Maternal risk factors for preterm birth: a country-based population analysis.

OBJECTIVE: The aim of this study was to identify maternal risk factors for spontaneous preterm birth (PTB) compared to delivery at term, in order to recognize high risk women and to provide a global overview of the Italian situation. STUDY DESIGN: A multicenter, observational and retrospective, cross-sectional study was designed. The study population comprised 7634 women recruited in 9 different University Maternity Hospitals in Italy. The main criteria for inclusion were: women having had vaginal preterm or term spontaneous delivery in each participating centre during the study period. The records related to deliveries occurring between April and December 2008. A multivariable logistic regression was employed to identify independent predictors of spontaneous preterm birth. Odds ratios (ORs) and 95% confidence intervals (95% CI) were reported with two-tailed probability (p) values. Statistical calculations were carried out using SAS version 9.1. A two-tailed p-value of 0.05 was used to define statistical significant results. RESULTS: A significant increased risk of PTB was found in women with BMI>25 (OR=1.662; 95% CI=1.033-2.676; p-value=0.0365) and in women employed in heavy work (OR=1.947; 95% CI=1.182-3.207; p-value=0.0089). Moreover there was a significant association between PTB and previous reproductive history. In fact a history of previous abortion (OR=1.954; 95% CI=1.162-3.285; p-value=0.0116) or previous cesarean section (OR=2.904; 95% CI=1.066-7.910; p-value=0.0371) was positively correlated to the increased risk of PTB and an important statistically significant association was calculated between PTB and previous pre-term delivery (OR=3.412; 95% CI=1.342-8.676; p-value=0.0099). All the other covariates examined as potential risk factors for PTB were not found to be statistically significantly related (p-value>0.05). CONCLUSIONS: The present study, applied to a substantial sample of Italian population, demonstrates that there are peculiar risk factors for spontaneous PTB in the Italian population examined. It shows an association between preterm delivery and certain maternal factors as: BMI, employment, previous abortions, previous PTBs and previous cesarean section.

Is there any association between periodontitis and preterm low birth weight?

OBJECTIVE: To estimate the association between periodontitis (PD) and preterm low birth weight (LBW). STUDY DESIGN: Observational study in a University clinical setting on a population of 120 pregnant women. RESULTS: One specialist in periodontics examined all the patients. Two thresholds for definition of PD were used, which detected respectively 29 women (24%) and 4 (3%) as affected by the pathology. Six patients were lost to follow-up. Out of the remaining 114, 1 had an abortion, while 20 (17%) delivered pre-term. Eleven per cent of all women delivered low-weight babies. Ten women (9%) delivered preterm LBW babies. No association was detected between any of the two definitions of PD and any of the adverse pregnancy outcomes. CONCLUSION: This study was unable to provide evidence of association between PD and preterm LBW.

Does fetal sex affect pregnancy outcome?

BACKGROUND: In maternal fetal medicine, gender differences in outcome are often observed. OBJECTIVE: This article reviews the fetal sex-dependent differences found in many aspects of pregnancy, from conception through birth. METHODS: The MEDLINE, EMBASE, and Current Contents databases were searched, for the years 1985 to 2006, using the following Medical Subject Headings and text words: fetal gender, finale, female, sex ratio at birth, pregnancy outcome, preterm birth, and stillbirth. The search was not limited by language. In addition, the bibliographies of known relevant articles were examined to capture any reports not already identified in the electronic search. All reports that provided information on gender differences in pregnancy outcome were included for review. RESULTS: An extremely high male-to-female ratio was found in fetuses born after very short-duration pregnancy; this level declined around the 20th week and stabilized at term. In the absence of manipulation, both the sex ratio at birth and the population sex ratio have been found to remain consistent. A higher incidence of preterm birth and premature preterm rupture of membranes has been observed in different populations among mothers of male newborns compared with mothers of females. It has been speculated that this higher incidence may be linked to the relatively greater weight at lower gestational age of male newborns versus females. Women carrying male fetuses had higher rates of gestational diabetes mellitus, fetal macrosomia, failure to progress during the first and second stages of labor, cord prolapse, nuchal cord, and true umbilical cord knots. Cesarean sections were also more frequently found among male neonates compared with females. CONCLUSIONS: Male sex is an independent risk factor for adverse pregnancy outcome. Evidence suggests that females have an advantage over males, with a better outcome in the perinatal period, particularly after preterm birth.