Prevalência de nascimentos prematuros como desfechos de infecções pela COVID-19 na gestação / Prevalence of Preterm Birth as an Outcome of COVID-19 Infections during Pregnancy / Prevalencia de nacimientos prematuros producto de la infección por COVID-19 durante el embarazo

Objetivo: estimar a prevalência de nascimento prematuro em gestantes infectadas pela Covid-19, comparar índices de prematuridade entre infectadas e não infectadas e elucidar fatores associados à prematuridade. Métodos: coorte retrospectiva, com coleta de dados por inquérito online, de abril a dezembro de 2022, com mulheres que estiveram gestantes durante a pandemia, com acesso à internet, idade superior a 18 anos e que preencheram o primeiro inquérito online. Protocolo de pesquisa aprovado pelo Comitê de Ética. Resultados: primeiro inquérito respondido por 304 gestantes/puérperas, e o segundo por 82 (27%), compondo a amostra final. O índice de prematuridade no primeiro inquérito foi de 7,2% (n=14), já no segundo, 8,5% (n=7). A infecção pela Covid-19 não foi associada à prematuridade. A prematuridade associou-se a baixo peso, à necessidade de internação em centros de terapia intensiva neonatal e internações após o nascimento. Conclusão: a infecção pela Covid-19 não influenciou no aumento de nascimentos prematuros.

Objective: to estimate the prevalence of preterm birth in pregnant women infected with Covid-19, compare prematurity rates between infected and non-infected, and elucidate factors associated with prematurity. Methods: a retrospective cohort study was conducted using online survey data collected from April to December 2022, involving women who were pregnant during the pandemic, had internet access, were over 18 years old, and completed the initial online survey. The research protocol was approved by the Ethics Committee. Results: the initial survey was completed by 304 pregnant/postpartum women, and the follow-up survey by 82 (27%), comprising the final sample. The preterm birth rate in the initial survey was 7.2% (n=14), and in the follow-up survey, it was 8.5% (n=7). Covid-19 infection was not associated with prematurity. Prematurity was associated with low birth weight, the need for neonatal intensive care unit admission, and postnatal hospitalizations. Conclusion: Covid-19 infection did not influence an increase in preterm births.

Objetivo: estimar la prevalencia de partos prematuros en gestantes infectadas por Covid-19, comparar las tasas de prematuridad entre gestantes infectadas y no infectadas y determinar los factores asociados a la prematuridad. Métodos: estudio de cohorte retrospectivo, con recolección de datos mediante encuesta online, de abril a diciembre de 2022, con mujeres que estuvieron embarazadas durante la pandemia, con acceso a internet, mayores de 18 años y que completaron la primera encuesta online. El protocolo de investigación fue aprobado por el Comité de Ética. Resultados: la primera encuesta fue respondida por 304 gestantes/puérperas, y la segunda por 82 (27%), que conformaron la muestra final. La tasa de prematuridad en la primera encuesta fue del 7,2% (n=14), en la segunda, del 8,5% (n=7). La infección por Covid-19 no se asoció con la prematuridad. La prematuridad se asoció con bajo peso, necesidad de internación en centros de cuidados intensivos neonatales e internaciones después del nacimiento. Conclusión: La infección por Covid-19 no influyó en el aumento de nacimientos prematuros.

Effect of chorioamnionitis on postnatal growth in very preterm infants: a population-based study in Japan.

PURPOSE: There is growing evidence that preterm infants born to mothers with chorioamnionitis (CAM) have increased risk of various neonatal morbidities and long-term neurological disorders; however, the effect of CAM on postnatal growth remains insufficiently investigated. This study evaluated the effect of histological CAM on postnatal growth trajectories in very preterm infants using a nationwide neonatal database in Japan. METHOD: A multicenter retrospective study was conducted using clinical data of 4220 preterm neonates who weighed ≤ 1500 g and were born at < 32 weeks of gestation between 2003-2017 (CAM group: n = 2110; non-CAM group: n = 2110). Z-scores for height and weight were evaluated at birth and 3 years of age. Univariable and multivariable analyses were conducted to evaluate the effect of histological CAM on ΔZ-scores of height and weight during the first three years with a stratification by infant sex and the stage of histological CAM. RESULTS: Multivariable analyses showed that histological CAM was associated with accelerated postnatal increase (ΔZ-score) in weight (ß coefficient [95% confidence interval]; 0.10 [0.00 to 0.20]), but not in height among females (0.06 [- 0.04 to 0.15]) and not in height and weight among males (0.04 [- 0.04 to 0.12] and 0.02 [- 0.07 to 0.11], respectively). An interaction analysis demonstrated no significant difference in the effect of histological CAM on the ΔZ-scores of height and weight during the first three years between male and female infants (height, p = 0.81; weight p = 0.25). CONCLUSIONS: Intrauterine exposure to maternal CAM contributes to accelerated postnatal weight gain in female preterm infants during the first three years.

"Sink or swim": mothers' experiences of extremely preterm infants after 15 years from birth.

OBJECTIVES: To evaluate the experience of parenting a preterm infant from birth to adolescence and to raise awareness of the complexity of premature birth and the child's subsequent developmental journey for the entire family. STUDY DESIGN: A phenomenological, qualitative approach using semi-structured interviews with open-ended questions was adopted to obtain retrospective, in-depth narratives. Seven mothers of adolescents born preterm with extremely low birth weight (ELBW) and admitted to a neonatal intensive care unit (NICU) participated in the study. Interviews were conducted by a trained researcher in qualitative methods, and independent coders performed data analysis. RESULTS: Three phases and eight core themes, chronologically organized, emerged from the thematic analysis: starting from preterm birth (panic, fear and uncertainty; hope and a positive attitude to the future; altered parental role), transitioning to life after hospitalization (fatigue and worry about an uncertain future; need of support), and extending into adolescence (adolescents' fragility; overprotection; post-traumatic personal growth). CONCLUSIONS: The birth of a preterm baby has significant repercussions for the entire family, not only in the period immediately following birth but also for many years afterwards, as the traumatic event is retraced with memories that remain both painful and vivid. These findings should be acknowledged by professionals working in the NICU to foster the development of targeted interventions that help parents build resilience, including from a personal growth perspective.

Ultrastructural Features of Left Ventricle Cardiomyocytes in Preterm Newborn Rats.

The structure of left ventricular cardiomyocytes of 1 day preterm newborn rats was studied using transmission electron microscopy. It was shown that the relative area of the nucleus in cardiomyocytes of preterm rats is lower, and the relative area of the cytoplasm is higher than in full-term rats, while the relative areas of myofibrils and mitochondria do not differ. In cardiomyocytes of preterm rats damaged mitochondria, subsegmental myofibrillar contracture, and cytoplasmic swelling were found on the first postnatal day. Preterm birth in rats, in contrast to birth at term, is accompanied by the development of a number of ultrastructural damages in cardiomyocytes.

Associations between birthweight and preterm birth and the ages at menarche and menopause.

BACKGROUND: Women who reach menarche and menopause at earlier ages have been shown to be at increased risk for numerous conditions including cardiovascular disease, cancer, depression, and obesity; however, risk factors for earlier ages of menarche and menopause are not fully understood. Therefore, we aimed to perform a retrospective investigation of the associations between a personal birthweight and/or being born preterm and the age of and menarche and menopause and related events in the Women's Health Initiative, a large, racially and ethnically diverse cohort of postmenopausal women. METHODS: At study entry, women reported their birthweight by category (< 6 lbs., 6-7 lbs. 15 oz, 8-9 lbs. 15 oz, or ≥ 10 lbs.) and preterm birth status (4 or more weeks premature). Ages at events related to menarche and menopause were also self-reported. Linear regression and logistic regression models were used to estimate unadjusted and adjusted effect estimates (ß) and odds ratios (OR), respectively (n ≤ 86,857). Individuals born preterm were excluded from all birthweight analyses. RESULTS: After adjustments, individuals born weighing < 6lbs. were more likely to reach natural menopause at an earlier age (adjusted ß=-0.361, SE = 0.09, P = < 0.001) and have a shorter reproductive window (adjusted ß = -0.287, SE = 0.10, p < 0.004) compared to individuals weighing 6-7 lbs. 15 oz. Individuals born preterm were also more likely to reach natural menopause at an earlier age (adjusted ß=-0.506, SE = 0.16, P = 0.001) and have a shorter reproductive window (adjusted ß = -0.418, SE = 0.17, p < 0.006). CONCLUSIONS: These findings raise concerns that, as more preterm and low birthweight individuals survive to adulthood, the prevalence of earlier-onset menarche and menopause may increase. Clinical counseling and interventions aimed at reducing the incidence of preterm and low birthweight births, as well as intensification of lifestyle modifications to reduce CVD risk among women with these early-life risk factors, should be prioritized.

Reliable event rates for disease mapping.

When analyzing spatially referenced event data, the criteria for declaring rates as "reliable" is still a matter of dispute. What these varying criteria have in common, however, is that they are rarely satisfied for crude estimates in small area analysis settings, prompting the use of spatial models to improve reliability. While reasonable, recent work has quantified the extent to which popular models from the spatial statistics literature can overwhelm the information contained in the data, leading to oversmoothing. Here, we begin by providing a definition for a "reliable" estimate for event rates that can be used for crude and model-based estimates and allows for discrete and continuous statements of reliability. We then construct a spatial Bayesian framework that allows users to infuse prior information into their models to improve reliability while also guarding against oversmoothing. We apply our approach to county-level birth data from Pennsylvania, highlighting the effect of oversmoothing in spatial models and how our approach can allow users to better focus their attention to areas where sufficient data exists to drive inferential decisions. We then conclude with a brief discussion of how this definition of reliability can be used in the design of small area studies.

Vaccine hesitancy among parents of children in their first two years of life.

Background: Vaccine hesitancy is considered a primary cause of outbreaks of vaccine-preventable infectious diseases. The Austrian vaccination plan includes 24 vaccinations in the first 2 years of life, 12 for free and 12 subject to a fee. Since preterm babies are more susceptible to severe infections, immunization is a vital protection strategy. This study examines the routine immunization schedule recommended for children in Austria, the number of timely vaccinations, and the number of delayed and rejected vaccinations. Possible reasons for vaccination delays and rejection and potential influencing factors (preterm birth, COVID-19 pandemic, information sources) are also analyzed. Methods: We included children aged 2 to 5 years who presented to Vienna's largest pediatric center with an Austrian mother-child pass and spent the first 2 years of their lives in Austria. Data was collected using questionnaires about the vaccination status, parents' reasons for any rejections or delays in the recommended vaccination regimen, the impact of the COVID-19 pandemic on individuals' vaccination behavior, and child-specific influencing factors such as preterm birth and socioeconomic factors. Results: 90% of the 150 study subjects follow the recommendations on routine vaccinations, while 40-62% accept vaccinations subject to a fee. Preterm infants received less fee-based (53%) as well as gratuitous (88%) vaccinations. While free vaccinations tend to be delayed, more fee based vaccinations are rejected. With free vaccinations, delays and refusals occur due to illness or missed appointments. In the case of fee- required vaccinations, however, fears of side effects are also one of the main reasons. Due to the COVID-19 pandemic, about a quarter of parents have become more skeptical about vaccines. However, the vaccination rate of premature babies is usually just below that of full-term babies. Physicians remain the most trustworthy source of information about vaccinations. Conclusion: Free vaccinations are more accepted by parents than fee based vaccinations. Preterm babies, which are a high risk group for vaccination preventable diseases, show a lower or delayed vaccination rate, which must be prevented through intensive doctor education. In addition, vaccination hesitancy changed during the COVID-19 pandemic, which needs to be addressed during the medical consultation.

Effects of kangaroo mother care combined with nurse-assisted mindfulness training for reducing stress among mothers of preterm infants hospitalized in the NICU: a randomized controlled trial.

BACKGROUND: Kangaroo mother care (KMC) can have a positive effect on the mental well-being of a mother. However, there are specific challenges associated with the process that may contribute to increased anxiety for the mother. By integrating nurse-assisted mindfulness training alongside KMC guidance, nurses may effectively alleviate maternal stress to a greater extent. METHODS: A single-centre randomized controlled trial was conducted to investigate the effects of KMC combined with nurse-assisted mindfulness training. The study included preterm infants with a gestational age of less than 32 weeks or a birth weight of less than 1500 g and their mothers, who were randomly divided into two groups. The intervention group consisted of mothers who received KMC combined with nurse-assisted mindfulness training for 14 days. The control group comprised mothers who received only KMC for 14 days. Data from both groups were collected and compared for analysis. RESULTS: Forty-seven infants and their mothers were included in the intervention group, whereas 44 pairs were included in the control group. After the intervention, the parental stressor scale scores for the neonatal intensive care unit (PSS: NICU) (3), PSS: NICU (4), and Hospital Anxiety and Depression Scale (HADS) scores for the intervention group were lower than those for the control group, whereas the Five Facet Mindfulness Questionnaire (FFMQ) (1), FFMQ (4), and FFMQ (5) scores for the intervention group were higher. The degree of change in the PSS: NICU and HADS scores was inversely correlated with the degree of change in the FFMQ score. The breast milk feed rate and weight gain rate were greater in the intervention group than in the control group. No adverse reactions were observed in either group. CONCLUSIONS: Kangaroo mother care combined with nurse-assisted mindfulness training is an acceptable, feasible, and effective procedure for reducing anxiety in mothers of preterm infants in the NICU, with potential benefits for the short-term prognosis of these infants. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR1900023697, registered on June 8, 2019, retrospectively registered.

Impact of COVID-19 in pregnancy on maternal and perinatal outcomes during the Delta variant period: a comparison of the Delta and pre-delta time periods, 2020-2021.

BACKGROUND: To describe the impact on maternal and perinatal outcomes of the Delta variant of COVID-19 compared to the pre-Delta period in pregnant women with COVID-19 infections in one large public, non-profit hospital system. METHODS: We conducted a retrospective chart review of identified COVID-19 diagnosed pregnant women with the outcome of pregnancy (livebirth or stillbirths). We assessed maternal and perinatal outcomes between the pre-delta and Delta variant time periods. RESULTS: A study cohort of 173 mother-baby dyads was identified from January 2020 to November 2021. Maternal outcomes showed a higher rate of cesarean section (33.8%,49%; p = 0.047), with a higher frequency for worsening maternal condition due to COVID-19 (2.8%, 13.7%; p = 0.016) and association with non-reassuring fetal heart tones as indications for cesarean Sect. (53.8%, 95%; p = 0.008) during the Delta time period. There were more preterm births (16.9%, 32.4%; p = 0.023) even when excluding stillbirths (16.9%,30%; p = 0.05). Cesarean section due to "worsening maternal condition" was an independent risk factors for early delivery (ß = 2.66, 93.32-62.02, p < 0.001). The neonates had a longer mean (7.1 days, 9.9 days; p < 0.001) and median (2 days, 3 days; p < 0.001) length of stay during the Delta period. There was no difference in Apgar scores, NICU admissions or need for respiratory support between time periods. CONCLUSION: In a public, non-profit health system, from January 2020 to November of 2021, mothers with a diagnosis of COVID-19 during pregnancy, there were more preterm deliveries during the Delta time period, as well as longer length of stay for liveborn babies.

The Strong Correlation Between Multiple Births and Preterm Birth Rates in Greece From 1991 to 2022.

Background This study aims to investigate the correlation between the rising preterm birth rate (PBR) in Greece from 1991 to 2022 and the incidence of multiple births. Methodology Official data on live births in Greece from 1991 to 2022 were sourced from the Hellenic Statistical Authority. The PBR, defined as the number of live births occurring at <37 gestational weeks, and the multiple birth rate (MBR), representing live births from multifetal gestations, were calculated per 100 total live births. The relationship between the PBR and the MBR was evaluated using the non-parametric Spearman's rank correlation coefficient (rho). This association was confirmed through linear regression models, with MBR as the independent variable and PBR as the dependent variable, calculating the beta coefficient (ß) and the coefficient of determination (R-squared). Results A very strong direct positive correlation was identified between PBR and MBR throughout the study period, with a Spearman's rho of 0.950 (p < 0.001). This conclusion was further supported by the linear regression model, which yielded a ß coefficient of 3.32 (95% confidence interval = 2.78 to 3.86, p < 0.001). The R-squared was 0.838, indicating that the change in MBR explained 83.8% of the rise in PBR. The strongest correlations were observed for moderate PBR (32-33 weeks) with a rho of 0.962 (p < 0.001) and late PBR (34-36 weeks) with a rho of 0.940 (p < 0.001). During the period of a steep increase in prematurity rates in the country (1991-2011), an almost perfect correlation between PBR and MBR (rho = 0.987, p < 0.001) was noted. However, in recent years (2011-2022), characterized by a marginal increase in PBR, this association diminished, with a rho of 0.655 (p = 0.021). Conclusions This analysis revealed a strong positive correlation between the PBR and MBR in Greece from 1991 to 2022, underscoring the significant impact of multiple pregnancies on the substantial increase in preterm births within the Greek population.

Global, regional, and national burden of preterm birth, 1990-2021: a systematic analysis from the global burden of disease study 2021.

Background: Preterm birth and its complications are leading causes of mortality among children under five years of age. Given the increasing burden of preterm birth on neonatal mortality and long-term health outcomes worldwide, a comprehensive global analysis is essential to guide effective public health interventions and policies. This study aims to assess the burden of preterm birth at the global, regional, and national levels. Methods: Using data from the Global Burden of Disease (GBD) 2021 database, this study analysed trends in age-standardized incidence rates (ASIR), age-standardized mortality rates (ASMR), and disability-adjusted life-years (DALYs) as primary outcomes for preterm birth from 1990 to 2021 at global, regional, and national levels. Data were assessed using joinpoint regression analysis, decomposition analysis, and the health inequality concentration index. Findings: Globally, the incidence, mortality and DALYs due to preterm birth have shown a declining trend, but ASIR started to increase in 2016. Males were more commonly born preterm than females (12329075.82, 95% uncertainty interval [UI]: 12192632.55-12464605.4 vs. 9224694.94, 95% UI: 9113876.1-9330107.89). Changes in DALYs were primarily due to epidemiological change (111.97%) and population (-21.59%). Low Socio-demographic Index (SDI) regions increased in annual incidence cases (43.1%, 95% UI: 40.17-46.09), while high SDI regions decreased in annual incidence cases (-9.6%, 95% UI: -11.45 to -7.79). The highest annual mortality and DALYs respectively occurred in sub-Saharan Africa (295490.66, 95% UI: 241762.78-353624.41) and South Asia (32760273.93, 95% UI: 27295547.76-39070225.69). Western sub-Saharan Africa showed the largest increase in annual incidence (98.95%, 95% UI: 94.77 to 103.09), and Australasia had the lowest annual mortality (287.18, 95% UI: 244.26-339.42) and DALYs (61081.4, 95% UI: 50897.33-73069.96). Western sub-Saharan Africa also had the highest ASMR (21.57, 95% confidence interval [CI]: 17.9-25.89). The highest ASIR (543.78, 95% CI: 535.11-553.21) and age-standardized DALYs (2064.65, 95% CI: 1717.27-2473.36) both occurred in South Asia, while the lowest ASIR and age-standardized DALYs were seen in East Asia (147.31, 95% CI: 144.22-150.85) and High-income Asia Pacific (143.32, 95% CI: 117.9-167.25). India, Nigeria, and Pakistan ranked highest globally in terms of annual incidence cases, mortality, and DALYs, while the lowest annual incidence, mortality and DALYs respectively occurred in Tokelau (2.34, 95% UI: 2.12-2.56), San Marino (0.04, 95% UI: 0.02-0.07) and Tokelau (17.22, 95% UI: 11.11-24.95). Interpretation: While the global burden of preterm birth has decreased, significant disparities persist, especially in low SDI regions. There is a need for more refined policies and preventive measures to effectively address preterm birth. Funding: No funds, grants, or other support was received.

Secular variation and risk factors of preterm birth in Hainan, the Free Trade Port in China from 2010 to 2021.

OBJECTIVES: Preterm delivery rates have increased obviously worldwide over the past decade, yet reliable epidemiological studies on the incidence of preterm birth and temporal trends are not available in Hainan, The Free Trade Port in China. We aimed to describe the rate of preterm birth and trends between 2010 and 2021 and to primarily explore risk factors associated with preterm birth in Hainan, China. METHODS: This was an observational study was based on data from the Hainan Provincial Birth Certificate System (HPBCS) for live births between 1 January 2010 and 31 December 2021. We included pregnancies resulting in at least one live birth, with newborns born at a gestational age of 28 weeks or greater, or with a birth weight of 1000 g or more. The outcome were preterm birth rates and their trends over time. Potential risk factors were collected, including infant gender, maternal age, paternal age, maternal ethnicity, paternal ethnicity, home address, and single or multiple pregnancies. The logistic regression model was used to assess the relationship between preterm birth and potential risk factors. RESULTS: A total of 1,537,239 live births and 86,328 preterm births were investigated, giving a total preterm birth rate of 5.62%. The overall preterm birth rate increased from 4.47% in 2010 to 7.12% in 2021 (compound annual growth rate [CAGR] 4.32). The CAGR of late preterm birth is consistent with the overall preterm birth rate (4.32%). The fastest growth is observed in the rate of very preterm births (5.53%), while the rate of moderate preterm births exhibits the slowest growth (3.87%). Infant gender, multiple pregnancy, home address, parental age, and ethnicity had significant effects on preterm birth. CONCLUSION: The preterm birth rate was increasing year by year from 2010 to 2021 in Hainan, The Free Trade Port in China. Incidence of preterm births in Hainan Province in relation to multiple pregnancies, infant sex, parental age, parental race and residential address.

Association between preterm birth and asthma and atopic dermatitis in preschool children: a nationwide population-based study.

Asthma and atopic dermatitis (AD) are representative chronic diseases in childhood. This study aimed to investigate the impact of preterm birth on the incidence and severity of asthma and AD in children, as well as to identify neonatal risk factors for asthma and AD. We used health claims data recorded between 2007 and 2014 in the Korean National Health Insurance Service database. We recruited 2,224,476 infants born between 2007 and 2014 and divided them into three groups: 3518 of extremely preterm (EP) infants (< 28 weeks of gestational age (GA)), 82,579 of other preterm (OP) infants (28-36 weeks of GA), and 2,138,379 of full-term (FT) infants (> 37 weeks of GA). We defined asthma as > 3 episodes of clinical visits in a year before 6 years of age, early asthma as onset at < 2 years of age, and severe asthma as > 1 event of status asthmaticus or admission to a hospital via an emergency room. AD was defined as ≥ 3 diagnoses in a year before 6 years of age, early AD as onset at < 2 years of age, and severe AD as prescription of high-potency topical steroids or immunosuppressants. An association of preterm birth with asthma and AD was assessed using inverse probability of treatment-weighted multivariable Cox regression analysis. Cardiorespiratory conditions, such as respiratory distress syndrome, bronchopulmonary dysplasia, patent ductus arteriosus, and pulmonary hypertension, significantly increased the risk of asthma. Specifically, bronchopulmonary dysplasia emerged as a significant risk factor for both severe and early-onset asthma (odds ratio (OR) 1.36, 95% CI 1.21-1.37 for severe asthma; OR 1.55, 95% CI 1.30-1.85 for early asthma), while it was associated with a decreased risk of AD (OR 0.86, 95% CI 0.80-0.92). Neonatal sepsis, jaundice, and retinopathy of prematurity were also identified as significant risk factors for later asthma. A stepwise increase in the risk of asthma with an increasing degree of prematurity was observed, with the OP group showing an adjusted hazard ratio (aHR) of 1.24 (95% CI: 1.22-1.26) and the EP group showing an aHR of 1.51 (95% CI: 1.41-1.63). Conversely, preterm birth was inversely associated with the risk of AD, with aHRs of 0.73 (95% CI: 0.67-0.79) for the OP group and 0.88 (95% CI: 0.87-0.89) for the EP group. Conclusion Preterm children have a significantly higher risk of asthma and lower risk of AD, with cardiorespiratory conditions significantly increasing the risk of asthma. Thus, we highlight the need for targeted respiratory management strategies for this high-risk population. What is Known: •Asthma and atopic dermatitis are prevalent chronic diseases in childhood, reducing the quality of life of children. •Preterm birth was associated with an increased risk of asthma, but few large nationwide studies. •Research on the relationship between preterm birth and pediatric atopic dermatitis is controversial, with few large nationwide studies. What is New: • Preterm children, especially born before 28 weeks of gestational age, had a significantly higher risk of asthma and lower risk of atopic dermatitis. • Cardiorespiratory comorbidities such as RDS, BPD, PDA, and pulmonary hypertension in neonatal period are prominent risk factors for asthma. • Preterm children are vulnerable to both early-onset and severe asthma.

The preventive health management self-efficacy related to preterm labor scale in reproductive-aged women: Validation of Turkish reliability and factor structure.

AIM: This study aims to test and adapt the Turkish psychometric properties of the preventive health management self-efficacy related to premature labor (PHMSE-PL) scale for women of reproductive age. METHODS: The study follows a methodological approach. The original scale comprises 34 items distributed across 5 subscales and is structured on a five-point Likert scale. The study sample consisted of 351 women aged 19 to 49, all without any physical or mental disabilities, irrespective of marital status or pregnancy status. Exclusion criteria encompassed women engaged in healthcare professions such as medical faculty, nursing, or midwifery, as well as those with a history of preterm birth during pregnancy. RESULTS: During the validity assessment of the scale, language, content, and construct validity were scrutinized. In the reliability phase, internal consistency and stability over time -analyses were conducted. Following confirmation of language validity, all items achieved a content validity index value exceeding 0.80. Exploratory and confirmatory factor analyses were employed to assess structural validity, revealing that the scale retained its original grouping into five sub-factors. These factors collectively accounted for 81.5% of the variance. The Cronbach's alpha coefficient for the entire scale reached 0.98, indicating high internal consistency. Test-retest analyses yielded a correlation coefficient of 0.99 between overall scale scores, demonstrating excellent consistency between the two measurement measurements. CONCLUSIONS: The PHMSE-PL scale adapted to Turkish culture demonstrated high levels of validity and reliability.

The role of the lower uterine segment thickness in predicting preterm birth in twin pregnancies presenting with threatened preterm labor.

OBJECTIVES: To examine the relationship between the lower uterine segment (LUS) thickness and the onset of labor in dichorionic twin pregnancies experiencing threatened preterm labor. METHODS: This prospective cohort study included dichorionic twin pregnancies between 24 and 32 weeks of gestation, presenting with symptoms of preterm labor. The LUS thickness and mid-anterior wall thickness were measured via transabdominal ultrasonography, cervical length, and posterior cervical lip thickness were measured transvaginally. The presence of the cervical sliding sign and funneling findings were recorded. RESULTS: Among the patients with an onset of labor before the 34th week, the mean LUS thickness was 3.8 ± 0.9 mm, compared to 4.6 ± 1.1 mm in those with an onset of labor at or after 340/7 GW, indicating a statistically significant difference (p=0.012). Similarly, accepting the GW threshold as 350/7 weeks, a statistically significant difference was found in the mean LUS thickness, which was 4.0 ± 1.0 mm in those with an earlier onset of labor and 4.7 ± 1.0 mm in those with a later onset of labor (p=0.022). While univariate analysis indicated that the LUS thickness was a significant predictor (p=0.017 for <34 GW and p=0.028 for <35 GW), multivariate analysis showed a reduced effect (p=0.04 and p=0.06, respectively). CONCLUSIONS: LUS was significantly thinner in pregnancies with an onset of labor before the 34th and 35th GW. The measurement of the LUS thickness can be considered an alternative method for predicting spontaneous preterm birth in dichorionic twin pregnancies.

Early-onset preeclampsia/gestational hypertension may be associated with a low incidence of cerebral palsy at 3 years old in singleton very low-birth-weight infants born at 28-31 weeks of gestation (EOPE-DQ study): a multi-center retrospective cohort study in 2013-2016.

Our aim was to evaluate the effects of any types of hypertensive disorders of pregnancy (HDP) on the development of either cerebral palsy (CP) or developmental delay (DD) at 3 years old in singleton very low-birth-weight (VLBW) infants born at 24-31 weeks of gestation. This was a retrospective cohort study of VLBW infants born at 24-31 weeks in 2013-2016 in Japan, using a nationwide obstetrical database, and Neonatal Research Network Japan (NRNJ) Database, accompanied by a secondary survey of women complicated with HDP (EOPE-DQ study). In 529 candidates for long-term follow-up in 7 tertiary centers, the percentage undergoing follow-up for CP at 3 years old was 56.1%, and the percentage receiving follow-up for DD at 3 years old was 54.1%. The percentage of PE/SPE/GH was significantly lower in infants with CP than in controls (1/22 [4.5%] vs. 66/274 [24.1%], p = 0.034); especially, in infants born at 28-31 weeks, the percentage of PE/SPE/GH was significantly lower in infants with CP than in controls (0/13 [0%] vs. 44/151 [29.1%], p = 0.021). The percentage of PE/SPE/GH was not different between infants with DD and controls (9/49 [18.4%] vs. 54/237 [22.8%], p = 0.574). The percentage of composite risk factors (either bronchopulmonary dysplasia at a postmenstrual age of 36 weeks, intraventricular hemorrhage, hypoxic ischemic encephalopathy, sepsis, necrotizing enterocolitis, or periventricular leukomalacia) was significantly higher in infants with DD than in controls. In conclusion, PE/SPE/GH around 30 weeks may be associated with a low incidence of CP.

A new screening of preterm birth in gestation with short cervix after pessary plus progesterone.

Objective: This study aims to create a new screening for preterm birth < 34 weeks after gestation with a cervical length (CL) ≤ 30 mm, based on clinical, demographic, and sonographic characteristics. Methods: This is a post hoc analysis of a randomized clinical trial (RCT), which included pregnancies, in middle-gestation, screened with transvaginal ultrasound. After observing inclusion criteria, the patient was invited to compare pessary plus progesterone (PP) versus progesterone only (P) (1:1). The objective was to determine which variables were associated with severe preterm birth using logistic regression (LR). The area under the curve (AUC), sensitivity, specificity, and positive predictive value (PPV) and negative predictive value (NPV) were calculated for both groups after applying LR, with a false positive rate (FPR) set at 10%. Results: The RCT included 936 patients, 475 in PP and 461 in P. The LR selected: ethnics white, absence of previous curettage, previous preterm birth, singleton gestation, precocious identification of short cervix, CL < 14.7 mm, CL in curve > 21.0 mm. The AUC (CI95%), sensitivity, specificity, PPV, and PNV, with 10% of FPR, were respectively 0.978 (0.961-0.995), 83.4%, 98.1%, 83.4% and 98.1% for PP < 34 weeks; and 0.765 (0.665-0.864), 38.7%, 92.1%, 26.1% and 95.4%, for P < 28 weeks. Conclusion: Logistic regression can be effective to screen preterm birth < 34 weeks in patients in the PP Group and all pregnancies with CL ≤ 30 mm.

C/EBPδ deficiency delays infection-induced preterm birth.

BACKGROUND: Parturition is an inflammation process. Exaggerated inflammatory reactions in infection lead to preterm birth. Although nuclear factor kappa B (NF-κB) has been recognized as a classical transcription factor mediating inflammatory reactions, those mediated by NF-κB per se are relatively short-lived. Therefore, there may be other transcription factors involved to sustain NF-κB-initiated inflammatory reactions in gestational tissues in infection-induced preterm birth. METHODS: Cebpd-deficient mice were generated to investigate the role of CCAAT enhancer-binding protein δ (C/EBPδ) in lipopolysaccharide (LPS)-induced preterm birth, and the contribution of fetal and maternal C/EBPδ was further dissected by transferring Cebpd-/- or WT embryos to Cebpd-/- or WT dams. The effects of C/EBPδ pertinent to parturition were investigated in mouse and human myometrial and amnion cells. The interplay between C/EBPδ and NF-κB was examined in cultured human amnion fibroblasts. RESULTS: The mouse study showed that LPS-induced preterm birth was delayed by Cebpd deficiency in either the fetus or the dam, with further delay being observed in conceptions where both the dam and the fetus were deficient in Cebpd. Mouse and human studies showed that the abundance of C/EBPδ was significantly increased in the myometrium and fetal membranes in infection-induced preterm birth. Furthermore, C/EBPδ participated in LPS-induced upregulation of pro-inflammatory cytokines as well as genes pertinent to myometrial contractility and fetal membrane activation in the myometrium and amnion respectively. A mechanistic study in human amnion fibroblasts showed that C/EBPδ, upon induction by NF-κB, could serve as a supplementary transcription factor to NF-κB to sustain the expression of genes pertinent to parturition. CONCLUSIONS: C/EBPδ is a transcription factor to sustain the expression of gene initiated by NF-κB in the myometrium and fetal membranes in infection-induced preterm birth. Targeting C/EBPδ may be of therapeutic value in the treatment of infection-induced preterm birth.

Vaginal Microflora in High Vaginal Swab in Prelabour Rupture of Membrane: A Descriptive Cross-sectional Study.

INTRODUCTION: Premature rupture of membrane (PROM) refers to the disruption of the fetal membrane before the beginning of labor, resulting in spontaneous leakage of amniotic fluid. Cervicovaginal infection is an important risk factor of PROM and can lead to complications to mother and the child. This study aimed to delineate the bacterial patterns found in PROM so that the ideal appropriate responsive antibiotics can be chosen. METHODS: A descriptive cross-sectional was done during the period of 6 months from December of 2023 to May 2023, to characterize the microorganisms in the vaginal fluid found in antenatal women presenting with premature rupture of membraneafter obtaining ethical approval (IRC number: 20102023/02). A total of 117 antenatal women diagnosed with premature rupture of membrane were included in the study. High vaginal swabs were collected for microbial culture and sensitivity. Data were entered using Microsoft Excel 2000 (v9.0) and Statistical Package for the Social Sciences (SPSS) software version 26.0 was used for analysis. RESULTS: Out of 117 samples, culture growth was present in the culture of high vaginal swabs of 23 (19.66%) women. The high vaginal swab cultures from the samples collected in women presenting with PROM reported 9 different types of pathogens E. coli in 12 (52.17%), Klebsiella in 4 (17.39%) and Pseudomonas in 2 (8.70%) cultures. CONCLUSIONS: This study reveals diverse microorganisms in premature rupture of membrane cases, with E. coli being the most common. Identifying these bacterial patterns is essential for selecting effective antibiotics, improving maternal and neonatal outcomes, and reducing morbidity and mortality by early detection and treatment of vaginal infections.

National Variation in Black Immigrant Preterm Births and the Role of County-Level Social Factors.

Preterm birth rates among Black individuals continue to be inequitably high in the USA. Black immigrants appear to have a preterm birth advantage over US-born counterparts. This national cross-sectional study of singleton non-Hispanic Black individuals in the USA from 2011 to 2018 aimed to investigate if the Black immigrant preterm birth advantage varied geographically and how this advantage associated with county-level social drivers of health. Generalized linear mixed models explored the odds of preterm birth (< 37 weeks) by birthing person's nativity, defined as US- versus foreign-born. In county-level analyses, five measures were explored as possible sources of structural risk for or resilience against preterm birth: percent of residents in poverty, percent uninsured, percent with more than a high school education, percent foreign-born, and racial polarization. County-level immigrant advantage among foreign-born compared to US-born Black individuals was defined by a disparity rate ratio (RR); RR < 1 indicated a county-level immigrant preterm birth advantage. Linear regression models at the level of counties quantified associations between county-level factors and disparity RRs. Among 4,072,326 non-Hispanic Black birthing individuals, immigrants had 24% lower adjusted odds of preterm birth compared to US-born Black individuals (aOR 0.77, 95% CI 0.76-0.78). In county-level analyses, the immigrant advantage varied across counties; disparity RRs ranged from 0.13 to 2.82. County-level lack of health insurance and education greater than high school were both associated with immigrant preterm birth advantage. Future research should explore policies within counties that impact risk of preterm birth for both US-born and immigrant Black individuals.