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Who is at risk for prolonged and postterm pregnancy?
Abstract
The objective of the study was to examine risk factors for postterm (gestational age >or= 42 weeks) or prolonged (gestational age >or= 41 weeks) pregnancy.
We conducted a retrospective cohort study of all term, singleton pregnancies delivered at a mature, managed care organization. The primary outcome measures were the rates of pregnancies greater than 41 or 42 weeks' gestation. Multivariable logistic regression models were used to control for potential confounding and interaction.
Specific risk factors for pregnancy beyond 41 weeks of gestation include obesity (adjusted odds ratio [aOR], 1.26; 95% confidence interval [CI], 1.16-1.37), nulliparity (aOR, 1.46; 95% CI 1.42-1.51), and maternal age 30-39 years (aOR, 1.06; 95% CI, 1.02-1.10) and 40 years or older (aOR, 1.07; 95% CI, 1.02-1.12). Additionally, African American, Latina, and Asian race/ethnicity were all associated with a lower risk of reaching 41 or 42 weeks of gestation.
Our findings suggest that there may be biological differences that underlie the risk for women to progress to 41 or 42 weeks of gestation. In particular, obesity is a modifiable risk factor and could potentially be prevented with prepregnancy or interpregnancy interventions.
... As previously reported, the prevalence of postterm births ranges from 1-10% worldwide, but large differences exist between and within countries depending on the diversity of the populations studied and variations in obstetric practices [11][12][13] . The etiology of postterm births is largely unknown, but multiple risk factors are associated with the prevalence of postterm births, including genetic factors 14,15 , maternal age [16][17][18][19] , education 16,18,19 , pregnancy body mass index [17][18][19][20] , primiparity [17][18][19]21 , previous postterm pregnancy 16,22 , and maternal obstetric complications 19 . Among these factors, some (e.g., maternal age, education, and primiparity) have shown conflicting results. ...
... As previously reported, the prevalence of postterm births ranges from 1-10% worldwide, but large differences exist between and within countries depending on the diversity of the populations studied and variations in obstetric practices [11][12][13] . The etiology of postterm births is largely unknown, but multiple risk factors are associated with the prevalence of postterm births, including genetic factors 14,15 , maternal age [16][17][18][19] , education 16,18,19 , pregnancy body mass index [17][18][19][20] , primiparity [17][18][19]21 , previous postterm pregnancy 16,22 , and maternal obstetric complications 19 . Among these factors, some (e.g., maternal age, education, and primiparity) have shown conflicting results. ...
... As previously reported, the prevalence of postterm births ranges from 1-10% worldwide, but large differences exist between and within countries depending on the diversity of the populations studied and variations in obstetric practices [11][12][13] . The etiology of postterm births is largely unknown, but multiple risk factors are associated with the prevalence of postterm births, including genetic factors 14,15 , maternal age [16][17][18][19] , education 16,18,19 , pregnancy body mass index [17][18][19][20] , primiparity [17][18][19]21 , previous postterm pregnancy 16,22 , and maternal obstetric complications 19 . Among these factors, some (e.g., maternal age, education, and primiparity) have shown conflicting results. ...
Postterm births are associated with an increased risk of adverse perinatal outcomes, but few studies have investigated the epidemiological characteristics of postterm births. We aimed to estimate the prevalence of postterm births and examine the potential association between maternal sociodemographic and obstetric characteristics and postterm births. Data were collected from China’s National Maternal Near Miss Surveillance System, 2012–2016. A logistic regression was used to assess the association between sociodemographic and obstetric characteristics and postterm births. A Poisson regression was used to determine the crude and adjusted trends of postterm births over time across regions. Among the 6,240,830 singleton births with gestational periods of 37 weeks or longer, 1.16% were postterm. The prevalence of postterm births was significantly higher in the western region and among mothers who delivered at a level ≤2 hospital, had a lower education, or were younger. A reduced risk of postterm births was observed among primiparous women, mothers who previously had a caesarean section, mothers with pregnancy complications, and mothers with ten or more antenatal visits. The risk of postterm births decreased as the number of antenatal visits increased. The overall postterm birth rates significantly decreased from 1.49% in 2012 to 0.70% in 2016. The postterm birth rates were markedly reduced in the east, central, and west regions, and the rate of the decrease was greater in the east than in the west. Furthermore, substantial decreases were observed across regions in 2014 and 2016. In conclusion, multiple sociodemographic and obstetric factors are associated with the prevalence of postterm births. A significant decreasing trend in postterm birth rates was observed in China.
... Despite the fact that it is recommended that obese women gain less weight than other women during pregnancy, prepregnancy obesity increases the likelihood of excessive intrapartum weight gain. This excess weight gain is in turn associated with weight retention 5-10 years later [67]. The timing of weight gain is also important for predicting adverse maternal health outcomes during pregnancy. ...
... Obesity and its late sequelae may prove to be one of the greatest threats to adulthood health in the developing world this century [66]. In the USA, 18-35% of pregnant women are clinically obese [67]. Obesity in pregnancy is of great concern not only due to adverse effects on maternal health and pregnancy outcomes [68] but also due to accumulating evidence of long term effects and complications of the offspring. ...
... Further work will be needed to assess the effectiveness of this intervention before it becomes standard. It also appears that increasing BMI at conception increases the likelihood of post-term pregnancy [67,68]. While induction of labor presents a particular challenge in the obese, allowing postdatism may be ill advised, particularly in the face of comorbid conditions such as diabetes, hypertension or growth disturbance. ...
The growing 'obesity epidemic' in the Western world is of particular concern for women of childbearing age. Both short- and long-term effects are associated with obesity in pregnancy for both the mother and her offspring. The nine chapters of this book are organized according to the natural course of the association between obesity and pregnancy. The book commences with an examination of the association between obesity and general maternal health during pregnancy and in nonpregnancy. The book then addresses the complications of obesity in pregnancy, screening and treatment of diabetes, weight optimization and weight gain during pregnancy, bariatric surgery and the impact on pregnancy outcome, appropriate antenatal care, considerations for labor and delivery, postnatal care, and finally, the association between maternal obesity and long-term sequelae to the offspring. The book includes thought-provoking discussion between the Editor and other authors together with multiple choice questions - a feature in all Clinical Insights books - facilitating continued learning for established professionals and providing a useful learning tool for those seeking deeper insight into these topics.
... Robust meta-analysis data demonstrate the relationship between BMI and pre-term birth (17,18). Despite published studies exploring the association between maternal BMI and post-term birth (19)(20)(21), there is a lack of robust evidence from meta-analyses. ...
... The 10 studies which had to be excluded from the metaanalyses due to a lack of comparable data for pooling included two studies only reporting maternal weight and not BMI (36,37); five did not report frequency data for participants and/or cases of post-term birth (21,(38)(39)(40)(41), and three did not have comparable BMI reference groups (one combined all non-obese (42), one combined underweight and recommended weight (43), and one combined recommended weight and overweight (44)). Of the 10 studies not included in the meta-analyses, six found a significantly increased risk of post-term birth in obese women compared with the reference group (21,(37)(38)(39)(40)44), while four did not find a significantly increased association (36,(41)(42)(43) (Table 3). ...
... The 10 studies which had to be excluded from the metaanalyses due to a lack of comparable data for pooling included two studies only reporting maternal weight and not BMI (36,37); five did not report frequency data for participants and/or cases of post-term birth (21,(38)(39)(40)(41), and three did not have comparable BMI reference groups (one combined all non-obese (42), one combined underweight and recommended weight (43), and one combined recommended weight and overweight (44)). Of the 10 studies not included in the meta-analyses, six found a significantly increased risk of post-term birth in obese women compared with the reference group (21,(37)(38)(39)(40)44), while four did not find a significantly increased association (36,(41)(42)(43) (Table 3). ...
Post-term birth is a preventable cause of perinatal mortality and severe morbidity. This review examined the association between maternal body mass index (BMI) and post-term birth at ≥42 and ≥41 weeks' gestation. Five databases, reference lists and citations were searched from May to November 2015. Observational studies published in English since 1990 were included. Linear and nonlinear dose-response meta-analyses were conducted by using random effects models. Sensitivity analyses assessed robustness of the results. Meta-regression and sub-group meta-analyses explored heterogeneity. Obesity classes were defined as I (30.0-34.9 kg m(-2) ), II (35.0-39.9 kg m(-2) ) and III (≥40 kg m(-2) ; IIIa 40.0-44.9 kg m(-2) , IIIb ≥ 45.0 kg m(-2) ). Searches identified 16,375 results, and 39 studies met the inclusion criteria (n = 4,143,700 births). A nonlinear association between maternal BMI and births ≥42 weeks was identified; odds ratios and 95% confidence intervals for obesity classes I-IIIb were 1.42 (1.27-1.58), 1.55 (1.37-1.75), 1.65 (1.44-1.87) and 1.75 (1.50-2.04) respectively. BMI was linearly associated with births ≥41 weeks: odds ratio is 1.13 (95% confidence interval 1.05-1.21) for each 5-unit increase in BMI. The strength of the association between BMI and post-term birth increases with increasing BMI. Odds are greatest for births ≥42 weeks among class III obesity. Targeted interventions to prevent the adverse outcomes associated with post-term birth should consider the difference in risk between obesity classes.
... Other smaller samples are also reported in the literature. [7][8][9][10][11][12]. ...
... In 2009, Caughey et al. In the United States, found a decreased risk of childbirth after 41 + 0 SA in women of African American, Latin and Asian descent compared to Caucasian women [8]. ...
To determine the duration of single-fetal pregnancy in black Senegalese women and the factors that contribute to it.
... Prolonged pregnancy increases the risk of stillbirth, neonatal morbidity and mortality, and the risk of CS associated to the induction of labour is higher than in inductions in earlier pregnancy weeks. 66 Nulliparity is one of the known risk factors for prolonged pregnancy, 67 and nulliparas form the majority of women undergoing induction of labour due to prolonged pregnancy 26 Previously Lactobacillus abundances have been shown to decline gradually toward birth. 19 Prevalence of L. crispatus -dominated vaginal microbiota, however, was higher after the due date among nulliparas in our study. ...
Background:
Vaginal microbiota and its potential contribution to preterm birth is under intense research. However, only few studies have investigated the vaginal microbiota in later stages of pregnancy or at the onset of labour.
Methods:
We used 16S rRNA gene amplicon sequencing to analyse cross-sectional vaginal swab samples from 324 Finnish women between 37-42 weeks of gestation, sampled before elective caesarean section, at the onset of spontaneous labour, and in pregnancies lasting ≥41 weeks of gestation. Microbiota data were combined with comprehensive clinical data to identify factors associated with microbiota variation.
Findings:
Vaginal microbiota composition associated strongly with advancing gestational age and parity, i.e. presence of previous deliveries. Absence of previous deliveries was a strong predictor of Lactobacillus crispatus dominated vaginal microbiota, and the relative abundance of L. crispatus was higher in late term pregnancies, especially among nulliparous women.
Interpretation:
This study identified late term pregnancy and reproductive history as factors underlying high abundance of gynaecological health-associated L. crispatus in pregnant women. Our results suggest that the vaginal microbiota affects or reflects the regulation of the duration of gestation and labour onset, with potentially vast clinical utilities. Further studies are needed to address the causality and the mechanisms on how previous labour, but not pregnancy, affects the vaginal microbiota. Parity and gestational age should be accounted for in future studies on vaginal microbiota and reproductive outcomes.
Funding:
This research was supported by EU H2020 programme Sweet Crosstalk ITN (814102), Academy of Finland, State Research Funding, and University of Helsinki.
... Therefore, our results indicated that rubella seronegative status in our multiparous gravidae plays proxy for subtle alteration in maternal immune response which increases occurrence of PE. Both increased PE and post-dated pregnancy had probably contributed to the increased perinatal and neonatal deaths, despite our policy of labour induction before 42 weeks gestation, as a gestation extending to 41 weeks and beyond is by itself associated with increased foetal hypoxia, antepartum and intrapartum foetal distress and acidosis, and intrauterine, neonatal and total perinatal deaths 31-33 , even though rubella sero-negativity has not been identified as a risk factor for prolonged and post-dated pregnancy 34,35 . ...
Routine antenatal rubella serological testing is adopted in many countries. In a population covered by universal childhood rubella immunization for four decades, we have observed an association between pre-eclampsia with maternal rubella seronegativity among multiparous gravidae. This retrospective cohort study was further performed to elucidate the interaction between parity status and rubella seronegativity on obstetric outcome in singleton pregnancies carried to ≥ 24 weeks gestation managed from 1997 to 2019, with the data retrieved from a computerized database used for annual statistics and auditing. Of the 133,926 singleton pregnancies eligible for the study, the 13,320 (9.9%) rubella seronegative gravidae had higher mean booking weight and body mass index (BMI), but shorter height, and higher incidence of advanced age (≥ 35 years), high BMI, short stature, and lower incidence of nulliparas. Univariate analysis showed that adverse obstetric outcomes were more frequently found among the multiparas. On multivariate analysis, there was increased postdated (> 41 weeks) pregnancy irrespective of parity status, while nulliparas had reduced gestational hypertension (aRR 0.714, 95% CI 0.567–0.899) and gestational diabetes (aRR 0.850, 95% CI 0.762–0.950), and multiparas had increased pre-eclampsia (aRR 1.261, 95% CI 1.005–1.582), neonatal death (aRR 2.796, 95% CI 1.243–6.291), and perinatal death (aRR 2.123, 95% CI 1.257–3.587). In conclusion, in a population covered by universal childhood rubella immunization, antenatal rubella seronegativity is associated with increased pre-eclampsia and perinatal loss only in multiparas, suggesting that the rubella seronegativity in these women served as proxy for some form of altered immune response which increases adverse pregnancy outcome.
... Potential covariates were identified as factors known from previous studies to influence both the risk of prolonged pregnancy and the risk of adverse neonatal and maternal outcomes. [18][19][20] Covariates for adjustment were identified using directed acyclic graphs and included maternal age, BMI, parity, and induction of labor. In addition, we adjusted for year of birth to account for any changes in clinical practice during the long study period. ...
Introduction:
Uncertainty remains about the most appropriate timing of induction of labor in late-term pregnancies. To address this issue, this study aimed to compare the risk of neonatal morbidity and pregnancy- and birth-related complications between gestational age (GA) 41+4 -42+0 and GA 41+0 -41+3 weeks.
Material and methods:
This nationwide registry-based cohort study included singleton births without major congenital malformations, with registered GA, and with intended vaginal delivery at GA 41+0 - 42+0 weeks between 2009 and 2018 in Denmark. Logistic regression models were used to estimate the crude risk ratio and adjusted risk ratio (RRA ) of neonatal and obstetric adverse outcomes in births at GA 41+4 - 42+0 weeks compared with GA 41+0 - 41+3 weeks. The results were adjusted for relevant confounders, including induction of labor.
Results:
A higher incidence of neonatal morbidity and birth complications was observed in births at GA 41+4 -42+0 weeks than in births at GA 41+0 -41+3 weeks. Neonatal morbidities included an increased risk of low Apgar score (Apgar 0-6 after 5 min; RRA 1.17, 95% confidence interval [CI] 1.01-1.34), meconium aspiration (RRA 1.25, 95% CI 1.06-1.48), need for respiratory support (continuous positive airway pressure; RRA 1.09, 95% CI 1.03-1.15), and a composite outcome of need for comprehensive treatment at a neonatal department or neonatal death (RRA 1.65, 95% CI 1.29-2.11). Birth complications included emergency cesarean section (RRA 1.17, 95% CI 1.14-1.21), severe lacerations (RRA 1.11, 95% Cl 1.04-1.17), and increased blood loss after birth (RRA 1.13, 95% CI 1.06-1.21).
Conclusions:
Births at GA 41+4 -42+0 weeks were associated with an increased risk of neonatal morbidity and birth complications compared with births at GA 41+0 -41+3 weeks. The results of this study may aid clinicians in deciding when to recommend induction of labor in late-term pregnancies.
... Prolonged pregnancy increases the risk of stillbirth, neonatal morbidity and mortality, and the risk of cesarean delivery associated to the induction of labor is higher than in inductions in earlier pregnancy weeks 51 . Nulliparity is one of the known risk factors for prolonged pregnancy 52 , and nulliparas form the majority of women undergoing induction of labor due to prolonged pregnancy 28 . Previously Lactobacillus abundances have been shown to decline gradually toward birth 20 . ...
Vaginal microbiota and its potential contribution to preterm birth has been under intense research in recent years. However, only few studies have studied vaginal microbiota in later stages of pregnancy or at the onset of labor. We analyzed vaginal swab samples collected between 37- and 42-weeks of gestation from 324 Finnish women before elective cesarean section, at the onset of spontaneous labor, and in pregnancies continuing beyond 41 weeks of gestation. Vaginal microbiota composition associated strongly with parity, i.e. previous deliveries, and advancing gestational age. Absence of previous deliveries was a strong predictor of L. crispatus dominated vaginal microbiota, and the relative abundance of L. crispatus was higher in late term pregnancies, especially among nulliparous women. The results underscore the importance of the vaginal microbiota for improving the currently limited understanding on how the duration of gestation and timing of birth is regulated, with potentially vast clinical utilities.
... Most common reason for casaerean sections in BMI<30 group was Meconium stained liquor intrapartum. Our results were similar to those of Perlow et al (21) who reported that massively obese pregnant women undergoing cesarean section were at significantly increased risk for peroperative morbidity. Norman JE et al (22) also found that obesity complicates operative delivery; it makes operative delivery more difficult, increases complications and paradoxically increases the need for operative delivery. ...
... for AMA on late-term pregnancy. 16 This difference can be due to a higher rate of induction of labor in women with AMA in our cohort, which decreases the number of women who can reach a higher gestational age or may be due to the fact that we studied a predefined low-risk population. ...
Introduction:
There is an increase in women delivering ≥35 years of age. We analyzed the association between advanced maternal age and pregnancy outcomes in late- and postterm pregnancies.
Material and methods:
A national cohort study was performed on obstetrical low-risk women using data from the Netherlands Perinatal Registry from 1999-2010. We included women >18 years of age with a singleton pregnancy at term. Women with a pregnancy complicated by congenital anomalies, hypertensive disorders or diabetes mellitus were excluded. Composite adverse perinatal outcome was defined as stillbirth, neonatal death, meconium aspiration syndrome, 5-minute Apgar score <7, neonatal intensive care unit admittance and sepsis. Composite adverse maternal outcome was defined as maternal death, placental abruption and postpartum hemorrhage of >1000ml.
Results:
We stratified the women in three age groups: 18-34 (n=1 321 366 (reference)); 35-39 (n=286 717) and ≥40 (n=40 909). Composite adverse perinatal outcome occurred in 1.6% in women aged 18-34, 1.7% in women aged 35-39 (relative risk (RR) 1.06; 95% confidence interval (CI) 1.03 to 1.08) and 2.2% in women aged ≥40 (RR 1.38; CI 1.29 to 1.47), with 5-minute Apgar score < 7 as the factor contributing most to the outcome. Composite adverse maternal outcome occurred in 4.6% in women aged 18-34 (ref), 5.0% in women aged 35-39 (RR 1.08; CI 1.06 to 1.10) and 5.2% in women aged ≥40 (RR 1.14; CI 1.09 to 1.19), with postpartum hemorrhage >1000ml as the factor contributing most to the outcome. In all age categories, the risk of adverse pregnancy outcomes was higher for nulliparous than for multiparous women. The risk of adverse outcomes increased in both nulliparous and parous women with advancing gestational age. When adjusted for parity, onset of labour and gestational age, advanced maternal age is associated with an increase in both composite adverse perinatal and maternal outcomes.
Conclusions:
The risk of adverse pregnancy outcome increases with advancing maternal age. Women aged ≥40, have an increased risk of adverse perinatal and maternal outcome when pregnancy goes beyond 41 weeks. Gestational age was more strongly associated with adverse perinatal and maternal outcomes than maternal age, but the difference was non-significant.
... Furthermore, obesity is associated with an increased risk of uterine fibroids, which may affect pregnancy outcomes and require specific clinical management [15,16]. There has also been reported to be an increase in obesity-related post-term pregnancy rates [17,18]. Although the precise cause of the increase in the incidence of post-term pregnancies in obese pregnancies is not fully known, it has been suggested that it could be due to a decrease in the onset of spontaneous labor rates [19,20]. ...
Objective:
To determine the effect of obesity on the onset of spontaneous labor, scheduled delivery rates and perinatal outcomes in term pregnancies.
Material and methods:
242 obese and 244 non-obese pregnant women ≥37 gestational weeks were compared in terms of the onset of spontaneous labor, scheduled delivery rates and perinatal outcomes.
Results:
Obese pregnant women had statistically significantly lower onset of spontaneous labor and higher rates of scheduled delivery. No difference was determined in respect of the type of delivery, 1st and 5th minutes APGAR scores and the need for intensive care. Higher values of birth weight, large for gestational age, macrosomia, gestational diabetes mellitus and preeclampsia were determined in obese women.
Conclusion:
The onset of spontaneous labor rates in term obese pregnancies were lower and scheduled delivery rates were higher than in the non-obese pregnancies. However, more extensive studies are needed to better understand this relationship.
... However, the reported effects of wealth on facility delivery were inconsistent across studies in East Africa [30]. Further, as this analysis only included women enrolled in the Safer Deliveries program in Zanzibar, Tanzania, the results may not be generalizable to other populations due to both regional differences in women's accuracy in LMP recall, use of the Islamic vs. Gregorian calendar, and natural variability in gestational duration [2,11,13,31] and structural differences in maternal health programs (i.e. CHW experience, timing of visits, and delivery date estimation). ...
Background:
Most maternal health programs in low- and middle- income countries estimate gestational age to provide appropriate antenatal care at the correct times throughout the pregnancy. Although various gestational dating methods have been validated in research studies, the performance of these methods has not been evaluated on a larger scale, such as within health systems. The objective of this research was to investigate the magnitude and impact of errors in estimated delivery dates on health facility delivery among women enrolled in a maternal health program in Zanzibar.
Methods:
This study included 4225 women who were enrolled in the Safer Deliveries program and delivered before May 31, 2017. The exposure of interest was error in estimated delivery date categorized as: severe overestimate, when estimated delivery date (EDD) was 36 days or more after the actual delivery date (ADD); moderate overestimate, when EDD was 15 to 35 days after ADD; accurate, when EDD was 6 days before to 14 days after ADD; and underestimate, when EDD was 7 days or more before ADD. We used Chi-squared tests to identify factors associated with errors in estimated delivery dates. We performed logistic regression to assess the impact of errors in estimated delivery dates on health facility delivery adjusting for age, district of residence, HIV status, and occurrence of past home delivery.
Results:
In our data, 28% of the estimated delivery dates were a severe overestimate, 23% moderate overestimate, 41% accurate, and 8% underestimate. Compared to women with an accurate delivery date, women with a moderate or severe overestimate were significantly less likely to deliver in a health facility (OR = 0.71, 95% CI: [0.59, 0.86]; OR = 0.74, 95% CI: [0.61, 0.91]). When adjusting for multiple confounders, women with moderate overestimates were significantly less likely to deliver in a health facility (AOR = 0.76, 95% CI: [0.61, 0.93]); the result moved slightly towards null for women with severe overestimates (AOR = 0.84, 95% CI: [0.69, 1.03]).
Conclusions:
The overestimation of women's EDDs reduces the likelihood of health facility delivery. To address this, maternal health programs should improve estimation of EDD or attempt to curb the effect of these errors within their programs.
... Preterm babies are at increased risk of complications such as cerebral palsy, autism and disability, with the risk increasing with decreasing gestational age at birth [2]. Post-term birth (≥42 weeks gestation) is also associated with an increased risk of stillbirth, neonatal and infant death [3][4][5], and an increased risk of maternal morbidity due to fetal macrosomia [6], caesarean section [7][8][9], haemorrhage [8] and thromboembolic disease [7]. ...
Background:
Preterm (< 37 weeks gestation) and post-term birth (≥42 weeks gestation) are associated with increased morbidity and mortality for mother and infant. Obesity (body mass index (BMI) ≥30 kg/m2) is increasing in women of reproductive age. Maternal obesity has been associated with adverse pregnancy outcomes including preterm and post-term birth. However, the effect sizes vary according to the subgroups of both maternal BMI and gestational age considered. The aim of this retrospective analysis was to determine the association between maternal obesity classes and gestational age at delivery.
Methods:
A secondary data analysis of 13 maternity units in England with information on 479,864 singleton live births between 1990 and 2007. BMI categories were: underweight (< 18.5 kg/m2), recommended weight (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2) and obesity classes I (30.0-34.9 kg/m2), II (35.0-39.9 kg/m2), IIIa (40-49.9 kg/m2) and IIIb (≥50 kg/m2). Gestational age at delivery categories were: Gestational age at delivery (weeks): extreme preterm (20-27), very preterm (28-31), moderately preterm (32-36), early term (37, 38), full term (39-40), late term (41) and post-term (≥42). The adjusted odds of births in each gestational age category (compared to full-term birth), according to maternal BMI categories were estimated using multinomial logistic regression. Missing data were estimated using multiple imputation with chained equations.
Results:
There was a J-shaped association between the absolute risk of extreme, very and moderate preterm birth and BMI category, with the greatest effect size for extreme preterm. The absolute risk of post-term birth increased monotonically as BMI category increased. The largest effect sizes were observed for class IIIb obesity and extreme preterm birth (adjusted OR 2.80, 95% CI 1.31-5.98).
Conclusion:
Women with class IIIb obesity have the greatest risks for inadequate gestational age. Combining obesity classes does not accurately represent risks for many women as it overestimates the risk of all preterm and post-term categories for women with class I obesity, and underestimates the risk for women in all other obesity classes.
... Prolonged ([41 weeks' gestation) and post-term pregnancies ([42 weeks' gestation) are associated with several adverse neonatal and maternal outcomes compared to term pregnancies ( Olesen et al. 2003). Primiparity, previous postterm pregnancy, male fetus, genetic predisposition, obesity, maternal age and ethnicity have all been linked to susceptibility for post-term pregnancy (Caughey et al. 2009). Genetic factors, both fetal and maternal, attribute up to 30-50% of prolonged pregnancies ( Laursen et al. 2004;Oberg et al. 2013). ...
Compared to other human microbiota, vaginal microbiota is fairly simple with low bacterial diversity and high relative abundance of Lactobacillus species. Lactobacillus dominance is even more pronounced during pregnancy. Genetic factors, such as ethnicity, along with environmental, individual and lifestyle factors all have an impact on vaginal microbiota composition. The composition of the vaginal microbiota appears to play an important role in pregnancy as recent studies have linked it to adverse obstetric outcomes such as preterm birth, a leading cause of neonatal morbidity and mortality worldwide. However, the same vaginal microbiota does not seem to cause the same response in all women, calling for future research to fully understand the complex host–microbiota interplay in normal and complicated pregnancies.
... Paternal genetik, maternal kilo, obezite, erkek fetal cinsiyet risk faktörleri arasındadır. Obezite bu etiyolojiler içinde tek önlenebilir olanıdır (10). ...
... 13 Further, African Americans are less likely than white women to reach 40 weeks' gestation (aOR, 0.81; 95% CI, 0.78e0.85). 28 However, the black populations in overseas studies may not be directly comparable with African migrants to Australia. ...
Objective: To investigate prevalence rates and the risk of ante‐ and intrapartum stillbirth in Western Australia with respect to maternal country of birth and ethnic origin.
Design, setting and participants: Whole population retrospective cohort analysis of de‐identified, linked routinely collected birth, perinatal and mortality data for all births to non‐Indigenous women in WA during 2005–2013.
Main outcome measures: Crude and adjusted odds ratios (aORs) with 95% confidence intervals were estimated by logistic regression and adjusted for confounding factors, for all stillbirths, antepartum stillbirths and intrapartum stillbirths, stratified by migrant status and ethnic background (white, Asian, Indian, African, Māori, other).
Results: Women born overseas were more likely to have a stillbirth than Australian‐born women (aOR, 1.26; 95% CI, 1.09–1.37). There was no significant difference for any type of stillbirth between Australian‐born women of white and non‐white backgrounds, but non‐white migrant women were more likely than white migrants to have a stillbirth (OR, 1.42; 95% CI, 1.19–1.70). Compared with Australian‐born women, migrants of Indian (aOR, 1.71; 95% CI, 1.17–2.47), African (aOR, 2.12; 95% CI, 1.46–3.08), and “other” ethnic origins (aOR, 1.43; 95% CI, 1.06–1.93) were more likely to have antepartum stillbirths; women of African (aOR, 5.08; 95% CI, 3.14–8.22) and “other” (aOR, 1.86; 95% CI, 1.15–3.00) background were more likely to have an intrapartum stillbirth.
Conclusions: Immigrants of African or Indian background appear to be at greater risk of ante‐ and intrapartum stillbirth in WA. Specific strategies are needed reduce the prevalence of stillbirth in these communities.
... In addition, postterm births can cause risks for both the mother and the infant such as fetal and neonatal mortality and morbidity, increased maternal morbidity, fetal macrosomia, placental insufficiency, meconium aspiration syndrome, and meconium aspiration (1). Potential reasons for postterm births include nulliparity, maternal age, race, and previous pregnancies with postterm deliveries or anencephaly (9). ...
Background:
Abnormalities in birth weight and gestational age cause several adverse maternal and infant outcomes. Our study aims to determine the potential factors that affect birth weight and gestational age, and their association.
Materials and methods:
We conducted this cross-sectional study of 4415 pregnant women in Tehran, Iran, from July 6-21, 2015. Joint multilevel multiple logistic regression was used in the analysis with demographic and obstetrical variables at the first level, and the hospitals at the second level.
Results:
We observed the following prevalence rates: preterm (5.5%), term (94%), and postterm (0.5%). Low birth weight (LBW) had a prevalence rate of 4.8%, whereas the prevalence rate for normal weight was 92.4, and 2.8% for macrosomia. Compared to term, older mother's age [odds ratio (OR)=1.04, 95% confidence interval (CI): 1.02-1.07], preeclampsia (OR=4.14, 95% CI: 2.71-6.31), multiple pregnancy (OR=18.04, 95% CI: 9.75- 33.38), and use of assisted reproductive technology (ART) (OR=2.47, 95% CI: 1.64-33.73) were associated with preterm birth. Better socioeconomic status (SES) was responsible for decreased odds for postterm birth compared to term birth (OR=0.53, 95% CI: 0.37-0.74). Cases with higher maternal body mass index (BMI) were 1.02 times more likely for macrosomia (95% CI: 1.01-1.04), and male infant sex (OR=1.78, 95% CI: 1.21-2.60). LBW was related to multiparity (OR=0.59, 95% CI: 0.42-0.82), multiple pregnancy (OR=17.35, 95% CI: 9.73-30.94), and preeclampsia (OR=3.36, 95% CI: 2.15-5.24).
Conclusion:
Maternal age, SES, preeclampsia, multiple pregnancy, ART, higher maternal BMI, parity, and male infant sex were determined to be predictive variables for birth weight and gestational age after taking into consideration their association by using a joint multilevel multiple logistic regression model.
... Some studies suggested that prolonged pregnancy beyond term is more prevalent in obese women [7,8]. For example, in a large retrospective study of 9336 births, 28.2% of obese women progressed beyond 41 weeks with an odds ratio (OR) 2.27 relative to normal weight pregnant women [7]. ...
Objective:
To test the hypothesis that there is a higher rate of unsuccessful induction of labor (IOL) in post-term obese pregnant women compared to non-obese ones.
Methods:
In this prospective cohort study, 144 obese (BMI > 30) and 144 non-obese (BMI < 29.9) post-term (> 41 weeks) pregnant women were recruited. IOL was done by misoprostol or amniotomy and oxytocin infusion according to the Bishop score. Comparison of percentage of failed IOL in both groups (primary outcome) was performed by the Chi-test. Logistic regression and multivariable regression were performed to assess the odds ratio (OR) of cesarean section (CS) and coefficient of delay in labor till vaginal delivery (VD) in obese versus (vs) non-obese groups. Adjustment for gestational age, parity, Bishop Score, membrane rupture and amniotic fluid index was done in both regression analyses.
Results:
CS rate was significantly higher in obese group [26.4 vs 15.9%; difference in proportion (95% CI) 0.1 (0.01, 0.19); P value 0.02]. 106 (73.6%) obese women and 121 (84.1%) non-obese women delivered vaginally. In addition, the duration till VD was significantly higher in obese group (22 vs 19 h, P value 0.01). After adjustment for possible confounding factors, the CS was still higher in the obese group in comparison to non-obese group (OR 2.02; 95% CI 1.1, 3.7; P value 0.02). This finding suggested that obesity was an independent factor for failure of IOL. In addition, after adjustment for these confounders, obesity had the risk of increasing labor duration by 2.3 h (95% CI 0.1, 4.5) in cases that ended in VD.
Conclusion:
Based on our results, we conclude that there is a higher risk of CS in obese postdate pregnant women undergoing IOL in comparison to non-obese counterparts. Therefore, obstetricians should pay more attention to advising pregnant women about optimal weight gain during pregnancy and counseling about the chances of VD in cases of IOL. CLINCALTRIAL.
Gov id:
NCT02788305.
... Among them, a gestational age between 28 and 36 weeks of pregnancy was the highest risk factor; this result is consistent with other studies that found that prematurity constitutes a very important risk factor of fetal and perinatal mortality [1,8,18,19]. Advanced gestational age, which is considered by other authors [20] to be a risk factor, does not appear to be a risk factor in this study because no case of fetal mortality occurs beyond the 42 weeks of pregnancy period. The reason for this finding is that health protocols in Spain dictate that births must occur before the end of week 42. ...
Purpose:
Perinatal mortality has been decreasing in Europe thanks to a reduction in neonatal mortality. The causes of fetal mortality remain poorly studied. The objective was to determine the late fetal mortality rate in Spain in 2015 and the associated factors.
Methods:
A cross-sectional study was performed using data regarding births in 2015 in Spain extracted from the National Institute of Statistics. Single births at 28 or more weeks of pregnancy were included. The sample comprised 340,371 births. Sociodemographic, obstetrical and neonatal variables were analyzed using univariate and multivariate logistic regression (MLR), with the fetal mortality from 28 weeks of pregnancy as the dependent variable.
Results:
The total number of late fetal deaths was 884 (2.6 × 1000). The MLR model showed that the following factors were associated with late fetal mortality: birth before 37 weeks of pregnancy (OR 13.1); weight of the newborn < 2500 g (OR 3.22) and ≥ 4000 g (OR 3.36); low training level (OR 2.28); and others, such as African origin, maternal age ≥ 35 years, primiparity and mothers who were single.
Conclusions:
The rate of late fetal mortality in Spain has not decreased and has remained at the same level as in 2010. This result is related to prematurity, low birth weight, macrosomia and sociodemographic factors, such as low maternal preparation, mothers of African origin, age ≥ 35 years and mothers who are single. It is necessary to improve the quality and accessibility of prenatal care and the early detection of risk factors.
... Penelitian yang dilakukan oleh Laursen, Laursen, Bille, Olesen, Hjelmborg, Skytthe, & Christensen (2004) menemukan bahwa kembar monozigot dan dizigot akan menyebabkan kehamilan yang berkepanjangan dan juga menemukan bahwa faktor genetik ibu mempengaruhi tingkat kehamilan postterm sebanyak 30 % dalam kehamilan. Faktor yang lain adalah usia ibu, obesitas, paritas, hipertensi kronik, diabetes milletus (Caughey, Stotland, Washington, & Escobar, 2009;Olesen, Westergaard, & Olsen, 2006;Roos, Sahlin, Ekman Ordeberg, Kieler, & Stephansson, 2010). ...
Introduction: Post-term pregnancy is a prolonged pregnancy period till 42 weeks or more that can be caused by varied factors such as hormonal and genetic. Although the incident rate is considerably small, it can bring negative impacts to mother and her baby. Thus, it is important to manage the post-term pregnancy by applying effective approaches such as Need for help Nursing Theory to ensure rapid and precise assessment, observation and immediate intervention carried out during delivery process. In addition, The Theory of Unpleasant symptoms can also be applied to minimize unpleasant symptoms either physically or psychologically and situational discomfort during the labor. Method: The five study cases revealed that the mothers experienced unpleasant symptoms that affected each other and required immediate treatment. Result: After termination with labor induction were conducted, different results were found among the cases. Case two to five after be indiuced, they gave birth trough vaginal birth, while case one ended with caesarean section because`of fetal distress. Conclusion: Mothers who experienced postterm pregnancy had different respond. Nurse role especially maternity nursing specialist is imperative during the gravidity termination period in performing nursing care to overcome problems experienced by mother with post-term pregnancy.
... 1 Apart from these racial and ethnic differences have also been cited to be the reasons for higher risk of prolonged and post-term pregnancy. 2 Globally, nearly 5 to 10 percent of all pregnancies continue to at least 42 weeks gestation. 3 In the absence of a national data base in India, the prevalence of pregnancies continuing 42 weeks or more has been reported to be ranging from 2% to 7.7%. ...
Background: Prolonged gestation complicates 5% to 10% of all pregnancies and confers increased risk to both the fetus and mother. In the west about 18% of all singleton pregnancies persist beyond 41 weeks, 10% (range, 3% to 14%) continue beyond 42 weeks and 4% (range, 2% to 7%) continue beyond 43 completed weeks in the absence of an obstetric intervention. The risks for prolonged and post-term pregnancy include obesity, nulliparity, maternal age >30 years. Apart from these racial and ethnic differences have also been cited to be the reasons for higher risk of prolonged and post-term pregnancy. Post term pregnancies are associated with various maternal and neonatal complications.Methods: A prospective study was carried out at Department of Obstetrics and Gynaecology, Command Hospital, Central Command, Lucknow. 100 patients were selected and divided into two groups and were followed up till the delivery. Data so collected was subjected to analysis using Statistical Package for Social Sciences version 15.0.Results: Majority of women enrolled in the study were aged above 25 years. Majority of women enrolled in the study were primigravida (67%). The Mean BMI of women enrolled in the study was 24.2±3.43 kg/m2 and the expectant and control groups were matched demographically and anthropometrically. The compromised modified biophysical profile was recorded in 33 (66%) of women in expectant group. Rate of caesarean delivery was 30% in expectant and 46% in control group. In the expectant group, AFD was the most common indication for caesarean section while control group had NPOL as the most common indication for caesarean section. In the expectant group, mean AFI showed a declining trend with increasing gestational age.Conclusions: It was concluded that expectant management using modified biophysical profile (MBPP) does not provide an additional value over prophylactically managed pregnancies. Although cesarean rate and NICU admission rates were lower in expectant group as compared to control group yet the utility of MBPP in expectant management could not be proven and needs further assessment in larger studies or pooled clinical trials.
... The risks factors of PP are not clarified. Recently, the obesity is the only one risk factor of PD that is supposed to be preventable (17). The prevention and treatment of PP is also a challenge in obstetrics because it has many adverse fetal outcomes with either reduced or normal uteroplacental functions (18). ...
Obesity is a global health problem even among pregnant women. Obesity alters quality of labor, such as preterm labor, prolonged labor, and higher oxytocin requirements in pregnant women. The most important factors to play a role in the altered gestational period and serve as drug targets to treat the consequences are female sexual hormones, calcium channels, adrenergic system, oxytocin, and prostaglandins. However, we have limited information about the impact of obesity on the pregnant uterine contractility and gestation time. Adipose tissue, which is the largest endocrine and paracrine organ, especially in obesity, is responsible for the production of adipokines and various cytokines and chemokines, and there are no reliable data available describing the relation between body mass index, glucose intolerance, and adipokines during pregnancy. Recent data suggest that the dysregulation of leptin, adiponectin, and kisspeptin during pregnancy contributes to gestational diabetes mellitus and pre-eclampsia. A preclinical method for obese pregnancy should be developed to clarify the action of adipokines and assess their impact in obesity. The deeper understanding of the adipokines-induced processes in obese pregnancy may be a step closer to the prevention and therapy of preterm delivery or prolonged pregnancy. Gestational weight gain is one of the factors that could influence the prenatal development, birth weight, and adiposity of newborn.
... 2 Other causes, such as advanced maternal age, nulliparity, previous cesarean section, male fetuses, and obesity, have been involved. [3][4][5][6][7][8] Post-term pregnancies are associated with increased fetal and neonatal morbidity and mortality. These fetuses are at higher risk of fetal macrosomia, meconium aspiration syndrome, dysmaturity, neonatal acidemia, umbilical cord compression due to oligohydramnios, abnormal antepartum or intrapartum fetal heart rate patterns, and stillbirth. ...
Aim:
The aim of this study was to compare vaginal misoprostol with the Cook cervical ripening balloon (CCRB) for induction of labor in late-term nulliparous women.
Methods:
This open, quasi-experimental, prospective study included 109 nulliparous women with late-term pregnancies and Bishop scores < 7. Fifty-five women were allocated to receive vaginal misoprostol 25 mcg and 54 received the CCRB to induce labor. The primary outcome was the time until delivery. Secondary outcomes included time to the onset of labor and obstetric and perinatal outcomes.
Results:
Women in the misoprostol group experienced shorter time until delivery (25.41 h vs 31.26 h; P < 0.01) and in a greater percentage gave birth within the first 24 h. Time to active stage of labor was 19.5 h and 23.8 h (P < 0.01) for misoprostol and the CCRB, respectively. There were no differences in the rates of cesarean section or post-partum anemia. Additionally, there were no differences in rates of tachysystolia, intrapartum fever, or meconium. Perinatal outcomes, post-partum pH, Apgar scores, and neonatal admissions were similar in the two groups.
Conclusion:
Misoprostol 25 mcg reduces labor induction time compared with the CCRB with similar safety in late-term pregnancies.
... A recent study of risk of Attention-Deficit Hyperactivity Disorder in a cohort of matched Swedish siblings suggests familial confounders of pre-term birth and offspring neurodevelopment may not be genetic. 53 With respect to confounding in post-term effects, maternal pre-pregnancy obesity is known to influence risk of late delivery [54][55][56][57] and may have confounded associations with offspring neurodevelopment if occurring over multiple pregnancies. [47][48][49][50][51][52] Furthermore, given that the familial risk of prolonged pregnancy may be largely genetic, 54,58-60 maternal or fetal genetic factors might confound associations if they also influence offspring neurodevelopment. ...
Background:
Numerous studies suggest pre-term birth is associated with cognitive deficit. However, less is known about cognitive outcomes following post-term birth, or the influence of weight variations within term or post-term populations. We examined associations between gestational age (GA) and school performance, by weight-for-GA, focusing on extremely pre- and post-term births.
Method:
Record linkage study of Swedish children born 1973-94 (n = 2 008 102) with a nested sibling comparison (n = 439 629). We used restricted cubic regression splines to examine associations between GA and the grade achieved on leaving secondary education, comparing siblings to allow stronger causal inference with regard to associations between GA and school performance.
Results:
Grade averages of both pre- and post-term children were below those of full-term counterparts and lower for those born small-for-GA. The adjusted grades of extremely pre-term children (at 24 completed weeks), while improving in later study periods, were lower by 0.43 standard deviations (95% confidence interval 0.38-0.49), corresponding with a 21-point reduction (19 to 24) on a 240-point scale. Reductions for extremely post-term children (at 45 completed weeks) were lesser [-0.15 standard deviation (-0.17 to -0.13) or -8 points (-9 to -7)]. Among matched siblings, we observed weaker residual effects of pre-term and post-term GA on school performance.
Conclusions:
There may be independent effects of fetal maturation and fetal growth on school performance. Associations among matched siblings, although attenuated, remained consistent with causal effects of pre- and post-term birth on school performance.
... Less is known about the causes of postterm birth (defined as birth at gestational age of 42 weeks and greater). Previous postterm births, male foetal sex, genetic predisposition, nulliparity and obesity are some of the risk factors for postterm birth (143). It is normal to induce labour in postterm pregnancies when there is potential harm to either the infant or the mother. ...
... Therefore, any empirical modifications were evaluated carefully to ensure that they were substantively plausible. The only plausible path suggested by this method was the addition of a direct path from FIRST to GA (Fig 3), which is consistent with the finding that primiparous women in the U.S. are more likely to carry their infants past their due date [16]. ...
The "fetal origins" hypothesis suggests that fetal conditions not only affect birth characteristics such as birth weight and gestational age, but also have lifelong health implications. Despite widespread interest in this hypothesis, few methodological advances have been proposed to improve the measurement and modeling of fetal conditions. A Statistics in Medicine paper by Bollen, Noble, and Adair examined favorable fetal growth conditions (FFGC) as a latent variable. Their study of Filipino children from Cebu provided evidence consistent with treating FFGC as a latent variable that largely mediates the effects of mother's characteristics on birth weight, birth length, and gestational age. This innovative method may have widespread utility, but only if the model applies equally well across diverse settings. Our study assesses whether the FFGC model of Cebu replicates and generalizes to a very different population of children from North Carolina (N = 705) and Pennsylvania (N = 494). Using a series of structural equation models, we find that key features of the Cebu analysis replicate and generalize while we also highlight differences between these studies. Our results support treating fetal conditions as a latent variable when researchers test the fetal origins hypothesis. In addition to contributing to the substantive literature on measuring fetal conditions, we also discuss the meaning and challenges involved in replicating prior research.
Objective
To test the hypothesis that obese primiparous women with an unfavorable cervix in delayed pregnancy may experience a worse induction of labor.
Study design
In total, 467 primiparas with poor cervical condition and delayed pregnancy (gestational age [GA]: >40weeks) were divided into an obese primiparas group (body mass index [BMI] >30kg/m ² ; n=166) and a non-obese primiparas group (BMI < 30kg/m ² ; (n=301). Labor was induced by various methods, double balloon, dinoprostone inserts, and amniotomy combined with oxytocin depending on the Bishop score. Experimental data were analyzed by Statistical Product Service Solutions (SPSS).
Results
BMI in the obese primiparas group was higher than in the non-obese group (33.91 ± 2.67 versus 24.09 ± 5.78, p<0.001), and there were significant differences in uterine tone and duration of contractions between the two groups in the second stage of labour (p=0.041, p=0.026, respectively).The rate of cesarean section (CS) was significantly higher in the primiparas group (23.49% versus 12.29%; P=0.002). There was a significant difference between the two groups in terms of the duration of time to vaginal delivery (VD) (18h versus 8h; P <0.001) while the duration until VD in the obese primiparas group within 12 hours and 24 hours was significantly longer (P <0.001). After adjusting for possible confounders, caesarean section rates remained high in the obese primiparas women (OR: 2.564;95%CI1.919,3.864;P<0.001). Similarly, after adjusting for the same confounding factors, obese primiparas women increased the duration until VD within 24 h by 3.598 hours.
Conclusion
Obese primiparas with an unfavorable cervix in delayed pregnancy have a significantly higher risk of CS and a longer duration until VD than non-obese primiparas during labor induction.
This study was conducted to examine the levels of vitamin D in postterm pregnancy. The study consisted of two groups: Group 1: women with postterm pregnancy in whom labour has not started (n = 40). Group 2: pregnant women with spontaneous labour between 37 and 41 weeks of gestation (n = 40). Demographic characteristics of individuals, age, body mass index, gravida, parity, living child, number of abortions and birth characteristics were recorded. Prepartum and postpartum haemoglobin (Hb) and haematocrit (Hct) values and vitamin D levels of pregnant women were measured. We found no significant differences in vitamin D levels, smoking, mode of delivery, induction of labour, methods of cervical ripening and maternal and perinatal complications between the groups (p > .05). D vitamin in the model had a statistically significant effect on prepartum Hb (p < .05). Vitamin D levels seem not to be associated with postterm pregnancy. Vitamin D had a statistically significant effect on prepartum Hb.
• IMPACT STATEMENT
• What is already known on this subject? The aetiology of post term pregnancy is not clearly known, factors such as foetal anencephaly, foetal sex, placental sulfatase deficiency, genetic factors, and high pre-pregnancy body mass index play a role.
• What do the results of this study add? Vitamin D levels seem not to be associated with postterm pregnancy. Vitamin D had a statistically significant effect on prepartum Hb.
• What are the implications of these findings for clinical practice and/or further research? Further studies are needed to clarify the relationship between vitamin D levels and postterm pregnancy.
ÖZ
Amaç: Çalışmada ilk tr imester deki lipid pr ofili ilepostterm gebelik (PTG) arasındaki ilişkiyi ve lipid profili-nin PTG için bir öngörü kriteri olup olamayacağını değer-lendirmeyi amaçladık.
Materyal ve Metot: Çalışmaya postter m dönemdeki329 (vaka grubu) ve term dönemdeki 97 (kontrol grubu)gebe dahil edildi. Hastaların demografik bilgileri, doğumşekilleri, ilk trimester lipid profilleri (total kolesterol, trig-liserid, HDL-K, LDL-K, VLDL-K düzeyleri) ile doğanbebeklerin APGAR skoru ve yenidoğan yoğun bakım(YDYB) kabulu kaydedildi. Çalışmada gruplar arasındakilipid profil farklılıkları değerlendirildi.
Bulgular: Gruplar ar asında yaş, gebelik sayısı, par iteve vücut kitle indeksi (VKI) açısından anlamlı farklılıksaptanmazken, ortalama APGAR skorları (p<0,001) veYDYB ihtiyacı (p<0,001) açısından anlamlı farklılık tespitedildi. PTG grubunda sezaryen (C/S) olma oranı termgruba göre daha yüksekti ve fark istatistiksel olarak an-lamlı bulundu (p<0,001). Gruplar arasında lipid profillerideğerlendirildiğinde; total kolesterol, trigliserid, HDL-K,LDL-K ve VLDL-K düzeylerinin PTG grubunda anlamlıolarak daha düşük olduğu saptandı (p<0,05).
Sonuç: Çalışmada, ilk tr imester lipid düzeyi düşüklüğüile PTG arasında anlamlı bir ilişki tespit edildi. Gebede ilk trimesterdeki düşük lipid seviyeleri, PTG’i öngörmek içinbir kriter olarak değerlendirilebilir. Bununla beraber PTG’ye neden olabilecek başka faktörlerde bulunduğun-dan lipid profili ile PTG arasındaki ilişkinin daha iyi anla-şılabilmesi için destekleyici prospektif çalışmalara ihtiyaçvardır.
Anahtar Kelimeler: İlk tr imester , kolester ol, lipid pr o-fili, Postterm gebelik, trigliserid
ABSTRACT
Objective: In this study, we investigated the associationbetween first trimester lipid profile and postterm pregnan-cy (PTG) and whether lipid profile can be a predictivecriterion for the development of PTG.
Materials and Methods: 329 pr egnant women withpostterm delivery and 97 pregnant women with term de-livery were included in the study. Demographic data,mode of delivery, first trimester lipid profiles (total cho-lesterol, triglyceride, HDL-C, LDL-C, VLDL-C), APGARscore of the babies born, and whether they required neona-tal intensive care. In the study, the lipid profile differencesbetween the groups were evaluated.
Results: While no significant differ ence was foundbetween the postterm and term pregnancy groups in termsof age, number of pregnancies, parity, and body massindex (BMI), a statistically significant difference wasfound in terms of mean APGAR score (p < 0.001) andYDYB requirement (p < 0.001). The rate of cesarean sec-tion in PTG group was higher than in term pregnanciesand the difference was statistically significant (p < 0.001).When the lipid profiles were evaluated between thegroups, it was found that the levels of total cholesterol,triglyceride, HDL-C, LDL-C and VLDL-C levels weresignificantly lower in the PTG group (p < 0.05).
Conclusion: In our study, low lipid levels in the fir sttrimester were found to be associated with PTG. Low lipidlevels in the first trimester of pregnancy can be consideredas a criterion for predicting PTG. However, because thereare other factors that may cause PTG, supportive prospec-tive studies are needed to better understand the relation-ship between lipid profile and PTG.
Keywords: Fir st tr imester , cholester ol, lipid pr ofile,postterm pregnancy, triglycerid
Importance
Nonoptimal gestational durations could be associated with neurodevelopmental disabilities, yet evidence regarding finer classification of gestational age and rates of multiple major neuropsychiatric disorders beyond childhood is limited.
Objective
To comprehensively evaluate associations between 6 gestational age groups and rates of 9 major types and 8 subtypes of childhood and adult-onset neuropsychiatric disorders.
Design, Setting, and Participants
This cohort study evaluated data from a nationwide register of singleton births in Denmark from January 1, 1978, to December 31, 2016. Data analyses were conducted from October 1, 2019, through November 15, 2020.
Exposures
Gestational age subgroups were classified according to data from the Danish Medical Birth Register: very preterm (20-31 completed weeks), moderately preterm (32-33 completed weeks), late preterm (34-36 completed weeks), early term (37-38 completed weeks), term (39-40 completed weeks, reference), and late or postterm (41-45 completed weeks).
Main Outcomes and Measures
Neuropsychiatric diagnostic records (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes F00-F99) were ascertained from the Danish Psychiatric Central Register up to August 10, 2017. Poisson regression was used to estimate the incidence rate ratio (IRR) and 95% CI for neuropsychiatric disorders, adjusting for selected sociodemographic factors.
Results
Of all 2 327 639 singleton births studied (1 194 925 male newborns [51.3%]), 22 647 (1.0%) were born very preterm, 19 801 (0.9%) were born moderately preterm, 99 488 (4.3%) were born late preterm, 388 416 (16.7%) were born early term, 1 198 605 (51.5%) were born at term, and 598 682 (25.7%) were born late or postterm. A gradient of decreasing IRRs was found from very preterm to late preterm for having any or each of the 9 neuropsychiatric disorders (eg, very preterm: IRR, 1.49 [95% CI, 1.43-1.55]; moderately preterm: IRR, 1.23 [95% CI, 1.18-1.28]; late preterm: IRR, 1.17 [95% CI, 1.14-1.19] for any disorders) compared with term births. Individuals born early term had 7% higher rates (IRR, 1.07 [95% CI, 1.06-1.08]) for any neuropsychiatric diagnosis and a 31% higher rate for intellectual disability (IRR, 1.31 [95% CI, 1.25-1.37]) compared with those born at term. The late or postterm group had lower IRRs for most disorders, except pervasive developmental disorders, for which the rate was higher for postterm births compared with term births (IRR, 1.06 [95% CI, 1.03-1.09]).
Conclusions and Relevance
Higher incidences of all major neuropsychiatric disorders were observed across the spectrum of preterm births. Early term and late or postterm births might not share a homogeneous low risk with individuals born at term. These findings suggest that interventions that address perinatal factors associated with nonoptimal gestation might reduce long-term neuropsychiatric risks in the population.
Résumé
Objectif: Analyser les pratiques professionnelles au sein d’un réseau de périnatalité sur la prise en charge des grossesses prolongées. L’objectif secondaire était d’évaluer la morbidité néonatale et maternelle en cas de grossesse prolongée.
Méthodes: Étude observationnelle, rétrospective réalisée dans les 23 maternités du réseau de périnatalité entre septembre et décembre 2018. Le critère d’inclusion était un accouchement à un terme ≥ 41⁺⁰ SA. Le critère de jugement principal était la conformité aux recommandations du CNGOF évaluée sur 10 items (conforme si score ≥ 80%). Les critères de jugement secondaires étaient des critères composites de morbidité néonatale (ventilation, réanimation et/ou score d’Apgar inférieur à 7 à 5 minutes de vie) et maternelle (lésion obstétricale du sphincter anal et/ou hémorragie du post-partum).
Résultats: Sur les 596 patientes incluses, 65,3% des dossiers étaient conformes. Les critères non conformes étaient surtout la recherche d’oligoamnios à l’échographie (46,8% ; n=279) et l’information des patientes (14,8% ; n=88). La morbidité néonatale concernait 40 nouveau-nés (6,0%) avec comme facteur de risque la dystocie des épaules (OR=5,2; IC 95% 1,4-19,7). La morbidité maternelle concernait 70 patientes (10,6%) notamment lorsque le travail est allongé (OR=1,1 par heure de travail ; IC 95% 1,02-1,24) et pour les utérus cicatriciels (OR=4,4; IC 95% 1,8-11,0).
Conclusions: Le rythme de surveillance des grossesses prolongées est en accord avec les recommandations nationales. Les axes d’améliorations sont la recherche d’un oligoamnios par la mesure de la plus grande citerne à l’échographie, et l’information faite aux patientes sur les possibilités de déclenchement.
Background:
The proposition that a pregnancy is 40 weeks or 280 days in duration is attributed to the German obstetrician Franz Naegele (1778-1851). His rule adds nine months and seven days to the first day of the last menstrual period. The expected date of confinement from this formula is approximately right in the majority of cases. However, the idea that this rule can apply to every pregnant female - young or old, nulliparous or multigravida, Caucasian, Asian, African, or Indigenous - stretches credulity. In addition, many women regard the 40-week date as a deadline, which if crossed, may then place the baby under stress. Forty weeks is such a simple, round, convenient figure that it has proved difficult to challenge, despite criticism. Nonetheless, what might have been an appropriate formula in Germany in the 19th century deserves to be revisited in the 21st.
Aims:
To review the length of pregnancy, in the light of current technology, in particular ultrasound scanning, and assisted reproductive techniques.
Material and methods:
A Medline search was performed for variables on the length of pregnancy, the expected date of confinement, and prolonged pregnancy.
Results:
A number of factors were found to significantly influence the length of a pregnancy, including ethnicity, height, variations in the menstrual cycle, the timing of ovulation, parity and maternal weight.
Conclusions:
Naegele's rule should be considered as a guideline for the expected date of confinement, and not a definite date.
Postterm pregnancy is defined as pregnancy that lasts 42 weeks (294 days) or more from the first day of the last menstrual period. Overall incidence varies between 4 and 19%. The incidence may vary by population, as a result of management practice differences for postterm pregnancies. Accurate determination of gestational age using last menstrual date and earliest ultrasound is essential for accurate diagnosis and management. Fetal, neonatal and maternal complications associated with this condition have always been underestimated. Fetal complications involve oligohydramnios, fetal macrosomia and increased fetal asphyxia during labour. Maternal complications include increased maternal anxiety and operative interference. Management strategies are antepartum surveillance and induction of labour.
Maternal obesity is the most common metabolic disturbance in pregnancy affecting >1 in 5 women in some countries. Babies born to obese women are heavier with more adiposity at birth, and are vulnerable to obesity and metabolic disease across the lifespan suggesting offspring health is ‘programmed’ by fetal exposure to an obese intra-uterine environment. The placenta plays a major role in dictating the impact of maternal health on prenatal development. Maternal obesity impacts the function of integral placental receptors and transporters for glucocorticoids and nutrients, key drivers of fetal growth, though mechanisms remain poorly understood. This review aims to summarise current knowledge in this area, and considers the impact of obesity on the epigenetic machinery of the placenta at this vital juncture in offspring development. Further research is required to advance understanding of these areas in the hope that the trans-generational cycle of obesity can be alleviated.
Post‐term pregnancy, defined as a pregnancy that extends to 42 weeks 0 days and beyond or a gestational length of 294 days or more, occurs in 5–10% of all births. Post‐term pregnancy has been associated with maternal and perinatal risks including postpartum hemorrhage, cephalopelvic disproportion, cesarean delivery, oligohydramnios, macrosomia, intrauterine growth restriction, and intrauterine fetal demise. Management strategies have been developed to evaluate and plan delivery for the post‐term pregnancy.
У огляді літературі висвітлено ряд причин переношування вагітності серед яких: зміна гормонального стану (високий рівень прогестинів та низький естрогенів), зміни у міометрії, імунний фактор, дисфункції гіпофізарно-адреналової системи плода, зміни у центральній нервовій системі, склеротичні процеси в судинах плаценти та плацентарного ложа, витончення гематохоріального бар’єру, апоптоз клітин плаценти, зміна морфології судин пуповини, порушення мікроциркуляції. Показаний негативний вплив переношеної вагітності на стан новонародженого.
Post‐term pregnancy is one that progresses to 42 weeks’ gestation. Key in making the proper diagnosis of post‐term pregnancy is accurate pregnancy dating, best done with confirmational first‐trimester ultrasound. The epidemiology is the opposite to preterm birth, with higher rates in obese women and those of white race/ethnicity. Such prolonged pregnancy is also seen more commonly with fetal complications such as anencephaly and placental sulfatase deficiency, pointing towards a fetal contribution to the initiation of labour. Complications of post‐term pregnancy include higher rates of stillbirth, caesarean delivery, meconium‐stained amniotic fluid, neonatal acidaemia and neonatal death. One advantage of post‐term pregnancy is that it is easily preventable with induction of labour. However, the timing of such induction during the term period is costly and understudied.
Introduction
Bone marrow cells (BMC) from obese adult mice display an increased apoptosis rate over proliferation. Hematopoietic stem cells (HSC) form all blood cells and are important BMC used in cell therapy. Because it is known that prenatal development can be affected by adverse metabolic epigenetic programming from the maternal organism, this work aimed to investigate the effects of maternal overweight on placenta and fetal liver hematopoietic niches.
Methods
Overweight was induced in female mice by overfeeding during lactation. After Swiss females were mated with healthy males, fetuses at 19 dpc (day post conception) and placentas were analyzed. Maternal biometric parameters were compared, and hematopoiesis in the dissociated placenta and fetal liver cells was analyzed by flow cytometry. Placenta morphology and protein content were also studied.
Results
The model induced accumulation of adipose tissue, weight gain, and maternal hyperglycemia. Placentas from the overfed group (OG) displayed altered morphology, higher carbohydrate and lipid deposition, and increased protein content of fibronectin and PGC-1α. Cytometric analysis showed that placentas from OG presented a higher percentage of circulating macrophages, endothelial progenitor cells, HSC, and progenitor cells. No difference was detected in the percentage of neutrophil granulocytes and total leukocytes or in the proliferation of total cells, HSC, or total leukocytes. With regard to liver analysis of the OG group, there was a significant increase in circulating macrophages, primitive HSC, and oval cells but no difference in hematopoietic progenitor cells, total leukocytes, or leukocyte or total cell proliferation.
Conclusion
Unregulated maternal metabolism can affect hematopoietic populations within the placenta and fetal liver.
Objective: To investigate whether postterm pregnancy (≥42 0/7 weeks’ gestation) increases the risk for adverse perinatal outcome.
Study design: In this population based cohort study, all singleton deliveries occurring between 1991 and 2014 in a tertiary medical center were included. Pregnancy and perinatal outcomes were compared between postterm and term deliveries (37 0/7 to 41 6/7 weeks’ gestation). Preterm deliveries, unknown gestational age, congenital malformations, and multiple gestations, were excluded. The association between postterm and adverse perinatal outcomes was evaluated using a general estimation equation (GEE) multivariable analyses.
Results: During the study period, 226,918 deliveries were included in the analysis. Of them, 95.9% (n = 217,544) were term and 4.1% (n = 9374) were postterm. Post-term pregnancies were more likely to be complicated with oligohydramnios, macrosomia, meconium stained amniotic fluid, shoulder dystocia, low Apgar scores, and hysterectomy (p < .05 in all). Perinatal mortality rates were significantly higher at postterm as well. Using the GEE model, the association between postterm and total perinatal mortality persisted (OR = 1.73, 95%CI 1.2–2.4), as well as specifically intrauterine fetal death (OR = 1.76, 95%CI 1.1–2.7) and intrapartum death (OR = 3.71, 95%CI 1.3–10.4).
Conclusions: Post-term delivery involves higher rates of adverse perinatal outcomes and is independently associated with significant perinatal mortality.
Background:
Few studies have evaluated risk factors associated with hospital birth among women planning to give birth in a birth center in the United States. This study describes the obstetrical risk factors for hospital birth among women intending to deliver in a birth center in Washington State.
Methods:
We performed a retrospective cohort study of Washington State birth certificate data for women with singleton, term pregnancies planning to give birth at a birth center from 2004 to 2011. We assessed risk factors for hospital birth including demographic, obstetrical, and medical characteristics. We used multivariable logistic regression to estimate the odds ratio (OR) and 95% confidence interval (CI) of the association between risk factors and hospital birth.
Results:
Among the 7118 women planning to give birth at a birth center during the study period, 7% (N = 501) had a hospital birth, and 93% delivered at a birth center (N = 6617). The strongest risk factors for hospital transfer included nulliparity (OR 7.2 [95% CI 5.3-9.8]), maternal age >40 years (OR 3.7 [95% CI 2.1-6.7]), inadequate prenatal care (OR 3.7 [95% CI 2.7-5.0]), body mass index ≥30 (OR 2.1 [95% CI 1.6-3.0]), government health insurance (OR 9.3 [95% CI 5.0-17.1]), and hypertension (10.1 [95% CI 5.7-18.1]). Among nulliparous women, all of these demographic and obstetrical factors remained strongly associated with hospital birth.
Conclusions:
This information may be useful for counseling women who plan a birth center birth about the risk of hospital birth.
Background
Gestation is a crucial timepoint in human development. Deviation from a term gestational age correlates with both acute and long-term adverse health effects for the child. Both being born preterm and post-term, that is, having short and long gestational ages, are heritable and influenced by the prenatal and perinatal environment. Despite the obvious heritable component, specific genetic influences underlying differences in gestational age are poorly understood.
Methods
We investigated the genetic architecture of gestational age in 9141 individuals, including 1167 born post-term, across two Northern Finland cohorts born in 1966 or 1986.
Results
Here we identify one globally significant intronic genetic variant within the ADAMTS13 gene that is associated with prolonged gestation (p=4.85×10⁻⁸). Additional variants that reached suggestive levels of significance were identified within introns at the ARGHAP42 and TKT genes, and in the upstream (5’) intergenic regions of the B3GALT5 and SSBP2 genes. The variants near the ADAMTS13, B3GALT5, SSBP2 and TKT loci are linked to alterations in gene expression levels (cis-eQTLs). Luciferase assays confirmed the allele specific enhancer activity for the BGALT5 and TKT loci.
Conclusions
Our findings provide the first evidence of a specific genetic influence associated with prolonged gestation. This study forms a foundation for a better understanding of the genetic and long-term health risks faced by induced and post-term individuals. The long-term risks for induced individuals who have a previously overlooked post-term potential may be a major issue for current health providers.
Objectives
The Republic of Korea (Korea) has experienced a steady increase in the number of births from immigrant women over the last 20 years. However, little is known about the birth outcomes of immigrant women in Korea. This study compared Korean birth data from immigrant and native women who married native men, and explored the factors that affected birth outcomes among immigrant women.
Design
Observational cross-sectional study.
Setting
Nationwide registry-based study in Korea.
Participants
A total of 70 258 records from immigrant women and 1700 976 records from native women were examined using the National Birth Registration Database, from 2010 to 2013.
Independent variable
Native Korean women and immigrant women who married native men.
Outcomes
Proportion of preterm births, post-term births, low birth weights and macrosomia.
Results
Adjusted ORs (aOR) were calculated for the adverse birth outcomes, and subgroup analyses were performed according to parity and mothers from three Asian countries (China, Vietnam, the Philippines). Multivariate logistic regression analyses were also conducted to evaluate the association of these factors with birth outcomes among immigrant women. Immigrant women had higher OR of post-term births (aOR 1.62; 95% CI 1.44 to 1.83) and low birth weights (aOR 1.17; CI 1.12 to 1.22). Mothers from the Philippines had higher OR of preterm births (aOR 1.26; CI 1.12 to 1.52) and Chinese mothers had higher OR of macrosomia (aOR 1.55; CI 1.44 to 1.66). The OR of post-term births and low birth weights was significantly higher in the first pregnancies of immigrant women.
Conclusions
This study has demonstrated higher proportions of adverse birth outcomes among immigrant women who married Korean men, compared with native women in Korea. Policies reducing the gap in birth outcomes between native and immigrant women are needed.
Introduction:
While there is evidence for a relationship between cell-free fetal DNA (cffDNA) and parturition, questions remain regarding whether cffDNA could trigger a pro-inflammatory response on the pathway to parturition. We hypothesized that placental and/or fetal DNA stimulates toll-like receptor 9 (TLR9) leading to secretion of pro-inflammatory cytokines by macrophage cells.
Methods:
Four in vitro DNA stimulation studies were performed using RAW 264.7 mouse peritoneal macrophage cells incubated in media containing the following DNA particles: an oligodeoxynucleotide (ODN2395), intact genomic DNA (from mouse placentas, fetuses and adult liver), mouse DNA complexed with DOTAP (a cationic liposome forming compound), and telomere-depleted mouse DNA. Interleukin 6 (IL6) secretion was measured in the media by enzyme-linked immunosorbent assay; and the cell pellet was homogenized for protein content (picograms IL6/mg protein).
Results:
Robust IL6 secretion was observed in response to ODN2395 (a CpG-rich TLR9 agonist), mouse DNA-DOTAP complexes, and telomere-depleted mouse DNA in concentrations of 5 to 15 μg/mL. In contrast, ODN A151 (containing telomere sequence motifs), intact genomic mouse DNA, and restriction enzyme-digested DNA had no effect on IL6 secretion. The IL6 response was significantly inhibited by chloroquine (10 μg/mL), thereby confirming the important role for TLR9 in the response by macrophage cells.
Conclusions:
DNA derived from mouse placentas and fetuses, and depleted of telomeric sequences, stimulates a robust pro-inflammatory response by macrophage cells, thereby supporting the hypothesis that cffDNA is able to stimulate an innate immune response that could trigger the onset of parturition. These findings are of clinical importance, as we search for effective treatment/prevention of preterm parturition.
Purpose: To study the role of fetal middle cerebral artery (MCA) Doppler evaluated prior to induction of labor in late-term pregnancies, in order to build an ultrasound-based predictive model for failed induction.
Materials and methods: A prospective cohort study on 250 nulliparous women carrying singleton late-term pregnancies was conducted. Prior to induction, each patient underwent to an ultrasound evaluation for fetal MCA Doppler. Additional ultrasound parameters such as cervical length (CL), membranes thickness, amniotic fluid index, placental location, and estimated fetal weight (EFW) were collected. According to the type of response, women were divided into three groups: (A) responders within 24 h; (B) responders after 24 h, and (C) no responders.
Results: Women who failed to enter active labor showed significantly higher fetal MCA pulsatility index (PI), longer CL and higher EFW. The estimated probability of logistic regression model combining the three variables achieved a sensitivity of 94.2% and a specificity of 86.36% (AUC, 0.926; 95% CI, 0.884 − 0.956, p < .0001) using as decision probability value the cut off >0.1838.
Conclusions: In late-term pregnancies, an ultrasound-based model including cervical length, MCA PI, and EFW achieved a good accuracy in predicting those women who are likely to fail induction of labor.
The frequency of post-term pregnancy ranges from 3.5 to 16%. Compared to full-term newborns perinatal morbidity was in the post-term pregnancy group 1.7 times higher and mortality - in 5.5 times.
The aim. To study the features of feto-placental complex functioning in the post-term pregnancy; to detect relationship between complications of the gestational period and perinatal outcomes based on the feto-placental complex violations.
Materials and Methods. To study the features of delayed delivery and perinatal outcomes in this case 96 pregnant women with prolonged delivery were analyzed for 2013-2015, who gave birth in the term of 41-42 weeks. As a control group we examined 41 pregnant women, who did not differ from the comparison group by clinical and demographic characteristics, but with delivery in term of 37-40 weeks.
Results. In women with term pregnancy placental lactogen was 14.64 mg / ml and it was higher than the same indicator of post-term pregnancy (10.31 mg / ml). Reducing placental lactogen leads to a decrease in biosynthetic processes and growth retardation. In women of term pregnancy we found increased levels of estriol – 12.11 ng / ml at the end of gestational period, compared with prolonged pregnancy group (7.16 ng / ml), which corresponds to our concepts of the post-term pregnancy pathogenic features formation – lack of estriol level increasing before the start of delivery. The examination of the control group women showed a strong increase of progesterone – 158.79 ng / ml, while in the group of post-term pregnancy this index was almost 2 times less – 85.83 ng / ml. In women of term pregnancy group marked increase cortisol level before delivery was observed to 36.11 nmol / ml, more than the same indicator of post-term pregnancy (29.25 nmol / ml). Increased stress hormone cortisol indicates the hypothalamus-pituitary- adrenal cortex system activation for childbirth preparation.
Conclusions. There is a statistically significant decrease in hormones of the fetoplacental complex in prolonged pregnancy compared to the control group: cortisol - 19 % (р
El problema de la obesidad de la parturienta se ha convertido en la actualidad en una dificultad frecuente, ya que, por ejemplo en Francia, afecta a casi el 10% de las mujeres. La mecánica obstétrica puede alterarse por una distocia de los tejidos blandos, de forma similar en caso de obesidad. Lo que cambia son las técnicas obstétricas, que deben adaptarse a esta situación, y ninguno de los obstetras de los siglos pasados ha descrito principios técnicos específicos de las obesas. En el manejo del trabajo de parto y de sus diferentes fases se deben tener en cuenta las dificultades inherentes a la obesidad, y el control del bienestar fetal puede también complicarse. La decisión de practicar una cesárea suele tomarse con demasiada rapidez con base en supuestos fracasos del inicio del trabajo de parto o supuestas distocias dinámicas, incrementando la tasa global en esta población. La propia técnica de la cesárea debe adaptarse y revisarse, con el fin de facilitar la vía de acceso y la extracción fetal y disminuir la morbilidad postoperatoria. Este artículo evalúa los conocimientos actuales del manejo del parto de la mujer obesa y analiza el impacto de la obesidad en el manejo del parto por vía vaginal y las especificidades de la cesárea en estas pacientes.
About 5% of babies are born postterm (that is, delivered after 42 completed weeks of gestation). Postterm infants experience more morbidity and mortality than term infants, prompting routine (and expensive) antenatal testing and active management of postterm pregnancies. This article reviews the epidemiology of postterm delivery. A few congenital conditions associated with disruption of the fetal-pituitary-adrenal axis as well as a rare maternal enzyme deficiency have long been identified with postterm delivery. In recent literature, environmental pollution, diet, and pharmaceutical agents have been associated with postterm birth. Very little systematic research has focused on identifying risk factors for this poorly understood birth outcome.
To examine the association between pregravid body mass index (BMI) and preterm delivery among black, white, and Hispanic women.
Preterm deliveries among 12,459 women (43.2% black, 39.3% white, and 17.5% Hispanic) enrolled in a large multicenter trial of preterm birth prevention were examined by pregravid BMI category (very low, less than 16.5; low, 16.5-19.7; normal, 19.8-26.0; high, greater than 26) and by pathway (all, early, late, spontaneous preterm labor, and premature rupture of membranes [PROM]).
More than one-fifth of both black (20.1%) and white (28.6%) women had low pregravid BMIs (less than 19.8), whereas only 11.7% of Hispanic women were under-weight. The overall prevalence of preterm delivery (gestational age less than 37 completed weeks) was 8.1% (10.3% in black, 7.3% in white, and 4.8% in Hispanic women). Among black and white women, bivariate analysis revealed an inverse linear association between pregravid BMI and the prevalence of all preterm deliveries (P < or = .001) and between pregravid BMI and the prevalence of late (33-36 weeks' gestation) preterm deliveries (P < .001). No such associations were observed for early (20-32 weeks' gestation) preterm delivery or among Hispanic women. Pregravid BMI was also associated inversely with spontaneous preterm labor among both black (P < or = .01) and white (P < .001) women, but not among Hispanic women. Logistic regression analysis (adjusting for the effects of maternal age, education, smoking, parity, previous preterm delivery, birth interval, and height) revealed that among black and white women, very low and low pregravid BMIs were associated with increased adjusted odds ratios for late (but not early) preterm delivery and for spontaneous preterm labor (but not PROM).
These observations suggest that low pregravid BMI is associated with an increase in the prevalence of late preterm delivery and of spontaneous preterm labor among black and white, but not Hispanic, women.
The neonatal (< 28 days) mortality rate (NMR) is one of the most commonly employed maternal and child health epidemiological measures. It is also being employed in quality measures ("report cards') used to assess the performance of health care organisations. The objectives were to (1) develop methods for the rapid quantification of the neonatal mortality rate in a multi-hospital system, the Kaiser Permanente Medical Care Program's Northern California Region (KPMCP NCR), (2) develop methods for generating facility-specific rates and case lists, and (3) ascertain the capture rates of the information sources available to us. Potential neonatal deaths were identified in the KPMCP NCR for the 1990 and 1991 calendar years from 3 sources: (1) clerical searches of local facility records, (2) electronic searches of the KPMCP NCR hospitalisation database, and (3) linking KPMCP electronic birth records to death certificate tapes. The medical records of all infants identified through these methods were reviewed. The neonatal mortality rate was calculated in three ways: (1) including all livebirths, (2) excluding births weighing < 500 g, and (3) adjusting for prematurity by increasing the follow-up period in preterm babies (these babies were included as neonatal deaths if they died up to 40 weeks corrected age + 27.9 days). A total of 352 records out of 64 469 birth records in the KPMCP NCR were reviewed. If one includes babies < 500 g, the neonatal mortality rate was 3.72/1000 livebirths; if these babies are excluded, the rate was 3.05/1000. Adjusting for prematurity increased these rates to 3.91/1000 and 3.24/1000, respectively. Accurate quantification of the neonatal mortality rate in a multi-hospital system requires the use of multiple information sources. Use of a single source can lead to varying rates of over- or under-estimation. It is possible to employ our methodology for both research and operational purposes.
To study stillbirths and neonatal mortality in the postterm period.
Register study of information obtained from the Swedish Medical Birth Registry (MBR), National Board of Health and Welfare, Stockholm.
Singleton pregnancies with deliveries occurring between 1982 and 1991 were selected involving 914,702 women (of whom 76,761 had a postterm pregnancy continuing beyond the 42nd week of amenorrhea). All 2,043 records of dead infants were scrutinized before analysis of neonatal deaths. Stratification was made for year of birth, maternal age, and parity.
Generally, the rates of stillbirths and neonatal deaths were low. The stillbirth rate was highest for primiparas at 38 completed weeks (2.72%), lowest at 40 weeks (1.23%), then increasing to 2.26% in the postterm period. The difference vs. multiparas was significant from 41 weeks onwards. Neonatal mortality was increased at 41 completed weeks for primiparas, but for multiparas it changed significantly first in the postterm period. The OR for a primipara to have an intrauterine death increased from 1.50 at 41 weeks (1.0 at 40 weeks) to 1.79 at 42 weeks and beyond. The OR for multiparas showed no sign of increase as gestation progressed.
The results of this study indicate an increased risk of stillbirth with gestational age for primiparas but not for multiparas. The neonatal death rate was increased for both primiparas and multiparas (after 42 completed weeks).
Spurred by demands for data from employer-purchasers and accreditation agencies and the adoption of strategies for disease management and outcome-based quality assurance, managed care organizations have recognized the need for rapid, convenient access to clinical information. Large investments in administrative and clinical data systems have also produced unprecedented opportunities for research on health care and epidemiology in large, defined populations. There is a long history of contributions to research by investigators who are based in the older nonprofit group and staff models of health maintenance organizations (HMOs). Many of these organizations maintain research units that are primarily funded by outside sources. Research includes descriptive and etiologic studies of epidemiology, randomized and observational studies of the effectiveness of treatment regimens, studies of disease costs and estimation of cost-effectiveness, investigations of risk predictions in populations, of risk and changes in organizational behavior, and evaluations of interventions to alter physician and patient behavior. The work is often conducted in collaboration with academic researchers. The HMO Research Network has recently been established to foster a scientific exchange among HMO-based researchers. As managed care organizations come to provide health care coverage to most U.S. citizens, research conducted by these organizations increasingly overlaps with public health research. Collaboration between HMO-based research centers and researchers from academia and government will undoubtedly continue to increase.
Our purpose was to examine the impact of gestational age and fetal growth restriction on fetal and neonatal mortality rates in the postterm pregnancy.
All deliveries occurring in Sweden between Jan. 1, 1987, and Dec. 31, 1992, were evaluated for participation in this study. Data were derived from the National Swedish Medical Birth Registry. Pregnancies were selected for inclusion in the study on the basis of the following criteria: (1) singleton pregnancy, (2) reliable dates, (3) gestational age > or = 40 weeks, and (4) maternal age 15 to 44 years. Fetal growth restriction was defined as birth weight <2 SD below the mean for gestational age. A total of 181,524 pregnancies met the inclusion criteria and formed the study population. Fetal and neonatal mortalities at 40 weeks' gestation were used as reference levels. Logistic regression analysis was used to estimate the independent effects of gestational age and fetal growth restriction on fetal and neonatal mortality rates.
A significant rise in the odds ratio for fetal death was detected from 41 weeks' gestation and on (odds ratios 1.5, 1.8, and 2.9 at 41, 42, and 43 weeks, respectively). Odds ratios for neonatal mortality did not demonstrate a significant gestational age dependency. Fetal growth restriction was associated with significantly higher odds ratios for both fetal and neonatal mortality rates at every gestational age examined (with odds ratios ranging from 7.1 to 10.0 for fetal death and from 3.4 to 9.4 for neonatal death).
Postterm pregnancies have long been considered to be at high risk for adverse perinatal outcome. This study documents a small but significant increase in fetal mortality in accurately dated pregnancies that extend beyond 41 weeks of gestation. This study also demonstrates that fetal growth restriction is independently associated with increased perinatal mortality in these pregnancies.
I studied whether changing a partner, and thus changing the likelihood of human leukocyte antigen (HLA) sharing between mating partners, affects the risk of preterm delivery in the subsequent pregnancy. I identified a total of 128,239 women who had two consecutive births during 1989-1991 through data linkage of the California birth certificates. Paternal date of birth and names on the records of the two consecutive births were compared to determine whether the same father was reported on both records. Three cohorts of women were formed on the basis of the gestational age of their first delivery: <34, 34-36, and >36 weeks. If parental HLA sharing is associated with preterm delivery, the likelihood of HLA sharing was expected to be in a decreasing order from most likely among a <34-week cohort to least likely among a >36-week cohort. Among women in the <34-week cohort, changing partners resulted in a 33% reduction in the risk of early preterm delivery in the subsequent pregnancy compared with those who did not change partners [95% confidence interval (CI), 0.52-0.88]. In contrast, among women in the >36-week cohort, changing partners led to a 16% increase in the risk of early preterm delivery in the subsequent pregnancy (95% CI = 1.04-1.30). Among women in the 34-36-week cohort, changing partners did not affect the risk of preterm delivery (95% CI = 0.78-1.25). These estimates were adjusted for maternal race/ethnicity, age, educational level, prenatal smoking, prenatal care, parity, and interval from birth to conception of the subsequent pregnancy. The findings from this study suggest that the effect of changing paternity depends on the pregnancy outcome with the previous partner and support the hypothesis that parental HLA sharing may be related to preterm delivery.
High-risk newborns are known to have higher than average utilization of services after discharge from the neonatal intensive care unit (NICU). Most studies on this subject report aggregate data over periods ranging from 1 to 3 years postdischarge. Little is known about events that are temporally close to NICU discharge.
To characterize rehospitalizations within the first 2 weeks after discharge from six community NICUs.
We scanned electronic databases and reviewed the charts of rehospitalized infants from six NICUs in the Kaiser Permanente Medical Care Program. We subdivided infants into five groups based on gestational age (GA) and birth hospitalization length of stay (LOS): 1) >/=37 weeks' GA with <4 days LOS (n = 2593); 2) >/=37 weeks' GA with >/=4 days' LOS (n = 1133); 3) from 33 to 36 weeks' GA with <4 days' LOS (n = 545); 4) from 33 to 36 weeks' GA with >/=4 days' LOS (n = 1196); and 5) <33 weeks' GA (n = 587). We performed bivariate and multivariate analyses to identify predictors that might be useful for practitioners.
There were 6054 newborns discharged alive from the six study NICUs between August 1, 1992 and December 31, 1995, and 99.5% of these infants remained in the health plan during the 2 weeks after NICU discharge. The overall rehospitalization rate was 2.72%, which is 20% higher than the rate among healthy term newborns in the Kaiser Permanente Medical Care Program (2.26%). The two most common reasons for rehospitalization were jaundice (62/165, 37.6%) and feeding difficulties (25/165, 15.2%). Infants with 33 to 36 weeks' GA and <4 days' LOS were rehospitalized at a significantly higher rate than were all other infants (5.69%); 71% of infants in this group were rehospitalized for jaundice. The following variables predicted rehospitalization in multivariate models: <33 weeks' GA (adjusted OR [AOR]: 1.88; 95% CI: 1.10-3.21), from 33 to 36 weeks' GA with <96 hours' LOS (AOR: 2.94; 95% CI: 1.87-4.62), and birth at facility B, which had the highest rehospitalization rate of the six facilities (AOR: 1.92; 95% CI: 1.39-2.65).
The rate of rehospitalization among NICU graduates is higher than among healthy term infants. Most of the rehospitalizations among infants with from 33 to 36 weeks' GA and <4 days' LOS are for illnesses that are not life-threatening. Collaborative studies and new process and outcomes measures are needed to assess the effectiveness of follow-up strategies in high-risk newborns.
The objective of this study was to determine the comparative financial burden of twice-weekly fetal testing from 41 weeks of gestation until delivery, as compared with early dating ultrasound evaluation in an indigent population.
All women who were seen for antepartum testing for postdating pregnancy at Lyndon Baines Johnson Hospital were enrolled. Patient age, parity, gestational age at initiation of prenatal care, the number of prenatal visits, gestational age at first ultrasound scan, and the number of biophysical profiles that were performed before delivery were recorded. The labor and delivery database was searched for all deliveries at >41 weeks of gestation. The charge for a single ultrasound scan at <20 weeks of gestation was compared with twice-weekly testing in the population as a whole with the use of three strategies (no dating ultrasound scans and biophysical profiles until delivery, routine dating ultrasound scan and routine induction at 41 weeks of gestation, and current practice at our institution).
One hundred twenty-seven subjects with postdated pregnancy were enrolled (mean age, 25.2 years; median parity, 0 [range, 0-6]). The mean gestational age at the initiation of prenatal care was 21.2 +/- 10.5 weeks. Forty-seven women (38.0%) initiated care at <20 weeks. The mean number of biophysical profiles performed before delivery was 1.5 +/- 1.34; the mean gestational age at delivery was 42.1 +/- 0.87 weeks (spontaneous labor, 39.6%; induced labor, 40.4%). The charge for a biophysical profile is $492.90 US dollars and $551.00 US dollars for a 20-week ultrasound scan; there is no difference in the charge for induced or spontaneous labor. During the 4-month study period, 1638 patients were delivered at our hospital; 341 patients were delivered at >41 weeks of gestation. The estimated financial burden of antenatal testing of 341 patients from 41 weeks to delivery was calculated to be $252,118 US dollars, compared with $902,538 US dollars for a single ultrasound scan at 20 weeks for the entire population of 1638 patients. The estimated financial burden of current practice (10% of patients with no prenatal care, 38% of patients with examination at <20 weeks who were eligible for dating ultrasound scanning, and 37% of patients with examination for postdate testing) was $402,457 US dollars.
Patients who were seen for postdate antepartum testing in an indigent population lack early initiation of prenatal care and early ultrasound scans. Because on average only 1.5 biophysical profiles are performed per patient before delivery, routine early ultrasound scanning and routine induction at 41 weeks of gestation would add considerable financial burden to the system.
This study was undertaken to estimate the risk of fetal and maternal complications associated with postterm delivery in Denmark.
A cross-sectional study that used records from the Danish Medical Birth Registry from 1978 to 1993 was performed. All women with registered prolonged pregnancy (n = 78022) and a 5% random sample of all women who gave birth (n = 47021) were linked to the Danish National Discharge Register. We established a postterm group of 77956 singleton deliveries and a term group of 34140 singleton spontaneous deliveries. Logistic regression models were used to analyze data.
The risk of perinatal and obstetric complications was high in postterm delivery compared with term delivery (adjusted odds ratios between 1.2 and 3.1). The risk of perinatal death was 1.33 (1.05-1.68).
Postterm delivery was associated with significantly increased risks of perinatal and maternal complications in Denmark in the period from 1978 to 1993.
The purpose of this study was to determine whether rates of hypertensive disorders of pregnancy increase beyond 37 weeks of gestation and to address how best to analyze these rates.
This was a retrospective cohort study of all women delivered beyond 37 weeks' gestational age from 1995 to 1999 at all Kaiser Permanente Medical Care Program delivery hospitals in Northern California. Rates of gestational hypertension, preeclampsia, and eclampsia were calculated by use of both pregnancy delivered (PD) and ongoing pregnancy (OP) as the denominator. Bivariate and multivariate analyses were conducted with use of P<.05 to indicate statistical significance.
Among the 135,560 women in this cohort, the rates of gestational hypertension, preeclampsia, and eclampsia were the same or decreased from 37 to 43 weeks' gestation using PD, but all three increased when calculated according to OP (P<.01).
We found that among complications of pregnancy that are diagnosed ante partum, use of a different denominator led to contradictory conclusions. When hypertensive disorders of pregnancy are analyzed, ongoing pregnancies should be used as the denominator.
To estimate when rates of pregnancy complications increase beyond 37 weeks of gestation.
We designed a retrospective, cohort study of all women delivered beyond 37 weeks of gestational age from 1992 to 2002 at a single community hospital. Rates of perinatal complications by gestational age were analyzed with both bivariate and multivariable analyses. Statistical significance was designated by P <.05.
Among the 45673 women who delivered at 37 completed weeks and beyond, the rates of meconium and macrosomia increased beyond 38 weeks of gestation (P <.001), the rates of operative vaginal delivery, chorioamnionitis, and endomyometritis all increased beyond 40 weeks of gestation (P <.001), and rates of intrauterine fetal death and cesarean delivery increased beyond 41 weeks of gestation (P <.001).
Risks to both mother and infant increase as pregnancy progresses beyond 40 weeks of gestation.
Sweeping the membranes is effective in bringing on labour but causes discomfort, some bleeding and irregular contractions. Sweeping the membranes during a cervical examination is done to bring on labour in women at term. The review of trials found that sweeping brings on labour and is generally safe where there are no other complications. Sweeping reduces the need for other methods of labour induction such as oxytocin or prostaglandins. The review also found that sweeping can cause discomfort during the procedure, some bleeding and irregular contractions.
To show the increased risk of adverse outcomes in labour and fetomaternal morbidity in obese women (BMI > 30).
A population-based observational study.
University Hospital of Wales. The study sample was drawn from the Cardiff Births Survey, a population-based database comprising of a total of 60,167 deliveries in the South Glamorgan area between 1990 and 1999. Population Primigravid women with a singleton uncomplicated pregnancy with cephalic presentation of 37 or more weeks of gestation with accurate information regarding height and weight recorded at the booking visit (measured by the midwives) were included in the study.
Comparisons were made between women with a body mass index of 20-30 and those with more than 30. SPSS version 10 was used for statistical analysis. Student's t test, chi(2) and Fisher's exact tests were used wherever appropriate.
Labour outcomes assessed were risk of postdates, induction of labour, mode of delivery, failed instrumental delivery, macrosomia and shoulder dystocia. Maternal adverse outcomes assessed were postpartum haemorrhage, blood transfusion, uterine and wound infection, urinary tract infection, evacuation of uterus, thromboembolism and third- or fourth-degree perineal tears. Fetal wellbeing was assessed using Apgar <7 at 5 minutes, trauma and asphyxia, cord pH < 7.2, babies requiring neonatal ward admissions, tube feeding and incubator.
We report an increased risk [quoted as odds ratio (OR) and confidence intervals CI)] of postdates, 1.4 (1.2-1.7); induction of labour, 1.6 (1.3-1.9); caesarean section, 1.6 (1.4-2); macrosomia, 2.1 (1.6-2.6); shoulder dystocia, 2.9 (1.4-5.8); failed instrumental delivery, 1.75 (1.1-2.9); increased maternal complications such as blood loss of more than 500 mL, 1.5 (1.2-1.8); urinary tract infections, 1.9 (1.1-3.4); and increased neonatal admissions with complications such as neonatal trauma, feeding difficulties and incubator requirement.
Obese women appear to be at risk of intrapartum and postpartum complications. Induction of labour appears to be the starting point in the cascade of events. They should be considered as high risk and counselled accordingly.
This study was undertaken to examine the costs of hospital care associated with different methods of delivery.
An 18-year population-based cohort study (1985-2002) using the Nova Scotia Atlee Perinatal Database compared outcomes in nulliparous women at term undergoing spontaneous or induced labor for planned vaginal delivery, or undergoing cesarean delivery without labor. Costs that were assessed included physician fees, nursing hours in the labor and delivery, postpartum and neonatal intensive care units, epidural use, induction of labor agents, and consumables.
A total of 27,614 pregnancies satisfied inclusion and exclusion criteria, 5233 of which had labor induced. A comparison of mean costs per mother/infant pair demonstrated that cesarean delivery in labor ($2137) was increased compared with spontaneous vaginal delivery ($1340, P=.01), assisted vaginal delivery ($1594, P=.01), and cesarean delivery without labor ($1532, P=.01). The cost of delivery after induction of labor ($1715) was increased compared with spontaneous onset of labor ($1474, P<.001).
Cesarean delivery in labor occurs more frequently with labor induction and is associated with increased costs compared with other methods of delivery.
The purpose of this study was to evaluate the interrelationship between ethnicity and obesity on obstetric outcomes.
This was a retrospective study examining the interaction between ethnicity and obesity for obstetric outcomes. Statistical methods included univariate and multivariate regression models.
In this study population of 22,658 women, 2150 (9.4%) were obese (body mass index [BMI] >29). Obesity increased the rate of cesarean delivery, gestational diabetes, preeclampsia, and macrosomia in each ethnic group. When compared with obese white women, higher rates of cesarean delivery were noted in obese African American (odds ratio [OR] 1.50, P < .05) and Asian (OR 1.73, P < .05) women. Gestational diabetes was increased twofold in obese Latina (OR 1.94, P < .05) and Asian (OR 2.20, P < .05) women, while preeclampsia was increased only in obese Latina (1.93, P < .05) women.
Obesity increases the risk of cesarean delivery, gestational diabetes, preeclampsia, and macrosomia, but this effect varies among different ethnicities. The biometrics of different ethnicities and associated obstetric outcomes needs further exploration.
The association between excessive gestational weight gain and preterm delivery is unclear, as is the association between low gestational weight gain and preterm delivery among overweight and obese women.
Using data from the Pregnancy Risk Assessment Monitoring System in 21 states, we estimated the risk of very (20-31 weeks) and moderately (32-36 weeks) preterm delivery associated with a combination of prepregnancy body mass index (BMI) and gestational weight gain among 113,019 women who delivered a singleton infant during 1996-2001. We categorized average weight gain (kilograms per week) as very low (<0.12), low (0.12-0.22), moderate (0.23-0.68), high (0.69-0.79), or very high (>0.79). We categorized prepregnancy BMI (kg/m) as underweight (<19.8), normal (19.8-26.0), overweight (26.1-28.9), obese (29.0-34.9), or very obese (>or=35.0). We examined associations for all women and for all women with no complications adjusting for covariates.
There was a strong association between very low weight gain and very preterm delivery that varied by prepregnancy BMI, with the strongest association among underweight women (adjusted odds ratio = 9.8; 95% confidence interval = 7.0-13.8) and the weakest among very obese women (2.3; 1.8-3.1). Very low weight gain was not associated with moderately preterm delivery for overweight or obese women. Women with very high weight gain had approximately twice the odds of very preterm delivery, regardless of prepregnancy BMI.
This study supports concerns about very low weight gain during pregnancy, even among overweight and obese women, and also suggests that high weight gain, regardless of prepregnancy BMI, deserves further investigation.
To determine coital incidence at term and to estimate its effect on labor onset and mode of delivery.
Healthy women with uncomplicated pregnancies and established gestational age were recruited to keep a diary of coital activity from 36 weeks of gestation until birth and to answer a short questionnaire. Two hundred women with complete coital diaries were available for analysis. Outcome measures include coitus, postdate pregnancy (defined as pregnancy beyond the estimated date of confinement), gestational length of at least 41 weeks, labor induction at 41 weeks of gestation, and mode of delivery
Reported sexual intercourse at term was influenced by a woman's perception of coital safety, her ethnicity, and her partner's age. After multivariable logistic regression analysis controlling for the women's ethnicity, education, occupation, perception of coital safety, and partner's age, coitus at term remained independently associated with reductions in postdate pregnancy (adjusted odds ratio [AOR] 0.28, 95% confidence interval [CI] 0.13-0.58, P = .001), gestational length of at least 41 weeks (AOR 0.10, 95% CI 0.04-0.28, P < .001), and requirement for labor induction at 41 weeks of gestation (AOR 0.08, 95% CI 0.03-0.26, P < .001). At 39 weeks of gestation, 5 (95% CI 3.3-10.3) couples needed to have intercourse to avoid one woman having to undergo labor induction at 41 weeks of gestation. Coitus at term had no significant effect on operative delivery (adjusted P = .15).
Reported sexual intercourse at term was associated with earlier onset of labor and reduced requirement for labor induction at 41 weeks.
II-2.
We sought to determine when rates of maternal pregnancy complications increase for low-risk nulliparous and multiparous women at term.
We designed a retrospective cohort study of low-risk women delivered beyond 37 weeks gestational age from 1976 to 2001. Rates of mode of delivery and maternal complications of labor and delivery were examined by gestational age with both bivariate and multivariate analyses. Statistical significance was designated by P<0.05.
We found that among the 32,828 low-risk women who delivered at 37 completed weeks and beyond, the rates of primary cesarean delivery, operative vaginal delivery, third- or fourth-degree perineal lacerations, and chorioamnionitis all increased at 40 weeks of gestation (P<0.001), and the rate of postpartum hemorrhage increased at 41 weeks of gestation (P<0.001). These increases of rates of complications were larger and increased at an earlier gestational age among nulliparous women.
We found that the risk of maternal complications for otherwise low risk nulliparous and multiparous women increased as pregnancy progressed beyond 40 weeks of gestation. Counseling of women who progress past their EDC should include comparing the risks of induction of labor to that of expectant management.
Adipose tissue is an active endocrine organ that secretes a variety of metabolically important substances including adipokines. These factors affect insulin sensitivity and may represent a link between obesity, insulin resistance, type 2 diabetes (DM), and nonalcoholic fatty liver disease (NAFLD). This study uses real-time polymerase chain reaction (PCR) quantification of mRNAs encoding adiponectin, leptin, and resistin on snap-frozen samples of intra-abdominal adipose tissue of morbidly obese patients undergoing bariatric surgery.
Morbidly obese patients undergoing bariatric surgery were studied. Patients were classified into two groups: Group A (with insulin resistance) (N=11; glucose 149.84 +/- 40.56 mg/dL; serum insulin 8.28 +/- 3.52 microU/mL), and Group B (without insulin resistance) (N=10; glucose 102.2 +/- 8.43 mg/dL; serum insulin 3.431 +/- 1.162 microU/mL).
Adiponectin mRNA in intra-abdominal adipose tissue and serum adiponectin levels were significantly lower in Group A compared to Group B patients (P<0.016 and P<0.03, respectively). Although serum resistin was higher in Group A than in Group B patients (P<0.005), resistin gene expression was not different between the two groups. Finally, for leptin, neither serum level nor gene expression was different between the two groups. Serum adiponectin level was the only predictor of nonalcoholic steatohepatitis (NASH) in this study (P=0.024).
Obese patients with insulin resistance have decreased serum adiponectin and increased serum resistin. Additionally, adiponectin gene expression is also decreased in the adipose tissue of these patients. This low level of adiponectin expression may predispose patients to the progressive form of NAFLD or NASH.
As a pregnancy continues beyond term the risks of babies dying inside the womb or in the immediate newborn period increase. Whether a policy of labour induction at a predetermined gestational age can reduce this increased risk is the subject of this review.
To evaluate the benefits and harms of a policy of labour induction at term or post-term compared to awaiting spontaneous labour or later induction of labour.
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (June 2006).
Randomized controlled trials conducted in women at or beyond term. The eligible trials were those comparing a policy of labour induction to a policy of awaiting spontaneous onset of labour. Trials comparing cervical ripening methods, membrane stripping/sweeping or nipple stimulation without any commitment to delivery within a certain time were excluded.
Two review authors independently evaluated potentially eligible trials and extracted data. Outcomes are analysed in two main categories: gestational age and cervix status.
We included 19 trials reporting on 7984 women. A policy of labour induction at 41 completed weeks or beyond was associated with fewer (all-cause) perinatal deaths (1/2986 versus 9/2953; relative risk (RR) 0.30; 95% confidence interval (CI) 0.09 to 0.99). The risk difference is 0.00 (95% CI 0.01 to 0.00). If deaths due to congenital abnormality are excluded, no deaths remain in the labour induction group and seven deaths remain in the no-induction group. There was no evidence of a statistically significant difference in the risk of caesarean section (RR 0.92; 95% CI 0.76 to 1.12; RR 0.97; 95% CI 0.72 to 1.31) for women induced at 41 and 42 completed weeks respectively. Women induced at 37 to 40 completed weeks were more likely to have a caesarean section with expectant management than those in the labour induction group (RR 0.58; 95% CI 0.34 to 0.99). There were fewer babies with meconium aspiration syndrome (41+: RR 0.29; 95% CI 0.12 to 0.68, four trials, 1325 women; 42+: RR 0.66; 95% CI 0.24 to 1.81, two trials, 388 women).
A policy of labour induction after 41 completed weeks or later compared to awaiting spontaneous labour either indefinitely or at least one week is associated with fewer perinatal deaths. However, the absolute risk is extremely small. Women should be appropriately counselled on both the relative and absolute risks.
To study how the relationship between gestational weight gain and spontaneous preterm birth interacts with maternal race or ethnicity and previous preterm birth status.
This was a retrospective cohort study of singleton births to women of normal or low prepregnancy body mass index. Gestational weight gain was measured as total weight gain divided by weeks of gestation at delivery, and weight gain was categorized as low (less than 0.27 kg/wk,), normal (0.27-0.52 kg/wk), or high (more than 0.52 kg/wk). Univariable and multivariable analyses were performed on the relationship between weight gain categories and spontaneous preterm birth, stratified by maternal race or ethnicity and history of previous preterm birth.
Overall, low weight gain was associated with spontaneous preterm birth (adjusted odds ratio [AOR] 2.5, 95% confidence interval [CI] 2.0-3.1). Although low gain was consistently associated with increased spontaneous preterm birth, some differences were found in subgroup analysis. Among African Americans with a previous preterm birth, both low and high weight gain were associated with increased odds of spontaneous preterm birth (AOR for low weight gain 4.3, 95% CI 1.2-15.5; AOR for high weight gain 6.1, 95% CI 1.8-20.2). For all other groups, high weight gain was not associated with spontaneous preterm birth. Among Asians with a previous preterm birth, low weight gain was not statistically significantly associated with spontaneous preterm birth (AOR 1.9, 95% CI 0.5-7.7). Among Asians there was also a non-statistically significant inverse relationship between high weight gain and spontaneous preterm birth (AOR 0.5, 95% CI 0.3-1.1).
These results confirm an association between low maternal weight gain and spontaneous preterm birth. The effect modification of maternal race or ethnicity and history of previous preterm birth on this association deserves further study.
II-2.
The purpose of this study was to compare birth outcomes that result from the active management of risk in pregnancy at term (AMOR-IPAT) to those outcomes that result from standard management.
This was a randomized clinical trial with 270 women of mixed parity. AMOR-IPAT used preventive labor induction to ensure delivery before the end of an estimated optimal time of delivery. Rates of 4 adverse obstetric events and 2 composite measures were used to evaluate birth outcomes.
The AMOR-IPAT-exposed group had a similar cesarean delivery rate (10.3% vs 14.9%; P = .25), but a lower neonatal intensive care unit admission rate (1.5% vs 6.7%; P = .03), a higher uncomplicated vaginal birth rate (73.5% vs 62.8%; P = .046), and a lower mean Adverse Outcome Index score (1.4 vs 8.6; P = .03).
AMOR-IPAT exposure improved the pattern of birth outcomes. Larger randomized clinical trials are needed to explore further the impact of AMOR-IPAT on birth outcomes and to determine the best methods of preventive labor induction.
Management of postterm pregnancy. Number 6, October 1997. American College of Obstetricians and Gynecologists
Postterm delivery: a challenge for epidemiologic research
- Shea
Induction of labour for improving birth outcomes for women at or beyond term
- Gulmezoglu