The Zambian Preterm Birth Prevention Study (ZAPPS): Cohort characteristics at enrollment.
The Zambian Preterm Birth Prevention Study (ZAPPS): Cohort characteristics at enrollment.
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DOI：
10.12688/gatesopenres.12820.2
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发表时间：
2018-12-04
影响因子：
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通讯作者：
Vwalika, Bellington
中科院分区：
文献类型：
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作者：
Castillo, Marcela C;Fuseini, Nurain M;Vwalika, Bellington
背景：撒哈拉以南非洲承受着不成比例的早产和其他不良后果负担。迫切需要更好地了解这些不良后果的人口统计学、临床和生物学基础，以便计划干预措施并为新发现提供信息。方法：赞比亚早产预防研究（ZAPPS）是在赞比亚卢萨卡妇女和新生儿医院（WNH）建立的一项前瞻性观察队列研究。我们从地区保健中心和妇女健康中心招募孕妇，并提供超声检查以确定资格。参与者接受常规产科护理、实验室检测、妊娠中期宫颈长度测量和连续胎儿生长监测。在分娩时，我们评估胎龄、出生体重、生命状态和性别，并分配分娩表型。我们在定期就诊时收集血液、尿液和阴道拭子标本，并将其储存在现场生物库中。2017年9月，本报告的主题——ZAPPS第一阶段的登记工作完成。第二阶段——仅限于未感染艾滋病毒的妇女——于2018年1月重新开放。结果：2015年8月至2017年9月，我们筛选了1784名女性，其中1450名（81.2%）符合纳入标准并入组。入组时中位年龄为27岁（IQR 23-32），中位胎龄为16周（IQR 13-18）。在已产妇女（N=866; 64%）中，21% （N=182）报告有流产史，49% （N=424）报告有早产史，13% （N=116）报告有死产史。HIV血清阳性率为24%。讨论：我们在赞比亚卢萨卡建立了一个大型孕妇和新生儿队列，以确定不良出生结果的决定因素。我们的首要目标是阐明生物学机制，努力确定早期发现和预防不良后果的新策略。我们希望这个队列的发现将有助于指导未来的研究、临床护理和政策。
Background:Sub-Saharan Africa bears a disproportionate burden of preterm birth and other adverse outcomes. A better understanding of the demographic, clinical, and biologic underpinnings of these adverse outcomes is urgently needed to plan interventions and inform new discovery. Methods:The Zambian Preterm Birth Prevention Study (ZAPPS) is a prospective observational cohort established at the Women and Newborn Hospital (WNH) in Lusaka, Zambia. We recruit pregnant women from district health centers and the WNH and offer ultrasound examination to determine eligibility. Participants receive routine obstetrical care, lab testing, midtrimester cervical length measurement, and serial fetal growth monitoring. At delivery, we assess gestational age, birthweight, vital status, and sex and assign a delivery phenotype. We collect blood, urine, and vaginal swab specimens at scheduled visits and store them in an on-site biorepository.In September 2017, enrollment of the ZAPPS Phase 1 - the subject of this report - was completed. Phase 2 - which is limited to HIV-uninfected women - reopened in January 2018. Results:Between August 2015 and September 2017, we screened 1784 women, of whom 1450 (81.2%) met inclusion criteria and were enrolled. The median age at enrollment was 27 years (IQR 23-32) and thee median gestational age was 16 weeks (IQR 13-18). Among parous women (N=866; 64%), 21% (N=182) reported a prior miscarriage, 49% (N=424) reported a prior preterm birth, and 13% (N=116) reported a prior stillbirth. The HIV seroprevalence was 24%. Discussion:We have established a large cohort of pregnant women and newborns at the WHN to characterize the determinants of adverse birth outcomes in Lusaka, Zambia. Our overarching goal is to elucidate biological mechanisms in an effort to identify new strategies for early detection and prevention of adverse outcomes. We hope that findings from this cohort will help guide future studies, clinical care, and policy.