scholarly journals Clinical and economic utility of a preterm birth predictor derived from an analysis of a large and diverse pregnancy cohort

2021 ◽  
Author(s):  
Julja Burchard ◽  
Glenn R. Markenson ◽  
George R. Saade ◽  
Louise C. Laurent ◽  
Kent D. Heyborne ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Clinical Utility ◽  
Care Management ◽  
Intervention Study ◽  
Neonatal Morbidity ◽  
Mortality And Morbidity ◽  
Increased Risk ◽  
Multimodal Care ◽  
Hospital Stays ◽  
Risk Predictor

Objective Evaluate clinical utility and cost effectiveness of identifying pregnancies at increased risk of preterm birth using a validated proteomic biomarker risk predictor to enable proactive intervention Study Design Pregnancies at elevated risk (≥15%) of preterm birth were identified in a cohort from TREETOP (NCT02787213), a study independent of biomarker development. In the screening arm, higher-risk subjects received simulated interventions based on published efficacy of multimodal treatment or care-management alone. Subjects in the non-screening arm received no interventions. Neonatal and maternal length of stay, neonatal mortality and morbidity and neonatal costs were compared between arms. Results Multimodal/care-management modeled treatments predicted reductions in neonatal (30%/22%) and maternal (9.2%/8.5%) hospital stays, neonatal morbidity and mortality (41%/29%), and neonatal costs (34%/16%) for the screening vs. non-screening arm. Conclusion Modeled interventions applied to pregnancies identified as higher-risk by a proteomic biomarker risk predictor demonstrate clinically and economically meaningful improvements in neonatal and maternal outcomes. 

scholarly journals Clinical Validation of a Proteomic Biomarker Threshold for Increased Risk of Spontaneous Preterm Birth

2021 ◽  
Author(s):  
Julja Burchard ◽  
Ashoka D. Polpitiya ◽  
Angela C. Fox ◽  
Todd Randolph ◽  
Tracey C. Fleischer ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Observational Study ◽  
Preterm Births ◽  
The United States ◽  
Elevated Risk ◽  
Clinical Validation ◽  
Spontaneous Preterm Birth ◽  
Effective Interventions ◽  
Increased Risk ◽  
Risk Predictor

AbstractPreterm births are prevalent and a leading cause of neonatal death in the United States. Despite the availability of effective interventions, to date there is not a robust and widely applicable test to identify pregnancies at high risk for spontaneous preterm birth (sPTB). Previously, a sPTB predictor based on the ratio of two proteins, IBP4/SHBG, was validated as an accurate predictor of sPTB in the observational study Proteomic Assessment of Preterm Risk (PAPR). Here it is demonstrated that the same predictor threshold associated with 2-fold increased risk of sPTB, namely −1.4, is also statistically significant for predicting elevated risk of sPTB in the observational study Multicenter Assessment of a Spontaneous Preterm Birth Risk Predictor (TreeToP).

scholarly journals The impact of interpregnancy interval on occurance of preterm births in the present pregnancy

2021 ◽  
Vol 10 (5) ◽  
pp. 2020
Author(s):  
Balaji Thanjavur Elumalai ◽  
Vaishnavi Govindarajan
Keyword(s):  
Preterm Birth ◽  
Preterm Births ◽  
Neonatal Morbidity ◽  
P Value ◽  
Interpregnancy Interval ◽  
Maternal Characteristics ◽  
Increased Risk ◽  
Pregnancy Intervals ◽  
The Impact ◽  
Present Pregnancy

Background: The pregnancy outcomes are influenced by the inter pregnancy intervals. Both short and long inter pregnancy intervals are known to adversely affect the mother and the baby. The main aim of birth spacing was to achieve ideal inter pregnancy intervals and thus to decrease maternal, neonatal morbidity and mortality.Methods: It is a prospective observational study. In this study, about 500 gravida 2 women who has delivered vaginally in the index pregnancy, with gestational age more than 28 weeks of gestation and with known interpregnancy interval were included in the study. They followed up to to delivery and occurance of preterm births in relation to maternal characteristics and interpregnancy interval were analysed.Results: Our study showed that Inter pregnancy intervals of 18-24 months were found to have the least number of preterm births when compared to intervals <18 months and >24 months. This association was found to be statistically significant (p value, Pearson chi square 0.0008). This relationship between inter pregnancy intervals and preterm births persisted when stratified according to maternal age, education, residence and BMI.A previous preterm birth was associated with increased risk of recurrent preterm birth (p value -0.034) and was statistically significant. The history of PROM in present pregnancy associated with preterm birth (p value -0.001) and association was statistically significant.Conclusions: From this study it was found that the 18-24 months birth to pregnancy interval is associated with the least incidence of preterm births. 

Prediction of preterm birth: the role cervical assessment by ultrasound and cervico-vaginal biomarkers

2020 ◽  
Author(s):  
Giuseppe Rizzo ◽  
Ilenia Mappa Mappa ◽  
Victoria Bitsadze ◽  
Jamilya Khizroeva ◽  
Alexander Makatsariya
Keyword(s):  
Preterm Birth ◽  
Neonatal Morbidity ◽  
Cervical Length ◽  
Fetal Fibronectin ◽  
Neonatal Deaths ◽  
A Value ◽  
Increased Risk ◽  
Asymptomatic Women

Preterm delivery (PTB) is one of the most common and serious complications of pregnancy. PTB accounts for approximately 70% of neonatal deaths and is a major cause of neonatal morbidity including respiratory distress syndrome, necrotising enterocolitis and long-term neurological disabilities. Prevention of PTB and its complications include identification among symptomatic women those at high risk of immediate delivery requiring prenatal corticosteroids administration. Transvaginal ultrasonographic evaluation of the cervical length (CL) is predictive of PTB and a value 15 mm identifies among symptomatic women approximately 70% of women who will deliver within one week. In the range of CL within 15 and 30 mm biomarkers n cervical-vaginal fluids (fetal fibronectin, phosphorylated insulin-like growth factor protein-1, placental alpha-microglobulin-, cytokines) and other ultrasonographic cervical variables (posterior cervical angle, elastography) improve the identification of women at risk, In asymptomatic women CL can be applied as screening and has been proposed as a universal screening during the second trimester in singleton gestations. The finding of a CL25mm is associated with an increased risk of subsequent PTB with a sensitivity between 30 and 60% that is improved with the combination of biomarkers. Asymptomatic women with a CL 25mm should be offered vaginal progesterone treatment for the prevention of preterm birth and neonatal morbidity. The role of cerclage and pessary is still controversial. In this review we discuss the evidence-based role of ultrasonographic cervical assessment and cervicovaginal biomarkers in the prediction of PTB in symptomatic and asymptomatic women

scholarly journals Clinical Validation of a Proteomic Biomarker Threshold for Increased Risk of Spontaneous Preterm Birth and Associated Clinical Outcomes: A Replication Study

2021 ◽  
Vol 10 (21) ◽  
pp. 5088
Author(s):  
Julja Burchard ◽  
Ashoka D. Polpitiya ◽  
Angela C. Fox ◽  
Todd L. Randolph ◽  
Tracey C. Fleischer ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Preterm Births ◽  
Neonatal Morbidity ◽  
Fold Increase ◽  
The United States ◽  
Independent Study ◽  
Adverse Outcomes ◽  
Spontaneous Preterm Birth ◽  
Increased Risk ◽  
Adverse Pregnancy

Preterm births are the leading cause of neonatal death in the United States. Previously, a spontaneous preterm birth (sPTB) predictor based on the ratio of two proteins, IBP4/SHBG, was validated as a predictor of sPTB in the Proteomic Assessment of Preterm Risk (PAPR) study. In particular, a proteomic biomarker threshold of −1.37, corresponding to a ~two-fold increase or ~15% risk of sPTB, significantly stratified earlier deliveries. Guidelines for molecular tests advise replication in a second independent study. Here we tested whether the significant association between proteomic biomarker scores above the threshold and sPTB, and associated adverse outcomes, was replicated in a second independent study, the Multicenter Assessment of a Spontaneous Preterm Birth Risk Predictor (TREETOP). The threshold significantly stratified subjects in PAPR and TREETOP for sPTB (p = 0.041, p = 0.041, respectively). Application of the threshold in a Kaplan–Meier analysis demonstrated significant stratification in each study, respectively, for gestational age at birth (p < 001, p = 0.0016) and rate of hospital discharge for both neonate (p < 0.001, p = 0.005) and mother (p < 0.001, p < 0.001). Above the threshold, severe neonatal morbidity/mortality and mortality alone were 2.2 (p = 0.0083,) and 7.4-fold higher (p = 0.018), respectively, in both studies combined. Thus, higher predictor scores were associated with multiple adverse pregnancy outcomes.

scholarly journals Role of oral micronized progesterone versus vaginal progesterone for prevention of preterm labour

2017 ◽  
Vol 6 (5) ◽  
pp. 1797
Author(s):  
Neeta Natu ◽  
Shikha Sonker ◽  
Nootan Chandwaskar ◽  
Sweta Agrawal
Keyword(s):  
Preterm Birth ◽  
Preterm Delivery ◽  
Neonatal Morbidity ◽  
Term Infant ◽  
Optimal Timing ◽  
Limited Information ◽  
Vaginal Progesterone ◽  
Increased Risk ◽  
Term Delivery ◽  
Micronized Progesterone

Background: Preterm birth remains a significant problem in obstetric care, affecting women and babies world-wide. Progesterone has an essential role in maintaining pregnancy by suppression of the calcium–calmodulin–myosin light chain kinase system. This study reflects the use of progesterone in preventing preterm birth.Methods: The data were collected as a retrospective study from SAMC and PGI Obstetric and Gynaecology Department.Results: With the use of Oral micronized progesterone out of 15 cases, term delivery 9 cases i.e. 60% and preterm delivery 6 cases i.e 40% and, with the use of vaginal progesterone suppository out of 15 cases, term delivery 11 cases i.e.73.3%, preterm delivery only 4 cases i.e 26.7%.Conclusions: Progesterone appears to be safe and efficacious in reducing the risk of preterm birth as well as NICU admissions, and neonatal morbidity and mortality in high risk patients. However, there is limited information available relating to longer-term infant and childhood outcomes, the assessment of which remains a priority. Further, trials are required to assess the optimal timing, mode of administration and dose of administration of progesterone therapy when given to women considered to be at increased risk of early birth.

Cyclooxygenase inhibitors for treating preterm labour: What is the molecular evidence?

2019 ◽  
Vol 97 (3) ◽  
pp. 222-231 ◽  
Author(s):  
Daniela Urrego ◽  
Anthony C. Liwa ◽  
William C. Cole ◽  
Stephen L. Wood ◽  
Donna M. Slater
Keyword(s):  
Preterm Birth ◽  
Preterm Labour ◽  
Scientific Evidence ◽  
Preterm Births ◽  
Cyclooxygenase Inhibitors ◽  
Molecular Evidence ◽  
Mortality And Morbidity ◽  
Cox Inhibitors ◽  
Increased Risk

Preterm birth (<37 weeks of gestation) significantly increases the risk of neonatal mortality and morbidity. As many as half of all preterm births occur following spontaneous preterm labour. Since in such cases there are no known reasons for the initiation of labour, treatment of preterm labour (tocolysis) has sought to stop labour contractions and delay delivery. Despite some success, the use of cyclooxygenase (COX) inhibitors is associated with maternal/fetal side effects, and possibly increased risk of preterm birth. Clinical use of these drugs predates the collection of molecular and biochemical evidence in vitro, examining the expression and activity of COX enzymes in pregnant uterine tissues with and without labour. Such evidence is important to the rationale that COX enzymes are, or are not, appropriate targets for the tocolysis. The current study systematically searched existing scientific evidence to address the hypothesis that COX expression/activity is increased with the onset of human labour, in an effort to determine whether there is a rationale for the use of COX inhibitors as tocolytics. Our review identified 44 studies, but determined that there is insufficient evidence to support or refute a role of COX-1/-2 in the onset of preterm labour that supports COX-targeted tocolysis.

scholarly journals Associations between pre-pregnancy body mass index, gestational weight gain and preterm birth: a cohort study in Wuhan, China

2020 ◽  
Author(s):  
Yiyang Guo ◽  
Chao Xiong ◽  
Aifen Zhou ◽  
Ronghua Hu ◽  
Rong Yang ◽  
...  
Keyword(s):  
Cohort Study ◽  
Weight Gain ◽  
Preterm Birth ◽  
Gestational Weight Gain ◽  
Early Pregnancy ◽  
Chinese Women ◽  
Tracking System ◽  
Mortality And Morbidity ◽  
Gestational Weight ◽  
Increased Risk

Abstract Background Preterm birth (PTB) is the leading cause of neonatal mortality and morbidity worldwide. Methods This cohort study aims to investigate the associations between pre-pregnancy BMI, total gestational weight gain (GWG), and the GWG during early pregnancy with PTB utilizing data of 83,096 Chinese women from the Wuhan Maternal and Children Healthcare Information Tracking System in China. Results Women who were underweight, overweight or obese before pregnancy had an higher overall risk of PTB compared with the normal group. Women who with a total GWG below the IOM recommendation had an increased risk of PTB compared to women who had GWG within the recommendation, whereas increased weekly early pregnancy GWG had a significant impact on the increasing risk of PTB. When stratified by subtypes of PTB, pre-pregnancy underweight was associated with higher risk of spontaneous PTB, and pre-pregnancy overweight /obese increased the risk of both spontaneous PTB and medically indicated PTB. Women with total GWG below the IOM recommendation had elevated risk for spontaneous PTB and PROM, and women with GWG above the recommendation had decreased risk for all three subtypes of PTB, whereas risk for the three subtypes of PTB increased along with increasing weekly GWG of early pregnancy. Conclusions Maternal underweight, overweight/obesity, total GWG, and GWG during early pregnancy should be considered in combination to reduce the risk of PTB, women should modify their weight gains during pregnancy according to the results.

scholarly journals Preterm birth: associated risk factors and outcome in tertiary care center

2017 ◽  
Vol 6 (8) ◽  
pp. 3271 ◽  
Author(s):  
Mamatha B. Shetty ◽  
Krupa B. M. ◽  
Mounica Malyala ◽  
Asha Swarup ◽  
Davis Sabu Pathadan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Preterm Birth ◽  
Neonatal Mortality ◽  
Care Center ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
Neonatal Morbidity ◽  
Mortality And Morbidity ◽  
Maternal Characteristics ◽  
Associated Risk Factors

Background: The major cause of infant mortality and morbidity is preterm birth. WHO has defined it as any birth before 37 completed weeks of gestation or fewer than 259 days since the last day of menstrual period. Objective of present study was to identify major etiological factors associated with preterm birth, and their effects on mode of delivery and neonatal mortality and morbidity.Methods: Retrospective cohorts study, which was conducted in M. S. Ramaiah Medical College, over period of 12 months (January 2015 to December 2015). The study included 343 women who delivered preterm they were followed from admission to discharge. Various parameters were analyzed like maternal characteristics, gestational age, associated risk factors, tocolysis, administration of steroids, and neonatal outcome.Results: The incidence of preterm birth among the total deliveries was approximately 18.01%. Although the risk factors included many, the most common occurring were hypertensive disorders during pregnancy approximately 32.9%, followed by preterm rupture of membranes (18.1%), idiopathic 14.9%, and previous LSCS at 12.2%. Neonatal mortality was 6.9% (24 neonates), and stillborn were 0.5% (2 neonates).Conclusions: Various risk factors for preterm labour are modifiable hence early detection and treatment prevents maternal morbidity and neonatal morbidity and mortality. Specific emphasis on regular antenatal checkups.

scholarly journals A Prenatal DHA Test to Help Identify Women at Increased Risk for Early Preterm Birth: A Proposal

Nutrients ◽  
2018 ◽  
Vol 10 (12) ◽  
pp. 1933 ◽  
Author(s):  
Kristina Jackson ◽  
William Harris
Keyword(s):  
Preterm Birth ◽  
Pregnant Women ◽  
Clinical Utility ◽  
Fish Intake ◽  
Blood Levels ◽  
Omega 3 ◽  
Childbearing Age ◽  
Increased Risk ◽  
The Us ◽  
Early Preterm Birth

Fish intake and docosahexaenoic acid (DHA), a nutrient found in fish, have been favorably linked to several pregnancy outcomes. The risk of early preterm birth (ePT, <34 weeks gestation) is associated with low fish intake and DHA blood levels and can be reduced by supplemental DHA. Here, we summarize the evidence linking blood DHA levels with risk for ePT birth, and based on the available studies, propose that women who are pregnant or trying to become pregnant aim for a red blood cell (RBC) DHA value of at least 5% (of total RBC fatty acids). In the US, ~70% of women of childbearing age are likely below this cut-point, and dietary intake data suggest that this group, including pregnant women, consumes ~60 mg/day DHA and that >90% of this group do not take an omega-3 supplement. Since the recommendations for women to consume fish and to take a 200 mg DHA supplement during pregnancy are not being heeded generally, there is a need to motivate practitioners and pregnant women to attend to these recommendations. Having an objective prenatal blood DHA test could provide such motivation. More research is needed to test the clinical utility of this proposed target prenatal DHA level.

SIGNIFICANCE OF PLACENTAL HISTOPATHOLOGICAL FINDINGS IN PRETERM/TERM BIRTH

2020 ◽  
Vol 4 (5) ◽  
Author(s):  
Monika Kushwaha ◽  
Sanjeev Narang
Keyword(s):  
Preterm Birth ◽  
Comparative Study ◽  
Pregnancy Outcome ◽  
Neonatal Morbidity ◽  
Research Centre ◽  
College Hospital ◽  
Cross Sectional ◽  
Chorionic Villi ◽  
Term Birth ◽  
Medical College

Background: This study is cross-sectional, observational and comparative study, at Index Medical College, Hospital & Research Centre, Indore, Madhya Pradesh from July 2017 to July 2019 with sample size 100 placentae. Method: The placenta received was evaluated blinded of maternal pregnancy outcome. The pattern of morphology was evaluated both qualitatively (type of lesion) and quantitatively (number of lesions). Result: In Present study 79% of the deliveries were term deliveries and 21% were preterm deliveries. On placental macroscopy, placenta weight was significantly low among the neonates of preterm deliveries (370.00±60.49) as compared to term deliveries (440.89±55.22). Preterm placenta had higher number of abnormal placental lesion compared to term pregnancies. Conclusion: The uteroplacental insufficiency defined as placental infarct, fibrosis of chorionic villi, thickening of blood vessels, and poor vascularity of chorionic villi. Placental histopathological lesions are strongly associated with maternal under perfusion and uteroplacental insufficiency. These are the reasons for preterm birth. Thus, knowledge of the etiological factor can be use to reduce maternal and neonatal morbidity and mortility. Keywords: Placenta, Term & Preterm.

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