618Is mode of first birth a risk factor for subsequent preterm birth?

Abstract Background Previous preterm birth is a strong predictor of subsequent preterm birth but less is known about the causes of preterm birth following a full-term pregnancy. Recent research highlighted previous caesarean as a potential risk factor and we aimed to further explore this risk. Methods This population-based record linkage study included all women in NSW, Australia who had a live singleton first birth at ≥ 37 weeks gestation, followed by a singleton second birth between 2005–2017. Relative risk (RR) and 95%CI of having a subsequent preterm birth, spontaneous preterm birth or preterm pre-labour caesarean was calculated using individual modified Poisson regression models, with mode of first birth as the exposure. Results Women who had an intrapartum (RR:1.26, 95%CI 1.19–1.32) or prelabour caesarean (RR:1.26,95%CI 1.18–1.35) first birth had a higher risk of subsequent preterm birth, than those who birthed vaginally. Those who had a pre-labour caesarean (RR:0.74, 95%CI 0.67–0.82) had a lower risk of subsequent spontaneous preterm birth. However, prior pre-labour caesarean also greatly increased the risk of subsequent preterm prelabour caesarean (RR:5.25, 95%CI 4.65–5.93). Conclusions Pre-labour and intrapartum caesareans have differing effects on the risk of subsequent spontaneous preterm birth and preterm pre-labour caesarean. Key messages The risk of subsequent preterm birth following a first birth caesarean depends on whether the caesarean occurred before or after the onset of labour and whether the subsequent preterm birth is spontaneous or a pre-labour caesarean.

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Corrigendum to “Is IVF/ICSI an Independent Risk Factor for Spontaneous Preterm Birth in Singletons? A Population-Based Cohort Study”

BioMed Research International ◽

10.1155/2019/4940314 ◽

2019 ◽

Vol 2019 ◽

pp. 1-1

Author(s):

Nina Jančar ◽

Barbara Mihevc Ponikvar ◽

Sonja Tomšič ◽

Eda Vrtačnik Bokal ◽

Sara Korošec

Keyword(s):

Risk Factor ◽

Cohort Study ◽

Preterm Birth ◽

Independent Risk Factor ◽

Population Based ◽

Spontaneous Preterm Birth

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Bacterial vaginosis in early pregnancy is associated with low birth weight and small for gestational age, but not with spontaneous preterm birth: A population-based study on Danish women

The Journal of Maternal-Fetal & Neonatal Medicine ◽

10.1080/14767050500361604 ◽

2006 ◽

Vol 19 (1) ◽

pp. 1-7 ◽

Cited By ~ 15

Author(s):

Poul Thorsen ◽

Ida Vogel ◽

Jørn Olsen ◽

Bernard Jeune ◽

Jes G. Westergaard ◽

...

Keyword(s):

Birth Weight ◽

Preterm Birth ◽

Low Birth Weight ◽

Bacterial Vaginosis ◽

Early Pregnancy ◽

Gestational Age ◽

Small For Gestational Age ◽

Population Based ◽

Spontaneous Preterm Birth ◽

Population Based Study

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Country of first birth and neonatal outcomes in migrant and Norwegian-born parous women in Norway: a population-based study

10.21203/rs.2.19047/v1 ◽

2019 ◽

Author(s):

Eline Skirnisdottir Vik ◽

Roy Miodini Nilsen ◽

Vigdis Aasheim ◽

Rhonda Small ◽

Dag Moster ◽

...

Keyword(s):

Preterm Birth ◽

Population Based ◽

Neonatal Outcomes ◽

Migrant Women ◽

First Birth ◽

Population Based Study ◽

Very Preterm ◽

Very Preterm Birth ◽

Adverse Neonatal Outcomes ◽

Moderately Preterm

Abstract Background: This study compares subsequent birth outcomes in migrant women who had already had a child before arriving in Norway with those in migrant women whose first birth occurred in Norway. The aim of this study was to investigate the associations between country of first birth and adverse neonatal outcomes (very preterm birth, moderately preterm birth, post-term birth, small for gestational age, large for gestational age, low Apgar score, stillbirth and neonatal death) in parous migrant and Norwegian-born women. Methods: National population-based study including second and subsequent singleton births in Norway from 1990-2016. Data were retrieved from the Medical Birth Registry of Norway and Statistics Norway. Neonatal outcomes were compared between births to: 1) migrant women with a first birth before immigration to Norway (n=30,062) versus those with a first birth after immigration (n=66,006), and 2) Norwegian-born women with a first birth outside Norway (n=6,205) versus those with a first birth in Norway (n=514,799). Associations were estimated as crude and adjusted odds ratios (aORs) with 95% confidence intervals (CIs) using multiple logistic regression. Results: Migrant women with a first birth before immigrating to Norway had increased odds of adverse outcomes in subsequent births relative to those with a first birth after immigration: very preterm birth (22-31 gestational weeks (gwks); aOR=1.27; CI 1.09-1.48), moderately preterm birth (32-36 gwks; aOR=1.10; CI 1.02-1.18), post-term birth (≥42 gwks; aOR=1.19; CI 1.11-1.27), low Apgar score (<7 at 5 minutes; aOR=1.27; CI 1.16-1.39) and stillbirth (aOR=1.29; CI 1.05-1.58). Similar results were found in the sample of births to Norwegian-born women. Conclusions: The increased odds of adverse neonatal outcomes for migrant and Norwegian-born women who had their first births outside Norway should serve as a reminder of the importance of taking a careful obstetric history in these parous women to ensure appropriate care for their subsequent pregnancies and births in Norway. Keywords: immigration, parous women, neonatal outcomes, obstetric history, predictor

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Labor Dystocia and Risk of Histological Chorioamnionitis and Funisitis: A Study from a Single Tertiary Referral Center

10.21203/rs.3.rs-120941/v1 ◽

2020 ◽

Author(s):

Hyo Kyozuka ◽

Tuyoshi Murata ◽

Toma Fukuda ◽

Shun Yasuda ◽

Aya Kanno ◽

...

Keyword(s):

Risk Factor ◽

Preterm Birth ◽

Confidence Interval ◽

Umbilical Cord ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Neonatal Outcomes ◽

Spontaneous Preterm Birth ◽

Labor Dystocia

Abstract Background: Intrauterine inflammation affects short- and long-term neonatal outcomes. Histological chorioamnionitis and funisitis are acute inflammatory responses in the fetal membranes and umbilical cord, respectively. Although labor dystocia includes a potential risk of intrauterine inflammation, the risk of labor dystocia in histological chorioamnionitis and funisitis has not been evaluated yet. This study aimed to examine the association between labor dystocia and risk of histological chorioamnionitis and funisitis.Methods: In this retrospective cohort study, the patients who underwent histopathological examinations of the placenta and umbilical cord at Fukushima Medical University Hospital, Japan, between 2015 and 2020, were included. From the dataset, the pathological findings of the patients with labor dystocia and spontaneous preterm birth were reviewed. Based on the location of leukocytes, the inflammation in the placenta (histological chorioamnionitis) and umbilical cord (funisitis) was graded as 0–3. Multiple logistic regression analysis was performed to evaluate the risk of histological chorioamnionitis, histological chorioamnionitis stage ≥2, funisitis, and funisitis stage ≥2.Result: Of 317 women who met the study criteria, 83 and 144 women had labor dystocia and spontaneous preterm birth, respectively, and 90 women were included as controls. Labor dystocia was a risk factor for histological chorioamnionitis (adjusted odds ratio, 6.3; 95% confidential interval, 1.9-20.5), histological chorioamnionitis stage ≥2 (adjusted odds ratio, 6.0; 95% confidence interval, 1.7-21.8), funisitis (adjusted odds ratio, 9.4; 95% confidence interval, 1.8-48.2), and funisitis stage ≥2 (adjusted odds ratio, 23.5; 95% confidence interval, 2.3-23.8). Spontaneous preterm birth was also a risk factor for histological chorioamnionitis (adjusted odds ratio, 3.7; 95% confidence interval, 1.7-7.8), histological chorioamnionitis stage ≥2 (adjusted odds ratio, 3.0; 95% confidence interval, 1.2-7.9), and funisitis (adjusted odds ratio, 4.5; 95% confidence interval, 1.2-16.8). However, the adjusted odds ratio was smaller in spontaneous preterm births than in labor dystocia. Conclusion: Labor dystocia is a risk factor for severe histological chorioamnionitis and funisitis. Further studies are required to evaluate the effects of histological chorioamnionitis and funisitis on long-term neonatal outcomes.

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Eligibility, Utilization, and Effectiveness of 17-Alpha Hydroxyprogesterone Caproate (17OHPC) in a Statewide Population-Based Cohort of Medicaid Enrollees

American Journal of Perinatology ◽

10.1055/s-0041-1739504 ◽

2021 ◽

Author(s):

Xi Wang ◽

Stephanie M. Garcia ◽

Katherine S. Kellom ◽

Rupsa C. Boelig ◽

Meredith Matone

Keyword(s):

Preterm Birth ◽

Neonatal Intensive Care ◽

Population Based ◽

Primary Objective ◽

Birth Certificates ◽

Spontaneous Preterm Birth ◽

Initiation Rate ◽

Live Births ◽

Hydroxyprogesterone Caproate ◽

Comparison Groups

Objectives The primary objective was to estimate the initiation and adherence rates of 17 α-hydroxyprogesterone caproate (17OHPC) among eligible mothers in a statewide population-based cohort of Medicaid enrollees. The secondary objectives were to (1) determine the association of maternal sociodemographic and clinical characteristics with 17OHPC utilization and (2) assess the real-world effectiveness of 17OHPC on recurrent preterm birth prevention and admission to neonatal intensive care unit (NICU). Study Design This is a retrospective cohort study using a linked, longitudinal administrative dataset of birth certificates and medical assistance claims. Medicaid-enrolled mothers in Pennsylvania were included in this study if they had at least one singleton live birth from 2014 to 2016 following at least one spontaneous preterm birth. Maternal Medicaid claims were used to ascertain the use of 17OHPC from various manufacturers, including compounded formulations. Propensity score matching was used to create a covariate balance between 17OHPC treatment and comparison groups. Results We identified 4,781 Medicaid-covered 17OHPC-eligible pregnancies from 2014 to 2016 in Pennsylvania, 3.4% of all Medicaid-covered singleton live births. The population-based initiation rate was 28.5% among eligible pregnancies. Among initiators, 50% received ≥16 doses as recommended, while 10% received a single dose only. The severity of previous spontaneous preterm birth was the strongest predictor for the initiation and adherence of 17OHPC. In the matched treatment (n = 1,210) and comparison groups (n = 1,210), we found no evidence of 17OHPC effectiveness. The risks of recurrent preterm birth (relative risk [RR] 1.10, 95% confidence interval [CI] 0.97–1.24) and births admitted to NICU (RR 1.00, 95% CI 0.84–1.18) were similar in treated and comparison mothers. Conclusion The 17OHPC-eligible population represented 3.4% of singleton live births. Less than one-third of eligible mothers initiated treatment. Among initiators, 50% were treatment adherent. We found no difference in the risk of recurrent preterm birth or admission to NICU between treatment and comparison groups. Key Points

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Abstract 08: Preterm Delivery and Maternal Cardiovascular Risk Factor Trajectories across the Life Course

Circulation ◽

10.1161/circ.135.suppl_1.08 ◽

2017 ◽

Vol 135 (suppl_1) ◽

Author(s):

Amanda R Markovitz ◽

Eirin B Haug ◽

Julie Horn ◽

Abigail Fraser ◽

Corrie Macdonald-Wallis ◽

...

Keyword(s):

Blood Pressure ◽

Risk Factor ◽

Cardiovascular Risk ◽

Preterm Birth ◽

Life Course ◽

Preterm Delivery ◽

First Birth ◽

Birth Registry ◽

Hs Crp ◽

The Life Course

Introduction: Preterm delivery (<37 weeks) predicts 2 to 3-fold greater risk of cardiovascular disease in mothers. Development of subclinical cardiovascular risk in these women prior to and following pregnancy is not well understood. Hypothesis: Women who deliver preterm have an adverse cardiovascular health profile even prior to pregnancy. Methods: Linked data from the population-based, longitudinal HUNT study (1984-2008) and the Medical Birth Registry of Norway (1967-2012) yielded clinical measurements and pregnancy outcomes for 23,179 parous women. Women had up to 3 measurements of body mass index, waist circumference, blood pressure, non-fasting lipids and glucose, and high-sensitivity C-reactive protein (hs-CRP) during a follow-up period between 20 years before first birth to 41 years after first birth. We used mixed effects linear spline models, adjusting for age, pre-pregnancy smoking, education, and time since last meal, to compare risk factor trajectories for women with preterm versus term/postterm first births. Results: Women with a preterm first birth (n=1,402, 6%) had significantly higher triglyceride (Figure 1 A) and glucose levels prior to pregnancy. They also experienced steeper increases in systolic and diastolic blood pressure, non-HDL cholesterol, triglycerides, and hs-CRP from first birth to age 50 compared to women who delivered at term/post-term (Figure 1 A,B). Measures of adiposity were similar throughout the life course. Conclusions: These results are consistent with the hypothesis that preterm birth is an early marker of cardiometabolic impairment. A history of preterm birth may predict high cardiovascular risk well before the development of traditional risk factors.

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