OBGYNE, Supplements / 22.11.2024

Editor's note:  Most supplements, including  lactoferrin, are not FDA approved or tested and therefore should be used only under the supervision of your health care provider. Pregnancy is an incredible journey, but it also brings its share of challenges, including keeping your immune system strong. Your immune system works overtime to protect both you and your growing baby, which makes it even more important to give it the support it needs. By adopting healthy habits and incorporating the right nutrients into your diet, you can boost your immune health and reduce the risks of common infections or illnesses during pregnancy. Here are 10 practical tips to strengthen your immune system while ensuring the safety and well-being of your little one.

1. Add Lactoferrin to Your Routine

A lactoferrin supplement  is a natural protein found in milk and other fluids that boosts immunity by supporting healthy gut bacteria and reducing inflammation. It also helps your body absorb iron more effectively, which is crucial during pregnancy. Before taking any supplements be sure to consult your healthcare provider. Lactoferrin is a dairy product and should not be taken in the case of suspected or diagnosed allergy to cow's milk proteins. (more…)
Chiropractic, OBGYNE / 23.10.2024

Editor's note:  Please check with your obstetrician before seeing a chiropractor. Pregnancy is an amazing adventure, but it comes with an honest proportion of bodily challenges for expecting mothers. From lower back aches and joint soreness to pelvic misalignment, the body undergoes massive changes that could affect routine lifestyle. Many mothers-to-be are searching out natural, scientific ways to alleviate those pregnancy-associated discomforts, and this is where prenatal chiropractic care comes in. A prenatal chiropractor focuses on assisting pregnant women through tailor-made chiropractic treatments that are gentle, secure, and, in particular, designed to address pregnancy-related issues. In this blog, we'll explore the potential benefits of prenatal chiropractic care and how it may help the general well-being of each mom and child during pregnancy. (more…)
Nursing Homes, OBGYNE / 17.10.2024

  The postpartum period can be both beautiful and challenging as new mothers navigate recovery while caring for their newborns. Creating a nurturing space at home is essential to support healing and emotional well-being.  As per the Cleveland Clinic, postpartum depression is a prevalent issue, with about 75% of new mothers experiencing the baby blues shortly after delivery. Of those, approximately 15% will go on to develop postpartum depression, which can significantly impact their recovery and overall well-being. In more severe cases, about one in 1,000 individuals may experience postpartum psychosis. This highlights the importance of support from qualified nursing professionals during this critical time. A comfortable, calming environment can significantly impact your recovery experience. From organizing your living area to incorporating elements that promote relaxation, small adjustments can make a big difference. In this article, we’ll explore how to design your postpartum space thoughtfully and practical tips to enhance your recovery journey at home. (more…)
Author Interviews, COVID -19 Coronavirus, JAMA, OBGYNE, Pediatrics / 16.10.2024

MedicalResearch.com Interview with: Eleni G. Jaswa, MD, MSc Assistant Professor, Ob/Gyn, Reproductive Science UCSF MedicalResearch.com: What is the background for this study? Response: Some infections during pregnancy have been associated with abnormal neurodevelopment in children. This is likely due to the infection itself, or the maternal immune system response to infection. We sought to determine whether maternal COVID-19 infection during pregnancy, a now common occurrence, was associated with changes in children's neurodevelopment out to 24-months-old, compared to control children not exposed to maternal COVID-19 in utero. (more…)
Fertility, OBGYNE / 11.10.2024

Women are looking to freeze their eggs, which is an option that is gaining popularity and provides fertility preservation for a level of control over family planning. Medical advances have made the procedure more reliable, and it allows women to put off having children without diminishing their chances of being able to conceive using their eggs later on. In this post, let’s get into why egg freezing is a powerful and how it can potentially give women more options when it comes to the capacity of reproduction. Better Chances of Getting Pregnant The quality and number of eggs decline with age, which makes getting pregnant more challenging. Freezing eggs can up their odds, as long as they do it at a younger age. Because generally speaking, lower-quality eggs do not respond as well to fertility treatments. (more…)
OBGYNE, Sleep Disorders / 30.09.2024

sleep-during-pregnancy.jpg   Sleep deprivation is something all new parents go through, but for many women, it starts before the baby is born. As your belly is growing, the baby is kicking, and your hormone levels are fluctuating, you are very likely to experience insomnia, poor sleep quality, or nighttime awakenings. Even though there is no magic solution that can fix your problems entirely, there are some things you can do to get some good night's sleep during pregnancy:

Create a Soothing Bedtime Routine

Try to come up with a bedtime ritual that you can perform every night to signal your brain and your body that it is time to sleep. First, stop using screens because modern devices produce blue light that impedes your body’s production of melatonin. So instead of scrolling through your phone, consider reading a book before bedtime. Additionally, introduce some habits that can support and improve your mental health during pregnancy. For example, you can take a soothing, warm bath, sip on a cup of warm milk or a caffeine-free tea, or listen to a guided meditation. Also, you can introduce aromatherapy to your bedroom. Using a pillow spray or a diffuser can make you feel more relaxed in minutes. Finally, stick with a consistent routine that provides you with at least eight hours of sleep every night. (more…)
OBGYNE / 25.09.2024

The journey from conception to bringing a new life into the world is filled with anticipation, preparation, and a series of important healthcare services. Maternity services are designed to provide comprehensive care for women throughout pregnancy, childbirth, and the postpartum period. These services ensure that both mother and baby have the best possible outcomes with the support of specialized healthcare professionals. But navigating the world of maternity care can often be overwhelming for expectant parents. In this article, we will explore the various aspects of maternity services, helping soon-to-be parents to make informed decisions for a healthy pregnancy and delivery.

Integrating Pediatric Care Into Your Postpartum Plan

pregnancy-maternal-care.png A critical but sometimes overlooked aspect of postpartum care is establishing a pediatric care plan for the newborn. Early well-child visits are essential for monitoring growth, administering vaccinations, and addressing any health concerns that may arise. These appointments also guide parents on milestones and the general development of their child. One innovative example of integrative maternity services is the model provided by modern maternity care centers. Such centers focus on a seamless transition from pregnancy to pediatric care, ensuring continuity and a holistic approach to both mother and baby's health. They work under the philosophy that a well-cared-for mother raises a healthy and happy child. (more…)
Anemia, Author Interviews, JAMA, OBGYNE / 23.08.2024

Esa M. Davis, M.D., M.P.H , F.A.A.F.P Professor of Medicine and Family and Community Medicine Associate Vice President of Community Health and Senior Associate Dean of pPopulation Health and Community Medicine University of Maryland School of Medicine Dr. Davis joined the U.S. Preventive Services Task Force in January 2021     MedicalResearch.com: What is the background for this study? What are the main findings? Response: Iron is important to overall health, and people need more iron when they are pregnant. This can make pregnant people at increased risk for iron deficiency, which can progress to anemia and cause complications for both moms and their babies. After reviewing the latest available research, the Task Force found that there is not enough evidence on whether pregnant people who do not have signs or symptoms of iron deficiency or anemia should be screened—or take iron supplements—to improve their health or the health of their baby.   (more…)
Mental Health Research, OBGYNE / 29.07.2024

It’s no secret pregnancy causes many changes in a woman’s body - physically and emotionally. One of the most common changes occurs in the brain, a phenomenon known as the pregnancy brain.  Pregnancy Brain ExplainedThe pregnancy brain is often referred to as momnesia or baby brain. This condition underlies the cognitive struggles and difficulty associated with concentrating that some women experience during pregnancy and sometimes after giving birth.  Generally, pregnancy is characterized by an increase in steroid hormones such as estrogen, progesterone, and cortisol. These hormones will be discussed in detail in the following sections. Steroid hormones are responsible for handling metabolism, inflammation, immune functions, salt and water balance, the development of sexual characteristics, and the ability to withstand injury and illness during pregnancy.   The genesis of pregnancy brain stems at least partially from the influx of these steroid hormones. This, among other factors, will be mentioned in this article. (more…)
AHA Journals, Author Interviews, Blood Pressure - Hypertension, OBGYNE / 29.05.2024

MedicalResearch.com Interview with: Emmanuel Bujold, Reproduction Mother and Child Health Unit CHU De Québec-Université Laval Research Center Université Laval Québec, QC Canada     MedicalResearch.com: What is the background for this study? Would you briefly describe what is meant by preeclampsia? Response: Preeclampsia is a complication of the second half of pregnancy, manifesting as high blood pressure and renal dysfunction. The only current treatment is to deliver the baby before it becomes complicated by damage to maternal organs or fetal distress. A few years ago, we demonstrated that aspirin started in the 1st trimester can prevent the majority of preeclampsias in pregnant women at risk. It has therefore become urgent to identify pregnant women at risk as early as the 1st trimester. (more…)
Author Interviews, OBGYNE / 19.03.2024

MedicalResearch.com Interview with: Chelsea A DeBolt, MD Assistant Professor, Obstetrics, Gynecology and Reproductive Science Division of Maternal-Fetal Medicine Icahn School of Medicine at Mount Sinai MedicalResearch.com: What is the background for this study? Response: Significant immunological shifts, systemically and at the maternal-fetal interface, are required for a successful pregnancy. Yet, there is a paucity of comprehensive data investigating the systemic immune changes within the same individual transitioning from the non-pregnant to pregnant state. (more…)
Author Interviews, Blood Pressure - Hypertension, JAMA, OBGYNE, USPSTF / 26.09.2023

MedicalResearch.com Interview with: Esa M. Davis, M.D., M.P.H , F.A.A.F.P Professor of Medicine and Family and Community Medicine Associate Vice President of Community Health and Senior Associate Dean of pPopulation Health and Community Medicine University of Maryland School of Medicine Dr. Davis joined the U.S. Preventive Services Task Force in January 2021 Esa M. Davis, M.D., M.P.H , F.A.A.F.P Professor of Medicine and Family and Community Medicine Associate Vice President of Community Health and Senior Associate Dean of pPopulation Health and Community Medicine University of Maryland School of Medicine Dr. Davis joined the U.S. Preventive Services Task Force in January 2021 MedicalResearch.com: What is the background for this study? Response: Hypertensive disorders of pregnancy, including gestational hypertension, preeclampsia, and eclampsia, are among the leading causes of serious complications and death for pregnant people in the United States. Pregnant women and pregnant people of all genders should have their blood pressure measured at each prenatal visit to help find and prevent serious health issues related to hypertensive disorders of pregnancy.  (more…)
Author Interviews, JAMA, OBGYNE, Pediatrics, USPSTF / 09.08.2023

MedicalResearch.com Interview with:x Wanda K. Nicholson, M.D., M.P.H., M.B.A. Senior Associate Dean for Diversity, Equity, and Inclusion Professor of Prevention and Community Health Milken Institute School of Public Health George Washington University Vice chair of the U.S. Preventive Services Task Force MedicalResearch.com: What is the background for this study? Response: Neural tube defects are when a baby’s spinal cord or brain don’t develop properly during pregnancy, which can cause serious complications including disability and death. The good news is that taking folic acid supplements before and during early pregnancy is proven to help prevent this from happening. (more…)
Author Interviews, Mental Health Research, Microbiome, Nature, OBGYNE, UCLA / 25.07.2023

MedicalResearch.com Interview with: Bridget Callaghan Ph.D. Assistant Professor of Psychology UCLA Dr. Callahan studies interactions between mental and physical health across development.   MedicalResearch.com: What is the background for this study? Response: A growing body of evidence links the gut microbiome to brain and immune functioning, and changes to that community of microorganisms is likely among the ways that hardship affects children’s socioemotional development. Limited evidence in humans has demonstrated the adversities experienced prenatally and during early life influence the composition of the gut microbiome, but no studies had examined whether stress experienced in a mother's own childhood could influence the microbiome of the next generation of children. (more…)
Author Interviews, JAMA, OBGYNE / 07.07.2023

MedicalResearch.com Interview with: Dorothy A. Fink, MD Deputy Assistant Secretary for Women's Health Director, Office on Women's Health US Department of Health & Human Services Rockville, MD MedicalResearch.com: What is the background for this study? Response: Delivery-related mortality in U.S. hospitals has decreased for all racial and ethnic groups, age groups, and modes of delivery while the prevalence of severe maternal mortality (SMM) increased for all patients, with higher rates for racial and ethnic minority patients of any age. This study specifically looked at inpatient delivery-related outcomes and found a 57% decrease from 2008-2021. The decreasing mortality rates within the inpatient delivery setting demonstrated as statistically significant and a welcome finding for all women. This study also looked with greater granularity at the impact of race, ethnicity, and age. Mortality for American Indian women decreased 92%, Asian women decreased 73%, Black women decreased 76%, Hispanic women decreased 60%, Pacific Islander women decreased 79%, and White women decreased 40% during the study period. (more…)
Author Interviews, Cannabis, JAMA, OBGYNE, Pediatrics / 26.06.2023

MedicalResearch.com Interview with: Alex P. Miller, PhD TranSTAR T32 Postdoctoral Fellow Department of Psychiatry Washington University School of Medicine St. Louis, MO   MedicalResearch.com: What is the background for this study? Response: Adolescent cannabis use is increasing in the United States. Prior research suggests that people who start using cannabis earlier are more likely to engage in problematic use and also experience greater mental health challenges and socioeconomic disadvantages overall. For example, children who begin using cannabis early are more likely to have behavioral problems and disorders and are more less likely to complete school. In our study, we used data from the Adolescent Brain Cognitive Development (ABCD) Study, which is following nearly 12,000 kids across the nation to track behavior and brain development as well as health from middle childhood to young adulthood. We looked at what factors are associated with the initiation of cannabis use by age 12-14. (more…)
Author Interviews, Infections, NIH, OBGYNE / 01.03.2023

MedicalResearch.com Interview with:
William A. Petri, MD PhDWilliam A. Petri, MD PhD Wade Hampton Frost Professor of Medicine and Vice Chair for Research of the Department of Medicine Professor of Medicine, Microbiology, Immunology and Cancer Biology, and Pathology, Medicine: Infectious Diseases and International Health, Medicine: Infectious Diseases and International Health
MedicalResearch.com: What is the background for this study? MedicalResearch.com We tested if prophylactic antibiotics could prevent sepsis and death in women in the late stages of normal vaginal labor and delivery. It was previously known that antibiotic were effective for this purpose in women undergoing C-section. The study was a randomized placebo-controlled trial at 8 international sites of nearly 30,000 women. (more…)
Author Interviews, OBGYNE, Sexual Health / 25.08.2022

MedicalResearch.com Interview with: Florence Z. Martin MRC Integrative Epidemiology Unit Population Health Sciences Bristol Medical School University of Bristol, Bristol, UK MedicalResearch.com: What is the background for this study? Response: Globally, rates of caesarean section are on the rise. Many things are contributing to this, including increasing maternal age, more women who have had prior caesareans, and changes in maternal preference. One reason that women have been cited to choose a caesarean in an uncomplicated pregnancy is the maintenance of sexual wellbeing postpartum (in other words, after their baby is born). The protection of sexual wellbeing following caesarean section is thought to be via the maintenance of vaginal tone and reduced risk of vaginal tearing. However, few studies have shown this to be true. Some studies investigating sexual outcomes in the year after birth found no difference between women who gave birth vaginally and those who delivered via caesarean section. Longer term evidence is sparse, with only one study looking up to 16 years postpartum and finding that women who give birth to all their children via caesarean section are at higher risk of experiencing sex-related pain. To contribute to previous studies and provide the first piece of evidence looking at sexual wellbeing as a whole several years after delivery, we used data from the Children of the 90s study (also known as the Avon Longitudinal Study of Parents and Children or ALSPAC). We aimed to compare sexual enjoyment, sexual frequency, and sex-related pain between women who delivered via caesarean section and those who delivered vaginally up to 18 years postpartum. (more…)
Author Interviews, Diabetes, NEJM, OBGYNE / 19.08.2022

MedicalResearch.com Interview with: Professor Caroline Crowther MB ChB, DCH, FRANZCOG, MD, DDU, FRCOG, CMFM Maternal Fetal Medicine Subspecialist Professor of Maternal & Perinatal Health Liggins Institue Waipapa Taumata Rau | University of Auckland MwdicalResearch.com: What is the background for this study? Response: Gestational diabetes is a growing and significant health problem worldwide for women affected and their babies. Treatment of gestational diabetes improves maternal and infant health but it remains unclear what degree of maternal hyperglycaemia should be used to make the diagnosis. Because of this uncertainty, recommended diagnostic criteria vary around the world. The GEMS randomised trial assessed whether use of lower glycaemic diagnostic criteria, recommended by the International Association of Diabetes and Pregnancy Study Groups would improve perinatal health, without increasing maternal risks, compared to use of higher criteria, and to assess the effects on use of the health services. (more…)
Author Interviews, Blood Pressure - Hypertension, JAMA, OBGYNE / 04.05.2022

MedicalResearch.com Interview with: Richard McManus MA PhD MBBS FRCGP FRCP Professor of Primary Care Dr. McManus chairs the Blood Pressure Monitoring Working Party of the British Hypertension Society Nuffield Department of Primary Care Health Sciences  MedicalResearch.com:  What is the background for this study?  Response: About one in ten people who are pregnant develop high blood pressure and almost half of these go onto to have pre-eclampsia. Many pregnant women and individuals are already measuring their own blood pressure – well over half of those with high blood pressure in a recent large survey in the UK but until recently there were no data to support this. (more…)
AHA Journals, Author Interviews, Fertility, Heart Disease / 27.04.2022

MedicalResearch.com Interview with: Pensée Wu, MBChB, MD(Res) Senior Lecturer, Honorary Consultant Obstetrician Subspecialist in Maternal Fetal Medicine School of Medicine, Keele University Staffordshire, UK MedicalResearch.com:  What is the background for this study? What are the main findings? Response: We looked at outcomes in pregnancies conceived with assisted reproductive technology and compared those with pregnancies that were conceived naturally. Using a hospital admissions database in the U.S. called the National inpatient sample between 2008 and 2016, we included >100,000 pregnancies conceived with assisted reproductive technology and 34 million naturally conceived pregnancies. We found that women with assisted reproductive technology-conceived pregnancies had doubled the risk of acute kidney injury and arrhythmias (irregular heart beats). These women also had a 1-3-1.6-fold risk of preterm birth, Caesarean delivery and placental abruption (placenta separating from the womb). We concluded that women should be informed of these risks during pre-pregnancy counselling.  (more…)
Author Interviews, Coffee, Heart Disease, JAMA, OBGYNE / 09.11.2021

MedicalResearch.com Interview with: Stefanie N. Hinkle, PhD Assistant Professor Department of Biostatistics Epidemiology and Informatics Perelman School of Medicine University of Pennsylvania MedicalResearch.com: What is the background for this study? Response: Over 80% of U.S. women of reproductive age consume caffeine daily.While most women decrease consumption after becoming pregnant, many continue to consume caffeine throughout pregnancy. The American College of Obstetricians and Gynecologists (ACOG) recommends that pregnant women limit their caffeine consumption to <200 mg/d out of an abundance of caution due to potential associations with pregnancy loss and fetal growth restriction at higher intakes. There remains limited data on associations with maternal cardiometabolic outcomes in pregnancy.   (more…)
Accidents & Violence, Addiction, Author Interviews, OBGYNE / 02.11.2021

MedicalResearch.com Interview with: Jeffrey Howard, PhD Associate Professor Department of Public Health College for Health, Community and Policy University of Texas at San Antonio MedicalResearch.com: What is the background for this study? Response: Drug and alcohol related mortality has been on the rise in the US for the past decade, which has drawn a lot of focus from researchers.  At the same time maternal mortality, deaths caused by pregnancy complications, is recognized to be higher in the US than in other developed nations. Very little has been reported about deaths among pregnant and recently pregnant women that are not caused by pregnancy complications, so my collaborators and I wanted to explore this.  We did not anticipate that drug and alcohol deaths and homicides would account for so many deaths among pregnant and recently pregnant women. (more…)
Author Interviews / 06.10.2021

MedicalResearch.com Interview with: Christine Toledo, PhD, MSN, APRN, FNP-C Assistant Professor Christine E. Lynn College of Nursing Florida Atlantic University MedicalResearch.com: What is the background for this study? Response: According to the United States Centers for Disease Control and Prevention, between 11 and 20 percent of women who give birth each year in the U.S. have postpartum depression symptoms, equating to nearly 800,000 women every year. Postpartum Depression provides significant health risks to both the mother and child and is the greatest risk factor for maternal suicide and infanticide.   (more…)
Author Interviews, JAMA, OBGYNE, USPSTF / 06.10.2021

MedicalResearch.com Interview with: Aaron B. Caughey, M.D., M.P.P., M.P.H., Ph.D. Professor and ChairDepartment of Obstetrics and Gynecology Associate dean for Women’s Health Research and Policy Oregon Health & Science University in Portland, OR. Founder and Chair, Centers for Disease Control and Prevention–funded Oregon Perinatal Collaborative MedicalResearch.com: What is the background for this study? What are the main findings? Response: Preeclampsia is one of the most serious health problems that can occur during pregnancy. It can lead to preterm birth, and in some cases even death of the pregnant person and their baby. The Task Force looked at the latest available evidence and found that low-dose aspirin can help prevent preeclampsia in pregnant people who are at highest risk, and it can also protect their babies. This new final recommendation is consistent with the Task Force’s 2014 recommendation statement and has the potential to save many lives.  (more…)
Author Interviews, HPV, JAMA, OBGYNE / 16.09.2021

MedicalResearch.com Interview with: Helen Trottier Ph.D Assistant Professor, Department of Social and Preventive Medicine, Researcher, CHU Sainte-Justine Research Center Université de Montréal Montréal, Québec, Canada MedicalResearch.com: What is the background for this study? Response: We know that HPV infection can have serious consequences such as the development of cancerous lesions in the cervix. HPV infection is also very prevalent in young women of childbearing age but the possible consequences of HPV in pregnancy have been poorly studied. Some population registers around the world have shown a reduction in the risk of preterm birth with HPV mass vaccination, but we must be careful with this kind of ecological correlation. We have set up a large cohort study in pregnant women to study the association between HPV in pregnancy and preterm birth by targeting certain HPV genotypes and the duration of the infection. (more…)
Author Interviews, Brigham & Women's - Harvard, JAMA, OBGYNE, Pediatrics, Weight Research / 28.08.2021

MedicalResearch.com Interview with: Emily Oken MD MPH Professor, Harvard Medical School Professor in the Department of Population Medicine Associate Director and Advisor, Oliver Wendell Holmes Society. Professor, Department of Nutrition, Harvard School of Public Health MedicalResearch.com: What is the background for this study? What are the main findings? Response: In this study of over 11,000 mothers and children, we found that a mothers with higher weight in late pregnancy had children with poorer performance on tests of cognition and behavior in childhood and adolescence. The findings are consistent with results from studies in other populations around the world, as well as animal experiments.  This research suggests that maternal nutrition is important for child health over the long-term, and specifically provides support for mothers to try to achieve healthy weight and nutritional status during pregnancy. (more…)
Author Interviews, JAMA, OBGYNE, USPSTF, Weight Research / 03.06.2021

MedicalResearch.com Interview with: Chien-Wen Tseng, M.D., M.P.H., M.S.E.E. The Hawaii Medical Service Association Endowed Chair Health Services and Quality Research Professor, and Associate Research Director Department of Family Medicine and Community Health University of Hawaii John A. Burns School of Medicine MedicalResearch.com: What is the background for this study? What are the main findings? Response: Gaining weight during pregnancy is natural but gaining too little or too much weight can be harmful for pregnant people and their babies. For the first time, the Task Force reviewed the evidence and found that counseling pregnant people on healthy weight gain during pregnancy can lower their risk for diabetes during pregnancy, emergency cesarean deliveries, and babies born with a birth weight that is too high. Pregnant people may not know what amount of weight gain is healthy during pregnancy, or how weight gain can affect their pregnancy and baby. We recommend that clinicians offer all pregnant people counseling on healthy weight gain throughout their pregnancy for healthier, safer pregnancies. (more…)
Author Interviews, Lancet, Nutrition, OBGYNE / 22.05.2021

MedicalResearch.com Interview with: Susan E. Carlson Ph.D. Associate Dean for Research Program Director,, AJ Rice Professor Department of Dietetics and Nutrition University of Kansas Medical Center Kansas City, KS MedicalResearch.com: What is the background for this study? What are its benefits? Response: DHA is an omega-3 fatty acid. Good food sources include some types of seafood (e.g., salmon, tuna, trout) and chicken eggs. Persons in the USA and in much of the developing world consume little dietary DHA. DHA supplements in pregnancy have been linked to lower risk of preterm birth for 20 years, especially early preterm births (<34 weeks gestation). For about 10 years, prenatal supplements with about 200 mg DHA have been readily available in the USA, however, no study has asked if this amount of DHA is optimal to reduce early preterm birth. Participants were given a supplement of 1000 mg or 200 mg DHA beginning before 20 weeks gestation using an adaptive randomization that periodically assigned more participants to the group with the fewest early preterm births. (more…)