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Goldenberg RL, Saleem S, Aziz A, McClure EM. International progress on stillbirth reduction: Changes in Stillbirth Rates in Selected Low and Middle-Income Countries from 2000 to 2021. Semin Perinatol 2024; 48:151868. [PMID: 38281882 DOI: 10.1016/j.semperi.2023.151868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
In this paper, we attempted to determine if there were reductions in low and middle - income country stillbirth rates since 2000 - focusing on sub-Saharan Africa, Asia and Latin America and the Caribbean. We used data made available by the United Nations Inter-agency Group for Child Mortality Estimation and the World Health Organization as well as the National Institute of Child Health and Human Development Global Network for Women's and Children's Health Research.. Overall, nearly every country evaluated had at least a small reduction in stillbirth rate from the year 2000 to 2021, but the reductions varied substantially between regions. Asia and Latin America/Caribbean had similar levels of reductions with a number of countries in each of those regions having rates in 2021 that were 40 % or more lower than those documented in 2000. No country in Africa documented a reduction in stillbirths of 40 % and many had stillbirth reductions of less than 15 %.
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O'Connor E, Leitao S, Fogarty AP, Greene R, O'Donoghue K. A systematic review of standardised tools used in perinatal death review programmes. Women Birth 2024; 37:88-97. [PMID: 37793961 DOI: 10.1016/j.wombi.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/14/2023] [Accepted: 09/20/2023] [Indexed: 10/06/2023]
Abstract
INTRODUCTION Reducing preventable perinatal deaths is the focus of perinatal death surveillance and response programmes. Standardised review tools can help identify modifiable factors in perinatal deaths. AIM This systematic review aimed to identify, compare, and appraise perinatal mortality review tools (PMRTs) in upper-middle to high-income countries. METHODS Four major scientific databases were searched for publications relating to perinatal death reviews. There were no restrictions on date, study, or publication type. Professional websites for each country were searched for relevant material. The Appraisal of Guidelines Research and Evaluation Health Systems (AGREE-HS) checklist was used for quality appraisal of each tool. A narrative synthesis was used to describe and compare tools. FINDINGS Ten PMRTs were included. Five PMRTs were from high-income countries, four from upper-middle income countries and one was designed for use in a global context. The structure, content, and quality of each PMRT varied. Each tool collected information about the antepartum, intrapartum, and neonatal periods and a section to classify perinatal deaths using a standardised classification system. All tools reviewed the care provided. Five tools included recommendation development for changes to clinical care. Four tools mentioned parent involvement in the review process. For quality appraisal, one review tool scored "high quality", six scored "moderate quality" and two scored "poor quality". CONCLUSION There is little standardisation when it comes to PMRTs. Guidance on structuring PMRTs in a standardised way is needed. Recommendation development from a review is important to highlight changes to care required to reduce preventable perinatal deaths.
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Affiliation(s)
- Emily O'Connor
- INFANT Research Centre, University College Cork, Cork, Ireland; Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland; National Perinatal Epidemiology Centre, Dept. of Obstetrics and Gynaecology, 5th Floor, Cork University Maternity Hospital, Ireland.
| | - Sara Leitao
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland; National Perinatal Epidemiology Centre, Dept. of Obstetrics and Gynaecology, 5th Floor, Cork University Maternity Hospital, Ireland
| | - Amy P Fogarty
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
| | - Richard Greene
- National Perinatal Epidemiology Centre, Dept. of Obstetrics and Gynaecology, 5th Floor, Cork University Maternity Hospital, Ireland
| | - Keelin O'Donoghue
- INFANT Research Centre, University College Cork, Cork, Ireland; Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
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Hantouli MN, Droullard DJ, Nash MG, Benson LS, Wright AS, Flum DR, Davidson GH. Operative vs Nonoperative Management of Acute Cholecystitis During the Different Trimesters of Pregnancy. JAMA Surg 2024; 159:28-34. [PMID: 37966823 PMCID: PMC10652218 DOI: 10.1001/jamasurg.2023.5803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/27/2023] [Indexed: 11/16/2023]
Abstract
Importance Acute cholecystitis (AC) management during pregnancy requires balancing the risk of pregnancy loss or preterm delivery (adverse pregnancy outcomes [APOs]) with or without surgery. Guidelines recommend cholecystectomy across trimesters; however, trimester-specific evidence on the risks of AC and its management is lacking. Objective To assess cholecystectomy frequency in pregnant people with AC, compare the rates of APOs in pregnant people with or without AC, and compare the rates of APOs in people with AC who did or did not undergo cholecystectomy. Design, Setting, and Participants This retrospective, population-based cohort study used data for pregnant people with AC from the IBM MarketScan Commercial Claims and Encounters Database from January 1, 2007, to December 31, 2019, and a propensity score-matched cohort of pregnant people without AC. Trimester status (first [T1], second [T2], and third [T3]), APOs, and cholecystectomy were defined by administrative claims. Data were analyzed from October 2021 to July 2022. Exposures Pregnant patients with or without AC. Pregnant patients with AC who did or did not receive cholecystectomy. Main Outcomes and Measures The main outcomes were cholecystectomy during pregnancy and APOs (ie, preterm delivery and pregnancy loss). Pregnant patients with and without AC were compared to assess the association of AC with risk of APOs. Propensity score inverse-probability weighting was used to calculate treatment-associated APO risk among patients with 1-year follow-up. Results The study included 5759 pregnant patients with AC (mean [SD] age, 30.1 [6.6] years) and 23 036 controls (mean [SD] age, 29.9 [6.7] years) after propensity score matching. Among 3426 pregnant patients with AC and 1-year follow-up, 1182 (34.5%) underwent cholecystectomy during the pregnancy (684 [41.7%] presenting with AC in T1, 404 [40.4%] in T2, and 94 [12.0%] in T3). Acute cholecystitis during pregnancy, irrespective of treatment, was associated with higher odds of APO compared with no AC during pregnancy across all trimesters (odds ratio [OR], 1.69 [95% CI, 1.54-1.85]). Compared with nonoperative management, receipt of surgery was associated with lower odds of APOs across all trimesters (OR, 0.75 [95% CI, 0.63-0.87]), in T1 (OR, 0.81 [95% CI, 0.66-1.00]), in T2 (OR, 0.71 [95% CI, 0.50-1.00]), and in T3 (OR, 0.45 [95% CI, 0.28-0.70]). Conclusions and Relevance In this study, cholecystectomy was associated with lower risk of APO in patients with AC across all trimesters, with the greatest benefit in T3. However, only 34.5% overall and 12.0% of patients in T3 had a cholecystectomy. These findings support guidelines recommending cholecystectomy during pregnancy and should inform decision-making discussions. Greater guideline adherence and surgery use, especially in T3, may represent an opportunity to improve outcomes for pregnant people with AC.
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Affiliation(s)
| | | | - Michael G. Nash
- Department of Biostatistics, School of Public Health, University of Washington, Seattle
| | - Lyndsey S. Benson
- Department of Obstetrics and Gynecology, University of Washington, Seattle
| | | | - David R. Flum
- Department of Surgery, University of Washington, Seattle
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Parry M, Torvaldsen S, Nippita TA, Bowen J, Morris JM, Ibiebele I. Trends in early gestation stillbirths and neonatal deaths in New South Wales, Australia 2002-2019. Aust N Z J Obstet Gynaecol 2023; 63:541-549. [PMID: 37062902 DOI: 10.1111/ajo.13685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
BACKGROUND Little research has focused on understanding trends in early gestation (20-27 weeks) stillbirths and neonatal deaths. AIMS To examine trends in early gestation stillbirths and neonatal deaths in New South Wales (NSW), Australia. MATERIALS AND METHODS Population-based cohort study of all births ≥20 weeks gestation among female NSW residents during 2002 to 2019, induced pregnancy terminations excluded. Stillbirth rates by gestational age and birth year were calculated per 1000 fetuses-at-risk (FAR). Neonatal death rates by gestational age and birth year were calculated per 1000 live births. Linear regression was used to examine trends in stillbirth and neonatal death rates among all, singleton and twin births. RESULTS Declining trends in early gestation stillbirth and neonatal death rates were found. Stillbirth rates decreased from 1.9 and 0.9/1000 FAR in 2002 to 1.6 and 0.7 in 2019 for 20-23 and 24-27 week groups, respectively. Neonatal rates decreased from 940 and 315/1000 live births in 2002 to 925 and 189 in 2019 for the 20-23 and 24-27 week groups, respectively. Among singleton births, declining trends in stillbirth and neonatal death rates across all age groups were observed, except for 37-38 week stillbirths. No trends in twin stillbirth rates were found across gestational age groups, although a decreasing trend was observed for 20-23 week twin neonatal deaths. CONCLUSIONS Trends in early gestation stillbirth and neonatal deaths have declined in recent decades in NSW but further efforts are needed to reduce both early and late gestation stillbirth rates among twin births.
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Affiliation(s)
- Marissa Parry
- Faculty of Medicine and Health, Reproduction and Perinatal Centre, Women and Babies Research, The University of Sydney, Sydney, New South Wales, Australia
- NSW Biostatistics Training Program, NSW Ministry of Health, Sydney, New South Wales, Australia
- Northern Sydney Local Health District, Kolling Institute, Sydney, New South Wales, Australia
| | - Siranda Torvaldsen
- Faculty of Medicine and Health, Reproduction and Perinatal Centre, Women and Babies Research, The University of Sydney, Sydney, New South Wales, Australia
- Northern Sydney Local Health District, Kolling Institute, Sydney, New South Wales, Australia
- School of Population Health, UNSW, Sydney, New South Wales, Australia
| | - Tanya A Nippita
- Faculty of Medicine and Health, Reproduction and Perinatal Centre, Women and Babies Research, The University of Sydney, Sydney, New South Wales, Australia
- Northern Sydney Local Health District, Kolling Institute, Sydney, New South Wales, Australia
- Department of Obstetrics and Gynaecology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Jennifer Bowen
- Faculty of Medicine and Health, Reproduction and Perinatal Centre, Women and Babies Research, The University of Sydney, Sydney, New South Wales, Australia
- Northern Sydney Local Health District, Kolling Institute, Sydney, New South Wales, Australia
- Department of Neonatology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Jonathan M Morris
- Faculty of Medicine and Health, Reproduction and Perinatal Centre, Women and Babies Research, The University of Sydney, Sydney, New South Wales, Australia
- Northern Sydney Local Health District, Kolling Institute, Sydney, New South Wales, Australia
- Department of Obstetrics and Gynaecology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Clinical Excellence Commission, New South Wales Ministry of Health, Sydney, New South Wales, Australia
| | - Ibinabo Ibiebele
- Faculty of Medicine and Health, Reproduction and Perinatal Centre, Women and Babies Research, The University of Sydney, Sydney, New South Wales, Australia
- Northern Sydney Local Health District, Kolling Institute, Sydney, New South Wales, Australia
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Marega M, El-Merhie N, Gökyildirim MY, Orth V, Bellusci S, Chao CM. Stem/Progenitor Cells and Related Therapy in Bronchopulmonary Dysplasia. Int J Mol Sci 2023; 24:11229. [PMID: 37446407 DOI: 10.3390/ijms241311229] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/18/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023] Open
Abstract
Bronchopulmonary dysplasia (BPD) is a chronic lung disease commonly seen in preterm infants, and is triggered by infection, mechanical ventilation, and oxygen toxicity. Among other problems, lifelong limitations in lung function and impaired psychomotor development may result. Despite major advances in understanding the disease pathologies, successful interventions are still limited to only a few drug therapies with a restricted therapeutic benefit, and which sometimes have significant side effects. As a more promising therapeutic option, mesenchymal stem cells (MSCs) have been in focus for several years due to their anti-inflammatory effects and their secretion of growth and development promoting factors. Preclinical studies provide evidence in that MSCs have the potential to contribute to the repair of lung injuries. This review provides an overview of MSCs, and other stem/progenitor cells present in the lung, their identifying characteristics, and their differentiation potential, including cytokine/growth factor involvement. Furthermore, animal studies and clinical trials using stem cells or their secretome are reviewed. To bring MSC-based therapeutic options further to clinical use, standardized protocols are needed, and upcoming side effects must be critically evaluated. To fill these gaps of knowledge, the MSCs' behavior and the effects of their secretome have to be examined in more (pre-) clinical studies, from which only few have been designed to date.
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Affiliation(s)
- Manuela Marega
- German Center for Lung Research (DZL), Department of Pulmonary and Critical Care Medicine and Infectious Diseases, Cardio-Pulmonary Institute (CPI), Universities of Giessen and Marburg Lung Center (UGMLC), Justus Liebig University Giessen, 35392 Giessen, Germany
- Department of Pediatrics, Centre for Clinical and Translational Research (CCTR), Helios University Hospital Wuppertal, Witten/Herdecke University, 42283 Wuppertal, Germany
| | - Natalia El-Merhie
- Institute for Lung Health (ILH), Member of the German Center for Lung Research (DZL), Justus Liebig University Giessen, 35392 Giessen, Germany
| | - Mira Y Gökyildirim
- Department of Pediatrics, University Medical Center Rostock, University of Rostock, 18057 Rostock, Germany
| | - Valerie Orth
- Department of Pediatrics, Centre for Clinical and Translational Research (CCTR), Helios University Hospital Wuppertal, Witten/Herdecke University, 42283 Wuppertal, Germany
| | - Saverio Bellusci
- German Center for Lung Research (DZL), Department of Pulmonary and Critical Care Medicine and Infectious Diseases, Cardio-Pulmonary Institute (CPI), Universities of Giessen and Marburg Lung Center (UGMLC), Justus Liebig University Giessen, 35392 Giessen, Germany
| | - Cho-Ming Chao
- German Center for Lung Research (DZL), Department of Pulmonary and Critical Care Medicine and Infectious Diseases, Cardio-Pulmonary Institute (CPI), Universities of Giessen and Marburg Lung Center (UGMLC), Justus Liebig University Giessen, 35392 Giessen, Germany
- Department of Pediatrics, Centre for Clinical and Translational Research (CCTR), Helios University Hospital Wuppertal, Witten/Herdecke University, 42283 Wuppertal, Germany
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Sewberath Misser VH, Hindori-Mohangoo AD, Shankar A, Wickliffe JK, Lichtveld MY, Mans DRA. Prenatal Exposure to Mercury, Manganese, and Lead and Adverse Birth Outcomes in Suriname: A Population-Based Birth Cohort Study. TOXICS 2022; 10:464. [PMID: 36006143 PMCID: PMC9414742 DOI: 10.3390/toxics10080464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/04/2022] [Accepted: 08/06/2022] [Indexed: 06/15/2023]
Abstract
Globally, adverse birth outcomes are increasingly linked to prenatal exposure to environmental contaminants, such as mercury, manganese, and lead. This study aims to assess an association between prenatal exposure to mercury, manganese, and lead and the occurrence of adverse birth outcomes in 380 pregnant women in Suriname. The numbers of stillbirths, preterm births, low birth weights, and low Apgar scores were determined, as well as blood levels of mercury, manganese, lead, and relevant covariates. Descriptive statistics were calculated using frequency distributions. The associations between mercury, manganese, and lead blood levels, on the one hand, and adverse birth outcomes, on the other hand, were explored using contingency tables, tested with the χ2-test (Fisher's exact test), and expressed with a p value. Multivariate logistic regression models were computed to explore independent associations and expressed as (adjusted) odds ratios (aOR) with 95% confidence intervals (CI). The findings of this study indicate no statistically significant relationship between blood mercury, manganese, or lead levels and stillbirth, preterm birth, low birth weight, and low Apgar score. However, the covariate diabetes mellitus (aOR 5.58, 95% CI (1.38-22.53)) was independently associated with preterm birth and the covariate hypertension (aOR 2.72, 95% CI (1.081-6.86)) with low birth weight. Nevertheless, the observed high proportions of pregnant women with blood levels of mercury, manganese, and lead above the reference levels values of public health concern warrants environmental health research on risk factors for adverse birth outcomes to develop public health policy interventions to protect pregnant Surinamese women and their newborns from potential long-term effects.
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Affiliation(s)
- Vinoj H. Sewberath Misser
- Department of Pharmacology, Faculty of Medical Sciences, Anton de Kom University of Suriname, Kernkampweg 5-7, Paramaribo, Suriname
| | - Ashna D. Hindori-Mohangoo
- Department of Environmental Health Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA
- Foundation for Perinatal Interventions and Research in Suriname (Perisur), Paramaribo, Suriname
| | - Arti Shankar
- Department of Environmental Health Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Jeffrey K. Wickliffe
- Department of Environmental Health Sciences, School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | | | - Dennis R. A. Mans
- Department of Pharmacology, Faculty of Medical Sciences, Anton de Kom University of Suriname, Kernkampweg 5-7, Paramaribo, Suriname
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Lupariello F, Di Vella G, Botta G. Stillbirth diagnosis and classification: comparison of ReCoDe and ICD-PM systems. J Perinat Med 2022; 50:713-721. [PMID: 35607751 DOI: 10.1515/jpm-2022-0014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 05/05/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The identification of causes of stillbirth (SB) can be a challenge due to several different classification systems of SB causes. In the scientific literature there is a continuous emergence of SB classification systems, not allowing uniform data collection and comparisons between populations from different geographical areas. For these reasons, this study compared two of the most used SB classifications, aiming to identify which of them should be preferable. METHODS A total of 191 SBs were retrospectively classified by a panel composed by three experienced-physicians throughout the ReCoDe and ICD-PM systems to evaluate which classification minimizes unclassified/unspecified cases. In addition, intra and inter-rater agreements were calculated. RESULTS ReCoDe defined: the 23.6% of cases as unexplained, placental insufficiency in the 14.1%, lethal congenital anomalies in the 12%, infection in the 9.4%, abruptio in the 7.3%, and chorioamnionitis in the 7.3%. ICD-PM defined: the 20.9% of cases as unspecified, antepartum hypoxia in the 44%, congenital malformations, deformations, and chromosomal abnormalities in the 11.5%, and infection in the 11.5%. For ReCoDe, inter-rater was agreement of 0.58; intra-rater agreements were 0.78 and 0.79. For ICD-PM, inter-rater agreement was 0.54; intra-rater agreements were of 0.76 and 0.71. CONCLUSIONS There is no significant difference between ReCoDe and ICD-PM classifications in minimizing unexplained/unspecified cases. Inter and intra-rater agreements were largely suboptimal for both ReCoDe and ICD-PM due to their lack of specific guidelines which can facilitate the interpretation. Thus, the authors suggest correctives strategies: the implementation of specific guidelines and illustrative case reports to easily solve interpretation issues.
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Affiliation(s)
- Francesco Lupariello
- Dipartimento di Scienze della Sanità Pubblica e Pediatriche - Sezione di Medicina Legale, "Università degli Studi di Torino" Torino, Italy
| | - Giancarlo Di Vella
- Dipartimento di Scienze della Sanità Pubblica e Pediatriche - Sezione di Medicina Legale, "Università degli Studi di Torino" Torino, Italy
| | - Giovanni Botta
- Dipartimento di Scienze Mediche - Anatomia Patologica, Unità Materno Fetal, "Università degli Studi di Torino" Torino, Italy
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Soltanghoraee H, Moradi-Lakeh M, Khalili N, Soltani A. A retrospective autopsy study of 42 cases of stillbirth in Avicenna Research Institute. BMC Pregnancy Childbirth 2022; 22:507. [PMID: 35739463 PMCID: PMC9229882 DOI: 10.1186/s12884-022-04822-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 06/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND According to the World Health Organization about 2.6 million deaths were reported worldwide in 2015. More than 98% of stillbirths occur in developing countries. At present, the causes of many cases of stillbirth are unknown due to the lack of necessary data and autopsies in Iran. The aim of this study was to investigate the most plausible cause of stillbirth by evaluating clinical records and autopsies. METHODS A cross-sectional study of 42 stillbirth autopsies in Avicenna Research Institute from 2012 to 2019, was conducted. Data were extracted from a checklist prepared by the project researchers. The checklist contains maternal demographic information, medical history and maternal illness, pregnancy risk factors, placenta and stillbirth information. Collected data were reviewed and classified according to the ReCoDe (Relevant Condition at Death) system. RESULTS In the present study, based on ReCoDe classification, related causes of 95.2% of stillbirths were identified and 4.8% were in the unclassified group. The most common causes were: Fetal causes (64.3%), umbilical cord (14.3%), placenta (7.1%), amniotic fluid (4.8%), maternal medical conditions (2.4%). The causes of about 70% of stillbirth in Iran are unexplained, but in this study, using autopsy results and ReCoDe classification, only 4.8% of stillbirth causes remained unexplained. CONCLUSIONS In our study, unknown cases were rare after autopsy. But considering the limitations and costs of autopsy, we need to design the guideline to specify cases who need an autopsy. Fetal autopsy, placental examination and clinical information could reduce the proportion of stillbirths that remain unexplained.
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Affiliation(s)
- Haleh Soltanghoraee
- Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
| | - Maziar Moradi-Lakeh
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research InstituteDepartment of Community and Family Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Narjes Khalili
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research InstituteDepartment of Community and Family Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Azadeh Soltani
- Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
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Gissler M, Durox M, Smith L, Blondel B, Broeders L, Hindori-Mohangoo A, Kearns K, Kolarova R, Loghi M, Rodin U, Szamotulska K, Velebil P, Weber G, Zurriaga O, Zeitlin J. Clarity and consistency in stillbirth reporting in Europe: why is it so hard to get this right? Eur J Public Health 2022; 32:200-206. [PMID: 35157046 PMCID: PMC8975542 DOI: 10.1093/eurpub/ckac001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Stillbirth is a major public health problem, but measurement remains a challenge even in high-income countries. We compared routine stillbirth statistics in Europe reported by Eurostat with data from the Euro-Peristat research network. Methods We used data on stillbirths in 2015 from both sources for 31 European countries. Stillbirth rates per 1000 total births were analyzed by gestational age (GA) and birthweight groups. Information on termination of pregnancy at ≥22 weeks’ GA was analyzed separately. Results Routinely collected stillbirth rates were higher than those reported by the research network. For stillbirths with a birthweight ≥500 g, the difference between the mean rates of the countries for Eurostat and Euro-Peristat data was 22% [4.4/1000, versus 3.5/1000, mean difference 0.9 with 95% confidence interval (CI) 0.8–1.0]. When using a birthweight threshold of 1000 g, this difference was smaller, 12% (2.9/1000, versus 2.5/1000, mean difference 0.4 with 95% CI 0.3–0.5), but substantial differences remained for individual countries. In Euro-Peristat, missing data on birthweight ranged from 0% to 29% (average 5.0%) and were higher than missing data for GA (0–23%, average 1.8%). Conclusions Routine stillbirth data for European countries in international databases are not comparable and should not be used for benchmarking or surveillance without careful verification with other sources. Recommendations for improvement include using a cut-off based on GA, excluding late terminations of pregnancy and linking multiple sources to improve the quality of national databases.
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Affiliation(s)
- Mika Gissler
- THL Finnish Institute for Health and Welfare, Helsinki, Finland and Karolinska Institute, Stockholm, Sweden
| | - Mélanie Durox
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), INSERM, INRA, Paris, F-75004, France
| | - Lucy Smith
- Department of Health Sciences, College of Life Sciences, University of Leicester, LE1 7RH, UK
| | - Béatrice Blondel
- THL Finnish Institute for Health and Welfare, Helsinki, Finland and Karolinska Institute, Stockholm, Sweden
| | - Lisa Broeders
- The Netherlands Perinatal Registry (Perined), Utrecht, The Netherlands
| | - Ashna Hindori-Mohangoo
- Foundation for Perinatal Interventions and Research in Suriname (PeriSur), Paramaribo, Suriname.,Tulane University, School of Public Health and Tropical Medicine, New Orleans, USA
| | - Karen Kearns
- National Finance Division, Healthcare Pricing Office, HSE, Dublin
| | | | - Marzia Loghi
- Directorate for Social Statistics and Welfare, Italian Statistical Institute (ISTAT), Rome, Italy
| | - Urelija Rodin
- Croatian Institute of Public Health, School of Public Health 'Andrija Štampar', School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Katarzyna Szamotulska
- Department of Epidemiology and Biostatistics, National Research Institute of Mother and Child, Warsaw, Poland
| | - Petr Velebil
- Institute for the Care of Mother and Child, Prague, Czech Republic
| | - Guy Weber
- Department of Epidemiology and Statistics, Directorate of Health, Luxembourg
| | - Oscar Zurriaga
- Public Health General Directorate, Valencia Regional Public Health Authority, Spain.,Public Health and Preventive Medicine Department, University of Valencia, Spain.,Centre for Network Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Jennifer Zeitlin
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), INSERM, INRA, Paris, F-75004, France
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Affiliation(s)
- Andrei S Morgan
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM U1153 EPOPé, INRA, Paris, France
- Elizabeth Garrett Anderson Institute for Women's Health London, University College London, London, UK
- Department of Neonatal Medicine, Maternité Port-Royal, Association Publique des Hôpitaux de Paris (APHP), Paris, France
| | - Marina Mendonça
- Department of Psychology, University of Warwick, Coventry, UK
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
| | - Nicole Thiele
- European Foundation for Care of the Newborn Infant, Munich, Germany
| | - Anna L David
- Elizabeth Garrett Anderson Institute for Women's Health London, University College London, London, UK
- National Institute for Health Research, University College London Hospital Biomedical Research Centre, London, UK
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11
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Epidemiology of Antepartum Stillbirths in Austria-A Population-Based Study between 2008 and 2020. J Clin Med 2021; 10:jcm10245828. [PMID: 34945123 PMCID: PMC8709287 DOI: 10.3390/jcm10245828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 11/17/2022] Open
Abstract
(1) Background: Across Europe, the incidence of antepartum stillbirth varies greatly, partly because of heterogeneous definitions regarding gestational weeks and differences in legislation. With this study, we sought to provide a comprehensive overview on the demographics of antepartum stillbirth in Austria, defined as non-iatrogenic fetal demise ≥22+0 gestational weeks (/40). (2) Methods: We conducted a population-based study on epidemiological characteristics of singleton antepartum stillbirth in Austria between January 2008 and December 2020. Data were derived from the validated Austrian Birth Registry. (3) Results: From January 2008 through December 2020, the antepartum stillbirth rate ≥20+0/40 was 3.10, ≥22+0/40 3.14, and ≥24+0/40 2.83 per 1000 births in Austria. The highest incidence was recorded in the federal states of Vienna, Styria, and Lower and Upper Austria, contributing to 71.9% of all stillbirths in the country. In the last decade, significant fluctuations in incidence were noted: from 2011 to 2012, the rate significantly declined from 3.40 to 3.07‰, whilst it significantly increased from 2.76 to 3.49‰ between 2019 and 2020. The median gestational age of antepartum stillbirth in Austria was 33+0 (27+2–37+4) weeks. Stillbirth rates ≤26/40 ranged from 164.98 to 334.18‰, whilst the lowest rates of 0.58–8.4‰ were observed ≥36/40. The main demographic risk factors were maternal obesity and low parity. (4) Conclusions: In Austria, the antepartum stillbirth rate has remained relatively stable at 2.83–3.10 per 1000 births for the last decade, despite a significant decline in 2012 and an increase in 2020.
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Kniffka MS, Nitsche N, Rau R, Kühn M. Stillbirths in Germany: On the rise, but no additional increases during the first COVID-19 lockdown. Int J Gynaecol Obstet 2021; 155:483-489. [PMID: 34287881 PMCID: PMC9087793 DOI: 10.1002/ijgo.13832] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 07/19/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To examine possible changes in the rate of stillbirths in Germany during the first COVID-19 lockdown. METHODS Population-level data of live births and stillbirths occurring between January 1995 and July 2020 were used and negative binomial regression was applied to estimate the rate of stillbirths in this period. The actual rate was compared to the expected figure for 2020. RESULTS A steady increase in stillbirths was detected in Germany since 2013. The stillbirth rate for January to July 2020 (4.148) was slightly lower than that of the same period in 2019 (4.242). Furthermore, all monthly rates of stillbirths during the first half of 2020 lie inside the 95% prediction interval of expected stillbirth rates for this period. CONCLUSION A growing body of studies on the indirect effect of the COVID-19 pandemic on stillbirths shows mixed and context-dependent evidence. In contrast to other European countries, stillbirth rates have been on the rise in Germany in the last decade. However, stillbirth rates during the first half of 2020 were not higher than expected. The results suggest that stillbirth rates have not changed during the first-wave COVID-19 lockdown in this high-income setting. However, further studies on the causes of the increasing trend in stillbirths in Germany are needed.
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Affiliation(s)
- Maxi S. Kniffka
- Laboratory of Fertility and Well‐BeingMax Planck Institute for Demographic ResearchRostockGermany
- Department of Sociology and DemographyUniversity of RostockRostockGermany
| | - Natalie Nitsche
- Laboratory of Fertility and Well‐BeingMax Planck Institute for Demographic ResearchRostockGermany
| | - Roland Rau
- Department of Sociology and DemographyChair of DemographyUniversity of RostockRostockGermany
- Laboratory of Statistical DemographyMax Planck Institute for Demographic ResearchRostockGermany
| | - Mine Kühn
- Laboratory of Population HealthMax Planck Institute for Demographic ResearchRostockGermany
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The psychological effects of stillbirth on parents: A qualitative evidence synthesis of psychoanalytic literature. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2021; 67:329-350. [PMID: 34524058 DOI: 10.13109/zptm.2021.67.3.329] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Objective: To review and synthesize existing psychoanalytic literature on the psychological impact of stillbirth on mothers and fathers. Method: This qualitative systematic review followed, as far as possible, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The Psychoanalytic Electronic Publishing Archive, the Single Case Archive, and PsycINFO (1999-2019) were searched to identify relevant articles published between 1999-2019 that report clinical material or theoretical considerations concerning the psychological effects of stillbirth on parents, as emerging during classical analytic or psychoanalytic therapy session/journey. A thematic synthesis was performed. Results: 46 articles were identified, providing data on the parents' experiences of grief and gender differences, the detrimental effects on the parental couple's relationship, the mother's identification with the dead baby, the importance for mothers to meet and care the stillborn baby, the mothers' drive for another pregnancy and the fear of further loss, the mothers' ambivalence toward subsequent pregnancy and child, the potential negative effects of unresolved bereavement on subsequent baby, and the replacement of a stillborn child. Conclusion: Our findings reveal there is some psychoanalytic literature providing insight into the psychological dynamics of parents after a stillbirth, with observations that could be used to improve psychological health care practices. One of the main therapeutic tasks was to facilitate parents to create a psychic space where they can bring to life, psychically, their lost and never- really-known stillborn baby, and to let him or her to be part of the on-going family narrative.
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Hocquette A, Durox M, Wood R, Klungsøyr K, Szamotulska K, Berrut S, Rihs T, Kyprianou T, Sakkeus L, Lecomte A, Zile I, Alexander S, Klimont J, Barros H, Gatt M, Isakova J, Blondel B, Gissler M, Zeitlin J. International versus national growth charts for identifying small and large-for-gestational age newborns: A population-based study in 15 European countries. THE LANCET REGIONAL HEALTH. EUROPE 2021; 8:100167. [PMID: 34557855 PMCID: PMC8454535 DOI: 10.1016/j.lanepe.2021.100167] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND To inform the on-going debate about the use of universal prescriptive versus national intrauterine growth charts, we compared perinatal mortality for small and large-for-gestational-age (SGA/LGA) infants according to international and national charts in Europe. METHODS We classified singleton births from 33 to 42 weeks of gestation in 2010 and 2014 from 15 countries (N = 1,475,457) as SGA (birthweight <10th percentile) and LGA (>90th percentile) using the international Intergrowth-21st newborn standards and national charts based on the customised charts methodology. We computed sex-adjusted odds ratios (aOR) for stillbirth, neonatal and extended perinatal mortality by this classification using multilevel models. FINDINGS SGA and LGA prevalence using national charts were near 10% in all countries, but varied according to international charts with a north to south gradient (3.0% to 10.1% and 24.9% to 8.0%, respectively). Compared with appropriate for gestational age (AGA) infants by both charts, risk of perinatal mortality was increased for SGA by both charts (aOR[95% confidence interval (CI)]=6.1 [5.6-6.7]) and infants reclassified by international charts from SGA to AGA (2.7 [2.3-3.1]), but decreased for those reclassified from AGA to LGA (0.6 [0.4-0.7]). Results were similar for stillbirth and neonatal death. INTERPRETATION Using international instead of national charts in Europe could lead to growth restricted infants being reclassified as having normal growth, while infants with low risks of mortality could be reclassified as having excessive growth. FUNDING InfAct Joint Action, CHAFEA Grant n°801,553 and EU/EFPIA Innovative Medicines Initiative 2 Joint Undertaking ConcePTION grant n°821,520. AH received a PhD grant from EHESP.
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Affiliation(s)
- Alice Hocquette
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, F-75004 Paris, France
| | - Mélanie Durox
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, F-75004 Paris, France
| | - Rachael Wood
- Public Health Scotland, Edinburgh and University of Edinburgh, Edinburgh, Scotland
| | - Kari Klungsøyr
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway and Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Katarzyna Szamotulska
- Institute of Mother and Child, Department of Epidemiology and Biostatistics, Warsaw, Poland
| | - Sylvan Berrut
- Federal Statistical Office FSO, Neuchâtel, Switzerland
| | - Tonia Rihs
- Federal Statistical Office FSO, Neuchâtel, Switzerland
| | | | - Luule Sakkeus
- Estonian Institute for Population Studies, Tallinn University, Tallinn, Estonia
| | - Aline Lecomte
- Department of Population Health, Luxembourg Institute of Health, Luxembourg
| | - Irisa Zile
- The Centre for Disease Prevention and Control of Latvia, Riga, Latvia
| | - Sophie Alexander
- Université Libre de Bruxelles, School of Public Health, Perinatal Epidemiology and Reproductive health Unit, Brussels, Belgium
| | | | - Henrique Barros
- University of Porto Medical School, Department of Public Health, Forensic Sciences and Medical Education, Porto, Portugal
| | - Miriam Gatt
- Directorate for Health Information and Research, National Obstetric Information Systems (NOIS) Register, Tal-Pietà, Malta
| | - Jelena Isakova
- Institute of Hygiene, Health Information Centre, Health Statistics Department, Vilnius, Lithuania
| | - Béatrice Blondel
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, F-75004 Paris, France
| | - Mika Gissler
- THL Finnish Institute for Health and Welfare, Information Services Department, Helsinki and Karolinska Institute, Department of Neurobiology, Care Sciences and Society, Stockholm, Sweden
| | - Jennifer Zeitlin
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, F-75004 Paris, France
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Hug L, You D, Blencowe H, Mishra A, Wang Z, Fix MJ, Wakefield J, Moran AC, Gaigbe-Togbe V, Suzuki E, Blau DM, Cousens S, Creanga A, Croft T, Hill K, Joseph KS, Maswime S, McClure EM, Pattinson R, Pedersen J, Smith LK, Zeitlin J, Alkema L. Global, regional, and national estimates and trends in stillbirths from 2000 to 2019: a systematic assessment. Lancet 2021; 398:772-785. [PMID: 34454675 PMCID: PMC8417352 DOI: 10.1016/s0140-6736(21)01112-0] [Citation(s) in RCA: 168] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/30/2021] [Accepted: 05/06/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND Stillbirths are a major public health issue and a sensitive marker of the quality of care around pregnancy and birth. The UN Global Strategy for Women's, Children's and Adolescents' Health (2016-30) and the Every Newborn Action Plan (led by UNICEF and WHO) call for an end to preventable stillbirths. A first step to prevent stillbirths is obtaining standardised measurement of stillbirth rates across countries. We estimated stillbirth rates and their trends for 195 countries from 2000 to 2019 and assessed progress over time. METHODS For a systematic assessment, we created a dataset of 2833 country-year datapoints from 171 countries relevant to stillbirth rates, including data from registration and health information systems, household-based surveys, and population-based studies. After data quality assessment and exclusions, we used 1531 datapoints to estimate country-specific stillbirth rates for 195 countries from 2000 to 2019 using a Bayesian hierarchical temporal sparse regression model, according to a definition of stillbirth of at least 28 weeks' gestational age. Our model combined covariates with a temporal smoothing process such that estimates were informed by data for country-periods with high quality data, while being based on covariates for country-periods with little or no data on stillbirth rates. Bias and additional uncertainty associated with observations based on alternative stillbirth definitions and source types, and observations that were subject to non-sampling errors, were included in the model. We compared the estimated stillbirth rates and trends to previously reported mortality estimates in children younger than 5 years. FINDINGS Globally in 2019, an estimated 2·0 million babies (90% uncertainty interval [UI] 1·9-2·2) were stillborn at 28 weeks or more of gestation, with a global stillbirth rate of 13·9 stillbirths (90% UI 13·5-15·4) per 1000 total births. Stillbirth rates in 2019 varied widely across regions, from 22·8 stillbirths (19·8-27·7) per 1000 total births in west and central Africa to 2·9 (2·7-3·0) in western Europe. After west and central Africa, eastern and southern Africa and south Asia had the second and third highest stillbirth rates in 2019. The global annual rate of reduction in stillbirth rate was estimated at 2·3% (90% UI 1·7-2·7) from 2000 to 2019, which was lower than the 2·9% (2·5-3·2) annual rate of reduction in neonatal mortality rate (for neonates aged <28 days) and the 4·3% (3·8-4·7) annual rate of reduction in mortality rate among children aged 1-59 months during the same period. Based on the lower bound of the 90% UIs, 114 countries had an estimated decrease in stillbirth rate since 2000, with four countries having a decrease of at least 50·0%, 28 having a decrease of 25·0-49·9%, 50 having a decrease of 10·0-24·9%, and 32 having a decrease of less than 10·0%. For the remaining 81 countries, we found no decrease in stillbirth rate since 2000. Of these countries, 34 were in sub-Saharan Africa, 16 were in east Asia and the Pacific, and 15 were in Latin America and the Caribbean. INTERPRETATION Progress in reducing the rate of stillbirths has been slow compared with decreases in the mortality rate of children younger than 5 years. Accelerated improvements are most needed in the regions and countries with high stillbirth rates, particularly in sub-Saharan Africa. Future prevention of stillbirths needs increased efforts to raise public awareness, improve data collection, assess progress, and understand public health priorities locally, all of which require investment. FUNDING Bill & Melinda Gates Foundation and the UK Foreign, Commonwealth and Development Office.
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Affiliation(s)
- Lucia Hug
- Division of Data, Analytics, Planning and Monitoring, UNICEF, New York, NY, USA.
| | - Danzhen You
- Division of Data, Analytics, Planning and Monitoring, UNICEF, New York, NY, USA
| | - Hannah Blencowe
- Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Anu Mishra
- Division of Data, Analytics, Planning and Monitoring, UNICEF, New York, NY, USA
| | - Zhengfan Wang
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, MA, USA
| | | | | | - Allisyn C Moran
- Department of Maternal, Newborn, Child and Adolescent Health, WHO, Geneva, Switzerland
| | | | - Emi Suzuki
- Development Data Group, World Bank, Washington, DC, USA
| | - Dianna M Blau
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Simon Cousens
- Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Trevor Croft
- The Demographic and Health Surveys Program, ICF, Rockville, MD, USA
| | | | - K S Joseph
- University of British Columbia, Vancouver, BC, Canada; Children's and Women's Hospital and Health Centre of British Columbia, Vancouver, BC, Canada
| | | | | | - Robert Pattinson
- SAMRC/UP Maternal and Infant Health Care Strategies Unit, Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa
| | | | - Lucy K Smith
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Jennifer Zeitlin
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Leontine Alkema
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, MA, USA
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Genowska A, Strukcinskiene B, Villerusa A, Konstantynowicz J. Converging or diverging trajectories of mortality under one year of age in the Baltic States: a comparison with the European Union. ACTA ACUST UNITED AC 2021; 79:76. [PMID: 33985577 PMCID: PMC8117592 DOI: 10.1186/s13690-021-00598-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 04/29/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Information about trends in perinatal and child health inequalities is scarce, especially in the Eastern Europe. We analyzed how mortality under 1 year of age has been changing in the Baltic States and the European Union (EU) over 25 years, and what associations occurred between changes in macroeconomic factors and mortality. METHODS Data on fetal, neonatal, infant mortality, and macroeconomic factors were extracted from WHO database. Joinpoint regression analysis was performed to analyze time trajectories of mortality over 1990-2014. We also investigated how the changes in health expenditures and Gross Domestic Product (GDP) contributed to the changes in mortality. RESULTS The reduction of fetal, neonatal and infant mortality in the Baltic countries led to convergence with the EU. In Estonia this process was the fastest, and then the rates tended to diverge. The strongest effect in reduction of neonatal mortality was related to the annual increase in health expenditure and GDP which had occurred in the same year, and a decrease in fetal mortality associated with an increase in health expenditure and GDP in the 4th and 5th year, respectively, following the initial change. CONCLUSIONS These findings outlined convergences and divergences in mortality under 1 year of age in the Baltic States compared with the patterns of the EU. Our data highlighted a need to define health policy directions aimed at the implementation of effective intervention modalities addressing reduction of risks in prenatal and early life.
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Affiliation(s)
- Agnieszka Genowska
- Department of Public Health, Medical University of Bialystok, Bialystok, Poland
| | | | - Anita Villerusa
- Department of Public Health and Epidemiology, Institute of Public Health, Rīga Stradinš University, Rīga, Latvia
| | - Jerzy Konstantynowicz
- Department of Pediatrics, Rheumatology, Immunology and Metabolic Bone Diseases, Medical University of Bialystok, University Children's Hospital, Bialystok, Poland.
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Zeitlin J. Learning from cross-country differences in stillbirth rates-Where to now? Paediatr Perinat Epidemiol 2021; 35:315-317. [PMID: 33871102 DOI: 10.1111/ppe.12768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 03/09/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Jennifer Zeitlin
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team, UMR 1153, Inserm (French National Institute for Health and Medical Research), Paris, France
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18
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Espinosa C, Becker M, Marić I, Wong RJ, Shaw GM, Gaudilliere B, Aghaeepour N, Stevenson DK. Data-Driven Modeling of Pregnancy-Related Complications. Trends Mol Med 2021; 27:762-776. [PMID: 33573911 DOI: 10.1016/j.molmed.2021.01.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 12/01/2020] [Accepted: 01/20/2021] [Indexed: 12/11/2022]
Abstract
A healthy pregnancy depends on complex interrelated biological adaptations involving placentation, maternal immune responses, and hormonal homeostasis. Recent advances in high-throughput technologies have provided access to multiomics biological data that, combined with clinical and social data, can provide a deeper understanding of normal and abnormal pregnancies. Integration of these heterogeneous datasets using state-of-the-art machine-learning methods can enable the prediction of short- and long-term health trajectories for a mother and offspring and the development of treatments to prevent or minimize complications. We review advanced machine-learning methods that could: provide deeper biological insights into a pregnancy not yet unveiled by current methodologies; clarify the etiologies and heterogeneity of pathologies that affect a pregnancy; and suggest the best approaches to address disparities in outcomes affecting vulnerable populations.
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Affiliation(s)
- Camilo Espinosa
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA; Department of Biomedical Data Sciences, Stanford University, Stanford, CA, USA
| | - Martin Becker
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA; Department of Biomedical Data Sciences, Stanford University, Stanford, CA, USA
| | - Ivana Marić
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Ronald J Wong
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Gary M Shaw
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Brice Gaudilliere
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA; Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Nima Aghaeepour
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA; Department of Biomedical Data Sciences, Stanford University, Stanford, CA, USA; Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - David K Stevenson
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA, USA.
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Zeitlin J, Durox M, Macfarlane A, Alexander S, Heller G, Loghi M, Nijhuis J, Sól Ólafsdóttir H, Mierzejewska E, Gissler M, Blondel B. Using Robson's Ten-Group Classification System for comparing caesarean section rates in Europe: an analysis of routine data from the Euro-Peristat study. BJOG 2021; 128:1444-1453. [PMID: 33338307 PMCID: PMC8359161 DOI: 10.1111/1471-0528.16634] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2020] [Indexed: 12/04/2022]
Abstract
Objective Robson's Ten Group Classification System (TGCS) creates clinically relevant sub‐groups for monitoring caesarean birth rates. This study assesses whether this classification can be derived from routine data in Europe and uses it to analyse national caesarean rates. Design Observational study using routine data. Setting Twenty‐seven EU member states plus Iceland, Norway, Switzerland and the UK. Population All births at ≥22 weeks of gestational age in 2015. Methods National statistical offices and medical birth registers derived numbers of caesarean births in TGCS groups. Main outcome measures Overall caesarean rate, prevalence and caesarean rates in each of the TGCS groups. Results Of 31 countries, 18 were able to provide data on the TGCS groups, with UK data available only from Northern Ireland. Caesarean birth rates ranged from 16.1 to 56.9%. Countries providing TGCS data had lower caesarean rates than countries without data (25.8% versus 32.9%, P = 0.04). Countries with higher caesarean rates tended to have higher rates in all TGCS groups. Substantial heterogeneity was observed, however, especially for groups 5 (previous caesarean section), 6, 7 (nulliparous/multiparous breech) and 10 (singleton cephalic preterm). The differences in percentages of abnormal lies, group 9, illustrate potential misclassification arising from unstandardised definitions. Conclusions Although further validation of data quality is needed, using TGCS in Europe provides valuable comparator and baseline data for benchmarking and surveillance. Higher caesarean rates in countries unable to construct the TGCS suggest that effective routine information systems may be an indicator of a country's investment in implementing evidence‐based caesarean policies. Tweetable abstract Many European countries can provide Robson's Ten‐Group Classification to improve caesarean rate comparisons. Many European countries can provide Robson's Ten‐Group Classification to improve caesarean rate comparisons.
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Affiliation(s)
- J Zeitlin
- CRESS, Obstetrical Perinatal and Paediatric Epidemiology Research Team, EPOPe, INSERM, INRA, Universite de Paris, Paris, France
| | - M Durox
- CRESS, Obstetrical Perinatal and Paediatric Epidemiology Research Team, EPOPe, INSERM, INRA, Universite de Paris, Paris, France
| | - A Macfarlane
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, UK
| | - S Alexander
- Perinatal Epidemiology and Reproductive Health Unit, CR2, School of Public Health, ULB, Brussels, Belgium
| | - G Heller
- Institute for Quality Assurance and Transparency in Health Care, Berlin, Germany
| | - M Loghi
- Directorate for Social Statistics and Welfare, Italian Statistical Institute (ISTAT), Rome, Italy
| | - J Nijhuis
- Department of Obstetrics & Gynaecology, Maastricht University Medical Centre, MUMC+, Maastricht, The Netherlands
| | - H Sól Ólafsdóttir
- Department of Obstetrics and Gynaecology, Landspitali University Hospital, Reykjavik, Iceland
| | - E Mierzejewska
- Department of Epidemiology and Biostatistics, National Research Institute of Mother and Child, Warsaw, Poland
| | - M Gissler
- Department of Epidemiology and Biostatistics, National Research Institute of Mother and Child, Warsaw, Poland
| | - B Blondel
- THL Finnish Institute for Health and Welfare, Helsinki, Finland.,Karolinska Institute, Stockholm, Sweden
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Doetsch JN, Marques SCS, Krafft T, Barros H. Impact of macro-socioeconomic determinants on sustainable perinatal health care in Portugal: a qualitative study on the opinion of healthcare professionals and experts. BMC Public Health 2021; 21:210. [PMID: 33494727 PMCID: PMC7836450 DOI: 10.1186/s12889-021-10194-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 01/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The WHO identified the importance of macro-socioeconomic determinants and political context as interlinked key factors affecting healthcare quality and health equity. As a response to the recent economic and financial crisis, Portugal approved in 2011 the Economic Adjustment Programme (EAP) to obtain financial assistance from the Troika in order to reduce public debt. This study aims to analyse the impact of the economic crisis and the EAP on perinatal healthcare quality for very preterm (VPT) and/or very low birth weight (VLBW) infants, as perceived by healthcare professionals and experts, within the health administrative regions of the two major metropolitan areas in Portugal. METHODS A qualitative approach was applied to receive an in-depth understanding and accomplish perspective variability. A purposive sampling technique was used. Semi-structured interviews were conducted with twenty-one healthcare professionals and experts between October 2018-July 2019. Inductive thematic analysis was performed which encompassed a five-step categorization procedure. Data analysis was undertaken by utilizing Nvivo2011 software. Evolved themes were then associated with WHO's Quality Standards on Maternal and New-born Care. A framework on the impact of macro-socioeconomic determinants on perinatal health care quality was developed. RESULTS Although participants did not perceive the quality of perinatal care had deteriorated, the analysis of their accounts on work experience revealed that it was indeed adversely modified in all WHO Quality Standards. Health care provision was perceived as detrimental in five main areas: 1) Availability of human resources; 2) Functional referral systems; 3) Competent and motivated human resources; 4) Emotional support; and 5) Essential physical resources available. Policy reforms by the EAP resulted in reduced timeliness of care, increased waiting times, cuts in sequence and duration of consultations, and deficiencies in follow-up care for VPT/VLBW infants and their mothers. The EAP directly influenced working environment of healthcare professionals by causing stress, burnout, work absence, and brain drain. CONCLUSION An interrelation between macro-socioeconomic determinants and perinatal health care quality was disclosed. The economic crisis and EAP have adversely modified equitable perinatal health care quality for VPT/VLBW infants and their mothers. Our findings underlined the negative impact of austerity policies on vulnerable populations.
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Affiliation(s)
- Julia Nadine Doetsch
- EPIUnit - Instituto de Saúde Pública da Universidade do Porto (ISPUP), Rua das Taipas 135, 4050-091, Porto, Portugal.
- Maastricht University, Faculty of Health, Medicine and Life Sciences (FHML), Care and Public Health Research Institute (CAPHRI), Maastricht, The Netherlands.
| | - Sandra C S Marques
- EPIUnit - Instituto de Saúde Pública da Universidade do Porto (ISPUP), Rua das Taipas 135, 4050-091, Porto, Portugal
- Centro em Rede de Investigação em Antropologia (CRIA) - Instituto Universitário de Lisboa, Lisbon, Portugal
| | - Thomas Krafft
- Maastricht University, Faculty of Health, Medicine and Life Sciences (FHML), Care and Public Health Research Institute (CAPHRI), Maastricht, The Netherlands
| | - Henrique Barros
- EPIUnit - Instituto de Saúde Pública da Universidade do Porto (ISPUP), Rua das Taipas 135, 4050-091, Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto (FMUP), Porto, Portugal
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21
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Ellwood DA, Flenady VJ. Stillbirth in Australia 6: The future of stillbirth research and education. Women Birth 2020; 33:537-539. [PMID: 33092704 DOI: 10.1016/j.wombi.2020.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/12/2020] [Accepted: 09/03/2020] [Indexed: 10/23/2022]
Abstract
The first five papers in the Stillbirths in Australia series have described the current state of stillbirth research and education in Australia, as well as the national approach being adopted to prevention. This final paper in the series asks 'where to from here?'. What does the next 5-10 years hold for those of us working in this field and how much more can be achieved? There are signs that we are moving in the right direction with a national prevention program about to rollout to add to the gains of the last two decades, and evidence of a more consistent approach to bereavement care. However, we must sharpen our equity lens and ensure that all groups are included in these efforts.
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Affiliation(s)
- David A Ellwood
- Griffith University School of Medicine and Gold Coast University Hospital, Gold Coast, Queensland, Australia; Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia.
| | - Vicki J Flenady
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia
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22
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Sexton JK, Coory M, Kumar S, Smith G, Gordon A, Chambers G, Pereira G, Raynes-Greenow C, Hilder L, Middleton P, Bowman A, Lieske SN, Warrilow K, Morris J, Ellwood D, Flenady V. Protocol for the development and validation of a risk prediction model for stillbirths from 35 weeks gestation in Australia. Diagn Progn Res 2020; 4:21. [PMID: 33323131 PMCID: PMC7739473 DOI: 10.1186/s41512-020-00089-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 10/29/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Despite advances in the care of women and their babies in the past century, an estimated 1.7 million babies are born still each year throughout the world. A robust method to estimate a pregnant woman's individualized risk of late-pregnancy stillbirth is needed to inform decision-making around the timing of birth to reduce the risk of stillbirth from 35 weeks of gestation in Australia, a high-resource setting. METHODS This is a protocol for a cross-sectional study of all late-pregnancy births in Australia (2005-2015) from 35 weeks of gestation including 5188 stillbirths among 3.1 million births at an estimated rate of 1.7 stillbirths per 1000 births. A multivariable logistic regression model will be developed in line with current Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis (TRIPOD) guidelines to estimate the gestation-specific probability of stillbirth with prediction intervals. Candidate predictors were identified from systematic reviews and clinical consultation and will be described through univariable regression analysis. To generate a final model, elimination by backward stepwise multivariable logistic regression will be performed. The model will be internally validated using bootstrapping with 1000 repetitions and externally validated using a temporally unique dataset. Overall model performance will be assessed with R2, calibration, and discrimination. Calibration will be reported using a calibration plot with 95% confidence intervals (α = 0.05). Discrimination will be measured by the C-statistic and area underneath the receiver-operator curves. Clinical usefulness will be reported as positive and negative predictive values, and a decision curve analysis will be considered. DISCUSSION A robust method to predict a pregnant woman's individualized risk of late-pregnancy stillbirth is needed to inform timely, appropriate care to reduce stillbirth. Among existing prediction models designed for obstetric use, few have been subject to internal and external validation and many fail to meet recommended reporting standards. In developing a risk prediction model for late-gestation stillbirth with both providers and pregnant women in mind, we endeavor to develop a validated model for clinical use in Australia that meets current reporting standards.
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Affiliation(s)
- Jessica K Sexton
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute - University of Queensland, Level 3 Aubigny Place, Brisbane, 4101, Australia.
| | - Michael Coory
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute - University of Queensland, Level 3 Aubigny Place, Brisbane, 4101, Australia
- University of Melbourne, Melbourne, Australia
| | - Sailesh Kumar
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Gordon Smith
- Department of Obstetrics & Gynaecology, University of Cambridge, Cambridge, UK
| | - Adrienne Gordon
- Sydney Medical School, University of Sydney, Sydney, Australia
- Royal Prince Alfred Hospital, Sydney, Australia
| | | | - Gavin Pereira
- School of Public Health, Curtin University, Perth, Australia
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
- Telelethon Kids Institute, Perth Children's Hospital, Perth, Australia
| | | | - Lisa Hilder
- National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health and School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - Philippa Middleton
- South Australian Health and Medical Research Institute, SAHMRI Women and Kids, Adelaide, Australia
- School of Medicine, The University of Adelaide, Adelaide, Australia
| | - Anneka Bowman
- South Australian Health and Medical Research Institute, SAHMRI Women and Kids, Adelaide, Australia
- School of Medicine, The University of Adelaide, Adelaide, Australia
| | | | - Kara Warrilow
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute - University of Queensland, Level 3 Aubigny Place, Brisbane, 4101, Australia
| | - Jonathan Morris
- Women and Babies Research, The University of Sydney Northern Clinical School, St. Leonards, Australia
- Northern Sydney Local Health District, Kolling Institute, Sydney, Australia
- Department of Obstetrics and Gynaecology, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, Australia
| | - David Ellwood
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute - University of Queensland, Level 3 Aubigny Place, Brisbane, 4101, Australia
- School of Medicine, Griffith University, Southport, Australia
| | - Vicki Flenady
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute - University of Queensland, Level 3 Aubigny Place, Brisbane, 4101, Australia.
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23
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Kelly K, Meaney S, Leitao S, O'Donoghue K. A review of stillbirth definitions: A rationale for change. Eur J Obstet Gynecol Reprod Biol 2020; 256:235-245. [PMID: 33248379 DOI: 10.1016/j.ejogrb.2020.11.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/04/2020] [Accepted: 11/06/2020] [Indexed: 11/26/2022]
Abstract
Stillbirth definitions vary between countries around the globe. The purpose of this paper was to explore stillbirth definitions used by high income countries around the world, specifically compared to Ireland, their stillbirth and mortality rates and to examine how these rates are influenced by standards of care, especially resuscitation efforts within the delivery room for very preterm infants. A literature review was performed using PubMed, Academic Search Complete, MEDLINE, and CINAHL. These databases were searched with the terms "(stillbirth OR still birth OR stillborn) AND (definition OR registration OR registry)" and "(fetal OR neonatal OR neonate) AND Viability AND Gestational Age" in two separate searches. The database searches returned 1081 results involving stillbirths and 164 results for neonatal viability. After title, abstract, full text review, and reference review 33 papers remained for use in this study. Within the European Union (EU), 59.2 % (n = 16), 14.8 % (n = 4), 11.1 % (n = 3), and 3.7 % (n = 1) countries classify stillbirths at gestational ages of ≥22 weeks, ≥24 weeks, ≥28 weeks, and ≥180 gestational days respectively. The median stillbirth rate in Europe using ≥28 weeks gestational age as a cut-off was 2.7 per 1000 births, but this increased to 3.3 per 1000 births when stillbirths from 24 to 27 weeks gestation were included. Of the thirteen countries whose mortality data was examined, survival rates for liveborn infants ranged from 0-37.3 %, 1.1-64.5 %, 31.0-77.7 %, and 59.1-85.7 % for the gestational ages of 22, 23, 24, and 25 weeks, respectively. In 1995, survival rates for the United Kingdom and Ireland were only 26 % for those born at 24 weeks gestation, however this has almost doubled in Ireland to 56.6 % in 2014-2017. Survival rates have improved to the point that, in 2014-2017, the survival rate of infants born at 23 weeks gestation (32.3 %) was 6 % higher than the rate for those born at 24 weeks gestation in 1995. Due to the improvement in survival rates, multiple international organisations recommend recording stillbirths from 22 weeks gestation and/or 500 g. Based on the findings from this review, and due to improving survival rates for periviable infants, it is recommended the stillbirth definition in Ireland should be updated to ≥22 weeks' gestation and ≥400 g to comply with improved medical developments.
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Affiliation(s)
- Kristin Kelly
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Ireland.
| | - Sarah Meaney
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Ireland; National Perinatal Epidemiology Centre (NPEC), University College Cork, Ireland
| | - Sara Leitao
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Ireland; National Perinatal Epidemiology Centre (NPEC), University College Cork, Ireland
| | - Keelin O'Donoghue
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Ireland; The Irish Center for Maternal and Child Health Research (INFANT), University College Cork, Ireland
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24
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Barrett PM, McCarthy FP, Evans M, Kublickas M, Perry IJ, Stenvinkel P, Khashan AS, Kublickiene K. Stillbirth is associated with increased risk of long-term maternal renal disease: a nationwide cohort study. Am J Obstet Gynecol 2020; 223:427.e1-427.e14. [PMID: 32112729 PMCID: PMC7479504 DOI: 10.1016/j.ajog.2020.02.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 01/31/2020] [Accepted: 02/19/2020] [Indexed: 01/30/2023]
Abstract
Background Stillbirth is a devastating adverse pregnancy outcome that may occur without any obvious reason or may occur in the context of fetal growth restriction, preeclampsia, or other obstetric complications. There is increasing evidence that women who experience stillbirths are at greater risk of long-term cardiovascular disease, but little is known about their risk of chronic kidney disease and end-stage renal disease. We conducted the largest study to date to investigate the subsequent risk of maternal chronic kidney disease and end-stage renal disease following stillbirth. Objective To identify whether pregnancy complicated by stillbirth is associated with subsequent risk of maternal chronic kidney disease and end-stage renal disease, independent of underlying medical or obstetric comorbidities. Study Design/Methods We conducted a population-based cohort study using nationwide data from the Swedish Medical Birth Register, National Patient Register, and Swedish Renal Register. We included all women who had live births and stillbirths from 1973 to 2012, with follow-up to 2013. Women with preexisting renal disease were excluded. Cox proportional hazard regression models were used to estimate adjusted hazard ratios and 95% confidence intervals for associations between stillbirth and maternal chronic kidney disease and end-stage renal disease respectively. We controlled for maternal age, year of delivery, country of origin, parity, body mass index, smoking, gestational diabetes, preeclampsia, and small for gestational age deliveries. Women who had a history of medical comorbidities, which may predispose to renal disease (prepregnancy cardiovascular disease, hypertension, diabetes, lupus, systemic sclerosis, hemoglobinopathy, or coagulopathy), were excluded from the main analysis and examined separately. Results There were 1,941,057 unique women who had 3,755,444 singleton pregnancies, followed up over 42,313,758 person-years. The median follow-up time was 20.7 years (interquartile range, 9.9–30.0 years). 13,032 women (0.7%) had at least 1 stillbirth. Women who had experienced at least 1 stillbirth had a greater risk of developing chronic kidney disease (adjusted hazard ratio, 1.26; 95% confidence interval, 1.09–1.45) and end-stage renal disease (adjusted hazard ratio, 2.25; 95% confidence interval, 1.55–3.25) compared with women who only had live births. These associations persisted after removing all stillbirths that occurred in the context of preeclampsia, and small for gestational age or congenital malformations (for chronic kidney disease, adjusted hazard ratio, 1.33; 95% confidence interval, 1.13–1.57; for end-stage renal disease, adjusted hazard ratio, 2.95; 95% confidence interval, CI 1.86–4.68). There was no significant association observed between stillbirth and either chronic kidney disease or end-stage renal disease in women who had preexisting medical comorbidities (chronic kidney disease, adjusted hazard ratio, 1.13; 95% confidence interval, 0.73–1.75 or end-stage renal disease, adjusted hazard ratio, 1.49; 95% confidence interval, 0.78–2.85). Conclusion Women who have a history of stillbirth may be at increased risk of chronic kidney disease and end-stage renal disease compared with women who have only had live births. This association persists independently of preeclampsia, and small for gestational age, maternal smoking, obesity, and medical comorbidities. Further research is required to determine whether affected women would benefit from closer surveillance and follow-up for future renal disease.
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25
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Cena L, Stefana A. Psychoanalytic Perspectives on the Psychological Effects of Stillbirth on Parents: A Protocol for Systematic Review and Qualitative Synthesis. Front Psychol 2020; 11:1216. [PMID: 32625140 PMCID: PMC7315820 DOI: 10.3389/fpsyg.2020.01216] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 05/11/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction: Despite the fact that stillbirth has a broad economic impact on health systems and society and despite the fact that the importance of appropriate psychological and social support for parents has been highlighted, there is still a lack of research exploring the intrapsychic and interpersonal dynamics and issues triggered by the experience of stillbirth. Healthcare professionals attempting to provide effective psychological support to bereaved parents who have suffered perinatal loss continue to struggle to achieve better and deeper understanding of their psychological states and processes. Psychoanalysis could play a key role in improving this situation, but the studies available are confined to journals of psychoanalysis, and there is a lack of synthesis, leaving this knowledge beyond the reach of scientists from other theoretical approaches or disciplines. This protocol proposes the systematic review and qualitative synthesis of articles from journals of psychoanalysis on the psychological effects on parents of stillbirth. Methods and Analysis: This systematic review will follow, as far as possible, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The Psychoanalytic Electronic Publishing Archive (1999–2019), the Single Case Archive (1999–2019), and PsycINFO (1999–2019) will be used to identify relevant articles. The review will include articles reporting clinical material and/or theoretical considerations concerning parent psychological states and processes triggered by the experience of stillbirth, and a meta-synthesis will be performed. Ethics and Dissemination: Formal ethical approval is not required for this study, as no primary data will be collected. The findings will be published in an international peer-reviewed journal.
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Affiliation(s)
- Loredana Cena
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Alberto Stefana
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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26
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Waiswa P, Higgins BV, Mubiri P, Kirumbi L, Butrick E, Merai R, Sloan NL, Walker D. Pregnancy outcomes in facility deliveries in Kenya and Uganda: A large cross-sectional analysis of maternity registers illuminating opportunities for mortality prevention. PLoS One 2020; 15:e0233845. [PMID: 32479522 PMCID: PMC7263583 DOI: 10.1371/journal.pone.0233845] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 05/13/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction As facility-based deliveries increase globally, maternity registers offer a promising way of documenting pregnancy outcomes and understanding opportunities for perinatal mortality prevention. This study aims to contribute to global quality improvement efforts by characterizing facility-based pregnancy outcomes in Kenya and Uganda including maternal, neonatal, and fetal outcomes at the time of delivery and neonatal discharge outcomes using strengthened maternity registers. Methods Cross sectional data were collected from strengthened maternity registers at 23 facilities over 18 months. Data strengthening efforts included provision of supplies, training on standard indicator definitions, and monthly feedback on completeness. Pregnancy outcomes were classified as live births, early stillbirths, late stillbirths, or spontaneous abortions according to birth weight or gestational age. Discharge outcomes were assessed for all live births. Outcomes were assessed by country and by infant, maternal, and facility characteristics. Maternal mortality was also examined. Results Among 50,981 deliveries, 91.3% were live born and, of those, 1.6% died before discharge. An additional 0.5% of deliveries were early stillbirths, 3.6% late stillbirths, and 4.7% spontaneous abortions. There were 64 documented maternal deaths (0.1%). Preterm and low birthweight infants represented a disproportionate number of stillbirths and pre-discharge deaths, yet very few were born at ≤1500g or <28w. More pre-discharge deaths and stillbirths occurred after maternal referral and with cesarean section. Half of maternal deaths occurred in women who had undergone cesarean section. Conclusion Maternity registers are a valuable data source for understanding pregnancy outcomes including those mothers and infants at highest risk of perinatal mortality. Strengthened register data in Kenya and Uganda highlight the need for renewed focus on improving care of preterm and low birthweight infants and expanding access to emergency obstetric care. Registers also permit enumeration of pregnancy loss <28 weeks. Documenting these earlier losses is an important step towards further mortality reduction for the most vulnerable infants.
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Affiliation(s)
- Peter Waiswa
- Maternal, Newborn and Child Health Centre of Excellence, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Brennan V. Higgins
- Department of Pediatrics, University of California San Francisco, San Francisco, California, United States of America
- * E-mail:
| | - Paul Mubiri
- Maternal, Newborn and Child Health Centre of Excellence, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Leah Kirumbi
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Elizabeth Butrick
- Institute of Global Health Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Rikita Merai
- Institute of Global Health Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Nancy L. Sloan
- Institute of Global Health Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Dilys Walker
- School of Medicine and Department of Obstetrics-Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America
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27
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Ravelli ACJ, Eskes M, van der Post JAM, Abu-Hanna A, de Groot CJM. Decreasing trend in preterm birth and perinatal mortality, do disparities also decline? BMC Public Health 2020; 20:783. [PMID: 32456627 PMCID: PMC7249399 DOI: 10.1186/s12889-020-08925-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 05/17/2020] [Indexed: 11/26/2022] Open
Abstract
Background In the Netherlands, several initiatives started after the publication of the PERISTAT findings that showed the perinatal mortality risk was higher than in other European countries. The objective of this study is 1) to report recent trends in perinatal mortality and in intermediate risk groups (preterm birth, congenital anomalies and small for gestational age (SGA)), 2) describing perinatal mortality risk among children born preterm, with congenital anomalies or SGA, and born in maternal high risk groups (parity, age, ethnicity and socio-economic status (SES)). Methods A nationwide cohort study in the Netherlands among 996,423 singleton births in 2010–2015 with a gestational age between 24.0 and 42.6 weeks. Trend tests, univariate and multivariable logistic regression analyses were used. We did separate analyses for gestational age subgroups and line of care. Results The perinatal mortality rate was 5.0 per 1000 and it decreased significantly from 5.6 in 2010 to 4.6 per 1000 in 2015. Preterm birth significantly declined (6.1% in 2010 to 5.6% in 2015). Analysis by gestational age groups showed that the largest decline in perinatal mortality of 32% was seen at 24–27 weeks of gestation where the risk declined from 497 to 339 per 1000. At term, the decline was 23% from 2.2 to 1.7 per 1000. The smallest decline was 3% between 32 and 36 weeks. In children with preterm birth, congenital anomalies or SGA, the perinatal mortality risk significantly declined. Main risk factors for perinatal mortality were African ethnicity (adjusted odds ratio (aOR) 2.1 95%CI [1.9–2.4]), maternal age ≥ 40 years (aOR1.9 95%CI [1.7–2.2]) and parity 2+ (aOR 1.4 95%CI [1.3–1.5]). Among the (post)term born neonates, there was no significant decline in perinatal mortality in women with low age, low or high SES, non-Western ethnicity and among women who started or delivered under primary care. Conclusions There is a decline in preterm birth and in perinatal mortality between 2010 and 2015. The decline in perinatal mortality is both in stillbirths and in neonatal mortality, most prominently among 24–27 weeks and among (post)term births. A possible future target could be deliveries among 32–36 weeks, women with high maternal age or non-Western ethnicity.
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Affiliation(s)
- Anita C J Ravelli
- Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. .,Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Martine Eskes
- Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Joris A M van der Post
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ameen Abu-Hanna
- Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Christianne J M de Groot
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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28
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Smith LK, Blondel B, Zeitlin J. Producing valid statistics when legislation, culture and medical practices differ for births at or before the threshold of survival: report of a European workshop. BJOG 2019; 127:314-318. [PMID: 31580509 PMCID: PMC7003918 DOI: 10.1111/1471-0528.15971] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2019] [Indexed: 11/29/2022]
Affiliation(s)
- L K Smith
- Department of Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - B Blondel
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France
| | - J Zeitlin
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France
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29
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Zeitlin J, Alexander S, Barros H, Blondel B, Delnord M, Durox M, Gissler M, Hindori-Mohangoo AD, Hocquette A, Szamotulska K, Macfarlane A. Perinatal health monitoring through a European lens: eight lessons from the Euro-Peristat report on 2015 births. BJOG 2019; 126:1518-1522. [PMID: 31260601 DOI: 10.1111/1471-0528.15857] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2019] [Indexed: 12/01/2022]
Affiliation(s)
- J Zeitlin
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre of Research in Epidemiology and Statistics (CRESS), DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - S Alexander
- Perinatal Epidemiology and Reproductive Health Unit, CR2, School of Public Health, ULB, Brussels, Belgium
| | - H Barros
- ISPUP-EPIUnit, Universidade do Porto, Porto, Portugal
| | - B Blondel
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre of Research in Epidemiology and Statistics (CRESS), DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - M Delnord
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre of Research in Epidemiology and Statistics (CRESS), DHU Risks in Pregnancy, Paris Descartes University, Paris, France.,Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - M Durox
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre of Research in Epidemiology and Statistics (CRESS), DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - M Gissler
- THL National Institute for Health and Welfare, Helsinki, Finland.,Karolinska Institute, Stockholm, Sweden
| | - A D Hindori-Mohangoo
- Department Child Health, Netherlands Organisation for Applied Scientific Research, TNO Healthy Living, Leiden, the Netherlands.,Perinatal Interventions Suriname, Perisur Foundation, Paramaribo, Suriname.,School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - A Hocquette
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre of Research in Epidemiology and Statistics (CRESS), DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - K Szamotulska
- Department of Epidemiology and Biostatistics, National Research Institute of Mother and Child, Warsaw, Poland
| | - A Macfarlane
- Centre for Maternal and Child Health Research, City, University of London, London, UK
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30
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Zile I, Ebela I, Rumba-Rozenfelde I. Maternal Risk Factors for Stillbirth: A Registry-Based Study. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:E326. [PMID: 31266254 PMCID: PMC6681231 DOI: 10.3390/medicina55070326] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 06/26/2019] [Accepted: 06/28/2019] [Indexed: 11/16/2022]
Abstract
Background and Objectives: The number of stillbirths has reduced more slowly than has maternal mortality or mortality in children younger than 5 years, which were explicitly targeted in the Millennium Development Goals. Placental pathologies and infection associated with preterm birth are linked to a substantial proportion of stillbirths. Appropriate preconception care and quality antenatal care that is accessible to all women has the potential to reduce stillbirth rates. The aim of the present study was to assess potential risk factors associated with stillbirth within maternal medical diseases and obstetric complications. Materials and Methods: Retrospective cohort study (2001-2014) was used to analyse data from the Medical Birth Register on stillbirth and live births as controls. Adjusted Odds ratios (aOR) with 95% confidence intervals (CI) were estimated. Multiple regression model adjusted for maternal age, parity and gestational age. Results: The stillbirth rate was 6.2 per 1000 live and stillbirths. The presence of maternal medical diseases greatly increased the risk of stillbirth including diabetes mellitus (aOR = 2.5; p < 0.001), chronic hypertension 3.1 (aOR = 3.1; p < 0.001) and oligohydromnios/polyhydromnios (aOR = 2.4; p < 0.001). Pregnancy complications such as intrauterine growth restriction (aOR = 2.2; p < 0.001) was important risk factor for stillbirth. Abruption was associated with a 2.8 odds of stillbirth. Conclusions: Risk factors most significantly associated with stillbirth include maternal history of chronic hypertension and abruptio placenta which is a common cause of death in stillbirth. Early identification of potential risk factors and appropriate perinatal management are important issues in the prevention of adverse fetal outcomes and preventive strategies need to focus on improving antenatal detection of fetal growth restriction.
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Affiliation(s)
- Irisa Zile
- Faculty of Medicine, Department of Paediatrica, University of Latvia, Raiņa bulvāris 19, Riga, LV-1050, Latvia.
- The Centre for Disease Prevention and Control of Latvia, Duntes 22, k-5, Riga, LV-1005, Latvia.
| | - Inguna Ebela
- Faculty of Medicine, Department of Paediatrica, University of Latvia, Raiņa bulvāris 19, Riga, LV-1050, Latvia
| | - Ingrida Rumba-Rozenfelde
- Faculty of Medicine, Department of Paediatrica, University of Latvia, Raiņa bulvāris 19, Riga, LV-1050, Latvia
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Norman M, Hallberg B, Abrahamsson T, Björklund LJ, Domellöf M, Farooqi A, Foyn Bruun C, Gadsbøll C, Hellström-Westas L, Ingemansson F, Källén K, Ley D, Maršál K, Normann E, Serenius F, Stephansson O, Stigson L, Um-Bergström P, Håkansson S. Association Between Year of Birth and 1-Year Survival Among Extremely Preterm Infants in Sweden During 2004-2007 and 2014-2016. JAMA 2019; 321:1188-1199. [PMID: 30912837 PMCID: PMC6439685 DOI: 10.1001/jama.2019.2021] [Citation(s) in RCA: 170] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 02/19/2019] [Indexed: 12/11/2022]
Abstract
Importance Since 2004-2007, national guidelines and recommendations have been developed for the management of extremely preterm births in Sweden. If and how more uniform management has affected infant survival is unknown. Objective To compare survival of extremely preterm infants born during 2004-2007 with survival of infants born during 2014-2016. Design, Setting and Participants All births at 22-26 weeks' gestational age (n = 2205) between April 1, 2004, and March 31, 2007, and between January 1, 2014, and December 31, 2016, in Sweden were studied. Prospective data collection was used during 2004-2007. Data were obtained from the Swedish pregnancy, medical birth, and neonatal quality registries during 2014-2016. Exposures Delivery at 22-26 weeks' gestational age. Main Outcomes and Measures The primary outcome was infant survival to the age of 1 year. The secondary outcome was 1-year survival among live-born infants who did not have any major neonatal morbidity (specifically, without intraventricular hemorrhage grade 3-4, cystic periventricular leukomalacia, necrotizing enterocolitis, retinopathy of prematurity stage 3-5, or severe bronchopulmonary dysplasia). Results During 2004-2007, 1009 births (3.3/1000 of all births) occurred at 22-26 weeks' gestational age compared with 1196 births (3.4/1000 of all births) during 2014-2016 (P = .61). One-year survival among live-born infants at 22-26 weeks' gestational age was significantly lower during 2004-2007 (497 of 705 infants [70%]) than during 2014-2016 (711 of 923 infants [77%]) (difference, -7% [95% CI, -11% to -2.2%], P = .003). One-year survival among live-born infants at 22-26 weeks' gestational age and without any major neonatal morbidity was significantly lower during 2004-2007 (226 of 705 infants [32%]) than during 2014-2016 (355 of 923 infants [38%]) (difference, -6% [95% CI, -11% to -1.7%], P = .008). Conclusions and Relevance Among live births at 22-26 weeks' gestational age in Sweden, 1-year survival improved between 2004-2007 and 2014-2016.
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Affiliation(s)
- Mikael Norman
- Division of Pediatrics, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
- Swedish Neonatal Quality Register, Umeå University Hospital, Umeå, Sweden
| | - Boubou Hallberg
- Division of Pediatrics, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Thomas Abrahamsson
- Departments of Clinical and Experimental Medicine and Pediatrics, Linköping University, Linköping, Sweden
| | - Lars J. Björklund
- Departments of Clinical Sciences and Pediatrics, Lund University and Skåne University Hospital, Lund, Sweden
| | - Magnus Domellöf
- Departments of Clinical Sciences and Pediatrics, Umeå University, Umeå Sweden
| | - Aijaz Farooqi
- Departments of Clinical Sciences and Pediatrics, Umeå University, Umeå Sweden
| | - Cathrine Foyn Bruun
- Departments of Clinical Sciences and Pediatrics, Umeå University, Umeå Sweden
| | - Christian Gadsbøll
- Departments of Clinical and Experimental Medicine and Pediatrics, Linköping University, Linköping, Sweden
- Departments of Clinical Sciences and Pediatrics, Lund University and Skåne University Hospital, Lund, Sweden
| | | | - Fredrik Ingemansson
- Department of Pediatrics, Ryhov County Hospital, Jönköping County Council, Jonkoping, Sweden
| | - Karin Källén
- Centre for Reproductive Epidemiology, Lund University, Lund, Sweden
| | - David Ley
- Departments of Clinical Sciences and Pediatrics, Lund University and Skåne University Hospital, Lund, Sweden
| | - Karel Maršál
- Departments of Clinical Sciences and Obstetrics and Gynecology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Erik Normann
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Fredrik Serenius
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Olof Stephansson
- Division of Clinical Epidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Division of Obstetrics and Gynecology, Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Lennart Stigson
- Department of Pediatrics, Institute for Clinical Sciences, Queen Silvia Children’s Hospital, Sahlgrenska Academy, Göteborg University, Göteborg, Sweden
| | - Petra Um-Bergström
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Sachs’ Children and Youth Hospital, Department of Neonatal Medicine, Södersjukhuset, Stockholm, Sweden
| | - Stellan Håkansson
- Swedish Neonatal Quality Register, Umeå University Hospital, Umeå, Sweden
- Departments of Clinical Sciences and Pediatrics, Umeå University, Umeå Sweden
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Wang LY, Chang YS, Liang FW, Lin YC, Lin YJ, Lu TH, Lin CH. Comparing regional neonatal mortality rates: the influence of registration of births as live born for birth weight <500 g in Taiwan. BMJ Paediatr Open 2019; 3:e000526. [PMID: 31414067 PMCID: PMC6668753 DOI: 10.1136/bmjpo-2019-000526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 06/28/2019] [Accepted: 07/01/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To investigate regional variation in the registration of births (still+live) as live born for birth weight <500 g and the impact on the city/county ranking of neonatal mortality rate (NMR) in Taiwan. DESIGN Population-based cross-sectional ecological study. SETTING 20 cities/counties in Taiwan. PARTICIPANTS Registered births for birth weight <500 g and neonatal deaths in 2015-2016. MAIN OUTCOME MEASURES City/county percentage of births <500 g registered as live born and ranking of city/county NMR (deaths per 1000 live births) including and excluding live births <500 g. RESULTS The percentage of births <500 g registered as live born ranged from 0% in Keelung City (0/26) and Penghu County (0/4) to 20% in Taipei City (112/558), 24% in Hsinchu County (5/21) and 28% in Hualien County (9/32). The change in city/county ranking of NMR from including to excluding live births <500 g was most prominent in Taipei City (from the 15th to the 1st) followed by Kaohsiung City (from the 18th to the 14th). CONCLUSIONS The city/county NMR in Taiwan is influenced by variation in the registration of live born for births with uncertain viability. We recommend presenting city/county NMR using both criteria (with or without minimum threshold of gestation period or birth weight) for better interpretation of the findings of comparisons of city/county NMR.
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Affiliation(s)
- Liang-Yi Wang
- Department of Public Health, National Cheng Kung University College of Medicine, Tainan, Taiwan
| | - Yu-Shan Chang
- Department of Pediatrics, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Fu-Wen Liang
- Department of Public Health, Kaohsiung Medical University College of Health Science, Kaohsiung, Taiwan
| | - Yung-Chieh Lin
- Department of Pediatrics, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Yuh-Jyh Lin
- Department of Pediatrics, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Tsung-Hsueh Lu
- Department of Public Health, National Cheng Kung University College of Medicine, Tainan, Taiwan
| | - Chyi-Her Lin
- Department of Pediatrics, National Cheng Kung University Hospital, Tainan, Taiwan
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Temmerman M, Lawn JE. Stillbirths count, but it is now time to count them all. Lancet 2018; 392:1602-1604. [PMID: 30269878 DOI: 10.1016/s0140-6736(18)32342-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 09/18/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Marleen Temmerman
- Department of Obstetrics and Gynaecology, Aga Khan University, Nairobi, Kenya; Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | - Joy E Lawn
- Centre for Maternal, Adolescent, Reproductive & Child Health, London School of Hygiene & Tropical Medicine, London, UK
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