Type 2 diabetes (T2D) is increasing in the United States, currently affecting 11.3% of the nation. The Developmental Origins of Health and Disease Hypothesis suggests that environmental stresses in utero and in early stages of life, such as preterm birth (age), can lead to development of adulthood diseases, including T2D. However, research on the association between preterm birth and T2D is sparse and predominantly based on European ancestry populations. We examined this association in postmenopausal women (N = 85,356) from the Women’s Health Initiative, a nationwide prospective cohort. Logistic regression models were used to examine the association between self-reported preterm birth and T2D status, adjusting for demographic and lifestyle covariates. Preterm birth was significantly and positively associated with odds of T2D at baseline (unadjusted: OR=1.51, 95% CI 1.24, 1.83; P

京都大学 / 新制・論文博士 / 博士(医学) / 乙第13514号 / 論医博第2264号 / 新制||医||1061(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 萩原 正敏, 教授 湊谷 謙司, 教授 中島 貴子 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

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The purpose of this study was to investigate the relationship between antenatal care (ANC) adequacy and preterm births. The researcher used the quantitative, descriptive, correlational, retrospective, case control design on a sample size of 40 cases and 80 controls. A checklist was used to collect data at one state hospital in Windhoek. When the Adequacy of Prenatal Care Use (APNCU) index was applied, premature birth was found to be less likely for women in the higher categories of care (OR 0.121; 95% CI 0.124–0.613) as compared to those in the lower categories. Similarly when the Content and Timing of care in Pregnancy (CTP) tool was used; women in the higher categories of care, were less likely (OR 0.114; 95% CI 0.012–1.056) to give birth prematurely as compared to those in the lower categories / Health Studies / M.A. (Health Studies)

Allostatic load, or the “wear and tear” on the body due to stress, is thought to have a negative impact on length of pregnancy and contribute to health disparities in preterm birth. However, the magnitude of the effect on birth outcomes is unknown, in part due to questions of timing of measurement of allostatic load during pregnancy. This study used linear regression analysis of data from 156 pregnant women to test whether allostatic load is a predictor of length of gestation in the study sample, finding that third trimester allostatic load predicted length of gestation among women with full-term births. The study also compared allostatic load in each trimester to determine an optimal time of measurement for prediction of preterm birth. Findings were inconclusive because regardless of trimester of measurement, allostatic load was not a significant predictor of gestational length in the sample. Finally, the study compared allostatic load with scores on the Everyday Stressors Index, a psychosocial measure, to understand the relative benefits of allostatic load measurement during pregnancy. Neither was found to be a statistically significant predictor of preterm birth, so direct comparisons were not possible. Implications and suggestions for future research are discussed.

Smoking during pregnancy remains a significant public health issue despite knowledge about the adverse maternal and fetal health effects. This research had six purposes: identifying effective smoking cessation strategies for low income pregnant women; identifying characteristics of Kentucky women who smoke during pregnancy; estimating the role of smoking on birth outcomes in Kentucky; exploring the impact of tobacco reduction on birth outcomes; identifying the characteristics of women participating in the Giving Infants and Families Tobacco-free Starts (GIFTS) pilot program; and evaluating the impact of GIFTS on smoking status and birth outcomes. Seven randomized controlled trials targeting low income women with smoking cessation interventions identified social support and incentives as promising strategies. Only one study focused on women living in rural settings. Live birth certificate data from 2004-2008 revealed that 26% of Kentucky women reported smoking during pregnancy. Continuing to smoke approximately doubled the odds for low birth weight (LBW) [Estimated Odds Ratio 1.95 (95% Confidence Interval 1.87-2.03)] and no breastfeeding initiation (NBI) [1.93 (1.87-1.98)] versus no pre-pregnancy smoking. Continuers also had higher odds for preterm birth (PTB) [1.25 (1.20-1.29)] and neonatal intensive care unit admissions (NICU) [1.20 (1.14-1.26)]. Reducers and quitters had increased odds of LBW and NBI. The probability of quitting relative to the probability of continuing was increased for women aged less than 25, non-White, Hispanic, graduate degree, obese and "other" payor source for the delivery. The GIFTS program targeted pregnant women receiving local health department services who reported recent or current tobacco use. Significantly increased odds of participation were identified for women reporting 1-5 [2.05 (1.06-3.94) ], 6-10 [2.06 (1.10-3.83)] and ≥11 [2.17 (1.12-4.20)] cigarettes per day compared to those reporting no cigarettes. Women with one [1.55 (1.07-2.24)] or two [1.83 (1.21-2.76)] previous quit attempts also had increased odds for participation compared to those with no quit attempts. GIFTS participants were significantly less likely to have preterm infants (p=.0369) than a matched comparison group. No significant differences were found on tobacco cessation, tobacco reduction or cessation, LBW, NICU, or NBI. This research has implications for future cessation efforts as well as policy development.

Preterm birth remains a major challenge in obstetrics. It complicates up to 13% of all pregnancies and accounts for approximately 80% of neonatal mortality and morbidity. Bacterial Vaginosis (BV) is associated with a 1.4-fold increased risk of preterm birth. Due to ineffectiveness of antibiotics in preventing preterm labour, probiotics have been proposed to serve as an alternative for treatment of BV and prevention of preterm birth. The objectives of this thesis were to determine 1) the effect of Lactobacillus rhamnosus GR-1 (L. rhamnosus GR-1) supernatant on cytokine profile and prostaglandin (PG)-regulating enzyme expression in lipopolysaccharide (LPS)-stimulated human chorion and placental trophoblast cells from human placentae, 2) the potential signaling pathways through which lactobacilli act and 3) the potential role of immune and placental trophoblast cells in initiating a response to LPS and L. rhamnosus GR-1 treatments. Primary cultures of human placental trophoblast cells were pre-treated with lactobacilli supernatant and then with LPS. In addition, immune cells were removed from cell suspensions using a magnetic purification technique to determine their role in modulating cytokine levels. The expression of pro- and anti-inflammatory cytokines and prostaglandin-regulating enzymes was then determined. We found sex-specific differences in the ability of LPS to increase the output of TNF-α, IL-10, and PTGS2. We also showed that L. rhamnosus GR-1 is able to act through the JAK/STAT and MAPK pathways to increase IL-10 and G-CSF, and independently down-regulates PTGS2 and TNF-α and up-regulates PGDH. The increase in G-CSF and PGDH were only observed in women carrying a female fetus. L. rhamnosus GR-1 may serve as an alternative to antibiotics in preventing some infection/inflammation-mediated cases of preterm birth.

Preterm birth, birth prior to 37 weeks gestation, is the leading cause of neonatal mortality and morbidity worldwide. While the uterine cavity and amniotic fluid largely remain sterile throughout gestation, bacterial infections can occur and are associated with preterm birth and/or preterm premature rupture of the fetal membranes (PPROM). Sneathia amnii can be detected as a component of the vaginal flora in healthy women; however, it’s also associated with bacterial vaginosis and preterm birth. Sn35, an isolate of S.amnii, was identified and sequenced through the Vaginal Human Microbiome Project at VCU. Our objective was to classify potential virulence determinants in Sn35 and we successfully identified a putative zinc endopeptidase. The zinc endopeptidase appeared to cleave itself in a site-specific manner under calcium-depleted conditions, resulting in a truncated protein. The truncated protein did have collagenase activity and bacteriolytic activity as well.