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Yang X, Liu P, Yu W, Zhang Z. The mediating role of pregnancy-induced hypertension on pre-pregnancy body mass index and adverse neonatal outcomes in women with assisted reproductive technology. J Matern Fetal Neonatal Med 2023; 36:2289348. [PMID: 38057122 DOI: 10.1080/14767058.2023.2289348] [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: 09/12/2023] [Accepted: 11/25/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVE To explore whether pregnancy-induced hypertension (PIH) mediates the association between pre-pregnancy body mass index (BMI) and adverse neonatal outcomes in women undergoing assisted reproductive technology (ART) for singleton pregnancies. METHODS This cohort study collected 79437 maternal data from the National Vital Statistics System (NVSS) between 2020 and 2021. Univariable and multivariable logistic regression models were applied to estimate the association between pre-pregnancy BMI and PIH in women receiving ART as well as the associations between pre-pregnancy BMI and PIH and adverse neonatal outcomes. The mediation effect of PIH on the association between pre-pregnancy BMI and adverse neonatal outcomes was estimated according to the total effect, natural direct effect, natural indirect effect, and percentage of mediation. RESULTS There were 25769 participants had adverse neonatal outcomes at the end of the follow-up. After adjusting for confounding factors, an increased risk of PIH in women receiving ART was identified in those with pre-pregnancy BMI ≥25 kg/m2 [odds ratio (OR)=1.92, 95% confidence interval (CI):1.84-2.01]. Pre-pregnancy BMI ≥25 kg/m2 was associated with an increased risk of adverse neonatal outcomes (OR = 1.26, 95%CI:1.22-1.30). Women with PIH had an increased risk of adverse neonatal outcomes (OR = 1.79, 95%CI:1.71-1.87). The percentage mediated by PIH in the association between pre-pregnancy BMI and adverse neonatal outcomes was 21.30%. CONCLUSION PIH partially mediated the association between pre-pregnancy BMI and adverse neonatal outcomes in women receiving ART, which recommends that women control weight before receiving ART.
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Affiliation(s)
- Xue Yang
- Department of Gynaecology and Obstetrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Pengyu Liu
- Medical unit, Troops 65739 PLA, Dandong, China
| | - Wenqian Yu
- Department of Gynaecology and Obstetrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zhitao Zhang
- Department of Gynaecology and Obstetrics, Shengjing Hospital of China Medical University, Shenyang, China
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Davies-Tuck ML, Davey MA, Hodges RL, Wallace EM. Fetal surveillance from 39 weeks' gestation to reduce stillbirth in South Asian-born women. Am J Obstet Gynecol 2023; 229:286.e1-286.e9. [PMID: 36907532 DOI: 10.1016/j.ajog.2023.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 02/23/2023] [Accepted: 02/28/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND In July 2017, the State of Victoria's largest maternity service implemented a new clinical guideline to reduce the rates of stillbirth at term for South Asian women. OBJECTIVE This study aimed to evaluate the impact of offering fetal surveillance from 39 weeks to South Asian-born women on rates of stillbirth and neonatal and obstetrical interventions. STUDY DESIGN This was a cohort study of all women receiving antenatal care at 3 large metropolitan university-affiliated teaching hospitals in Victoria, who gave birth in the term period between January 2016 and December 2020. Differences in rates of stillbirth, neonatal deaths, perinatal morbidities, and interventions after July 2017 were determined. Multigroup interrupted time-series analysis was used to assess changes in rates of stillbirth and induction of labor. RESULTS A total of 3506 South Asian-born women gave birth before, and 8532 after the change in practice. There was a 64% reduction in term stillbirth (95% confidence interval, 87% to 2%; P=.047) after the change in practice from 2.3 per 1000 births to 0.8 per 1000 births. The rates of early neonatal death (3.1/1000 vs 1.3/1000; P=.03) and special care nursery admission (16.5% vs 11.1%; P<.001) also decreased. There were no significant differences in admission to the neonatal intensive care unit, 5-minute Apgar score <7, or birthweight, or differences in the trends of induction of labor per month. CONCLUSION Fetal monitoring from 39 weeks may offer an alternative to routine earlier induction of labor to reduce the rates of stillbirth without causing an increase in neonatal morbidity and attenuating trends in obstetrical interventions.
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Affiliation(s)
| | - Mary-Ann Davey
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| | - Ryan L Hodges
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia; Monash Health, Clayton, Australia
| | - Euan M Wallace
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia; Department of Health and Human Services, Melbourne, Australia
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South-Asian women's experiences of earlier additional, fetal monitoring to reduce stillbirth: An exploratory qualitative study. Women Birth 2023; 36:e213-e218. [PMID: 35902344 DOI: 10.1016/j.wombi.2022.06.013] [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: 03/31/2022] [Revised: 06/23/2022] [Accepted: 06/28/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND In an attempt to reduce the rates of stillbirth at term among South-Asian born women, Victoria's largest maternity service, Monash Health, implemented a new clinical guideline in 2017 that recommended additional earlier, twice weekly monitoring to assess fetal wellbeing from 39 weeks for South-Asian women. In acknowledging the importance of woman centred, culturally responsive care, this study aimed to understand South-Asian women's, experiences, of the additional earlier fetal monitoring. METHODS An exploratory qualitative study was conducted using semi-structured phone interviews six weeks postpartum, across June and July 2021, with South-Asian born women who underwent the earlier monitoring from 39 weeks. Women were asked questions regarding their understanding of the monitoring, their experiences of the monitoring process and any impact the monitoring or results had on their pregnancy, labour and birth. Interviews were recorded and transcribed verbatim. Data were analysed using a thematic approach and an inductive coding strategy. RESULTS Seventeen women from India, Sri Lanka, Pakistan and Afghanistan were interviewed. the main themes were i: gaining peace of mind, need for better communication, did the women really have a choice? and comparisons to maternity care in the country of origin. Women experienced positive reassurance of their baby's well-being from the monitoring and were happy with the earlier, extra care. However, women described receiving variable explanations of the purpose of the monitoring. Ineffective communication and logistical barriers were highlighted to negatively impact women's ability to engage in shared decision making and their overall experience of the earlier monitoring. CONCLUSIONS The additional monitoring is reported by these women to have an overall positive impact on their maternity care. Future work should explore the experiences of non-English speaking South-Asian women and those who declined monitoring.
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Ibrahimou B, Sun N, Burchfield S, Shrestha P, Veitzman F, Bursac Z, Salihu H, Dagne G, Gasana J, Guilarte TR. Race as a moderator of the association between ethnicity, preeclampsia and neonatal respiratory distress syndrome. World J Pediatr 2022; 18:568-573. [PMID: 35650375 PMCID: PMC10574812 DOI: 10.1007/s12519-022-00571-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/17/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Boubakari Ibrahimou
- Department of Biostatistics, Florida International University, Robert Stempel College of Public Health and Social Work, 11200 S.W. 8th Street, AHC5, Miami, FL, 33199, USA.
| | - Ning Sun
- Department of Biostatistics, Florida International University, Robert Stempel College of Public Health and Social Work, 11200 S.W. 8th Street, AHC5, Miami, FL, 33199, USA
| | - Shelbie Burchfield
- Department of Biostatistics, Florida International University, Robert Stempel College of Public Health and Social Work, 11200 S.W. 8th Street, AHC5, Miami, FL, 33199, USA
| | - Priyanka Shrestha
- Department of Biostatistics, Florida International University, Robert Stempel College of Public Health and Social Work, 11200 S.W. 8th Street, AHC5, Miami, FL, 33199, USA
| | - Fernanda Veitzman
- Department of Biostatistics, Florida International University, Robert Stempel College of Public Health and Social Work, 11200 S.W. 8th Street, AHC5, Miami, FL, 33199, USA
| | - Zoran Bursac
- Department of Biostatistics, Florida International University, Robert Stempel College of Public Health and Social Work, 11200 S.W. 8th Street, AHC5, Miami, FL, 33199, USA
| | - Hamisu Salihu
- Center of Excellence in Health Equity, Training and Research, Baylor College of Medicine, One Baylor Plaza MS: 411, Houston, TX, 77030, USA
| | - Getachew Dagne
- College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd, MDC 56, Tampa, FL, 33612, USA
| | - Janvier Gasana
- Faculty of Public Health, Department of Environmental and Occupational Health, Kuwait University, Block 7 Street 32013119, PO Box 24923, Safat, Hawally, Kuwait
| | - Tomas R Guilarte
- Department of Environmental Health Sciences, Florida International University, Robert Stempel College of Public Health and Social Work, 11200 S.W. 8th Street, AHC5, Miami, FL, 33199, USA
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Senanayake H, Mariani I, Valente EP, Piccoli M, Armocida B, Businelli C, Rishard M, Covi B, Lazzerini M. Outcomes of induction versus spontaneous onset of labour at 40 and 41 GW: findings from a prospective database, Sri Lanka. BMC Pregnancy Childbirth 2022; 22:518. [PMID: 35761191 PMCID: PMC9235207 DOI: 10.1186/s12884-022-04800-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/01/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives The World Health Organization recommends induction of labour (IOL) for low risk pregnancy from 41 + 0 gestational weeks (GW). Nevertheless, in Sri Lanka IOL at 40 GW is a common practice. This study compares maternal/newborn outcomes after IOL at 40 GW (IOL40) or 41 GW (IOL41) versus spontaneous onset of labour (SOL). Methods Data were extracted from the routine prospective individual patient database of the Soysa Teaching Hospital for Women, Colombo. IOL and SOL groups were compared using logistic regression. Results Of 13,670 deliveries, 2359 (17.4%) were singleton and low risk at 40 or 41 GW. Of these, 456 (19.3%) women underwent IOL40, 318 (13.5%) IOL41, and 1585 (67.2%) SOL. Both IOL40 and IOL41 were associated with an increased risk of any maternal/newborn negative outcomes (OR = 2.21, 95%CI = 1.75–2.77, p < 0.001 and OR = 1.91, 95%CI = 1.47–2.48, p < 0.001 respectively), maternal complications (OR = 2.18, 95%CI = 1.71–2.77, p < 0.001 and OR = 2.34, 95%CI = 1.78–3.07, p < 0.001 respectively) and caesarean section (OR = 2.75, 95%CI = 2.07–3.65, p < 0.001 and OR = 3.01, 95%CI = 2.21–4.12, p < 0.001 respectively). Results did not change in secondary and sensitivity analyses. Conclusions Both IOL groups were associated with higher risk of negative outcomes compared to SOL. Findings, potentially explained by selection bias, local IOL protocols and CS practices, are valuable for Sri Lanka, particularly given contradictory findings from other settings. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04800-1.
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Influence of Maternal Region of Birth on Placental Pathology of Babies Born Small. CHILDREN 2022; 9:children9030388. [PMID: 35327760 PMCID: PMC8947328 DOI: 10.3390/children9030388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 03/05/2022] [Accepted: 03/09/2022] [Indexed: 11/16/2022]
Abstract
Background: Placental pathology is a common antecedent factor in infants born small for gestational age. Maternal region of birth can influence rates of SGA. Aims: To determine the association of maternal region of birth on placental pathology in babies that are born small, comparing a South Asian born population with Australia and New Zealand born women. Materials and methods: A retrospective cohort study was conducted at Monash Health, the largest public health service in Victoria. Mother-baby pairs above 34 weeks’ gestation and birth weight less than 10th centile born in 2016 were included. Placental pathology reports and medical records were reviewed. Statistical analyses of placental and selected neonatal outcomes data were performed. Results: Three hundred and eleven small for gestational age babies were included in this study, of which 171 were born to South Asian mothers and 140 to Australian and New Zealand mothers. There were no significant differences in gestational age at birth between the groups (38.7 (1.6) vs. 38.3 (1.7) weeks, p = 0.06). Placental pathology (macroscopic and microscopic) data comparisons showed no significant differences between the two groups (81% major abnormality in both groups). This was despite South Asian small for gestational age babies being less likely to require admission to a special care nursery or neonatal intensive care unit (35 vs. 41%, p = 0.05), or have a major congenital abnormality (2.3 vs. 4.3%, p = 0.04). Conclusion: In this observational study, maternal region of birth did not have an influence on placental pathology of babies born small, despite some differences in neonatal outcomes.
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Young NE, Davies‐Tuck M, Malhotra A. Influence of maternal region of birth on neonatal outcomes of babies born small. Acta Paediatr 2021; 110:158-165. [PMID: 32460365 DOI: 10.1111/apa.15375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/14/2020] [Accepted: 05/20/2020] [Indexed: 11/28/2022]
Abstract
AIM To compare neonatal outcomes of small for gestational age (SGA) infants born to South Asian (SA)-born women and Australian/New Zealand (ANZ)-born women. METHODS Retrospective cohort study at a hospital network in Australia. Maternal and neonatal data were collected for infants born SGA between 2013 and 2017 to SA- or ANZ-born women. Rates of perinatal mortality and neonatal morbidities were analysed between groups. RESULTS A total of 1018 SA and 959 ANZ SGA infants were included. SA SGA babies were older (median [IQR] 39 [38-40] weeks) and heavier (2590 [2310-2780] grams) compared to ANZ SGA babies (38 [37-40] weeks and 2480 [2059-2740] grams; P < .001 for both). After adjustment for differences in demographics, SA SGA babies were 1.5 times more likely to develop hypothermia (CI: 1.16-1.88, P = .001), but 60% less likely to be born with a major congenital malformation (CI: 0.24-0.67, P = .001) and 36% less likely to need gavage feeding (CI: 0.43-0.93, P = .02) compared to ANZ SGA babies. CONCLUSION Small for gestational age babies of SA-born women have different neonatal outcomes as compared to those born to ANZ-born women. Further research into influence of maternal region of birth on placental function, organogenesis and body composition of SGA babies is warranted.
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Affiliation(s)
| | - Miranda Davies‐Tuck
- The Ritchie Centre Hudson Institute of Medical Research Melbourne Vic. Australia
| | - Atul Malhotra
- The Ritchie Centre Hudson Institute of Medical Research Melbourne Vic. Australia
- Monash Newborn Monash Children’s Hospital Melbourne Vic. Australia
- Department of Paediatrics Monash University Melbourne Vic. Australia
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Berman Y, Ibiebele I, Randall D, Torvaldsen S, Nippita TA, Bowen J, Baldwin HJ, Todd SM, Morris JM, Ford JB, Patterson JA. Rates of neonatal morbidity by maternal region of birth and gestational age in New South Wales, Australia 2003-2016. Acta Obstet Gynecol Scand 2020; 100:331-338. [PMID: 33007108 DOI: 10.1111/aogs.14012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 09/11/2020] [Accepted: 09/15/2020] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Research suggests that neonatal morbidity differs by maternal region of birth at different gestational ages. This study aimed to determine the overall and gestation-specific risk of neonatal morbidity by maternal region of birth, after adjustment for maternal, infant and birth characteristics, for women giving birth in New South Wales, Australia, from 2003 to 2016. MATERIAL AND METHODS The study utilized a retrospective cohort study design using linked births, hospital and deaths data. Modified Poisson regression was used to determine risk with 95% confidence intervals (95% CI) of neonatal morbidity by maternal region of birth, overall and at each gestational age, compared with Australian or New Zealand-born women giving birth at 39 weeks. RESULTS There were 1 074 930 live singleton births ≥32 weeks' gestation that met the study inclusion criteria, and 44 394 of these were classified as morbid, giving a neonatal morbidity rate of 4.13 per 100 live births. The gestational age-specific neonatal morbidity rate declined from 32 weeks' gestation, reaching a minimum at 39 weeks in all maternal regions of birth. The unadjusted neonatal morbidity rate was highest in South Asian-born women at most gestations. Adjusted rates of neonatal morbidity between 32 and 44 weeks were significantly lower for babies born to East (adjusted relative risk [aRR] 0.65, 95% CI 0.62-0.68), South-east (aRR 0.76, 95% CI 0.73-0.79) and West Asian-born (aRR 0.93, 95% CI 0.88-0.98) mothers, and higher for babies of Oceanian-born (aRR 1.11, 95% CI 1.04-1.18) mothers, compared with Australian or New Zealand-born mothers. Babies of African, Oceanian, South Asian and West Asian-born women had a lower adjusted risk of neonatal morbidity than Australian or New Zealand-born women until 37 or 38 weeks' gestation, and thereafter an equal or higher risk in the term and post-term periods. CONCLUSIONS Maternal region of birth is an independent risk factor for neonatal morbidity in New South Wales.
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Affiliation(s)
- Ye'elah Berman
- Women and Babies Research, The University of Sydney Northern Clinical School, St Leonards, NSW, Australia.,NSW Biostatistics Training Program, NSW Ministry of Health, Sydney, NSW, Australia
| | - Ibinabo Ibiebele
- Women and Babies Research, The University of Sydney Northern Clinical School, St Leonards, NSW, Australia.,Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Deborah Randall
- Women and Babies Research, The University of Sydney Northern Clinical School, St Leonards, NSW, Australia.,Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Siranda Torvaldsen
- Women and Babies Research, The University of Sydney Northern Clinical School, St Leonards, NSW, Australia.,Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia.,School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Tanya A Nippita
- Women and Babies Research, The University of Sydney Northern Clinical School, St Leonards, NSW, Australia.,Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia.,Department of Obstetrics and Gynecology, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia
| | - Jennifer Bowen
- Women and Babies Research, The University of Sydney Northern Clinical School, St Leonards, NSW, Australia.,Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia.,Department of Neonatology, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia
| | - Heather J Baldwin
- Women and Babies Research, The University of Sydney Northern Clinical School, St Leonards, NSW, Australia.,Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Stephanie M Todd
- Women and Babies Research, The University of Sydney Northern Clinical School, St Leonards, NSW, Australia.,NSW Biostatistics Training Program, NSW Ministry of Health, Sydney, NSW, Australia
| | - Jonathan M Morris
- Women and Babies Research, The University of Sydney Northern Clinical School, St Leonards, NSW, Australia.,Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia.,Department of Obstetrics and Gynecology, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia
| | - Jane B Ford
- Women and Babies Research, The University of Sydney Northern Clinical School, St Leonards, NSW, Australia.,Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Jillian A Patterson
- Women and Babies Research, The University of Sydney Northern Clinical School, St Leonards, NSW, Australia.,Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia
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