Latest news with #preterm birth
Medscape
2 days ago
- Health
- Medscape
Preterm Birth Predicts Adult Health Problems
Adults born preterm were significantly more likely to have cardiometabolic risk factors and internalized mental health issues than full-term peers, according to an ongoing preterm birth cohort study in the US. 'This study addresses a significant gap in understanding the long-term health effects of preterm birth in the US,' said lead author Amy D'Agata, PhD, of the College of Nursing, The University of Rhode Island, Kingston, Rhode Island, in an interview. Although the annual preterm birth rate in the US has held at a relatively stable 10%-12% for decades, since the 1970s, more preterm infants are surviving because of advances in neonatal intensive care, D'Agata said. Millions of individuals born preterm are aging into adulthood, but few data are available on their long-term health outcomes, she noted. In the new study, published in JAMA Network Open , D'Agata and colleagues reviewed data from a cohort of individuals who received level III neonatal intensive care at a single center between 1985 and 1989. The study population included 158 preterm-born and 55 full-term born adult control individuals. Preterm was defined as weighing under 1850 g at birth with various neonatal diagnoses; critically ill infants and those with major congenital abnormalities were excluded. The mean age across the groups was 35 years; 50% were women. The researchers used latent growth curve models to show changes over time. Overall, the preterm individuals who had higher medical risk in early life were significantly more likely to have a range of health problems at 35 years of age, notably, higher triglycerides than control individuals (beta value, 53.97; P = .03). Measures of systolic blood pressure and central adiposity also were significantly higher in the preterm birth group (beta values of 7.15 and 0.22, respectively), whereas bone density and high-density lipoprotein cholesterol were lower (beta values of -1.14 and -13.07, respectively). In addition, internalizing mental health problems were significantly more common in the preterm cohort than in the control individuals (beta value, 0.85; P = .01) but no difference in externalizing mental health problems was noted between the groups. The researchers also reviewed the impact of social protection and childhood socioeconomic status and found no association between these and physical or psychological health risks in adults born preterm. The Long View of Preterm Birth The population of adults born preterm remains largely invisible to the US healthcare system and its clinicians, highlighting critical issues of health equity and quality of care, D'Agata told Medscape Medical News . 'Much of the existing research in this area has focused on international, homogeneous populations, creating a need for rigorous, US-based longitudinal data to guide healthcare policy and clinical practice,' she added. 'These findings generally confirmed what has been observed internationally, that there is a link between higher early life medical risk and increased likelihood of mental health issues, elevated systolic blood pressure, unfavorable cholesterol and triglyceride levels, body fat distribution, and lower bone density among adults born preterm, and it was notable to see these clear and consistent associations replicated in a US cohort using a prospective, longitudinal design,' said D'Agata. The study findings emphasized the need to inquire about birth history in adult care settings and suggest that those born preterm and their families must be their own health advocates, if necessary, said D'Agata. 'Even if a patient isn't asked about their birth history, they should share it,' she noted. Clinicians work hard to provide the best care, but it takes time for evidence-based research to inform clinical practice, she said. 'Although our birth cohort is small and comes from a single geographic region, the results generally align with international findings,' D'Agata told Medscape Medical News . However, future studies should include more racially and ethnically diverse cohorts from multiple clinical settings, she said. Research is needed not only to examine which subgroups of preterm individuals are most at risk but also to differentiate between those with varying degrees of early life complications, she added. Long Follow-Up Strengthens Findings The 35-year duration of the preterm birth cohort study was impressive and valuable, said Tim Joos, MD, a clinician with a combination internal medicine/pediatrics practice at Neighborcare Health in Seattle. 'We don't often have the long game in mind, in healthcare as well as in other parts of our society,' said Joos, who was not involved in the study. 'We don't tend to follow pediatric conditions into adulthood,' he noted. The current study findings demonstrated a long-term psychological and physical impact of prematurity on adult health that was humbling, Joos told Medscape Medical News . Looking ahead, the results highlight not only the need to continue to prevent preterm birth but also to the importance of asking older patients about preterm birth as part of their health history, he said.
Medscape
22-07-2025
- Health
- Medscape
Post-Cerclage Cervical Length as Predictor of Preterm Birth
TOPLINE: Post-cerclage cervical length (CL) was a significant predictor of spontaneous preterm birth (sPTB; < 34 weeks of gestation) in women who underwent cervical cerclage, predominantly outperforming pre-cerclage CL. METHODOLOGY: Researchers in the UK conducted a retrospective cohort study at four preterm birth prevention clinics between January 2008 and March 2021 to assess the predictive value of CL measurements, both before and after cervical cerclage, for sPTB (< 34 weeks of gestation). They included 331 women who underwent cervical cerclage and had both pre- and post-cerclage CL measured per the standardised protocol using transvaginal ultrasound as recommended by the Cervical Length Education and Review program. The primary outcome was sPTB (< 34 weeks of gestation), assessed using multivariable logistic regression modelling (adjusting for pre- and post-cerclage CL, gestational age at cerclage, and direction of the CL change) and receiver operating characteristic (ROC) curves. TAKEAWAY: Both pre-cerclage CL (area under the ROC curve [AUC], 0.635; 95% CI, 0.559-0.712) and post-cerclage CL (AUC, 0.677; 95% CI, 0.604-0.751) were predictors of sPTB. Adjusted models incorporating gestational age at cerclage demonstrated that both pre-cerclage CL (odds ratio [OR], 0.964; P = .018) and post-cerclage CL (OR, 0.940; P < .001) were significant predictors of sPTB. In a comparative model analysis, the effect of post-cerclage CL on sPTB was greater than that of pre-cerclage CL (OR, 0.943; P < .001 vs OR, 0.974; P = .058). Overall, sPTB was reported in 11.9% of women with history-indicated cerclage vs 24.3% of those with ultrasound-indicated cerclage and 36.8% of those with emergency cerclage (P = .003). IN PRACTICE: "Clinicians performing cervical cerclage should aim to maximize total CL when inserting cerclage and continue to monitor CL after cerclage insertion," the authors wrote. SOURCE: This study was led by K. E. Mountain and S. Ng, March of Dimes Prematurity Research Centre at The Institute of Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, England. It was published online on July 09, 2025, in Ultrasound in Obstetrics & Gynecology. LIMITATIONS: This study included only women who underwent cervical cerclage, limiting the use of pre-cerclage CL thresholds for decision-making guidance. Metrics related to the cerclage position within the cervical canal were not assessed. Additionally, the intervals between pre- and post-cerclage scans and cervical cerclage were not standardised. DISCLOSURES: This study was supported by the National Institute for Health and Care Research Imperial Biomedical Research Centre, London, and Tommy's Charity, London, UK. The authors reported having no conflicts of interest. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
