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1.
Z Geburtshilfe Neonatol ; 223(5): 304-316, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31623006

RESUMO

AIMS: This is an official guideline of the German Society for Gynecology and Obstetrics (DGGG), the Austrian Society for Gynecology and Obstetrics (ÖGGG) and the Swiss Society for Gynecology and Obstetrics (SGGG). The aim of this guideline is to improve the prediction, prevention and management of preterm birth based on evidence obtained from recent scientific literature, the experience of the members of the guideline commission and the views of self-help groups. METHODS: Based on the international literature, the members of the participating medical societies and organizations developed Recommendations and Statements. These were adopted following a formal process (structured consensus conference with neutral moderation, voting was done in writing using the Delphi method to achieve consensus). RECOMMENDATIONS: Part I of this short version of the guideline lists Statements and Recommendations on the epidemiology, etiology, prediction and primary and secondary prevention of preterm birth.


Assuntos
Guias de Prática Clínica como Assunto , Nascimento Prematuro , Áustria , Feminino , Humanos , Recém-Nascido , Gravidez , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etiologia , Nascimento Prematuro/prevenção & controle , Prevenção Primária , Sistema de Registros , Prevenção Secundária , Sociedades Médicas
2.
BJOG ; 126(12): 1448-1454, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31386246

RESUMO

OBJECTIVE: To examine the association between maternal alcohol consumption during pregnancy and the risk of preterm delivery. DESIGN: Prospective cohort study. SETTING: The Japan Environment and Children's Study (JECS). POPULATION: A total of 94 349 singleton pregnancies. METHODS: Participants completed questionnaires detailing alcohol consumption during the first trimester and during the second and third trimesters. Participants were divided into four categories according to alcohol consumption (non-drinkers, consumers of 1-149 g, 150-299 g and ≥300 g ethanol/week). We examined the effect of alcohol consumption during different stages of pregnancy on the risk of preterm delivery. Odds ratios (OR) and 95% CI were calculated relative to non-drinkers using logistic regression. MAIN OUTCOME MEASURES: Medical record-based preterm delivery. RESULTS: Alcohol consumption during the second and third trimesters, but not during the first trimester, was associated with increased risk of preterm delivery. Heavy alcohol consumption (≥300 g ethanol/week) during the second and third trimesters was associated with a four-fold higher risk compared with non-drinkers (multivariable OR 4.52; 95% CI 1.68-12.2). Light alcohol consumption (1-149 g ethanol/week) tended to be associated with lower risk of preterm delivery (multivariable OR 0.78; 95% CI 0.60-1.00). CONCLUSIONS: Heavy alcohol consumption during the second and third trimesters was associated with increased risk of preterm delivery among pregnant women. TWEETABLE ABSTRACT: Heavy drinking during pregnancy may increase the risk of preterm delivery.


Assuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Nascimento Prematuro/epidemiologia , Adulto , Estudos de Coortes , Feminino , Humanos , Japão/epidemiologia , Serviços de Saúde Materno-Infantil , Gravidez , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Nascimento Prematuro/etiologia , Estudos Prospectivos , Fatores de Risco , Inquéritos e Questionários
3.
JAMA ; 322(7): 632-641, 2019 08 20.
Artigo em Inglês | MEDLINE | ID: mdl-31429897

RESUMO

Importance: Maternal hypothyroidism and hyperthyroidism are risk factors for preterm birth. Milder thyroid function test abnormalities and thyroid autoimmunity are more prevalent, but it remains controversial if these are associated with preterm birth. Objective: To study if maternal thyroid function test abnormalities and thyroid autoimmunity are risk factors for preterm birth. Data Sources and Study Selection: Studies were identified through a search of the Ovid MEDLINE, EMBASE, Web of Science, the Cochrane Central Register of Controlled Trials, and Google Scholar databases from inception to March 18, 2018, and by publishing open invitations in relevant journals. Data sets from published and unpublished prospective cohort studies with data on thyroid function tests (thyrotropin [often referred to as thyroid-stimulating hormone or TSH] and free thyroxine [FT4] concentrations) or thyroid peroxidase (TPO) antibody measurements and gestational age at birth were screened for eligibility by 2 independent reviewers. Studies in which participants received treatment based on abnormal thyroid function tests were excluded. Data Extraction and Synthesis: The primary authors provided individual participant data that were analyzed using mixed-effects models. Main Outcomes and Measures: The primary outcome was preterm birth (<37 weeks' gestational age). Results: From 2526 published reports, 35 cohorts were invited to participate. After the addition of 5 unpublished data sets, a total of 19 cohorts were included. The study population included 47 045 pregnant women (mean age, 29 years; median gestational age at blood sampling, 12.9 weeks), of whom 1234 (3.1%) had subclinical hypothyroidism (increased thyrotropin concentration with normal FT4 concentration), 904 (2.2%) had isolated hypothyroxinemia (decreased FT4 concentration with normal thyrotropin concentration), and 3043 (7.5%) were TPO antibody positive; 2357 (5.0%) had a preterm birth. The risk of preterm birth was higher for women with subclinical hypothyroidism than euthyroid women (6.1% vs 5.0%, respectively; absolute risk difference, 1.4% [95% CI, 0%-3.2%]; odds ratio [OR], 1.29 [95% CI, 1.01-1.64]). Among women with isolated hypothyroxinemia, the risk of preterm birth was 7.1% vs 5.0% in euthyroid women (absolute risk difference, 2.3% [95% CI, 0.6%-4.5%]; OR, 1.46 [95% CI, 1.12-1.90]). In continuous analyses, each 1-SD higher maternal thyrotropin concentration was associated with a higher risk of preterm birth (absolute risk difference, 0.2% [95% CI, 0%-0.4%] per 1 SD; OR, 1.04 [95% CI, 1.00-1.09] per 1 SD). Thyroid peroxidase antibody-positive women had a higher risk of preterm birth vs TPO antibody-negative women (6.6% vs 4.9%, respectively; absolute risk difference, 1.6% [95% CI, 0.7%-2.8%]; OR, 1.33 [95% CI, 1.15-1.56]). Conclusions and Relevance: Among pregnant women without overt thyroid disease, subclinical hypothyroidism, isolated hypothyroxinemia, and TPO antibody positivity were significantly associated with higher risk of preterm birth. These results provide insights toward optimizing clinical decision-making strategies that should consider the potential harms and benefits of screening programs and levothyroxine treatment during pregnancy.


Assuntos
Doenças Autoimunes/diagnóstico , Iodeto Peroxidase/imunologia , Complicações na Gravidez/diagnóstico , Nascimento Prematuro/etiologia , Doenças da Glândula Tireoide/diagnóstico , Testes de Função Tireóidea , Adulto , Autoanticorpos/sangue , Doenças Autoimunes/sangue , Doenças Autoimunes/complicações , Feminino , Idade Gestacional , Humanos , Hipotireoidismo/complicações , Hipotireoidismo/diagnóstico , Recém-Nascido , Gravidez , Complicações na Gravidez/sangue , Doenças da Glândula Tireoide/sangue , Doenças da Glândula Tireoide/complicações , Tireotropina/sangue , Tiroxina/sangue
4.
BMC Public Health ; 19(1): 705, 2019 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-31174511

RESUMO

BACKGROUND: Air pollution is becoming an increased burden to the world. Previous studies have confirmed its effects on adverse birth outcomes, but few associated with premature small for gestational age (SGA). We report a retrospective cohort study conducted in Changzhou city to evaluate the association between air pollutants (PM2.5, SO2 and NO2) and premature SGA during pregnancy. METHODS: A total of 46,224 births were collected from January, 2013 to December, 2016, in Changzhou Maternity and Child Health Care Hospital, finally 2709 preterm births were admitted for study. Corresponding air monitoring data were collected from Changzhou Environmental Protection Agency. Generalized estimating equations were used to examine the association between these air pollutants and premature SGA controlling for individual covariates in single- and multi-pollutant models. RESULTS: We found that, in the third trimester, every 10 µg/m3 increments in PM2.5 concentration were associated with premature SGA (OR = 1.18, 95% CI: 1.03-2.83; OR = 1.37, 95% CI: 1.03-3.58) in two- and three-pollutants models. In the whole gestation, a 10 µg/m3 increment in PM2.5 concentration in two- and three-pollutant models were related to premature SGA (OR = 1.53, 95% CI: 1.38-2.47; OR = 1.73, 95% CI: 1.18-2.57). The OR (95% CI) of premature SGA were increasing across quintiles of PM2.5, SO2, NO2 concentrations during the whole gestation period adjusting for confounders (P for trend < 0.001). CONCLUSIONS: These results indicated that pregnant women exposed to PM2.5, combined with other pollutants in the third trimester have a higher risk to deliver premature SGA babies, providing further evidence linking PM2.5 and pregnancy outcomes.


Assuntos
Poluição do Ar/efeitos adversos , Exposição Ambiental/efeitos adversos , Recém-Nascido Pequeno para a Idade Gestacional , Exposição Materna/efeitos adversos , Nascimento Prematuro/epidemiologia , Adulto , Poluentes Atmosféricos/análise , China/epidemiologia , Feminino , Humanos , Recém-Nascido , Material Particulado/análise , Gravidez , Resultado da Gravidez , Nascimento Prematuro/etiologia , Estudos Retrospectivos
5.
Malar J ; 18(1): 161, 2019 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-31060615

RESUMO

BACKGROUND: Iron supplementation before a first pregnancy may improve the future health of mother and baby by reducing maternal anaemia. Iron supplementation could, however, increase malaria infections, notably in primigravidae who are most susceptible. The pathogenicity of other iron-utilizing pathogens could also increase, causing inflammation leading to increased risk of adverse birth outcomes. This paper reports pre-specified secondary birth outcomes from a safety trial in Burkina Faso in an area of high malaria endemicity. Primary outcomes from that trial had investigated effects of long-term weekly iron supplementation on malaria and genital tract infections in non-pregnant and pregnant women. METHODS: A double-blind, randomized controlled trial. Nulliparous, mainly adolescent women, were individually randomized periconceptionally to receive weekly either 60 mg elemental iron and 2.8 mg folic acid, or 2.8 mg folic acid alone, continuing up to the first antenatal visit for those becoming pregnant. Secondary outcomes were ultrasound-dated gestational age, fetal growth, placental malaria, chorioamnionitis and iron biomarkers. Seasonal effects were assessed. Analysis was by intention to treat. RESULTS: 478 pregnancies occurred to 1959 women: 258/980 women assigned iron and folic acid and 220/979 women assigned folic acid alone. Malaria prevalence at the first antenatal visit was 53% (iron) and 55% (controls). Mean birthweight was 111 g lower in the iron group (95% CI 9:213 g, P = 0.033). Mean gestational ages were 264 days (iron) and 269 days (controls) (P = 0.012), with 27.5% under 37 weeks compared to 13.9% in controls (adjRR = 2.22; 95% CI 1.39-3.61) P < 0.001). One-third of babies were growth restricted, but incidence did not differ by trial arm. Half of placentae had evidence of past malaria infection. C-reactive protein > 5 mg/l was more common prior to births < 37 weeks (adjRR = 2.06, 95% CI 1.04-4.10, P = 0.034). Preterm birth incidence during the rainy season was ~ 50% in the iron arm and < 20% in controls (P = 0.001). Chorioamnionitis prevalence peaked in the dry season (P = 0.046), with no difference by trial arm (P = 0.14). CONCLUSION: Long-term weekly iron supplementation given to nulliparous women in a malaria endemic area was associated with higher risk of preterm birth in their first pregnancy. Trial Registration NCT01210040. Registered with Clinicaltrials.gov on 27th September 2010.


Assuntos
Suplementos Nutricionais/efeitos adversos , Ferro/administração & dosagem , Malária/epidemiologia , Fenômenos Fisiológicos da Nutrição Materna , Nascimento Prematuro/etiologia , Adolescente , Peso ao Nascer/efeitos dos fármacos , Burkina Faso/epidemiologia , Método Duplo-Cego , Doenças Endêmicas , Feminino , Ácido Fólico/administração & dosagem , Idade Gestacional , Humanos , Recém-Nascido , Ferro/efeitos adversos , Malária/complicações , Micronutrientes/administração & dosagem , Micronutrientes/efeitos adversos , Gravidez , Nascimento Prematuro/epidemiologia , Prevalência , Fatores de Risco , Adulto Jovem
6.
Medicine (Baltimore) ; 98(20): e15733, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31096533

RESUMO

BACKGROUND: Antiphospholipid syndrome (APS) is a rare heterogenous autoimmune disorder with severe life-threatening complications shown during pregnancy. In this analysis, we aimed to systematically compare the pregnancy outcomes (both maternal and fetal) in patients with APS. METHODS: Web of Science, Google Scholar, Medicus, Cochrane Central, Embase, and Medline were searched for relevant English publications. The main inclusion criteria were based on studies that compared pregnancy outcomes in patients with APS vs a control group. Statistical analysis was carried out by the RevMan software version 5.3. This analysis involved dichotomous data, and risk ratios (RR) with 95% confidence intervals (CIs) were used to represent the analysis. RESULTS: Eight studies consisting of a total number of 212,954 participants were included. Seven hundred seventy participants were pregnant women with APS and 212,184 participants were assigned to the control group. Pregnancy-induced hypertension was significantly higher in women with APS (RR: 1.81, 95% CI: 1.33 - 2.45; P = .0002). The risks of fetal loss (RR: 1.33, 95% CI: 1.00-1.76; P = .05), abortion (RR: 2.42, 95% CI: 1.46-4.01; P = .0006), thrombosis (RR: 2.83, 95% CI: 1.47-5.44; P = .002), and preterm delivery (RR: 1.89, 95% CI: 1.52-2.35; P = .00001) were also significantly higher in women with APS. However, placental abruption (RR: 1.35, 95% CI: 0.78-2.34; P = .29) and pulmonary embolism were not significantly different (RR: 1.47, 95% CI: 0.11-19.20; P = .77). The risk of neonatal mortality (RR: 3.95, 95% CI: 1.98-7.86; P = .0001), infants small for gestational age (RR: 1.38, 95% CI: 1.04-1.82; P = .02), premature infants (RR: 1.86, 95% CI: 1.52-2.28; P = .0001), and infants who were admitted to neonatal intensive care unit (RR: 3.35, 95% CI: 2.29-4.89; P = .00001) were also significantly higher in women with APS. CONCLUSION: This analysis showed APS to be associated with significantly worse pregnancy outcomes when compared to the control group. A significantly higher risk of maternal and fetal complications was observed in this category of patients. Therefore, intense care should be given to pregnant women with APS to monitor unwanted outcomes and allow a successful pregnancy.


Assuntos
Síndrome Antifosfolipídica/complicações , Complicações na Gravidez/epidemiologia , Aborto Espontâneo/epidemiologia , Aborto Espontâneo/etiologia , Síndrome Antifosfolipídica/epidemiologia , Estudos de Casos e Controles , Feminino , Humanos , Hipertensão Induzida pela Gravidez/epidemiologia , Hipertensão Induzida pela Gravidez/etiologia , Lactente , Mortalidade Infantil , Recém-Nascido Prematuro , Recém-Nascido Pequeno para a Idade Gestacional , Gravidez , Complicações na Gravidez/classificação , Resultado da Gravidez , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etiologia
7.
BMC Infect Dis ; 19(1): 422, 2019 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-31092224

RESUMO

BACKGROUND: Cholera increases the risk of harmful effects on foetuses. We prospectively followed pregnant women unaware of their pregnancy status who received a study agent in a clinical trial evaluating the association between exposure to an oral cholera vaccine (OCV) and foetal survival. METHODS: Study participants were selected from a randomized placebo-controlled trial conducted in Dhaka, Bangladesh. The vaccination campaign was conducted between January 10 and February 4, 2014. We enrolled women who were exposed to an OCV or placebo during pregnancy (Cohort 1) and women who were pregnant after the vaccination was completed (Cohort 2). Our primary endpoint was pregnancy loss (spontaneous miscarriage or stillbirth), and the secondary endpoints were preterm delivery and low birth weight. We employed a log-binomial regression to calculate the relative risk of having adverse outcomes among OCV recipients compared to that among placebo recipients. RESULT: There were 231 OCV and 234 placebo recipients in Cohort 1 and 277 OCV and 299 placebo recipients in Cohort 2. In Cohort 1, the incidence of pregnancy loss was 113/1000 and 115/1000 among OCV and placebo recipients, respectively. The adjusted relative risk for pregnancy loss was 0.97 (95% CI: 0.58-1.61; p = 0.91) in Cohort 1. We did not observe any variation in the risk of pregnancy loss between the two cohorts. The risks for preterm delivery and low birth weight were not significantly different between the groups in both cohorts. CONCLUSIONS: Our study provides additional evidence that exposure to an OCV during pregnancy does not increase the risk of pregnancy loss, preterm delivery, or low birth weight, suggesting that pregnant women in cholera-affected regions should not be excluded in a mass vaccination campaign. TRIAL REGISTRATION: The study is registered at ( http://clinicaltrials.gov ). Identifier: NCT02027207 .


Assuntos
Aborto Espontâneo/etiologia , Vacinas contra Cólera/efeitos adversos , Cólera/diagnóstico , Nascimento Prematuro/etiologia , Administração Oral , Adolescente , Adulto , Bangladesh/epidemiologia , Cólera/epidemiologia , Cólera/prevenção & controle , Vacinas contra Cólera/imunologia , Estudos de Coortes , Feminino , Humanos , Incidência , Vacinação em Massa , Pessoa de Meia-Idade , Efeito Placebo , Gravidez , Gestantes , Cuidado Pré-Natal , Risco , Adulto Jovem
8.
Int J Gynaecol Obstet ; 146(1): 110-117, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31055833

RESUMO

OBJECTIVE: To explore a conceptual framework of clinical conditions associated with preterm birth (PTB) by cluster analysis, assessing determinants for different PTB subtypes and related maternal and neonatal outcomes. METHODS: Secondary analysis of the Brazilian Multicentre Study on Preterm Birth of 33 740 births in 20 maternity hospitals between April 2011 and July 2012. In accordance with a prototype concept based on maternal, fetal, and placental conditions, an adapted k-means model and fuzzy algorithm were used to identify clusters using predefined conditions. The mains outcomes were phenotype clusters and maternal and neonatal outcomes. RESULTS: Among 4150 PTBs, three clusters of PTB phenotypes were identified: women who had PTB without any predefined conditions; women with mixed conditions; and women who had pre-eclampsia, eclampsia, HELLP syndrome and fetal growth restriction. The prevalence of different preterm subtypes differed significantly in the three clusters, varying from 80.95% of provider-initiated PTBs in cluster 3-6.62% in cluster 1 (P<0.001). Although some maternal characteristics differed among the clusters, maternal and neonatal outcomes did not. CONCLUSIONS: The analysis identified three clusters with distinct phenotypes. Women from the different clusters had different subtypes of PTB and maternal and pregnancy characteristics.


Assuntos
Resultado da Gravidez/epidemiologia , Nascimento Prematuro/etiologia , Adulto , Brasil/epidemiologia , Análise por Conglomerados , Feminino , Retardo do Crescimento Fetal/epidemiologia , Lógica Fuzzy , Humanos , Recém-Nascido , Fenótipo , Pré-Eclâmpsia/epidemiologia , Gravidez , Nascimento Prematuro/epidemiologia , Prevalência , Fatores de Risco
9.
Expert Opin Pharmacother ; 20(11): 1365-1376, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31090482

RESUMO

INTRODUCTION: Women with schizophrenia and their babies are at high risk of adverse outcomes in pregnancy and childbirth. A better understanding of the specific risks conferred by the illness itself and by the treatment provided will help guide more effective care of these women. AREAS COVERED: Herein, the authors review genetic, demographic, socioeconomic, nutritional and lifestyle risks associated with schizophrenia in pregnancy. They also cover specific risks associated with typical antipsychotic medications, specific risks associated with atypical antipsychotic medications, risks associated with polypharmacy and risks of developmental delay in children exposed to antipsychotic medications in utero. EXPERT OPINION: Our understanding of the risks that women with schizophrenia face in pregnancy from their illness and from the treatment they receive continues to evolve. As our ability to analyze data progresses, the risks conferred by antipsychotic medication treatment appear to lessen in clinical and statistical significance, whilst the true risks to these women and their babies from their experience of disadvantage continue to set them aside from the general population. Reducing polypharmacy and providing comprehensive and supportive care can minimize harm to women with schizophrenia and their babies.


Assuntos
Antipsicóticos/uso terapêutico , Esquizofrenia/tratamento farmacológico , Antipsicóticos/efeitos adversos , Feminino , Humanos , Obesidade/etiologia , Gravidez , Complicações na Gravidez/tratamento farmacológico , Nascimento Prematuro/etiologia , Fatores de Risco , Esquizofrenia/patologia , Fatores Socioeconômicos
10.
Nat Med ; 25(6): 1012-1021, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31142849

RESUMO

The incidence of preterm birth exceeds 10% worldwide. There are significant disparities in the frequency of preterm birth among populations within countries, and women of African ancestry disproportionately bear the burden of risk in the United States. In the present study, we report a community resource that includes 'omics' data from approximately 12,000 samples as part of the integrative Human Microbiome Project. Longitudinal analyses of 16S ribosomal RNA, metagenomic, metatranscriptomic and cytokine profiles from 45 preterm and 90 term birth controls identified harbingers of preterm birth in this cohort of women predominantly of African ancestry. Women who delivered preterm exhibited significantly lower vaginal levels of Lactobacillus crispatus and higher levels of BVAB1, Sneathia amnii, TM7-H1, a group of Prevotella species and nine additional taxa. The first representative genomes of BVAB1 and TM7-H1 are described. Preterm-birth-associated taxa were correlated with proinflammatory cytokines in vaginal fluid. These findings highlight new opportunities for assessment of the risk of preterm birth.


Assuntos
Microbiota , Nascimento Prematuro/microbiologia , Vagina/microbiologia , Adulto , Afro-Americanos , Biodiversidade , Estudos de Coortes , Citocinas/metabolismo , Feminino , Interações entre Hospedeiro e Microrganismos/imunologia , Humanos , Recém-Nascido , Mediadores da Inflamação/metabolismo , Estudos Longitudinais , Metagenômica , Microbiota/genética , Microbiota/imunologia , Nascimento Prematuro/etiologia , Nascimento Prematuro/imunologia , Fatores de Risco , Estados Unidos , Vagina/imunologia , Adulto Jovem
11.
Reprod Health ; 16(1): 43, 2019 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-30992027

RESUMO

BACKGROUND: Reducing the incidence of preterm birth is a national priority. Maternal cigarette smoking is strongly and consistently associated with preterm birth. The objective of this study was to examine prenatal exposure based on combined measures of timing (by trimester) and intensity level (the number of cigarettes smoked per day) of maternal smoking to identify a pregnancy period with the highest risk of preterm birth. METHODS: A sample of 2,485,743 singleton births was drawn from the 2010 National Center of Health Statistics (NCHS) linked birth/infant death file of US residents in 33 states that implemented the revised 2003 birth certificate. Nine mutually exclusive smoking status categories were created to assess prenatal exposure across pregnancy in association with preterm birth. Gestational age was based on the obstetric estimate. Multiple logistic regression analyses were conducted to compare the odds of preterm birth among women who smoked at different intensity levels in the second or third trimester with those who smoked only in the first trimester. RESULTS: Overall, 7.95% of women had a preterm birth; 8.90% of low intensity (less than a pack/day) smokers in the first trimester only, 12.99% of low and 15.38% of high intensity (pack a day or more) smokers in the first two trimesters, and 10.56% of low and 11.35% of high intensity smokers in all three trimesters delivered preterm. First and second trimester high (aOR 1.85, 95% CI: 1.66, 2.06) and low intensity smokers (aOR 1.51, 95% CI: 1.41, 1.61) had higher odds of preterm birth compared to those who smoked less than a pack a day only in the first trimester, but the odds did not increase for all three trimester smokers relative to the first and second trimester smokers. In sensitivity analysis, adjustment for exposure misclassification error corrected data and testing for effect modification by maternal race/ethnicity found no significant interaction. CONCLUSIONS: This study documented a biologically plausible vulnerability window for smoking exposure and the increased risk of preterm birth. For women who do not modify their smoking behavior preconception, preterm birth risk of smoking remains low until late in the first trimester.


Assuntos
Nascimento Prematuro/etiologia , Efeitos Tardios da Exposição Pré-Natal , Fumar/efeitos adversos , Adulto , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Gravidez , Trimestres da Gravidez , Nascimento Prematuro/epidemiologia , Fatores de Risco , Fatores de Tempo
12.
Life Sci ; 228: 215-220, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31002916

RESUMO

AIMS: Small-for-gestational-age (SGA) fetus is an important public health issue because of its high mortality and long-term effects on health. Maternal hyperuricemia is associated with diverse adverse pregnant outcomes and neonatal disturbance. We aimed to evaluate whether maternal hyper-uric acid (HUA) is associated with the risk of SGA fetus and to explore whether it can modify the association between maternal hyper-blood pressure (HBP) and SGA fetus. MATERIALS AND METHODS: We performed a population-based cross-section retrospective study, a total of 6715 pregnant females were recruited. Multiple logistic regression analysis was performed to identify risk factors significantly correlated with SGA fetus, and then studied the effect of maternal HUA on the association between maternal HBP and SGA fetus. KEY FINDINGS: We collected 537 SGA fetuses among 6715 pregnant females. Maternal HUA was an independent risk factor for SGA delivery (odds ratio (OR), 2.737; 95% confidence interval (CI), 2.110-3.551). A dose-response association between maternal uric acid and SGA delivery was found among normotensive and hypertensive group. Compared with those whose uric acid was lower than 270 µmo/L with normal-blood pressure (NBP), the risk for SGA delivery in those whose uric acid was higher than 370 µmo/L with stage 2 or 3 hypertension increased 12.695-fold. SIGNIFICANCE: Our results suggest that maternal HUA could increase the risk of neonatal SGA, and maternal HUA could be superimposed upon pre-existing maternal HBP and increase the risk for SGA fetus.


Assuntos
Hipertensão/complicações , Hiperuricemia/complicações , Recém-Nascido Pequeno para a Idade Gestacional , Complicações na Gravidez/etiologia , Nascimento Prematuro/etiologia , Adulto , Pressão Sanguínea , Feminino , Humanos , Recém-Nascido , Masculino , Gravidez , Resultado da Gravidez , Estudos Retrospectivos , Fatores de Risco
13.
J Pregnancy ; 2019: 3849596, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30941218

RESUMO

In 1990, Institute of Medicine (IOM) recommended gestational weight gain (GWG) ranges for women in the United States primarily to improve infant birth weight. Changes in key aspects of reproductive health of women of child bearing age, a rising prevalence of obesity, and noncommunicable diseases prompted the revision of IOM guidelines in 2009. However, there is no such recommendation available for Asian women. This systematic review assesses the utility of IOM-2009 guidelines among Indian and other Asian pregnant women in terms of maternal and fetal outcomes. 624 citations were identified using PubMed and Google Scholar, out of which 13 were included. Prospective/retrospective studies of healthy Asian women with a singleton pregnancy which specifically examined fetal-maternal outcomes relative to IOM-2009 guidelines were included. Results. Majority of pregnant Indian women achieved less GWG than the recommendations whereas a mixed trend was noticed among the other Asian pregnant women. The most common fetal-maternal complications among the excessive GWG women were found to be macrosomia, large for gestational age and caesarean section followed by gestational diabetes and hypertension, whereas low birth weight, small for gestational age and preterm birth, was found to be associated with low GWG women. The findings highlight the need for appropriate GWG limits across the different body mass index levels specifically for Indians and other Asian population. However, there are not enough publications regarding the utility of IOM-2009 guidelines among the Indian and other Asian women. Thus, higher-quality researches are warranted in future to further validate the findings of the present review.


Assuntos
Ganho de Peso na Gestação , Guias de Prática Clínica como Assunto , Adolescente , Adulto , Grupo com Ancestrais do Continente Asiático , Índice de Massa Corporal , Cesárea , Bases de Dados Bibliográficas , Diabetes Gestacional/etiologia , Diabetes Gestacional/prevenção & controle , Feminino , Macrossomia Fetal/etiologia , Macrossomia Fetal/prevenção & controle , Idade Gestacional , Humanos , Hipertensão Induzida pela Gravidez/etiologia , Hipertensão Induzida pela Gravidez/prevenção & controle , Recém-Nascido de Baixo Peso , Gravidez , Nascimento Prematuro/etiologia , Nascimento Prematuro/prevenção & controle , Adulto Jovem
14.
BMC Pregnancy Childbirth ; 19(1): 110, 2019 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-30940112

RESUMO

BACKGROUND: Aboriginal infants have poorer birth outcomes than non-Aboriginal infants. Harmful use of tobacco, alcohol, and other substances is higher among Aboriginal women, as is violence, due to factors such as intergenerational trauma and poverty. We estimated the proportion of small for gestational age (SGA) births, preterm births, and perinatal deaths that could be attributed to these risks. METHODS: Birth, hospital, mental health, and death records for Aboriginal singleton infants born in Western Australia from 1998 to 2010 and their parents were linked. Using logistic regression with a generalized estimating equation approach, associations with birth outcomes and population attributable fractions were estimated after adjusting for demographic factors and maternal health during pregnancy. RESULTS: Of 28,119 births, 16% of infants were SGA, 13% were preterm, and 2% died perinatally. 51% of infants were exposed in utero to at least one of the risk factors and the fractions attributable to them were 37% (SGA), 16% (preterm) and 20% (perinatal death). CONCLUSIONS: A large proportion of adverse outcomes were attributable to the modifiable risk factors of substance use and assault. Significant improvements in Aboriginal perinatal health are likely to follow reductions in these risk factors. These results highlight the importance of identifying and implementing risk reduction measures which are effective in, and supported by, Aboriginal women, families, and communities.


Assuntos
Violência Doméstica/estatística & dados numéricos , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Complicações na Gravidez/etiologia , Fumar/efeitos adversos , Transtornos Relacionados ao Uso de Substâncias/complicações , Adulto , Feminino , Humanos , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Modelos Logísticos , Morte Perinatal/etiologia , Gravidez , Complicações na Gravidez/epidemiologia , Resultado da Gravidez , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etiologia , Fatores de Risco , Austrália Ocidental/epidemiologia
15.
BMC Pregnancy Childbirth ; 19(1): 119, 2019 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-30953457

RESUMO

BACKGROUND: Maternal prepregnancy body mass index (BMI) is associated with several infant outcomes, but it is unclear whether these associations reflect causal relationships. We conducted a study of interpregnancy change in BMI (IPC-BMI) to improve understanding of the associations between BMI and large for gestational age (LGA), small for gestational age (SGA), and preterm birth (PTB). METHODS: Birth certificate data from 2481 linked sibling pairs (Texas, 2005-2012) were used to estimate IPC-BMI and evaluate its association with LGA, SGA, and PTB in the younger sibling of the pair. Multivariable logistic regression was used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) using data from the full sample and within strata defined by prepregnancy BMI for the older sibling. RESULTS: On average, women gained 1.1 BMI units between pregnancies. In the full sample, interpregnancy BMI decreases were associated with reduced odds of LGA and increased odds of SGA and PTB (IPC-BMI < -1 versus 0 to < 1: LGA aOR 0.7, 95% CI 0.4, 1.1; SGA aOR 1.6, 95% CI 1.0, 2.7; PTB aOR 1.9, 95% CI 1.3, 2.8). In stratified analyses, similar associations were observed in some, but not all, strata. Findings for interpregnancy BMI increases were less consistent, with little evidence for associations between these outcomes and the most extreme IPC-BMI increases. CONCLUSIONS: There is growing evidence that interpregnancy BMI decreases are associated with LGA, SGA, and PTB. However, taken as a whole, the literature provides insufficient evidence to establish causal links between maternal BMI and these outcomes.


Assuntos
Intervalo entre Nascimentos/estatística & dados numéricos , Peso ao Nascer , Índice de Massa Corporal , Complicações na Gravidez/etiologia , Ganho de Peso , Adulto , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Modelos Logísticos , Análise Multivariada , Obesidade/complicações , Razão de Chances , Gravidez , Nascimento Prematuro/etiologia , Fatores de Risco , Texas
16.
Fertil Steril ; 111(6): 1145-1150, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30955846

RESUMO

OBJECTIVE: To describe the relationship between interpregnancy interval (IPI) and perinatal outcomes in singleton live births after frozen embryo transfer (FET). DESIGN: Retrospective analysis of the Society for Assisted Reproductive Technology Clinical Outcome Reporting System cohort including patients with a history of live birth from ART who returned for an FET cycle between 2004 and 2013. SETTING: Not applicable. PATIENT(S): A total of 19,270 singleton live births from FET subsequent to a live birth. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Odds for preterm delivery (<37, <34, <28 weeks) and low birth weight (<2,500, <1,500 g) adjusted for age, body mass index, and history of prior preterm delivery. RESULT(S): Of 74,456 autologous FET cycles following an index live birth, 24,091 resulted in a repeat live birth, with 19,270 singleton live births. An IPI of <12 months occurred in 19% of cycles. Adjusted odds (aORs) for preterm delivery at <37 weeks were significantly increased for an IPI of <6 months (aOR 2.05, 95% confidence interval [CI] 1.48-2.84), 6 to <12 months (aOR 1.26, 95% CI 1.06-1.49), and 18 to <24 months (aOR 1.23, 95% CI 1.06-1.43) when compared with the reference interval of 12 to <18 months. Additionally, an IPI of <6 months was associated with increased odds for low birth weight (aOR 3.06, 95% CI 2.07-4.52) and very low birth weight (aOR 5.65, 95% CI 2.96-10.84) compared with an IPI of 12 to <18 months. CONCLUSION(S): In this nationally representative population, an interval from delivery to start of an FET cycle of <12 months is associated with increased odds for preterm delivery among singleton live births. Consistent with data for patients undergoing fresh IVF, the data support delaying FET 12 months from a live birth.


Assuntos
Criopreservação , Transferência Embrionária , Fertilização In Vitro , Infertilidade/terapia , Tempo para o Tratamento , Adulto , Peso ao Nascer , Bases de Dados Factuais , Transferência Embrionária/efeitos adversos , Feminino , Fertilidade , Fertilização In Vitro/efeitos adversos , Idade Gestacional , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Infertilidade/diagnóstico , Infertilidade/fisiopatologia , Nascimento Vivo , Paridade , Gravidez , Taxa de Gravidez , Nascimento Prematuro/etiologia , Nascimento Prematuro/fisiopatologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Tempo para Engravidar , Resultado do Tratamento
17.
BMC Pregnancy Childbirth ; 19(1): 128, 2019 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-30987614

RESUMO

BACKGROUND: There are controversies over the effects of Ramadan fasting on pregnancy outcomes, and women's perspectives of fasting are diverse. This study aimed to assess the perspectives and pregnancy outcomes of maternal Ramadan fasting in the second trimester of pregnancy. METHODS: A case-control study was conducted at Hawler Maternity Teaching Hospital of Erbil, Iraq from October 2017 to January 2018. Out of 301 participating women, 155 fasted during the second trimester of their current pregnancy, while the remaining 146 did not. Mothers were asked concerning their fasting behaviors and perception of fasting during pregnancy. The main outcomes of this study were gestational diabetes, preterm labour, preeclampsia, low birth weight, Apgar score, height, weight, and head circumference of the newborn. RESULTS: About 80% of the women in the fasting group fasted for 21-29 days during Ramadan, out of whom 38.7% completed fasting for the entire Ramadan period. The results revealed that the decision to fast during pregnancy was negatively associated with the mother's educational level and occupation. Weight gain during pregnancy in the fasting women was approximately 0.4 kg less than those who did not fast. The incidence of gestational diabetes was 2.6% in the fasting women, while it was 8.3% in the non-fasting mothers (P = 0.02). Regression analysis showed that women who did not fast during the second trimester of pregnancy were 1.51 times more likely to develop gestational diabetes [odd ratio (OR) 1.51; 95% confidence intervals (CI) 0.06, 0.74, P = 0.01]. It was also found that among the women in the fasting categories, those who fasted for 21-29 days during pregnancy had a lower risk of gestational diabetes compared to the other groups. More than half of the mothers in the fasting group (60%) perceived that fasting during pregnancy was compulsory for healthy and non-healthy women, comparing with those who did not fast. CONCLUSION: It was found that fasting during the second trimester of the pregnancy decreased the risk of gestational diabetes and excessive weight gain during pregnancy. Most of Iraqi women did not fully recognize their right to be exempted from fasting during pregnancy by the Islamic law.


Assuntos
Diabetes Gestacional/etiologia , Jejum/psicologia , Islamismo/psicologia , Segundo Trimestre da Gravidez/psicologia , Nascimento Prematuro/etiologia , Adolescente , Adulto , Estudos de Casos e Controles , Jejum/efeitos adversos , Feminino , Ganho de Peso na Gestação , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Iraque , Gravidez , Resultado da Gravidez , Adulto Jovem
18.
Pregnancy Hypertens ; 15: 16-22, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30825914

RESUMO

OBJECTIVES: This study depicts the dose-response relationship between blood pressure (BP) during pregnancy and adverse birth outcomes in different trimesters. STUDY DESIGN: We used restricted cubic spline to quantify the dose-response relationship between maternal BP in different trimesters and risk of adverse birth outcomes (small for gestational age, SGA; and pre-term birth, PTB). The data were from the Ma'anshan birth cohort study in China (N = 3273). MAIN OUTCOME MEASURES: Risk of SGA and PTB. RESULTS: There were dose-response associations of both systolic blood pressure (SBP) and diastolic blood pressure (DBP) with risk of SGA in the third trimester and with PTB in both second and third trimesters. In the third trimester, compared with SBP of 120 mmHg, the odds ratios (ORs) and 95% confidence intervals (CI) of SGA were 1.12 (1.01-1.19), 1.32 (1.10-1.60), 1.65 (1.20-2.27) and 2.05 (1.30-3.24) for SBP of 125, 130, 135 and 140 mmHg, respectively. The corresponding ORs and 95% CIs of PTB were 1.15 (1.00-1.32), 1.59 (1.28-1.98), 2.35 (1.66-3.33) and 3.47 (2.10-5.73), respectively. Compared with DBP of 70 mmHg, the ORs and 95% CIs of SGA were 1.44 (1.16-1.78) and 3.04 (2.06-4.50) for DBP of 80 and 90 mmHg, respectively. The corresponding ORs and 95% CIs of PTB were 1.32 (0.93-1.90) and 3.58 (2.21-5.78), respectively. CONCLUSIONS: A consistent set of dose-response relationships between maternal BP and adverse birth outcomes were observed. Most importantly, we found that moderately elevated maternal BP, even within a normal range, increased the risk of adverse birth outcomes.


Assuntos
Pressão Sanguínea/fisiologia , Nascimento Prematuro/etiologia , Adulto , Determinação da Pressão Arterial/métodos , China , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Recém-Nascido Pequeno para a Idade Gestacional , Masculino , Gravidez , Trimestres da Gravidez , Estudos Prospectivos , Autorrelato , Adulto Jovem
19.
Medicine (Baltimore) ; 98(13): e15060, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30921237

RESUMO

The rate of preterm birth has been increasing worldwide. Most preterm babies are at increased risk of central nervous system impairments as well as respiratory and gastrointestinal complications. The aim of this study was to investigate the trends in preterm birth and associated factors contributing to preterm delivery in Taiwan. Information on obstetric antecedents and risk factors of preterm birth of pregnant women was obtained from the Taiwan National Medical Birth Register database. All live births from 2001 to 2011 in Taiwan were included in this study. A total of 2,334,532 live births from 2001 to 2011 were included in this study. Overall, the proportion of preterm deliveries increased by 11.1% (from 8.2% in 2001 to 9.1% in 2011). Multiple logistic regression analyses showed that nulliparity, multiple births, maternal medical complications, maternal age <20 years or ≥40 years, and medical indication for earlier delivery were positively associated with an increased risk of preterm delivery. Nulliparous women aged younger than 20 years and older than 40 years should be recognized as at-risk for preterm birth.


Assuntos
Parto Obstétrico/tendências , Nascimento Vivo/epidemiologia , Nascimento Prematuro/epidemiologia , Adulto , Feminino , Humanos , Recém-Nascido , Modelos Logísticos , Masculino , Idade Materna , Paridade , Gravidez , Nascimento Prematuro/etiologia , Sistema de Registros , Fatores de Risco , Taiwan/epidemiologia , Adulto Jovem
20.
Int J Gynaecol Obstet ; 145(2): 149-157, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30828808

RESUMO

BACKGROUND: Studies on the impact of adenomyosis and its pregnancy complications have yielded conflicting results. OBJECTIVE: To determine the likelihood of adverse pregnancy outcomes among women with adenomyosis relative to women without adenomyosis. SEARCH STRATEGY: PubMed, Embase, Scopus, and Web of Science were searched for studies published up to June 15, 2018. SELECTION CRITERIA: Observational studies with medically confirmed pregnancy outcomes as endpoints. DATA COLLECTION AND ANALYSIS: Two researchers independently screened and selected relevant studies. Dichotomous data for all adverse pregnancy outcomes were expressed as an odds ratio (OR) with 95% confidence interval (CI), and combined in a meta-analysis by using a random-effects model. MAIN RESULTS: Six studies (322 cases and 9420 controls) were eligible for inclusion in the meta-analysis. Women with adenomyosis had an increased likelihood of preterm birth (OR, 3.05; 95% CI, 2.08-4.47; P˂0.001), small for gestational age (OR, 3.22; 95% CI, 1.71-6.08; P˂0.001), and pre-eclampsia (OR, 4.35; 95% CI, 1.07-17.72; P=0.042). CONCLUSION: Adenomyosis seems to have a detrimental impact on pregnancy outcomes, resulting in a higher likelihood of preterm birth, small for gestational age, and pre-eclampsia.


Assuntos
Adenomiose/complicações , Pré-Eclâmpsia/etiologia , Complicações na Gravidez , Nascimento Prematuro/etiologia , Estudos de Casos e Controles , Feminino , Humanos , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Estudos Observacionais como Assunto , Gravidez , Resultado da Gravidez
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