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dc.contributor.author
Goldenberg, Robert L.
dc.contributor.author
Thorsten, Vanessa R.
dc.contributor.author
Althabe, Fernando
dc.contributor.author
Saleem, Sarah
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Garces, Ana
dc.contributor.author
Carlo, Waldemar A.
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Pasha, Omrana
dc.contributor.author
Chomba, Elwyn
dc.contributor.author
Goudar, Shivaprasad
dc.contributor.author
Esamai, Fabian
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Krebs, Nancy F.
dc.contributor.author
Derman, Richard J.
dc.contributor.author
Liechty, Edward A.
dc.contributor.author
Patel, Archana
dc.contributor.author
Hibberd, Patricia L.
dc.contributor.author
Buekens, Pierre
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Koso-Thomas, Marion
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Miodovnik, Menachem
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Jobe, Alan H.
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Wallace, Dennis D.
dc.contributor.author
Belizan, Jose
dc.contributor.author
McClure, Elizabeth M.
dc.date.available
2020-06-08T15:16:21Z
dc.date.issued
2016-06
dc.identifier.citation
Goldenberg, Robert L.; Thorsten, Vanessa R.; Althabe, Fernando; Saleem, Sarah; Garces, Ana; et al.; The global network antenatal corticosteroids trial: Impact on stillbirth; BioMed Central; Reproductive Health; 13; 1; 6-2016; 1-10
dc.identifier.issn
1471-2458
dc.identifier.uri
http://hdl.handle.net/11336/106839
dc.description.abstract
Background: Antenatal corticosteroids are commonly used to reduce neonatal mortality, but most research to date has been in high-resource settings and few studies have evaluated its impact on stillbirth. In the Antenatal Corticosteroids Trial (ACT), a multi-country trial to assess impact of a multi-faceted intervention including antenatal corticosteroids to reduce neonatal mortality associated with preterm birth, we found an overall increase in 28-day neonatal mortality and stillbirth associated with the intervention.METHODS:The ACT was a cluster-randomized trial conducted in 102 clusters across 7 research sites in 6 countries (India [2 sites], Pakistan, Zambia, Kenya, Guatemala and Argentina), comparing an intervention to train birth attendants at all levels of the health system to identify women at risk of preterm birth, administer corticosteroids and refer women at risk. Because of inadequate gestational age dating, the <5(th) percentile birth weight was used as a proxy for preterm birth. A pre-specified secondary outcome of the trial was stillbirth.RESULTS:After adjusting for the pre-trial imbalance in stillbirth rates, the ACT intervention was associated with a non-significant increased risk of stillbirth (aRR 1.08, 95 % CI, 0.99-1.17, p-0.073). Additionally, the stillbirth rate was higher in the term births (1.20 95 % CI 1.06-1.37, 0.004) and among those with signs of maceration (RR 1.18 (1.04-1.35), p = 0.013) in the intervention vs. control clusters. Differences in obstetric care favored the control clusters and maternal infection was likely more common in the intervention clusters.CONCLUSIONS:In this pragmatic trial, limited data were available to identify the causes of the increase in stillbirths in the intervention clusters. A higher rate of stillbirth in the intervention clusters prior to the trial, differences in obstetric care and an increase in maternal infection are potential explanations for the observed increase in stillbirths in the intervention clusters during the trial.
dc.format
application/pdf
dc.language.iso
eng
dc.publisher
BioMed Central
dc.rights
info:eu-repo/semantics/openAccess
dc.rights.uri
https://creativecommons.org/licenses/by/2.5/ar/
dc.subject
stillbirth
dc.subject.classification
Epidemiología
dc.subject.classification
Ciencias de la Salud
dc.subject.classification
CIENCIAS MÉDICAS Y DE LA SALUD
dc.title
The global network antenatal corticosteroids trial: Impact on stillbirth
dc.type
info:eu-repo/semantics/article
dc.type
info:ar-repo/semantics/artículo
dc.type
info:eu-repo/semantics/publishedVersion
dc.date.updated
2020-06-02T20:39:43Z
dc.identifier.eissn
1742-4755
dc.journal.volume
13
dc.journal.number
1
dc.journal.pagination
1-10
dc.journal.pais
Reino Unido
dc.journal.ciudad
Londres
dc.description.fil
Fil: Goldenberg, Robert L.. Columbia University; Estados Unidos
dc.description.fil
Fil: Thorsten, Vanessa R.. RTI International; Estados Unidos
dc.description.fil
Fil: Althabe, Fernando. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina
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Fil: Saleem, Sarah. Columbia University; Estados Unidos. Aga Khan University; Pakistán
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Fil: Garces, Ana. No especifíca;
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Fil: Carlo, Waldemar A.. University of Alabama at Birmingham; Estados Unidos
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Fil: Pasha, Omrana. Aga Khan University; Pakistán
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Fil: Chomba, Elwyn. University Teaching Hospital; Zambia
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Fil: Goudar, Shivaprasad. KLE University’s; India
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Fil: Esamai, Fabian. Moi University; Kenia
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Fil: Krebs, Nancy F.. University of Colorado School of Medicine; Estados Unidos
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Fil: Derman, Richard J.. Christiana Care Health System; Estados Unidos
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Fil: Liechty, Edward A.. Indiana University; Estados Unidos
dc.description.fil
Fil: Patel, Archana. Lata Medical Research Foundation; India
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Fil: Hibberd, Patricia L.. Massachusetts General Hospital; Estados Unidos
dc.description.fil
Fil: Buekens, Pierre. Tulane School of Public Health and Tropical Medicine; Estados Unidos
dc.description.fil
Fil: Koso-Thomas, Marion. Eunice Kennedy Shriver National Institute of Child Health and Human Development; Estados Unidos
dc.description.fil
Fil: Miodovnik, Menachem. Eunice Kennedy Shriver National Institute of Child Health and Human Development; Estados Unidos
dc.description.fil
Fil: Jobe, Alan H.. Cincinnati Children’s Hospital; Estados Unidos
dc.description.fil
Fil: Wallace, Dennis D.. RTI International; Estados Unidos
dc.description.fil
Fil: Belizan, Jose. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina
dc.description.fil
Fil: McClure, Elizabeth M.. RTI International; Estados Unidos
dc.journal.title
Reproductive Health
dc.relation.alternativeid
info:eu-repo/semantics/altIdentifier/url/https://reproductive-health-journal.biomedcentral.com/articles/10.1186/s12978-016-0174-4
dc.relation.alternativeid
info:eu-repo/semantics/altIdentifier/doi/http://dx.doi.org/10.1186/s12978-016-0174-4
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