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1.
BMC Pregnancy Childbirth ; 22(1): 254, 2022 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-35346088

RESUMO

OBJECTIVE: Our aim was to assess diagnostic accuracy in the prediction of small for gestational age (SGA <10th centile) and fetal growth restricted (FGR) (SGA <3rd centile) fetuses using three different sonographic methods in pregnancies at increased risk of fetal growth restriction: 1) fetal abdominal circumference (AC) z-scores, 2) estimated fetal weight (EFW) z-scores according to postnatal reference standard; 3) EFW z-scores according to a prenatal reference standard. METHODS: Singleton pregnancies at increased risk of fetal growth restriction seen in two university hospitals between 2014 and 2015 were studied retrospectively. EFW was calculated using formulas proposed by the INTERGROWTH-21st project and Hadlock; data derived from publications by the INTEGROWTH-twenty-first century project and Hadlock were used to calculate z-scores (AC and EFW). The accuracy of different methods was calculated and compared. RESULTS: The study group included 406 patients. Prenatal standard EFW z-scores derived from INTERGROWTH-21st project and Hadlock and co-workers performed similarly and were more accurate in identifying SGA infants than using AC z-scores or a postnatal reference standard. The subgroups analysis demonstrated that EFW prenatal standard was more or similarly accurate compared to other methods across all subgroups, defined by gestational age and birth weight. CONCLUSIONS: Prenatal standard EFW z-scores derived from either INTERGROWTH-21 st project or Hadlock and co-workers publications demonstrated a statistically significant advantage over other biometric methods in the diagnosis of SGA fetuses.


Assuntos
Retardo do Crescimento Fetal , Peso Fetal , Feminino , Retardo do Crescimento Fetal/diagnóstico por imagem , Feto , Idade Gestacional , Humanos , Gravidez , Diagnóstico Pré-Natal , Estudos Retrospectivos , Ultrassonografia Pré-Natal/métodos
2.
rev.cuid. (Bucaramanga.2010) ; 13(1): 1-15, 20221213.
Artigo em Espanhol | LILACS, BDENF - Enfermagem, COLNAL | ID: biblio-1369169

RESUMO

Objetivos: Describir el comportamiento de la sífilis gestacional y congénita en Colombia, entre el 2012 y 2018, a partir de registro de notificación Nacional. Materiales y Métodos: Estudio ecológico, exploratorio a partir de Notificaciones al sistema de vigilancia de salud Pública. Se estimaron la tasa de incidencia y la razón de prevalencia para cada departamento. Se establecieron cada una las estimaciones según rangos, para los 33 departamentos evaluados y se expresaron en mapas a escala de grises según tasas y razones evaluadas. Además, se presentan curvas epidemiológicas por semanas notificación para sífilis gestacional y congénita. Resultados. Arauca, Santander, Cesar y Caldas, presentaron el mayor incremento entre 2012 y 2018 para sífilis gestacional. Para el mismo periodo, Santander, Casanare y Amazonas presentaron un aumento para sífilis Congénita, mientras que en los demás departamentos se evidenció una disminución en los eventos. Se encontraron diferencias significativas en el reporte de casos entre un año y otro, para el país, en ambos eventos (p< 0,001). Conclusiones. En Colombia se encontró un aumento de sífilis gestacional, mientras, para sífilis congénita existió variabilidad con tendencia a aumentar en los últimos años.


Objective: To describe the behavior of pregnancy and congenital syphilis in Colombia between 2012 and 2019 according to national notifications records. Materials and Methods: An ecological exploratory study was conducted based on notifications to the public health surveillance system. The incidence rate and prevalence ratio were estimated for each department. Each estimate was established per ranges for 33 departments evaluated and expressed in grayscale maps based on rates and ratios evaluated. Epidemic curves by week of notification for pregnancy and congenital syphilis are also shown. Results: Arauca, Santander, Cesar and Caldas had the highest increase in pregnancy syphilis between 2012 and 2019 while Santander, Casanare and Amazonas had an increase in congenital syphilis during the same period. Other departments had a decrease in these events. Significant differences were found in case reporting from year to year in both events in the country (p<0.001). Conclusions: In Colombia, an increase in pregnancy syphilis was found while a variability with an increasing trend was found for congenital syphilis in recent years.


Objetivos: Descrever o comportamento da sífilis gestacional e congênita na Colômbia entre 2012 e 2019, com base nos registros nacionais de notificação.Materiais e Métodos: Estudo ecológico, exploratório, baseado em notificações ao sistema de vigilância sanitária pública. A taxa de incidência e a taxa de prevalência foram estimadas para cada departamento. As estimativas foram estabelecidas de acordo com intervalos para os 33 departamentos avaliados e expressas em mapas em escala de cinza, de acordo com as taxas e rácios avaliados. Além disso, curvas epidemiológicas por semanas de notificação são apresentadas para sífilis gestacional e congênita. Resultados: Arauca, Santander, Cesar e Caldas apresentaram o maior aumento entre 2012 e 2019 para a sífilis gestacional. No mesmo período, Santander, Casanare e Amazonas mostraram um aumento para a sífilis congênita, enquanto os outros departamentos mostraram uma diminuição nos eventos. Foram encontradas diferenças significativas no relato de casos de um ano para o outro, para o país, em ambos os eventos (p<0,001). Conclusões. Na Colômbia, houve um aumento da sífilis gestacional, enquanto para a sífilis congênita houve variabilidade com tendência a aumentar nos últimos anos.


Assuntos
Humanos , Feminino , Cuidado Pré-Natal , Sífilis Congênita , Idade Gestacional , Monitoramento Epidemiológico
3.
Rom J Morphol Embryol ; 63(1): 203-207, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36074685

RESUMO

Sacrococcygeal teratomas (SCTs) are rare congenital tumors. With the improvement of diagnostic imaging methods and follow-up protocols in pregnancies, in utero detection of these tumors has increased. Despite these progresses, SCTs may present difficulties in establishing in utero diagnosis and subsequent management. We present two cases of SCT in 18 weeks, respectively 22 weeks pregnancy, diagnosed using ultrasound imaging and pathologically confirmed. Also, the article aims to recapitulate clinicopathological aspects and prognosis of these lesions, following the review of the literature.


Assuntos
Neoplasias Pélvicas , Neoplasias da Coluna Vertebral , Teratoma , Feminino , Idade Gestacional , Humanos , Gravidez , Diagnóstico Pré-Natal , Região Sacrococcígea/patologia , Teratoma/diagnóstico por imagem , Ultrassonografia Pré-Natal
4.
Annu Int Conf IEEE Eng Med Biol Soc ; 2022: 346-349, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-36085974

RESUMO

Hypoxemia, characterized by low blood oxygen levels is pervasive in preterm infants and is associated with development of multiple adverse cardiovascular morbidities. In clinical practice, it is often quantified using frequency, pattern and time spent in it. A predictive tool of hypoxemia occurrence will aid clinicians in risk stratifying infant oxygenation patterns and improving personalized care. As a first step towards this goal in characterizing the underlying temporal processes, we studied inter-hypoxemia interval distributions in preterm infants on oxygen supplementation. We derived regression relationships of characterizing parameters of the distributions with gestational age and birth weight of infants. The modeling and goodness of fit tests of pooled and individual inter-hypoxemia intervals indicated that the inverse Gaussian and Birnbaum Saunders distributions fit well over short time scales and the lognormal at longer time scales. Information from distribution modeling may provide insights into hypoxemia recurrence times and be helpful in developing models to predict severe hypoxemic events that may be translated to personalized care in clinical settings. Clinical relevance - Understanding the stochastic nature of temporal processes underlying hypoxemia in preterm infants is a critical step towards developing predictive models for their occurrence. This may potentially aid in the neonatal care and treatment of these vulnerable infants.


Assuntos
Hipóxia , Recém-Nascido Prematuro , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Distribuição Normal , Oxigênio
5.
Taiwan J Obstet Gynecol ; 61(5): 794-799, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36088046

RESUMO

OBJECTIVE: The purpose of this study was to establish a new reference chart and growth standards for fetal biometry in Taiwan. MATERIALS AND METHODS: 2047 singleton pregnancies were enrolled in this study with 15,813 fetal scans between 18 and 40 gestational weeks. A reference chart and normal range for fetal biparietal diameter (BPD), abdominal circumference (AC) and femur length (FL) was established by longitudinal quantile regression model. 330 women with comorbidities including gestational hypertension, preeclampsia and gestational diabetes were excluded and 1717 pregnant women were enrolled for the growth standard. RESULTS: The new reference values were significantly larger across all gestational ages compared with the prior National Taiwan University reference chart in 1983. Compared with Intergrowth-21st, the BPD was larger at 18-23 weeks, the AC was larger at 18-24 weeks and the FL was larger at 18-36 weeks whereas they were all smaller at 29-40 weeks for the BPD, at 32-40 weeks for the AC and at 38-40 weeks for the FL. A quantile regression equation of biometry was established. BPD, AC, and FL had weekly growth of 2.5, 9.87 and 2.15 mm. Prepregnancy body weight, height, age, and gestational diabetes increased fetal size. Both gestational and chronic hypertension decreased fetal size. CONCLUSION: To promote maternal-fetal safety, a new reference chart and growth standard for fetal biometry is necessary to measure fetal growth.


Assuntos
Diabetes Gestacional , Ultrassonografia Pré-Natal , Biometria , Feminino , Feto , Idade Gestacional , Humanos , Gravidez
6.
Taiwan J Obstet Gynecol ; 61(5): 847-853, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36088054

RESUMO

OBJECTIVE: To compare the cesarean section (CS) rates of obstetricians with a preference of labor induction at early versus late gestational age. MATERIAL AND METHODS: Medical records of women who were low risk, nulliparous, singleton pregnancy, and >37 weeks and delivered their babies, were reviewed. Obstetricians, who preferred labor induction at<41 weeks, were allocated to the early induction group; and the other obstetricians were allocated to the late induction group. RESULTS: The late induction group had a higher percentage of labor induction at ≥41 weeks, compared with the early induction group (21% vs. 8%, p = 0.007). The late induction group had a lower CS rate (11.0% vs. 19.1%, p < 0.001). Multivariable Cox proportional hazard model revealed that the early induction group (hazard ratio [HR] = 2.14, p < 0.001), maternal age (HR = 1.04, p = 0.001), premature rupture of membranes (HR = 1.59, p = 0.006), and birth body weight (kg, HR = 2.13, p < 0.001) were independent predictors of CS. In women receiving labor induction (n = 312), birth body weight (kg, HR = 1.72, p = 0.04) was the sole predictor of CS; and there is a trend that the early induction group (HR = 1.54, p = 0.051) has a higher CS rate, compared with the late induction group. However, gestational age at labor induction was not a predictor of CS. CONCLUSION: In low-risk pregnancies, obstetricians preferring labor induction at early gestational age seem to be associated with a higher CS rate, compared with obstetricians preferring labor induction at late gestational age. Nonetheless, the above finding seems to be associated with physician's factor, instead of gestational age at labor induction.


Assuntos
Cesárea , Médicos , Peso ao Nascer , Feminino , Idade Gestacional , Humanos , Paridade , Gravidez , Fatores de Risco
7.
BMC Ophthalmol ; 22(1): 367, 2022 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-36096834

RESUMO

BACKGROUND: The aim of the study was to determine the incidence and risk factors of retinopathy of prematurity (ROP) in premature, extremely low birth weight (BW, ELBW) and extremely low gestational age (GA, ELGA) infants. METHODS: The medical records of preterm infants who were screened for ROP between January 2012 and December 2020 were retrospectively reviewed. Only one eye of each infant with higher grade ROP was included in the study. BW; GA; medical characteristics; the presence, severity, and need for treatment of ROP were recorded. Infants were divided into groups according to BW (≤1000 g, 1001-1750 g, > 1750 g) and GA (≤25w, 26-28w, 29-31w, 32-34w, ≥35w) and data were analyzed. RESULTS: Data of 2186 infants were evaluated. The overall incidences of any stage ROP and ROP requiring treatment were 43.5 and 8.0%, respectively. These rates were 81.1 and 23.9% in ELBW (≤1000 g) infants and were 92.9 and 64.3% in ELGA (≤25w) infants, respectively. The rates of ROP, the median duration of oxygen therapy and systemic diseases increased significantly as BW and GA decreased. The median duration of oxygen therapy and the rates of sepsis, pulmonary dysplasia (BPD), and intraventricular hemorrhage (IVH) were statistically higher in infants with ROP compared to those without ROP (p < 0.001). Multivariate regression analysis demonstrated that low BW and GA; prolonged duration of oxygen therapy; presence of PDA and necrotizing enterocolitis (NEC) were important risk factors for ROP. CONCLUSIONS: ELBW and ELGA infants develop higher rates of ROP and severe ROP. Prolonged duration of oxygen therapy, the presence of concomitant neonatal sepsis, BPD, IVH, PDA, and NEC further increases the risk of ROP.


Assuntos
Recém-Nascido de Peso Extremamente Baixo ao Nascer , Retinopatia da Prematuridade , Idade Gestacional , Humanos , Incidência , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Oxigênio , Retinopatia da Prematuridade/epidemiologia , Retinopatia da Prematuridade/etiologia , Estudos Retrospectivos , Fatores de Risco
8.
Early Hum Dev ; 173: 105657, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36087459

RESUMO

BACKGROUND: Vasoactive-Inotropic Score (VIS) is a weighted sum of various vasopressors and inotropes; its utility among preterm neonates is understudied. OBJECTIVE: To investigate the association between maximum VIS (VISmax) during the first 12, 24 and 48 h of treatment among preterm neonates who received vasopressors/inotropes, and the composite outcome of death/severe neuroinjury (sNI). METHODS: Retrospective cohort study, over 6-years, including neonates <35 weeks gestational age (GA). Infants who met the primary composite outcome of death or sNI (defined as new intraventricular hemorrhage ≥grade 3 or periventricular leukomalacia) were compared to those who survived without sNI. Maximum VIS was categorized as <10, 10-19 or ≥ 20 for comparison. RESULTS: 192 infants (mean GA and birth weight 26.8 ± 3.3 weeks and 952 ± 528 g, respectively) were included. The most common primary diagnosis was sepsis/necrotizing enterocolitis (69 %). Median VIS for the entire cohort was 10. Death/sNI was associated with lower GA at birth and treatment, as well as higher frequency of VISmax of 10-19 or ≥20, compared to <10, during each time period (all p < 0.01). Multivariable regression revealed GA at treatment and VISmax ≥ 20 [not 10-19, referenced to <10] were associated death/sNI; adjusted odds ratio (95 % CI) for VISmax ≥ 20 within 12, 24, and 48 h were 4.2 (1.6-11.0), 4.9 (1.9-12.3), and 6.7 (2.7-16.7), respectively. CONCLUSIONS: Vasoactive-Inotropic Score may be a valid measure to quantify cardiovascular support in preterm infants needing hemodynamic support. Maximum VIS ≥20 within 48 h of treatment initiation may identify patients at high risk of adverse outcomes.


Assuntos
Enterocolite Necrosante , Doenças do Recém-Nascido , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Estudos Retrospectivos
9.
Early Hum Dev ; 173: 105663, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36087460

RESUMO

BACKGROUND: Postnatal growth restriction (PGR) is common in very preterm infants (VPIs) and is associated with adverse short and long-term developmental outcomes. Postnatal growth status for VPIs in middle- or low-income countries remains unclear. AIMS: To evaluate PGR in VPIs and identify maternal and neonatal factors, clinical practice, and major neonatal morbidities associated with PGR in China. STUDY DESIGN: Prospective cohort study. SUBJECTS: We included 6085 infants born at <32 weeks gestation who were admitted at 57 hospitals in the Chinese Neonatal Network in 2019. OUTCOME MEASURES: Birth and discharge weights were converted to age-specific Z-scores. PGR was defined as a decrease in weight z-score from birth to discharge >2. RESULTS: The overall incidence of PGR was 19.9 %. The mean (standard deviation [SD]) weight Z-score was 0.12 (0.78) at birth and decreased to -1.36 (0.98) at discharge. About 4.0 % of VPIs were small for gestational age (SGA) at birth and 25.5 % of SGA infants had PGR. The incidence of PGR increased with decreasing gestational age except in the SGA subgroup. Each 1-unit increase in birthweight Z-score was associated with a 1.49-fold increased risk for PGR. Late initiation of enteral feeds and late achievement of full enteral feeds were positively associated with PGR. The common morbidities that influenced PGR were necrotizing enterocolitis ≥ stage II, patent ductus arteriosus requiring medical or surgical treatment, sepsis, bronchopulmonary dysplasia, and respiratory distress syndrome requiring surfactants. CONCLUSION: Nearly one fifth of VPIs were PGR, and one fourth of SGA had PGR, which warranted further study to investigate underlying causes by which to improve postnatal growth in very preterm infants in future.


Assuntos
Doenças do Prematuro , Recém-Nascido Prematuro , Feminino , Retardo do Crescimento Fetal/epidemiologia , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Doenças do Prematuro/epidemiologia , Recém-Nascido de muito Baixo Peso , Estudos Prospectivos , Tensoativos
10.
Clin Perinatol ; 49(3): 573-586, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36113923

RESUMO

Fetal MRI is a safe, noninvasive examination of the fetus and placenta, a complement to ultrasonography. MRI provides detailed CNS evaluation, including depicting parenchymal architecture and posterior fossa morphology, and is key in prenatal assessment of spinal dysraphism, neck masses, and ventriculomegaly. Fetal MRI is typically performed after 22 weeks gestation, and ultrafast T1 and T2-weighted MRI sequences are the core of the exam, with advanced sequences such as diffusion weighted imaging used for specific questions. The fetal brain grows and develops rapidly, and familiarity with gestational age specific norms is essential to MRI interpretation.


Assuntos
Feto , Diagnóstico Pré-Natal , Feminino , Feto/diagnóstico por imagem , Idade Gestacional , Humanos , Imageamento por Ressonância Magnética/métodos , Gravidez , Cuidado Pré-Natal , Diagnóstico Pré-Natal/métodos
11.
Clin Perinatol ; 49(3): 693-713, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36113930

RESUMO

One of the most common definitions of microcephaly cited is that of an occipitofrontal circumference (OFC) of the head that is less than two standard deviations below the average for age (or gestational age, if identified prenatally) and sex. Similarly, severe microcephaly is defined as an OFC that is less than three standard deviations below the average. Microcephaly is not a diagnosis, but rather, a finding that is secondary to a multitude of etiologies that can be categorized as prenatal versus postnatal, genetic versus environmental, and congenital versus acquired.


Assuntos
Microcefalia , Feminino , Idade Gestacional , Humanos , Microcefalia/diagnóstico por imagem , Gravidez , Ultrassonografia Pré-Natal/métodos
12.
Artigo em Inglês | MEDLINE | ID: mdl-36078258

RESUMO

Preterm births (PTB) are the leading cause of neonatal deaths, the majority of which occur in low- and middle-income countries, particularly those in Sub-Saharan Africa (SSA). Understanding the epidemiology of prematurity is an essential step towards tackling the challenge of PTB in the sub-continent. We performed a scoping review of the burden, predictors and outcomes of PTB in SSA. We searched PubMed, Embase, and three other databases for articles published from the database inception to 10 July 2021. Studies reporting the prevalence of PTB, the associated risk factors, and/or its outcomes were eligible for inclusion in this review. Our literature search identified 4441 publications, but only 181 met the inclusion criteria. Last menstrual period (LMP) was the most commonly used method of estimating gestational age. The prevalence of PTB in SSA ranged from 3.4% to 49.4%. Several risk factors of PTB were identified in this review. The most frequently reported risk factors (i.e., reported in ≥10 studies) were previous history of PTB, underutilization of antenatal care (<4 visits), premature rupture of membrane, maternal age (≤20 or ≥35 years), inter-pregnancy interval, malaria, HIV and hypertension in pregnancy. Premature babies had high rates of hospital admissions, were at risk of poor growth and development, and were also at a high risk of morbidity and mortality. There is a high burden of PTB in SSA. The true burden of PTB is underestimated due to the widespread use of LMP, an unreliable and often inaccurate method for estimating gestational age. The associated risk factors for PTB are mostly modifiable and require an all-inclusive intervention to reduce the burden and improve outcomes in SSA.


Assuntos
Nascimento Prematuro , Adulto , Feminino , Idade Gestacional , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Gravidez , Nascimento Prematuro/epidemiologia , Cuidado Pré-Natal , Fatores de Risco
13.
Artigo em Inglês | MEDLINE | ID: mdl-36078670

RESUMO

With advances in medical care and efforts to care for continually smaller and younger preterm infants, the gestational age of viability has decreased, including as young as 21 or 22 weeks of gestation [...].


Assuntos
Doenças do Prematuro , Recém-Nascido Prematuro , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Parto , Gravidez
14.
Artigo em Inglês | MEDLINE | ID: mdl-36078758

RESUMO

OBJECTIVE: This study aimed to describe neurodevelopment in fetal growth restriction children at the age of six. Secondly, we tried to demonstrate influencing factors that can improve or exacerbate this development, as well as predictive factors that might select a population at risk to assist with early childhood support. METHOD: It was a study of 70 children affected with FGR. FGR was based on these definitions: birth weight below the 3rd percentile or birth weight below the 10th percentile with an abnormal hemodynamic Doppler study. Neurodevelopment was assessed at 6 years old by means of Batelle Development Inventory. A global development quotient under a 100 score was considered a neurodevelopment delay. All variables regarding pregnancy care, delivery episode, postpartum, neonatal care, sociodemographic issues, and the need for support in the first years were studied. RESULTS: The mean gestational age at diagnosis was 33.14 weeks (standard deviation (SD = 4.31), with 32.9% of early-onset diagnoses. The mean gestational age at delivery was 35.61 (SD = 3.21), and the cesarean rate was 64.3%. The average age of the children at the moment of the evaluation was 76.20-month-old (SD = 3.70). The mean global development quotient was 97.28 (SD = 13.97). We were able to record a 57.1% of global development delay. In the cases of cognition, only 17.1% of the children registered a delay. Motor and communication skills were the most frequently affected. We discovered that socioeconomic status was positively related to the global development quotient, as well as both gestational age at delivery and middle cerebral artery pulsatility index was positively related to the global development quotient. CONCLUSIONS: We found a higher neurodevelopment delay rate (57.1%). We could relate a higher gestational age at delivery and a higher MCA percentile with better global neurodevelopment quotients.


Assuntos
Retardo do Crescimento Fetal , Artérias Umbilicais , Peso ao Nascer , Criança , Pré-Escolar , Feminino , Retardo do Crescimento Fetal/epidemiologia , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Gravidez , Estudos Retrospectivos , Ultrassonografia Pré-Natal , Artérias Umbilicais/diagnóstico por imagem
15.
Artigo em Inglês | MEDLINE | ID: mdl-36141991

RESUMO

This study designed to evaluate the short- and long-term outcomes of outborn and inborn preterm infants enhancing the regional perinatal system in South Korea. It is a prospective cohort study of the Korean neonatal network database for infants born at <29 weeks of gestation between 2013 and 2015. Of 2995 eligible infants, 312 were outborn, and 976 completed the assessment of long-term outcome at 18-24 months of corrected age. The mean gestational age was significantly younger in outborn infants than in inborn infants (p = 0.004). The mean Apgar score at 5 min was higher in inborn infants (p = 0.046). More inborn preterm infants died before discharge (p < 0.001); however, most of the other short-term outcomes occurred significantly more often in outborn infants than in inborn infants. The outborn infants had higher odds of neurodevelopmental impairment (adjusted odds ratio (aOR) 2.412, 95% confidence interval (CI) 1.585-3.670), cerebral palsy (aOR 4.460, 95% CI 2.249-8.845) and developmental impairment (aOR 2.238, 95% CI 1.469-3.408). In preterm infants, the location of birth may be a key factor influencing short- and long-term outcomes. Thus, to provide adequate care and efficiently allocate medical resources to high-risk preterm infants, nationwide regional perinatal systems need to be improved and standardized.


Assuntos
Mortalidade Infantil , Recém-Nascido Prematuro , Estudos de Coortes , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Gravidez , Estudos Prospectivos
16.
Sci Rep ; 12(1): 16016, 2022 Sep 26.
Artigo em Inglês | MEDLINE | ID: mdl-36163455

RESUMO

Concentrations of the hormone leptin, which is produced by adipose tissue, increase with increasing BMI, whereas leptin sensitivity often declines with higher BMI. Thus, altered leptin signaling may play a role in reproductive health risks observed with increasing BMI, which include later onset and slow progression of labor. Conflicting evidence from clinical, animal and in vitro studies have suggested that leptin either promotes or inhibits labor. We hypothesized that serum leptin concentrations or serum leptin: body mass index (BMI) ratios in women may be associated with the initiation and progression of labor. Following informed consent, serum samples were collected from 90 women with singleton pregnancies at the time of routine glucose-challenge testing, for measurement of leptin. The potential influence of leptin on gestation length and cervical dilation timing were examined by multiple linear regression. Data were analyzed from 63 participants who met exclusion and inclusion criteria. Leptin concentrations (log-transformed) at 24-28 weeks gestation were not significantly correlated with first trimester BMI . Log serum leptin and leptin: BMI ratio each were significantly associated with shorter total gestation length in uncomplicated, term pregnancies. In contrast, the mid-pregnancy leptin concentrations were not associated with progression of labor, assessed by cervical dilation over time. The association between higher serum leptin and shorter gestation length is consistent with the hypothesis that leptin promotes, or is permissive for, the onset of labor.


Assuntos
Trabalho de Parto , Leptina , Índice de Massa Corporal , Feminino , Idade Gestacional , Glucose , Humanos , Gravidez
18.
BMC Med ; 20(1): 333, 2022 09 28.
Artigo em Inglês | MEDLINE | ID: mdl-36167547

RESUMO

BACKGROUND: Identifying pregnancies at risk for preterm birth, one of the leading causes of worldwide infant mortality, has the potential to improve prenatal care. However, we lack broadly applicable methods to accurately predict preterm birth risk. The dense longitudinal information present in electronic health records (EHRs) is enabling scalable and cost-efficient risk modeling of many diseases, but EHR resources have been largely untapped in the study of pregnancy. METHODS: Here, we apply machine learning to diverse data from EHRs with 35,282 deliveries to predict singleton preterm birth. RESULTS: We find that machine learning models based on billing codes alone can predict preterm birth risk at various gestational ages (e.g., ROC-AUC = 0.75, PR-AUC = 0.40 at 28 weeks of gestation) and outperform comparable models trained using known risk factors (e.g., ROC-AUC = 0.65, PR-AUC = 0.25 at 28 weeks). Examining the patterns learned by the model reveals it stratifies deliveries into interpretable groups, including high-risk preterm birth subtypes enriched for distinct comorbidities. Our machine learning approach also predicts preterm birth subtypes (spontaneous vs. indicated), mode of delivery, and recurrent preterm birth. Finally, we demonstrate the portability of our approach by showing that the prediction models maintain their accuracy on a large, independent cohort (5978 deliveries) from a different healthcare system. CONCLUSIONS: By leveraging rich phenotypic and genetic features derived from EHRs, we suggest that machine learning algorithms have great potential to improve medical care during pregnancy. However, further work is needed before these models can be applied in clinical settings.


Assuntos
Nascimento Prematuro , Algoritmos , Registros Eletrônicos de Saúde , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Aprendizado de Máquina , Gravidez , Nascimento Prematuro/diagnóstico , Nascimento Prematuro/epidemiologia
19.
Sci Rep ; 12(1): 16235, 2022 Sep 28.
Artigo em Inglês | MEDLINE | ID: mdl-36171270

RESUMO

The aim of this study was to assess the relation between early exposure to stressful events and symptoms of the Attention-Deficit/Hyperactivity Disorder (ADHD) in children, based on the outcomes from a natural experiment. It was hypothesized that children pre- and postnatally exposed to cyclone Aila have increased ADHD symptoms compared to the control group, and the effect depends on the timing of the exposure. Indian children (8-11 years) prenatally (N = 336) and early postnatally (N = 216) exposed to cyclone Aila were compared to a non-exposed control peer group (N = 285). ADHD symptoms were assessed using the Conner's Teacher Rating Scale Revised. The main effect of exposure to the cyclone on the total ADHD symptoms' score, ADHD index, Hyperactivity and Oppositional symptoms was significant and independent to covariates: age and sex of children, gestational age and birth weight, maternal stress during the year before the study and the socioeconomic status of a family. The timing of exposure and sex of the children were found to be a significant moderator of the relation between early exposure to the natural disaster and ADHD symptoms. The prenatal, but also early postnatal exposure to stressful experiences such as a natural disaster, may disturb the development of cognitive functions and behavioural control, thus increasing the risk of ADHD in children.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Desastres Naturais , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Transtorno do Deficit de Atenção com Hiperatividade/etiologia , Criança , Feminino , Idade Gestacional , Humanos , Gravidez , Agitação Psicomotora , Classe Social
20.
Open Biol ; 12(9): 220151, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-36102059

RESUMO

The metabolic changes associated with intrauterine growth restriction (IUGR) particularly affect the liver, which is a central metabolic organ and contributes significantly to the provision of energy and specific nutrients and metabolites. Therefore, our aim was to decipher and elucidate the molecular pathways of developmental processes mediated by miRNAs and mRNAs, as well as the metabolome in fetal liver tissue in IUGR compared to appropriate for gestational age groups (AGA). Discordant siblings representing the extremes in fetal weight at day 63 post conception (dpc) were selected from F2 fetuses of a cross of German Landrace and Pietrain. Most of the changes in the liver of IUGR at midgestation involved various lipid metabolic pathways, both on transcript and metabolite levels, especially in the category of sphingolipids and phospholipids. Differentially expressed miRNAs, such as miR-34a, and their differentially expressed mRNA targets were identified. Sex-specific phenomena were observed at both the transcript and metabolite levels, particularly in male. This suggests that sex-specific adaptations in the metabolic system occur in the liver during midgestation (63 dpc). Our multi-omics network analysis reveals interactions and changes in the metabolic system associated with IUGR and identified an important biosignature that differs between IUGR and AGA piglets.


Assuntos
Retardo do Crescimento Fetal , MicroRNAs , Animais , Feminino , Retardo do Crescimento Fetal/genética , Retardo do Crescimento Fetal/metabolismo , Idade Gestacional , Humanos , Fígado/metabolismo , Masculino , Metabolômica , Gravidez , Suínos
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