1
|
Bailey HD, Gray C, Adane AA, Strobel NA, White SW, Marriott R, Tessema GA, Shepherd CCJ, Sharp M. Early mortality among aboriginal and non-aboriginal women who had a preterm birth in Western Australia: A population-based cohort study. Paediatr Perinat Epidemiol 2023; 37:31-44. [PMID: 36331146 PMCID: PMC10946802 DOI: 10.1111/ppe.12929] [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: 04/05/2022] [Revised: 09/19/2022] [Accepted: 09/21/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Having a preterm (<37 weeks' gestation) birth may increase a woman's risk of early mortality. Aboriginal and Torres Strait Islander (hereafter Aboriginal) women have higher preterm birth and mortality rates compared with other Australian women. OBJECTIVES We investigated whether a history of having a preterm birth was associated with early mortality in women and whether these associations differed by Aboriginal status. METHODS This retrospective cohort study used population-based perinatal records of women who had a singleton birth between 1980 and 2015 in Western Australia linked to Death Registry data until June 2018. The primary and secondary outcomes were all-cause and cause-specific mortality respectively. After stratification by Aboriginal status, rate differences were calculated, and Cox proportional hazard regression was used to estimate adjusted hazard ratios (HR) and 95% confidence intervals (CI) for all-cause and cause-specific mortality. RESULTS There were 20,244 Aboriginal mothers (1349 deaths) and 457,357 non-Aboriginal mothers (7646 deaths) with 8.6 million person-years of follow-up. The all-cause mortality rates for Aboriginal mothers who had preterm births and term births were 529.5 and 344.0 (rate difference 185.5, 95% CI 135.5, 238.5) per 100,000 person-years respectively. Among non-Aboriginal mothers, the corresponding figures were 125.5 and 88.6 (rate difference 37.0, 95% CI 29.4, 44.9) per 100,000 person-years. The HR for all-cause mortality for Aboriginal and non-Aboriginal mothers associated with preterm birth were 1.48 (95% CI 1.32, 1.66) and 1.35 (95% CI 1.26, 1.44), respectively, compared with term birth. Compared with mothers who had term births, mothers of preterm births had higher relative risks of mortality from diabetes, cardiovascular, digestive and external causes. CONCLUSIONS Both Aboriginal and non-Aboriginal women who had a preterm birth had a moderately increased risk of mortality up to 38 years after the birth, reinforcing the importance of primary prevention and ongoing screening.
Collapse
Affiliation(s)
- Helen D. Bailey
- Curtin Medical School, Faculty of Health SciencesCurtin UniversityPerthWestern AustraliaAustralia
- Telethon Kids InstituteThe University of Western AustraliaNedlandsWestern AustraliaAustralia
| | - Caitlin Gray
- Telethon Kids InstituteThe University of Western AustraliaNedlandsWestern AustraliaAustralia
| | - Akilew A. Adane
- Telethon Kids InstituteThe University of Western AustraliaNedlandsWestern AustraliaAustralia
- Ngangk Yira Research Institute for ChangeMurdoch UniversityMurdochWestern AustraliaAustralia
| | - Natalie A. Strobel
- Kurongkurl KatitjinEdith Cowan UniversityMount LawleyWestern AustraliaAustralia
| | - Scott W. White
- Division of Obstetrics and GynaecologyThe University of Western AustraliaNedlandsWestern AustraliaAustralia
- Maternal Fetal Medicine ServiceKing Edward Memorial HospitalSubiacoWestern AustraliaAustralia
| | - Rhonda Marriott
- Ngangk Yira Research Institute for ChangeMurdoch UniversityMurdochWestern AustraliaAustralia
| | - Gizachew A. Tessema
- Curtin School of Population Health, Faculty of Health SciencesCurtin UniversityPerthWestern AustraliaAustralia
| | - Carrington C. J. Shepherd
- Curtin Medical School, Faculty of Health SciencesCurtin UniversityPerthWestern AustraliaAustralia
- Telethon Kids InstituteThe University of Western AustraliaNedlandsWestern AustraliaAustralia
- Ngangk Yira Research Institute for ChangeMurdoch UniversityMurdochWestern AustraliaAustralia
| | - Mary Sharp
- Telethon Kids InstituteThe University of Western AustraliaNedlandsWestern AustraliaAustralia
- Department of NeonatologyKing Edward Memorial HospitalSubiacoWestern AustraliaAustralia
- Centre for Neonatal Research and EducationThe University of Western AustraliaNedlandsWestern AustraliaAustralia
- Department of NeonatologyPerth Children's HospitalNedlandsWestern AustraliaAustralia
| |
Collapse
|
2
|
Factors Associated with Increased Risk of Early Severe Neonatal Morbidity in Late Preterm and Early Term Infants. J Clin Med 2021; 10:jcm10061319. [PMID: 33806821 PMCID: PMC8004864 DOI: 10.3390/jcm10061319] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 12/28/2022] Open
Abstract
Although the risk of neonatal mortality is generally low for late preterm and early term infants, they are still significantly predisposed to severe neonatal morbidity (SNM) despite being born at relatively advanced gestations. In this study, we investigated maternal and intrapartum risk factors for early SNM in late preterm and early term infants. This was a retrospective cohort study of non-anomalous, singleton infants (34+0-38+6 gestational weeks) born at the Mater Mother's Hospital in Brisbane, Australia from January 2015 to May 2020. Early SNM was defined as a composite of any of the following severe neonatal outcome indicators: admission to neonatal intensive care unit (NICU) in conjunction with an Apgar score <4 at 5 min, severe respiratory distress, severe neonatal acidosis (cord pH < 7.0 or base excess <-12 mmol/L). Multivariable binomial logistic regression analyses using generalized estimating equations (GEE) were used to identify risk factors. Of the total infants born at 34+0-38+6 gestational weeks, 5.7% had at least one component of the composite outcome. For late preterm infants, pre-existing diabetes mellitus, instrumental birth and emergency caesarean birth for non-reassuring fetal status were associated with increased odds for early SNM, whilst for early term infants, pre-existing and gestational diabetes mellitus, antepartum hemorrhage, instrumental, emergency caesarean and elective caesarean birth were significant risk factors. In conclusion, we identified several risk factors contributing to early SNM in late preterm and early term cohort. Our results suggest that predicted probability of early SNM decreased as gestation increased.
Collapse
|
3
|
Burger RJ, Temmink JD, Wertaschnigg D, Ganzevoort W, Reddy M, Davey MA, Wallace EM, Mol BW. Trends in singleton preterm birth in Victoria, 2007 to 2017: A consecutive cross-sectional study. Acta Obstet Gynecol Scand 2021; 100:1230-1238. [PMID: 33382080 PMCID: PMC8359202 DOI: 10.1111/aogs.14074] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/16/2020] [Accepted: 12/23/2020] [Indexed: 01/01/2023]
Abstract
Introduction Preterm birth is a major cause of perinatal morbidity and mortality worldwide. In many countries preterm birth rates are increasing, largely as a result of increases in iatrogenic preterm birth, whereas in other countries rates are stable or even declining. The objective of the study is to describe trends in singleton preterm births in Victoria from 2007 to 2017 in relation to trends in perinatal mortality to identify opportunities for improvements in clinical care. Material and methods We conducted a consecutive cross‐sectional study in all women with a singleton pregnancy giving birth at ≥20 weeks of pregnancy in Victoria, Australia, between 2007 and 2017, inclusive. Rates of preterm birth and perinatal mortality were calculated and trends were analyzed in all pregnancies, in pregnancies complicated by fetal growth problems, hypertension, (pre)eclampsia or prelabor rupture of membranes (PROM), and in (low‐risk) pregnancies not complicated by any of these conditions. Results There were 811 534 singleton births between 2007 and 2017. Preterm birth increased from 5.9% (4074 births) to 6.4% (4893 births; P < .001), due to an increase in iatrogenic preterm birth from 2.5% (1730 births) to 3.6% (2730 births; P < .001). Comparable trends were seen in pregnancies complicated by fetal growth problems and hypertension and in pregnancies not complicated by small for gestational age (SGA), hypertension, (pre)eclampsia or PROM (all P < .001). In pregnancies complicated by SGA, hypertension, (pre)eclampsia or PROM the perinatal mortality rate from 20 weeks of gestation fell (13 to 12 per 1000 births; P < .001). In pregnancies not complicated by SGA, hypertension, (pre)eclampsia or PROM there was no significant change in the perinatal mortality from 28 weeks and no decrease in the preterm weekly prospective stillbirth risk. Conclusions The singleton preterm birth rate in Victoria is increasing, driven by an increase in iatrogenic preterm birth, both in pregnancies complicated by SGA and hypertension, and in pregnancies not complicated by SGA, hypertension, (pre)eclampsia or PROM. While perinatal mortality decreased in the pregnancies complicated by SGA, hypertension, (pre)eclampsia or PROM, no significant reduction in perinatal mortality from 28 weeks or in preterm weekly prospective stillbirth risk was noted in the pregnancies not complicated by any of these conditions.
Collapse
Affiliation(s)
- Renée J Burger
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia.,Reproduction and Development Research Institute, Department of Obstetrics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Josephina D Temmink
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia.,Reproduction and Development Research Institute, Department of Obstetrics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Dagmar Wertaschnigg
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia.,Department of Obstetrics and Gynecology, Paracelsus Medical University, Salzburg, Austria
| | - Wessel Ganzevoort
- Reproduction and Development Research Institute, Department of Obstetrics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Maya Reddy
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
| | - Mary-Ann Davey
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia.,Safer Care Victoria, Melbourne, VIC, Australia
| | - Euan M Wallace
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia.,Safer Care Victoria, Melbourne, VIC, Australia
| | - Ben-Willem Mol
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
| |
Collapse
|