Exposición a temperaturas extremas y su efecto en la gestación en un departamento de Colombia / Exposure to extreme temperatures and its effect on pregnancy in a department of Colombia

Introducción: Diversas investigaciones han establecido la relación entre temperatura y duración del embarazo, la exposición a temperaturas altas durante el embarazo plantea interrogantes en especial el papel que esta juega frente a los partos prematuros y partos de bajo peso, es indispensable determinar si las temperaturas altas o bajas tienen un comportamiento protector o de riesgo sobre el feto durante la gestación en regiones tropicales. Objetivo: describir la relación entre la exposición a temperaturas altas y bajas durante el embarazo y su efecto en la edad gestacional y peso al momento del parto en los recién nacidos del departamento del Guaviare-Colombia. Metodología: Estudio tipo observacional, analítico, retrospectivo de corte transversal que busco determinar la relación entre exposición a temperaturas altas y bajas durante el embarazo y su efecto en la edad gestacional y peso al momento del parto en los recién nacidos, el universo estuvo conformado por 10.137 nacidos vivos, de los cuales 9.932 cumplieron los criterios de inclusión. Se determinó Odds Ratio para estimar la asociación entre las variables. Resultados: Dentro de la semana de retraso 3 el estar expuesto a temperaturas máximas percentil 90 es un factor protector para la ganancia ponderal de peso OR < 1, la exposición a temperaturas mínimas percentil 10 se asoció como factor protector para el parto prematuro en la semana de retraso 1 y 2 OR < 1.Conclusión: A pesar del beneficio de las altas y bajas temperaturas durante el embarazo en la ganancia ponderal de peso y disminución del parto prematuro, es recomendable prevenir la exposición a temperaturas extremas durante el periodo de gestación[AU]

Introduction: Various investigations have established the relationship between temperature and duration of pregnancy. Exposure to high temperatures during pregnancy raises questions, especially the role it plays in premature births and low-weight births. It is essential to determine whether high temperatures or low have a protective or risky behavior on the fetus during pregnancy in tropical regions.Objective: to describe the relationship between exposure to high and low temperatures during pregnancy and its effect on gestational age and weight at the time of delivery in newborns in the department of Guaviare-Colombia.Methodology:Observational, analytical, retrospective cross-sectional study that sought to determine the relationship between exposure to high and low temperatures during pregnancy and its effect on gestational age and weight at the time of delivery in newborns. The universe was made up of 10,137 births. alive, of which 9,932 met the inclusion criteria. Odds Ratio was determined to estimate the association between the variables.Results:Within the 3rd week of delay, being exposed to maximum temperatures at the 90th percentile is a protective factor for weight gain OR < 1, exposure to minimum temperatures at the 10th percentile was associated as a protective factor for premature birth in the week. of delay 1 and 2 OR < 1. Conclusion: Despite the benefit of high and low temperatures during pregnancy in weight gain and reduction in premature birth, it is advisable to prevent exposure to extreme temperatures during the gestation period[AU]

Introdução: Várias investigações estabeleceram a relação entre temperatura e duração da gravidez. A exposição a altas temperaturas durante a gravidez levanta questões, especialmente o papel que desempenha nos partos prematuros e nos nascimentos de baixo peso. É essencial determinar se as temperaturas altas ou baixas têm um comportamento protetor ou de risco para o feto durante a gravidez em regiões tropicais. Objetivo:descrever a relação entre a exposição a altas e baixas temperaturas durante a gravidez e seu efeito na idade gestacional e no peso no momento do parto em recém-nascidos no departamento de Guaviare-Colômbia. Metodologia: Estudo observacional, analítico, retrospectivo e transversal que buscou determinar a relação entre a exposição a altas e baixas temperaturas durante a gravidez e seu efeito na idade gestacional e no peso no momento do parto em recém-nascidos. O universo foi composto por 10.137 nascimentos. vivos, dos quais 9.932 preencheram os critérios de inclusão. O Odds Ratio foi determinado para estimar a associação entre as variáveis. Resultados:Na 3ª semana de atraso, a exposição a temperaturas máximas no percentil 90 é fator de proteção para ganho de peso OR < 1, a exposição a temperaturas mínimas no percentil 10 foi associada como fator de proteção para parto prematuro na semana. de atraso 1 e 2 OR < 1.Conclusão:Apesar do benefício das altas e baixas temperaturas durante a gravidez no ganho de peso e redução do parto prematuro, é aconselhável evitar a exposição a temperaturas extremas durante o período de gestação[AU]

Effects of mechanical ventilation on neurodevelopment at 12 months in preterm low birth weight pediatric patients: a systematic review.

Introduction: The objective of this review is to know the existing scientific evidence about the effects of mechanical ventilation (MV) on neurological development in low-birth-weight premature pediatric patients after 12 months of life, taking as background the direct impact that ventilation has on the central nervous system in the newborn during the first days of life. Methods: A systematic search was carried out between 2003 and 2024 in the data bases of: PUBMED, Cochrane Library Plus, PEDro, CINAHL, and SciELO, and two investigators scored the articles according to the Newcastle-Ottawa Assessment scale. Results: Were found 129 non-replicated articles, and 10 cohort and cross-sectional studies were selected that performed an assessment of neurodevelopment in the three spheres after 12 months of life in corrected age of premature infants exposed to ventilator support and related the two variables independently. Conclusions: Mechanical ventilation is an independent neurodevelopmental risk factor in low-birth-weight preterm infants. The time of exposure and the type of ventilation were the variables with the most scientific evidence. Systematic Review Registration: https://www.crd.york.ac.uk/, Identifier CRD42023446797.

Trends in gestational age at live birth in Scotland from 2005 to 2019: a population-based study.

Background: Gestation at birth is associated with short and long-term outcomes. This study used high quality, national, administrative data to examine trends in gestation at birth in Scotland. Methods: This observational study used maternity hospital discharge records for 2005 to 2019 to determine trends in the percentage of live births that were preterm (<37 weeks gestation), term (37-41 weeks), and post-term (≥42 weeks), overall and by maternal age and deprivation category. Preterm births were further examined by category of preterm birth (moderate to late [32-36 weeks]; very [28-31 weeks]; extremely [<28 weeks] preterm), and onset of labour (spontaneous; provider-initiated). Singleton and multiple births were examined separately. Aggregate logistic regression was used to estimate the annual change in the odds of a birth being in a specified gestational category. Results: The percentage of singleton births in Scotland that were preterm decreased from 2005 (6.5%, 3,361/51,665) to 2010 (5.8%, 3268/56344), then increased to 2019 (7.2%, 3,408/47,507). The percentage of singleton births that were spontaneous moderate to late, very, and extremely preterm all increased between 2010 and 2019. The percentage of singleton births that were provider-initiated moderate to late preterm also increased between 2010 and 2019, however provider-initiated very or extremely preterm birth decreased. The percentage of singleton births that were preterm increased over time across all maternal age and deprivation categories, with increases greatest in groups at highest baseline risk. The percentage of singleton births that were post-term increased from 2005 to 2009, then decreased to 2019. Conclusions: There has been an increase in spontaneous preterm birth from 2010 to 2019, which is not fully explained by changes in maternal age or deprivation. Further research to examine the contribution of other, preventable, risk factors is warranted. Trends in provider-initiated preterm birth, and post-term birth, are likely to reflect changing clinical practice.

Differences Between Preterm and Full-Term Infants in Electroencephalogram Power Spectral Density Slope.

A growing body of literature suggests that power spectral density (PSD) slope, measured using electroencephalography (EEG), might reflect synaptic activity and be a useful marker of early brain development. The objective of this article is to identify differences between preterm and full-term infants in PSD slope in active and quiet sleep. This is a secondary analysis of two studies, including premature (N = 33) (30 0/7 and 36 0/7 weeks' gestation) and full-term infants (N = 22). EEG was performed at near term-equivalent age in premature infants and within 36 h after birth in full-term infants. The natural log of the EEG power spectrum was plotted versus the natural log of the frequency spectrum. To estimate PSD slope, the power law exponent derived from the slope of the log(power) versus log(frequency) was calculated for the 1-20 Hz range and the 21-40 Hz range. Linear regression models were fit for each region in active and quiet sleep to examine the association between the PSD slope and infant age group. Preterm versus full-term infants demonstrated a less negative slope across multiple brain regions in active and quiet sleep. PSD slope may be an early measure of altered brain development in premature infants.

Sleep-disordered breathing in a multi-ethnic cohort of preterm adolescents and adults: assessment of neonatal and subsequent risk factors.

STUDY OBJECTIVES: Determine whether preterm-born adolescents and adults have sleep-disordered breathing (SDB), as documented by abnormal overnight oximetry. METHODS: This single-center cross-sectional study prospectively enrolled adolescents and adults born moderately to extremely preterm (≤32 weeks gestation or <1500 grams birth weight) or full term to complete a study visit, STOP-Bang questionnaire, and overnight oximetry. Oxygen desaturation index (ODI) was compared in preterm versus term with Poisson regression models. Subgroup analyses in preterm participants evaluated associations of neonatal risk factors with ODI. RESULTS: Ninety-six preterm and 44 term participants completed study procedures. Preterm participants more often reported snoring (25% vs 9%; p=0.03) and excessive fatigue (62% vs 40%; p=0.02), and had higher body mass index, leading to higher STOP-Bang scores (2±1 vs 1±1; p<0.001). Preterm participants had 40% higher ODI (incidence rate ratio (IRR): 1.40; 95% CI [1.07,1.83]; p=0.02). However, after adjusting for classic risk factors for SDB including age and STOP-Bang score in a multivariable model, history of preterm birth did not predict additive risk for SDB. Among neonatal factors, a patent ductus arteriosus was associated with a higher ODI (IRR 1.99; 95% CI [1.37,2.91]; p<0.001). CONCLUSIONS: Preterm-born adolescents and adults in this study have higher rates of snoring, daytime fatigue, and nocturnal desaturations compared to those term-born. However, the risk of elevated ODI is best attributed to obesity in this cohort and not the history of prematurity. Additionally, a history of a patent ductus arteriosus increased risk for SDB.

Effect of combination of uterine artery doppler and vitamin D level on perinatal outcomes in second trimester pregnant women.

OBJECTIVES: To investigate the effect of the combination of uterine artery (UtA) Doppler and vitamin D levels on perinatal outcomes in second trimester pregnants was aimed. METHODS: UtA Dopplers and vitamin D levels of 226 pregnant women in the second trimester were measured. Patients were followed for adverse pregnancy outcomes. The relationship of this combination with these pregnancy outcomes was evaluated. RESULTS: Sensitivity and specificity values ​​are respectively; Left UtA-S/D ratio for preeclampsia was 85.29 and 81.77 %, left UtA-RI was 90.62 and 43.30 % for preterm birth, and 76.19 and 66.34 % for the development of fetal distress had the best predictive effect. Vitamin D values ​​had no predictive value for any parameter (p>0.005). CONCLUSIONS: UtA Doppler has a good predictive value for many adverse pregnancy outcomes. However, in order to correlate these results with second trimester vitamin D levels, more homogeneous and specific groups are needed.

Impact of gestational age on the management of acute appendicitis during pregnancy: A nationwide observational study.

OBJECTIVE: To compare conservative management and appendectomy for acute appendicitis during pregnancy by trimester. METHODS: This retrospective cohort study used data from a national inpatient database from July 2010 to March 2022. Pregnant women diagnosed with acute appendicitis were included. Multivariable analysis using generalized estimating equations was performed to compare outcomes between conservative management and appendectomy across trimesters. The main outcomes were preterm labor, preterm delivery, or abortion; antepartum hemorrhage; duration of hospitalization; and duration of antibiotic use. RESULTS: A total of 3158 individuals from 632 acute-care hospitals were eligible. The proportion of conservative management versus appendectomy by trimester were 507 (49.1%) versus 525 (50.9%) in the first, 690 (44.6%) versus 856 (55.4%) in the second, and 337 (58.1%) versus 243 (41.9%) in the third. In the second trimester, appendectomy was associated with a higher rate of preterm delivery, preterm labor, or abortion (odds ratio [OR], 2.91 [95% confidence interval (CI), 1.62-5.25]). Antepartum hemorrhage occurred more frequently for appendectomy in the first (OR, 2.12 [95% CI, 1.31-3.43]) and third (OR, 2.43 [95% CI, 1.79-3.31]) trimesters. Appendectomy was associated with a longer duration of hospitalization in the second (2.15 days; 95% CI, 1.14-3.17 days) and third (3.97 days; 95% CI, 2.22-5.71 days) trimesters. Antibiotic use duration was shorter for appendectomy in the first (-1.20 days [95% CI -1.51 to -0.90 days]) and second (-0.61 days [95% CI -0.90 to -0.32 days]) trimesters. CONCLUSIONS: Clinical outcomes of acute appendicitis during pregnancy vary by trimester. Considering the appendectomy risks, conservative management may be viable depending on the clinical context and trimester.

Cognitive and motor improvement by tummy time practice in preemies from low-income settings: a randomized clinical trial.

Introduction: Early intervention and parental education for preemies are limited in some low-income countries. Thus, this study aimed to assess whether daily tummy time (TT) associated with usual care (UC) enhances motor and cognitive development in preemies from low-income countries. The main and secondary aim was to assess prone head elevation (PHE) and motor and cognitive functions, respectively. Methods: Thirty-one preemies with a mean gestational age at birth of 33.3 ± 1.6 weeks and weighing <2,500 g were included and 18 completed all assessments. Parents from the TT group were asked to perform TT with their preemies for at least 20 min during daily activities and playtime. Motor and cognitive functions were assessed by a blinded examiner using the motor and cognitive composite scores of Bayley-III after two and four months of corrected age. PHE was given by the angle from the tragus of the ear to the supporting surface of the infant; measurements were obtained using the Kinovea® software at baseline, after two, three, and four months of corrected age. Results: The Bayley-III motor composite score of the TT group was higher than the UC group after two and four months of corrected age. The PHE angle increased over time but did not differ between groups. Discussion: Nevertheless, TT expanded the perspective of preemies to explore their bodies and environment, favoring the stimuli for motor and cognitive patterns. The loss of participants (31%) was one of the limitations of the study, illustrating the challenge of providing continued early interventions to preemies from low-income countries. In this sense, TT practice is a home intervention that may improve motor and cognitive function of preemies immediately after hospital discharge.

Reproductive outcomes after antenatal corticosteroids: Secondary analysis of 50-year follow-up of the Auckland steroid randomized trial.

INTRODUCTION: Antenatal corticosteroids are widely used to prevent morbidity and mortality after preterm birth, but there are ongoing concerns about the possible risk of long-term adverse effects, including perturbation of endocrine systems, with potential implications for reproduction. A small number of animal studies have suggested possible adverse effects on reproduction after antenatal exposure to corticosteroids, but there is a paucity of human data. MATERIAL AND METHODS: This is a secondary cohort analysis of the 50-year follow-up of the Auckland Steroid Trial (1969-1974) comparing antenatal exposure to corticosteroids or placebo. Participants whose mothers took part in the placebo-controlled randomized trial of antenatal corticosteroids completed a questionnaire reporting reproductive outcomes at 50 years of age. The main outcome was at least one pregnancy ≥20 weeks or fathered at least one pregnancy ≥20 weeks. Additional outcomes included a number of pregnancies or fathered pregnancies ≥20 weeks, outcomes relating to female reproductive lifespan (including age at menarche and menopause), and outcomes relating to their offspring (including birthweight and gestation). RESULTS: Of 917 eligible participants, 415 (45% of eligible) completed the questionnaire at a mean (SD) age of 49.3 (1.0) years. The proportion of participants who had experienced at least one pregnancy ≥20 weeks or fathered at least one pregnancy ≥20 weeks was similar in betamethasone and placebo-exposed groups (163/217 [75%] vs. 136/190 [72%]; RR 1.08, (95% CI 0.95 to 1.22); p = 0.23). Participants exposed to betamethasone had a slightly higher number of pregnancies or fathered pregnancies ≥20 weeks compared to those exposed to placebo (mean 1.89 vs. 1.60; marginal mean difference 0.20, (95% CI 0.03-0.37); p = 0.03). Other outcomes, including female reproductive lifespan and offspring-related outcomes, were similar in both randomized groups. There were also no differences in any outcomes between those born preterm and those born at term. CONCLUSIONS: Antenatal exposure to corticosteroids appears to have no clinically important effect on reproductive outcomes to 50 years.

Evaluation of antenatal care quality for preterm birth prevention using an auditable scoring system: A retrospective, descriptive, longitudinal study in Sydney, Australia.

INTRODUCTION: Preterm birth continues to be one of the most significant contributors to perinatal death. This study aims to evaluate the quality of antenatal care provided to women delivering preterm. METHODS: This was a retrospective, descriptive, longitudinal review of all women who had antenatal care within a single Australian tertiary hospital and delivered spontaneously between 24 and 37 weeks of gestation, using an auditable scoring system assessing potential interventions for prevention of preterm birth. The review was limited to singleton pregnancies without fetal abnormalities delivering between January 2013 and April 2015. The audit tool was developed by reference to established 'best practice' guidance for prediction and prevention of preterm birth based on Royal Australian and New Zealand College of Obstetricians and Gynaecologists guidelines and published literature. Different pathways were assessed for women deemed either low- or high-risk at the outset of antenatal care. RESULTS: A series of 161 pregnancies that delivered preterm (between 24 and 37 weeks' gestation) were reviewed. The quality of antenatal care was scored 'good' in 42.9% and 50% of high-risk and low-risk women, respectively. Care was scored 'adequate', with room for improvement in 51.4% and 45.2% of the two corresponding groups. The main deficiencies in care were recorded evidence of assessment of cervical length (absent in 35% of cases) and failure to screen for bacterial vaginosis in high-risk women. CONCLUSIONS: Auditing antenatal care for prevention of preterm birth allows identification of suboptimal practice allowing service improvement and potential intervention for preterm birth prevention.

Chronic kidney disease associated with extremely premature birth and extremely low birth weight may progress through the burden of growth.

Chronic kidney disease associated with low birth weight and/or premature birth (L/P-CKD) in infants may result from a decreased number of nephrons at birth. These infants may develop acute kidney injury due to exposure to nephrotoxic substances or other events during nephrogenesis in early infancy. Nonetheless, L/P-CKD progression remains unclear. We present three cases of L/P-CKD diagnosed after neonatal intensive care unit (NICU) discharge. Three patients were born extremely prematurely (gestational age, 24-26 weeks) with extremely low birth weight (606-906 g). They were admitted to the NICU (117-311 days) anad received several nephrotoxic medications during the early postnatal period. They showed elevated serum creatinine levels at 4 weeks after birth, which decreased to normal levels at NICU discharge. Proteinuria was first detected during adolescence (10-15 years) on annual school urine screening, with a remarkable increase in their height (18 - 50.8 cm), without known episodes of urinary tract infection, dehydration, lifestyle-related issues, such as excessive salt/protein intake, and extreme lack of exercise that might have caused kidney damage. Their kidneys were smaller than normal on renal ultrasonography. Open renal biopsy findings indicated glomerulomegaly and perihilar glomerulosclerosis in two of the three patients, suggesting glomerular hypertension. The remarkable differences between the body height before CKD and the timing of diagnosis of CKD could contribute to the progress of CKD. Long-term follow-up of low birth weight and extremely premature infants, from NICU discharge until adulthood, should be established.

Retinopathy of Prematurity in Eight Portuguese Neonatal Intensive Care Units: Incidence, Risk Factors, and Progression-A Prospective Multicenter Study.

BACKGROUND/OBJECTIVES: Retinopathy of prematurity (ROP) is a retinal neovascular disease affecting preterm infants. Identifying risk factors for its development and progression is critical for effective screening and prevention. This study aimed to analyze the incidence of ROP and identify key risk factors for its development and progression. METHODS: We conducted a prospective, observational cohort study on 455 neonates (gestational age [GA] < 32 weeks or birth weight < 1500 g) across eight Portuguese NICUs. RESULTS: ROP incidence was 37.8%, with 4.6% requiring treatment. Multivariate analysis identified low GA and the number of red blood cell (RBC) transfusions as significant factors for ROP development and progression. After adjusting for these variables, platelet transfusions, high maximum fraction of inspired oxygen (FiO2) in the second week, and surfactant use remained significantly associated with ROP development, while early and late sepsis, maternal chronic hypertension, and delayed enteral nutrition were associated with progression to ROP requiring treatment. CONCLUSIONS: These findings underscore the importance of addressing low GAs and adult RBC transfusions in ROP risk management and suggest that maximum FiO2, platelet transfusions, and sepsis also play crucial roles. Larger studies are needed to validate these results and explore preventive interventions, particularly regarding the impact of multiple adult RBC transfusions on fetal hemoglobin percentages.

Black women and the preemie prep for parents (P3) program: Exploratory analysis of a clinical trial.

•Black women receiving the smartphone P3 program had more preterm birth knowledge.•Black women receiving the P3 program were more prepared for healthcare decisions.•Black women receiving the P3 program talked more with partners about preterm birth.•Smartphone preterm birth education may overcome clinic-based education barriers.

Association of Anti-Annexin A5 Antibody With Pregnancy Outcomes: A Cohort Study: Anti-annexin A5 antibody with pregnancy outcomes.

OBJECTIVE: This study aims to evaluate the correlation between anti-annexin A5 (aANXA5) antibody in the blood and pregnancy outcomes . METHODS: This study is a retrospective cohort study based on singleton pregnancies of the Third Affiliated Hospital of Wenzhou Medical University from May 2018 to December 2022. Baseline characteristics were collected from all participants. Logistic regression and interaction effect analyses were utilized to examine the risk impact of aANXA5 on pregnancy complications, adjusting for age, BMI, abortion, ANA, and aCL. Restricted cubic spline (RCS) and threshold effect analysis were applied to explore the relationship between aANXA5 levels and preterm birth (PTB), as well as pregnancy-induced hypertension (PIH). RESULTS: The study included 501 participants, with 51 (10.2%) testing positive for aANXA5 and 450 (89.8%) testing negative. The aANXA5 positive group exhibited higher rates of ANA and antibodies to thyroglobulin (TGAb), along with increased incidences of PTB and PIH. Positive aANXA5 status was independently linked to an elevated risk of PTB (OR: 2.53, 95% CI: 1.30-4.94) and PIH (OR: 4.23, 95% CI: 1.54-11.62). Subsequent subgroup analysis indicated no significant interaction between the groups (p > 0.05). Threshold analysis revealed that the OR for PTB was 1.20 (95% CI: 1.03-1.39) in participants with aANXA5 levels ≥ 32.77 ng/mL, and the OR for PIH was 1.62 (95% CI: 1.15-2.28) in those with aANXA5 levels ≥ 33.20 ng/mL. CONCLUSION: AANXA5 is independently associated with an increased risk of PTB and PIH. The identified optimal predictive cutoff values are 32.77 ng/mL for PTB and 33.20 ng/mL for PIH.

A Neural Network-based Approach to Prediction of Preterm Birth using Non-invasive Tests.

Background: One of the main reasons for neonatal deaths is preterm delivery, and infants who have survived preterm birth (PB) are at risk of significant health complications. However, an effective method for reliable and accurate prediction of preterm labor has yet to be proposed. Objective: This study proposes an artificial neural network (ANN)-based approach for early prediction of PB, and consequently can hint physicians to start the treatment earlier, reducing the chance of morbidity and mortality in the infant. Material and Methods: This historical cohort study proposes a feed-forward ANN with 7 hidden neurons to predict PB. Thirteen risk factors of PB were collected from 300 pregnant women (150 with preterm delivery and 150 normal) as the ANN inputs from 2018 to 2019. From each group, 70%, 15%, and 15% of the subjects were randomly selected for training, validation, and testing of the model, respectively. Results: The ANN achieved an accuracy of 79.03% for the classification of the subjects into two classes normal and PB. Moreover, a sensitivity of 73.45% and specificity of 84.62% were obtained. The advantage of this approach is that the risk factors used for prediction did not require any lab test and were collected in a questionnaire. Conclusion: The efficacy of the proposed approach for the early identification of pregnant women, who are at high risk of preterm delivery, leads to necessary care and clinical interventions, applied during the pregnancy.

Changing Indications for Cervical Cerclage Following the Introduction of Routine Ultrasound Surveillance of Cervical Length for Prediction and Prevention of Preterm Birth.

Background: Preterm birth (PTB) is associated with significant neonatal mortality and morbidity. Universal measurement of cervical length has been proposed as a screening tool to direct intervention to prevent PTB. Aim: To assess the impact of the introduction of sonographic mid-trimester cervical length screening on the use of cervical cerclage and PTB. Material and Methods: A retrospective cohort study reviewed two groups of women who underwent cervical cerclage before and after the introduction of universal sonographic cervical length screening. Demographics and outcomes were compared using Student's t test, Fisher's Exact test and Kaplan-Meier analysis. Results: Following introduction of universal cervical length screening, the overall rate of cerclage increased from 2.5/1000 births to 6.0/1000 births (p < 0.01). There was a reduction in the proportion of sutures placed purely based on maternal history (50.0% to 30.4%; p < 0.001), while the proportion of sutures placed following ultrasound assessment increased in both high- (21.7 to 36.6%) and low-risk (11.7% to 30.4%) women (p < 0.001). The overall rate of PTB <37 weeks in women has a cerclage was 25.7% and was highest in women undergoing rescue cerclage (64.3%; p < 0.01). There was no difference in the rate of PTB between high- and low-risk women undergoing history- or ultrasound-indicated cerclage. Mean pregnancy length was most prolonged in low-risk women undergoing ultrasound-indicated cerclage, extending gestation from 33.9 to 38.3 weeks (p < 0.01). Conclusion: Universal cervical length screening results in an increase in the use of cerclage, specifically on the basis of the ultrasound findings. Women who were at low risk but then underwent ultrasound-indicated cerclage experienced most prolongation of pregnancy. Women who were at high risk but had a suture on the basis of ultrasound findings-indicated cerclage represent an alternative method of management with no significant difference in the gestational age of delivery.

Association of birth and periodontal disease in Bolivia, Chile and Colombia / Asociación de parto prematuro y enfermedad periodontal en Bolivia, Chile y Colombia

ABSTRACT Introduction. Preterm birth is a major medical, social, and economic problem that causes a large proportion of neonatal mortality and morbidity, has a high impact on the healthcare system, and affects family quality of life. The weight of newborns with mothers with periodontal disease is significantly lower compared to mothers not affected by this oral disease. This adverse outcome is considered a global public health problem based on epidemiological data. Objective. To determine the association between the prevalence of preterm births and periodontal disease in Bolivia, Chile, and Colombia from 2000 to 2020. Materials and methods. This ecological study considered the population of women in Bolivia, Chile, and Colombia, according to the prevalence of preterm births and periodontal disease discriminated by age. The study covered the period between 2000 and 2020. The search strategy within the Institute for Health Metrics and Evaluation investigative tool included prevalence, age groups, causes of preterm births and periodontal disease, context and locations, women, and rates. Statistical analysis included a simple linear regression between preterm births and periodontal disease for each age group within each country. Results. Preterm birth rates were higher in the 15-19 years age group (Bolivia: 697,563; Chile: 844,864; Colombia: 804,126). The periodontal disease prevalence increased with age, as we observed in the 45-49 years group (Bolivia: 22,077,854; Chile: 34,297,901, Colombia: 32,032.830). According to age groups, the linear regression was statistically significant (p < 0.001) in all age groups for the Bolivian population over 30 years for the Colombian, and only in the 15-19 years group for the Chilean women. Conclusion. An association was found between preterm births and periodontal disease in all age groups in Bolivia, only in the group of 15 to 19 years in Chile, and 30 years and up in Colombia over the 20-year period.

RESUMEN Introducción. El parto prematuro es un problema médico, social y económico importante, causa gran mortalidad y morbilidad neonatal, tiene un impacto importante en el sistema de salud y afecta la calidad de vida de las familias. El peso de los recién nacidos de madres con enfermedad periodontal es significativamente menor en comparación con los de madres no afectadas por esta enfermedad bucal. Este resultado adverso se considera un problema de salud pública global según los datos epidemiológicos. Objetivo. Determinar la asociación entre la prevalencia de parto prematuro y la enfermedad periodontal en Bolivia, Chile y Colombia entre el 2000 y el 2020. Materiales y métodos. Este estudio ecológico consideró las poblaciones de mujeres de Bolivia, Chile y Colombia, y la prevalencia de partos prematuros y enfermedad periodontal, discriminadas por grupos de edad. El estudio abarcó el período entre el 2000 y el 2020. La estrategia de búsqueda con la herramienta de investigación del Institute for Health Metrics and Evaluation incluyó prevalencia, grupos de edad, años entre 2000 y 2020, causas de parto prematuro y enfermedad periodontal, contexto y ubicaciones, mujeres y tasas. El análisis estadístico incluyó una regresión lineal simple entre parto prematuro y enfermedad periodontal para cada grupo de edad dentro de cada país. Resultados. Las tasas de partos prematuros fueron mayores en el grupo de 15 a 19 años (Bolivia: 697.563, Chile: 844.864, Colombia: 804.126). La prevalencia de la enfermedad periodontal aumentó con la edad, particularmente en el grupo de 45 a 49 años (Bolivia: 22'077.854, Chile: 34'297.901, Colombia: 32'032,830). Según los grupos de edad, la regresión lineal fue estadísticamente significativa (p < 0,001) para todos los grupos evaluados de la población boliviana, en los grupos mayores de 30 años para las colombianas y solo en el grupo de 15 a 19 años para las mujeres chilenas. Conclusión. Se encontró asociación entre el parto prematuro y la enfermedad periodontal en todos los grupos de edad en Bolivia, solo en el grupo de 15 a 19 años en Chile, y de 30 años y más en Colombia en el período evaluado de 20 años.

Differences in Factors Associated With Preterm and Term Stillbirth: A Secondary Cohort Analysis of the DESiGN Trial.

OBJECTIVE: To identify whether maternal and pregnancy characteristics associated with stillbirth differ between preterm and term stillbirth. DESIGN: Secondary cohort analysis of the DESiGN RCT. SETTING: Thirteen UK maternity units. POPULATION: Singleton pregnant women and their babies. METHODS: Multiple logistic regression was used to assess whether the 12 factors explored were associated with stillbirth. Interaction tests assessed for a difference in these associations between the preterm and term periods. MAIN OUTCOME MEASURE: Stillbirth stratified by preterm (<37+0 weeks') and term (37+0-42+6 weeks') births. RESULTS: A total of 195 344 pregnancies were included. Six hundred and sixty-seven were stillborn (3.4 per 1000 births), of which 431 (65%) were preterm. Significant interactions were observed for maternal age, ethnicity, IMD, BMI, parity, smoking, PAPP-A, gestational hypertension, pre-eclampsia and gestational diabetes but not for chronic hypertension and pre-existing diabetes. Stronger associations with term stillbirth were observed in women with obesity compared to BMI 18.5-24.9 kg/m2 (BMI 30.0-34.9 kg/m2 term adjusted OR 2.1 [95% CI 1.4-3.0] vs. preterm aOR 1.1 [0.8-1.7]; BMI ≥ 35.0 kg/m2 term aOR 2.2 [1.4-3.4] vs. preterm aOR 1.5 [1.2-1.8]; p-interaction < 0.01), nulliparity compared to parity 1 (term aOR 1.7 [1.1-2.7] vs. preterm aOR 1.2 [0.9-1.6]; p-interaction < 0.01) and Asian ethnicity compared with White (p-interaction < 0.01). A weaker or lack of association with term, compared to preterm, stillbirth was observed for older maternal age, smoking and pre-eclampsia. CONCLUSION: Differences in association exist between mothers experiencing preterm and term stillbirth. These differences could contribute to design of timely surveillance and interventions to further mitigate the risk of stillbirth.

Consequences of Natural and Man-made Disasters on Pregnancy Outcomes and Complications: A Systematic Review.

Introduction: Due to their unique circumstances, pregnant women face a heightened risk of experiencing pregnancy complications during and after catastrophic events. This study aims to investigate the consequences of both natural and man-made disasters on pregnancy outcomes. Method: This study is a systematic review. Searches were performed until May 31, 2024, in the electronic databases including Medline, Web of Science, Embase, and Scopus. Outcomes such as preterm birth, low birth weight (LBW), small for gestational age (SGA), stillbirth, spontaneous abortion, and pregnancy-related blood pressure complications were studied. Result: The search conducted in the databases yielded 3307 non-duplicate records. After reading the abstracts, 3204 articles were excluded based on inclusion and exclusion criteria. Full texts of 103 article were obtained. However, upon reading the full texts of articles, 13 of them did not meet the inclusion criteria for the study. Consequently, 90 articles were ultimately included. Conclusion: Natural and man-made disasters exert significant influence on adverse pregnancy outcomes. While it is impossible to prevent the incidence of natural disasters and often man-made disasters occur abruptly, the negative consequences of disasters, particularly natural ones, can be mitigated by enhancing prenatal care and avoiding detrimental elements such as smoking and alcohol.

Cerclage suture type to prevent pregnancy loss in women requiring a vaginal cervical cerclage: the C-STICH RCT.

Background: Second trimester miscarriage and preterm birth is a significant global problem. Surgical cervical cerclage is performed to prevent pregnancy loss and preterm birth. It utilises either a monofilament or braided suture. It is hypothesised that a braided material becomes colonised with pathogenic bacteria that causes vaginal dysbiosis, infection and cerclage failure. Objectives: The primary objective of the study was to examine the effectiveness of using a monofilament suture material as opposed to a braided suture material on pregnancy loss in women requiring a vaginal cervical cerclage. Design: Superiority open randomised controlled trial. Setting: Seventy-five maternity sites across the UK. Participants: Women experiencing a singleton pregnancy requiring a cervical cerclage. Interventions: Monofilament suture or braided suture. Main outcome measures: The primary outcome was pregnancy loss (miscarriage and perinatal mortality, including any stillbirth or neonatal death in the first week of life). Secondary outcomes included the core outcome set for preterm birth. Methods: Women were randomised on a 1 : 1 basis to monofilament or braided cerclage utilising a bespoke randomisation service with minimisation dependent on the site, indication for cerclage, intention to use progesterone and planned surgical technique. The inclusion criteria were three or more previous mid-trimester losses or preterm births, insertion of a cerclage in a previous pregnancy, a history of a mid-trimester loss or preterm birth with a shortened cervical length in the current pregnancy or in women who clinicians deemed at risk of preterm birth. The exclusion criteria were an emergency or rescue cerclage, age of < 18 years, being unable to give informed consent or the cerclage having to be placed abdominally. The original sample size was calculated based on a relative risk reduction of 41% from a pregnancy loss rate of 19% in the braided group to 11% in the monofilament group with 90% power and alpha at p = 0.05. The independent data monitoring committee noted a lower-than-anticipated pooled event rate within the trial and recommended an increase in sample size to 2050. The outcome data were collected using clinical record forms from the maternal and neonatal medical records and reported to Birmingham Clinical Trials Unit. Results: A total of 2049 women were randomised, after withdrawals and loss to follow-up, data on 1005 women in the monofilament group and 993 women in the braided group were included. The baseline demographics between the groups were similar. There was no evidence of a difference in pregnancy loss rates between the monofilament and braided groups (80/1003 vs. 75/993; adjusted risk ratio: 1.05, 95% confidence interval: 0.79 to 1.40; adjusted risk difference: 0.002, 95% confidence interval: -0.02 to 0.03). Limitations: The trial did not collect long-term paediatric outcomes. There were no safety concerns. Conclusions: There was no evidence of a difference in pregnancy loss between a monofilament suture and a braided suture. Future work: Long-term follow-up of neonates born within the C-STICH (cerclage suture type for an insufficient cervix and its effects on health outcomes) trial. Trial registration: This trial is registered as ISRCTN15373349. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 13/04/107) and is published in full in Health Technology Assessment; Vol. 28, No. 40. See the NIHR Funding and Awards website for further award information.

Cervical cerclage is an operation performed in pregnancy to prevent miscarriage and preterm birth. A cervical cerclage is sometimes recommended in women who have had babies born prematurely before or who have had previous cervical surgery. A cerclage operation involves a stitch being inserted around the neck of the womb (cervix) to keep it closed during pregnancy and to prevent it opening prematurely. When performing the operation, the doctor can use different types of threads made of different materials. The threads used to perform the operation are called sutures. One suture type is a single strand or monofilament thread, and the other is a multifilament braided thread with lots of thin strands woven together. Some evidence has suggested that using a monofilament suture thread prevented pregnancy loss by preventing infection. Therefore, we performed a randomised controlled trial of the use of monofilament suture thread versus braided suture thread, aiming to reduce pregnancy loss in women who were having a cerclage as part of their routine care. The women consented to take part in the study and were randomly allocated to their cerclage performed with either a monofilament or braided suture thread; there was no other change to their planned pregnancy care. What happened in their pregnancy was recorded from their medical records and analysed. A total of 2049 women agreed to take part in the study and consented to the analysis of their pregnancy and neonatal outcomes. Cerclage suture type for an insufficient cervix and its effects on health outcomes showed that there was no difference in pregnancy loss between the two suture threads. There was decreased maternal sepsis and decreased chorioamnionitis (which is an infection inside the womb during labour) in the women who received a monofilament suture, which needs further investigation. Although more women who had a cerclage using the monofilament thread needed a small operation and an anaesthetic, often between 36 and 37 weeks, to remove the monofilament suture prior to a vaginal birth, there were no differences in the outcomes for their babies.