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1.
Psychosocial stress has been identified as a potential risk factor for preterm birth. However, an association has not been found consistently, and a consensus on the extent to which stress and preterm birth are linked is still lacking. A literature search was performed with a combination of keywords and MeSH terms to detect studies of psychosocial stress and preterm birth. Studies were included in the review if psychosocial stress was measured with a standardized, validated instrument and if the outcomes included either preterm birth or low birthweight. Within the 138 studies that met inclusion criteria, 85 different instruments were used. Measures that had been designed specifically for pregnancy were used infrequently, although scales were sometimes modified for the pregnant population. The many different measures that have been used may be a factor that accounts for the inconsistent associations that have been observed.  相似文献   

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Objective: To examine long-term psychosocial distress in women with a history of early onset preeclampsia (PE) compared to a comparison group. Methods: Women with and without a history of early onset PE participating in the ‘Preeclampsia Risk EValuation in FEMales’ (PREVFEM) study were sent questionnaires, on average 14.1 years (SD?=?3.2, range 5–23 years) after the index pregnancy. In total 265 (77%) women with PE and 268 (78%) age-matched women without PE returned questionnaires (mean age 43.5, SD =4.6 years). Group differences were examined on indicators of psychosocial distress, depressive symptoms, anxiety, fatigue, loneliness, marital quality, trait optimism and Type D personality, and unadjusted and adjusted for a priori chosen and study-specific covariates. In secondary analyses, the effect of previously detected hypertension was examined, as well as pregnancy-related events within the PE group. Results: Women with a history of PE reported more subsequent depressive symptoms (B?=?0.70, 95% CI 0.09–1.32, p?=?0.026) and more fatigue (B?=?1.12, 95% CI 0.07–2.18, p?=?0.037) compared to the non-PE group, but the differences explained less than 1% of the variance. The differences remained after adjustment for age, BMI and education level, and additional adjustment for partner, being unemployed and physical activity. No significant differences were observed for anxiety, loneliness, marital quality, optimism, or Type D personality. These differences were not explained by four-year previously measured elevated blood pressure in the PE group. Having had a stillborn child or early neonatal death during the index pregnancy was associated with higher depressive symptoms, anxiety, fatigue, and loneliness in the PE group, but these factors explained only a small proportion of the variance in these psychosocial distress factors. Conclusion: A history of early PE is associated with slightly higher levels of depressive symptoms and fatigue on average 14 years later, but this is unlikely to be of clinical relevance.  相似文献   

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Objective: This study was designed to characterize and compare the maternal and newborn epidemiological characteristics through analysis of environmental factors, sociodemographic characteristics and clinical characteristics between the different clinical subtypes of preterm birth (PTB): Idiopathic (PTB-I), premature rupture of the membranes (PTB-PPROM) and medically indicated (PTB-M). The two subtypes PTB-I and PTB-PPROM grouped are called spontaneous preterm births (PTB-S).

Methods: A retrospective, observational study was conducted in 1.291 preterm nonmalformed singleton live-born children to nulliparous and multiparous mother’s in Tucumán-Argentina between 2005 and 2010. Over 50 maternal variables and 10 newborn variables were compared between the different clinical subtypes. The comparisons were done to identify heterogeneity between subtypes of preterm birth: (PTB-S) versus (PTB-M), and within spontaneous subtype: (PTB-I) versus (PTB-PPROM). In the same way, two conditional logistic multivariate regressions were used to compare the odds ratio (OR) between PTB-S and PTB-M, as well as PTB-I and PTB-PPROM. We matched for maternal age when comparing maternal variables and gestational age when comparing infant variables.

Results: The PTB-I subtype was characterized by younger mothers of lower socio-economic status, PTB-PPROM was characterized by environmental factors resulting from inflammatory processes, and PTB-M was characterized by increased maternal or fetal risk pregnancies.

Conclusions: The main risk factor for PTB-I and PTB-M was having had a prior preterm delivery; however, previous spontaneous abortion was not a risk factor, suggesting a reproductive selection mechanism.  相似文献   

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Abstract

Objective.?Maternal hemoglobin concentration is inversely related to newborn size presumably through plasma volume constriction. We sought to determine whether birth weight would show an inverse relationship to hemoglobin concentration in a group of infants whose mothers had preeclampsia, where plasma volume constriction is common.

Methods.?Electronic and paper chart review identified 142 nulliparous women with preeclampsia (excluding hemolysis, elevated liver enzymes, low platelets syndrome). Birth weight percentile was determined based on cross-sectional hybrid growth curves. Maximal third trimester maternal hemoglobin concentrations were obtained and standardised to z-scores based on gestational age matched normative data. Birth weight percentile was examined as a function of hemoglobin z-score using appropriate statistics.

Results.?Average gestational age at delivery was 35.9?±?1.9 weeks. Mean birth weight percentile for infants of preeclamptic mothers was 34?±?32. Mean hemoglobin z-score for mothers with preeclampsia was 0.3?±?1.5, significantly higher than a control population (p?=?0.04). Maternal hemoglobin z-score was inversely associated with birth weight percentile (r?=??0.18, p?=?0.03).

Conclusion.?Maternal hemoglobin concentrations are significantly elevated prior to delivery in women with preeclampsia. There is a statistically significant inverse correlation of maternal hemoglobin concentration to birth weight percentile.  相似文献   

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先兆子痫致早产在单-双胎妊娠中的母儿结局分析   总被引:1,自引:0,他引:1  
目的 探讨重度妊高征先兆子痫致医源性早产在单胎妊娠和双胎妊娠中的母儿结局。方法 回顾性总结北京大学第一医院 1993年 1月~ 2 0 0 2年 12月间收治的孕周小于 37周的 12 2例单胎妊娠和 11例双胎妊娠的先兆子痫孕妇的妊娠结局。以单、双胎妊娠分为两组比较其发病情况、疾病进展、母儿并发症及结局。采用SAS软件进行计算机统计分析。结果 双胎妊娠与单胎妊娠发生妊高征及先兆子痫的差异无显著性 (P >0 0 5 )。双胎孕妇期待治疗时间明显短于单胎孕妇 (P <0 0 5 ) ,两组孕妇的母儿并发症及围产儿死亡率差异无显著性 (P >0 0 5 )。结论 双胎妊娠与单胎妊娠易发生妊高征及先兆子痫的可能性相同。如果双胎妊娠合并先兆子痫孕妇在积极控制病情 ,促胎肺成熟的同时及时终止妊娠 ,其母儿并发症及围产儿死亡率与单胎妊娠合并先兆子痫的母儿并发症及围产儿死亡率相同。  相似文献   

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Objective

The aim of this study was to identify maternal risk factors for spontaneous preterm birth (PTB) compared to delivery at term, in order to recognize high risk women and to provide a global overview of the Italian situation.

Study design

A multicenter, observational and retrospective, cross-sectional study was designed. The study population comprised 7634 women recruited in 9 different University Maternity Hospitals in Italy. The main criteria for inclusion were: women having had vaginal preterm or term spontaneous delivery in each participating centre during the study period. The records related to deliveries occurring between April and December 2008. A multivariable logistic regression was employed to identify independent predictors of spontaneous preterm birth. Odds ratios (ORs) and 95% confidence intervals (95% CI) were reported with two-tailed probability (p) values. Statistical calculations were carried out using SAS version 9.1. A two-tailed p-value of 0.05 was used to define statistical significant results.

Results

A significant increased risk of PTB was found in women with BMI > 25 (OR = 1.662; 95% CI = 1.033–2.676; p-value = 0.0365) and in women employed in heavy work (OR = 1.947; 95% CI = 1.182–3.207; p-value = 0.0089). Moreover there was a significant association between PTB and previous reproductive history. In fact a history of previous abortion (OR = 1.954; 95% CI = 1.162–3.285; p-value = 0.0116) or previous cesarean section (OR = 2.904; 95% CI = 1.066–7.910; p-value = 0.0371) was positively correlated to the increased risk of PTB and an important statistically significant association was calculated between PTB and previous pre-term delivery (OR = 3.412; 95% CI = 1.342–8.676; p-value = 0.0099). All the other covariates examined as potential risk factors for PTB were not found to be statistically significantly related (p-value > 0.05).

Conclusions

The present study, applied to a substantial sample of Italian population, demonstrates that there are peculiar risk factors for spontaneous PTB in the Italian population examined. It shows an association between preterm delivery and certain maternal factors as: BMI, employment, previous abortions, previous PTBs and previous cesarean section.  相似文献   

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Objective: Moderate fish intake in early pregnancy is associated with decreased risk of preterm birth (PTB). Obesity during pregnancy is characterized by inflammation and insufficiency of essential fatty acids. The objective of this study was to measure the association between fish intake during pregnancy and risk of recurrent spontaneous (s) PTB among lean, overweight, and obese women.

Design: This is secondary analysis of a randomized controlled trial of omega-3 fatty acid supplementation for recurrent PTB prevention, 2005–2006. The primary exposure was fish intake at time of enrollment (16–22.9-week gestation). The primary outcomes were sPTB <37 weeks and sPTB <35 weeks. Maternal prepregnancy body mass index was treated as an effect modifier.

Subjects: Eight hundred and fifty-two women were included, 47% were lean, 25% overweight, and 28% obese.

Results: In this cohort, among lean, but not overweight or obese women, ≥1 serving of fish per week was associated with decreased frequency of sPTB <37 weeks compared with <1 serving of fish per week (45.1% versus 27.5%, p?=?.001) and spontaneous PTB <35 (21.4% versus 11.6%, p?=?.01). In adjusted models, as fish intake increased, the predicted probability of sPTB decreased in lean women but increased in overweight and obese women (p for interaction?Conclusion: Fish intake was associated with lower probability of sPTB in lean women and higher probability in obese women. These findings warrant further investigation to understand the dietary or metabolic factors associated with obesity that may modulate benefit of fish intake during pregnancy.  相似文献   

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BACKGROUND: [corrected] There is evidence that maternal exposure to ambient air pollution during pregnancy is associated with adverse birth outcomes. OBJECTIVE: To assess preterm birth (PTB) in relation to maternal exposure to ambient air pollution. DESIGN: Retrospective cohort. SETTING: Brisbane, Australia. POPULATION: A total of 28,200 singleton live births for the period of 1 July 2000 to 30 June 2003. METHODS: Average maternal exposure estimates for ambient particulate matter (PM(10) and bsp), ozone (O(3)) and nitrogen dioxide were calculated over the first 3 months after last menstrual period (LMP) and the last 3 months prior to birth (individually and combined as trimesters). MAIN OUTCOME MEASURES: PTB was defined as gestation <37 weeks and odds ratios (OR) were calculated for PTB per interquartile range increase in the maternal exposure estimate for each pollutant. Various covariates were controlled for, including season of birth. RESULTS: Exposure to PM(10) and O(3) during trimester one was associated with an increased risk of PTB (OR = 1.15, 95% CI 1.06-1.25 and OR = 1.26, 95% CI 1.10-1.45, respectively). The PM(10) exposure effect associated with trimester one was strongly related to exposure during the first month post-LMP (PM(10), month one; OR = 1.19, 95% CI 1.13-1.26). CONCLUSION: These results suggest that maternal exposure to low levels of ambient air pollution is associated with PTB.  相似文献   

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Objective: Examine the association of mothers’ psychosocial stressors before and during pregnancy with their children’s diagnosis of attention deficit hyperactivity disorder (ADHD).

Methods: This study included 2140 mother–child pairs who had at least one postnatal pediatric visit at the Boston Medical Center between 2003 and 2015. Child ADHD was determined via International Classification of Diseases, Ninth Revision (ICD-9) codes documented in electronic medical records. Latent factors of maternal stress and social support and measures of the physical home environment and psychosocial adversities were constructed using exploratory factor analysis. The association between the latent factors and child ADHD diagnosis was examined using multiple logistic regression, controlling for known risk factors for ADHD.

Results: Children were 1.45 (95% CI: 1.06, 1.99) and 3.03 (95% CI: 2.19, 4.20) times more likely to receive an ADHD diagnosis if their mother experienced a major stressful event during pregnancy or reported a high level of perceived stress, respectively. The number of family adversities increases the risk of ADHD diagnosis [second quartile: OR?=?1.90; CI (1.31, 2.77); third quartile: OR?=?1.96?CI (1.34, 2.88); fourth quartile: OR?=?2.89?CI (2.01, 4.16)] compared to first quartile.

Conclusions: In this prospective, predominantly urban, low-income, minority birth cohort, mothers’ psychosocial stress before and during pregnancy appears to be an independent risk factor for the development of ADHD in their children.  相似文献   


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Epidemiological studies have reported an inconsistent relationship between maternal lipid levels and preterm birth (PTB). We performed this meta-analysis to evaluate the association between maternal dyslipidemia and PTB. Overall, three nested case-control studies and eight cohort studies were eligible. Effect estimates [odds ratio(OR)/relative risk] were pooled using a fixed-effects or a random-effects model. Subgroup and metaregression analyses were conducted to evaluate the sources of heterogeneity. Eleven studies involving 13,025 pregnant women were included. Compared with pregnant women with normal lipid levels, the women with elevated levels of lipids had an increased risk of PTB, and the pooled OR was 1.68 [95% confidence interval (CI): 1.25–2.26)]; meanwhile, women with lower levels of lipids also had a trend of an increased risk of PTB (OR = 1.52, 95% CI = 0.60–3.82). The pooled ORs for elevated levels of total cholesterol, triglycerides, low density lipoprotein-cholesterol, and lower levels of high density lipoprotein-cholesterol were 1.71 (95% CI: 1.05–2.79), 1.55 (95% CI: 1.13–2.12), 1.19 (95% CI: 0.95–1.48), and 1.33 (95% CI: 1.14–1.56), respectively. The present meta-analysis found that maternal dyslipidemia during pregnancy, either the elevated total cholesterol or triglycerides, was associated with an increased risk of PTB. These findings indicate that a normal level of maternal lipid during pregnancy may reduce the risk of PTB.  相似文献   

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Background: A recent large meta-analysis concluded that prior surgical abortion was an independent risk factor for spontaneous preterm birth (PTB), while they found no significant correlation between PTB and medical abortion.

Objective: To evaluate the potential impact of changes in US abortion rates and practices on US incidence of PTB rate.

Study design: This was an epidemiologic analysis of legal abortion and PTB data in the USA from 2003 to 2012. Birth data (annual total birth, annual number and incidence of PTB, defined as PTB <37 weeks) are from National Vital Statistics Reports from the National Center for Health Statistics, Center of Disease Control and Prevention (CDC). Abortion data were collected using Abortion Surveillance provided by the CDC. Abortion incidence was reported overall, and by type: surgical, medical method and procedures reported as “other” such as intrauterine instillation and hysterectomy/hysterotomy. To test for the trend of abortion and of PTB over time, we used the chi-squared test for trend. The primary outcome of our study was the correlation trend analysis between abortion rate and PTB rate. Pearson correlation test was used. A two-tailed p value of 0.05 or less was considered significant.

Results: From 2003 to 2012 there were 41 206 315 births in USA, of which 5 042 982 (12.2%) were <37 weeks. The PTB rate declined significantly from 12.3% in 2003 to 11.5% in 2012 (p value test for trend <.04). Out of the 6 122 649 legal abortions, reported by type of procedure, performed from 2003 to 2012 in USA, 5 132 789 were surgical abortion (82.8%) and 860 288 (14.0%) were medical. Chi-squared test for trend showed that the rate of surgical abortion significantly decreased from 88.9 to 78.0% (p?p?p?=?.01) and of surgical abortion (p?=?.02) over time. The higher the surgical abortion rate, the higher the incidence of PTB (Pearson correlation 0.712); the higher the medical abortion rate, the lower the incidence of PTB (Pearson correlation ?0.731).

Conclusion: Recent changes in abortion practices may be associated with the current decrease in US incidence of PTB. Further study on the effect of surgical versus medical abortion is warranted regarding a possible effect on the incidence of PTB.  相似文献   

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泌尿生殖道感染是诱发早产的重要因素,无论何种泌尿生殖道感染,都有增加早产的风险。泌尿生殖道感染导致早产的机制尚不十分清楚,可能与免疫系统稳态的失衡、前列腺素分泌增加以及基因的多态性相关。早期筛查感染能否降低早产的发生率,不同的学者说法不一。但是,对早产高危人群,尽早进行泌尿生殖道感染的筛查对预防早产的益处是肯定的。  相似文献   

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Objective: To present the outcome of expectant management of preterm preeclampsia in Indonesia, and the effect of ongoing treatment with methylprednisolone (MP) on maternal and perinatal outcome.

Material and methods: Prospective RCT on 48 patients with early-onset preeclampsia. Following the administration of dexamethasone for fetal lung maturation, patients were randomized to receive 25?mg MP group IV for the first week, decreasing to 12.5?mg during 2nd week and continued till birth, or matching IV placebo treatment (PL group). Prolongation of entry to delivery interval served as primary outcome measurement.

Results: The average time gained with expectant management was almost 14 days. However, there was no difference of mean time interval between entry to delivery between the PL (13.8 days) and MP (13.7 days) groups. Antenatal ongoing treatment with IV MP also did not improve maternal and/or perinatal outcome and might be associated with a higher risk for severe maternal infections – in particular tuberculosis.

Conclusion: Expectant management of preterm preeclampsia is a realistic option in a major Indonesian perinatal referral center. Steroids (outside the use for fetal lung maturation) should not be used in the expectant management of preterm preeclampsia in Indonesia.  相似文献   

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