Preterm birth: the impact of risk factors on pregnancy outcomes

Abstract

BACKGROUND: Despite the achievements of modern obstetrics and neonatology, the problem of preterm birth remains one of the most pressing.

AIM: The aim of this study was to evaluate the influence of risk factors on the outcome of threatened preterm birth.

MATERIALS AND METHODS: This prospective cohort study included the analysis of clinical and anamnestic data of 130 patients delivered at various gestational ages. The main group comprised 68 women with preterm delivery, with the control group consisting of 62 women with timely delivery.

RESULTS: The outcome of preterm birth is adversely affected by overweight in the group of modifiable risk factors, by history of premature birth in the immediate family in the group of non-modifiable risk factors, and by a previous COVID-19, anemia and autonomic nervous system disorders in the group of potentially modifiable risk factors. The most reliable prognostic marker for the development of preterm labor was the shortening of the cervical length of less than 2.5 cm according to ultrasound.

CONCLUSIONS: The formation of risk groups based on the analysis of clinical, anamnestic, medical, and social data, as well as somatic and gynecological diseases can help avoid the development of adverse outcomes of preterm birth.

Keywords

premature birth / premature newborn / risk factors / cervix

References

[1] Radzinsky VE, Orazmuradov AA, Savenkova IV. Preterm labour: an open problem in XXI century. Kuban Sci Med Bull. 2020;27(4):27−37. (In Russ.). DOI: 10.25207/1608-6228-2020-27-4-27-37

[2] Радзинский В.Е., Оразмурадов А.А., Савенкова И.В. Преждевременные роды — нерешенная проблема XXI века // Кубанский научный медицинский вестник. 2020. Т. 27. № 4. С. 27−37. DOI: 10.25207/1608-6228-2020-27-4-27-37

[3] Rossiyskoye obshchestvo akusherov-ginekologov, Assotsiatsiya akusherskikh anesteziologov-reanimatologov, Nauchno-prakticheskiy Sovet Minzdrava RF. Prezhdevremenn•yye rody. Klinicheskiye rekomendatsii. Moscow, 2020. (In Russ.). [cited 2022 May 14]. Available from: https://base.garant.ru/75051372/

[4] Российское общество акушеров-гинекологов, Ассоциация акушерских анестезиологов-реаниматологов, Научно-практический Совет Минздрава РФ. Преждевременные роды. Клинические рекомендации. М., 2020. [дата обращения: 14.05.2022]. Доступ по ссылке: https://base.garant.ru/75051372/

[5] Radzinsky VE, Kostin IN, Olenev AS. Preterm delivery is an unsettled World problem. Obstetrics and Gynecology. News. Opinions. Education. 2018;S3:55−64. (In Russ.). DOI: 10.24411/2303-9698-2018-13909

[6] Радзинский В.Е., Костин И.Н., Оленев А.С. Преждевременные роды — нерешенная мировая проблема // Акушерство и гинекология. Новости. Мнения. Обучение. 2018. № S3. С. 55−64. DOI: 10.24411/2303-9698-2018-13909

[7] Yakovleva OV, Glukhova TN, Rogozhina IE. Evaluation of the effectiveness of measures to improve the outcomes of preterm birth (review). Evaluation of the effectiveness of measures to improve the outcomes of preterm birth. Saratov Journal of Medical Scientific Research. 2020;16(1):17−23. (In Russ.)

[8] Яковлева О.В., Глухова Т.Н., Рогожина И.Е. Оценка эффективности мероприятий по улучшению исходов преждевременных родов // Саратовский научно-медицинский журнал. 2020. Т. 16. № 1. С. 17−23.

[9] Lamont K, Scott NW, Jones GT, Bhattacharya S. Risk of recurrent stillbirth: systematic review and meta-analysis. BMJ. 2015;350:h3080. DOI: 10.1136/bmj.h3080

[10] Lamont K., Scott N.W., Jones G.T., Bhattacharya S. Risk of recurrent stillbirth: systematic review and meta-analysis // BMJ. 2015. Vol. 350. P. h3080. DOI: 10.1136/bmj.h3080

[11] Skripnichenko YuP, Baranov II, Tokova ZZ. Statistics of the preterm births. Russian Journal of Human Reproduction. 2014;(4)11−14. (In Russ.)

[12] Скрипниченко Ю.П., Баранов И.И., Токова З.З. Статистика преждевременных родов // Проблемы репродукции. 2014. Т. 20. № 4. С. 11−14.

[13] Lawn JE, Kinney MV, Belizan JM, et al. Born too soon: Accelerating actions for prevention and care of 15 million newborns born too soon. Reprod Health. 2013;10(1):S6. DOI: 10.1186/1742-4755-10-S1-S6

[14] Lawn J.E., Kinney M.V., Belizan J.M., et al. Born too soon: Accelerating actions for prevention and care of 15 million newborns born too soon // Reprod. Health. 2013. Vol. 10. No. 1. P. S6. DOI: 10.1186/1742-4755-10-S1-S6

[15] Blencowe H, Cousens S, Oestergaard MZ, et al. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet. 2012;379(9832):2162−2172. DOI: 10.1016/S0140-6736(12)60820-4

[16] Blencowe H., Cousens S., Oestergaard M.Z., et al. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications // Lancet. 2012. Vol. 379. No. 9832. P. 2162−2172. DOI: 10.1016/S0140-6736(12)60820-4

[17] World Health Organization. [Internet]. Preterm birth. [cited 2022 May 14]. Available from: https://www.who.int › detail

[18] World Health Organization. [Internet]. Preterm birth. [дата обращения: 14.05.2022]. Доступ по ссылке: https://www.who.int/ru/news-room/fact-sheets/detail/preterm-birth

[19] Radzinskiy VE. Akusherskaya agressiya. Moscow: Status Praesens; 2017. (In Russ.)

[20] Радзинский В.Е. Акушерская агрессия. М.: Status Praesens; 2017.

[21] World Health Organization. [Internet]. The Global strategy for women’s, children’s and adolescents’ health (2016-2030): a roadmap based on evidence and country experience. [cited 2022 May 14]. Available from: https://globalstrategy.everywomaneverychild.org/pdf/EWEC_globalstrategyreport_200915_FINAL_WEB.pdf

[22] World Health Organization. [Internet]. The Global strategy for women’s, children’s and adolescents’ health (2016-2030): a roadmap based on evidence and country experience. [дата обращения: 14.05.2022]. Доступ по ссылке: https://globalstrategy.everywomaneverychild.org/pdf/EWEC_globalstrategyreport_200915_FINAL_WEB.pdf

[23] Aylamazyan EK, Kuzminykh TU. Controversial questions of preterm birth. Journal of obstetrics and women’s diseases. 2013;62(4):97−105. (In Russ.). DOI: 10.17816/JOWD62497-105

[24] Айламазян Э.К., Кузьминых Т.У. Дискуссионные вопросы преждевременных родов // Журнал акушерства и женских болезней. 2013. Т. 62. № 4. C. 97−105. DOI: 10.17816/JOWD62497-105

[25] Zemet R, Schiff E, Manovitch Z, et al. Quantitative assessment of physical activity in pregnant women with sonographic short cervix and the risk for preterm delivery: A prospective pilot study. PLoS One. 2018;13(6):e0198949. DOI: 10.1371/journal.pone.0198949

[26] Zemet R., Schiff E., Manovitch Z., et al. Quantitative assessment of physical activity in pregnant women with sonographic short cervix and the risk for preterm delivery: A prospective pilot study // PLoS One. 2018. Vol. 13. No. 6. P. e0198949. DOI: 10.1371/journal.pone.0198949

[27] Newman RB, Goldenberg RL, Iams JD, et al. Preterm prediction study: comparison of the cervical score and Bishop score for prediction of spontaneous preterm delivery. Obstet Gynecol. 2008;112(3):508−515. DOI: 10.1097/AOG.0b013e3181842087

[28] Newman R.B., Goldenberg R.L., Iams J.D., et al. Preterm prediction study: comparison of the cervical score and Bishop score for prediction of spontaneous preterm delivery // Obstet. Gynecol. 2008. Vol. 112. No. 3. P. 508−515. DOI: 10.1097/AOG.0b013e3181842087

[29] Fuchs F, Monet B, Ducruet T, et al. Effect of maternal age on the risk of preterm birth: A large cohort study. PLoS One. 2018;13(1):e0191002. DOI: 10.1371/journal.pone.0191002

[30] Fuchs F., Monet B., Ducruet T., et al. Effect of maternal age on the risk of preterm birth: A large cohort study // PLoS One. 2018. Vol. 13. No. 1. P. e0191002. DOI: 10.1371/journal.pone.0191002

[31] Lawlor DA, Mortensen L, Andersen AM. Mechanisms underlying the associations of maternal age with adverse perinatal outcomes: a sibling study of 264 695 Danish women and their firstborn offspring. Int J Epidemiol. 2011;40(5):1205−1214. DOI: 10.1093/ije/dyr084

[32] Lawlor D.A., Mortensen L., Andersen A.M. Mechanisms underlying the associations of maternal age with adverse perinatal outcomes: a sibling study of 264 695 Danish women and their firstborn offspring // Int. J. Epidemiol. 2011. Vol. 40. No. 5. P. 1205−1214. DOI: 10.1093/ije/dyr084

[33] Fraser AM, Brockert JE, Ward RH. Association of young maternal age with adverse reproductive outcomes. N Engl J Med. 1995;332(17):1113−1117. DOI: 10.1056/NEJM199504273321701

[34] Fraser A.M., Brockert J.E., Ward R.H. Association of young maternal age with adverse reproductive outcomes // N. Engl. J. Med. 1995. Vol. 332. No. 17. P. 1113−1117. DOI: 10.1056/NEJM199504273321701

[35] Mayo JA, Lu Y, Stevenson DK, et al. Parental age and preterm birth: a population-based cohort of nearly 3 million California livebirths from 2007 to 2012. J Perinatol. 2021;41(9):2156−2164. DOI: 10.1038/s41372-020-00894-7

[36] Mayo J.A., Lu Y., Stevenson D.K., et al. Parental age and preterm birth: a population-based cohort of nearly 3 million California livebirths from 2007 to 2012 // J. Perinatol. 2021. Vol. 41. No. 9. P. 2156−2164. DOI: 10.1038/s41372-020-00894-7

[37] Radzinsky VE, Khamoshina MB, Chakchurina IA, Orazmuradova АА. Obstetrical and perinatal complications in young primiparas. DoctorRu. 2019;162(7):6–11. (In Russ.). DOI: 10.31550/1727-2378-2019-162-7-6-11

[38] Радзинский В.Е., Хамошина М.Б., Чакчурина И.А., Оразмурадова А.А. Акушерские и перинатальные осложнения у юных первородящих // Доктор Ру. 2019. № 7(162). С. 6−11. DOI: 10.31550/1727-2378-2019-162-7-6-11

[39] Kulavsky VA, Ziganshin AM, Kulavsky EV, Ziganshina EA. The problems of premature birth in the current population of adolescent girls. Mother and Baby in Kuzbass. 2014;3(58):47−50. (In Russ.)

[40] Кулавский В.А., Зиганшин А.М., Кулавский Е.В., Зиганшина Э.А. Медико-социальные проблемы преждевременных родов у девочек подростков // Мать и дитя в Кузбассе. 2014. № 3 (58). С. 47−50.

[41] Belokrinitskaya TE, Artymuk NV, Filippov OS, Frolova NI. Maternal and perinatal outcomes during Covid-19 pandemia in Far East and Siberian federal region of Russia. Russian Journal of Human Reproduction. 2021;27(2):130−136. (In Russ.). DOI: 10.17116/repro202127021130

[42] Белокриницкая Т.Е., Артымук Н.В., Филиппов О.С., Фролова Н.И. Материнские и перинатальные исходы в условиях пандемии новой коронавирусной инфекции COVID-19 в Дальневосточном и Сибирском федеральных округах // Проблемы репродукции. 2021. Т. 27. № 2. С. 130–136. DOI: 10.17116/repro202127021130

[43] Norwitz ER, Caughey AB. Progesterone supplementation and the prevention of preterm birth. Rev Obstet Gynecol. 2011;4(2):60−72.

[44] Norwitz E.R., Caughey A.B. Progesterone supplementation and the prevention of preterm birth // Rev. Obstet. Gynecol. 2011. Vol. 4. No. 2. P. 60−72.

[45] Wilson PW. Established risk factors and coronary artery disease: the Framingham Study. Am J Hypertens. 1994;7(7 Pt 2):7S−12S. DOI: 10.1093/ajh/7.7.7s

[46] Wilson P.W. Established risk factors and coronary artery disease: the framingham study // Am. J. Hypertens. 1994. Vol. 7. No. 7. Pt. 2. P. 7S−12S. DOI: 10.1093/ajh/7.7.7s

[47] Marsoosi V, Pirjani R, Asghari Jafarabadi M, et al. Cervical gland area as an ultrasound marker for prediction of preterm delivery: A cohort study. Int J Reprod Biomed. 2017;15(11):729−734.

[48] Marsoosi V., Pirjani R., Asghari Jafarabadi M., et al. Cervical gland area as an ultrasound marker for prediction of preterm delivery: A cohort study // Int. J. Reprod. Biomed. 2017. Vol. 15. No. 11. P. 729−734.

[49] Mudrov VA, Ziganshin AM, Yashchuk AG, et al. Possibilities for diagnosis and prediction of preterm labor at the present stage. Kazan Medical Journal. 2021;102(1):47−59. (In Russ.). DOI: 10.17816/KMJ2021-47

[50] Мудров В.А., Зиганшин А.М., Ящук А.Г., и др. Возможности диагностики и прогнозирования преждевременных родов на современном этапе // Казанский медицинский журнал. 2021. Т. 102. № 1. С. 47–59. DOI: 10.17816/KMJ2021-47

[51] Volkov VG, Chursina OV. The modern possibilities of prediction of preterm birth. Journal of new medical technologies. Electronic. 2020;1:30−35. (In Russ.). DOI: 10.24411/2075-4094-2020-16593

[52] Волков В.Г., Чурсина О.В. Современные возможности прогнозирования преждевременных родов // Вестник новых медицинских технологий. Электронное издание. 2020. № 1. С. 30−35. DOI: 10.24411/2075-4094-2020-16593

RIGHTS & PERMISSIONS

Eсо-Vector