Dataset Information

The association of beta-2 adrenoceptor genotype with short-cervix mediated preterm birth: a case-control study.

ABSTRACT:

Objective

To determine whether ?2 -adrenoceptor (?2 AR) genotype is associated with shortening of the cervix or with preterm birth (PTB) risk among women with a short cervix in the second trimester.

Design

A case-control ancillary study to a multicentre randomised controlled trial.

Setting

Fourteen participating centres of the Maternal-Fetal Medicine Units Network of the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Population

Four hundred thirty-nine women, including 315 with short cervix and 124 with normal cervical length.

Methods

Nulliparous women with cervical length <30 mm upon a 16-22-week transvaginal sonogram and controls frequency-matched for race/ethnicity with cervical lengths ?40 mm were studied. ?2 AR genotype was determined at positions encoding for amino acid residues 16 and 27.

Main outcome measures

Genotype distributions were compared between case and control groups. Within the short cervix group, pregnancy outcomes were compared by genotype, with a primary outcome of PTB <37 weeks.

Results

Genotype data were available at position 16 for 433 women and at position 27 for 437. Using a recessive model testing for association between short cervix and genotype, and adjusted for ethnicity, there was no statistical difference between cases and controls for Arg16 homozygosity (OR 0.7, 95% CI 0.4-1.3) or Gln27 homozygosity (OR 0.9, 95% CI 0.3-2.7). Among cases, Arg16 homozygosity was not associated with protection from PTB or spontaneous PTB. Gln27 homozygosity was not associated with PTB risk, although sample size was limited.

Conclusions

?2 AR genotype does not seem to be associated with short cervical length or with PTB following the second-trimester identification of a short cervix. Influences on PTB associated with ?2 AR genotype do not appear to involve a short cervix pathway.

SUBMITTER: Miller R

PROVIDER: S-EPMC4508241 | biostudies-literature | 2015 Sep

REPOSITORIES: biostudies-literature

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Publications

The association of beta-2 adrenoceptor genotype with short-cervix mediated preterm birth: a case-control study.

Miller R R Smiley R R Thom E A EA Grobman W A WA Iams J D JD Mercer B M BM Saade G G Tita A T AT Reddy U M UM Rouse D J DJ Sorokin Y Y Blackwell S C SC Esplin M S MS Tolosa J E JE Caritis S N SN

BJOG : an international journal of obstetrics and gynaecology 20150120 10

<h4>Objective</h4>To determine whether β2 -adrenoceptor (β2 AR) genotype is associated with shortening of the cervix or with preterm birth (PTB) risk among women with a short cervix in the second trimester.<h4>Design</h4>A case-control ancillary study to a multicentre randomised controlled trial.<h4>Setting</h4>Fourteen participating centres of the Maternal-Fetal Medicine Units Network of the Eunice Kennedy Shriver National Institute of Child Health and Human Development.<h4>Population</h4>Four ...[more]

PMID: 25600430

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Project description:ImportanceA short cervix as assessed by transvaginal ultrasound is an established risk factor for preterm birth. Study findings for a cervical pessary to prevent preterm delivery in singleton pregnancies with transvaginal ultrasound evidence of a short cervix have been conflicting.ObjectiveTo determine if cervical pessary placement decreases the risk of preterm birth or fetal death prior to 37 weeks among individuals with a short cervix.Design, setting, and participantsWe performed a multicenter, randomized, unmasked trial comparing a cervical pessary vs usual care from February 2017 through November 5, 2021, at 12 centers in the US. Study participants were nonlaboring individuals with a singleton pregnancy and a transvaginal ultrasound cervical length of 20 mm or less at gestations of 16 weeks 0 days through 23 weeks 6 days. Individuals with a prior spontaneous preterm birth were excluded.InterventionsParticipants were randomized 1:1 to receive either a cervical pessary placed by a trained clinician (n = 280) or usual care (n = 264). Use of vaginal progesterone was at the discretion of treating clinicians.Main outcome and measuresThe primary outcome was delivery or fetal death prior to 37 weeks.ResultsA total of 544 participants (64%) of a planned sample size of 850 were enrolled in the study (mean age, 29.5 years [SD, 6 years]). Following the third interim analysis, study recruitment was stopped due to concern for fetal or neonatal/infant death as well as for futility. Baseline characteristics were balanced between participants randomized to pessary and those randomized to usual care; 98.9% received vaginal progesterone. In an as-randomized analysis, the primary outcome occurred in 127 participants (45.5%) randomized to pessary and 127 (45.6%) randomized to usual care (relative risk, 1.00; 95% CI, 0.83-1.20). Fetal or neonatal/infant death occurred in 13.3% of those randomized to receive a pessary and in 6.8% of those randomized to receive usual care (relative risk, 1.94; 95% CI, 1.13-3.32).Conclusions and relevanceCervical pessary in nonlaboring individuals with a singleton gestation and with a cervical length of 20 mm or less did not decrease the risk of preterm birth and was associated with a higher rate of fetal or neonatal/infant mortality.Trial registrationClinicalTrials.gov Identifier: NCT02901626.

Project description:BackgroundEarly neonatal death caused by preterm birth contributes the most for perinatal death. The prevalence of preterm birth continues to rise and is a significant public health problem. The exact cause of preterm birth is yet unanswered, as mostly preterm birth happens spontaneously. Predictors of preterm birth in developing countries like Ethiopia were not well investigated, and no study was conducted before this in the study area.ObjectivesTo identify predictors of preterm birth in Western Ethiopia, 2017/2018.MethodsHealth facility-based unmatched case-control study was conducted from October 20/2017-march 20/2018 in 4 Hospitals. A total sample size of 358 women was recruited. From this 72 were cases and 286 were controls. Cases were mothers who gave Preterm birth, and controls were mothers who gave birth at term. Ethical clearance was obtained from Wollega University ethical review committee. A pre tested, structured questionnaire was used to collect data. Data entry and analysis was done using Epi Data 3.1 and SPSS version 21, respectively. Logistic regression was done to identify predictors of preterm birth.ResultThree hundred fifty-eight women participated in this study of which 72 were cases and 286 were controls; making the overall response rate of 100%. Lack of antenatal care visit [AOR = 3.18, 95% CI 1.37-7.38]),(Having 1-2 antenatal care visit [AOR = 2.27, 95% CI 1.18-4.35]),history of previous preterm)[AOR = 5.19, 95% CI1.29-20.88],Short Interpregnancy Interval [AOR = 4.41.95% CI 2.05-9.47],Having Reproductive tract infections [AOR = 2.54, 95% CI 1.02-6.32] and having Obstetric complications [AOR = 2.48,95% CI 1.31-4.71] were found to be predictors of preterm birth.Conclusion and recommendationRisk factors of preterm delivery are multifactorial and depend on geographical and demographic features of the population studied. Hence results of studies from one area might not be applicable to another area. Antenatal care visits are unique opportunities for early diagnosis and treatment of problems. Therefore, antenatal care should be strengthened, and appropriate counseling should be given at each antenatal care follow up. Maintainning optimum birth interval through family planning, and early identification and treatment of reproductive tract infections are mandatory.

Project description:Currently known risk factors explain only a small fraction of preterm birth (PTB). Previous PTB is one of the most important predictors. However, this information is not available in primiparous women. Few studies have looked at associations between regulatory cytokine expression (RCE) and PTB and the results are conflicting.To investigate the association of RCE-Interleukin 10 (IL-10) and Transforming Growth Factor β (TGF-β)-with PTB, and to assess whether bacterial vaginosis (BV) is involved in this relationship.This was a case-control study nested in a prospective cohort-called BRISA. Women with singleton pregnancies were interviewed from 22 to 25 weeks of gestational age (GA). Women were recruited from health services in São Luís, Brazil. A blood sample was collected and gynecological examination was performed. Serum IL-10 and TGF-β were determined using cytometric bead array. Nugent score >7 and/or the presence of clue cells were used for BV diagnosis. All PTB estimated by ultrasound dating performed before 20 weeks of gestational age were considered cases. Controls were selected by simple random sampling from the rest of the cohort, at a 2:1 ratio. Different models were tested, according to the main independent variable. Odds ratios (OR) and 95% confidence intervals (95%CI) were estimated by regression analyses.The study included 327 pregnant women, 109 cases and 218 controls. No associations were found between BV and PTB (P = 1.44; 95%CI: 0.51-3.77). Low levels of IL-10 (OR = 2.92 95%CI: 1.38-6.16) or TGF-β (OR = 16.90 95%CI: 6.42-44.51) or both simultaneously (OR = 77.16 95%CI: 7.99-744.88) were associated with increasing odds of PTB, even after adjustment for confounding.Decreased RCE is a risk factor for PTB. This relationship, however, is not triggered by the presence of BV. Low IL-10/TGF-β levels from 22 to 25 weeks of GA could be used as early predictors of PTB. We suggest monitoring of these RCE, especially among primiparous women, for whom history of previous PTB is not available.

Project description:BackgroundPreterm birth is serious public health worldwide, and early prediction of preterm birth in pregnant women may provide assistance for timely intervention and reduction of preterm birth. This study aimed to develop a preterm birth prediction model that is readily available and convenient for clinical application.MethodsData used in this case-control study were extracted from the National Vital Statistics System (NVSS) database between 2018 and 2019. Univariate and multivariate logistic regression analyses were utilized to find factors associated with preterm birth. Odds ratio (OR) and 95% confidence interval (CI) were used as effect measures. The area under the curve (AUC), accuracy, sensitivity, and specificity were utilized as model performance evaluation metrics.ResultsData from 3,006,989 pregnant women in 2019 and 3,039,922 pregnant women in 2018 were used for the model establishment and external validation, respectively. Of these 3,006,989 pregnant women, 324,700 (10.8%) had a preterm birth. Higher education level of pregnant women [bachelor (OR = 0.82; 95%CI, 0.81-0.84); master or above (OR = 0.82; 95%CI, 0.81-0.83)], pre-pregnancy overweight (OR = 0.96; 95%CI, 0.95-0.98) and obesity (OR = 0.94; 95%CI, 0.93-0.96), and prenatal care (OR = 0.48; 95%CI, 0.47-0.50) were associated with a reduced risk of preterm birth, while age ≥ 35 years (OR = 1.27; 95%CI, 1.26-1.29), black race (OR = 1.26; 95%CI, 1.23-1.29), pre-pregnancy underweight (OR = 1.26; 95%CI, 1.22-1.30), pregnancy smoking (OR = 1.27; 95%CI, 1.24-1.30), pre-pregnancy diabetes (OR = 2.08; 95%CI, 1.99-2.16), pre-pregnancy hypertension (OR = 2.22; 95%CI, 2.16-2.29), previous preterm birth (OR = 2.95; 95%CI, 2.88-3.01), and plurality (OR = 12.99; 95%CI, 12.73-13.24) were related to an increased risk of preterm birth. The AUC and accuracy of the prediction model in the testing set were 0.688 (95%CI, 0.686-0.689) and 0.762 (95%CI, 0.762-0.763), respectively. In addition, a nomogram based on information on pregnant women and their spouses was established to predict the risk of preterm birth in pregnant women.ConclusionsThe nomogram for predicting the risk of preterm birth in pregnant women had a good performance and the relevant predictors are readily available clinically, which may provide a simple tool for the prediction of preterm birth.

Project description:OBJECTIVES:Women with a sonographic short cervix in the mid-trimester are at increased risk for preterm delivery. This study was undertaken to determine the efficacy and safety of using micronized vaginal progesterone gel to reduce the risk of preterm birth and associated neonatal complications in women with a sonographic short cervix. METHODS:This was a multicenter, randomized, double-blind, placebo-controlled trial that enrolled asymptomatic women with a singleton pregnancy and a sonographic short cervix (10-20 mm) at 19 + 0 to 23 + 6 weeks of gestation. Women were allocated randomly to receive vaginal progesterone gel or placebo daily starting from 20 to 23 + 6 weeks until 36 + 6 weeks, rupture of membranes or delivery, whichever occurred first. Randomization sequence was stratified by center and history of a previous preterm birth. The primary endpoint was preterm birth before 33 weeks of gestation. Analysis was by intention to treat. RESULTS:Of 465 women randomized, seven were lost to follow-up and 458 (vaginal progesterone gel, n=235; placebo, n=223) were included in the analysis. Women allocated to receive vaginal progesterone had a lower rate of preterm birth before 33 weeks than did those allocated to placebo (8.9% (n=21) vs 16.1% (n=36); relative risk (RR), 0.55; 95% CI, 0.33-0.92; P=0.02). The effect remained significant after adjustment for covariables (adjusted RR, 0.52; 95% CI, 0.31-0.91; P=0.02). Vaginal progesterone was also associated with a significant reduction in the rate of preterm birth before 28 weeks (5.1% vs 10.3%; RR, 0.50; 95% CI, 0.25-0.97; P=0.04) and 35 weeks (14.5% vs 23.3%; RR, 0.62; 95% CI, 0.42-0.92; P=0.02), respiratory distress syndrome (3.0% vs 7.6%; RR, 0.39; 95% CI, 0.17-0.92; P=0.03), any neonatal morbidity or mortality event (7.7% vs 13.5%; RR, 0.57; 95% CI, 0.33-0.99; P=0.04) and birth weight < 1500 g (6.4% (15/234) vs 13.6% (30/220); RR, 0.47; 95% CI, 0.26-0.85; P=0.01). There were no differences in the incidence of treatment-related adverse events between the groups. CONCLUSIONS:The administration of vaginal progesterone gel to women with a sonographic short cervix in the mid-trimester is associated with a 45% reduction in the rate of preterm birth before 33 weeks of gestation and with improved neonatal outcome.

Dataset Information

The association of beta-2 adrenoceptor genotype with short-cervix mediated preterm birth: a case-control study.

Objective

Design

Setting

Population

Methods

Main outcome measures

Results

Conclusions

Publications

The association of beta-2 adrenoceptor genotype with short-cervix mediated preterm birth: a case-control study.

Similar Datasets

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