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Introduction: A considerable amount of neonatal morbidity and mortality worldwide is caused by preterm birth. To date, the underlying etiology of preterm birth has not been fully clarified. Previous studies demonstrate that inflammation is one of the pathological factors that might cause preterm birth, and that there is a difference between primiparous and multiparous women in immune response to pregnancy. The objective of this prospective cohort study was to investigate the role of two inflammatory markers, ferritin and C‐reactive protein (CRP) and preterm birth, in first trimester women, stratified for parity. In addition, a possible association between high ferritin and CRP, and a possible association between high ferritin and CRP and preterm birth were assessed. Material and methods: A total of 2044 healthy, low‐risk pregnant women from primary obstetric care in the Netherlands participated in this study. Their ferritin and CRP levels were evaluated at 12 weeks' gestation. Levels above the parity specific 95th percentile were defined as high. The main outcome of this study was to assess the presence of a possible association between parity specific high ferritin and CRP, and preterm birth. The secondary outcomes were the ferritin and CRP levels of women, stratified for parity, and the possible association between high ferritin and CRP levels. Logistic regression analysis was performed with preterm birth as a dependent variable and parity specific high ferritin and CRP as an independent variable, adjusting for age and history of preterm birth. Results: Ferritin levels decreased with increasing parity. Ferritin and CRP levels at 12 weeks' gestation were significantly higher in women with preterm birth. In primiparous women, high ferritin levels (OR: 2.5, CI: 1.14–5.38) and high CRP levels (OR: 5.0, CI: 2.61–9.94) were independently associated with preterm birth. In multiparous women, high ferritin levels (OR: 6.0, CI: 2.28–16.67) were independently associated with preterm birth while high CRP levels were not. Conclusions: First trimester parity specific ferritin and CRP levels could play a part in predictive models for preterm birth, and further research for their additive role in preterm birth is needed. [ABSTRACT FROM AUTHOR]

Objective: To assess the association between trajectories of comorbid anxiety and depressive (CAD) symptoms assessed in each pregnancy trimester and physiological birth. Design: Large longitudinal prospective cohort study with recruitment between January 2013 and September 2014. Setting: Primary care, in the Netherlands. Population: Dutch‐speaking pregnant women with gestational age at birth ≥37 weeks, and without multiple pregnancy, severe psychiatric disorder or chronic disease history. Methods: Pregnancy‐specific anxiety and depressive symptoms were measured prospectively in each trimester of pregnancy using the negative affect subscale of the Tilburg Pregnancy Distress Scale and Edinburgh (Postnatal) Depression Scale. Data on physiological birth were obtained from obstetric records. Multivariate growth mixture modelling was performed in MPLUS to determine longitudinal trajectories of CAD symptoms. Multiple logistic regression analysis was used to examine the association between trajectories and physiological birth. Main outcome measures: Trajectories of CAD symptoms and physiological birth. Results: Seven trajectories (classes) of CAD symptoms were identified in 1682 women and subsequently merged into three groups: group 1—persistently low levels of symptoms (reference class 1; 79.0%), group 2—intermittently high levels of symptoms (classes 3, 6 and 7; 11.2%), and group 3—persistently high levels of symptoms (classes 2, 4 and 5; 9.8%). Persistently high levels of CAD symptoms (group 3) were associated with a lower likelihood of physiological birth (odds ratio 0.67, 95% confidence interval 0.47–0.95, P = 0.027) compared with the reference group (persistently low levels of symptoms), after adjusting for confounders. Conclusions: This study is the first showing evidence that persistently high CAD levels, assessed in each pregnancy trimester, are associated with a lower likelihood of physiological birth. Linked article: This article is commented on by Gustaf Rejnö, pp.506 in this issue. To view this mini commentary visit https://doi.org/10.1111/1471‐0528.17389 This article includes Author Insights, a video abstract available at: https://vimeo.com/732411350 [ABSTRACT FROM AUTHOR]

We thank Grogan and Srinivasan[1] for writing a letter with interesting comments on our previously published article by Hulsbosch et al.[2] In this paper we investigated the association between comorbid anxiety and depressive (CAD) symptoms during pregnancy, and the likelihood of a physiological birth (defined as birth at term, free from intervention during labour, with a healthy mother and baby). Grogan and Srinivasan[1] suggest investigation of whether there is an association in our cohort between traumatic birth and persistent anxiety during pregnancy. GRAPH: ICMJE GRAPH: ICMJE GRAPH: ICMJE GRAPH: ICMJE GRAPH: ICMJE GRAPH: ICMJE GRAPH: ICMJE GRAPH: ICMJE GRAPH: ICMJE Footnotes 1 A comment on the recently published letter by Grogan and Srinivasan: The effect of antenatal depressive and anxious symptoms on the rate of physiological births. [Extracted from the article]

Objective. To assess the prevalence of antenatal depressive disorder in different trimesters and to evaluate the relation of psychosocial risk factors to antenatal depressive disorder. Design. Cohort follow-up. Setting. University Hospital, Kaunas, Lithuania. Sample. Two hundred and thirty pregnant women consecutively admitted. Methods. At 12-16 weeks, 22-26 weeks, and 32-36 weeks of pregnancy, participants were screened for depression using the World Health Organization's Composite International Diagnostic Interview Short Form (CIDI-SF). Women who gave at least one positive answer to the CIDI-SF depression-screening question were evaluated for depressive disorder using the non-patient version of the Structured Clinical Interview for DSM-III-R (SCID-NP). Psychosocial stressors and two Big Five Personality dimensions, neuroticism and extraversion, were also evaluated. Main outcome measures. Prevalence of depressive disorder. Results. The prevalence of the antenatal depressive disorder at 12-16 weeks' gestation was 6.1%, at 22-26 weeks 3.5%, and at 32-36 weeks 4.4%. In the first trimester, a greater prevalence of current depressive disorder was independently associated with unplanned and unwanted pregnancy, high neuroticism, low education, and a previous history of depression; in the second trimester with unplanned and unwanted pregnancy and high neuroticism; in the third trimester with unplanned and unwanted pregnancy, high neuroticism, and the occurrence of psychosocial stressors during the last year. Conclusions. The highest prevalence of depressive disorders was found in the first trimester, the lowest in mid-pregnancy. Several determinants (unwanted and unplanned pregnancy, high neuroticism) were independent predictors of antenatal depressive disorders throughout whole pregnancy, while other determinants (low education, previous history of depression, the occurrence of psychosocial stressors at the end of pregnancy) were trimester specific. [ABSTRACT FROM AUTHOR]

Objective: To assess the association between trajectories of comorbid anxiety and depressive (CAD) symptoms assessed in each pregnancy trimester and physiological birth., Design: Large longitudinal prospective cohort study with recruitment between January 2013 and September 2014., Setting: Primary care, in the Netherlands., Population: Dutch-speaking pregnant women with gestational age at birth ≥37 weeks, and without multiple pregnancy, severe psychiatric disorder or chronic disease history., Methods: Pregnancy-specific anxiety and depressive symptoms were measured prospectively in each trimester of pregnancy using the negative affect subscale of the Tilburg Pregnancy Distress Scale and Edinburgh (Postnatal) Depression Scale. Data on physiological birth were obtained from obstetric records. Multivariate growth mixture modelling was performed in MPLUS to determine longitudinal trajectories of CAD symptoms. Multiple logistic regression analysis was used to examine the association between trajectories and physiological birth., Main Outcome Measures: Trajectories of CAD symptoms and physiological birth., Results: Seven trajectories (classes) of CAD symptoms were identified in 1682 women and subsequently merged into three groups: group 1-persistently low levels of symptoms (reference class 1; 79.0%), group 2-intermittently high levels of symptoms (classes 3, 6 and 7; 11.2%), and group 3-persistently high levels of symptoms (classes 2, 4 and 5; 9.8%). Persistently high levels of CAD symptoms (group 3) were associated with a lower likelihood of physiological birth (odds ratio 0.67, 95% confidence interval 0.47-0.95, P = 0.027) compared with the reference group (persistently low levels of symptoms), after adjusting for confounders., Conclusions: This study is the first showing evidence that persistently high CAD levels, assessed in each pregnancy trimester, are associated with a lower likelihood of physiological birth., (© 2022 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)