Re­searchers try­ing to pre­dict pre­ma­ture births

Sec­ond study will de­ter­mine if ex­tremely low-birth-weight pre­emies age faster as adults

The Hamilton Spectator - - LOCAL - JOANNA FR­KETICH

Pre­dict­ing pre­ma­ture labour and pre­vent­ing it be­fore it starts is the fo­cus of a McMaster Uni­ver­sity study.

The im­por­tance of iden­ti­fy­ing preg­nant women most at risk is ev­i­dent in a sec­ond study look­ing at po­ten­tial se­ri­ous health ef­fects of be­ing born too early.

It will de­ter­mine if ex­tremely low-birth­weight pre­emies age faster as adults.

Both stud­ies are among 25 in Canada re­ceiv­ing a to­tal of $1.85 mil­lion from the Cana­dian In­sti­tutes of Health Re­search (CIHR) to spend a year find­ing ways to im­prove health out­comes for ba­bies and moms.

“I think it is a re­ally im­por­tant time in Canada for preterm birth re­search,” said Dr. Sarah McDon­ald, high-risk ob­ste­tri­cian at Hamil­ton Health Sciences and pro­fes­sor of ob­stet­rics and gy­ne­col­ogy at McMaster. “I think we are on the cusp of mak­ing some re­ally big changes that will help to de­crease our preterm birth rate.”

McDon­ald’s study will comb through thou­sands of On­tario births — about six per cent of births are pre­ma­ture when twins or other mul­ti­ples are ex­cluded — look­ing for fac­tors dur­ing preg­nancy, in the mother’s med­i­cal his­tory or dur­ing her other births that could flag those most at risk.

The ul­ti­mate goal is to de­velop tools to help doc­tors and mid­wives pre­dict which women are more likely to have pre­emies.

“The ideal first step would be pre­ven­tion,” said McDon­ald. “The sec­ond step if we can’t pre­vent preterm birth, can we pre­vent some of the con­di­tions that go with preterm birth?”

For the women, it would mean hav­ing the most ap­pro­pri­ate care­giver from the out­set, giv­ing birth in a hos­pi­tal best equipped to care for pre­emies, re­ceiv­ing pre­ven­ta­tive treat­ments to ward off early labour or strengthen a baby’s lungs and be­ing bet­ter pre­pared to han­dle such a trau­matic event.

“If we could un­der­stand bet­ter which women were at risk, we might be able to tar­get care to those women in a dif­fer­ent way and hope­fully im­prove out­comes,” said McDon­ald.

Pre­dict­ing early labour is the next piece in the puz­zle af­ter McDon­ald and a team of 20 in­ter­na­tional col­lab­o­ra­tors de­ter­mined the best way to pre­vent it.

Their re­search pub­lished in April in in­ter­na­tional jour­nal of ob­stet­rics and gy­ne­col­ogy BGOG con­cluded the hor­mone pro­ges­terone worked bet­ter than hold­ing the cervix closed with an op­er­a­tion called cer­clage or a rub­ber ring placed in the vagina called a pes­sary.

“The study was im­por­tant be­cause all three were be­ing used to try to pre­vent preterm birth,” said McDon­ald. “The ques­tion that I and most high-risk ob­ste­tri­cians had was, ‘What is the best way?’”

Pro­ges­terone was found to half the odds of be­ing born be­fore 34 weeks of preg­nancy and half the chance of pre­emies dy­ing in a spe­cial type of meta-anal­y­sis that took two years to com­plete and was funded by CIHR.

McDon­ald says the tablet placed in the vagina once a day could pre­vent as many as one-third of preterm births.

“It’s a re­ally ef­fec­tive method that seems to have no down­sides to it,” she said. “If we can pre­vent it, it’s so much bet­ter than treat­ing the out­come.”

One of those po­ten­tial out­comes is pre­ma­ture ag­ing as an adult.

Hamil­ton re­searchers work­ing with what is be­lieved to be the world’s long­est stud­ied co­hort of ex­tremely low-birth-weight pre­emies ob­served they look older than they should as adults and ap­pear to be ex­pe­ri­enc­ing de­cline in car­diac phys­i­ol­ogy faster.

“The grant will pro­vide us with an op­por­tu­nity to an­swer the ques­tion of whether they are ag­ing more quickly,” said Dr. Ryan Van Lieshout, as­sis­tant pro­fes­sor of psy­chi­a­try and be­havioural neu­ro­sciences at McMaster. “If they are ag­ing faster, it’s very im­por­tant for them and their physi­cians to be aware.”

The study will ex­am­ine 100 pre­emies weigh­ing less than 1,000 grams when born in Hamil­ton be­tween 1977 and 1982 and com­pare them to 89 of their peers born at term.

Re­searchers will not only look at whether their ag­ing is ac­cel­er­ated but why to de­ter­mine if there are ways to slow or pre­vent it.

“More of th­ese ba­bies are be­ing born than ever be­fore and be­cause of ad­vances in tech­nol­ogy more of them are sur­viv­ing than ever be­fore,” said Van Lieshout. “We re­ally want to do this work so we can help them be as healthy as pos­si­ble as they get older … We’re re­ally hop­ing to iden­tify things that are re­versible or things that we can in­ter­vene on to help them age in as healthy way as pos­si­ble.”

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