The role of maternal infection in preterm birth: evidence from the Brazilian Multicentre Study on Preterm Birth (EMIP)

OBJECTIVES: Evidence suggests that infection or inflammation is a major contributor to early spontaneous preterm birth (sPTB). Therefore, this study aimed to investigate the development and causes of maternal infection associated with maternal and neonatal outcomes in women with sPTB. METHODS: This was a secondary analysis of a multicenter cross-sectional study with a nested case–control component, the Brazilian Multicentre Study on Preterm Birth (EMIP), conducted from April 2011 to July 2012 in 20 Brazilian referral obstetric hospitals. Women with preterm birth (PTB) and their neonates were enrolled. In this analysis, 2,682 women undergoing spontaneous preterm labor and premature pre-labor rupture of membranes were included. Two groups were identified based on self-reports or prenatal or hospital records: women with at least one infection factor and women without any maternal infection (vulvovaginitis, urinary tract infection, or dental infection). A bivariate analysis was performed to identify potential individual risk factors for PTB. The odds ratios (ORs) with their respective 95% confidence intervals were calculated. RESULTS: The majority of women with sPTB fulfilled at least one criterion for the identification of maternal infection (65.9%), and more than half reported having urinary tract infection during pregnancy. Approximately 9.6% of women with PTB and maternal infection were classified as having periodontal infection only. Apart from the presence of a partner, which was more common among women with infectious diseases (p=0.026; OR, 1.28 [1.03–1.59]), other variables did not show any significant difference between groups. CONCLUSION: Maternal infection was highly prevalent in all cases of sPTBs, although it was not clearly associated with the type of PTB, gestational age, or any adverse neonatal outcomes

Methodological Issues on Planning and Running the Brazilian Multicenter Study on Preterm Birth

Objectives. Assuming that the occurrence of preterm births and their maternal and neonatal associated conditions in Brazil are not completely known, a multicenter study was proposed. The purpose of this paper is to describe the methods used, its processes, achievements, and challenges. Study Design. A multicenter cross-sectional study on preterm births in Brazilian facilities plus a nested case-control study to assess their associated factors. A description of all steps of planning and implementing such a nationwide study, including strategies for dealing with problems arising during the process, is presented. Results. 20 referral hospitals in different regions of Brazil participated in the study. A detailed questionnaire for data collection, an electronic platform for data transcription and monitoring, research materials, and specific monitoring tools were developed; then data management and analyses were performed. Finally, we got information on 4,150 preterm births and 1,146 term births. Conclusions. This study represented the first step of a planned comprehensive assessment of preterm birth in Brazil, with detailed information that will lead to several analyses and further studies, bringing the knowledge to improve screening, diagnosis, and treatment practices in maternal and perinatal health with the final purpose of reducing the burden of this condition in the country

Adverse effects in children exposed to maternal HIV and antiretroviral therapy during pregnancy in Brazil: a cohort study

RESUMO Introdução O uso da terapia antirretroviral (TARV) na gestação se associou a dramática redução da transmissão vertical (TV) do HIV, porém demonstrou poder estar relacionado a efeitos adversos neonatais. O objetivo deste estudo foi avaliar os efeitos neonatais decorrentes da exposição à TARV materna. Métodos estudo observacional analítico de uma coorte de recém-nascidos de gestantes infectadas pelo HIV atendidos no Serviço de Obstetrícia do CAISM/UNICAMP entre 2000 e 2015. Foram avaliados os seguintes efeitos adversos: anemia, plaquetopenia, alteração hepática, prematuridade, baixo peso e malformação congênita. Os dados foram coletados dos prontuários dos pacientes e inseridos em banco específico. A análise descritiva foi realizada por meio de frequências simples (n) e relativas (%) e cálculos de média, desvio-padrão e mediana. As associações entre variáveis foram testadas por meio do Qui-quadrado ou Exato de Fisher (n < 5) e Razão de Risco com respectivo valor de p para as categóricas e por meio do t Student (dados paramétricos) ou Mann-Whitney (não-paramétricos) para as quantitativas. O nível de significância foi de 0,05. A análise multivariada foi realizada através da Regressão Logística de COX. No processamento e análise dos dados, foi utilizado o programa SAS 9.4. Resultados foram analisados dados de 787 recém-nascidos. A taxa de TV do HIV foi de 2,3%, sendo 0,8% nos últimos 5 anos. Os efeitos adversos observados foram alteração hepática (36%), anemia (25,7%), baixo peso (22,5%), prematuridade (21,7%), crianças pequenas para idade gestacional (PIG) (18%), malformações congênitas (10%) e plaquetopenia (3,6%). Em análise multivariada, o CD4 periparto maior que 200 células/mm3 foi protetor para baixo peso e prematuridade, e a cesárea esteve associada ao baixo peso ao nascimento, mas não ao parto prematuro. A anemia esteve associada ao parto prematuro e à exposição a zidovudina materna. A alteração hepática esteve associada à carga viral materna periparto detectável e à exposição a nevirapina. Não houve associação entre diferentes esquemas de TARV e tempo de exposição às drogas maternas com prematuridade, baixo peso e malformação congênita. Conclusão a TARV potente materna com consequente controle da carga viral é o maior fator responsável pela redução da TV do HIV. Ela está associada a frequência elevada de efeitos adversos no recém-nascido, porém a maioria de menor gravidade

Intracluster Correlation Coefficients For The Brazilian Multicenter Study On Preterm Birth (emip): Methodological And Practical Implications.

Cluster-based studies in health research are increasing. An important characteristic of such studies is the presence of intracluster correlation, typically quantified by the intracluster correlation coefficient (ICC), that indicate the proportion of data variability that is explained by the way of clustering. The purpose of this manuscript was to evaluate ICC of variables studied in the Brazilian Multicenter Study on Preterm Birth. This was a multicenter cross-sectional study on preterm births involving 20 referral hospitals in different regions of Brazil plus a nested case-control study to assess associated factors with spontaneous preterm births. Estimated prevalence rates or means, ICC with 95% confidence intervals, design effects and mean cluster sizes were presented for more than 250 maternal and newborn variables. Overall, 5296 cases were included in the study (4,150 preterm births and 1,146 term births). ICC ranged from 0.3 was found in some clinical management aspects well defined in literature such as use of corticosteroids, indicating there was homogeneity in clusters for these variables. Clusters selected for Brazilian Multicenter Study on Preterm Birth had mainly heterogeneous findings and these results can help researchers estimate the required sample size for future studies on maternal and perinatal health.145

Brazilian multicentre study on preterm birth (EMIP): prevalence and factors associated with spontaneous preterm birth

Background:Preterm birth rate is increasing and is currently a worldwide concern. The purpose of this study was to estimate the prevalence of preterm birth in a sample of health facilities in Brazil and to identify the main risk factors associated with spontaneous preterm births. Methods and Findings:This was a multicentre cross sectional study on preterm births in 20 referral obstetric hospitals with a case-control component to identify factors associated with spontaneous preterm birth. Surveillance was implemented at all centres to identify preterm births. For eligible consenting women, data were collected through a post-delivery questionnaire completed with information from all mother-newborn medical records until death or discharge or at a maximum of 60 days post-delivery, whichever came first. The risk of spontaneous preterm birth was estimated with OR and 95%CI for several predictors. A non-conditional logistic regression analysis was then performed to identify independently associated factors. The overall prevalence of preterm birth was 12.3%. Among them, 64.6% were spontaneous and 35.4% therapeutic. In the case-control component, 2,682 spontaneous preterm births were compared to a sample of 1,146 term births. Multivariate analyses identified the following as risk factors for spontaneous preterm birth among women with at least one previous birth: a previous preterm birth (OR adj= 3.19, 2.30–4.43), multiple pregnancy (ORadj = 29.06, 8.43–100.2), cervical insufficiency (ORadj= 2.93, 1.07–8.05), foetal malformation (ORadj= 2.63, 1.43–4.85), polyhydramnios (ORadj = 2.30, 1.17–4.54), vaginal bleeding (ORadj= 2.16, 1.50–3.11), and previous abortion (ORadj= 1.39, 1.08–1.78). High BMI (ORadj = 0.94, 0.91–0.97) and weight gain during gestation (ORadj = 0.92, 0.89–0.95) were found to be protective factors. Conclusions:The preterm birth rate in these health facilities in Brazil is high and spontaneous preterm births account for two thirds of them. A better understanding of the factors associated with spontaneous preterm birth is of utmost importance for planning effective measures to reduce the burden of its increasing rates

Call to action for a South American network to fight COVID-19 in pregnancy

A call to action for joint efforts by South American centers to tackle COVID-19 in pregnancy150226026

Risk estimates for spontaneous preterm birth according to some maternal obstetric history, comparing women who delivered prematurely (CASES) and women who delivered at term (CONTROLS).

<p><b>OR*:</b> Odds Ratio adjusted for the cluster effect design; <b>CI:</b> confidence interval; <b>(^*):</b> excluded Primigravida from the analysis.</p><p>Values in bold mean they are statistically significant.</p><p>Risk estimates for spontaneous preterm birth according to some maternal obstetric history, comparing women who delivered prematurely (CASES) and women who delivered at term (CONTROLS).</p