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Jin M, Liu X, Liu X, Wu Y, Zhang Y, Zhang L, Li Z, Ye R, Li N. Association of pre-/early pregnancy high blood pressure and pregnancy outcomes: a systemic review and meta-analysis. J Matern Fetal Neonatal Med 2024; 37:2296366. [PMID: 38151254 DOI: 10.1080/14767058.2023.2296366] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 12/13/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Maternal high blood pressure (BP) was associated with adverse pregnancy outcomes. This study aimed to synthesize evidence on the association between high BP prior to or in early pregnancy with maternal and fetal complications. METHODS We searched the cohort studies assessing the effect of high BP in the Medline, Embase, Web of Science and China National Knowledge Internet databases. A random-effects model was used to estimate the pooled odds ratios (ORs) with 95% confidence intervals (CIs). The protocol was registered in PROSPERRO (CRD 42023414945). RESULTS 23 eligible studies were identified. High BP prior to or in early pregnancy was associated with higher odds of hypertensive disorders of pregnancy (OR 2.90, 95% CI 1.91-3.89), gestational hypertension (2.56, 2.01-3.12), preeclampsia (3.20, 2.66-3.74), gestational diabetes mellitus (1.71, 1.36-2.06), preterm birth (1.66, 1.39-1.93), stillbirth (2.01, 1.45-2.58) and neonatal intensive care unit admission (1.22, 1.08-1.37). Subgroup analyses indicated that pre-hypertension could significantly increase the odds of these outcomes except for stillbirth, though the odds were lower than hypertension. CONCLUSIONS High BP prior to or in early pregnancy was associated with adverse pregnancy outcomes and this association increased with hypertension severity. The findings emphasized an urgent need for heightened surveillance for maternal BP, especially pre-hypertensive status.
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Affiliation(s)
- Ming Jin
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, China
- Institute of Reproductive and Child Health, Peking University/Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, Beijing, China
| | - Xiaowen Liu
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, China
- Institute of Reproductive and Child Health, Peking University/Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, Beijing, China
| | - Xiaojing Liu
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, China
- Institute of Reproductive and Child Health, Peking University/Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, Beijing, China
| | - Yaxian Wu
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, China
- Institute of Reproductive and Child Health, Peking University/Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, Beijing, China
| | - Yali Zhang
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, China
- Institute of Reproductive and Child Health, Peking University/Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, Beijing, China
| | - Le Zhang
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, China
- Institute of Reproductive and Child Health, Peking University/Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, Beijing, China
| | - Zhiwen Li
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, China
- Institute of Reproductive and Child Health, Peking University/Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, Beijing, China
| | - Rongwei Ye
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, China
- Institute of Reproductive and Child Health, Peking University/Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, Beijing, China
| | - Nan Li
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, China
- Institute of Reproductive and Child Health, Peking University/Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, Beijing, China
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Blankstein AR, Sigurdson SM, Frehlich L, Raizman Z, Donovan LE, Lemieux P, Pylypjuk C, Benham JL, Yamamoto JM. Pre-existing Diabetes and Stillbirth or Perinatal Mortality: A Systematic Review and Meta-analysis. Obstet Gynecol 2024:00006250-990000000-01125. [PMID: 39088826 DOI: 10.1097/aog.0000000000005682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 05/23/2024] [Indexed: 08/03/2024]
Abstract
OBJECTIVE Despite the well-recognized association between pre-existing diabetes mellitus and stillbirth or perinatal mortality, there remain knowledge gaps about the strength of association across different populations. The primary objective of this systematic review and meta-analysis was to quantify the association between pre-existing diabetes and stillbirth or perinatal mortality, and secondarily, to identify risk factors predictive of stillbirth or perinatal mortality among those with pre-existing diabetes. DATA SOURCES MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials from inception to April 2022. METHODS OF STUDY SELECTION Cohort studies and randomized controlled trials in English or French that examined the association between pre-existing diabetes and stillbirth or perinatal mortality (as defined by the original authors) or identified risk factors for stillbirth and perinatal mortality in individuals with pre-existing diabetes were included. Data extraction was performed independently and in duplicate with the use of prespecified inclusion and exclusion criteria. Assessment for heterogeneity and risk of bias was performed. Meta-analyses were completed with a random-effects model. TABULATION, INTEGRATION, AND RESULTS From 7,777 citations, 91 studies met the inclusion criteria. Pre-existing diabetes was associated with higher odds of stillbirth (37 studies; pooled odds ratio [OR] 3.74, 95% CI, 3.17-4.41, I2=82.5%) and perinatal mortality (14 studies; pooled OR 3.22, 95% CI, 2.54-4.07, I2=82.7%). Individuals with type 1 diabetes had lower odds of stillbirth (pooled OR 0.81, 95% CI, 0.68-0.95, I2=0%) and perinatal mortality (pooled OR 0.73, 95% CI, 0.61-0.87, I2=0%) compared with those with type 2 diabetes. Prenatal care and prepregnancy diabetes care were significantly associated with lower odds of stillbirth (OR 0.26, 95% CI, 0.11-0.62, I2=87.0%) and perinatal mortality (OR 0.41, 95% CI, 0.29-0.59, I2=0%). CONCLUSION Pre-existing diabetes confers a more than threefold increased odds of both stillbirth and perinatal mortality. Maternal type 2 diabetes was associated with a higher risk of stillbirth and perinatal mortality compared with maternal type 1 diabetes. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42022303112.
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Affiliation(s)
- Anna R Blankstein
- Department of Medicine, the Department of Obstetrics, Gynecology and Reproductive Sciences, and the Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, the Department of Community Health Sciences, the Department of Medicine, the Department of Obstetrics and Gynecology, the Alberta Children's Hospital Research Institute, the O'Brien Institute for Public Health, and the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, and the Department of Medicine, Université Laval, Quebec City, Quebec, Canada; and Stanford Lifestyle Medicine, Stanford University, Redwood City, California
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Brown HK, Strauss R, Fung K, Mataruga A, Chan V, Mollayeva T, Urbach N, Colantonio A, Cohen E, Dennis CL, Ray JG, Saunders N, Vigod SN. Mental Illness in the 2 Years Prior to Pregnancy in a Population With Traumatic Brain Injury: A Cross-Sectional Study: La maladie mentale dans les deux ans précédant une grossesse dans une population souffrant de lésion cérébrale traumatique : une étude transversale. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2024; 69:607-617. [PMID: 38659409 PMCID: PMC11298096 DOI: 10.1177/07067437241249957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
OBJECTIVE Existing studies, in mostly male samples such as veterans and athletes, show a strong association between traumatic brain injury (TBI) and mental illness. Yet, while an understanding of mental health before pregnancy is critical for informing preconception and perinatal supports, there are no data on the prevalence of active mental illness before pregnancy in females with TBI. We examined the prevalence of active mental illness ≤2 years before pregnancy (1) in a population with TBI, and (2) in subgroups defined by sociodemographic, health, and injury-related characteristics, all compared to those without TBI. METHOD This population-based cross-sectional study was completed in Ontario, Canada, from 2012 to 2020. Modified Poisson regression generated adjusted prevalence ratios (aPRs) of active mental illness ≤2 years before pregnancy in 15,585 females with TBI versus 846,686 without TBI. We then used latent class analysis to identify subgroups with TBI according to sociodemographic, health, and injury-related characteristics and subsequently compared them to females without TBI on their outcome prevalence. RESULTS Females with TBI had a higher prevalence of active mental illness ≤2 years before pregnancy than those without TBI (44.1% vs. 25.9%; aPR 1.46, 95% confidence interval, 1.43 to 1.49). There were 3 TBI subgroups, with Class 1 (low-income, past assault, recent TBI described as intentional and due to being struck by/against) having the highest outcome prevalence. CONCLUSIONS Females with TBI, and especially those with a recent intentional TBI, have a high prevalence of mental illness before pregnancy. They may benefit from mental health screening and support in the post-injury, preconception, and perinatal periods. PLAIN LANGUAGE TITLE Mental illness in the 2 years before pregnancy in a population with traumatic brain injury.
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Affiliation(s)
- Hilary K. Brown
- Department of Health & Society, University of Toronto Scarborough, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
| | | | | | | | - Vincy Chan
- KITE Research Institute-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Tatyana Mollayeva
- KITE Research Institute-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Natalie Urbach
- School of Medicine, Queen's University, Kingston, ON, Canada
| | - Angela Colantonio
- KITE Research Institute-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Eyal Cohen
- ICES, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Hospital for Sick Children, Toronto, ON, Canada
- Edwin SH Leong Centre for Healthy Children, University of Toronto, Toronto, ON, Canada
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Cindy-Lee Dennis
- Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
- Lunenfeld-Tannenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada
| | - Joel G. Ray
- ICES, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
| | - Natasha Saunders
- ICES, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Hospital for Sick Children, Toronto, ON, Canada
- Edwin SH Leong Centre for Healthy Children, University of Toronto, Toronto, ON, Canada
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Simone N. Vigod
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Cai F, Hamm RF, Schwartz N. FATE: The Effect of Fetal Antenatal Testing Education on Patient Knowledge and Satisfaction. Am J Perinatol 2024; 41:e788-e793. [PMID: 36096149 PMCID: PMC10172386 DOI: 10.1055/a-1941-4414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE This study aimed to evaluate the effect of a physician-created educational infographic on the knowledge and attitudes of patients undergoing antenatal fetal surveillance. STUDY DESIGN This single-center prospective cohort study evaluated the impact of implementing an electronic educational infographic about antenatal fetal surveillance. English-speaking women receiving antenatal surveillance between the ages of 18 to 50 years were approached for inclusion. The preimplementation group enrolled women receiving antenatal surveillance between March 8, 2021, and April 2, 2021, who received usual care. Postimplementation, from April 5 to May 6, 2021, patients at our site received the infographic about antenatal fetal surveillance at their first antenatal testing appointment. Both pre- and postimplementation groups received a 5-question multiple-choice knowledge and 12-question attitude survey between 320/7 to 336/7 weeks at baseline (prior to receipt of infographic in postimplementation group) and again between 350/7 to 366/7 weeks. Patients were included in the analysis only if they completed both surveys. Differences from initial to final survey were compared between groups. RESULTS Of 106 patients who completed the initial survey, 74 (69.8%) participants finished both surveys (preimplementation = 39 and postimplementation = 35). There were no significant differences in demographics between the two groups, including in baseline knowledge (p = 0.58) or attitude tests (p = 0.57). There was no significant difference in knowledge on final surveys between groups (p = 0.79). However, utilization of the infographic was associated with a significant increase in attitude survey score from initial to final survey in the postimplementation group as compared with usual care (median difference: pre = 0, interquartile rang [IQR]: [-1 to +4] vs. post = +3, IQR: [+1 to +6], p = 0.016). CONCLUSION A physician-created infographic on antepartum fetal testing was associated with overall improved patient attitude toward fetal testing, showing that small education interventions can increase patient satisfaction with care. KEY POINTS · A physician-created, readable, and patient-oriented education resource is feasible.. · Infographic patient-education materials do not change patient knowledge about antenatal testing.. · Infographic patient-education materials can improve patient attitude toward antenatal testing..
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Affiliation(s)
- Fei Cai
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Rebecca F. Hamm
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nadav Schwartz
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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Dongarwar D, Ajewole V, Spooner KK, Tran V, Adebusuyi T, Onyenaka C, Bakare O, Emeh C, Baines K, Boua D, Mossi Y, Egbejimi A, Ibrahim S, Olaleye O, Salihu HM. Racial and Ethnic Disparities in Stillbirth among Pregnant Women with Obesity. Am J Perinatol 2024; 41:e2138-e2144. [PMID: 37230474 PMCID: PMC11059530 DOI: 10.1055/a-2099-8494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE The aim of this study was to examine the relationship between obesity and risk of stillbirth among pregnant women with obesity in the United States, with a focus on racial and ethnic disparities. STUDY DESIGN We conducted a retrospective cross-sectional analysis of birth and fetal data from the 2014 to 2019 National Vital Statistics System (N = 14,938,384 total births) to examine associations between maternal body mass index (BMI) and risk of stillbirth. Cox's proportional hazards regression model was used to compute adjusted hazard ratios (HR) as a measure of risk of stillbirth in relation to maternal BMI. RESULTS The stillbirth rate was 6.70 per 1,000 births among women with prepregnancy obesity, while the stillbirth rate among women with a normal (nonobese) prepregnancy BMI was 3.85 per 1,000 births. The risk of stillbirth was greater among women with obesity compared with women without obesity (HR: 1.39; 95% confidence interval [CI]: 1.37-1.41). Compared with non-Hispanic (NH) Whites, women identifying as NH-other (HR: 1.66; 95% CI: 1.61-1.72) and NH-Black (HR: 1.31; 95% CI: 1.26-1.35) were at higher risk of stillbirth, while Hispanic women had a decreased likelihood of stillbirth (HR: 0.38; 95% CI: 0.37-0.40). CONCLUSION Obesity is a modifiable risk factor for stillbirth. Public health awareness campaigns and strategies targeting weight management in women of reproductive age and racial/ethnic populations at highest risk for stillbirth, are needed. KEY POINTS · Stillbirth rates differ by race and ethnicity.. · Risk of stillbirth was greatest among women with obesity.. · Stillbirth rates rise with ascending prepregnancy BMI..
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Affiliation(s)
- Deepa Dongarwar
- Center of Excellence in Health Equity, Training and Research, Baylor College of Medicine, Houston, Texas
| | - Veronica Ajewole
- Department of Pharmaceutical Science, College of Pharmacy and Health Sciences, Texas Southern University, Houston, Texas
| | - Kiara K. Spooner
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
| | - Vincent Tran
- Department of Pharmaceutical Science, College of Pharmacy and Health Sciences, Texas Southern University, Houston, Texas
| | - Tolulope Adebusuyi
- Department of Pharmaceutical Science, College of Pharmacy and Health Sciences, Texas Southern University, Houston, Texas
| | - Collins Onyenaka
- Department of Pharmaceutical Science, College of Pharmacy and Health Sciences, Texas Southern University, Houston, Texas
| | - Oluwatoyin Bakare
- Department of Pharmaceutical Science, College of Pharmacy and Health Sciences, Texas Southern University, Houston, Texas
| | - Clinton Emeh
- Department of Pharmaceutical Science, College of Pharmacy and Health Sciences, Texas Southern University, Houston, Texas
| | - Kameren Baines
- Department of Pharmaceutical Science, College of Pharmacy and Health Sciences, Texas Southern University, Houston, Texas
| | - Danielle Boua
- Department of Pharmaceutical Science, College of Pharmacy and Health Sciences, Texas Southern University, Houston, Texas
| | - Yhenew Mossi
- Department of Pharmaceutical Science, College of Pharmacy and Health Sciences, Texas Southern University, Houston, Texas
| | - Anuoluwapo Egbejimi
- Department of Pharmaceutical Science, College of Pharmacy and Health Sciences, Texas Southern University, Houston, Texas
| | - Samira Ibrahim
- Department of Pharmaceutical Science, College of Pharmacy and Health Sciences, Texas Southern University, Houston, Texas
| | - Omonike Olaleye
- Department of Pharmaceutical Science, College of Pharmacy and Health Sciences, Texas Southern University, Houston, Texas
| | - Hamisu M. Salihu
- Center of Excellence in Health Equity, Training and Research, Baylor College of Medicine, Houston, Texas
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
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Adams A, Dongarwar D, Shay L, Baroni M, Williams E, Ehieze P, Wilson R, Awoseyi A, Salihu HM. Social Determinants of Health and Risk of Stillbirth in the United States. Am J Perinatol 2024; 41:e477-e485. [PMID: 36055282 DOI: 10.1055/s-0042-1756141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Our aim was to evaluate the impact of social determinants of health (SDoH) risk factors on stillbirth among pregnancy-related hospitalizations in the United States. STUDY DESIGN We conducted a cross-sectional analysis of delivery-related hospital discharges using annualized data (2016-2017) from the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample. The International Classification of Diseases, 10th Revision ICD-10-CM codes were used to select women with singleton stillbirth. Z-codes were utilized to identify SDoH risk factors and their subtypes. The association between SDoH risk factors and stillbirth was assessed using survey logistic regression models. RESULTS We analyzed 8,148,646 hospitalizations, out of which 91,140 were related to stillbirth hospitalizations, yielding a stillbirth incidence of 1.1%. An increased incidence was observed for non-Hispanic (NH) Blacks (1.7%) when compared with NH Whites (1.0%). The incidence of stillbirth was greater in hospitalizations associated with SDoH risk factors compared with those without risk factors [2.0% vs. 1.1% (p <0.001)]. Among patients with SDoH risk factors, the rate of stillbirth was highest in those designated as NH other (3.0%). Mothers that presented with SDoH risk factors had a 60% greater risk of stillbirth compared with those without (odds ratio [OR] = 1.61 [95% confidence interval (CI) = 1.33-1.95], p < 0.001). The SDoH issues that showed the most significant risk for stillbirth were: occupational risk (OR = 7.05 [95% CI: 3.54-9.58], p < 0.001), upbringing (OR = 1.87 [95% CI: 1.23-2.82], p < 0.001), and primary support group and family (OR = 5.45 [95% 3.84-7.76], p < 0.001). CONCLUSION We found pregnancies bearing SDoH risk factors to be associated with a 60% elevated risk for stillbirth. Future studies should target a variety of risk reduction strategies aimed at modifiable SDoH risk factors that can be widely implemented at both the population health level as well as in the direct clinical setting. KEY POINTS · Health disparities exist in stillbirth rates, especially among NH Black women.. · Social determinants of health risk factors increase the risk of stillbirth.. · There is a need for further study on the impact of specific SDoH risk factors on stillbirth risk..
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Affiliation(s)
- April Adams
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Deepa Dongarwar
- Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, Texas
| | - Lena Shay
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Mariana Baroni
- Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, Texas
| | - Eunique Williams
- Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, Texas
| | - Priscilla Ehieze
- Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, Texas
| | - Rhanna Wilson
- Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, Texas
| | - Alexia Awoseyi
- Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, Texas
| | - Hamisu M Salihu
- Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, Texas
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Wolfson C, Qian J, Creanga AA. Levels, Trends, and Risk Factors for Stillbirths in the United States: 2000-2017. Am J Perinatol 2024; 41:e601-e611. [PMID: 35973798 DOI: 10.1055/a-1925-2131] [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: 11/01/2022]
Abstract
OBJECTIVE This study documents 2000 to 2017 trends in stillbirth rates and changes in associations between known maternal and fetal risk factors and stillbirths for 2000 to 2002 versus 2015 to 2017 in the United States. STUDY DESIGN We conducted a retrospective, population-based analysis of stillbirths and live-births using national vital statistics data. We calculated annual stillbirth rates overall and by gestational age; and examined stillbirth rates by maternal age, race-ethnicity, and state for 2000 to 2002 versus 2015 to 2017. We used Chi-squared tests to examine associations between maternal and fetal risk factors separately for early (20-27 weeks) and late (28+ weeks) stillbirths compared with live-births for 2000 to 2002 versus 2015 to 2017. RESULTS Stillbirth rates declined by 7.5% (p < 0.001) during 2000 to 2006 but remained flat at approximately 6 stillbirths per 1,000 births thereafter. Throughout 2000 to 2017, there were significant improvements in stillbirth rates at 39+ weeks nationally (p < 0.001), but rates varied greatly between and within states. Sociodemographic (advanced maternal age, Black race, low education, unmarried status, and rural residence), obstetric, and other medical factors (>3 births, use of infertility treatment, maternal obesity, diabetes, chronic hypertension, eclampsia, no prenatal care, and tobacco use) were significantly more prevalent in women with late than early stillbirths or live births. Notably, late and total stillbirth rates were approximately 30% higher for women >35 years than for women <35 years and twice as high for non-Hispanic Black than non-Hispanic White women; American Indian/Alaska Native women represented the only racial-ethnic group with significantly higher late stillbirth rates in 2015 to 2017 than in 2000 to 2002. Pregnancy and fetal factors (multiple pregnancy, male fetus, and breech presentation) were more prevalent in women with early than late stillbirths or live births. CONCLUSION U.S. stillbirth rates have plateaued since 2006. There are persistent differential risk profiles for early versus late stillbirths which can inform stillbirth prevention strategies (e.g., close observation of women with risk factors for stillbirth) and new research into the causes of stillbirths by gestational age. KEY POINTS · U.S. stillbirth rates have plateaued since 2006.. · Stillbirth rates vary between and within U.S. states and by maternal and fetal factors.. · Early versus late stillbirths have different risk profiles which can guide stillbirth prevention strategies..
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Affiliation(s)
- Carrie Wolfson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jiage Qian
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Andreea A Creanga
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland
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Lähde H, Karlsson H, Karlsson L, Perasto L, Varis V, Rinne K, Paavonen EJ, Polo-Kantola P. Sleep disturbances in late pregnancy: associations with induction of labor. Arch Gynecol Obstet 2024:10.1007/s00404-024-07492-4. [PMID: 38580856 DOI: 10.1007/s00404-024-07492-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 03/21/2024] [Indexed: 04/07/2024]
Abstract
PURPOSE Sleep disturbances, which are common during pregnancy, may compromise labor. Nevertheless, little is known about associations between sleep disturbances and the likelihood of ending up induction of labor (IOL). Accordingly, we aimed to evaluate the connections between sleep disturbances during pregnancy and IOL. METHODS Altogether 1778 women from the FinnBrain Birth Cohort Study with gestation weeks over 37 + 6 were enrolled in the study. The women were divided into IOL (n = 331) and spontaneous onset of labor (SOL, n = 1447) groups. Sleep disturbances in late pregnancy were evaluated using the Basic Nordic Sleep Questionnaire. Logistic regression analyses were conducted with adjustments for age, body mass index, parity, smoking, and depressive symptoms. RESULTS Sleep disturbances were frequent in both IOL and SOL groups. In the IOL group 43.0% and in the SOL group 39.0% had poor general sleep quality (P = 0.186). Nocturnal awakenings occurred most commonly, in 94.0% and 93.9%, respectively (P = 0.653). In the IOL group, more women (22.7%) were habitual snorers than in the SOL group (17.0%, P = 0.017), however, the difference lost the statistical significance in adjusted analysis (P = 0.848). Women in the IOL group were more likely to be short sleepers (< 7 h) compared to those in the SOL group (20.2% and 15.4%, respectively, P = 0.034) with no difference after adjustment (P = 0.133). The two groups showed no differences in sleep loss (P = 0.252). CONCLUSIONS Deterioration in sleep quality was noticeable in pregnant women, but it was unconnected with IOL. As the frequency of IOL is increasing, more research for related risk factors is needed.
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Affiliation(s)
- Henna Lähde
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Savitehtaankatu 5, 20521, Turku, Finland.
| | - Hasse Karlsson
- FinnBrain Birth Cohort Study, Department of Clinical Medicine, Turku Brain and Mind Center, University of Turku, Turku, Finland
- Department of Psychiatry, Turku University Hospital and University of Turku, Turku, Finland
- Centre for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland
| | - Linnea Karlsson
- FinnBrain Birth Cohort Study, Department of Clinical Medicine, Turku Brain and Mind Center, University of Turku, Turku, Finland
- Centre for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland
- Department of Clinical Medicine, Pediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Laura Perasto
- FinnBrain Birth Cohort Study, Department of Clinical Medicine, Turku Brain and Mind Center, University of Turku, Turku, Finland
- Centre for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland
| | - Viliina Varis
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Savitehtaankatu 5, 20521, Turku, Finland
| | - Kirsi Rinne
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Savitehtaankatu 5, 20521, Turku, Finland
| | - E Juulia Paavonen
- The Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
- Child Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Päivi Polo-Kantola
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Savitehtaankatu 5, 20521, Turku, Finland
- Sleep Research Unit, University of Turku, Turku, Finland
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9
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Fisher SC, Romitti PA, Tracy M, Howley MM, Jabs EW, Browne ML. Associations between maternal periconceptional alcohol consumption and risk of omphalocele among offspring, National Birth Defects Prevention Study, 1997-2011. Prev Med 2024; 180:107891. [PMID: 38342385 DOI: 10.1016/j.ypmed.2024.107891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 02/13/2024]
Abstract
OBJECTIVE Previous studies of alcohol consumption during pregnancy and omphalocele have produced mixed results. We updated an earlier analysis of National Birth Defects Prevention Study (NBDPS) data, adding six years of participants, to examine associations between maternal alcohol consumption and omphalocele. METHODS NBDPS was a multi-site, population-based case-control study in the United States. Cases were identified from birth defect surveillance programs in 10 states; controls were liveborn infants without a birth defect randomly selected from the same catchment areas. Mothers self-reported alcohol consumption during the periconceptional period (one month before through the third gestational month) via telephone interview. Our study included mothers of 410 omphalocele cases and 11,219 controls with estimated dates of delivery (EDDs) during 1997-2011. We used logistic regression to estimate adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for periconceptional alcohol consumption and omphalocele. We performed a probabilistic bias analysis to evaluate the impact of alcohol exposure misclassification on our results. RESULTS Overall, 44% of case and 38% of control mothers reported periconceptional alcohol consumption; 22% and 17%, respectively, reported binge drinking. Any maternal periconceptional alcohol consumption was associated with modestly increased odds of omphalocele (AOR 1.35, 95% CI 1.09, 1.68), as was binge drinking (AOR 1.47, 95% CI 1.08, 2.01). Our bias analysis yielded estimates further from the null. CONCLUSIONS We observed modest associations between maternal periconceptional alcohol consumption and omphalocele. Based on our bias analysis, studies of alcohol and birth defects not accounting for exposure misclassification may underestimate associations.
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Affiliation(s)
- Sarah C Fisher
- Birth Defects Registry, New York State Department of Health, Albany, NY, United States.
| | - Paul A Romitti
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, United States
| | - Melissa Tracy
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Rensselaer, NY, United States
| | - Meredith M Howley
- Birth Defects Registry, New York State Department of Health, Albany, NY, United States
| | - Ethylin Wang Jabs
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Department of Genetic Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States; Department of Clinical Genomics, Mayo Clinic, Rochester, MN, United States
| | - Marilyn L Browne
- Birth Defects Registry, New York State Department of Health, Albany, NY, United States; Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Rensselaer, NY, United States
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Potter LA, Ly SH, Pei X, Ponzini MD, Wilson MD, Hou MY. Characteristics and outcomes of patients undergoing second-trimester dilation and evacuation for intrauterine fetal demise vs induced abortion. Contraception 2023; 126:110118. [PMID: 37453657 PMCID: PMC10528417 DOI: 10.1016/j.contraception.2023.110118] [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] [Received: 04/12/2023] [Revised: 07/06/2023] [Accepted: 07/10/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVES Patients with intrauterine fetal demise (IUFD) are at higher risk of complications when undergoing dilation and evacuation (D&E) compared to patients undergoing abortion for other indications. We aimed to compare baseline characteristics and describe outcomes, including frequencies of complications such as disseminated intravascular coagulation (DIC) and hemorrhage, in patients undergoing D&E for IUFD vs induced abortion, with a goal of identifying associated risk factors for complications. STUDY DESIGN We conducted a retrospective matched cohort study of patients undergoing nonemergent D&Es for singleton ≥14-0/7-week IUFD January 1, 2019 to May 31, 2021, matched with two patients undergoing induced second-trimester D&Es by cesarean delivery history, patient age, and gestational age (GA). We collected demographics, history, GA, coagulation studies, quantitative blood loss (QBL), and complications. We calculated descriptive statistics and tested for association using chi-square, Fisher's exact, t, and Wilcoxon's rank sum tests. RESULTS Of 1390 procedures, 64 patients with IUFD met inclusion criteria and were matched with 128 patients undergoing induced D&E. Eight (12.5%) patients with IUFD and six (4.7%) undergoing induced D&E had hemorrhage (odds ratio [OR] = 2.90, 95% confidence interval [0.96, 8.77]). Six (9.4%) patients with IUFD and none undergoing induced D&E had DIC (OR = 28.56 [1.58, 515.38]). Median QBL was 75.0 mL (50, 162.5) for patients with IUFD vs 110.0 mL (50, 200) for those undergoing induced D&E (p = 0.083). Twelve (18.8%) patients with IUFD vs seven (5.5%) undergoing induced D&E received at least one intervention due to bleeding complications (p = 0.004). CONCLUSIONS We found a higher DIC frequency but no significant difference in hemorrhage or QBL in IUFD D&E compared to induced abortion. Our IUFD D&E complication frequency is higher than those previously published. IMPLICATIONS Our results affirm current standards of care for D&E in patients with IUFD. Large referral centers may have higher proportions of complications compared to other sites.
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Affiliation(s)
- Laura A Potter
- University of California, Davis School of Medicine, Sacramento, California, United States
| | - Serena H Ly
- University of California, Davis School of Medicine, Sacramento, California, United States
| | - Xiaohe Pei
- University of California, Davis School of Medicine, Sacramento, California, United States
| | - Matthew D Ponzini
- Department of Public Health Sciences, University of California, Davis, Sacramento, California, United States
| | - Machelle D Wilson
- Department of Public Health Sciences, University of California, Davis, Sacramento, California, United States
| | - Melody Y Hou
- Department of Obstetrics and Gynecology, University of California, Davis, Sacramento, California, United States.
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11
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Hong J, Crawford K, Odibo AO, Kumar S. Risks of stillbirth, neonatal mortality, and severe neonatal morbidity by birthweight centiles associated with expectant management at term. Am J Obstet Gynecol 2023; 229:451.e1-451.e15. [PMID: 37150282 DOI: 10.1016/j.ajog.2023.04.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 04/21/2023] [Accepted: 04/26/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND Determining the optimal time of birth at term is challenging given the ongoing risks of stillbirth with increasing gestation vs the risks of significant neonatal morbidity at early-term gestations. These risks are more pronounced in small infants. OBJECTIVE This study aimed to evaluate the risks of stillbirth, neonatal mortality, and severe neonatal morbidity by comparing expectant management with delivery from 37+0 weeks of gestation. STUDY DESIGN This was a retrospective cohort study evaluating women with singleton, nonanomalous pregnancies at 37+0 to 40+6 weeks' gestation in Queensland, Australia, delivered from 2000 to 2018. Rates of stillbirth, neonatal death, and severe neonatal morbidity were calculated for <3rd, 3rd to <10th, 10th to <25th, 25th to <90th, and ≥90th birthweight centiles. The composite risk of mortality with expectant management for an additional week in utero was compared with rates of neonatal mortality and severe neonatal morbidity. RESULTS Of 948,895 singleton, term nonanomalous births, 813,077 occurred at 37+0 to 40+6 weeks' gestation. Rates of stillbirth increased with gestational age, with the highest rate observed in infants with birthweight below the third centile: 10.0 per 10,000 (95% confidence interval, 6.2-15.3) at 37+0 to 37+6 weeks, rising to 106.4 per 10,000 (95% confidence interval, 74.6-146.9) at 40+0 to 40+6 weeks' gestation. The rate of neonatal mortality was highest at 37+0 to 37+6 weeks for all birthweight centiles. The composite risk of expectant management rose sharply after 39+0 to 39+6 weeks, and was highest in infants with birthweight below the third centile (125.2/10,000; 95% confidence interval, 118.4-132.3) at 40+0 to 40+6 weeks' gestation. Balancing the risk of expectant management and delivery (neonatal mortality), the optimal timing of delivery for each birthweight centile was evaluated on the basis of relative risk differences. The rate of severe neonatal morbidity sharply decreased in the period between 37+0 to 37+6 and 38+0 to 38+6 weeks, particularly for infants with birthweight below the third centile. CONCLUSION Our data suggest that the optimal time of birth is 37+0 to 37+6 weeks for infants with birthweight <3rd centile and 38+0 to 38+6 weeks' gestation for those with birthweight between the 3rd and 10th centile and >90th centile. For all other birthweight centiles, birth from 39+0 weeks is associated with the best outcomes. However, large numbers of planned births are required to prevent a single excess death. The healthcare costs and acceptability to women of potential universal policies of planned birth need to be carefully considered.
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Affiliation(s)
- Jesrine Hong
- Mater Research Institute, The University of Queensland, Brisbane, Australia; Mayne Medical School, The University of Queensland, Brisbane, Australia; Department of Obstetrics and Gynecology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Kylie Crawford
- Mater Research Institute, The University of Queensland, Brisbane, Australia; Mayne Medical School, The University of Queensland, Brisbane, Australia; School of Public Health, The University of Queensland, Brisbane, Australia
| | - Anthony O Odibo
- Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Sailesh Kumar
- Mater Research Institute, The University of Queensland, Brisbane, Australia; Mayne Medical School, The University of Queensland, Brisbane, Australia; National Health and Medical Research Council, Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia.
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12
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Lyu T, Liang C, Liu J, Hung P, Zhang J, Campbell B, Ghumman N, Olatosi B, Hikmet N, Zhang M, Yi H, Li X. Risk for stillbirth among pregnant individuals with SARS-CoV-2 infection varied by gestational age. Am J Obstet Gynecol 2023; 229:288.e1-288.e13. [PMID: 36858096 PMCID: PMC9970919 DOI: 10.1016/j.ajog.2023.02.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 02/19/2023] [Accepted: 02/21/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND Despite previous research findings on higher risks of stillbirth among pregnant individuals with SARS-CoV-2 infection, it is unclear whether the gestational timing of viral infection modulates this risk. OBJECTIVE This study aimed to examine the association between timing of SARS-CoV-2 infection during pregnancy and risk of stillbirth. STUDY DESIGN This retrospective cohort study used multilevel logistic regression analyses of nationwide electronic health records in the United States. Data were from 75 healthcare systems and institutes across 50 states. A total of 191,403 pregnancies of 190,738 individuals of reproductive age (15-49 years) who had childbirth between March 1, 2020 and May 31, 2021 were identified and included. The main outcome was stillbirth at ≥20 weeks of gestation. Exposures were the timing of SARS-CoV-2 infection: early pregnancy (<20 weeks), midpregnancy (21-27 weeks), the third trimester (28-43 weeks), any time before delivery, and never infected (reference). RESULTS We identified 2342 (1.3%) pregnancies with COVID-19 in early pregnancy, 2075 (1.2%) in midpregnancy, and 12,697 (6.9%) in the third trimester. After adjusting for maternal and clinical characteristics, increased odds of stillbirth were observed among pregnant individuals with SARS-CoV-2 infection only in early pregnancy (odds ratio, 1.75, 95% confidence interval, 1.25-2.46) and midpregnancy (odds ratio, 2.09; 95% confidence interval, 1.49-2.93), as opposed to pregnant individuals who were never infected. Older age, Black race, hypertension, acute respiratory distress syndrome or acute respiratory failure, and placental abruption were found to be consistently associated with stillbirth across different trimesters. CONCLUSION Increased risk of stillbirth was associated with COVID-19 only when pregnant individuals were infected during early and midpregnancy, and not at any time before the delivery or during the third trimester, suggesting the potential vulnerability of the fetus to SARS-CoV-2 infection in early pregnancy. Our findings underscore the importance of proactive COVID-19 prevention and timely medical intervention for individuals infected with SARS-CoV-2 during early and midpregnancy.
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Affiliation(s)
- Tianchu Lyu
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Chen Liang
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC.
| | - Jihong Liu
- Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Peiyin Hung
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Jiajia Zhang
- Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Berry Campbell
- Department of Obstetrics and Gynecology, School of Medicine Columbia, University of South Carolina, Columbia, SC
| | - Nadia Ghumman
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Bankole Olatosi
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Neset Hikmet
- Department of Integrated Information Technology, College of Engineering and Computing, University of South Carolina, Columbia, SC
| | - Manting Zhang
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Honggang Yi
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Xiaoming Li
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC
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13
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Thompson KD, Meyers DJ, Lee Y, Cu-Uvin S, Bengtson AM, Wilson IB. Antiretroviral Therapy Use Was Not Associated with Stillbirth or Preterm Birth in an Analysis of U.S. Medicaid Pregnancies to Persons with HIV. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2023; 4:438-447. [PMID: 37638332 PMCID: PMC10457643 DOI: 10.1089/whr.2023.0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/26/2023] [Indexed: 08/29/2023]
Abstract
Background Using a U.S. based, nationally representative sample, this study compares stillbirth and preterm birth outcomes between women living with HIV (WWH) who did and did not use antiretroviral therapy (ART) during pregnancy, additionally assessing ART duration and regimen type. Methods Using 2001 to 2012 Medicaid Analytic eXtract (MAX) data from the 14 states with the highest prevalence of HIV. We estimated two, propensity score matched, multivariate logistic regression models for both outcomes of stillbirth and preterm birth: (1) any ART use and (2) the number of months on ART during pregnancy for ART users, adjusting for patient-level covariates. Results Only 34.6% of pregnancies among WWH had a history of ART use and among those, the proportions of stillbirth and preterm birth were 0.9% and 7.9%, respectively. Any ART use was not significantly associated with either outcome of stillbirth (marginal effects [MEs]: 0.06%, 95% confidence interval [CI]: -0.17 to 0.28) or preterm birth (ME: -0.12%, 95% CI: -0.79 to 0.55). For ART users, duration of ART was not significantly associated with either outcome. Black race was a strong independent predictor in both models (stillbirth: 0.80% and 0.84%, preterm birth: 4.19% and 3.76%). Neither protease inhibitor (PI) nor boosted PI regimens were more strongly associated with stillbirth or preterm birth than nucleoside reverse transcriptase inhibitor-based regimens. Conclusion ART use during pregnancy was low during this period. Our findings suggest that ART use and ART regimen are not associated, positively or negatively, with stillbirth or preterm birth for mothers with Medicaid. Additionally, our findings highlight a persisting need to address disparities in these outcomes for Black women.
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Affiliation(s)
- Kathryn D. Thompson
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - David J. Meyers
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Yoojin Lee
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Susan Cu-Uvin
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
- Providence/Boston Center for AIDS Research (CFAR), Brown University, Providence, Rhode Island, USA
| | - Angela M. Bengtson
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Ira B. Wilson
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
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14
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McElwee ER, Oliver EA, McFarling K, Haney A, Cuff R, Head B, Karanchi H, Loftley A, Finneran MM. Risk of Stillbirth in Pregnancies Complicated by Diabetes, Stratified by Fetal Growth. Obstet Gynecol 2023; 141:801-809. [PMID: 36897128 DOI: 10.1097/aog.0000000000005102] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 12/12/2022] [Indexed: 03/11/2023]
Abstract
OBJECTIVE To compare stillbirth rates per week of expectant management stratified by birth weight in pregnancies complicated by gestational diabetes mellitus (GDM) or pregestational diabetes mellitus. METHODS A national population-based retrospective cohort study of singleton, nonanomalous pregnancies complicated by pregestational diabetes or GDM was performed using national birth and death certificate data from 2014 to 2017. Stillbirth rates per 10,000 patients (stillbirth incidence at gestational age week/ongoing pregnancies-[0.5×live births at gestational age week]) were determined for each week of pregnancy from 34 to 39 completed weeks of gestation. Pregnancies were stratified by birth weight, categorized as having small-for-gestational-age (SGA), appropriate-for-gestational-age (AGA), or large-for-gestational-age (LGA) fetuses, assigned by sex-based Fenton criteria. Relative risk (RR) and 95% CI for stillbirth were calculated for each gestational age week compared with the GDM-related AGA group. RESULTS We included 834,631 pregnancies complicated by either GDM (86.9%) or pregestational diabetes (13.1%) in the analysis, with a total of 3,033 stillbirths. Stillbirth rates increased with advancing gestational age for pregnancies complicated by both GDM and pregestational diabetes regardless of birth weight. Compared with pregnancies with AGA fetuses, those with both SGA and LGA fetuses were significantly associated with an increased risk of stillbirth at all gestational ages. Ongoing pregnancies at 37 weeks of gestation complicated by pregestational diabetes with LGA or SGA fetuses had respective stillbirth rates of 64.9 and 40.1 per 10,000 patients. Pregnancies complicated by pregestational diabetes had an RR of stillbirth of 21.8 (95% CI 17.4-27.2) for LGA fetuses and 13.5 (95% CI 8.5-21.2) for SGA fetuses compared with GDM-related AGA at 37 weeks of gestation. The greatest absolute risk of stillbirth was in pregnancies complicated by pregestational diabetes at 39 weeks of gestation with LGA fetuses (97/10,000). CONCLUSION Pregnancies complicated by both GDM and pregestational diabetes affected by pathologic fetal growth have an increased risk of stillbirth with advancing gestational age. This risk is significantly higher with pregestational diabetes, especially pregestational diabetes with LGA fetuses.
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Affiliation(s)
- Eliza R McElwee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, and the Division of Endocrinology, Department of Internal Medicine, Medical University of South Carolina, Charleston, South Carolina; and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
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15
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Lucchini M, Rayport Y, Valeri L, Jelic S, St-Onge MP, O'Brien LM, Alcantara C. Racial/ethnic disparities in sleep-disordered breathing during pregnancy in the nuMoM2b study. Obesity (Silver Spring) 2023; 31:923-933. [PMID: 36863765 DOI: 10.1002/oby.23697] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 12/07/2022] [Accepted: 12/09/2022] [Indexed: 03/04/2023]
Abstract
OBJECTIVE The aim of this study was to assess the prevalence and severity of sleep-disordered breathing (SDB) across racial/ethnic groups in 3702 pregnant people at 6 to 15 and 22 to 31 weeks gestational age, examine whether BMI modifies the association between race/ethnicity and SDB, and investigate whether interventions to reduce weight might reduce racial/ethnic disparities in SDB. METHODS Differences by race/ethnicity in SDB prevalence and severity were quantified via linear, logistic, or quasi-Poisson regression. Controlled direct effect was used to estimate whether intervening on BMI would remove/diminish differences by race/ethnicity in SDB severity. RESULTS This study comprised 61.2% non-Hispanic White (nHW), 11.9% non-Hispanic Black (nHB), 18.5% Hispanic, and 3.7% Asian people. SDB prevalence was higher for nHB compared with nHW pregnant people at 6 to 15 weeks (odds ratio [OR] 1.81, 95% CI [1.07, 2.97]), whereas at 21 to 32 weeks, Asian pregnant people had a higher SDB prevalence than nHW (OR 2.2, 95% CI [1.1, 4.0]). The severity of SDB differed across racial/ethnic groups in early pregnancy, with nHB pregnant people having a higher apnea-hypopnea index (AHI) (OR 1.35, 95% CI [1.07, 1.69]) compared with nHW. Having overweight/obesity was associated with a higher AHI (β = 2.36, 95% CI [1.97, 2.84]). Controlled direct effect analyses indicated that in early pregnancy, nHB and Hispanic pregnant people would have a lower AHI compared with nHW people had they had normal weight. CONCLUSIONS This study extends knowledge on racial/ethnic disparities in SDB to a pregnant population.
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Affiliation(s)
- Maristella Lucchini
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Yael Rayport
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Linda Valeri
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Sanja Jelic
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Marie-Pierre St-Onge
- Division of General Medicine and Sleep Center of Excellence, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Louise M O'Brien
- Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Michigan Medicine, Ann Arbor, Michigan, USA
- Division of Sleep Medicine, Department of Neurology, Michigan Medicine, Ann Arbor, Michigan, USA
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16
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Gantt A, Metz TD, Kuller JA, Louis JM, Cahill AG, Turrentine MA. Obstetric Care Consensus #11, Pregnancy at age 35 years or older. Am J Obstet Gynecol 2023; 228:B25-B40. [PMID: 35850202 DOI: 10.1016/j.ajog.2022.07.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Centers for Disease Control and Prevention data from 2020 demonstrate the continued upward trend in the mean age of pregnant individuals in the United States. Observational studies demonstrate that pregnancy in older individuals is associated with increased risks of adverse pregnancy outcomes-for both the pregnant patient and the fetus-that might differ from those found in younger pregnant populations, even in healthy individuals with no other comorbidities. There are several studies that suggest that advancing age at the time of pregnancy is associated with greater disparities in severe maternal morbidity and mortality. This document seeks to provide evidence-based clinical recommendations for minimizing adverse outcomes associated with pregnancy with anticipated delivery at an advanced maternal age. The importance and benefits of accessible health care from prepregnancy through postpartum care for all pregnant individuals cannot be overstated. However, this document focuses on and addresses the unique differences in pregnancy-related care for women and all those seeking obstetrical care with anticipated delivery at the age of 35 years or older within the framework of routine pregnancy care. This Obstetric Care Consensus document was developed using an a priori protocol in conjunction with the authors listed above.
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17
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Thompson RA, Thompson JMD, Wilson J, Cronin RS, Mitchell EA, Raynes-Greenow CH, Li M, Stacey T, Heazell AEP, O'Brien LM, McCowan LME, Anderson NH. Risk factors for late preterm and term stillbirth: A secondary analysis of an individual participant data meta-analysis. BJOG 2023. [PMID: 36852504 DOI: 10.1111/1471-0528.17444] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 12/14/2022] [Accepted: 01/09/2023] [Indexed: 03/01/2023]
Abstract
OBJECTIVE Identify independent and novel risk factors for late-preterm (28-36 weeks) and term (≥37 weeks) stillbirth and explore development of a risk-prediction model. DESIGN Secondary analysis of an Individual Participant Data (IPD) meta-analysis investigating modifiable stillbirth risk factors. SETTING An IPD database from five case-control studies in New Zealand, Australia, the UK and an international online study. POPULATION Women with late-stillbirth (cases, n = 851), and ongoing singleton pregnancies from 28 weeks' gestation (controls, n = 2257). METHODS Established and novel risk factors for late-preterm and term stillbirth underwent univariable and multivariable logistic regression modelling with multiple sensitivity analyses. Variables included maternal age, body mass index (BMI), parity, mental health, cigarette smoking, second-hand smoking, antenatal-care utilisation, and detailed fetal movement and sleep variables. MAIN OUTCOME MEASURES Independent risk factors with adjusted odds ratios (aOR) for late-preterm and term stillbirth. RESULTS After model building, 575 late-stillbirth cases and 1541 controls from three contributing case-control studies were included. Risk factor estimates from separate multivariable models of late-preterm and term stillbirth were compared. As these were similar, the final model combined all late-stillbirths. The single multivariable model confirmed established demographic risk factors, but additionally showed that fetal movement changes had both increased (decreased frequency) and reduced (hiccoughs, increasing strength, frequency or vigorous fetal movements) aOR of stillbirth. Poor antenatal-care utilisation increased risk while more-than-adequate care was protective. The area-under-the-curve was 0.84 (95% CI 0.82-0.86). CONCLUSIONS Similarities in risk factors for late-preterm and term stillbirth suggest the same approach for risk-assessment can be applied. Detailed fetal movement assessment and inclusion of antenatal-care utilisation could be valuable in late-stillbirth risk assessment.
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Affiliation(s)
- R A Thompson
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand
| | - J M D Thompson
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand
| | - J Wilson
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand
| | - R S Cronin
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand
- Women's Health Division, Counties Manukau Health, Auckland, New Zealand
| | - E A Mitchell
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand
| | - C H Raynes-Greenow
- Sydney School of Public Health, University of Sydney, Camperdown, New South Wales, Australia
| | - M Li
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand
- Women's Health Division, Counties Manukau Health, Auckland, New Zealand
| | - T Stacey
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - A E P Heazell
- University of Manchester, Manchester, UK
- University of Michigan, Ann Arbor, Michigan, USA
| | - L M O'Brien
- University of Michigan, Ann Arbor, Michigan, USA
| | - L M E McCowan
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand
| | - N H Anderson
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand
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Tesfay N, Tariku R, Zenebe A, Hailu G, Taddese M, Woldeyohannes F. Timing of perinatal death; causes, circumstances, and regional variations among reviewed deaths in Ethiopia. PLoS One 2023; 18:e0285465. [PMID: 37159458 PMCID: PMC10168579 DOI: 10.1371/journal.pone.0285465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 04/17/2023] [Indexed: 05/11/2023] Open
Abstract
INTRODUCTION Ethiopia is one of the countries facing a very high burden of perinatal death in the world. Despite taking several measures to reduce the burden of stillbirth, the pace of decline was not that satisfactory. Although limited perinatal mortality studies were conducted at a national level, none of the studies stressed the timing of perinatal death. Thus, this study is aimed at determining the magnitude and risk factors that are associated with the timing of perinatal death in Ethiopia. METHODS National perinatal death surveillance data were used in the study. A total of 3814 reviewed perinatal deaths were included in the study. Multilevel multinomial analysis was employed to examine factors associated with the timing of perinatal death in Ethiopia. The final model was reported through the adjusted relative risk ratio with its 95% Confidence Interval, and variables with a p-value less than 0.05 were declared statistically significant predictors of the timing of perinatal death. Finally, a multi-group analysis was carried out to observe inter-regional variation among selected predictors. RESULT Among the reviewed perinatal deaths, 62.8% occurred during the neonatal period followed by intrapartum stillbirth, unknown time of stillbirth, and antepartum stillbirth, each contributing 17.5%,14.3%, and 5.4% of perinatal deaths, respectively. Maternal age, place of delivery, maternal health condition, antennal visit, maternal education, cause of death (infection and congenital and chromosomal abnormalities), and delay to decide to seek care were individual-level factors significantly associated with the timing of perinatal death. While delay reaching a health facility, delay to receive optimal care health facility, type of health facility and type region were provincial-level factors correlated with the timing of perinatal death. A statistically significant inter-regional variation was observed due to infection and congenital anomalies in determining the timing of perinatal death. CONCLUSION Six out of ten perinatal deaths occurred during the neonatal period, and the timing of perinatal death was determined by neonatal, maternal, and facility factors. As a way forward, a concerted effort is needed to improve the community awareness of institutional delivery and ANC visit. Moreover, strengthening the facility level readiness in availing quality service through all paths of the continuum of care with special attention to the lower-level facilities and selected poor-performing regions is mandatory.
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Affiliation(s)
- Neamin Tesfay
- Centre of Public Health Emergency Management, Ethiopian Public Health Institutes, Addis Ababa, Ethiopia
| | - Rozina Tariku
- Centre of Public Health Emergency Management, Ethiopian Public Health Institutes, Addis Ababa, Ethiopia
| | - Alemu Zenebe
- Centre of Public Health Emergency Management, Ethiopian Public Health Institutes, Addis Ababa, Ethiopia
| | - Girmay Hailu
- Centre of Public Health Emergency Management, Ethiopian Public Health Institutes, Addis Ababa, Ethiopia
| | - Muse Taddese
- Centre of Public Health Emergency Management, Ethiopian Public Health Institutes, Addis Ababa, Ethiopia
| | - Fitsum Woldeyohannes
- Health Financing Program, Clinton Health Access Initiative, Addis Ababa, Ethiopia
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19
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Hosier H, Xu X, Underwood K, Ackerman-Banks C, Campbell KH, Reddy UM. Racial and ethnic differences in severe maternal morbidity among singleton stillbirth deliveries. Am J Obstet Gynecol MFM 2022; 4:100708. [PMID: 35964935 DOI: 10.1016/j.ajogmf.2022.100708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/22/2022] [Accepted: 08/08/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite growing evidence suggesting racial or ethnic disparities in the risk of severe maternal morbidity among live births, there is little research investigating potential differences in severe maternal morbidity risk among stillbirths across race and ethnicity. OBJECTIVE This study aimed to compare the risk of severe maternal morbidity by race and ethnicity among patients with singleton stillbirth pregnancies. STUDY DESIGN We used the California Linked Birth File database to perform a retrospective analysis of singleton stillbirth pregnancies delivered at 20 to 42 weeks' gestation between 2007 and 2011. The database contained information from fetal death certificates linked to maternal hospital discharge records. We defined severe maternal morbidity using the Centers for Disease Control and Prevention composite severe maternal morbidity indicator and compared rates of severe maternal morbidity across racial and ethnic groups. Multivariable regression analysis was used to examine how race and ethnicity were associated with severe maternal morbidity risk after accounting for the influence of patients' clinical risk factors, socioeconomic characteristics, and attributes of the delivery hospital. RESULTS Of the 9198 patients with singleton stillbirths, 533 (5.8%) experienced severe maternal morbidity. Non-Hispanic Black patients had a significantly higher risk of severe maternal morbidity (10.6% vs 5.2% in non-Hispanic White patients, 5.2% in Hispanic patients, and 5.1% in patients with other race or ethnicity; P<.001). The higher risk of severe maternal morbidity among non-Hispanic Black patients persisted even after adjusting for patients' clinical, socioeconomic, and hospital characteristics (adjusted odds ratio for non-Hispanic Black vs non-Hispanic White patients, 1.74; 95% confidence interval, 1.21-2.50). Further analysis separating blood-transfusion and nontransfusion severe maternal morbidity showed a higher risk of blood transfusion in non-Hispanic Black patients, which remained significant after adjusting for patients' clinical, socioeconomic, and hospital characteristics (adjusted odds ratio for non-Hispanic Black vs non-Hispanic White patients, 1.64; 95% confidence interval, 1.11-2.43). However, the higher risk of nontransfusion severe maternal morbidity in non-Hispanic Black patients was no longer significant after adjusting for patients' clinical risk factors (adjusted odds ratio for non-Hispanic Black vs non-Hispanic White patients, 1.38; 95% confidence interval, 0.83-2.30). CONCLUSION Severe maternal morbidity occurred in 5.8% of patients with a singleton stillbirth. Risk of severe maternal morbidity in stillbirth was higher in patients with non-Hispanic Black race, which was likely owing to a higher risk of hemorrhage, as evidenced by increased rate of blood transfusion.
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Affiliation(s)
- Hillary Hosier
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT.
| | - Xiao Xu
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT
| | - Katherine Underwood
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT
| | - Christina Ackerman-Banks
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT
| | - Katherine H Campbell
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT
| | - Uma M Reddy
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT
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20
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Ananth CV, Fields JC, Brandt JS, Graham HL, Keyes KM, Zeitlin J. Evolving stillbirth rates among Black and White women in the United States, 1980-2020: A population-based study. LANCET REGIONAL HEALTH. AMERICAS 2022; 16:100380. [PMID: 36777154 PMCID: PMC9903913 DOI: 10.1016/j.lana.2022.100380] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/16/2022] [Accepted: 10/10/2022] [Indexed: 12/14/2022]
Abstract
Background Given slowing secular declines and persistent racial disparities, stillbirth remains a major health burden in the US. We investigate changes in stillbirth rates overall and for Black and White women, and determine how maternal age, delivery year (period), and birth year (cohort) have shaped trends. Methods We designed a sequential time-series analysis utilising the 1980 to 2020 US vital records data of live births and stillbirths at ≥24 weeks gestation. Stillbirth rates overall and among Black and White women were examined. We undertook an age-period-cohort analysis to evaluate temporal changes in stillbirth trends. Findings Of 157,192,032 live births and 710,832 stillbirths between 1980 and 2020, stillbirth rates per 1000 births declined from 10.6 (95% confidence interval [CI] 10.5, 10.7) in 1980 to 5.8 (95% CI 5.7, 5.8) in 2020. Stillbirth rates declined from 9.2 to 5.0 per 1000 births among White women (rate ratio [RR] 0.54, 95% CI 0.53, 0.55), and from 17.4 to 10.1 per 1000 births among Black women (RR 0.57, 95% CI 0.55, 0.59). Black women experienced persistent two-fold higher rates compared to White women (2.01, 95% CI 1.97, 2.05 in 2020). Stillbirth rates declined until 2005, increased from 2005 to the mid-2010s and plateaued thereafter. Strong cohort effects contributed to declining rates in earlier cohorts (1930-1955) and increasing rates among women born after 1980. Interpretation Age, period, and birth cohorts greatly influenced US stillbirth rates over the last forty years. The decline in stillbirth rate was evident between 1980 and 2005, however subsequent declines have been minimal, reflecting no further gains for cohorts of women born in 1955-1980 and stagnation of period effects starting in 2005. A significant racial disparity persisted with a two-fold excess in stillbirth rates for Black compared to White women, underscoring the need for targeted health and social policies to address disparities. Funding None.
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Affiliation(s)
- Cande V. Ananth
- Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA,Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA,Cardiovascular Institute of New Jersey, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA,Environmental and Occupational Health Sciences Institute (EOHSI), Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA,Corresponding author. Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, NJ, USA.
| | - Jessica C. Fields
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Justin S. Brandt
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Hillary L. Graham
- Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Katherine M. Keyes
- Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, NY, USA
| | - 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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21
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Bligard KH, Dicke JM, Stout MJ, Nelson DM, Frolova AI, Cahill AG, Raghuraman N. Etiology and evaluation of stillbirth in patients with obesity. J Matern Fetal Neonatal Med 2022; 35:10181-10186. [PMID: 36102165 DOI: 10.1080/14767058.2022.2122797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVE Maternal obesity is a risk factor for stillbirth, but whether or not the etiology of stillbirth differs in gravidas with and without obesity is unknown. We categorized stillbirths in a contemporary cohort to test the hypothesis that the etiology of stillbirth is different in gravidas with and without obesity. METHODS This retrospective cohort study included all gravidas with a stillbirth ≥20 weeks' gestation between 2010 and 2017 and a normal mid-trimester anatomic survey by ultrasound assessment at a large academic institution. Pregnancies were excluded if delivery data were unavailable, a multifetal gestation was present, or there was an antenatally diagnosed fetal structural or genetic anomaly. Our primary exposure was maternal obesity, defined as a body mass index (BMI) ≥ 30 kg/m2 at the time of anatomic survey. Our primary outcome was stillbirth etiology, as classified by the initial causes of fetal death tool from the Stillbirth Collaborative Research Network and includes maternal, obstetric, hematologic, fetal, infectious, placental, other, or unexplained categories. Our secondary outcomes included the evaluation performed on each stillbirth, compliance with the recommended stillbirth evaluation by the American College of Obstetricians and Gynecologists (ACOG), and the percentage of abnormal results for each of the tests ordered for stillbirth evaluation. RESULTS Of 118 stillbirths meeting the inclusion criteria, 44 (37.3%) occurred in gravidas with obesity and 74 (62.7%) were in patients without obesity. An obstetric complication was the most commonly identified etiology for stillbirth, found in 40.9% of cases with obesity versus in 29.7% of cases without obesity (aOR 1.09, 95% CI 0.47-2.66). The likelihood of any specific etiology of stillbirth was not significantly different in gravidas of the two weight groups, after controlling for confounders. However, assignment to the unexplained stillbirth category was significantly less common in women with obesity, compared to those without obesity (aOR 0.18, 95% CI 0.05-0.67). There was no difference in testing performed on each stillbirth between the groups. Compliance with the ACOG-recommended diagnostic evaluation for stillbirth was similar in the two groups but was only performed in 10.2% of all cases of stillbirth. Placental pathology was the test most likely to yield an abnormal result in both groups, but the percentage of abnormal results for this and all other tests was the same in the presence and absence of obesity. CONCLUSION There is no specific etiology of stillbirth seen in gravidas with obesity, compared to those without obesity, after controlling for maternal confounders. We surmise that the evaluation recommended for stillbirth assessment in the general population is appropriate for stillbirth evaluation in gravidas with obesity. Testing pursued was similar between groups, but compliance with ACOG recommendations for testing after stillbirth was deficient in the cohort. Future work should aim to identify and address barriers to completing the recommended stillbirth evaluation.
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Affiliation(s)
- Katherine H Bligard
- Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Jeffrey M Dicke
- Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Molly J Stout
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - D Michael Nelson
- Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Antonina I Frolova
- Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Alison G Cahill
- Department of Women's Health, Dell Medical School University of Texas, Austin, TX, USA
| | - Nandini Raghuraman
- Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
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Lucchini M, O’Brien LM, Kahn LG, Brennan PA, Glazer Baron K, Knapp EA, Lugo-Candelas C, Shuffrey L, Dunietz GL, Zhu Y, Wright RJ, Wright RO, Duarte C, Karagas MR, Ngai P, O’Connor TG, Herbstman JB, Dioni S, Singh AM, Alcantara C, Fifer WP, Elliott AJ. Racial/ethnic disparities in subjective sleep duration, sleep quality, and sleep disturbances during pregnancy: an ECHO study. Sleep 2022; 45:zsac075. [PMID: 35724979 PMCID: PMC9453625 DOI: 10.1093/sleep/zsac075] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/23/2022] [Indexed: 01/10/2023] Open
Abstract
In the United States, racial/ethnic minoritized groups experience worse sleep than non-Hispanic Whites (nHW), but less is known about pregnant people. This is a key consideration since poor sleep during pregnancy is common and associated with increased risk of adverse perinatal outcomes. This study reports the prevalence of subjective sleep measures in a multi-racial/ethnic pregnant population from the Environmental influences on Child Health Outcomes (ECHO) program. Participants' self-reported race and ethnicity were grouped into: nHW, non-Hispanic Black/African American (nHB/AA), Hispanic, non-Hispanic Asian (nHA). Analyses examined trimester-specific (first (T1), second (T2), third (T3)) nocturnal sleep duration, quality, and disturbances (Pittsburgh Sleep Quality Index and ECHO maternal sleep health questionnaire). Linear or multinomial regressions estimated the associations between race/ethnicity and each sleep domain by trimester, controlling for body mass index and age, with nHW as reference group. We repeated analyses within maternal education strata. nHB/AA participants reported shorter sleep duration (T2: β = -0.55 [-0.80,-0.31]; T3: β = -0.65 [-0.99,-0.31]) and more sleep disturbances (T2: β = 1.92 [1.09,2.75]; T3: β = 1.41 [0.09,2.74]). Hispanic participants reported longer sleep duration (T1: β = 0.22 [0.00004,0.44]; T2: β = 0.61 [0.47,0.76]; T3: β = 0.46 [0.22,0.70]), better sleep quality (Reference group: Very good. Fairly good T1: OR = 0.48 [0.32,0.73], T2: OR = 0.36 [0.26,0.48], T3: OR = 0.31 [0.18,0.52]. Fairly bad T1: OR = 0.27 [0.16,0.44], T2: OR = 0.46 [0.31, 0.67], T3: OR = 0.31 [0.17,0.55]), and fewer sleep disturbances (T2: β = -0.5 [-1.0,-0.12]; T3: β = -1.21 [-2.07,-0.35]). Differences persisted within the high-SES subsample. Given the stark racial/ethnic disparities in perinatal outcomes and their associations with sleep health, further research is warranted to investigate the determinants of these disparities.
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Affiliation(s)
- Maristella Lucchini
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Louise M O’Brien
- Division of Sleep Medicine, Department of Neurology, and Department of Obstetrics & Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Linda G Kahn
- Departments of Pediatrics and Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | | | - Kelly Glazer Baron
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA
| | - Emily A Knapp
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Claudia Lugo-Candelas
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Lauren Shuffrey
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Galit Levi Dunietz
- Division of Sleep Medicine, Department of Neurology, and Department of Obstetrics & Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Yeyi Zhu
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Rosalind J Wright
- Department of Environmental Medicine and Public Health and Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robert O Wright
- Department of Environmental Medicine and Public Health and Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Cristiane Duarte
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Margaret R Karagas
- Department of Epidemiology, Geisel School of Medicine at Dartmouth College, Hanover, NH, USA
| | - Pakkay Ngai
- Division of Pediatric Pulmonology, Department of Pediatrics, Hackensack Meridian School of Medicine, Hackensack, NJ, USA
| | - Thomas G O’Connor
- Departments of Psychiatry, Psychology, Neuroscience, and Obstetrics and Gynecology, University of Rochester, Rochester, NY, USA
| | - Julie B Herbstman
- Department of Environmental Health Sciences, Mailman School of Public Health, New York NY, USA
| | - Sean Dioni
- Department of Pediatrics, Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Anne Marie Singh
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | - William P Fifer
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
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McLaren H, Cancino D, McCulloch M, Wolff S, French V. Rates of complication for dilation and evacuation versus induction of labor in treatment of second trimester intrauterine fetal demise. Eur J Obstet Gynecol Reprod Biol 2022; 277:16-20. [PMID: 35970003 DOI: 10.1016/j.ejogrb.2022.08.003] [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: 04/04/2022] [Revised: 08/01/2022] [Accepted: 08/04/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate clinical differences in the safety of dilation and evacuation (D&E) and induction of labor (IOL) for the treatment of intrauterine fetal demise (IUFD) between 14 and 24 weeks gestation. STUDY DESIGNS A retrospective chart review was conducted at a single institution comparing rates of major and minor complications between patients who undergo D&E and those that undergo IOL in the treatment of IUFD between 14 and 24 weeks gestation. Demographic and medical variables were stratified by management method and analyzed using chi-squared and t-tests where appropriate. RESULTS Patients who underwent IOL were of a more advanced gestational age and more likely to be uninsured. Patients who underwent D&E were more likely to be privately insured. Hospital time for an IOL was significantly longer than for D&E. Composite rates of complication did not differ significantly between management groups. Patients treated with D&E were more likely to require uterine aspiration. CONCLUSIONS D&E and IOL are equally safe methods for the management of IUFD between 14 and 24 weeks gestation. Both options should be made available to patients who experience this rare pregnancy outcome.
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Affiliation(s)
- Hilary McLaren
- Department of Obstetrics and Gynecology, University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, IL 60637, USA
| | - Dominic Cancino
- School of Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA
| | - Megan McCulloch
- School of Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA
| | - Sharon Wolff
- Department of Population Health, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA
| | - Valerie French
- Department of Obstetrics and Gynecology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
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Abstract
SUMMARY Centers for Disease Control and Prevention data from 2020 demonstrate the continued upward trend in the mean age of pregnant individuals in the United States. Observational studies demonstrate that pregnancy in older individuals is associated with increased risks of adverse pregnancy outcomes-for both the pregnant patient and the fetus-that might differ from those in a younger pregnant population, even in healthy individuals with no other comorbidities. There are several studies that suggest advancing age at the time of pregnancy is associated with greater disparities in severe maternal morbidity and mortality. This document seeks to provide evidence-based clinical recommendations for minimizing adverse outcomes associated with pregnancy with anticipated delivery at an advanced maternal age. The importance and benefits of accessible health care from prepregnancy through postpartum care for all pregnant individuals cannot be overstated. However, this document focuses on and addresses the unique differences in pregnancy-related care for women and all those seeking obstetric care with anticipated delivery at age 35 years or older within the framework of routine pregnancy care. This Obstetric Care Consensus document was developed using an a priori protocol in conjunction with the authors listed above.
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Tsimbos C, Verropoulou G, Petropoulou D. Socioeconomic inequality and stillbirth rate disparities among native and foreign mothers: evidence from Greece. SN SOCIAL SCIENCES 2022; 2:140. [PMID: 35910539 PMCID: PMC9310690 DOI: 10.1007/s43545-022-00410-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 06/15/2022] [Indexed: 11/29/2022]
Abstract
We study, for the first time, stillbirth differentials among native and migrant populations in Greece using national vital registration microdata for the period of 2010–2014. We employ conventional demographic measures and propose a standardization procedure to delineate the effect of selected distributions of livebirths on the observed stillbirth rates. The stillbirth rate among immigrant mothers is 40% higher than among natives, an excess which persists throughout gestational intervals and age groups. Our findings also show a clear gradient of stillbirth rates by maternal education, favoring more educated women, and this finding applies to both native and immigrant mothers. Our standardization methodology shows that the distribution of births by maternal educational level and age play a role; this finding implies that elevated immigrant stillbirth rates may be attributed to a certain extent to the specific characteristics of this group, since immigrant women have, on average, a younger age structure and lower educational attainment.
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Affiliation(s)
- Cleon Tsimbos
- Department of Statistics and Insurance Science, University of Piraeus, Piraeus, Greece
| | - Georgia Verropoulou
- Department of Statistics and Insurance Science, University of Piraeus, Piraeus, Greece
| | - Dimitra Petropoulou
- Department of Economics, The London School of Economics and Political Science, London, UK
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Maternal Race and Stillbirth: Cohort Study and Systematic Review with Meta-Analysis. J Clin Med 2022; 11:jcm11123452. [PMID: 35743521 PMCID: PMC9224577 DOI: 10.3390/jcm11123452] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/10/2022] [Accepted: 06/13/2022] [Indexed: 12/10/2022] Open
Abstract
Accurate identification of independent predictors of stillbirth is needed to define preventive strategies. We aim to examine the independent contribution of maternal race in the risk of stillbirth after adjusting for maternal characteristics and medical history. There are two components to the study: first, prospective screening in 168,966 women with singleton pregnancies coordinated by the Fetal Medicine Foundation (FMF) and second, a systematic review and meta-analysis of studies reporting on race and stillbirth. In the FMF study, logistic regression analysis found that in black women, the risk of stillbirth, after adjustment for confounders, was higher than in white women (odds ratio 1.78, 95% confidence interval 1.50 to 2.11). The risk for other racial groups was not significantly different. The literature search identified 20 studies that provided data on over 6,500,000 pregnancies, but only 10 studies provided risks adjusted for some maternal characteristics; consequently, the majority of these studies did not provide accurate contribution of different racial groups to the prediction of stillbirth. It is concluded that in women of black origin, the risk of stillbirth, after adjustment for confounders, is about twofold higher than in white women. Consequently, closer surveillance should be granted for these women.
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Thompson KD, Meyers DJ, Lee Y, Cu-Uvin S, Wilson IB. HIV-Positive and HIV-Negative Women with Medicaid Have Similar Rates of Stillbirth and Preterm Birth. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2022; 3:1-9. [PMID: 35136871 PMCID: PMC8812497 DOI: 10.1089/whr.2021.0068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/08/2021] [Indexed: 04/12/2023]
Abstract
Introduction: Women living with human immunodeficiency virus (WLHIV) may face additional challenges and differential birth outcomes when compared with women without human immunodeficiency virus (HIV). There is limited research to date studying birth outcomes among a nationally representative sample of WLHIV. This study compares stillbirth and prematurity rates between HIV-positive (HIV+) and HIV-negative (HIV-) mothers in the Medicaid program. Methods: We used 12 years (2001-2012) of Medicaid Analytic eXtract data. We included Medicaid claims from the 14 states with the highest prevalence of HIV: California, Florida, Georgia, Illinois, Louisiana, Massachusetts, Maryland, North Carolina, New Jersey, New York, Ohio, Pennsylvania, Texas, and Virginia. Primary outcomes were stillbirth and preterm birth. We used logistic regression models adjusting for age, race, Medicaid coverage, eligibility, substance use, rurality, comorbidities, and state fixed effects to compare differences in rates for women with and without HIV. Results: Our study included a total of 33,078 HIV+ and 7,663,758 HIV- pregnancies from Medicaid enrollees between 2001 and 2012. The proportions of stillbirths and preterm births were higher for HIV+ when compared with HIV- mothers (0.9% vs. 0.7% and 8.0% vs. 6.6%, p < 0.0001). After adjusting for covariates, being HIV+ was not significantly associated with both stillbirth (odds ratio [OR]: 1.05) or prematurity (OR: 1.01). Black race was a strong independent predictor of both stillbirth and prematurity (OR: 1.99 and 1.51, p < 0.01). Rurality and substance abuse were not associated with either outcome. Conclusions: After adjustment for relevant covariates, maternal HIV infection was not associated with increased rates of stillbirth or preterm birth in the Medicaid program in the United States. It is imperative that we understand and eliminate the clinical, social, and contextual factors that are responsible for the strong association between black race and poor perinatal outcomes that we observe.
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Affiliation(s)
- Kathryn D. Thompson
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- *Address correspondence to: Kathryn D. Thompson, Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Providence, RI 02903, USA,
| | - David J. Meyers
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Yoojin Lee
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Susan Cu-Uvin
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
- Providence/Boston Center for AIDS Research (CFAR), Providence, Rhode Island, USA
| | - Ira B. Wilson
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
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Liu Y, Wu Y, Pan Z, Jiang F, Lu Y, Meng Y. Single-Dose Versus Multiple-Dose GnRH Agonist for Luteal-Phase Support in Women Undergoing IVF/ICSI Cycles: A Network Meta-Analysis of Randomized Controlled Trials. Front Endocrinol (Lausanne) 2022; 13:802688. [PMID: 35432219 PMCID: PMC9008129 DOI: 10.3389/fendo.2022.802688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 03/02/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although gonadotropin-releasing hormone (GnRH) agonist has been introduced as a beneficial luteal phase support (LPS), the optimal strategy of GnRH agonist remains unclear. This network meta-analysis was therefore performed to determine the comparative efficacy and safety of multiple-dose versus single-dose GnRH agonist protocol for LPS in patients undergoing IVF/ICSI cycles. METHODS We searched relevant studies in PubMed, Embase and the Cochrane Registry of Controlled Trials (CENTRAL) from their inception util to September 2021. Live birth, clinical pregnancy rate, multiple pregnancy rate, and clinical abortion rate was evaluated. Pairwise and network meta-analysis were conducted using RevMan and ADDIS based on random-effects model, respectively. Moreover, the prioritization of protocols based on ranking probabilities for different outcomes were performed. RESULTS Sixteen RCTs met our eligibility criteria. Pairwise meta-analysis showed that multiple-dose protocol of GnRH agonist was effective for increasing live birth rate (OR 1.80, 95% CI 1.15 to 2.83, p=0.01) and clinical pregnancy rate (OR 1.89, 95% CI 1.01 to 3.56, p=0.05) as well as decreasing clinical abortion rate (OR 0.55, 95% CI 0.34 to 0.90, p=0.02). Meanwhile, single-dose protocol of GnRH agonist was effective for increasing clinical pregnancy rate (OR 1.45, 95% CI 1.11 to 1.89, p=0.007) and multiple pregnancy rate (OR 2.55, 95% CI 1.12 to 5.78, p=0.03). However, network meta-analysis only confirmed that multiple-dose protocol of GnRH agonist was the best efficacious strategy for live birth rate (OR 2.04, 95% CrI 1.19 to 3.93) and clinical pregnancy rate (OR 2.10, 95% CrI 1.26 to 3.54). CONCLUSION Based on the results of NMA, multiple-dose protocol may be the optimal strategy for patients undergoing IVF/ICSI cycles owing to its advantage in increasing live birth and clinical pregnancy rate. Moreover, single-dose protocol may be the optimal strategy for improving multiple pregnancy rate. However, with the limitations, more RCTs are required to confirm our findings.
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Affiliation(s)
| | | | | | | | - Youhui Lu
- *Correspondence: Yushi Meng, ; Youhui Lu,
| | - Yushi Meng
- *Correspondence: Yushi Meng, ; Youhui Lu,
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Lemieux P, Benham JL, Donovan LE, Moledina N, Pylypjuk C, Yamamoto JM. The association between gestational diabetes and stillbirth: a systematic review and meta-analysis. Diabetologia 2022; 65:37-54. [PMID: 34676425 DOI: 10.1007/s00125-021-05579-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 07/21/2021] [Indexed: 12/16/2022]
Abstract
AIMS/HYPOTHESIS Controversy exists over whether gestational diabetes increases the risk of stillbirth. The aim of this review was to examine the association between gestational diabetes and stillbirth. METHODS We performed searches of the published literature to May 2021. Study selection and data extraction were performed in duplicate by independent reviewers. Meta-analyses of summary measures were conducted using random-effect models for cohort and case-control studies separately. The study protocol was registered in PROSPERO (registration ID CRD42020166939). RESULTS From 9981 citations, 419 were identified for full-text review and 73 met inclusion criteria (n = 70,292,090). There was no significant association between gestational diabetes and stillbirth in cohort studies (pooled OR 1.04 [95% CI 0.90, 1.21]; I2 86.1%) or in case-control studies (pooled OR 1.57 [95% CI 0.83, 2.98]; I2 94.8%). Gestational diabetes was associated with lower odds of stillbirth among cohort studies presenting with an adjusted OR (pooled OR 0.78 [95% CI 0.68, 0.88]; I2 42.7%). Stratified analyses by stillbirth ≥28 weeks' gestation, studies published prior to 2013 and studies identified as low quality demonstrated a significantly higher odds of stillbirth in meta-regression (p = 0.016, 0.023 and 0.005, respectively). Egger's test for all included cohort studies (p = 0.018) suggests publication bias for the main meta-analysis. CONCLUSIONS/INTERPRETATION Given the substantial heterogeneity across studies, there are insufficient data to define the relationship between stillbirth and gestational diabetes adequately. In the main analyes, gestational diabetes was not associated with an increased risk of stillbirth. However, heterogeneity across studies means this finding should be interpreted cautiously.
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Affiliation(s)
- Patricia Lemieux
- Department of Medicine, CHU de Québec - University Laval, Quebec City, QC, Canada
| | - Jamie L Benham
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Lois E Donovan
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Nadia Moledina
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Christy Pylypjuk
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, MB, Canada
- Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB, Canada
| | - Jennifer M Yamamoto
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB, Canada.
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada.
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Canelón SP, Butts S, Boland MR. Evaluation of Stillbirth Among Pregnant People With Sickle Cell Trait. JAMA Netw Open 2021; 4:e2134274. [PMID: 34817585 PMCID: PMC8613600 DOI: 10.1001/jamanetworkopen.2021.34274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/18/2021] [Indexed: 11/14/2022] Open
Abstract
Importance Relative to what is known about pregnancy complications and sickle cell disease (SCD), little is known about the risk of pregnancy complications among those with sickle cell trait (SCT). There is a lack of clinical research among sickle cell carriers largely due to low sample sizes and disparities in research funding. Objective To evaluate whether there is an association between SCT and a stillbirth outcome. Design, Setting, and Participants This retrospective cohort study included data on deliveries occurring between January 1, 2010, and August 15, 2017, at 4 quaternary academic medical centers within the Penn Medicine health system in Pennsylvania. The population included a total of 2482 deliveries from 1904 patients with SCT but not SCD, and 215 deliveries from 164 patients with SCD. Data were analyzed from May 3, 2019, to September 16, 2021. Exposures The primary exposure of interest was SCT, identified using clinical diagnosis codes recorded in the electronic health record. Main Outcomes and Measures A multivariate logistic regression model was constructed to assess the risk of stillbirth using the following risk factors: SCD, numbers of pain crises and blood transfusions before delivery, delivery episode (as a proxy for parity), prior cesarean delivery, multiple gestation, patient age, marital status, race and ethnicity, ABO blood type, Rhesus (Rh) factor, and year of delivery. Results This cohort study included 50 560 patients (63 334 deliveries), most of whom were aged 25 to 34 years (29 387 of 50 560 [58.1%]; mean [SD] age, 29.5 [6.1] years), were single at the time of delivery (28 186 [55.8%]), were Black or African American (23 777 [47.0%]), had ABO blood type O (22 879 [45.2%]), and were Rhesus factor positive (44 000 [87.0%]). From this general population, 2068 patients (4.1%) with a sickle cell gene variation were identified: 1904 patients (92.1%) with SCT (2482 deliveries) and 164 patients (7.9%) with SCD (215 deliveries). In the fully adjusted model, SCT was associated with an increased risk of stillbirth (adjusted odds ratio [aOR], 8.94; 95% CI, 1.05-75.79; P = .045) while adjusting for the risk factors of SCD (aOR, 26.40; 95% CI, 2.48-280.90; P = .007) and multiple gestation (aOR, 4.68; 95% CI, 3.48-6.29; P < .001). Conclusions and Relevance The results of this large, retrospective cohort study indicate an increased risk of stillbirth among pregnant people with SCT. These findings underscore the need for additional risk assessment during pregnancy for sickle cell carriers.
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Affiliation(s)
- Silvia P. Canelón
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia
| | - Samantha Butts
- Division of Reproductive Endocrinology and Infertility, Penn State College of Medicine and Penn State Health, Hershey, Pennsylvania
| | - Mary Regina Boland
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia
- Institute for Biomedical Informatics, University of Pennsylvania, Philadelphia
- Center for Excellence in Environmental Toxicology, University of Pennsylvania, Philadelphia
- Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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Arslan E, Allshouse AA, Page JM, Varner MW, Thorsten V, Parker C, Dudley DJ, Saade GR, Goldenberg RL, Stoll BJ, Hogue CJ, Bukowski R, Conway D, Pinar H, Reddy UM, Silver RM. Maternal serum fructosamine levels and stillbirth: a case-control study of the Stillbirth Collaborative Research Network. BJOG 2021; 129:619-626. [PMID: 34529344 DOI: 10.1111/1471-0528.16922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 09/12/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the association between maternal fructosamine levels at the time of delivery and stillbirth. DESIGN Secondary analysis of a case-control study. SETTING Multicentre study of five geographic catchment areas in the USA. POPULATION All singleton stillbirths with known diabetes status and fructosamine measurement, and representative live birth controls. MAIN OUTCOME MEASURES Fructosamine levels in stillbirths and live births among groups were adjusted for potential confounding factors, including diabetes. Optimal thresholds of fructosamine to discriminate stillbirth and live birth. RESULTS A total of 529 women with a stillbirth and 1499 women with a live birth were included in the analysis. Mean fructosamine levels were significantly higher in women with a stillbirth than in women with a live birth after adjustment (177 ± 3.05 versus 165 ± 2.89 μmol/L, P < 0.001). The difference in fructosamine levels between stillbirths and live births was greater among women with diabetes (194 ± 8.54 versus 162 ± 3.21 μmol/L), compared with women without diabetes (171 ± 2.50 versus 162 ± 2.56 μmol/L). The area under the curve (AUC) for fructosamine level and stillbirth was 0.634 (0.605-0.663) overall, 0.713 (0.624-0.802) with diabetes and 0.625 (0.595-0.656) with no diabetes. CONCLUSIONS Maternal fructosamine levels at the time of delivery were higher in women with stillbirth compared with women with live birth. Differences were substantial in women with diabetes, suggesting a potential benefit of glycaemic control in women with diabetes during pregnancy. The small differences noted in women without diabetes are not likely to justify routine screening in all cases of stillbirth. TWEETABLE ABSTRACT Maternal serum fructosamine levels are higher in women with stillbirth than in women with live birth, especially in women with diabetes.
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Affiliation(s)
- E Arslan
- Department of Obstetrics and Gynecology, University of Utah Health Sciences, Salt Lake City, Utah, USA
| | - A A Allshouse
- Department of Obstetrics and Gynecology, University of Utah Health Sciences, Salt Lake City, Utah, USA
| | - J M Page
- Department of Obstetrics and Gynecology, University of Utah Health Sciences, Salt Lake City, Utah, USA.,Department of Obstetrics and Gynecology, Intermountain Health Care, Murray, Utah, USA
| | - M W Varner
- Department of Obstetrics and Gynecology, University of Utah Health Sciences, Salt Lake City, Utah, USA
| | - V Thorsten
- RTI International, Research Triangle Park, North Carolina, USA
| | - C Parker
- RTI International, Research Triangle Park, North Carolina, USA
| | - D J Dudley
- Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, Virginia, USA
| | - G R Saade
- Department of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - R L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University, New York, New York, USA
| | - B J Stoll
- Department of Pediatrics, McGovern Medical School at University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - C J Hogue
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - R Bukowski
- Department of Women's Health, University of Texas Health Science Center at Austin, Austin, Texas, USA
| | - D Conway
- Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - H Pinar
- Division of Perinatal Pathology, Brown University School of Medicine, Providence, Rhode Island, USA
| | - U M Reddy
- Department of Obstetrics and Gynecology, Yale School of Medicine, New Haven, Connecticut, USA
| | - R M Silver
- Department of Obstetrics and Gynecology, University of Utah Health Sciences, Salt Lake City, Utah, USA
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Indications for Outpatient Antenatal Fetal Surveillance: ACOG Committee Opinion, Number 828. Obstet Gynecol 2021; 137:e177-e197. [PMID: 34011892 DOI: 10.1097/aog.0000000000004407] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
ABSTRACT The purpose of this Committee Opinion is to offer guidance about indications for and timing and frequency of antenatal fetal surveillance in the outpatient setting. Antenatal fetal surveillance is performed to reduce the risk of stillbirth. However, because the pathway that results in increased risk of stillbirth for a given condition may not be known and antenatal fetal surveillance has not been shown to improve perinatal outcomes for all conditions associated with stillbirth, it is challenging to create a prescriptive list of all indications for which antenatal fetal surveillance should be considered. This Committee Opinion provides guidance on and suggests surveillance for conditions for which stillbirth is reported to occur more frequently than 0.8 per 1,000 (the false-negative rate of a biophysical profile) and which are associated with a relative risk or odds ratio for stillbirth of more than 2.0 compared with pregnancies without the condition. Table 1 presents suggestions for the timing and frequency of testing for specific conditions. As with all testing and interventions, shared decision making between the pregnant individual and the clinician is critically important when considering or offering antenatal fetal surveillance for individuals with pregnancies at high risk for stillbirth or with multiple comorbidities that increase the risk of stillbirth. It is important to emphasize that the guidance offered in this Committee Opinion should be construed only as suggestions; this guidance should not be construed as mandates or as all encompassing. Ultimately, individualization about if and when to offer antenatal fetal surveillance is advised.
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Al Khalaf SY, O'Reilly ÉJ, Barrett PM, B Leite DF, Pawley LC, McCarthy FP, Khashan AS. Impact of Chronic Hypertension and Antihypertensive Treatment on Adverse Perinatal Outcomes: Systematic Review and Meta-Analysis. J Am Heart Assoc 2021; 10:e018494. [PMID: 33870708 PMCID: PMC8200761 DOI: 10.1161/jaha.120.018494] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Maternal chronic hypertension is associated with adverse pregnancy outcomes. Previous studies examined the association between either chronic hypertension or antihypertensive treatment and adverse pregnancy outcomes. We aimed to synthesize the evidence on the effect of chronic hypertension/antihypertensive treatment on adverse pregnancy outcomes. Methods and Results Medline/PubMed, EMBASE, and Web of Science were searched; we included observational studies and assessed the effect of race/ethnicity, where possible, following a registered protocol (CRD42019120088). Random-effects meta-analyses were used. A total of 81 studies were identified on chronic hypertension, and a total of 16 studies were identified on antihypertensive treatment. Chronic hypertension was associated with higher odds of preeclampsia (adjusted odd ratio [aOR], 5.43; 95% CI, 3.85-7.65); cesarean section (aOR, 1.87; 95% CI, 1.6-2.16); maternal mortality (aOR, 4.80; 95% CI, 3.04-7.58); preterm birth (aOR, 2.23; 95% CI, 1.96-2.53); stillbirth (aOR, 2.32; 95% CI, 2.22-2.42); and small for gestational age (SGA) (aOR, 1.96; 95% CI, 1.6-2.40). Subgroup analyses indicated that maternal race/ethnicity does not influence the observed associations. Women with chronic hypertension on antihypertensive treatment (versus untreated) had higher odds of SGA (aOR, 1.86; 95% CI, 1.38-2.50). Conclusions Chronic hypertension is associated with adverse pregnancy outcomes, and these associations appear to be independent of maternal race/ethnicity. In women with chronic hypertension, those on treatment had a higher risk of SGA, although the number of studies was limited. This could result from a direct effect of the treatment or because severe hypertension during pregnancy is a risk factor for SGA and women with severe hypertension are more likely to be treated. The effect of antihypertensive treatment on SGA needs to be further tested with large randomized controlled trials.
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Affiliation(s)
- Sukainah Y Al Khalaf
- School of Public Health University College Cork Cork Ireland.,INFANT Research Centre University College Cork Ireland
| | - Éilis J O'Reilly
- School of Public Health University College Cork Cork Ireland.,Department of Nutrition Harvard T.H. Chan School of Public Health Boston MA
| | - Peter M Barrett
- School of Public Health University College Cork Cork Ireland.,INFANT Research Centre University College Cork Ireland
| | | | - Lauren C Pawley
- Department of Anatomy and Neuroscience University College Cork Cork Ireland
| | - Fergus P McCarthy
- INFANT Research Centre University College Cork Ireland.,Department of Obstetrics and Gynaecology University College Cork Cork Ireland
| | - Ali S Khashan
- School of Public Health University College Cork Cork Ireland.,INFANT Research Centre University College Cork Ireland
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Abstract
OBJECTIVES To evaluate the recurrence risk of stillbirth. DESIGN Retrospective cohort study. SETTING AND POPULATION All births 1992-2017, Alberta, Canada. METHODS Retrospective cohort study. MAIN OUTCOME MEASURES Stillbirth was defined as the death in utero of a fetus with gestational age ≥20 weeks or weighing ≥500 g. Stillbirths were further subdivided into those occurring before labour and those in labour. RESULTS We identified 744 897 births from 308 478 women. Of these, 3698 women experienced a stillbirth and, of these, 97.7%, experienced only one. For women with a small-for-gestational- age stillbirth in the first birth, their risk of a subsequent antepartum stillbirth was increased substantially: 4.09%, relative risk (RR) 10.39, 95% CI 5.81-18.59. For women with a first birth appropriate-for-gestational-age stillbirth with no risk factors such as pregnancy induced hypertension, the risk with pre-existing diabetes mellitus or hypertension was also increased but to a much lesser degree (RR 2.46, 95% CI 1.23-4.91). For women who had experienced a first birth intrapartum stillbirth, the risk of another intrapartum stillbirth was very high (3.59%, RR 36.50, 95% CI 20.17-66.05). Most of these births also occurred prior to 24 weeks' gestation: 83% (10/12). CONCLUSIONS The risk of recurrent antepartum stillbirth is low. The increase in risk in instances where the antepartum stillbirth was not growth-restricted is not clinically meaningful. Given the very low risk in any given gestational week, fetal surveillance is unlikely to be effective and may lead to unnecessary interventions. Intrapartum stillbirth has a very high recurrence risk but may not be preventable. TWEETABLE ABSTRACT Stillbirth recurrence is rare.
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Affiliation(s)
- S L Wood
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB, Canada
| | - S Tang
- Department of Obstetrics and Gynecology, Foothills Medical Centre, Alberta Health Services, Calgary, AB, Canada
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Ornoy A, Becker M, Weinstein-Fudim L, Ergaz Z. Diabetes during Pregnancy: A Maternal Disease Complicating the Course of Pregnancy with Long-Term Deleterious Effects on the Offspring. A Clinical Review. Int J Mol Sci 2021; 22:2965. [PMID: 33803995 PMCID: PMC7999044 DOI: 10.3390/ijms22062965] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 02/28/2021] [Accepted: 03/11/2021] [Indexed: 12/12/2022] Open
Abstract
In spite of the huge progress in the treatment of diabetes mellitus, we are still in the situation that both pregestational (PGDM) and gestational diabetes (GDM) impose an additional risk to the embryo, fetus, and course of pregnancy. PGDM may increase the rate of congenital malformations, especially cardiac, nervous system, musculoskeletal system, and limbs. PGDM may interfere with fetal growth, often causing macrosomia, but in the presence of severe maternal complications, especially nephropathy, it may inhibit fetal growth. PGDM may also induce a variety of perinatal complications such as stillbirth and perinatal death, cardiomyopathy, respiratory morbidity, and perinatal asphyxia. GDM that generally develops in the second half of pregnancy induces similar but generally less severe complications. Their severity is higher with earlier onset of GDM and inversely correlated with the degree of glycemic control. Early initiation of GDM might even cause some increase in the rate of congenital malformations. Both PGDM and GDM may cause various motor and behavioral neurodevelopmental problems, including an increased incidence of attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). Most complications are reduced in incidence and severity with the improvement in diabetic control. Mechanisms of diabetic-induced damage in pregnancy are related to maternal and fetal hyperglycemia, enhanced oxidative stress, epigenetic changes, and other, less defined, pathogenic mechanisms.
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Affiliation(s)
- Asher Ornoy
- Adelson School of Medicine, Ariel University, Ariel 40700, Israel;
- Laboratory of Teratology, Department of Medical Neurobiology, Hebrew University Hadassah Medical School, Jerusalem 91120, Israel; (L.W.-F.); (Z.E.)
| | - Maria Becker
- Adelson School of Medicine, Ariel University, Ariel 40700, Israel;
| | - Liza Weinstein-Fudim
- Laboratory of Teratology, Department of Medical Neurobiology, Hebrew University Hadassah Medical School, Jerusalem 91120, Israel; (L.W.-F.); (Z.E.)
| | - Zivanit Ergaz
- Laboratory of Teratology, Department of Medical Neurobiology, Hebrew University Hadassah Medical School, Jerusalem 91120, Israel; (L.W.-F.); (Z.E.)
- Medical Center, Hadassah Hebrew University, Mount Scopus, Jerusalem 91240, Israel
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Abstract
OBJECTIVE To characterize stillbirths associated with pregestational diabetes and gestational diabetes mellitus (GDM) in a large, prospective, U.S. case-control study. METHODS A secondary analysis of stillbirths among patients enrolled in a prospective; multisite; geographically, racially, and ethnically diverse case-control study in the United States was performed. Singleton gestations with complete information regarding diabetes status and with a complete postmortem evaluation were included. A standard evaluation protocol for stillbirth cases included postmortem evaluation, placental pathology, clinical testing as performed at the discretion of the health care professional, and a recommended panel of tests. A potential cause of death was assigned to stillbirth cases using a standardized classification tool. Demographic and delivery characteristics among women with pregestational diabetes and GDM were compared with characteristics of women with no diabetes in pairwise comparisons using χ or two-sample t tests as appropriate. Sensitivity analysis was performed excluding pregnancies with genetic conditions or major fetal malformations. RESULTS Of 455 stillbirth cases included in the primary analysis, women with stillbirth and diabetes were more likely to be older than 35 years and have a higher body mass index. They were also more likely to have a gestational hypertensive disorder than women without diabetes (28% vs 9.1%; P<.001). Women with pregestational diabetes had more large-for-gestational-age (LGA) neonates (26% vs 3.4%; P<.001). Stillbirths occurred more often at term in women with pregestational diabetes (36%) and those with GDM (52%). Maternal medical complications, including pregestational diabetes and others, were more often identified as a probable or possible cause of death among stillbirths with maternal diabetes (43% vs 4%, P<.001) as compared with stillbirths without diabetes. CONCLUSION Compared with stillbirths in women with no diabetes, stillbirths among women with pregestational diabetes and GDM occur later in pregnancy and are associated with hypertensive disorders of pregnancy, maternal medical complications, and LGA.
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Abstract
Background: The recommended gestational age to deliver pregnancies complicated by diabetes ranges from 34 to 39 weeks of gestation. The objective of this study was to determine the optimal gestational age for delivery of patients with diabetes to minimize perinatal death. Methods: We extracted a population-based cohort of singleton, nonanomalous infants of diabetic pregnancies from the Missouri birth registry for the period January 1, 1989 to December 31, 2005 and compared perinatal outcomes of planned deliveries at 37, 38, 39, and 40 weeks to expectant management. Planned deliveries were identified by induction or cesarean delivery without documented medical or obstetric indications. The primary outcome was perinatal death, defined as stillbirth or neonatal death within 28 days of birth. Secondary outcomes were independent stillbirth, independent neonatal death, and a composite adverse neonatal event of assisted ventilation >30 minutes, birth injury, seizures, or 5-minute Apgar score ≤3. Groups were compared using t test and chi-square as appropriate. Results: In 4,905 diabetic pregnancies reaching 37 weeks, 1,012 (20.6%) patients were insulin dependent. Overall, the risk of perinatal death at any gestational age examined was low (3/1,000 births or lower), as was the risk of the adverse perinatal outcome (<2%). When only patients who were insulin dependent were included in the analysis, the risk of perinatal death at any gestational age remained low at 6 per 1,000 births or fewer. Conclusion: Delivery as early as 37 weeks is reasonable for women who have diabetes, although the absolute risk of perinatal death is low at 37 to 39 weeks.
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Avagliano L, Monari F, Po’ G, Salerno C, Mascherpa M, Maiorana A, Facchinetti F, Bulfamante GP. The Burden of Placental Histopathology in Stillbirths Associated With Maternal Obesity. Am J Clin Pathol 2020; 154:225-235. [PMID: 32338725 DOI: 10.1093/ajcp/aqaa035] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Obesity is an increasing health problem that has become a common medical disorder among women of childbearing age, representing worldwide a risk factor for stillbirth. The aim of the study is to evaluate the association between placental histopathologic findings and obesity in stillbirth. METHODS Placentas were analyzed according to the Amsterdam consensus statement. Histologic findings in stillbirth from obese and lean mothers were analyzed and compared with those observed in liveborn controls. RESULTS Stillbirth in obese mothers displayed placental pathology in all gestational ages, mostly at term of pregnancy. The most observed placental lesions were those consistent with maternal vascular malperfusion of the placental bed. Decidual arteriopathy and placental infarcts appeared specifically associated with maternal obesity. Moreover, obese women with stillbirth showed the highest cumulative number of placental lesions. CONCLUSIONS Considering the significant association between stillbirth, maternal obesity, and placental histopathologic findings, health care providers should be aware about the importance of placental examination in obese women, especially in stillborn cases. The high prevalence of lesions consistent with vascular malperfusion of the placental bed suggests that stillbirth prevention strategies in obese women should rely on the development of tools to study and improve decidual artery functioning early in pregnancy.
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Affiliation(s)
- Laura Avagliano
- Department of Health Sciences, San Paolo Hospital Medical School, University of Milan, Milan, Italy
| | - Francesca Monari
- Obstetrics and Gynecology Unit, Mother-Infant and Adult Department of Medical and Surgical Sciences, Modena, Italy
| | - Gaia Po’
- Obstetrics and Gynecology Unit, Mother-Infant and Adult Department of Medical and Surgical Sciences, Modena, Italy
| | - Cristina Salerno
- Obstetrics and Gynecology Unit, Mother-Infant and Adult Department of Medical and Surgical Sciences, Modena, Italy
| | - Margaret Mascherpa
- Department of Health Sciences, San Paolo Hospital Medical School, University of Milan, Milan, Italy
| | - Antonino Maiorana
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabio Facchinetti
- Obstetrics and Gynecology Unit, Mother-Infant and Adult Department of Medical and Surgical Sciences, Modena, Italy
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Khalili N, Heidarzadeh M, Habibelahi A, Tayefi B, Ramezani M, Rampisheh Z, Tehrani-Banihashemi A, Mirbaha F, Raji F, Babaee E, Taghizadeh Asl R, Moradi-Lakeh M, Naghavi M, Mokdad AH. Stillbirth in Iran and associated factors (2014-2016): A population-based study. Med J Islam Repub Iran 2020; 34:38. [PMID: 32617277 PMCID: PMC7320973 DOI: 10.34171/mjiri.34.38] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Indexed: 12/02/2022] Open
Abstract
Background: Under Every Newborn Action Plan (ENAP), stillbirth rate in every country should be reduced by 12 or fewer per 1000 total births by 2030. The aims of this study were to determine stillbirth rate at national and subnational levels and to investigate its associated risk factors in Iran. Methods: Using all data from Iranian Maternal and Neonatal Network (IMaN), we calculated stillbirth rate of Iran from 2014-2016. This network registers information of almost all births across the country. The logistic regression was used to estimate the adjusted odds ratio (aOR) with 95% confidence intervals (CIs) for stillbirth. Results: In 2014, still birth rate was 7.40 per 1000 births. In 2015 and 2016, stillbirth rates were 7.22 per 1000 births and 7.63 per 1000 births, respectively. The most important related factors of stillbirth were preterm birth (aOR= 62.53, 95% CI; 60.77-64.34), sexual ambiguity (aOR= 14.51, 95% CI; 12.76-16.50), and post term birth (aOR= 3.31, 95% CI; 2.66-4.13). Conclusion: Under Every Newborn Action Plan (ENAP), stillbirth rate in every country should be reduced by 12 or fewer per 1000 total births by 2030. Iran has achieved stillbirth target of ENAP at national level. It is important for the health care system to establish and improve specific and focused policies, interventions, and programs for achieving this target even in the most deprived areas.
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Affiliation(s)
- Narjes Khalili
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Department of Community and Family Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | | | - Abbas Habibelahi
- Neonatal Health Office, Ministry of Health and Medical Education, Tehran, Iran
| | - Batool Tayefi
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Department of Community and Family Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mozhdeh Ramezani
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Department of Community and Family Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Rampisheh
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Department of Community and Family Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Arash Tehrani-Banihashemi
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Department of Community and Family Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Fariba Mirbaha
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Department of Community and Family Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Farima Raji
- Neonatal Health Office, Ministry of Health and Medical Education, Tehran, Iran
| | - Ebrahim Babaee
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Department of Community and Family Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Rahim Taghizadeh Asl
- Maastricht University, CAPHRI, Department of Health Promotion, Maastricht, Netherlands
| | - Maziar Moradi-Lakeh
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Department of Community and Family Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
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Gibbins KJ, Pinar H, Reddy UM, Saade GR, Goldenberg RL, Dudley DJ, Drews-Botsch C, Freedman AA, Daniels LM, Parker CB, Thorsten V, Bukowski R, Silver RM. Findings in Stillbirths Associated with Placental Disease. Am J Perinatol 2020; 37:708-715. [PMID: 31087311 PMCID: PMC6854286 DOI: 10.1055/s-0039-1688472] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Placental disease is a leading cause of stillbirth. Our purpose was to characterize stillbirths associated with placental disease. STUDY DESIGN The Stillbirth Collaborative Research Network conducted a prospective, case-control study of stillbirths and live births from 2006 to 2008. This analysis includes 512 stillbirths with cause of death assignment and a comparison group of live births. We compared exposures between women with stillbirth due to placental disease and those due to other causes as well as between women with term (≥ 37 weeks) stillbirth due to placental disease and term live births. RESULTS A total of 121 (23.6%) out of 512 stillbirths had a probable or possible cause of death due to placental disease by Initial Causes of Fetal Death. Characteristics were similar between stillbirths due to placental disease and other stillbirths. When comparing term live births to stillbirths due to placental disease, women with non-Hispanic black race, Hispanic ethnicity, lack of insurance, or who were born outside of the United States had higher odds of stillbirth due to placental disease. Nulliparity and antenatal bleeding also increased risk of stillbirth due to placental disease. CONCLUSION Multiple discrete exposures were associated with stillbirth caused by placental disease. The relationship between these factors and utility of surveillance warrants further study.
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Affiliation(s)
| | - Halit Pinar
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Uma M. Reddy
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
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Eckert LO, Jones CE, Kachikis A, Bardají A, Silva FTD, Absalon J, Rouse CE, Khalil A, Cutland CL, Kochhar S, Munoz FM. Obstetrics risk Assessment: Evaluation of selection criteria for vaccine research studies in pregnant women. Vaccine 2020; 38:4542-4547. [PMID: 32448618 PMCID: PMC7211583 DOI: 10.1016/j.vaccine.2020.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 04/18/2020] [Accepted: 05/06/2020] [Indexed: 10/31/2022]
Abstract
Vaccines designed for use in pregnancy and vaccine trials specifically involving pregnant women are rapidly expanding. One of the key challenges in designing maternal immunization trials is that developing exclusion criteria requires understanding and quantifying the background risk for adverse pregnancy outcomes in the pregnancy being studied, which can occur independent of any intervention and be unrelated to vaccine administration. The Global Alignment of Immunization Safety Assessment in Pregnancy (GAIA) project has developed and published case definitions and guidelines for data collection, analysis, and evaluation of maternal immunization safety in trials involving pregnant women. Complementing this work, we sought to understand how to best assess obstetric risk of adverse outcomes and differentiate it from the assessment of vaccine safety. Quantification of obstetric risk is based on prior and current obstetric, and maternal medical history. We developed a step-wise approach to evaluate and quantify obstetric and maternal risk factors in pregnancy based on review of published literature and guidelines, and critically assessed these factors in the context of designing inclusion and exclusion criteria for maternal vaccine studies. We anticipate this risk assessment evaluation may assist clinical trialists with study design decisions, including selection of exclusion criteria for vaccine trials involving pregnant women, consideration of sub-group classification, such as high or low risk subjects, or schedule considerations, such as preferred trimester of gestation for an intervention during pregnancy. Additionally, this tool may be utilized in data stratification at time of study analyses.
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Affiliation(s)
- Linda O Eckert
- Department of Obstetrics and Gynecology University of Washington, School of Medicine Seattle, WA; Department of Global Health, University of Washington School of Medicine, Seattle, WA.
| | - Christine E Jones
- Faculty of Medicine and Institute for Life Sciences, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Alisa Kachikis
- Department of Obstetrics and Gynecology University of Washington, School of Medicine Seattle, WA
| | - Azucena Bardají
- ISGlobal, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | | | - Caroline E Rouse
- Department of Obstetrics & Gynecology, Indiana University, Indianapolis, IN
| | - Asma Khalil
- Department of Obstetrics & Gynecology, St. George's Hospital, University of London, London, UK
| | - Clare L Cutland
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, African Leadership Iin Vaccinology Expertise, Faculty of Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sonali Kochhar
- Department of Global Health, University of Washington School of Medicine, Seattle, WA; Global Healthcare Consulting, India; Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Flor M Munoz
- Department of Pediatrics and Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, United States.
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Risk of Stillbirth in Women with Gestational Diabetes and High Blood Pressure. IRANIAN JOURNAL OF PUBLIC HEALTH 2020; 49:773-781. [PMID: 32548058 PMCID: PMC7283174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Both Gestational diabetes and hypertension almost affect 10.5% of the pregnancies. This study was conducted to investigate and compare the pregnancy outcomes in women with gestational diabetes or high blood pressure with outcomes belonging to healthy mothers. METHODS This population-based case-control study was conducted in 8 provinces and two cities of Iran on women referred to the public health centers during 2015 to 2018. Descriptive statistics for variables presented by percentages and frequencies and logistic regression analysis was used to analyze data at a significance level of less than 0.05. RESULTS Some variables such as ethnicity, maternal education and age, gestational diabetes, high blood pressure and previous pregnancy outcome were significantly associated with stillbirth. Maternal age greater than 35 yr (OR=1.78, CI: 1.29-2.48), maternal illiteracy (OR=3.67, CI: 2.25-5.98), a previous stillbirth (OR=9.92, CI: 4.98-19.78), gestational diabetes among women who had never had a screening test (OR =3.91, CI: 2.96-5.18) and high blood pressure (OR =1.95, CI: 1.38-2.77) were important factors associated with stillbirth. Maternal and paternal occupation, paternal education and age, place of residence, smoking and maternal BMI were significantly associated with stillbirth. CONCLUSION Gestational diabetes, hypertension, a previous miscarriage, stillbirth, first pregnancy, low education level, advanced maternal age and ethnicity were associated with an increased risk of stillbirth. It is necessary to provide high-quality healthcare services before and during pregnancy particularly for those at heightened risk and improve knowledge of mothers on the side effects of each of the mentioned risk factors in order to control these factors more effectively and thus reducing the risk of stillbirth.
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43
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A maternal serum metabolite ratio predicts fetal growth restriction at term. Nat Med 2020; 26:348-353. [PMID: 32161413 DOI: 10.1038/s41591-020-0804-9] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 01/30/2020] [Indexed: 11/08/2022]
Abstract
Fetal growth restriction (FGR) is the major single cause of stillbirth1 and is also associated with neonatal morbidity and mortality2,3, impaired health and educational achievement in childhood4,5 and with a range of diseases in later life6. Effective screening and intervention for FGR is an unmet clinical need. Here, we performed ultrahigh performance liquid chromatography-tandem mass spectroscopy (UPLC-MS/MS) metabolomics on maternal serum at 12, 20 and 28 weeks of gestational age (wkGA) using 175 cases of term FGR and 299 controls from the Pregnancy Outcome Prediction (POP) study, conducted in Cambridge, UK, to identify predictive metabolites. Internal validation using 36 wkGA samples demonstrated that a ratio of the products of the relative concentrations of two positively associated metabolites (1-(1-enyl-stearoyl)-2-oleoyl-GPC (P-18:0/18:1) and 1,5-anhydroglucitol) to the product of the relative concentrations of two negatively associated metabolites (5α-androstan-3α,17α-diol disulfate and N1,N12-diacetylspermine) predicted FGR at term. The ratio had approximately double the discrimination as compared to a previously developed angiogenic biomarker7, the soluble fms-like tyrosine kinase 1:placental growth factor (sFLT1:PlGF) ratio (AUC 0.78 versus 0.64, P = 0.0001). We validated the predictive performance of the metabolite ratio in two sub-samples of a demographically dissimilar cohort, Born in Bradford (BiB), conducted in Bradford, UK (P = 0.0002). Screening and intervention using this metabolite ratio in conjunction with ultrasonic imaging at around 36 wkGA could plausibly prevent adverse events through enhanced fetal monitoring and targeted induction of labor.
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Obstetric Care Consensus #10: Management of Stillbirth: (Replaces Practice Bulletin Number 102, March 2009). Am J Obstet Gynecol 2020; 222:B2-B20. [PMID: 32004519 DOI: 10.1016/j.ajog.2020.01.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Stillbirth is one of the most common adverse pregnancy outcomes, occurring in 1 in 160 deliveries in the United States. In developed countries, the most prevalent risk factors associated with stillbirth are non-Hispanic black race, nulliparity, advanced maternal age, obesity, preexisting diabetes, chronic hypertension, smoking, alcohol use, having a pregnancy using assisted reproductive technology, multiple gestation, male fetal sex, unmarried status, and past obstetric history. Although some of these factors may be modifiable (such as smoking), many are not. The study of specific causes of stillbirth has been hampered by the lack of uniform protocols to evaluate and classify stillbirths and by decreasing autopsy rates. In any specific case, it may be difficult to assign a definite cause to a stillbirth. A significant proportion of stillbirths remains unexplained, even after a thorough evaluation. Evaluation of a stillbirth should include fetal autopsy; gross and histologic examination of the placenta, umbilical cord, and membranes; and genetic evaluation. The method and timing of delivery after a stillbirth depend on the gestational age at which the death occurred, maternal obstetric history (eg, previous hysterotomy), and maternal preference. Health care providers should weigh the risks and benefits of each strategy in a given clinical scenario and consider available institutional expertise. Patient support should include emotional support and clear communication of test results. Referral to a bereavement counselor, peer support group, or mental health professional may be advisable for management of grief and depression.
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Abstract
Stillbirth is one of the most common adverse pregnancy outcomes, occurring in 1 in 160 deliveries in the United States. In developed countries, the most prevalent risk factors associated with stillbirth are non-Hispanic black race, nulliparity, advanced maternal age, obesity, preexisting diabetes, chronic hypertension, smoking, alcohol use, having a pregnancy using assisted reproductive technology, multiple gestation, male fetal sex, unmarried status, and past obstetric history. Although some of these factors may be modifiable (such as smoking), many are not. The study of specific causes of stillbirth has been hampered by the lack of uniform protocols to evaluate and classify stillbirths and by decreasing autopsy rates. In any specific case, it may be difficult to assign a definite cause to a stillbirth. A significant proportion of stillbirths remains unexplained even after a thorough evaluation. Evaluation of a stillbirth should include fetal autopsy; gross and histologic examination of the placenta, umbilical cord, and membranes; and genetic evaluation. The method and timing of delivery after a stillbirth depend on the gestational age at which the death occurred, maternal obstetric history (eg, previous hysterotomy), and maternal preference. Health care providers should weigh the risks and benefits of each strategy in a given clinical scenario and consider available institutional expertise. Patient support should include emotional support and clear communication of test results. Referral to a bereavement counselor, peer support group, or mental health professional may be advisable for management of grief and depression.
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Song M, Liu C, Hu R, Wang F, Huo Z. Administration effects of single-dose GnRH agonist for luteal support in females undertaking IVF/ICSI cycles: A meta-analysis of randomized controlled trials. Exp Ther Med 2019; 19:786-796. [PMID: 31885714 DOI: 10.3892/etm.2019.8251] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 09/13/2019] [Indexed: 11/06/2022] Open
Abstract
The aim of the present meta-analysis was to evaluate the effects of the addition of single-dose gonadotropin-releasing hormone agonist (GnRHa) for luteal support on pregnancy outcomes in females partaking in in vitro fertilization or intracytoplasmic sperm injection cycles. In total, the studies were hand-searched from six electronic databases to compare the pregnancy outcomes between single-dose GnRHa administered as luteal phase support (GnRHa group) and regular luteal support (control group). In the GnRHa group, single-dose GnRH agonist were administered at 5/6 days after IVF/ICSI procedures. In the control group, single-dose GnRH agonist was not added during luteal phase support. Only randomized controlled trials were included. Sensitivity analysis was performed using Revman 5.3 software; the high heterogeneity identified in the present analysis was primarily caused by one study included. Following exclusion of this particular study, the meta-analysis results indicated significantly higher rates of ongoing pregnancy or live birth per transfer (P=0.002), clinical pregnancy per transfer (CPR; P=0.001) and multiple pregnancy per pregnancy (P=0.020) in the GnRHa group compared with those in the control group. Meta-analysis of a subgroup of trials with long-acting GnRH-a ovarian treatment protocols indicated that the rate of ongoing pregnancy or live birth (P=0.080), CPR (P=0.090) and multiple pregnancy per pregnancy (P=0.140) were not significantly different between the two groups. However, the results from trials that had used a multi-dose GnRH antagonist ovarian treatment protocol indicated a significantly higher ongoing pregnancy or live birth rate per transfer (P=0.010), CPR per transfer (P<0.0001) and multiple pregnancy rate per pregnancy (P=0.003) compared with those in the control group. The present results suggested that administration of single-dose GnRH agonist in the luteal phase may be an ideal choice for patients undergoing IVF/ICSI therapy.
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Affiliation(s)
- Mengling Song
- Department of Reproductive Medicine, General Hospital of Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region 750004, P.R. China.,Key Laboratory of Fertility Preservation and Maintenance of Ministry of Education, Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region 750004, P.R. China
| | - Chunlian Liu
- Department of Reproductive Medicine, General Hospital of Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region 750004, P.R. China.,Key Laboratory of Fertility Preservation and Maintenance of Ministry of Education, Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region 750004, P.R. China
| | - Rong Hu
- Department of Reproductive Medicine, General Hospital of Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region 750004, P.R. China.,Key Laboratory of Fertility Preservation and Maintenance of Ministry of Education, Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region 750004, P.R. China
| | - Feimiao Wang
- Department of Reproductive Medicine, General Hospital of Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region 750004, P.R. China.,Key Laboratory of Fertility Preservation and Maintenance of Ministry of Education, Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region 750004, P.R. China
| | - Zhenghao Huo
- Key Laboratory of Fertility Preservation and Maintenance of Ministry of Education, Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region 750004, P.R. China
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Raimondi S, Mascherpa M, Ravaldi C, Vannacci A, Marconi AM, Bulfamante GP, Avagliano L. How many roads lead to stillbirth rate reduction? A 30-year analysis of risk factors in a Northern Italy University care center. J Matern Fetal Neonatal Med 2019. [DOI: 10.1080/14767058.2019.1622675 [online ahead of print]] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Affiliation(s)
- S. Raimondi
- Molecular and Pharmaco-Epidemiology Unit, Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
- CiaoLapo, Charity for Healthy Pregnancy, Stillbirth and Perinatal Loss Support, Prato, Italy
| | - M. Mascherpa
- Department of Health Sciences, San Paolo Hospital Medical School, University of Milan, Milan, Italy
| | - C. Ravaldi
- CiaoLapo, Charity for Healthy Pregnancy, Stillbirth and Perinatal Loss Support, Prato, Italy
- Department of Health Sciences, University of Florence, Florence, Italy
| | - A. Vannacci
- CiaoLapo, Charity for Healthy Pregnancy, Stillbirth and Perinatal Loss Support, Prato, Italy
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - A. M. Marconi
- Department of Health Sciences, San Paolo Hospital Medical School, University of Milan, Milan, Italy
| | - G. P. Bulfamante
- Department of Health Sciences, San Paolo Hospital Medical School, University of Milan, Milan, Italy
| | - L. Avagliano
- Department of Health Sciences, San Paolo Hospital Medical School, University of Milan, Milan, Italy
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48
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Raimondi S, Mascherpa M, Ravaldi C, Vannacci A, Marconi AM, Bulfamante GP, Avagliano L. How many roads lead to stillbirth rate reduction? A 30-year analysis of risk factors in a Northern Italy University care center. J Matern Fetal Neonatal Med 2019; 34:952-959. [PMID: 31113267 DOI: 10.1080/14767058.2019.1622675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Stillbirths affect more than 2.5 million pregnancies worldwide every year and the progress in reducing stillbirth rates is slower than that required by World Health Organization. The aim of the present study was to investigate which factors were associated with stillbirths in a University Hospital in the North of Italy, over a time span of 30 years. The goal was to identify which factors are potentially modifiable to reduce stillbirth rate. METHODS Retrospective case-control study (358 stillbirths, 716 livebirths) subdivided into two study periods (1987-2006 and 2007-2017). RESULTS The prevalence of conception obtained by assisted reproductive technologies, pregnancy at advanced maternal age, and complications of pregnancy such as preeclampsia, fetal growth restriction (FGR), and other fetal diseases (abnormal fetal conditions including fetal anemia, fetal hydrops, TORCH infections) increased through the years of the study. Despite a rising prevalence, the last 10 years showed a significant reduction in stillbirths associated with preeclampsia and FGR. Similarly, the risk of stillbirth related to abnormal fetal conditions decreased in the second study period and a history of previous stillbirth becomes a nonsignificant risk factor. CONCLUSIONS Altogether these results suggest that in pregnancies perceived as "high risk" (i.e. previous stillbirth, preeclampsia, FGR, abnormal fetal conditions) appropriate care and follow-up can indeed lower stillbirth rates. In conclusion, the road to stillbirth prevention passes inevitably through awareness and recognition of risk factors.
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Affiliation(s)
- S Raimondi
- Molecular and Pharmaco-Epidemiology Unit, Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy.,CiaoLapo, Charity for Healthy Pregnancy, Stillbirth and Perinatal Loss Support, Prato, Italy
| | - M Mascherpa
- Department of Health Sciences, San Paolo Hospital Medical School, University of Milan, Milan, Italy
| | - C Ravaldi
- CiaoLapo, Charity for Healthy Pregnancy, Stillbirth and Perinatal Loss Support, Prato, Italy.,Department of Health Sciences, University of Florence, Florence, Italy
| | - A Vannacci
- CiaoLapo, Charity for Healthy Pregnancy, Stillbirth and Perinatal Loss Support, Prato, Italy.,Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - A M Marconi
- Department of Health Sciences, San Paolo Hospital Medical School, University of Milan, Milan, Italy
| | - G P Bulfamante
- Department of Health Sciences, San Paolo Hospital Medical School, University of Milan, Milan, Italy
| | - L Avagliano
- Department of Health Sciences, San Paolo Hospital Medical School, University of Milan, Milan, Italy
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Tasew H, Zemicheal M, Teklay G, Mariye T. Risk factors of stillbirth among mothers delivered in public hospitals of Central Zone, Tigray, Ethiopia. Afr Health Sci 2019; 19:1930-1937. [PMID: 31656476 PMCID: PMC6794504 DOI: 10.4314/ahs.v19i2.16] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Stillbirth is a death before the complete expulsion or extraction from the mother. The burden is severe and high in developing countries. Risk factors for stillbirth are not yet studied in Ethiopia. OBJECTIVE To identify risk factors of stillbirth among mothers delivered in public hospitals of Central Zone Tigray, Ethiopia. METHODS A case-control study design was used. Data collection period was from January to April 2018. Study subjects 63 cases and 252 controls were selected using systematic random sampling technique from respective hospitals. The interviewer-administered questionnaire, observational, and chart analysis were used to collect the data. A binary logistic regression model was employed. Results were presented at significance level P-value <0.05. RESULTS Maternal hypertension [AOR=12.83; 95% CI 3.38, 48.83], low birth weight [AOR=5.6; 95% CI 2.39, 13.38], pre-term [AOR=2.6;95%CI 1.12,6.16], alcohol intake [AOR=7.56; 95% CI 1.68, 34.04], polyhydramnios [AOR=13.43; 95% CI 3.63, 49.67], and meconium stained amniotic fluid [AOR=7.88; 95% CI 1.73, 8.18] were risk factors of stillbirth. CONCLUSION The risk of stillbirth is increased with increasing maternal complication like maternal hypertension, alcohol consumption, polyhydramnios, and meconium-stained amniotic fluid. The occurrence of preterm and low birth weight of the fetus had an effect on the risk of stillbirth.
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Affiliation(s)
- Hagos Tasew
- School of Nursing, College of Health Science and Comprehensive Specialized Hospital, Aksum University, Tigray, Ethiopia
| | - Micheal Zemicheal
- School of Medicine, College of Health Science and Comprehensive Specialized Hospital, Aksum University, Tigray, Ethiopia
| | - Girmay Teklay
- School of Nursing, College of Health Science and Comprehensive Specialized Hospital, Aksum University, Tigray, Ethiopia
| | - Teklewoini Mariye
- School of Nursing, College of Health Science and Comprehensive Specialized Hospital, Aksum University, Tigray, Ethiopia
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Abdi F, Alimoradi Z, Alidost F. Pregnancy outcomes and effects of antiretroviral drugs in HIV-positive pregnant women: a systematic review. Future Virol 2019. [DOI: 10.2217/fvl-2018-0213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aim: Despite the clear morbidity, mortality and vertical transmission rates in women infected with HIV, there is still controversy surrounding the relationship between maternal infection and adverse neonatal outcomes. Antiretroviral therapy during pregnancy is considered the main and most effective method for reducing the vertical transmission of infection. However, there is no consensus over potential associations between antiretroviral therapy and adverse pregnancy outcomes. This systematic review focuses on the effects of antiretroviral drugs on pregnancy outcomes in HIV-positive women. Methods: After searching MEDLINE, the Cochrane Database of Systematic Reviews, the ISI Web of Sciences and EMBASE, 570 potentially eligible papers were identified. Only 32 papers were selected based on the inclusion criteria. Results: The most prevalent adverse pregnancy outcomes were low birth weight, preterm birth and stillbirth. Conclusion: Considering the higher prevalence of adverse pregnancy outcomes in HIV-infected women, HIV screening methods should be administered in all pregnant women. Appropriate treatment modalities should also be selected to minimize adverse pregnancy outcomes.
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Affiliation(s)
- Fatemeh Abdi
- Student Research Committee, Nursing & Midwifery Faculty, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zainab Alimoradi
- Department of Midwifery, Nursing & Midwifery Faculty, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Farzane Alidost
- Department of Reproductive Health, Nursing & Midwifery Faculty, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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