Several international studies have indicated an association between socioeconomic deprivation levels and adverse birth outcomes. In contrast, those investigating an association between socioeconomic status and low birth weight using nationwide data are limited in Japan. In this study, we investigated an association between municipal socioeconomic deprivation level and low birth weight by an ecological study.Nationwide municipal-specific Vital Statistics data from 2013 to 2017 were used. We calculated the low birth weight rate and standardized incidence ratio (SIR) for low birth weight for each municipality and plotted them on a Japanese map. Furthermore, the correlation coefficient between them and the deprivation level were calculated. In addition, a spatial regression model including other municipal characteristics was used to investigate an association between low birth weight and the deprivation level.p-value < 0.001) among municipalities, and that between the socioeconomic deprivation level and the SIR for low birth weight was 0.260 . In addition, the spatial regression analysis showed the deprivation level was significantly and positively associated with low birth weight.Municipalities with relatively high SIR for low birth weight were dispersed across all of Japan. The correlation coefficient between the socioeconomic deprivation level and low birth weight rate was 0.196 (The socioeconomic deprivation level and low birth weight were positively associated, and a further study using individual data is warranted to verify reasons for the association. Worldwide, the prevalence of low birth weight is estimated to have decreased from 2000 to 2015 . Low birAmong the risk factors for low birth weight is socioeconomic status. Studies have reported that lower socioeconomic status is associated with a higher prevalence of low birth weight in infants , 9. In cArea-level socioeconomic deprivation is an indicator which is used for investigating differences in health outcomes depending on areal-based socioeconomic status. There are many studies indicating an association between area-level socioeconomic deprivation and adverse outcomes in other countries –17, and In this study, we investigated an association between municipal socioeconomic deprivation level and low birth weight rate using nationwide municipal-specific data.Low birth weight infants are defined as infants whose birth weight are less than 2,500 g. Aggregate data on numbers of low birth weight infants and births for each municipality during the period 2013–2017 were obtained from the Specified Report of Vital Statistics . AdditioAs an indicator of municipal socioeconomic deprivation level, an indicator derived from multiple socioeconomic characteristics of municipalities was used . PrincipSocioeconomic deprivation level = 0.591 In addition, other municipal characteristics that are possibly associated with regional differences in low birth weight rate were used in the analysis. Specifically, population density, number of births per capita, proportion of women aged 15–49, number of physicians working in an obstetrics and gynecology department per capita, number of medical clinics per capita, and number of hospitals per capita. Physicians working in an “obstetrics and gynecology” department include those working in an obstetrics department. Data on municipal socioeconomic characteristics and other characteristics were obtained from Census data, the survey on taxation status of municipal taxes, the Survey of Medical Institutions, the Statistics of Physicians, Dentists and Pharmacists, the Municipalities Area Statistics of Japan, and the population, demographics, and household numbers based on the basic resident register published by the Ministry of Internal Affairs and Communications –29. RegaMoreover, map data of Japan were obtained from the digital national land information published by the Ministry of Land, Infrastructure, Transport, and Tourism, and were further processed by the authors .As part of the statistical analyses, the low birth weight rate was calculated for each municipality using data on the number of low birth weight infants and total births. There were regional differences in maternal age distribution among municipalities, and an analysis was conducted taking into account maternal age. First, the low birth weight rate for each maternal age group was calculated for all of Japan. For this analysis, publicly available aggregate data grouped by maternal ages  were used, after which we conducted an analysis based on those maternal age groups. Then, the number of births was multiplied with the low birth weight rate in Japan for each maternal age group and municipality, and the expected number of low birth weight infants for each maternal age group and municipality was calculated. By summing the expected number of low birth weight infants for all maternal age groups, the expected number of low birth weight infants was calculated for each municipality. Therefore, the expected number of low birth weight infants for each municipality where  studies , 32. Spe studies , 34. SIRSubsequently, an ecological study was conducted to investigate an association between low birth weight births and the socioeconomic deprivation level using municipal-level data. The low birth weight rate and the SIR were plotted onto a Japanese map to show geographical differences in low birth weight rates across Japan. In addition, a scatterplot between the deprivation level and the SIR for low birth weight was shown, and the Pearson correlation coefficient between them was calculated. Moreover, the municipalities were classified into quintiles, and summary statistics of low birth weight rate and other municipal characteristics were calculated for each quintile.p values were calculated for the Poisson regression model, and the posterior mean of relative risk for low birth weight and 95% credible intervals were calculated in the Bayesian spatial regression model. All the explanatory variables were scaled when applying a regression model. Because a spatial model was used, municipalities on islands which were not adjacent to another municipality were not used in the ecological analysis. Additionally, six municipalities whose populations in 2015 were extremely small because of evacuations were not used in the ecological study. All statistical analyses were conducted using R, ver.4.1.3 (https://www.R-project.org/).Poisson regression model was applied using the number of low birth weight infants as the response variable and the socioeconomic deprivation level and other municipal characteristics as explanatory variables. The expected number of low birth weight infants was used as an offset term in the Poisson regression model in order to adjust for the difference in number of births and maternal ages among municipalities. However, spatial autocorrelation of the outcomes is usually observed. Therefore, Moran’s I statistics for the residuals of the Poisson regression analysis were calculated in order to measure for spatial autocorrelation. Bayesian spatial regression modeling was also used to investigate the association and to account for spatial autocorrelation . In the An approval by institutional review board was not required because only data that are publicly available were used.There were 4,962,247 births and 471,050 low birth infants in total in Japan from 2013 to 2017.Table Figure p-value < 0.001), and that between the socioeconomic deprivation level and the SIR for low birth weight was 0.260 . Thus, there was a positive correlation.Figure Table p < 0.001), and it was suggested that it is better to use a spatial model in the analysis. The Bayesian spatial regression model showed a similar association, and a significant association was observed between the deprivation level and low birth weight.Table An association between municipal socioeconomic deprivation level and the low birth weight in Japan was investigated, and a positive correlation was observed between them. In addition, a significant and positive association was identified for the association in the regression analysis. Here possible reasons for this phenomenon are discussed.A possible reason for the association is that women with lower socioeconomic status tend to have risk factors associated with lower birth weight of their infants. Maternal smoking is a major risk factor associated with low birth weight in infants , 37. In Inadequate use of prenatal care was another possible reason for the association. Although the number of hospitals and medical clinics per capita was indeed large in the deprived areas, those medical cases might have been inadequately utilized in those deprived areas. A previous study suggested that prenatal care use effectively lowered the prevalence of low birth weight in a prefecture in Japan . Other sAn implication of this study is that differences in low birth weight rates existed which were dependent on municipalities and municipal socioeconomic deprivation level. It is known that inter-prefecture disparities in under-5 year old mortality widened over the decades in Japan, and increasing socioeconomic gradients are suggested as a possible reason . There iA strength of this study is that Vital Statistics in all of Japan were used for the analysis. Therefore, the results indicated trends in all of Japan. Furthermore, although a previous epidemiological study showed a positive association between income and low birth weight in Japan , this stThere are some limitations. First, this was an ecological study, and an ecological fallacy might have existed in the presumed association. Second, it is not certain from this study whether the individual’s socioeconomic status, or the neighborhood’s deprivation was associated more with regional differences seen in low birth weight rates. Third, data on major factors associated with low birth weight, such as the gestational age, parity, fetal number, number of hospitals with departments of obstetrics and gynecology, could not be obtained for each municipality. Studies taking into account of preterm or term by gestational ages among low birth weight infants will be important in the future. Fourth, the mechanisms causing or influencing the association between deprivation and low birth weight in infants are not yet known. For example, it is not known whether the deprivation level increases preterm birth and/or intrauterine growth restriction. A study using individual data and examining various types of adverse birth outcomes will be important to resolve these limitations in the future.   We investigated an association between municipal socioeconomic deprivation level and low birth weight rate using aggregate national vital statistics data for all of Japan. As a result, there was a positive correlation between the deprivation level and SIR for low birth weight. In addition, a spatial regression analysis showed that there was a significant and positive association between the deprivation level and low birth weight.


Birth order has a significant impact on perinatal and long-term outcomes. Preterm birth rates, ranging from 5% to 18%, are regrettably still high in industrialized and developing countries, making them the main contributor to infant mortality and morbidity. Infection, cervical pathology, uterine overdistension, progesterone deficiency, stress on the mother and fetus, allograft reaction, allergic phenomena, and likely more unknown factors are just a few of the causes of preterm birth syndrome. These several causes may improperly stimulate the usual pathway between the decidua and the fetal membranes, resulting in cervical ripening, membrane rupture, and uterine contractility. Some of the mechanisms underpinning these actions include receptors, chemokines, and inflammatory cytokines. For early identification, treatment, and avoidance of negative consequences, it is essential to understand the cellular and metabolic mechanisms that cause preterm labor. Clinicians and researchers are crucial to improving our knowledge of the biochemistry of preterm delivery, identifying risk factors, and creating treatments for this challenging condition. Intrauterine growth restriction and pre-eclampsia or eclampsia are frequent causes of suspected preterm births. “Spontaneous preterm births” occur after preterm labor that develops without warning with an early membrane rupture. It is thought that the condition that may cause these births may have several causes, such as uterine overdistension, vascular disease, infection, or inflammation. Unplanned preterm births have several reasons, including the black race, periodontal disease, low mother body mass index (BMI), and previous preterm births. A short cervical length and a high cervical-vaginal fetal fibronectin concentration are the two best signs of premature birth. Premature births occur before the 37th week of pregnancy, though local variations exist in the low-gestational age cutoff that distinguishes them from spontaneous abortion . PretermProgesterone withdrawal, oxytocin initiation, and decidual activation are three theories for the start of term labor . ProgestMethodologyThe databases PubMed, Medline, Scopus, Embase, and Web of Science were used in the literature search. Transvaginal ultrasound, short cervical length (CL), progesterone, premature birth, and other search phrases were employed. They were included if studies matched our predetermined inclusion criteria, such as premature birth. Our review did not include abstracts, conference articles, systematic reviews, or meta-analyses. There were no restrictions on the publishing date of articles, and only those written in English were considered.CausesInfection or inflammation, ischemia or bleeding in the uteroplacental, uterine overdistension, stress, and other immunologically generated processes are a few causes of preterm labor . Since aCongenital deficiencies are frequently caused by exposure to certain medicines, sometimes known as teratogenic drugs, and are one of the major causes of newborn death. Congenital disabilities-also is known as teratogenic conditions-have a high probability of developing due to exposure to certain chemicals, which is one of the main factors in infant mortality . PretermIt makes sense to define risk factors for predicting preterm delivery for several reasons. Finding at-risk women is the initial stage, after which risk-specific therapy may start. Second, the risk factors could assist in pinpointing a population for study on specific treatments. Finally, determining risk factors may offer vital insight into preterm birth mechanisms. Preterm birth has been associated with a wide range of maternal or fetal characteristics, including the mother's demographics, nutritional status, pregnancy history, current pregnancy characteristics, psychological traits, negative behaviors, infection, uterine contractions, CL, and biochemical and genetic markers .Premature birth is more likely to occur in pregnancies that are near in time to an earlier delivery. After adjusting for confounding factors, an interpregnancy gap of fewer than six months is more significant than a risk of premature delivery that is two times greater . A smallBiological and genetic markersTo assess how well biomarkers predict preterm birth, saliva and other biological fluids  have been used. Numerous analytes, particularly those connected to inflammation, have been measured, including cytokines, chemokines, estrogen, and others, and many of them have been linked to premature birth . StudiesBiochemical markers found in bodily fluids, such as amniotic fluid, urine, cervical mucus, vaginal secretions, serum or plasma, and saliva, have been used to detect preterm labor. A fetal fibronectin glycoprotein may be discovered in the decidua basalis’ extracellular fluid near the intervillous space . BetweenDiagnosisNumerous studies have looked at placental alpha microglobulin-1 (PAMG-1) to determine if it may predict future spontaneous preterm birth in women who had early labor signs, symptoms, or complaints . The PAMPrevention and treatmentExperience with assisted reproduction shows that when the number of embryos transplanted is reduced, particular professional techniques can quickly reduce the risk of preterm birth. Folic acid ingestion before pregnancy is indicated to avoid congenital disabilities. Additionally, research suggests that folic acid supplements taken before conception  may lessen the likelihood of preterm births. For expecting moms and their offspring, quitting smoking is beneficial . ControlPyelonephritis and the chance of having a baby too soon are decreased by checking for asymptomatic bacteriuria and getting the proper treatment. According to preliminary data, determining the cervix length in preterm labor patients can aid treatment modifications and lead to a pregnancy extension of roughly four days . RegularSurgery may be required to treat some uterine anomalies in patients . Premature birth is far more likely to occur in multiple pregnancies, typically resulting from assisted reproductive technologies . To decrTertiary interventions focus on women who are about to enter preterm labor, rupture their membranes or bleed early. Combining ultrasonography with the fibronectin test increases diagnostic precision and decreases false-positive findings. While early labor interventions may not be able to give the fetus enough time to continue growing and maturing in cases of progressive cervical dilatation and effacement, they may be able to postpone delivery long enough for the mother to be transferred to a facility that is prepared with the necessary tools and is trained to handle preterm births . To keepSince preterm delivery is one of the leading causes of death and neurodevelopmental problems in children under five worldwide, it continues to be a critical public health concern. The most common cause of mortality for children under the age of five globally is preterm delivery, but with developments in technology and medicine, more babies born just before they are no longer viable are surviving. With increased survival, long-term neurologic impairments are more likely to develop. Preterm delivery, a severe healthcare concern, affects 15 million infants annually. The March of Dimes and other advocacy organizations’ research and lobbying activities have brought preterm birth prevention to the public’s notice. However, there is compelling evidence that preterm birth rates are rising globally and in most countries.


Progesterone is widely used to improve the adverse pregnancy outcomes related to vaginal bleeding during early pregnancy. However, the evidence of its effectiveness is equivocal.Six thousand six hundred fifteen mother-infant pairs from Tongji Maternal and Child Health Cohort (TMCHC) were involved in the study. Information on vaginal bleeding, progesterone administration in early pregnancy were obtained at enrolment. Birth outcomes were obtained from the hospital notes. Body weight of the infants at 12 months of age was collected by telephone interview. Multivariable logistic regression was conducted to estimate the effect of vaginal bleeding and progesterone administration in early pregnancy on birth outcomes and weight status of infants at 12 months of age.21.4% (1418/6615) participants experienced bleeding in early pregnancy, and 47.5% (674/1418) of them were treated with progesterone. There were no significant associations between progesterone supplementation in early pregnancy and offspring outcomes. Compared to women without bleeding or any therapy, women with bleeding and progesterone therapy experienced increased risk of preterm , and delivering a small-for-gestational-age (SGA)  or low birth weight (LBW)  neonate, and offspring of them had an increased risk of weight for age z-score (WAZ) < -1 at 12 months of age .Offspring of mothers with bleeding and progesterone therapy were more likely to be a premature, SGA or LBW neonate, and had lower weight at 12 months of age. Progesterone supplementation may have no beneficial effect on improving adverse offspring outcomes related to early vaginal bleeding.NCT03099837 on 4 April 2017.TMCHC was registered at clinicaltrials.gov as The online version contains supplementary material available at 10.1186/s12884-022-04711-1. Emerginscarried –6, smallscarried , and lowscarried , 6, whilscarried , 8.Progesterone is an immunomodulatory molecule produced by the corpus luteum in the onset of early pregnancy , and plaThe present study aimed to determine the independent and combined effect of early bleeding and progesterone supplementation on birth outcomes and the growth of infants in the first year of life through a prospective cohort study.The study was embedded in the ongoing Tongji Maternal and Child Health Cohort , which is a population-based prospective cohort study designed to investigate the short- and long- term effect of exposures in the pregnancy on the health of mother-infant pairs. From January 2013 to May 2016, eligible participants were invited to join the TMCHC study at their first prenatal care visit in three research hospitals of Wuhan, China.n = 49), test-tube baby (n = 38), twin births (n = 142), triplets (n = 1), miscarriages (n = 160), stillbirths (n = 3), taking Chinese medicine in early pregnancy (n = 216), missing gestational weight gain (n = 49) and information at birth (n = 570), 6615 participants were included to examine the association of maternal vaginal bleeding and progesterone supplementation in early pregnancy with the risk of adverse birth outcomes. 3181 infants’ weight at 12 months of age were followed up and were eligible to investigate the effect of maternal early vaginal bleeding and progesterone supplementation on the growth of infants in the first year of life.Of 7843 pregnant women joined the TMCHC study at 10–16 weeks of gestation who reported the detail information about vaginal bleeding and medical treatments in early pregnancy, after excluding those with polycystic ovarian syndrome , obstetrical information , medical characteristics , lifestyle  and pre-gravid weight. Maternal height and weight were accurately measured at the same time.The information about vaginal bleeding and progesterone supplementation were retrospectively collected at enrolment. Participants were instructed to report whether vaginal bleeding occurred, and were asked: “Have you ever taken progesterone for therapeutic purposes since pregnancy?”, if “Yes”, the diagnosis of disease or symptom, the start date and duration of progesterone treatment were recorded. Most of the participants took progesterone for treating vaginal bleeding, and the others took progesterone due to low progesterone level in early pregnancy.2) was calculated from self-reported pre-gravid weight and height measured at the first antenatal visit. Subjects were categorized as underweight (BMI < 18.5), normal weight (18.5 ≤ BMI < 24.0), overweight or obese (BMI ≥ 24.0) accordingly [Participants were followed up regularly to have their body weights measured and other health information collected by medical examination. Information on birth outcomes  were obtained immediately after delivery from the hospital notes. Gestational age was calculated by self-reported last menstrual period at enrolment and confirmed by ultrasound examination at 11–14 weeks of gestation. Pre-pregnancy body mass index  women without bleeding and any treatment; 2) women without bleeding but taking progesterone; 3) women with bleeding but untreated; 4) women with bleeding and treated with progesterone. The demographics characteristics were compared among four groups. Descriptive statistics were summarized as mean ± SD for continuous variables and frequency (n) and percentages (%) for categorical variables. Differences of characteristics were assessed by one-way analysis of variance (ANOVA) for continuous variables and chi-square test for categorical variables. Multivariable logistic regression was conducted to estimate the independent and combined effect of vaginal bleeding and progesterone supplementation in early pregnancy on offspring outcomes including very preterm, preterm, SGA, LBW, and WAZ < -1 at 12 months of age. In order to investigate whether progesterone therapy in early pregnancy can improve offspring outcomes among women with bleeding, women with bleeding and non-treatment were used as reference group and multivariable logistic regression was performed to calculate the odd ratios (ORs) with 95% Confidence Intervals (95%CIs) for offspring outcomes.n = 28), and any breastfeeding at 12 months of age (n = 45), therefore we used multiple imputation to deal with missing data when assessed the association between exposures and infants’ growth, and then presented the results of pooled analyses.Gestational weight gain, gestational age at delivery, fetal gender, birth weight, birth length, and breast feeding are often strong predictors of offspring’s growth and were therefore considered as potential confounders. However, these variables might lie on the causal pathway from exposure to outcomes. Therefore, we calculated the risk in different models. Model I was adjusted for maternal age, pre-pregnancy BMI, nulliparity, gravidity, history of spontaneous abortion, history of induced abortion, drinking before pregnancy, and gestational age at enrollment. Gestational weight gain and fetal gender were further adjusted in model II to calculate ORs(95%CIs) of very preterm and preterm. Gestational age at delivery, Gestational weight gain, and fetal gender were also adjusted when calculated the ORs (95%CIs) of SGA, and LBW in model II. OR(95%CI) of WAZ < -1 at 12 months of age in model II was also further adjusted for gestational age at delivery, gestational weight gain, fetal gender, birth weight, birth length, and any breastfeeding at 12 months of age. In our study, there were small amounts of missing data in birth length .To eliminate the potential effect of maternal pre-pregnancy BMI, age, parity and preterm on offspring outcomes and reinforce the validity of our results, complementary analyses were conducted by multivariable logistic regression to investigate the association of maternal bleeding and progesterone therapy in early pregnancy with offspring outcomes among women with pre-pregnancy BMI 18.5–23.9 kg/mP < 0.05 was considered statistically significant.All the statistical analyses were performed using SAS 9.4 software , and Of the 6615 pregnant women, 1418 (21.4%) reported vaginal bleeding and 47.5% (674/1418) of them treated with progesterone in early pregnancy. In those without bleeding in early pregnancy (5197 of the 6615), 7.2% (376/5197) reported taking progesterone due to low progesterone level in early pregnancy. The median (interquartile range) of gestational age at the beginning of vaginal bleeding was 6  weeks and the duration of progesterone supplementation was 15  days. Participants baseline characteristics are shown in Table The association of vaginal bleeding and progesterone supplementation in early pregnancy with the risk of offspring outcomes were shown in Table Table In the sensitivity analyses Table S, after eIn the current study, women with vaginal bleeding in early pregnancy had an elevated risk of very preterm and preterm regardless administration of progesterone. There were no significant associations between progesterone administration and offspring outcomes respectively among women with bleeding or not. The risk of very preterm and preterm birth remained increased in women experienced bleeding and treated with progesterone. In addition, offspring of those women were more likely to be a SGA and LBW at birth and had lower weight at 12 months of age.In the current study, vaginal bleeding in early pregnancy was associated with an increased risk of preterm, which is consistent to several previous studies –6. We al2 or ≥ 24.0 kg/m2, age ≥ 35 years, multiparity and preterm, offspring of women with bleeding and progesterone treatment in early pregnancy remained a significant increase in the risk of LBW and WAZ < -1 at 12 months of age. Hence, exposure of heavy vaginal bleeding in early pregnancy may have a negative long-term effect against the infant’s growth.A prospective study of 3531 women observed that only heavy bleeding but not spotting or slight bleeding in the first trimester was associated with a decrease in mean birth weight, even though they did not find significantly association with the risk of LBW and SGA . A recenThe study had several strengths. Firstly, the information of vaginal bleeding and progesterone administration in early pregnancy were collected at 10–16 weeks’ gestation, which was soon after the event and may minimize the recall bias. Secondly, we estimated the long-term effect of maternal vaginal bleeding and progesterone supplementation in early pregnancy on offspring’s growth. Nevertheless, some limitations of our study also should be considered. For one thing, we obtained data from a prospective cohort study and participants did not report the daily dose of progesterone administration, so it is limited to assess the association of the dose of progesterone administration with birth outcomes. In addition, we lacked the detail information of vaginal blood loss in early pregnancy, so it was unclear whether women with heavier bleeding were more likely to be given progesterone, and we cannot assess the association of the severity of bleeding with birth outcomes. More randomized controlled trials are needed to evaluate the safety and efficacy of progesterone supplementation.In summary, vaginal bleeding in early pregnancy may increase the risk of preterm birth, regardless of progesterone treatment. Offspring of mothers with bleeding and progesterone therapy were more likely to be SGA or LBW neonate and had lower weight at 12 months of age. Progesterone supplementation may have no beneficial effect on improving offspring outcomes.Additional file 1: Table S1. The association of vaginal bleeding and progesterone administration in early pregnancy with offspring outcomes among women with pre-pregnancy BMI 18.5-23.9 kg/m2, age < 35 years, primiparity and term pregnancy (≥ 37 weeks of gestation) (n=3605).


Prematurity comes with a varying range of complications, implying a high prevalence of complications and mortality and depending on the severity of prematurity and the sustained inflammation among these infants, which recently sparked an important scientific interest. The primary objective of this prospective study was to establish the degree of inflammation in very (VPIs) and extremely preterm infants (EPIs) in association with the histology findings of the umbilical cord (UC), while the secondary objective was to study the inflammatory markers in the neonates’ blood as predictors of fetal inflammatory response (FIR). A total of thirty neonates were analyzed, ten of them being born extremely premature (<28 weeks of gestation) and twenty very premature (28–32 weeks of gestation). The EPIs had considerably higher levels of IL-6 at birth than VPIs (638.2 pg/mL vs. 151.1 pg/mL). The CRP levels at delivery did not vary substantially across groups; however, after days, the EPIs had significantly higher CRP levels (11.0 mg/dL vs. 7.2 mg/dL). In contrast, the LDH was considerably higher in the extremely preterm infants at birth and four days after birth. Surprisingly, the proportions of infants with pathologically increased inflammatory markers did not differ between the EPIs and VPIs. The LDH increased considerably in both groups, although the CRP levels increased exclusively among the VPIs. The stage of inflammation in the UC did not vary substantially between the EPIs and VPIs. The majority of infants were identified with Stage 0 UC inflammation (40% in EPI vs. 55% in VPIs). There was a substantial correlation link between gestational age and newborn weight and a significant inverse correlation among gestational age and IL-6 and LDH levels. There was a strong negative association between weight and IL-6 (rho = −0.349) and LDH (rho = −0.261). The stage of the UC inflammation demonstrated a statistically significant direct connection with IL-6 (rho = 0.461) and LDH (rho = 0.293), but none with the CRP. Further studies involving a bigger population size of preterm newborns are required to validate the findings and analyze more inflammatory markers, while prediction models on inflammatory markers that are measured expectantly, before the onset of preterm labor, need to be created. The death rate for very premature newborns has decreased thanks to advancements in newborn care . DespiteIn preterm deliveries, the frequency of histologically diagnosed chorioamnionitis is roughly fifty percent, and its prevalence is negatively correlated to the mother’s gestational age ,9. ChoriResearch has been conducted on a wide variety of cytokines and associated inflammatory indicators in correlation with premature birth . Some haThis study aims to analyze the correlation among FIR in the context of preterm birth, as assessed by histochemical analysis of the umbilical cord, associated or not with funisitis. The main goal was to determine the level of inflammation of very and extremely premature neonates in correlation with the histological findings of the umbilical cord, while the secondary objective was to analyze the inflammatory markers from the neonates’ blood, as determinants for FIR. This prospective research project was performed at the Maternity Hospital of the “Pius Brinzeu” County Emergency Clinical Hospital Timisoara and in the neonatal intensive care unit (NICU), at the “Louis Turcanu” Children’s Emergency Clinical Hospital Timisoara, which are associated with the “Victor Babes” University of Medicine and Pharmacy Timisoara (UMFVBT). UMFVBT is governed by the local committee on ethics, which authorizes scientific research based on the International Conference on Harmonization from Helsinki about technical standards for research projects involving humans. The research was conducted in accordance with the ethical norms of the institutions where the study was performed. On 8 January 2021, protocol number 3 was granted clearance to conduct the current investigation. The duration of the study spanned for two years, from January 2021 until January 2023. Premature delivery labor was described as the development of continuous uterine contractions happening at a frequency of at least two per 10 min, accompanied by a modification in the cervical morphology, accompanied by birth before 37 full weeks of gestation. After receiving parental or legal guardian approval, newborns were enrolled in the research. After clearance by the Research Ethics Committee at UMFVBT, the informed consent form was used in accordance with ethical standards and research principles. The study was conducted in a manner that is safe for the environment, and without any harm to the patient, or genetical engineering being involved. Premature newborns delivered vaginally, with a gestational age of less than 32 weeks (31 weeks and 6 days of amenorrhea) admitted to the neonatal intensive care unit will be included in the study. Birth weight was not considered as an exclusion criterion, but the gestational age of 22 weeks was considered as the lower limit for fetal viability. Very preterm newborns were considered from 28 to 32 weeks of gestation, while extremely premature newborns were those born earlier than 28 weeks . The primary objective was to demonstrate the existence of fetal inflammation in preterm deliveries; therefore, it was necessary to obtain an umbilical cord segment from the proximal 5 cm from the neonate, which was obtained in the neonatal/maternity ward, independent of maternal disease. Therefore, no data on maternal pathology are presented in the current study. The interleukin 6 (IL-6), C-reactive protein (CRP), and lactate dehydrogenase (LDH) levels were also used to evaluate fetal inflammation, in correlation with the histopathologic evaluation of the umbilical cord. The variables taken into consideration included the neonates’ baseline characteristics such as the weight (grams), weight range, gender , gestational age (weeks), inflammatory markers , umbilical cord inflammation stage, and fetal inflammatory response stage.The following procedures were performed for each neonate included in the study: (1) Umbilical cord histochemical analysis, including umbilical cord segment sampling (approximately 10 cm) from the distal third of the umbilical cord ; preservation of the segment in aqueous formaldehyde solution  for transport to the pathology laboratory; fixation of the retrieved sample in paraffin; microscopic examination of umbilical cord sections, performed by the same pathologist. (2) Blood collection for determination of C-reactive protein, IL-6, and LDH at birth, from venous blood, and at 4 days postnatally, also from venous blood. The cord blood was extracted using a needle and placed in EDTA tubes. After collection, blood was held vertically at +4 degrees Celsius in sealed tubes without agitation until analysis.The histopathology of umbilical cord inflammation correlated with FIR was established as follows, based on existing guidelines ,31,32:  p-value”, where a “p-value” lower than 0.05 was considered statistically significant. Using a convenience sample method for an incidence of less than 1% of extreme prematurity in the general population , a margiAmong the 30 participants, ten infants were extremely premature (EPIs) and the other twenty were very preterm infants (VPIs). As expected, it was observed that the average weight was significantly lower among extremely premature newborns (871.5 g vs. 1502.0 g). Regarding the weight range, 70% in the EPI group were born with a weight between 500 and 1000 g, while in the VPI group 55% were born with a weight ranging between 1000 and 1500 g. There were in total 16 male infants and 14 females, as seen in p-value < 0.001). The CRP levels at birth did not differ significantly between groups, but after 4 days the CRP increased significantly higher among the very premature infants . On the other hand, the lactate dehydrogenase was significantly more elevated among the extremely premature, both at birth and 4 days after birth. Surprisingly, the proportions of infants with pathologically increased inflammatory markers did not differ between the EPIs and VPIs, regardless of IL-6, CRP, or LDH.p-value = 0.003) and in the VPI group , respectively. However, the CRP levels increased significantly only among the very preterm infants , although those in the EPI group were born extremely preterm.The comparison of inflammatory markers measured at birth and 4 days after birth between extremely premature newborns and very premature newborns is presented in Lastly, the correlation analysis presented in The current study determined an important association between the level of prematurity defined by gestational age and the degree of inflammation of the neonate described by the FIR. However, the association of an UC inflammatory process, as described by the inflammatory cells from the UC samples and the inflammatory cells identified in the UC at the moment of birth (funisitis), was not statistically significant. In the studied patients with funisitis, our results revealed alterations in oxidative and inflammatory mediators in cord blood as a result of the prenatal FIR, associated with a very preterm birth or extreme prematurity. The current study proposed to histologically analyze the umbilical cord instead of measuring only the inflammatory markers of the newborn, due to the difference in mechanisms that trigger FIR, previously documented by Para et al. . The resSimilarly, another recent study attempted to quantify the level of inflammation among preterm newborn patients in comparison with full-term newborns . PretermAnother study attempted to observe the molecular basis of the inflammation process that happens within the umbilical cord in the premature neonates, but the research was performed in vitro . The resThe current research implies that monitoring cytokine concentrations might aid in the identification of infections and other inflammatory processes that might be involved in the onset of a premature labor. Other studies have shown that it is feasible to quantify inflammation markers in amniotic fluid obtained non-invasively from the vaginal fluids of women experiencing preterm labor. High levels of IL-6 in amniotic fluid accurately predicted the FIR . By incoCombining anti-inflammatory medication and antimicrobials has been recommended to address intra-uterine infections and minimize inflammatory responses that contribute to preterm labor and unfavorable fetal outcomes. The particular combination of corticosteroids and NSAIDs exemplifies how appropriate therapies improve the survival of preterm newborns by increasing lung maturation, but also decrease the level of inflammation that can reduce the risk of FIR. Similar to betamethasone monotherapy, another research demonstrated that the combination treatment successfully lowered the production of the pro-inflammatory cytokines . Other iAnother recent study comparable to ours was performed recently, with a population size bigger than 200 participants . The resRegarding the blood sampling and histopathological analysis of UC samples in our study, it should be mentioned that only one proximal portion of the UC was sampled, without a comparison from a more distal portion. Moreover, the venous sampling for inflammatory markers can influence the results, since the slow blood flow can determine a higher degree of margination of the inflammatory cells, and therefore a higher quantity of inflammatory markers, which was demonstrated in two studies ,44. BlanAmong the limitations of the current study, there is the lack of a control group to compare the level of inflammatory markers in the umbilical cord and blood. Another limiting factor is the relatively small sample size that reduces the statistical power of our findings. Additionally, clinical observations and newborns’ short-term or long-term outcomes were not considered. As for the future perspectives based on this pilot study, a bigger project is expected to involve preterm newborns between the 32nd and the 37th week of gestation, in comparison with the EPI and VPI infants that were analyzed now. A wider range of inflammatory markers and complications such as prematurity retinopathy will be studied, as well as histopathological analysis of the placenta, besides the umbilical cord. Further studies involving a bigger population size of preterm newborns are required to validate findings and analyze more inflammatory markers. Prediction models can also be created in prospective studies based on inflammatory markers that are measured expectantly, before the onset of preterm labor. The quantity of inflammatory markers and inflammatory cells is greater in the cord blood of neonates as the gestational age decreases. As an early sign of dangerous inflammatory conditions, assessing the inflammatory markers may be useful from the cord blood of the infant, instead of analyzing the UC samples under the microscope, which comes at greater prices and a much longer time needed to analyze the samples. The marker analysis can be conducted in a matter of minutes and provides a good overview of the stage of funisitis and potential complications while helping to decide the further management of the preterm newborn, such as administering corticosteroids and NSAIDs.


Is treating pregnant individuals with periodontitis with chlorhexidine mouthwash plus scaling and root planing associated with birth outcomes?In this systematic review and meta-analysis including 12 studies with 5735 participants, chlorhexidine mouthwash plus scaling and root planing, but not scaling and root planing alone, was associated with reduced risks of preterm birth and low birth weight.These findings suggest that using chlorhexidine mouthwash with scaling and root planing to treat periodontitis in pregnant individuals may improve birth outcomes. This systematic review and meta-analysis assesses heterogeneity by chlorhexidine use in randomized clinical trials evaluating the effect of scaling and root planing (SRP) vs no treatment on birth outcomes. Chlorhexidine mouthwash enhances treatment effects of conventional periodontal treatment, but data on chlorhexidine as a source of heterogeneity in meta-analyses assessing the treatment of maternal periodontitis in association with birth outcomes are lacking.To assess possible heterogeneity by chlorhexidine use in randomized clinical trials (RCTs) evaluating the effect of periodontal treatment  vs no treatment on birth outcomes.Cochrane Oral Health’s Trials Register, Cochrane Pregnancy and Childbirth’s Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE Ovid, Embase Ovid, LILACS BIREME Virtual Health Library , US National Institutes of Health Ongoing Trials Register , and the WHO International Clinical Trials Registry Platform were searched through March 2022.RCTs were included if they were conducted among pregnant individuals with periodontitis, used interventions consisting of SRP vs no periodontal treatment, and assessed birth outcomes.Data were abstracted with consensus of 2 reviewers using Rayyan and assessed for bias with the Cochrane Risk of Bias 2 tool before random effects subgroup meta-analyses. Analyses were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline.Outcomes of interest were preterm birth  and low birth weight .There were 12 studies with a total of 5735 participants evaluating preterm birth. Control group participants did not receive any treatment or use chlorhexidine during pregnancy. All intervention group participants received SRP; in 5 of these studies (with 2570 participants), pregnant participants in the treatment group either received chlorhexidine mouthwash or advice to use it, but participants in the remaining 7 studies (with 3183 participants) did not. There were 8 studies with a total of 3510 participants evaluating low birth weight, including 3 studies with SRP plus chlorhexidine (with 594 participants) and 6 studies with SRP only (with 2916 participants). The SRP plus chlorhexidine groups had lower risk of preterm birth  and low birth weight  but not the SRP-only groups .These findings suggest that treating maternal periodontitis with chlorhexidine mouthwash plus SRP was associated with reduced risk of preterm and low birth weight. Well-conducted RCTs are needed to test this hypothesis. The effect of periodontal treatment on birth outcomes could also have been underestimated in intention-to-treat analyses of RCTs if the intervention benefited both fetal survival and the outcomes when outcomes were determined only if the fetus survived (such as the case in preterm birth or low birth weight).10Although maternal periodontitis is associated with increased risk of adverse birth outcomes in observational studies15 Chlorhexidine mouthwash used in conjunction with SRP among individuals with periodontal disease has been reported to be associated with reduced dental plaque, mild gum disease, gum bleeding,16 and counts of Fusobacterium nucleatum,17 an organism that has been associated with both periodontal disease and adverse birth outcomes.18 Chlorhexidine and cetylpyridium chloride mouthwashes disrupt oral biofilm formation and maturation, thereby reducing the bacterial bioburden in healthy adults without periodontitis.19 Cetylpyridinium chloride mouthwash, which has a similar effect on the oral microbiome as chlorhexidine, improved the oral health of pregnant participants and reduced risk of premature rupture of membranes in one RCT,20 and reduced risk of preterm birth by 74% in another.21 Chlorhexidine has been recommended in low-income settings for intrapartum and vaginal wiping, neonatal wiping, and umbilical cord cleaning during childbirth to improve birth outcomes.22 Therefore, chlorhexidine mouthwash use could be a source of heterogeneity in the Cochrane review.7Five of the studies included in the Cochrane review used chlorhexidine mouthwash in addition to scaling and root planing (SRP) in the intervention groups.7 of RCTs evaluating SRP in relation to birth outcomes, classifying the studies by whether the intervention additionally included chlorhexidine mouthwash. We then conducted a subgroup meta-analysis by chlorhexidine use.To test this hypothesis, we updated a recently conducted Cochrane reviewCRD42022307420). The study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline.We submitted the protocol to PROSPERO  with or without chlorhexidine mouthwash vs no periodontal treatment or mouthwash use during pregnancy, ascertained birth outcomes, and reported preterm birth  or low birth weight . RCTs evaluating the effect of mouthwash alone on birth outcomes were not included.7 and updated the search using the search criteria in that report from October 2016 through March 2022. With the help of a medical librarian, we conducted the search in the Cochrane Oral Health’s Trials Register, Cochrane Pregnancy and Childbirth’s Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE Ovid, Embase Ovid, LILACS BIREME Virtual Health Library , US National Institutes of Health Ongoing Trials Register , and the WHO International Clinical Trials Registry Platform. Details of the search terms and strategy are provided in the eAppendix in We included all the studies in the 2017 Cochrane review on this topic conducted by Iheozor-Ejiofor and colleagues23 After removing duplicates, 2 reviewers (R.D.G. and M.A.) independently reviewed the titles and abstracts using prespecified criteria and selected full articles for review. The reviewers sorted out disagreements on study selection through discussion. The final set of studies to be included in the meta-analysis were evaluated for risk of bias.Search results were entered into Rayyan software.12 excluded individuals who were lost to follow-up and preterm births that were planned. We included all participants who were randomized and spontaneous or planned preterm births in the López studies,12 while the Cochrane review7 included just unplanned preterm births reported in the López et al studies.The number of events and total number of participants by intervention group (SRP with or without chlorhexidine mouthwash vs no treatment or mouthwash use) were entered into Excel (2010 release) spreadsheets (Microsoft) for preterm birth and low birth weight separately. We also collected information about chlorhexidine use and year of study. The studies conducted by López and colleaguesStudy quality was determined by the Cochrane Risk of Bias 2 tool. Two investigators (A.T.M. and R.D.G.) independently reviewed all 12 studies for bias using the Risk of Bias 2 template and arrived at a single measure following discussion.Q-statistic with a 2-sided P < .05 to evaluate a common association across the studies.Log risk ratios of the effect sizes were summarized with random-effects models using Stata software version 17 (StataCorp). Subgroup analyses by chlorhexidine use were conducted. The log risk ratios and summary measures were exponentiated before displaying the results in forest plots. Publication bias was assessed using a funnel plot. The risk of bias plot was prepared using R statistical software version 4.2.1 . We used the We repeated the analyses using the preterm definitions in the Cochrane review. To evaluate the excess influence of any one study we repeated the main analyses for preterm with Stata’s leave-one-out option. Data were analyzed from May 18 to August 25, 2022.29 with 5735 participants evaluating preterm birth (<37 weeks); chlorhexidine mouthwash was used in 5 of those studies15 (with 2570 participants) and not in 7 studies29 (with 3183 participants). There were 8 studies with 3510 participants evaluating low birth weight (<2500 g), including 3 studies14 that used chlorhexidine (with 594 participants) and 5 studies29 that did not (2916 participants). Details of the studies are described in the 29 that were consistent with a strong protective effect had the larger standard errors . In subgroup analyses, a lower risk of preterm birth was observed when chlorhexidine was added to the treatment of maternal periodontitis , but there was no association when chlorhexidine was not included in the treatment . The risk estimates in the subgroups were different ; there was evidence of heterogeneity within the chlorhexidine subgroup  but not in the no-chlorhexidine subgroup  ; however, there was evidence of heterogeneity across the studies (P = .10) .Q7 = 15.19; P = .03). Periodontal treatment was associated with lower risk of low birth weight when chlorhexidine was included  but not alone . There was no evidence of heterogeneity within the subgroups . The test of difference in the chlorhexidine vs no chlorhexidine subgroups was Q1) = 5.55 (P = .02) , but there was evidence of heterogeneity across the studies (P = .02) .12 as in the Cochrane review . After correction for bias, the intention-to-treat analyses changed from an odds ratio of 1.14  before correction to 0.94 .9 In another large study evaluating this question among 1078 participants, there were 4 stillbirths during follow-up, all of which were in the control group.15 The probability of this happening by chance is 0.0625. We were unable to correct for this bias because we did not have access to the primary data for the study. In both of these studies, the investigators pointed out these potential limitations, but bias correction was not done in these or any of the other studies, which could have underestimated any potentially beneficial effect of the intervention.This study has some limitations. One limitation was that all the RCTs included in this analysis were susceptible to survival bias, which occurs if the intervention benefits both the outcome and fetal survival.15 in Australia among mostly well-educated White participants with possibly less severe periodontal disease, the remaining 4 studies that used chlorhexidine mouthwash were conducted in less affluent communities among participants with poor oral health, possibly contributing to heterogeneity. Indeed, such observations have been interpreted to suggest that individuals at higher risk of adverse pregnancy outcomes due to income inequality and racial and ethnic disparities32 or residence in low-resource settings33 may differentially benefit more from interventions targeting reductions in oral infection and inflammation.35Another limitation was that adherence with chlorhexidine mouthwash was not reported in any of the studies. In 3 of 5 studies evaluating preterm birth, the investigators provided the participants chlorhexidine mouthwash, while in the other 2, participants were advised to use it. This could be a source of heterogeneity in the studies that used chlorhexidine. Another methodologic shortcoming of the RCTs was that they varied in size and were too small for assessment of potential effect modification by other factors, such as oral health status at baseline, which could help identify participants most likely to benefit from the intervention if it was indeed effective. Apart from the study conducted by Newnham and colleaguesF nucleatum is associated not only with periodontitis prevalence36 and progression,37 but also with chorioamnionitis,39 preterm birth,41 stillbirth,42 neonatal sepsis,43 and preeclamplia.44 In adverse pregnancy outcomes, F nucleatum has been isolated from the amniotic sac, fetal membranes, cord blood, fetal lung, neonatal gastric aspirates, and stomach.48 Infective strains of F nucleatum produce protein adhesion A, which binds to vascular endothelial cadherin, increasing endothelium permeability, allowing F nucleatum and other organisms to enter the systemic circulation.49 In the placenta, F nucleatum with protein adhesion A increases permeability of the vascular endothelium of the umbilical blood vessels, making a pathway for it to enter the amniotic sac.50 In a double-blind placebo-controlled RCT, an intervention consisting of chlorhexidine and cetylpyridinium chloride mouthwash reduced dental plaque, gingival bleeding, and counts of F nucleatum and Prevotella intermedia in 3 months among individuals with moderate to severe periodontitis who were unable to maintain good oral hygiene.17 A Cochrane review16 of RCTs evaluating chlorhexidine mouthwash as an adjunct to mechanical oral hygiene found that chlorhexidine use was associated with less dental plaque, gingival bleeding, and gingival inflammation over 4 to 6 weeks among individuals with periodontal disease. In a crossover trial, chlorhexidine mouthwash increased abundance of Firmicutes and Proteobacteria  and reduced content of Bacteroidetes, Saccharibacteria, SR1, and Fusobacteria  among individuals without periodontal disease.19 Cetylpyridinium chloride mouthwash without mechanical oral hygiene reduced preterm birth in pregnant individuals with periodontal disease who were at high risk of preterm birth,21 and it reduced risk of premature rupture of membranes without affecting preterm birth in another RCT.20 Thus, the addition of an antimicrobial mouthwash, such as chlorhexidine, could enhance the protective effect of SRP in adverse birth outcomes. This may explain why conventional periodontal treatment was associated with favorable birth outcomes when combined with chlorhexidine use but not otherwise. Despite weaknesses in the RCTs included in this review, it is possible that a true causal effect may also be present.It is plausible that beneficial effects of chlorhexidine on the microbiome, oral health, and on the effectiveness of SRP may also account, at least partially, for the differences in results between studies including chlorhexidine and those that did not. The findings of this systematic review and meta-analysis are consistent with the hypothesis that adding chlorhexidine to conventional treatment of maternal periodontitis has a protective association in preventing adverse birth outcomes. The risks of preterm birth and low birth weight were lower in the subgroups in which chlorhexidine mouthwash was added to conventional periodontal treatment vs when it was not.F nucleatum in preterm birth and the effectiveness of chlorhexidine, suggest that treating maternal periodontal disease with a combination of an antimicrobial mouthwash and conventional periodontal treatment may improve birth outcomes.A large, well-conducted RCT evaluating a combination of antimicrobial mouthwash and periodontal treatment in relation to birth outcomes would answer this question. However, such a study has not been conducted, to our knowledge. Our findings, taken together with emerging evidence of the role of


Predicting birth weight and identifying its risk factors are clinically important. This study aims to use interpretable machine learning to predict birth weight and identity important predictors.This prospective cohort study was conducted in Tongzhou Maternal and Child Health Care Hospital of Beijing, China, recruiting pregnant women between June 2018 and February 2019. We used 24 features to predict infant birth weight, including gestational age, mother's age, parity, history of macrosomia delivery, pre-pregnancy body mass index (BMI), height, father's BMI, lifestyle , and biomarker (fasting glucose and lipids) features. Study outcome was birth weight of infant. We used 8 supervised learning models including 4 individual , and 4 ensemble estimators  to predict birth weight. Model accuracy was measured by root mean squared error (RMSE) of 10-fold cross validation on the training set and RMSE of prediction on the test set. We used permutation importance algorithm to understand the prediction from the models and what affected them.This study included 4,754 mother-child dyads. RMSEs were lower in voting ensemble for regression, linear regression, and SVR than random forest, AdaBoost, and gradient boosted tree. The 5 most important predictors for infant birth weight were gestational age, fetal sex, preterm birth, mother's height, and pre-pregnancy BMI. After adding ultrasound-measured indicators of fetal growth into predictors, mother's height and pre-pregnancy BMI remained the most important predictors in predicting the outcome.Mother's height and pre-pregnancy BMI were identified as important predictors for infant birth weight. Interpretable machine learning is a promising tool in the prediction of birth weight. Prediction of birth weight is clinically important. In the short term, low birth weight increases the risk of stillbirth, preterm birth, intrapartum-related events, and neonatal death ; in the Genetic, environmental, and gestational factors can affect the size of birth weight. Complex non-linear relationship or interactions might exist in high-dimensional data, making it difficult for conventional linear models to accurately predict birth weight. Machine learning methods, widely used in biomedical research , might bMachine learning is analogous to “a black box” due to its unintuitive interpretability in early years. Recent progress in methodology has made machine learning both predictable and interpretable , 8. Thishttps://clinicaltrials.gov/, NCT03814395), and aimed to study the health effects of pre-pregnancy and prenatal exposures on mother-child dyads. Pregnant women were recruited between June 2018 and February 2019 at baseline. Eligibility criteria were: (1) aged 18–45 years; (2) <14 weeks of gestation; (3) living in Tongzhou District during the past half year and not planning to move out of Tongzhou District after delivery; (4) planning to receive prenatal care and give birth in Tongzhou Maternal and Child Health Hospital. A total of 5,426 eligible pregnancy women were recruited into the cohort. Ethical approval of the study was granted by the Peking University Institution Review Board (IRB00001052-18003). Written informed consent was obtained from all participants.The Peking University Birth Cohort in Tongzhou (PKUBC-T) was a prospective cohort study conducted in Tongzhou Maternal and Child Health Hospital of Beijing, China. This cohort was prospectively registered in ClinicalTrials.gov , excluded those with diabetes or hypertension prior to pregnancy (n = 44), and finally included 4,754 mother-child dyads.For the present study, we included pregnant women with singleton live births (2), height (cm), father's BMI (kg/m2), family income last year (yuan), smoking in the last 3 months , dietary energy intake per day , alcohol consumption , number of days performing moderate to vigorous physical activity (MVPA) per week. Information of 6 predictors were collected from the hospital information system with vigorous quality control: gestational diabetes , gestational hypertension , eclampsia/preeclampsia , preterm birth , gestational age, and fetal sex . Information of the other 7 predictors were collected from blood samples, including fasting plasma glucose concentrations (mmol/L) and 25(OH)D3 (ng/mL) measured between 24 and 28 gestational weeks, fasting concentrations of triglyceride (mmol/L), cholesterol (mmol/L), hemoglobin (g/L), thyroid-stimulating hormone , and free thyroxine  measured in the first trimester . In the sensitivity analyses, we added ultrasound-measured indicators of fetal growth  collected before 14 gestational weeks as the predictors.We selected predictors (features) based on literature review of studies on this topic , 9. We fStudy outcome was infant birth weight. We obtained it from the hospital information system in Tongzhou Maternal and Child Health Care Hospital of Beijing.We used a tool of scikit-learn 0.24  to conduWe first preprocessed data  was used to measure the accuracy of the model. Lower value of RMSE indicated better performance of the model.i-th sample, and  by the permutation-based method in two steps. First, a baseline score (RMSE) was calculated for the final model. Second, a feature is permutated (randomly shuffled) from the dataset to break the association of the feature with the target, and the model evaluation score was calculated again to obtain the permutation score. The second step was repeated for 50 times. The permutation-based feature importance was calculated as the mean difference between the baseline score and the permutation score; that is, a larger difference indicates the higher importance of the feature in the model. We also used partial dependence plots to visualize the direction and size of associations  between the outcome and the inputted features, marginalizing over the values of all other input features. The interpretability methods used above were all carried out on the test datasets.The average infant birth weight was 3362.0 g [standard deviation (SD): 471.8]. The description of study sample is shown in n = 275), except that the predictor of preterm birth was replaced by the history of macrosomia , and more importantly, the studies did not interpret results from machine learning models by calculating feature importance or plotting partial dependence plots. Another study  identified in this study have been validated in other studies in the independent study samples, thereby supporting the validity of the models. First, a cross-sectional study involving 1,511 children (<10 years) in Brazil found that low maternal stature was associated with low birth weight . Second,The study had several strengths. First, this is a prospective cohort study, making the association between predictors and birth weight less likely to be inversely causal. Second, this study included many predictors covering not only maternal demographic features, but also father's BMI, and important biomarkers such as hemoglobin, lipids, and glucose, et al. Third, the study used feature importance algorithms and partial dependence plots, increasing the interpretability of machine learning models.Nevertheless, the study also had some limitations. Sample size of this study was not large enough to accurately fit more parameters in machine learning models as compared to conventional regression models. This might at least partly interpret the unsatisfactory accuracy of the model measured by RMSE (≈370), which means the mean difference between predicted and true values is 370 gram (accounts for 11% of the mean birth weight). Additionally, findings from this pilot study should be interpreted cautiously, and the results will be tested in an external independent dataset in the future.Considering complex relationship inherent in pregnancy predictors, researchers have called for using both linear regression and other machine learning algorithms in the prediction of pregnancy outcomes. Our study stands for a first step towards the application of machine learning algorithms into prediction of birth weight. Findings of our study indicate that machine learning algorithms are feasible in the present prediction task. Using more features and trying more combinations of hyperparameters in a larger sample can establish a more accurate prediction model in the future. This method may have important practical significance in predicting fetal growth during pregnancy.Mother's height and pre-pregnancy BMI were identified as important predictors for infant birth weight. Interpretable machine learning is a promising tool in the prediction of birth weight.


The usage of near-infrared (NIR) fluorescence imaging with indocyanine green (ICG) has gained popularity in many procedures in pediatric surgery. ICG generates fluorescent light only when it combines with a protein. We herein report a novel technique for detecting pancreaticobiliary maljunction (PBMJ) with co-injection of bile and ICG in laparoscopic choledochal cyst resection and hepaticojejunostomy for a pediatric patient. A 4-year-old girl presented with abdominal pain and intermittent vomiting. Enhanced computed tomography and magnetic resonance cholangiopancreatography showed a 17-mm type Ia choledochal cyst. Definitive PBMJ was not detected preoperatively. Laparoscopic choledochal cyst resection and hepaticojejunostomy were performed using five ports. A percutaneous silicon catheter was inserted into the gallbladder, and bile juice was aspirated. The amylase level of the bile juice was over 3 × 105 IU/L. The aspirated bile juice and ICG were mixed and co-injected into the gallbladder through the catheter. ICG combined with protein in bile juice and generated fluorescent light. Dilated common bile duct and pancreas were detected by NIR fluorescence imaging. This imaging technique was helpful for detecting the dissection margin of the distal side of the choledochal cyst inside the pancreatic tissue and preventing injury of the pancreatic tissue. This is the first case of ICG application for laparoscopic choledochal cyst resection in a pediatric patient. After resection of the choledochal cyst, laparoscopic hepaticojejunostomy was completely performed. Our technique is a safe and low-invasive method of detecting and excising the distal side of the cyst without a risk of radiography and residual bile duct. Previous research has confirmed that patients with choledochal cysts have an elevated risk of cholangiocarcinoma. Complete choledochal cyst excision is necessary to prevent cholangiocarcinoma.The use of near-infrared (NIR) fluorescence imaging with indocyanine green (ICG) has gained popularity in many procedures in pediatric surgery.Because ICG generates fluorescent light only when it combines with serum proteins, it is usually injected into a vein.First, we mixed ICG and bile ex vivo and performed observation using a near-infrared/ICG camera . Bile extracted from another patient who underwent laparoscopic cholecystectomy was mixed with ICG at various concentrations. The strongest fluorescence image was obtained with a mixture of 30% ICG and 70% bile, so we planned to use this concentration for laparoscopic choledochal cyst excision.A 4-year-old girl presented with abdominal pain and intermittent vomiting. Enhanced computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP) showed a 17-mm type Ia choledochal cyst according to the Todani classification ,1B. D2insufflation. Three additional trocars and a 2.4-mm needle-type grasper  were inserted into the right upper abdomen  and at the right side of the umbilicus , the left lateral abdomen , and left upper abdomen .Laparoscopic choledochal cyst excision was performed using five ports. Under general anesthesia, the patient was placed in a broad base position, and a 10-mm 30° laparoscope was inserted through an umbilical incision along with a trocar with a multichannel port device . Pneumoperitoneum was established with 8-mm Hg CO5IU/L, and PBMJ was suspected. Bile juice and ICG  were mixed with the same concentration of ex vivo experiment and co-injected into the gallbladder through the catheter (After dissecting the dilated common bile duct, a percutaneous silicon catheter was inserted into the gallbladder, and bile juice was aspirated. The amylase level of the bile juice was over 3 × 10atheter . The diatheter . InjuryBecause this was our first case using this technique, we also confirmed PBMJ with intraoperative cholangiography using iodine contrast agents. The distal side of the choledochal cyst was transected safely just above the junction based on the findings of ICG imaging and cholangiography ,2D. TThe postoperative course was uneventful, with no complications reported. She was discharged on postoperative day 13. No complications occurred 4 months after the operation.We have reported several techniques for laparoscopic choledochal cyst excision and hepaticojejunostomy in pediatric patients.Only one case of ICG fluorescence imaging in an adult choledochal cyst excision using the da Vinci system has been reported.Regarding the long-term complications derived from the remnant of the cyst, the development of malignancy following choledochal cyst excision has been reported. Cholangiocarcinoma occurs at various locations, including the remnant of the cyst and intrapancreatic duct.ICG fluorescence imaging has been described as ICG combined with protein-generated fluorescent light.We report for the first time a novel technique for detecting the distal side of a choledochal cyst and possible PBMJ via the co-injection of bile and ICG in laparoscopic choledochal cyst excision and hepaticojejunostomy for a pediatric patient. This technique is very useful and can help determine the transection level of the distal side of the choledochal cyst without radiography.


U.S. Hispanic teens experience higher rates of unintended pregnancy than white teens. Limited research has been done to explore the sociocultural factors that impact Hispanic teens and their decisions about birth control and long-acting reversible contraception (LARC). The theory of planned behavior served as a framework for this study and teen perspectives about contraceptive decision making. This study aimed to identify the sociocultural factors that impact Hispanic teens when they make decisions about birth control and LARC.We interviewed Hispanic teens from school-based health centers in New Mexico during their schedule medical appointments. Interviews were audio recorded, transcribed, and coded using content analysis coding methods and a descriptive qualitative design.A total of 20 Hispanic teens participated in this study, all were female and between the ages of 14 and 19 years.Five themes emerged from the analysis process that impact Hispanic teen contraceptive choice, these are family, religion, culture, peer influence, and other factors.Among both LARC and non-LARC groups, peer influence was the most frequently cited reason for contraceptive decision making. Relationships with family were cited as barriers for Hispanic teens, where lack of communication and abstinence-only beliefs made it difficult to seek contraception. Findings demonstrate that teens selected LARCs because of the impacts on menstrual cycles and clinician influence. Teens who did not self-select LARC discussed ease of protection and the utilization of birth control as a transition to LARC. Teen pregnancy and birth create health,5 educational,7 financial,8 psychological,9 and cultural barriers to success for teen mothers and children. Teen mothers experience disparities across a wide range of health and well-being indicators.Nearly half of American teenagers (4 million) are sexually experienced.10 Disparities caused by age, ethnicity, poverty, and discrimination create barriers to medical care and receipt of social services, education, and employment.Many of these disparities may be due to lack of alignment between postnatal behavioral health care and social services for teenage mothers that leads to poor engagement in services and subsequent poor outcomes. More than half of teen mothers experience postpartum depression, by far the highest rate of any new mothers.12 Teens from single-parent households, those who are born to a mother who had her first child in her teen years, and those whose mothers do not have a General Education Diploma are more likely to initiate sexual activity.4 Hispanic males are less likely to report using contraception at first time having sex than white counterparts and Hispanic females are much more likely to rely on condom use alone  during their last sexual encounter.4 Pregnancy rates for Hispanic teenagers are at least twice as high as they are for non- Hispanic white teenagers.9There are significant health disparities in unintended and teen pregnancy, with poorer women and women of color experiencing significantly higher rates.2 Although rates of teen pregnancy are decreasing nationally, disparate reductions have been found in NM. In NM, 84% of teen births are to Hispanic and Native American women.13 In our own pilot study with predominately Hispanic teens receiving primary care services in NM, 69.7% are sexually active and 36.8% report past year unprotected sex.14 The study explored decisions of contraception to gain cultural knowledge of external influences that effect teen pregnancy.New Mexico (NM) has one of the highest rates of teen pregnancy in the nation, with 8% of teen women becoming pregnant in a given year.15 With pregnancy rates of <0.01%, LARCs have the potential to transform reproductive health care and dramatically decrease rates of unintended pregnancy. Both the American Academy of Pediatrics and the American College of Obstetrics and Gynecology recommend LARCs as the first-line contraceptive choice for adolescents who choose to be sexually active.16Long-acting reversible contraceptives (LARCs), such as implants and intrauterine devices (IUDs), are the most effective forms of birth control. LARC methods are safe, easy to use, long lasting, easily reversible, highly acceptable among patients, have limited contraindications for use, and are >20 times as effective as oral contraceptive pills.4 Among multilevel factors currently known to impact LARC use, the primary factors appear to be knowledge, access, and cost. The Contraceptive CHOICE Project demonstrated that providing women with education and access to LARCs promotes LARC use and decreases rates of unintended teen pregnancy and abortion.16 In this prospective cohort study, 10,000 women who wanted to avoid pregnancy for at least 1 year were read a brief script regarding LARCs and offered an array of contraception options at no cost.Despite these strong recommendations, to date, only 5.8% of sexually active female teenagers nationally have used a LARC method.17 However, there is a gap in the current literature about LARCs and decision making among Hispanic teens and young women.Sixty-seven percent (67%) of women who received the CHOICE intervention chose an LARC method. Several factors have been found to impact uptake of LARCs across age groups, including access, cost, and knowledge provided in a health clinic setting.18 Several qualitative studies and a few quantitative studies suggest high levels of LARC misinformation and concerns about side effects among Hispanic women.19Unfortunately, little is known about the psychosocial factors that may impact decision making and serve as elements that could be targeted through intervention, especially for adolescents. A continuous premise has been that multilevel contextual factors such as cultural values, attitudes, and acculturation may impact LARC decision making, but there has been little empirical work to inform this assumption.20In addition, many Hispanic teens report a perceived disconnect with health systems and providers impacting their willingness to access and engage in care. Previous research suggests that Hispanic teens feel judged for their reproductive health choices and feel the single birth control option is being pushed on them.21 The TEMPO intervention invites teens to think critically about the impact an unintended pregnancy could have on their lives, including how it would affect important life domains such as family and social relationships, education, employment, and independence.In our prior study, we demonstrated that a motivational interviewing brief intervention called TEMPO (Teens Exploring and Managing Prevention Options) delivered in a health care setting decreases rates of unprotected sex among teens at risk for unintended pregnancy.21 serve as a call to action to investigate barriers and facilitators to reproductive health faced by Hispanic adolescents. Such information could be invaluable in helping generate a multilevel culturally appropriate intervention to increase LARC uptake and reduce the occurrence of unintended teen pregnancies among Hispanic teens.Such an intervention could be enhanced by increased knowledge regarding the multilevel contextual factors impacting decision making around LARCs. Knowledge about such factors could also inform the development of interventions that occur outside of health care settings across multidimensional levels of influence within the community. Rates of unintended teen pregnancy in NM, combined with disparities between Hispanic and white populations,22 This study utilized a descriptive qualitative design.We used the theory of planned behavior (TBP) to explore perspectives and experience of Hispanic teens selecting birth control at a school-based health center. The TBP has been used previously with Hispanic teens to explore how motivations impact behavioral intentions and the proceeding behaviors.Female Hispanic teens attending a school-based clinic for first-time contraception counseling were invited to participate in a face-to-face interview after their visit, to discuss their motives for either accepting or refusing an LARC. The study recruited young women who accepted LARC and those who chose another form of contraception other than LARC. LARC can be defined as IUD or/and birth control implant.Inclusion criteria were self-reported Hispanic ethnicity, ages 14–19 years, presenting to a primary care clinic for a first-time reproductive health care contraception counseling visit, and being able to read and speak English or Spanish. Exclusion criteria were self-reported pregnancy or pregnancy discovered during optional contraception consultation, expressed suicidality, obvious cognitive impairment, or inability to provide informed consent.A research assistant in the waiting or examination room approached all female patients attending the clinic for reproductive health services. The research assistant asked the patient whether she was interested in learning whether she was eligible to participate in a study. Interested patients were given a brief self-administered screening instrument on an iPad using secure data capture software that assessed inclusion/exclusion criteria. Patients who were not eligible were told so and thanked for their willingness to be screened.Participants who met eligibility criteria were informed that they may be eligible for participation and asked whether they wanted to learn about the study. After the patient's medical visit, a research assistant entered the examination room and described the study to the patient using a brief recruitment script. Patients interested in participating completed an informed consent document.2 Participants consented to study participation on their own and a waiver of parent permission was granted by the University of New Mexico Internal Review Board (IRB). This study was submitted and IRB approved as a modification to the larger TEMPO project protocol (No. 18-375).All medical contraception consultation services provided to research participants in this study were confidential and did not require parental permission consistent with the state of NM law that allows minors 13 years of age and older to receive services without consent.An interview guide was drafted and adapted with input from the study team, mentors, and a literature review focused on factors impacting LARC adoption. The study was designed and analyzed by an interdisciplinary team including teens from the community, a community member working with expectant and parenting teens, a family physician focused on adolescent health, a clinical psychologist, and public health and qualitative research experts. The guide was developed using the framework of intersectionality and integrated questions informed by socioecological concepts such as power, social policy, cultural values, income, education, occupation, family, social class, gender, and race/ethnicity.The interview began in an open manner in which participants were asked for their main reason for choosing or not choosing an LARC. Once no new information emerged from the open questioning, we continued with the semistructured guide, to cover all aspects that might have contributed to the decision-making process.23Interviews were transcribed and analyzed by members of the research team. Members of the qualitative research team independently read transcripts from sets of two to three interviews, then met together to develop an initial coding structure from the transcripts. The team met on a biweekly basis to review each of the initial nominal codes collectively, identifying commonalities and resolving discrepancies resulting in a preliminary organizing scheme. Once a set of codes for the first group of transcripts was agreed on, analysts applied the organizing scheme to each of the transcripts using the conventional content analysis technique.A total of 58 adolescents agreed to be screened for the study: 20 were enrolled and 38 were ineligible. Ineligibility was due to not being Hispanic, not being within the study age range, or not attending the clinic to discuss contraception with a provider for the first time. Participants were interviewed immediately after their appointment to make birth control decisions, so their motivations and experiences are reflected in real time.Seven themes emerged from the analysis process. Themes were often cited as motivators for choosing a specific birth control method among a majority of participants in each group. Three themes and two subthemes were identified among both LARC and non-LARC users, two themes were found among LARC users only, and two additional themes were discussed among non-LARC users only.For both LARC and non-LARC users, peer influence, relationship with family, and side effects played a crucial role in birth control decisions.Participants almost always mentioned a friend, cousin, or sister who supported them in their contraceptive decision or educated them about different birth control options. Participants were often more likely to receive the birth control a peer had recommended or used beforehand as long as the peer's experience with the contraceptive was relatively painless and they cited it as being effective.[my friend] told me she was on the shot. She gave me the idea to come and get the shot here at the clinic. (Participant #2) (birth control shot)I was like nope, I'm not going to get it. But then, I talked to one of my friends and she was like no, it's a good step. She talked me through it. (Participant #21) (arm implant)My resources are just like my experiences with the people that I've talked to. (Participant #25) (IUD)However, misconceptions regarding the side effects of birth control were often spread through this peer influence.[my friend] has the shot too. I talked to her about it. I was like can you let me know? She was like you are going to get hungry. You are going to start to gain weight. I was like I don't want to gain weight. (Participant #6) (birth control shot)Support from a peer may have been so essential to the teen's contraceptive choice because they often faced opposition from one or both of their parents. The Hispanic adolescents within our study discussed familial beliefs surrounding abstinence and premarital sex as barriers to candid conversations about sex. Most teens found it difficult to conduct these conversations with their parents or older family members because it was seldom discussed within the family and considered taboo.I don't want to talk to them about [sex] because it's really uncomfortable for me talking to my parents. (Participant #2) (birth control shot)Don't have sex until you are older. That's all [my parents] really tell me.. . They don't really mention birth controls or what is going to happen after. They just tell me that I'm going to have a kid and I'm not going to be able to support [it]. (Participant #8) (Plan B)Teens who felt comfortable discussing sexual issues with their family members sometimes found support from a female relative such as an aunt, sister, or, less frequently, a mother. Feelings of wanting to live up to a parent or family member's expectations encouraged them to seek out birth control.I really talk to my mom about everything. .. She's really the one that's impacted me. But like I said, since I am having unprotected sex, I don't want to accidentally mess up and I don't want that feeling of disappointment from my parents. (Participant #4) (arm implant)In addition, whether or not teens were able to discuss sexual issues with their mother, they often expressed regret that their mother was unable to give them advice about a specific contraceptive option.I think that if I was with my mom and she knew that I was getting birth control, I would have gotten that, the arm one. .. it's just safer. (Participant #6) (birth control shot)I just really need [my mom's] approval. Like I feel that I can get any of these or whatever the doctor suggests for me. But like I need her approval. I can't do it confidential. (Participant #8) (Plan B)Both LARC and non-LARC users received misinformation about contraceptives, whether it was through a peer or the internet. Most often these misconceptions centered around side effects and the impact birth control has on the user's health.A lot of girls complain about weight gain and their periods. You know, a lot of people are like, oh I don't have my period. That's really unhealthy. (Participant #40) (arm implant)Hispanic teens struggle to make informed decisions about birth control due to a perceived communication disconnect between them and their clinicians, coupled with misinformation spread by peers and the internet.I was talking about getting birth control and [my doctor] would be like well, you are at a young age. Why would you do that to your body? (Participant #45) (birth control shot)My resources are just like my experiences with the people that I've talked to. (Participant #25) (IUD)Because from what I heard many women that are on the pills become infertile or they have to take the pill every day and I would forget. (Participant #16) (birth control shot)Those who chose an LARC discussed their menstrual cycles and period symptoms as reasons for getting the contraceptive. Often, the idea of reducing the pain of cramps or getting a lighter period was a large motivator in getting an LARC. This was more frequently mentioned among LARC users, whereas non-LARC users often mentioned their menstrual cycles in relation to confidentiality.I care because like I don't want my mom suspecting like oh, why haven't you gotten your period? Yeah. (Participant #45) (birth control shot)Clinician influence was frequently mentioned in that clinicians played a pivotal role in giving reassurance to and validation of the teen's contraceptive decision. This said, a clinician could often not dissuade a teen once they chose a form of contraception.My healthcare provider, she was really sweet and she went through everything and what everything did, how long it lasted, the positive and negatives of each and every birth control possible. (Participant #57) (arm implant)Those who chose a non-LARC option mentioned ease of protection and a need for a transition into LARC. The idea behind “transitional birth control” was that users could experiment with the hormone levels and side effects of non-LARC contraception before receiving the more daunting LARC.Non-LARC users discussed ease of protection in that hiding their use of birth control was cited as a crucial factor in their overall decision. Adolescents often needed to hide their use of birth control from disapproving parents who had differing beliefs about abstinence and birth control.I wanted to get on birth control but I'm just afraid my mom is gonna find out somehow. (Participant #8) (Plan B)The birth control I chose today was the shot.. . I spoke to my mom about having birth control.. . she said, you are not ready. .. so, I decided that maybe I should get something that won't last too long. That way she won't find out. (Participant #6) (birth control shot)Those who mentioned ease of protection frequently discussed their concerns surrounding their periods. A birth control that made them lose their periods was not ideal because some of the participants had mothers who tracked their menstrual cycles or would notice not having to buy tampons, pads, or other sanitary supplies for their daughters.I had a lot of concerns about my period because. .. [my mom is] usually on that like when I'm on my period. Do you need pads or do you need...? I was very concerned because my mom asks a lot about it. (Participant #6) (birth control shot)The birth control shot was often cited as a useful transition into LARC use. Adolescents wanted to use birth control shot and other contraceptives to observe how their bodies would react to hormonal birth control and whether LARC would be a better option in the future.I think it's better to get the injection first to see how I react and then I will get the implant. (Participant #16) (birth control shot)When I run out of the pills, I might come back and get an implant or one of the IUDs. (Participant #7) (birth control pill)Findings given in 22 findings suggest that motivators about contraceptives include: teen attitudes, beliefs of LARC and non-LARC, family normative beliefs around abstinence and birth control, and subjective norms. School-based health clinics gave Hispanic teens autonomy and perceived control over their contraceptive selection.One of the major takeaways of this study is understanding motivators among Hispanic for their choice of birth control. Using the theory of planned behavior as a guidePeer influence was the most frequently cited reason for contraceptive decision making among both groups. Relationships with family were barriers and supports for Hispanic teens, where some report the lack of communication and abstinence-only beliefs made it difficult to seek contraception. Hispanic teens were concerned about side effects from birth control and received misinformation from the internet and their peers, this calls for improved evidence-based culturally-centered communications about the side effects of LARC and non-LARC methods.LARC users were concerned about their menstrual cycle and symptoms, along with clinician influences. Non-LARC users expressed transitional birth control strategies and ease or protection, where Hispanic teens could hide their use in birth control because they would have menstrual cycles.Findings from this study are not generalizable to other populations or school-based health settings. A limitation is that interviews were conducted to teens who were already seeking contraceptive counseling. A public health policy hurdle is to get teens into the clinic and due to the setting of the study, the data did not capture the perspective of teens who have not scheduled an appointment. Also, a limitation is the school-based health clinic's policy of providing confidential birth control services. This may have resulted in a higher recruitment of teens who wanted to hide their birth control decisions from their parents, and their reasons for choosing LARCs may have been different than those of teens who did not use LARCs.24 Another limitation is time, where recruitment and interviewing occurred during a school year and provide a description based on the students enrolled during that time period. Larger studies that explore LARC and non-LARC decision making and satisfaction with contraceptive selection are also needed. Even with these limitations, the findings fill a gap in the current contraceptive literature about Hispanic teens.Social desirability bias is a limitation that we acknowledge, where Hispanic teens may have responded to interview questions based on what they viewed as most desirable by the interviewer.25; however, in this study, parental communication was limited. In the absence of parental support, school-based confidential health centers like the one presented in this study give teens autonomy in their selection of a birth control method that is best for their bodies and lives .Hispanic teen's need access to contraceptive services. Subjective and normative beliefs about sexual relationships and behaviors among Hispanic teens impact their decision-making process. Family and parent communication around sexual behavior influences teen decisions to use birth control26 Possible future study may include developing strategies to communicate accurate and reliable information to Hispanic teens. Policies that support school-based health centers and confidential birth control must be expanded to all states, and for all populations, especially groups such as Hispanic teens who experience higher rates of unintended pregnancies.Although some studies have reported discrimination within the health care setting, especially when it comes to accessing birth control, participants in this study did not report experiences of discrimination. A major strength of this study was that the interviewer was a young Hispanic woman and able to speak Spanish. Previous studies suggest that culture match is essential in the interview process with Hispanic populations.This is the first study that we are aware of that explores contraceptive selection of LARC and non-LARC methods in a Hispanic teen population in NM. Findings underscore the need for continued efforts to promote evidence-based health communication strategies and culturally matched interventions for Hispanic teens.


The birth premature babies with hypoxic-ischemic damage to the neutral system with the subsequent development of hypoxic encephalopathy (HIE). Monitoring of the mental development and neurological status of such prematurely born children is carried out taking into account the corrected age and traditional scales.To compare indicators of psychomotor development in preterm infants  with and without hypoxic-ischemic encephalopathy.A prospective study was carried out in the neurological department. The study included data from infants with a gestational age of < 32 weeks of gestation. Scale score immediately after birth and at corrected ages in the first, third and sixth months of life .rd (80% of children) and 6th months of life, there were no statistically significant differences in psychomotor development between groups with and without hypoxic-ischemic encephalopathy.Data from 95 newborns were eligible for conclusion. Of these, 67 children took part in the study, 32,8% of them were diagnosed with hypoxic-ischemic encephalopathy. In newborns with HIE gestational age at birth was less so they received parenteral nutrition for a longer time, the body weight gained during the hospital stay was less, they needed more time to switch to enteral nutrition. And only at the 3In this study, it was shown that in premature infants with hypoxic-ischemic encephalopathy, normal indicators of psychomotor development and neurological status were restored at the corrected age only by 6 months of age.No significant relationships.