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Preterm birth interventions – 4 studies found possible vitamin D benefit – Cochrane – Nov 2018


Interventions during pregnancy to prevent preterm birth: an overview of Cochrane systematic reviews.

Cochrane Database Syst Rev. 2018 Nov 14;11:CD012505.
doi: 10.1002/14651858.CD012505.pub2. Not available on sci-hub as of 11/28/2018
Medley N1, Vogel JP, Care A, Alfirevic Z.

BACKGROUND:
Preterm birth (PTB) is a major factor contributing to global rates of neonatal death and to longer-term health problems for surviving infants. Both the World Health Organization and the United Nations consider prevention of PTB as central to improving health care for pregnant women and newborn babies. Current preventative clinical strategies show varied efficacy in different populations of pregnant women, frustrating women and health providers alike, while researchers call for better understanding of the underlying mechanisms that lead to PTB.

OBJECTIVES:
We aimed to summarise all evidence for interventions relevant to the prevention of PTB as reported in Cochrane systematic reviews (SRs). We intended to highlight promising interventions and to identify SRs in need of an update.

METHODS:
We searched the Cochrane Database of Systematic Reviews (2 November 2017) with key words to capture any Cochrane SR that prespecified or reported a PTB outcome. Inclusion criteria focused on pregnant women without signs of preterm labour or ruptured amniotic membranes. We included reviews of interventions for pregnant women irrespective of their risk status. We followed standard Cochrane methods.We applied GRADE criteria to evaluate the quality of SR evidence. We assigned graphic icons to classify the effectiveness of interventions as: clear evidence of benefit; clear evidence of harm; clear evidence of no effect or equivalence; possible benefit; possible harm; or unknown benefit or harm. We defined clear evidence of benefit and clear evidence of harm to be GRADE moderate- or high-quality evidence with a confidence interval (CI) that does not cross the line of no effect. Clear evidence of no effect or equivalence is GRADE moderate- or high-quality evidence with a narrow CI crossing the line of no effect. Possible benefit and possible harm refer to GRADE low-quality evidence with a clear effect (CI does not cross the line of no effect) or GRADE moderate- or high-quality evidence with a wide CI. Unknown harm or benefit refers to GRADE low- or very low-quality evidence with a wide CI.

MAIN RESULTS:
We included 83 SRs; 70 had outcome data. Below we highlight key results from a subset of 36 SRs of interventions intended to prevent PTB.

OUTCOME:
preterm birth
Clear evidence of benefit
Four SRs reported clear evidence of benefit to prevent specific populations of pregnant women from giving birth early, including midwife-led continuity models of care versus other models of care for all women; screening for lower genital tract infections for pregnant women less than 37 weeks' gestation and without signs of labour, bleeding or infection; and zinc supplementation for pregnant women without systemic illness. Cervical cerclage showed clear benefit for women with singleton pregnancy and high risk of PTB only.
Clear evidence of harm
No included SR reported clear evidence of harm. No effect or equivalence For pregnant women at high risk of PTB, bedrest for women with singleton pregnancy and antibiotic prophylaxis during the second and third trimester were of no effect or equivalent to a comparator.
Possible benefit
Four SRs found possible benefit in:

  • group antenatal care for all pregnant women;
  • antibiotics for pregnant women with asymptomatic bacteriuria;
  • pharmacological interventions for smoking cessation for pregnant women who smoke;
  • and vitamin D supplements alone for women without pre-existing conditions such as diabetes.

Possible harm
One SR reported possible harm (increased risk of PTB) with intramuscular progesterone, but this finding is only relevant to women with multiple pregnancy and high risk of PTB. Another review found possible harm with vitamin D, calcium and other minerals for pregnant women without pre-existing conditions.

OUTCOME:
perinatal death
Clear evidence of benefit
Two SRs reported clear evidence of benefit to reduce pregnant women's risk of perinatal death: midwife-led continuity models of care for all pregnant women; and fetal and umbilical Doppler for high-risk pregnant women.
Clear evidence of harm
No included SR reported clear evidence of harm.
No effect or equivalence
For pregnant women at high risk of PTB, antibiotic prophylaxis during the second and third trimester was of no effect or equivalent to a comparator.
Possible benefit One SR reported possible benefit with cervical cerclage for women with singleton pregnancy and high risk of PTB.
Possible harm
One SR reported possible harm associated with a reduced schedule of antenatal visits for pregnant women at low risk of pregnancy complications; importantly, these women already received antenatal care in settings with limited resources.

OUTCOMES:
preterm birth and perinatal death
Unknown benefit or harm
For pregnant women at high risk of PTB for any reason including multiple pregnancy, home uterine monitoring was of unknown benefit or harm. For pregnant women at high risk due to multiple pregnancy: bedrest, prophylactic oral betamimetics, vaginal progesterone and cervical cerclage were all of unknown benefit or harm.

AUTHORS' CONCLUSIONS:
Implications for practice
The overview serves as a map and guide to all current evidence relevant to PTB prevention published in the Cochrane Library. Of 70 SRs with outcome data, we identified 36 reviews of interventions with the aim of preventing PTB. Just four of these SRs had evidence of clear benefit to women, with an additional four SRs reporting possible benefit. No SR reported clear harm, which is an important finding for women and health providers alike.The overview summarises no evidence for the clinically important interventions of cervical pessary, cervical length assessment and vaginal progesterone because these Cochrane Reviews were not current. These are active areas for PTB research.
The graphic icons we assigned to SR effect estimates do not constitute clinical guidance or an endorsement of specific interventions for pregnant women. It remains critical for pregnant women and their healthcare providers to carefully consider whether specific strategies to prevent PTB will be of benefit for individual women, or for specific populations of women.
Implications for research
Formal consensus work is needed to establish standard language for overviews of reviews and to define the limits of their interpretation.
Clinicians, researchers and funders must address the lack of evidence for interventions relevant to women at high risk of PTB due to multiple pregnancy.


VitaminDWiki Pregnancy pages with PRETERM of PRE-TERM in title (61 as of May 2022)

This list is automatically updated

Items found: 62
Title Modified
4.4 X more likely to have a preterm birth if low vitamin D while pregnant - May 2022 23 May, 2022
Arab preterm infants often have less than 10 ng of vitamin D - 2010 15 May, 2022
Preterm birth interventions – 4 studies found possible vitamin D benefit – Cochrane – Nov 2018 15 May, 2022
Preterm birth might be prevented by Vitamin D, Omega-3, etc. (International survey) – Jan 2019 15 May, 2022
Preterm Births - promising preventions – anti-oxidants, Vitamin D, Omega-3, Zinc, etc. – Jan 2019 15 May, 2022
Preterm birth chance reduced – with 17P or Vitamin D – June 2015 15 May, 2022
Preterm birth reduction by nutrients - Vitamin D is the best, Omega-3 is next best – May 2022 15 May, 2022
Omega-3 supplementation reduced preterm birth rate by 4X – RCT July 2020 10 Apr, 2022
Preterm birth rate of pregnant smokers cut in half if take Omega-3 – RCT May 2017 20 Feb, 2022
Preterm birth varies with season: 25 percent more likely if conception in autumn – Feb 2022 04 Feb, 2022
Pre-term birth rate cut in half with 1000 milligrams of Omega-3 (if initially low) – RCT May 2021 04 Jun, 2021
Preterm birth risk increased 16 pcnt if heat wave (perhaps outside less) - Nov 2020 16 Nov, 2020
Preterm birth associated with many genes, including the Vitamin D Receptor again – Jan 2020 30 Jan, 2020
Preterm birth 8X more likely if poor Vitamin D Receptor – Dec 2019 31 Dec, 2019
8 percent fewer preterm births if adequate Selenium from food – Aug 2019 24 Dec, 2019
Pregnant women in Australia to take Omega-3 when told of reduction in preterm births – Dec 2019 19 Nov, 2019
Preterm birth 9 X more likely if fetus had a poor Vitamin D Receptor and previous miscarriage – Aug 2017 12 Nov, 2019
Preterm birth rate not vary with vitamin D level (when all are less than 30 ng) – Oct 2019 17 Oct, 2019
Extreme preterm infants helped somewhat by 800 IU of vitamin D – RCT Jan 2018 01 Oct, 2019
Preterm Births reduced by Omega-3, Zinc, and Vitamin D – Aug 2019 09 Aug, 2019
Preterm birth increases risk of heart disease by 1.5 X by age 40 – June 2019 06 Aug, 2019
Preterm Births decreased by Omega-3 (analysis of 184 countries) – April 2019 27 Apr, 2019
Preterm birth 3X more likely if low vitamin D – Oct 2018 07 Feb, 2019
Omega-3 index of 5 greatly decreases the risk of an early preterm birth – Dec 2018 04 Jan, 2019
Preterm birth cost for employers approximately 50,000 dollars – Oct 2017 28 Sep, 2018
Preterm births 12 X more likely if poor Vitamin D Receptor (white infants in Italy) – meta-analysis Aug 2018 27 Aug, 2018
Third trimester Vitamin D levels were lower if pre-term labor was expected – March 2018 24 Mar, 2018
Preterm birth 4X more likely if very low Vitamin D (Chinese) - Feb 2018 28 Feb, 2018
Preterm birth rates increased in 15 European countries – Oct 2013 23 Dec, 2017
Vitamin D intervention reduces preterm births and low birth weight by 60 percent – Cochrane Reviews – Nov 2017 07 Dec, 2017
Preterm birth rate increased 60 percent in 50 years (US) 26 Nov, 2017
Preterm births are VERY costly – Feb 2017 26 Nov, 2017
Preterm births strongly related to Vitamin D, Vitamin D Receptor, Iodine, Omega-3, etc 13 Nov, 2017
Vitamin D Receptor is associated with preeclampsia, gestational diabetes and preterm birth – Nov 2017 10 Nov, 2017
Preterm birth trend toward 2.5 X more likely if less than 10 ng of Vitamin D – Aug 2017 26 Aug, 2017
Preterm birth rate reduced by vitamin D – 78 percent if non-white, 39 percent if white – July 2017 27 Jul, 2017
Preterm birth more likely if dark skinned and low vitamin D (not white-skinned) – April 2017 06 Jul, 2017
Risk of preterm birth twice as likely when less than 10 ng of vitamin D – Nov 2016 13 Apr, 2017
Preterm labor 20 times more likely if low vitamin D, etc. (India) – Feb 2017 08 Mar, 2017
Preterm birth rate reduced by 43 percent with adequate Vitamin D supplementation – meta-analysis Feb 2017 02 Mar, 2017
Pre-term birth - many of risk factors are associated with low vitamin D 27 Feb, 2017
Preterm birth rate reduced 57 percent by Vitamin D – Nov 2015 23 Jan, 2017
Vitamin D Webinar - cost of pre-term birth etc- Baggerly Nov 2013 11 Dec, 2016
Preterm birth extended by 2 weeks with Omega-3 – Meta-analysis Nov 2015 10 Dec, 2016
Omega-3 supplementation during pregnancy reduce early preterm births (save 1500 USD per child) – Aug 2016 12 Oct, 2016
Zinc helps pregnancies – 14 percent fewer preterm births, etc. – Cochrane RCT Feb 2015 14 Jun, 2016
Preterm birth has become the leading cause of infant mortality (vitamin D not mentioned) – JAMA June 2016 07 Jun, 2016
Preterm birth 30 percent more likely if low vitamin D – meta-analysis May 2016 20 May, 2016
Asthmatic pregnant women had 30 percent more preterm births if air pollution (vitamin D not mentioned) – March 2016 09 Mar, 2016
Omega-3 helps pregnancy in many ways: preterm 26 percent less likely etc – review July 2012 08 Sep, 2015
Extreme preterm survival 30 percent less likely if little sunshine 23-28 weeks – June 2015 05 Sep, 2015
Magnesium (Sulfate) reduces risk of cerebral palsy for those at risk of pre-term births – Dec 2013 18 Aug, 2015
Respiratory distress after preterm birth is more likely if low vitamin D – review April 2015 05 Aug, 2015
Pre-term births reduced in half if 40 ng of vitamin D in 3rd trimester – Nov 2014 15 Mar, 2015
Chance of preterm birth is strongly associated with low vitamin D – Feb 2015 05 Feb, 2015
The more preterm the birth, the lower the vitamin D level (both mothers and infants) – Feb 2014 05 Feb, 2015
Preterm infants more likely to have vitamin D levels below 20 ng – Feb 2014 05 Feb, 2015
Decreased risk of preterm birth if have more than 36 ng of vitamin D – Jan 2015 09 Jan, 2015
Pre-term birth 3X more likely and C-section 4X if less than 20 ng of vitamin D – May 2012 13 Feb, 2014
Recurrent pre term birth and low vitamin D – Dec 2012 23 Jan, 2013
Blacks have more pre-term births due to low nutrients such as vitamin D – Sept 2011 14 Sep, 2011
Pre-term birth not associated with first tri-mester vitamin D – April 2011 21 Apr, 2011


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