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Hiscock RJ, Atkinson JA, Tong S, Walker SP, Kennedy A, Cheong JYL, Quach JL, Gurrin LC, Hastie R, Lindquist A. Educational Outcomes for Children at 7 to 9 Years of Age After Birth at 39 vs 40 to 42 Weeks' Gestation. JAMA Netw Open 2023; 6:e2343721. [PMID: 37976062 PMCID: PMC10656640 DOI: 10.1001/jamanetworkopen.2023.43721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/06/2023] [Indexed: 11/19/2023] Open
Abstract
Importance Birth at 39 weeks' gestation is common and thought to be safe for mother and neonate. However, findings of long-term outcomes for children born at this gestational age have been conflicting. Objective To evaluate the association of birth at 39 weeks' gestation with childhood numeracy and literacy scores at ages 7 to 9 years compared with birth at 40 to 42 weeks' gestation. Design, Setting, and Participants In this Australian statewide, population-based cohort study using a causal inference framework based on target trial emulation, perinatal data on births between January 1, 2005, and December 31, 2011, were linked to educational outcomes at 7 to 9 years of age. Statistical analyses were performed from December 2022 to June 2023. Exposure Birth at 39 weeks' gestation compared with birth at 40 to 42 weeks' gestation. Main Outcomes and Measures Numeracy and literacy outcomes were assessed at 7 to 9 years of age using Australian National Assessment Program-Literacy and Numeracy data and defined by overall z score across 5 domains (grammar and punctuation, reading, writing, spelling, and numeracy). Multiple imputation and doubly robust inverse probability weighted regression adjustment were used to estimate population average causal effects. Results The study population included 155 575 children. Of these children, 49 456 (31.8%; 24 952 boys [50.5%]) were born at 39 weeks' gestation and were compared with 106 119 (68.2%; 52 083 boys [49.1%]) born at 40 to 42 weeks' gestation. Birth at 39 weeks' gestation was not associated with altered educational outcomes for children aged 7 to 9 years compared with their peers born at 40 to 42 weeks' gestation (mean [SE] z score, 0.0008 [0.0019] vs -0.0031 [0.0038]; adjusted risk difference, -0.004 [95% CI, -0.015 to 0.007]). Each educational domain was investigated, and no significant difference was found in grammar and punctuation (risk difference [RD], -0.006 [95% CI, -0.016 to 0.005]), numeracy (RD, -0.009 [95% CI, -0.020 to 0.001]), spelling (RD, 0.001 [95% CI, -0.011 to 0.0013]), reading (RD, -0.008 [95% CI, -0.019 to 0.003]), or writing (RD, 0.006 [95% CI, -0.005 to 0.016]) scores for children born at 39 weeks' gestation compared with those born at 40 to 42 weeks' gestation. Birth at 39 weeks' gestation also did not increase the risk of scoring below national minimum standards in any of the 5 tested domains. Conclusions and Relevance Using data from a statewide linkage study to emulate the results of a target randomized clinical trial, this study suggests that there is no evidence of an association of birth at 39 weeks' gestation with numeracy and literacy outcomes for children aged 7 to 9 years.
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Affiliation(s)
- Richard J. Hiscock
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, Victoria, Australia
| | - Jessica A. Atkinson
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, Victoria, Australia
| | - Stephen Tong
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, Victoria, Australia
| | - Susan P. Walker
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, Victoria, Australia
| | - Amber Kennedy
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, Victoria, Australia
| | - Jeanie Y. L. Cheong
- Newborn Research, Royal Women’s Hospital, Parkville, Victoria, Australia
- Victorian Infant Brain Studies, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Victoria, Australia
| | - Jon L. Quach
- Melbourne Graduate School of Education, University of Melbourne, Carlton, Victoria, Australia
| | - Lyle C. Gurrin
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Roxanne Hastie
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, Victoria, Australia
| | - Anthea Lindquist
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, Victoria, Australia
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Faulks F, Shafiei T, McLachlan H, Forster D, Mogren I, Copnell B, Edvardsson K. Perinatal outcomes of socially disadvantaged women in Australia: A population-based retrospective cohort study. BJOG 2023; 130:1380-1393. [PMID: 37077044 DOI: 10.1111/1471-0528.17501] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 02/27/2023] [Accepted: 03/12/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVE To examine the perinatal outcomes of women who experience social disadvantage using population-based perinatal data collected between 1999 and 2016. DESIGN Population-based, retrospective cohort study. SETTING Victoria, Australia. POPULATION OR SAMPLE A total of 1 188 872 singleton births were included. METHODS Cohort study using routinely collected perinatal data. Multiple logistic regression was performed to determine associations between social disadvantage and adverse maternal and neonatal outcomes with confidence limits set at 99%. Time-trend analysis for perinatal outcomes was performed in relation to area-level disadvantage measures. MAIN OUTCOME MEASURES Incidence of maternal admission to intensive care unit (ICU), postpartum haemorrhage (PPH) and caesarean section, perinatal mortality, preterm birth, low birthweight (LBW), and admission to special care nursery/neonatal intensive care unit (SCN/NICU). RESULTS Social disadvantage was associated with higher odds of adverse perinatal outcomes. Disadvantaged women were more likely to be admitted to ICU, have a PPH or experience perinatal mortality (stillbirth or neonatal death) and their neonates were more likely to be admitted to SCN/NICU, be born preterm and be LBW. A persistent social gradient existed across time for the most disadvantaged women for all outcomes except caesarean section. CONCLUSIONS Social disadvantage has a marked negative impact on perinatal outcomes. This aligns with national and international evidence regarding the impact of disadvantage. Strategies that improve access to, and reduce fragmentation in, maternity care in addition to initiatives that address the social determinants of health may contribute to improving perinatal outcomes for socially disadvantaged women.
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Affiliation(s)
- Fiona Faulks
- Judith Lumley Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Touran Shafiei
- Judith Lumley Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Helen McLachlan
- Judith Lumley Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Della Forster
- School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
| | - Ingrid Mogren
- Department of Clinical Sciences, Umeå University, Umeå, Sweden
| | - Beverley Copnell
- School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
| | - Kristina Edvardsson
- School of Nursing and Midwifery/Judith Lumley Centre, La Trobe University, Bundoora, Victoria, Australia
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Hui L, Marzan MB, Potenza S, Rolnik DL, Said JM, Palmer KR, Whitehead CL, Sheehan PM, Ford J, Pritchard N, Mol BW, Walker SP. Collaborative maternity and newborn dashboard (CoMaND) for the COVID-19 pandemic: a protocol for timely, adaptive monitoring of perinatal outcomes in Melbourne, Australia. BMJ Open 2021; 11:e055902. [PMID: 34815291 PMCID: PMC8611235 DOI: 10.1136/bmjopen-2021-055902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has resulted in a range of unprecedented disruptions to maternity care with documented impacts on perinatal outcomes such as stillbirth and preterm birth. Metropolitan Melbourne has endured one of the longest and most stringent lockdowns in globally. This paper presents the protocol for a multicentre study to monitor perinatal outcomes in Melbourne, Australia, during the COVID-19 pandemic. METHODS Multicentre observational study analysing monthly deidentified maternal and newborn outcomes from births >20 weeks at all 12 public maternity services in Melbourne. Data will be merged centrally to analyse outcomes and create run charts according to established methods for detecting non-random 'signals' in healthcare. Perinatal outcomes will include weekly rates of total births, stillbirths, preterm births, neonatal intensive care admissions, low Apgar scores and fetal growth restriction. Maternal outcomes will include weekly rates of: induced labour, caesarean section, births before arrival to hospital, postpartum haemorrhage, length of stay, general anaesthesia for caesarean birth, influenza and COVID-19 vaccination status, and gestation at first antenatal visit. A prepandemic median for all outcomes will be calculated for the period of January 2018 to March 2020. A significant shift is defined as ≥6 consecutive weeks, all above or below the prepandemic median. Additional statistical analyses such as regression, time series and survival analyses will be performed for an in-depth examination of maternal and perinatal outcomes of interests. ETHICS AND DISSEMINATION Ethics approval for the collaborative maternity and newborn dashboard project has been obtained from the Austin Health (HREC/64722/Austin-2020) and Mercy Health (ref. 2020-031). TRIAL REGISTRATION NUMBER ACTRN12620000878976; Pre-results.
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Affiliation(s)
- Lisa Hui
- Department of Obstetrics and Gynaecology, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Perinatal Medicine, Mercy Hospital for Women, Heidelberg, Victoria, Australia
- Department of Obstetrics and Gynaecology, The Northern Hospital, Northern Health, Epping, Victoria, Australia
- Reproductive Epidemiology Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Melvin B Marzan
- Department of Obstetrics and Gynaecology, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Stephanie Potenza
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Daniel L Rolnik
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash Medical Centre, Monash Health, Clayton, Victoria, Australia
| | - Joanne M Said
- Department of Obstetrics and Gynaecology, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Maternal-Fetal Medicine, Joan Kirner Women's and Children's Hospital, Western Health, St Albans, Victoria, Australia
| | - Kirsten R Palmer
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash Medical Centre, Monash Health, Clayton, Victoria, Australia
| | - Clare L Whitehead
- Department of Obstetrics and Gynaecology, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Penelope M Sheehan
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
- Department of Obstetrics and Gynaecology, Box Hill Hospital, Eastern Health, Box Hill, Victoria, Australia
| | - Jolyon Ford
- Department of Obstetrics and Gynaecology, Frankston Hospital, Peninsula Health, Frankston, Victoria, Australia
| | - Natasha Pritchard
- Department of Obstetrics and Gynaecology, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Perinatal Medicine, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash Medical Centre, Monash Health, Clayton, Victoria, Australia
| | - Susan P Walker
- Department of Obstetrics and Gynaecology, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Perinatal Medicine, Mercy Hospital for Women, Heidelberg, Victoria, Australia
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Giles ML, Davey MA, Wallace EM. Associations Between Maternal Immunisation and Reduced Rates of Preterm Birth and Stillbirth: A Population Based Retrospective Cohort Study. Front Immunol 2021; 12:704254. [PMID: 34557193 PMCID: PMC8454544 DOI: 10.3389/fimmu.2021.704254] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 07/26/2021] [Indexed: 11/13/2022] Open
Abstract
Stillbirth and preterm birth (PTB) remain two of the most important, unresolved challenges in modern pregnancy care. Approximately 10% of all births are preterm with nearly one million children dying each year due to PTB. It remains the most common cause of death among children under five years of age. The numbers for stillbirth are no less shocking with 2.6 million babies stillborn each year. With minimal impact on the rate of these adverse birth outcomes over the past decade there is an urgent need to identify more effective interventions to tackle these problems. In this retrospective cohort study, we used whole-of-population data, to determine if maternal immunization during pregnancy against influenza and/or pertussis, is associated with a lower risk of PTB, delivering a small-for-gestational age (SGA) infant, developing preeclampsia or stillbirth. Women with a singleton pregnancy at 28 or more weeks' gestation delivering in Victoria, Australia from July 2015 to December 2018 were included in the analysis. Log-binomial regression was used to measure the relationship between vaccination during pregnancy against influenza and against pertussis, with preterm birth, SGA, preeclampsia and stillbirth. Variables included in the adjusted model were maternal age, body mass index, first or subsequent birth, maternal Indigenous status, socio-economic quintile, smoking, public or private maternity care and metropolitan or rural location of the hospital. Women who received influenza vaccine were 75% less likely to have a stillbirth (aRR 025; 95% CI 0.20, 0.31), and 31% less likely to birth <37 weeks (aRR 0.69; 95% CI 0.66, 0.72). Women who received pertussis vaccine were 77% less likely to have a stillbirth (aOR 0.23; 95% CI 0.18, 0.28) and 32% less likely to birth <37 weeks gestation (aRR 0.68; 95% CI 0.66, 0.71). Vaccination also reduced the odds of small for gestational age by 13% and reduced the odds of pre-eclampsia when restricted to primiparous women. This association was seen over four different influenza seasons and independent of the time of year suggesting that any protective effect on obstetric outcomes afforded by maternal vaccination may not be due to a pathogen-specific response but rather due to pathogen-agnostic immune-modulatory effects.
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Affiliation(s)
- Michelle L. Giles
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
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Selvaratnam RJ, Wallace EM, Wolfe R, Anderson PJ, Davey MA. Association Between Iatrogenic Delivery for Suspected Fetal Growth Restriction and Childhood School Outcomes. JAMA 2021; 326:145-153. [PMID: 34255007 PMCID: PMC8278267 DOI: 10.1001/jama.2021.8608] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Timely delivery of infants suspected of having fetal growth restriction (FGR) is a balance between preventing stillbirth and minimizing prematurity, particularly because many infants with suspected FGR have normal growth. OBJECTIVE To explore the association between iatrogenic delivery for suspected FGR and childhood school outcomes. DESIGN, SETTING, AND PARTICIPANTS A retrospective whole-population cohort study linking perinatal data from births 32 weeks' or more gestation between January 1, 2003, to December 31, 2013, to developmental and educational test scores at preparatory school, and at school grades 3, 5, and 7 in Victoria, Australia. Follow-up was concluded in 2019. EXPOSURES Suspicion or nonsuspicion of FGR, presence or absence of iatrogenic delivery (defined as early induction of labor or cesarean delivery prior to labor) for suspected FGR, and presence or absence of small for gestational age (SGA). MAIN OUTCOMES AND MEASURES The coprimary outcomes were being in the bottom 10th percentile on 2 or more of 5 developmental domains at school entry and being below the national minimum standard on 2 or more of 5 educational domains in grades 3, 5, or 7. RESULTS In the birth population of 705 937 infants, the mean gestation at birth was 39.1 (SD, 1.5) weeks and the mean birth weight was 3426 (SD, 517) grams. The birth population linked to 181 902 children with developmental results and 425 717 children with educational results. Compared with infants with severe SGA (birth weight <3rd percentile) not suspected of having FGR, infants with severe SGA delivered for suspected FGR were born earlier (mean gestation, 37.9 weeks vs 39.4 weeks). They also had a significantly increased risk of poor developmental outcome at school entry (16.2% vs 12.7%; absolute difference, 3.5% [95% CI, 0.5%-6.5%]); adjusted odds ratio [aOR], 1.36 [95% CI, 1.07-1.74]) and poor educational outcomes in grades 3, 5, and 7 (for example, in grade 7: 13.4% vs 10.5%; absolute difference, 2.9% [95% CI, 0.4%-5.5%]); aOR, 1.33 [95% CI, 1.04-1.70]). There was no significant difference between infants with normal growth (birth weight ≥10th percentile) delivered for suspected FGR and those not suspected of having FGR in developmental outcome (8.6% vs 8.1%; absolute difference, 0.5% [95% CI, -1.1% to 2.0%]); aOR, 1.17 [95% CI, 0.95-1.45]) or educational outcome in grade 3, 5 or 7, despite being born earlier (mean gestation, 38.0 weeks vs 39.1 weeks). CONCLUSIONS AND RELEVANCE In this exploratory study conducted in Victoria, Australia, iatrogenic delivery of infants with severe SGA due to suspected FGR was associated with poorer school outcomes compared with infants with severe SGA not suspected of having FGR. Iatrogenic delivery of infants with normal growth due to suspected FGR was not associated with poorer school outcomes compared with infants with normal growth not suspected of having FGR.
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Affiliation(s)
- Roshan John Selvaratnam
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
- Safer Care Victoria, Department of Health, Victorian Government, Victoria, Australia
| | - Euan Morrison Wallace
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
- Safer Care Victoria, Department of Health, Victorian Government, Victoria, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Peter John Anderson
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
- School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Mary-Ann Davey
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
- Safer Care Victoria, Department of Health, Victorian Government, Victoria, Australia
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Lindquist AC, Hastie RM, Hiscock RJ, Pritchard NL, Walker SP, Tong S. Risk of major labour-related complications for pregnancies progressing to 42 weeks or beyond. BMC Med 2021; 19:126. [PMID: 34030675 PMCID: PMC8145839 DOI: 10.1186/s12916-021-01988-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/19/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Post-term gestation beyond 41+6 completed weeks of gestation is known to be associated with a sharp increase in the risk of stillbirth and perinatal mortality. However, the risk of common adverse outcomes related to labour, such as shoulder dystocia and post-partum haemorrhage for those delivering at this advanced gestation, remains poorly characterised. The objective of this study was to examine the risk of adverse, labour-related outcomes for women progressing to 42 weeks gestation or beyond, compared with those giving birth at 39 completed weeks. METHODS We performed a state-wide cohort study using routinely collected perinatal data in Australia. Comparing the two gestation cohorts, we examined the adjusted relative risk of clinically significant labour-related adverse outcomes, including macrosomia (≥ 4500 at birth), post-partum haemorrhage (≥1000 ml), shoulder dystocia, 3rd or 4th degree perineal tear and unplanned caesarean section. Parity, maternal age and mode of birth were adjusted for using logistic regression. RESULTS The study cohort included 91,314 women who birthed at 39 completed weeks and 4317 at ≥42 completed weeks. Compared to 39 weeks gestation, those giving birth ≥42 weeks gestation had an adjusted relative risk (aRR) of 1.85 (95% CI 1.55-2.20) for post-partum haemorrhage following vaginal birth, 2.29 (95% CI 1.89-2.78) following instrumental birth and 1.44 (95% CI 1.17-1.78) following emergency caesarean section; 1.43 (95% CI 1.16-1.77) for shoulder dystocia (for non-macrosomic babies); and 1.22 (95% CI 1.03-1.45) for 3rd or 4th degree perineal tear (all women). The adjusted relative risk of giving birth to a macrosomic baby was 10.19 (95% CI 8.26-12.57) among nulliparous women and 4.71 (95% CI 3.90-5.68) among multiparous women. The risk of unplanned caesarean section was 1.96 (95% CI 1.86-2.06) following any labour and 1.47 (95% CI 1.38-1.56) following induction of labour. CONCLUSIONS Giving birth at ≥42 weeks gestation may be an under-recognised risk factor for several important, labour-related adverse outcomes. Clinicians should be aware that labour at this advanced gestation incurs a higher risk of adverse outcomes. In addition to known perinatal risks, the risk of obstetric complications should be considered in the counselling of women labouring at post-term gestation.
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Affiliation(s)
- Anthea C Lindquist
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia. .,Mercy Perinatal, Mercy Hospital for Women, 163 Studley Rd., Heidelberg, Victoria, 3084, Australia.
| | - Roxanne M Hastie
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia.,Mercy Perinatal, Mercy Hospital for Women, 163 Studley Rd., Heidelberg, Victoria, 3084, Australia
| | - Richard J Hiscock
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia.,Mercy Perinatal, Mercy Hospital for Women, 163 Studley Rd., Heidelberg, Victoria, 3084, Australia
| | - Natasha L Pritchard
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia.,Mercy Perinatal, Mercy Hospital for Women, 163 Studley Rd., Heidelberg, Victoria, 3084, Australia
| | - Susan P Walker
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia.,Mercy Perinatal, Mercy Hospital for Women, 163 Studley Rd., Heidelberg, Victoria, 3084, Australia
| | - Stephen Tong
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia.,Mercy Perinatal, Mercy Hospital for Women, 163 Studley Rd., Heidelberg, Victoria, 3084, Australia
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Baldwin HJ, Nippita TA, Torvaldsen S, McGee TM, Rickard K, Patterson JA. Validation of anaemia, haemorrhage and blood disorder reporting in hospital data in New South Wales, Australia. BMC Res Notes 2021; 14:167. [PMID: 33947454 PMCID: PMC8094525 DOI: 10.1186/s13104-021-05584-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 04/23/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Hospital data are a useful resource for studying pregnancy complications, including bleeding-related conditions, however, the reliability of these data is unclear. This study aims to examine reliability of reporting of bleeding-related conditions, including anaemia, obstetric haemorrhage and blood disorders, and procedures, such as blood transfusion and hysterectomy, in coded hospital records compared with obstetric data from two large tertiary hospitals in New South Wales. RESULTS There were 36,051 births between 2011 and 2015 included in the analysis. Anaemia and blood disorders were poorly reported in the hospital data, with sensitivity ranging from 2.5% to 24.8% (positive predictive value (PPV) 12.0-82.6%). Reporting of postpartum haemorrhage, transfusion and hysterectomy showed high sensitivity (82.8-96.0%, PPV 78.0-89.6%) while moderate consistency with the obstetric data was observed for other types of obstetric haemorrhage (sensitivity: 41.9-65.1%, PPV: 50.0-56.8%) and placental complications (sensitivity: 68.2-81.3%, PPV: 20.3-72.3%). Our findings suggest that hospital data may be a reliable source of information on postpartum haemorrhage, transfusion and hysterectomy. However, they highlight the need for caution for studies of anaemia and blood disorders, given high rates of uncoded and 'false' cases, and suggest that other sources of data should be sought where possible.
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Affiliation(s)
- Heather J. Baldwin
- The University of Sydney Northern Clinical School, Women and Babies Research, C/O University Department of O&G, Level 5, Douglas Building, Royal North Shore Hospital, St Leonards, NSW 2065 Australia
- Northern Sydney Local Health District, Kolling Institute, St Leonards, NSW Australia
| | - Tanya A. Nippita
- The University of Sydney Northern Clinical School, Women and Babies Research, C/O University Department of O&G, Level 5, Douglas Building, Royal North Shore Hospital, St Leonards, NSW 2065 Australia
- Northern Sydney Local Health District, Kolling Institute, St Leonards, NSW Australia
- Department of Obstetrics and Gynaecology, Royal North Shore Hospital, St Leonards, NSW Australia
| | - Siranda Torvaldsen
- The University of Sydney Northern Clinical School, Women and Babies Research, C/O University Department of O&G, Level 5, Douglas Building, Royal North Shore Hospital, St Leonards, NSW 2065 Australia
- Northern Sydney Local Health District, Kolling Institute, St Leonards, NSW Australia
- School of Public Health and Community Medicine, UNSW, Sydney, NSW Australia
| | - Therese M. McGee
- OG Department, Clinical Support Unit, Level 3, G Block, Westmead Hospital, Westmead, NSW Australia
- The University of Sydney Westmead Clinical School, Westmead, NSW Australia
| | - Kristen Rickard
- The University of Sydney Northern Clinical School, Women and Babies Research, C/O University Department of O&G, Level 5, Douglas Building, Royal North Shore Hospital, St Leonards, NSW 2065 Australia
- Northern Sydney Local Health District, Kolling Institute, St Leonards, NSW Australia
- Department of Obstetrics and Gynaecology, Royal North Shore Hospital, St Leonards, NSW Australia
| | - Jillian A. Patterson
- The University of Sydney Northern Clinical School, Women and Babies Research, C/O University Department of O&G, Level 5, Douglas Building, Royal North Shore Hospital, St Leonards, NSW 2065 Australia
- Northern Sydney Local Health District, Kolling Institute, St Leonards, NSW Australia
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Burger RJ, Temmink JD, Wertaschnigg D, Ganzevoort W, Reddy M, Davey MA, Wallace EM, Mol BW. Trends in singleton preterm birth in Victoria, 2007 to 2017: A consecutive cross-sectional study. Acta Obstet Gynecol Scand 2021; 100:1230-1238. [PMID: 33382080 PMCID: PMC8359202 DOI: 10.1111/aogs.14074] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/16/2020] [Accepted: 12/23/2020] [Indexed: 01/01/2023]
Abstract
Introduction Preterm birth is a major cause of perinatal morbidity and mortality worldwide. In many countries preterm birth rates are increasing, largely as a result of increases in iatrogenic preterm birth, whereas in other countries rates are stable or even declining. The objective of the study is to describe trends in singleton preterm births in Victoria from 2007 to 2017 in relation to trends in perinatal mortality to identify opportunities for improvements in clinical care. Material and methods We conducted a consecutive cross‐sectional study in all women with a singleton pregnancy giving birth at ≥20 weeks of pregnancy in Victoria, Australia, between 2007 and 2017, inclusive. Rates of preterm birth and perinatal mortality were calculated and trends were analyzed in all pregnancies, in pregnancies complicated by fetal growth problems, hypertension, (pre)eclampsia or prelabor rupture of membranes (PROM), and in (low‐risk) pregnancies not complicated by any of these conditions. Results There were 811 534 singleton births between 2007 and 2017. Preterm birth increased from 5.9% (4074 births) to 6.4% (4893 births; P < .001), due to an increase in iatrogenic preterm birth from 2.5% (1730 births) to 3.6% (2730 births; P < .001). Comparable trends were seen in pregnancies complicated by fetal growth problems and hypertension and in pregnancies not complicated by small for gestational age (SGA), hypertension, (pre)eclampsia or PROM (all P < .001). In pregnancies complicated by SGA, hypertension, (pre)eclampsia or PROM the perinatal mortality rate from 20 weeks of gestation fell (13 to 12 per 1000 births; P < .001). In pregnancies not complicated by SGA, hypertension, (pre)eclampsia or PROM there was no significant change in the perinatal mortality from 28 weeks and no decrease in the preterm weekly prospective stillbirth risk. Conclusions The singleton preterm birth rate in Victoria is increasing, driven by an increase in iatrogenic preterm birth, both in pregnancies complicated by SGA and hypertension, and in pregnancies not complicated by SGA, hypertension, (pre)eclampsia or PROM. While perinatal mortality decreased in the pregnancies complicated by SGA, hypertension, (pre)eclampsia or PROM, no significant reduction in perinatal mortality from 28 weeks or in preterm weekly prospective stillbirth risk was noted in the pregnancies not complicated by any of these conditions.
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Affiliation(s)
- Renée J Burger
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia.,Reproduction and Development Research Institute, Department of Obstetrics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Josephina D Temmink
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia.,Reproduction and Development Research Institute, Department of Obstetrics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Dagmar Wertaschnigg
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia.,Department of Obstetrics and Gynecology, Paracelsus Medical University, Salzburg, Austria
| | - Wessel Ganzevoort
- Reproduction and Development Research Institute, Department of Obstetrics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Maya Reddy
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
| | - Mary-Ann Davey
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia.,Safer Care Victoria, Melbourne, VIC, Australia
| | - Euan M Wallace
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia.,Safer Care Victoria, Melbourne, VIC, Australia
| | - Ben-Willem Mol
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
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Melody S, Wills K, Knibbs LD, Ford J, Venn A, Johnston F. Adverse birth outcomes in Victoria, Australia in association with maternal exposure to low levels of ambient air pollution. ENVIRONMENTAL RESEARCH 2020; 188:109784. [PMID: 32574853 DOI: 10.1016/j.envres.2020.109784] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/28/2020] [Accepted: 06/04/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The relationship between maternal exposure to air pollution and birth outcomes is not well characterised where ambient air pollution is relatively low. OBJECTIVES We aimed to explore the association between maternal exposure to ambient nitrogen dioxide (NO2) and fine particulate matter (PM2.5) and a range of birth outcomes in Victoria, Australia. Secondary aims were to explore whether obstetric conditions, such as gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy, were effect modifiers in observed relationships. METHODS We included all singleton births occurring in Victoria, Australia from 1st March 2012 to 31st December 2015 using routinely collected government data. Outcomes included birth weight, small for gestational age (SGA), term low birth weight (tLBW), large for gestational age (LGA), and spontaneous preterm birth (sPTB). We estimated exposure to annual ambient NO2 and PM2.5 concentrations, assigned to maternal residence at time of birth. Confounders included maternal, meteorological and temporal variables. Multivariable linear regression and log-binomial regression were used for continuous and dichotomous outcomes, respectively. RESULTS There were 285,594 births during the study period. Average NO2 exposure was 6.0 parts per billion (ppb, median 5.6; interquartile range (IQR) 3.9) and PM2.5 was 6.9 μg/m3 (median 7.1, IQR 1.3). IQR increases in ambient NO2 and PM2.5 were associated with fetal growth restriction, including decrements in birth weight (NO2 β -22.8 g; 95%CI -26.0, -19.7; PM2.5 β -14.8 g; 95%CI -17.4, -12.2) and increased risk of SGA (NO2 RR 1.08; 95%CI 1.06, 1.10; PM2.5 RR 1.05; 95%CI 1.04, 1.07) and tLBW (NO2 RR 1.06; 95%CI 1.01, 1.10; PM2.5 RR 1.04; 95%CI 1.03, 1.08). Women with GDM and hypertensive disorders of pregnancy had greater decrements in birth weight in association with pollutant exposure. DISCUSSION In this exploratory study using an annual metric of exposure, maternal exposure to low-level ambient air pollution was associated with fetal growth restriction, which carries substantial public health implications.
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Affiliation(s)
- Shannon Melody
- Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia.
| | - Karen Wills
- Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia
| | - Luke D Knibbs
- School of Public Health, The University of Queensland, Herston, Queensland, Australia
| | - Jane Ford
- Clinical and Population Perinatal Health Research, Kolling Institute, Northern Sydney Local Health District, Australia
| | - Alison Venn
- Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia
| | - Fay Johnston
- Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia
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10
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Maternal Exposure to Ambient Air Pollution and Pregnancy Complications in Victoria, Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072572. [PMID: 32283665 PMCID: PMC7178226 DOI: 10.3390/ijerph17072572] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 04/07/2020] [Accepted: 04/07/2020] [Indexed: 12/12/2022]
Abstract
The relationship between maternal exposure to ambient air pollution and pregnancy complications is not well characterized. We aimed to explore the relationship between maternal exposure to ambient nitrogen dioxide (NO2) and fine particulate matter (PM2.5) and hypertensive disorders of pregnancy, gestational diabetes mellitus (GDM) and placental abruption. Using administrative data, we defined a state-wide cohort of singleton pregnancies born between 1 March 2012 and 31 December 2015 in Victoria, Australia. Annual average NO2 and PM2.5 was assigned to maternal residence at the time of birth. 285,594 singleton pregnancies were included. An IQR increase in NO2 (3.9 ppb) was associated with reduced likelihood of hypertensive disorders of pregnancy (RR 0.89; 95%CI 0.86, 0.91), GDM (RR 0.92; 95%CI 0.90, 0.94) and placental abruption (RR 0.81; 95%CI 0.69, 0.95). Mixed observations and smaller effect sizes were observed for IQR increases in PM2.5 (1.3 µg/m3) and pregnancy complications; reduced likelihood of hypertensive disorders of pregnancy (RR 0.95; 95%CI 0.93, 0.97), increased likelihood of GDM (RR 1.02; 95%CI 1.00, 1.03) and no relationship for placental abruption. In this exploratory study using an annual metric of exposure, findings were largely inconsistent with a priori expectations and further research involving temporally resolved exposure estimates are required.
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11
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Edvardsson K, Axmon A, Powell R, Davey MA. Male-biased sex ratios in Australian migrant populations: a population-based study of 1 191 250 births 1999-2015. Int J Epidemiol 2019; 47:2025-2037. [PMID: 30052991 PMCID: PMC6280923 DOI: 10.1093/ije/dyy148] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2018] [Indexed: 11/22/2022] Open
Abstract
Background The naturally occurring male-to-female (M/F) ratio at birth is 1.05. Higher ratios found primarily in countries across Asia have been attributed to prenatal sex selection due to son preference. There is growing evidence that sex-selective practices continue following migration; however, little is known about these practices following migration to Australia. Methods In this population-based study we assessed M/F ratios at birth per mother’s country of birth for all registered births 1999–2015 in Victoria, Australia (n = 1 191 250). We also compared the M/F ratio among births to mothers born elsewhere to that of mothers born in Australia, stratified by time period and parity. Results Compared with the naturally occurring M/F ratio as well as to the M/F ratio among births to mothers born in Australia, there was an increased ratio of male births to mothers born in India, China and South-East Asia, particularly at higher parities and in more recent time periods (elevated M/F ratios ranged from 1·079 to 1·248, relative risks of male birth ranged from 1·012 to 1·084 with confidence intervals between 1·001 and 1·160 and P-values between 0·005 and 0·039). The most male-biased sex ratios were found among multiple births to Indian-born mothers, and parity of two or more births to Indian and Chinese-born mothers in 2011–15. Conclusions The male-biased sex ratios observed in this study indicate that prenatal sex selection may be continuing following migration to Australia from countries where these practices have been documented. The excess of males among multiple births raises the question as to what role assisted reproduction plays. Findings also suggest that systematic discrimination against females starts in the womb.
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Affiliation(s)
- Kristina Edvardsson
- Judith Lumley Centre, La Trobe University, Bundoora, VIC, Australia.,Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
| | - Anna Axmon
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Rhonda Powell
- School of Law, University of Canterbury, Christchurch, New Zealand
| | - Mary-Ann Davey
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
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12
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Davies-Tuck ML, Wallace EM, Davey MA, Veitch V, Oats J. Planned private homebirth in Victoria 2000-2015: a retrospective cohort study of Victorian perinatal data. BMC Pregnancy Childbirth 2018; 18:357. [PMID: 30176816 PMCID: PMC6122533 DOI: 10.1186/s12884-018-1996-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 08/24/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The outcomes for planned homebirth in Victoria are unknown. We aimed to compare the rates of outcomes for high risk and low risk women who planned to birth at home compared to those who planned to birth in hospital. METHODS We undertook a population based cohort study of all births in Victoria, Australia 2000-2015. Women were defined as being of low or high risk of adverse pregnancy outcomes according to the eligibility criteria for homebirth and either planning to birth at home or in a hospital setting at the at the onset of labour. Rates of perinatal and maternal mortality and morbidity as well as obstetric interventions were compared. RESULTS Three thousand nine hundred forty-five women planned to give birth at home with a privately practising midwife and 829,286 women planned to give birth in a hospital setting. Regardless of risk status, planned homebirth was associated with significantly lower rates of all obstetric interventions and higher rates of spontaneous vaginal birth (p ≤ 0.0001 for all). For low risk women the rates of perinatal mortality were similar (1.6 per 1000 v's 1.7 per 1000; p = 0.90) and overall composite perinatal (3.6% v's 13.4%; p ≤ 0.001) and maternal morbidities (10.7% v's 17.3%; p ≤ 0.001) were significantly lower for those planning a homebirth. Planned homebirth among high risk women was associated with significantly higher rates of perinatal mortality (9.3 per 1000 v's 3.5 per 1000; p = 0.009) but an overall significant decrease in composite perinatal (7.8% v's 16.9%; p ≤ 0.001) and maternal morbidities (16.7% v's 24.6%; p ≤ 0.001). CONCLUSION Regardless of risk status, planned homebirth was associated with significantly lower rates of obstetric interventions and combined overall maternal and perinatal morbidities. For low risk women, planned homebirth was also associated with similar risks of perinatal mortality, however for women with recognized risk factors, planned homebirth was associated with significantly higher rates of perinatal mortality.
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Affiliation(s)
- Miranda L. Davies-Tuck
- The Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright Street, Clayton, Vic, 3168 Australia
- Safer Care Victoria, 50 Lonsdale Street, Melbourne, 3000 Australia
| | - Euan M. Wallace
- The Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright Street, Clayton, Vic, 3168 Australia
- Safer Care Victoria, 50 Lonsdale Street, Melbourne, 3000 Australia
| | - Mary-Ann Davey
- Safer Care Victoria, 50 Lonsdale Street, Melbourne, 3000 Australia
- Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, 246 Clayton Rd, Clayton, Vic, 3168 Australia
| | - Vickie Veitch
- Safer Care Victoria, 50 Lonsdale Street, Melbourne, 3000 Australia
| | - Jeremy Oats
- Consultative Council on Obstetric and Paediatric Mortality and Morbidity (CCOPMM) Department of Health and Human Services, 50 Lonsdale Street, Melbourne, 3000 Australia
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13
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Affiliation(s)
- Monique F Kilkenny
- 1 Monash University, Australia.,2 Florey Institute of Neuroscience and Mental Health, Australia
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14
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Davies-Tuck ML, Davey MA, Wallace EM. Maternal region of birth and stillbirth in Victoria, Australia 2000-2011: A retrospective cohort study of Victorian perinatal data. PLoS One 2017; 12:e0178727. [PMID: 28586367 PMCID: PMC5460852 DOI: 10.1371/journal.pone.0178727] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 05/17/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There is growing evidence from high-income countries that maternal country of birth is a risk factor for stillbirth. We aimed to examine the association between maternal region of birth and stillbirth between 2000 and 2011 inclusive in Victoria, Australia. METHODS Retrospective population based cohort study of all singleton births at 24 or more weeks gestational age from 2000-2011 in Victoria, Australia. Stillbirths due to termination of pregnancy, babies with congenital anomalies and Indigenous mothers were excluded. Main Outcome Measure: Stillbirth. RESULTS Over the 12-year period there were 685,869 singleton births and 2299 stillbirths, giving an overall stillbirth rate of 3·4 per 1000 births. After adjustment for risk factors, compared to women born in Australia/New Zealand, women born in South Asia (aOR 1.27, 95% CI 1.01-1.53, p = 0.01), were more likely to have a stillbirth whereas women born in South East and East Asia were (aOR 0.60, (95% CI 0.49-0.72, p<0.001) less likely to have a stillbirth. Additionally, the increasing rate of stillbirth as gestation length progressed began to rise earlier and more steeply in the South Asian compared to Australian/New Zealand born women. The following risk factors were also significantly associated with an increased odds of stillbirth in multivariate analyses: maternal age <20 and 35 years and more, nulliparity, low socio-economic status, previous stillbirth, no ultrasound reported in 1st trimester, pre-existing hypertension, antepartum haemorrhage and failure to detect growth restriction antenatally. CONCLUSION Maternal region of birth is an independent risk factor for stillbirth. Improvements in the rate of stillbirth, particularly late pregnancy stillbirth, are likely to be gained in high-income settings where clinical care is informed by maternal region of birth.
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Affiliation(s)
- Miranda L. Davies-Tuck
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Melbourne, Victoria, Australia
| | - Mary-Ann Davey
- Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Clayton, Melbourne, Victoria, Australia
| | - Euan M. Wallace
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Clayton, Melbourne, Victoria, Australia
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