Pregnancy risk factors for very premature delivery: what role do hypertension, obesity and diabetes play?

Spiegler, Juliane; Stichtenoth, Guido; Weichert, J.; König, Inke R.; Schlaud, Martin; Wense, A. v.d.; Olbertz, Dirk; Gurth, Heidrun; Schiffmann, Jan-Holger; Bohnhorst, Bettina; Gortner, Ludwig; Herting, Egbert; Göpel, Wolfgang

doi:10.1007/s00404-013-2739-6

Cited by 23 publications

(15 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In our study we took each characteristic that was significantly different in our affected and unaffected groups separately and find only the maternal characteristic gestational hypertension is significantly linked to adverse outcome. Our findings linking gestational hypertension to preterm birth are very similar to those of a recent publication by Spiegler et al [15] reporting on pregnancy risk factors for preterm birth, who found 28% hypertension in the adverse outcome group vs 8% in the control group (we find 28% vs 10%). Thus the connection between hypertension and HG pregnancies may explain, in part, the increased risk of poor fetal outcome.…”

Section: Resultssupporting

confidence: 92%

Antihistamines and other prognostic factors for adverse outcome in hyperemesis gravidarum

Fejzo¹,

Magtira²,

Schoenberg³

et al. 2013

European Journal of Obstetrics & Gynecology and Reproductiv

View full text Add to dashboard Cite

Objective The purpose of this study is to determine the frequency of adverse perinatal outcome in women with hyperemesis gravidarum and identify prognostic factors. Study design This is a case-control study in which outcomes of first pregnancies were compared between 254 women with hyperemesis gravidarum treated with intravenous fluids and 308 controls. Prognostic factors were identified by comparing the clinical profile of patients with hyperemesis gravidarum with a normal and an adverse pregnancy outcome. Binary responses were analyzed using either a Chi-square or Fisher exact test and continuous responses were analyzed using a t-test. Results Women with hyperemesis gravidarum have over a 4-fold increased risk of poor outcome including preterm birth and lower birth weight (p < 0.0001). Among maternal characteristics, only gestational hypertension had an influence on outcome (p < 0.0001). Treatment as an outpatient and/or by alternative medicine (acupuncture/acupressure/Bowen massage) was associated with a positive outcome (p < 0.0089). Poor outcomes were associated with early start of symptoms (p < 0.019), and treatment with methylprednisolone (p < 0.0217), promethazine (p < 0.0386), and other antihistamines [diphenhy- dramine (Benadryl), dimenhydrinate (Gravol), doxylamine (Unisom), hydroxyzine (Vistaril/Atarax), doxylamine and pyridoxine (Diclectin/Bendectin)] (p < 0.0151) independent of effectiveness. Among these medications, only the other antihistamines were prescribed independent of severity: they were effective in less than 20% of cases and were taken by almost 50% of patients with an adverse outcome. Conclusion Poor outcomes are significantly greater in women with HG and are associated with gestational hypertension, early symptoms, and antihistamine use. Given these results, there is an urgent need to address the safety and effectiveness of medications containing antihistamines in women with severe nausea of pregnancy.

show abstract

Section: Resultssupporting

confidence: 92%

Antihistamines and other prognostic factors for adverse outcome in hyperemesis gravidarum

Fejzo¹,

Magtira²,

Schoenberg³

et al. 2013

European Journal of Obstetrics & Gynecology and Reproductiv

View full text Add to dashboard Cite

show abstract

“…In several studies maternal hypertension has been shown to be significantly associated with PTB outcomes [28–30]. In the current study, we observed a similar trend in which maternal hypertension was significantly associated with all categories of preterm delivery.…”

Section: Discussionsupporting

confidence: 88%

“…A study looking at the biological determinant of late PTB found that placental ischemia as a result of hypertensive diseases in pregnancy increased the odds of late preterm delivery [31]. Other maternal medical conditions associated with increased risk of preterm delivery included placenta previa, placenta abruption, and preterm premature rupture of membranes, all of which are in concordance with other reported studies in the region and globally [16, 17, 19, 29, 30, 32, 33]. Approximately one in ten women in this cohort was infected with HIV and was in treatment to prevent maternal to child transmission (PMTCT).…”

Section: Discussionsupporting

confidence: 76%

Characteristics and risk factors of preterm births in a tertiary center in Lagos, Nigeria

et al. 2016

View full text Add to dashboard Cite

IntroductionPreterm birth is a dire complication of pregnancy that poses huge long-term medical and financial burdens for affected children, their families, and the health care system. The aim of the present study was to identify characteristics associated with preterm births at the Lagos University Teaching Hospital (LUTH), Lagos, Nigeria from 2011 to 2013.MethodsWe obtained Information from 5,561 maternal, fetal/neonatal and obstetric records from the labor ward. We excluded delivery at less than 22 weeks (0.25%), post-term birth at ≥42 weeks gestation (1.3%), and unknown gestation (1.4%). Additionally, we excluded records of multiple births (5.4%) and stillbirths (8.3%) leaving 4,691 records of singleton live-births for analysis. Logistic regression analysis was performed comparing preterm birth (22-36 weeks gestation) to term birth (37-41 weeks gestation). Multiple variable models adjusting for maternal age, parity, fetal position, delivery method and booking status were also evaluated. Multinomial regression was used to identify characteristics associated with preterm birth (PTB) defined as early PTB (22-31 weeks gestation), moderate PTB (32-34 weeks gestation), late PTB (35-36 weeks gestation), compared to term birth (37-41 completed weeks gestation).ResultsFrom our data, 16.8% of the singleton live-birth deliveries were preterm (<37 weeks gestation). Of these, 4.7% were early (22-31 weeks), 4.5% were moderate (32-34 weeks) and 7.7% were late (35-36) PTBs. Older maternal age (≥35 years) [odds ratio (OR) = 1.41], hypertension (OR = 3.44) and rupture of membranes (OR = 4.03) were significantly associated with increased odds of PTB. Women being treated for the prevention of mother-to-child transmission of HIV were at a significantly decreased risk for PTB (OR = 0.70). Sixteen percent of women in this cohort were not registered for antenatal care in LUTH. These non-registered subjects had significantly greater odds of all categories of PTB, including early (odds ratio (OR) = 20.8), moderate (OR = 8.68), and late (OR = 2.15).ConclusionPTB and risks for PTB remain high in Nigeria. We recommend that any high risk pregnancy should be referred to a tertiary center for prenatal care in order to significantly reduce adverse birth outcomes such as PTBs.

show abstract

“…Spiegler et al investigated the influence of diabetes on the risk of very premature birth, surprisingly finding no significant connection between these two conditions [24]. The limitation of above study is the identification of neonates with very low birth weight born in the 22nd-36th week of gestation with those delivered prematurely, not taking into account premature newborns presenting birth weight adequate for gestational age.…”

Section: Discussionmentioning

confidence: 98%

Gestational age at birth and mode of delivery – analysis of 1280 cases of diabetic pregnancies and review of the literature

Rajewska¹,

Celewicz²,

Torbé³

2017

Pomeranian J Life Sci

View full text Add to dashboard Cite

Introduction:The aim of the study to analyze the gestational age at delivery, delivery mode, and indications for caesarean section in 1280 women suffering from diabetes mellitus. Materials and methods:The gestational diabetes (GD) group was divided into classes: G1 (n = 620) of women who needed diet only, and G2 (n = 524), who needed insulin administration. The pregestational diabetes (PGD) group was categorized in subgroups: of classes B, C and D -BCD (n = 103) and of classes R, F and RF (VC -vascular complications) (n = 33). Results: In the GD-group 4.3% of deliveries occurred in <34th week of gestation, while in the PGD-group the percentage of such births was 10.29 (p = 0.0045). The lowest percentage of deliveries <34th week was observed in G2, and the highest in the VC-subgroup. The occurrence of delivery <37th week in GD was lower than in the PGD-group (p = 0.002). It was rarest in G2 and most frequent in the VC-subgroup. The percentage of caesarean section was lower in GD than in the PGD-group (47.94 vs. 74.26; p < 0.001). In the VC-subgroup it was near 100, while the lowest occurrence was noticed in the G1-subgroup. In both groups, caesarean delivery was performed more often because of foetal indications. Foetal indications prevailed in subgroups G1, G2 and BCD, while in the VC-subgroup most indications were of maternal condition. Conclusions: Diabetes accompanying pregnancy increases the risk of preterm birth, especially in cases of pre-pregnancy diabetes complicated by vascular disease. Caesarean delivery is more often necessary in women with pre-pregnancy diabetes than in those with gestational diabetes mellitus. The most typical caesarean section among the diabetic women is that performed because of maternal indications in pre-pregnancy diabetes complicated by vascular disease. Keywords: caesarean section; diabetes mellitus; pregnancy; preterm birth. ABSTRAKT Wstęp:Celem pracy była analiza wieku urodzeniowego noworodków, sposobu rozwiązania i wskazań do cięcia cesarskiego w 1280 przypadkach ciąż powikłanych cukrzycą. Materiały i metody: Ciężarne z cukrzycą ciążową (grupa GD) podzielono na podgrupę kobiet z cukrzycą klasy G1 (n = 620), u których normalizację glikemii osiągnięto wyłącznie dzięki leczeniu dietetycznemu, oraz podgrupę kobiet z cukrzycą klasy G2 (n = 524), u których poza leczeniem dietetycznym stosowano również insulinoterapię. Ciężarne z cukrzycą rozpoznaną przed ciążą (grupa PGD) podzielono na podgrupę kobiet z cukrzycą klasy B, C i D (BCD; n = 103) i na podgrupę kobiet z powikła-niami naczyniowymi VC (vascular complications), z cukrzycą klasy R, F i RF (n = 33). Wyniki: W grupie GD 4,3% porodów odbyło się przed ukończe-niem 34. tygodnia ciąży, a w grupie PGD -10,29% (p = 0,0045). Najniższy odsetek porodów <34. tygodnia ciąży zanotowano w podgrupie G2, a najwyższy w podgrupie VC. Również odsetek porodów przed ukończeniem 37. tygodnia ciąży był niższy w grupie GD niż w grupie PGD (p = 0,002) i najniższy w podgrupie G2, a najwyższy w podgrupie VC. Odsetek rozwiązań cięciem cesarsk...

show abstract

Pregnancy risk factors for very premature delivery: what role do hypertension, obesity and diabetes play?

Abstract: Premature birth seems to be correlated to gestational hypertension and associated problems in about ¼ of VLBW infants. Further studies should focus on preventing and treating gestational hypertension to avoid premature delivery and associated neonatal morbidity.

Cited by 23 publications

References 20 publications

Antihistamines and other prognostic factors for adverse outcome in hyperemesis gravidarum

Antihistamines and other prognostic factors for adverse outcome in hyperemesis gravidarum

Characteristics and risk factors of preterm births in a tertiary center in Lagos, Nigeria

Gestational age at birth and mode of delivery – analysis of 1280 cases of diabetic pregnancies and review of the literature

Contact Info

Product

Resources

About