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Objectives: Preterm premature rupture of membranes (PPROM) is a major contributor to overall preterm birth (PTB) rates. A short interpregnancy interval (IPI) is a well-known risk factor for PTB. It is unknown if a short IPI specifically affects the risk of developing PPROM in a subsequent pregnancy. We sought to determine the association between IPI and the risk of PPROM in a subsequent pregnancy.Methods: A retrospective cohort study using the Missouri birth certificate database of singleton births from 2003 to 2013 was conducted. A short IPI (delivery of the prior pregnancy to conception of the index pregnancy) was defined as ≤6 months. IPI >6 months was categorized into two groups: IPI 7-23 months and IPI ≥24 months. PPROM was defined as premature rupture of membranes between 160 and 366 weeks. Multivariable logistic regression was conducted to determine the association between IPI and PPROM while controlling for maternal age, race, body mass index (BMI), education level, use of social services (Medicaid insurance, food stamps, or participation in the WIC [Women, Infants, and Children] program), tobacco use, and history of PTB. Secondary outcome included the gestational age at delivery, categorized into five subgroups (≤240, 241-280, 281-320, 321-340, and 341-366 weeks).Results: 474,957 subjects with singleton gestations had data available to calculate the IPI. Of these, 1.4% (n = 6797) experienced PPROM. IPI ≤6 months was significantly associated with an increased risk of developing PPROM compared with patients with IPI ≥24 months (odds ratio (OR) 1.80, 95% CI 1.70-1.90, p < .001). A higher proportion of women with IPI ≤6 months delivered between 281 and 320 weeks compared to the other two IPI groups (27.0 versus 15.0 and 16.4%, p < .001). Individual maternal factors associated with an increased risk of PPROM included advanced maternal age, African American race, BMI <18.5 kg/m2, BMI ≥30 kg/m2, use of social services, tobacco use, and a prior PTB.Conclusion: Our data demonstrate that an IPI of ≤6 months is significantly associated with an increased risk of developing PPROM in the subsequent pregnancy. Of greater clinical relevance is that these women were more likely to deliver between 281 and 320 weeks as compared with women with a longer IPI. Novel to this study is the establishment of a specific link between a short IPI and PPROM with subsequent early delivery. Several maternal demographic factors known to be associated with PTB risk were also found to be associated with an increased risk of PPROM. Further studies are necessary to elucidate plausible biologic mechanisms ultimately leading to the development and implementation of preventive and therapeutic strategies for this high-risk cohort. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study is to investigate the effect of maternal obesity on fetal size in first- and second-trimester pregnancies and to determine duration of pregnancy as estimated by a variety of methods.Methods: Between 2006 and 2011, a cohort study included (n = 9055) singleton pregnancies that resulted in live birth at Holbaek Hospital in Denmark. This study recorded first- and second-trimester fetal measurements and maternal anthropometry. Characteristics considered included mother's age, parity, height, body mass index (BMI), smoking habits, and sex of child. The correlation between BMI and duration of pregnancy was analyzed by time-to-event analysis and accounted for medical intervention by censoring while correlation of BMI on fetal size was evaluated by multiple regression analysis.Results: Adjusting for maternal and fetal characteristics, BMI was associated with prolonged pregnancy duration (0.20-0.22 d per kg/m2 (standard error (SE) 0.02)) when using ultrasound and 0.26 d per kg/m2 (SE: 0.03) when using last menstrual period. With increasing BMI, fetal biometries in first and second trimester were significantly smaller than expected (0.08 mm per kg/m2 when measured by crown rump length (SE 0.02)).Conclusions: Maternal BMI is correlated to smaller fetal size in early pregnancy and prolongs duration of pregnancy. [ABSTRACT FROM AUTHOR]

Purpose: Maternal thyroid gland dysfunction may adversely affect pregnancy outcome. We aimed to examine the association between subclinical thyroid dysfunction, both hypothyroidism and hyperthyroidism, to adverse pregnancy outcome.Materials and Methods: Retrospective cohort study of all women with an available first trimester thyroid function testing and known pregnancy outcome, categorized to subclinical hypothyroidism, or hyperthyroidism and evaluated for complication during gestation and delivery.Results: Four thousand five hundred and four women were included in the final analysis - 3231 were euthyroid, 73 (1.6%) were categorized as subclinical hyperthyroidism and 1200 (26.6%) had subclinical hypothyroidism. Low thyroid-stimulating hormone (TSH) levels, i.e. subclinical hyperthyroidism, correlates with higher rates of placental abruption and extremely low birth weight, below 1500 g. Also, the risk for preterm delivery prior to 34 gestational weeks is higher among women with subclinical hypothyroidism, with greater risk among those with a higher TSH level. (OR 1.81, 95% CI 1.0-3.28 for TSH 2.5-4.0 mIU/L and OR 2.33, 95% CI 1.11-4.42 for those with TSH > 4 4.0 mIU/L).Conclusions: Subclinical hypothyroidism is associated with an increased risk for preterm delivery prior to 34 gestational weeks. Additionally, subclinical hyperthyroidism may also have a role in adverse pregnancy outcome - low birth weight and placental abruption - although this needs to be further explored. [ABSTRACT FROM AUTHOR]

Objective: To analyze the course of twin pregnancies, deliveries and neonatal outcome after in vitro fertilization (IVF) and compare them with spontaneous twins (ST). Methods: The studied material consisted of 131 women in twin pregnancies: 43 patients with IVF and 83 with ST, who delivered at the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw in years 2005-2009. Results: Complications of pregnancy, especially imminent abortion and imminent preterm delivery, were significantly more often diagnosed in IVF versus ST. The rate of preterm delivery was similar in both groups. The vast majority of all analyzed twin pregnancies were delivered by cesarean section. The dominant indication was other than cephalic presentation of either one of the twins. Regardless of the group, all cases of neonatal mortality were a result of sepsis and extreme prematurity. The length of hospitalization and treatment period depended mostly on prematurity. It was also dependent on the method of conception - IVF was in favor of shorter treatment time. Conclusions: The method of conception seems not to have a negative impact on the course of pregnancy, risk of preterm delivery and obstetric outcome. Neonatal complications of IVF and spontaneous twins are mostly a result of prematurity. [ABSTRACT FROM AUTHOR]