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Clark JA, Smith LK, Armstrong N. Midwives' and obstetricians' practice, perspectives and experiences in relation to altered fetal movement: A focused ethnographic study. Int J Nurs Stud 2024; 150:104643. [PMID: 38043485 DOI: 10.1016/j.ijnurstu.2023.104643] [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: 01/16/2023] [Revised: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Reducing avoidable stillbirth is a global priority. The stillbirth rate in England compares unfavourably to that of some other high-income countries. Poorly-managed episodes of altered fetal movement have been highlighted as a key contributor to avoidable stillbirth, and strategies introduced in England in 2016 to reduce perinatal mortality included recommendations for the management of reduced fetal movement. Despite a downward trend in stillbirth rates across the UK, the effects of policies promoting awareness of fetal movement remain uncertain. OBJECTIVE To provide in-depth knowledge of how practice and clinical guidance relating to altered fetal movement are perceived, enacted and experienced by midwives and obstetricians, and explore the relationship between recommended fetal movement care and actual fetal movement care. DESIGN A focused ethnographic approach comprising over 180 h of observation, 15 interviews, and document analysis was used to explore practice at two contrasting UK maternity units. SETTINGS Antenatal services at two UK maternity units, one in the Midlands and one in the North of England. PARTICIPANTS Thirty-six midwives, obstetricians and sonographers and 40 pregnant women participated in the study across 52 observed care episodes and relevant unit activity. Twelve midwives and three obstetricians additionally participated in formal semi-structured interviews. METHODS Fieldnotes, interview transcripts, policy documents, maternity notes and clinical guidelines were analysed using a modified constant comparison method to identify important themes. RESULTS fetal movement practice was mostly consistent and in line with guideline recommendations. Notwithstanding, most midwives and obstetricians had concerns about this area of care, including challenges in diagnosis, conflicting evidence about activity, heightened maternal anxiety, and high rates of monitoring and intervention in otherwise low-risk pregnancies. To address these issues, midwives spent considerable time reassuring women through information and regular monitoring, and coaching them to perceive fetal movement more accurately. CONCLUSIONS Practice relating to altered fetal movement might be more uniform than in the past. However, a heightened focus on fetal movement is associated by some midwives and obstetricians with potential harms, including increased anxiety in pregnancy, and high rates of monitoring and intervention in pregnancies where there are no 'objective concerns'. Challenges in diagnosing a significant change in fetal movement with accuracy might mean that interventions and resources are not being directed towards those pregnancies most at risk. More research is needed to determine how healthcare professionals can engage in conversations about fetal movement and stillbirth to support safe outcomes and positive experiences in pregnancy and birth. REGISTRATION Not registered. TWEETABLE ABSTRACT Midwives and obstetricians take #reducedfetalmovement seriously but worry this 'unreliable' symptom increases anxiety, monitoring and intervention in many 'low risk' pregnancies.
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Affiliation(s)
- Julia A Clark
- Department of Population Health Sciences, University of Leicester, Leicester, UK; School of Health Science, The University of Nottingham, Nottingham, UK.
| | - Lucy K Smith
- Department of Population Health Sciences, University of Leicester, Leicester, UK.
| | - Natalie Armstrong
- Department of Population Health Sciences, University of Leicester, Leicester, UK
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Wolfova K, Miller EC. Impact of adverse pregnancy outcomes on brain vascular health and cognition. Res Pract Thromb Haemost 2024; 8:102331. [PMID: 38404945 PMCID: PMC10884518 DOI: 10.1016/j.rpth.2024.102331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/19/2023] [Accepted: 01/07/2024] [Indexed: 02/27/2024] Open
Abstract
A State of the Art lecture titled "Impact of Adverse Pregnancy Outcomes on Brain Vascular Health and Cognition" was presented at the International Society on Thrombosis and Haemostasis Congress in 2023. Adverse pregnancy outcomes, encompassing conditions such as gestational hypertension, eclampsia, preeclampsia, preterm birth, fetal growth restriction, stillbirth, and gestational diabetes, may form part of an underrecognized pathway from early adulthood reproductive health factors to later-life vascular cognitive impairment and dementia in women. Adverse pregnancy outcomes are caused by dysregulated vascular and metabolic adaptations during pregnancy, and these pathophysiological changes may persist after delivery. Adverse pregnancy outcomes may contribute to the increased risk of cognitive impairment and dementia directly through vascular and metabolic dysregulation and subsequent development of cardiovascular diseases, or other biological processes may be at play, such as shared maternal risk factors. Extensive epidemiologic evidence has shown that many cognitive impairment and dementia cases may be prevented or delayed by strategies targeting midlife cardiovascular health. Despite the recognized importance of adverse pregnancy outcomes for cardiovascular health, the literature on associated long-term health outcomes is limited. In this State of the Art review article, we summarize the current epidemiologic evidence on the relationship between adverse pregnancy outcomes and cognitive impairment and dementia and provide an overview of the potential pathophysiological mechanisms. Finally, we summarize relevant new data on this topic presented during the 2023 International Society on Thrombosis and Haemostasis Congress.
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Affiliation(s)
- Katrin Wolfova
- Department of Neurology, Columbia University, New York, New York, USA
- Department of Epidemiology, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Eliza C. Miller
- Department of Neurology, Columbia University, New York, New York, USA
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Norman M, Padkaer Petersen J, Stensvold HJ, Thorkelsson T, Helenius K, Brix Andersson C, Ørum Cueto H, Domellöf M, Gissler M, Heino A, Håkansson S, Jonsson B, Klingenberg C, Lehtonen L, Metsäranta M, Rønnestad AE, Trautner S. Preterm birth in the Nordic countries-Capacity, management and outcome in neonatal care. Acta Paediatr 2023. [PMID: 36912750 DOI: 10.1111/apa.16753] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/07/2023] [Accepted: 03/09/2023] [Indexed: 03/14/2023]
Abstract
AIM Organisation of care, perinatal and neonatal management of very preterm infants in the Nordic regions were hypothesised to vary significantly. The aim of this observational study was to test this hypothesis. METHODS Information on preterm infants in the 21 greater healthcare regions of Denmark, Finland, Iceland, Norway and Sweden was gathered from national registers in 2021. Preterm birth rates, case-mix, perinatal interventions, neonatal morbidity and survival to hospital discharge in very (<32 weeks) and extremely preterm infants (<28 weeks of gestational age) were compared. RESULTS Out of 287 642 infants born alive, 16 567 (5.8%) were preterm, 2389 (0.83%) very preterm and 800 (0.28%) were extremely preterm. In very preterm infants, exposure to antenatal corticosteroids varied from 85% to 98%, live births occurring at regional centres from 48% to 100%, surfactant treatment from 28% to 69% and use of mechanical ventilation varied from 13% to 77% (p < 0.05 for all comparisons). Significant regional variations within and between countries were also seen in capacity in neonatal care, case-mix and number of admissions, whereas there were no statistically significant differences in survival or major neonatal morbidities. CONCLUSION Management of very preterm infants exhibited significant regional variations in the Nordic countries.
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Affiliation(s)
- Mikael Norman
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Jesper Padkaer Petersen
- The Danish Clinical Quality Program - National Clinical Registries (RKKP), Aarhus, Denmark
- Department of Paediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Hans Jørgen Stensvold
- Department of Neonatal Intensive Care, Clinic of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Thordur Thorkelsson
- Department of Neonatal Medicine, Children's Hospital Iceland, Landspitali University Hospital, Reykjavík, Iceland
| | - Kjell Helenius
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland
- Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Charlotte Brix Andersson
- The Danish Clinical Quality Program - National Clinical Registries (RKKP), Aarhus, Denmark
- Department of Obstetrics and Gynaecology, Aalborg University Hospital, Thisted, Denmark
| | - Heidi Ørum Cueto
- The Danish Clinical Quality Program - National Clinical Registries (RKKP), Aarhus, Denmark
| | - Magnus Domellöf
- Department of Clinical Sciences, Paediatrics, Umeå University, Umeå, Sweden
| | - Mika Gissler
- Department of Knowledge Brokers, THL Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Anna Heino
- Department of Knowledge Brokers, THL Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Stellan Håkansson
- Department of Clinical Sciences, Paediatrics, Umeå University, Umeå, Sweden
| | - Baldvin Jonsson
- Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Claus Klingenberg
- Paediatric Research Group, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway
- Department of Paediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Liisa Lehtonen
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland
- Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Marjo Metsäranta
- Department of Paediatrics, New Children's Hospital, Paediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Arild E Rønnestad
- Department of Neonatal Intensive Care, Clinic of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
- Medical Faculty, Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Simon Trautner
- The Danish Clinical Quality Program - National Clinical Registries (RKKP), Aarhus, Denmark
- Department of Intensive Care of Newborns and Small Children, University Hospital of Copenhagen, Copenhagen, Denmark
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Brown HK, Chen S, Guttmann A, Havercamp SM, Parish S, Ray JG, Vigod SN, Tarasoff LA, Lunsky Y. Neonatal Outcomes of Mothers With a Disability. Pediatrics 2022; 150:e2021055318. [PMID: 35934737 PMCID: PMC9694113 DOI: 10.1542/peds.2021-055318] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/04/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To assess the risk of neonatal complications among women with a disability. METHODS This population-based cohort study comprised all hospital singleton livebirths in Ontario, Canada from 2003 to 2018. Newborns of women with a physical (N = 144 187), sensory (N = 44 988), intellectual or developmental (N = 2207), or ≥2 disabilities (N = 8823) were each compared with 1 593 354 newborns of women without a disability. Outcomes were preterm birth <37 and <34 weeks, small for gestational age birth weight (SGA), large for gestational age birth weight, neonatal morbidity, and mortality, neonatal abstinence syndrome (NAS), and NICU admission. Relative risks were adjusted for social, health, and health care characteristics. RESULTS Risks for neonatal complications were elevated among newborns of women with disabilities compared with those without disabilities. Adjusted relative risks were especially high for newborns of women with an intellectual or developmental disability, including preterm birth <37 weeks (1.37, 95% confidence interval 1.19-1.58), SGA (1.37, 1.24-1.59), neonatal morbidity (1.42, 1.27-1.60), NAS (1.53, 1.12-2.08), and NICU admission (1.53, 1.40-1.67). The same was seen for newborns of women with ≥2 disabilities, including preterm birth <37 weeks (1.48, 1.39-1.59), SGA (1.13, 1.07-1.20), neonatal morbidity (1.28, 1.20-1.36), NAS (1.87, 1.57-2.23), and NICU admission (1.35, 1.29-1.42). CONCLUSIONS There is a mild to moderate elevated risk for complications among newborns of women with disabilities. These women may need adapted and enhanced preconception and prenatal care, and their newborns may require extra support after birth.
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Affiliation(s)
- Hilary K. Brown
- Department of Health & Society, University of Toronto Scarborough, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | | | - Astrid Guttmann
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Hospital for Sick Children, Toronto, Ontario, Canada
- Edwin HS Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Susan M. Havercamp
- Center for Psychiatry and Behavioral Health, Wexner Medical Center, Ohio State University, Columbus, Ohio, United States
| | - Susan Parish
- College of Health Professions, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Joel G. Ray
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Simone N. Vigod
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Lesley A. Tarasoff
- Department of Health & Society, University of Toronto Scarborough, Toronto, Ontario, Canada
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction & Mental Health, Toronto, Ontario, Canada
| | - Yona Lunsky
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction & Mental Health, Toronto, Ontario, Canada
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Pekkola M, Tikkanen M, Gissler M, Loukovaara M, Paavonen J, Stefanovic V. Delivery characteristics in pregnancies with stillbirth: a retrospective case-control study from a tertiary teaching hospital. J Perinat Med 2022; 50:814-821. [PMID: 33629576 DOI: 10.1515/jpm-2020-0573] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 02/08/2021] [Indexed: 01/24/2023]
Abstract
OBJECTIVES We compared delivery characteristics and outcome of women with stillbirth to those with live birth. METHODS This was a retrospective case-control study from Helsinki University Hospital, Finland. The study population comprised 214 antepartum singleton stillbirths during 2003-2015. Two age-adjusted controls giving live birth in the same year at the same institution were chosen for each case from the Finnish Medical Birth Register. Delivery characteristics and adverse pregnancy outcomes were compared between the cases and controls, adjusted for gestational age. RESULTS Labor induction was more common (86.0 vs. 22.0%, p<0.001, gestational age adjusted odds ratio [aOR] 35.25, 95% confidence interval [CI] 12.37-100.45) and cesarean sections less frequent (9.3 vs. 28.7%, p<0.001, aOR 0.21, 95% CI 0.10-0.47) among women with stillbirth. Duration of labor was significantly shorter among the cases (first stage 240.0 min [115.0-365.0 min] vs. 412.5 min [251.0-574.0 min], p<0.001; second stage 8.0 min [0.0-16.0 min] vs. 15.0 min [4.0-26.0 min], p<0.001). Placental abruption was more common in pregnancies with stillbirth (15.0 vs. 0.9%, p<0.001, aOR 8.52, 95% CI 2.51-28.94) and blood transfusion was needed more often (10.7 vs. 4.4%, p=0.002, aOR 6.5, 95% CI 2.10-20.13). The rates of serious maternal complications were low. CONCLUSIONS Most women with stillbirth delivered vaginally without obstetric complications. The duration of labor was shorter in pregnancies with stillbirth but the risk for postpartum interventions and bleeding complications was higher compared to those with live birth.
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Affiliation(s)
- Maria Pekkola
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Minna Tikkanen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mika Gissler
- THL, Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Neurobiology, Care Sciences, and Society, Karolinska Institute, Stockholm, Sweden
| | - Mikko Loukovaara
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jorma Paavonen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Vedran Stefanovic
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Olecká I, Dobiáš M, Lemrová A, Ivanová K, Fürst T, Krajsa J, Handlos P. Indeterminacy of the Diagnosis of Sudden Infant Death Syndrome Leading to Problems with the Validity of Data. Diagnostics (Basel) 2022; 12:diagnostics12071512. [PMID: 35885418 PMCID: PMC9319831 DOI: 10.3390/diagnostics12071512] [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: 05/16/2022] [Revised: 06/13/2022] [Accepted: 06/16/2022] [Indexed: 11/27/2022] Open
Abstract
The validity of infant mortality data is essential in assessing health care quality and in the setting of preventive measures. This study explores different diagnostic procedures used to determine the cause of death across forensic settings and thus the issue of the reduced validity of data. All records from three forensic medical departments that conducted autopsies on children aged 12 months or younger (n = 204) who died during the years 2007–2016 in Moravia were included. Differences in diagnostic procedures were found to be statistically significant. Each department works with a different set of risk factors and places different emphasis on different types of examination. The most significant differences could be observed in sudden infant death syndrome and suffocation diagnosis frequency. The validity of statistical data on the causes of infant mortality is thus significantly reduced. Therefore, the possibilities of public health and social policy interventions toward preventing sudden and unexpected infant death are extraordinarily complicated by this lack of data validity.
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Affiliation(s)
- Ivana Olecká
- Department of Christian Social Work, Sts Cyril and Methodius Faculty of Theology, Palacký University Olomouc, 779 00 Olomouc, Czech Republic;
| | - Martin Dobiáš
- Department of Forensic Medicine and Medical Law, Faculty of Medicine and Dentistry, Palacký University Olomouc, 779 00 Olomouc, Czech Republic
- Correspondence:
| | - Adéla Lemrová
- Department of Public Health, Faculty of Medicine and Dentistry, Palacký University Olomouc, 779 00 Olomouc, Czech Republic; (A.L.); (K.I.)
| | - Kateřina Ivanová
- Department of Public Health, Faculty of Medicine and Dentistry, Palacký University Olomouc, 779 00 Olomouc, Czech Republic; (A.L.); (K.I.)
| | - Tomáš Fürst
- Department of Mathematical Analysis and Applications of Mathematics, Faculty of Science, Palacký University Olomouc, 779 00 Olomouc, Czech Republic;
| | - Jan Krajsa
- Department of Forensic Medicine, Faculty of Medicine, Masaryk University & St. Anne’s University Hospital Brno, 602 00 Brno, Czech Republic;
| | - Petr Handlos
- Institute of Pathology, Faculty of Medicine, University of Ostrava & University Hospital in Ostrava, 701 03 Ostrava, Czech Republic;
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Clowse M, Fischer-Betz R, Nelson-Piercy C, Scheuerle AE, Stephan B, Dubinsky M, Kumke T, Kasliwal R, Lauwerys B, Förger F. Pharmacovigilance pregnancy data in a large population of patients with chronic inflammatory disease exposed to certolizumab pegol. Ther Adv Musculoskelet Dis 2022; 14:1759720X221087650. [PMID: 35464812 PMCID: PMC9023886 DOI: 10.1177/1759720x221087650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/15/2022] [Indexed: 12/29/2022] Open
Abstract
Introduction: Chronic inflammatory diseases (CIDs), including rheumatic diseases and other inflammatory conditions, often affect women of reproductive age. Tumor necrosis factor inhibitors (TNFi) are widely used to treat CID, but there is limited information on outcomes of TNFi-exposed pregnancies. We evaluated pregnancy outcomes from 1392 prospectively reported pregnancies exposed to certolizumab pegol (CZP), a PEGylated, Fc-free TNFi with no to minimal placental transfer. Methods: CZP-exposed pregnancies in patients with CID from the UCB Pharmacovigilance global safety database were reviewed from the start of CZP clinical development (July 2001) to 1 November 2020. To limit bias, the analysis focused on prospectively reported cases with known pregnancy outcomes. Results: In total, 1392 prospective pregnancies with maternal CZP exposure and known pregnancy outcomes (n = 1425) were reported; 1021 had at least first-trimester CZP exposure. Live birth was reported in 1259/1425 (88.4%) of all prospective outcomes. There were 150/1425 (10.5%) pregnancy losses before 20 weeks (miscarriage/induced abortion), 11/1425 (0.8%) stillbirths, and 5/1392 (0.4%) ectopic pregnancies. Congenital malformations were present in 30/1259 (2.4%) live-born infants, of which 26 (2.1%) were considered major according to the Metropolitan Atlanta Congenital Defects Program criteria. There was no pattern of congenital malformations. Discussion and conclusion: No signal for adverse pregnancy outcomes or congenital malformations was observed in CZP-exposed pregnancies. Although the limitations of data collected through this methodology (including underreporting, missing information, and absence of a comparator group) should be considered, these data provide reassurance for women with CID who require CZP treatment during pregnancy, and their treating physicians.
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Affiliation(s)
- Megan Clowse
- Division of Rheumatology, Duke University Medical Center, 3535, Durham, NC 27710, USA
| | - Rebecca Fischer-Betz
- Department for Rheumatology and Hiller Research Institute, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | | | - Angela E. Scheuerle
- Department of Pediatrics, Division of Genetics and Metabolism, UT Southwestern Medical Center, Dallas, TX, USA
| | - Brigitte Stephan
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Marla Dubinsky
- The Susan and Leonard Feinstein IBD Center, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | | | | | | | - Frauke Förger
- Department of Rheumatology and Immunology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
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Matthews RJ, Draper ES, Manktelow BN, Kurinczuk JJ, Fenton AC, Dunkley-Bent J, Gallimore I, Smith LK. Understanding ethnic inequalities in stillbirth rates: a UK population-based cohort study. BMJ Open 2022; 12:e057412. [PMID: 35264402 PMCID: PMC8968514 DOI: 10.1136/bmjopen-2021-057412] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To investigate inequalities in stillbirth rates by ethnicity to facilitate development of initiatives to target those at highest risk. DESIGN Population-based perinatal mortality surveillance linked to national birth and death registration (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK). SETTING UK. PARTICIPANTS 4 391 569 singleton births at ≥24+0 weeks gestation between 2014 and 2019. MAIN OUTCOME MEASURES Stillbirth rate difference per 1000 total births by ethnicity. RESULTS Adjusted absolute differences in stillbirth rates were higher for babies of black African (3.83, 95% CI 3.35 to 4.32), black Caribbean (3.60, 95% CI 2.65 to 4.55) and Pakistani (2.99, 95% CI 2.58 to 3.40) ethnicities compared with white ethnicities. Higher proportions of babies of Bangladeshi (42%), black African (39%), other black (39%) and black Caribbean (37%) ethnicities were from most deprived areas, which were associated with an additional risk of 1.50 stillbirths per 1000 births (95% CI 1.32 to 1.67). Exploring primary cause of death, higher stillbirth rates due to congenital anomalies were observed in babies of Pakistani, Bangladeshi and black African ethnicities (range 0.63-1.05 per 1000 births) and more placental causes in black ethnicities (range 1.97 to 2.24 per 1000 births). For the whole population, over 40% of stillbirths were of unknown cause; however, this was particularly high for babies of other Asian (60%), Bangladeshi (58%) and Indian (52%) ethnicities. CONCLUSIONS Stillbirth rates declined in the UK, but substantial excess risk of stillbirth persists among babies of black and Asian ethnicities. The combined disadvantage for black, Pakistani and Bangladeshi ethnicities who are more likely to live in most deprived areas is associated with considerably higher rates. Key causes of death were congenital anomalies and placental causes. Improved strategies for investigation of stillbirth causes are needed to reduce unexplained deaths so that interventions can be targeted to reduce stillbirths.
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Affiliation(s)
- Ruth J Matthews
- Department of Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Elizabeth S Draper
- Department of Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Bradley N Manktelow
- Department of Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Jennifer J Kurinczuk
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, Oxfordshire, UK
| | - Alan C Fenton
- Newcastle Neonatal Service, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | | | - Ian Gallimore
- Department of Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Lucy K Smith
- Department of Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK
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Gissler M, Durox M, Smith L, Blondel B, Broeders L, Hindori-Mohangoo A, Kearns K, Kolarova R, Loghi M, Rodin U, Szamotulska K, Velebil P, Weber G, Zurriaga O, Zeitlin J. Clarity and consistency in stillbirth reporting in Europe: why is it so hard to get this right? Eur J Public Health 2022; 32:200-206. [PMID: 35157046 PMCID: PMC8975542 DOI: 10.1093/eurpub/ckac001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Stillbirth is a major public health problem, but measurement remains a challenge even in high-income countries. We compared routine stillbirth statistics in Europe reported by Eurostat with data from the Euro-Peristat research network. Methods We used data on stillbirths in 2015 from both sources for 31 European countries. Stillbirth rates per 1000 total births were analyzed by gestational age (GA) and birthweight groups. Information on termination of pregnancy at ≥22 weeks’ GA was analyzed separately. Results Routinely collected stillbirth rates were higher than those reported by the research network. For stillbirths with a birthweight ≥500 g, the difference between the mean rates of the countries for Eurostat and Euro-Peristat data was 22% [4.4/1000, versus 3.5/1000, mean difference 0.9 with 95% confidence interval (CI) 0.8–1.0]. When using a birthweight threshold of 1000 g, this difference was smaller, 12% (2.9/1000, versus 2.5/1000, mean difference 0.4 with 95% CI 0.3–0.5), but substantial differences remained for individual countries. In Euro-Peristat, missing data on birthweight ranged from 0% to 29% (average 5.0%) and were higher than missing data for GA (0–23%, average 1.8%). Conclusions Routine stillbirth data for European countries in international databases are not comparable and should not be used for benchmarking or surveillance without careful verification with other sources. Recommendations for improvement include using a cut-off based on GA, excluding late terminations of pregnancy and linking multiple sources to improve the quality of national databases.
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Affiliation(s)
- Mika Gissler
- THL Finnish Institute for Health and Welfare, Helsinki, Finland and Karolinska Institute, Stockholm, Sweden
| | - Mélanie Durox
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), INSERM, INRA, Paris, F-75004, France
| | - Lucy Smith
- Department of Health Sciences, College of Life Sciences, University of Leicester, LE1 7RH, UK
| | - Béatrice Blondel
- THL Finnish Institute for Health and Welfare, Helsinki, Finland and Karolinska Institute, Stockholm, Sweden
| | - Lisa Broeders
- The Netherlands Perinatal Registry (Perined), Utrecht, The Netherlands
| | - Ashna Hindori-Mohangoo
- Foundation for Perinatal Interventions and Research in Suriname (PeriSur), Paramaribo, Suriname.,Tulane University, School of Public Health and Tropical Medicine, New Orleans, USA
| | - Karen Kearns
- National Finance Division, Healthcare Pricing Office, HSE, Dublin
| | | | - Marzia Loghi
- Directorate for Social Statistics and Welfare, Italian Statistical Institute (ISTAT), Rome, Italy
| | - Urelija Rodin
- Croatian Institute of Public Health, School of Public Health 'Andrija Štampar', School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Katarzyna Szamotulska
- Department of Epidemiology and Biostatistics, National Research Institute of Mother and Child, Warsaw, Poland
| | - Petr Velebil
- Institute for the Care of Mother and Child, Prague, Czech Republic
| | - Guy Weber
- Department of Epidemiology and Statistics, Directorate of Health, Luxembourg
| | - Oscar Zurriaga
- Public Health General Directorate, Valencia Regional Public Health Authority, Spain.,Public Health and Preventive Medicine Department, University of Valencia, Spain.,Centre for Network Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Jennifer Zeitlin
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), INSERM, INRA, Paris, F-75004, France
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10
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Al-shehri H, Dahmash DT, Rochow N, Alturki B, Alrajhi D, Alayed F, Alhazani F, Alsuhibany H, Naser AY. Hospital Admission Profile of Neonates for Conditions Originating in the Perinatal Period in England and Wales Between 1999‒2020: An Ecological Study. Int J Gen Med 2022. [DOI: 10.2147/ijgm.s354847] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
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11
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Lovers AAK, Ugwumadu A, Georgieva A. Cardiotocography and Clinical Risk Factors in Early Term Labor: A Retrospective Cohort Study Using Computerized Analysis With Oxford System. Front Pediatr 2022; 10:784439. [PMID: 35372157 PMCID: PMC8966702 DOI: 10.3389/fped.2022.784439] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/14/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The role of cardiotocography (CTG) in fetal risk assessment around the beginning of term labor is controversial. We used routinely collected clinical data in a large tertiary hospital to investigate whether infants with "severe compromise" at birth exhibited fetal heart rate abnormalities in their first-hour CTGs and/or other clinical risks, recorded as per routine care. MATERIALS AND METHODS Retrospective data from 27,927 parturitions (single UK tertiary site, 2001-2010) were analyzed. Cases were included if the pregnancy was singleton, ≥36 weeks' gestation, cephalic presentation, and if they had routine intrapartum CTG as per clinical care. Cases with congenital abnormalities, planned cesarean section (CS), or CS for reasons other than "presumed fetal compromise" were excluded. We analyzed first-hour intrapartum CTG recordings, using intrapartum Oxford System (OxSys) computer-based algorithms. To reflect the effect of routine clinical care, the data was stratified into three exclusive groups: infants delivered by CS for "presumed fetal compromise" within 2 h of starting the CTG (Emergency CS, n = 113); between 2 and 5 h of starting the CTG (Urgent CS, n = 203); and the rest of deliveries (Others, n = 27,611). First-hour CTG and clinical characteristics were compared between the groups, sub-divided to those with and without severe compromise: a composite outcome of stillbirth, neonatal death, neonatal seizures, encephalopathy, resuscitation followed by ≥48 h in neonatal intensive care unit. Two-sample t-test, X2 test, and Fisher's exact test were used for analysis. RESULTS Compared to babies without severe compromise, those with compromise had significantly higher proportion of cases with baseline fetal heart rate ≥150 bpm; non-reactive trace; reduced long-term and short-term variability; decelerative capacity; and no accelerations in the first-hour CTG across all groups. Prolonged decelerations(≥3 min) were also more common. Thick meconium and small for gestational age were consistently more common in compromised infants across all groups. There was more often thick meconium, maternal fever ≥38 C, sentinel events, and other clinical risk factors in the Emergency CS and Urgent CS compared to the Others group. CONCLUSION A proportion of infants born with severe compromise had significantly different first-hour CTG features and clinical risk factors.
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Affiliation(s)
- Aimée A K Lovers
- Nuffield Department of Women's and Reproductive Health, Big Data Institute, University of Oxford, Oxford, United Kingdom
| | - Austin Ugwumadu
- Department of Obstetrics and Gynaecology, St George's, University of London, London, United Kingdom
| | - Antoniya Georgieva
- Nuffield Department of Women's and Reproductive Health, Big Data Institute, University of Oxford, Oxford, United Kingdom
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12
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Economic crisis and stillbirth ratios: Evidence from Southern Europe. PLoS One 2021; 16:e0259623. [PMID: 34793519 PMCID: PMC8601575 DOI: 10.1371/journal.pone.0259623] [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: 10/25/2020] [Accepted: 10/23/2021] [Indexed: 11/19/2022] Open
Abstract
In this paper we assess the impact of the recent European recession on stillbirth indices over the course of the 2000s and 2010s; the analysis focuses on four Southern European countries (Greece, Italy, Spain, Portugal), which were seriously affected by the sovereign debt crisis from around 2008 to 2017. We use national vital statistics and established economic indicators for the period 2000-2017; stillbirth ratios (stillbirths per 1000 livebirths) are the chosen response variable. For the purpose of the study, we employ correlation analysis and fit regression models. The overall impact of economic indicators on the stillbirth indices is sizeable and statistically robust. We find that a healthy economy is associated with low and declining levels of stillbirth measures. In contrast, economic recession appears to have an adverse effect (Greece, Italy and Spain), or an unclear impact (Portugal), on the stillbirth outcome. This study provides evidence of the adverse effect of the European sovereign debt crisis and ensuing period of austerity on a scarcely explored aspect of health.
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13
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Vidiella-Martin J, Been JV, Van Doorslaer E, García-Gómez P, Van Ourti T. Association Between Income and Perinatal Mortality in the Netherlands Across Gestational Age. JAMA Netw Open 2021; 4:e2132124. [PMID: 34726746 PMCID: PMC8564582 DOI: 10.1001/jamanetworkopen.2021.32124] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/30/2021] [Indexed: 12/15/2022] Open
Abstract
Importance The association between household income and perinatal health outcomes has been understudied. Examining disparities in perinatal mortality within strata of gestational age and before and after adjusting for birth weight centile can reveal how the income gradient is associated with gestational age, birth weight, and perinatal mortality. Objectives To investigate the association between household income and perinatal mortality, separately by gestational age strata and time of death, and the potential role of birth weight centile in mediating this association. Design, Setting, and Participants This cross-sectional study used individually linked data of all registered births in the Netherlands with household-level income tax records. Singletons born between January 1, 2004, and December 31, 2016, at 24 weeks to 41 weeks 6 days of gestation with complete information on birth outcomes and maternal characteristics were studied. Data analysis was performed from March 1, 2018, to August 30, 2021. Exposures Household income rank (adjusted for household size). Main Outcomes and Measures Perinatal mortality, stillbirth (at ≥24 weeks of gestation), and early neonatal mortality (at ≤7 days after birth). Disparities were expressed as bottom-to-top ratios of projected mortality among newborns with the poorest 1% of households vs those with the richest 1% of households. Generalized additive models stratified by gestational age categories, adjusted for potential confounding by maternal age at birth, maternal ethnicity, parity, sex, and year of birth, were used. Birth weight centile was included as a potential mediator. Results Among 2 036 431 singletons in this study (1 043 999 [51.3%] males; 1 496 579 [73.5%] with mother of Dutch ethnicity), 121 010 (5.9%) were born before 37 weeks of gestation, and 8720 (4.3 deaths per 1000) died during the perinatal period. Higher household income was positively associated with higher rates of perinatal survival, with an unadjusted bottom-to-top ratio of 2.18 (95% CI, 1.87-2.56). The bottom-to-top ratio decreased to 1.30 (95% CI, 1.22-1.39) after adjustment for potential confounding factors and inclusion of birth weight centile as a possible mediator. The fully adjusted ratios were lower for stillbirths (1.27; 95% CI, 1.20-1.36) than for early neonatal deaths (1.35; 95% CI, 1.14-1.66). Inequalities in perinatal mortality were found for newborns at greater than 26 weeks of gestation but not between 24 and 26 weeks of gestation (fully adjusted bottom-to-top ratio, 0.89; 95% CI, 0.77-1.04). Conclusions and Relevance The results of this large nationally representative cross-sectional study suggest that a large part of the increased risk of perinatal mortality among low-income women is mediated via a lower birth weight centile. The absence of disparities at very low gestational ages suggests that income-related risk factors for perinatal mortality are less prominent at very low gestational ages. Further research should aim to understand which factors associated with preterm birth and lower birth weight can reduce inequalities in perinatal mortality.
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Affiliation(s)
- Joaquim Vidiella-Martin
- Erasmus School of Economics, Tinbergen Institute and Erasmus Centre for Health Economics Rotterdam, Rotterdam, the Netherlands
- Centre for Health Service Economics and Organisation, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Jasper V. Been
- Division of Neonatology, Department of Paediatrics, Erasmus MC Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, the Netherlands
- Division of Obstetrics and Fetal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, the Netherlands
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Eddy Van Doorslaer
- Erasmus School of Economics, Tinbergen Institute and Erasmus Centre for Health Economics Rotterdam, Rotterdam, the Netherlands
- Erasmus School of Health Policy and Management, Rotterdam, the Netherlands
| | - Pilar García-Gómez
- Erasmus School of Economics, Tinbergen Institute and Erasmus Centre for Health Economics Rotterdam, Rotterdam, the Netherlands
| | - Tom Van Ourti
- Erasmus School of Economics, Tinbergen Institute and Erasmus Centre for Health Economics Rotterdam, Rotterdam, the Netherlands
- Erasmus School of Health Policy and Management, Rotterdam, the Netherlands
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14
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Knudsen CK, Christesen AMS, Heuckendorff S, Fonager K, Johansen MN, Overgaard C. The risk of preterm birth in combinations of socioeconomic position and mental health conditions in different age groups: a Danish nationwide register-based cohort study. BMC Pregnancy Childbirth 2021; 21:696. [PMID: 34649508 PMCID: PMC8515728 DOI: 10.1186/s12884-021-04138-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 09/21/2021] [Indexed: 11/13/2022] Open
Abstract
Background Inequality in preterm birth is a world-wide challenge that has proved difficult for maternity care services to meet. Reducing the inequality requires identification of pregnant women at particularly high risk of preterm birth in order to target interventions. Therefore, the aim was to estimate the risk of preterm birth in women with different combinations of socioeconomic position, mental health conditions, and age. Methods In this nationwide register-based cohort study, we included all first-time mothers that gave birth to a singleton liveborn infant in Denmark between 2000 and 2016. The absolute and relative risk of preterm birth (< 37 weeks of gestation) was examined in different combinations of educational level (high, intermediate, and low) and mental health conditions (no, minor, and moderate/severe) in three age strata (≤23, 24–30, and ≥ 31 years). We estimated the relative risk using Poisson regression with a robust error variance. As additive interaction can help identify subgroups where limited resources can be of best use, we measured the attributable proportion to assess the risk that is due to interaction of the different exposures. Results Of the 415,523 included first-time mothers, 6.3% gave birth prematurely. The risk of preterm birth increased with decreasing educational level and increasing severity of mental health conditions in all age strata, but most in women aged ≥31 years. The highest absolute risk was 12.9% [95% CI: 11.2;14.8%] in women aged ≥31 years with low education and moderate/severe mental health conditions resulting in a relative risk of 2.23 [95% CI: 1.93–2.58] compared to the unexposed reference group in that age strata. We found positive additive interaction between low education and mental health conditions in women aged 24–30 and ≥ 31 years and between age ≥ 31 years and combinations of mental health conditions and educational levels. Conclusion The inequality in preterm birth increased with increasing age. To reduce inequality in preterm birth focused attention on women with higher age further combined with lower educational levels and mental health conditions is essential. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04138-0.
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Affiliation(s)
- Camilla Klinge Knudsen
- Department of Social Medicine, Aalborg University Hospital, Havrevangen 1, 9000, Aalborg, Denmark. .,Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
| | - Amanda Marie Somer Christesen
- Department of Social Medicine, Aalborg University Hospital, Havrevangen 1, 9000, Aalborg, Denmark.,Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Signe Heuckendorff
- Department of Social Medicine, Aalborg University Hospital, Havrevangen 1, 9000, Aalborg, Denmark.,Department of Clinical Medicine, Danish Center for Clinical Health Services Research (DACS), Aalborg University, Aalborg, Denmark
| | - Kirsten Fonager
- Department of Social Medicine, Aalborg University Hospital, Havrevangen 1, 9000, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Charlotte Overgaard
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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15
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El Jamaly H, Eslick GD, Weltman M. Systematic review with meta-analysis: autoimmune hepatitis in pregnancy. Scand J Gastroenterol 2021; 56:1194-1204. [PMID: 34396871 DOI: 10.1080/00365521.2021.1953127] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Maternal and fetal outcomes in pregnant patients with autoimmune hepatitis (AIH) has been largely unexplored. AIM This meta-analysis aims to determine the level of evidence associated with both maternal and fetal outcomes in patients with AIH. METHODS We conducted a comprehensive literature search. The studies included AIH patients who had at least one pregnancy with a previously known or index presentation diagnosis of AIH. We used a random-effects model using odds ratios (OR) with 95% confidence intervals (CI). RESULTS Fourteen studies with 1452 AIH patients and with a total of 1556 gestations were included. Analysis revealed statistically significant increased likelihood of diabetes mellitus in the AIH group (OR: 5.73, 95% CI: 2.73-12.02; p < .001, n = 2) compared to controls. Fetal outcomes that indicated a statistically significant association with AIH included premature birth (OR: 2.20, 95% CI:1.66-2.91; p < .001, n = 3), small for gestational age (SGA) births (OR: 2.48, 95% CI:1.37-4.51; p = .003, n = 2) and low birth weight (LBW) (OR: 3.04, 95% CI:1.85-5.01; p < .001, n = 1). AIH pregnancies were significantly less likely to have a full-term birth (OR: 0.32, 95% CI:0.21-0.49; p < .001, n = 2). CONCLUSIONS This meta-analysis provides the first pooled evidence that autoimmune hepatitis is associated with a substantial increase in maternal Pre-pregnancy and gestational diabetes mellitus, and that AIH females are more likely to have premature births, small for gestational age (SGA) births, and low birth weight (LBW) babies and a substantial decrease in full term birth compared to normal controls. This data is important for clinicians managing these patients before, during and after pregnancy.
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Affiliation(s)
- Hydar El Jamaly
- Department of Gastroenterology and Hepatology, Nepean Hospital, Penrith, Australia.,Nepean Clinical School, The University of Sydney, Penrith, Australia
| | - Guy D Eslick
- NHMRC Centre for Digestive Health, Hunter Medical Research Institute, The University of Newcastle, Newcastle, Australia
| | - Martin Weltman
- Department of Gastroenterology and Hepatology, Nepean Hospital, Penrith, Australia.,Nepean Clinical School, The University of Sydney, Penrith, Australia
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Murano Y, Shoji H, Ikeda N, Okawa N, Hayashi K, Kantake M, Morisaki N, Shimizu T, Gilmour S. Analysis of Factors Associated With Body Mass Index at Ages 18 and 36 Months Among Infants Born Extremely Preterm. JAMA Netw Open 2021; 4:e2128555. [PMID: 34648012 PMCID: PMC8517745 DOI: 10.1001/jamanetworkopen.2021.28555] [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] [Indexed: 12/04/2022] Open
Abstract
IMPORTANCE The development of neonatology has been associated with improved survival among infants born extremely preterm, and understanding their long-term outcomes is becoming increasingly important. However, there is little information on body mass index (BMI) among these children. OBJECTIVE To determine factors associated with BMI at ages 18 months and 36 months among infants born extremely preterm. DESIGN, SETTING, AND PARTICIPANTS This retrospective, multicenter cohort study was conducted using data from the Neonatal Research Network Japan database for 8838 infants born at gestational ages 23 to 28 weeks with data on BMI at 18 months and 36 months. Data were analyzed from April 2018 through June 2021. EXPOSURES BMI and BMI z score at ages 18 months and 36 months were regressed with gestational age, intrauterine growth restriction (IUGR) status, and complications during pregnancy and the neonatal period separately by presence of multiple pregnancy and sex. MAIN OUTCOMES AND MEASURES BMI and BMI z score at ages 18 months and 36 months. RESULTS Among 16 791 eligible infants born extremely preterm, 8838 infants were included in the analysis. There were 7089 infants born from single pregnancies (mean [SD] gestational age, 26.0 [1.6] weeks; 3769 [53.2%] boys; mean [SD] birth weight, 847 [228] g) and 1749 infants born from multiple pregnancies (mean [SD] gestational age, 26.3 [1.5] weeks; 903 [51.6%] boys; mean [SD] birth weight, 860 [217] g). In single pregnancies, every week of increased gestational age was associated with an increase in BMI of 0.21 (95% CI, 0.17-0.25) among boys and 0.20 (95% CI, 0.15-0.25) among girls at age 18 months and 0.21 (95% CI, 0.18-0.24) among boys and 0.21 (95% CI, 0.18-0.24) among girls at age 36 months. There was an interaction association between gestational age and IUGR among boys at age 36 months, with a decrease in the change associated with gestational age of 0.12 (95% CI, 0.05-0.19). Every week of increased gestational age in single pregnancies was associated with an increase in BMI z score of 0.14 (95% CI, 0.17-0.21) among boys and 0.17 (95% CI, 0.13-0.21) among girls at age 18 months and 0.19 (95% CI, 0.16-0.22) among boys and 0.17 (95% CI, 0.15-0.20) among girls at age 36 months. Among single pregnancies, IUGR was associated with a decrease in BMI among boys (0.59 [95% CI, 0.23-0.95]) and girls (0.75 [95% CI, 0.39-1.11]) and BMI z score among boys 0.85 [95% CI, 0.25-0.95)] and girls (0.67 [95% CI, 0.36-0.97] at age 18 months and BMI among boys (0.44 [95% CI, 0.17-0.18]) and girls (0.84 [95% CI, 0.55-1.12]) and BMI z score among boys (0.46 [95% CI, 0.21-0.71]) and girls (0.77 [95% CI, 0.53-1.01]) at age 36 months. In multiple pregnancies, IUGR was associated with a decrease in BMI z score at age 36 months among boys (0.26 [95% CI, 0.42-0.89]) and girls (0.29 [95% CI, 0.22-0.79]). In single pregnancies intraventricular hemorrhage (IVH) was associated with a decrease in BMI of 0.47 (95% CI, 0.21-0.73) among boys and 0.42 (95% CI, 0.13-0.71) among girls at age 18 months and 0.53 (95% CI, 0.32-0.74) among boys and 0.31 (95% CI, 0.07-0.54) among girls at age 36 months. IVH was associated with a decrease in BMI z score in single pregnancies of 0.63 (95% CI, 0.20-0.41) among boys and 0.35 (95% CI, 0.12-0.60) among girls at age 18 months and 0.53 (95% CI, 0.34-0.71) among boys and 0.30 (95% CI, 0.11-0.50) among girls at age 36 months. Similar associations were seen in multiple pregnancies. CONCLUSIONS AND RELEVANCE This study found that gestational age, the presence of IUGR and multiple pregnancy, and IVH complications were associated with infant BMI at ages 18 months and 36 months. These findings suggest that these complicating factors should be considered when setting growth targets and nutrition strategies for infants born extremely preterm.
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Affiliation(s)
- Yayoi Murano
- Department of Pediatrics, Juntendo University Faculty of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
- Graduate School of Public Health, St. Luke’s International University, Akashi-cho, Chuo-ku, Tokyo, Japan
| | - Hiromichi Shoji
- Department of Pediatrics, Juntendo University Faculty of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Naho Ikeda
- Department of Pediatrics, Juntendo University Faculty of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Natsuki Okawa
- Department of Pediatrics, Juntendo University Faculty of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Kuniyoshi Hayashi
- Graduate School of Public Health, St. Luke’s International University, Akashi-cho, Chuo-ku, Tokyo, Japan
| | - Masato Kantake
- Department of Pediatrics, Juntendo University Faculty of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Naho Morisaki
- Department of Social Medicine, National Center for Child Health and Development, Okura, Setagaya-ku, Tokyo, Japan
| | - Toshiaki Shimizu
- Department of Pediatrics, Juntendo University Faculty of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Stuart Gilmour
- Graduate School of Public Health, St. Luke’s International University, Akashi-cho, Chuo-ku, Tokyo, Japan
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17
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Hocquette A, Durox M, Wood R, Klungsøyr K, Szamotulska K, Berrut S, Rihs T, Kyprianou T, Sakkeus L, Lecomte A, Zile I, Alexander S, Klimont J, Barros H, Gatt M, Isakova J, Blondel B, Gissler M, Zeitlin J. International versus national growth charts for identifying small and large-for-gestational age newborns: A population-based study in 15 European countries. THE LANCET REGIONAL HEALTH. EUROPE 2021; 8:100167. [PMID: 34557855 PMCID: PMC8454535 DOI: 10.1016/j.lanepe.2021.100167] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND To inform the on-going debate about the use of universal prescriptive versus national intrauterine growth charts, we compared perinatal mortality for small and large-for-gestational-age (SGA/LGA) infants according to international and national charts in Europe. METHODS We classified singleton births from 33 to 42 weeks of gestation in 2010 and 2014 from 15 countries (N = 1,475,457) as SGA (birthweight <10th percentile) and LGA (>90th percentile) using the international Intergrowth-21st newborn standards and national charts based on the customised charts methodology. We computed sex-adjusted odds ratios (aOR) for stillbirth, neonatal and extended perinatal mortality by this classification using multilevel models. FINDINGS SGA and LGA prevalence using national charts were near 10% in all countries, but varied according to international charts with a north to south gradient (3.0% to 10.1% and 24.9% to 8.0%, respectively). Compared with appropriate for gestational age (AGA) infants by both charts, risk of perinatal mortality was increased for SGA by both charts (aOR[95% confidence interval (CI)]=6.1 [5.6-6.7]) and infants reclassified by international charts from SGA to AGA (2.7 [2.3-3.1]), but decreased for those reclassified from AGA to LGA (0.6 [0.4-0.7]). Results were similar for stillbirth and neonatal death. INTERPRETATION Using international instead of national charts in Europe could lead to growth restricted infants being reclassified as having normal growth, while infants with low risks of mortality could be reclassified as having excessive growth. FUNDING InfAct Joint Action, CHAFEA Grant n°801,553 and EU/EFPIA Innovative Medicines Initiative 2 Joint Undertaking ConcePTION grant n°821,520. AH received a PhD grant from EHESP.
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Affiliation(s)
- Alice Hocquette
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, F-75004 Paris, France
| | - Mélanie Durox
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, F-75004 Paris, France
| | - Rachael Wood
- Public Health Scotland, Edinburgh and University of Edinburgh, Edinburgh, Scotland
| | - Kari Klungsøyr
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway and Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Katarzyna Szamotulska
- Institute of Mother and Child, Department of Epidemiology and Biostatistics, Warsaw, Poland
| | - Sylvan Berrut
- Federal Statistical Office FSO, Neuchâtel, Switzerland
| | - Tonia Rihs
- Federal Statistical Office FSO, Neuchâtel, Switzerland
| | | | - Luule Sakkeus
- Estonian Institute for Population Studies, Tallinn University, Tallinn, Estonia
| | - Aline Lecomte
- Department of Population Health, Luxembourg Institute of Health, Luxembourg
| | - Irisa Zile
- The Centre for Disease Prevention and Control of Latvia, Riga, Latvia
| | - Sophie Alexander
- Université Libre de Bruxelles, School of Public Health, Perinatal Epidemiology and Reproductive health Unit, Brussels, Belgium
| | | | - Henrique Barros
- University of Porto Medical School, Department of Public Health, Forensic Sciences and Medical Education, Porto, Portugal
| | - Miriam Gatt
- Directorate for Health Information and Research, National Obstetric Information Systems (NOIS) Register, Tal-Pietà, Malta
| | - Jelena Isakova
- Institute of Hygiene, Health Information Centre, Health Statistics Department, Vilnius, Lithuania
| | - Béatrice Blondel
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, F-75004 Paris, France
| | - Mika Gissler
- THL Finnish Institute for Health and Welfare, Information Services Department, Helsinki and Karolinska Institute, Department of Neurobiology, Care Sciences and Society, Stockholm, Sweden
| | - Jennifer Zeitlin
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, F-75004 Paris, France
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18
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Oligbu G, Ahmed L, Ferraras-Antolin L, Ladhani S. Retrospective analysis of neonatal deaths secondary to infections in England and Wales, 2013-2015. Arch Dis Child Fetal Neonatal Ed 2021; 106:363-369. [PMID: 33239280 DOI: 10.1136/archdischild-2020-319093] [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: 03/02/2020] [Revised: 07/28/2020] [Accepted: 11/03/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To estimate the overall and infection-related neonatal mortality rate and the pathogens responsible using electronic death registrations. DESIGN Retrospective analysis of national electronic death registrations data. SETTING England and Wales. PATIENTS Neonates aged <28 days. MAIN OUTCOME MEASURES Overall and infection-related mortality rate per 1000 live births in term, preterm (28-36 weeks) and extremely preterm (<28 weeks) neonates; the contribution of infections and specific pathogens; comparison with mortality rates in 2003-2005. RESULTS The neonatal mortality rate during 2013-2015 (2.4/1000 live births; 5095 deaths) was 31% lower than in 2003-2005 (3.5/1000; 6700 deaths). Infection-related neonatal mortality rate in 2013-2015 (0.32/1000; n=669) was 20% lower compared with 2003-2015 (0.40/1000; n=768), respectively. Infections were responsible for 13.1% (669/5095) of neonatal deaths during 2013-2015 and 11.5% (768/6700) during 2003-2005. Of the infection-related deaths, 44.2% (296/669) were in term, 19.9% (133/669) preterm and 35.9% (240/669) extremely preterm neonates. Compared with term infants (0.15/1000 live births), infection-related mortality rate was 5.9-fold (95% CI 4.7 to 7.2) higher in preterm (0.90/1000) and 188-fold (95% CI 157 to 223) higher in extremely preterm infants (28.7/1000) during 2013-2015. A pathogen was recorded in 448 (67%) registrations: 400 (89.3%) were bacterial, 37 (8.3%) viral and 11 (2.4%) fungal. Group B streptococcus (GBS) was reported in 30.4% (49/161) of records that specified a bacterial infection and 7.3% (49/669) of infection-related deaths. CONCLUSIONS Overall and infection-related neonatal mortality rates have declined, but the contribution of infection and of specific pathogens has not changed. Further preventive measures, including antenatal GBS vaccine may be required to prevent the single most common cause of infection-related deaths in neonates.
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Affiliation(s)
- Godwin Oligbu
- Immunisation and Countermeasures Division, Public Health England, Colindale, London, UK.,Paediatric Infectious Diseases Research Group, St George's University of London, London, UK
| | - Leila Ahmed
- Paediatric Infectious Diseases Research Group, St George's University of London, London, UK
| | - Laura Ferraras-Antolin
- Paediatric Infectious Diseases Research Group, St George's University of London, London, UK
| | - Shamez Ladhani
- Immunisation and Countermeasures Division, Public Health England, Colindale, London, UK .,Paediatric Infectious Diseases Research Group, St George's University of London, London, UK
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Åmark H, Pilo C, Hulthén Varli I. Stillbirth in term and late term gestations in Stockholm during a 20-year period, incidence and causes. PLoS One 2021; 16:e0251965. [PMID: 34033674 PMCID: PMC8148351 DOI: 10.1371/journal.pone.0251965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 05/06/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction The incidence of stillbirth has decreased marginally or remained stable during the past decades in high income countries. A recent report has shown Stockholm to have a lower incidence of stillbirth at term than other parts of Sweden. The risk of antepartum stillbirth increases in late term and postterm pregnancies which is one of the factors contributing to the current discussion regarding the optimal time of induction of labor due to postterm pregnancy. Material and methods This is a cohort study based on the Stockholm Stillbirth Database which contains all cases of stillbirth from 1998-2018 in Stockholm County. All cases were reviewed systematically and the cause of death was evaluated according to the Stockholm Stillbirth Classification. Stillbirths diagnosed between gestational week (GW) 37+0 and 40+6 n = 605 were compared to stillbirths diagnosed from GW 41+0 and onwards n = 157, according to the cause of stillbirth and pregnancy and maternal characteristics. The aim was to evaluate the incidence of stillbirth over time and the incidence of stillbirth diagnosed from GW 41+0. Results In Stockholm County the overall incidence of stillbirth has decreased from 4.6/1000 births during the period 1998-2004 to 3.4/1000 births during the period 2014-2018, p-value <0.001. When comparing the same time periods, the incidence of stillbirth diagnosed from GW 41+0 and onwards has decreased from 0.5/1000 births to 0.15/1000 births, p-value <0.001. Among women still pregnant at GW 41+0 the incidence of stillbirth has decreased from 1.8/ 1000 to 0.5/ 1000. When comparing stillbirths diagnosed at GW 37+0-40+6 with stillbirths diagnosed from GW 41+0 and onwards infection was a more common cause of stillbirth in the latter group. Conclusion In Stockholm County there was a decreasing incidence of stillbirth overall and in stillbirths diagnosed from 41+0 weeks of gestation and onwards during the period 1998-2018. In stillbirths diagnosed from GW 41+0 and onwards infection was a more common cause of death compared to stillbirths diagnosed between GW 37+0 and 40+6.
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Affiliation(s)
- Hanna Åmark
- Department of Clinical Science and Education, Unit of Obstetrics and Gynecology, Karolinska Institute, Södersjukhuset, Stockholm, Sweden
- * E-mail:
| | - Christina Pilo
- Department of Obstetrics and Gynecology, Södertälje Hospital, Stockholm, Sweden
| | - Ingela Hulthén Varli
- Department of Women´s and Children´s Health, Karolinska Institutet, Stockholm, Sweden
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20
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Genowska A, Strukcinskiene B, Villerusa A, Konstantynowicz J. Converging or diverging trajectories of mortality under one year of age in the Baltic States: a comparison with the European Union. ACTA ACUST UNITED AC 2021; 79:76. [PMID: 33985577 PMCID: PMC8117592 DOI: 10.1186/s13690-021-00598-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 04/29/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Information about trends in perinatal and child health inequalities is scarce, especially in the Eastern Europe. We analyzed how mortality under 1 year of age has been changing in the Baltic States and the European Union (EU) over 25 years, and what associations occurred between changes in macroeconomic factors and mortality. METHODS Data on fetal, neonatal, infant mortality, and macroeconomic factors were extracted from WHO database. Joinpoint regression analysis was performed to analyze time trajectories of mortality over 1990-2014. We also investigated how the changes in health expenditures and Gross Domestic Product (GDP) contributed to the changes in mortality. RESULTS The reduction of fetal, neonatal and infant mortality in the Baltic countries led to convergence with the EU. In Estonia this process was the fastest, and then the rates tended to diverge. The strongest effect in reduction of neonatal mortality was related to the annual increase in health expenditure and GDP which had occurred in the same year, and a decrease in fetal mortality associated with an increase in health expenditure and GDP in the 4th and 5th year, respectively, following the initial change. CONCLUSIONS These findings outlined convergences and divergences in mortality under 1 year of age in the Baltic States compared with the patterns of the EU. Our data highlighted a need to define health policy directions aimed at the implementation of effective intervention modalities addressing reduction of risks in prenatal and early life.
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Affiliation(s)
- Agnieszka Genowska
- Department of Public Health, Medical University of Bialystok, Bialystok, Poland
| | | | - Anita Villerusa
- Department of Public Health and Epidemiology, Institute of Public Health, Rīga Stradinš University, Rīga, Latvia
| | - Jerzy Konstantynowicz
- Department of Pediatrics, Rheumatology, Immunology and Metabolic Bone Diseases, Medical University of Bialystok, University Children's Hospital, Bialystok, Poland.
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21
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Bailey HD, Kotecha SJ, Watkins WJ, Adane AA, Shepherd CCJ, Kotecha S. Comparison of stillbirth trends over two decades in Wales, United Kingdom and Western Australia: An international retrospective cohort study. Paediatr Perinat Epidemiol 2021; 35:302-314. [PMID: 33666946 DOI: 10.1111/ppe.12739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 10/15/2020] [Accepted: 10/18/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Stillbirth is a critical public health issue worldwide. While the rates in high-income countries are relatively low, there are persistent between-country disparities. OBJECTIVES To compare stillbirth rates and trends in Wales and the State of Western Australia (WA), Australia, and provide insights into any differences. METHODS In this international retrospective cohort study, we pooled population-based data collections of all births ≥24 weeks' gestation (excluding terminations for congenital anomalies) between 1993 and 2015, divided into six time periods. The stillbirth rate per 1000 births was estimated for each cohort in each time period. Multivariable Poisson regression analyses, adjusted for appropriateness of growth, socio-economic status, maternal age, and multiple birth, were performed to evaluate the interaction between cohort and time period. Relative risk (RR) and 95% confidence interval (CI) for each time period and cohort were calculated. RESULTS There were 767 731 births (3725 stillbirths) in Wales and 648 373 (2431 stillbirths) in WA. The overall stillbirth rate declined by 15.9% over the study period in Wales (from 5.3 in 1993-96 to 4.5 per 1000 births in 2013-15; Ptrend < .01) but by 40.4% in WA (from 4.9 to 2.9 per 1000 births in WA; Ptrend < .01). Using 1993-96 in WA as the reference group, the adjusted RRs for stillbirths at 37-38 weeks' gestation in the most recent study period (2013-15) were 0.85 (95% CI 0.64, 1.13) in Wales and 0.51 (95% CI 0.36, 0.73) in WA. CONCLUSIONS The stillbirth rates between Wales and WA have widened in the last two decades (especially among late-term births), although the absolute rates for both are distinctly higher than the best-performing nations. While the differences may be partly explained by timing of birth and maternal life style behaviours such as smoking, it is important to identify and ameliorate the associated risk factors to support a reduction in preventable stillbirths.
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Affiliation(s)
- Helen D Bailey
- Telethon Kids Institute, University of Western Australia, Nedlands, WA, Australia
| | - Sarah J Kotecha
- Department of Child Health, Cardiff University School of Medicine, Cardiff, UK
| | - William J Watkins
- Department of Child Health, Cardiff University School of Medicine, Cardiff, UK
| | - Akilew A Adane
- Telethon Kids Institute, University of Western Australia, Nedlands, WA, Australia
| | - Carrington C J Shepherd
- Telethon Kids Institute, University of Western Australia, Nedlands, WA, Australia.,Ngangk Yira Research Centre for Aboriginal Health and Social Equity, Murdoch University, Murdoch, WA, Australia
| | - Sailesh Kotecha
- Department of Child Health, Cardiff University School of Medicine, Cardiff, UK
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Brink LT, Nel DG, Hall DR, Odendaal HJ. The Intricate Interactions between Maternal Smoking and Drinking During Pregnancy and Birthweight Z-Scores of Preterm Births. JOURNAL OF WOMEN'S HEALTH CARE AND MANAGEMENT 2021; 2:10.47275/2692-0948-121. [PMID: 34723283 PMCID: PMC8553154 DOI: 10.47275/2692-0948-121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND The extent to which smoking and drinking in a local community is associated with nutrition and Z-scores of infants from spontaneous preterm deliveries, is uncertain. AIM To investigate associations of different levels of maternal smoking and drinking in spontaneous preterm birth with infant birthweight Z-scores. METHODS Information, including gestational age (determined by earliest ultrasound), maternal arm circumference (measured at enrolment), smoking-drinking data (obtained up to 4 occasions), birthweight data (obtained from medical records) and birthweight Z-scores (calculated from INTERGROWTH- 21st study), collected over a period of nine years was used to compare 407 spontaneous preterm births with 3 493 spontaneous term births Analyses of variance, correlations and multiple regression were performed in STATISTICA. RESULTS Women with spontaneous preterm birth, had significantly lower gravidity and smaller arm circumference when compared to women with spontaneous birth at term. Women with spontaneous preterm birth drank more and heavier during pregnancy, and more smoked. Gestational age at birth was significantly longer in heavy-smokers-heavy-drinkers compared to heavy-smokers-no-drinkers (7.1 days) and in no-smokers-heavy-drinkers when compared to no-smokers-no-drinkers (11.2 days). Birthweight was significantly lower in low-smokers-heavy-drinkers when compared to low-smokers-no-drinkers (240g) and in heavy-smokers-low-drinkers when compared to no-smokers-low-drinkers (273g). Birthweight Z-scores were significantly lower in low-smokers-heavy-drinkers when compared to low-smokers-low-drinkers and low-smokers-no-drinkers; and, also significantly lower in heavy-smokers-low-drinkers when compared to low-smokers-low-drinkers and no-smokers-low-drinkers. CONCLUSION Alcohol aggravates the detrimental effect of smoking on birthweight and birthweight Z-scores but seems to counteract the negative association of smoking with gestational age.
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Affiliation(s)
- Lucy T Brink
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - Daan G Nel
- Department of Statistics and Actuarial Science, Stellenbosch University, South Africa
| | - David R Hall
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - Hein J Odendaal
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
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Marques LJP, Silva ZPD, Alencar GP, Almeida MFD. [Contributions by the investigation of fetal deaths for improving the definition of underlying cause of death in the city of São Paulo, Brazil]. CAD SAUDE PUBLICA 2021; 37:e00079120. [PMID: 33729304 DOI: 10.1590/0102-311x00079120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 07/28/2020] [Indexed: 11/22/2022] Open
Abstract
This study aimed to analyze the time trend in stillbirth rate (SBR) and the contribution by investigation to improving the definition of underlying cause of stillbirth in the city of São Paulo, Brazil, according to the place where the death certificate was issued. An ecological approach was used to analyze the trend in SBR by weight stratum (< 2,500g and ≥ 2,500g) and total deaths in the city in 2007-2017. Prais-Winsten generalized linear regression was used. The study of cases analyzed the underlying causes of stillbirth from 2012 to 2014, before and after the investigation, time of conclusion of the investigation, and redefinition of the underlying cause of stillbirths by type of issuer. In deaths with < 2,500g, there was an upward trend in SBR of 1.5% per year and a reduction (-1.3% per year) in stillbirths ≥ 2,500g. Total deaths presented a stable trend. In 2012-2014, 90% of deaths with ≥ 2,500g were investigated. After investigation, the underlying cause of death was redefined in 15% of the deaths, and not otherwise specified stillbirth (P95) represented 25% of the causes of death. The highest proportion of changes in the underlying cause of death occurred in deaths for which the death certificate was issued by the death certification review service (17%), while in health services the proportion was 10.6%. In conclusion, the SBR in deaths with ≥ 2,500g showed a downward trend. There was a significant redefinition of underlying causes, especially in those attested by the death certification review service. However, the redefinition was insufficient to expand the proportion of causes of death that would allow a better understanding of the mortality conditions.
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24
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Stillbirth in Greece during the years of economic crisis: a population-based study. Eur J Pediatr 2020; 179:1157-1166. [PMID: 32062708 DOI: 10.1007/s00431-020-03588-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 01/16/2020] [Accepted: 01/17/2020] [Indexed: 10/25/2022]
Abstract
The recent economic crisis has been linked with declines in population health. Evidence on the impact of the crisis on stillbirth rates is scarce. The aim of this study was to assess trends of stillbirth rates in Greece during the pre-crisis (2004-2008) and crisis period (2009-2015) and explore risk factors. Nationwide data (n = 1,276,816 births; 5023 stillbirths) were used to assess rates and trends through Poisson and joinpoint regressions. Multivariable Poisson regressions by nationality were fitted. The overall annual stillbirth rate was 3.9/1000 births with higher rates among non-Greeks (5.0/1000) than Greeks (3.7/1000). Non-significant decreasing trends were noted for Greeks (- 0.5%, 95% confidence interval [CI] - 1.4, 0.4%) versus non-significant increasing trends in non-Greeks (1.4%, 95% CI - 0.5, 3.3%). After adjusting for possible confounders, the relative stillbirth risk (RR) increased during the crisis versus the pre-crisis period (RRGreeks 1.61, 95% CI 1.50, 1.74; RRnon-Greeks 1.92, 95% CI 1.64, 2.26). Multiplicity, birth order, birth size, maternal education, marital status, and parental age were risk factors.Conclusions: Bidirectional stillbirth trends were observed among Greeks and non-Greeks, whereas the RR increased by 2-fold during the crisis. Persisting disparities require tailored employment of preventive measures ensuring optimal quality of the child's and maternal health.What is Known:• Stillbirth rate is a key population health indicator reflecting economic development and health care services within a population.• The recent economic crisis has been linked with declines in population health.What is New:• Economic crisis, ethnic minorities, and several modifiable factors seem to be significant determinants of stillbirth risk.
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25
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Ravelli ACJ, Eskes M, van der Post JAM, Abu-Hanna A, de Groot CJM. Decreasing trend in preterm birth and perinatal mortality, do disparities also decline? BMC Public Health 2020; 20:783. [PMID: 32456627 PMCID: PMC7249399 DOI: 10.1186/s12889-020-08925-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 05/17/2020] [Indexed: 11/26/2022] Open
Abstract
Background In the Netherlands, several initiatives started after the publication of the PERISTAT findings that showed the perinatal mortality risk was higher than in other European countries. The objective of this study is 1) to report recent trends in perinatal mortality and in intermediate risk groups (preterm birth, congenital anomalies and small for gestational age (SGA)), 2) describing perinatal mortality risk among children born preterm, with congenital anomalies or SGA, and born in maternal high risk groups (parity, age, ethnicity and socio-economic status (SES)). Methods A nationwide cohort study in the Netherlands among 996,423 singleton births in 2010–2015 with a gestational age between 24.0 and 42.6 weeks. Trend tests, univariate and multivariable logistic regression analyses were used. We did separate analyses for gestational age subgroups and line of care. Results The perinatal mortality rate was 5.0 per 1000 and it decreased significantly from 5.6 in 2010 to 4.6 per 1000 in 2015. Preterm birth significantly declined (6.1% in 2010 to 5.6% in 2015). Analysis by gestational age groups showed that the largest decline in perinatal mortality of 32% was seen at 24–27 weeks of gestation where the risk declined from 497 to 339 per 1000. At term, the decline was 23% from 2.2 to 1.7 per 1000. The smallest decline was 3% between 32 and 36 weeks. In children with preterm birth, congenital anomalies or SGA, the perinatal mortality risk significantly declined. Main risk factors for perinatal mortality were African ethnicity (adjusted odds ratio (aOR) 2.1 95%CI [1.9–2.4]), maternal age ≥ 40 years (aOR1.9 95%CI [1.7–2.2]) and parity 2+ (aOR 1.4 95%CI [1.3–1.5]). Among the (post)term born neonates, there was no significant decline in perinatal mortality in women with low age, low or high SES, non-Western ethnicity and among women who started or delivered under primary care. Conclusions There is a decline in preterm birth and in perinatal mortality between 2010 and 2015. The decline in perinatal mortality is both in stillbirths and in neonatal mortality, most prominently among 24–27 weeks and among (post)term births. A possible future target could be deliveries among 32–36 weeks, women with high maternal age or non-Western ethnicity.
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Affiliation(s)
- Anita C J Ravelli
- Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. .,Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Martine Eskes
- Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Joris A M van der Post
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ameen Abu-Hanna
- Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Christianne J M de Groot
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Oh J, Achiron A, Celius EG, Chambers C, Derwenskus J, Devonshire V, Hellwig K, Hutton GJ, McCombe P, Moore M, Rog D, Schneider JR, Simm RF, Sousa L, Vincent SG, Chung L, Daizadeh N, Mitchell C, Compston DAS. Pregnancy outcomes and postpartum relapse rates in women with RRMS treated with alemtuzumab in the phase 2 and 3 clinical development program over 16 years. Mult Scler Relat Disord 2020; 43:102146. [PMID: 32498033 DOI: 10.1016/j.msard.2020.102146] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 02/28/2020] [Accepted: 04/21/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Relapsing-remitting multiple sclerosis (RRMS) is frequently diagnosed in women of reproductive age. Because the use of disease-modifying therapies (DMTs) early in the disease course is increasing, it is important to evaluate the safety of DMTs in pregnant women and their developing fetuses. Alemtuzumab, approved for the treatment of relapsing forms of MS, is administered as 2 courses of 12 mg/day on 5 consecutive days at baseline and on 3 consecutive days 12 months later. Alemtuzumab is eliminated from the body within approximately 30 days after administration; it is recommended that women of childbearing potential use effective contraception during and for 4 months after treatment. Here, we report pregnancy outcomes in alemtuzumab-treated women from the phase 2 and 3 clinical development program over 16 years. METHODS We followed 972 women who had alemtuzumab in phase 2 (CAMMS223 [NCT00050778]) and phase 3 (CARE-MS I [NCT00530348], CARE-MS II [NCT00548405]) studies, and/or in 2 consecutive extension studies (NCT00930553; NCT02255656 [TOPAZ]). In the extension studies, patients could receive additional alemtuzumab (12 mg/day on 3 days; ≥12 months apart) as needed for disease activity. All women who received alemtuzumab in the clinical development program were included. Pregnant or lactating patients were followed up for safety. RESULTS As of November 26, 2018, 264 pregnancies occurred in 160 alemtuzumab-treated women, with a mean age at conception of 32.6 years, and mean time from last alemtuzumab dose to conception of 35.9 months. Of the 264 pregnancies, 233 (88%) were completed, 11 (4%) were ongoing, and 20 (8%) had unknown outcomes; 16 (6%) conceptions occurred within 4 months, and 5 conceptions within 1 month of the last alemtuzumab dose. Of the 233 completed pregnancies with known outcomes, there were 155 (67%) live births with no congenital abnormalities or birth defects, 52 (22%) spontaneous abortions, 25 (11%) elective abortions, and 1 (0.4%) stillbirth. Maternal age was associated with an increased risk of spontaneous abortion in alemtuzumab-treated patients (<35 years: 15%; ≥35 years: 37%; relative risk [RR], 2.46 [95% CI: 1.53-3.95], p=0.0002). Risk of spontaneous abortion was not increased in patients becoming pregnant ≤4 months versus >4 months since alemtuzumab exposure (19% vs 23%; RR, 1.08 [95% CI: 0.41-2.85], p=0.88). Autoimmune thyroid adverse events did not increase risk for spontaneous abortion (patients with vs without thyroid adverse events, 23.7% vs 21.3%; RR, 1.11 [95% CI: 0.69-1.80], p=0.75). Annualized relapse rate was 0.10 and 0.12 in the 2 years prior to pregnancy (post alemtuzumab), and was 0.22, 0.12, and 0.12 in each of the first 3 years postpartum, respectively. CONCLUSION Normal live births were the most common outcome in women exposed to alemtuzumab 12 mg or 24 mg in clinical studies. Spontaneous abortion rate in alemtuzumab-treated patients was comparable with rates in the general population and treatment-naive MS patients, and was not increased in women with pregnancy onset within 4 months of alemtuzumab exposure. There was a minimal increase in postpartum relapses.
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Affiliation(s)
- Jiwon Oh
- St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
| | - Anat Achiron
- The Chaim Sheba Medical Center, Tel Hashomer, Israel; Tel Aviv University, Tel Aviv, Israel.
| | - Elisabeth G Celius
- Oslo University Hospital Ullevål and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | | | - Joy Derwenskus
- Murfreesboro Medical Clinic and SurgiCenter, Murfreesboro, TN, United States
| | | | - Kerstin Hellwig
- St. Josef Hospital, Ruhr University Bochum, Bochum, Germany.
| | | | | | - Marie Moore
- Carolinas Health MS Center, Charlotte, NC, United States.
| | - David Rog
- Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, United Kingdom.
| | | | | | - Livia Sousa
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
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Lebreton E, Crenn-Hebert C, Menguy C, Howell EA, Gould JB, Dechartres A, Zeitlin J. Composite neonatal morbidity indicators using hospital discharge data: A systematic review. Paediatr Perinat Epidemiol 2020; 34:350-365. [PMID: 32207172 PMCID: PMC7418783 DOI: 10.1111/ppe.12665] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 01/13/2020] [Accepted: 02/09/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Neonatal morbidity is associated with lifelong impairments, but the absence of a consensual definition and the need for large data sets limit research. OBJECTIVES To inform initiatives to define standard outcomes for research, we reviewed composite neonatal morbidity indicators derived from routine hospital discharge data. DATA SOURCES PubMed (updated on October 12, 2018). The search algorithm was based on three components: "morbidity," "neonatal," and "hospital discharge data." STUDY SELECTION AND DATA EXTRACTION Studies investigating neonatal morbidity using a composite indicator based on hospital discharge data were included. Indicators defined for specific conditions (eg congenital anomalies, maternal addictions) were excluded. The target population, objectives, component morbidities, diagnosis and procedure codes, validation methods, and prevalence of morbidity were extracted. SYNTHESIS For each study, we assessed construct validity by describing the methods used to select the indicator components and evaluated whether the authors assessed internal and external validity. We also calculated confidence intervals for the prevalence of the morbidity composite. RESULTS Seventeen studies fulfilled inclusion criteria. Indicators targeted all (n = 4), low-/moderate-risk (n = 9), and very preterm (VPT, n = 4) infants. Components were similar for VPT infants, but domains and diagnosis codes within domains varied widely for all and low-/moderate-risk infants. Component selection was described for 8/17 indicators and some form of validation reported for 12/17. Neonatal morbidity prevalence ranged from 4.6% to 9.0% of all infants, 0.4% to 8.0% of low-/moderate-risk infants, and 17.8% to 61.0% of VPT infants. CONCLUSIONS Multiple neonatal morbidity indicators based on hospital discharge data have been used for research, but their heterogeneity limits comparisons between studies. Standard neonatal outcome measures are needed for benchmarking and synthesis of research results.
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Affiliation(s)
- Elodie Lebreton
- Data Science and Analytics Department, SESAN, Paris, France,Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), INSERM, INRA, F-75004 Paris, France,Perinat-ARS-IDF, Regional Health Agency of Ile-de-France (ARS-IDF), Paris, France
| | - Catherine Crenn-Hebert
- Perinat-ARS-IDF, Regional Health Agency of Ile-de-France (ARS-IDF), Paris, France,Maternity unit, Louis Mourier University Hospital, APHP, Colombes, France
| | - Claudie Menguy
- Perinat-ARS-IDF, Regional Health Agency of Ile-de-France (ARS-IDF), Paris, France,Department of Medical Information, André Grégoire Hospital, Montreuil, France
| | - Elizabeth A. Howell
- Women’s Health Research Institute, Department of Obstetrics, Gynecology, and Reproductive Science, and Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jeffrey B. Gould
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Agnès Dechartres
- Sorbonne Université, Inserm U1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Département Biostatistique, santé publique, information médicale - Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Jennifer Zeitlin
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), INSERM, INRA, F-75004 Paris, France
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Wolf HT, Brok J, Henriksen TB, Greisen G, Salvig JD, Pryds O, Hedegaard M, Weber T, Hegaard HK, Pinborg A, Huusom LD, Rasmussen I, Näslund I, Aabakke A, Helleland L, Shalmi A, Svare J, Christiansen U, Ledertoug S, Holm AM, Boris J, Olesen A, Sørensen R. Antenatal magnesium sulphate for the prevention of cerebral palsy in infants born preterm: a double‐blind, randomised, placebo‐controlled, multi‐centre trial. BJOG 2020; 127:1217-1225. [DOI: 10.1111/1471-0528.16239] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2020] [Indexed: 12/01/2022]
Affiliation(s)
- HT Wolf
- Department of Obstetrics and GynaecologyHvidovre University Hospital Hvidovre Denmark
| | - J Brok
- Department of Paediatric and Adolescent MedicineCopenhagen University HospitalRigshospitalet Copenhagen Denmark
| | - TB Henriksen
- Department of Paediatrics (Intensive Care Neonatology)Aarhus University Hospital Aarhus Denmark
- Perinatal Epidemiology Research UnitDepartment of PaediatricsAarhus University Hospital Aarhus Denmark
| | - G Greisen
- Department of NeonatologyRigshospitaletCopenhagen University Hospital Copenhagen Denmark
| | - JD Salvig
- Department of Obstetrics and GynecologyAarhus University Hospital Aarhus Denmark
| | - O Pryds
- Department of PaediatricsHvidovre University Hospital Hvidovre Denmark
| | - M Hedegaard
- Klinik Hedegaard Copenhagen Denmark
- Department of Obstetrics and GynaecologyRigshospitaletCopenhagen University Hospital Copenhagen Denmark
| | - T Weber
- Department of Obstetrics and GynaecologyHvidovre University Hospital Hvidovre Denmark
| | - HK Hegaard
- Department of Obstetrics and GynaecologyRigshospitaletCopenhagen University Hospital Copenhagen Denmark
- The Research Unit Women’s and Children’s HealthThe Juliane Marie CentreRigshospitaletCopenhagen University Hospital Copenhagen Denmark
| | - A Pinborg
- Department of Obstetrics and GynaecologyHvidovre University Hospital Hvidovre Denmark
- The Fertility ClinicRigshospitaletCopenhagen University Hospital Copenhagen Denmark
| | - LD Huusom
- Department of Obstetrics and GynaecologyHvidovre University Hospital Hvidovre Denmark
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Ravelli ACJ, Eskes M, de Groot CJM, Abu-Hanna A, van der Post JAM. Intrapartum epidural analgesia and low Apgar score among singleton infants born at term: A propensity score matched study. Acta Obstet Gynecol Scand 2020; 99:1155-1162. [PMID: 32142154 PMCID: PMC7497260 DOI: 10.1111/aogs.13837] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/25/2020] [Accepted: 02/28/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The associations of epidural analgesia and low Apgar score found in the Swedish Registry might be a result of confounding by indication. The objective of this study was to assess the possible effect of intrapartum epidural analgesia on low Apgar score and neonatal intensive care unit (NICU) admission in term born singletons with propensity score matching. MATERIAL AND METHODS This was a propensity score matched study (n = 257 872) conducted in a national cohort of 715 449 term live born singletons without congenital anomalies in the Netherlands. Mothers with prelabor cesarean section were excluded. Main outcome measures were 5-minute Apgar score <7, 5-minute Apgar score <4 and admission to a NICU for at least 24 hours. First, an analysis of the underlying risk factors for low Apgar score <7 was performed. Multivariable analyses were applied to assess the effect of the main risk factor, intrapartum epidural analgesia, on low Apgar score to adjust the results for confounding factors. Second, a propensity score matched analysis on the main risk factors for epidural analgesia was applied. By propensity score matching the (confounding) characteristics of the women who received epidural analgesia with the characteristics of the control women without epidural analgesia, the effect of possible confounding by indication is minimized. RESULTS Intrapartum epidural analgesia was performed in 128 936 women (18%). Apgar score <7 was present in 1.0%, Apgar score <4 in .2% and NICU admission in .4% of the deliveries. The strongest risk factor for Apgar score <7 was epidural analgesia (adjusted odds ratio [aOR] 1.9, 95% confidence interval [CI] 1.8-2.0). The propensity score matched adjusted analysis of women with epidural analgesia showed significant adverse neonatal outcomes: aOR 1.8 (95% CI 1.7-1.9) for AS <7, aOR 1.6 (95% CI 1.4-1.9) for AS <4 and aOR 1.7 (95% CI 1.6-1.9) for NICU admission. The results of epidural analgesia on AS <7 were also significantly increased for spontaneous start of labor (aOR 2.0, 95% CI 1.8-2.1) and for spontaneous delivery. CONCLUSIONS Intrapartum epidural analgesia at term is strongly associated with low Apgar score and more NICU admissions, especially in spontaneous deliveries. This association needs further research and awareness.
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Affiliation(s)
- Anita C J Ravelli
- Department of Medical Informatics, Amsterdam University Medical Center, Amsterdam, the Netherlands.,Department of Obstetrics and Gynecology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Martine Eskes
- Department of Medical Informatics, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Christianne J M de Groot
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Ameen Abu-Hanna
- Department of Medical Informatics, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Joris A M van der Post
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center, Amsterdam, the Netherlands
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Bertens LCM, Burgos Ochoa L, Van Ourti T, Steegers EAP, Been JV. Persisting inequalities in birth outcomes related to neighbourhood deprivation. J Epidemiol Community Health 2020; 74:232-239. [PMID: 31685540 PMCID: PMC7035720 DOI: 10.1136/jech-2019-213162] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/14/2019] [Accepted: 10/19/2019] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Health inequalities can be observed in early life as unfavourable birth outcomes. Evidence indicates that neighbourhood socioeconomic circumstances influence health. However, studies looking into temporal trends in inequalities in birth outcomes including neighbourhood socioeconomic conditions are scarce. The aim of this work was to study how inequalities in three different key birth outcomes have changed over time across different strata of neighbourhood deprivation. METHODS Nationwide time trends ecological study with area-level deprivation in quintiles as exposure. The study population consisted of registered singleton births in the Netherlands 2003-2017 between 24 and 41 weeks of gestation. Outcomes used were perinatal mortality, premature birth and small for gestational age (SGA). Absolute rates for all birth outcomes were calculated per deprivation quintile. Time trends in birth outcomes were examined using logistic regression models. To investigate relative inequalities, rate ratios for all outcomes were calculated per deprivation quintile. RESULTS The prevalence of all unfavourable birth outcomes decreased over time: from 7.2 to 4.1 per 1000 births for perinatal mortality, from 61.8 to 55.6 for premature birth, and from 121.9 to 109.2 for SGA. Inequalities in all birth outcomes have decreased in absolute terms, and the decline was largest in the most deprived quintile. Time trend analyses confirmed the overall decreasing time trends for all outcomes, which were significantly steeper for the most deprived quintile. In relative terms however, inequalities remained fairly constant. CONCLUSION In absolute terms, inequalities in birth outcomes by neighbourhood deprivation in the Netherlands decreased between 2003 and 2017. However, relative inequalities remained persistent.
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Affiliation(s)
- Loes C M Bertens
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Lizbeth Burgos Ochoa
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Tom Van Ourti
- Erasmus School of Economics, University of Rotterdam, Rotterdam, The Netherlands
- Tinbergen Institute, Amsterdam, The Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Jasper V Been
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
- Division of Neonatology, Department of Paediatrics, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
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Carvalho CA, Silva AAMD, Victora C, Goldani M, Bettiol H, Thomaz EBAF, Barros F, Horta BL, Menezes A, Cardoso V, Cavalli RC, Santos I, Batista RFL, Simões VM, Barbieri M, Barros A. Changes in Infant and Neonatal Mortality and Associated Factors in Eight Cohorts from Three Brazilian Cities. Sci Rep 2020; 10:3249. [PMID: 32094364 PMCID: PMC7039903 DOI: 10.1038/s41598-020-59910-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 01/31/2020] [Indexed: 01/06/2023] Open
Abstract
Stillbirth (SBR), perinatal (PMR), neonatal (NMR) and infant mortality rates (IMR) are declining in Brazil and the factors associated with these falls are still being investigated. The objective of the present study was to assess changes in SBR, PMR, NMR and IMR over time and to determine the factors associated with changes in NMR and IMR in eight Brazilian cohorts. All cohorts are population-based (Ribeirão Preto in 1978/79, 1994 and 2010; Pelotas in 1982, 1993 and 2004; and São Luís in 1997/98 and 2010). Were included data on 41440 children. All indicators were decreased, except in the city of Pelotas, from 1993 to 2004, and except SBR in São Luís. Sociodemographic variables seem to be able to explain reductions of NMR and IMR in Ribeirão Preto, from 1978/79 to 1994, and in São Luís. In Ribeirão Preto, from 1994 to 2010 declines in NMR and IMR seem to be explained by reductions in intrauterine growth restriction (IUGR). Newborn’s gestational age had diminished in all cohorts, preventing even greater reductions of NMR and IMR. Improved sociodemographic variables and reduction of IUGR, seem to be able to explain part of the decrease observed. NMR and IMR could have been reduced even more, were it not for the worsening in gestational age distribution.
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Affiliation(s)
- Carolina A Carvalho
- Federal Institute of Maranhão; Federal University of Maranhão, Post Graduate Program in Collective Health, Rua Barão de Itapary, nº 155, Centro, Zipcode: 65.020-070, São Luís, MA, Brazil.
| | - Antônio A M da Silva
- Federal University of Maranhão, Post Graduate Program in Collective Health, Rua Barão de Itapary, nº 155, Centro, Zipcode: 65.020-070, São Luís, MA, Brazil
| | - César Victora
- Federal University of Pelotas, Post Graduate Program in Epidemiology, Pelotas, Brazil
| | - Marcelo Goldani
- Federal University of Rio Grande do Sul, Department of Pediatrics, Porto Alegre, Brazil
| | - Heloísa Bettiol
- University of São Paulo, Department of Puericulture and Pediatrics, Ribeirão Preto, Brazil
| | - Erika Barbara Abreu Fonseca Thomaz
- Federal University of Maranhão, Post Graduate Program in Collective Health, Rua Barão de Itapary, nº 155, Centro, Zipcode: 65.020-070, São Luís, MA, Brazil
| | - Fernando Barros
- Catholic University of Pelotas, Post-Graduate Program in Health and Behavior and Federal University of Pelotas, Post Graduate Program in Epidemiology, Pelotas, Brazil
| | - Bernardo L Horta
- Federal University of Pelotas, Post Graduate Program in Epidemiology, Pelotas, Brazil.,University of São Paulo, Department of Puericulture and Pediatrics, Ribeirão Preto, Brazil
| | - Ana Menezes
- Federal University of Pelotas, Post Graduate Program in Epidemiology, Pelotas, Brazil
| | - Viviane Cardoso
- University of São Paulo, Department of Puericulture and Pediatrics, Ribeirão Preto, Brazil
| | | | - Iná Santos
- Federal University of Pelotas, Post Graduate Program in Epidemiology, Pelotas, Brazil.,Catholic University of Pelotas, Post-Graduate Program in Health and Behavior and Federal University of Pelotas, Post Graduate Program in Epidemiology, Pelotas, Brazil
| | - Rosângela F L Batista
- Federal University of Maranhão, Post Graduate Program in Collective Health, Rua Barão de Itapary, nº 155, Centro, Zipcode: 65.020-070, São Luís, MA, Brazil
| | - Vanda Maria Simões
- Federal University of Maranhão, Post Graduate Program in Collective Health, Rua Barão de Itapary, nº 155, Centro, Zipcode: 65.020-070, São Luís, MA, Brazil
| | - Marco Barbieri
- University of São Paulo, Department of Puericulture and Pediatrics, Ribeirão Preto, Brazil
| | - Aluisio Barros
- Federal University of Pelotas, Post Graduate Program in Epidemiology, Pelotas, Brazil
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Fernández-Alcántara M, Schul-Martin L, García Caro MP, Montoya-Juárez R, Pérez-Marfil MN, Zech E. 'In the hospital there are no care guidelines': experiences and practices in perinatal loss in Spain. Scand J Caring Sci 2020; 34:1063-1073. [PMID: 31922624 DOI: 10.1111/scs.12816] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 12/16/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND OBJECTIVES Healthcare professionals play an important role in supporting and attending to families that experience a perinatal loss. Previous research has identified the existence of obstacles that professionals may encounter during their practices. The main objective of the current research was to identify and examine the subjective experiences and practices of experienced professionals attending to perinatal loss in the hospital context in Spain. DESIGN Qualitative descriptive design. SETTING Three different hospitals in Spain. PARTICIPANTS Sixteen professionals were interviewed, including doctors, nurses, midwives, nursing assistants, a psychologist and a funeral home manager. METHODS Individual semi-structured interviews focusing on three areas were carried out: practices with the baby-foetus, practices with parents and interaction with the team. A thematic analysis was performed using the three main focuses of the semi-structured interview (deductive approach) and the codes that emerged from the data (inductive approach). RESULTS Regarding guideline-based care for the baby/foetus, participants made a distinction between the initial process of care for the baby and the decision-making process with parents. Where support for families was concerned, participants identified considerable variability in the practices used and lack of organisational and care guidelines, psychological support and follow-up. Finally, interactions with other team members were perceived as a source of support, although participants identified a significant lack of coordination. CONCLUSION Participants reported variability of practices in care for the baby and parents, lack of continuity-of-care guidelines and the importance of support from a coordinated healthcare team.
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Affiliation(s)
- Manuel Fernández-Alcántara
- Mind, Brain, and Behaviour Research Centre (CIMCYC), University of Granada, Granada, Spain.,Department of Health Psychology, University of Alicante, Alicante, Spain
| | - Laetitia Schul-Martin
- Psychological Sciences Research Institute, Catholic University of Louvain, Louvain, Belgium
| | - Mª Paz García Caro
- Mind, Brain, and Behaviour Research Centre (CIMCYC), University of Granada, Granada, Spain.,Department of Nursing, University of Granada, Granada, Spain
| | - Rafael Montoya-Juárez
- Mind, Brain, and Behaviour Research Centre (CIMCYC), University of Granada, Granada, Spain.,Department of Nursing, University of Granada, Granada, Spain
| | - Mª Nieves Pérez-Marfil
- Mind, Brain, and Behaviour Research Centre (CIMCYC), University of Granada, Granada, Spain.,Department of Personality, Psychological Assessment and Treatment, University of Granada, Granada, Spain
| | - Emmanuelle Zech
- Psychological Sciences Research Institute, Catholic University of Louvain, Louvain, Belgium
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Childhood neurodevelopment after spontaneous versus indicated preterm birth. Am J Obstet Gynecol MFM 2020; 2:100082. [PMID: 33345968 DOI: 10.1016/j.ajogmf.2019.100082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 12/18/2019] [Accepted: 12/20/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Preterm birth is the leading cause of neonatal morbidity and mortality. Individuals who survive preterm birth are at a higher risk for many long-term adverse effects, including neurodevelopmental deficits. There are many well-established risk factors for worse neurologic outcomes spanning the prenatal and postnatal periods; however, investigators have yet to assess whether the cause of preterm birth has an impact on neurodevelopment. OBJECTIVE Our objective was to assess whether neurologic outcomes differ by children born via indicated versus spontaneous preterm birth. STUDY DESIGN We performed secondary analysis of a multicenter trial assessing magnesium for neuroprotection in women at risk for preterm delivery from 24 to 31 weeks. We included women with live, nonanomalous, singleton gestations who delivered preterm; we excluded women whose children were missing 2-year follow-up information for reasons other than perinatal demise. The primary exposure was type of preterm birth: (1) spontaneous if the child's mother presented with preterm labor or ruptured membranes, or (2) indicated if the child was delivered preterm iatrogenically. The primary outcome was death (including stillbirths, neonatal intensive care unit deaths, and deaths after discharge) or an abnormal Bayley II score by 2 years of age, defined as a Mental Developmental Index score or Psychomotor Developmental Index score 2 standard deviations below the mean. Secondary outcomes included death or Mental Developmental Index and Psychomotor Developmental Index scores 1 standard deviation or less, and neonatal morbidities associated with prematurity. Bivariate analyses of baseline characteristics by exposure were conducted. A logistic regression model was fitted to adjust for confounders. RESULTS Of 1678 subjects, 1631 (97.2%) underwent spontaneous preterm birth and 47 (2.8%) underwent indicated preterm birth. Baseline maternal demographics and gestational age at delivery were similar between groups (29.6 weeks ± 7.8 versus 28.8 weeks ± 2.5, P = .07). A Psychomotor Developmental Index score 2 standard deviations or less below the mean or death occurred in 340 (20.9%) spontaneous preterm birth subjects and 17 (36.2%) indicated preterm birth subjects (P = .01). When adjusting for confounders, there remained an increased probability of a Psychomotor Developmental Index scores 2 standard deviations or less or death in indicated preterm birth subjects (P = .02). Although not statistically significant, indicated preterm birth was also associated with higher odds of Mental Developmental Index scores 2 standard deviations or less or death, Psychomotor Developmental scores 1 standard deviation or less or death, and Mental Developmental Index scores 1 standard deviation or less or death (1.76, 1.59, and 1.45, respectively). Limiting the analysis to small for gestational age infants, there was no difference in neurologic outcomes. The same was true for when we excluded small for gestational age infants from our analysis. However, after adjusting for small for gestational age, the odds of a Psychomotor Developmental Index score 2 standard deviations or less or death remained significant higher in the indicated preterm birth group (adjusted odds ratio, 1.98; 95% confidence interval, 1.01-3.88). CONCLUSION In this cohort of pregnant women who delivered preterm, indicated deliveries were associated with worse psychomotor development than were spontaneous deliveries. Other outcomes appeared to be poor, but our numbers were limited. This finding should be confirmed in a larger cohort of women undergoing medically indicated preterm deliveries.
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Abstract
OBJECTIVES For many years, routine elective induction of labour at gestational week (GW) 42+0 has been recommended in Denmark. In 2011, a more proactive protocol was introduced aimed at reducing stillbirths, and practice changed into earlier routine induction, i.e. between 41+3 and 41+5 GW. The present study evaluates a national change in induction of labour regime. The trend of maternal and neonatal consequences are monitored in the preintervention period (2000-2010) compared with the postintervention period (2012-2016). DESIGN A national retrospective register-based cohort study. SETTING Denmark. PARTICIPANTS All births in Denmark 41+3 to 45+0 GWs between 2000 and 2016 (N = 152 887). OUTCOME MEASURES Primary outcomes: stillbirths, perinatal death, and low Apgar scores. Additional outcomes: birth interventions and maternal outcomes. RESULTS For the primary outcomes, no differences in stillbirths, perinatal death, and low Apgar scores were found comparing the preintervention and postintervention period. Of additional outcomes, the trend changed significantly postintervention concerning use of augmentation of labour, epidural analgesia, induction of labour and uterine rupture (all p<0.05). There was no significant change in the trend for caesarean section and instrumental birth. Most notable for clinical practice was the increase in induction of labour from 41% to 65% (p<0.01) at 41+3 weeks during 2011 as well as the rare occurrence of uterine ruptures (from 2.6 to 4.2 per thousand, p<0.02). CONCLUSIONS Evaluation of a more proactive regimen recommending induction of labour from GW 41+3 compared with 42+0 using national register data found no differences in neonatal outcomes including stillbirth. The number of women with induced labour increased significantly.
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Affiliation(s)
- Eva Rydahl
- Department of Midwifery, University College Copenhagen, Copenhagen N, Denmark
- Department of Clinical Medicine, Aarhus Universitet, Aarhus N, Denmark
| | - Eugene Declercq
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Mette Juhl
- Department of Midwifery, University College Copenhagen, Copenhagen N, Denmark
| | - Rikke Damkjær Maimburg
- Department of Clinical Medicine, Aarhus Universitet, Aarhus N, Denmark
- Department of Gynaecology Obstetrics, Aarhus University Hospital, Aarhus Universitet, Aarhus, Denmark
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Wiegerinck MMJ, Eskes M, van der Post JAM, Mol BW, Ravelli ACJ. Intrapartum and neonatal mortality in low-risk term women in midwife-led care and obstetrician-led care at the onset of labor: A national matched cohort study. Acta Obstet Gynecol Scand 2019; 99:546-554. [PMID: 31713236 DOI: 10.1111/aogs.13767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 09/15/2019] [Accepted: 10/28/2019] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Midwife-led models of care have been the subject of debate for many years. We conducted a study to compare intrapartum and neonatal mortality rates in midwife-led (primary) vs obstetrician-led (secondary) care at the onset of labor in low-risk term women. MATERIAL AND METHODS We performed an unmatched and a propensity score matched cohort study using data from the national perinatal audit registry (PAN) and from the national perinatal registry (PERINED) of the Netherlands. We included women with singleton pregnancies (without congenital anomalies or antepartum fetal death) who gave birth at term between 2010 and 2012. We excluded the following major risk factors: non-vertex position of the fetus, previous cesarean birth, hypertension, diabetes mellitus, prolonged rupture of membranes (≥24 hours), vaginal bleeding in the second half of pregnancy, nonspontaneous start of labor and post-term pregnancy (≥42 weeks). The primary outcome was intrapartum or neonatal mortality up to 28 days after birth. Secondary outcome measures were mode of delivery and a 5-minute Apgar score <7. RESULTS We included 259 211 women. There were 100/206 642 (0.48‰) intrapartum and neonatal deaths in the midwife group and 23/52 569 (0.44‰) in the obstetrician group (odds ratio [OR] 1.11, 95% CI 0.70-1.74). Propensity score matched analysis showed mortality rates of 0.49‰ (26/52 569) among women in midwife-led care and 0.44‰ (23/52 569) for women in obstetrician-led care (OR 1.13, 95% CI 0.65-1.98). In the midwife group there were significantly lower rates of vaginal instrumental deliveries (8.4% vs 13.0%; matched OR 0.65, 95% CI 0.62-0.67) and intrapartum cesarean sections (2.6% vs 8.2%; matched OR 0.32, 95% CI 0.30-0.34), and fewer neonates with low Apgar scores (<7 after 5 minutes) (0.69% vs 1.11%; matched OR 0.61, 95% CI 0.53-0.69). CONCLUSIONS Among low-risk term women, there were comparable intrapartum and neonatal mortality rates for women starting labor in midwife-led vs obstetrician-led care, with lower intervention rates and fewer low Apgar scores in the midwife group.
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Affiliation(s)
- Melanie M J Wiegerinck
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center, Amsterdam, The Netherlands.,Department of Obstetrics and Gynecology, OLVG hospital, Amsterdam, The Netherlands
| | - Martine Eskes
- Department of Medical Informatics, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Joris A M van der Post
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Ben W Mol
- Department of Obstetrics and Gynecology, Monash University, Melbourne, Vic, Australia
| | - Anita C J Ravelli
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center, Amsterdam, The Netherlands.,Department of Medical Informatics, Amsterdam University Medical Center, Amsterdam, The Netherlands
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Adane AA, Bailey HD, Marriott R, Farrant BM, White SW, Stanley FJ, Shepherd CCJ. Disparities between Aboriginal and non-Aboriginal perinatal mortality rates in Western Australia from 1980 to 2015. Paediatr Perinat Epidemiol 2019; 33:412-420. [PMID: 31518017 DOI: 10.1111/ppe.12580] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/25/2019] [Accepted: 08/06/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Perinatal mortality rates are typically higher in Aboriginal than non-Aboriginal populations of Australia. OBJECTIVES This study aimed to examine the pattern of stillbirth and neonatal mortality rate disparities over time in Western Australia, including an evaluation of these disparities across gestational age groupings. METHODS All singleton births (≥20 weeks gestation) in Western Australia between 1980 and 2015 were included. Linked data were obtained from core population health datasets of Western Australia. Stillbirth and neonatal mortality rates and percentage changes in the rates over time were calculated by Aboriginal status and gestational age categories. RESULTS From 1980 to 2015, data were available for 930 926 births (925 715 livebirths, 5211 stillbirths and 2476 neonatal deaths). Over the study period, there was a substantial reduction in both the Aboriginal (19.6%) and non-Aboriginal (32.3%) stillbirth rates. These reductions were evident in most gestational age categories among non-Aboriginal births and in Aboriginal term births. Concomitantly, neonatal mortality rates decreased in all gestational age windows for both populations, ranging from 32.1% to 77.5%. The overall stillbirth and neonatal mortality rate differences between Aboriginal and non-Aboriginal birth decreased by 0.6 per 1000 births and 3.9 per 1000 livebirths, respectively, although the rate ratios (RR 2.51, 95% CI 2.14, 2.94) and (RR 2.94, 95% CI 2.24, 3.85), respectively reflect a persistent excess of Aboriginal perinatal mortality across the study period. CONCLUSIONS Despite steady improvements in perinatal mortality rates in Western Australia over 3½ decades, the gap between Aboriginal and non-Aboriginal rates remains unchanged in relative terms. There is a continuing, pressing need to address modifiable risk factors for preventable early mortality in Aboriginal populations.
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Affiliation(s)
- Akilew A Adane
- Telethon Kids Institute, The University of Western Australia, West Perth, WA, Australia
| | - Helen D Bailey
- Telethon Kids Institute, The University of Western Australia, West Perth, WA, Australia
| | - Rhonda Marriott
- Ngangk Yira Research Centre, Murdoch University, Perth, WA, Australia
| | - Brad M Farrant
- Telethon Kids Institute, The University of Western Australia, West Perth, WA, Australia
| | - Scott W White
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, WA, Australia.,Maternal Fetal Medicine Service, King Edward Memorial Hospital, Subiaco, WA, Australia
| | - Fiona J Stanley
- Telethon Kids Institute, The University of Western Australia, West Perth, WA, Australia
| | - Carrington C J Shepherd
- Telethon Kids Institute, The University of Western Australia, West Perth, WA, Australia.,Ngangk Yira Research Centre, Murdoch University, Perth, WA, Australia
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Best KE, Seaton SE, Draper ES, Field DJ, Kurinczuk JJ, Manktelow BN, Smith LK. Assessing the deprivation gap in stillbirths and neonatal deaths by cause of death: a national population-based study. Arch Dis Child Fetal Neonatal Ed 2019; 104:F624-F630. [PMID: 30842208 DOI: 10.1136/archdischild-2018-316124] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 01/16/2019] [Accepted: 01/17/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate socioeconomic inequalities in cause-specific stillbirth and neonatal mortality to identify key areas of focus for future intervention strategies to achieve government ambitions to reduce mortality rates. DESIGN Retrospective cohort study. SETTING England, Wales, Scotland and the UK Crown Dependencies. PARTICIPANTS All singleton births between 1 January 2014 and 31 December 2015 at ≥24 weeks' gestation. MAIN OUTCOME MEASURE Cause-specific stillbirth or neonatal death (0-27 days after birth) per 10 000 births by deprivation quintile. RESULTS Data on 5694 stillbirths (38.1 per 10 000 total births) and 2368 neonatal deaths (15.9 per 10 000 live births) were obtained from Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK (MBRRACE-UK). Women from the most deprived areas were 1.68 (95% CI 1.56 to 1.81) times more likely to experience a stillbirth and 1.67 (95% CI 1.48 to 1.87) times more likely to experience a neonatal death than those from the least deprived areas, equating to an excess of 690 stillbirths and 231 neonatal deaths per year associated with deprivation. Small for gestational age (SGA) unexplained antepartum stillbirth was the greatest contributor to excess stillbirths accounting for 33% of the deprivation gap in stillbirths. Congenital anomalies accounted for the majority (59%) of the deprivation gap in neonatal deaths, followed by preterm birth not SGA (24-27 weeks, 27%). CONCLUSIONS Cause-specific mortality rates at a national level allow identification of key areas of focus for future intervention strategies to reduce mortality. Despite a reduction in the deprivation gap for stillbirths and neonatal deaths, public health interventions should primarily focus on socioeconomic determinants of SGA stillbirth and congenital anomalies.
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Affiliation(s)
- Kate E Best
- Institute of Health and Society, Newcastle University, Newcastle-upon-Tyne, UK
| | - Sarah E Seaton
- Department of Health Sciences, University of Leicester, Leicester, UK
| | | | - David J Field
- Department of Health Sciences, University of Leicester, Leicester, UK
| | | | | | - Lucy K Smith
- Department of Health Sciences, University of Leicester, Leicester, UK
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Erkamp JS, Jaddoe VWV, Mulders AGMGJ, Steegers EAP, Reiss IKM, Duijts L, Gaillard R. Customized versus population birth weight charts for identification of newborns at risk of long-term adverse cardio-metabolic and respiratory outcomes: a population-based prospective cohort study. BMC Med 2019; 17:186. [PMID: 31619225 PMCID: PMC6796410 DOI: 10.1186/s12916-019-1424-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 09/11/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Customized birth weight charts take into account physiological maternal characteristics that are known to influence fetal growth to differentiate between physiological and pathological abnormal size at birth. It is unknown whether customized birth weight charts better identify newborns at risk of long-term adverse outcomes than population birth weight charts. We aimed to examine whether birth weight classification according to customized charts is superior to population charts at identification of newborns at risk of adverse cardio-metabolic and respiratory health outcomes. METHODS In a population-based prospective cohort study among 6052 pregnant women and their children, we measured infant catch-up growth, overweight, high blood pressure, hyperlipidemia, liver steatosis, clustering of cardio-metabolic risk factors, and asthma at age 10. Small size and large size for gestational age at birth was defined as birth weight in the lowest or highest decile, respectively, of population or customized charts. Association with birth weight classification was assessed using logistic regression models. RESULTS Of the total of 605 newborns classified as small size for gestational age by population charts, 150 (24.8%) were reclassified as appropriate size for gestational age by customized charts, whereas of the total of 605 newborns classified as large size for gestational age by population charts, 129 (21.3%) cases were reclassified as appropriate size for gestational age by customized charts. Compared to newborns born appropriate size for gestational age, newborns born small size for gestational age according to customized charts had increased risks of infant catch-up growth (odds ratio (OR) 5.15 (95% confidence interval (CI) 4.22 to 6.29)), high blood pressure (OR 2.05 (95% CI 1.55 to 2.72)), and clustering of cardio-metabolic risk factors at 10 years (OR 1.66 (95% CI 1.18 to 2.34)). No associations were observed for overweight, hyperlipidemia, liver steatosis, or asthma. Newborns born large-size for gestational age according to customized charts had higher risk of catch-down-growth only (OR 3.84 (95% CI 3.22 to 4.59)). The direction and strength of the observed associations were largely similar when we used classification according to population charts. CONCLUSIONS Small-size-for-gestational-age newborns seem to be at risk of long-term adverse cardio-metabolic health outcomes, irrespective of the use of customized or population birth weight charts.
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Affiliation(s)
- Jan S Erkamp
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Paediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Paediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Annemarie G M G J Mulders
- Department of Obstetrics & Gynaecology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Eric A P Steegers
- Department of Obstetrics & Gynaecology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Irwin K M Reiss
- Division of Neonatology, Department of Paediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Liesbeth Duijts
- Division of Neonatology, Department of Paediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Division of Respiratory Medicine and Allergology, Department of Paediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Romy Gaillard
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands. .,Department of Paediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
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Godeluck A, Gérardin P, Lenclume V, Mussard C, Robillard PY, Sampériz S, Benhammou V, Truffert P, Ancel PY, Ramful D. Mortality and severe morbidity of very preterm infants: comparison of two French cohort studies. BMC Pediatr 2019; 19:360. [PMID: 31623604 PMCID: PMC6796444 DOI: 10.1186/s12887-019-1700-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 08/29/2019] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND In Reunion Island, a French overseas department, the burden of preterm birth and perinatal mortality exceed those observed in mainland France, despite similar access to standard perinatal care. The purpose of the study was to compare the outcome of two cohorts of NICU-admitted very preterm infants born between 24 and 31 weeks of gestation (WG): the registry-based OGP (Observatoire de la Grande Prématurité, Reunion Island, 2008-2013) cohort, and the nationwide EPIPAGE-2 (mainland France, 2011) observational cohort. METHODS The primary outcome was adverse neonatal outcomes defined as a composite indicator of in-hospital mortality or any of three following severe morbidities: bronchopulmonary dysplasia (BPD), necrotising enterocolitis, or severe neurological injury (periventricular leukomalacia or grade III-IV intraventricular haemorrhages). Logistic regression modelling adjusting for confounders was performed. RESULTS A total of 1272 very preterm infants from the Reunionese OGP cohort and 3669 peers from the mainland EPIPAGE-2 cohort were compared. Adverse neonatal outcomes were more likely observed in the OGP cohort (32.6% versus 26.6%, p < 0.001), as result of both increased in-hospital mortality across all gestational age strata and increased BPD among the survivors of the 29-31 WG stratum. After adjusting for gestational age, gender and multiple perinatal factors, the risk of adverse neonatal outcomes was higher in the OGP cohort than in the EPIPAGE-2 cohort across all gestational age strata. CONCLUSIONS Despite similar guidelines for standard perinatal care, very preterm infants born in Reunion Island have a higher risk for death or severe morbidity compared with those born in mainland France.
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Affiliation(s)
| | - Patrick Gérardin
- INSERM CIC1410 Epidémiologie Clinique, CHU de la Réunion, Saint Pierre, Réunion
| | - Victorine Lenclume
- INSERM CIC1410 Epidémiologie Clinique, CHU de la Réunion, Saint Pierre, Réunion
| | - Corinne Mussard
- INSERM CIC1410 Epidémiologie Clinique, CHU de la Réunion, Saint Pierre, Réunion
| | - Pierre-Yves Robillard
- CHU de la Réunion, Saint Pierre, Réunion
- Centre d'Etudes Périnatales de l'Océan Indien (CEPOI), Université de la Réunion, EA 7388, Saint-Denis, France
| | | | | | - Patrick Truffert
- CHU Lille, EA 2694 Public Health, Epidemiology and Quality of Care unit, F-59000, Lille, France
| | - Pierre-Yves Ancel
- INSERM U 1153, CHU Cochin Hôtel Dieu, Paris, France
- Université Paris Descartes, Paris, France
- URC - CIC1419 Plurithématique, Cochin Hôtel Dieu, Paris, France
| | - Duksha Ramful
- CHU de la Réunion, Saint Denis, Réunion.
- INSERM CIC1410 Epidémiologie Clinique, CHU de la Réunion, Saint Pierre, Réunion.
- Postal address: Neonatal and pediatric intensive care unit, Félix Guyon Hospital, CHU de La Réunion, Allée des Topazes, CS 11021, 97400, Saint-Denis Cedex, La Réunion, France.
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Zeitlin J, Alexander S, Barros H, Blondel B, Delnord M, Durox M, Gissler M, Hindori-Mohangoo AD, Hocquette A, Szamotulska K, Macfarlane A. Perinatal health monitoring through a European lens: eight lessons from the Euro-Peristat report on 2015 births. BJOG 2019; 126:1518-1522. [PMID: 31260601 DOI: 10.1111/1471-0528.15857] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2019] [Indexed: 12/01/2022]
Affiliation(s)
- J Zeitlin
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre of Research in Epidemiology and Statistics (CRESS), DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - S Alexander
- Perinatal Epidemiology and Reproductive Health Unit, CR2, School of Public Health, ULB, Brussels, Belgium
| | - H Barros
- ISPUP-EPIUnit, Universidade do Porto, Porto, Portugal
| | - B Blondel
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre of Research in Epidemiology and Statistics (CRESS), DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - M Delnord
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre of Research in Epidemiology and Statistics (CRESS), DHU Risks in Pregnancy, Paris Descartes University, Paris, France.,Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - M Durox
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre of Research in Epidemiology and Statistics (CRESS), DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - M Gissler
- THL National Institute for Health and Welfare, Helsinki, Finland.,Karolinska Institute, Stockholm, Sweden
| | - A D Hindori-Mohangoo
- Department Child Health, Netherlands Organisation for Applied Scientific Research, TNO Healthy Living, Leiden, the Netherlands.,Perinatal Interventions Suriname, Perisur Foundation, Paramaribo, Suriname.,School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - A Hocquette
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre of Research in Epidemiology and Statistics (CRESS), DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - K Szamotulska
- Department of Epidemiology and Biostatistics, National Research Institute of Mother and Child, Warsaw, Poland
| | - A Macfarlane
- Centre for Maternal and Child Health Research, City, University of London, London, UK
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Helenius K, Gissler M, Lehtonen L. Trends in centralization of very preterm deliveries and neonatal survival in Finland in 1987-2017. Transl Pediatr 2019; 8:227-232. [PMID: 31413956 PMCID: PMC6675682 DOI: 10.21037/tp.2019.07.05] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Very preterm infants are at high risk of death and complications of prematurity. Optimal outcomes are achieved if these infants are delivered in hospitals with the highest level of neonatal expertise. Centralization of very preterm deliveries to such hospitals has been recommended for decades, and is supported by a large body of literature. However, centralization may not be easy to implement due to financial, organizational and workforce-related issues. In this review, we present the scientific background for centralization, how it has been successfully implemented in Finland and how neonatal survival has changed following this implementation.
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Affiliation(s)
- Kjell Helenius
- Department of Clinical Medicine, University of Turku, Turku, Finland.,Department of Paediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland
| | - Mika Gissler
- National Institute for Health and Welfare, Helsinki, Finland
| | - Liisa Lehtonen
- Department of Clinical Medicine, University of Turku, Turku, Finland.,Department of Paediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland
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Delnord M, Mortensen L, Hindori-Mohangoo AD, Blondel B, Gissler M, Kramer MR, Richards JL, Deb-Rinker P, Rouleau J, Morisaki N, Nassar N, Bolumar F, Berrut S, Nybo Andersen AM, Kramer MS, Zeitlin J. International variations in the gestational age distribution of births: an ecological study in 34 high-income countries. Eur J Public Health 2019; 28:303-309. [PMID: 29020399 DOI: 10.1093/eurpub/ckx131] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Few studies have investigated international variations in the gestational age (GA) distribution of births. While preterm births (22-36 weeks GA) and early term births (37-38 weeks) are at greater risk of adverse health outcomes compared to full term births (39-40 weeks), it is not known if countries with high preterm birth rates also have high early term birth rates. We examined rate associations between preterm and early term births and mean term GA by mode of delivery onset. Methods We used routine aggregate data on the GA distribution of singleton live births from up to 34 high-income countries/regions in 1996, 2000, 2004, 2008 and 2010 to study preterm and early term births overall and by spontaneous or indicated onset. Pearson correlation coefficients were adjusted for clustering in time trend analyses. Results Preterm and early term births ranged from 4.1% to 8.2% (median 5.5%) and 15.6% to 30.8% (median 22.2%) of live births in 2010, respectively. Countries with higher preterm birth rates in 2004-2010 had higher early term birth rates (r > 0.50, P < 0.01) and changes over time were strongly correlated overall (adjusted-r = 0.55, P < 0.01) and by mode of onset. Conclusion Positive associations between preterm and early term birth rates suggest that common risk factors could underpin shifts in the GA distribution. Targeting modifiable population risk factors for delivery before 39 weeks GA may provide a useful preterm birth prevention paradigm.
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Affiliation(s)
- Marie Delnord
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Laust Mortensen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ashna D Hindori-Mohangoo
- Department Child Health, TNO, The Netherlands Organisation for Applied Scientific Research, Leiden, The Netherlands.,Department Public Health, Faculty of Medical Sciences, Anton de Kom University of Suriname, Paramaribo, Suriname.,Perinatal Interventions Suriname (Perisur) Foundation, Paramaribo, Suriname
| | - Béatrice Blondel
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Mika Gissler
- THL National Institute for Health and Welfare, Helsinki, Finland.,Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Michael R Kramer
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jennifer L Richards
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Paromita Deb-Rinker
- Surveillance and Epidemiology Division, Centre for Chronic Disease Prevention, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Jocelyn Rouleau
- Surveillance and Epidemiology Division, Centre for Chronic Disease Prevention, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Naho Morisaki
- Department of Lifecourse Epidemiology, Department of Social Medicine, National Center for Child Health and Development, Setagayaku, Tokyo, Japan
| | - Natasha Nassar
- MenziesKids, Menzies Centre for Health Policy, Sydney School of Public Health, University of Sydney, Sydney, Australia
| | | | - Sylvie Berrut
- Federal Department of Home Affairs FDHA, Federal Statistical Office FSO, Health Section, Neuchâtel, Switzerland
| | | | - Michael S Kramer
- Departments of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, Canada
| | - Jennifer Zeitlin
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
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Nassel D, Chartrand C, Doré-Bergeron MJ, Lefebvre F, Ballantyne M, Van Overmeire B, Luu TM. Very Preterm Infants with Technological Dependence at Home: Impact on Resource Use and Family. Neonatology 2019; 115:363-370. [PMID: 30909270 DOI: 10.1159/000496494] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 01/02/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To examine the impact of medical complexity among very preterm infants on health care resource use, family, and neurodevelopmental outcomes at 18 months' corrected age. METHODS This observational cohort study of Canadian infants born < 29 weeks' gestational age in 2009-2011 compared infants with and those without medical complexity defined as discharged home with assistive medical technology. Health care resource use and family outcomes were collected. Children were assessed for cerebral palsy, deafness, blindness, and developmental delay at 18 months. Logistic regression analysis was performed for group comparisons. RESULTS Overall, 466/2,337 infants (20%) needed assistive medical technology at home including oxygen (79%), gavage feeding (21%), gastrostomy or ileostomy (20%), CPAP (5%), and tracheostomy (3%). Children with medical complexity were more likely to be re-hospitalized (OR 3.6, 95% CI 3.0-4.5) and to require ≥2 outpatient services (OR 4.4, 95% CI 3.5-5.6). Employment of both parents at 18 months was also less frequent in those with medical complexity compared to those without medical complexity (52 vs. 60%, p < 0.01). Thirty percent of children with medical complexity had significant neurodevelopmental impairment compared to 13% of those without medical complexity (p < 0.01). Lower gestational age, lower birth weight, bronchopulmonary dysplasia, sepsis, and surgical necrotizing enterocolitis were associated with a risk of medical complexity. CONCLUSION Medical complexity is common following very preterm birth and has a significant impact on health care use as well as family employment and is more often associated with neurodevelopmental disabilities. Efforts should be deployed to facilitate care coordination upon hospital discharge and to support families of preterm children with medical complexity.
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Affiliation(s)
- Delphine Nassel
- Hôpital Erasme, Department of Pediatrics, Université Libre de Bruxelles, Brussels, Belgium, .,Centre Hospitalier Universitaire Sainte-Justine, Department of Pediatrics, University of Montreal, Montreal, Québec, Canada,
| | - Caroline Chartrand
- Centre Hospitalier Universitaire Sainte-Justine, Department of Pediatrics, University of Montreal, Montreal, Québec, Canada
| | - Marie-Joëlle Doré-Bergeron
- Centre Hospitalier Universitaire Sainte-Justine, Department of Pediatrics, University of Montreal, Montreal, Québec, Canada
| | - Francine Lefebvre
- Centre Hospitalier Universitaire Sainte-Justine, Department of Pediatrics, University of Montreal, Montreal, Québec, Canada
| | - Marilyn Ballantyne
- Holland Bloorview Kids Rehabilitation Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Bart Van Overmeire
- Hôpital Erasme, Department of Pediatrics, Université Libre de Bruxelles, Brussels, Belgium
| | - Thuy Mai Luu
- Centre Hospitalier Universitaire Sainte-Justine, Department of Pediatrics, University of Montreal, Montreal, Québec, Canada
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The safety of atovaquone-proguanil for the prevention and treatment of malaria in pregnancy: A systematic review. Travel Med Infect Dis 2019; 27:20-26. [DOI: 10.1016/j.tmaid.2019.01.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/09/2019] [Accepted: 01/10/2019] [Indexed: 11/22/2022]
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Pilkington H, Prunet C, Blondel B, Charreire H, Combier E, Le Vaillant M, Amat-Roze JM, Zeitlin J. Travel Time to Hospital for Childbirth: Comparing Calculated Versus Reported Travel Times in France. Matern Child Health J 2018; 22:101-110. [PMID: 28780684 DOI: 10.1007/s10995-017-2359-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objectives Timely access to health care is critical in obstetrics. Yet obtaining reliable estimates of travel times to hospital for childbirth poses methodological challenges. We compared two measures of travel time, self-reported and calculated, to assess concordance and to identify determinants of long travel time to hospital for childbirth. Methods Data came from the 2010 French National Perinatal Survey, a national representative sample of births (N = 14 681). We compared both travel time measures by maternal, maternity unit and geographic characteristics in rural, peri-urban and urban areas. Logistic regression models were used to study factors associated with reported and calculated times ≥30 min. Cohen's kappa coefficients were also calculated to estimate the agreement between reported and calculated times according to women's characteristics. Results In urban areas, the proportion of women with travel times ≥30 min was higher when reported rather than calculated times were used (11.0 vs. 3.6%). Longer reported times were associated with non-French nationality [adjusted odds ratio (aOR) 1.3 (95% CI 1.0-1.7)] and inadequate prenatal care [aOR 1.5 (95% CI 1.2-2.0)], but not for calculated times. Concordance between the two measures was higher in peri-urban and rural areas (52.4 vs. 52.3% for rural areas). Delivery in a specialised level 2 or 3 maternity unit was a principal determinant of long reported and measured times in peri-urban and rural areas. Conclusions for Practice The level of agreement between reported and calculated times varies according to geographic context. Poor measurement of travel time in urban areas may mask problems in accessibility.
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Affiliation(s)
- Hugo Pilkington
- Département de Géographie, Université Paris 8 Vincennes-Saint-Denis, UMR7533 Ladyss, 2 rue de la Liberté, 93526, Saint-Denis, France.
| | - Caroline Prunet
- INSERM U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Research on Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris Descartes University, Paris, France
| | - Béatrice Blondel
- INSERM U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Research on Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris Descartes University, Paris, France
| | - Hélène Charreire
- Université Paris-Est, LabUrba, Ecole d'urbanisme de Paris, Créteil, France
| | - Evelyne Combier
- Centre d'épidémiologie des populations (CEP), University of Burgundy, EA4184 CHU, Hôpital du Bocage, Dijon, France
| | - Marc Le Vaillant
- Centre de Recherche, médecine, sciences, santé, santé mentale, société (CERMES3) INSERM U988 - CNRS UMR 8211, Villejuif Cedex, France
| | | | - Jennifer Zeitlin
- INSERM U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Research on Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris Descartes University, Paris, France
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Mantakas X, Dalivigkas I, Aravantinos L, Goutas N, Goudeli C, Vlahos N. Placenta and Umbilical Cord Cause in Antepartum Deaths. Cureus 2018; 10:e3556. [PMID: 30648088 PMCID: PMC6324925 DOI: 10.7759/cureus.3556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 11/06/2018] [Indexed: 12/15/2022] Open
Abstract
Stillbirth is a sudden and painful event for parents and obstetrical specialists as well. It is, therefore, of greatest importance to be able to give answers for the cause in order to plan a subsequent pregnancy. The aim of this retrospective study is to estimate the placental and umbilical cord cause of intrauterine death in relation to different gestational ages. The study took place on the Medical Birth Registry of Aretaieio Hospital, National and Kapodistrian University, Athens, Greece. We include a total of 19,283 pregnancies from 1998 to 2012. In this study period, 431 embryonic deaths occurred. The clinical history was documented on admission at delivery. Conditions thought to be associated with the intrauterine fetal death were recorded. Gestational age was calculated from the last menstrual period as well as with the three-trimester system. The autopsy, placenta and umbilical cord examination were performed by the same laboratory of pathology in Aretaieio University Hospital. We found that the majority of stillbirths occurred in the second trimester. We examined placenta and umbilical cord in all cases. The most frequent histologic abnormalities were those indicated placental vascular insufficiency. As far as the umbilical cord is concerned we found that the inflammatory disorder was the most common in antepartum deaths. A single umbilical artery was significantly related to gestational diabetes and congenital embryonic anomalies. Finally, our results showed steady declines in antepartum deaths during 1998-2012. As a result, we reached the conclusion that in order to reduce the fetal death rate, we have to insist on the autopsy of the placenta and umbilical cord in order to gain the appropriate information in counseling the parents.
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Affiliation(s)
| | | | | | - Nikos Goutas
- Pathology, Medical School of Athens, Athens, GRC
| | - Christina Goudeli
- Obstetrics and Gynecology, "Saint Savvas" Cancer Hospital, Athens, GRC
| | - Nikos Vlahos
- Obstetrics and Gynecology, Aretaieio Hospital, Athens, GRC
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Smith LK, Hindori-Mohangoo AD, Delnord M, Durox M, Szamotulska K, Macfarlane A, Alexander S, Barros H, Gissler M, Blondel B, Zeitlin J. Quantifying the burden of stillbirths before 28 weeks of completed gestational age in high-income countries: a population-based study of 19 European countries. Lancet 2018; 392:1639-1646. [PMID: 30269877 DOI: 10.1016/s0140-6736(18)31651-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 07/05/2018] [Accepted: 07/12/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND International comparisons of stillbirth allow assessment of variations in clinical practice to reduce mortality. Currently, such comparisons include only stillbirths from 28 or more completed weeks of gestational age, which underestimates the true burden of stillbirth. With increased registration of early stillbirths in high-income countries, we assessed the reliability of including stillbirths before 28 completed weeks in such comparisons. METHODS In this population-based study, we used national cohort data from 19 European countries participating in the Euro-Peristat project on livebirths and stillbirths from 22 completed weeks of gestation in 2004, 2010, and 2015. We excluded countries without national data for stillbirths by gestational age in these periods, or where data available were not comparable between 2004 and 2015. We also excluded those countries with fewer than 10 000 births per year because the proportion of stillbirths at 22 weeks to less than 28 weeks of gestation is small. We calculated pooled stillbirth rates using a random-effects model and changes in rates between 2004 and 2015 using risk ratios (RR) by gestational age and country. FINDINGS Stillbirths at 22 weeks to less than 28 weeks of gestation accounted for 32% of all stillbirths in 2015. The pooled stillbirth rate at 24 weeks to less than 28 weeks declined from 0·97 to 0·70 per 1000 births from 2004 to 2015, a reduction of 25% (RR 0·75, 95% CI 0·65-0·85). The pooled stillbirth rate at 22 weeks to less than 24 weeks of gestation in 2015 was 0·53 per 1000 births and did not significantly changed over time (RR 0·97, 95% CI 0·80-1·16) although changes varied widely between countries (RRs 0·62-2·09). Wide variation in the percentage of all births occurring at 22 weeks to less than 24 weeks of gestation suggest international differences in ascertainment. INTERPRETATION Present definitions used for international comparisons exclude a third of stillbirths. International consistency of reporting stillbirths at 24 weeks to less than 28 weeks suggests these deaths should be included in routinely reported comparisons. This addition would have a major impact, acknowledging the burden of perinatal death to families, and making international assessments more informative for clinical practice and policy. Ascertainment of fetal deaths at 22 weeks to less than 24 weeks should be stabilised so that all stillbirths from 22 completed weeks of gestation onwards can be reliably compared. FUNDING EU Union under the framework of the Health Programme and the Bridge Health Project.
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Affiliation(s)
- Lucy K Smith
- Department of Health Sciences, University of Leicester, Leicester, UK.
| | - Ashna D Hindori-Mohangoo
- Netherlands Organisation for Applied Scientific Research, TNO Healthy Living, Department Child Health, Leiden, Netherlands; Perinatal Interventions Suriname, Perisur Foundation, Paramaribo, Suriname; Tulane University, School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Marie Delnord
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France
| | - Mélanie Durox
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France
| | - Katarzyna Szamotulska
- Department of Epidemiology and Biostatistics, National Research Institute of Mother and Child, Warsaw, Poland
| | - Alison Macfarlane
- Centre for Maternal and Child Health Research, City, University of London, London, UK
| | - Sophie Alexander
- Perinatal Epidemiology and Reproductive Health Unit, ULB, Brussels, Belgium
| | | | - Mika Gissler
- THL National Institute for Health and Welfare, Helsinki, Finland; Karolinska Institute, Stockholm, Sweden
| | - Béatrice Blondel
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France
| | - Jennifer Zeitlin
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France
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Lykke C, Ekholm O, Schmiegelow K, Olsen M, Sjøgren P. All-cause mortality rates and home deaths decreased in children with life-limiting diagnoses in Denmark between 1994 and 2014. Acta Paediatr 2018; 107:1781-1785. [PMID: 29566441 DOI: 10.1111/apa.14331] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 01/11/2018] [Accepted: 03/16/2018] [Indexed: 11/30/2022]
Abstract
AIM Specialised paediatric palliative care has not previously been a priority in Denmark. The aim of this study was to support its development and organisation, by examining why and where children died using official national data for 1994-2014. METHODS We obtained data on 9462 children who died before the age of 18 from the Danish Register of Causes of Death. The causes of deaths were listed according to the codes in the International Classification of Diseases. RESULTS The all-cause mortality rate decreased by 52% over the study period, and infants below one year accounted for 61% of all deaths. The decline in infant mortality (26%) primarily reflected fewer deaths due to congenital malformations and chromosomal abnormalities (68%) and perinatal deaths (30%). In children aged one year to 17 years, the substantial decrease (65%) was due to external causes (75%) and neoplasms (57%). The relative proportion of hospital deaths increased, while home deaths decreased. CONCLUSION All-cause mortality rate decreased markedly, and the relative proportion of hospital deaths increased. The results may reflect more aggressive and effective treatment attempts to save lives, but some terminally ill children may be deprived of the option of dying at home.
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Affiliation(s)
- Camilla Lykke
- Department of Oncology; Copenhagen University Hospital; Rigshospitalet; Copenhagen Denmark
| | - Ola Ekholm
- National Institute of Public Health; University of Southern Denmark; Copenhagen Denmark
| | - Kjeld Schmiegelow
- Department of Pediatrics and Adolescent Medicine; Copenhagen University Hospital; Rigshospitalet; Copenhagen Denmark
| | - Marianne Olsen
- Department of Pediatrics and Adolescent Medicine; Copenhagen University Hospital; Rigshospitalet; Copenhagen Denmark
| | - Per Sjøgren
- Department of Oncology; Copenhagen University Hospital; Rigshospitalet; Copenhagen Denmark
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Zile I, Ebela I, Folkmanis V, Rumba Rozenfelde I. Maternal and Neonatal Characteristics for Late Foetal Death in Latvia between 2001 and 2014: Population-Based Study. J Pregnancy 2018; 2018:2630797. [PMID: 30112211 PMCID: PMC6077522 DOI: 10.1155/2018/2630797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 06/21/2018] [Accepted: 07/04/2018] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Stillbirth is one of the most common adverse pregnancy outcomes worldwide. Late foetal death (LFD) rates are mostly used for international comparisons because of the large variations in stillbirth rates between countries. OBJECTIVE To examine trends in LFD (including antepartum and intrapartum) by multiple births, birth weight, and maternal age in two time periods. METHODS A retrospective cohort study was used to analyse data from the Medical Birth Register (2001-2014), divided into 2 periods of 7 years each. In total, data on 1,340 singletons were analysed. This study calculated LFD rates and rate ratios (RR). RESULTS The overall LFD rate showed a slight statistically significant reduction (p < 0.001) of 18% between 2001-2007 and 2008-2014. There was a slight increase in the mortality rate from multiple pregnancies (RR 1.1/1000; 95% CI 0.6-1.9). There were no major differences in the LFD rate by maternal age during the time periods. CONCLUSIONS LFD decreased (RR 0.8/1000 births), as well as intrapartum LFD (RR 0.6/1000 births). Older maternal age influenced pregnancy outcomes, and higher LFD rates were observed in the age group ≥35 years. Substantial intrapartum stillbirths rates indicate problems with quality of intrapartum care and emergency obstetric care. Further research is needed to evaluate the strategies necessary to substantially reduce the number of stillbirths in the country.
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Affiliation(s)
- Irisa Zile
- Faculty of Medicine, Department of Paediatrics, University of Latvia, Raina bulv. 19, Riga LV-1586, Latvia
- Department of Research, Statistics and Health Promotion, Centre for Disease Prevention and Control of Latvia, Duntes 22, k-5, Riga LV-1005, Latvia
| | - Inguna Ebela
- Faculty of Medicine, Department of Paediatrics, University of Latvia, Raina bulv. 19, Riga LV-1586, Latvia
| | - Valdis Folkmanis
- Faculty of Medicine, Department of Paediatrics, University of Latvia, Raina bulv. 19, Riga LV-1586, Latvia
| | - Ingrida Rumba Rozenfelde
- Faculty of Medicine, Department of Paediatrics, University of Latvia, Raina bulv. 19, Riga LV-1586, Latvia
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Grisaru-Granovsky S, Boyko V, Lerner-Geva L, Hammerman C, Rottenstreich M, Samueloff A, Schimmel MS, Reichman B. The mortality of very low birth weight infants: the benefit and relative impact of changes in population and therapeutic variables. J Matern Fetal Neonatal Med 2018; 32:2443-2451. [DOI: 10.1080/14767058.2018.1438398] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Sorina Grisaru-Granovsky
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University Medical School of Jerusalem, Jerusalem, Israel
| | - Valentina Boyko
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University Medical School of Jerusalem, Jerusalem, Israel
| | - Liat Lerner-Geva
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University Medical School of Jerusalem, Jerusalem, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Cathy Hammerman
- Department of Neonatology, Shaare Zedek Medical Center, affiliated with the Hebrew University Medical School of Jerusalem, Jerusalem, Israel
| | - Misgav Rottenstreich
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University Medical School of Jerusalem, Jerusalem, Israel
| | - Arnon Samueloff
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University Medical School of Jerusalem, Jerusalem, Israel
| | - Michael S. Schimmel
- Department of Neonatology, Shaare Zedek Medical Center, affiliated with the Hebrew University Medical School of Jerusalem, Jerusalem, Israel
| | - Brian Reichman
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Women & Children’s Health Research Unit, Gertner Institute, Tel Hashomer, Israel
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