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1.
PLoS One ; 15(1): e0227976, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31995596

RESUMO

Psychosocial stress during pregnancy has been associated with adverse pregnancy outcomes including preterm birth (PTB). This has not been studied in Puerto Rico, an area with high PTB rates. Our objective was to develop a conceptual model describing the interrelationships between measures of psychosocial stress and depression, a result of stress, among pregnant women in Puerto Rico and to examine their associations with PTB. We used data from the Puerto Rico Testsite for Exploring Contamination Threats pregnancy cohort (PROTECT, N = 1,047) to examine associations among depression and different continuous measures of psychosocial stress using path analysis. Psychosocial stress during pregnancy was assessed using validated measures of perceived stress, negative life experiences, neighborhood perceptions and social support. Logistic regression was used to examine associations between psychosocial stress measures in tertiles and PTB. Perceived stress, negative life experiences, and neighborhood perceptions influenced depression through multiple pathways. Our model indicated that perceived stress had the strongest direct effect on depression, where one standard deviation (SD) increase in perceived stress was associated with a 57% SD increase in depression. Negative life experiences were directly but also indirectly, through perceived stress, associated with depression. Finally, neighborhood perceptions directly influenced negative life experiences and perceived stress and consequently had an indirect effect on depression. Psychosocial stress was not associated with PTB across any of the measures examined. Our study examined interrelationships between multiple measures of psychosocial stress and depression among a pregnant Puerto Rican population and identified negative neighborhood perceptions as important upstream factors leading to depression. Our findings highlight the complex relationship between psychosocial stress measures and indicate that psychosocial stress and depression, assessed using 5 different scales, were not associated with PTB. Future research should investigate other environmental and behavioral risk factors contributing to higher rates of PTB in this population.


Assuntos
Depressão/psicologia , Gestantes/psicologia , Nascimento Prematuro/epidemiologia , Estresse Psicológico/epidemiologia , Adulto , Depressão/epidemiologia , Depressão/fisiopatologia , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Gravidez , Resultado da Gravidez/psicologia , Nascimento Prematuro/fisiopatologia , Porto Rico/epidemiologia , Características de Residência , Fatores de Risco , Apoio Social , Estresse Psicológico/fisiopatologia , Estresse Psicológico/psicologia
2.
PLoS One ; 15(1): e0224874, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31995557

RESUMO

Antenatal vaginal progesterone (VP) reduces the risk of preterm birth (PTB) in women with shortened cervical length, and we hypothesize that it may also prevent PTB in women with HIV as their primary risk factor. We conducted a pilot feasibility study in Lusaka, Zambia to investigate uptake, adherence, and retention in preparation for a future efficacy trial. This was a double-masked, placebo-controlled, randomized trial of 200mg daily self-administered VP suppository or placebo. Pregnant women with HIV who were initiating or continuing antiretroviral therapy were eligible for participation. Potential participants underwent ultrasound to assess eligibility; we excluded those ≥24 gestational weeks, with non-viable, multiple gestation, or extrauterine pregnancies, with short cervix (<2.0cm), or with prior spontaneous PTB. Participants initiated study product between 20-24 weeks of gestation and continued to 37 weeks (or delivery, if sooner). The primary outcome was adherence (proportion achieving ≥80% study product use), assessed by dye stain assay of returned single-use vaginal applicators. Secondary outcomes with pre-defined feasibility targets were: uptake (≥50% eligible participants enrolled) and retention (≥90% ascertainment of delivery outcomes). We also evaluated preliminary efficacy by comparing the risk of spontaneous PTB <37 weeks between groups. From July 2017 to June 2018, 208 HIV-infected pregnant women were eligible for screening and 140 (uptake = 67%) were randomly allocated to VP (n = 70) or placebo (n = 70). Mean adherence was 94% (SD±9.4); 91% (n = 125/137) achieved overall adherence ≥80%. Delivery outcomes were ascertained from 134 (96%) participants. Spontaneous PTB occurred in 10 participants (15%) receiving placebo and 8 (12%) receiving progesterone (RR 0.82; 95%CI:0.34-1.97). Spontaneous PTB < 34 weeks occurred in 6 (9%) receiving placebo and 4 (6%) receiving progesterone (RR 0.67; 95%CI:0.20-2.67). In contrast to findings from vaginal microbicide studies in HIV-uninfected, non-pregnant women, our trial participants were highly adherent to daily self-administered vaginal progesterone. The study's a priori criteria for uptake, adherence, and retention were met, indicating that a phase III efficacy trial would be feasible.


Assuntos
Infecções por HIV/tratamento farmacológico , Nascimento Prematuro/tratamento farmacológico , Progesterona/administração & dosagem , Vagina/efeitos dos fármacos , Administração Intravaginal , Adulto , Medida do Comprimento Cervical , Colo do Útero/efeitos dos fármacos , Colo do Útero/fisiopatologia , Colo do Útero/virologia , Estudos de Viabilidade , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Infecções por HIV/virologia , Humanos , Recém-Nascido , Gravidez , Gravidez Múltipla , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/fisiopatologia , Vagina/fisiopatologia , Vagina/virologia , Zâmbia/epidemiologia
4.
Biomed Res Int ; 2019: 2965094, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31886197

RESUMO

Background: Low Birth Weight (LBW) is a serious public health concern in low- and middle-income countries. Globally, 20 million, an estimated 15% to 20% of babies were born with LBW, and, of these, 13% were in sub-Saharan Africa. Although the World Health Assembly targeted to reduce LBW by 30% by the end of 2025, little has been done on and known about LBW. To meet the goal successfully and efficiently, more research studies on the problem are vital. Hence, the aim of this study was to determine the prevalence and the associated factors of LBW in Dire Dawa city, eastern Ethiopia. Objective: The purpose of this study was to assess the prevalence and the associated factors of low birth weight in Dire Dawa City, eastern Ethiopia, 2017. Method: A cross-sectional study designed was conducted, and using a systematic sampling technique, 431 mothers who gave birth in the public hospitals in Dire Dawa city from July 01 to August 30, 2018, were selected. Stillbirth and infants with birth defects were excluded from the study. Well-trained data collectors collected the data using a structured questionnaire which was pretested. The data were analyzed using SPSS Version 22.0. The Adjusted Odds Ratio (AOR) with 95% confidence interval (CI) was applied in multivariate logistic regression models, and p value less than 0.05 was considered as statistical significant. Result: The prevalence of low birth weight was 21%. Not received nutritional counseling during antenatal care (AOR = 2.03, 95% CI: 1.01, 4.06), preterm birth (AOR = 18.48, 95% CI: 6.51, 52.42), maternal smoking (AOR = 3.97, 95% CI: 1.59, 9.88), and height of the mother less than 150 cm (AOR = 3.54, 95% CI: 1.07, 11.76) were significantly associated with Low birth weight. Conclusion: There was a high prevalence of low birth weight in the study area. Effective dietary counseling and additional diet, implementing proven strategies to prevent preterm birth and avoid smoking during pregnancy might decrease the low birth weight and then enhance child survival.


Assuntos
Recém-Nascido de Baixo Peso/fisiologia , Modelos Logísticos , Nascimento Prematuro/epidemiologia , Adulto , Etiópia/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido de Baixo Peso/metabolismo , Recém-Nascido , Mães , Gravidez , Nascimento Prematuro/metabolismo , Nascimento Prematuro/fisiopatologia , Fatores de Risco , Fumar , Inquéritos e Questionários
5.
Int J Pediatr Otorhinolaryngol ; 127: 109667, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31499263

RESUMO

OBJECTIVE: To compare the frequency and type of diagnoses associated with pharyngeal dysfunction (PD) in children presenting with early versus late onset sleep disordered breathing (SDB). METHODS: This was a retrospective, cross-sectional study. A consecutive series of children ≤3 years old who underwent management for SDB were retrospectively identified from a prospectively kept surgical database. The early onset group was compared with two separate late onset (≥4years old) groups. Diagnoses associated with PD included gastroesophageal reflux disease (GERD), swallowing dysfunction, prematurity, asthma, and obesity. Distribution of PD diagnoses, airway lesions, syndromic conditions, pulse oximetry scores, and endoscopic pattern of airway obstruction were compared. RESULTS: 73 patients with early onset SDB were identified (51 boys, mean age 2.25 ±â€¯0.64 years, range 1.75-3 years) and compared with two groups of later onset SDB consisting of 75 and 72 patients with mean ages of 7.58 ±â€¯2.40 years and 8.04 ±â€¯3.34 years respectively (range 4-16 years). The early onset SDB group had a higher prevalence of PD diagnoses compared to the later onset group with 35 of 73 patients being diagnosed compared to 41 of 147 children (p = 0.01). Early onset SDB patients were more likely to have GERD or swallowing dysfunction (p < 0.01) while later onset patients more commonly presented with associated asthma or obesity (p < 0.01). There was no statistically significant difference in airway lesions between groups. CONCLUSION: Early-onset SDB is associated with conditions causing PD more often than later-onset SDB. Identifying these conditions and optimizing their management may impact outcomes in treating pediatric SDB.


Assuntos
Doenças Faríngeas/complicações , Faringe/fisiopatologia , Síndromes da Apneia do Sono/complicações , Síndromes da Apneia do Sono/fisiopatologia , Adolescente , Idade de Início , Obstrução das Vias Respiratórias/diagnóstico por imagem , Obstrução das Vias Respiratórias/etiologia , Asma/complicações , Criança , Pré-Escolar , Estudos Transversais , Transtornos de Deglutição/complicações , Endoscopia , Feminino , Refluxo Gastroesofágico/complicações , Humanos , Lactente , Masculino , Obesidade/complicações , Oximetria , Doenças Faríngeas/fisiopatologia , Nascimento Prematuro/fisiopatologia , Estudos Retrospectivos , Síndromes da Apneia do Sono/diagnóstico
6.
Taiwan J Obstet Gynecol ; 58(4): 454-459, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31307732

RESUMO

The abnormal development of placental vascularization leads to placental insufficiency, which further reduces the nutrient and trace exchange between maternal circulation and fetal circulation. These changes cause maternal and fetal complications. The objective of our systematic review was to explore the effects of maternal smoking on placental vascularization. The eligibility criteria were: articles with experimental, quasi-experimental or observational design, performed on human subjects, that study the association, correlation or causation between maternal smoking and changes in placental vascular network. A total of 33 full-text papers were assessed for eligibility, resulting in 12 original articles that were included in the systematic review. Doppler studies confirm reductions in blood flow velocity waveforms and increase in RI in the uterine, umbilical and fetal middle cerebral arteries. These findings are confirmed by morphometric measurements of fetal capillaries in villi that were shown to be smaller in smoke exposure groups.


Assuntos
Descolamento Prematuro da Placenta/etiologia , Exposição Materna/efeitos adversos , Insuficiência Placentária/diagnóstico por imagem , Resultado da Gravidez , Nascimento Prematuro/etiologia , Fumar/efeitos adversos , Descolamento Prematuro da Placenta/fisiopatologia , Adulto , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Placenta/irrigação sanguínea , Placenta/diagnóstico por imagem , Insuficiência Placentária/fisiopatologia , Gravidez , Nascimento Prematuro/fisiopatologia , Medição de Risco , Ultrassonografia Pré-Natal/métodos
7.
Respir Res ; 20(1): 102, 2019 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-31126291

RESUMO

BACKGROUND: Bronchopulmonary dysplasia (BPD) is a risk factor for respiratory disease in adulthood. Despite the differences in underlying pathology, patients with a history of BPD are often treated as asthmatics. We hypothesized that pulmonary outcomes and health-related quality of life (HRQoL) were different in adults born preterm with and without a history of BPD compared to asthmatics and healthy individuals. METHODS: We evaluated 96 young adults from the LUNAPRE cohort ( clinicaltrials.gov/ct2/show/NCT02923648 ), including 26 individuals born preterm with a history of BPD (BPD), 23 born preterm without BPD (preterm), 23 asthmatics and 24 healthy controls. Extensive lung function testing and HRQoL were assessed. RESULTS: The BPD group had more severe airway obstruction compared to the preterm-, (FEV1- 0.94 vs. 0.28 z-scores; p ≤ 0.001); asthmatic- (0.14 z-scores, p ≤ 0.01) and healthy groups (0.78 z-scores, p ≤ 0.001). Further, they had increased ventilation inhomogeneity compared to the preterm- (LCI 6.97 vs. 6.73, p ≤ 0.05), asthmatic- (6.75, p = 0.05) and healthy groups (6.50 p ≤ 0.001). Both preterm groups had lower DLCO compared to healthy controls (p ≤ 0.001 for both). HRQoL showed less physical but more psychological symptoms in the BPD group compared to asthmatics. CONCLUSIONS: Lung function impairment and HRQoL in adults with a history of BPD differed from that in asthmatics highlighting the need for objective assessment of lung health.


Assuntos
Asma/epidemiologia , Asma/fisiopatologia , Displasia Broncopulmonar/epidemiologia , Displasia Broncopulmonar/fisiopatologia , Adolescente , Asma/diagnóstico , Displasia Broncopulmonar/diagnóstico , Estudos de Coortes , Feminino , Volume Expiratório Forçado/fisiologia , Humanos , Recém-Nascido , Masculino , Nascimento Prematuro/diagnóstico , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/fisiopatologia , Qualidade de Vida/psicologia , Testes de Função Respiratória/métodos , Adulto Jovem
8.
Int J Mol Sci ; 20(9)2019 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-31071949

RESUMO

Individuals born preterm have higher rates of neurodevelopmental disorders such as schizophrenia, autistic spectrum, and attention deficit/hyperactivity disorders. These conditions are often sexually dimorphic and with different developmental trajectories. The etiology is likely multifactorial, however, infections both during pregnancy and in childhood have emerged as important risk factors. The association between sex- and age-dependent vulnerability to neuropsychiatric disorders has been suggested to relate to immune activation in the brain, including complex interactions between sex hormones, brain transcriptome, activation of glia cells, and cytokine production. Here, we will review sex-dependent effects on brain development, including glia cells, both under normal physiological conditions and following perinatal inflammation. Emphasis will be given to sex-dependent effects on brain regions which play a role in neuropsychiatric disorders and inflammatory reactions that may underlie early-life programming of neurobehavioral disturbances later in life.


Assuntos
Encéfalo/crescimento & desenvolvimento , Inflamação/fisiopatologia , Transtornos do Neurodesenvolvimento/fisiopatologia , Neuroglia/patologia , Transtorno do Deficit de Atenção com Hiperatividade/fisiopatologia , Transtorno do Espectro Autista/fisiopatologia , Encéfalo/diagnóstico por imagem , Encéfalo/fisiopatologia , Humanos , Inflamação/diagnóstico por imagem , Nascimento Prematuro/fisiopatologia , Esquizofrenia/fisiopatologia , Caracteres Sexuais
9.
PLoS One ; 14(4): e0215440, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30998794

RESUMO

Preterm and low birth weight infants are at greater risk for mortality and a variety of health and developmental problems. Data from the Finger Lakes Perinatal Data System database on 316,956 deliveries occurring between 2004-2014 and pregnancy outcomes were analyzed to assess the association of periodontal (gum) disease with depression, other maternal factors and adverse birth outcomes. Adjusted effects of periodontal disease and depression on adverse birth outcomes were estimated using multiple logistic regression models and path analysis. Having preterm delivery was associated significantly with depression (OR = 1.177; 95% CI: [1.146, 1.208]), having adequate health care (OR = 1.638; 95% CI: [1.589, 1.689]), smoking during pregnancy (OR = 1.259; 95% CI: [1.220, 1.300]), and being less educated (OR = 1.214; 95% CI: [1.174, 1.256]). Having low birth weight was significantly associated with depression (OR = 1.206; 95% CI: [1.170, 1.208]), smoking during pregnancy (OR = 1.855; 95% CI: [1.793, 1.919]), and being less educated (OR = 1.322; 95% CI: [1.275, 1.370]). Periodontal disease was significantly associated with alcohol use during pregnancy (OR = 1.314; 95% CI: [1.227, 1.407]) and white race (OR = 1.192; 95% CI: [1.167, 1.217]). Depression was significantly associated with periodontal disease (OR = 1.762; 95% CI: [1.727, 1.797]) and alcohol use during pregnancy (OR = 1.470; 95% CI: [1.377, 1.570]). We concluded that a positive association existed between depression during pregnancy and adverse birth outcomes, and that depression served as a mediator in the association of periodontal disease with adverse birth outcomes.


Assuntos
Depressão , Recém-Nascido de Baixo Peso , Nascimento Vivo , Doenças Periodontais , Nascimento Prematuro , Depressão/epidemiologia , Depressão/fisiopatologia , Feminino , Humanos , New York , Doenças Periodontais/epidemiologia , Doenças Periodontais/fisiopatologia , Gravidez , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/fisiopatologia
10.
PLoS One ; 14(4): e0215748, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30998803

RESUMO

BACKGROUND: Melatonin stimulates the production of progesterone, which is essential for the maintenance of pregnancy. Since melatonin in blood is reduced due to work under illuminated conditions during night work, it has been hypothesized that night work may increase the risk of preterm birth. Previous meta-analyses have not revealed increased risk of preterm birth in women working night shifts during pregnancy. Still, these studies might have been limited by inaccurate self-reports of timing, intensity and duration of night work most likely causing bias towards the null. The aim of this is study was to investigate if the frequency and duration of night work during the first (week 1-12) and second (week 13-22) trimester of pregnancy were associated with risk of preterm birth when objective and prospective data on night work are used. METHOD: In a register-based prospective cohort study, we obtained individual day-to-day information on working hours from The Danish Working Hour Database (DWHD, a payroll database including all public service employees in administrative Danish Regions from 2007-2013) and information on preterm birth from the Danish Medical Birth Registry. Night-shift was defined as at least three working hours between 23:00 and 06:00. Preterm birth was defined as giving birth during gestational weeks 23-37. Odds of preterm birth according to working night shifts were analysed by logistic regression. RESULTS: We identified 16,501 pregnant women eligible for the study, of which 10,202 women (61.8%) had at least one night-shift during the first 22 gestational weeks. The risk of preterm birth was not elevated among women working night shifts compared to women working only day shifts during either the first or second trimester. Within night-shift workers, the risk was not related to the number of night shifts, the duration of night shifts, consecutive night shifts or quick returns defined as short intervals between shifts. Odds of preterm birth was not related to change of working schedule from the first to second trimester, although women changing from night shifts in the first trimester to day work only in the second trimester displayed a weak increased odds of preterm birth (OR 1.21, 95%CI 0.98-1.49) compared to women working night shifts in both trimesters. CONCLUSION: Our results, which are without bias from self-report of either exposure or outcome, are in line with the results of previous meta-analyses. Due to the detailed information on hours worked during pregnancy, we were able to investigate several dimensions of night work not previously investigated, of which none were associated with elevated risk of preterm birth.


Assuntos
Primeiro Trimestre da Gravidez , Segundo Trimestre da Gravidez , Nascimento Prematuro , Sistema de Registros , Jornada de Trabalho em Turnos/efeitos adversos , Adulto , Feminino , Humanos , Gravidez , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/fisiopatologia , Estudos Prospectivos , Fatores de Risco
11.
PLoS One ; 14(4): e0214864, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30973908

RESUMO

Preterm birth is associated with heightened risk for attention-deficit/hyperactivity disorder (ADHD)-like symptoms and neurocognitive impairments, including impairments in performance monitoring. Here, we investigate the cognitive and neurophysiological processes from a performance-monitoring task in preterm-born adolescents and examine whether these processes in preterm-born adolescents reflect identical neurophysiological impairments to those observed in term-born adolescents with ADHD. We compared 186 preterm-born individuals to 69 term-born individuals with ADHD and 135 term-born controls on cognitive-performance measures and event-related potentials (ERPs) of conflict monitoring (N2) and error processing (ERN, Pe) from a flanker task. Preterm-born adolescents demonstrated reduced N2, ERN and Pe amplitudes, compared to controls, and similar ERN and Pe impairments to term-born adolescents with ADHD. While ADHD symptoms correlated with ERN amplitude at FCz among the preterm-born, ERN amplitude at Fz, N2 and Pe amplitude were not associated with ADHD symptoms. Preterm-born individuals show impairments on neurophysiological indices of conflict monitoring (N2) and error processing (ERN and Pe). Early neurophysiological error processing may be a marker underlying the processes linked to the increased risk for ADHD among preterm-born individuals. Error detection processes are malleable and potential targets for non-pharmacological interventions. Preterm-born individuals are likely to benefit from early interventions.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/etiologia , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Nascimento Prematuro/psicologia , Adolescente , Adulto , Transtorno do Deficit de Atenção com Hiperatividade/fisiopatologia , Estudos de Casos e Controles , Criança , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/fisiopatologia , Disfunção Cognitiva/psicologia , Eletroencefalografia , Potenciais Evocados , Feminino , Humanos , Recém-Nascido , Masculino , Testes Neuropsicológicos , Nascimento Prematuro/fisiopatologia , Desempenho Psicomotor , Fatores de Risco , Adulto Jovem
12.
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
13.
Int J Pediatr Otorhinolaryngol ; 122: 165-169, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31035174

RESUMO

INTRODUCTION: Dysphonia is a known consequence of premature birth, and is usually associated with endotracheal intubation in the neonatal period or surgical ligation of persistent patent ductus arteriosus. Recently, cases of dysphonia, in the absence of these causative factors, have been reported. OBJECTIVES: This review seeks to identify literature pertaining to those aspects of laryngeal development that may potentially be disrupted by premature birth. The purpose of the review is to determine whether there is any possible anatomical or physiological explanation for dysphonia to arose solely from premature birth. METHODS: This scoping review was conducted in accordance with the guidelines prescribed by Arskey and O'Malley (2005). Fifteen relevant papers were identified. Results were categorized into age-related categories, to identify changes in the developmental trajectory. Based on the results of the literature search, a further category of unphonated larynges was added. RESULTS: Potential differences in the laryngeal framework (e.g., the development of the cricoid cartilage and the shape of the glottis) and vocal fold histology, depending on gestational age and post-natal phonation were identified. Much literature focused on the macula flavae, however, the layers of the lamina propria were also discussed. DISCUSSION: It is unclear whether the process of differentiation of the layers of the lamina propria, which commences in the second to third months of life in term-born infants, is disrupted by prematurity. Further, development of the macula flavae continues until at least 28 weeks' gestation. Preterm children may not phonate immediately after birth, which may also affect laryngeal development.


Assuntos
Disfonia/etiologia , Laringe/crescimento & desenvolvimento , Laringe/patologia , Nascimento Prematuro/fisiopatologia , Idade Gestacional , Humanos , Fonação , Prega Vocal/embriologia
14.
Twin Res Hum Genet ; 22(2): 120-123, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-31023394

RESUMO

Planning for the preterm birth of a fetus with known anomalies can raise complex ethical issues. This is particularly true of multiple pregnancies, where the interests of each fetus and of the expectant parent(s) can conflict. In these complex situations, parental wishes and values can also conflict with the recommendations of treating clinicians. In this article, we consider the case of a dichorionic twin pregnancy complicated by the diagnosis of vein of Galen aneurysmal malformation (VGAM) in one of the twins at 28 weeks' gestation. Subsequent deterioration of the affected twin prompted the parents to request preterm delivery to prevent the imminent in-utero demise of the affected twin. However, given the associated risks of prematurity, complying with the parents' request may have disadvantaged the health and wellbeing of the unaffected twin. This article canvases the complex ethical issues raised when parents request preterm delivery of a multiple pregnancy complicated by a fetal anomaly in one twin, and the various ethical tools and frameworks that clinicians can draw on to guide their decision-making in such cases.


Assuntos
Doenças em Gêmeos/diagnóstico , Complicações na Gravidez/diagnóstico , Gravidez de Gêmeos/fisiologia , Malformações da Veia de Galeno/diagnóstico , Doenças em Gêmeos/epidemiologia , Doenças em Gêmeos/genética , Doenças em Gêmeos/patologia , Feminino , Feto/diagnóstico por imagem , Feto/patologia , Idade Gestacional , Humanos , Recém-Nascido , Gravidez , Complicações na Gravidez/diagnóstico por imagem , Complicações na Gravidez/genética , Complicações na Gravidez/fisiopatologia , Resultado da Gravidez , Gravidez Múltipla/fisiologia , Gravidez de Gêmeos/genética , Nascimento Prematuro/diagnóstico por imagem , Nascimento Prematuro/fisiopatologia , Fatores de Risco , Gêmeos Monozigóticos/genética , Ultrassonografia Pré-Natal , Malformações da Veia de Galeno/diagnóstico por imagem , Malformações da Veia de Galeno/genética , Malformações da Veia de Galeno/fisiopatologia
15.
Biomed Res Int ; 2019: 9185059, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30886867

RESUMO

Introduction: Umbilical cord milking is a procedure in which clamped or unclamped umbilical cord is grasped, and blood is pushed ("stripped") two to four times towards the newborn, in a rapid time frame, usually within 20 seconds. The target of umbilical cord milking is to provide infants with their whole potential blood volume-of which they are deprived when early cord clamping is carried out-completing placental transfusion in a shorter time than delayed cord clamping. The aim of this narrative review is to analyse the literature regarding umbilical cord milking in term and late-preterm infants and to assess all possible benefits and limits of this procedure in clinical practice, especially in comparison to immediate and delayed cord clamping. Methods: We analysed literature data concerning maternal, as well as neonatal, outcomes for term and late-preterm (gestational age ≥ 34 weeks) newborns who received umbilical cord milking. Results: Most studies show comparable benefits for both umbilical cord milking and delayed cord clamping, especially in terms of haematological parameters when compared to immediate cord clamping. Umbilical cord milking may be a feasible procedure also for newborns requiring resuscitation. Conclusions: Literature data concerning positive effects of umbilical cord milking are encouraging and suggest that umbilical cord milking may be a quick and effective method to provide placental transfusions to depressed infants. However, the lack of standardised procedures and the variation in evaluated outcomes as well as the limited number of patients enrolled in trials, along with the retrospective nature of some of them, prevent recommending umbilical cord milking as a routine procedure.


Assuntos
Recém-Nascido Prematuro/sangue , Nascimento Prematuro/sangue , Cordão Umbilical/irrigação sanguínea , Transfusão de Sangue , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Gravidez , Nascimento Prematuro/fisiopatologia , Nascimento a Termo , Cordão Umbilical/patologia
16.
Nat Commun ; 10(1): 1305, 2019 03 21.
Artigo em Inglês | MEDLINE | ID: mdl-30899005

RESUMO

Failure to predict and understand the causes of preterm birth, the leading cause of neonatal morbidity and mortality, have limited effective interventions and therapeutics. From a cohort of 2000 pregnant women, we performed a nested case control study on 107 well-phenotyped cases of spontaneous preterm birth (sPTB) and 432 women delivering at term. Using innovative Bayesian modeling of cervicovaginal microbiota, seven bacterial taxa were significantly associated with increased risk of sPTB, with a stronger effect in African American women. However, higher vaginal levels of ß-defensin-2 lowered the risk of sPTB associated with cervicovaginal microbiota in an ethnicity-dependent manner. Surprisingly, even in Lactobacillus spp. dominated cervicovaginal microbiota, low ß-defensin-2 was associated with increased risk of sPTB. These findings hold promise for diagnostics to accurately identify women at risk for sPTB early in pregnancy. Therapeutic strategies could include immune modulators and microbiome-based therapeutics to reduce this significant health burden.


Assuntos
Colo do Útero/microbiologia , Imunidade Inata , Microbiota/imunologia , Nascimento Prematuro/diagnóstico , Vagina/microbiologia , beta-Defensinas/genética , Adulto , Grupo com Ancestrais do Continente Africano , Teorema de Bayes , Biomarcadores/metabolismo , Estudos de Casos e Controles , Grupo com Ancestrais do Continente Europeu , Feminino , Expressão Gênica , Humanos , Recém-Nascido , Lactobacillus/classificação , Lactobacillus/imunologia , Lactobacillus/isolamento & purificação , Mobiluncus/classificação , Mobiluncus/imunologia , Mobiluncus/isolamento & purificação , Gravidez , Nascimento Prematuro/etnologia , Nascimento Prematuro/imunologia , Nascimento Prematuro/fisiopatologia , Prognóstico , Risco , beta-Defensinas/imunologia
17.
Int J Pediatr Otorhinolaryngol ; 121: 88-94, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30878558

RESUMO

AIM: Aim of this study was to compare the absolute and interpeak latencies of Auditory Brainstem Responses (ABR) in very preterm and late preterm infants at 1 month and 3 months of corrected age. METHOD: ology: ABR traces were obtained from 80 preterm infants (40 very preterm and 40 late preterm) at 1 month and 3 months of corrected age in a prospective, comparative cohort study. Auditory click stimuli at 70 dBnHL and 30 dBnHL, with repetition rate of 11.1/s were used. Absolute latencies of peak I, III, V and interpeak latencies of peak I-V, I-III and III-V were analyzed and compared between preterm groups at 1 month and 3 months of corrected age. Wilcoxon Signed Ranks test was used to compare the ABR variables. Mann Whitney test was used to make inferences between groups. RESULTS: There was a statistically significant difference in absolute latencies and interpeak latencies between very preterm and late preterm infants at 1 month of corrected age (p < 0.05). Absolute latency of peak I was similar among both groups of preterms. Absolute latencies of peak III, V and interpeak latencies I-III, III-V and I-V were prolonged in very preterm infants at 1 month of corrected age. However, these latencies were significantly reduced at 3 months of corrected age. This indicated accelerated maturation/myelination of the central auditory nervous system in very preterm infants. Absolute latencies of peak III and V and interpeak interval I-V was reduced in late preterm infants at 3 months of corrected age and this was statistically significant. This reduction in latency was considered to be a normal age dependent change. CONCLUSION: Findings of the current study revealed that there was no deviation in the pattern of auditory maturation among preterms; it followed the typical 'caudal to rostral' form of maturation. Very preterm infants have less mature neuronal development compared with late preterm infants at 1 month of corrected age which catches up at 3 months of corrected age.


Assuntos
Potenciais Evocados Auditivos do Tronco Encefálico/fisiologia , Audição/fisiologia , Doenças do Prematuro/fisiopatologia , Nascimento Prematuro/fisiopatologia , Estudos de Coortes , Feminino , Humanos , Lactente , Recém-Nascido , Estudos Longitudinais , Estudos Prospectivos
18.
Clin Neurophysiol ; 130(5): 675-682, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30870803

RESUMO

OBJECTIVES: An abbreviated gestational period may interrupt intrauterine brain development and constitutes a serious risk factor. Many preterm children show some form of attention deficits in later life. However, there is ambiguity about the nature and extent of these attention deficits in the literature. Moreover, the majority of studies investigated attention functions in preterm children on a symptom based level or using neuropsychological tasks. In contrast, neurophysiological studies have been comparatively scarce which will be addressed in the current study. METHODS: We investigated attention functioning in 27 low risk preterm children and 20 term children of 5-6 years of age by using EEG recording in an attention driven task (oddball task). RESULTS: Compared with term children, preterm children showed no attention deficits on a symptom level, but failed to show an increased oddball P3. CONCLUSION: Current results suggest subclinical attentional changes in preterm children on the electrophysiological level in contrast to normal performance in attentional behavioral tests. SIGNIFICANCE: Our results emphasize to have a closer look at preterm children early in preschool age even though clinically relevant symptoms seem to be absent.


Assuntos
Atenção/fisiologia , Encéfalo/fisiopatologia , Potencial Evocado P300/fisiologia , Recém-Nascido Prematuro/fisiologia , Nascimento Prematuro/fisiopatologia , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Testes Neuropsicológicos
19.
Biomed Res Int ; 2019: 5476350, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30775382

RESUMO

Background: Our aim was to describe the steps in planning, implementing, and running a multicentre cohort study of maternal and perinatal health using a high-quality biobank comprised of maternal serum, plasma, and hair samples collected from five sites in Brazil. The Preterm SAMBA study, conducted by the Brazilian Network for Studies on Reproductive and Perinatal Health, was an innovative approach used to identify women at higher risk for preterm birth. It is also of great importance in the study of other maternal and perinatal complications in the context of Brazil, which is a middle-income country. Methods: We described phases of planning, implementing, and running the Preterm SAMBA study, a multicentre Brazilian cohort study of low-risk nulliparous pregnant women, to validate a set of metabolite biomarkers for preterm birth identified in an external cohort. Procedures and strategies used to plan, implement, and maintain this multicentre preterm birth study are described in detail. Barriers and experience cited in the current narrative are not usually discussed in the scientific literature or published study protocols. Results: Several barriers and strategies were identified in different phases of the Preterm SAMBA study at different levels of the study framework (steering committee; coordinating and local centres). Strategies implemented and resources used in the study are a legacy of the Brazilian Network, aimed at training collaborators in such complex settings. Conclusion: The Brazilian Network for Studies on Reproductive and Perinatal Health has gained some experience in conducting a multicentre cohort study using a resourceful biobank which may be helpful to other research groups and maternal/perinatal health networks that plan on employing a similar approach to a similar background.


Assuntos
Bancos de Espécimes Biológicos , Nascimento Prematuro/epidemiologia , Reprodução/fisiologia , Adulto , Brasil/epidemiologia , Feminino , Humanos , Recém-Nascido , Saúde Materna , Gravidez , Nascimento Prematuro/fisiopatologia , Fatores de Risco
20.
BMJ Open ; 9(1): e023417, 2019 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-30782707

RESUMO

INTRODUCTION: Preterm birth (PTB) results from heterogeneous influences and is a major contributor to neonatal mortality and morbidity that continues to have adverse effects on infants beyond the neonatal period. This protocol describes the procedures to determine molecular signatures predictive of PTB through high-frequency sampling during pregnancy, at delivery and the postpartum period. METHODS AND ANALYSIS: Four hundred first trimester pregnant women from either Myanmar or Thailand of either Karen or Burman ethnicity, with a viable, singleton pregnancy will be enrolled in this non-interventional, prospective pregnancy birth cohort study and will be followed through to the postpartum period. Fortnightly finger prick capillary blood sampling will allow the monitoring of genome-wide transcript abundance in whole blood. Collection of stool samples and vaginal swabs each trimester, at delivery and postpartum will allow monitoring of intestinal and vaginal microbial composition. In a nested case-control analysis, perturbations of transcript abundance in capillary blood as well as longitudinal changes of the gut, vaginal and oral microbiome will be compared between mothers giving birth to preterm and matched cases giving birth to term neonates. Placenta tissue of preterm and term neonates will be used to determine bacterial colonisation as well as for the establishment of coding and non-coding RNA profiles. In addition, RNA profiles of circulating, non-coding RNA in cord blood serum will be compared with those of maternal peripheral blood serum at time of delivery. ETHICS AND DISSEMINATION: This research protocol that aims to detect perturbations in molecular trajectories preceding adverse pregnancy outcomes was approved by the ethics committee of the Faculty of Tropical Medicine, Mahidol University in Bangkok, Thailand (Ethics Reference: TMEC 15-062), the Oxford Tropical Research Ethics Committee (Ethics Reference: OxTREC: 33-15) and the local Tak Province Community Ethics Advisory Board. The results of this cooperative project will be disseminated in multiple publications staggered over time in international peer-reviewed scientific journals. TRIAL REGISTRATION NUMBER: NCT02797327; Pre-results.


Assuntos
Microbiota/fisiologia , Nascimento Prematuro/sangue , Feminino , Humanos , Placenta/microbiologia , Gravidez , Nascimento Prematuro/fisiopatologia , Estudos Prospectivos , Ultrassonografia Pré-Natal , Vagina/microbiologia
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