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ABSTRACT: OBJECTIVE: This study aimed to comprehensively describe inflammatory responses to trivalent influenza virus vaccine (TIV) among pregnant women and determine whether responses differ compared to non-pregnancy. METHODS: Twenty-eight pregnant and 28 non-pregnant women were vaccinated. Serum cytokines were measured at baseline, and 1, 2, and 3 days post-vaccination. Anti-influenza antibody titers were measured at baseline and 1 month post-vaccination. RESULTS: Overall, following vaccination, tumor necrosis factor (TNF)-α and interleukin(IL)-6 increased significantly, peaking at 1 day post-vaccination (P's < 0.001). Pregnant versus non-pregnant women showed no differences in IL-6, TNF-α, or IL-1β responses. Pregnant women showed no change in IL-8 and increases in migration inhibitory factor (MIF), while non-pregnant showed decreases in both. Pregnancy did not significantly alter antibody responses. CONCLUSIONS: Inflammatory responses to TIV are mild, transient, and generally similar in pregnant and non-pregnant women. Given the variability evidenced, vaccination may provide a useful model for studying individual differences in inflammatory response propensity.
American Journal Of Reproductive Immunology 04/2013; · 2.17 Impact Factor
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ABSTRACT: : To evaluate whether women with known risk factors for preterm birth will manifest different rates of cervical shortening preceding a spontaneous preterm birth.
: We conducted a secondary analysis of data from the Maternal--Fetal Medicine Units Network Preterm Prediction Study. Known risk factors for preterm birth were recorded. Cervical lengths were measured between 22+0 weeks and 24+6 weeks, and again 4 weeks later. Cervical slope was defined as the change in cervical length between these visits divided by time (millimeters per week). Preterm birth was defined as preterm premature rupture of membranes or spontaneous preterm labor leading to delivery before 37 weeks of gestation. We analyzed the data for 2,584 women using logistic regression and tested for interaction between risk factors in the model to determine whether cervical shortening preceded preterm births in all variable groups.
: Cervical slope was not significantly associated with preterm birth (P=.9) in women with vaginal bleeding. Cervical slope was significantly associated with preterm birth in women without a history of vaginal bleeding (odds ratio 1.2, 95% confidence interval 1.1-1.4).
: Pregnancies without vaginal bleeding have a 20% increase in the risk of preterm birth for each additional millimeter per week increase in cervical slope. Pregnancies with vaginal bleeding are at risk for preterm birth but do not appear to undergo progressive cervical shortening. This suggests that women with vaginal bleeding undergo a different mechanism leading to preterm birth.
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Obstetrics and Gynecology 02/2013; 121(2 Pt 1):260-4. · 4.73 Impact Factor
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American journal of obstetrics and gynecology 12/2012; · 3.28 Impact Factor
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William A Grobman,
Elizabeth A Thom,
Catherine Y Spong, Jay D Iams,
George R Saade,
Brian M Mercer,
Alan T N Tita,
Dwight J Rouse,
Yoram Sorokin,
Ronald J Wapner,
Kenneth J Leveno,
Sean Blackwell,
M Sean Esplin,
Jorge E Tolosa,
John M Thorp,
Steve N Caritis,
J Peter Van Dorsten
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ABSTRACT: OBJECTIVE: We sought to evaluate whether 17 alpha-hydroxyprogesterone caproate (17-OHP) reduces preterm birth (PTB) in nulliparous women with a midtrimester cervical length (CL) <30 mm. STUDY DESIGN: In this multicenter randomized controlled trial, nulliparous women with a singleton gestation between 16 and 22 3/7 weeks with an endovaginal CL <30 mm (<10th percentile in this population) were randomized to weekly intramuscular 17-OHP (250 mg) or placebo through 36 weeks. The primary outcome was PTB <37 weeks. RESULTS: The frequency of PTB did not differ between the 17-OHP (n = 327) and placebo (n = 330) groups (25.1% vs 24.2%; relative risk, 1.03; 95% confidence interval, 0.79-1.35). There also was no difference in the composite adverse neonatal outcome (7.0% vs 9.1%; relative risk, 0.77; 95% confidence interval, 0.46-1.30). CONCLUSION: Weekly 17-OHP does not reduce the frequency of PTB in nulliparous women with a midtrimester CL <30 mm.
American journal of obstetrics and gynecology 09/2012; · 3.28 Impact Factor
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Robert L Andres,
Yuan Zhao,
Mark A Klebanoff,
John C Hauth,
Steve N Caritis,
J Christopher Carey,
Ronald J Wapner, Jay D Iams,
Kenneth J Leveno,
Menachem Miodovnik,
Baha Sibai,
J Peter Van Dorsten,
Mitchell P Dombrowski,
Mary J O'Sullivan,
Oded Langer
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ABSTRACT: Objective To determine if tobacco use increases the incidence of preterm premature rupture of the membranes (pPROM) or alters perinatal outcomes after pPROM.Study Design This is a secondary analysis of the databases of three completed Eunice Kennedy Shriver National Institute of Child Health and Human Development-supported Maternal Fetal Medicine Units Network studies. Self-reported tobacco exposure data was obtained. Its relationship with the incidence of pPROM and associated neonatal outcome measures were assessed.Results There was no difference in the incidence of pPROM when comparing nonsmokers to those using tobacco. Although a trend was seen between the incidence of pPROM and the amount smoked, this did not reach statistical significance. Among the patients with pPROM, the use of tobacco was not associated with an increase in perinatal morbidity.Conclusion Our data do not support a significant relationship between tobacco use and pPROM.
American Journal of Perinatology 08/2012; · 1.32 Impact Factor
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ABSTRACT: Adverse pregnancy outcomes, including preterm birth, are markedly higher among African-Americans versus Whites. Stress-induced immune dysregulation may contribute to these effects. Epstein-Barr virus (EBV) reactivation provides a robust model for examining cellular immune competence. This study examined associations of EBV virus capsid antigen immunoglobulin G (VCA IgG) with gestational stage, race, and racial discrimination in women during pregnancy and postpartum.
Fifty-six women (38 African-American, 18 White) were included. African-Americans and Whites did not differ in age, education, income, parity, or body mass index (ps⩾.51). During the 1st, 2nd, and 3rd trimester and ∼5weeks postpartum, women completed measures of racial discrimination, perceived stress, anxiety, depressive symptoms and health behaviors. EBV VCA IgG antibody titers were measured via ELISA in serum collected at each visit.
In the overall sample, EBV VCA IgG antibody titers were lower in the 3rd versus 1st trimester (p=.002). At every timepoint (1st, 2nd, 3rd trimester and postpartum), African-American women exhibited higher serum EBV VCA IgG antibody titers than Whites (ps<.001). This effect was most pronounced among African-Americans reporting greater racial discrimination [p=.03 (1st), .04 (2nd), .12 (3rd), .06 (postpartum)]. Associations of race and racial discrimination with EBV VCA IgG antibody titers were not accounted for by other measures of stress or health behaviors.
Compared to Whites, African-American women showed higher EBV VCA IgG antibody titers, indicative of impaired cellular immune competence, across pregnancy and postpartum. This effect was particularly pronounced among African-American women reporting greater racial discrimination, supporting a role for chronic stress in this association. In women overall, EBV antibody titers declined during late as compared to early pregnancy. This may be due to pregnancy-related changes in cell-mediated immune function, humoral immune function, and/or antibody transfer to the fetus in late gestation. As a possible marker of stress-induced immune dysregulation during pregnancy, the role of EBV reactivation in racial disparities in perinatal health warrants further attention.
Brain Behavior and Immunity 08/2012; 26(8):1280-7. · 4.72 Impact Factor
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ABSTRACT: Objective: To assess cerclage benefit in women with short cervix also receiving 17-α-hydroxyprogesterone caproate (17P) to prevent recurrent preterm birth (PTB). Methods: Secondary analysis of a multicenter trial of ultrasound-indicated cerclage for shortened cervical length (CL). Women with prior spontaneous PTB at 16-33 6/7 weeks, singleton gestation and CL < 25 mm between 16 and 22 6/7 weeks were counseled on use of 17P and randomized to cerclage or no cerclage. Outcomes of women who received 17P were analyzed by randomization group. Primary outcome was PTB < 35 weeks. Results: 99 women received 17P: 47 cerclage; 52 no cerclage. Rates of PTB < 35 weeks were similar, 30% for cerclage and 38% for no cerclage (aOR 0.64 (0.27-1.52)). In women with CL < 15 mm, PTB < 35 weeks was reduced for the cerclage group (17% vs. 75%, p = 0.02). However, this difference was nullified after controlling for total progesterone doses received (p = 0.40). Conclusions: Cerclage was shown not to offer additional benefit for the prevention of recurrent PTB in women with short CL < 25 mm receiving 17P, but the sample size is insufficient for a definite conclusion given the 36% nonsignificant decrease in the odds of PTB < 35 weeks. Cerclage may further offer substantial benefit to women with very short CL < 15 mm and further study is needed.
The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 08/2012; · 1.36 Impact Factor
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Maged M Costantine,
Yinglei Lai,
Steven L Bloom,
Catherine Y Spong,
Michael W Varner,
Dwight J Rouse,
Susan M Ramin,
Steve N Caritis,
Alan M Peaceman,
Yoram Sorokin,
Anthony Sciscione,
Brian M Mercer,
John M Thorp,
Fergal D Malone,
Margaret Harper, Jay D Iams
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ABSTRACT: Objective To compare population versus customized fetal growth norms in identifying neonates at risk for adverse outcomes (APO) associated with small for gestational age (SGA).Study Design Secondary analysis of an intrapartum fetal pulse oximetry trial in nulliparous women at term. Birth weight percentiles were calculated using ethnicity- and gender-specific population norms and customized norms (Gardosi).Results Of the studied neonates, 508 (9.9%) and 584 (11.3%) were SGA by population (SGApop) and customized (SGAcust) norms, respectively. SGApop infants were significantly associated with a composite adverse neonatal outcome, neonatal intensive care admission, low fetal oxygen saturation, and reduced risk of cesarean delivery; both SGApop and SGAcust infants were associated with a 5-minute Apgar score < 4. The ability of customized and population birth weight percentiles in predicting APO was poor (12 of 14 APOs had area under the curve of <0.6).Conclusion In this intrapartum cohort, neither customized nor normalized population norms adequately identified neonates at risk of APO related to SGA.
American Journal of Perinatology 08/2012; · 1.32 Impact Factor
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Steve N Caritis,
Hyagriv N Simhan,
Yuan Zhao,
Dwight J Rouse,
Alan M Peaceman,
Anthony Sciscione,
Catherine Y Spong,
Michael W Varner,
Fergal D Malone, Jay D Iams,
Brian M Mercer,
John M Thorp,
Yoram Sorokin,
Marshall Carpenter,
Julie Lo,
Susan M Ramin,
Margaret Harper
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ABSTRACT: OBJECTIVE: We sought to evaluate in women with twin gestation the relationship between 17-hydroxyprogesterone caproate (17-OHPC) concentration and gestational age at delivery and select biomarkers of potential pathways of drug action. STUDY DESIGN: Blood was obtained between 24-28 weeks (epoch 1) and 32-35 weeks (epoch 2) in 217 women with twin gestation receiving 17-OHPC or placebo. Gestational age at delivery and concentrations of 17-OHPC, 17-hydroxyprogesterone, progesterone, C-reactive protein (CRP), and corticotrophin-releasing hormone were assessed. RESULTS: Women with higher concentrations of 17-OHPC delivered at earlier gestational ages than women with lower concentrations (P < .001). Women receiving 17-OHPC demonstrated significantly higher (P = .005) concentrations of CRP in epoch 1 than women receiving placebo but CRP values were similar in epoch 2 in both groups. A highly significant (P < .0001) positive relationship was observed between 17-OHPC concentration and progesterone and 17-hydroxyprogesterone concentrations at both epochs. Corticotropin-releasing hormone concentrations did not differ by treatment group. CONCLUSION: 17-OHPC may adversely impact gestational age at delivery in women with twin gestation.
American journal of obstetrics and gynecology 08/2012; · 3.28 Impact Factor
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Leslie Myatt,
Rebecca G Clifton,
James M Roberts,
Catherine Y Spong,
John C Hauth,
Michael W Varner,
John M Thorp,
Brian M Mercer,
Alan M Peaceman,
Susan M Ramin,
Marshall W Carpenter, Jay D Iams,
Anthony Sciscione,
Margaret Harper,
Jorge E Tolosa,
George Saade,
Yoram Sorokin,
Garland D Anderson
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ABSTRACT: To identify clinical characteristics and biochemical markers in first-trimester samples that would possibly predict the subsequent development of preeclampsia.
We conducted a multicenter observational study in 2,434 nulliparous women at low risk to identify biomarkers that possibly predict preeclampsia. Clinical history, complete blood count, and biochemical markers were assessed in the first trimester. The trophoblast and angiogenesis markers ADAM-12, pregnancy-associated plasma protein-A, placental protein 13, placental growth factor, soluble fms-like tyrosine kinase-1, and endoglin were measured in a case-control subset of 174 women with preeclampsia and 509 women in the control group.
Univariable analysis revealed maternal age, race, marital status, years of education, source of medical payment, prenatal caregiver, body mass index (BMI, calculated as weight (kg)/[height (m)]), and systolic blood pressure at enrollment were significantly associated with preeclampsia. Mean platelet volume was greater at enrollment in women who later had development of preeclampsia (median 9.4 compared with 9.0 femtoliter (fl); P=.02). First-trimester concentrations (multiples of the median) of ADAM-12 (1.14 compared with 1.04; P=.003), pregnancy-associated plasma protein-A (0.94 compared with 0.98; P=.04), and placental growth factor (0.83 compared with 1.04; P<.001) were significantly different in women who had development of preeclampsia compared with women in the control group. The optimal multivariable model included African American race, systolic blood pressure, BMI, education level, ADAM-12, pregnancy-associated plasma protein-A, and placental growth factor, and yielded an area under the curve of 0.73 (95% confidence interval 0.69-0.77) and a sensitivity of 46.1% (95% confidence interval 38.3-54.0) for 80% specificity.
A multivariable analysis of clinical data and biochemical markers in the first trimester did not identify a model that had clinical utility for predicting preeclampsia in a nulliparous population at low risk.
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Obstetrics and Gynecology 06/2012; 119(6):1234-42. · 4.73 Impact Factor
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Sally Y Segel,
Carlos A Carreño,
Steven J Weiner,
Steven L Bloom,
Catherine Y Spong,
Michael W Varner,
Dwight J Rouse,
Steve N Caritis,
William A Grobman,
Yoram Sorokin,
Anthony Sciscione,
Brian M Mercer,
John M Thorp,
Fergal D Malone,
Margaret Harper, Jay D Iams
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ABSTRACT: Objective To study the relationship between fetal station and successful vaginal delivery in nulliparous women.Study Design This was a secondary analysis from a previously reported trial of pulse oximetry. Vaginal delivery rates were evaluated and compared with respect to the fetal station. Spontaneous labor and induction of labor groups were evaluated separately. Multivariable logistic regression analysis was performed to adjust for confounding factors.Results Successful vaginal delivery was more frequent with an engaged vertex for spontaneous labor (86.2% versus 78.6%; p = 0.01) and induced labor (87.7% versus 66.1%; p < 0.01). After adjustment, engaged fetal vertex was not associated with vaginal delivery for spontaneous labor (odds ratio [OR] 1.5; 95% confidence interval [CI] 0.95 to 2.3; p = 0.08) or for women with induced labor (OR 2.2; 95% CI 0.96 to 5.1; p = 0.06).Conclusion Among nulliparous women enrolled in the FOX randomized trial in spontaneous labor or for labor induction, an engaged fetal vertex does not affect their vaginal delivery rate.
American Journal of Perinatology 05/2012; 29(9):723-730. · 1.32 Impact Factor
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ABSTRACT: Objective: To assess whether type of suture material affects cerclage efficacy for preterm birth (PTB) prevention. Methods: Secondary analysis of a multicenter trial of ultrasound-indicated cerclage for short cervical length (CL), in which women with prior spontaneous PTB at 16-33 6/7 weeks, a singleton gestation and CL < 25 mm between 16-22 6/7 weeks, were randomized to McDonald cerclage or no cerclage. Outcomes of women who underwent cerclage were analyzed by type of suture material, comparing polyester braided thread (Mersilene™ or Ethibond™) to Mersilene tape™. Primary outcome was PTB < 35 weeks. Results: 138 women underwent McDonald cerclage: 84 (61%) received polyester braided thread and 46 (33%) Mersilene tape™. Eight (6%) received monofilament suture and were excluded from analysis. Rates of PTB < 35 weeks were similar, 35% for polyester braided thread vs 24% for Mersilene tape™ (p = .24). Birth gestational age was also similar among the 2 groups (p = .18). Conclusion: Type of suture material may not affect ultrasound-indicated cerclage efficacy in high-risk women with short CL, but further study is needed. Polyester braided thread (Mersilene™ or Ethibond™) and polyester braided Mersilene tape™ seem to have similar efficacy.
The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 05/2012; 25(11):2287-2290. · 1.36 Impact Factor
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ABSTRACT: OBJECTIVE: To evaluate whether increasing body mass index (BMI) alters the efficacy of ultrasound directed cerclage in women with a history of preterm birth. METHODS: Planned secondary analysis of a multicenter trial. Women with prior spontaneous preterm birth were screened for short cervix and randomly assigned to cerclage or not for cervical length (CL) <25 mm. RESULTS: Overall (n = 986), BMI was not associated with CL (p = 0.68), birth gestational age (GA) (p = 0.12), or birth <35 weeks (p=0.68). For the cerclage group (n=148), BMI had no significant effect. For the no cerclage group (n=153), BMI decreased GA with an estimated slope of -0.14 weeks per kg/m(2) (p = 0.03). This result was driven primarily by several women with BMI >47 kg/m(2) . CONCLUSION: In women at high risk for recurrent preterm birth, BMI was not associated with CL or birth GA. BMI did not appear to adversely affect ultrasound indicated cerclage. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.
Ultrasound in Obstetrics and Gynecology 04/2012; · 3.01 Impact Factor
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Alan Thevenet N Tita,
Yinglei Lai,
Steven L Bloom,
Catherine Y Spong,
Michael W Varner,
Susan M Ramin,
Steve N Caritis,
William A Grobman,
Yoram Sorokin,
Anthony Sciscione,
Marshall W Carpenter,
Brian M Mercer,
John M Thorp,
Fergal D Malone,
Margaret Harper, Jay D Iams
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ABSTRACT: The objective of the study was to compare pregnancy outcomes by completed week of gestation after 39 weeks with outcomes at 39 weeks.
Secondary analysis of a multicenter trial of fetal pulse oximetry in spontaneously laboring or induced nulliparous women at a gestation of 36 weeks or longer. Maternal outcomes included a composite (treated uterine atony, blood transfusion, and peripartum infections) and cesarean delivery. Neonatal outcomes included a composite of death, neonatal respiratory and other morbidities, and neonatal intensive care unit admission.
Among the 4086 women studied, the risks of the composite maternal outcome (P value for trend < .001), cesarean delivery (P < .001), and composite neonatal outcome (P = .047) increased with increasing gestational age from 39 to 41 or more completed weeks. Adjusted odds ratios (95% confidence interval) for 40 and 41 or more weeks, respectively, compared with 39 weeks were 1.29 (1.03-1.64) and 2.05 (1.60-2.64) for composite maternal outcome, 1.28 (1.05-1.57) and 1.75 (1.41-2.16) for cesarean delivery, and 1.25 (0.86-1.83) and 1.37 (0.90-2.09) for composite neonatal outcome.
Risks of maternal morbidity and cesarean delivery but not neonatal morbidity increased significantly beyond 39 weeks.
American journal of obstetrics and gynecology 03/2012; 206(3):239.e1-8. · 3.28 Impact Factor
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JAMA The Journal of the American Medical Association 12/2011; 306(22):2506-7. · 30.03 Impact Factor
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ABSTRACT: Traditionally, obstetricians have grouped together all pregnancy losses before the mid-second trimester as spontaneous abortions. However, this nomenclature is arbitrary, outdated, and not clinically useful. Using this system, miscarriages due to genetic abnormalities, fetal deaths associated with abnormal placental growth and development, and spontaneous preterm births of liveborn fetuses at previable gestations are lumped together in a single category. In addition, the term abortion is fraught with emotional connotations for families suffering the loss of a pregnancy. Thus, whereas the existing classification for pregnancy loss has served a somewhat pragmatic role, it ignores precepts of developmental biology and the clinical realities of these adverse pregnancy outcomes. In this article, we propose a more useful nomenclature for pregnancy loss and preterm births that is informative and is based on developmental periods in gestation and shared pathophysiology.
Obstetrics and Gynecology 12/2011; 118(6):1402-8. · 4.73 Impact Factor
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Lynn H Johnson,
Delicia C Mapp,
Dwight J Rouse,
Catherine Y Spong,
Brian M Mercer,
Kenneth J Leveno,
Michael W Varner, Jay D Iams,
Yoram Sorokin,
Susan M Ramin,
Menachem Miodovnik,
Mary J O'Sullivan,
Alan M Peaceman,
Steve N Caritis
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ABSTRACT: To assess the relationship between umbilical cord blood magnesium concentration and level of delivery room resuscitation received by neonates.
This was a secondary analysis of a controlled fetal neuroprotection trial that enrolled women at imminent risk for delivery between 24 and 31 weeks' gestation and randomly allocated them to receive either intravenous magnesium sulfate or placebo. The cohort included 1507 infants with data available on total cord blood Mg concentration and delivery room resuscitation. Multivariate logistic regression was used to estimate the association between cord blood Mg concentration and highest level of delivery room resuscitation, using the following hierarchy: none, oxygen only, bag-mask ventilation with oxygen, intubation, and chest compressions.
There was no relationship between cord blood Mg and delivery room resuscitation (OR, 0.92 for each 1.0-mEq/L increase in Mg; 95% CI, 0.83-1.03). Maternal general anesthesia was associated with increased neonatal resuscitation (OR, 2.51; 95% CI, 1.72-3.68). Each 1-week increase in gestational age at birth was associated with decreased neonatal resuscitation (OR, 0.63; 95% CI, 0.60-0.66).
Cord blood Mg concentration does not correlate with the level of delivery room resuscitation of infants exposed to magnesium sulfate for fetal neuroprotection.
The Journal of pediatrics 11/2011; 160(4):573-577.e1. · 4.02 Impact Factor
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Jay D Iams
American journal of obstetrics and gynecology 11/2011; 205(5):395. · 3.28 Impact Factor
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Michael S Kramer,
Aris Papageorghiou,
Jennifer Culhane,
Zulfiqar Bhutta,
Robert L Goldenberg,
Michael Gravett, Jay D Iams,
Agustin Conde-Agudelo,
Sarah Waller,
Fernando Barros,
Hannah Knight,
Jose Villar
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ABSTRACT: In 2009, the Global Alliance to Prevent Prematurity and Stillbirth Conference charged the authors to propose a new comprehensive, consistent, and uniform classification system for preterm birth. This first article reviews issues related to measurement of gestational age, clinical vs etiologic phenotypes, inclusion vs exclusion of multifetal and stillborn infants, and separation vs combination of pathways to preterm birth. The second article proposes answers to the questions raised here, and the third demonstrates how the proposed system might work in practice.
American journal of obstetrics and gynecology 10/2011; 206(2):108-12. · 3.28 Impact Factor
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ABSTRACT: Despite the increase in indicated late preterm births, spontaneous preterm labor and preterm premature rupture of the fetal membranes are the most common antecedent diagnoses leading to births between 34-0/7 and 36-6/7 weeks of gestation. Regional and institutional variation in the rates of late spontaneous preterm birth suggests that there may be opportunities to reduce the number of these births. This article summarizes the factors contributing to late spontaneous preterm birth and offers suggestions to improve care for these mothers and infants.
Seminars in perinatology 10/2011; 35(5):309-13. · 2.33 Impact Factor
