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Category Archives: Birth

Physicians Weigh in on Study in The Lancet on Use of Antenatal Corticosteroids in Prevention of Pre-term Birth

The Society for Maternal-Fetal Medicine (organization representing physicians specializing in high-risk pregnancy) weighed in on the Antenatal Corticosteroids Trial that was published in yesterday’s issue of The Lancet. The study was designed to test whether a multifaceted intervention consisting of provider training, tools to identify women at increased risk for preterm birth, and corticosteroids given to the mother improves outcomes of the baby over usual care in these settings.

While giving corticosteroids to the mother in the U.S. has been shown to improve outcome of preterm babies, the Trial showed no benefit and maybe even some harm. SMFM has reviewed the evidence and concluded that the results of the Trial should not alter practice in the U.S. The Trial was specific to the health care settings involved in the study and would not be applicable to the settings in the U.S. There are several reasons why corticosteroids would be of benefit in the U.S. but not in low-resource settings. The technology and neonatal care available in the U.S. was not available to the Trial and would have likely changed the results. For example, women in the Trial did not have access to ultrasound, most delivered in a non-hospital setting, and neonatal intensive care was not available.

The Society for Maternal-Fetal Medicine commends the National Institute of Child Health and Development for supporting studies in low-resource settings and the investigators for completing such a complex study. It is important to evaluate treatments in the specific practice settings where they will be used rather than applying what has been proven beneficial in other settings. While this trial should inform practice and recommendations in similar settings to the ones included, it should not alter the management of women at risk for preterm birth in the US. Antenatal administering of corticosteroids to these women remains one of the most important measures to decrease neonatal mortality and morbidity in the U.S. Until further evidence becomes available from ongoing studies (e.g. Antenatal Late Preterm Steroid),
the use of antenatal corticosteroids should be limited to women at risk for preterm birth who are less than 34 weeks’ gestation.

To view The Lancet study, go to: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2961651-2/fulltext

Society for Maternal-Fetal Medicine Recognizes Need to Reduce America’s Infant Mortality Rate

WASHINGTON,  Sept. 10, 2014—In recognition of September as National Infant Mortality Awareness Month, the Society for Maternal-Fetal Medicine encourages its members, U.S. policymakers and citizens to recognize the need to reduce America’s infant mortality rate. Despite recent declines, the rates of infant mortality in the U.S. remain at the bottom of the list of developing countries.

 

One key factor that will improve SMFM’s goals of reducing infant mortality is to reduce preterm birth –the leading cause of infant morbidity and mortality. Preterm birth accounts for nearly 70 percent of infant deaths, and women in the U.S. suffer among the highest preterm birth rates in the world: one in nine babies born in the United States (11.5 percent) is delivered before 37 completed weeks of gestation.  While babies born before 32 weeks represent only 2 percent of all births, they result in half (54 percent) of infant deaths.  The rate of infant mortality for babies born very low birth weight (less than 1,500 grams) is 100 times higher than that for babies born weighing more than 2,500 grams.

 

Reducing infant mortality starts with preventing pregnancy complications that result in preterm birth, including preterm labor, preeclampsia, and placental dysfunction. SMFM  strongly believes that wider implementation of guidelines on the use of progesterone and cervical cerclage to reduce preterm birth as published in 2012 by SMFM, the American Congress of Obstetricians and Gynecologists  and American College of Nurse-Midwives would go a long way to reducing infant mortality rates in this country. Along those lines, SMFM, along with ACOG and ACNM sent a letter on August 13 to U.S. Department of Health and Human Services Secretary Sylvia Mathews Burwell regarding this very issue.

 

Other areas for improvement include wider use of low dose aspirin to prevent preeclampsia, strategies for smoking cessation, appropriate use of antibiotics to prevent neonatal Group B Strep sepsis, timely corticosteroid administration to accelerate fetal lung maturity, Doppler ultrasound for management of fetal growth restriction, and strategies to prolong pregnancy in women with preterm premature rupture of the membranes. Any initiative to decrease infant mortality by improving pregnancy outcomes should address racial and ethnic health disparities as well as improving pre-pregnancy health and access to prenatal and inter-pregnancy care. While these approaches should decrease infant mortality to some degree, reducing it further will require investment in more research in order to improve our understanding of the etiology, prevention, and management of these pregnancy complications.

 

As high-risk pregnancy doctors and caregivers to those most vulnerable women and their babies, SMFM members are in the unique position to deal with obstetrical conditions that, in aggregate, have the largest impact on infant mortality. Those include preterm birth, preeclampsia, congenital anomalies, perinatal infections and utero-placental insufficiency. SMFM is committed to ensuring that our nation’s mothers and babies are the healthiest they can be.

 

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The Society for Maternal-Fetal Medicine (est. 1977) is the premiere membership organization for obstetricians/gynecologists who have additional formal education and training in maternal-fetal medicine.  The society is devoted to reducing high-risk pregnancy complications by sharing expertise through continuing education to its 2,000 members on the latest pregnancy assessment and treatment methods. It also serves as an advocate for improving public policy, and expanding research funding and opportunities for maternal-fetal medicine. The group hosts an annual meeting in which groundbreaking new ideas and research in the area of maternal-fetal medicine are shared and discussed.  For more information visit www.smfm.org.

Study Suggests That Genetic Predisposition to Brain Injury After Preterm Birth is Sex-Specific

In a study to be presented on February 14 between 1:15 p.m., and 3:30 p.m. PST, at the Society for Maternal-Fetal Medicine’s annual meeting, The Pregnancy Meeting ™, in San Francisco, researchers will report that variation in a gene involved in inflammation is associated with developmental problems after preterm birth in females, but not males.

Largest Population Based Study Finds Better Outcome for Frozen Embryo Replacement vs. IVF

In a study to be presented on February 14 between 1:15 p.m., and 3:30 p.m. PST, at the Society for Maternal-Fetal Medicine’s annual meeting, The Pregnancy Meeting ™, in San Francisco, California, researchers will present findings showing perinatal outcomes of frozen/thawed embryo replacement (FER) have better outcomes compared to fresh in vitro fertilization (IVF), but worse outcomes compared to the non-IVF general population.

Study Suggests Around-the-Clock Labor Coverage is Associated with a Higher Likelihood of Trial of Labor for Women who Previously had Cesarean Delivery

In a study to be presented on February 16 between 8 a.m., and 10 a.m. PST, at the Society for Maternal-Fetal Medicine’s annual meeting, The Pregnancy Meeting ™, in San Francisco, researchers will report findings that suggest around-the-clock labor and delivery coverage decreased the odds of cesarean delivery.

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