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1.
MMWR Morb Mortal Wkly Rep ; 68(22): 489-493, 2019 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-31170123

RESUMO

Breast milk is the optimal source of infant nutrition. For the nearly one in 10 infants born prematurely in the United States annually (1), breast milk is especially beneficial, helping prevent sepsis and necrotizing enterocolitis and promoting neurologic development (2). National estimates of newborn feeding practices by gestational age have not been available previously. CDC analyzed 2017 birth certificate data from 48 states and the District of Columbia (3,194,873; 82.7% of all births) to describe receipt of breast milk among extremely preterm (20-27 weeks), early preterm (28-33 weeks), late preterm (34-36 weeks), and term (≥37 weeks) infants with further stratification by maternal and infant characteristics. The prevalence of infants receiving any breast milk was 83.9% overall and varied by gestational age, with 71.3% of extremely preterm infants, 76.0% of early preterm infants, 77.3% of late preterm infants, and 84.6% of term infants receiving any breast milk. Disparities in receipt of breast milk by several sociodemographic factors, including maternal race/ethnicity, were noted across gestational age groups. These estimates suggest that many infants, particularly infants at high risk for medical complications, might not be receiving breast milk. Efforts are needed to increase the implementation of existing evidence-based policies and practices that support breast milk feeding, particularly for medically fragile infants (2,3).


Assuntos
Aleitamento Materno/estatística & dados numéricos , Idade Gestacional , Leite Humano , Feminino , Humanos , Lactente Extremamente Prematuro , Recém-Nascido , Recém-Nascido Prematuro , Nascimento a Termo , Estados Unidos
2.
Lancet ; 393(10183): 1805, 2019 05 04.
Artigo em Inglês | MEDLINE | ID: mdl-31057168
3.
BMJ ; 365: l1656, 2019 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-31064770

RESUMO

OBJECTIVE: To investigate associations between Apgar scores of 7, 8, and 9 (versus 10) at 1, 5, and 10 minutes, and neonatal mortality and morbidity. DESIGN: Population based cohort study. SETTING: Sweden. PARTICIPANTS: 1 551 436 non-malformed live singleton infants, born at term (≥37 weeks' gestation) between 1999 and 2016, with Apgar scores of ≥7 at 1, 5, and 10 minutes. EXPOSURES: Infants with Apgar scores of 7, 8, and 9 at 1, 5, and 10 minutes were compared with those with an Apgar score of 10 at 1, 5, and 10 minutes, respectively. MAIN OUTCOME MEASURES: Neonatal mortality and morbidity, including neonatal infections, asphyxia related complications, respiratory distress, and neonatal hypoglycaemia. Adjusted odds ratios (aOR), adjusted rate differences (aRD), and 95% confidence intervals were estimated. RESULTS: Compared with infants with an Apgar score of 10, aORs for neonatal mortality, neonatal infections, asphyxia related complications, respiratory distress, and neonatal hypoglycaemia were higher among infants with lower Apgar scores, especially at 5 and 10 minutes. For example, the aORs for respiratory distress for an Apgar score of 9 versus 10 were 2.0 (95% confidence interval 1.9 to 2.1) at 1 minute, 5.2 (5.1 to 5.4) at 5 minutes, and 12.4 (12.0 to 12.9) at 10 minutes. Compared with an Apgar score of 10 at 10 minutes, the aRD for respiratory distress was 9.5% (95% confidence interval 9.2% to 9.9%) for an Apgar score of 9 at 10 minutes, and 41.9% (37.7% to 46.4%) for an Apgar score of 7 at 10 minutes. A reduction in Apgar score from 10 at 5 minutes to 9 at 10 minutes was also associated with higher odds of neonatal morbidity, compared with a stable Apgar score of 10 at 5 and 10 minutes. CONCLUSIONS: In term non-malformed infants with Apgar scores within the normal range (7 to 10), risks of neonatal mortality and morbidity are higher among infants with lower Apgar score values, and also among those experiencing a reduction in score from 5 minutes to 10 minutes (compared with infants with stable Apgar scores of 10).


Assuntos
Índice de Apgar , Mortalidade Infantil , Doenças do Recém-Nascido/mortalidade , Mães/estatística & dados numéricos , Adulto , Índice de Massa Corporal , Escolaridade , Feminino , Inquéritos Epidemiológicos , Humanos , Lactente , Mortalidade Infantil/tendências , Recém-Nascido , Masculino , Idade Materna , Razão de Chances , Gravidez , Estudos Prospectivos , Fatores de Risco , Índice de Gravidade de Doença , Suécia/epidemiologia , Nascimento a Termo , Fatores de Tempo , Adulto Jovem
4.
Pediatr Ann ; 48(4): e175-e181, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-30986319

RESUMO

Respiratory distress occurs in 5% to 7% of live births at term gestation. Most cases are mild and transient and can be attributed to transient tachypnea of the newborn or "wet lung." Severe respiratory distress is often due to nonpulmonary causes such as sepsis or congenital heart disease. Occasionally, term neonatal respiratory distress is associated with an inherited primary lung disease such as primary ciliary dyskinesia or surfactant metabolism defects. These lung diseases have characteristic presentations in the neonatal period and are important to recognize, as they necessitate different management approaches and have lifelong implications. Suspicion for these diseases should prompt referral to a pediatric pulmonologist. [Pediatr Ann. 2019;48(4):e175-e181.].


Assuntos
Pulmão/patologia , Síndrome do Desconforto Respiratório do Recém-Nascido/etiologia , Doença Crônica , Humanos , Recém-Nascido , Síndrome do Desconforto Respiratório do Recém-Nascido/diagnóstico , Nascimento a Termo
5.
BMC Womens Health ; 19(1): 56, 2019 04 25.
Artigo em Inglês | MEDLINE | ID: mdl-31023295

RESUMO

BACKGROUND: Individuals born very preterm or with very low birth weight (VLBW) have a reduced likelihood to reproduce according to population-based register studies. Extremely low-birth weight born adults had a lower reproduction rate for both men and women in a follow-up study. AIM: To investigate if being born with VLBW is associated with differences in the reproductive health, i.e. age of menarche, menstrual cycle pattern, pregnancy rates and hormone profile compared with women born at term. METHODS: A prospective long-term follow-up of a cohort of live-born VLBW children and their controls studied repeatedly since birth and now assessed at 26-28 years of age. Of the totally 80 girls enrolled from birth 49 women (24 VLBW women and 25 controls) participated in the current follow-up. The women's anthropometric data and serum hormone levels were analysed. RESULTS: The reproductive hormone levels, including Anti-Mullerian Hormone, did not differ significantly between VLBW women and their controls. Both groups reported menstrual cycle irregularities and pregnancies to the same extent but the VLBW women reported 1.5 years later age of menarche. The VLBW subjects had a catch-up growth within 18 months of birth but remained on average 5 cm shorter in adult height. There were no significant differences in BMI, sagittal abdominal diameter, blood pressure or in their answers regarding life style between the VLBW women and the controls. CONCLUSION: No differences in the reproductive hormone levels were found between VLBW women and their controls. Although age at menarche was somewhat higher in the VLBW group menstrual cycles and pregnancy rates were similar in the VLBW and control groups. Further follow-up studies are required to elucidate the health outcomes of being born VLBW.


Assuntos
Recém-Nascido de muito Baixo Peso , Menarca , Ciclo Menstrual , Taxa de Gravidez , Reprodução , Nascimento a Termo , Adulto , Peso ao Nascer , Pressão Sanguínea , Estudos de Coortes , Feminino , Seguimentos , Humanos , Gravidez , Estudos Prospectivos
6.
Sex Reprod Healthc ; 19: 78-83, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30928139

RESUMO

OBJECTIVE: To investigate the quality of intrapartum care provided at Rwandan healthcare facilities to women undergoing normal pregnancy and spontaneous full-term labour. METHODS: A cross-sectional study was conducted over eight weeks during 2014-2015 in 18 healthcare facilities in Kigali City and the Northern Province: eight health centres, seven district hospitals, one provincial hospital, one private hospital, and one referral hospital. Data were collected from medical records and a questionnaire including the Bologna score with its five variables: presence of a companion, use of partograph, no augmentation of labour, birth in a non-supine position, and skin-to skin contact. RESULTS: Among the 435 women who fulfilled the inclusion criteria during the study period, mean age was 27.4 years and 41.8% were primiparous. The assisting healthcare professionals were midwives (49.4%), nurses (28.8%), and physicians (22%), and birth occurred at health centres (29%), district hospitals (40%), and the referral hospital (31%). Mean Bologna score was 2.03 of the maximum 5 (range: 0-4). Only one woman (0.2%) had a companion present (her husband). A partograph was used for the majority (84.8%), and 88.0% had no augmentation of labour with oxytocin. Few (6.2%) gave birth in a non-supine position, and few (12.4%) had early skin-to-skin contact with their newborn. CONCLUSION: There are several areas for improving childbirth care according to the Bologna score. Healthy newborns should be placed skin-to-skin with their mothers shortly after birth, non-supine birthing positions should be encouraged, and the importance of a companion during labour and birth should be considered.


Assuntos
Parto Obstétrico/normas , Instalações de Saúde/normas , Assistência Perinatal/normas , Nascimento a Termo , Adulto , Entorno do Parto , Centros Comunitários de Saúde/normas , Estudos Transversais , Parto Obstétrico/métodos , Feminino , Hospitais de Distrito/normas , Hospitais Privados/normas , Humanos , Início do Trabalho de Parto , Relações Mãe-Filho , Posicionamento do Paciente , Gravidez , Ruanda , Adulto Jovem
7.
BJOG ; 126(10): 1252-1257, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30946519

RESUMO

OBJECTIVE: To assess intrapartum/neonatal mortality and morbidity risk in infants born at 37 weeks of gestation compared with infants born at 39-41 weeks of gestation. DESIGN: Nationwide cohort study. SETTING: The Netherlands. POPULATION: A total of 755 198 women delivering at term of a singleton without congenital malformations during 2010-14. METHODS: We used data from the national perinatal registry (PERINED). Analysis was performed with logistic regression and stratification for the way labour started and type of care. MAIN OUTCOME MEASURES: Intrapartum or neonatal mortality up to 28 days and adverse neonatal outcome (neonatal mortality, 5-minute Apgar <7, and/or neonatal intensive care unit admission). RESULTS: At 37 weeks of gestation intrapartum/neonatal mortality was 1.10‰ compared with 0.59‰ at 39-41 weeks (P < 0.0001). Adjusted odds ratio (aOR) for 37 weeks compared with 39-41 weeks was 1.84 (95% CI) 1.39-2.44). Adverse neonatal outcome at 37 weeks was 21.4‰ compared with 12.04‰ at 39-41 weeks (P < 0.0001) with an aOR 1.63 (95% CI 1.53-1.74). Spontaneous start of labour at 37 weeks of gestation was significantly associated with increased intrapartum/neonatal mortality with an aOR of 2.20 (95% CI 1.56-3.10), in both primary (midwifery-led) care and specialist care. Neither induction of labour nor planned caesarean section showed increased intrapartum/neonatal mortality risk. CONCLUSIONS: Birth at 37 weeks of gestation is independently associated with a higher frequency of clinically relevant adverse perinatal outcomes than birth at 39-41 weeks. In particular, spontaneous start of labour at 37 weeks of gestation doubles the risk for intrapartum/neonatal mortality. Extra fetal monitoring is warranted. TWEETABLE ABSTRACT: Birth at 37 weeks of gestation gives markedly higher intrapartum/neonatal mortality risk than at 39-41 weeks, especially with spontaneous start of labour.


Assuntos
Parto Obstétrico/mortalidade , Mortalidade Infantil/tendências , Assistência Perinatal/estatística & dados numéricos , Nascimento a Termo , Adulto , Estudos de Coortes , Feminino , Humanos , Lactente , Recém-Nascido , Trabalho de Parto , Países Baixos/epidemiologia , Razão de Chances , Gravidez , Resultado da Gravidez , Prova de Trabalho de Parto
8.
BMC Pregnancy Childbirth ; 19(1): 122, 2019 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-30971199

RESUMO

BACKGROUND: Fetal weight estimation is of key importance in the decision-making process for obstetric planning and management. The literature is inconsistent on the accuracy of measurements with either ultrasound or clinical examination, known as Leopold's manoeuvres, shortly before term. Maternal BMI is a confounding factor because it is associated with both the fetal weight and the accuracy of fetal weight estimation. The aim of our study was to compare the accuracy of fetal weight estimation performed with ultrasound and with clinical examination with respect to BMI. METHODS: In this prospective blinded observational study we investigated the accuracy of clinical examination as compared to ultrasound measurement in fetal weight estimation, taking the actual birth weight as the gold standard. In a cohort of all consecutive patients who presented in our department from January 2016 to May 2017 to register for delivery at ≥37 weeks, examination was done by ultrasound and Leopold's manoeuvres to estimate fetal weight. All examiners (midwives and physicians) had about the same level of professional experience. The primary aim was to compare overall absolute error, overall absolute percent error, absolute percent error > 10% and absolute percent error > 20% for weight estimation by ultrasound and by means of Leopold's manoeuvres versus the actual birth weight as the given gold standard, namely separately for normal weight and for overweight pregnant women. RESULTS: Five hundred forty-three patients were included in the data analysis. The accuracy of fetal weight estimation was significantly better with ultrasound than with Leopold's manoeuvres in all absolute error calculations made in overweight pregnant women. For all error calculations performed in normal weight pregnant women, no statistically significant difference was seen in the accuracy of fetal weight estimation between ultrasound and Leopold's manoeuvres. CONCLUSIONS: Data from our prospective blinded observational study show a significantly better accuracy of ultrasound for fetal weight estimation in overweight pregnant women only as compared to Leopold's manoeuvres with a significant difference in absolute error. We did not observe significantly better accuracy of ultrasound as compared to Leopold's manoeuvres in normal weight women. Further research is needed to analyse the situation in normal weight women.


Assuntos
Antropometria/métodos , Peso Fetal , Exame Físico/estatística & dados numéricos , Diagnóstico Pré-Natal/estatística & dados numéricos , Ultrassonografia Pré-Natal/estatística & dados numéricos , Adulto , Peso ao Nascer , Feminino , Humanos , Recém-Nascido , Palpação , Exame Físico/métodos , Gravidez , Diagnóstico Pré-Natal/métodos , Estudos Prospectivos , Método Simples-Cego , Nascimento a Termo
9.
BJOG ; 126(9): 1148-1155, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30989788

RESUMO

OBJECTIVE: To compare the World Health Organization (WHO) recommended orally administrated dosage of misoprostol (25 µg) with a vaginal slow-release (7 µg/hour) insert of misoprostol regarding time from induction to delivery and safety of the method. DESIGN: Open label, Randomised controlled trial (RCT). SETTING: Delivery ward at a secondary referral hospital in Stockholm, Sweden, from 1 October 2016 to 21 February 2018. POPULATION: One hundred and ninety-six primiparous women with singletons in cephalic presentation at ≥37 weeks of gestation and with a Bishop score of ≤4. METHODS: Women were randomised to an oral solution of misoprostol (Cytotec® n = 99) or vaginal slow-release misoprostol (Misodel® [MVI] n = 97). MAIN OUTCOME MEASURES: Primary outcome: time from induction to vaginal delivery. SECONDARY OUTCOMES: mode of delivery; proportion of vaginal deliveries within 24 hours (VD24); neonates with an Apgar score of <7 at 5 minutes; pH < 7.10; postpartum haemorrhage (PPH) of >1000 ml; hyperstimulation; and women's delivery experience (VAS). RESULTS: There was no difference in the time to delivery [corrected] (median 21.1 hours in the MVI group and 23.2 hours in the oral group; Kaplan-Mayer log rank P = 0.31). There was no difference regarding the proportion of VD24 (50.5 versus 55.7%, P = 0.16). Hyperstimulation with non-reassuring cardiotocography (CTG) was more common in the MVI group (14.4 versus 3.0%, P < 0.01). Terbutaline (Bricanyl® ) was used more often for hyperstimulation in the MVI group (22.7 versus 4.0%, P < 0.01). There was no difference in the numbers of children admitted to the neonatal intensive care unit (NICU). CONCLUSIONS: Vaginal delivery after induction of labour (IOL) with slow-release misoprostol did not result in a shorter time from induction to vaginal delivery, compared with oral misoprostol solution, but was associated with a higher risk for hyperstimulation and fetal distress. There were no differences in mode of delivery or neonatal outcome. TWEETABLE ABSTRACT: IOL with MVI was similar to oral solution of misoprostol but hyperstimulation and fetal distress were more common.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Trabalho de Parto Induzido/métodos , Misoprostol/administração & dosagem , Ocitócicos/administração & dosagem , Administração Intravaginal , Administração Oral , Adulto , Índice de Apgar , Cardiotocografia/estatística & dados numéricos , Preparações de Ação Retardada , Feminino , Humanos , Recém-Nascido , Paridade , Gravidez , Suécia , Nascimento a Termo/efeitos dos fármacos , Fatores de Tempo , Resultado do Tratamento
11.
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
12.
Ital J Pediatr ; 45(1): 30, 2019 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-30832683

RESUMO

BACKGROUND: Vitamin K is a key point for guarantee normal blood clotting and its level in newborns is commonly low, so a supplementation after delivery is mandatory. Vitamin K prophylaxis in newborns is still an open field of debate: many types of protocol have been proposed in different years and Countries, and sometimes with great variability inside the same Nation (for instance, in Italy a national consensus is not available, so different protocols are employed). Recommendations include different protocols for healthy newborns born at term, but the unpreventable presence of bleeding favouring factors (i.e. blood vessels malformations) or limiting intestinal absorption of liposoluble vitamins (i.e. cholestasis), which could be unrecognized or subclinical in the perinatal period, rises some concerning about the most precautionary route of administration and the timing of further doses after the first one given at birth. The purpose of this report is to underline the most recent evidences available in literature and to arise a debate about this topic, in order to stimulate the production of evidence-based guidelines concerning the prophylaxis with vitamin K1 in newborn infants, considering that many bleeding risk factors are not recognizable at birth. CASE PRESENTATION: We are hereby presenting an emblematic case concerning the risk of intracranial bleeding in an apparently healthy newborn: the described infant did not show any pathological elements in pregnancy history or perinatal life which suggest a possible increased risk of bleeding and the needing of a particular approach in the administration of vitamin K1, but at the end of the first week of life presented an intracranial bleeding with neurological symptoms that required treatment for vitamin K deficiency. CONCLUSIONS: Univocal recommendations about vitamin K prophylaxis are not available and the contrast between oral and intramuscular routes persists unsolved. The difficulty to certainly identify an infant eligible for oral administration of vitamin K1 at birth suggests that the intramuscular route should be preferred. How to prosecute the supplementation in the first months of life is still an open topic of debate.


Assuntos
Hemorragias Intracranianas/etiologia , Guias de Prática Clínica como Assunto , Sangramento por Deficiência de Vitamina K/complicações , Sangramento por Deficiência de Vitamina K/tratamento farmacológico , Vitamina K/administração & dosagem , Medicina Baseada em Evidências , Feminino , Humanos , Recém-Nascido , Injeções Intramusculares , Hemorragias Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/tratamento farmacológico , Itália , Imagem por Ressonância Magnética/métodos , Determinação de Necessidades de Cuidados de Saúde , Neonatologia/normas , Medição de Risco , Nascimento a Termo , Sangramento por Deficiência de Vitamina K/diagnóstico
13.
Proc Inst Mech Eng H ; 233(3): 362-371, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30706756

RESUMO

In this study, an attempt has been made to identify the origin of multifractality in uterine electromyography signals and to differentiate term (gestational age > 37 weeks) and preterm (gestational age ≤ 37 weeks) conditions by multifractal detrended moving average technique. The signals obtained from a publicly available database, recorded from the abdominal surface during the second trimester, are used in this study. The signals are preprocessed and converted to shuffle and surrogate series to examine the source of multifractality. Multifractal detrended moving average algorithm is applied on all the signals. The presence of multifractality is verified using scaling exponents, and multifractal spectral features are extracted from the spectrum. The variation of multifractal features in term and preterm conditions is analyzed statistically using Student's t-test. The results of scaling exponents show that the uterine electromyography or electrohysterography signals reveal multifractal characteristics in term and preterm conditions. Further investigation indicates the existence of long-range correlation as the primary source of multifractality. Among all extracted features, strength of multifractality, exponent index, and maximum and peak singularity exponents are statistically significant ( p < 0.05) in differentiating term and preterm conditions. The coefficient of variation is found to be lower for strength of multifractality and peak singularity exponent, which reveal that these features exhibit less inter-subject variance. Hence, it appears that multifractal analysis can aid in the diagnosis of preterm or term delivery of pregnant women.


Assuntos
Eletromiografia , Fractais , Nascimento Prematuro/diagnóstico , Nascimento Prematuro/fisiopatologia , Processamento de Sinais Assistido por Computador , Nascimento a Termo/fisiologia , Útero/fisiologia , Algoritmos , Feminino , Humanos , Útero/fisiopatologia
14.
BJOG ; 126(7): 901-905, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30758126

RESUMO

OBJECTIVES: To evaluate the association of a history of threatened preterm labour (TPL) followed by term delivery with the risk of spontaneous preterm delivery (PTD) in subsequent pregnancy. DESIGN: Population-based cohort study. SETTING: Data of the National Health Insurance Claims Database and a national health-screening programme for infants and children in South Korea. POPULATION: Women who had their first singleton delivery in 2010 and a subsequent second singleton delivery between 2011 and 2015. METHODS: Multivariable analysis adjusting for maternal age and interval between first and second deliveries was used to assess the risk of PTD based on PTD, TPL followed by term delivery, and term delivery in the first pregnancy. MAIN OUTCOME MEASURES: The risk of PTD during the second pregnancy. RESULTS: This study included 115 629 women with two consecutive deliveries during the study period. Spontaneous PTD rates in the second pregnancy were 7.71, 2.22 and 1.02% in women with PTD, TPL followed by term delivery, and term delivery in the first pregnancy, respectively. Threatened preterm labour followed by term delivery in the first pregnancy was associated with increased risk of PTD in the subsequent pregnancy after adjustment for potential confounding factors (adjusted odds ratio 2.21; 95% CI 1.76-2.78). CONCLUSION: Although women with a history of TPL followed by term delivery had a lower risk of PTD during a subsequent pregnancy compared with those with history of previous PTD, they still had a significantly increased risk of PTD compared with those who delivered at term without TPL. TWEETABLE ABSTRACT: The history of threatened preterm labour followed by term delivery is related to increased risk of subsequent spontaneous preterm delivery.


Assuntos
Ameaça de Aborto/epidemiologia , Nascimento Prematuro/epidemiologia , Nascimento a Termo/fisiologia , Adulto , Estudos de Coortes , Feminino , Humanos , Idade Materna , Gravidez , Recidiva , República da Coreia/epidemiologia , Fatores de Risco
16.
BMC Pregnancy Childbirth ; 19(1): 40, 2019 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-30669972

RESUMO

BACKGROUND: U.S. mortality rate of term infants is higher than most other developed countries. Term infant mortality is associated with exogenous socio-environmental factors. Previous research links low socioeconomic status and rurality with high infant mortality, but does not examine the effect of individual level factors on this association. Separating out the effect of contextual factors from individual level factors has important implications for targeting interventions. Therefore, we aim to estimate the independent effect of poverty and urban-rural classification on term infant mortality. METHODS: We used linked 2013 period cohort birth-infant death files from the National Center for Health Statistics (NCHS). Counties were assigned to low, medium and high poverty groups using US Census Bureau county-level percent of children ≤18 years living in poverty, and were classified based on NCHS urban-rural classification. Bivariate and multilevel logistic regression models were used to estimate odds of term infant death, accounting for individual and county level variables. RESULTS: There were 2,551,828 term births in 2013, with an overall term mortality of 2.1 per 1000 births. Odds of term infant mortality increased from 1.4 (95% CI: 1.2, 1.6) to 1.8 (95% CI: 1.6, 2.0) comparing births over increasing county poverty to those in the lowest. The associations remained significant in the multivariable model, for highest poverty 1.3 (95% CI: 1.1, 1.5). Similarly, the odds of term infant mortality increased with increasing rurality, from 1.3 (95% CI: 1.2, 1.5) in medium metro counties to 1.7 (95% CI: 1.5, 2.0) in non-core counties compared to large fringe metro counties. However, only rural non-core counties remained statistically associated with increased risk of term infant mortality after adjusting for individual level maternal characteristics. CONCLUSIONS: High poverty and very rural counties remained associated with term infant mortality independent of individual maternal sociodemographic, health and obstetric factors. Interventions should focus on contextual factors such as economic environment and availability of health and social services in addition to individual factors to reduce term infant mortality.


Assuntos
Mortalidade Infantil , Pobreza/estatística & dados numéricos , População Rural/estatística & dados numéricos , Nascimento a Termo , População Urbana/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Modelos Logísticos , Masculino , Análise Multinível , Gravidez , Estados Unidos/epidemiologia
17.
Midwifery ; 71: 71-76, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30690202

RESUMO

BACKGROUND: When compared with full-term birth (39 to <42 weeks), early-term birth (37 to <39 weeks) is associated with adverse neonatal outcomes that may impede breastfeeding. Breastfeeding provides numerous benefits to infants and could potentially offset the effects of early-term birth. However, the effect of early-term birth on any and exclusive breastfeeding duration among healthy normal weight infants is unclear. OBJECTIVES: The objective of this study was to examine the association between early-term birth and breastfeeding duration and exclusivity among healthy term infants. METHODS: Two prospective cohorts of 2704 healthy mother-infant pairs were recruited in Hong Kong in 2006-07 and 2011-12. Participants were followed prospectively for 12 months or until they stopped breastfeeding. RESULTS: Approximately one-third (32.8%) of the infants were born early-term. More than one-half of all participants had stopped breastfeeding by three months postpartum and approximately one-half of the infants were not being exclusively breastfed by two weeks postpartum. There was no significant difference in the odds of any (adjusted odds ratio [aOR] = 1.05; 95% 0.85, 1.31) or exclusive (aOR = 0.89; 95% 0.73, 1.08) breastfeeding at one-month postpartum between infants born early-term and at full-term. There was also no significant difference in the duration of any (adjusted hazard ratio [aHR] = 1.0; 95% 0.91, 1.10) or exclusive (aHR = 1.0; 95% 0.91, 1.09) breastfeeding between early-term and full-term infants. CONCLUSION: In this cohort, early-term birth was not associated with breastfeeding duration and exclusivity. This suggests that, in the absence of neonatal complications, early-term birth itself may not lead to a shorter duration of any or exclusive breastfeeding.


Assuntos
Aleitamento Materno/métodos , Avaliação de Resultados (Cuidados de Saúde)/estatística & dados numéricos , Resultado da Gravidez , Adulto , Aleitamento Materno/efeitos adversos , Aleitamento Materno/estatística & dados numéricos , Estudos de Coortes , Feminino , Idade Gestacional , Hong Kong/epidemiologia , Humanos , Recém-Nascido , Gravidez , Nascimento Prematuro/epidemiologia , Modelos de Riscos Proporcionais , Estudos Prospectivos , Nascimento a Termo , Fatores de Tempo
18.
Fertil Steril ; 111(3): 588-596.e1, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30630591

RESUMO

OBJECTIVE: To investigate plasma antimüllerian hormone (AMH) concentration and its relation to steroid hormone levels in pregnant women with polycystic ovary syndrome (PCOS) and controls at term. DESIGN: Case-control study. SETTING: University-affiliated hospital. PATIENT(S): A total of 74 pregnant women at term: 25 women with PCOS (aged 31.6 ± 3.9 years [mean ± standard deviation], body mass index 24.0 ± 3.9 kg/m2, mean gestational length 279 ± 9 days) and 49 controls (aged 31.7 ± 3.3 years, body mass index 24.0 ± 3.3 kg/m2, mean gestational length 281 ± 9 days). INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Plasma AMH and steroid hormone levels. RESULT(S): Antimüllerian hormone, T, and androstenedione levels were higher in women with PCOS at term compared with controls, whereas estrogen and P levels were similar. The differences were pronounced in women carrying a female fetus. Testosterone and AMH levels correlated positively in both groups, but E2 levels only in women with PCOS. CONCLUSION(S): Pregnant women with PCOS present with elevated AMH and androgen levels even at term, suggesting a hormonal imbalance during PCOS pregnancy. Differences were detected especially in pregnancies with a female fetus, raising the question of whether female pregnancies are more susceptible to AMH and steroid hormone actions.


Assuntos
Hormônio Antimülleriano/sangue , Hormônios Esteroides Gonadais/sangue , Síndrome do Ovário Policístico/sangue , Adulto , Androstenodiona/sangue , Biomarcadores/sangue , Estudos de Casos e Controles , Estradiol/sangue , Feminino , Humanos , Síndrome do Ovário Policístico/diagnóstico , Síndrome do Ovário Policístico/fisiopatologia , Gravidez , Fatores Sexuais , Nascimento a Termo , Testosterona/sangue
19.
Nutrients ; 11(1)2019 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-30626044

RESUMO

We longitudinally compared fatty acids (FA) from human milk (HM) of mothers delivering term and preterm infants. HM was collected for 4 months postpartum at 12 time points for preterm and for 2 months postpartum at 8 time points for term group. Samples were collected from the first feed of the morning, and single breast was fully expressed. FA were analyzed by gas chromatography coupled with flame ionization detector. Oleic, palmitic and linoleic acids were the most abundant FA across lactation and in both groups. Preterm colostrum contained significantly (p < 0.05) higher 8:0, 10:0, 12:0, sum medium chain fatty acids (MCFA), 18:3 n-3 FA compared to term counterparts. Preterm mature milk contained significantly higher 12:0, 14:0, 18:2 n-6, sum saturated fatty acids (SFA), and sum MCFA. We did not observe any significant differences between the preterm and term groups for docosahexaenoic acid, arachidonic acid and eicosapentaenoic acid at any stage of lactation. Overall, preterm milk was higher for SFA with a major contribution from MCFA and higher in 18:2 n-6. These observational differences needs to be studied further for their implications on preterm developmental outcomes and on fortification strategies of either mothers' own milk or donor human milk.


Assuntos
Colostro/metabolismo , Ácidos Graxos/metabolismo , Idade Gestacional , Lactação/metabolismo , Leite Humano/metabolismo , Nascimento Prematuro , Nascimento a Termo , Adulto , Ácido Araquidônico , Mama/metabolismo , Aleitamento Materno , Ácidos Docosa-Hexaenoicos/metabolismo , Ácido Eicosapentaenoico/metabolismo , Feminino , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Mães , Período Pós-Parto , Gravidez , Suíça
20.
BMC Pregnancy Childbirth ; 19(1): 9, 2019 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-30616561

RESUMO

BACKGROUND: Uterine fibroids are the most common uterine tumours in females of reproductive age. During pregnancy, uterine fibroids may be complicated by aseptic necrobiosis. We herein report an ambiguous clinical presentation of uterine fibroids in pregnancy and discuss the diagnostic challenges encountered in our resource-constraint setting. CASE PRESENTATION: A term pregnant Cameroonian woman was admitted to our maternity unit with clinical findings suggestive of a strangulated umbilical hernia. She underwent an emergency caesarean section which fortuitously revealed aseptic necrobiosis of a uterine fibroid, managed within the same surgical intervention by myomectomy. Her post-operative course was uneventful. CONCLUSION: The authors highlight the need for a high index of suspicion by healthcare providers, as well as the need for a multidisciplinary approach for a favourable maternal and foetal outcome.


Assuntos
Leiomioma/diagnóstico , Transtornos Necrobióticos/diagnóstico , Complicações Neoplásicas na Gravidez/diagnóstico , Neoplasias Uterinas/diagnóstico , Adulto , Camarões , Cesárea , Diagnóstico Diferencial , Feminino , Humanos , Gravidez , Nascimento a Termo , Miomectomia Uterina , Útero/patologia , Útero/cirurgia
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