Hindawi BioMed Research International Volume 2019, Article ID 4870938, 2 pages https://doi.org/10.1155/2019/4870938 Editorial Preterm Labor: Up to Date George Daskalakis ,1 Birgit Arabin,2,3 Aris Antsaklis,1 and Luis Cabero Roura4 1 First Department of Obstetrics and Gynecology, Maternal-Fetal Medicine Unit, National and Kapodistrian University of Athens, Alexandra Maternity Hospital Athens, Greece 2 Center of Mother and Child, Philipps University of Marburg, Baldingerstrasse, 35032 Marburg, Germany 3 Clara Angela Foundation, Berlin, Germany 4 Preterm Birth Prevention Clinic, High-Risk Pregnancy Unit, Maternal-Foetal Medicine, Department of Obstetrics and Gynaecology, Hospital Universitari Vall d’Hebron, Vall d’Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona (UAB), Barcelona., Spain Correspondence should be addressed to George Daskalakis; gdaskalakis@yahoo.com Received 30 April 2019; Accepted 30 April 2019; Published 9 May 2019 Copyright © 2019 George Daskalakis et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Preterm birth is a syndrome with many causes [1]. The rates spontaneous onset of preterm birth. The purpose of the of preterm births (PTB) have increased to approximately present special issue is to highlight specific aspects of PTB. 15 million cases per year [2]. Despite the fact that current In a first review article, B. Staude et al. investigated the efforts of primary, secondary, and tertiary interventions try pathophysiologic background that correlates altered micro- to decrease the rates of PTB, the prevalence of prematurity biome to neonatal complications, including retinopathy, still ranges between 5% in some high-income countries and necrotizing enterocolitis, disrupted psychomotor develop- more than 20% in some low-income countries such as in sub- ment, and autonomic regulation. The authors report that Saharan Africa and South Asia. breast milk is of detrimental importance during early human Perinatal mortality, neonatal mortality, and neonatal and development as the maternal microbes that are excreted long-term morbidity are inversely associated with gesta- from the mammary gland and absorbed by direct contact tional age at birth. Frequent neonatal complications include of the skin surrounding the areola support the neonate to periventricular leukomalacia, necrotizing enterocolitis, respi- establish a rich diverse microbiome. The authors conclude ratory distress syndrome, jaundice and kernicterus, neonatal that this is an ongoing field of research. Respiratory dis- infections, and prolonged hospitalization. Since the quality tress syndrome (RDS) is a predominant complication of of neonatal care additionally affects the outcome, there is a prematurity. Its prevalence remains high in preterm neonates, vicious circle of poor perinatal and neonatal healthcare with despite the institution of tocolytics, corticosteroids, and long-term consequences for the economy in all societies, but surfactant in current clinical practice. In the present article A. mainly within poor countries or within subgroups of low Niesluchowska-Hoxha et al. investigated the impact of several socioeconomic status of higher income countries. A history risk factors on the rate of RDS by multivariable analysis [3]. of preterm birth is the most dominant risk factor; however, Their findings suggest that female gender decreased the odds most determinants from the maternal history such as smok- of developing RDS by approximately 50%, whereas abnor- ing, nutritional depletion, short interpregnancy interval, or mal fetoplacental circulation and fetal distress detected by advanced maternal age are only weakly associated with PTB. abnormal uterine artery and middle cerebral artery Doppler Meanwhile, transvaginal sonography of the cervix is used as increased the risk for RDS. a screening tool to indicate precocious cervical ripening by Research in gestational diabetes (GDM) has proven the using centile values of the cervical length. emerging role of adipokines in high risk pregnancies [4]. Iatrogenic preterm birth as caused by fetal growth In their present article R. Mierzynski et al. investigated restriction and/or preeclampsia has to be differentiated from the efficacy of serum adiponectin and omentin-1 levels in 2 BioMed Research International predicting PTB in patients with GDM. The authors reported George Daskalakis that omentin-1 may be used to predict preterm birth as they Birgit Arabin estimated that an increase of omentin level by 100 ng/ml Aris Antsaklis decreases the possibility of preterm birth by almost 75%. On Luis Cabero Roura the other hand, adiponectin did not seem to correlate with preterm birth. Further investigation is needed. References Inflammation is a significant determinant of PTB. The nuclear factor-𝜅B (NF-𝜅B) has been implicated in the patho- [1] R. Romero, S. K. Dey, and S. J. Fisher, “Preterm labor: one genesis of PTB as a mediator. Downstream regulatory ele- syndrome, many causes,” Science, vol. 345, no. 6198, pp. 760– ment antagonist modulator (DREAM) is a regulator of the 765, 2014. NF-𝜅B in nongestational tissues. P. Goradia et al. investigated [2] G. Daskalakis, M. Goya, V. Pergialiotis et al., “Prevention DREAM expression in primary myometrial and amnion cells of spontaneous preterm birth,” Archives of Gynecology and and observed that DREAM mRNA expression is increased Obstetrics, vol. 299, no. 5, pp. 1261–1273, 2019. and that, in myometrial and amnion cells, DREAM regulates [3] A. Niesłuchowska-Hoxha, W. Cnota, B. Czuba et al., “A ret- proinflammatory and prelabour mediators. The authors con- rospective study on the risk of respiratory distress syndrome clude that DREAM is a promising factor that may be used in singleton pregnancies with preterm premature rupture of in the future in the diagnosis and management of preterm membranes between 24+0 and 36+6 weeks, using regression labour. analysis for various factors,” BioMed Research International, vol. 2018, Article ID 7162478, 6 pages, 2018. In vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) have also been associated with an increased [4] I. Bellos, G. Fitrou, V. Pergialiotis, D. N. Perrea, and G. Daskalakis, “Serum levels of adipokines in gestational diabetes: risk of PTB. N. Jancar et al. investigate this correlation in a a systematic review,” Journal of Endocrinological Investigation, large population sample that included 267 718 women from 2018. Slovenia. They observed that IVF-ICSI nearly tripled the risk of early PTB (OR 2.8) and doubled the risk of late PTB (OR 1.7). Given this information, the authors suggested that women undergoing IVF-ICSI should be closely followed dur- ing pregnancy to allow early identification and management of cases at risk. Next to cervical length the detection of the uterocervical angle (UCA) by transvaginal sonography has been investi- gated to detect a risk for PTB. In our systematic review we sought to investigate the published evidence and identified 11 relevant articles. Thereby it was observed that reduced UCA during the second trimester of pregnancy seems to be an independent factor that may help predict PTB <34 weeks. Nevertheless, significant heterogeneity was noted in terms of the investigated outcomes and UCA cut-off values. Several methods have been introduced as preventive strategies for PTB in women with a shortened cervix, includ- ing vaginal progesterone, 17OH progesterone caproate, cervi- cal cerclage, and cervical pessary [2]. Among these methods, both, cervical cerclage and pessary placement, require exper- tise to ensure optimal outcomes. N. Vasudeva et al. reviewed 39 patients that underwent elective McDonald cerclage (26 cases) or an emergency cerclage (13 cases). The authors noted the significant impact of cerclage in reducing PTB rates and reported that there is a need for a surveillance program to optimize outcomes. In conclusion, we hope that the present issue helps to provide some update in the field of PTB that may be used to guide current clinical practice and expand future research. Conflicts of Interest B. Arabin has a direct ownership interest in the company that designed and produces and now distributes the Arabin pessary. The company is privately held and the profit is used to support the Clara Angela Foundation. The remaining authors report no conflicts of interest.