Clinical risk factors for preterm birth and evaluating maternal psychology in the postpartum period

BACKGROUND Although the specific pathogenesis of preterm birth(PTB)has not been thoroughly clarified,it is known to be related to various factors,such as pregnancy complications,maternal socioeconomic factors,lifestyle habits,reproductive history,environmental and psychological factors,prenatal care,and nutritional status.PTB has serious implications for newborns and families and is associated with high mortality and complications.Therefore,the prediction of PTB risk can facilitate early intervention and reduce its resultant adverse consequences.AIM To analyze the risk factors for PTB to establish a PTB risk prediction model and to assess postpartum anxiety and depression in mothers.METHODS A retrospective analysis of 648 consecutive parturients who delivered at Shenzhen Bao’an District Songgang People’s Hospital between January 2019 and January 2022 was performed.According to the diagnostic criteria for premature infants,the parturients were divided into a PTB group(n=60)and a full-term(FT)group(n=588).Puerperae were assessed by the Self-rating Anxiety Scale(SAS)and Self rating Depression Scale(SDS),based on which the mothers with anxiety and depression symptoms were screened for further analysis.The factors affecting PTB were analyzed by univariate analysis,and the related risk factors were identified by logistic regression.RESULTS According to univariate analysis,the PTB group was older than the FT group,with a smaller weight change and greater proportions of women who underwent artificial insemination and had gestational diabetes mellitus(P<0.05).In addition,greater proportions of women with reproductive tract infections and greater white blood cell(WBC)counts(P<0.05),shorter cervical lengths in the second trimester and lower neutrophil percentages(P<0.001)were detected in the PTB group than in the FT group.The PTB group exhibited higher postpartum SAS and SDS scores than did the FT group(P<0.0001),with a higher number of mothers experiencing anxiety and depression(P<0.001).Multivariate logistic regression analysis revealed that a greater maternal weight change,the presence of gestational diabetes mellitus,a shorter cervical length in the second trimester,a greater WBC count,and the presence of maternal anxiety and depression were risk factors for PTB(P<0.01).Moreover,the risk score of the FT group was lower than that of the PTB group,and the area under the curve of the risk score for predicting PTB was greater than 0.9.CONCLUSION This study highlights the complex interplay between postpartum anxiety and PTB,where maternal anxiety may be a potential risk factor for PTB,with PTB potentially increasing the incidence of postpartum anxiety in mothers.In addition,a greater maternal weight change,the presence of gestational diabetes mellitus,a shorter cervical length,a greater WBC count,and postpartum anxiety and depression were identified as risk factors for PTB.

Evaluating the Efficacy of Cervical Tactile Ultrasound Technique as a Predictive Tool for Spontaneous Preterm Birth

Background: Premature cervical softening and shortening may be considered an early mechanical failure that predispose to preterm birth. Purpose: This study aims to explore the applicability of an innovative cervical tactile ultrasound approach for predicting spontaneous preterm birth (sPTB). Materials and Methods: Eligible participants were women with low-risk singleton pregnancies in their second trimester, enrolled in this prospective observational study. A Cervix Monitor (CM) device was designed with a vaginal probe comprising four tactile sensors and a single ultrasound transducer operating at 5 MHz. The probe enabled the application of controllable pressure to the external cervical surface, facilitating the acquisition of stress-strain data from both anterior and posterior cervical sectors. Gestational age at delivery was recorded and compared against cervical elasticity. Results: CM examination data were analyzed for 127 women at 240/7 - 286/7 gestational weeks. sPTB was observed in 6.3% of the cases. The preterm group exhibited a lower average cervical stress-to-strain ratio (elasticity) of 0.70 ± 0.26 kPa/mm compared to the term group’s 1.63 ± 0.65 kPa/mm with a p-value of 1.1 × 10−4. Diagnostic accuracy for predicting spontaneous preterm birth based solely on cervical elasticity data was found to be 95.0% (95% CI, 88.5 - 100.0). Conclusion: These findings suggest that measuring cervical elasticity with the designed tactile ultrasound probe has the potential to predict spontaneous preterm birth in a cost-effective manner.

Comparison of Perinatal Outcomes in Late Preterm Spontaneous and Indicated Preterm Birth Neonates

Objective: We aimed to compare the perinatal outcomes in late preterm spontaneous and indicated birth neonates. Methods: We studied 289 late preterm births, classified as either aspontaneous late preterm birth (sLPTB) group (preterm labor with intact membranes and preterm premature rupture of membranes) or an indicated late preterm birth (iLPTB) group (hypertensive disorder in pregnancy, placental causes, and maternal diseases), according to the delivery indication. We then compared the maternal and neonatal characteristics and perinatal outcomes, including the Apgar score, admission to the neonatal intensive care unit (NICU) or special care nursery (SCN), duration of NICU stay, and the rate of composite morbidity (antibiotic use, hypoglycemia, hypocalcemia, hyperbilirubinemia requiring phototherapy, respiratory support, and respiratory distress syndrome). Results: A total of 198 neonates were in the sLPTB group and 91 were in the iLPTB group. In spite of greater gestational age at the time of delivery in the iLPTB group, the mean birth weight was lower than that in the sLPTB group. Additionally, the iLPTB group showed lower Apgar scores, and higher rates of NICU or SCN admission, respiratory support, and hypoglycemia, but there was no difference in the rate of composite morbidity between the two groups. Conclusion: iLPTB neonates had lower birth weights despite greater gestational age than those in the sLPTB group, but there was no difference in the rate of composite morbidity between the two groups.

A Time Series Analysis of Outdoor Air Pollution and Preterm Birth in Shanghai, China

Objective To investigate the relation between air pollution exposure and preterm birth in Shanghai, China. Methods We examined the effect of ambient air pollution on preterm birth using time-series approach in Shanghai in 2004. This method can eliminate potential confounding by individual risk factors that do not change over a short period of time. Daily numbers of preterm births were obtained from the live birth database maintained by Shanghai Municipal Center of Disease Control and Prevention. We used the generalized additive model （GAM） with penalized splines to analyze the relation between preterm birth, air pollution, and covariates. Results We observed a significant effect of outdoor air pollution only with 8-week exposure before preterm births. An increase of 10 μg/m^3 of 8-week average PM10, SO2, NO2, and O3 corresponded to 4.42% （95%CI 1.60%, 7.25%）, 11.89% （95%CI 6.69%, 17.09%）, 5.43% （95%CI 1.78%, 9.08%）, and 4.63% （95%CI 0.35%, 8.91%） increase of preterm birth. We did not find any significant acute effect of outdoor air pollution on preterm birth in the week before birth. Conclusion Ambient air pollution may contribute to the risk of preterm birth in Shanghai. Our analyses also strengthen the rationale for further limiting air pollution level in the city.

Ethnic Differences in Preterm Birth Risks for Pregnant Women with Thyroid Dysfunction or Autoimmunity:A Meta-analysis

Objective Abnormal maternal thyroid function is associated with preterm birth.However,this association stays dubious in relevant individual studies for ethnic difference reasons and lack of direct supporting data.This study aimed to evaluate the relationship between preterm birth and thyroid dysfunction or autoimmunity based on ethnic differences.Methods Relevant studies were identified through searches of MEDLINE,Excerpta Medica,Wan Fang,China Biological Medicine disc,and China National Knowledge Infrastructure from inception to June 15,2016.Original articles in which an incidence or prevalence of thyroid dysfunction or autoimmunity before second trimester of pregnancy could be extracted were included.Results Thirty-two unique studies were included for the final meta-analysis.Patients involved were divided into two groups：Group 1（G1） and Group 2（G2） comprising of Asian and Caucasian populations,respectively.Positive thyroid antibodies were associated with the occurrence of preterm birth in both G1 [odds ratio（OR）：3.62,95% confidence interval（CI）：2.83-4.65] and G2（OR：1.35,95% CI：1.17-1.56）;hypothyroidism,only in G2（OR：1.20,CI：1.09-1.33）;and subclinical hypothyroidism or hypothyroxinemia,in neither group.Conclusion Thyroid autoimmunity may be a more favorable factor leading to preterm birth among pregnant women of different ethnicities,compared with thyroid dysfunction.

Risk Factors for Low Birth Weight and Preterm Birth：A Population-based Case-control Study in Wuhan,China

Low birth weight（LBW） and preterm birth（PB） are associated with newborn mortality and diseases in adulthood.We explored factors related to LBW and PB by conducting a population-based case-control study from January 2011 to December 2013 in Wuhan,China.A total of 337 LBW newborn babies,472 PB babies,and 708 babies with normal birth weights and born from term pregnancies were included in this study.Information of newborns and their parents was collected by trained investigators using questionnaires and referring to medical records.Univariate and logistic regression analyses with the stepwise selection method were used to determine the associations of related factors with LBW and PB.Results showed that maternal hypertension（OR=6.78,95% CI：2.27–20.29,P=0.001）,maternal high-risk pregnancy（OR=1.53,95% CI：1.06–2.21,P=0.022）,and maternal fruit intake ≥300 g per day during the first trimester（OR=1.70,95% CI：1.17–2.45,P=0.005） were associated with LBW.BMI ≥24 kg/m^2 of mother prior to delivery（OR=0.48,95% CI：0.32–0.74,P=0.001） and gestation ≥37 weeks（OR=0.01,95% CI：0.00–0.02,P〈0.034） were protective factors for LBW.Maternal hypertension（OR=3.36,95% CI：1.26–8.98,P=0.016）,maternal high-risk pregnancy（OR=4.38,95% CI：3.26–5.88,P〈0.001）,maternal meal intake of only twice per day（OR=1.88,95% CI：1.10–3.20,P=0.021）,and mother liking food with lots of aginomoto and salt（OR=1.60,95% CI：1.02–2.51,P=0.040） were risk factors for PB.BMI ≥24 kg/m^2 of mother prior to delivery（OR=0.66,95% CI：0.47–0.93,P=0.018）,distance of house from road ≥36 meters（OR=0.72,95% CI：0.53– 0.97,P=0.028）,and living in rural area（OR= 0.60,95% CI：0.37–0.99,P=0.047） were protective factors for PB.Our study demonstrated some risk factors and protective factors for LBW and PB,and provided valuable information for the prevention of the conditions among newborns.

An implementation study of barriers to universal cervical length screening for preterm birth prevention at tertiary hospitals in Thailand:Healthcare managers’perspectives

Objective:To identify healthcare managers’perspectives on the barriers to implementing cervical length screening to prevent preterm births.Methods:In PhaseⅠ,10 healthcare managers were interviewed.PhaseⅡcomprised questionnaire development and data validation.In PhaseⅢ,the questionnaire was administered to 40 participants,and responses were analyzed.Results:Their average related work experience was(21.0±7.2)years;39(97.5%)respondents also had healthcare management responsibilities at their respective hospitals.Most hospitals were reported to have enough obstetricians(31 cases,77.5%)and to be able to accurately perform cervical length measurements(22 cases,55.0%).However,no funding was allocated to universal cervical length screening(39 cases,97.5%).Most respondents believed that implementing universal screening,as per Ministry of Public Health policies,would prevent preterm births(28 cases,70.0%).Moreover,they suggested that hospital fees for cervical length measurements should be waived(34 cases,85.0%).Three main perceived barriers to universal screening at tertiary hospitals were identified.They were heavy obstetrician workloads(20 cases,50.0%);inadequate numbers of medical personnel(24 cases,60.0%);not believing that the screening test could prevent preterm birth(8 cases,20%)and lack of free drug support for preterm birth prevention in high-risk cases(29 cases,72.5%).Conclusions:The main obstacles to universal cervical length screening are heavy staff workloads and inadequate government funding for ultrasound scanning and hormone therapy.The healthcare managers do not believe that the universal cervical length screening can help to reduce preterm birth.

Socioeconomic, biological and genetic factors influencing preterm birth

The etiology of preterm birth is mostly underestimated in developing countries.Current presumptions are that both environmental and genetic factors contribute towards its onset and are responsible for the higher frequency of neonatal deaths.Despite there being considerable scientific data on preterm births across the world,the frequency of its occurrence and threat to the survival of neonates are alarming.It is important that variations among populations should be considered as the socioeconomic status,climatic zones and other genetic,as well as epidemiological factors vary,so as to draw definitive conclusions on the pathogenesis of preterm birth.Predictive biomarkers,prevention and optimum treatment strategies are still being discovered,but with well-designed studies and collaborative efforts,maternal and child healthcare can be prioritized.The purpose of this review is to understand the contributing factors of preterm birth as it is a critical issue and needs in-depth understanding with planned scientific studies to decrease the rate of preterm birth and complication related to it.Furthermore,the review enlists various factors linked to preterm birth viz.,high maternal age,psychological state,environmental contaminants,infection,cervical length,addiction,cytokine interaction,preeclampsia,genetic composition,ethnicity,oxidative stress and microRNAs.We have summarized the status of preterm birth,its causes,and future line of work required to prevent mortality of mother and neonate that will help us design successful studies which aim to reduce preterm births effectively.

Association between preterm birth risk and polymorphism and expression of the DNA repair genes OGG1 and APE1 in Saudi women

Genomic instability and mutations caused by increases in oxidative stress during pregnancy can damage the fetoplacental unit and can upshot preterm birth.Oxidative damage to DNA may possibly be involved in etiology of preterm birth(PTB)which can be repaired by DNA repair gene.In the present study,we assessed the association of base excision repair gene family by analyzing the association of single nucleotide polymorphisms and genes expression in 8-oxoguanine glycosylase-1(OGG1)and apurinic-apyrimidinic endonuclease 1(APE1)genes with risk of preterm birth in Saudi women.We analyzed genotypes of four single nucleotide polymorphisms(SNPs)(rs1052133,rs293795,rs2072668 and rs2075747)in OGG1 gene and three SNPs(rs1130409,rs3136814,and rs3136817)in APE1 gene using TaqMan Genotyping assay kits in 50 pairs of preterm cases and individually matched controls.Also,gene expression level was explored by RT-PCR in 10 pairs of preterm placental tissues and individually matched normal placental tissues.Two OGG1 SNP,rs1052133(OR=0.497;c2=1.11;p=0.292)and rs2072668(OR=0.408;c2=1.90;p=0.167)and one APE1 SNP rs3136817(OR=0.458;c2=0.40;p=0.527)showed nonsignificant protective effect against PTB development.The expression of both genes under study was found lower in the PTB patients.Genotype and allele frequencies of both gene SNPs did not show any association with the risk of preterm delivery in Saudi women(P˃0.05).However,synthesis and release of OGG1 and APE1 proteins decreased in preterm placental tissues compared to term delivery reflects the probability of being one of the mechanisms leading to preterm birth.

Mental health impact on Black,Asian and Minority Ethnic populations with preterm birth:A systematic review and meta-analysis

BACKGROUND Preterm birth(PTB)is one of the main causes of neonatal deaths globally,with approximately 15million infants are born preterm.Women from the Black,Asian,and Minority Ethnic(BAME)populations maybe at higher risk of PTB,therefore,the mental health impact on mothers experiencing a PTB is particularly important,within the BAME populations.AIM To determine the prevalence of mental health conditions among BAME women with PTB as well as the methods of mental health assessments used to characterise the mental health outcomes.METHODS A systematic methodology was developed and published as a protocol in PROSPERO(CRD420-20210863).Multiple databases were used to extract relevant data.I2 and Egger's tests were used to detect the heterogeneity and publication bias.A trim and fill method was used to demonstrate the influence of publication bias and the credibility of conclusions.RESULTS Thirty-nine studies met the eligibility criteria from a possible 3526.The prevalence rates of depression among PTB-BAME mothers were significantly higher than full-term mothers with a standardized mean difference of 1.5 and a 95%confidence interval(CI)29%-74%.The subgroup analysis indicated depressive symptoms to be time sensitive.Women within the very PTB category demonstrated a significantly higher prevalence of depression than those categorised as non-very PTB.The prevalence rates of anxiety and stress among PTB-BAME mothers were significantly higher than in full-term mothers(odds ratio of 88%and 60%with a CI of 42%-149%and 24%-106%,respectively).CONCLUSION BAME women with PTB suffer with mental health conditions.Many studies did not report on specific mental health outcomes for BAME populations.Therefore,the impact of PTB is not accurately represented in this population,and thus could negatively influence the quality of maternity services they receive.

Preterm Birth at the Community University Hospital Center (Central African Republic)

The preterm Birth is the main cause of hospitalizing in the pathologic pregnancy service because of its deadly and morbidity rate observing into new born. The purpose of this Study: The purpose of this study is to study the epidemiology, clinic and prediction of preterm delivery in the Maternity at the community university hospital Center. Methodology: Over a 12 month period, we conducted a descriptive and analytical cross-sectional study of preterm delivery cases in the obstetrics and gynecology clinic of the community university hospital Center. The data was collected from the survey records and then analyzed by Epi Info version 3.5.4. Results: The preterm delivery rate related to delivery in the pregnancy pathology department was 17.5%. A high proportion was noticed on patients aged from 20 - 24 years old (28.2%), single (95.8%) and pauciparous (39.5%) were observed. Pelvic pain is the main cause of consultation (100%). 83.1% of the cases were cured by Nifedipine. The higher neonatal mortality is in the pregnancy period less than 30 weeks, with statistically significant difference. Conclusion: Preterm birth is a common disease in the Department. It’s more about young unmarried women. Neonatal mortality is higher Among pregnant women less than 30 weeks of pregnancy.

Association between Prenatal Care Utilization and Risk of Preterm Birth among Chinese Women

It is recognized that prenatal care plays an important role in reducing adverse birth. Chinese pregnant women with medical condition were required to seek additional health care based on the recommended at least 5 times health care visits. This study was to estimate the association between prenatal care utilization（PCU） and preterm birth（PTB）, and to investigate if medical conditions during pregnancy modified the association. This population-based case control study sampled women with PTB as cases; one control for each case was randomly selected from women with term births. The Electronic Perinatal Health Care Information System（EPHCIS） and a questionnaire were used for data collection. The PCU was measured by a renewed Prenatal Care Utilization（APNCU） index. Logistic regression models were used to estimate odds ratios（OR） and the 95% confidence interval（95% CI）. Totally, 2393 women with PTBs and 4263 women with term births were collected. In this study, 695（10.5%） women experienced inadequate prenatal care, and 5131（77.1%） received adequate plus prenatal care. Inadequate PCU was associated with PTB（adjusted OR： 1.41, 95% CI： 1.32–1.84）; the similar positive association was found between adequate plus PCU and PTB. Among women with medical conditions, these associations still existed; but among women without medical conditions, the association between inadequate PCU and PTB disappeared. Our data suggests that women receiving inappropriate PCU are at an increased risk of having PTB, but it does depend on whether the woman has a medical condition during pregnancy.

Risk Factors Associated with Preterm Birth at Hasan Sadikin General Hospital in 2015

Background: Preterm birth defined as childbirth occurring at less than 37 completed weeks or 259 days of gestation. The causes of preterm birth are complex and multifactorial, many risk factors that contribute in it. Knowledge of risk factors is crucial for predicting the incidence of preterm births. This study aimed to determine the factors associated with preterm birth at the Hasan Sadikin General Hospital. Method: This study was a cross-sectional analytic using secondary data. Data derived from medical records maternity patients in the Department of Obstetrics and Gynecology Hasan Sadikin General Hospital taken in 2015. 1944 patients’ medical records who gave birth met the inclusion criteria. Data analyses used were bivariate (chi square) and multivariate (logistic regression). Result: The result showed that the variables including age (p = 0.043, OR = 1.586), antenatal care (p p p p p p Conclusion: There is a significant relationship between age, antenatal care, preterm birth history birth, anemia, hypertension, and antepartum hemorrhage with preterm birth as risk factors.

Determinants of Preterm Birth at the Postnatal Ward of Kenyatta National Hospital, Nairobi, Kenya

Background: Preterm birth, delivery prior to 37 completed weeks or 259 days gestation, is a worldwide maternal and perinatal challenge and is a leading cause of neonatal morbidity and mortality. Preterm birth remains the leading cause of perinatal and postnatal mortality and morbidity especially in developing countries where the health care services are suffering from limited resources. Premature babies usually suffer from both immediate and long term consequences. Right after birth, they have difficulties in breathing, temperature regulation, bleeding, infection and other problems due to organ immaturity. Their growth and developmental milestones will also be affected leading poor physical, mental, educational and psychosocial problems as a long term consequences. Preterm deliveries were responsible for 1 million out of the 6.3 million deaths of children under5 in2013 REF _Ref493689700 \r \h \* MERGEFORMAT [1]. In Kenyatta National hospital, few studies have been carried out to determine the prevalence and factors associated with preterm birth. Hence the aim of this study is to determine the prevalence and factors associated with preterm birth at Kenyatta national hospital (KNH), Nairobi, Kenya. Materials and Methods: This was a hospital based descriptive cross-sectional study involving randomly selected respondents (N = 183) from post natal ward of Kenyatta National Hospital. Systematic random sampling method was applied to recruit the study respondents. A pre-tested semi-structured questionnaire was employed to collect information on the possible determinants of Preterm birth. Data was analysed usingSPSSsoftware version 22.0. Descriptive analysis was done using mean and frequency proportion. Inferential analysis using chi-square test was used to establish association different variables. The ethical approval to conduct the study was obtained from KNH-University of Nairobi Ethical Review Committee (KNH-UoN ERC). Permission to collect data was sought from the KNH and consent was obtained from the selected respondents before administering the questionnaire. Result: The prevalence rate of preterm birth was 20.2%. History of urinary tract infection during pregnancy [AOR = 4.62;95% CI = 1.56 - 4.67;P = 0.013], history of preterm birth [AOR = 5.8;95% CI = 1.18 - 10.30;P = 0.001], history of abortion [AOR = 3.54;95% CI = 1.18 - 10.41;P = 0.016], history of hypertension during pregnancy [AOR = 2.04;95% CI = 1.14 - 3.64;P = 0.012], maternal age (≥31 years) [AOR = 2.81;95% CI = 1.24 - 5.87;P = 0.012] and alcohol consumption during pregnancy [AOR = 2.56;95% CI = 0.68 - 9.64;P = 0.014] were determined as significant risk factors for preterm birth. Conclusion and recommendation: The determinants of preterm birth are multifactorial including history of abortion, preterm birth, urinary tract infection, hypertension and alcohol consumption during pregnancy. Most of these risk factors of preterm birth are controllable if reproductive age mothers are educated properly. It is very important for antenatal mothers to adhere to the guidelines of antenatal visits so that those at risk are spotted and close monitoring can done in order to reduce this high rate of preterm birth and its negative consequences. Strategies to avert the high prevalence of preterm birth and its associated morbidity and mortality must be given priority at national, regional and international levels, so that the Millennium Development Goal (MDG) 4 can be achieved.

Cervicovaginal Inflammatory Cytokines, Obesity and Inter-Pregnancy Interval Negatively Affect Pregnancy Duration in Pregnant Women at High-Risk for Recurrent Spontaneous Preterm Birth

Objectives: Evaluation of change of cervicovaginal fluid (CVF) cytokines’ levels during pregnancy and its relation to incidence of preterm birth (PTB). Patients & Methods: Pregnant women with history of PTB and cervical length α (TNF-α) and interleukins (IL)-6 and -10 levels. Study outcomes included differences in cytokines’ levels between samples and groups. Results: Sample-I cytokines’ levels were significantly higher in study than control women. Cytokines’ levels in Sample-II were significantly higher in control, while were significantly lower in study women compared to Sample-I. Sixteen study women had PTB and had significantly higher CVF levels of IL-10 and TNF-α estimated in both samples than women had no PTB. Pregnancy duration was negatively correlated with maternal body mass index (BMI) and cytokines’ levels, while was positively correlated with inter-pregnancy interval (IPI). Cytokines’ levels were positively correlated with BMI and negatively correlated with IPI. Short IPI and high TNF-α levels are negative predictors for pregnancy duration. Conclusion: High BMI, short IPI and high CVF inflammatory cytokines’ levels negatively affect pregnancy duration especially in women with history of recurrent PTB. Early prophylactic CC for women at high-risk of SPTB can modulate local immune disturbance, reduce incidence of SPTB and prolong pregnancy duration.

Role of Vaginal Progesterone in Prevention of Preterm Labor in Women with Previous History of One or More Previous Preterm Births

Objective: To evaluate whether prophylactic administration of 200 mg vaginal progesterone can reduce the incidence of preterm birth in women with documented history of preterm birth Setting: Obstetrics and Gynecology Department, Zagazig University Hospital, Egypt. Methods: Ninety patients with previous history of preterm birth prior to 37 week presenting with singleton pregnancy between 20 - 24 weeks were randomly allocated to receive either the progesterone 200 mg vaginal suppository or no treatment. Results: The incidence of preterm labor before 37 weeks of gestation was significantly lower in the study group than in the control group (22.2% vs. 53.3%) especially in earlier gestational ages. While, the mean birth weight was significantly higher in the study group than in control group (2872.67 ± 565.76 gm vs. 2487.78 ± 742.40 gm). The neonatal morbidities and mortality associated with preterm labor were significantly lower in the study group than in the control group as shown by lower incidence of neonatal RDS (13.3% vs. 31.1%;P = 0.043) and lower incidence of the need for NICU admission (15.6% vs. 35.5%;P = 0.03). Conclusion: Administration of prophylactic vaginal progesterone (200 mg, daily) can significantly reduce the rate of preterm birth before 37, 32 and 28 wks of gestation among women with previous spontaneous preterm birth. In addition, the rates of RDS and admission to NICU were significantly decreased among infants of women assigned to progesterone treatment. Also, there was an additional benefit of vaginal progesterone for prevention of preterm birth in women who had prior spontaneous preterm birth and cervical length 25 mm.

Oral Micronized or Parenteral Progesterone versus Health Education in the Prevention of Preterm Birth: A Single Blinded Randomized Controlled Trial

The primary aim of this study was to evaluate the possible prophylactic role of progesterone in women with a history of spontaneous preterm birth (PTB) while the secondary aim was to compare oral or intramuscular progesterone versus health education in such cases. Methods: A randomized, single blinded interventional randomized controlled trial was conducted. It comprised 90 cases with a history of PTB who were divided into 3 equal groups who received oral micronized progestogen capsule 200 mg daily (group A), parenteral 17 α-hydroxyprogesterone caproate 250 mg weekly IM injections (group B) or received health education including rest (group C) starting from 20 weeks till the end of 34 weeks of gestation. Results: This study included eligible 90 pregnant women at high risk of PTB who continued follow-up. For socio-demographic characteristics, there were no significant differences between the groups in respect to age, residence, education level, occupation, gravidity, parity and number of living children apart from significant difference between group A and C regarding mean patients’ age. Mode and place of delivery did not differ between the groups while gestational age at time of delivery was significantly better on using injectable than oral progesterone. Neonatal birth weight was significantly higher in group B if compared separately to groups A and C and was still significantly higher in group A if compared with group C. NICU admission rate was higher in group C if compared to group B or to the combined group A and B. Compliance was significantly higher in group B if compared to both group A and C and was significantly higher in the intervention group A and B if compared to group C. Conclusions: Progesterone supplementation has a significant role in prevention of PTB if compared with just health education. Progesterone injections expressed significantly better results than oral micronized progesterone in terms of prolongation of gestational age, better neonatal birth weight and less admission rate to the NICUs.

Maternal Euthyroid Hyperthyroxinemia May Reduce Preterm Birth Rate in Multiparous Women

Hypothyroidism, defined as thyrotropin (TSH) above and free thyroxine (fT4) serum level below the reference rage, as well as hyperthyroidism, defined as suppressed TSH and elevated thyroid hormones exceeding the upper limit of the reference range, may have major impacts on fertility and pregnancy outcome. Ideally, euthyroidism, defined as TSH and fT4 in the reference range, should be established and preserved during pregnancy prior to gestation. High estrogen levels during pregnancy stimulate the synthesis of maternal thyroxine-binding-globulin (TBG) in the liver, increasing TBG serum concentration by 2 - 3 fold compared to the initial value and affecting thus maternal fT4 serum level. As a consequence, maternal thyroid function adapts by increasing synthesis and secretion of thyroxine. TBG-induced elevation of serum thyroxine either total or free in the absence of hyperthyroidism is defined as euthyroid hyperthyroxinemia. Since TBG concentration declines first after delivery, pregnancy-induced euthyroid hyperthyroxinemia constitutes a physiological metabolic state. Depending on functional capacity, maternal thyroid may exhaust, resulting in hypothyroxinemia, which increases the risk of fetal neurodevelopmental impairment and preterm birth. The study aims to determine whether L-Thyroxine (L-T4) replacement, sustaining pregnancy-induced maternal euthyroid hyperthyroxinemia during the whole pregnancy by keeping fT4 level in the high normal reference range might reduce preterm birth rate. Preterm birth rate of women with singleton gestation and L-T4-induced high normal fT4 level constituting the study group (n = 918) was compared with the preterm birth rate of women with singleton gestation (n = 6414) who completed a questionnaire concerning L-T4 administration during pregnancy. Two groups were formed. In group A we compared the preterm birth rate between women with L-T4-induced high normal fT4 level and a control group without L-T4 administration during pregnancy. In group B we compared the preterm birth rate of women already receiving L-T4 prior to conception, maintaining dosage to keep fT4 level in the high normal reference range during gestation to a control group with L-T4 intake during pregnancy. The preterm birth rates in group A declined by 51% (p = 0.01) and in group B by 87% (p = 0.001) in multiparous women, while in primiparous the preterm birth rate was similar between study and the control group. Sustaining a high normal fT4 level during pregnancy with L-T4 may significantly reduce preterm birth rate in multiparous women.

Decidual cell expressed tissue factor promotes endometrial hemostasis while mediating abruption associated preterm birth

During human pregnancy, progesterone induced decidual cells protect against hemorrhage: 1) as endovascular trophoblast breech and remodel uterine blood vessels;and 2) in the third stage of labor following preterm and term delivery. De- cidual cells promote hemostasis through enhanced expression of tissue factor (TF), the primary initiator of hemostasis via thrombin generation, and plasminogen activator inhibitor-1, which inactivates tissue type plasminogen activator, the primary fibrinolytic agent. Abruptions (decidual hemorrhage) produce excess thrombin which acts as autocrine/paracrine inducer of decidual cell expressed matrix metalloproteinases and of neutrophil chemoattractant and activator, interleukin-8. The latter mediates aseptic abruption-related neutrophil infiltration. During abruptions, decidual cell and neutrophil-derived proteases effectively degrade the decidual and fetal membrane extracellular matrix to promote preterm premature rupture of the membranes and preterm delivery (PTD). Decidual cell-derived thrombin weakens the amniotic membrane and lowers decidual cell-expressed progesterone receptor levels by increasing phospho-ERK1/2 signaling. The resulting functional progesterone withdrawal accompanies PTD.

Do Protease Inhibitors Increase Preterm Births in Human Immunodeficiency Virus-Infected Patients?

Objective: To compare preterm delivery (PTD) rates in HIV-infected patients on a protease inhibitor (PI)-based and a PI-sparing regimen. Study Design: This is a retrospective review of records of HIV-infected pregnant women between 2000 and 2007 at University Hospital, Newark, NJ. Patients were grouped according to PI exposure during pregnancy. Rates of preterm birth were compared, and the analysis was performed irrespectively of the etiology or indication of the preterm birth. Multivariate analysis including substance use, PI use, initial CD4 count, and history of PTD was performed. Results: There were 129 pregnant women in the PI group and 59 in the PI-sparing group. The PTD rate did not differ between the PI group and PI-sparing group (27.9% vs 25.4%, P = 0.72). 28.6% of those who delivered preterm had a previous PTD compared to 8.4% of those who delivered at term (P = 0.0019). Patients who delivered preterm had a higher rate of substance use (37.3% vs 19.7%, P = 0.0128). In the multivariate analysis, only history of PTD was significant (P = 0.018). Conclusion: Contrary to other studies, PIs were not associated with PTD. Other known risk factors of PTD, specifically past PTD and substance use, should be considered and targeted for risk reduction during pregnancy.