Marijuana Use during Pregnancy and Preterm Birth: A Prospective Cohort Study

2020 ◽  
Author(s):  
Mark A. Klebanoff ◽  
Diana G. Wilkins ◽  
Sarah A. Keim
Keyword(s):  
Cohort Study ◽  
Preterm Birth ◽  
Relative Risk ◽  
High Risk ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Marijuana Use ◽  
Adjusted Relative Risk ◽  
Spontaneous Preterm Birth ◽  
Increased Risk

Objective The aim of this study is to estimate the association between marijuana use during pregnancy and total, spontaneous and indicated preterm birth. Study Design Prospective cohort study of women receiving antenatal care at The Ohio State University from 2010 to 2015. Marijuana use was assessed by questionnaire, record abstraction, and urine toxicology. Women were followed through the end of pregnancy. Relative risks were assessed with Poisson regression and time to delivery with proportional hazard models. Results Of 363 eligible women, 119 (33%) used marijuana in pregnancy by at least one measure. In this high-risk cohort, preterm birth occurred to 36.0% of users and 34.6% of nonusers (p = 0.81). The unadjusted relative risk of all preterm birth was 1.06 (95% confidence interval [CI]: 0.76–1.47); the adjusted relative risk was similar 1.04 (95% CI: 0.72–1.50). Spontaneous preterm birth was nonsignificantly elevated among users before 1.32 (95% CI: 0.89–1.96), and after 1.21 (95% CI: 0.76–1.94) adjustment. Indicated preterm birth was nonsignificantly reduced before 0.52 (95% CI: 0.22–1.23) and after 0.75 (95% CI: 0.29–2.15) adjustment. The unadjusted hazard ratio (HR) for time to preterm birth was 1.26 (95% CI: 0.84–2.00); the adjusted HR was 1.32 (95% CI: 0.80–2.07). Both unadjusted 1.77 (95% CI: 1.06–2.93) and adjusted 2.16 (95% CI: 1.16–4.02) HRs for spontaneous preterm birth were significantly elevated, primarily due to an increased risk of spontaneous birth <28 weeks among users. The unadjusted and adjusted HRs for time to indicated preterm birth were 0.69 (95% CI: 0.33–1.43) and 0.58 (95% CI: 0.23–1.46). Conclusion Marijuana use was not associated with total preterm birth in this cohort, suggesting that among women already at high risk of preterm birth, marijuana does not increase risk further. However, there was a suggestion that pregnant women who use marijuana may deliver earlier, particularly from spontaneous preterm birth, than women who do not use marijuana.

scholarly journals Accelerated Fetal Growth in Early Pregnancy and Risk of Preterm Birth: A Prospective Cohort Study

2020 ◽  
Author(s):  
Evangelia Elenis ◽  
Anna-Karin Wikström ◽  
Marija Simic
Keyword(s):  
Cohort Study ◽  
Preterm Birth ◽  
Prospective Cohort Study ◽  
Fetal Growth ◽  
Early Pregnancy ◽  
Prospective Cohort ◽  
Late Gestation ◽  
Second Trimester ◽  
Spontaneous Preterm Birth ◽  
Increased Risk

Abstract Background: Preterm birth (occurring before 37 completed weeks of gestation) affects 15 million infants annually, 7.5% of which die due to related complications. The detection and early diagnosis are therefore paramount in order to prevent the development of prematurity and its consequences. So far, focus has been laid on the association between reduced intrauterine fetal growth during late gestation and prematurity. The aim of the current study was to investigate the association between accelerated fetal growth in early pregnancy and the risk of preterm birth. Methods: This prospective cohort study included 69 617 singleton pregnancies without congenital malformations and with available biometric measurements during the first and second trimester. Estimation of fetal growth was based on measurements of biparietal diameter (BPD) at first and second trimester scan. We investigated the association between accelerated fetal growth and preterm birth prior to 37 weeks of gestation. The outcome was further stratified into very preterm birth (before 32 weeks of gestation) or moderate preterm birth (between 32 and 37 weeks of gestation) and medically induced or spontaneous preterm birth and was further explored. Results: The odds of prematurity were increased among fetuses with accelerated BPD growth (> 90th centile) estimated between first and second ultrasound scan, even after adjustment for possible confounders (aOR 1.36; 95% CI 1.20-1.54). The findings remained significant what regards moderate preterm births but not earlier births. Regarding medically induced preterm birth, the odds were found to be elevated in the group of fetuses with accelerated growth in early pregnancy (aOR 1.34; 95% CI 1.11-1.63). On the contrary, fetuses with delayed fetal growth exhibited lower risk for both overall and spontaneous preterm birth.Conclusions: Fetuses with accelerated BPD growth in early pregnancy, detected by ultrasound examination during the second trimester, exhibited increased risk of being born preterm. The findings of the current study suggest that fetal growth in early pregnancy should be taken into account when assessing the likelihood for preterm birth.

scholarly journals Accelerated fetal growth in early pregnancy and risk of preterm birth: a prospective cohort study

2020 ◽  
Author(s):  
Evangelia Elenis ◽  
Anna-Karin Wikström ◽  
Marija Simic
Keyword(s):  
Cohort Study ◽  
Preterm Birth ◽  
Prospective Cohort Study ◽  
Fetal Growth ◽  
Early Pregnancy ◽  
Prospective Cohort ◽  
Preterm Births ◽  
Second Trimester ◽  
Spontaneous Preterm Birth ◽  
Very Preterm

Abstract Background: Preterm birth (occurring before 37 completed weeks of gestation) affects 15 million infants annually, 7.5% of which die due to related complications. The detection and early diagnosis are therefore paramount in order to prevent the development of prematurity and its consequences. So far, focus has been laid on the association between reduced intrauterine fetal growth during late gestation and prematurity. The aim of the current study was to investigate the association between accelerated fetal growth in early pregnancy and the risk of preterm birth. Methods: This prospective cohort study included 69 617 singleton pregnancies without congenital malformations and with available biometric measurements during the first and second trimester. Estimation of fetal growth was based on measurements of biparietal diameter (BPD) at first and second trimester scan. We investigated the association between accelerated fetal growth and preterm birth prior to 37 weeks of gestation. The outcome was further stratified into very preterm birth (before 32 weeks of gestation) or moderate preterm birth (between 32 and 37 weeks of gestation) and medically induced or spontaneous preterm birth and was further explored. Results: The odds of prematurity were increased among fetuses with accelerated BPD growth (> 90th centile) estimated between first and second ultrasound scan, even after adjustment for possible confounders (aOR 1.36; 95% CI 1.20-1.54). The findings remained significant what regards moderate preterm births but not very preterm births. Regarding medically induced preterm birth, the odds were found to be elevated in the group of fetuses with accelerated growth in early pregnancy (aOR 1.34; 95% CI 1.11-1.63). On the contrary, fetuses with delayed fetal growth exhibited lower odds for both overall and spontaneous preterm birth.Conclusions: Fetuses with accelerated BPD growth in early pregnancy, detected by ultrasound examination during the second trimester, exhibited increased odds of being born preterm. The findings of the current study suggest that fetal growth in early pregnancy should be taken into account when assessing the risk for preterm birth.

scholarly journals Improving Utilization of Aspirin for Prevention of Preeclampsia in a High-Risk Urban Cohort: A Prospective Cohort Study

2020 ◽  
Author(s):  
Rupsa C. Boelig ◽  
Mariam Wanees ◽  
Tingting Zhan ◽  
Vincenzo Berghella ◽  
Amanda Roman
Keyword(s):  
Cohort Study ◽  
Preterm Birth ◽  
High Risk ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Screening Tool ◽  
Adjusted Risk ◽  
High Risk Patients ◽  
Risk Patients ◽  
One Year

Objective This study aimed to evaluate the utilization of aspirin for preeclampsia prevention before and after implementation of a screening tool during nuchal translucency (NT) ultrasound. Study Design One-year prospective cohort study of patients at high risk for preeclampsia after the implementation of a screening tool (postscreen) administered to all patients at check in for NT (11–13 weeks) ultrasound. Prospective cohort was compared with one-year retrospective cohort (prescreen) the year prior (2017). All patients who presented for NT ultrasound in both cohorts were evaluated for the presence of one or more risk factor for preeclampsia with screening tool collected prospectively and chart review retrospectively. Provider recommendation for aspirin determined by documentation in prenatal record. Primary outcome was rate of provider recommendation for aspirin pre versus post screening tool, compared by Chi-square test and adjusted for potential confounders with multiple regression analysis. Results Pre- (n = 156) and postscreen (n = 136) cohorts were similar except for race and multifetal gestation. Prescreen, rate of provider recommendation for aspirin was 74%. Of those with prior preeclampsia, 96% were recommended aspirin, compared with 64% of patients with other risk factors (p < 0.001). Postscreen, provider recommendation of aspirin improved to 95% (p < 0.001). Rate of preeclampsia/gestational hypertension were similar between cohorts; however, there was a reduced adjusted risk in overall preterm birth <37 weeks (adjusted odds ratio [aOR] = 0.50 [0.25–0.99]) and preterm birth <34 weeks (aOR = 0.33 [0.13–0.88]) postscreening tool implementation. Conclusion Prior to implementation of a simple screening questionnaire, approximately 25% of high risk patients did not receive the recommendation of aspirin for preeclampsia prevention. High-risk patients who lack a history of preeclampsia were less likely to be advised of aspirin prophylaxis. Use of a simple universal screening tool at time of NT ultrasound significantly improved utilization of aspirin for preeclampsia prevention and may improve patient outcomes. Key Points

scholarly journals The Predictive Value of the Cervical Consistency Index to Predict Spontaneous Preterm Birth in Asymptomatic Twin Pregnancies at the Second-Trimester Ultrasound Scan: A Prospective Cohort Study

2020 ◽  
Vol 9 (6) ◽  
pp. 1784
Author(s):  
Johannes van der Merwe ◽  
Isabel Couck ◽  
Francesca Russo ◽  
Xavier P. Burgos-Artizzu ◽  
Jan Deprest ◽  
...  
Keyword(s):  
Cohort Study ◽  
Preterm Birth ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Transvaginal Ultrasound ◽  
Characteristic Curve ◽  
Cervical Length ◽  
Consistency Index ◽  
Spontaneous Preterm Birth ◽  
Twin Pregnancies

Novel transvaginal ultrasound (TVU) markers have been proposed to improve spontaneous preterm birth (sPTB) prediction. Preliminary results of the cervical consistency index (CCI), uterocervical angle (UCA), and cervical texture (CTx) have been promising in singletons. However, in twin pregnancies, the results have been inconsistent. In this prospective cohort study of asymptomatic twin pregnancies assessed between 18+0–22+0 weeks, we evaluated TVU derived cervical length (CL), CCI, UCA, and the CTx to predict sPTB < 34+0 weeks. All iatrogenic PTB were excluded. In the final cohort of 63 pregnancies, the sPTB rate < 34+0 was 16.3%. The CCI, UCA, and CTx, including the CL was significantly different in the sPTB < 34+0 weeks group. The best area under the receiver operating characteristic curve (AUC) for sPTB < 34+0 weeks was achieved by the CCI 0.82 (95%CI, 0.72–0.93), followed by the UCA with AUC 0.72 (95%CI, 0.57–0.87). A logistic regression model incorporating parity, chorionicity, CCI, and UCA resulted in an AUC of 0.91 with a sensitivity of 55.3% and specificity of 88.1% for predicting sPTB < 34+0. The CCI performed better than other TVU markers to predict sPTB < 34+0 in twin gestations, and the best diagnostic accuracy was achieved by a combination of parity, chorionicity, CCI, and UCA.

Modified classification of Gram-stained vaginal smears to predict spontaneous preterm birth: a prospective cohort study

2007 ◽  
Vol 196 (6) ◽  
pp. 528.e1-528.e6 ◽  
Author(s):  
Hans Verstraelen ◽  
Rita Verhelst ◽  
Kristien Roelens ◽  
Geert Claeys ◽  
Steven Weyers ◽  
...  
Keyword(s):  
Cohort Study ◽  
Preterm Birth ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Spontaneous Preterm Birth ◽  
Vaginal Smears

scholarly journals Accelerated fetal growth in early pregnancy and risk of preterm birth: a prospective cohort study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Evangelia Elenis ◽  
Anna-Karin Wikström ◽  
Marija Simic
Keyword(s):  
Cohort Study ◽  
Preterm Birth ◽  
Prospective Cohort Study ◽  
Fetal Growth ◽  
Early Pregnancy ◽  
Prospective Cohort ◽  
Preterm Births ◽  
Second Trimester ◽  
Spontaneous Preterm Birth ◽  
Very Preterm

Abstract Background Preterm birth (occurring before 37 completed weeks of gestation) affects 15 million infants annually, 7.5% of which die due to related complications. The detection and early diagnosis are therefore paramount in order to prevent the development of prematurity and its consequences. So far, focus has been laid on the association between reduced intrauterine fetal growth during late gestation and prematurity. The aim of the current study was to investigate the association between accelerated fetal growth in early pregnancy and the risk of preterm birth. Methods This prospective cohort study included 69,617 singleton pregnancies without congenital malformations and with available biometric measurements during the first and second trimester. Estimation of fetal growth was based on measurements of biparietal diameter (BPD) at first and second trimester scan. We investigated the association between accelerated fetal growth and preterm birth prior to 37 weeks of gestation. The outcome was further stratified into very preterm birth (before 32 weeks of gestation) or moderate preterm birth (between 32 and 37 weeks of gestation) and medically induced or spontaneous preterm birth and was further explored. Results The odds of prematurity were increased among fetuses with accelerated BPD growth (> 90th centile) estimated between first and second ultrasound scan, even after adjustment for possible confounders (aOR 1.36; 95% CI 1.20–1.54). The findings remained significant what regards moderate preterm births but not very preterm births. Regarding medically induced preterm birth, the odds were found to be elevated in the group of fetuses with accelerated growth in early pregnancy (aOR 1.34; 95% CI 1.11–1.63). On the contrary, fetuses with delayed fetal growth exhibited lower odds for both overall and spontaneous preterm birth. Conclusions Fetuses with accelerated BPD growth in early pregnancy, detected by ultrasound examination during the second trimester, exhibited increased odds of being born preterm. The findings of the current study suggest that fetal growth in early pregnancy should be taken into account when assessing the risk for preterm birth.

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