The Alabama Preterm Birth Study: Intrauterine infection and placental histologic findings in preterm births of males and females less than 32 weeks

AbstractAround 40% of preterm births are attributed to ascending intrauterine infection, and Ureaplasma parvum (UP) is commonly isolated in these cases. Here we present a mouse model of ascending UP infection that resembles human disease, using vaginal inoculation combined with mild cervical injury induced by a common spermicide (Nonoxynol-9, as a surrogate for any mechanism of cervical epithelial damage). We measure bacterial load in a non-invasive manner using a luciferase-expressing UP strain, and post-mortem by qPCR and bacterial titration. Cervical exposure to Nonoxynol-9, 24 h pre-inoculation, facilitates intrauterine UP infection, upregulates pro-inflammatory cytokines, and increases preterm birth rates from 13 to 28%. Our results highlight the crucial role of the cervical epithelium as a barrier against ascending infection. In addition, we expect the mouse model will facilitate further research on the potential links between UP infection and preterm birth.

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Analysis risk factors for preterm births in children under care of the Department of Pediatric Rehabilitation in Bialystok

Progress in Health Sciences ◽

10.5604/01.3001.0012.8328 ◽

2018 ◽

Vol 8 (2) ◽

pp. 99-104

Author(s):

G. Dytrych ◽

D. Sienkiewicz

Keyword(s):

Risk Factors ◽

Preterm Birth ◽

Body Mass ◽

Genetic Diseases ◽

Congenital Toxoplasmosis ◽

Preterm Births ◽

Intrauterine Infection ◽

Fetal Distress ◽

Uterine Bleeding ◽

Pediatric Rehabilitation

Introduction: Preterm birth is the birth of a baby at fewer than 37 weeks' gestational age. Preterm infants are at risk for numerous medical problems including neurological, cardiological, respiratory, and infection. Purpose: To analyse the selected risk factors of preterm births among children under the care of the Department of Pediatric Rehabilitation in Białystok Materials and methods: The retrospective study included 96 preterm children with very low body mass less than 1500 grams. All children lived in the Podlasie region of Poland. We analysed the risk factors for preterm birth based on the medical files. The detailed interview included: the course of pregnancy, diseases before pregnancy, the prevalence of genetic diseases in the nearest family, and the earlier miscarriages. Results: The intrauterine infection (20 cases), fetal distress, (19 cases), uterine bleeding (15 cases), multiple pregnancies (13 cases) were the most often risk factors of preterm births. Only a few cases concerned congenital toxoplasmosis and cytomegaly, malformation of the reproductive system, mother diseases during the pregnancy. The gender of the child did not determine the preterm birth. A significant correlation between preterm birth and the sequence of pregnancy preterm birth was related with first pregnancy in 47% of cases. There was no correlation between i. body mass and sex, ii. earlier miscarriages and preterm births. Conclusions: The risk factors of preterm births are diverse. Most common causes of preterm births were the intrauterine infection, fetal distress, and uterine bleeding.

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A birth population-based survey of preterm morbidity and mortality by gestational age

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03726-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Xiaojing Guo ◽

Xiaoqiong Li ◽

Tingting Qi ◽

Zhaojun Pan ◽

Xiaoqin Zhu ◽

...

Keyword(s):

Birth Weight ◽

Preterm Birth ◽

Preterm Infants ◽

Birth Defects ◽

Gestational Age ◽

Death Rate ◽

Preterm Births ◽

Mortality Rates ◽

Morbidity And Mortality ◽

Hospital Death

Abstract Background Despite 15–17 millions of annual births in China, there is a paucity of information on prevalence and outcome of preterm birth. We characterized the outcome of preterm births and hospitalized preterm infants by gestational age (GA) in Huai’an in 2015, an emerging prefectural region of China. Methods Of 59,245 regional total births, clinical data on 2651 preterm births and 1941 hospitalized preterm neonates were extracted from Huai’an Women and Children’s Hospital (HWCH) and non-HWCH hospitals in 2018–2020. Preterm prevalence, morbidity and mortality rates were characterized and compared by hospital categories and GA spectra. Death risks of preterm births and hospitalized preterm infants in the whole region were analyzed with multivariable Poisson regression. Results The prevalence of extreme, very, moderate, late and total preterm of the regional total births were 0.14, 0.53, 0.72, 3.08 and 4.47%, with GA-specific neonatal mortality rates being 44.4, 15.8, 3.7, 1.5 and 4.3%, respectively. There were 1025 (52.8% of whole region) preterm admissions in HWCH, with significantly lower in-hospital death rate of inborn (33 of 802, 4.1%) than out-born (23 of 223, 10.3%) infants. Compared to non-HWCH, three-fold more neonates in HWCH were under critical care with higher death rate, including most extremely preterm infants. Significantly all-death risks were found for the total preterm births in birth weight < 1000 g, GA < 32 weeks, amniotic fluid contamination, Apgar-5 min < 7, and birth defects. For the hospitalized preterm infants, significantly in-hospital death risks were found in out-born of HWCH, GA < 32 weeks, birth weight < 1000 g, Apgar-5 min < 7, birth defects, respiratory distress syndrome, necrotizing enterocolitis and ventilation, whereas born in HWCH, antenatal glucocorticoids, cesarean delivery and surfactant use decreased the death risks. Conclusions The integrated data revealed the prevalence, GA-specific morbidity and mortality rate of total preterm births and their hospitalization, demonstrating the efficiency of leading referral center and whole regional perinatal-neonatal network in China. The concept and protocol should be validated in further studies for prevention of preterm birth.

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Spontaneous Preterm Birth: Is Prevention with Aspirin Possible?

Geburtshilfe und Frauenheilkunde ◽

10.1055/a-1226-6599 ◽

2021 ◽

Author(s):

Richard Berger ◽

Ioannis Kyvernitakis ◽

Holger Maul

Keyword(s):

Preterm Birth ◽

Low Dose ◽

Randomized Study ◽

Preterm Births ◽

Spontaneous Preterm Birth ◽

Dose Aspirin ◽

Nulliparous Women ◽

Low Dose Aspirin ◽

Secondary Analyses ◽

Double Blinded

Abstract Background The rate of preterm births in Germany is 8.6%, which is very high compared to other European countries. As preterm birth contributes significantly to perinatal morbidity and mortality rates, the existing prevention strategies need to be optimized and expanded further. About ⅔ of all women with preterm birth have preterm labor or premature rupture of membranes. They are bracketed together under the term “spontaneous preterm birth” as opposed to iatrogenic preterm birth, for example as a consequence of preeclampsia or fetal growth retardation. Recent studies suggest that low-dose aspirin does not just reduce the rate of iatrogenic preterm births but can also further reduce the rate of spontaneous preterm births. This review article presents the current state of knowledge. Method A selective literature search up until April 2020 was done in PubMed, using the terms “randomized trial”, “randomized study”, “spontaneous preterm birth”, and “aspirin”. Results Secondary analyses of prospective randomized studies on the prevention of preeclampsia with low-dose aspirin show that this intervention also significantly reduced the rate of spontaneous preterm births in both high-risk and low-risk patient populations. The results of the ASPIRIN trial, a prospective, randomized, double-blinded multicenter study carried out in six developing countries, also point in this direction, with the figures showing that the daily administration of 81 mg aspirin starting before 14 weeks of gestation lowered the preterm birth rate of nulliparous women without prior medical conditions by around 11% (11.6 vs. 13.1%; RR 0.89; 95% CI: 0.81 – 0.98, p = 0.012). Conclusion Further studies on this issue are urgently needed. If these confirm the currently available results, then it would be worth discussing whether general aspirin prophylaxis for all pregnant women starting at the latest in 12 weeks of gestation is indicated.

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Magnitude of spontaneous preterm birth and its associated factors among preterm birth in NICU wards in Asella Teaching and Referral Hospital, Asella, Oromia, Ethiopia

Journal of International Medical Research ◽

10.1177/03000605211034693 ◽

2021 ◽

Vol 49 (8) ◽

pp. 030006052110346

Author(s):

Techane Sisay Tuji ◽

Addisu Dabi Wake ◽

Gezahegn Badeg Adere ◽

Aselefu Beka Wedajo ◽

Batu Dekeba Obole ◽

...

Keyword(s):

Risk Factors ◽

Preterm Birth ◽

Healthcare Providers ◽

Preterm Births ◽

Cross Sectional Study ◽

Spontaneous Preterm Birth ◽

Related Factors ◽

Cross Sectional ◽

Bivariate Logistic Regression ◽

Associated Risk Factors

Objective To assess the prevalence of spontaneous preterm births and to identify the associated risk factors. Methods This single-centre cross-sectional study enrolled women that experienced a preterm birth as registered on the neonatal log-book between 30 December 2019 and 30 December 2020. A pre-tested structured checklist was used to collect data (sociodemographic characteristics; obstetric-related factors; medical history; and pregnancy-related factors). Bivariate logistic regression analyses were applied to identify factors associated with spontaneous preterm birth. A multivariate model identified significant independent risk factors. Results A total of 310 patients participated in the study. The prevalence of spontaneous preterm birth in this population was 67.1% (208 of 310; 95% confidence interval [CI] 61.5, 71.9). Patients without a partner (adjusted odds ratio [AOR] = 1.470, 95% CI 1.23, 4.42), patients residing in a rural area (AOR = 2.51, 95% CI 1.123, 5.513) and those with a history of PIH during their current pregnancy (AOR = 0.104, 95% CI 0.053, 0.014) were significantly more likely to have a spontaneous preterm birth. Conclusion The prevalence of spontaneous preterm birth in in this study was high. Healthcare providers and all stakeholders should focus on screening pregnant women at the risk of spontaneous preterm birth.

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Impact of smoking and fetal gender on preterm delivery

Journal of Developmental Origins of Health and Disease ◽

10.1017/s2040174420000999 ◽

2020 ◽

pp. 1-6

Author(s):

Veronika Günther ◽

Ibrahim Alkatout ◽

Alexandra Stein ◽

Nicolai Maass ◽

Alexander Strauss ◽

...

Keyword(s):

Risk Factors ◽

Preterm Birth ◽

Preterm Delivery ◽

Preterm Infants ◽

Preterm Births ◽

World Health ◽

Smoking During Pregnancy ◽

Fetal Gender ◽

Extremely Preterm ◽

Heavy Smokers

Abstract According to the World Health Organization, smoking is the most important risk factor for adverse pregnancy outcomes in industrialized nations. We aimed to establish how fetal gender and smoking interact with regard to perinatal outcomes, especially preterm delivery. Data from 220,339 singleton pregnancies, obtained from the German Perinatal Survey in Schleswig-Holstein and registered between 2004 and 2017 were analyzed in regard to smoking behavior, fetal gender, and preterm delivery. The rate of preterm births was directly proportional to the women’s consumption of nicotine. The rate of preterm deliveries was 6.8% among nonsmokers, and 13.2% in women who were very heavy smokers (≥22 cigarettes/day). Very heavy smoking (≥22 cigarettes/day) had a marked impact on extremely preterm births (<28 weeks of gestation) and very preterm births (28–31 weeks of gestation). Preterm births increased by 1.2% from heavy smokers to very heavy smokers; the differences between the other groups ranged between 0.1% and 0.4%. Fetal gender also had an impact on preterm birth: male infants were predominant in nearly all groups of women who delivered preterm infants. Smoking during pregnancy and male gender are both risk factors for preterm delivery. Fetal gender should be given greater attention as one of the several risk factors of preterm birth. Due to the high rate of morbidity among preterm infants and enormous costs for the healthcare system, women should be encouraged to cease or at least reduce smoking during pregnancy.

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Telomeres and replicative cellular aging of the human placenta and chorioamniotic membranes

Scientific Reports ◽

10.1038/s41598-021-84728-2 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Tsung-Po Lai ◽

Mark Simpson ◽

Krunal Patel ◽

Simon Verhulst ◽

Jungsik Noh ◽

...

Keyword(s):

Dna Damage ◽

Preterm Birth ◽

Telomere Length ◽

Human Placenta ◽

Replicative Senescence ◽

Preterm Births ◽

Full Term ◽

Cellular Aging ◽

Telomere Dysfunction ◽

Replicative Aging

AbstractRecent hypotheses propose that the human placenta and chorioamniotic membranes (CAMs) experience telomere length (TL)-mediated senescence. These hypotheses are based on mean TL (mTL) measurements, but replicative senescence is triggered by short and dysfunctional telomeres, not mTL. We measured short telomeres by a vanguard method, the Telomere shortest length assay, and telomere-dysfunction-induced DNA damage foci (TIF) in placentas and CAMs between 18-week gestation and at full-term. Both the placenta and CAMs showed a buildup of short telomeres and TIFs, but not shortening of mTL from 18-weeks to full-term. In the placenta, TIFs correlated with short telomeres but not mTL. CAMs of preterm birth pregnancies with intra-amniotic infection showed shorter mTL and increased proportions of short telomeres. We conclude that the placenta and probably the CAMs undergo TL-mediated replicative aging. Further research is warranted whether TL-mediated replicative aging plays a role in all preterm births.

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Investigation of Metronidazole Use during Pregnancy and Adverse Birth Outcomes

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.06477-11 ◽

2012 ◽

Vol 56 (9) ◽

pp. 4800-4805 ◽

Cited By ~ 46

Author(s):

Catherine A. Koss ◽

Dana C. Baras ◽

Sandra D. Lane ◽

Richard Aubry ◽

Michele Marcus ◽

...

Keyword(s):

New York ◽

Birth Weight ◽

Preterm Birth ◽

Low Birth Weight ◽

Congenital Anomalies ◽

New York State ◽

Multivariable Analysis ◽

Preterm Births ◽

First Trimester ◽

First Trimester Of Pregnancy

ABSTRACTTo assess whether treatment with metronidazole during pregnancy is associated with preterm birth, low birth weight, or major congenital anomalies, we conducted chart reviews and an analysis of electronic data from a cohort of women delivering at an urban New York State hospital. Of 2,829 singleton/mother pairs, 922 (32.6%) mothers were treated with metronidazole for clinical indications, 348 (12.3%) during the first trimester of pregnancy and 553 (19.5%) in the second or third trimester. There were 333 (11.8%) preterm births, 262 (9.3%) infants of low birth weight, and 52 infants (1.8%) with congenital anomalies. In multivariable analysis, no association was found between metronidazole treatment and preterm birth (odds ratio [OR], 1.02 [95% confidence interval [CI], 0.80 to 1.32]), low birth weight (OR, 1.05 [95% CI, 0.77 to 1.43]), or treatment in the first trimester and congenital anomalies (OR, 0.86 [0.30 to 2.45]). We found no association between metronidazole treatment during the first or later trimesters of pregnancy and preterm birth, low birth weight, or congenital anomalies.

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