and attrition. Unadjusted and adjusted data from included studies were extracted by two reviewers. There were significantly increased odds of LBW among unintended pregnancies [odds ratio (OR) 1.36, 95% confidence interval (CI) 1.25, 1.48] ending in a live birth. Within the unintended category, mistimed (OR 1.31, 95% CI 1.13, 1.52) and unwanted (OR 1.51, 95% CI 1.29, 1.78) pregnancies were associated with LBW. There were statistically significantly increased odds of PTB among unintended (OR 1.31, 95% CI 1.09, 1.58), and unwanted (OR 1.50, 95% CI 1.41, 1.61) but not for mistimed (OR 1.36, 95% CI 0.96, 1.93) pregnancies. Unintended, unwanted, and mistimed pregnancies ending in a live birth are associated with a significantly increased risk of LBW and PTB.     

超声对宫颈检测在早产中的应用价值

目的:探讨超声检测宫颈长度及形态对妊娠分娩结局的影响,为预测早产发生提供重要参考依据。方法:经腹、会阴、阴道超声检测100例早产的孕妇的宫颈管长度及宫颈形态,比较不同长度和形态的早产率。结果:100例早产中70例宫颈长度检测,宫颈长度<25mm早产率约70%,宫颈长度在25~29mm早产率约21%,宫颈长度≥30mm早产率约9%。100例早产中30例宫颈形态检测,"T"形宫颈早产率约10%,"Y"形宫颈早产率约13%,"V"形宫颈早产率约30%,"U"形宫颈早产率约47%。结论:超声对宫颈长度及形态检测在早产中的应用价值很高。     

Acknowledging the Impact of Race and Ethnicity on Better Birth Outcomes: Celebrating the Work of Emile Papiernik

Maternal and Child Health Journal -     

Associations Between Maternal Exposure to Child Abuse,Preterm Birth,and Very Preterm Birth in Young,Nulliparous Women

Maternal and Child Health Journal - Objectives Preterm birth (PTB) is a leading cause of infant morbidity and mortality. One goal of Healthy People 2020 is to understand the role of preconception...     

Total Adverse Childhood Experiences and Preterm Birth: A Systematic Review

Maternal and Child Health Journal - Total adverse childhood experiences (ACEs) are gaining prominence as a risk factor for preterm birth (PTB). The emerging literature examining this relationship...     

Teen Maternal Age and Very Preterm Birth of Twins

Background: As teen singleton pregnancy is associated with higher risks of adverse birth outcome, and twin pregnancy, regardless of maternal age, may result in poor outcome, teens pregnant with twins may represent a particularly vulnerable group. However, little has been documented regarding teen twin pregnancy outcome. Objective: To characterize the risk of very preterm birth among teens having twins. Design: Cross-sectional analysis of the US 1995–2000 Matched Multiple Birth Data Set. Methods: We calculated the risk of very preterm birth (<33 weeks' gestation) for teen and young adult mothers of twins (≤16 years, 17–18 years, 19–20 years), compared to 21–24 year olds, stratified by race/ethnicity. Adjusted odds ratios were estimated controlling for marital status and entry into prenatal care. Results: Odds of very preterm birth decreased significantly with increasing age. Odds ratios ranged from 2.07 (1.73,2.48) to 1.20 (1.11,1.29) according to maternal age for White teen mothers, from 1.76 (1.48,2.09) to 1.13 (1.03,1.24) for Black teen mothers, and from 2.19 (1.77,2.72) to 1.15 (1.02,1.31) for Hispanic teen mothers. Odds of very preterm birth among teen mothers of twins were about the same as those for teen mothers of singletons. Conclusions: Teens having twins have higher odds of very preterm birth than young adult mothers. However, the association between age and preterm birth was similar among teen mothers having twins as for those having singletons.     

Telomere Length and Preterm Birth in Pregnant Mexican-Origin Women

Objectives

Despite the obstacles of limited education and employment opportunities—and the stress associated with immigration and pregnancy—Mexican immigrant women have low rates of preterm birth (PTB) compared to the US national average for all races and ethnicities. Stressors during pregnancy, and stressors associated with acculturation, may accelerate cellular aging manifested by shortened telomere length (TL) in pregnant women. Our objectives were to: (1) determine whether women with PTBs had shorter telomere lengths compared to women who had full term births; (2) assess the association of acculturation with TL and PTB.

Methods

This prospective pilot study collected data from 100 self-identified Mexican-origin pregnant women. Survey data included self-administered sociodemographic and acculturation measures and was collected from participants via paper and pen, while biologic data was collected via a single blood draw during a regularly scheduled prenatal visit between 26 and 36 weeks gestation. PTB data was collected from the participant’s medical record after delivery.

Results

TL was significantly associated with PTB; the median TL of the women with PTB was less than the median TL for the full sample (p?=?0.02). Based on regression analysis for PTB vs acculturation, we found no significant associations between acculturation and PTB or TL.

Conclusions for Practice

This study provides important evidence of the association between shortened maternal TL and adverse birth outcomes. By linking social, clinical and biologic data, we can enhance our understanding of social determinants that may affect racial and ethnic disparities in preterm birth.

     

The Association Between Second Hand Smoke and Low Birth Weight and Preterm Delivery

To determine the association between maternal exposure to SHS and low birth weight and preterm delivery. This cross-sectional study was carried out in the four main governmental hospitals dealing with deliveries in the north of Jordan. A consecutive 8,490 women who delivered in these hospitals between April 2007 and September 2007 were included in the study after excluding those who reported active smoking during the current pregnancy. Pre-structured questionnaire and review of hospital records were used to collect data about maternal background, obstetric history, medical history, and data related to second hand smoke exposure. Overall, 13.8% of women gave birth to a preterm baby and 10.0% gave birth to a low birth weight baby. About 12.6% of women who were exposed to SHS delivered low birth weight babies compared to 7.7% for non exposed women. The rate of preterm delivery among the exposed group was significantly higher than that among the non-exposed group (17.2 vs. 10.6%). In the multivariate analysis, exposure to SHS during pregnancy was significantly associated with increased odds of low birth weight (OR = 1.56 (95% CI 1.31, 1.89)) and preterm delivery (OR = 1.61 (95% CI: 1.30, 1.99)). Exposure of women to SHS during pregnancy is associated with increased odds of low birth weight and preterm delivery. Health care professionals should carry out educational programs to increase awareness and understanding of pregnant women and their husbands about the harmful effects of second hand smoke on birth outcomes.     

The Psychosocial Impact of Epilepsy in Childhood

Epilepsy is a chronic medical condition that affects many children The impact of epilepsy on children's psychosocial life and development are surveyed, and some of the problems faced by children and adolescents with epilepsy are identified The importance of experiencing success, developing self-respect, and learning to be independent are stressed, since these issues are important for adult success and happiness Health care workers need to know about the totality of health care needs of children with epilepsy, including medical and psychosocial factors, so they can act as advocates to help remove the barriers these children face.