The Distribution of Clinical Phenotypes of Preterm Birth Syndrome

Barros, Fernando C.; Papageorghiou, Aris T.; Victora, Cesar G; Noble, J. Alison; Pang, Ruoming; Iams, Jay D.; Ismail, Leila Cheikh; Goldenberg, Robert L.; Lambert, Ann; Kramer, Michael S.; Carvalho, Maria; Conde-Agudelo, Agustín; Jaffer, Y A; Bertino, Enrico; Gravett, Michael G.; Altman, DG; Ohuma, Eric O; Purwar, Manorama; Frederick, Ihunnaya O.; Bhutta, Zulfiqar Ahmed; Kennedy, Stephen; Villar, José

doi:10.1001/jamapediatrics.2014.3040

Cited by 147 publications

(113 citation statements)

References 36 publications

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“…28–30;48 Our observation of risk across subtypes for preexisting hypertension, preexisting diabetes, and previous PTB are consistent with findings in Western Australia, Nova-Scotia, and in a recent World Health Organization (WHO) multi-country survey (Table S5). 28–30 Our findings with respect to risk across groupings for preeclampsia and anemia are consistent with the WHO multi-country survey 32 but differ somewhat from those in Australia 30 where investigators found that anemia was only associated with PPROM and medically-indicated PTB and found that preeclampsia was only associated with preterm labor and medically-indicated PTB.…”

Section: Discussionsupporting

confidence: 87%

Maternal characteristics and mid‐pregnancy serum biomarkers as risk factors for subtypes of preterm birth

Jelliffe-Pawlowski

Baer

Blumenfeld

et al. 2015

BJOG

105

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Objective To examine the relationship between maternal characteristics, serum biomarkers, and preterm birth (PTB) by spontaneous and medically-indicated subtypes. Design Population-based cohort. Setting California, United States of America. Population From a total population of 1,004,039 live singleton births in 2009 and 2010, 841,665 pregnancies with linked birth certificate and hospital discharge records were included. Methods Characteristics were compared for term and preterm deliveries by PTB subtype using logistic regression and odds ratios adjusted for maternal characteristics and obstetric factors present in final stepwise models (adjORs) and 95% confidence intervals (CIs). First and second trimester serum marker levels were analyzed in a subset of 125,202 pregnancies with available first and second trimester serum biomarker results. Main Outcome Measure PTB by subtype. Results In fully adjusted models, ten characteristics and three serum biomarkers were associated with increased risk in each PTB subtype (Black race/ethnicity, preexisting hypertension with and without preeclampsia, gestational hypertension with preeclampsia, preexisting diabetes, anemia, previous PTB, one or ≥ two previous cesarean section(s), interpregnancy interval ≥ 60 months, low first trimester pregnancy-associated plasma protein A, high second trimester alpha-fetoprotein, and high second trimester dimeric inhibin A). These risks occurred in 51.6 to 86.2% of all pregnancies ending in PTB depending on subtype. The highest risk observed was for medically-indicated PTB < 32 weeks in women with preexisting hypertension and preeclampsia (adjOR 89.7, 27.3 – 111.2). Conclusions Our findings suggest a shared etiology across PTB subtypes. These commonalities point to targets for further study and exploration of risk reduction strategies.

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Section: Discussionsupporting

confidence: 87%

Maternal characteristics and mid‐pregnancy serum biomarkers as risk factors for subtypes of preterm birth

Jelliffe-Pawlowski

Baer

Blumenfeld

et al. 2015

BJOG

105

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“…First, as preterm birth is often described as a syndrome [24], this study will allow for nested studies examining maternal, fetal, and placental risk factors that contribute to preterm birth. As such, preterm birth phenotyping studies using the framework described by Barros et al (2012) will be nested at some of our sites [25]. Second, as GA assessment will prove to be a challenge in many of our sites, this poses a unique opportunity to test other measures to more accurately estimate GA.…”

Section: Discussionmentioning

confidence: 99%

Strengthening intrapartum and immediate newborn care to reduce morbidity and mortality of preterm infants born in health facilities in Migori County, Kenya and Busoga Region, Uganda: a study protocol for a randomized controlled trial

Otieno

Waiswa

Butrick

et al. 2018

Trials

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BackgroundPreterm birth (birth before 37 weeks of gestation) and its complications are the leading contributors to neonatal and under-5 mortality. The majority of neonatal deaths in Kenya and Uganda occur during the intrapartum and immediate postnatal period. This paper describes our study protocol for implementing and evaluating a package of facility-based interventions to improve care during this critical window.Methods/designThis is a pair-matched, cluster randomized controlled trial across 20 facilities in Eastern Uganda and Western Kenya. The intervention facilities receive four components: (1) strengthening of routine data collection and data use activities; (2) implementation of the WHO Safe Childbirth Checklist modified for preterm birth; (3) PRONTO simulation training and mentoring to strengthen intrapartum and immediate newborn care; and (4) support of quality improvement teams. The control facilities receive both data strengthening and introduction of the modified checklist. The primary outcome for this study is 28-day mortality rate among preterm infants. The denominator will include all live births and fresh stillbirths weighing greater than 1000 g and less than 2500 g; all live births and fresh stillbirths weighing between 2501 and 3000 g with a documented gestational age less than 37 weeks.DiscussionThe results of this study will inform interventions to improve personnel and facility capacity to respond to preterm labor and delivery, as well as care for the preterm infant.Trial registrationClinicalTrials.gov, ID: NCT03112018. Registered on 13 April 2017.Electronic supplementary materialThe online version of this article (10.1186/s13063-018-2696-2) contains supplementary material, which is available to authorized users.

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“…Spontaneous preterm birth (sPTB) was formerly divided into two general categories, namely cervical dysfunction ( cervical insufficiency or cervical incompetence ) or preterm labor (typically thought to be the result of intrauterine infection or bleeding). A more current understanding is that sPTB from all causes can be seen as part of an extremely complex continuum involving multiple phenotypes (Barros et al, 2015; Solomon and Iams, 2014). The etiology of sPTB is multifactorial, involving diverse precipitating factors such as infection and inflammation, bleeding, poor nutrition, demographics, stress, ethnicity and race, genetic predispositions and many others, all presumably with individual, and overlapping, molecular mechanisms (Gravett et al, 2010).…”

Section: The Clinical Problem Of Preterm Birthmentioning

confidence: 99%

“…The etiology of sPTB is multifactorial, involving diverse precipitating factors such as infection and inflammation, bleeding, poor nutrition, demographics, stress, ethnicity and race, genetic predispositions and many others, all presumably with individual, and overlapping, molecular mechanisms (Gravett et al, 2010). A recent attempt to categorize phenotypes of preterm birth showed that approximately 25% of these births are neither medically indicated nor associated with any known phenotype (Barros et al, 2015). …”

Section: The Clinical Problem Of Preterm Birthmentioning

confidence: 99%

The mechanical role of the cervix in pregnancy

Myers

Feltovich

Mazza

et al. 2015

Journal of Biomechanics

194

158

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Appropriate mechanical function of the uterine cervix is critical for maintaining a pregnancy to term so that the fetus can develop fully. At the end of pregnancy, however, the cervix must allow delivery, which requires it to markedly soften, shorten and dilate. There are multiple pathways to spontaneous preterm birth, the leading global cause of death in children less than 5 years old, but all culminate in premature cervical change, because that is the last step in the final common pathway to delivery. The mechanisms underlying premature cervical change in pregnancy are poorly understood, and therefore current clinical protocols to assess preterm birth risk are limited to surrogate markers of mechanical function, such as sonographically measured cervical length. This is what motivates us to study the cervix, for which we propose investigating clinical cervical function in parallel with a quantitative engineering evaluation of its structural function. We aspire to develop a common translational language, as well as generate a rigorous integrated clinical-engineering framework for assessing cervical mechanical function at the cellular to organ level. In this review, we embark on that challenge by describing the current landscape of clinical, biochemical, and engineering concepts associated with the mechanical function of the cervix during pregnancy. Our goal is to use this common platform to inspire novel approaches to delineation of normal and abnormal cervical function in pregnancy.

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The Distribution of Clinical Phenotypes of Preterm Birth Syndrome

Cited by 147 publications

References 36 publications

Maternal characteristics and mid‐pregnancy serum biomarkers as risk factors for subtypes of preterm birth

Maternal characteristics and mid‐pregnancy serum biomarkers as risk factors for subtypes of preterm birth

Strengthening intrapartum and immediate newborn care to reduce morbidity and mortality of preterm infants born in health facilities in Migori County, Kenya and Busoga Region, Uganda: a study protocol for a randomized controlled trial

The mechanical role of the cervix in pregnancy

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