A Novel Nomogram for Predicting the Risk of Premature Delivery Based on the Thyroid Function in Pregnant Women

BackgroundMaternal thyroid dysfunction and autoantibodies were associated with preterm delivery. However, recommendations for cutoff values of thyroperoxidase antibody (TPOAb) positivity and thyroid-stimulating homone (TSH) associated with premature delivery are lacking.ObjectiveTo identify the pregnancy-specific cutoff values for TPOAb positivity and TSH associated with preterm delivery. To develop a nomogram for the risk prediction of premature delivery based on maternal thyroid function in singleton pregnant women without pre-pregnancy complications.MethodsThis study included data from the International Peace Maternity and Child Care Health Hospital (IPMCH) in Shanghai, China, between January 2013 and December 2016. Added data between September 2019 and November 2019 as the test cohort. Youden’s index calculated the pregnancy-specific cutoff values for TPOAb positivity and TSH concentration. Univariate and multivariable logistic regression analysis were used to screen the risk factors of premature delivery. The nomogram was developed according to the regression coefficient of relevant variables. Discrimination and calibration of the model were assessed using the C-index, Hosmer-Lemeshow test, calibration curve and decision curve analysis.Results45,467 pregnant women were divided into the training and validation cohorts according to the ratio of 7: 3. The testing cohort included 727 participants. The pregnancy-specific cutoff values associated with the risk of premature delivery during the first trimester were 5.14 IU/mL for TPOAb positivity and 1.33 mU/L for TSH concentration. Multivariable logistic regression analysis showed that maternal age, history of premature delivery, elevated TSH concentration and TPOAb positivity in the early pregnancy, preeclampsia and gestational diabetes mellitus were risk factors of premature delivery. The C-index was 0.62 of the nomogram. Hosmer-Lemeshow test showed that the Chi-square value was 2.64 (P = 0.955 > 0.05). Decision curve analysis showed a positive net benefit. The calibration curves of three cohorts were shown to be in good agreement.ConclusionsWe identified the pregnancy-specific cutoff values for TPOAb positivity and TSH concentration associated with preterm delivery in singleton pregnant women without pre-pregnancy complications. We developed a nomogram to predict the occurrence of premature delivery based on thyroid function and other risk factors as a clinical decision-making tool.

The Effect of Maternal Vitamin D Intake on the Incidence of Nonspecific Respiratory Distress in Infants: A Randomized Clinical Trial

Background vitamin D deficiency is associated with respiratory problems in neonates. The late preterm or near-term neonates who have been admitted for tachypnea and fully recovered before 12 h, we called Non-specific respiratory distress syndrome (NRDS). The present study aimed to evaluate the effect of 25(OH) D administration in pregnant women at risk of preterm delivery on the incidence of NRDS in their infants. Methods This single-blind clinical trial was performed on mothers and neonates with a gestational age of 32-37 weeks who were referred with labor pains from February 20th 2021 to June29th 2021 in the obstetrics and gynecology department and intensive treatment unit of Ghaem Hospital, Mashhad University of Medical Sciences, Iran. Within 72 h of preterm delivery, a single dose of 50,000 units of intramuscular 25-hydroxy vitamin D was injected into pregnant women in the intervention group. Also a sample containing 1.5 ml of whole blood was taken from the umbilical cord of the infant and mother to assess the level of vitamin D. Results In the present study, there was a significant relationship between the two groups of control and intervention in terms of weight (P=001), first (P=0.027) and fifth minute Apgar score (P=0.001) in infant, incidence of NRDS (P=0.001) and maternal age (P=0.004). The results showed no statistically significant difference between the two groups in terms of gender (p = 0.673), type of delivery (p = 0.299), level of vitamin D of the mothers (P=0.053) and infants (P=0.805). Conclusions The single injection of vitamin D into the mother prone to preterm birth over 31 weeks of gestation reduces transient respiratory problems in these infants. Trial registration: IRCT20110807007244N7 (19/02/2021)

Transient hyperglycemia, impaired glucose tolerance and gestational diabetes mellitus (GDM) in preterm pregnant women receiving antenatal steroids

OBJECTIVE:To determine the frequency of transient hyperglycemia, impaired glucose tolerance and gestational diabetes mellitus(GDM) in preterm pregnant women receiving antenatal steroids. METHODOLOGY:This descriptive cross-sectional study was carried out in Maternal and Child Health Center unit 1 (MCH-1) at Pakistan Institute of Medical Sciences Islamabad Pakistan from January 2017 till August 2017. A total of 365 pregnant women presenting to emergency and outpatient department with preterm labor (alive morphologically normal babies), with preterm premature rupture of membranes (PPROM) and other conditions which require early delivery including preeclampsia, IUGR requiring preterm delivery, severe oligohydramnios, antepartum hemorrhage(APH), women receiving two doses dexamethasone and all those with BSR>126mg/dl were included in the study. Multiple pregnancies, advanced preterm labor (cervix > 5cm dilated), gestational diabetes mellitus (GDM) or type I/II diabetes mellitus (DM), chorioamnionitis and taking any medication that affects glucose metabolism were excluded from the study. After ethical approval, informed consent was taken from study participants. Blood sugar levels before the commencement of 1st dose of dexamethasone were noted. Blood sugar profile (fasting, 2 hours after lunch, 2 hours after dinner) were carried out. 2nd dose of dexamethasone was given after 12 hours of 1st dose. Profile was carried out till euglycemia or 5 days if sugars remain deranged. Patients having deranged levels for greater than 5 days were advised 75 g oral glucose tolerance test(OGTT) and labelled as having impaired glucose tolerance or gestational diabetes mellitus. RESULTS: In our study, 57.57%(n=213) were between 18-30 years, 42.43%(n=157) were between 31-40 years of age, mean age was calculated as 28.92+5.54 while mean gestational age was 31.19+1.92 weeks. Frequency of transient hyperglycemia, impaired glucose tolerance and gestational diabetes mellitus(GDM) in preterm pregnant women receiving antenatal steroids revealed 62.16%(n=230) had transient hyperglycemia, 9.46%(n=35) had impaired glucose tolerance, 2.16%(n=8) had gestational diabetes and 26.22%(n=97) had no blood glucose abnormality. CONCLUSION: We concluded that the frequency of abnormal glucose levels increases in preterm pregnant women receiving antenatal steroids. Therefore, single blood sugar level done routinely before dexamethasone therapy are insufficient to judge the glucose metabolic status and should be closely monitored during the use of antenatal corticosteroids. KEYWORDS: Preterm delivery, antenatal steroids, transient hyperglycemia, impaired glucose tolerance and gestational diabetes mellitus(GDM)

An obstetric outcome in pregnant women with consumption of tobacco

Background: Tobacco is known to be an established cause of adverse pregnancy outcome. Scientific studies, encompassing various ethnic groups, cultures and countries, have shown that cigarette smoking during pregnancy significantly affects mother, unborn fetus and the newborn baby.Methods: A hospital based cross sectional study was performed on 933 patients, separated in two groups: tobacco users and tobacco non-users and findings from each group were compared.Results: Incidence of complications like anemia, PIH and abruption increase with maternal usage of tobacco during pregnancy, chances of preterm delivery and ectopic pregnancy was raised, rate of wound complication was more in tobacco user women. There was no significant difference in mode of delivery.Conclusions: In the present study may establish association of tobacco consumption with adverse neonatal and obstetrics outcome and may encourage administration to focus on IEC (information, education, communication) to reduce tobacco consumption during pregnancy. Incidence of complications like anemia, PIH, abruption increase with maternal usage of tobacco during pregnancy. Chances of preterm delivery and ectopic pregnancy, was raised usage with of tobacco.

Analysis of Risk Factors Associated With Preterm Delivery After Fetoscopic Laser Surgery for TTTS

Objective Fetoscopic laser surgery (FLS) is currently the standard treatment for twin to twin transfusion syndrome (TTTS). This study aims to improve the perinatal outcomes of TTTS patients by analyzing the risk factors associated with preterm delivery after FLS for TTTS. Methods A prospective cohort study was conducted in 97 cases of patients with TTTS who underwent FLS at the Third Affiliated Hospital of Zhengzhou University from May 2018 to December 2020. A multivariate logistic regression model was used to determine the risk factors associated with preterm delivery. Finally, ROC curve was utilized to analyze the diagnostic value of related risk factors. Results A total of 90 TTTS patients were included in the study. There were 37 cases in group A and 53 cases in group B. Through multivariate logistic regression model analysis, three risk factors related to the gestational age of childbirth <32 weeks were identified: preoperative CL < 27.5 mm (OR, 10.9; P <0.001), PPROM (OR, 4.0; P=0.024), placental abruption (OR, 17.6; P=0.018). ROC curve analysis suggested that the AUC of the combined diagnosis of the three factors was 0.799 (P<0.001), which has a high value for predicting preterm delivery at low gestational age. Conclusion Multivariate logistic regression analysis demonstrated that CL < 27.5 mm, PPROM and placental abruption were connected with preterm delivery before 32 weeks of pregnancy. Identifying and intervening the corresponding risk factors can improve the pregnancy and neonatal outcomes after fetoscopic surgery, and promote the improvement of fetoscopic surgery techniques.