Human Development Index (HDI) of the maternal country of origin as a predictor of perinatal outcomes - a longitudinal study conducted in Spain

Factors Associated with Receiving No Maternal or Neonatal Interventions among Periviable Deliveries

OBJECTIVE

 The aim of this study was to quantify the influence of maternal sociodemographic, medical, and pregnancy characteristics on not receiving maternal and neonatal interventions with deliveries occurring at 22 to 23 weeks of gestation.

STUDY DESIGN

 This was a case-control study of U.S. live births at 220/6 to 236/7 weeks of gestation using vital statistics birth records from 2012 to 2016. We analyzed births that received no interventions for periviable delivery. Births were defined as having no interventions if they did not receive maternal (cesarean delivery, maternal hospital transfer, or antenatal corticosteroid administration) or neonatal interventions (neonatal intensive care unit admission, surfactant administration, antibiotic administration, or assisted ventilation). Logistic regression estimated the influence of maternal and pregnancy factors on the receipt of no interventions when delivery occurred at 22 to 23 weeks.

RESULTS

 Of 19,844,580 U.S. live births in 2012-2016, 24,379 (0.12%) occurred at 22 to 23 weeks; 54.3% of 22-week deliveries and 15.7% of 23-week deliveries received no interventions. Non-Hispanic Black maternal race was associated with no maternal interventions at 22 and 23 weeks. Private insurance, singleton pregnancy, and small for gestational age were associated with receiving no neonatal interventions at 22 and 23 weeks of gestation.

CONCLUSION

 Withholding or refusing maternal and neonatal interventions occurs frequently at the threshold of viability. Our data highlight various sociodemographic, pregnancy, and medical factors associated with decisions to not offer or receive maternal or neonatal interventions when birth occurs at the threshold of viability. The data elucidate observed practices and may assist in the development of further research.

KEY POINTS

· Non-Hispanic Black race was associated with receiving no maternal interventions.. · Indicators of high socioeconomic status were associated with no neonatal inventions.. · Patient-level factors influence the receipt of no interventions for periviable birth..

Association between inadequate prenatal care and low birth weight of newborns in Peru: Evidence from a peruvian demographic and health survey

Objective

To assess the association between inadequate prenatal care (IPNC) and Low birth weight (LBW) in newborns of singleton gestation mothers in Peru.

Methods

We performed a secondary analysis of data from the 2019 Demographic and Health Survey. We included a total of 10,186 women of reproductive age (15 - 49 years) who had given birth to a singleton child in the last 5 years. The dependent variable was LBW (< 2500 g). The independent variables were IPNC (inadequate: when at least one of the IPNC components was absent [number of PNC visits ≥ 6, first PNC visit during the first trimester, compliance with PNC visit contents, and PNC visits provided by trained health personnel]) and each of its components. We evaluated the association using logistic regression models to estimate crude odds ratios and adjusted odds ratios (aOR) and their respective 95% confidence intervals (95% CI).

Results

We found that approximately six out of 100 live births had LBW and that seven out of 10 women had received IPNC. We observed that receiving IPNC (aOR: 1.39; 95% CI: 1.09 - 1.77) and having less than six prenatal control visits (aOR: 3.20; 95% CI: 2.48 - 4.13) were associated with higher odds of LBW regardless of the mother's age, educational level, occupation, wealth, region, rural origin, ethnicity, sex of the newborns, and place of delivery. While, regarding to the other PNC components, first prenatal control in the first trimester (aOR: 0.99; 95% CI: 0.76 - 1.28) and compliance with prenatal control contents (aOR: 1.07; 95% CI: 0.86 - 1.34), they were associated with lower and higher odds of LBW, respectively, regardless of the same adjustment variables, but it was not statistically significant.

Conclusions

IPNC and having less than six PNC visits were associated with higher odds of LBW. Therefore, it is very important to implement strategies that ensure access to quality prenatal care is necessary to reduce the consequences of LBW.

Improved Trends in the Mortality-to-Incidence Ratios for Liver Cancer in Countries with High Development Index and Health Expenditures

Primary liver cancer is one of the leading causes of death globally. Liver cancer has a unique geographical distribution, as its etiologies include chronic viral infections and aging. We hypothesize that the human development index (HDI), current health expenditure (CHE) per capita, and CHE-to-gross domestic product ratio (CHE/GDP) influence the incidence, mortality, and mortality-to-incidence ratios (MIRs) of liver cancer worldwide. Data were obtained from the Global Cancer Observatory (GLOBOCAN) database and the World Health Organization. MIRs and the changes in MIR over time (δMIR) were used to evaluate the correlation of expenditures on healthcare and the HDI disparities via Spearman's rank correlation coefficient. The crude incidence and mortality were significantly associated with HDI, CHE per capita, and CHE/GDP. Specifically, there were significant associations between δMIR and HDI, as well as between δMIR and CHE per capita. However, there were no significant associations between δMIR and CHE/GDP. Evidently, a favorable liver cancer δMIR was not associated with CHE/GDP, although it had a significant association with HDI and CHE per capita. These results are worthy of the attention of public health systems in correlation to improved outcomes in liver cancer.

A global study of the association of cesarean rate and the role of socioeconomic status in neonatal mortality rate in the current century

Introduction

Caesarean section (C/S) rates have significantly increased across the world over the past decades. In the present population-based study, we sought to evaluate the association between C/S and neonatal mortality rates.

Material and methods

This retrospective ecological study included longitudinal data of 166 countries from 2000 to 2015. We evaluated the association between C/S rates and neonatal mortality rate (NMR), adjusting for total fertility rate, human development index (HDI), gross domestic product (GDP) percentage, and maternal age at first childbearing. The examinations were also performed considering different geographical regions as well as regions with different income levels.

Results

The C/S rate and NMR in the 166 included countries were 19.97% ± 10.56% and 10 ± 10.27 per 1000 live birth, respectively. After adjustment for confounding variables, C/S rate and NMR were found correlated (r = -1.1, p < 0.001). Examination of the relationship between C/S rate and NMR in each WHO region resulted in an inverse correlation in Africa (r = -0.75, p = 0.005), Europe (r = -0.12, p < 0.001), South-East Asia (r = -0.41, p = 0.01), and Western Pacific (r = -0.13, p = 0.02), a direct correlation in America (r = 0.06, p = 0.04), and no correlation in Eastern Mediterranean (r = 0.01, p = 0.88). Meanwhile, C/S rate and NMR were inversely associated in regions with upper-middle (r = -0.15, p < 0.001) and lower-middle (r = -0.24, p < 0.001) income levels, directly associated in high-income regions (r = 0.02, p = 0.001), and not associated in low-income regions (p = 0.13). In countries with HDI below the centralized value of 1 (the real value of 0.9), the correlation between C/S rate and NMR was negative while it was found positive in countries with HDI higher than the mentioned cut-off.

Conclusions

This study indicated that NMR associated with C/S is dependent on various socioeconomic factors such as total fertility rate, HDI, GDP percentage, and maternal age at first childbearing. Further attentions to the socioeconomic status are warranted to minimize the NMR by modifying the C/S rate to the optimum cut-off.

Psychological, Psychosocial and Obstetric Differences between Spanish and Immigrant Mothers: Retrospective Observational Study

This study analyzed the influence of psychological and psychosocial factors of pregnant women at an obstetric level. The possible differences between Spaniards and immigrants were studied. This was a retrospective observational study. The sample has been divided into two study cohorts, one consisting of Spanish pregnant women and one consisting of foreign pregnant women. Both completed the Revised Postpartum Depression Predictors Inventory and the Patient Health Questionnaire-9. A total of 15.9% of Spanish women and 23.2% of immigrants had depressive symptoms. Immigrants claim to have less support at the partner, family, and friendship levels than Spaniards. Moreover, 16.4% of Spaniards vs. 8.1% of immigrants had pregnancy complications; Cesarean section was performed in 16.2% of Spaniards vs. 7.9% of immigrants. A greater number of premature births were detected in immigrants than in Spaniards. Access to universal healthcare is a protective factor against socioeconomic and cultural conditions affecting the mental and obstetrical health of immigrants.

Influence of the Human Development Index on the Maternal-Perinatal Morbidity and Mortality of Pregnant Women with SARS-CoV-2 Infection: Importance for Personalized Medical Care

Coronavirus disease-19 (COVID-19) is perhaps the most worrisome pandemic in the 21st century, having entailed devastating consequences for the whole society during the last year. Different studies have displayed an existing association between pregnancy and COVID-19 severity due to the various physiological changes that occur during gestation. Recent data identified maternal country of origin as an important determinant of COVID-19 presentation in pregnant women. However, the explanation of this fact remains to be fully elucidated. Therefore, the purpose of this work is to analyze the possible relationship between Human Development Index (HDI) of maternal country of origin with the morbimortality of pregnant women and their newborns. Here, we conducted a multicentric, ambispective, observational case-control study (1:1 ratio) and compare with the HDI of each country (group 1-very high HDI, group 2-high HDI, group 3-medium HDI, and group 4-low HDI). In total, 1347 pregnant women with confirmed SARV-CoV-2 infection (cases) were enrolled, and each was paired with one control to give a total number of 2694 participants from 81 tertiary care centers. Among the women with SARS-CoV-2 infection, more cases were produced of perinatal mortality, overall maternal morbidity, COVID-19 maternal morbidity, C-sections, hypertensive maternal morbidity, and perinatal morbidity. Our results described an inverse association between HDI and maternofetal morbidity and mortality. Moreover, the countries with an HDI lower than 1 showed higher rates of patients with maternal COVID-19-related morbidity (6.0% vs. 2.4%, p < 0.001), a need for oxygen therapy (4.7% vs. 1.8%, p < 0.001), and maternal ICU admission (2.6% vs. 1.0%, p = 0.007). Compared to other risk factors such as overweight, obesity, preexisting and obstetric comorbidities, HDI emerged as an independent risk factor explaining much of the increased maternal-perinatal morbidity and mortality detected in our group of cases. Further research is needed to establish to confirm the real impact of this factor and its components on pregnancy outcomes.

Maternal and Perinatal Outcomes in Patients with Suspected COVID-19 and Their Relationship with a Negative RT-PCR Result

This study was designed to examine maternal-perinatal outcomes in pregnant women with suspected coronavirus disease 2019 (COVID-19) according to the result of a real-time reverse transcription polymerase chain reaction (RT-PCR) test and to investigate possible variables that could be useful for predicting a negative RT-PCR result. Participants of this retrospective cohort study were obstetrics patients with suspected COVID-19 who underwent an RT-PCR test in a tertiary hospital in Madrid, Spain. Maternal-perinatal features were analysed according to the results of this test. Clinical, radiological and analytical characteristics that could be associated with a negative result were also explored. In a final subgroup analysis, patients were included if they had pneumonia and a negative test result for the virus. Out of the 111 obstetric patients with suspected COVID-19 that were enrolled, 38.7% returned a negative result. In this RT-PCR-negative group, we recorded lower rates of pneumonia (21.4% vs. 45.6%, p = 0.009), severe or critical clinical features (4.7% vs. 11.8% and 0.0% vs. 5.9%, p = 0.02, respectively), lower lactate dehydrogenase (LDH) levels (168 UI/L vs. 224.5 UI/L, p = 0.003), a greater need for maternal treatment (60.3% vs 24.4%, p < 0.001), a reduced need for oxygen therapy (2.4% vs 28.8%, p < 0.001) and a lower rate of intensive care unit admission (0.0% vs. 3.7%, p = 0.046) than the RT-PCR-positive group. While no differences were found in other variables, the monocyte count was higher (946.2/μL vs. 518.8/μL, p = 0.022) in this group. The predictive model for a negative test result included the monocyte count, LDH level and no need for oxygen therapy. This model was able to identify 73.5% of patients with a negative RT-PCR result. Only 11% of the patients with pneumonia testing negative for the virus had IgG antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The proportion of pregnant women with suspected COVID-19 and a negative RT-PCR result was nearly 39%. In these patients, the symptoms were mild and the systemic severity of the disease was lower. The monocyte count, LDH level and no need for oxygen therapy were the factors that were more related to a negative test result in this group. These variables could be used to guide the management of patients with suspected COVID-19, mainly while waiting for RT-PCR results or in settings where this test is not available.

Secular trends in stillbirth by maternal socioeconomic status in Spain 2007-15: a population-based study of 4 million births

Introduction

Stillbirth, one of the urgent concerns of preventable perinatal deaths, has wide-reaching consequences for society. We studied secular stillbirth trends by maternal socioeconomic status (SES) in Spain.

Methods

We developed a population-based observational study, including 4 083 919 births during 2007–15. We estimate stillbirth rates and secular trends by maternal SES. We also evaluated the joint effect of maternal educational attainment and the Human Development Index (HDI) of women’s country of origin on the risk of stillbirth. The data and statistical analysis can be accessed for reproducibility in a GitHub repository: https://github.com/migariane/Stillbirth

Results

We found a consistent pattern of socioeconomic inequalities in the risk of delivering a stillborn, mainly characterized by a persistently higher risk, over time, among women with lower SES. Overall, women from countries with low HDIs and low educational attainments had approximately a four times higher risk of stillbirth (RR: 4.44; 95%CI: 3.71–5.32). Furthermore, we found a paradoxical reduction of the stillbirth gap over time between the highest and the lowest SESs, which is mostly due to the significant and increasing trend of stillbirth risk among highly educated women of advanced maternal age.

Conclusion

Our findings highlight no improvement in stillbirth rates among women of lower SES and an increasing trend among highly educated women of advanced maternal age over recent years. Public health policies developing preventive programmes to reduce stillbirth rates among women with lower SES are needed as well as the necessity of further study to understand the growing trend of age-related stillbirths among highly educated women in Spain.

Economic Crisis Impact and Social Determinants of Perinatal Outcomes and Infant Mortality in Greece

(1) Background: To explore the effects of the 2008 economic crisis on maternal, perinatal and infant mortality in Greece and the socio-economic determinants associated with them; (2) Methods: The annual rates of stillbirth (SBR), perinatal mortality (PMR), infant mortality (IMR), neonatal mortality (NNMR), post-neonatal mortality (PNMR), low birth weight (LBW), and maternal mortality (MMR) were calculated for the years 2000–2016. Average Annual Percent Changes (AAPC) were calculated by the period before and after 2008. The expected rates of 2009–2016 and the observed-to-expected rate ratios (RR) were calculated. Correlation and multiple linear regression analyses were used to test the impact of socio-economic variables on health outcomes; (3) Results: A reverse in downwards trends of PNM, IMR, and NNMR is observed since 2009. All observed values of 2009–2016 were found significantly higher than the expected ones by 12–34%. All indicators except SBR were found negatively correlated with GDP and DHI. A positive correlation was found between IMR, NNMR, and LBW and long-term unemployment, and no association with public health expenditure; (4) Conclusions: Economic crisis was associated with remarkable adverse effects on perinatal outcomes and infant mortality, mainly determined by long-term unemployment and income reduction. The findings stress a need for interventions to protect maternity and child health during crises.

Influence of Family Income Level on Obstetric and Perinatal Outcomes in Spain

For pregnant women, having a low family income status is associated with late prenatal attendance and an increased risk of adverse outcomes during pregnancy, delivery, and immediately after delivery. However, the influence of the socioeconomic level on maternal and child health may be minimal as long as the health system model is able to neutralise health inequity. For this reason, the objective of this study is to determine the relationship between the socioeconomic level assessed through monthly household income and obstetric and perinatal outcomes in the Spanish Health System, where midwives play a relevant role. To meet this objective, a cross-sectional observational study aimed at women who have been mothers between 2013 and 2018 in Spain was developed. The final study population was 5942 women. No statistically significant differences with linear trend were found between income level and obstetric and perinatal outcomes after the adjustment by confounding factors (pregnancy composite morbidity, p = 0.447; delivery composite morbidity, p = 0.590; perinatal composite morbidity, p = 0.082; postpartum composite morbidity, p = 0.407). The main conclusion is that, in the current Spanish health system, household income as an indicator of socioeconomic status is not related to perinatal outcomes after the adjustment by confounding factors. These results are likely due to the public model of our health system that serves all citizens on equal footing, although other social and individual factors may have influenced these results

Measuring inequalities of development at the sub-national level: From the human development index to the human life indicator

Despite being one of the most common measures of development, the Human Development Index [HDI] has been much criticized for its consistency, data requirements, difficulty of interpretation and trade-offs between indicators. The ‘Human Life Indicator’ [HLI] has been proposed as a ‘simple effective means’ of measuring development and, more specifically, as a viable alternative to the HDI. Reducing inequalities within countries is a core component of the Sustainable Development Goals; yet sub-national HDIs are subject to the same criticisms as national level indices (potentially more so). Our goal in this paper is to demonstrate ‘proof of concept’ in terms of the systematic application of the HLI to measure development at the subnational level. Using life tables for the United States of America, we calculate, for the first time, HLIs for each state for the period 1959–2016. This country was chosen for the comparatively long run of available sub-national life tables. We also calculate the extent to which mortality is distributed across the life course—a further measure of inequality and the role of the social determinants of health. The HLI clearly shows how striking regional inequalities exist across the United States. We find that HLI and HDI for the most recent time period are strongly correlated. The analysis demonstrates that HLI represents an effective means of measuring development at the sub-national level. Compared to HDI, HLIs are characterized by simpler calculation and interpretation; fewer data requirements; less measurement error; more consistency over time; and no trade-offs between components. A current challenge of producing sub-national HLIs is the lack of comprehensive civil registration and vital statistics systems in many parts of the Global South from which sub-national life tables can be generated. However, as more and more countries develop these systems the potential to produce HLIs will inevitably increase.

Human Development Index of the maternal country of origin and its relationship with maternal near miss: A systematic review of the literature

Background

The reduction in maternal mortality worldwide has increased the interest in studying more frequent severe events such as maternal near miss. The Human Development Index is a sociodemographic country-specific variable that includes key human development indicators such as living a long and healthy life, acquiring knowledge, and enjoying a decent standard of living, allowing differentiation between countries. In a globalised environment, it is necessary to study whether the Human Development Index of each patient's country of origin can be associated with the maternal near-miss rate and thus classify the risk of maternal morbidity and mortality.

Methods

A systematic review of the literature published between 2008 and 2019 was conducted, including all articles that reported data about maternal near miss in their sample of pregnant women, in addition to describing the study countries of their sample population. The Human Development Index of the study country, the maternal near-miss rate, the maternal mortality rate, and other maternal-perinatal variables related to morbidity and mortality were used.

Results

After the systematic review, eighty two articles from over thirty countries were included, for a total of 3,699,697 live births, 37,191 near miss cases, and 4029 mortality cases. A statistically significant (p <0.05) inversely proportional relationship was observed between the Human Development Index of the study country and the maternal near-miss and mortality rates. The most common cause of maternal near miss was haemorrhage, with an overall rate of 38.5%, followed by hypertensive disorders of pregnancy (34.2%), sepsis (7.5%), and other undefined causes (20.9%).

Conclusions

The Human Development Index of the maternal country of origin is a sociodemographic variable allowing differentiation and classification of the risk of maternal mortality and near miss in pregnant women. The most common cause of maternal near miss published in the literature was haemorrhage.

Trial registration

PROSPERO ID: CRD 42019133464

Evaluating maternal and child health indicators for the Sustainable Development Goals in 2018: what is Iran's position?

OBJECTIVES

Since many Millennium Development Goals (MDGs) were not achieved, countries including Iran—despite achieving some of the MDGs—need regular planning to achieve the Sustainable Development Goals (SDGs) by 2030. This article examines maternal and child health indicators in the early years of the SDGs in Iran relative to several other countries.

METHODS

This study was carried out through a secondary analysis of maternal and child health indicators in Iran. The results were compared with data from other countries divided into three groups: countries with upper-middle income levels, countries in the Eastern Mediterranean region, and the countries covered by the Outlook Document 1,404 (a regional classification). Then, the relationship between these indicators and the Human Development Index was investigated.

RESULTS

Iran has attained better results than other countries with respect to maternal mortality, family planning, skilled birth attendance, under-5 deaths, incidence of hepatitis B, diphtheria-tetanus-pertussis vaccination coverage, and antenatal care. In contrast, Iran performed worse than other countries with respect to under-5 wasting, under-5 stunting, and care-seeking behavior for children.

CONCLUSIONS

Overall, among the 11 indicators surveyed, Iran has attained better-than-average results and seems to be improving. We recommend that Iran continue interventions in the field of maternal and child health.

Maternal mortality in Spain and its association with country of origin: cross-sectional study during the period 1999-2015

Background

The available literature suggests that there are significant differences in maternal mortality according to maternal origin in high income countries. The objective of this study was to quantify the risk of maternal death by maternal origin and region of Spain where the birth occurred and to identify the most important causes of maternal death in our country.

Methods

An ecological cross-sectional study was conducted that included all deliveries that resulted in maternal survival and cases of maternal death during 1999–2015 in Spain. A descriptive analysis of the maternal mortality rate by maternal origin, region and year of birth was performed. The risk of maternal death was calculated using univariate and multivariate logistic regression analysis, with adjustment for the variables included in the descriptive analysis.

Results

There were 272 maternal deaths during this period, most of which were due to haemorrhage (63 cases, 23.16%).Women whose continent of origin was South America had the highest adjusted risk of maternal death, with an OR of 3.92 (95% CI 2.75–5.58). The region of Spain with the highest risk of maternal death was Ceuta, with an OR of 12.11 (95% CI 2.02–72.68).

Conclusions

This study shows that there are inequalities in maternal mortality according to maternal origin and region where labour occurred. These findings highlight the need to establish strategies at the national and European levels to analyse the most relevant causes and risk factors associated with maternal mortality in order to reduce it and pay closer attention in identifying and carefully managing pregnant women from this at risk groups.

Diarrhea deaths in children among countries with different levels of the human development index

The present study investigated the effect of human development index (HDI) on diarrheal deaths per 1000 live births in children under 5 years old in 2015. In addition, the association between HDI, and the use of improved drinking-water sources and sanitation facilities were evaluated in this year. 75 countries that their information was available in Global Analysis and Assessment of Sanitation and Drinking-Water (GLAAS) conducted by the World Health Organization (WHO) were included in this study. The data required was obtained from WHO and United Nations Development Programme (UNDP) websites. Pearson's correlation coefficient and linear regression were used to evaluate the correlation and association between the variables, respectively. The results showed that there is a significant relationship between HDI and diarrhea-associated deaths per 1000 live births in children during 2015 (B = −354.85, CI95%: −408.91, −300.79). In addition, HDI was associated with the use of improved drinking-water sources (B = 83.93, CI95%: 64.71, 103.15) and improved sanitation facilities (B = 199.90, CI95%: 174.39, 225.42) in 2015. These findings indicate the association between HDI and the measures relevant to diarrheal disease among children. Therefore, in order to achieve to the Millennium Development Goals regarding child health, policymakers should concentrate on environmental and social factors affecting health.

Dataset on the prevalence of tobacco smoking in men and women of selected countries whit difference human development

This study was conducted to investigate the effect of human development index (HDI) on tobacco smoking prevalence in men and women of countries which their data about tobacco smoking were available for 2015. Pearson's correlation coefficient and linear regression were used to investigate the association between HDI and all types of smoking, particularly cigarette. Daily smoking and current smoking were used as tobacco smoking indices. The information about prevalence of tobacco smoking and HDI was obtained from the World Health Organization (WHO) website and United Nations Development Programme (UNDP), respectively. The results showed that there is no statistically significant relationship between HDI and current tobacco smoking in men (B = −0.45_CI 95%: −29.97, 29.06). However, the same association was significant for women (B = 43.87, CI 95%: 24.97–62.78). The results indicated that women in developed countries are more at risk of health effects attributed to tobacco smoking. Countries should focus on socioeconomic factors to prevent the spread of risk factors for non-communicable diseases.