Fetal fibronectin detection in preterm labor: evaluation of a prototype bedside dipstick technique and cervical assessment

OBJECTIVE: The aims of this study were to evaluate a prototype bedside test for fetal fibronectin detection in women with symptoms of preterm labor, to compare the efficacy of obtaining fetal fibronectin swabs with and without a speculum, and to assess the value of combining the fetal fibronectin test with cervical dilatation for predicting delivery within 10 days

The interaction between the maternal BMI and angiogenic gene polymorphisms associates with the risk of spontaneous preterm birth

Obesity is associated with an increased level of inflammation. Interactions between inflammatory and angiogenic pathways are implicated in the major pregnancy disorders. The aim of this study was to investigate whether functional polymorphisms in angiogenesis-regulating genes (VEGFA rs699947, VEGFA rs3025039, KDR rs2071559 and ANGPT1 rs2507800) interact with the maternal BMI to modify the risk of a spontaneous preterm birth (sPTB). We conducted a nested case–control study of 1190 nulliparous Caucasian women (107 sPTBs and 1083 controls). Spontaneous PTB was defined as spontaneous preterm labour or a preterm premature rupture of membranes resulting in a preterm birth at <37 weeks of gestation. DNA was extracted from the peripheral blood and genotyped using the Sequenom MassARRAY system. Among overweight or obese women (BMI ≥25), the VEGFA rs699947 AA genotype was associated with a higher risk of sPTBs [odds ratio (OR) = 2.4, 95% confidence interval (CI): 1.4–4.6, P = 0.001] and a significant interaction between the BMI and the polymorphism was detected (OR = 4.2, 95% CI: 1.7–10.9, P = 0.003). Among women with a BMI < 25, ANGPT1 rs2507800 AA genotype was associated with a higher risk of sPTB (OR = 2.3, 95% CI: 1.2–4.4, P = 0.02) and a significant interaction between BMI and the polymorphism was detected (OR = 3.3, 95% CI: 1.1–9.3, P = 0.02). All results remained significant after adjusting for potential confounding factors. The maternal BMI interacts with angiogenesis-regulating gene polymorphisms to modify the risk of sPTBs. Trial Registry Name: Screening nulliparous women to identify the combinations of clinical risk factors and/or biomarkers required to predict pre-eclampsia, small-for-gestational-age babies and spontaneous preterm birth (https://www.anzctr.org.au). Registration number: ACTRN12607000551493.Prabha H. Andraweera, Gustaaf A. Dekker, Steven D. Thompson, Robyn A. North, Lesley M.E. McCowan and Claire T. Roberts on behalf of the SCOPE Consortiu

Relationships of maternal body mass index and plasma biomarkers with childhood body mass index and adiposity at 6 years; the Children of SCOPE study

Background: Maternal obesity has been implicated in the origins of childhood obesity through a sub-optimal environment in-utero. Objective: We examined relationships of maternal early pregnancy body mass index (BMI), overweight/obesity and plasma biomarkers of obesity, inflammation, insulin resistance and placental function with measures of childhood BMI and adiposity.Methods: BMI z-score, sum of skinfold thicknesses (SST), body fat percentage (BFP, by bioelectrical impedance), waist, arm and hip circumferences were measured in 1,173 6-year-old children of nulliparous pregnant women in the SCOPE study, New Zealand. Relationships of maternal early pregnancy (15 weeks’ gestation) BMI and biomarkers with these childhood anthropometric measures were assessed by linear regression, with appropriate adjustment.Results: 28.1% of mothers were overweight and 10.1% obese; compared with normal weight mothers, the BFP of their children were 5.3% higher [0.16 SD (95% CI 0.04 to 0.29) p=0.01] and 7.8% higher [0.27 (0.08 to 0.47) p=0.006] with comparable values for BMI z-score, arm, waist and hip circumferences. Early pregnancy maternal BMI and plasma placental growth factor (PlGF) were associated with higher child’s SST, BMI z-score, hip circumference and BFP. None of the metabolic or inflammatory maternal biomarkers were associated with childhood obesity. Conclusion: In this contemporary large prospective cohort study with extensive maternal/childhood phenotyping and a high prevalence of maternal overweight/obesity, we found independent relationships of maternal early pregnancy BMI with childhood BMI and adiposity, similar associations were observed with PlGF which may imply a role for placenta function in the developmental programming of childhood obesity risk

Does fetal size affect maternal perception of fetal movements? Evidence from an individual participant data meta-analysis

Introduction: Maternal perception of fetal movements during pregnancy are reassuring; however, the perception of a reduction in movements are concerning to women and known to be associated with increased odds of late stillbirth. Prior to full term, little evidence exists to provide guidelines on how to proceed unless there is an immediate risk to the fetus. Increased strength of movement is the most commonly reported perception of women through to full term, but perception of movement is also hypothesized to be influenced by fetal size. The study aimed to assess the pattern of maternal perception of strength and frequency of fetal movement by gestation and customized birthweight quartile in ongoing pregnancies. A further aim was to assess the association of stillbirth to perception of fetal movements stratified by customized birthweight quartile. Material and methods: This analysis was an individual participant data meta-analyses of five case–control studies investigating factors associated with stillbirth. The dataset included 851 cases of women with late stillbirth (&gt;28 weeks' gestation) and 2257 women with ongoing pregnancies who then had a liveborn infant. Results: The frequency of prioritized fetal movement from 28 weeks' gestation showed a similar pattern for each quartile of birthweight with increased strength being the predominant perception of fetal movement through to full term. The odds of stillbirth associated with reduced fetal movements was increased in all quartiles of customized birthweight centiles but was notably greater in babies in the lowest two quartiles (Q1: adjusted OR: 9.34, 95% CI: 5.43, 16.06 and Q2: adjusted OR: 6.11, 95% CI: 3.11, 11.99). The decreased odds associated with increased strength of movement was present for all customized birthweight quartiles (adjusted OR range: 0.25–0.56). Conclusions: Increased strength of fetal movements in late pregnancy is a positive finding irrespective of fetal size. However, reduced fetal movements are associated with stillbirth, and more so when the fetus is small.</p