Research agenda for preterm birth: Recommendations from the March of Dimes

Harvard University, Cambridge, Massachusetts, United States
American Journal of Obstetrics and Gynecology (Impact Factor: 3.97). 10/2005; 193(3 Pt 1):626-35. DOI: 10.1016/j.ajog.2005.02.106
Source: PubMed

ABSTRACT Preterm birth (PTB) is a common, serious, and costly health problem affecting nearly 1 in 8 births in the United States. Burdens from PTB are especially severe for the very preterm infant (<32 weeks' gestation), comprising 2% of all US births. Successful prevention needs to include newly focused and adequately funded research, incorporating new technologies and recognition that genetic, environmental, social, and behavioral factors interact in complex pathogeneses and multiple pathways leading to PTB. The March of Dimes Scientific Advisory Committee created this prioritized research agenda, which is aimed at garnering serious attention and expanding resources to make major inroads into the prevention of PTB, targeting six major, overlapping categories: epidemiology, genetics, disparities, inflammation, biologic stress, and clinical trials. Analogous to other common, complex disorders, progress in prevention will require incorporating multipronged risk reduction strategies that are based on sound scientific discovery, as well as on effective translation into clinical care.

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    ABSTRACT: Objective To describe the postpartum health of predominantly Hispanic participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and identify how health characteristics differ between mothers who delivered preterm or low birth weight infants and those who did not. Design Cross-sectional survey among postpartum WIC mothers. Setting Los Angeles and Orange Counties, CA. Participants WIC participants within 1 year of delivery (n = 1,420). Main Outcome Measures Postpartum health behaviors, health characteristics, and birth spacing intentions and behaviors. Analysis Frequencies of health characteristics were estimated using analyses with sample weights. Differences were assessed with chi-square and Fisher exact tests with Bonferroni correction for pairs of tests. Results Many women exhibited postpartum risk factors for future adverse health events, including overweight or obesity (62.3%), depressive symptoms (27.5%), and no folic acid supplementation (65.5%). Most characteristics did not differ significantly (P > .025) between mothers of preterm infants and full-term infants or between mothers of low birth weight and normal birth weight infants. Conclusions and Implications Despite few differences between postpartum characteristics of mothers who delivered preterm or low birth weight infants and those who did not, a high percentage of mothers had risk factors that need to be addressed. Current postpartum educational activities of WIC programs should be evaluated and shared.
    Journal of Nutrition Education and Behavior 11/2014; 46(6). DOI:10.1016/j.jneb.2014.06.008 · 1.47 Impact Factor
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    ABSTRACT: Background:Levels of a number of some biomarkers have been associated with spontaneous preterm birth. This study was aimed to evaluate the relation between C-reactive protein (CRP) with preterm labor and response to tocolytic therapy.Materials and Methods:Seventy five pregnant women with symptoms of preterm labor (cases) in compare with 75 term women (controls) were enrolled. Baseline data and CRP was recorded. So, cases were under treatment tocolysis with the use of magnesium sulfate, and then they were followed till delivery time to assess the response to the treatment.Results:Sixteen patients with symptoms of preterm labor did not response to the treatment and delivered prematurely and 59 women response to tocolytic treatment and delivered at term. The curve constructed cut-off value for >3.6 (AUC, 0.683; SE, 0.041; P < 0.0001) for CRP, indicating a significant relationship with preterm labor. Also, there was significant relationship between CRP level with response to the treatment in cut-off >1.8 (AUC, 0.738; SE, 0.076; P = 0.001) for CRP.Conclusions:Maternal concentrations of CRP can be used as appropriate biomarker for predicting preterm labor and response to tocolytic therapy in pregnant women.
    07/2014; 3:154. DOI:10.4103/2277-9175.137864
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    ABSTRACT: Background The SNAP (Smoking and Nicotine in Pregnancy) trial compared nicotine replacement therapy (NRT) patches with placebo in pregnant smokers; although NRT doubled cessation rates in the first 4 weeks, by delivery no differences in maternal smoking or birth outcomes were noted. As a result, NRT used in standard doses during pregnancy is considered ineffective for smoking cessation. Subsequent effects of NRT on the children of treated mothers are unknown because no trials have investigated the effect of gestational NRT use beyond birth. To assess whether NRT use in pregnancy might cause harm to infants, we aimed to compare effects of NRT and placebo on infant development 2 years after delivery. Methods 1050 pregnant smokers aged 16–45 years, at 12–24 weeks' gestation, and smoking at least five cigarettes per day were recruited from seven hospitals in England between May 1, 2007, and Feb 26, 2010, and followed up until their infants were 2 years old. Participants were randomly assigned (1:1) via a computer-generated pseudorandom code with permuted blocks of randomly varying size to receive 8-week courses of NRT patches (15 mg/16 h) (n=521) or matched placebo (n=529); both groups received behavioural smoking cessation support. Randomisation was stratified by site with participants, health-care professionals, and research staff masked to treatment allocation. The primary results for participants and infants at delivery were published in 2012; we present results from the trial cohort 2 years after birth. After delivery, questionnaires were posted to participants and, if there was no response, to family physicians. The primary outcome at 2 years was infants' survival without developmental impairment (ie, no disability or problems with behaviour or development). Treatment groups were compared on an intention-to-treat basis. The trial is registered with, number ISRCTN07249128. Findings Questionnaires were returned at 2 years for 891 (88%) of 1010 live singleton births (445 of (88%) 503 given NRT and 446 (88%) of 507 given placebo). Because of missing data, developmental outcomes, including four infant deaths, were documented for 888 of (88%) 1010 singleton infants; 445 (88%) of 503 infants in NRT group and 443 (87%) of 507 infants in placebo. In the NRT group, 323 (73%) of 445 infants had no impairment compared with 290 (65%) of 443 infants in the placebo group (odds ratio [OR] 1·40, 95% CI 1·05–1·86, p=0·023). At 2 years, 15 (3%) of 521 mothers in the NRT group and nine (2%) of 529 mothers in the placebo groups self-reported prolonged smoking abstinence since a quit date set in pregnancy (OR 1·71, 95% CI 0·74–3·94, p=0·20). Adverse events were not collected after delivery, but previously reported adverse pregnancy and birth outcomes were similar in the two groups. Interpretation Infants born to women who used NRT for smoking cessation in pregnancy were more likely to have unimpaired development. NRT had no effect on prolonged abstinence from smoking but did cause a temporary doubling of smoking cessation shortly after randomisation during pregnancy, which could explain findings. If findings are confirmed by subsequent research, this has potential implications for the management of smoking in pregnancy. Funding National Institute for Health Research Health Technology Assessment Programme.
    09/2014; DOI:10.1016/S2213-2600(14)70157-2

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