Kirsten Riis Andreasen

Cytokines and the risk of preterm delivery in twin pregnancies.

OBJECTIVE: To estimate the association between cytokine levels in twin pregnancies and risk of spontaneous preterm delivery, including the effect of progesterone treatment. METHODS: This secondary analysis of a randomized placebo-controlled trial investigating the effect of progesterone treatment on preterm delivery in twin pregnancies included 523 women with available dried blood spot samples collected before treatment with progesterone (n=258) or placebo (n=265) and after 4–8 weeks of treatment. Samples were analyzed for cytokines using a sandwich immunoassay. Cytokine levels in spontaneous preterm delivery at 34–37 weeks of gestation and spontaneous preterm delivery before 34 weeks of gestation were compared with delivery at 37 weeks of gestation or more for placebo-treated women. The association between interleukin (IL)-8 and risk of spontaneous preterm delivery before 34 weeks of gestation was estimated further, including comparison according to treatment. Statistical analyses included Kruskal-Wallis test, Mann-Whitney U test, linear regression, and Cox regression analysis. RESULTS: We found a statistically significant association between IL-8 and spontaneous preterm delivery. At 23–33 weeks of gestation, the median IL-8 level was 52 pg/mL (interquartile range 39–71, range 19–1,061) for term deliveries compared with 65 pg/mL (interquartile range 43–88, range 14–584) for spontaneous preterm delivery at 34–37 weeks of gestation and 75 pg/mL (interquartile range 57–102, range 22–1,715) for spontaneous preterm delivery before 34 weeks of gestation (P<.001). Risk of spontaneous preterm delivery was associated with a large weekly increase in IL-8 (hazard ratio 2.0, 95% confidence interval [CI] 1.2–3.3). There was no effect of progesterone treatment on IL-8 levels. Levels of IL-8 at 18–24 weeks of gestation were associated with a cervix less than 30 mm (odds ratio 1.8, 95% CI 1.2–2.7). CONCLUSION: Risk of spontaneous preterm delivery before 34 weeks of gestation is increased in women with high IL-8 levels. Progesterone treatment does not affect IL-8 levels. CLINICAL TRIAL REGISTRATION: EudraCT, https://eudract.ema.europa.eu, 2006-000503-41, and ClinicalTrials.gov, www.clinicaltrials.gov, NCT00329914. LEVEL OF EVIDENCE: II

Long‐term effects of prenatal progesterone exposure: neurophysiological development and hospital admissions in twins up to 8 years of age

To perform a neurophysiological follow‐up at 48 or 60 months of age in children exposed prenatally to progesterone compared with a placebo and evaluate their medical histories up to 8 years of age.

Short- and long-term perinatal outcome in twin pregnancies affected by weight discordance

The objective was to investigate the association between chorionicity‐specific intertwin birthweight discordance and adverse outcomes including long‐term follow up at 6, 18, and 48–60 months after term via Ages and Stages Questionnaire.

Pregnancy outcomes in a cohort of women with a preconception body mass index >50 kg/m2

We describe characteristics and risk factors regarding pregnancy outcome in women with a preconception body mass index (BMI) >50 kg/m2 compared with women with BMI ≤50 kg/m2 in a retrospective population cohort study in singleton pregnancies from the Danish Medical Birth Registry. Results were analyzed as relative risks by a two‐proportion z‐test. Women with preconception BMI >50 kg/m2 smoked, developed gestational diabetes and pre‐eclampsia, and needed induction of labor more frequently than mothers with BMI ≤50 kg/m2. Examination of the case records showed that many attempted vaginal delivery without epidural analgesia, 21% needed an emergency cesarean section (compared with 12% among women with BMI ≤50 kg/m2), and 25% underwent general anesthesia in this context. Many neonates were macrosomic and 34% needed neonatal intensive care and early feeding compared with 6% of neonates from women with BMI ≤50 kg/m2. Women with an extremely high preconception BMI develop more pregnancy complications and their neonates appear affected by this as well.

Long-term effects of prenatal progesterone exposure: neurophysiological development and hospital admissions in twins up to 8 years of age: Prenatal progesterone exposure and outcome in twins

To perform a neurophysiological follow‐up at 48 or 60 months of age in children exposed prenatally to progesterone compared with a placebo and evaluate their medical histories up to 8 years of age.

Long-term effects of prenatal progesterone exposure: neurophysiological development and hospital admissions in twins up to 8 years of ageneurophysiological development and hospital admissionsin twins up to 8 years of age

To perform a neurophysiological follow‐up at 48 or 60 months of age in children exposed prenatally to progesterone compared with a placebo and evaluate their medical histories up to 8 years of age.