Dario Elias1, Hebe Campaña2,3, Fernando A Poletta2,4, Silvina L Heisecke5, Juan A Gili2,6, Julia Ratowiecki2, Mariela Pawluk2, Maria R Santos2,3,7, Viviana Cosentino2,8, Rocio Uranga2,9, Cesar Saleme10, Monica Rittler2,11, Hugo B Krupitzki5,12, Jorge S Lopez Camelo2,4, Lucas G Gimenez2,4. 1. Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina. darioezequielelias@protonmail.com. 2. Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina. 3. Comisión de Investigaciones Científicas, Buenos Aires, Argentina. 4. Instituto Nacional de Genética Médica Populacional (INAGEMP), CEMIC-CONICET, Ciudad Autónoma de Buenos Aires, Argentina. 5. Dirección de Investigación, CEMIC-CONICET, Ciudad Autónoma de Buenos Aires, Argentina. 6. Instituto Académico Pedagógico de Ciencias Humanas, Universidad Nacional de Villa María, Córdoba, Argentina. 7. Instituto Multidisciplinario de Biología Celular, Buenos Aires, Argentina. 8. Hospital Interzonal General de Agudos Luisa C. de Gandulfo, Buenos Aires, Argentina. 9. Hospital San Juan de Dios, Buenos Aires, Argentina. 10. Instituto de Maternidad y Ginecología Nuestra Señora de las Mercedes, Tucumán, Argentina. 11. Hospital Materno Infantil Ramón Sardá, Ciudad Autónoma de Buenos Aires, Argentina. 12. Instituto Universitario, Centro de Educación Médica e Investigaciones Clínicas (CEMIC-IUC), Ciudad Autónoma de Buenos Aires, Argentina.
Abstract
BACKGROUND: The aim of this study was to determine the mediating effect of spontaneous preterm birth (PTB) main predictors that would allow to suggest etiological pathways. METHODS: We carried out a case-control study, including sociodemographic characteristics, habits, health care, and obstetric data of multiparous women who gave birth at a maternity hospital from Tucumán, Argentina, between 2005 and 2010: 998 women without previous PTB who delivered at term and 562 who delivered preterm. We selected factors with the greatest predictive power using a penalized logistic regression model. A data-driven Bayesian network including the selected factors was created where we identified pathways and performed mediation analyses. RESULTS: We identified three PTB pathways whose natural indirect effect was greater than zero with a 95% confidence interval: maternal age less than 20 years mediated by few prenatal visits, vaginal bleeding in the first trimester mediated by vaginal bleeding in the second trimester, and urinary tract infection mediated by vaginal bleeding in the second trimester. The effect mediated in these pathways showed greater sensitivity to confounders affecting the variables mediator-outcome and exposure-mediator in the same direction. CONCLUSION: The identified pathways suggest PTB etiological lines related to social disparities and exposure to genitourinary tract infections. IMPACT: Few prenatal visits (<5) and vaginal bleeding are two of the main predictors for spontaneous preterm birth in the studied population. Few prenatal visits mediates part of the risk associated with maternal age less than 20 years and vaginal bleeding in the second trimester mediates part of the risk associated with vaginal bleeding in the first trimester and with urinary tract infection. Social disparities and exposure to genitourinary tract infections would be etiological lines of spontaneous preterm birth.
BACKGROUND: The aim of this study was to determine the mediating effect of spontaneous preterm birth (PTB) main predictors that would allow to suggest etiological pathways. METHODS: We carried out a case-control study, including sociodemographic characteristics, habits, health care, and obstetric data of multiparous women who gave birth at a maternity hospital from Tucumán, Argentina, between 2005 and 2010: 998 women without previous PTB who delivered at term and 562 who delivered preterm. We selected factors with the greatest predictive power using a penalized logistic regression model. A data-driven Bayesian network including the selected factors was created where we identified pathways and performed mediation analyses. RESULTS: We identified three PTB pathways whose natural indirect effect was greater than zero with a 95% confidence interval: maternal age less than 20 years mediated by few prenatal visits, vaginal bleeding in the first trimester mediated by vaginal bleeding in the second trimester, and urinary tract infection mediated by vaginal bleeding in the second trimester. The effect mediated in these pathways showed greater sensitivity to confounders affecting the variables mediator-outcome and exposure-mediator in the same direction. CONCLUSION: The identified pathways suggest PTB etiological lines related to social disparities and exposure to genitourinary tract infections. IMPACT: Few prenatal visits (<5) and vaginal bleeding are two of the main predictors for spontaneous preterm birth in the studied population. Few prenatal visits mediates part of the risk associated with maternal age less than 20 years and vaginal bleeding in the second trimester mediates part of the risk associated with vaginal bleeding in the first trimester and with urinary tract infection. Social disparities and exposure to genitourinary tract infections would be etiological lines of spontaneous preterm birth.
Authors: A Beresniak; E Bertherat; W Perea; G Soga; R Souley; D Dupont; S Hugonnet Journal: Bull World Health Organ Date: 2012-01-20 Impact factor: 9.408
Authors: Lucas G Gimenez; Hugo B Krupitzki; Allison M Momany; Juan A Gili; Fernando A Poletta; Hebe Campaña; Viviana R Cosentino; César Saleme; Mariela Pawluk; Jeffrey C Murray; Eduardo E Castilla; Enrique C Gadow; Jorge S Lopez-Camelo Journal: J Matern Fetal Neonatal Med Date: 2015-12-23
Authors: Hugo B Krupitzki; Enrique C Gadow; Juan A Gili; Belén Comas; Viviana R Cosentino; César Saleme; Jeffrey C Murray; Jorge S Lopez Camelo Journal: Am J Perinatol Date: 2012-11-06 Impact factor: 1.862
Authors: Lucas G Gimenez; Allison M Momany; Fernando A Poletta; Hugo B Krupitzki; Juan A Gili; Tamara D Busch; Cesar Saleme; Viviana R Cosentino; Mariela S Pawluk; Hebe Campaña; Enrique C Gadow; Jeffrey C Murray; Jorge S Lopez-Camelo Journal: Pediatr Res Date: 2017-05-31 Impact factor: 3.756
Authors: Dario E Elias; Maria R Santos; Hebe Campaña; Fernando A Poletta; Silvina L Heisecke; Juan A Gili; Julia Ratowiecki; Viviana Cosentino; Rocio Uranga; Diana Rojas Málaga; Alice Brinckmann Oliveira Netto; Ana Carolina Brusius-Facchin; César Saleme; Mónica Rittler; Hugo B Krupitzki; Jorge S Lopez Camelo; Lucas G Gimenez Journal: J Community Genet Date: 2022-08-17