scholarly journals Morbidity in Late Preterm Birth: A Retrospective Cohort Study Assessing the Role of Immaturity versus Antecedent Factors

Neonatology ◽  
2021 ◽  
pp. 1-8
Author(s):  
Melissa Lorenzo ◽  
Megan Laupacis ◽  
Wilma M. Hopman ◽  
Imtiaz Ahmad ◽  
Faiza Khurshid
Keyword(s):  
Cohort Study ◽  
Preterm Birth ◽  
Preterm Delivery ◽  
Gestational Age ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Late Preterm ◽  
Multiple Gestation ◽  
Late Preterm Birth ◽  
Apnea Of Prematurity

<b><i>Introduction:</i></b> Late preterm infants (LPIs) are infants born between 34<sup>0/7</sup> and 36<sup>6/7</sup> weeks gestation. Morbidities in these infants are commonly considered a result of prematurity; however, some research has suggested immaturity may not be the sole cause of morbidities. We hypothesize that antecedents leading to late preterm birth are associated with different patterns of morbidities and that morbidities are the result of gestational age superimposed by the underlying etiologies of preterm delivery. <b><i>Methods:</i></b> This is a retrospective cohort study of late preterm neonates born at a single tertiary care center. We examined neonatal morbidities including apnea of prematurity, hyperbilirubinemia, hypoglycemia, and the requirement for continuous positive airway pressure (CPAP). Multivariable logistic regression analysis was performed to estimate the risk of each morbidity associated with 3 categorized antecedents of delivery, that is, spontaneous preterm labor, preterm premature rupture of membranes (PPROM), and medically indicated birth. We calculated the predictive probability of each antecedent resulting in individual morbidity across gestational ages. <b><i>Results:</i></b> 279 LPIs were included in the study. Decreasing gestational age was associated with significantly increased risk of apnea of prematurity, hyperbilirubinemia, and requirement of CPAP. In our cohort, the risk of hypoglycemia increased with gestational age, with the greatest incidence at 36<sup>0−6</sup> weeks. There was no significant association of risk of selected morbidities and the antecedents of late preterm delivery, with or without adjustment for gestational age, multiple gestation, small for gestational age (SGA), antenatal steroids, and delivery method. <b><i>Discussion and Conclusion:</i></b> This study found no difference in morbidity risk related to 3 common antecedents of preterm birth in LPIs. Our research suggests that immaturity is the primary factor in determining adverse outcomes, intensified by factors resulting in prematurity.

scholarly journals Comparison of adverse perinatal outcomes between Asians and Caucasians: a population-based retrospective cohort study in Ontario

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Na Zeng ◽  
Erica Erwin ◽  
Wendy Wen ◽  
Daniel J. Corsi ◽  
Shi Wu Wen ◽  
...  
Keyword(s):  
Cohort Study ◽  
Birth Weight ◽  
Preterm Birth ◽  
Cesarean Section ◽  
Gestational Age ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Perinatal Outcomes ◽  
Population Based ◽  
Adverse Perinatal Outcomes

Abstract Background Racial disparities in adverse perinatal outcomes have been studied in other countries, but little has been done for the Canadian population. In this study, we sought to examine the disparities in adverse perinatal outcomes between Asians and Caucasians in Ontario, Canada. Methods We conducted a population-based retrospective cohort study that included all Asian and Caucasian women who attended a prenatal screening and resulted in a singleton birth in an Ontario hospital (April 1st, 2015-March 31st, 2017). Generalized estimating equation models were used to estimate the independent adjusted relative risks and adjusted risk difference of adverse perinatal outcomes for Asians compared with Caucasians. Results Among 237,293 eligible women, 31% were Asian and 69% were Caucasian. Asians were at an increased risk of gestational diabetes mellitus, placental previa, early preterm birth (< 32 weeks), preterm birth, emergency cesarean section, 3rd and 4th degree perineal tears, low birth weight (< 2500 g, < 1500 g), small-for-gestational-age (<10th percentile, <3rd percentile), neonatal intensive care unit admission, and hyperbilirubinemia requiring treatment, but had lower risks of preeclampsia, macrosomia (birth weight > 4000 g), large-for-gestational-age neonates, 5-min Apgar score < 7, and arterial cord pH ≤7.1, as compared with Caucasians. No difference in risk of elective cesarean section was observed between Asians and Caucasians. Conclusion There are significant differences in several adverse perinatal outcomes between Asians and Caucasians. These differences should be taken into consideration for clinical practices due to the large Asian population in Canada.

scholarly journals Maternal metabolic profiling to assess fetal gestational age and predict preterm delivery: a two-centre retrospective cohort study in the US

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e040647
Author(s):  
Karl G Sylvester ◽  
Shiying Hao ◽  
Jin You ◽  
Le Zheng ◽  
Lu Tian ◽  
...  
Keyword(s):  
Cohort Study ◽  
Preterm Birth ◽  
Gestational Age ◽  
Retrospective Cohort Study ◽  
Metabolic Profiling ◽  
Retrospective Cohort ◽  
Clinical Care ◽  
Full Term ◽  
Additional Patient ◽  
Term Pregnancy

ObjectivesThe aim of this study was to develop a single blood test that could determine gestational age and estimate the risk of preterm birth by measuring serum metabolites. We hypothesised that serial metabolic modelling of serum analytes throughout pregnancy could be used to describe fetal gestational age and project preterm birth with a high degree of precision.Study designA retrospective cohort study.SettingTwo medical centres from the USA.ParticipantsThirty-six patients (20 full-term, 16 preterm) enrolled at Stanford University were used to develop gestational age and preterm birth risk algorithms, 22 patients (9 full-term, 13 preterm) enrolled at the University of Alabama were used to validate the algorithms.Outcome measuresMaternal blood was collected serially throughout pregnancy. Metabolic datasets were generated using mass spectrometry.ResultsA model to determine gestational age was developed (R2=0.98) and validated (R2=0.81). 66.7% of the estimates fell within ±1 week of ultrasound results during model validation. Significant disruptions from full-term pregnancy metabolic patterns were observed in preterm pregnancies (R2=−0.68). A separate algorithm to predict preterm birth was developed using a set of 10 metabolic pathways that resulted in an area under the curve of 0.96 and 0.92, a sensitivity of 0.88 and 0.86, and a specificity of 0.96 and 0.92 during development and validation testing, respectively.ConclusionsIn this study, metabolic profiling was used to develop and test a model for determining gestational age during full-term pregnancy progression, and to determine risk of preterm birth. With additional patient validation studies, these algorithms may be used to identify at-risk pregnancies prompting alterations in clinical care, and to gain biological insights into the pathophysiology of preterm birth. Metabolic pathway-based pregnancy modelling is a novel modality for investigation and clinical application development.

scholarly journals Maternal High Triglyceride Levels During Early Pregnancy and Risk of Preterm Delivery: A Retrospective Cohort Study

2018 ◽  
Vol 104 (4) ◽  
pp. 1249-1258 ◽  
Author(s):  
Xian-hua Lin ◽  
Dan-dan Wu ◽  
Cheng Li ◽  
Yi-jing Xu ◽  
Ling Gao ◽  
...  
Keyword(s):  
Cohort Study ◽  
Preterm Delivery ◽  
Early Pregnancy ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Maternal Obesity ◽  
Late Preterm ◽  
Sensitivity Analyses ◽  
Singleton Pregnancy ◽  
Related Risk

Abstract Context Maternal obesity increases the risk of preterm delivery. Obesity is known to be associated with altered lipid metabolism. Objective To investigate the associations between high maternal triglyceride (mTG) levels during early pregnancy and risks of preterm delivery stratified by early pregnancy body mass index (BMI). Design Retrospective cohort study. Setting University-based maternity center. Patients 49,612 women with singleton pregnancy who underwent fasting serum lipid screening during early pregnancy. Main Outcome Measures Risk of preterm delivery (total, &lt;37 weeks; early, 28 to 33 weeks; and late, 34 to 36 weeks). Results Among women enrolled, 2494 had a preterm delivery, including 438 early preterm and 2056 late preterm delivery. High mTG (&gt;90th percentile, 2.04 mM) was associated with shortened gestation. Risks of total, early, and late preterm deliveries increased with mTG levels, and the high mTG–related risk was highest for early preterm delivery [adjusted odds ratio (AOR) 1.72; 95% CI, 1.30 to 2.29]. After stratification by BMI, high mTG was associated with risk of preterm delivery in both overweight or obese (OWO) women (AOR 1.32; 95% CI, 1.02 to 1.70) and women with normal BMI (AOR 1.36; 95% CI, 1.16 to 1.59). In additional sensitivity analyses, we found that high mTG was related to higher risks of preterm delivery among OWO women and women with normal BMI (AOR, 1.54; 95% CI, 1.07 to 2.22 and 1.62, 1.34 to 1.96, respectively), especially early preterm delivery (AOR 2.47; 95% CI, 1.19 to 5.10, and AOR 2.50; 95% CI, 1.65 to 3.78, respectively). Conclusions High mTG level during early pregnancy increased the risks of preterm delivery not only in OWO women but also in women with normal BMI.

scholarly journals Impact of gestational age on child intelligence, attention and executive function at age 5: a cohort study

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e028982 ◽  
Author(s):  
Emilie Pi Fogtmann Sejer ◽  
Frederik Jager Bruun ◽  
Julie Anna Slavensky ◽  
Erik Lykke Mortensen ◽  
Ulrik Schiøler Kesmodel
Keyword(s):  
Cohort Study ◽  
Executive Function ◽  
Preterm Birth ◽  
Gestational Age ◽  
Parental Education ◽  
Mean Difference ◽  
Late Preterm ◽  
Late Preterm Birth ◽  
The Mean ◽  
The Impact

ObjectivesPreterm birth can affect cognition, but other factors including parental education and intelligence may also play a role, but few studies have adjusted for these potential confounders. We aimed to assess the impact of gestational age (GA), late preterm birth (34 to <37 weeks GA) and very to moderately preterm birth (<34 weeks GA) on intelligence, attention and executive function in a population of Danish children aged 5 years.DesignPopulation-based prospective cohort study.SettingDenmark 2003–2008.ParticipantsA cohort of 1776 children and their mothers sampled from the Danish National Birth Cohort with information on GA, family and background factors and completed neuropsychological assessment at age 5.Primary outcome measuresWechsler Preschool and Primary Scale of Intelligence-Revised, Test of Everyday Attention for Children at Five and Behaviour Rating Inventory of Executive Function scores.ResultsFor preterm birth <34 weeks GA (n=8), the mean difference in full-scale intelligence quotient(IQ) was −10.6 points (95% CI −19.4 to −1.8) when compared with the term group ≥37 weeks GA (n=1728), and adjusted for potential confounders. For the teacher-assessed Global Executive Composite, the mean difference was 5.3 points (95% CI 2.4 to 8.3) in the adjusted analysis, indicating more executive function difficulties in the preterm group <34 weeks GA compared with the term group. Maternal intelligence and parental education were weak confounders. No associations between late preterm birth 34 to <37 weeks GA (n=40) and poor cognition were shown.ConclusionsThis study showed substantially lower intelligence and poorer executive function in children born <34 weeks GA compared with children born at term. GA may play an important role in determining cognitive abilities independent of maternal intelligence and parental education. Studies with larger sample sizes are needed to confirm these findings, as the proportion of children born preterm in this study population was small.

scholarly journals A Retrospective Cohort Study of Safety Outcomes in New Zealand Infants Exposed to Tdap Vaccine in Utero

Vaccines ◽  
2019 ◽  
Vol 7 (4) ◽  
pp. 147 ◽  
Author(s):  
Helen Petousis-Harris ◽  
Yannan Jiang ◽  
Lennex Yu ◽  
Donna Watson ◽  
Tony Walls ◽  
...  
Keyword(s):  
Cohort Study ◽  
New Zealand ◽  
Preterm Birth ◽  
Gestational Age ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
National Level ◽  
Birth Asphyxia ◽  
Large For Gestational Age ◽  
The Government

We aimed to evaluate the safety of maternal Tdap; thus, we assessed health events by examining the difference in birth and hospital-related outcomes of infants with and without fetal exposure to Tdap. This was a retrospective cohort study using linked administrative datasets. The study population were all live-born infants in New Zealand (NZ) weighing at least 400 g at delivery and born to women who were eligible for the government funded, national-level vaccination program in 2013. Infants were followed from birth up to one year of age. There were a total of 69,389 eligible infants in the cohort. Of these, 8299 infants were born to 8178 mothers exposed to Tdap (12%), primarily between 28 and 38 weeks gestation as per the national schedule. Among the outcomes, we found a reduced risk for moderate to late preterm birth, low birth weight, small for gestational age, large for gestational age, respiratory distress syndrome, transient tachypnea of newborn, tachycardia or bradycardia, haemolytic diseases, other neonatal jaundice, anaemia, syndrome of infant of mother with gestational diabetes, and hypoglycemia in infants born to vaccinated mothers. There was no association between maternal Tdap, infant Apgar score at 5 min after birth, asphyxia, sepsis or infection, or hypoxic ischemic encephalopathy. Infant exposure to Tdap during pregnancy was associated with a higher mean birthweight (not clinically significant) and higher odds for ankyloglossia and neonatal erythema toxicum diagnoses. There were insufficient observations to allow examination of the effect of Tdap on extreme preterm and very preterm birth, and stillbirth, infant death, or microcephaly. Overall, we found no outcomes of concern associated with the administration of Tdap during pregnancy. NZ Health and Disability Ethics Committee Approval #14/N.T.A/169/AM05.

scholarly journals Associations Between Maternal Immunisation and Reduced Rates of Preterm Birth and Stillbirth: A Population Based Retrospective Cohort Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Michelle L. Giles ◽  
Mary-Ann Davey ◽  
Euan M. Wallace
Keyword(s):  
Cohort Study ◽  
Preterm Birth ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Obstetric Outcomes ◽  
Specific Response ◽  
Singleton Pregnancy ◽  
Indigenous Status

Stillbirth and preterm birth (PTB) remain two of the most important, unresolved challenges in modern pregnancy care. Approximately 10% of all births are preterm with nearly one million children dying each year due to PTB. It remains the most common cause of death among children under five years of age. The numbers for stillbirth are no less shocking with 2.6 million babies stillborn each year. With minimal impact on the rate of these adverse birth outcomes over the past decade there is an urgent need to identify more effective interventions to tackle these problems. In this retrospective cohort study, we used whole-of-population data, to determine if maternal immunization during pregnancy against influenza and/or pertussis, is associated with a lower risk of PTB, delivering a small-for-gestational age (SGA) infant, developing preeclampsia or stillbirth. Women with a singleton pregnancy at 28 or more weeks’ gestation delivering in Victoria, Australia from July 2015 to December 2018 were included in the analysis. Log-binomial regression was used to measure the relationship between vaccination during pregnancy against influenza and against pertussis, with preterm birth, SGA, preeclampsia and stillbirth. Variables included in the adjusted model were maternal age, body mass index, first or subsequent birth, maternal Indigenous status, socio-economic quintile, smoking, public or private maternity care and metropolitan or rural location of the hospital. Women who received influenza vaccine were 75% less likely to have a stillbirth (aRR 025; 95% CI 0.20, 0.31), and 31% less likely to birth &lt;37 weeks (aRR 0.69; 95% CI 0.66, 0.72). Women who received pertussis vaccine were 77% less likely to have a stillbirth (aOR 0.23; 95% CI 0.18, 0.28) and 32% less likely to birth &lt;37 weeks gestation (aRR 0.68; 95% CI 0.66, 0.71). Vaccination also reduced the odds of small for gestational age by 13% and reduced the odds of pre-eclampsia when restricted to primiparous women. This association was seen over four different influenza seasons and independent of the time of year suggesting that any protective effect on obstetric outcomes afforded by maternal vaccination may not be due to a pathogen-specific response but rather due to pathogen-agnostic immune-modulatory effects.

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