Preterm Birth

Analizar el impacto sobre el crecimiento fetal del tratamiento con glucocorticoides para acelerar la maduración del pulmón fetal, según el número de ciclos administrados.Se ha utilizado la base de datos del Estudio Colaborativo Español de Malformaciones Congénitas (ECEMC) en una muestra de 29.557 recién nacidos vivos no gemelos sin defectos congénitos. Se compararon, mediante un análisis estratificado por edad gestacional al nacimiento, el peso, la talla y el perímetro cefálico de los expuestos prenatalmente a betametasona o dexametasona con los no expuestos. Para el control de factores de confusión o interacción (año de nacimiento, edad materna, edad gestacional, paridad, consumo de tabaco y/o bebidas alcohólicas, diabetes crónica, diabetes gestacional y otras enfermedades crónicas) se utilizó un modelo lineal general con efectos aleatorios, en el que la variable aleatoria fue el lugar de nacimiento.La exposición prenatal a 2 o más ciclos de glucocorticoides comporta una disminución del peso, la talla y el perímetro cefálico en prematuros. Concretamente, en la muestra analizada supone una pérdida del 22% del peso (p < 0,0001), del 5% de la talla (p = 0,002) y del 6% del perímetro cefálico al nacimiento (p = 0,0005). La exposición a un solo ciclo también comporta una pérdida significativa del peso y la talla, aunque no del perímetro cefálico. Asimismo, se ha observado una interacción significativa entre el tratamiento y la edad gestacional, lo cual indica que el impacto de la medicación es más acusado en los más prematuros.En este análisis retrospectivo la exposición prenatal a glucocorticoides para acelerar la maduración pulmonar fetal se asoció, en los recién nacidos prematuros, a un efecto negative sobre el peso, la talla y el perímetro cefálico. Este efecto fue más acusado en los prematuros expuestos a más de un ciclo de glucocorticoides.To study the effects of antenatal corticosteroids treatment to promote fetal lung maturation, on fetal growth, depending on the number of the courses administered.The study was based on data from the Spanish Collaborative Study of Congenital Malformations (ECEMC), analysing a sample of 29,557 singleton liveborn infants without congenital defects. An stratified analysis by gestational age was performed to compare the weight, length and head circumference at birth, in the exposed and unexposed infants to dexamethasone/ betamethasone. To control confounding factors (year of birth, maternal age, gestational age, parity, maternal smoking and/or alcohol consumption, gestational diabetes, non-gestational diabetes and other maternal chronic diseases) we used a general linear model with random effects, being the randomised variable the place of birth.The exposure to more than one course of antenatal corticosteroids resulted in a significant reduction of birth weight, length and head circumference in singleton preterm infants. The birth weight decreased by 22% (p < 0.0001), the length 5% (p = 0.002) and the head circumference 6% (p = 0.0005). The treatment with only one course reduced also significantly the weight and length but not the head circumference. In addition, we observed a significant interaction between the treatment and gestational age at birth indicating that the effect of corticosteroids is stronger in the most premature babies.In this retrospective analysis, the antenatal exposure to corticosteroids to promote fetal maturation is associated with diminished weight, length and head circumference in the premature newborn infant. This negative effect was greater in those premature babies exposed to multiple courses.

Prematurity and perinatal insults lead to increased developmental vulnerability. The home-based Infant Behavioral Assessment and Intervention Program (IBAIP) was designed to improve development of preterm infants. In a multicenter randomized controlled trial the effect of IBAIP on mother-infant interaction was studied as a secondary outcome. Mother-infant interaction was assessed during the Still-face procedure at 6 months corrected age. One hundred and twelve mother-infant dyads (57 intervention, 55 control) were studied. Findings partially supported our hypothesis that the intervention would increase maternal sensitivity in interaction with their preterm infants. No effects were found on infant self-regulatory behavior or positive interaction behavior.   The family-centered and strength-based approach of IBAIP appears to be a promising intervention method to promote sensitive mother-infant interaction at home after discharge from hospital. However, no positive effects were found on infant interaction behavior.

This ecological study analyzed the association between pesticide use and prematurity, low weight and congenital abnormality at birth, infant death by congenital abnormality, and fetal death in Brazil in 2001. Simple linear regression analysis has determined a positive association between pesticide use and prematurity, low birth weight, and congenital abnormality. The association between pesticide use and low birth weight (p = 0.045) and, congenital abnormality (p = 0.004) and infant death rate by congenital abnormality (p = 0.039) remained after the adjustment made by the proportion of pregnant women with a low number of prenatal care visits.

Background: The birth of a preterm infant has a greater risk of developmental disabilities health, and growth problems than infants born at full term. The aim of the present study was toexamine the effect of an educational program based on health belief model on prevention of preterm birth among newly pregnant women Design: A quasi-experimental study design was used (time series design) pre/post-test, two groups are studied. Tools: Datawere collected through two tools 1) An Interviewing Questionnaire sheetwhich include two parts; sociodemographic characteristics of studied sample and knowledge assessment sheet.2) Modified Health Belief Model Questionnaire. Results: there was no statistically significant difference between study and control groups regarding demographic characteristics. There was no statistically significant difference regarding mean knowledge score before and after program implementation among the control group. Health belief model were greatly improved after intervention than pre intervention among study group while there were minimal improvement after intervention than pre intervention among control group. There was a positive statistically significant correlation between total knowledge and total health belief model in study group after program implementation. Conclusion: The present study concluded that education program in early pregnancy could be positively associated with the decreased risk of preterm birth. Pregnant women should be trained and empowered to contribute positively in making pregnancy safer. Recommendations: Establishing strategies to enhance the women's understanding of prevention preterm birth by applying this model to a large sample in various obstetrics and gynecological outpatient clinics..

Pre-B-cell colony enhancing factor (PBEF) was first isolated from an activated peripheral blood lymphocyte cDNA library and was found to be involved in the maturation of B-cell precursors. It was subsequently identified as one of the genes upregulated by distending the human fetal membranes in vitro. Here we report on the genomic organization of this gene, which is composed of 11 exons and 10 introns, spanning 34.7 kb of genomic DNA. Neither the gene nor the protein has any homology with other cytokines in any currently available database. The use of two promoters (proximal and distal) may result in differential, tissue specific expression of the PBEF transcripts. The 5&#39;-flanking region lacks the classical sequence motif that would place it with the hematopoietic cytokines; however, it has several putative regulatory elements, suggesting that this gene may be chemically and mechanically responsive to inducers of transcription. The three PBEF mRNA transcripts were observed in bot...

Background Previous publications indicate that acupuncture is efficient for the treatment of pelvic girdle pain, PGP, in pregnant women. However, the use of acupuncture for PGP is rare due to insufficient documentation of adverse effects of this treatment in this specific condition. The aim of the present work was to assess adverse effects of acupuncture on the pregnancy, mother, delivery and the fetus/neonate in comparison with women that received stabilising exercises as adjunct to standard treatment or standard treatment alone. Methods In all, 386 women with PGP entered this controlled, single-blind trial. They were randomly assigned to standard treatment plus acupuncture (n = 125), standard treatment plus specific stabilising exercises (n = 131) or to standard treatment alone (n = 130) for 6 weeks. Acupuncture that may be considered strong was used and treatment was started as early as in the second trimester of pregnancy. Adverse effects were recorded during treatment and throughout the pregnancy. Influence on the fetus was measured with cardiotocography (CTG) before-during and after 43 acupuncture sessions in 43 women. A standardised computerized method to analyze the CTG reading numerically (Oxford 8000, Oxford, England) was used. After treatment, the women rated their overall experience of the treatment and listed adverse events if any in a questionnaire. Data of analgesia and oxytocin augmentation during labour, duration of labour, frequency of preterm birth, operative delivery, Apgar score, cord-blood gas/acid base balance and birth weight were also recorded. Results There were no serious adverse events after any of the treatments. Minor adverse events were common in the acupuncture group but women rated acupuncture favourably even despite this. The computerized or visually assessed CTG analyses of antenatal recordings in connection with acupuncture were all normal. Conclusion This study shows that acupuncture administered with a stimulation that may be considered strong led to minor adverse complaints from the mothers but had no observable severe adverse influences on the pregnancy, mother, delivery or the fetus/neonate.

Background and Aim: In the last few decades, the total number of preterm newborns, with ges-tational age less than 35 weeks, who survived the prematurity conditions, has increased significantly. This might lead to a high prevalence of late neurocognitive and developmental abnormalities. The neurological development is closely related to the hearing and language acquisition ; these factors play a crucial role in social and emotional growth. The present review emphasizes the consequences of preterm birth on neurodevelopment, speech-language, and auditory system. Recent Findings: The relationship between the preterm birth and neural developmental indicates that prematurity could lead to a higher risk of cerebral palsy, developmental delay, and mental retardation as compared to the birth at term. The preterm newborns would be deprived of normally enriched hearing experience during the length of hospital stay, which is markedly different from that of the typical full-term new-borns. This altered hearing ability might impede the early normal development of auditory neural pathways in preterm children, posing serious

The consequences of very preterm birth are long-lasting and cognitive outcomes do not seem to have improved over the last decades. Adolescents born very preterm showed impairments in neurocognitive processes that are involved in cognitive control. On the contrary, processes that do not require cognitive control, such as the involuntary control of eye movements and implicit sequence learning, were not impaired. The deficits in cognitive control were found to play an important role in the impairments in intelligence, academic performance, inattentive behavior, and social problems that were observed in adolescents born very preterm. In future research, a shift is to be made from studying group-level outcomes to studying the large individual differences in outcomes after very preterm birth. This will provide more insight in the specific difficulties of certain subgroups of children and will help us understand which children have an increased risk for poor outcomes. This aids the early identification of high-risk infants that may benefit from close monitoring and early support and the development of prevention and intervention strategies targeting factors that contribute to adverse outcomes after very preterm birth. In addition, there is a need for a more holistic approach of child development, in which the contribution of various interacting biological and environmental factors to functioning across a range of developmental
domains should be considered. The findings in this thesis emphasize that the improvement of outcomes after very preterm birth should receive the highest priority.

The aim of this study was to investigate the psychological impact of Kangaroo Mother Care KMC on mother–infant bonding in cases of premature delivery. Examined variables were mother– infant relationships, maternal anxiety levels, and infant interactive signals. The KMC method requires that babies be undressed and held upright between their mother's breasts for a minimum of 1 hr a day, from birth until they are discharged from hospital. The present study examined 40 premature infants and their mothers, with 21 dyads experiencing KMC and 19 receiving traditional care TC. Maternal emotional stress was assessed with the Parent Stress Index-Short Form questionnaire Abidin, 1990, and mother–newborn interactive style was assessed with the Nursing Child Assessment Feeding Scale Barnard, 1975. Results revealed a better mother–infant interactive style, a significant decrease in maternal emotional stress, and better infant ability to make requests and respond to parental interactive style in the KMC group. RESUMEN: El propósito de este estudio fue el de investigar el impacto sicológico del Cuidado de la Madre Canguro KMC en la relactión madre-infante en los casos de un parto prematuroc Se examin-aron estas variables. relaciones entre madre e infante, niveles de ansiedad maternal, señales interactivas del infante. El método de Cuidado de la Madre Canguro requiere que los bebés sean desvestidos y sostenidos entre los pechos de la madre por un mínimo de una hora al día, a partir del nacimiento hasta que se les dé de alta en el hospital. El presente estudio examinó 40 infantes prematuros y sus madres, con 21 díadas que experimentaban el Cuidado de la Madre Canguro, y 19 díadas que recibían el cuidado tradicional TC. El estrés emocional de la madre fue evaluado con el cuestionario corto del Indice de Estrés de la Madre Abidin, 1990, y el estilo interactivo entre la madre y su recién nacido fue evaluado con la Escala de Evaluación de Alimentación en la Crianza del Niño Barnard, 1975. Los resultados revelaron un mejor estilo interactivo entre la madre y su infante, un significativa baja en el estrés

This review summarizes the level of epidemiologic evidence for relationships between prenatal and/or early life exposure to environmental chemical contaminants and fetal, child, and adult health. Discussion focuses on fetal loss, intrauterine growth restriction, preterm birth, birth defects, respiratory and other childhood diseases, neuropsychological deficits, premature or delayed sexual maturation, and certain adult cancers linked to fetal or childhood exposures. Environmental exposures considered here include chemical toxicants in air, water, soil/house dust and foods (including human breast milk), and consumer products. Reports reviewed here included original epidemiologic studies (with at least basic descriptions of methods and results), literature reviews, expert group reports, meta-analyses, and pooled analyses. Levels of evidence for causal relationships were categorized as sufficient, limited, or inadequate according to predefined criteria. There was sufficient epidemiological evidence for causal relationships between several adverse pregnancy or child health outcomes and prenatal or childhood exposure to environmental chemical contaminants. These included prenatal high-level methylmercury (CH(3)Hg) exposure (delayed developmental milestones and cognitive, motor, auditory, and visual deficits), high-level prenatal exposure to polychlorinated biphenyls (PCBs), polychlorinated dibenzofurans (PCDFs), and related toxicants (neonatal tooth abnormalities, cognitive and motor deficits), maternal active smoking (delayed conception, preterm birth, fetal growth deficit [FGD] and sudden infant death syndrome [SIDS]) and prenatal environmental tobacco smoke (ETS) exposure (preterm birth), low-level childhood lead exposure (cognitive deficits and renal tubular damage), high-level childhood CH(3)Hg exposure (visual deficits), high-level childhood exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) (chloracne), childhood ETS exposure (SIDS, new-onset asthma, increased asthma severity, lung and middle ear infections, and adult breast and lung cancer), childhood exposure to biomass smoke (lung infections), and childhood exposure to outdoor air pollutants (increased asthma severity). Evidence for some proven relationships came from investigation of relatively small numbers of children with high-dose prenatal or early childhood exposures, e.g., CH(3)Hg poisoning episodes in Japan and Iraq. In contrast, consensus on a causal relationship between incident asthma and ETS exposure came only recently after many studies and prolonged debate. There were many relationships supported by limited epidemiologic evidence, ranging from several studies with fairly consistent findings and evidence of dose-response relationships to those where 20 or more studies provided inconsistent or otherwise less than convincing evidence of an association. The latter included childhood cancer and parental or childhood exposures to pesticides. In most cases, relationships supported by inadequate epidemiologic evidence reflect scarcity of evidence as opposed to strong evidence of no effect. This summary points to three main needs: (1) Where relationships between child health and environmental exposures are supported by sufficient evidence of causal relationships, there is a need for (a) policies and programs to minimize population exposures and (b) population-based biomonitoring to track exposure levels, i.e., through ongoing or periodic surveys with measurements of contaminant levels in blood, urine and other samples. (2) For relationships supported by limited evidence, there is a need for targeted research and policy options ranging from ongoing evaluation of evidence to proactive actions. (3) There is a great need for population-based, multidisciplinary and collaborative research on the many relationships supported by inadequate evidence, as these represent major knowledge gaps. Expert groups faced with evaluating epidemiologic evidence of potential causal relationships repeatedly encounter problems in summarizing the available data. A major driver for undertaking such summaries is the need to compensate for the limited sample sizes of individual epidemiologic studies. Sample size limitations are major obstacles to exploration of prenatal, paternal, and childhood exposures during specific time windows, exposure intensity, exposure-exposure or exposure-gene interactions, and relatively rare health outcomes such as childhood cancer. Such research needs call for investments in research infrastructure, including human resources and methods development (standardized protocols, biomarker research, validated exposure metrics, reference analytic laboratories). These are needed to generate research findings that can be compared and subjected to pooled analyses aimed at knowledge synthesis.

Background
Fossil fuel combustion by-products, including particulate matter (PM2.5), polycyclic aromatic hydrocarbons (PAH), nitrogen dioxide (NO2) and carbon dioxide (CO2), are a significant threat to children's health and equality. Various policies to reduce emissions have been implemented to reduce air pollution and mitigate climate change, with sizeable estimated health and economic benefits. However, only a few adverse outcomes in children have been considered, resulting in an undercounting of the benefits to this vulnerable population.

Objectives
Our goal was to expand the suite of child health outcomes addressed by programs to assess health and economic benefits, such as the Environmental Protection Agency (EPA) Benefits Mapping and Analysis Program (BenMAP), by identifying concentration-response (C-R) functions for six outcomes related to PM2.5, NO2, PAH, and/or PM10: preterm birth (PTB), low birthweight (LBW), autism, attention deficit hyperactivity disorder, IQ reduction, and the development of childhood asthma.

Methods
We conducted a systematic review of the literature published between January 1, 2000 and April 30, 2018 to identify relevant peer-reviewed case-control and cohort studies and meta–analyses. In some cases meta-analyses were available that provided reliable C-R functions and we assessed their consistency with subsequent studies. Otherwise, we reviewed all eligible studies published between our search dates.

Results
For each pollutant and health outcome, we present the characteristics of each selected study. We distinguish between C-R functions for endpoints having a causal or likely relationship (PTB, LBW, autism, asthma development) with the pollutants for incorporation into primary analyses and endpoints having a suggestive causal relationship with the pollutants (IQ reduction, ADHD) for secondary analyses.

Conclusion
We have identified C-R functions for a number of adverse health outcomes in children associated with air pollutants largely from fossil fuel combustion. Their incorporation into expanded assessments of health benefits of clean air and climate mitigation policies will provide an important incentive for preventive action.