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THE LATEST INFO ABOUT PREVENTING PRETERM BIRTH

If you are trying to find current information on preterm birth and bed rest, there’s no need to search the Web endlessly. Keep ’Em Cookin’ stays on top of all the latest news, studies, and statistics and reports them here.

2.15.10

2D ULTRASOUND MEASUREMENT OF THE FETAL ADRENAL GLAND ACCURATELY PREDICTS RISK OF PRETERM BIRTH

Measuring the fetal zone of the adrenal gland with 2D ultrasound to predict preterm birth is as effective as using less available 3D imaging to measure fetal adrenal gland volume. Both are more accurate than the conventional technique of measuring cervical length.

"We previously discovered that 3D adrenal gland volume is a very accurate predictor of preterm birth," said Dr. Ozhan Turan, the study's author. "However most people around the world don't have access to that technology, therefore, we have created measurements that can be done with 2D ultrasound that are very effective to predict pre-term birth."

"Prior to this we haven't had a good method to predict who will present with pre-term labor." said Dr. Turan. "Measuring the cervical length leads to a high percentage of false positives and also it has limited sensitivity," he continued. "Hopefully, if adopted, this method will allow for an easy inexpensive way to identify real pre-term deliveries. Therefore we will be better managing these pregnancies."

The study was presented at the Society for Maternal-Fetal Medicine 30th Annual Meeting: The Pregnancy Meeting.
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2.9.10

UNIVERSAL SCREENING FOR SHORT CERVIX BY ULTRASOUND CAN REDUCE PRETERM BIRTHS

Using ultrasound to screen all pregnant women for signs of a shortening cervix improves pregnancy outcomes and is a cost-effective way to reduce preterm birth, report Yale School of Medicine researchers in a new study.

Shortened cervical length increases the likelihood of a preterm birth. All high-risk patients—those who have had a prior preterm birth—are routinely screened at 20 to 24 weeks gestation to test for cervical length. However, screening is not often given to low-risk pregnant women, and researchers did not know whether it was cost-effective to screen women at low risk.

Erika Werner, M.D., clinical instructor in the Department of Obstetrics, Gynecology & Reproductive Sciences at Yale, found that screening low-risk women is not only cost effective, it is cost-saving.

Werner and her team developed a computer model to mimic the outcomes and costs that occur when women are screened routinely, compared to when no screening occurs. They found that universal screening was cost-effective when compared to routine care. In fact, for every 100,000 women, routine care costs $6,523,365 more than the screening strategy. It also improved quality of life and resulted in fewer neonatal deaths and infants with long-term neurological disorders.

“Since only 10 percent of preterm birth occurs in women with a history of preterm birth, cervical length screening may be the best way to decrease the number of babies born prematurely,” said Werner.

Other Yale authors on the study included Christina S. Han, M.D., Christian M. Pettker, M.D., Catalin S. Buhimschi, M.D., Joshua A. Copel, M.D., Edmund F. Funai, M.D., and Stephen F. Thung, M.D."
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2.8.10

NEW RESEARCH SHOWS GENETIC LINK TO PRETERM LABOR RISK

A new study shows that the genes of both the mother and the fetus can make them susceptible to an inflammatory response that increases the risk of preterm labor and birth.

Silent, undetected infections and inflammation are major risk factors for preterm labor and birth, says Roberto Romero, MD, Chief of the Perinatology Research Branch at the National Institute of Child Health and Human Development. One of every three preterm births occurs to a mother who has an infection in her uterus, but has no symptoms.

Dr. Romero led a team of physicians and scientists studying a large number of genes involved in the control of labor that could help explain the complex process that triggers preterm birth. They found DNA variants in genes involved in fighting infection in the pregnant woman and the fetus. Although these variants increased the risk of preterm labor and birth, they have been preserved by evolution because they are needed to fight infection, Dr. Romero said.

"This research gives us even more evidence as to the relationship between genetics and preterm birth and is a step toward personalized medicine," said Alan R. Fleischman, MD, medical director of the March of Dimes. "This has the potential to allow us to identify a woman who is at risk for delivering early and provide her with specialized, individualized care so that she may carry her baby to term, and help give more babies a healthy start in life."
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12.15.09

STUDY SHOWS COMMON ANTIBIOTIC NOT EFFECTIVE IN PREVENTING PRETERM LABOR

Researchers at Liverpool University tested whether using the drug azithromycin to treat bacteria before it is detected would prevent early childbirths, defined as births before 37 weeks of gestation.

"Infection can occur early in pregnancy and remain undetected, so one way of reducing incidences of preterm labor may be to administer antibiotics before patients display any signs of infection," said Jim Neilson, professor at Liverpool University's School of Reproductive and Developmental Medicine. "Our study showed, however, that treating infection with azithromycin had no impact on reducing incidences of preterm labor."
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11.17.09

U.S. EARNS A "D" ON PREMATURE BIRTH REPORT CARD

Today the March of Dimes released its annual Premature Birth Report Card. Overall, the United States received a grade of “D.” The rate of premature birth in America is higher than that of most other developed nations, with one in eight babies born premature in our country. Click here for your state’s results and to learn more.

11.2.09

NOVEMBER IS PREMATURITY AWARENESS MONTH

All month long, KeepEmCookin.com will be hosting a Q & A with three guest obstetricians. They'll be available to answer your questions about preterm labor, preterm birth, and pregnancy after a preemie. Please e-mail your questions to info@keepemcookin.com. Look for new questions and answers on our Pregnancy After A Preemie page.

9.17.09

CERVICAL LENGTH PLUS fFN TEST: STRONG PREDICTOR OF PRETERM BIRTH IN TWIN PREGNANCIES

In twin pregnancies where no symptoms of preterm labor are present, the combination of fetal fibronectin testing and cervical length testing between 22 and 32 weeks gestation can identify pregnancies that are at a significantly increased risk for preterm birth, according to a study published in the September 2009 issue of American Journal of Obstetrics & Gynecology.

Researchers retrospectively reviewed the pregnancies of 155 women pregnant with twins, comparing those who had fFN testing, those who had cervical length testing, and those who had both tests, at any point from 22 to 32 weeks gestation. A positive fFN test result from 22 to 32 weeks or a cervical length of less than 2.0 cm showed an increased risk of 8.3 percent for spontaneous preterm birth.  The combination of a positive fFN test result and a cervical length of less than 2.0 cm was an even greater predictor for preterm delivery than either positive test alone. Specifically, the risk for spontaneous preterm birth at less than 32 weeks was 54.5 percent in instances where women had both a positive fFN and a cervical length less than 2.0 cm.

"It appears that screening asymptomatic twin pregnancies, which also pose a high risk for preterm birth, with fFN result and cervical length is a useful strategy for the determination of which women are at higher and lower risk for preterm delivery," the study's authors wrote.

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8.20.09

STUDY SHOWS LINK BETWEEN FETAL FIBRONECTIN TESTING AND TREATMENT DECISIONS

Researchers at King’s College London concluded that that fFN testing has the potential to improve risk assessment and impact treatment decisions, including the administering of steroids, increased surveillance, or cerclage intervention in the asymptomatic high-risk population involved in the study.

“The results of our study clearly indicate that fFN testing influenced management in a significant number of patients. A large number of women were asymptomatic at testing. Fetal fibronectin testing could be offered more widely and has the potential to benefit patient management,” said Prof. Andrew Shennan, study co-author and Ob/Gyn at St. Thomas’ Hospital in London, England.

Conducted at the Maternal and Fetal Research Unit at St. Thomas’ Hospital in London, the study included nearly 100 patients between 23 and 34 weeks gestation. After using the fFN test with women who had clinical symptoms showing a risk of preterm birth as well as with women without symptoms, clinicians were asked to determine if the results from the test changed the medical management of their patients. Clinician responses indicated that fFN testing had the potential to change management in nearly 90 percent of cases.

“Another important benefit of fFN testing,” Shennan said, “is the ability to avoid overtreatment of women with negative test results. In addition to providing assurance to women and their doctors that preterm birth is not imminent, fFN testing—if more widely used in the asymptomatic population—could also translate into significant cost savings to the health care system.”

The fetal fibronectin test assesses the risk of preterm birth in women from 22 to 35 weeks gestation with known risk factors or with signs and symptoms of preterm labor. The fFN test measures the presence of fetal fibronectin, the glue-like substance that holds the baby in the womb. A negative result means fetal fibronectin is minimally present and there is a less than one percent chance of delivering in the next two weeks. A positive result is a strong independent predictor of preterm birth before 32 weeks.

More information on the fetal fibronectin test can be found at www.fullterm.net. The study was published in the online version of the European Journal of Obstetrics & Gynecology and Reproductive Biology.

8.15.09

MEN: 10 TIPS FOR KEEPING YOUR BED REST MAMA HAPPY

By Scotty Schrier

I won't say it has been easy. My amazing wife we’ll call her Lilcapmom has been in the hospital for almost 3 weeks now. Lilcapmom is a perpetually busy woman. She likes to be in a constant state of movement, so this bed rest has been a special level of hell for her. I have tried to make her stay in the hospital as comfortable as possible by implementing the following ideas for dads.

1. Nintendo DS
This is a must! There are so many games out there that are catering to adults now, that you aren't going to be stuck with some kiddie title. If mama likes mysteries, then there are several titles to enjoy. Not to mention all of the brain-teaser/puzzle variety games. I also got one for myself and we can play several games together even with owning only one copy of the game.

2. Food
Comfort food. Home-cooked food. Whatever her favorite food is. Hospital food is decent at best.

3. Comfort Food
I listed it again, because nothing beats the melancholy monster quite like some ice cream.

4. Vanity-type Products
Being laid up in a hospital can be enough to make any woman feel less than beautiful!
        a. Scented lotions
        b. Hair ties
        c. Scented room spray run this by the nurse first
There's more you can do; these are just a few examples. You know what your lady likes. Make it happen!

5. Beauty Treatments
Arrange for a nail technician or hair-dresser to come in. I talked to the woman who cuts our hair and she was more than happy to come in and give Lilcapmom a haircut. Lilcapmom was SO excited! It really raised her mood for a couple of days afterwards. You can NOT put a price on that smile.

6. Nurses
Take care of the nurses who are taking care of your family! I cannot stress this enough! I watched the entire floor light up when I spent $5.99 on a dozen assorted doughnuts and brought them in for breakfast for our nurses. Trust me, if you show them how much you appreciate everything they do, they will work that much harder to make sure that your stay is enjoyable. You may call it bribery...I call it Goodwill Insurance. You will NOT regret it, I promise!

7. Pity Parties
If you wife is on the pity pot...LET HER! She's going to be upset and moody... She's pregnant and now has NO independence. Lilcapmom cried one night because she didn't want to have to hit the nurse button just to plug her Nintendo DS in. Bed rest is NOT a vacation any more than a prison sentence is. Being treated like an invalid has a way of demoralizing a person. This is YOUR time to shine dad! Be the man that every woman wishes she had. If you act like an ass now...you will NEVER live it down. What I'm trying to say is that even if you think she's being irrational, chances are she thinks it too...but is powerless to do anything about it. Just hold her and make sure you have tissues for her.

8. No Complaining
Do NOT complain about what a burden you think this is on you. She's going to feel badly enough about not being able to do the normal things in life. She does NOT need to feel like she's inconveniencing you in any way. I don't care if you are only getting 2 hours of sleep a night, you can't let her know how tired you are. She already feels guilty, and pregnancy-induce guilt is ten times worse than any other kind. Steer clear of it at all costs! If her bed rest happens during the “nesting” phase, be prepared for her to be upset about not being able to help finish the baby's room.

9. Give Yourself a Break
Take some time to give yourself a break as well. Man, you are going to run your butt off and be asked to handle things that you weren't expecting. Make sure that you aren't running yourself into the ground needlessly. If the kitchen goes to hell while she's in the hospital, that's fine as long as it gets cleaned by the time she gets home. In that hour you were going to use to clean the kitchen, have a beer and relax a little. No one in their right mind could hold it against you.

10. Create a Support Team
Make sure there is a support net of some sort. Give her options of people she can vent to. That way you won't be the focal point of ALL of her frustrations. This will lead to fewer hurt feelings and much less animosity. You also need to vent about things as well. You can't vent on each other; otherwise you WILL end up in an argument. And you do not want to be THAT guy!

This is just a starter list. Mostly just remember that what she is doing right now is possibly the single most important moment in your child's life. Bed rest is given for a reason. And mama is going to need every ounce of support you can give her right now.

Now go out there and be the best damned daddy you can be! It starts way earlier than the day they come out...
   

Scotty Schrier is an aspiring author and dad-to-be. He currently resides with his wife and pets in Tampa, Fla., and is anxiously awaiting the arrival of their first child. To see more of his writing you can go to www.bleedingsweat.com for his archive of short stories.

6.15.09

HOW TO MAINTAIN MUSCLE TONE WHILE ON BED REST

 And also help speed your bed rest recovery

By Darline Turner-Lee

Bed rest is seldom in any woman’s plan for her pregnancy. Yet each year some 700,000 to 1 million women willingly succumb to their obstetricians’ bed rest prescriptions to ensure the best hope for their babies.

However, bed rest is not without risk. Numerous research studies report that inactivity—even for as short a time as two weeks—results in loss of muscle mass and strength. NASA studies done to evaluate the effects of weightlessness on female astronauts found that in 60 days women lost up to 25 percent of muscle mass and nearly half of their muscle strength.

Pregnant women prescribed bed rest are often inactive for months at a time. As a result, pregnant women on bed rest are at increased risk of developing blood clots in their legs that could dislodge, then travel to the heart, lungs or brain and be fatal.

So what is a woman on bed rest to do, not only to guard against these potential health risks but also to speed her recovery postpartum I recommend engaging in modified exercises while on bed rest. Each woman’s circumstances are unique, so consult with your obstetrician or midwife before performing these exercises.

The following four exercises are samples of exercises that women on bed rest can do to stimulate their leg muscles, increase blood circulation and reduce the risk of a blood clot forming in the legs. They can be done with a rubber exercise band or with a long bath towel to provide a bit of resistance. Do them two to three times a day.

Quad/Hamstring Curls: Lay on your side with your body straight. Wrap the towel around your top foot and hold the ends of the towel in your hand. Slowly bend your top knee bringing your foot the heel to your buttocks. Release to starting position and repeat 10 times on each side.

Quadriceps Extensions: Sit upright in bed comfortably propped up with pillows. Wrap the towel around both feet and hold an end in each hand. Slowly slide your feet towards you, bending your knees and using the towel for assistance. Only go as far as is comfortable. If you feel pressure in your lower abdomen, stretch your feet back out! Then slowly push your feet back out, giving a bit of resistance with the towel. Repeat 10 times.

Abduction/Adduction: Sit upright in bed comfortably propped up with pillows. Wrap the towel around both feet and hold an end in each hand. Slowly open your legs to a wide “V”, holding the towel firmly to provide a bit of resistance. Slowly bring your legs back together using the towel to assist. Repeat 10 times.

Calf Stretches: Sit upright in bed comfortably propped up with pillows. Wrap the towel around the balls of the feet and hold an end in each hand. Slowly point and flex your toes, tightening and releasing your leg muscles. Repeat 10 times.

You can also perform these exercises if you are released from bed rest before delivery, to speed your recovery and help regain your strength.

Darline Turner-Lee is a physician assistant, ACSM Clinical Exercise Specialist and a certified perinatal fitness instructor. She developed and produced Bedrest Fitness, a full-body modified fitness program for pregnant women on prescribed bed rest. For more information or to purchase the DVD, visit www.mamasonbedrest.com.

5.5.09

STUDY: VETERINARIANS AT HIGHER RISK FOR PRETERM BIRTH

Long work hours and exposure to anesthetics may raise pregnant veterinarians' risk of premature delivery, a new study suggests.

To investigate possible occupational factor associated with prematurity, Dr. Adeleh Shirangi, of Imperial College London in the UK, and colleagues evaluated 399 female vets who had at least one baby. They found a higher rate of preterm delivery among those who regularly used anesthesia without a "scavenging" system for clearing excess gas from the operating room. Compared with other vets, women who had been exposed to unscavenged anesthesia gas for at least one hour per week were between two and three times more likely to delivery prematurely, Shirangi's group reported in the journal Obstetrics & Gynecology.

Similarly, vets who worked more than 45 hours per week were nearly four times more likely to have a preterm birth than those with shorter work weeks. The results add to an earlier study in which Shirangi's team found that several exposures in veterinary practice, including unscavenged anesthetics, X-rays and pesticides, seemed to raise the risk of miscarriage. The research suggests that female vets, and other women who work in the area, should take some precautionary steps, according to Shirangi.

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4.5.09

ESTROGEN LEVELS MAY ALLOW DOCS TO PREDICT AND PREVENT PRETERM LABOR

The trigger for the start of labor has been a mystery, but new research which will be published in an upcoming issue of the Journal of Clinical Endocrinology & Metabolism has yielded very important information about the interaction of hormones and the onset of labor.  Researchers in Australia have found that the relative levels of two forms of estrogen, estradiol, E2, and estriol , E3, are involved in causing women to go into labor.

Researchers studied 500 pregnant women, and found that that the ratio of E3 to E2 rose rapidly as labor approached.  When the levels of E2 and E3 were roughly the same, there was no drive for labor.

In a previous study, these researchers found that a placental hormone, corticotrophin-releasing hormone CRH , peaks at the time of labor and that CRH levels rise earlier in women who deliver prematurely.  Now, they have also shown that CRH can act on the adrenal glands of the fetus, causing them to produce a steroid hormone that the placenta then uses to make E3. There is a strong correlation between CRH and E3 levels in the mother’s blood in the weeks before birth, which further supports the belief that CRH increases E3 levels.

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3.23.09

CDC REPORTS SLIGHT DECLINE IN PRETERM BIRTH RATE

The annual percentage of preterm births in the United States dropped to 12.66 percent of all births in 2007, compared to 12.8 percent in 2006, according to preliminary data released by the CDC last week.

"It is a small victory, but still significant," says Angela Davids, founder of KeepEmCookin.com, an organization that educates women about the risk of preterm birth and the warning signs of preterm labor. "If the percentage of preterm births in 2006 had been the same as it was in 2007, there would have been 6,528 fewer babies born prematurely in 2006," Davids says.

The report, released March 18 by the Centers for Disease Control and Prevention’s National Center for Health Statistics, estimates that births in 2007 rose 1 percent to 4,317,119. This is the highest number of births ever registered for the United States, even surpassing the peak of the postwar Baby Boom. The end result is 546,547 preterm births for 2007, compared to 545,991 in 2006. For both years, that is 1 in 8 pregnancies that ended too soon, endangering the lives of newborns and presenting those who survived with a lifetime of potential health complications.

The preterm rate infants delivered at less than 37 weeks of gestation per 100 births has generally been on the rise for more than two decades, the report said. The 2007 decline was predominately among those born at 34 to 36 weeks, which is sometimes called “late preterm.” The late preterm rate, which has increased by more than 25 percent since 1990, was down slightly between 2006 and 2007, from 9.14 to 9.03 percent. The study also reported that the total preterm rate declined modestly among births to non-Hispanic white mothers from 11.7 to 11.5 percent, and non-Hispanic black mothers from 18.5 to 18.3 percent for 2006 to 2007, but increased slightly for Hispanic mothers at 12.3 percent, up from 12.2. The rates for American Indian or Alaska Native mothers dropped from 14.2 percent to 13.9, while the rates for Asian or Pacific Islander mothers remained the same at 10.9 percent.

In support of a continued decrease in the number of preterm births each year, KeepEmCookin.com will continue to place its greatest emphasis on educating pregnant women to recognize preterm labor symptoms. KeepEmCookin.com also helps women to identify their risk factors for preterm birth, and provides an online support group for women experiencing high-risk pregnancies.

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2.26.09

FDA ADDS WARNING TO HEARTBURN DRUG REGLAN

Note: Women on bed rest are more likely to suffer heartburn, and their doctors may want to prescribe Reglan. Doctors may also prescribe Reglan to premature babies, to aid in digestion. Please strongly consider the new FDA warning.

Federal health officials are adding their sternest warning to a heartburn drug that has been linked to muscle spasms. The Food and Drug Administration said the drug metoclopramide , widely known as Reglan, has been shown to cause spasms and tics when used for long periods of time or at high doses. The problems include uncontrollable movement of the limbs, face and tongue, and are usually irreversible, even after patients stop taking the drug, according to the FDA's warning.

The agency is requiring drugmakers to add a black box warning, the most serious type available, to their products.

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2.11.09

MARCH OF DIMES PROVIDES $2.7 MILLION IN NEW FUNDING FOR PRETERM BIRTH RESEARCH

Scientists intend to identify microbes that may cause preterm labor in some women, investigate the role of an enzyme in preventing uterine contractions and an early birth, and look at different groups of women to find genetic and environmental risk factors for prematurity.

The work of seven researchers will be supported for the next three years by new March of Dimes Prematurity Research Initiative PRI grants. The nearly $2.7 million in new grants continues March of Dimes support for efforts to predict and prevent preterm birth. These 2009 grants bring the five-year-old program’s grant total to nearly $14 million.

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2.2.09

RESCUE COURSE OF STEROIDS IMPROVES OUTCOMES FOR PREEMIES

A new study shows that premature babies born before 34 weeks have a 31 percent reduction in serious complications when given a "rescue course" of Antenatal Corticosteroids ACS , with no adverse side effects noted. "Premature babies are very susceptible to respiratory problems which may lead to additional severe complications," said Dr. James Kurtzman, M.D. Associate Professor, UC Irvine Medical Center. "Antenatal steroids clearly reduce the risk of these respiratory complications."

Years ago, doctors gave multiple courses of antenatal steroids to mothers who were at risk for delivering prematurely. However, certain studies found that there were possible adverse affects to multiple ACS courses because babies were found to have slightly smaller head circumferences and lower birth weights. As a result, the National Institutes of Health NIH recommended further study.

"The effect of the NIH recommendation was that doctors were only giving one ACS course, and they were nervous about when to give it for the best effect. They often waited until the last minute, and some women didn't get a complete treatment or didn't get it at all," said Dr. Kurtzman. "What this study has found is that we can give women who threaten to deliver prematurely an initial ACS course, and if they remain pregnant, we can give one 'rescue course' closer to delivery. By doing so, the babies' complications are reduced by about a third with no adverse side effects found."

In this study, which took place over five years in 18 different medical centers and was supported by the Pediatrix Medical Group, 437 patients were randomized 233 in the study group, and 214 in the placebo group. The results showed a significant reduction in composite neonatal morbidity for babies born prior to 34 weeks in the "rescue steroid" group versus placebo 43.9 percent versus 63.6 percent as well as significant decrease in respiratory distress syndrome, ventilator support, and surfactant use. When all neonates were included in the analysis regardless of the gestational age at delivery, a significant reduction in composite morbidity in the "rescue steroid" group was still demonstrated 32.1 percent versus 42.6 percent .

The study was authored by James Kurtzman, M.D., University of California Irvine and Saddleback Women's Hospital; Thomas Garite, M.D., University of California Irvine; Reese Clark, M.D., and Kimberly Maurel, R.N., M.S.N., Pediatrix Medical Group on behalf of the Pediatrix Collaborative Research Network. The study will be published in the March 2009 issue of the American Journal of Obstetrics and Gynecology.

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1.31.09

PREECLAMPSIA AND THE POTENTIAL FOR EARLY DIAGNOSIS

Clues to the cause of preeclampsia, a common, but serious hypertension complication of pregnancy that has puzzled doctors and researchers for decades, point to proteins that misfold and aggregate, according to Yale School of Medicine researchers.

These misshapen proteins can be easily detected in the urine, affording a new approach to early diagnosis of the disease, the Yale researchers report in new findings presented at the Society for Maternal Fetal Medicine scientific meetings in San Diego, Calif.

Preeclampsia is one of the most common causes of death in pregnant women in the United States and is responsible for about 76,000 maternal deaths worldwide each year. It is also a leading cause of preterm delivery. Delivery is the only reliable treatment for preeclampsia, and establishing a correct diagnosis can be difficult, especially in women with preexisting hypertension, lupus or kidney disease.

“These results support the hypothesis that preeclampsia is a pregnancy-specific protein misfolding disease,” said lead author on the abstract, Irina Buhimschi, M.D., associate professor in the Department of Obstetrics, Gynecology & Reproductive Sciences. “Our urine dye test is a rapid and non-invasive test that can be used to definitively diagnose preeclampsia.”

In a study of 111 pregnant women, Buhimschi and her team used proteomics to identify key abnormal proteins in the urine weeks before preeclampsia becomes clinically apparent. In order to carry out their individual functions properly, proteins must fold themselves correctly into three-dimensional structures. Misfolding, or failure to fold into the intended shape, produces proteins with different properties that are mainly guided by their shape rather than their amino acid sequence. Proteins of different amino acid sequences may share common shapes when misfolded.

Buhimschi and her team designed a test based on a dye that sticks to misfolded proteins. They analyzed the urine of women in the study starting in the first trimester of pregnancy. Buhimschi was able to use this simple test to identify a study participant who went on to develop severe preeclampsia and required early delivery.

Further work in Buhimschi’s lab, using conformation-specific antibodies developed in Charles Glabe’s laboratory at University of California-Irvine, showed that misfolded shapes similar to those found in Alzheimer’s disease are also present in the urine of preeclamptic women. In contrast to the misfolded proteins identified in Alzheimer’s disease, however, the misfolded aggregates identified in preeclampsia are composed of a group of different proteins, including SERPIN-A1 also known as alpha-1-antitrypsin .

“Our findings are compelling for several reasons,” said Buhimschi. “This novel identification of preeclampsia as a disorder of protein misfolding opens a door for researchers that may lead to testing of new drugs or developing new therapies. Our future work will seek to determine whether the different shapes employed by the misfolded proteins in preeclampsia are linked to specific clinical symptoms and the different ways this intriguing disease manifests.”

Other authors on the abstracts are Catalin Buhimschi, Margaret Baumbusch and Guomao Zhao from Yale School of Medicine; Charles Glabe from University of California-Irvine and Sabina Janciauskiene from the Wallenberg Laboratory in Malmö, Sweden.

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1.30.09

THE EFFECTIVENESS OF 17P MAY HAVE A GENETIC LINK

New research may explain why taking progesterone to prevent preterm birth is effective for only some women, according to information presented today at the 29th Annual Society for Maternal-Fetal Medicine meeting. The drug, 17 alpha-hydroxyprogesterone caproate or 17P , is a synthetic form of the progesterone hormone naturally produced during pregnancy. It has been demonstrated in clinical trials to prevent some recurrent preterm births, but not all.

 “This study helps strengthen the theory that genetic variation in the human progesterone receptor plays an important role in the effectiveness of 17P,” says Tracy Manuck, M.D., study author and SMFM member.

“Dr. Manuck’s research gives us a tantalizing clue as to why 17P works for some women, but not for others,” said Alan R. Fleischman, M.D., senior vice president and medical director of the March of Dimes. “With further research along these lines, we hope to someday be able to prevent preterm birth from happening in the first place by screening women before they get pregnant, and identifying those whose babies could get a healthy start in life with the help of 17P.”

The study assessed whether women with genetic variations known as single nucleotide polymorphisms SNPs in the human progesterone receptor gene were more or less likely to respond to 17P for the prevention of recurrent spontaneous preterm birth. All patients had at least one prior spontaneous preterm birth. The study extracted DNA from the saliva of 389 patients, and then genotyped 20 SNPs in the region of the progesterone receptor gene. Two hundred and fifty-eight 66 percent of the study participants received 17P and 131 34 percent   received a placebo. Spontaneous preterm birth was less common among women who received 17P, as previous studies have shown.

After controlling for factors known to be associated with recurrent prematurity, multiple discoveries were made: Two SNPs were identified among African-American patients to be predictive of response to progesterone treatment. There was also an interaction between progesterone treatment and genotype of three additional polymorphisms for non-African-American women delivering very preterm less than 32 weeks gestation .

The study, The Relationship Between Polymorphisms in the Human Progesterone Receptor and Clinical Response to 17 Alpha-Hydroxyprogesterone Caproate for the Prevention of Recurrent Spontaneous Preterm Birth, was sponsored by the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Unit Network and the University of Utah.

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1.13.09

MOUTH BACTERIA COULD INCREASE RISK OF PRETERM LABOR

Previously undiscovered bacteria usually found in the mouth could be responsible for up to 80 percent of early preterm labors, estimate doctors from Case Western and Yale Universities in a new study published recently in the Journal of Clinical Microbiology.

Labor itself is still somewhat of a mystery to science, which makes puzzling out preterm labor even more difficult. Anything from socioeconomic status and race to bacterial infection and genetics have been linked to preterm births, but a definitive cause is still elusive. Researchers think they have found a major cause, at least in mice. By infecting the rodents with Bergeyella, a previously unknown bacteria found in the mice, the researchers caused preterm births.

In humans, the scientists showed a strong correlation between infection and preterm births. Doctors removed amniotic fluid from 46 different women with potentially higher risk pregnancies. Of that group, 21 delivered an early preterm baby 32 weeks or earlier. Nineteen of those women, or about 85 percent, were positive for previously undetected bacteria.The bacteria normally live in the mouth, but if a cut, cavity or other wound allows the bacteria to enter the blood stream, they can travel and eventually colonize the uterus. That triggers an immune response, which can inflame the uterus and eventually cause a mother to go into labor prematurely.

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1.7.09

NEW DATA: PRETERM BIRTH RATE RISES AGAIN

Nearly 543,000 babies were born preterm in 2006, according to the National Center for Health Statistics, which today released "Births: Final data for 2006." The increase in the preterm birth rate represents 12.8 percent of all births. The percentage of infants delivered at less than 37 completed weeks of gestation has risen 20 percent since 1990. Most of this rise is attributable to the increases in "late" preterm births 34 to 36 weeks , up 25 percent since 1990. Preterm birth rates rose slightly for Hispanic infants, but were unchanged among non-Hispanic white and non-Hispanic black infants.

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1.7.09

EDUCATIONAL LEVEL LINKED TO PRETERM BIRTH

Pregnant women with low levels of education are nearly twice as likely as their more educated peers to give birth prematurely, researchers from the Netherlands report. However, most of the risk can be attributed to the disadvantages that come with poor education, rather than educational level itself. In fact, as Dr. Pauline W. Jansen told Reuters Health, "Factors identified in this study, such as young age, stressful circumstances, smoking habits, and overweight are modifiable by up-to-date interventions." Jansen and her colleagues investigated the characteristics of 3830 pregnant women of Dutch origin, age 31 years on average. Among them, 1264 reported high education above the Bachelor's degree level while 638 reported no more than three years of secondary school the low group . The remaining women reported education levels somewhere in between. The researchers found that the women with the lowest educational level were 89 percent more likely to have a preterm birth than the most highly educated women. However, women with low education also seemed to accumulate psychosocial stress and unhealthy lifestyle factors "that turned out to be associated with their increased risk of preterm birth," Jansen and colleagues report in the Archives of Disease in Childhood—Fetal and Neonatal Edition.

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12.20.08

EVEN "LATE" PRETERM BIRTHS STILL POSE SERIOUS RISKS

More than half a million babies are born preterm in the United States each year, and preterm births are on the rise. Late preterm births, or births that occur between 34 and 36 weeks approximately 4 to 6 weeks before the mother's due date , account for more than 70% of preterm births. Despite the large number of affected babies, many people are unaware of the serious health problems related to late preterm births. A new study and an accompanying editorial in The Journal of Pediatrics investigate the serious neurological problems associated with late preterm births.

Dr. Joann Petrini of the March of Dimes and colleagues from institutions throughout the United States studied more than 140,000 babies born between 2000 and 2004, ranging from preterm 30 to 37 weeks to full term 37 to 41 weeks . The researchers evaluated the babies' neurological development and found that late preterm babies were more than three times as likely to be diagnosed with cerebral palsy as full term babies. They also found that late preterm babies were at an increased risk for developmental delay or mental retardation.

Editorialist Dr. Michael Kramer of McGill University points out that the "rates of preterm births are increasing, especially in the United States, and the associated risks are a serious public health concern." He sees the increasing number of twins and induced labors as contributing factors in the rise of preterm births. "The rise in twins may be due to the use of fertility treatments like hormones and in-vitro fertilization," Dr. Kramer explains. However, he notes that the increased risks may not always come from early delivery itself, but from other underlying problems, such as gestational diabetes, that may lead to early delivery.

According to Dr. Petrini, "The negative outcomes of many babies born late preterm can no longer be described as temporary or benign." She suggests that late preterm babies may benefit from neuron-developmental assessments and stresses that elective delivery through cesarean section or induction should not be performed before 39 weeks unless medically necessary. Additionally, Dr. Kramer urges mothers and families to be aware of the risks when considering infertility treatments and induction of labor.

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11.25.08

FIRST-EVER PLACEBO-CONTROLLED TEST OF NIFEDIPINE

When a pregnant woman goes into early labor, her obstetrician may give her drugs to quiet the woman's uterus and prevent premature birth.

New research shows, however, that one popular drug works no better than a placebo at maintaining pregnancy after the initial bout of preterm labor is halted, say scientists at the Stanford University School of Medicine, Lucile Packard Children's Hospital and Santa Clara Valley Medical Center. The new trial is the first-ever placebo-controlled test of nifedipine, a muscle relaxant originally developed to lower blood pressure, and its effect on premature delivery with prolonged treatment. The findings were published in the December issue of the journal Obstetrics and Gynecology.

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11.12.08

NATION GETS A “D” AS MARCH OF DIMES RELEASES PREMATURE BIRTH REPORT CARD

In the first of what will be an annual Premature Birth Report Card, the nation received a “D” and not a single state earned an “A,” when the March of Dimes compared actual preterm birth rates to the national Healthy People 2010 objective.

In addition to providing state rankings, the March of Dimes Premature Birth Report Card analyzes several contributing factors and prevention opportunities, including rates of late preterm birth, smoking, and uninsured women of childbearing age. The purpose is to raise public awareness of the growing crisis of preterm birth so elected and appointed officials will commit more resources to address this problem and policymakers will support development of strategies that benefit mothers and babies.

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10.17.08

MOTHERS LAUNCH NATIONAL PETITION FOR PREEMIES

Mothers are casting their votes for healthy babies and asking all Americans to join them in signing the March of Dimes 2008 Petition for Preemies. They’re putting public officials, and all Americans, on notice that it’s time to focus on the growing problem of premature birth, the leading cause of newborn death.

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