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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Available from: Calvin Hobel, Aug 21, 2015
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    • "Preterm delivery, defined as delivery before 37 weeks of gestation , constitutes a major problem in terms of neonatal mortality , morbidity, and healthcare costs [1] [2] [3]. Timely intervention and treatment with tocolytics and corticosteroids improves neonatal outcome [4]. "
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    ABSTRACT: Background. Analysis of the electrohysterogram (EHG) is a promising diagnostic tool for preterm delivery. For the introduction in the clinical practice, analysis of the EHG should be reliable and automated to guarantee reproducibility. Study Goal. Investigating the feasibility of automated analysis of the EHG conduction velocity (CV) for detecting imminent delivery. Materials and Methods. Twenty-two patients presenting with uterine contractions (7 preterm) were included. An EHG was obtained noninvasively using a 64-channel high-density electrode grid. Contractions were selected based on the estimated intrauterine pressure derived from the EHG, the tocodynamometer, and maternal perception. Within the selected contractions, the CV vector was identified in two dimensions. Results. Nine patients delivered within 24 hours and were classified as a labor group. 64 contractions were analyzed; the average amplitude of the CV vector was significantly higher for the labor group, 8.65 cm/s ± 1.90, compared to the nonlabor group, 5.30 cm/s ± 1.47 (P < 0.01). Conclusion. The amplitude of the CV is a promising parameter for predicting imminent (preterm) delivery. Automated estimation of this parameter from the EHG signal is feasible and should be regarded as an important prerequisite for future clinical studies and applications.
    Computational and Mathematical Methods in Medicine 12/2013; 2013:627976. DOI:10.1155/2013/627976 · 1.02 Impact Factor
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    • "Studies indicate that early intervention with this vulnerable population is essential for reducing the high risk of adverse neurodevelopmental outcomes associated with preterm birth (Roberts et al., 2008). The need for culturally sensitive early intervention strategies (Green et al., 2005; Hanson & Lynch, 2004) is particularly important given that the risk of being born VLBW (Reagan & Salsberry, 2005), as well as evidencing poorer developmental outcomes, is higher among ethnic minority children (Schmidt et al., 2002; Vohr et al., 2005). An important aspect of creating culturally sensitive interventions involves acquiring a better understanding of ethnic differences associated with developmental outcomes among children born VLBW. "
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    ABSTRACT: Children born very low birth weight (<1500g, VLBW) are at increased risk for developmental delays. Play is an important developmental outcome to the extent that child's play and social communication are related to later development of self-regulation and effective functional skills, and play serves as an important avenue of early intervention. The current study investigated associations between maternal flexibility and toddler play sophistication in Caucasian, Spanish speaking Hispanic, English speaking Hispanic, and Native American toddlers (18-22 months adjusted age) in a cross-sectional cohort of 73 toddlers born VLBW and their mothers. We found that the association between maternal flexibility and toddler play sophistication differed by ethnicity (F(3,65)=3.34, p=.02). In particular, Spanish speaking Hispanic dyads evidenced a significant positive association between maternal flexibility and play sophistication of medium effect size. Results for Native Americans were parallel to those of Spanish speaking Hispanic dyads: the relationship between flexibility and play sophistication was positive and of small-medium effect size. Findings indicate that for Caucasians and English speaking Hispanics, flexibility evidenced a non-significant (negative and small effect size) association with toddler play sophistication. Significant follow-up contrasts revealed that the associations for Caucasian and English speaking Hispanic dyads were significantly different from those of the other two ethnic groups. Results remained unchanged after adjusting for the amount of maternal language, an index of maternal engagement and stimulation; and after adjusting for birth weight, gestational age, gender, test age, cognitive ability, as well maternal age, education, and income. Our results provide preliminary evidence that ethnicity and acculturation may mediate the association between maternal interactive behavior such as flexibility and toddler developmental outcomes, as indexed by play sophistication. Addressing these association differences is particularly important in children born VLBW because interventions targeting parent interaction strategies such as maternal flexibility must account for ethnic-cultural differences in order to promote toddler developmental outcomes through play paradigms.
    Infant behavior & development 09/2012; 35(4):860-869. DOI:10.1016/j.infbeh.2012.07.008 · 1.34 Impact Factor
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    • "PTSD is a stress-related disorder that is associated with dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis generally and in pregnancy (Shalev et al. 2008; Seng et al. 2008; King et al. 2008). Biologic stress is considered one of the four confirmed pathways to preterm birth (Green et al. 2005) due to the generation of placental and fetal membrane-derived corticotrophin-releasing hormone when stress is elevated. This in turn augments placental estrogen and fetal adrenal cortisol production. "
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    ABSTRACT: To determine whether African American women expecting their first infant carry a disproportionate burden of posttraumatic stress disorder morbidity, we conducted a comparative analysis of cross-sectional data from the initial psychiatric interview in a prospective cohort study of posttraumatic stress disorder effects on childbearing outcomes. Participants were recruited from maternity clinics in three health systems in the Midwestern USA. Eligibility criteria were being 18 years or older, able to speak English, expecting a first infant, and less than 28 weeks gestation. Telephone interview data was collected from 1,581 women prior to 28 weeks gestation; four declined to answer racial identity items (n = 1,577), 709 women self-identified as African American, 868 women did not. Measures included the Life Stressor Checklist, the National Women's Study Posttraumatic Stress Disorder Module, the Composite International Diagnostic Interview, and the Centers for Disease Control's Perinatal Risk Assessment Monitoring System survey. The 709 African American pregnant women had more trauma exposure, posttraumatic stress disorder symptoms and diagnosis, comorbidity and pregnancy substance use, and had less mental health treatment than 868 non-African Americans. Lifetime prevalence was 24.0% versus 17.1%, respectively (OR = 1.5, p = 0.001). Current prevalence was 13.4% versus 3.5% (OR = 4.3, p < 0.001). Current prevalence of posttraumatic stress disorder (PTSD) was four times higher among African American women. Their risk for PTSD did not differ by sociodemographic status, but was explained by greater trauma exposure. Traumatic stress may be an additional, addressable stress factor in birth outcome disparities.
    Archives of Women s Mental Health 05/2011; 14(4):295-306. DOI:10.1007/s00737-011-0218-2 · 1.96 Impact Factor
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