Ethnic disparity in spontaneous preterm birth and maternal pre-pregnancy body mass index

Torloni, Maria Regina; Fortunato, Stephen J.; Betrán, Ana Pilar; Williams, Scott M.; Brou, Lina; Drobek, Cayce; Merialdi, Mario; Menon, Ramkumar

doi:10.1007/s00404-011-2102-8

Cited by 19 publications

(12 citation statements)

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“…Our findings help to explain the inconsistent findings between pre-pregnancy BMI and PTB outcomes reported in previous studies202122232425262728 and suggest that such inconsistency may be partly due to the interactions between maternal genotype (that is, rs11161721) and pre-pregnancy BMI. We showed that the impact of pre-pregnancy BMI on overall PTB risk depends on the maternal genotype at rs11161721.…”

Section: Discussionsupporting

confidence: 51%

“…First, maternal pre-pregnancy overweight/obesity (OWO) is prevalent in the BBC (>50%), which is significant from clinical and public health perspectives, and also ensures sufficient statistical power to identify a significant G × E interaction in this study. In addition, previous studies on the associations of pre-pregnancy BMI or OWO with PTB have yielded inconsistent results, including positive20212223, null2425 or negative associations262728. It is possible that such inconsistent findings may be in part due to maternal gene × pre-pregnancy BMI interaction29, which is largely unexplored.…”

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confidence: 99%

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Genome-wide approach identifies a novel gene-maternal pre-pregnancy BMI interaction on preterm birth

et al. 2017

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Preterm birth (PTB) contributes significantly to infant mortality and morbidity with lifelong impact. Few robust genetic factors of PTB have been identified. Such ‘missing heritability' may be partly due to gene × environment interactions (G × E), which is largely unexplored. Here we conduct genome-wide G × E analyses of PTB in 1,733 African-American women (698 mothers of PTB; 1,035 of term birth) from the Boston Birth Cohort. We show that maternal COL24A1 variants have a significant genome-wide interaction with maternal pre-pregnancy overweight/obesity on PTB risk, with rs11161721 (PG × E=1.8 × 10−8; empirical PG × E=1.2 × 10−8) as the top hit. This interaction is replicated in African-American mothers (PG × E=0.01) from an independent cohort and in meta-analysis (PG × E=3.6 × 10−9), but is not replicated in Caucasians. In adipose tissue, rs11161721 is significantly associated with altered COL24A1 expression. Our findings may provide new insight into the aetiology of PTB and improve our ability to predict and prevent PTB.

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Section: Discussionsupporting

confidence: 51%

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confidence: 99%

Genome-wide approach identifies a novel gene-maternal pre-pregnancy BMI interaction on preterm birth

et al. 2017

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“…We do note that obese women have decreased odds for spontaneous preterm birth compared to normal weight women in several studies and an analysis by race-ethnicity suggests that obese non-Hispanic blacks have the greatest reduction in spontaneous preterm births. (52, 53)…”

Section: Discussionmentioning

confidence: 99%

Obesity in Pregnancy: A Qualitative Approach to Inform an Intervention for Patients and Providers

Kominiarek

Peacock

2015

Matern Child Health J

101

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Objective To investigate perceptions of minority pregnant women and providers about obesity and gestational weight gain (GWG), and to explore strategies to improve management of obesity in pregnancy with an emphasis on group prenatal care. Methods Sixteen primarily non-Hispanic black pregnant women with a body mass index ≥30kg/m2 and 19 prenatal care providers participated in focus groups. Discussion topics included GWG goals, body image, health behaviors, and group prenatal care with additional emphasis on provider training needs. Results Women frequently stated a GWG goal >20lbs. Women described a body image not in line with clinical recommendations (“200 pounds is not that big.”). They avoided the term “obese.” They were interested in learning about nutrition and culturally-acceptable healthy cooking. Women would enjoy massage and exercise in group settings, though definitions of “exercise” varied. Family members could help, but generational differences posed challenges. Most had to “encourage myself” and “do this for me and the baby.” Providers expressed discomfort discussing GWG and difficulty finding the right words for obesity, which was partially attributed to their own weight. They noted the challenges they faced during prenatal care including time constraints, cultural myths, and system issues. Providers considered a group setting with social support an ideal environment to address health behaviors in obese women. Conclusions Culturally-tailored programs that use acceptable terms for obesity, provide education regarding healthy eating and safe exercise, and encourage support from social networks may be effective in addressing GWG in obese minority women. Provider training in communication skills is necessary to address obesity in pregnancy.

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“…Malnutrition increases vulnerability to infection and predisposes pregnant women to adverse obstetrical outcomes including preterm delivery, although findings on obesity and the risk of preterm birth are mixed. Recent research suggests that the association between body mass index (BMI) and risk of preterm birth may differ by race or ethnic group, underscoring the complexity of the role nutrition plays in triggering preterm birth [28]. Providers can administer nutritional supplements and counselling services during routine antenatal visits.…”

Section: Section I Delivering Effective Care To Women During Pregnanmentioning

confidence: 99%

Born Too Soon: Care during pregnancy and childbirth to reduce preterm deliveries and improve health outcomes of the preterm baby

Requejo¹,

Merialdi

Althabe

et al. 2013

Reprod Health

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Pregnancy and childbirth represent a critical time period when a woman can be reached through a variety of mechanisms with interventions aimed at reducing her risk of a preterm birth and improving her health and the health of her unborn baby. These mechanisms include the range of services delivered during antenatal care for all pregnant women and women at high risk of preterm birth, services provided to manage preterm labour, and workplace, professional and other supportive policies that promote safe motherhood and universal access to care before, during and after pregnancy. The aim of this paper is to present the latest information about available interventions that can be delivered during pregnancy to reduce preterm birth rates and improve the health outcomes of the premature baby, and to identify data gaps. The paper also focuses on promising avenues of research on the pregnancy period that will contribute to a better understanding of the causes of preterm birth and ability to design interventions at the policy, health care system and community levels. At minimum, countries need to ensure equitable access to comprehensive antenatal care, quality childbirth services and emergency obstetric care. Antenatal care services should include screening for and management of women at high risk of preterm birth, screening for and treatment of infections, and nutritional support and counselling. Health workers need to be trained and equipped to provide effective and timely clinical management of women in preterm labour to improve the survival chances of the preterm baby. Implementation strategies must be developed to increase the uptake by providers of proven interventions such as antenatal corticosteroids and to reduce harmful practices such as non-medically indicated inductions of labour and caesarean births before 39 weeks of gestation. Behavioural and community-based interventions that can lead to reductions in smoking and violence against women need to be implemented in conjunction with antenatal care models that promote women's empowerment as a strategy for reducing preterm delivery. The global community needs to support more discovery research on normal and abnormal pregnancies to facilitate the development of preventive interventions for universal application. As new evidence is generated, resources need to be allocated to its translation into new and better screening and diagnostic tools, and other interventions aimed at saving maternal and newborn lives that can be brought to scale in all countries.DeclarationThis article is part of a supplement jointly funded by Save the Children's Saving Newborn Lives programme through a grant from The Bill & Melinda Gates Foundation and March of Dimes Foundation and published in collaboration with the Partnership for Maternal, Newborn and Child Health and the World Health Organization (WHO). The original article was published in PDF format in the WHO Report "Born Too Soon: the global action report on preterm birth" (ISBN 978 92 4 150343 30), which involved collaboratio...

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Ethnic disparity in spontaneous preterm birth and maternal pre-pregnancy body mass index

Abstract: The risk for PTB in women with different pre-pregnancy BMI categories differs according to ethnicity.

Cited by 19 publications

References 40 publications

Genome-wide approach identifies a novel gene-maternal pre-pregnancy BMI interaction on preterm birth

Genome-wide approach identifies a novel gene-maternal pre-pregnancy BMI interaction on preterm birth

Obesity in Pregnancy: A Qualitative Approach to Inform an Intervention for Patients and Providers

Born Too Soon: Care during pregnancy and childbirth to reduce preterm deliveries and improve health outcomes of the preterm baby

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