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1.
MMWR Morb Mortal Wkly Rep ; 71(1): 26-30, 2022 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-34990445

RESUMO

COVID-19 vaccines are recommended during pregnancy to prevent severe maternal morbidity and adverse birth outcomes; however, vaccination coverage among pregnant women has been low (1). Concerns among pregnant women regarding vaccine safety are a persistent barrier to vaccine acceptance during pregnancy. Previous studies of maternal COVID-19 vaccination and birth outcomes have been limited by small sample size (2) or lack of an unvaccinated comparison group (3). In this retrospective cohort study of live births from eight Vaccine Safety Datalink (VSD) health care organizations, risks for preterm birth (<37 weeks' gestation) and small-for-gestational-age (SGA) at birth (birthweight <10th percentile for gestational age) after COVID-19 vaccination (receipt of ≥1 COVID-19 vaccine doses) during pregnancy were evaluated. Risks for preterm and SGA at birth among vaccinated and unvaccinated pregnant women were compared, accounting for time-dependent vaccine exposures and propensity to be vaccinated. Single-gestation pregnancies with estimated start or last menstrual period during May 17-October 24, 2020, were eligible for inclusion. Among 46,079 pregnant women with live births and gestational age available, 10,064 (21.8%) received ≥1 COVID-19 vaccine doses during pregnancy and during December 15, 2020-July 22, 2021; nearly all (9,892; 98.3%) were vaccinated during the second or third trimester. COVID-19 vaccination during pregnancy was not associated with preterm birth (adjusted hazard ratio [aHR] = 0.91; 95% CI = 0.82-1.01). Among 40,627 live births with birthweight available, COVID-19 vaccination in pregnancy was not associated with SGA at birth (aHR = 0.95; 95% CI = 0.87-1.03). Results consistently showed no increased risk when stratified by mRNA COVID-19 vaccine dose, or by second or third trimester vaccination, compared with risk among unvaccinated pregnant women. Because of the small number of first-trimester exposures, aHRs for first-trimester vaccination could not be calculated. These data add to the evidence supporting the safety of COVID-19 vaccination during pregnancy. To reduce the risk for severe COVID-19-associated illness, CDC recommends COVID-19 vaccination for women who are pregnant, recently pregnant (including those who are lactating), who are trying to become pregnant now, or who might become pregnant in the future (4).


Assuntos
Vacinas contra COVID-19/administração & dosagem , COVID-19/prevenção & controle , Recém-Nascido Prematuro , Recém-Nascido Pequeno para a Idade Gestacional , Nascimento Prematuro/epidemiologia , Adolescente , Adulto , Estudos de Coortes , Feminino , Humanos , Pessoa de Meia-Idade , Segurança do Paciente , Gravidez , Prevalência , Estudos Retrospectivos , Medição de Risco , SARS-CoV-2/imunologia , Estados Unidos/epidemiologia , Adulto Jovem
2.
Environ Pollut ; 292(Pt A): 118264, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34606968

RESUMO

Preterm birth is the second most common cause of death in children under 5 years of age. The etiology of preterm birth has not yet been elucidated. Although maternal exposure to endocrine disrupting chemicals (EDCs) may increase the risk for preterm birth, associations have not been confirmed. We performed a meta-analysis to elucidate the relationships between maternal exposure to EDCs and preterm birth. A systematic search of PubMed, Ovid-EMBASE, and the Cochrane Library (CENTRAL) for relevant published studies providing quantitative data on the association between maternal EDC exposure and preterm birth in humans was conducted in July 2021. To calculate the overall estimates, we pooled the adjusted regression coefficients with 95% confidence intervals (CIs) from each study by the inverse variance method. A total of 59 studies were included. The pooled results indicated that maternal exposure to metals (OR, 1.23; 95% CI, 1.17 to 1.29) and phthalates (OR, 1.31; 95% CI, 1.21 to 1.42) was related to an increased risk for preterm birth. Specifically, maternal exposure to lead, cadmium, chromium, copper and manganese appeared to be correlated with an elevated risk for preterm birth. Additionally, maternal exposure to monoethyl phthalate (MEP), mono-2-ethyl-5-carboxypentyl phthalate (MECPP), monobenzyl phthalate (MBzP), and di (2-ethylhexyl) phthalate (DEHP) was also associated with preterm birth. In conclusion, maternal exposure to metals and phthalates may increase the risk for preterm birth based on current evidence.


Assuntos
Disruptores Endócrinos , Poluentes Ambientais , Ácidos Ftálicos , Nascimento Prematuro , Criança , Pré-Escolar , Exposição Ambiental , Feminino , Humanos , Recém-Nascido , Exposição Materna , Ácidos Ftálicos/toxicidade , Gravidez , Nascimento Prematuro/induzido quimicamente , Nascimento Prematuro/epidemiologia , Análise de Regressão
3.
Environ Pollut ; 292(Pt B): 118476, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34763012

RESUMO

Preconception and prenatal exposure to phthalates has been associated with an increased risk of preterm birth. However, it is unclear whether there are periods of heightened susceptibility during pregnancy. This prospective cohort study included 386 women undergoing fertility treatment who gave birth to a singleton infant during 2005 through 2018. Eleven phthalate metabolites were measured in spot urine samples collected at each trimester. In approximately 50% of participants, two metabolites of 1,2-cyclohexane dicarboxylic acid diisononyl ester (DINCH), a phthalate substitute, were also measured. The molar sum of four di(2-ethylhexyl) phthalate metabolites (∑DEHP) was calculated. We evaluated the associations of mean maternal biomarker concentrations with risk of preterm birth using modified log-binomial models and utilized multiple informant models to compare trimester-specific associations. We examined the relative biomarker concentration across gestation comparing women with preterm birth to women with term delivery using quadratic mixed model. The risk ratio for preterm birth associated with a one-unit increase in the natural log-transformed urinary concentrations of ∑DEHP (mean during pregnancy) was 1.21 (95% confidence interval (CI): 0.84, 1.72). In multiple informant models, these associations were strongest in the third trimester (RR = 1.51; 95% CI: 1.17, 1.95). Estimated mean ∑DEHP concentrations were higher among women with preterm than term delivery, especially late in gestation. Associations with preterm birth were also observed for each of the four individual DEHP metabolites. Detection of cyclohexane-1,2-dicarboxylic acid monocarboxyisooctyl ester (MCOCH), a metabolite of DINCH, appeared to be positively related to preterm birth. In this prospective cohort of subfertile couples, maternal ∑DEHP metabolite concentrations during pregnancy were associated with an increased risk of preterm birth, particularly during late gestation.


Assuntos
Infertilidade , Ácidos Ftálicos , Nascimento Prematuro , Feminino , Humanos , Recém-Nascido , Gravidez , Nascimento Prematuro/induzido quimicamente , Nascimento Prematuro/epidemiologia , Estudos Prospectivos
4.
Int J Gynaecol Obstet ; 156(1): 64-70, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33471369

RESUMO

OBJECTIVE: To determine the association between cervical polyps in early pregnancy and late abortion and spontaneous preterm birth (SPTB). We also aimed to explore the relationship between cervical polyps and cervical insufficiency in the second trimester. METHODS: We conducted a retrospective cohort study of 2941 singleton pregnant women between January 2010 and December 2015. The frequency of late abortion and SPTB (before 28, 34, or 37 weeks of pregnancy) was compared between the two groups of 142 (4.8%) patients who had cervical polyps early in the pregnancy (P group) and 2799 who did not (non-P group). Multivariate analysis was performed to identify risk factors for late abortion and SPTB. RESULTS: The incidence of late abortion and SPTB was significantly higher in the P group than in the non-P group. Cervical polyps in early pregnancy were selected as independent risk factors for late abortion and SPTB before 28, 34, or 37 weeks of pregnancy. The P group had a significantly higher rate of cases requiring therapeutic cervical cerclage than the non-P group. CONCLUSION: Cervical polyps in early pregnancy are risk factors for late abortion and SPTB. They are also associated with the occurrence of cervical insufficiency.


Assuntos
Cerclagem Cervical , Nascimento Prematuro , Incompetência do Colo do Útero , Medida do Comprimento Cervical , Feminino , Humanos , Recém-Nascido , Gravidez , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etiologia , Estudos Retrospectivos , Fatores de Risco , Incompetência do Colo do Útero/epidemiologia
5.
Environ Res ; 203: 111811, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34339697

RESUMO

Human exposure to glyphosate-based herbicides (GBH) is increasing rapidly worldwide. Most existing studies on health effects of glyphosate have focused on occupational settings and cancer outcomes and few have examined this common exposure in relation to the health of pregnant women and newborns in the general population. We investigated associations between prenatal glyphosate exposure and length of gestation in The Infant Development and the Environment Study (TIDES), a multi-center US pregnancy cohort. Glyphosate and its primary degradation product [aminomethylphosphonic acid (AMPA)] were measured in urine samples collected during the second trimester from 163 pregnant women: 69 preterm births (<37 weeks) and 94 term births, the latter randomly selected as a subset of TIDES term births. We examined the relationship between exposure and length of gestation using multivariable logistic regression models (dichotomous outcome; term versus preterm) and with weighted time-to-event Cox proportional hazards models (gestational age in days). We conducted these analyses in the overall sample and secondarily, restricted to women with spontaneous deliveries (n = 90). Glyphosate and AMPA were detected in most urine samples (>94 %). A shortened gestational length was associated with maternal glyphosate (hazard ratio (HR): 1.31, 95 % confidence interval (CI) 1.00-1.71) and AMPA (HR: 1.32, 95%CI: 1.00-1.73) only among spontaneous deliveries using adjusted Cox proportional hazards models. In binary analysis, glyphosate and AMPA were not associated with preterm birth risk (<37 weeks). Our results indicate widespread exposure to glyphosate in the general population which may impact reproductive health by shortening length of gestation. Given the increasing exposure to GBHs and the public health burden of preterm delivery, larger confirmatory studies are needed, especially in vulnerable populations such as pregnant women and newborns.


Assuntos
Herbicidas , Nascimento Prematuro , Criança , Feminino , Glicina/análogos & derivados , Glicina/toxicidade , Herbicidas/toxicidade , Humanos , Recém-Nascido , Gravidez , Gestantes , Nascimento Prematuro/induzido quimicamente , Nascimento Prematuro/epidemiologia
6.
Environ Res ; 203: 111872, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34403668

RESUMO

There is limited population-scale evidence on the burden of exposure to wildfire smoke during pregnancy and its impacts on birth outcomes. In order to investigate this relationship, data on every singleton birth in California 2006-2012 were combined with satellite-based estimates of wildfire smoke plume boundaries and high-resolution gridded estimates of surface PM2.5 concentrations and a regression model was used to estimate associations with preterm birth risk. Results suggest that each additional day of exposure to any wildfire smoke during pregnancy was associated with an 0.49 % (95 % CI: 0.41-0.59 %) increase in risk of preterm birth (<37 weeks). At sample median smoke exposure (7 days) this translated to a 3.4 % increase in risk, relative to an unexposed mother. Estimates by trimester suggest stronger associations with exposure later in pregnancy and estimates by smoke intensity indicate that observed associations were driven by higher intensity smoke-days. Exposure to low intensity smoke-days had no association with preterm birth while an additional medium (smoke PM2.5 5-10 µg/m3) or high (smoke PM2.5 > 10 µg/m3) intensity smoke-day was associated with an 0.95 % (95 % CI: 0.47-1.42 %) and 0.82 % (95 % CI: 0.41-1.24 %) increase in preterm risk, respectively. In contrast to previous findings for other pollution types, neither exposure to smoke nor the relative impact of smoke on preterm birth differed by race/ethnicity or income in our sample. However, impacts differed greatly by baseline smoke exposure, with mothers in regions with infrequent smoke exposure experiencing substantially larger impacts from an additional smoke-day than mothers in regions where smoke is more common. We estimate 6,974 (95 % CI: 5,513-8,437) excess preterm births attributable to wildfire smoke exposure 2007-2012, accounting for 3.7 % of observed preterm births during this period. Our findings have important implications for understanding the costs of growing wildfire smoke exposure, and for understanding the benefits of smoke mitigation measures.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Nascimento Prematuro , Incêndios Florestais , Poluentes Atmosféricos/efeitos adversos , Poluentes Atmosféricos/análise , California/epidemiologia , Feminino , Humanos , Recém-Nascido , Exposição Materna/efeitos adversos , Material Particulado/efeitos adversos , Material Particulado/análise , Gravidez , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etiologia , Fumaça/efeitos adversos
7.
Paediatr Perinat Epidemiol ; 36(1): 13-22, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34951022

RESUMO

BACKGROUND: Climate change is increasing the frequency and intensity of heatwaves. Prior studies associate high temperature with preterm birth. OBJECTIVES: We tested the hypotheses that acute exposure to extreme heat was associated with higher risk of live spontaneous preterm birth (≥20 and <37 completed weeks), and that risks were higher among people of colour and neighbourhoods with heat-trapping landcover or concentrated racialised economic disadvantage. METHODS: We conducted a retrospective cohort study of people giving birth between 2007 and 2011 in Harris County, Texas (Houston metropolitan area) (n = 198,013). Exposures were daily ambient apparent temperature (ATmax in 5°C increments) and dry-bulb temperatures (Tmax and Tmin >historical [1971-2000] summertime 99th percentile) up to a week prior for each day of pregnancy. Survival analysis controlled for individual-level risk factors, secular and seasonal trends. We considered race/ethnicity, heat-trapping neighbourhood landcover and Index of Concentration at the Extremes as effect modifiers. RESULTS: The frequency of preterm birth was 10.3%. A quarter (26.8%) of people were exposed to ATmax ≥40°C, and 22.8% were exposed to Tmax and Tmin >99th percentile while at risk. The preterm birth rate among the exposed was 8.9%. In multivariable models, the risk of preterm birth was 15% higher following extremely hot days (hazard ratio [HR] 1.15 (95% confidence interval [CI] 1.01, 1.30) for ATmax ≥40°C vs. <20°C; HR 1.15 (95% CI 1.02, 1.28) for Tmax and Tmin >99th percentile). Censoring at earlier gestational ages suggested stronger associations earlier in pregnancy. The risk difference associated with extreme heat was higher in neighbourhoods of concentrated racialised economic disadvantage. CONCLUSIONS: Ambient heat was associated with spontaneous preterm birth, with stronger associations earlier in pregnancy and in racially and economically disadvantaged neighbourhoods, suggesting climate change may worsen existing social inequities in preterm birth rates.


Assuntos
Calor Extremo , Nascimento Prematuro , Calor Extremo/efeitos adversos , Feminino , Idade Gestacional , Temperatura Alta , Humanos , Recém-Nascido , Gravidez , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etiologia , Estudos Retrospectivos
9.
Chemosphere ; 286(Pt 2): 131833, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34426128

RESUMO

Due to the poor living and healthcare conditions, preterm birth (PTB) in rural population is a pressing health issue. However, PTB studies in rural population are rare. To explore the effects of air pollutants on PTB in rural population, we collected 697,316 medical records during 2014-2016 based on the National Free Preconception Health Examination Project. Logistic regression models were used to estimate the association between air pollutants and PTB and the modifying effects of demographic characteristics. Relative contribution and principal component analysis-generalized linear model (PCA-GLM) analysis were used to explore the most significant air pollutant and gestational period. Our results demonstrated that PTB risk is positively associated with exposure to air pollutants including PM10, PM2.5, SO2, NO2, and CO, while negatively associated with O3 exposure (P < 0.05). In addition, we found that NO2 was the largest contributor to the risk of PTB caused by air pollutants (26.5%). The third trimester of pregnancy was the most sensitive exposure window. PCA-GLM analysis showed that the first component (a combination of PM, SO2, NO2, and CO) increased the risk of PTB. Moreover, we found that rural women who are younger, had higher educated, multi-parity, or smoke appeared to be more sensitive to the association between air pollutants exposure and PTB (P-interaction<0.05). Our findings suggested that increased air pollutants except O3 were associated with elevated PTB risk, especially among vulnerable mothers. Therefore, the effects of air pollutants exposure on PTB should be mitigated by restricting emission sources of NO2 and SO2 in rural population, especially during the third trimester.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Nascimento Prematuro , Efeitos Tardios da Exposição Pré-Natal , Poluentes Atmosféricos/análise , Poluentes Atmosféricos/toxicidade , Poluição do Ar/análise , Poluição do Ar/estatística & dados numéricos , China/epidemiologia , Feminino , Humanos , Recém-Nascido , Exposição Materna/estatística & dados numéricos , Material Particulado/análise , Material Particulado/toxicidade , Gravidez , Nascimento Prematuro/induzido quimicamente , Nascimento Prematuro/epidemiologia , População Rural
11.
Inquiry ; 58: 469580211064125, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34907788

RESUMO

Despite remarkable progress in the reduction of under-five mortality, the rate of perinatal and neonatal mortality is still high especially in developing countries. The adverse outcome associated with preterm birth is one of the major public health challenges in Africa. However, there are limited and inconsistent studies conducted on the effect of preterm birth on adverse perinatal and neonatal outcomes in Ethiopia. Therefore, this systematic review and meta-analysis aimed to investigate the association between preterm birth and its adverse perinatal and neonatal outcomes in Ethiopia. We systematically searched several electronic databases like PubMed, Web of Science, SCOPUS, CINAHL, Google Scholar, African Journals Online databases and Science Direct. All identified observational studies were included. The I1 statistics were used to assess the heterogeneity among the studies. A random-effects model was computed to estimate the pooled effect of preterm birth on adverse perinatal and neonatal outcomes. Thirty-three studies with a total of 20 109 live births were included in the final meta-analysis. Our meta-analysis showed that preterm birth increased the odds of perinatal mortality by 10-folds [POR = 9.56 (95% CI: 5.47, 19.69)] and there was a 5.44-folds risk of stillbirth [Odds Ratio = 5.44 (95% CI: 3.57, 8.28)] among women who gave birth before 37 weeks of gestation. In addition, preterm birth was significantly associated with neonatal hypothermia [OR=3.54 (95% CI: 2.41, 5.21)], neonatal mortality [OR= 3.16 (95% CI: 1.57, 6.34). The sub-group analysis of this meta-analysis showed that there was an increased risk of neonatal sepsis [OR=2.33 (95% CI: 1.15, 4.71)] among preterm babies. Preterm births significantly increased the risk of adverse perinatal and neonatal outcomes in Ethiopia. Therefore, scale-up strategies and improving the quality of maternal and child health care providers should be an area of intervention to reduce adverse outcomes associated with preterm birth. The Federal Ministry of Health and concerned bodies should work towards the prevention of preterm birth and its adverse outcomes.


Assuntos
Nascimento Prematuro , Criança , Etiópia/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Gravidez , Nascimento Prematuro/epidemiologia
12.
Zhongguo Dang Dai Er Ke Za Zhi ; 23(12): 1242-1249, 2021 Dec 15.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-34911607

RESUMO

OBJECTIVES: To investigate the incidence of preterm birth and risk factors for preterm birth. METHODS: A prospective cohort study was performed for the pregnant women in early pregnancy and their spouses, who underwent prenatal examination for the first time in Hunan Provincial Maternal and Child Health Care Hospital from May 2014 to December 2016 and decided to be hospitalized for delivery. A questionnaire survey was performed to collect exposure information possibly related to preterm birth. The hospital's medical record system was used for information verification and to record the pregnancy outcome. A multivariate logistic regression analysis was used to investigate the risk factors for preterm birth. RESULTS: A total of 6 764 pregnant women with complete data were included, and the incidence rate of preterm birth was 17.09%. The multivariate logistic regression analysis showed that a history of adverse pregnancy outcomes, eating areca nut before pregnancy, a history of pregnancy complications, a history of hepatitis, no folate supplementation during pregnancy, medication during pregnancy, active smoking and passive smoking during pregnancy, drinking during pregnancy, unbalanced diet during pregnancy, high-intensity physical activity during pregnancy, and natural conception after treatment of infertility or assisted conception as the way of conception were risk factors for preterm birth (P<0.05). Additionally, the pregnant women whose spouses were older, had a higher body mass index or smoked had an increased risk for preterm birth (P<0.05). A higher level of education of pregnant women or their spouses and lower gravidity were protective factors against preterm birth (P<0.05). CONCLUSIONS: There are many risk factors for preterm birth. Special attention should be paid to the life behaviors of pregnant women during pregnancy, and health education should be strengthened for pregnant women and their spouses to develop good living habits and reduce the incidence of preterm births.


Assuntos
Nascimento Prematuro , Poluição por Fumaça de Tabaco , Criança , Feminino , Humanos , Recém-Nascido , Gravidez , Resultado da Gravidez , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etiologia , Estudos Prospectivos , Fatores de Risco
13.
Ann Glob Health ; 87(1): 122, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34900622

RESUMO

Background: Smoking is one of the modifiable risk factors for adverse maternal and neonatal outcomes and is associated with low birth weight, preterm birth, respiratory, antepartum and intrapartum stillbirth, and perinatal death as well as long-term morbidity in offspring and sudden unexpected infant death. The rate of smoking in low- and middle-income countries is still relevantly high, and Jordan is no exception. Objective: To investigate the effect of active and passive smoking during pregnancy on adverse pregnancy outcomes. Methods: The case-control study was conducted in Jordan in June 2020. Healthy women with full-term singleton pregnancy (n = 180) were interviewed and stratified into three groups: Group I, active smokers; Group II, passive smokers; and Group III, nonsmokers. The study variables included demographic data, current pregnancy history, cotinine level of mothers and newborns, and perinatal outcomes. Statistical analysis was performed using the application package IBM SPSS 25. Various algorithms of statistical analysis were used depending on the type of distribution of feature and data quality. The threshold for statistical significance was set at p < 0.05. Results: Active smokers had significantly lower gestational age at delivery compared to passive and nonsmoking women (p = 0.038 and p = 0.003, respectively). Neonates from active smoking mothers had significantly lower birth weight compared to neonates from passive and nonsmoking women (p = 0.016 and p = 0.019, respectively), significantly lower head and chest circumferences compared to babies from passive smokers (p < 0.001 and p = 0.036, respectively), and significantly lower first-minute Apgar score compared to those from nonsmoking women (p = 0.023). The urine cotinine level was significantly higher in both active and passive smoking women (both p < 0.01), and it was significantly higher in newborns who had been exposed to smoking in utero despite maternal active or passive smoking status (both p < 0.001). There was a weak negative correlation between urine cotinine level and birth weight: r = -0.14 for maternal cotinine level and r = -0.15 for neonate cotinine level. Conclusions: The current study illustrated that smoking during pregnancy leads to offspring with reduced birth weight, birth length, and head and chest circumference; reduces delivery gestational age; and lowers the first-minute Apgar score. Our study findings highlight the need for further research issued to smoking effects on perinatal outcomes, the implementation of actions to develop cessation interventions in the preconception period, and an evaluation of useful interventions to enhance a smoking-free environment during pregnancy.


Assuntos
Nascimento Prematuro , Poluição por Fumaça de Tabaco , Peso ao Nascer , Estudos de Casos e Controles , Países em Desenvolvimento , Feminino , Humanos , Recém-Nascido , Exposição Materna/estatística & dados numéricos , Gravidez , Nascimento Prematuro/epidemiologia , Fumar/efeitos adversos , Fumar/epidemiologia , Poluição por Fumaça de Tabaco/efeitos adversos
14.
Health Technol Assess ; 25(61): 1-102, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34751645

RESUMO

BACKGROUND: Around 60,000 babies are born preterm (prior to 37 weeks' gestation) each year in the UK. There is little evidence on the optimal birth mode (vaginal or caesarean section). OBJECTIVE: The overall aim of the CASSAVA project was to determine if a trial to define the optimal mode of preterm birth could be carried out and, if so, determine what sort of trial could be conducted and how it could best be performed. We aimed to determine the specific groups of preterm women and babies for whom there are uncertainties about the best planned mode of birth, and if there would be willingness to recruit to, and participate in, a randomised trial to address some, but not all, of these uncertainties. This project was conducted in response to a Heath Technology Assessment programme commissioning call (17/22 'Mode of delivery for preterm infants'). METHODS: We conducted clinician and patient surveys (n = 224 and n = 379, respectively) to identify current practice and opinion, and a consensus survey and Delphi workshop (n = 76 and n = 22 participants, respectively) to inform the design of a hypothetical clinical trial. The protocol for this clinical trial/vignette was used in telephone interviews with clinicians (n = 24) and in focus groups with potential participants (n = 13). RESULTS: Planned sample size and data saturation was achieved for all groups except for focus groups with participants, as this had to be curtailed because of the COVID-19 pandemic and data saturation was not achieved. There was broad agreement from parents and health-care professionals that a trial is needed. The clinician survey demonstrated a variety of practice and opinion. The parent survey suggested that women and their families generally preferred vaginal birth at later gestations and caesarean section for preterm infants. The interactive workshop and Delphi consensus process confirmed the need for more evidence (hence the case for a trial) and provided rich information on what a future trial should entail. It was agreed that any trial should address the areas with most uncertainty, including the management of women at 26-32 weeks' gestation, with either spontaneous preterm labour (cephalic presentation) or where preterm birth was medically indicated. Clear themes around the challenges inherent in conducting any trial emerged, including the concept of equipoise itself. Specific issues were as follows: different clinicians and participants would be in equipoise for each clinical scenario, effective conduct of the trial would require appropriate resources and expertise within the hospital conducting the trial, potential participants would welcome information on the trial well before the onset of labour and minority ethnic groups would require tailored approaches. CONCLUSION: Given the lack of evidence and the variation of practice and opinion in this area, and having listened to clinicians and potential participants, we conclude that a trial should be conducted and the outlined challenges resolved. FUTURE WORK: The CASSAVA project could be used to inform the design of a randomised trial and indicates how such a trial could be carried out. Any future trial would benefit from a pilot with qualitative input and a study within a trial to inform optimal recruitment. LIMITATIONS: Certainty that a trial could be conducted can be determined only when it is attempted. TRIAL REGISTRATION: Current Controlled Trials ISRCTN12295730. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 61. See the NIHR Journals Library website for further project information.


Assuntos
COVID-19 , Manihot , Nascimento Prematuro , Cesárea , Estudos de Viabilidade , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Pandemias , Gravidez , Nascimento Prematuro/epidemiologia , SARS-CoV-2
15.
Medicina (Kaunas) ; 57(11)2021 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-34833476

RESUMO

The connection between endometriosis and pregnancy outcomes is trending among the research topics. Until recently, endometriosis and its painful symptomatology were considered to be alleviated by pregnancy. However, these beliefs have shifted, as emerging literature has demonstrated the role of this condition in affecting pregnancy evolution. The underlying pathogenesis of endometriosis is still poorly understood, all the more when pregnancy complications are involved. Debatable opinions on endometriosis associated with obstetric complications exist because of the potential bias resulting from the heterogeneity of preceding evidence. This review aims to evaluate the connection between endometriosis and adverse pregnancy outcomes and their shared pathogenic mechanisms. We searched PubMed and EMBASE and focused on the studies that include placenta praevia, premature rupture of membranes, spontaneous preterm birth, gestational hypertension, preeclampsia, obstetric hemorrhages (ante- and postpartum bleeding, abruptio placentae), miscarriage, stillbirth, neonatal death, gestational diabetes mellitus, gestational cholestasis, small for gestational age, and their association with endometriosis. Not only the risks of emergence were highlighted, but also the pathogenic connections. Epigenetic alterations of some genes were found to be mirrored both in endometriosis and obstetric complications. This review issues a warning for providing increased attention to pregnant women with endometriosis and newborns as higher risks of preeclampsia, placental issues, and preterm deliveries are associated.


Assuntos
Endometriose , Complicações na Gravidez , Nascimento Prematuro , Endometriose/complicações , Endometriose/epidemiologia , Feminino , Humanos , Recém-Nascido , Placenta , Gravidez , Complicações na Gravidez/epidemiologia , Resultado da Gravidez , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etiologia
16.
BMC Pregnancy Childbirth ; 21(1): 761, 2021 Nov 10.
Artigo em Inglês | MEDLINE | ID: mdl-34758778

RESUMO

BACKGROUND: The ongoing spread coronavirus disease worldwide has caused major disruptions and led to lockdowns. Everyday lifestyle changes and antenatal care inaccessibility during the coronavirus disease 2019 (COVID-19) pandemic have variable results that affect pregnancy outcomes. This study aimed to assess the alterations in stillbirth, neonatal-perinatal mortality, preterm birth, and birth weight during the COVID-19 national lockdown. METHODS: We used the data from the Jordan stillbirths and neonatal death surveillance system to compare pregnancy outcomes (gestational age, birth weight, small for gestational age, stillbirth, neonatal death, and perinatal death) between two studied periods (11 months before the pandemic (May 2019 to March 2020) vs. 9 months during the pandemic (April 2020 to March 1st 2020). Separate multinomial logistic and binary logistic regression models were used to compare the studied outcomes between the two studied periods after adjusting for the effects of mother's age, income, education, occupation, nationality, health sector, and multiplicity. RESULTS: There were 31106 registered babies during the study period; among them, 15311 (49.2%) and 15795 (50.8%) births occurred before and during the COVID-19 lockdown, respectively. We found no significant differences in preterm birth and stillbirth rates, neonatal mortality, or perinatal mortality before and during the COVID-19 lockdown. Our findings report a significantly lower incidence of extreme low birth weight (ELBW) infants (<1kg) during the COVID-19 lockdown period than that before the lockdown (adjusted OR 0.39, 95% CI 0.3-0.5: P value <0.001) CONCLUSIONS: During the COVID-19 lockdown period, the number of infants born with extreme low birth weight (ELBW) decreased significantly. More research is needed to determine the impact of cumulative socio-environmental and maternal behavioral changes that occurred during the pandemic on the factors that contribute to ELBW infants.


Assuntos
COVID-19/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Adulto , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Transmissão Vertical de Doenças Infecciosas/estatística & dados numéricos , Jordânia , Mortalidade Perinatal , Gravidez , Nascimento Prematuro/epidemiologia , Natimorto/epidemiologia
17.
Taiwan J Obstet Gynecol ; 60(6): 1043-1046, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34794735

RESUMO

OBJECTIVES: Aim of this study is to evaluate the prognosis of pregnant women having SARS-CoV-2 infection and investigate whether there was a difference in perinatal outcomes between pregnant women who had SARS-CoV-2 infection and those who did not. MATERIALS AND METHODS: This prospective observational study was conducted with 116 singleton pregnancies. Cases enrolling in the study were divided into two groups. While those in the first group had a history of SARS-CoV-2 infection (n = 46) the second group consisted of healthy pregnant women (n = 70). RESULTS: Emergency Cesarean section was performed on three SARS-CoV-2 infected pregnancies (30, 33 and 34 gestational weeks). Intensive care unit admission was required for all three cases after delivery and two of them died. Among the pregnancies that had an infection in the third trimester, 71.4% (n = 20) of them had delivery in 14 days after diagnosis and 17.4% (n = 8) of their newborns were followed up at newborn intensive care unit. Overall, only one newborn had a positive swab test result for SARS-CoV-2. There was no statistically significant difference between groups regarding their delivery week (37.02 ± 5.85 vs 38.5 ± 2.33). Similarly, there was no significant difference between groups, concerning mean age, parity, and birth weight (P = 0.707, P = 0.092, P = 0.334; P < 0.05). Furthermore, the difference between SARS-CoV-2 infected pregnancies that were followed up as inpatient or outpatient with respect to the delivery week and birth weight was not significant (p > 0.05). Also, APGAR 5 scores of hospitalized women (9.3 ± 1.1) were found to be lower than the outpatient group (9.8 ± 0.8) (P = 0.043; p < 0.05). CONCLUSION: No significant difference was detected between groups in terms of the delivery week, birth weight, and APGAR scores. The inpatient group was found to have lower APGAR 5 scores.


Assuntos
COVID-19/diagnóstico , Cesárea/estatística & dados numéricos , Parto Obstétrico , Transmissão Vertical de Doenças Infecciosas , Complicações Infecciosas na Gravidez/mortalidade , Gestantes/psicologia , Aborto Espontâneo/epidemiologia , Peso ao Nascer , COVID-19/mortalidade , COVID-19/terapia , COVID-19/virologia , Feminino , Humanos , Recém-Nascido , Pandemias , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/terapia , Complicações Infecciosas na Gravidez/virologia , Resultado da Gravidez , Nascimento Prematuro/epidemiologia , SARS-CoV-2
18.
BMC Pregnancy Childbirth ; 21(1): 767, 2021 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-34772364

RESUMO

BACKGROUND: The COVID-19 pandemic led to regional or nationwide lockdowns as part of risk mitigation measurements in many countries worldwide. Recent studies suggest an unexpected and unprecedented decrease in preterm births during the initial COVID-19 lockdowns in the first half of 2020. The objective of the current study was to assess the effects of the two months of the initial national COVID-19 lockdown period on the incidence of very and extremely preterm birth in the Netherlands, stratified by either spontaneous or iatrogenic onset of delivery, in both singleton and multiple pregnancies. METHODS: Retrospective cohort study using data from all 10 perinatal centers in the Netherlands on very and extremely preterm births during the initial COVID-19 lockdown from March 15 to May 15, 2020. Incidences of very and extremely preterm birth were calculated using an estimate of the total number of births in the Netherlands in this period. As reference, we used data from the corresponding calendar period in 2015-2018 from the national perinatal registry (Perined). We differentiated between spontaneous versus iatrogenic onset of delivery and between singleton versus multiple pregnancies. RESULTS: The incidence of total preterm birth < 32 weeks in singleton pregnancies was 6.1‰ in the study period in 2020 versus 6.5‰ in the corresponding period in 2015-2018. The decrease in preterm births in singletons was solely due to a significant decrease in iatrogenic preterm births, both < 32 weeks (OR 0.71; 95%CI 0.53 to 0.95) and < 28 weeks (OR 0.53; 95%CI 0.29 to 0.97). For multiple pregnancies, an increase in preterm births < 28 weeks was observed (OR 2.43; 95%CI 1.35 to 4.39). CONCLUSION: This study shows a decrease in iatrogenic preterm births during the initial COVID-19-related lockdown in the Netherlands in singletons. Future studies should focus on the mechanism of action of lockdown measures and reduction of preterm birth and the effects of perinatal outcome.


Assuntos
COVID-19/prevenção & controle , Trabalho de Parto Induzido/tendências , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etiologia , Feminino , Política de Saúde , Humanos , Doença Iatrogênica/epidemiologia , Incidência , Lactente Extremamente Prematuro , Recém-Nascido , Modelos Logísticos , Países Baixos/epidemiologia , Gravidez , Cuidado Pré-Natal/métodos , Cuidado Pré-Natal/tendências , Fatores de Proteção , Estudos Retrospectivos , Fatores de Risco
19.
BMJ Open ; 11(10): e047553, 2021 10 21.
Artigo em Inglês | MEDLINE | ID: mdl-34675010

RESUMO

OBJECTIVES: This study aims to evaluate the prevalence and outcome of twin pregnancies in Botswana. SETTING: The Tsepamo Study conducted birth outcomes surveillance at 8 government-run hospitals (~45% of all births in Botswana) from August 2014 to June 2018 and expanded to 18 hospitals (~70% of all births in Botswana) from July 2018 to March 2019. PARTICIPANTS: Data were collected for all live-born and stillborn in-hospital deliveries with a gestational age (GA) greater than 24 weeks. This analysis included 117 593 singleton and 3718 twin infants (1859 sets (1.6%)) born to 119 477 women between August 2014 and March 2019 and excluded 73 higher order multiples (23 sets of triplets and 1 set of quadruplets). OUTCOMES MEASURED: Our primary outcomes were preterm delivery (<37 weeks GA), very preterm delivery (<32 weeks GA) and stillbirth (APGAR (Appearance, Pulse, Grimace, Activity, Respiration) score of 0, 0, 0). RESULTS: Women with twin pregnancies had a similar median number of antenatal care visits (9 vs 10), but were more likely to deliver in a tertiary centre (54.8% vs 45.1%, p<0.001) and more likely to have a cesarean-section (54.6% vs 22.0%, p<0.001) than women with singletons. Compared with singletons, twin pregnancies had a higher risk of preterm delivery (<37 weeks GA) (47.6% vs 16.7%, adjusted risk ratio (aRR) 2.8, 95% CI 2.7 to 2.9) and very preterm delivery (<32 weeks) (11.8% vs 4.0%, aRR 3.0 95% CI 2.6 to 3.4). Among all twin pregnancies, 128 (6.9%) had at least one stillborn infant compared with 2845 (2.4%) stillbirths among singletons (aRR 2.8, 95% CI 2.3 to 3.3). CONCLUSION: Adverse birth outcomes are common among twins in Botswana, and are often severe. Interventions that allow for earlier identification of twin gestation and improved antenatal management of twin pregnancies may improve infant and child survival.


Assuntos
Gravidez de Gêmeos , Nascimento Prematuro , Botsuana/epidemiologia , Criança , Feminino , Humanos , Lactente , Recém-Nascido , Gravidez , Resultado da Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Prevalência
20.
Acta Obstet Gynecol Scand ; 100(11): 1995-2002, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34698370

RESUMO

INTRODUCTION: To determine the impact on preterm birth (PTB) of a history of large loop excision of the transformation zone (LLETZ)-alone compared with a history of previous preterm birth-alone (PPTB) or a history of both (LLETZ+PPTB). Secondary analyses were performed to evaluate the impact of antenatal interventions, depth of cervical excision, and patient risk factors on PTB rate in each cohort. MATERIAL AND METHODS: A retrospective observational cohort study of women referred to a tertiary Antenatal Prematurity Prevention Clinic with a history of LLETZ, PPTB, or LLETZ+PPTB. Information was collated from routinely collected clinical data on patient demographics, previous obstetric history, LLETZ dimensions, antenatal investigations/interventions, and gestation at delivery. RESULTS: A total of 1231 women with singleton pregnancies were included, 543 with history of LLETZ-alone, 607 with a history of PPTB-alone and 81 with a history of LLETZ+PPTB. PTB rates were 8.8% in the LLETZ-alone group, which mirrored the PTB rate in the local background obstetric population (8.9%) compared with 28.7% in the PPTB-alone and 37.0% in the LLETZ+PPTB cohorts. PTB rates were higher in LLETZ cohorts treated with antenatal intervention (cervical cerclage or progesterone pessary) and there was no evidence of an effect of intervention on risk of PTB in post-excision patients with identified shortened mid-trimester cervical length. Logistic regression modeling identified PPTB as a strong predictor of recurrent PTB. Excision depth was correlated with gestation at delivery in the LLETZ-alone group (r = -0.183, p < 0.01) although this only reached statistical significance at depths of 20 mm or more (odds ratio [OR] 3.40, 95% CI 1.04-1.11, p = 0.04). Depth of excision was not correlated with delivery gestation in the LLETZ+PPTB group (r = -0.031, p = 0.82). CONCLUSIONS: PPTB has a greater impact on subsequent PTB risk compared with depth of cervical excisional treatment. The value and nature of antenatal interventions should be investigated in the post-excision population.


Assuntos
Neoplasia Intraepitelial Cervical/cirurgia , Nascimento Prematuro/epidemiologia , Adulto , Feminino , Humanos , Recém-Nascido , Gravidez , Estudos Retrospectivos , Fatores de Risco , Reino Unido/epidemiologia
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