Trophectoderm biopsy is associated with lower risks of moderate to extreme prematurity and low birthweights: a national registry cohort study of singleton livebirths from frozen-thawed blastocyst transfers.

BACKGROUND: Trophectoderm biopsy has become the mainstay assisted reproductive technique performed for preimplantation genetic testing, accounting for 43.8% of embryo transfer cycles in the United States in 2019 alone. Despite its prevalence, data on the obstetric and perinatal outcomes post-trophectoderm biopsy remains sparse and mixed. OBJECTIVE: This study aimed to examine the risks of adverse perinatal outcomes in birthweights and prematurity after transfers of the vitrified-thawed blastocyst with trophectoderm biopsy for preimplantation genetic testing. STUDY DESIGN: This was a retrospective observational cohort study of 45,712 singleton livebirths resulting from autologous vitrified-thawed blastocyst transfer cycles with or without trophectoderm biopsy for preimplantation genetic testing, reported by participating member clinics to the Society for Assisted Reproductive Technology national registry between 2014 and 2017. Adverse perinatal outcomes of preterm births and low birthweights were analyzed. Multivariable regression analyses were performed to control for covariates. Comparing the trophectoderm biopsy (n=21,584) and no trophectoderm biopsy (n=24,128) groups, adjusted odds ratios were calculated for the outcomes of small-for-gestational-age, large-for-gestational-age, low birthweight <2500 g, very low birthweight <1500 g, extremely low birthweight <1000 g, late preterm births <37 weeks, moderate preterm births <34 weeks, and extremely preterm births <28 weeks. RESULTS: Women in the trophectoderm biopsy group were older and more likely to have prior pregnancies, deliveries, and a history of spontaneous abortions. Tobacco use, diminished ovarian reserve, and recurrent pregnancy loss were also more prevalent in the trophectoderm biopsy group. Trophectoderm biopsy was not associated with small-for-gestational-age (adjusted odds ratio, 0.97; 95% confidence interval, 0.85-1.12; P=.72) or large-for-gestational-age newborns (adjusted odds ratio, 1.10; 95% confidence interval, 0.99-1.22; P=.09). Risks of preterm births <37 weeks gestation were similar between the biopsy and nonbiopsy groups (adjusted odds ratio, 0.93; 95% confidence interval, 0.85-1.02; P=.11). Trophectoderm biopsy was associated with a significantly lower risk of low birthweight <2500 g (adjusted odds ratio, 0.80; 95% confidence interval, 0.70-0.92; P<.001), very low birthweight <1500 g (adjusted odds ratio, 0.62; 95% confidence interval, 0.46-0.83; P<.001), extremely low birthweight <1000 g (adjusted odds ratio, 0.48; 95% confidence interval, 0.31-0.74; P<.001), moderate preterm birth <34 weeks (adjusted odds ratio, 0.76; 95% confidence interval, 0.64-0.91; P=.003), and extreme preterm birth <28 weeks (adjusted odds ratio, 0.63; 95% confidence interval, 0.43-0.92; P=.02). CONCLUSION: Trophectoderm biopsy is not associated with increased risks of small-for-gestational-age, large-for-gestational-age, or late preterm birth. Risks of low birthweight, very low birthweight, and extremely low birthweight from moderate and extreme preterm births are lower after trophectoderm biopsy, possibly by selecting against confined placental mosaicism or inducing placental epigenetic changes, the mechanisms of which warrant further investigation.

Association between residential green spaces and pregnancy outcomes: a systematic review and meta-analysis.

Residential exposure to greenness has shown positive influences on pregnancy outcomes like birth weight, preterm births, and small to gestational age (SGA) deliveries. We aimed to comprehensively review and investigate these associations by conducting a systematic review with meta-analysis. Relevant studies were retrieved from PubMed, EMBASE, ScienceDirect, and Google Scholar databases before June 2023. Summary effect estimates included birth weight, low birth weight (LBW), preterm births, and SGA which were calculated for 0.1 unit increase in residential greenness exposure. Overall quality of the evidence was examined through Joanna Briggs Institute (JBI) critical appraisal tool. The review included 31 articles and found a statistically significant increase in birth weight measured at 250 m buffer distance (ß = 8.95, 95% CI = 1.63-16.27). Green spaces were also associated with lower odds of LBW (OR = 0.97, 95% CI = 0.96-0.98). Residential greenness had positive impacts on pregnancy outcomes that calls for emphasis on urban planning, especially in developing countries.

[Epidemiology and risk factors for preterm births in north-western Algeria]. / Épidémiologie et facteurs de risque de la prématurité dans le nord-ouest algérien.

Introduction: preterm births continue to be the main cause of infant and child mortality as well as sensory-motor disabilities and neurodevelopmental difficulties worldwide. The rate of preterm births has been rising, in particular in Algeria. The purpose of this study is to determine the frequency of preterm births in the Oran Wilaya and to identify risk factors. Methods: we used data from a multicentre cross-sectional study carried out in all Public Maternity Hospitals in the Oran Wilaya (13). The study included parturient women who had given birth to a live and/or stillborn child (with birthweights ≥500 g), whose gestational age was greater than or equal to 24-36 weeks of amenorrhoea. Mothers´ demographic, medical and socio-behavioural factors were recorded. Logistic regression was used to study predictors of prematurity. Results: preterm birth rate was 9.9% (45/452). The average age of patients was 30.4±6 years; multiple pregnancies accounted for 2.2% of births. Factors related to prematurity were the risk of premature labour (aOR=4.68; 95% CI: 2.27-9.64), the lack of clinical monitoring of pregnancy (OR=2.83; CI 95%: 1.83-6.05) and gestational hypertension (aOR = 3.69, 95% CI: 1.83-8.8). Conclusion: the rate of preterm births is in line with the rate observed in neighbouring countries. The study identified predictive factors, some of which are already targeted by the national perinatal program. However, it is essential to continue to lead efforts to improve the monitoring and management of pregnancies and premature births at all levels of care.

Corrigendum: Microbiota dynamics, metabolic and immune interactions in the cervicovaginal environment and their role in spontaneous preterm birth.

[This corrects the article DOI: 10.3389/fimmu.2023.1306473.].

Factors Influencing the Implementation of Infant Warming Devices Among Healthcare Workers in Malawian Hospitals.

Objectives. Preterm infants are at risk of hypothermia. This study described the available infant warming devices (IWDs) and explored the barriers and facilitators to their implementation in neonates in Malawi. Methods. A qualitative descriptive study was conducted among 19 health care workers in Malawi from January to March 2020. All interviews were digitally recorded, transcribed, and managed using NVivo and analyzed using a thematic approach. Results. The warming devices included radiant warmers, Blantyre hot-cots, wall-mounted heaters, portable warmers, and incubators. Inadequate equipment and infrastructure and gaps in staff knowledge and capacity were reported as the main challenges to optimal IWD implementation. Caregiver acceptance was described as the main facilitator. Strategies to optimize implementation of IWD included continuous practical training and adequate availability of equipment and spare parts. Conclusion. Implementation of warming devices for the management of neonatal hypothermia is effective when there are adequate human and material resources.

Screening for women at risk of spontaneous preterm birth, including cervical incompetence.

Preterm births remain one of the biggest challenges in obstetrics worldwide. With the advancement of neonatal care, more premature neonates survive with long term consequences. Therefore, preventing or delaying preterm births starting from the preconceptional or antenatal periods are important. Among the numerous screening strategies described, not one can fit into all. Nonetheless, approaches including identifying women with modifiable risk factors for preterm births, genitourinary infections and short cervical length are the most useful. In this article, the current evidence is summarized and the best strategies for common clinical scenerios including cervical incompetence, history of second trimester loss or early preterm births, incidental short cervix and multiple pregnancy are discussed.

Extreme prematurity: Factors associated with perinatal management and morbi-mortality in western Normandy, France.

BACKGROUND: Extreme prematurity (birth before 26 weeks of gestation), presents complex challenges and can lead to various complications. Survival rates of extremely preterm infants are lower in France than in other countries. The choice between active and palliative care is decisive in managing these births. OBJECTIVE: To conduct an observational study focused on factors associated with perinatal management, mortality, and morbidity outcomes among extremely preterm births in a regional perinatal network. METHODS: We undertook a retrospective, multicenter study within the western Normandy perinatal network, encompassing live births between 230/6 and 256/6 weeks from 2015 to 2019. Data were extracted from the perinatal network database and medical records. RESULTS: One hundred and seven infants born from 94 women were included. In the antenatal period, 79 were exposed to corticosteroids, 66 to magnesium sulfate, and 67 to antibiotics. Active care at birth was provided to 84 neonates of whom 42 survived. In total, 65 infants died. Among the 42 surviving neonates, 9 experienced no severe morbidity, 29 displayed one and 4 exhibited two criteria of severe morbidity. Active care was associated with gestational age. Neonatal survival was correlated with antenatal exposure to antibiotics and magnesium sulfate as well as with postnatal corticosteroids. We found no significant association between mortality and gestational age at birth. CONCLUSION: Prognostic factors must be weighed to discuss active antenatal care which is crucial for survival of extremely preterm neonates. Cooperation between obstetricians and neonatal caregivers is a cornerstone on a regional perinatal network scale.

Microbiota dynamics, metabolic and immune interactions in the cervicovaginal environment and their role in spontaneous preterm birth.

Differences in the cervicovaginal microbiota are associated with spontaneous preterm birth (sPTB), a significant cause of infant morbidity and mortality. Although establishing a direct causal link between cervicovaginal microbiota and sPTB remains challenging, recent advancements in sequencing technologies have facilitated the identification of microbial markers potentially linked to sPTB. Despite variations in findings, a recurring observation suggests that sPTB is associated with a more diverse and less stable vaginal microbiota across pregnancy trimesters. It is hypothesized that sPTB risk is likely to be modified via an intricate host-microbe interactions rather than due to the presence of a single microbial taxon or broad community state. Nonetheless, lactobacilli dominance is generally associated with term outcomes and contributes to a healthy vaginal environment through the production of lactic acid/maintenance of a low pH that excludes other pathogenic microorganisms. Additionally, the innate immunity of the host and metabolic interactions between cervicovaginal microbiota, such as the production of bacteriocins and the use of proteolytic enzymes, exerts a profound influence on microbial populations, activities, and host immune responses. These interplays collectively impact pregnancy outcomes. This review aims to summarize the complexity of cervicovaginal environment and microbiota dynamics, and associations with bacterial vaginosis and sPTB. There is also consideration on how probiotics may mitigate the risk of sPTB and bacterial vaginosis.