W. Kirschner

Strategies in the Prevention of Preterm Births During and Before Pregnancy

Preterm birth – defined as a childbirth before 259 days of gestation (<37 weeks) – is the major challenge in obstetrics and gynaecology worldwide. Preterm birth is associated with high perinatal mortality and surviving children often suffer higher morbidity throughout their lives. The incidence of preterm birth is very high in developing countries but also in some developed countries. According to a worldwide WHO report, Africa and North America, with rates of 11.9% and 10.6% in 2005, are the regions with the highest rates of incidence (Beck et al., 2010). Preterm birth not only causes much harm but also is associated with high costs. Despite considerable technical and medical improvements in obstetrics over recent decades, in developed countries preterm birth rates are not decreasing. On the contrary, the incidence continues to increase. In relation to possible preventive and epidemiologically well-founded measures, although onset and aetiology are not completely understood, our epidemiological knowledge concerning risk and protective factors of preterm birth is in no way poor. As regards preventive approaches, a distinction has to be made between primary and secondary preventive interventions, with this chapter focusing on the former. After presenting some epidemiological and economic data on preterm birth, we will summarise the scope and results of certain programmes aiming to prevent preterm births. Subsequently, we will introduce the framework and methods of our prevention programme BabyCare. Special attention will be given to the evaluative methods and results achieved by our programme in terms of effectiveness and efficiency. While we can register a considerable and stable reduction in the incidence of preterm birth by at least 25% when comparing participants in the programme with a control data set, epidemiological analysis of our data indicates further that certain persistent risk factors of preterm birth observed in relation to programme participants require additional preventive measures which, ideally, should be implemented at the pre-conceptual stage. Consequently, after releasing the BabyCare Program in 2000, the PlanBaby Program was launched in 2007. In conclusion, interventional as well as evaluative problems and limitations of our programmes will be discussed.

Ernährung als Thema in der Schwangerenvorsorge

ZusammenfassungTrotz der qualitativ hochwertigen Lebensmittelangebote in den entwickelten Ländern stellt die Ernährung in der Schwangerschaft ein wichtiges Thema dar. Eine quantitativ bedarfsgerechte und qualitativ hochwertige Ernährung sowie ein Körpergewicht in der Nähe des Normalgewichts verringern Komplikationen im Verlauf der Schwangerschaft, bei der Geburt sowie auch Beeinträchtigungen des späteren Gesundheitszustandes der Mutter und des Kindes. Die Ernährungsberatung des Frauenarztes sollte mit einem festen Schema unter Einsatz einfacher begleitender Instrumente erfolgen. In der Regel, wenn kein abnormer Body-Mass-Index vorliegt, bedarf es nur in schwierigen Fällen der Hinzuziehung von Fachkollegen.AbstractDespite the availability of high-quality food in developed countries, nutrition during pregnancy remains an important issue. Following a well-balanced nutrition plan (in terms of quantity and quality) and maintaining a healthy weight gain will reduce complications during pregnancy and birth as well as lower the health risks of both the mother and the child in later life. Nutrition counseling by the gynecologist should be based on a guided schema supported by simple additional materials. As a rule—with the exception of an abnormal body mass index—the consultation of other specialists is needed only in complicated cases.

Forty to fifty-five-year-old women and iron deficiency: clinical considerations and quality of life

Abstract Between the age of 40 and 55 years, women experience important changes in their lives. This period, which corresponds to the perimenopause for most women, is associated with the risk of iron deficiency anemia (IDA). The clinical presentation of anemia can be misleading, and the underlying cause, particularly bleeding, is frequently treated without concomitant iron prescription. Iron deficiency (ID) remains a social and economic burden in European countries. Underdiagnosed and undertreated, this problem has a strong negative impact on women’s quality of life. The risk factors for ID are well known. The physician’s role is essential in recognizing the symptoms, identifying the risk factors, detecting IDA by testing hemoglobin, and evaluating the degree of ID by measuring serum ferritin (SF). Iron therapy treats the anemia and restores iron stores, thus decreasing symptoms such as fatigue and restoring quality of life. Among the available forms of iron, evidence is in favor of ferrous sulfate in a slow release formulation, which is well-tolerated and results in good adherence, a key factor for efficacious supplementation.

Wie viel ist nötig, wie viel gefährlich?

Die Frage nach der angemessenen Gewichtszunahme in der Schwangerschaft beschäftigt Geburtsmediziner und Ernährungswissenschaftler bereits seit Jahrzehnten. In der frühen Hälfte des letzten Jahrhunderts wurde z. B. in den USA eine Gewichtszunahme von 6,8 kg toleriert [6]. Ab den 70er-Jahren gab es wiederholt Modifikationen dieser Empfehlungen hin zu höheren Gewichtzunahmen.

Correspondence (letter to the editor): methodological problems.

When considering the common problem of publication bias it is to be welcomed that the evaluation results from this study were published. In view of the fact that 1887 of 7469 pregnant women (25%) mentioned at least one abnormal test value, but only 803 (10.8%) sought a medical examination and only 642 (9%) were treated with whatever medications, it becomes obvious that a reduction in the preterm birth rate cannot always be achieved. One of the study’s problems is that it is impossible to figure out, even as a tendency, why vaginal pH self-testing is not efficacious. This is due to an accumulation of methodological problems in the intervention and evaluation. Interventions have to be well planned and controlled with regard to their structures, processes, and outcomes. The aim of planning and conducting interventions is to generate, in a case-control approach, intervention groups that are not selected by health or social status. In the reported study, the case group included a sample that was without exception self-selected. In the context of the study, it was not possible to control the structures and processes; the intervention was conducted under the pregnant women’s own direction. Whether and how the pH test glove was used was elicited only by means of a questionnaire. The control group was not questioned. Only by doing so it would have been possible, however, to recognize the selection in the groups and possibly to standardize these. The present study does not raise any doubt in the individual medical benefits of the glove. However, any further administration of the glove to study populations should always be accompanied by a robust evaluation.