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1.
PLoS Med ; 17(8): e1003158, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32810187

RESUMO

BACKGROUND: Most of the women who smoke before pregnancy continue smoking during pregnancy, and some start to quit smoking after being pregnant, although existing guidelines for pregnancy recommend that women who smoke should quit smoking before pregnancy. Findings about the timing and intensity of maternal smoking, especially low-intensity smoking (1-9 cigarettes per day), and preterm birth are still inconsistent and ambiguous. This study aimed to examine the association of the timing of smoking and doses of smoking before pregnancy and during the first or second trimester of pregnancy with preterm birth in a large-scale population-based retrospective cohort study. METHODS AND FINDINGS: We used nationwide birth certificate data from singleton mother-infant pairs in the United States National Vital Statistics System, 2011-2018. All adult women with live singleton births, without preexisting hypertension or diabetes, and with complete data on smoking and gestational age at delivery were included. Participants reported their smoking status (yes or no) and daily number of cigarettes consumed before and during each trimester of pregnancy. The outcome of interest was preterm birth, defined as a birth before 37 weeks of gestation. Logistic regression models were used to estimate the odds ratio (OR) with 95% confidence intervals (CIs) of preterm birth associated with smoking status and the number of cigarettes consumed, adjusting for maternal age, race/ethnicity, parity, education levels, prepregnancy BMI, previous history of preterm birth, marital status, infant sex, and initiation of prenatal care. This study included 25,623,479 women, with a mean age of 29 years (range 20-50 years); 13,742,486 (53.6%) participants were of non-Hispanic white ancestry, 5,971,598 (23.3%) of Hispanic ancestry, and 3,417,456 (13.34%) of non-Hispanic black ancestry. The prevalence of preterm birth was 9.3% (n = 2,378,398). We found that maternal smoking during pregnancy, even at a very low level of intensity, was associated with an increased risk of preterm delivery. The adjusted ORs (95% CI) of preterm birth for mothers who smoked 1-2, 3-5, 6-9, 10-19, and ≥20 cigarettes per day during the first trimester compared with mothers who did not smoke were 1.31 (1.29-1.33), 1.31 (1.30-1.32), 1.33 (1.31-1.35), 1.44 (1.43-1.45), and 1.53 (1.52-1.55), respectively (all P values < 0.001), whereas for those who smoked during the second trimester, the corresponding ORs were 1.37 (1.35-1.39), 1.36 (1.35-1.38), 1.36 (1.34-1.38), 1.48 (1.47-1.49), and 1.59 (1.58-1.61), respectively (all P values < 0.001). Furthermore, smokers who quit before pregnancy, regardless of smoking intensity, had a comparable risk of preterm birth with nonsmokers, although this was not the case when cessation occurred in the first or second trimester of pregnancy. The major limitation of this study is the self-reported information about smoking, which may be subject to information bias. In addition, we cannot rule out the possibility of residual confounding caused by unmeasured factors in an observational research design. CONCLUSIONS: In this study, we observed that low-intensity cigarette consumption during either the first or second trimester of pregnancy, even as low as 1-2 cigarettes per day, was associated with an increased risk of preterm birth. These findings suggest that there is no safe level or safe trimester for maternal smoking during pregnancy. Women of reproductive age who smoke should be strongly encouraged and supported to quit smoking before pregnancy.


Assuntos
Fumar Cigarros/efeitos adversos , Fumar Cigarros/epidemiologia , Comportamento Materno , Nascimento Prematuro/epidemiologia , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Adulto , Fumar Cigarros/tendências , Relação Dose-Resposta a Droga , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Nascimento Prematuro/diagnóstico , Nascimento Prematuro/etiologia , Efeitos Tardios da Exposição Pré-Natal/diagnóstico , Efeitos Tardios da Exposição Pré-Natal/etiologia , Fatores de Risco , Autorrelato , Estados Unidos/epidemiologia , Adulto Jovem
2.
Medicine (Baltimore) ; 99(28): e21172, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664156

RESUMO

Preterm birth is the most important cause of neonatal mortality and morbidity worldwide. The aim of this study was to identify factors associated with preterm birth and examine the heterogeneity and interactions between these factors.We collected data from 1607 pregnant women treated at Nanjing Maternity and Child Health Care Hospital in China. The women included in the study were divided into the full-term group and the preterm-birth group. We used t-tests to compare the characteristics of age and body mass index, Chi-square tests for the other variables, and we used the Wald test to calculate the interaction between factors that may affect preterm birth. The heterogeneity test was used to study the relationship between subgroups. Multivariable logistic regression analysis was used to explore the associations between risk factors and preterm birth, which included all risk factors. All tests were 2-tailed, P < 0.05 was considered significant, and 95% confidence intervals were estimated for percentages.There was no statistical difference in basic characteristics such as age between the full-term and preterm groups. We found 6 independent risk factors that were associated with preterm birth (P < .05): preeclampsia (PE), intrahepatic cholestasis, premature rupture of the membranes (PROM), placenta previa, chorioamnionitis, and scarred uterus. Five combinations of these factors were statistically significant (P < .05) in terms of heterogeneity: PE and PROM; placenta previa and polyhydramnios; chorioamnionitis and PE; PROM and maternal body mass index; and PROM and gestational diabetes mellitus. Ultimately, the 2 subgroups that showed interactions were PE and PROM and chorioamnionitis and PE.The interaction between different factors over the course of preterm birth cannot be ignored. When independent risk factors are combined with other diseases, such as PE combined with PROM or chorioamnionitis in this study, it may more likely result in preterm birth. Thus, this situation deserves particular clinical attention.


Assuntos
Corioamnionite/epidemiologia , Diabetes Gestacional/epidemiologia , Ruptura Prematura de Membranas Fetais/epidemiologia , Placenta Prévia/epidemiologia , Nascimento Prematuro/etiologia , Adulto , China/epidemiologia , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Modelos Logísticos , Gravidez , Nascimento Prematuro/epidemiologia , Estudos Retrospectivos , Fatores de Risco
3.
Rev Esp Quimioter ; 33(5): 313-326, 2020 Oct.
Artigo em Espanhol | MEDLINE | ID: mdl-32683837

RESUMO

OBJECTIVE: The appearance of new infectious diseases, such as COVID-19, poses a challenge in monitoring pregnancy and preventing obstetric and neonatal complications. A scoping review has the objective to review the information available in pregnant women infected with the MERS-CoV, SARSCoV, SARS-CoV-2 coronaviruses to assess the similarities in terms of and differences in the clinical characteristics of the mothers and neonatal outcomes. METHODS: We carried out a bibliographic search (scoping review) according to the PRISMA guidelines between March and April 2020 in the MEDLINE, SciELO, and CUIDEN databases and the Elsevier COVID-19 Information Center. RESULTS: We analyzed 20 articles with a total of 102 cases. 9 of MERS-CoV, 14 of SARS-CoV and 79 of SARS-CoV-2. Fever (75.5%) and pneumonia (73.5%) were the most frequent symptoms in infected pregnant women. The most frequent obstetric complications were the threat of premature delivery (23.5%) and caesarean section (74.5%). No vertical transmission was documented in any of the infants. CONCLUSIONS: All three coronaviruses produce pneumonia with very similar symptoms, being milder in the case of SARSCoV2. Despite documented obstetric complications, neonatal outcomes are mostly favorable. Increased knowledge is needed to improve and prevent obstetric and neonatal complications from these infections in pregnant women.


Assuntos
Betacoronavirus , Coronavírus da Síndrome Respiratória do Oriente Médio , Complicações Infecciosas na Gravidez , Vírus da SARS , Síndrome Respiratória Aguda Grave/complicações , Adulto , Cesárea , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Feminino , Febre/etiologia , Humanos , Recém-Nascido , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Pneumonia Viral/etiologia , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Resultado da Gravidez , Nascimento Prematuro/etiologia , Síndrome Respiratória Aguda Grave/epidemiologia , Avaliação de Sintomas/estatística & dados numéricos
4.
Arch Gynecol Obstet ; 302(3): 595-602, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32705338

RESUMO

PURPOSE: To investigate the association between maternal HBsAg-positive status and pregnancy outcomes. METHODS: The study enrolled women with singleton pregnancies who delivered during January-December 2018. Data of maternal demographics and main adverse pregnancy outcomes were collected from the institutional medical records and analyzed by univariate and multivariate logistic regression models to determine the association between maternal HBV markers (HBsAg/HBeAg/HBV-DNA loads status) and adverse pregnancy outcomes. RESULTS: Total 1146 HBsAg-positive and 18,354 HBsAg-negative pregnant women were included. After adjusting for potential confounding variables, maternal HBsAg-positive status was associated with a high risk of gestational diabetes mellitus (GDM) [adjusted odds ratio (aOR) = 1.24; 95% confidence interval (CI) 1.07-1.43], intrahepatic cholestasis of pregnancy (ICP) (aOR = 3.83; 95% CI 3.14-4.68), preterm birth (aOR = 1.42; 95% CI 1.17-1.72), and neonatal asphyxia (aOR = 2.20; 95% CI 1.34-3.63). Further, higher risks of ICP and neonatal asphyxia remained with either HBeAg-positive status (aOR = 1.64; 95% CI 1.10-2.44; aOR = 3.08; 95% CI 1.17-8.00) or high HBV-DNA load during the second trimester (aOR = 1.52; 95% CI 1.06-2.35; aOR = 4.20; 95% CI 4.20-15.83) among HBsAg-positive pregnant women. CONCLUSION: Women with maternal HBsAg-positive status may have increased risks of GDM, ICP, preterm birth, and neonatal asphyxia; furthermore, the risks of ICP and neonatal asphyxia were higher in women with HBeAg-positive status and a high HBV-DNA load during the second trimester among the HBsAg-positive pregnant women, implying that careful surveillance for chronic HBV infection during pregnancy is warranted.


Assuntos
Colestase Intra-Hepática/virologia , Antígenos de Superfície da Hepatite B/sangue , Hepatite B/complicações , Complicações Infecciosas na Gravidez/virologia , Complicações na Gravidez/virologia , Nascimento Prematuro/virologia , Adulto , Colestase Intra-Hepática/epidemiologia , Diabetes Gestacional/epidemiologia , Diabetes Gestacional/virologia , Feminino , Hepatite B/virologia , Antígenos E da Hepatite B/sangue , Vírus da Hepatite B/imunologia , Humanos , Recém-Nascido , Gravidez , Complicações na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Resultado da Gravidez , Gestantes , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etiologia , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
5.
Ann Afr Med ; 19(2): 113-118, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32499467

RESUMO

Background: There is still conflicting evidence on the extent to which maternal hyperhomocysteinemia is a risk factor for pregnancy complications. Aims: The study aimed to investigate the impact of elevated maternal homocysteine concentrations on adverse pregnancy outcomes among Nigerian women in Lagos. Materials and Methods: This was a prospective cohort study conducted at the Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria. Participants were enrolled during the first trimester of pregnancy following which relevant data were obtained by the interview. Fasting blood samples were collected for the measurement of maternal homocysteine concentration using the enzyme-linked immunosorbent assay method. Pregnancy outcomes and complications were obtained by abstracting the antenatal, delivery, and newborn medical records. Preterm births, low-birth weight (LBW), and antepartum fetal death were used as confirmatory outcome variables in the final analysis. Descriptive statistics for all data were computed using SPSS version 22.0. The associations between the variables were tested and multivariate analyses were used to study the effects of the major baseline characteristics on the pregnancy outcome. P < 0.05 was considered statistically significant. Conclusions: The prevalence of hyperhomocysteinemia among mothers in Lagos was relatively low. The associations between hyperhomocysteinemia and adverse pregnancy outcomes could have implications in future for the prevention of these adverse outcomes. Results: Hyperhomocysteinemia was recorded in 41 (24.6%) patients. Women with a high homocysteine concentration and those with a normal homocysteine level did not differ significantly in terms of age (P = 0.684), level of education (P = 0.866), and parity (P = 0.647). Women with hyperhomocysteinemia had an approximately twelve-fold higher risk of preterm birth (P = 0.001) and a ten-fold higher risk of delivering a term neonate with LBW (P = 0.004), but had no risk of antepartum fetal death (P = 0.118) compared to women with a normal homocysteine concentration.


Assuntos
Homocisteína/sangue , Mães/estatística & dados numéricos , Nascimento Prematuro/epidemiologia , Adolescente , Adulto , Biomarcadores/sangue , Estudos de Coortes , Feminino , Idade Gestacional , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Pessoa de Meia-Idade , Nigéria/epidemiologia , Gravidez , Complicações na Gravidez/epidemiologia , Resultado da Gravidez , Nascimento Prematuro/etiologia , Prevalência , Estudos Prospectivos , Fatores de Risco
6.
Arch Gynecol Obstet ; 302(3): 611-618, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32529298

RESUMO

OBJECTIVE: Women with inflammatory bowel disease (IBD) have an increased risk for adverse pregnancy outcome, so as women using assisted reproduction technology (ART). However, data are scarce regarding the risk imposed by the combination of both. Thus, we aimed to assess pregnancy outcome in these women. METHODS: A retrospective case-control study, of women with IBD who conceived using ART due to female infertility. The study group (IBD-ART) was matched using propensity score and compared in a 1:1 ratio with three control groups, IBD patients who conceived spontaneously (IBD-SP), women using ART (H-ART) and women who conceived spontaneously (H-SP). RESULTS: The study group comprised of 49 women with IBD conceived via ART that gave birth at our center during the study period. All studied groups did not differ in demographics and obstetric characteristics. IBD groups (both ART and spontaneous) were comparable in disease status prior and throughout pregnancy. Maternal outcome showed no difference regarding preterm birth and pregnancy complications among all studied groups. Women in the IBD-ART group had decreased rates of vaginal delivery (34.7% vs 57.1%, p = 0.032) and higher rates of elective CS (32.7% vs 14.3%, p = 0.048) in comparison to H-SP group, but comparable rates to both IBD-SP and H-ART groups. Neonatal outcomes were comparable among all studied groups. In a sub-analysis by disease type, a higher rate of gestational diabetes was found among ulcerative colitis patients using ART (29.4% Crohn's vs 6.1% UC, p = 0.025). CONCLUSION: Patients with IBD undergoing ART have comparable pregnancy outcome to women using ART and to patients with IBD with spontaneous pregnancy.


Assuntos
Colite Ulcerativa/complicações , Doença de Crohn/complicações , Infertilidade Feminina/terapia , Doenças Inflamatórias Intestinais/complicações , Complicações na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Técnicas de Reprodução Assistida/estatística & dados numéricos , Adulto , Estudos de Casos e Controles , Parto Obstétrico , Diabetes Gestacional/etiologia , Feminino , Humanos , Recém-Nascido , Infertilidade Feminina/etiologia , Gravidez , Complicações na Gravidez/etiologia , Nascimento Prematuro/etiologia , Técnicas de Reprodução Assistida/efeitos adversos , Estudos Retrospectivos
7.
Int J Gynaecol Obstet ; 150(1): 10-16, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32524594

RESUMO

BACKGROUND: Preterm birth (PTB) and pre-eclampsia independently, and frequently concurrently, adversely affect the pregnancy outcomes of millions of mothers and infants worldwide each year. OBJECTIVES: To fill the gap between PTB and pre-eclampsia, which continue to constitute the two most important current global challenges to maternal and perinatal health. METHODS: Pubmed, Embase, and Cochrane databases were searched from inception until December 2019 using the terms spontaneous PTB (SPTB), indicated preterm delivery (IPTD), early-onset pre-eclampsia, and pre-eclampsia. RESULTS: History of PTB and pre-eclampsia were the strongest risk factors contributing to the occurrence of SPTB or IPTB. The risk of PTB and pre-eclampsia among non-Hispanic African American women was higher than the rate among all other racial/ethnic groups in the United States. Low-dose aspirin (LDA) has been reported to reduce the risk of pre-eclampsia by at least 10% and PTB by at least 14%. Lastly, women and their fetuses who develop early-onset pre-eclampsia are at higher risk for developing hypertension and cardiovascular disease later in life. CONCLUSIONS: While better clarity is needed, efforts to coordinate prevention of both PTB and pre-eclampsia, even though imperfect, are critically important as part of any program to make motherhood as safe as possible.


Assuntos
Pré-Eclâmpsia/epidemiologia , Nascimento Prematuro/epidemiologia , Adulto , Feminino , Humanos , Recém-Nascido , Pré-Eclâmpsia/prevenção & controle , Gravidez , Nascimento Prematuro/etiologia , Nascimento Prematuro/prevenção & controle , Fatores de Risco , Revisões Sistemáticas como Assunto
8.
Int J Gynaecol Obstet ; 150(1): 17-23, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32524595

RESUMO

BACKGROUND: There is a substantial variation in rates of preterm delivery between different parts of the world. The understanding of these variations, as well as the biological mechanisms behind spontaneous preterm delivery, is limited. Although the benefit of antenatal interventions has been shown to be limited, using well-known risk factors for spontaneous preterm delivery to select the correct pregnant women for targeted interventions is important from both a medical and caregiving perspective. OBJECTIVE: To provide an introduction to a substantial research area dealing with risk factors of spontaneous preterm delivery. METHODS: Risk factors in this review were classified as demographical, obstetrical, and gynecological and those related to the current pregnancy according to high-quality evidence of recent literature. RESULTS AND CONCLUSION: An introduction to a substantial research area in maternal and fetal medicine was provided that might help clinicians to better understand the risk factors related to preterm delivery and select the correct pregnant women for targeted interventions.


Assuntos
Nascimento Prematuro/etiologia , Cuidado Pré-Natal/métodos , Feminino , Humanos , Recém-Nascido , Gravidez , Nascimento Prematuro/diagnóstico , Fatores de Risco
9.
J Pregnancy ; 2020: 9435972, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32411468

RESUMO

Preterm birth is delivery before 37 completed weeks. A study was conducted to evaluate the association of maternal serum concentrations of selenium, copper, and zinc and preterm birth. There were 181 women in this nested case-control study, 90/181 (49.7%) term and 91/181 (50.3%) preterm pregnant women. The overall mean serum concentration of selenium was 77.0, SD 19.4 µg/L; of copper was 2.50, SD 0.52 mg/L; and of zinc was 0.77, SD 0.20 mg/L with reference values of 47-142 µg/L, 0.76-1.59 mg/L, and 0.59-1.11 mg/L, respectively. For preterm birth, mean serum concentration for selenium was 79.7, SD 21.6 µg/L; for copper was 2.61, SD 0.57 mg/L; and for zinc was 0.81, SD 0.20 mg/L compared to that for term births: selenium (74.2; SD 16.5 µg/L; p = 0.058), copper (2.39; SD 0.43 mg/L; p = 0.004), and zinc (0.73; SD 0.19 mg/L; p = 0.006), respectively. In an adjusted analysis, every unit increase in maternal selenium concentrations gave increased odds of being a case OR 1.01 (95% CI: 0.99; 1.03), p = 0.234; copper OR 1.62 (95% CI: 0.80; 3.32), p = 0.184; zinc OR 6.88 (95% CI: 1.25; 43.67), p = 0.032. Results show that there was no deficiency of selenium and zinc and there were high serum concentrations of copper in pregnancy. Preterm birth was associated with higher maternal serum concentrations of copper and zinc.


Assuntos
Cobre/sangue , Gravidez/sangue , Nascimento Prematuro/etiologia , Selênio/sangue , Zinco/sangue , Estudos de Casos e Controles , Feminino , Humanos , Malaui , Risco
10.
PLoS One ; 15(4): e0232463, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32353024

RESUMO

Transabdominal cerclage (TAC) is reported to be effective for preventing preterm birth in women with unsuccessful transvaginal cerclage (TVC) history. However, TAC has rarely been performed in twin pregnancy given the lack of sufficient evidence and the technical difficulty of the operation. Thus, it is unclear whether TAC is an effective procedure for twin pregnancy in women with a history of unsuccessful TVC. The aim of this study is to compare the characteristics and pregnancy outcomes after TAC in twin pregnancy versus singleton pregnancy, to examine whether twin pregnancy is a risk factor for very preterm birth (before 32 weeks) after TAC, and to determine whether TAC is effective in preventing preterm birth in twin pregnancy. This single-center retrospective cohort study included women who underwent TAC because of unsuccessful TVC history between January 2007 and June 2018. Of 165 women who underwent TAC, 19 had twins and 146 had singletons. Our results showed that the neonatal survival rate improved dramatically when TAC was performed (15.4% (prior pregnancy) vs 94.0% (after TAC) in twins, p<0.01; 22.8% (prior pregnancy) vs 91.1% (after TAC) in singletons, p<0.01). Moreover, the risk of very preterm birth was significantly decreased after TAC in both groups (36/39 (92.3%) (prior pregnancy) vs 2/19 (10.5%) (after TAC) in twins, p<0.01; 290/337 (86.1%) (prior pregnancy) vs 17/146 (11.6%) (after TAC) in singletons, p<0.01). More advanced maternal age and history of prior preterm delivery between 26+0 and 36+6 weeks were independently associated with very preterm birth, whereas the presence of a twin pregnancy was not associated with very preterm birth on multivariate logistic regression analysis. These results suggest that TAC is associated with successful prevention of very preterm birth and improved neonatal survival rates in the absence of procedure-related major complications in women with twin pregnancy and previous unsuccessful TVC history.


Assuntos
Cerclagem Cervical/métodos , Resultado da Gravidez , Gravidez de Gêmeos , Nascimento Prematuro/prevenção & controle , Adulto , Cerclagem Cervical/efeitos adversos , Colo do Útero/cirurgia , Feminino , Humanos , Recém-Nascido , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Gravidez , Nascimento Prematuro/etiologia , Nascimento Prematuro/mortalidade , Estudos Retrospectivos , Taxa de Sobrevida , Falha de Tratamento
11.
PLoS One ; 15(5): e0233097, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32470065

RESUMO

OBJECTIVE: To evaluate not only the risk of total preterm birth (PTB) but also spontaneous preterm birth (sPTB) and indicated preterm birth (iPTB) in vanishing twin (VT). STUDY DESIGN: This is a secondary analysis of a multicenter prospective cohort study. In 12 different healthcare institutions, women with singleton pregnancies were enrolled in early pregnancy and followed up till delivery. RESULTS: A total of 4,746 women were included in the final analysis, and. the frequency of VT was 1.1% (54/4746). VT group had a higher risk for total PTB (PTB<34 weeks, 2.1% vs. 14.8%, p<0.001; PTB<32 weeks, 1.6% vs. 13.0%, p<0.001; PTB<28 weeks, 0.9% vs. 13.0%, p<0.001) than singleton group. The VT group had increased risk for both sPTB and iPTB (<34 weeks, <32 weeks, and <28 weeks), and this increased risk for sPTB and iPTB in VT group remained significant even after controlling for confounders such as maternal age, parity, pre-pregnancy BMI, and mode of conception. CONCLUSION: Vanishing twin can be an independent risk factor for both sPTB and iPTB when compared with singleton pregnancy.


Assuntos
Nascimento Prematuro/epidemiologia , Adulto , Índice de Massa Corporal , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Idade Materna , Gravidez , Gravidez de Gêmeos , Nascimento Prematuro/etiologia , Estudos Prospectivos , Fatores de Risco
12.
Arch Gynecol Obstet ; 302(1): 1-4, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32409923

RESUMO

BACKGROUND: Effective prevention of preterm birth as cause of serious risks for the infant as well as the mother pre- and postpartum is one of the still unsolved problems in modern medicine. METHOD: The government of the State of Thuringia in cooperation with the professional organization of obstetricians and gynecologists decided in 2016 to reestablish and promote a self-care screening program based on intravaginal (i.vag.) pH measurement to reduce the incidence of preterm birth by early diagnosis and therapy of genital infection. RESULTS: Starting at zero in 2016, > 80% of pregnant women in the state had their vaginal pH monitored at the end of 2018 (n = 17.180). This was associated with a reduced incidence of early preterm birth measured by gestational week ≤ 32 (1.46 vs. 1.26%). CONCLUSION: The fourth millennium goal missed worldwide in 2015 as well as the newly declared third objective of the UN could come closer using the simple and cheap i.vag. pH-self-screening regime in prevention of preterm birth, an approach partly turning the woman from being object of medical care to being the subject in self-control of her pregnancy. This is also a well perceived change in paradigm from the perspective of females as well as physicians.


Assuntos
Programas de Rastreamento/métodos , Nascimento Prematuro/epidemiologia , Vagina/química , Aborto Espontâneo/prevenção & controle , Administração Intravaginal , Feminino , Idade Gestacional , Humanos , Concentração de Íons de Hidrogênio , Incidência , Recém-Nascido , Gravidez , Nascimento Prematuro/etiologia , Nascimento Prematuro/prevenção & controle , Vagina/metabolismo , Vagina/microbiologia
13.
Arch Gynecol Obstet ; 302(1): 31-45, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32445067

RESUMO

PURPOSE: The use of assisted reproductive technology (ART) has increased in the last 2 decades and continuous surveillance is needed. This systematic review aims to assess the risk of adverse neonatal outcomes (preterm birth [PTB], low birth weight [LBW], small-for-gestationalage [SGA] and large for gestational-age [LGA]), in singleton pregnancies conceived by fresh or frozen embryo transfer (FET) compared to spontaneous conceptions. METHODS: Cohort studies were identified from MEDLINE, Embase, Cochrane Library (January 2019), and manual search. Meta-analyses were performed to estimate odds ratios (OR) using random effects models in RevMan 5.3 and I-squared (I2) test > 50% was considered as high heterogeneity. RESULTS: After 3142 titles and abstracts were screened, 1180 full-text articles were assessed, and 14 were eligible. For fresh embryo transfer, the pooled ORs were PTB 1.64 (95% CI 1.46, 1.84); I2 = 97%; LBW 1.67 (95% CI 1.52, 1.85); I2 = 94%; SGA 1.46 [95% CI 1.11, 1.92]; I2 = 99%, LGA 0.88 (95% CI 0.80, 0.87); I2 = 80%). For frozen, the pooled ORs were PTB 1.39 (95% CI 1.34, 1.44); I2 = 0%; LBW 1.38 (95% CI 0.91, 2.09); I2 = 98%; SGA 0.83 (95% CI 0.57, 1.19); I2 = 0%, LGA 1.57 (95% CI 1.48, 1.68); I2 = 22%). CONCLUSIONS: When compared with spontaneous pregnancies, fresh, but not frozen was associated with LBW and SGA. Both fresh and frozen were associated with PTB. Frozen was uniquely associated with LGA. Despite improvements in ART protocols in relation to pregnancy rates, attention is needed towards monitoring adverse neonatal outcomes in these pregnancies.


Assuntos
Transferência Embrionária/efeitos adversos , Transferência Embrionária/métodos , Fertilização , Retardo do Crescimento Fetal/etiologia , Infertilidade/terapia , Nascimento Prematuro/etiologia , Técnicas de Reprodução Assistida , Estudos de Coortes , Criopreservação , Feminino , Retardo do Crescimento Fetal/epidemiologia , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Gravidez , Resultado da Gravidez , Taxa de Gravidez , Nascimento Prematuro/epidemiologia , Resultado do Tratamento
14.
J Reprod Immunol ; 139: 103122, 2020 06.
Artigo em Inglês | MEDLINE | ID: covidwho-9352

RESUMO

The 2019 novel coronavirus disease (COVID-19) was first detected in December 2019 and became epidemic in Wuhan, Hubei Province, China. COVID-19 has been rapidly spreading out in China and all over the world. The virus causing COVID-19, SARS-CoV-2 has been known to be genetically similar to severe acute respiratory syndrome coronavirus (SARS-CoV) but distinct from it. Clinical manifestation of COVID-19 can be characterized by mild upper respiratory tract infection, lower respiratory tract infection involving non-life threatening pneumonia, and life-threatening pneumonia with acute respiratory distress syndrome. It affects all age groups, including newborns, to the elders. Particularly, pregnant women may be more susceptible to COVID-19 since pregnant women, in general, are vulnerable to respiratory infection. In pregnant women with COVID-19, there is no evidence for vertical transmission of the virus, but an increased prevalence of preterm deliveries has been noticed. The COVID-19 may alter immune responses at the maternal-fetal interface, and affect the well-being of mothers and infants. In this review, we focused on the reason why pregnant women are more susceptible to COVID-19 and the potential maternal and fetal complications from an immunological viewpoint.


Assuntos
Betacoronavirus/imunologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/imunologia , Suscetibilidade a Doenças/imunologia , Pneumonia Viral/complicações , Pneumonia Viral/imunologia , Complicações Infecciosas na Gravidez/imunologia , China , Infecções por Coronavirus/patologia , Feminino , Humanos , Pandemias , Pneumonia Viral/patologia , Gravidez , Complicações Infecciosas na Gravidez/virologia , Nascimento Prematuro/etiologia
15.
J Reprod Immunol ; 139: 103122, 2020 06.
Artigo em Inglês | MEDLINE | ID: covidwho-27137

RESUMO

The 2019 novel coronavirus disease (COVID-19) was first detected in December 2019 and became epidemic in Wuhan, Hubei Province, China. COVID-19 has been rapidly spreading out in China and all over the world. The virus causing COVID-19, SARS-CoV-2 has been known to be genetically similar to severe acute respiratory syndrome coronavirus (SARS-CoV) but distinct from it. Clinical manifestation of COVID-19 can be characterized by mild upper respiratory tract infection, lower respiratory tract infection involving non-life threatening pneumonia, and life-threatening pneumonia with acute respiratory distress syndrome. It affects all age groups, including newborns, to the elders. Particularly, pregnant women may be more susceptible to COVID-19 since pregnant women, in general, are vulnerable to respiratory infection. In pregnant women with COVID-19, there is no evidence for vertical transmission of the virus, but an increased prevalence of preterm deliveries has been noticed. The COVID-19 may alter immune responses at the maternal-fetal interface, and affect the well-being of mothers and infants. In this review, we focused on the reason why pregnant women are more susceptible to COVID-19 and the potential maternal and fetal complications from an immunological viewpoint.


Assuntos
Betacoronavirus/imunologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/imunologia , Suscetibilidade a Doenças/imunologia , Pneumonia Viral/complicações , Pneumonia Viral/imunologia , Complicações Infecciosas na Gravidez/imunologia , China , Infecções por Coronavirus/patologia , Feminino , Humanos , Pandemias , Pneumonia Viral/patologia , Gravidez , Complicações Infecciosas na Gravidez/virologia , Nascimento Prematuro/etiologia
16.
J Reprod Immunol ; 139: 103122, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32244166

RESUMO

The 2019 novel coronavirus disease (COVID-19) was first detected in December 2019 and became epidemic in Wuhan, Hubei Province, China. COVID-19 has been rapidly spreading out in China and all over the world. The virus causing COVID-19, SARS-CoV-2 has been known to be genetically similar to severe acute respiratory syndrome coronavirus (SARS-CoV) but distinct from it. Clinical manifestation of COVID-19 can be characterized by mild upper respiratory tract infection, lower respiratory tract infection involving non-life threatening pneumonia, and life-threatening pneumonia with acute respiratory distress syndrome. It affects all age groups, including newborns, to the elders. Particularly, pregnant women may be more susceptible to COVID-19 since pregnant women, in general, are vulnerable to respiratory infection. In pregnant women with COVID-19, there is no evidence for vertical transmission of the virus, but an increased prevalence of preterm deliveries has been noticed. The COVID-19 may alter immune responses at the maternal-fetal interface, and affect the well-being of mothers and infants. In this review, we focused on the reason why pregnant women are more susceptible to COVID-19 and the potential maternal and fetal complications from an immunological viewpoint.


Assuntos
Betacoronavirus/imunologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/imunologia , Suscetibilidade a Doenças/imunologia , Pneumonia Viral/complicações , Pneumonia Viral/imunologia , Complicações Infecciosas na Gravidez/imunologia , China , Infecções por Coronavirus/patologia , Feminino , Humanos , Pandemias , Pneumonia Viral/patologia , Gravidez , Complicações Infecciosas na Gravidez/virologia , Nascimento Prematuro/etiologia
17.
BJOG ; 127(10): 1217-1225, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32237024

RESUMO

OBJECTIVE: To study the effect of antenatal magnesium sulphate (MgSO4 ) on cerebral palsy (CP) in a manner that also provides adequate power for a linked trial sequential analysis. DESIGN: Double-blind, randomised, placebo-controlled, multi-centre trial. SETTING: Fourteen Danish obstetric departments. POPULATION: In total, 560 pregnant women at risk for preterm delivery before 32 weeks of gestation were randomised from December 2011 to January 2018. Those women gave birth to 680 children. METHODS: Women were randomised to receive either a loading dose of 5 g MgSO4 followed by 1 g/hour or a placebo in identical volumes. The children were followed up at a corrected age of 18 months or older with a review of their medical charts and with the Ages and Stages Questionnaire. MAIN OUTCOME MEASURE: The primary outcome measure was moderate to severe CP. Secondary outcomes included mortality, neonatal morbidity, blindness and mild CP. RESULTS: The crude rates of moderate to severe CP in the MgSO4 group and the placebo group were 2.0% and 3.3%, respectively. The adjusted odds of moderate to severe CP were lower in the MgSO4 group than in the placebo group (odds ratio 0.61; 95% CI 0.23-1.65). CONCLUSIONS: Antenatal MgSO4 before 32 weeks of gestation decreases the likelihood of moderate to severe CP; these results are entirely consistent with other randomised evidence summarised in the linked trial sequential analysis. TWEETABLE ABSTRACT: Antenatal magnesium sulphate may decrease the risk of moderate to severe cerebral palsy in children born before 32 weeks of gestation.


Assuntos
Paralisia Cerebral/prevenção & controle , Sulfato de Magnésio/administração & dosagem , Fármacos Neuroprotetores/administração & dosagem , Nascimento Prematuro/tratamento farmacológico , Adulto , Dinamarca , Método Duplo-Cego , Feminino , Humanos , Lactente , Recém-Nascido , Gravidez , Nascimento Prematuro/etiologia , Cuidado Pré-Natal/métodos , Índice de Gravidade de Doença
18.
Am J Perinatol ; 37(8): 866-868, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32330970

RESUMO

Novel coronavirus disease 2019 (COVID-19) infection occurring during pregnancy is associated with an increased risk of preterm delivery. This case report describes successful treatment of preterm labor during acute COVID-19 infection. Standard treatment for preterm labor may allow patients with acute COVID-19 infection to recover without the need for preterm delivery. KEY POINTS: · Acute COVID-19 infection is associated with a high rate of preterm delivery.. · Standard treatment for preterm labor such as intravenous magnesium sulfate, antepartum steroid therapy and antibiotic prophylaxis for group B streptococcus infection were effective in this patient.. · In the absence of maternal or fetal compromise, acute COVID-19 infection is not an indication for early elective delivery..


Assuntos
Infecções por Coronavirus , Glucocorticoides/administração & dosagem , Sulfato de Magnésio/administração & dosagem , Pandemias , Pneumonia Viral , Complicações Infecciosas na Gravidez , Nascimento Prematuro , Antibioticoprofilaxia/métodos , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Feminino , Humanos , Recém-Nascido , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Gravidez , Complicações Infecciosas na Gravidez/fisiopatologia , Complicações Infecciosas na Gravidez/terapia , Complicações Infecciosas na Gravidez/virologia , Resultado da Gravidez , Nascimento Prematuro/etiologia , Nascimento Prematuro/prevenção & controle , Infecções Estreptocócicas/prevenção & controle , Tocolíticos/administração & dosagem
19.
Arch Gynecol Obstet ; 301(5): 1207-1212, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32274636

RESUMO

PURPOSE: To characterize the population of women who underwent mid-trimester preterm premature rupture of membrane (PPROM) in a country where mid-trimester abortions are legal and available. METHODS: A retrospective cross-sectional cohort study was conducted at a tertiary referral hospital, during 2013-2016. Mid-trimester defined as gestational age 13 + 0 to 23 + 6 weeks. Rupture of membrane was defined by documentation of fluid passing through the cervix on sterile speculum examination, and a positive Nitrazine (Bristol-Myers Squibb, Princeton, NJ) or erning test. All records were evaluated for medical history, laboratory data, postnatal examination, and autopsy findings, and a database was constructed. RESULTS: A total of 61 women were hospitalized for mid-trimester PPROM during the study period. Mean maternal age was 32 ± 5.98, range 20-45 years old. The majority (50, 82%) of patients decided to terminate their pregnancy before reaching the limit of viability at 24 weeks gestation. The overall prognosis of pregnancies reaching term was better than expected, with six (9.8%) patients delivering live babies and four of them born at term (36 ± 5 to 40 ± 6 weeks gestation), all after PPROM following amniocentesis or selective fetal reduction. A total of 60% of women with hypothyroidism had unbalanced TSH levels above 4.0 mIU/L prior to their pregnancy. A notable number of women (15, 24.6%) had PPROM following a pregnancy achieved by assisted reproductive technology (ART). CONCLUSIONS: Most women with diagnosed mid-trimester PPROM opted for pregnancy termination before the limit of viability when granted the choice. Possible risk factors for early PPROM are unbalanced hypothyroidism and ART. PPROM following amniocentesis can in some cases reseal and reach term, suggesting conservative treatment is a reasonable management for those cases.


Assuntos
Feto Abortado , Ruptura Prematura de Membranas Fetais/mortalidade , Resultado da Gravidez/epidemiologia , Nascimento Prematuro/mortalidade , Adulto , Amniocentese , Estudos Transversais , Feminino , Ruptura Prematura de Membranas Fetais/etiologia , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Nascimento Vivo/epidemiologia , Idade Materna , Pessoa de Meia-Idade , Complicações do Trabalho de Parto/etiologia , Mortalidade Perinatal , Gravidez , Segundo Trimestre da Gravidez , Nascimento Prematuro/etiologia , Estudos Retrospectivos , Fatores de Risco , Natimorto/epidemiologia , Adulto Jovem
20.
Arch Gynecol Obstet ; 301(5): 1189-1198, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32274638

RESUMO

PURPOSE: This cross-sectional case-control study of post-partum women aimed to estimate whether maternal periodontitis was a predictive contributor to preterm birth and to identify other risk factors associated with preterm birth in our target population. METHODS: The case group included women who delivered preterm (74 cases) and the control group included women who had a normal term delivery (120 controls). Medical records, a 16-item questionnaire, and a full-mouth periodontal examination were used to collect information about socio-demographic characteristics, general health problems, birth-related information, behavioral factors and periodontal status. Logistic regression analysis was used to estimate the strength of the relationship between predictors and the categorical outcome variable, preterm birth. RESULTS: The bivariate analysis revealed the significant associations between preterm birth and socio-demographic factors (educational level, p = 0.003), antepartum smoking habit (p = 0.001) and birth weight lower than 2500 g (p < 0.001). The multivariate analysis highlighted that the presence of post-partum maternal periodontitis and its severity remained independent risk factors of preterm birth in the presence of antepartum smoking habit and route of delivery [adjusted OR 2.26, 95% CI (1.06; 4.82), respectively, OR 3.46, 95% CI (1.08; 11.15)]. CONCLUSION: Post-partum maternal periodontal disease and its severity might, in part, be considered as contributor to preterm deliveries before 37 weeks of gestation.


Assuntos
Retardo do Crescimento Fetal/etiologia , Periodontite/complicações , Complicações Infecciosas na Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Fumar/efeitos adversos , Adulto , Peso ao Nascer , Estudos de Casos e Controles , Estudos Transversais , Feminino , Hospitais , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Índice Periodontal , Periodontite/epidemiologia , Período Pós-Parto , Gravidez , Complicações Infecciosas na Gravidez/microbiologia , Resultado da Gravidez , Nascimento Prematuro/etiologia , Fatores de Risco , Romênia/epidemiologia , Poluição por Fumaça de Tabaco/efeitos adversos
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