McElrath et al. Respond to "Disaggregating Preterm Birth"

McElrath, Thomas F.; Dammann, Olaf; Boggess, Kim; Onderdonk, Andrew; Markenson, Glenn; Harper, Margaret; Delpapa, Ellen; Allred, Elizabeth N.; Leviton, Alan

doi:10.1093/aje/kwn196

Cited by 5 publications

(13 citation statements)

References 8 publications

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“…41 In addition to stillbirth, 42 perinatal liver disease, 43 and intrauterine growth restriction in monochorionic twins, 44 fetal vessel thrombosis has been linked to adverse neurologic outcomes, including neonatal encephalopathy 45 and neonatal stroke. 46 In the ELGAN cohort, it has been associated with ventriculomegaly of the offspring, 47 which, in turn, is associated with low MDI. 4 One antecedent that we identified, maternal obesity, is of particular interest because it is potentially modifiable and its prevalence is increasing.…”

Section: Discussionmentioning

confidence: 99%

“…[52][53][54][55] Perhaps most relevant to our study is the association with fetal growth restriction. 19,56 In addition, obesity is linked to chronic illnesses 57,58 and social disadvantage, 59 which might affect the mother-infant interaction and the resources available to enhance the home environment.…”

Section: Discussionmentioning

confidence: 99%

“…The clinical circumstances that led to each maternal admission and ultimately to each preterm delivery were operationally defined. 19 A course of antenatal adrenal corticosteroids given to enhance fetal lung maturation was considered complete if the gravida received 2 doses of betamethasone 24 hours apart and delivered at least 48 hours after the first dose, or if she received 4 doses of dexamethasone at 12-hour intervals. Neonatal data were collected from the newborn' s medical record.…”

Section: Figurementioning

confidence: 99%

“…20 The 6 initiators of preterm delivery, preterm labor, prelabor rupture of the fetal membranes, placental abruption, cervical insufficiency, preeclampsia, and delivery for fetal indications, are defined elsewhere. 19 …”

Section: Variable Definitionsmentioning

confidence: 99%

“…Fully 91% of children had this developmental assessment, which included a neurologic examination 19,23,24 and the BSID, second edition (BSID-II). 25 Of these children, 77% had their examination within the range of 23.5-27.9 months.…”

Section: Developmental Assessment At 24 Monthsmentioning

confidence: 99%

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Antenatal Antecedents of Cognitive Impairment at 24 Months In Extremely Low Gestational Age Newborns

2012

PEDIATRICS

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WHAT'S KNOWN ON THIS SUBJECT: Among extremely premature infants, survival has improved, but the rate of cognitive impairment has not. Impaired cognition is the most frequent developmental problem identified in survivors. Several antenatal factors have been associated with cognitive impairment, mostly related to social disadvantage. WHAT THIS STUDY ADDS:In addition to social disadvantage, antenatal characteristics associated with cognitive impairment include maternal obesity and thrombosis of fetal stem vessels. Prenatal infection and inflammation were not associated with impaired early cognitive function among extremely preterm infants. abstract BACKGROUND AND OBJECTIVES: Extremely low gestational age neonates are more likely than term infants to develop cognitive impairment. Few studies have addressed antenatal risk factors of this condition. We identified antenatal antecedents of cognitive impairment determined by the Mental Development Index (MDI) portion of the Bayley Scales of Infant Development, Second Edition (BSID-II), at 24 months corrected age. METHODS:We studied a multicenter cohort of 921 infants born before 28 weeks of gestation during 2002 to 2004 and assessed their placentas for histologic characteristics and microorganisms. The mother was interviewed and her medical record was reviewed. At 24 months adjusted age, children were assessed with BSID-II. Multinomial logistic models were used to estimate odds ratios. RESULTS:A total of 103 infants (11%) had an MDI ,55, and 99 infants (11%) had an MDI between 55 and 69. No associations were identified between organisms recovered from the placenta and developmental delay. Factors most strongly associated with MDI ,55 were thrombosis of fetal vessels (OR 3.1; 95% confidence interval [CI] 1.2, 7.7), maternal BMI .30 (OR 2.0; 95% CI 1.1, 3.5), maternal education #12 years (OR 3.4; 95% CI 1.9, 6.2), nonwhite race (OR 2.2; 95% CI 1.3, 3.8), birth weight z score , 22 (OR 2.8; 95% CI 1.1, 6.9), and male gender (OR 2.7; 95% CI 1.6, 4.5).CONCLUSIONS: Antenatal factors, including thrombosis of fetal vessels in the placenta, severe fetal growth restriction, and maternal obesity, convey information about the risk of cognitive impairment among extremely premature newborns. Pediatrics 2012;129:494-502

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Figurementioning

confidence: 99%

Section: Variable Definitionsmentioning

confidence: 99%

Section: Developmental Assessment At 24 Monthsmentioning

confidence: 99%

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Antenatal Antecedents of Cognitive Impairment at 24 Months In Extremely Low Gestational Age Newborns

2012

PEDIATRICS

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Environmental Phthalate Exposure and Preterm Birth

2014

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IMPORTANCE Preterm birth is a leading cause of neonatal mortality with a variety of contributing causes and risk factors. Environmental exposures represent a group of understudied but potentially important factors. Phthalate diesters are used extensively in a variety of consumer products worldwide. Consequently, exposure in pregnant women is highly prevalent OBJECTIVE To assess the relationship between phthalate exposure during pregnancy and preterm birth. DESIGN Nested case-control study. SETTING Brigham and Women’s Hospital, Boston, MA, USA. PARTICIPANTS Women were recruited for a prospective observational cohort study from 2006–2008. Each provided demographic data, biological samples, and information about birth outcomes. Within this group we selected 130 cases of preterm birth and 352 randomly assigned controls, and analyzed urine samples from up to three time points during pregnancy for levels of phthalate metabolites. MAIN OUTCOME MEASURES We examined associations between average levels of phthalate exposure during pregnancy and preterm birth, defined as <37 weeks completed gestation, as well as spontaneous preterm birth, defined as preterm preceded by spontaneous preterm labor or preterm premature rupture of the membranes (N=57). RESULTS Geometric means of the di-2-ethylhexyl phthalate (DEHP) metabolites mono-(2-ethyl)-hexyl phthalate (MEHP) and mono-(2-ethyl-5-carboxypentyl) phthalate (MECPP), as well as mono-n-butyl phthalate (MBP) were significantly higher in cases compared to controls. In adjusted models, MEHP, MECPP, and ∑DEHP metabolites were associated with significantly increased odds of preterm birth. When spontaneous preterm births were examined alone, MEHP, mono-(2-ethyl-5-oxohexyl) phthalate (MEOHP), MECPP, ∑DEHP, MBP, and mono-(3-carboxypropyl) phthalate (MCPP) metabolite levels were all associated with significantly elevated odds of prematurity. CONCLUSIONS AND RELEVANCE Women exposed to phthalates during pregnancy have significantly increased odds of delivering preterm. Steps should be taken to decrease maternal exposure to phthalates during pregnancy.

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Association of Antenatal Depression with Clinical Subtypes of Preterm Birth

et al. 2018

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Objective To estimate the association between antenatal depression and spontaneous preterm birth (SPTB) relative to medically indicated preterm birth (MPTB). Study Design This was a secondary analysis of a nested case–control study of preterm birth (PTB). The exposure was a clinical diagnosis of antenatal depression. The outcome was PTB at <37 weeks classified as SPTB (spontaneous labor, preterm premature rupture of membranes, placental abruption, and cervical shortening); and MPTB (preeclampsia and intrauterine growth restriction). Multinomial logistic regression models compared women without PTB versus MPTB and SPTB, adjusting for age, race, parity, tobacco use, insurance status, and prepregnancy body mass index, and history of PTB for SPTB. Results Among 443 pregnant women, 15.6% had an SPTB and 8.6% had an MPTB, and 16% were diagnosed with antenatal depression. Women with an SPTB were three times more likely to have antenatal depression compared with women without an SPTB (adjusted odds ratio [AOR]: 2.81; 95% confidence interval [CI]: 1.40–5.63). No significant association was identified between antenatal depression and MPTB (AOR: 1.77; 95% CI: 0.67–4.62). The association between antenatal depression and SPTB did not change after adjusting the aforementioned model for a history of PTB and antidepressant use. Conclusion Antenatal depression may differentially affect the risk of PTB through an increase in the odds of SPTB. These results have implications for future studies on prevention and treatment options for depression and PTB.

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McElrath et al. Respond to "Disaggregating Preterm Birth"

Cited by 5 publications

References 8 publications

Antenatal Antecedents of Cognitive Impairment at 24 Months In Extremely Low Gestational Age Newborns

Antenatal Antecedents of Cognitive Impairment at 24 Months In Extremely Low Gestational Age Newborns

Environmental Phthalate Exposure and Preterm Birth

Association of Antenatal Depression with Clinical Subtypes of Preterm Birth

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