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Vousden N, Bunch K, Kenyon S, Kurinczuk JJ, Knight M. Impact of maternal risk factors on ethnic disparities in maternal mortality: a national population-based cohort study. Lancet Reg Health Eur 2024; 40:100893. [PMID: 38585675 PMCID: PMC10998184 DOI: 10.1016/j.lanepe.2024.100893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/15/2024] [Accepted: 03/15/2024] [Indexed: 04/09/2024]
Abstract
Background Ethnic disparities in maternal mortality are consistently reported. This study aimed to investigate the contribution of known risk factors including age, socioeconomic status, and medical comorbidities to observed ethnic disparities in the United Kingdom (UK). Methods A cohort of all women who died during or up to six weeks after pregnancy in the UK 2009-2019 were identified through national surveillance. No single denominator population included data on all risk factors, therefore we used logistic regression modelling to compare to 1) routine population birth and demographic data (2015-19) (routine data comparator) and 2) combined control groups of four UK Obstetric Surveillance System studies (UKOSS) control comparator)). Findings There were 801 maternal deaths in the UK between 2009 and 2019 (White: 70%, Asian: 13%, Black: 12%, Chinese/Other: 3%, Mixed: 2%). Using the routine data comparator (n = 3,519,931 maternities) to adjust for demographics, including social deprivation, women of Black ethnicity remained at significantly increased risk of maternal death compared with women of white ethnicity (adjusted OR 2.43 (95% Confidence Interval 1.92-3.08)). The risk was greatest in women of Caribbean ethnicity (aOR 3.55 (2.30-5.48)). Among women of White ethnicity, risk of mortality increased as deprivation increased, but women of Black ethnicity had greater risk irrespective of deprivation. Using the UKOSS control comparator (n = 2210), after multiple adjustments including smoking, body mass index, and comorbidities, women of Black and Asian ethnicity remained at increased risk (aOR 3.13 (2.21-4.43) and 1.57 (1.16-2.12) respectively). Interpretation Known risk factors do not fully explain ethnic disparities in maternal mortality. The impact of socioeconomic deprivation appears to differ between ethnic groups. Funding This research is funded by the National Institute for Health and Care Research (NIHR) Policy Research Programme, conducted through the Policy Research Unit in Maternal and Neonatal Health and Care, PR-PRU-127-21202.
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Affiliation(s)
- Nicola Vousden
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK
| | - Kathryn Bunch
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK
| | - Sara Kenyon
- Institute of Applied Health Research, University of Birmingham, UK
| | - Jennifer J. Kurinczuk
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK
| | - Marian Knight
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK
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Boo YY, Bora AK, Chhabra S, Choudhury SS, Deka G, Kakoty S, Kumar P, Mahanta P, Minz B, Rani A, Rao S, Roy I, Solomi V C, Verma A, Zahir F, Deka R, Kurinczuk JJ, Nair M. Maternal and fetal factors associated with stillbirth in singleton pregnancies in 13 hospitals across six states in India: A prospective cohort study. Int J Gynaecol Obstet 2024; 165:462-473. [PMID: 38234106 DOI: 10.1002/ijgo.15367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/25/2023] [Accepted: 12/28/2023] [Indexed: 01/19/2024]
Abstract
OBJECTIVE This study aimed to investigate the incidence of and risk factors for stillbirth in an Indian population. METHODS We conducted a secondary data analysis of a hospital-based cohort from the Maternal and Perinatal Health Research collaboration, India (MaatHRI), including pregnant women who gave birth between October 2018-September 2023. Data from 9823 singleton pregnancies recruited from 13 hospitals across six Indian states were included. Univariable and multivariable Poisson regression analysis were performed to examine the relationship between stillbirth and potential risk factors. Model prediction was assessed using the area under the receiver-operating characteristic (AUROC) curve. RESULTS There were 216 stillbirths (48 antepartum and 168 intrapartum) in the study population, representing an overall stillbirth rate of 22.0 per 1000 total births (95% confidence interval [CI]: 19.2-25.1). Modifiable risk factors for stillbirth were: receiving less than four antenatal check-ups (adjusted relative risk [aRR]: 1.75, 95% CI: 1.25-2.47), not taking any iron and folic acid supplementation during pregnancy (aRR: 7.23, 95% CI: 2.12-45.33) and having severe anemia in the third trimester (aRR: 3.37, 95% CI: 1.97-6.11). Having pregnancy/fetal complications such as hypertensive disorders of pregnancy (aRR: 1.59, 95% CI: 1.03-2.36), preterm birth (aRR: 4.41, 95% CI: 3.21-6.08) and birth weight below the 10th percentile for gestational age (aRR: 1.35, 95% CI: 1.02-1.79) were also associated with an increased risk of stillbirth. Identified risk factors explained 78.2% (95% CI: 75.0%-81.4%) of the risk of stillbirth in the population. CONCLUSION Addressing potentially modifiable antenatal factors could reduce the risk of stillbirths in India.
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Affiliation(s)
- Yebeen Ysabelle Boo
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Amrit K Bora
- Sonapur District Hospital, Guwahati, Assam, India
| | - Shakuntala Chhabra
- Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra, India
| | | | - Gitanjali Deka
- Tezpur Medical College and Hospital, Tezpur, Assam, India
| | - Swapna Kakoty
- Fakhruddin Ali Ahmed Medical College and Hospital, Barpeta, Assam, India
| | - Pramod Kumar
- Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra, India
| | | | - Bina Minz
- Sewa Bhawan Hospital Society, Basna, Chhattisgarh, India
| | - Anjali Rani
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Sereesha Rao
- Silchar Medical College and Hospital, Silchar, Assam, India
| | - Indrani Roy
- Nazareth Hospital, Shillong, Meghalaya, India
| | - Carolin Solomi V
- Makunda Christian Leprosy and General Hospital, Karimganj, Assam, India
| | - Ashok Verma
- Dr Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India
| | - Farzana Zahir
- Assam Medical College (AMC), Dibrugarh, Assam, India
| | - Rupanjali Deka
- Srimanta Sankaradeva University of Health Sciences, Guwahati, Assam, India
| | - Jennifer J Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Manisha Nair
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Gale C, Sharkey D, Fitzpatrick KE, Mactier H, Morelli A, Nakahara M, Hurd M, Placzek A, Knight M, Ladhani SN, Draper ES, Doherty C, Quigley MA, Kurinczuk JJ. Characteristics and outcomes of neonates hospitalised with SARS-CoV-2 infection in the UK by variant: a prospective national cohort study. Arch Dis Child Fetal Neonatal Ed 2024; 109:279-286. [PMID: 37968087 DOI: 10.1136/archdischild-2023-326167] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/25/2023] [Indexed: 11/17/2023]
Abstract
OBJECTIVE Neonatal infection with wildtype SARS-CoV-2 is rare and good outcomes predominate. We investigated neonatal outcomes using national population-level data to describe the impact of different SARS-CoV-2 variants. DESIGN Prospective population-based cohort study. SETTING Neonatal, paediatric and paediatric intensive care inpatient care settings in the UK. PATIENTS Neonates (first 28 days after birth) with confirmed SARS-CoV-2 infection who received inpatient care, March 2020 to April 2022. Neonates were identified through active national surveillance with linkage to national SARS-CoV-2 testing data, routinely recorded neonatal data, paediatric intensive care data and obstetric and perinatal mortality surveillance data. OUTCOMES Presenting signs, clinical course, severe disease requiring respiratory support are presented by the dominant SARS-CoV-2 variant in circulation at the time. RESULTS 344 neonates with SARS-CoV-2 infection received inpatient care; breakdown by dominant variant: 146 wildtype, 123 alpha, 57 delta and 18 omicron. Overall, 44.7% (153/342) neonates required respiratory support; short-term outcomes were good with 93.6% (322/344) of neonates discharged home. Eleven neonates died: seven unrelated to SARS-CoV-2 infection, four were attributed to neonatal SARS-CoV-2 infection (case fatality 4/344, 1.2% 95% CI 0.3% to 3.0%) of which three were born preterm due to maternal COVID-19. More neonates were born very preterm (23/54) and required invasive ventilation (27/57) when delta variant was predominant, and all four SARS-CoV-2-related deaths occurred in this period. CONCLUSIONS Inpatient care for neonates with SARS-CoV-2 was uncommon. Although rare, severe neonatal illness was more common during the delta variant period, potentially reflecting more severe maternal disease and associated preterm birth. TRIAL REGISTRATION NUMBER ISRCTN60033461.
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Affiliation(s)
- Chris Gale
- School of Public Health, Faculty of Medicine, Imperial College of Science Technology and Medicine, London, UK
| | - Don Sharkey
- Academic Child Health, School of Medicine, University of Nottingham, Nottingham, UK
| | | | | | | | - Mariko Nakahara
- National Perinatal Epidemiology Unit, Oxford University, Oxford, UK
| | - Madeleine Hurd
- National Perinatal Epidemiology Unit, Oxford University, Oxford, UK
| | - Anna Placzek
- National Perinatal Epidemiology Unit, Oxford University, Oxford, UK
| | - Marian Knight
- National Perinatal Epidemiology Unit, Oxford University, Oxford, UK
| | | | | | - Cora Doherty
- Neonatology, University Hospital of Wales, Cardiff, UK
| | - Maria A Quigley
- National Perinatal Epidemiology Unit, Oxford University, Oxford, UK
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Engjom HM, Ramakrishnan R, Vousden N, Bunch K, Morris E, Simpson N, Gale C, O'Brien P, Quigley M, Brocklehurst P, Kurinczuk JJ, Knight M. Perinatal outcomes after admission with COVID-19 in pregnancy: a UK national cohort study. Nat Commun 2024; 15:3234. [PMID: 38622110 PMCID: PMC11018846 DOI: 10.1038/s41467-024-47181-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 03/22/2024] [Indexed: 04/17/2024] Open
Abstract
There are few population-based studies of sufficient size and follow-up duration to have reliably assessed perinatal outcomes for pregnant women hospitalised with SARS-CoV-2 infection. The United Kingdom Obstetric Surveillance System (UKOSS) covers all 194 consultant-led UK maternity units and included all pregnant women admitted to hospital with an ongoing SARS-CoV-2 infection. Here we show that in this large national cohort comprising two years' active surveillance over four SARS-CoV-2 variant periods and with near complete follow-up of pregnancy outcomes for 16,627 included women, severe perinatal outcomes were more common in women with moderate to severe COVID-19, during the delta dominant period and among unvaccinated women. We provide strong evidence to recommend continuous surveillance of pregnancy outcomes in future pandemics and to continue to recommend SARS-CoV-2 vaccination in pregnancy to protect both mothers and babies.
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Affiliation(s)
- Hilde Marie Engjom
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK
- Division of Physical and Mental Health, Norwegian Institute of Public Health, 5015, Bergen, Norway
| | - Rema Ramakrishnan
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK
| | - Nicola Vousden
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK
| | - Kathryn Bunch
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK
| | - Edward Morris
- Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK
| | - Nigel Simpson
- Department of Women's and Children's Health, School of Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Chris Gale
- Neonatal Medicine, School of Public Health, Faculty of Medicine, London, London, UK, SW7 2BX and Centre for Paediatrics and Child Health, Imperial College, London, SW7 2AZ, UK
| | - Pat O'Brien
- Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK
- Institute for Women's Health, University College London, London, UK
| | - Maria Quigley
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK
| | - Peter Brocklehurst
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jennifer J Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK.
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Broughan JM, Martin D, Higgins T, Swan G, Cullum A, Kurinczuk JJ, Draper ES, Luyt K, Wellesley DG, Stevens S, Tedstone A, Rankin J. Prevalence of neural tube defects in England prior to the mandatory fortification of non-wholemeal wheat flour with folic acid: a population-based cohort study. Arch Dis Child 2024; 109:106-112. [PMID: 37875332 PMCID: PMC10850651 DOI: 10.1136/archdischild-2023-325856] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 10/02/2023] [Indexed: 10/26/2023]
Abstract
OBJECTIVES To determine the baseline trends in the total birth prevalence of neural tube defects (NTDs) in England (2000-2019) to enable the impact of folic acid fortification of non-wholemeal wheat flour to be monitored. DESIGN Population-based, observational study using congenital anomaly (CA) registration data for England curated by the National Congenital Anomaly and Rare Disease Registration Service (NCARDRS). SETTING Regions of England with active registration in the time period. PARTICIPANTS Babies that were liveborn or stillborn and pregnancies that resulted in a termination of pregnancy or a late miscarriage (20-23 weeks' gestation) with an NTD. MAIN OUTCOME MEASURES Total birth prevalence of anencephaly, spina bifida and all NTDs in England. Poisson regression analysis was used to evaluate time trends with regional register as a random effect. The progress of national registration across England was assessed. RESULTS There were 4541 NTD pregnancies out of 3 637 842 births in England; 1982 anencephaly and 2127 spina bifida. NTD prevalence was 12.5 (95% CI 12.1 to 12.9) per 10 000 total births. NTD prevalence per 10 000 total births was significantly higher in 2015-2019 (13.6, 95% CI 12.9 to 14.4) compared with 2010-2014 (12.1, 95% CI 11.7 to 12.5). An increasing trend in NTDs overall was detected (incidence rate ratio (IRR) 1.01, 1.00 to 1.02), although further analysis determined this effect was confined to 2015-2019 (compared against 2000-2004, IRR 1.14, 1.04 to 1.24). The birth prevalence of anencephaly reflected this pattern. The prevalence of spina bifida remained relatively stable over time. CONCLUSIONS Baseline NTD prevalence for England has been established. National and standardised CA registration is in place, facilitating the systematic and consistent monitoring of pre-fortification and post-fortification NTD trends and evaluating the impact of fortification on NTD prevalence.
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Affiliation(s)
| | - Danielle Martin
- National Disease Registration Service (NDRS), NHS England, Redditch, UK
| | - Thomas Higgins
- National Disease Registration Service (NDRS), NHS England, Redditch, UK
| | - Gillian Swan
- Office for Health Improvement and Disparities, United Kingdom Department of Health and Social Care, London, UK
| | - Adrienne Cullum
- Office for Health Improvement and Disparities, United Kingdom Department of Health and Social Care, London, UK
| | | | | | - Karen Luyt
- Translational Health Sciences, University of Bristol Medical School, Bristol, UK
| | | | - Sarah Stevens
- National Disease Registration Service (NDRS), NHS England, Redditch, UK
| | - Alison Tedstone
- Office for Health Improvement and Disparities, United Kingdom Department of Health and Social Care, London, UK
| | - Judith Rankin
- National Disease Registration Service (NDRS), NHS England, Redditch, UK
- Institute of Health & Society, Newcastle University, Newcastle, UK
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Gwacham-Anisiobi U, Boo YY, Oladimeji A, Kurinczuk JJ, Roberts N, Opondo C, Nair M. Effects of community-based interventions for stillbirths in sub-Saharan Africa: a systematic review and meta-analysis. EClinicalMedicine 2024; 67:102386. [PMID: 38152414 PMCID: PMC10751841 DOI: 10.1016/j.eclinm.2023.102386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/29/2023] [Accepted: 12/04/2023] [Indexed: 12/29/2023] Open
Abstract
Background Sub-Saharan Africa (SSA) alone contributed to 42% of global stillbirths in 2019, and the rate of stillbirth reduction has remained slow. There has been an increased uptake of community-based interventions to combat stillbirth in the region, but the effects of these interventions have been poorly assessed. Our objectives were to examine the effect of community-based interventions on stillbirth in SSA. Methods In this systematic review and meta-analysis, we searched eight databases (MEDLINE [OvidSP], Embase [OvidSP], Cochrane Central Register of Controlled Trials, Global Health, Science Citation Index and Social Science Citation index [Web of Science Core Collection], CINAHL [EBSCOhost] and Global Index Medicus) and four grey literature sources from January 1, 2000 to July 7, 2023 for relevant studies from SSA. Community-based interventions targeting stillbirths solely or as part of complex interventions, with or without hospital interventions were included, while hospital-only interventions, microcredit schemes and maternity waiting home interventions were excluded. Study quality was assessed using the Cochrane risk of bias and National Heart, Lung and Blood Institute's tools. The study outcome was odds of stillbirth in intervention versus control communities. Pooled odds ratios (ORs) were estimated using random-effects models, and subgroup analyses were performed by intervention type and strategies. Publication bias was evaluated by funnel plot and Egger's test. This study is registered with PROSPERO, CRD42021296623. Findings Of the 4223 records identified, seventeen studies from fifteen SSA countries were eligible for inclusion. One study had four arms (community only, hospital only, community and hospital, and control arms), so information was extracted from each arm. Analysis of 13 of the 17 studies which had community-only intervention showed that the odds of stillbirth did not vary significantly between community-based intervention and control groups (OR 0.96; 95% CI 0.78-1.17, I2 = 57%, p ≤ 0.01, n = 63,884). However, analysis of four (out of five) studies that included both community and health facility components found that in comparison with community only interventions, this combination strategy significantly reduced the odds of stillbirth by 17% (OR 0.83; 95% CI 0.79-0.87, I2 = 11%, p = 0.37, n = 244,868), after excluding a study with high risk of bias. The quality of the 17 studies were graded as poor (n = 2), fair (n = 9) and good (n = 6). Interpretation Community-based interventions alone, without strengthening the quality and capacity of health facilities, are unlikely to have a substantial effect on reducing stillbirths in SSA. Funding Nuffield Department of Population Health, Balliol College, the Clarendon Fund, Medical Research Council.
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Affiliation(s)
- Uchenna Gwacham-Anisiobi
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Yebeen Ysabelle Boo
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | | | - Jennifer J. Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Nia Roberts
- Bodleian Health Care Libraries, University of Oxford, Oxford, United Kingdom
| | - Charles Opondo
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Manisha Nair
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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Jackson R, Woodward K, Ireland M, Larkin C, Kurinczuk JJ, Knight M, Gale C, Johnson S, Cornish R, Chakkarapani E. Antenatal and neonatal exposure to SARS-CoV-2 and children's development: a systematic review and meta-analysis. Pediatr Res 2023:10.1038/s41390-023-02954-y. [PMID: 38114608 DOI: 10.1038/s41390-023-02954-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/14/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVES To conduct a systematic review of the impact of antenatal and neonatal exposure to SARS-CoV-2 on developmental outcomes in preterm and term-born infants. METHODS We searched Embase, Emcare, MEDLINE, PsycINFO, Web of Science and grey literature on May 27, 2022 and updated on May 8, 2023. Studies defining exposure with a positive SARS-CoV-2 protein or genetic material, used a contemporaneous non-exposed cohort, and reported developmental outcomes up to 2 years of age were included. RESULTS Four out of 828 screened studies were included. Meta-analysis included 815 infants screened for developmental delay (n = 306 exposed; n = 509 non-exposed) between 3- and 11-months of age. Among term-born infants, we did not find an increased risk of delay in communication (odd's ratio: 0.73 (95% CI: 0.24-2.24)), gross motor (1.50 (0.62, 3.62)), fine motor (2.90 (0.58, 14.43)), problem-solving (1.19 (0.54, 2.66)) or personal-social development (1.93 (0.78, 4.75)) in exposed infants. The number of preterm-born infants in the exposed (n = 37) and comparison cohorts (n = 41) were too few to report meaningful comparisons. CONCLUSION Evidence regarding the potential impact of antenatal or neonatal exposure to SARS-CoV-2 infection on developmental outcomes in early infancy is limited and inconsistent. Larger cohorts with outcomes beyond the first year of life are needed. IMPACT The current evidence examining associations between SARS-CoV-2 exposure during the neonatal period and developmental outcomes in infancy is limited by there being few studies with extremely small sample sizes. Based on sparse data there was no consistent association between antenatal or neonatal exposure to SARS-CoV-2 infection and an adverse impact on developmental outcomes below 12 months of age for babies born preterm or at term. This study highlights that larger cohorts with outcomes assessed beyond the first year are needed to determine the potential longer-term impact of SARS-CoV-2 infection exposure on child development.
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Affiliation(s)
- Rebecca Jackson
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Kathryn Woodward
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Meg Ireland
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Conor Larkin
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Jennifer J Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Chris Gale
- Neonatal Medicine, School of Public Health, Imperial College London, London, United Kingdom
| | - Samantha Johnson
- Department of Population Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Rosie Cornish
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Ela Chakkarapani
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.
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Hua X, Rivero-Arias O, Quigley MA, Kurinczuk JJ, Carson C. Long-term healthcare utilization and costs of babies born after assisted reproductive technologies (ART): a record linkage study with 10-years' follow-up in England. Hum Reprod 2023; 38:2507-2515. [PMID: 37804539 PMCID: PMC10694410 DOI: 10.1093/humrep/dead198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 08/22/2023] [Indexed: 10/09/2023] Open
Abstract
STUDY QUESTION Is the long-term health care utilization of children born after ART more costly to the healthcare system in England than children born to mothers with no fertility problems? SUMMARY ANSWER Children born after ART had significantly more general practitioner (GP) consultations and higher primary care costs up to 10 years after birth, and significantly higher hospital admission costs in the first year after birth, compared to children born to mothers with no fertility problems. WHAT IS KNOWN ALREADY There is evidence that children born after ART are at an increased risk of adverse birth outcomes and a small increased risk of rare adverse outcomes in childhood. STUDY DESIGN, SIZE, DURATION We conducted a longitudinal study of 368 088 mother and baby pairs in England using a bespoke linked dataset. Singleton babies born 1997-2018, and their mothers, who were registered at GP practices in England contributing data to the Clinical Practice Research Datalink (CPRD), were identified through the CPRD GOLD mother-baby dataset; this data was augmented with further linkage to the mothers' Human Fertilisation and Embryology Authority (HFEA) Register data. Four groups of babies were identified through the mothers' records: a 'fertile' comparison group, an 'untreated sub-fertile' group, an 'ovulation induction' group, and an ART group. Babies were followed-up from birth to 28 February 2021, unless censored due to loss to follow-up (e.g. leaving GP practice, emigration) or death. PARTICIPANTS/MATERIALS, SETTING, METHODS The CPRD collects anonymized coded patient electronic health records from a network of GPs in the UK. We estimated primary care costs and hospital admission costs for babies in the four fertility groups using the CPRD GOLD data and the linked Hospital Episode Statistics (HES) Admitted Patient Care (APC) data. Linear regression was used to compare the care costs in the different groups. Inverse probability weights were generated and applied to adjust for potential bias caused by attrition due to loss to follow-up. MAIN RESULTS AND THE ROLE OF CHANCE Children born to mothers with no fertility problems had significantly fewer consultations and lower primary care costs compared to the other groups throughout the 10-years' follow up. Regarding hospital costs, children born after ART had significantly higher hospital admission costs in the first year after birth compared to those born to mothers with no fertility problems (difference = £307 (95% CI: 153, 477)). The same pattern was observed in children born after untreated subfertility and ovulation induction. LIMITATIONS, REASONS FOR CAUTION HFEA linkage uses non-donor data cycles only, and the introduction of consent for data use reduced the availability of HFEA records after 2009. The fertility groups were derived by augmenting HFEA data with evidence from primary care records; however, there remains some potential misclassification of exposure groups. The cost of neonatal critical care is not captured in the HES APC data, which may cause underestimation of the cost differences between the comparison group and the infertility groups. WIDER IMPLICATIONS OF THE FINDINGS The findings can help anticipate the financial impact on the healthcare system associated with subfertility and ART, particularly as the demand for these treatments grows. STUDY FUNDING/COMPETING INTEREST(S) C.C. and this work were funded by a UK Medical Research Council Career Development Award [MR/L019671/1] and a UK MRC Transition Support Award [MR/W029286/1]. X.H. is an Australia National Health and Medical Research Council (NHMRC) Emerging Leadership Fellow [grant number 2009253]. The authors declare no competing interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Xinyang Hua
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Oliver Rivero-Arias
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Maria A Quigley
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jennifer J Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Claire Carson
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Fellmeth G, Kanwar P, Sharma D, Chawla K, DasGupta N, Chhajed S, Chandrakant, Jose EC, Thakur A, Gupta V, Bharti OK, Singh S, Desai G, Thippeswamy H, Kurinczuk JJ, Chandra P, Nair M, Verma A, Kishore MT, Alderdice F. Women's awareness of perinatal mental health conditions and the acceptability of being asked about mental health in two regions in India: a qualitative study. BMC Psychiatry 2023; 23:829. [PMID: 37957589 PMCID: PMC10644637 DOI: 10.1186/s12888-023-05323-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 10/29/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Mental health conditions are common during pregnancy and the first year after childbirth. Early detection allows timely support and treatment to be offered, but identifying perinatal mental health conditions may be challenging due to stigma and under-recognition of symptoms. Asking about symptoms of mental health conditions during routine antenatal and postnatal appointments can help to identify women at risk. This study explores women's awareness of perinatal mental health conditions, their views on the acceptability of being asked about mental health and any preference for specific assessment tools in two regions in India. METHODS Focus group discussions (FGDs) were conducted with pregnant, post-partum and non-perinatal women in Kangra, Himachal Pradesh (northern India) and Bengaluru, Karnataka (southern India). Settings included a hospital antenatal clinic and obstetric ward, Anganwadi Centres and Primary Health Centres. FGDs were facilitated, audio-recorded and transcribed. Narratives were coded for emerging themes and analysed using thematic analysis. RESULTS Seven FGDs including 36 participants were conducted. Emerging themes were: manifestations of and contributors to mental health conditions; challenges in talking about mental health; and the acceptability of being asked about mental health. Difficult familial relationships, prioritising the needs of others and pressure to have a male infant were cited as key stressors. Being asked about mental health was generally reported to be acceptable, though some women felt uncomfortable with questions about suicidality. No preference for any specific assessment tool was reported. CONCLUSIONS Women face many stressors during the perinatal period including difficult familial relationships and societal pressure to bear a male infant. Being asked about mental health was generally considered to be acceptable, but questions relating to suicidality may be challenging in a community setting, requiring sensitivity by the interviewer. Future studies should assess the acceptability of mental health assessments in 'real world' antenatal and postnatal clinics and explore ways of overcoming the associated challenges in resource-constrained settings.
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Affiliation(s)
- Gracia Fellmeth
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - Pankaj Kanwar
- Department of Psychiatry, Dr Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India
| | - Diksha Sharma
- Department of Obstetrics and Gynaecology, Dr Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India
| | | | - Neha DasGupta
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Shreyash Chhajed
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Chandrakant
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Emily C Jose
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Anita Thakur
- Department of Psychiatry, Dr Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India
| | - Vikesh Gupta
- Department of Psychiatry, Dr Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India
| | - Omesh Kumar Bharti
- State Institute of Health and Family Welfare, Department of Health and Family Welfare, Government of Himachal Pradesh, Shimla, India
| | - Sukhjit Singh
- Department of Psychiatry, Dr Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India
| | - Geetha Desai
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Harish Thippeswamy
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Jennifer J Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Prabha Chandra
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Manisha Nair
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Ashok Verma
- Department of Obstetrics and Gynaecology, Dr Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India
| | - M Thomas Kishore
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Fiona Alderdice
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland
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10
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Seaton SE, Agarwal R, Draper ES, Fenton AC, Kurinczuk JJ, Manktelow BN, Smith LK. Estimated neonatal survival of very preterm births across the care pathway: a UK cohort 2016-2020. Arch Dis Child Fetal Neonatal Ed 2023; 108:562-568. [PMID: 37080732 DOI: 10.1136/archdischild-2022-324987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 03/30/2023] [Indexed: 04/22/2023]
Abstract
OBJECTIVE Currently used estimates of survival are nearly 10 years old and relate to only those babies admitted for neonatal care. Due to ongoing improvements in neonatal care, here we update estimates of survival for singleton and multiple births at 22+0 to 31+6 weeks gestational age across the perinatal care pathway by gestational age and birth weight. DESIGN Retrospective analysis of routinely collected data. SETTING A national cohort from the UK and British Crown Dependencies. PATIENTS Babies born at 22+0 to 31+6 weeks gestational age from 1 January 2016 to 31 December 2020. INTERVENTIONS None. MAIN OUTCOME MEASURES Survival to 28 days. RESULTS Estimates of neonatal survival are provided for babies: (1) alive at the onset of care during the birthing process (n=43 763); (2) babies where survival-focused care was initiated (n=42 004); and (3) babies admitted for neonatal care (n=41 158). We have produced easy-to-use survival charts for singleton and multiple births. Generally, survival increased with increasing gestational age at birth and with increasing birth weight. For all births with a birthweight over 1000 g, survival was 90% or higher at all three stages of care. CONCLUSIONS Survival estimates are a vital tool to support and supplement clinical judgement within perinatal care. These up-to-date, national estimates of survival to 28 days are provided based on three stages of the perinatal care pathway to support ongoing clinical care. These novel results are a key resource for policy and practice including counselling parents and informing care provision.
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Affiliation(s)
- Sarah E Seaton
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Ridhi Agarwal
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Elizabeth S Draper
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Alan C Fenton
- Newcastle Neonatal Service, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | | | - Bradley N Manktelow
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Lucy K Smith
- Department of Population Health Sciences, University of Leicester, Leicester, UK
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11
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Elkington M, Kurinczuk JJ, Pasupathy D, Plachcinski R, Rogers J, Williams C, Rowe R. Postpartum haemorrhage occurring in UK midwifery units: A national population-based case-control study to investigate incidence, risk factors and outcomes. PLoS One 2023; 18:e0291795. [PMID: 37796876 PMCID: PMC10553245 DOI: 10.1371/journal.pone.0291795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 09/02/2023] [Indexed: 10/07/2023] Open
Abstract
OBJECTIVES To estimate the incidence of, and investigate risk factors for, postpartum haemorrhage (PPH) requiring transfer to obstetric care following birth in midwifery units (MU) in the UK; to describe outcomes for women who experience PPH requiring transfer to obstetric care. METHODS We conducted a national population-based case-control study in all MUs in the UK using the UK Midwifery Study System (UKMidSS). Between September 2019 and February 2020, 1501 women with PPH requiring transfer to obstetric care following birth in an MU, and 1475 control women were identified. We used multivariable logistic regression, generating adjusted odds ratios (aORs) and 95% confidence intervals (CIs) to investigate risk factors for PPH requiring transfer to obstetric care. RESULTS The incidence of PPH requiring transfer to obstetric care following birth in an MU was 3.7% (95% CI 3.6%-3.9%). Factors independently associated with PPH requiring transfer to obstetric care were smoking during pregnancy (aOR = 0.73; 95% CI 0.56-0.94), nulliparity (aOR = 1.96; 95% CI 1.66-2.30), previous PPH (aOR = 2.67; 95% CI 1.67-4.25), complications in a previous pregnancy other than PPH (aOR = 2.40; 95% CI 1.25-4.60), gestational age ≥41 weeks (aOR = 1.36; 95% CI 1.10-1.69), instrumental birth (aOR = 2.69; 95% CI 1.53-4.72), third stage of labour ≥60 minutes (aOR = 5.56; 95% CI 3.93-7.88), perineal trauma (aOR = 4.67; 95% CI 3.16-6.90), and birthweight 3500-3999g (aOR = 1.71; 95% CI 1.42-2.07) or ≥4000g (aOR = 2.31; 95% CI 1.78-3.00). One in ten (10.6%) cases received a blood transfusion and one in five (21.0%) were admitted to higher level care. CONCLUSIONS The risk factors identified in this study align with those identified in previous research and with current guidelines for women planning birth in an MU in the UK. Maternal outcomes after PPH were broadly reassuring and indicative of appropriate management. NHS organisations should ensure that robust guidelines are in place to support management of PPH in MUs.
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Affiliation(s)
- Madeline Elkington
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Jennifer J. Kurinczuk
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Dharmintra Pasupathy
- Reproduction and Perinatal Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Rachel Plachcinski
- Independent Parent, Patient and Public Involvement Consultant, Dewsbury, United Kingdom
| | - Jane Rogers
- Consultant Midwife, Formerly at University Hospitals Southampton, Southampton, United Kingdom
| | - Catherine Williams
- Independent Parent, Patient and Public Involvement Consultant, Henley on Thames, United Kingdom
| | - Rachel Rowe
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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12
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Hua X, Petrou S, Coathup V, Carson C, Kurinczuk JJ, Quigley MA, Boyle E, Johnson S, Macfarlane A, Rivero-Arias O. Gestational age and hospital admission costs from birth to childhood: a population-based record linkage study in England. Arch Dis Child Fetal Neonatal Ed 2023; 108:485-491. [PMID: 36759168 PMCID: PMC10447377 DOI: 10.1136/archdischild-2022-324763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 01/27/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVE To examine the association between gestational age at birth and hospital admission costs from birth to 8 years of age. DESIGN Population-based, record linkage, cohort study in England. SETTING National Health Service (NHS) hospitals in England, UK. PARTICIPANTS 1 018 136 live, singleton births in NHS hospitals in England between 1 January 2005 and 31 December 2006. MAIN OUTCOME MEASURES Hospital admission costs from birth to age 8 years, estimated by gestational age at birth (<28, 28-29, 30-31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41 and 42 weeks). RESULTS Both birth admission and subsequent admission hospital costs decreased with increasing gestational age at birth. Differences in hospital admission costs between gestational age groups diminished with increasing age, particularly after the first 2 years following birth. Children born extremely preterm (<28 weeks) and very preterm (28-31 weeks) still had higher average hospital admission costs (£699 (95% CI £419 to £919) for <28 weeks; £434 (95% CI £305 to £563) for 28-31 weeks) during the eighth year of life compared with children born at 40 weeks (£109, 95% CI £104 to £114). Children born extremely preterm had the highest 8-year cumulative hospital admission costs per child (£80 559 (95% CI £79 238 to £82 019)), a large proportion of which was incurred during the first year after birth (£71 997 (95% CI £70 866 to £73 097)). CONCLUSIONS The association between gestational age at birth and hospital admission costs persists into mid-childhood. The study results provide a useful costing resource for future economic evaluations focusing on preventive and treatment strategies for babies born preterm.
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Affiliation(s)
- Xinyang Hua
- Centre for Health Policy, Melbourne School for Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Stavros Petrou
- Nuffield Department of Primary Care Health, University of Oxford, Oxford, UK
| | - Victoria Coathup
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Claire Carson
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jennifer J Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Maria A Quigley
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Elaine Boyle
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Samantha Johnson
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Alison Macfarlane
- Centre for Maternal and Child Health Research, City, University of London, London, UK
| | - Oliver Rivero-Arias
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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13
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Ali S, Mactier H, Morelli A, Hurd M, Placzek A, Knight M, Ladhani SN, Draper ES, Sharkey D, Doherty C, Kurinczuk JJ, Quigley MA, Gale C. Neonatal outcomes of maternal SARS-CoV-2 infection in the UK: a prospective cohort study using active surveillance. Pediatr Res 2023; 94:1203-1208. [PMID: 36899124 PMCID: PMC10000338 DOI: 10.1038/s41390-023-02527-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 01/25/2023] [Accepted: 01/30/2023] [Indexed: 03/12/2023]
Abstract
BACKGROUND Newborns may be affected by maternal SARS-CoV-2 infection during pregnancy. We aimed to describe the epidemiology, clinical course and short-term outcomes of babies admitted to a neonatal unit (NNU) following birth to a mother with confirmed SARS-CoV-2 infection within 7 days of birth. METHODS This is a UK prospective cohort study; all NHS NNUs, 1 March 2020 to 31 August 2020. Cases were identified via British Paediatric Surveillance Unit with linkage to national obstetric surveillance data. Reporting clinicians completed data forms. Population data were extracted from the National Neonatal Research Database. RESULTS A total of 111 NNU admissions (1.98 per 1000 of all NNU admissions) involved 2456 days of neonatal care (median 13 [IQR 5, 34] care days per admission). A total of 74 (67%) babies were preterm. In all, 76 (68%) received respiratory support; 30 were mechanically ventilated. Four term babies received therapeutic hypothermia for hypoxic ischaemic encephalopathy. Twenty-eight mothers received intensive care, with four dying of COVID-19. Eleven (10%) babies were SARS-CoV-2 positive. A total of 105 (95%) babies were discharged home; none of the three deaths before discharge was attributed to SARS-CoV-2. CONCLUSION Babies born to mothers with SARS-CoV-2 infection around the time of birth accounted for a low proportion of total NNU admissions over the first 6 months of the UK pandemic. Neonatal SARS-CoV-2 was uncommon. STUDY REGISTRATION ISRCTN60033461; protocol available at http://www.npeu.ox.ac.uk/pru-mnhc/research-themes/theme-4/covid-19 . IMPACT Neonatal unit admissions of babies born to mothers with SARS-CoV-2 infection comprised only a small proportion of total neonatal admissions in the first 6 months of the pandemic. A high proportion of babies requiring neonatal admission who were born to mothers with confirmed SARS-CoV-2 infection were preterm and had neonatal SARS-CoV-2 infection and/or other conditions associated with long-term sequelae. Adverse neonatal conditions were more common in babies whose SARS-CoV-2-positive mothers required intensive care compared to those whose SARS-CoV-2-positive mothers who did not.
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Affiliation(s)
- Shohaib Ali
- School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Helen Mactier
- Princess Royal Maternity and the University of Glasgow, Glasgow, UK
| | - Alessandra Morelli
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Madeleine Hurd
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Anna Placzek
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Marian Knight
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Shamez N Ladhani
- Paediatric Infectious Diseases and Vaccinology, St. George's University of London, London, UK
| | - Elizabeth S Draper
- Department of Health Sciences, Centre for Medicine, University of Leicester, University Road, Leicester, UK
| | - Don Sharkey
- Centre for Perinatal Research, School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Jennifer J Kurinczuk
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Maria A Quigley
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Chris Gale
- School of Public Health, Faculty of Medicine, Imperial College London, Chelsea and Westminster Campus, 369 Fulham Road, London, SW10 9NH, UK.
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14
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Gwacham-Anisiobi U, Boo YY, Oladimeji A, Kurinczuk JJ, Roberts N, Opondo C, Nair M. Types, reporting and acceptability of community-based interventions for stillbirth prevention in sub-Saharan Africa (SSA): a systematic review. EClinicalMedicine 2023; 62:102133. [PMID: 37593225 PMCID: PMC10430180 DOI: 10.1016/j.eclinm.2023.102133] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 08/19/2023] Open
Abstract
Background Community-based interventions are increasingly being implemented in Sub-Saharan Africa (SSA) for stillbirth prevention, but the nature of these interventions, their reporting and acceptability are poorly assessed. In addition to understanding their effectiveness, complete reporting of the methods, results and intervention acceptability is essential as it could potentially reduce research waste from replication of inadequately implemented and unacceptable interventions. We conducted a systematic review to investigate these aspects of community-based interventions for preventing stillbirths in SSA. Methods In this systematic review, eight databases (MEDLINE(OvidSP), Embase (OvidSP), Cochrane Central Register of Controlled Trials, Global Health, Science Citation Index and Social Science Citation index (Web of Science Core Collection), CINAHL (EBSCOhost) and Global Index Medicus) and four grey literature sources were searched from January 1, 2000 to July 7, 2023 for relevant quantitative and qualitative studies from SSA (PROSPERO-CRD42021296623). Following deduplication, abstract screening and full-text review, studies were included if the interventions were community-based with or without a health facility component. The main outcomes were types of community-based interventions, completeness of intervention reporting using the TIDier (Template for Intervention Description and replication) checklist, and themes related to intervention acceptability identified using a theoretical framework. Study quality was assessed using the Cochrane risk of bias and National Heart, Lung and Blood Institute's tools. Findings Thirty-nine reports from thirty-four studies conducted in 18 SSA countries were eligible for inclusion. Four types of interventions were identified: nutritional, infection prevention, access to skilled childbirth attendants and health knowledge/behaviour of women. These interventions were implemented using nine strategies: mHealth (defined as the use of mobile and wireless technologies to support the achievement of health objectives), women's groups, community midwifery, home visits, mass media sensitisation, traditional birth attendant and community volunteer training, community mobilisation and transport vouchers. The completeness of reporting using the TIDier checklist varied across studies with a very low proportion of the included studies reporting the intervention intensity, dosing, tailoring and modification. The quality of the included studies were graded as poor (n = 6), fair (n = 14) and good (n = 18). Though interventions were acceptable, only 4 (out of 7) studies explored women's perceptions, mostly focusing on perceived intervention effects and how they felt, omitting key constructs like ethicality, opportunity cost and burden of participation. Interpretation Different community-based interventions have been tried and evaluated for stillbirth prevention in SSA. The reproducibility and implementation scale-up of these interventions may be limited by incomplete intervention descriptions in the published literature. To strengthen impact, it is crucial to holistically explore the acceptability of these interventions among women and their families. Funding Clarendon/Balliol/NDPH DPhil scholarship for UGA. MN is funded by a Medical Research Council Transition Support Award (MR/W029294/1).
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Affiliation(s)
- Uchenna Gwacham-Anisiobi
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Yebeen Ysabelle Boo
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | | | - Jennifer J. Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Nia Roberts
- Bodleian Health Care Libraries, University of Oxford, Oxford, United Kingdom
| | - Charles Opondo
- London Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Manisha Nair
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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15
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Goulding A, McQuaid F, Lindsay L, Agrawal U, Auyeung B, Calvert C, Carruthers J, Denny C, Donaghy J, Hillman S, Hopcroft L, Hopkins L, McCowan C, McLaughlin T, Moore E, Ritchie L, Simpson CR, Taylor B, Fenton L, Pollock L, Gale C, Kurinczuk JJ, Robertson C, Sheikh A, Stock S, Wood R. Confirmed SARS-CoV-2 infection in Scottish neonates 2020-2022: a national, population-based cohort study. Arch Dis Child Fetal Neonatal Ed 2023; 108:367-372. [PMID: 36609412 PMCID: PMC10313998 DOI: 10.1136/archdischild-2022-324713] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 12/10/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To examine neonates in Scotland aged 0-27 days with SARS-CoV-2 infection confirmed by viral testing; the risk of confirmed neonatal infection by maternal and infant characteristics; and hospital admissions associated with confirmed neonatal infections. DESIGN Population-based cohort study. SETTING AND POPULATION All live births in Scotland, 1 March 2020-31 January 2022. RESULTS There were 141 neonates with confirmed SARS-CoV-2 infection over the study period, giving an overall infection rate of 153 per 100 000 live births (141/92 009, 0.15%). Among infants born to women with confirmed infection around the time of birth, the confirmed neonatal infection rate was 1812 per 100 000 live births (15/828, 1.8%). Two-thirds (92/141, 65.2%) of neonates with confirmed infection had an associated admission to neonatal or (more commonly) paediatric care. Six of these babies (6/92, 6.5%) were admitted to neonatal and/or paediatric intensive care; however, none of these six had COVID-19 recorded as their main diagnosis. There were no neonatal deaths among babies with confirmed infection. IMPLICATIONS AND RELEVANCE Confirmed neonatal SARS-CoV-2 infection was uncommon over the first 23 months of the pandemic in Scotland. Secular trends in the neonatal confirmed infection rate broadly followed those seen in the general population, although at a lower level. Maternal confirmed infection at birth was associated with an increased risk of neonatal confirmed infection. Two-thirds of neonates with confirmed infection had an associated admission to hospital, with resulting implications for the baby, family and services, although their outcomes were generally good. Ascertainment of confirmed infection depends on the extent of testing, and this is likely to have varied over time and between groups: the extent of unconfirmed infection is inevitably unknown.
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Affiliation(s)
| | - Fiona McQuaid
- Department of Child Life and Health, University of Edinburgh, Edinburgh, UK
| | | | - Utkarsh Agrawal
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Bonnie Auyeung
- School of Philosophy, Psychology and Language Sciences, The University of Edinburgh, Edinburgh, UK
| | - Clara Calvert
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | | | | | - Sam Hillman
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Lisa Hopcroft
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Colin McCowan
- School of Medicine, University of St Andrews, St Andrews, UK
| | | | | | - Lewis Ritchie
- Academic Primary Care, University of Aberdeen, Aberdeen, UK
| | - Colin R Simpson
- Usher Institute, University of Edinburgh, Edinburgh, UK
- School of Health, Victoria University of Wellington, Wellington, New Zealand
| | | | | | - Louisa Pollock
- Child Health, University of Glasgow, Glasgow, UK
- Department of Paediatric Infectious Diseases and Immunology, Royal Hospital for Children, Glasgow, UK
| | - Chris Gale
- Academic Neonatal Medicine, Imperial College London, London, UK
| | | | - Chris Robertson
- Public Health Scotland, Edinburgh, UK
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Sarah Stock
- Public Health Scotland, Edinburgh, UK
- Obstetrics and Gynaecology, MRC Centre for Reproductive Health University of Edinburgh, Edinburgh, UK
| | - Rachael Wood
- Public Health Scotland, Edinburgh, UK
- Usher Institute, University of Edinburgh, Edinburgh, UK
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16
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Latt SM, Alderdice F, Elkington M, Awng Shar M, Kurinczuk JJ, Rowe R. Primary postpartum haemorrhage and longer-term physical, psychological, and psychosocial health outcomes for women and their partners in high income countries: A mixed-methods systematic review. PLoS One 2023; 18:e0274041. [PMID: 37315027 PMCID: PMC10266652 DOI: 10.1371/journal.pone.0274041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 05/15/2023] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVES Most research about outcomes following postpartum haemorrhage (PPH) has focused on immediate outcomes. There are fewer studies investigating longer-term maternal morbidity following PPH, resulting in a significant knowledge gap. This review aimed to synthesize the evidence about the longer-term physical and psychological consequences of primary PPH for women and their partners from high income settings. METHODS The review was registered with PROSPERO and five electronic databases were searched. Studies were independently screened against the eligibility criteria by two reviewers and data were extracted from both quantitative and qualitative studies that reported non-immediate health outcomes of primary PPH. RESULTS Data were included from 24 studies, of which 16 were quantitative, five were qualitative and three used mixed-methods. The included studies were of mixed methodological quality. Of the nine studies reporting outcomes beyond five years after birth, only two quantitative studies and one qualitative study had a follow-up period longer than ten years. Seven studies reported outcomes or experiences for partners. The evidence indicated that women with PPH were more likely to have persistent physical and psychological health problems after birth compared with women who did not have a PPH. These problems, including PTSD symptoms and cardiovascular disease, may be severe and extend for many years after birth and were more pronounced after a severe PPH, as indicated by a blood transfusion or hysterectomy. There was limited evidence about outcomes for partners after PPH, but conflicting evidence of association between PTSD and PPH among partners who witnessed PPH. CONCLUSION This review explored existing evidence about longer-term physical and psychological health outcomes among women who had a primary PPH in high income countries, and their partners. While the evidence about health outcomes beyond five years after PPH is limited, our findings indicate that women can experience long lasting negative impacts after primary PPH, including PTSD symptoms and cardiovascular disease, extending for many years after birth. PROSPERO REGISTRATION PROSPERO registration number: CRD42020161144.
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Affiliation(s)
- Su Mon Latt
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Fiona Alderdice
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Madeline Elkington
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Mahkawnghta Awng Shar
- Health and Nutrition Specialist, United Nations International Children Fund, Myanmar
| | - Jennifer J. Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Rachel Rowe
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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Boo YY, Gwacham-Anisiobi U, Thakrar DB, Roberts N, Kurinczuk JJ, Lakhanpaul M, Nair M. Facility-based stillbirth review processes used in different countries across the world: a systematic review. EClinicalMedicine 2023; 59:101976. [PMID: 37180470 PMCID: PMC10173150 DOI: 10.1016/j.eclinm.2023.101976] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 05/16/2023] Open
Abstract
Background Facility-based stillbirth review provides opportunities to estimate incidence, evaluate causes and risk factors for stillbirths, and identify any issues related to the quality of pregnancy and childbirth care which require improvement. Our aim was to systematically review all types and methods of facility-based stillbirth review processes used in different countries across the world, to examine how stillbirth reviews in facility settings are being conducted worldwide and to identify the outcomes of implementing the reviews. Moreover, to identify facilitators and barriers influencing the implementation of the identified facility-based stillbirth reviews processes by conducting subgroup analyses. Methods A systematic review of published literature was conducted by searching MEDLINE (OvidSP) [1946-present], EMBASE (OvidSP) [1974-present], WHO Global Index Medicus (globalindexmedicus.net), Global Health (OvidSP) [1973-2022 Week 8] and CINAHL (EBSCOHost) [1982-present] from their inception until 11 January, 2023. For unpublished or grey literature, the WHO databases, Google Scholar and ProQuest Dissertations & Theses Global were searched, as well as hand searching the reference lists of included studies. MESH terms encompassing "∗Clinical Audit", "∗Perinatal Mortality", "Pregnancy Complications", and "Stillbirth" were used with Boolean operators. Studies that used a facility-based review process or any approach to evaluate care prior to stillbirth, and explained the methods used were included. Reviews and editorials were excluded. Three authors (YYB, UGA, and DBT) independently screened and extracted data, and assessed the risk of bias using an adapted JBI's Checklist for Case Series. A logic model was used to inform the narrative synthesis. The review protocol was registered with PROSPERO, CRD42022304239. Findings A total of 68 studies from 17 high-income (HICs) and 22 low-and-middle-income countries (LMICs) met the inclusion criteria from a total of 7258 identified records. These were stillbirth reviews conducted at different levels: district, state, national, and international. Three types were identified: audit, review, and confidential enquiry, but not all desired components were included in most processes, which led to a mismatch between the description of the type and the actual method used. Routine data from hospital records was the most common data source for identifying stillbirths, and case assessment was based on stillbirth definition in 48 out of 68 studies. Hospital notes were the most common source of information about care received and causes/risk factors for stillbirth. Short-term and medium-term outcomes were reported in 14 studies, but impact of the review process on reducing stillbirth, which is more difficult to establish, was not reported in any study. Facilitators and barriers in implementing a successful stillbirth review process identified from 14 studies focused on three main themes: resources, expertise, and commitment. Interpretation This systematic review's findings identified that there is a need for clear guidelines on how to measure the impact of implementation of changes based on outputs of stillbirth reviews and methods to enable effective dissemination of learning points in the future and promoting them through training platforms. In addition, there is a need to develop and adopt a universal definition of stillbirth to facilitate meaningful comparison of stillbirth rates between regions. The key limitation of this review is that while using a logic model for narrative synthesis was deemed most appropriate for this study, sequence of implementing a stillbirth review in the real world is not linear, and assumptions are often not met. Therefore, the logic model proposed in this study should be interpreted with flexibility when designing a stillbirth review process. The generated learnings from the stillbirth review processes inform the action plans and allow facilities to consider where the changes should happen to improve the quality of care in the facilities, enabling positive short-term and medium-term outcomes. Funding Kellogg College, University of Oxford, Clarendon Fund, University of Oxford, Nuffield Department of Population Health, University of Oxford and Medical Research Council (MRC).
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Affiliation(s)
- Yebeen Ysabelle Boo
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Uchenna Gwacham-Anisiobi
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Dixa B. Thakrar
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Nia Roberts
- Bodleian Health Care Libraries, University of Oxford, Oxford, United Kingdom
| | - Jennifer J. Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Monica Lakhanpaul
- UCL Great Ormond Street Institute of Child Health, Faculty of Population Health Sciences, University College London, London, United Kingdom
| | - Manisha Nair
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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18
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Bergman JEH, Barišić I, Addor MC, Braz P, Cavero-Carbonell C, Draper ES, Echevarría-González-de-Garibay LJ, Gatt M, Haeusler M, Khoshnood B, Klungsøyr K, Kurinczuk JJ, Latos-Bielenska A, Luyt K, Martin D, Mullaney C, Nelen V, Neville AJ, O'Mahony MT, Perthus I, Pierini A, Randrianaivo H, Rankin J, Rissmann A, Rouget F, Sayers G, Schaub B, Stevens S, Tucker D, Verellen-Dumoulin C, Wiesel A, Gerkes EH, Perraud A, Loane MA, Wellesley D, de Walle HEK. Amniotic band syndrome and limb body wall complex in Europe 1980-2019. Am J Med Genet A 2023; 191:995-1006. [PMID: 36584346 DOI: 10.1002/ajmg.a.63107] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/29/2022] [Accepted: 12/19/2022] [Indexed: 12/31/2022]
Abstract
Amniotic band syndrome (ABS) and limb body wall complex (LBWC) have an overlapping phenotype of multiple congenital anomalies and their etiology is unknown. We aimed to determine the prevalence of ABS and LBWC in Europe from 1980 to 2019 and to describe the spectrum of congenital anomalies. In addition, we investigated maternal age and multiple birth as possible risk factors for the occurrence of ABS and LBWC. We used data from the European surveillance of congenital anomalies (EUROCAT) network including data from 30 registries over 1980-2019. We included all pregnancy outcomes, including live births, stillbirths, and terminations of pregnancy for fetal anomalies. ABS and LBWC cases were extracted from the central EUROCAT database using coding information responses from the registries. In total, 866 ABS cases and 451 LBWC cases were included in this study. The mean prevalence was 0.53/10,000 births for ABS and 0.34/10,000 births for LBWC during the 40 years. Prevalence of both ABS and LBWC was lower in the 1980s and higher in the United Kingdom. Limb anomalies and neural tube defects were commonly seen in ABS, whereas in LBWC abdominal and thoracic wall defects and limb anomalies were most prevalent. Twinning was confirmed as a risk factor for both ABS and LBWC. This study includes the largest cohort of ABS and LBWC cases ever reported over a large time period using standardized EUROCAT data. Prevalence, clinical characteristics, and the phenotypic spectrum are described, and twinning is confirmed as a risk factor.
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Affiliation(s)
- Jorieke E H Bergman
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ingeborg Barišić
- Children's Hospital Zagreb, Centre of Excellence for Reproductive and Regenerative Medicine, Medical School University of Zagreb, Zagreb, Croatia
| | - Marie-Claude Addor
- Department of Woman-Mother-Child, University Medical Center CHUV, Lausanne, Switzerland
| | - Paula Braz
- RENAC-Registo Nacional de Anomalias Congénitas, Epidemiology Department, National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal
| | - Clara Cavero-Carbonell
- Rare Diseases Research Unit, Foundation for the Promotion of the Research in Healthcare and Biomedicine, Valencia, Spain
| | | | | | - Miriam Gatt
- Malta Congenital Anomalies Registry, Directorate for Health Information and Research, G'mangia, Malta
| | - Martin Haeusler
- Department of Obstetrics and Gynaecology, Medical University of Graz, Graz, Austria
| | - Babak Khoshnood
- Université de Paris Cité, Obstetrical Perinatal and Paediatric Epidemiology Research Team (EPOPé), CRESS, INSERM, INRA, Paris, France
| | - Kari Klungsøyr
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
| | - Jennifer J Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Anna Latos-Bielenska
- Polish Registry of Congenital Malformations, Department of Medical Genetics, Poznan University of Medical Sciences, Poznan, Poland
| | - Karen Luyt
- South West Congenital Anomaly Register (SWCAR), Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Carmel Mullaney
- Department of Public Health, HSE South East Area, Dublin, Ireland
| | - Vera Nelen
- Provincial Institute of Hygiene, Antwerp, Belgium
| | - Amanda J Neville
- IMER Registry, Centre for Clinical and Epidemiological Research, University of Ferrara and Azienda Ospedaliero Universitario di Ferrara, Ferrara, Italy
| | - Mary T O'Mahony
- Department of Public Health HSE-South, St Finbarr's Hospital, Cork, Ireland
| | - Isabelle Perthus
- Auvergne Registry of Congenital Anomalies (CEMC-Auvergne), Department of Clinical Genetics, Centre de Référence des Maladies Rares, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Anna Pierini
- Unit of Epidemiology of Rare Diseases and Congenital Anomalies, Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Hanitra Randrianaivo
- Unit of Genetic Medical and Register of Congenital Malformations, CHU St Pierre La Reunion, Réunion, France
| | - Judith Rankin
- South West Congenital Anomaly Register (SWCAR), Bristol Medical School, University of Bristol, Bristol, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Anke Rissmann
- Malformation Monitoring Centre Saxony-Anhalt, Medical Faculty Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Florence Rouget
- Brittany Registry of Congenital Anomalies, CHU Rennes, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), UMR_S 1085, Rennes, France
| | - Gerardine Sayers
- National Health Intelligence Unit, R&D Health Service Executive, Dublin, Ireland
| | - Bruno Schaub
- French West Indies Registry, Registre des Malformations des Antilles (REMALAN), Maison de la Femme de la Mère et de l'Enfant, University Hospital of Martinique, Fort-de-France, France
| | | | - David Tucker
- Congenital Anomaly Register & Information Service for Wales (CARIS), Public Health Wales, Swansea, UK
| | | | - Awi Wiesel
- Births Registry Mainz Model, University of Mainz Medical Center, Mainz, Germany
| | - Erica H Gerkes
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Annie Perraud
- European Commission, Joint Research Centre (JRC), Ispra, Italy
| | - Maria A Loane
- Faculty of Life & Health Sciences, Ulster University, Northern Ireland, UK
| | - Diana Wellesley
- Faculty of Medicine and Wessex Clinical Genetics Service, Princess Anne Hospital, University Hospital Southampton, Southampton, UK
| | - Hermien E K de Walle
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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19
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Coi A, Barisic I, Garne E, Pierini A, Addor MC, Aizpurua Atxega A, Ballardini E, Braz P, Broughan JM, Cavero-Carbonell C, de Walle HEK, Draper ES, Gatt M, Häusler M, Kinsner-Ovaskainen A, Kurinczuk JJ, Lelong N, Luyt K, Mezzasalma L, Mullaney C, Nelen V, Odak L, O'Mahony MT, Perthus I, Randrianaivo H, Rankin J, Rissmann A, Rouget F, Schaub B, Tucker D, Wellesley D, Wiśniewska K, Yevtushok L, Santoro M. Epidemiology of aplasia cutis congenita: A population-based study in Europe. J Eur Acad Dermatol Venereol 2023; 37:581-589. [PMID: 36300660 DOI: 10.1111/jdv.18690] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 10/06/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Aplasia cutis congenita (ACC) is a rare congenital anomaly characterized by localized or widespread absence of skin at birth, mainly affecting the scalp. Most information about ACC exists as individual case reports and medium-sized studies. OBJECTIVES This study aimed to investigate the epidemiology of ACC, using data from a large European network of population-based registries for congenital anomalies (EUROCAT). METHODS Twenty-eight EUROCAT population-based registries in 16 European countries were involved. Poisson regression models were exploited to estimate the overall and live birth prevalence, to test time trends in prevalence between four 5-year periods and to evaluate the impact of the change of coding for ACC from the unspecific ICD9-BPA code to the specific ICD10 code. Proportions of ACC cases associated with other anomalies were reported. RESULTS Five hundred cases were identified in the period 1998-2017 (prevalence: 5.10 per 100,000 births). Prevalence across 5-year periods did not differ significantly and no significant differences were evident due to the change from ICD9 to ICD10 in ACC coding. Heterogeneity in prevalence was observed across registries. The scalp was the most common site for ACC (96.4%) and associated congenital anomalies were present in 33.8% of cases. Patau and Adams-Oliver syndromes were the most frequent among the associated chromosomal anomalies (88.3%) and the associated genetic syndromes (57.7%), respectively. 16% of cases were associated with limb anomalies and 15.4% with congenital heart defects. A family history of ACC was found in 2% of cases. CONCLUSION To our knowledge, this is the only population-based study on ACC. The EUROCAT methodologies provide reliable prevalence estimates and proportions of associated anomalies.
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Affiliation(s)
- Alessio Coi
- Unit of Epidemiology of Rare Diseases and Congenital Anomalies, Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Ingeborg Barisic
- Children's Hospital Zagreb, Centre of Excellence for Reproductive and Regenerative Medicine, Medical School University of Zagreb, Zagreb, Croatia
| | - Ester Garne
- Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
| | - Anna Pierini
- Unit of Epidemiology of Rare Diseases and Congenital Anomalies, Institute of Clinical Physiology, National Research Council, Pisa, Italy
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Marie-Claude Addor
- Department of Woman-Mother-Child, University Medical Center CHUV, Lausanne, Switzerland
| | - Amaia Aizpurua Atxega
- Public Health Division of Gipuzkoa, Biodonostia Research Institute, Donostia-San Sebastian, Spain
| | - Elisa Ballardini
- Neonatal Intensive Care Unit, Paediatric Section, IMER Registry (Emilia Romagna Registry of Birth Defects), Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Paula Braz
- Epidemiology Department, National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal
| | - Jennifer M Broughan
- National Congenital Anomaly and Rare Disease Registration Service, National Disease Registration Service, NHS Digital, Leeds, UK
| | - Clara Cavero-Carbonell
- Rare Diseases Research Unit, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region, Valencia, Spain
| | - Hermien E K de Walle
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Elizabeth S Draper
- Department Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Miriam Gatt
- Malta Congenital Anomalies Registry, Directorate for Health Information and Research, G'Mangia, Malta
| | | | | | - Jennifer J Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Nathalie Lelong
- Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Paris, France
| | - Karen Luyt
- South West Congenital Anomaly Register, Bristol Medical School, University of Bristol, Bristol, UK
| | - Lorena Mezzasalma
- Unit of Epidemiology of Rare Diseases and Congenital Anomalies, Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Carmel Mullaney
- Department of Public Health, HSE South East, Lacken, Kilkenny, Ireland
| | - Vera Nelen
- Provincial Institute of Hygiene, Antwerp, Belgium
| | - Ljubica Odak
- Children's Hospital Zagreb, Centre of Excellence for Reproductive and Regenerative Medicine, Medical School University of Zagreb, Zagreb, Croatia
| | - Mary T O'Mahony
- Department of Public Health, HSE South (Cork & Kerry), Cork, Ireland
| | - Isabelle Perthus
- Auvergne Registry of Congenital Anomalies (CEMC-Auvergne), Department of Clinical Genetics, Centre de Référence des Maladies Rares, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Hanitra Randrianaivo
- Register of Congenital Malformations Isle of Reunion Island, CHU St Pierre, la Reunion, Reunion, France
| | - Judith Rankin
- National Congenital Anomaly and Rare Disease Registration Service, National Disease Registration Service, NHS Digital, Leeds, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Anke Rissmann
- Malformation Monitoring Centre Saxony-Anhalt, Medical Faculty Otto-von-Guericke University, Magdeburg, Germany
| | - Florence Rouget
- Brittany Registry of Congenital Anomalies, CHU Rennes, Univ Rennes, Inserm, EHESP, IRSET (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France
| | - Bruno Schaub
- French West Indies Registry, Registre des Malformations des Antilles (REMALAN), Maison de la Femme de la Mère et de l'Enfant, University Hospital of Martinique, Fort-de-France, France
| | - David Tucker
- Congenital Anomaly Register & Information Service for Wales (CARIS), Public Health Wales, Swansea, UK
| | - Diana Wellesley
- University Hospital Southampton, Faculty of Medicine and Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton, UK
| | - Katarzyna Wiśniewska
- Epidemiology Unit, Department of Preventive Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Lyubov Yevtushok
- OMNI-Net Ukraine Birth Defects Program and Rivne Regional Medical Diagnostic Center, Rivne, Ukraine
| | - Michele Santoro
- Unit of Epidemiology of Rare Diseases and Congenital Anomalies, Institute of Clinical Physiology, National Research Council, Pisa, Italy
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Aderoba AK, Ioannou C, Kurinczuk JJ, Quigley MA, Cavallaro A, Impey L. The impact of a universal late third-trimester scan for fetal growth restriction on perinatal outcomes in term singleton births: A prospective cohort study. BJOG 2023; 130:791-802. [PMID: 36660877 DOI: 10.1111/1471-0528.17395] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 11/02/2022] [Accepted: 12/30/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To investigate perinatal mortality, morbidity and obstetric intervention following the introduction of a universal late third-trimester ultrasound scan for growth restriction. DESIGN Prospective cohort study. SETTING Oxfordshire (OUH), UK. POPULATION Women with a non-anomalous singleton pregnancy undergoing pregnancy care and term delivery at OUH with an estimated due date (EDD) of birth between 1 January 2014 and 30 September 2019. METHODS Universal ultrasound for fetal growth restriction between 35+0 and 36+6 weeks was introduced in 2016. The outcomes of the next 18 631 eligible term pregnancies were compared, adjusting for covariates and time, with the previous 18 636 who had clinically indicated ultrasounds only. 'Screen-positives' for growth restriction were managed according to a pre-determined protocol which included non-intervention for some small-for-gestational-age babies. MAIN OUTCOME MEASURES Extended perinatal mortality, a composite of mortality or encephalopathy Grade II-III, and expedited birth. Other outcomes included composite adverse outcomes used elsewhere, detection of low birthweight and birth from 37+0 to 38+6 weeks. RESULTS Extended perinatal deaths decreased 27% and severe morbidity decreased 33% but neither change was statistically significant (adjusted odd ratio [aOR] 0.53, 95% confidence interval [C1] 00.18-1.56 and aOR 0.71, 95% CI 0.31-1.63). Expedited births changed from 35.2% to 37.7% (aOR 0.99, 95% CI 0.92-1.06). Birthweight (<10th centile) detection using fetal biometry alone was 31.4% and rose to 40.5% if all abnormal scan parameters were used. CONCLUSION Improvements in mortality and severe morbidity subsequent to introducing a universal ultrasound for growth restriction are encouraging but remain unclear. Little change in intervention is possible. The antenatal detection of low birthweight remains poor but improves where markers of growth restriction are used.
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Affiliation(s)
- Adeniyi Kolade Aderoba
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.,Centre for Population Health and Interdisciplinary Research, HealthMATE-360, Ondo Town, Nigeria
| | - Christos Ioannou
- Department of Fetal Medicine, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK.,Nuffield Department of Women's Reproductive Health, John Radcliffe Hospital, Oxford University, Oxford, UK
| | - Jennifer J Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Maria A Quigley
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Angelo Cavallaro
- Department of Fetal Medicine, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK.,Nuffield Department of Women's Reproductive Health, John Radcliffe Hospital, Oxford University, Oxford, UK
| | - Lawrence Impey
- Department of Fetal Medicine, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK.,Nuffield Department of Women's Reproductive Health, John Radcliffe Hospital, Oxford University, Oxford, UK
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21
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Odd D, Stoianova S, Williams T, Odd D, Kurinczuk JJ, Wolfe I, Luyt K. What is the relationship between deprivation, modifiable factors and childhood deaths: a cohort study using the English National Child MortalityDatabase. BMJ Open 2022; 12:e066214. [PMID: 36600341 PMCID: PMC9743372 DOI: 10.1136/bmjopen-2022-066214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES The aim of this analysis is to identify the patterns of social deprivation and childhood mortality; and identify potential points where public health, social and education interventions, or health policy may be best targeted. DESIGN Decile of deprivation and underlying population distribution was derived using Office for National Statistics data. The risk of death was then derived using a Poisson regression model, calculating the increasing risk of death for each increasing deprivation decile. SETTING England. PARTICIPANTS 2688 deaths before 18 years of age reviewed between April 2019 and March 2020. MAIN OUTCOME MEASURES The relationship between deprivation and risk of death; for deaths with, and without modifiable factors. RESULTS There was evidence of increasing mortality risk with increase in deprivation decile, with children in the least deprived areas having a mortality of 13.25 (11.78-14.86) per 100 000 person-years, compared with 31.14 (29.13-33.25) in the most deprived decile (RR 1.08 (95% CI 1.07 to 1.10)); with the gradient of risk stronger in children who died with modifiable factors than those without (RR 1.12 (95% CI 1.09 to 1.15)) vs (RR 1.07 (95% CI 1.05 to 1.08)). Deprivation subdomains of employment, adult education, barriers to housing and services, and indoor living environments appeared to be the most important predictors of child mortality CONCLUSIONS: There is a clear gradient of increasing child mortality across England as measures of deprivation increase; with a striking finding that this varied little by area, age or other demographic factor. Over one-fifth of all child deaths may be avoided if the most deprived half of the population had the same mortality as the least deprived. Children dying in more deprived areas may have a greater proportion of avoidable deaths. Adult employment, and improvements to housing, may be the most efficient place to target resources to reduce these inequalities.
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Affiliation(s)
- David Odd
- Division of Population Medicine, Cardiff University, Cardiff, UK
- National Child Mortality Database, University of Bristol, Bristol, UK
| | - Sylvia Stoianova
- National Child Mortality Database, University of Bristol, Bristol, UK
| | - Tom Williams
- National Child Mortality Database, University of Bristol, Bristol, UK
| | - Dawn Odd
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | | | - Ingrid Wolfe
- Department of Women's and Children's Health, King's College London, London, UK
| | - Karen Luyt
- National Child Mortality Database, University of Bristol, Bristol, UK
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Lokubal P, Corcuera I, Balil JM, Frischer SR, Kayemba CN, Kurinczuk JJ, Opondo C, Nair M. Abortion decision-making process trajectories and determinants in low- and middle-income countries: A mixed-methods systematic review and meta-analysis. EClinicalMedicine 2022; 54:101694. [PMID: 36277313 PMCID: PMC9579809 DOI: 10.1016/j.eclinm.2022.101694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND About 45.1% of all induced abortions are unsafe and 97% of these occur in low- and middle-income countries (LMICs). Women's abortion decisions may be complex and are influenced by various factors. We aimed to delineate women's abortion decision-making trajectories and their determinants in LMICs. METHODS We searched Medline, EMBASE, PsychInfo, Global Health, Web of Science, Scopus, IBSS, CINAHL, WHO Global Index Medicus, the Cochrane Library, WHO website, ProQuest, and Google Scholar for primary studies and reports published between January 1, 2000, and February 16, 2021 (updated on June 06, 2022), on induced abortion decision-making trajectories and/or their determinants in LMICs. We excluded studies on spontaneous abortion. Two independent reviewers extracted and assessed quality of each paper. We used "best fit" framework synthesis to synthesise abortion decision-making trajectories and thematic synthesis to synthesise their determinants. We analysed quantitative findings using random effects model. The study protocol is registered with PROSPERO number CRD42021224719. FINDINGS Of the 6960 articles identified, we included 79 in the systematic review and 14 in the meta-analysis. We identified nine abortion decision-making trajectories: pregnancy awareness, self-reflection, initial abortion decision, disclosure and seeking support, negotiations, final decision, access and information, abortion procedure, and post-abortion experience and care. Determinants of trajectories included three major themes of autonomy in decision-making, access and choice. A meta-analysis of data from 7737 women showed that the proportion of the overall women's involvement in abortion decision-making was 0.86 (95% CI:0.73-0.95, I2 = 99.5%) and overall partner involvement was 0.48 (95% CI:0.29-0.68, I2 = 99.6%). INTERPRETATION Policies and strategies should address women's perceptions of safe abortion socially, legally, and economically, and where appropriate, involvement of male partners in abortion decision-making processes to facilitate safe abortion. Clinical heterogeneity, in which various studies defined "the final decision-maker" differentially, was a limitation of our study. FUNDING Nuffield Department of Population Health DPhil Scholarship for PL, University of Oxford, and the Medical Research Council Career Development Award for MN (Grant Ref: MR/P022030/1).
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Affiliation(s)
- Paul Lokubal
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Corresponding author at: National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington OX3 7LF Oxford, UK.
| | - Ines Corcuera
- Chelsea and Westminster Hospital, NHS Foundation Trust, London, UK
| | | | - Sandrena Ruth Frischer
- Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Christine Nalwadda Kayemba
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Jennifer J. Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Charles Opondo
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Manisha Nair
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Allin BSR, Opondo C, Bradnock T, Kenny SE, Kurinczuk JJ, Walker G, Knight M. Impact of rectal dissection technique on primary-school-age outcomes for a British and Irish cohort of children with Hirschsprung disease. J Pediatr Surg 2022; 57:902-911. [PMID: 35934524 DOI: 10.1016/j.jpedsurg.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/22/2022] [Accepted: 05/06/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND This prospective cohort study compared primary-school-aged outcomes between children with Hirschsprung disease (HD) following Soave, Duhamel or Swenson procedures. METHODS Children with histologically proven HD were identified in British/Irish paediatric surgical centers (01/10/2010-30/09/2012). Parent/clinician outcomes were collected when children were 5-8 years old and combined with management/early outcomes data. Propensity score/covariate adjusted multiple-event-Cox and multivariable logistic regression analyses were used. RESULTS 277 (91%) of 305 children underwent a pull-through (53% Soave, 37% Duhamel, 9% Swenson). Based upon 259 children (94%) with complete operative data, unplanned reoperation rates (95% CI) per-person year of follow-up were 0.11 (0.08-0.13), 0.34 (0.29-0.40) and 1.06 (0.86-1.31) in the Soave/Duhamel/Swenson groups respectively. Adjusted Hazard Ratios for unplanned reoperation compared with the Soave were 1.50 (95% CI 0.66-3.44, p = 0.335) and 7.57 (95% CI 3.39-16.93, p < 0.001) for the Duhamel/Swenson respectively. Of 217 post-pull-through children with 5-8 year follow-up, 62%, 55%, and 62% in Soave/Duhamel/Swenson groups reported faecal incontinence. In comparison to Soave, Duhamel was associated with lower risk of faecal incontinence (aOR 0.34,95%CI 0.13-0.89,p = 0.028). Of 191 children without a stoma, 42%, 59% and 30% in Soave/Duhamel/Swenson groups required assistance to maintain bowel movements; compared to Soave, the Duhamel group were more likely to require assistance (aOR 2.61,95% CI 1.03-6.60,p = 0.043). CONCLUSIONS Compared with Soave, Swenson was associated with increased risk of unplanned reoperation, whilst Duhamel was associated with reduced risk of faecal incontinence, but increased risk of constipation at 5-8 years of age. The risk profiles described can be used to inform consent discussions between surgeons and parents. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Benjamin S R Allin
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford OX37LF, UK; Chelsea and Westminster Hospital NHS Foundation Trust, Headley way, Headington, Oxford OX39DU, UK.
| | - Charles Opondo
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford OX37LF, UK
| | - Timothy Bradnock
- Royal Hospital for Children, Govan Road, Glasgow, Scotland G514TF, UK
| | - Simon E Kenny
- Alder Hey Children's Hospital, University of Liverpool, Eaton Road, Liverpool L122AP, UK
| | - Jennifer J Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford OX37LF, UK
| | - Gregor Walker
- Royal Hospital for Children, Govan Road, Glasgow, Scotland G514TF, UK
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford OX37LF, UK
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Fitzpatrick KE, Abdel-Fattah M, Hemelaar J, Kurinczuk JJ, Quigley MA. Planned mode of birth after previous cesarean section and risk of undergoing pelvic floor surgery: A Scottish population-based record linkage cohort study. PLoS Med 2022; 19:e1004119. [PMID: 36413515 PMCID: PMC9681109 DOI: 10.1371/journal.pmed.1004119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 10/06/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The global rise in cesarean sections has led to increasing numbers of pregnant women with a history of previous cesarean section. Policy in many high-income settings supports offering these women a choice between planned elective repeat cesarean section (ERCS) or planned vaginal birth after previous cesarean (VBAC), in the absence of contraindications to VBAC. Despite the potential for this choice to affect women's subsequent risk of experiencing pelvic floor disorders, evidence on the associated effects to fully counsel women is lacking. This study investigated the association between planned mode of birth after previous cesarean section and the woman's subsequent risk of undergoing pelvic floor surgery. METHODS AND FINDINGS A population-based cohort study of 47,414 singleton term births in Scotland between 1983 to 1996 to women with 1 or more previous cesarean sections was conducted using linked Scottish national routine datasets. Cox regression was used to investigate the association between planned as well as actual mode of birth and women's subsequent risk of having any pelvic floor surgery and specific types of pelvic floor surgery adjusted for sociodemographic, maternal medical, and obstetric-related factors. Over a median of 22.1 years of follow-up, 1,159 (2.44%) of the study population had pelvic floor surgery. The crude incidence rate of any pelvic floor surgery per 1,000 person-years was 1.35, 95% confidence interval (CI) 1.27 to 1.43 in the overall study population, 1.75, 95% CI 1.64 to 1.86 in the planned VBAC group and 0.66, 95% CI 0.57 to 0.75 in the ERCS group. Planned VBAC compared to ERCS was associated with a greater than 2-fold increased risk of the woman undergoing any pelvic floor surgery (adjusted hazard ratio [aHR] 2.38, 95% CI 2.03 to 2.80, p < 0.001) and a 2- to 3-fold increased risk of the woman having surgery for pelvic organ prolapse or urinary incontinence (aHR 3.17, 95% CI 2.47 to 4.09, p < 0.001 and aHR 2.26, 95% CI 1.79 to 2.84, p < 0.001, respectively). Analysis by actual mode of birth showed these increased risks were only apparent in the women who actually had a VBAC, with the women who needed an in-labor non-elective repeat cesarean section having a comparable risk of pelvic floor surgery to those who had an ERCS. The main limitation of this study is the potential for misclassification bias. CONCLUSIONS This study suggests that among women with previous cesarean section giving birth to a singleton at term, planned VBAC compared to ERCS is associated with an increased risk of the woman subsequently undergoing pelvic floor surgery including surgery for pelvic organ prolapse and urinary incontinence. However, these risks appear to be only apparent in women who actually give birth vaginally as planned, highlighting the role of vaginal birth rather than labor in pelvic floor dysfunction requiring surgery. The findings provide useful additional information to counsel women with previous cesarean section about the risks and benefits associated with their future birth choices.
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Affiliation(s)
- Kathryn E. Fitzpatrick
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- * E-mail:
| | - Mohamed Abdel-Fattah
- The Aberdeen Centre for Women’s Health Research, University of Aberdeen, Aberdeen, United Kingdom
| | - Joris Hemelaar
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Department of Obstetrics, Women’s Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Jennifer J. Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Maria A. Quigley
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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Morelli A, Rogers J, Sanders J, Kurinczuk JJ, Rowe R. Outcomes for women admitted for labour care to alongside midwifery units in the UK following a postpartum haemorrhage in a previous pregnancy: A national population-based cohort and nested case-control study using the UK Midwifery Study System (UKMidSS). Women Birth 2022; 36:e361-e368. [PMID: 36376224 DOI: 10.1016/j.wombi.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/26/2022] [Accepted: 11/08/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Women who have experienced a postpartum haemorrhage (PPH) 'requiring treatment or transfusion' are typically advised to plan birth in obstetric-led settings in subsequent pregnancies. Many UK alongside midwifery units (AMU) admit women for labour care following a previous PPH. We aimed to describe outcomes in women admitted for labour care to AMUs following a previous PPH, compare outcomes with other multiparous women admitted to the same AMUs, and explore risk factors for recurrence. METHODS A national cohort and nested case-control study using the UK Midwifery Study System (UKMidSS), between August 2018 and April 2019. Multivariable Poisson regression and logistic regression were performed to compare outcomes and investigate risk factors for recurrence. FINDINGS Women who experienced a previous PPH were significantly more likely than comparison women to: have a PPH requiring transfer to obstetric care (4·2% vs. 2·4%, aRR=1·65, 95% CI 1·14-2·38), be transferred to obstetric care for any reason (17·8% vs 11·9%; aRR=1·41; 95% CI 1·09-1·83), and have any PPH≥ 500 ml (22·7% vs 11·1%, aRR=1·86, 95% CI 1·49-2·32). Among women with a previous PPH, previous blood loss > 1500 ml; uterotonics for previous PPH; Caesarean associated with previous PPH; gestation at admission and higher birthweight were independent risk factors for PPH. CONCLUSION Women considering birth in an AMU after a previous PPH should be advised that they are at increased risk of experiencing a subsequent PPH requiring transfer to obstetric care, compared with other multiparous women who have not had a PPH. The absolute risk of a subsequent PPH in this group is low and comparable to the overall risk of having a PPH among women having a spontaneous vaginal birth in England.
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Affiliation(s)
- Alessandra Morelli
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, United Kingdom.
| | - Jane Rogers
- University Hospitals Southampton, Coxford Road, Southampton SO16 5YA, United Kingdom
| | - Julia Sanders
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University Room 1.7, Ty Dewi Sant, Heath Park, Cardiff CF14 4XN, United Kingdom
| | - Jennifer J Kurinczuk
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, United Kingdom
| | - Rachel Rowe
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, United Kingdom. https://twitter.com/@RachelRowe3
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Kelly L, Fitzpatrick R, Kurinczuk JJ, Rivero-Arias O, Alderdice F. Assessing the Validity of the Long-Term Conditions Questionnaire (LTCQ) in Women During Pregnancy and the First Year Following Birth. Patient Relat Outcome Meas 2022; 13:221-228. [PMID: 36285189 PMCID: PMC9588285 DOI: 10.2147/prom.s376070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/31/2022] [Indexed: 11/07/2022] Open
Abstract
Background The aim of this study was to validate a generic patient-reported outcome measure, the Long-Term Conditions Questionnaire (LTCQ), among pregnant and postpartum women living with a pre-existing long-term condition (LTC). Methods Cognitive interviews were conducted with women who were currently pregnant or had given birth within the past year and living with a pre-existing LTC (n=11) and with healthcare professionals working in maternal care (n=11) to explore the acceptability of LTCQ items. An online survey was subsequently administered among women who were pregnant or had given birth within the past year and living with a pre-existing LTC (n=718). Tests of validity were performed including assessing correlations between the LTCQ and reference measures, the Well-being in Pregnancy (WiP) Questionnaire and the EuroQol EQ-5D-5L. Internal consistency was assessed using the Cronbach's alpha statistic. Results All LTCQ items were considered relevant and appropriate for use with women who were pregnant or had given birth within the past year. The most commonly reported LTC among the online survey sample (n=718) was a mental health condition (n=350, 48.7%) followed by joint, bone and connective tissues (n= 212, 29.5%) and gastrointestinal (n=143, 19.9%) condition. Data indicated LTCQ scores behaved in a predictable pattern, demonstrating poorer scores for women reporting a greater number of LTCs; mean (SD) scores, one LTC= 61.86 (17.8), two LTCs= 55.29 (16.0), three LTCs= 49.84 (15.52) and four LTCs= 44.94 (12.2). Poorer scores were also reported for women living with at least one mental health condition compared to those reporting no mental health condition, mean score = 66.18 (SD 16.7) v 48.64 (SD 13.3), p<0.001 respectively. As anticipated, LTCQ scores demonstrated significant correlations in the expected direction with both the EQ-5D-5L and WiP scores. For all LTCQ items, the Cronbach's alpha statistic was 0.93. Conclusion Data presented here indicate that the LTCQ, which assesses living well with one or more LTC, is suitable for use among pregnant and postpartum women, from both the woman's perspective and from the perspectives of maternity healthcare professionals. Use of the LTCQ would facilitate the identification of unmet needs within this high-risk cohort and support the exploration of how LTCs may affect women throughout the pregnancy and post-natal period. Understanding unmet needs within this cohort of women provides an opportunity to link up specialist care within maternity services and enhance personalised care.
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Affiliation(s)
- Laura Kelly
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK,Harris Manchester College, University of Oxford, Oxford, UK
| | - Ray Fitzpatrick
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jennifer J Kurinczuk
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Oliver Rivero-Arias
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Fiona Alderdice
- Harris Manchester College, University of Oxford, Oxford, UK,NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK,Correspondence: Fiona Alderdice, NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Headington, Oxford, OX3 7LF, United Kingdom, Tel +44 0 1865617901, Email
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Fitzpatrick KE, Quigley MA, Smith DJ, Kurinczuk JJ. Planned mode of birth after previous caesarean section and women's use of psychotropic medication in the first year postpartum: a population-based record linkage cohort study. Psychol Med 2022; 52:3210-3221. [PMID: 33504384 PMCID: PMC9693703 DOI: 10.1017/s0033291720005322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 11/02/2020] [Accepted: 12/17/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Policy in many high-income settings supports giving pregnant women with previous caesarean section a choice between an elective repeat caesarean section (ERCS) or planning a vaginal birth after previous caesarean (VBAC), provided they have no contraindications to VBAC. Despite the potential for this choice to influence women's mental health, evidence about the associated effect to counsel women and identify potential targets for intervention is limited. This study investigated the association between planned mode of birth after previous caesarean and women's subsequent use of psychotropic medications. METHODS A population-based cohort study of 31 131 women with one or more previous caesarean sections who gave birth to a term singleton in Scotland between 2010 and 2015 with no prior psychotropic medications in the year before birth was conducted using linked Scottish national datasets. Cox regression was used to investigate the association between planned mode of birth and being dispensed psychotropic medications in the first year postpartum adjusted for socio-demographic, medical, pregnancy-related factors and breastfeeding. RESULTS Planned VBAC (n = 10 220) compared to ERCS (n = 20 911) was associated with a reduced risk of the mother being dispensed any psychotropic medication [adjusted hazard ratio (aHR) 0.85, 95% confidence interval (CI) 0.78-0.92], an antidepressant (aHR 0.83, 95% CI 0.76-0.90), and at least two consecutive antidepressants (aHR 0.83, 95% CI 0.75-0.91) in the first year postpartum. CONCLUSIONS Women giving birth by ERCS were more likely than those having a planned VBAC to be dispensed psychotropic medication including antidepressants in the first year postpartum. Further research is needed to establish the reasons behind this new finding.
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Affiliation(s)
- Kathryn E. Fitzpatrick
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Maria A. Quigley
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Daniel J. Smith
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Jennifer J. Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Fitzpatrick KE, Quigley MA, Kurinczuk JJ. Planned mode of birth after previous cesarean section: A structured review of the evidence on the associated outcomes for women and their children in high-income setting. Front Med (Lausanne) 2022; 9:920647. [PMID: 36148449 PMCID: PMC9486480 DOI: 10.3389/fmed.2022.920647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 08/08/2022] [Indexed: 12/05/2022] Open
Abstract
In many high-income settings policy consensus supports giving pregnant women who have had a previous cesarean section a choice between planning an elective repeat cesarean section (ERCS) or planning a vaginal birth after previous cesarean (VBAC), provided they have no contraindications to VBAC. To help women make an informed decision regarding this choice, clinical guidelines advise women should be counseled on the associated risks and benefits. The most recent and comprehensive review of the associated risks and benefits of planned VBAC compared to ERCS in high-income settings was published in 2010 by the US Agency for Healthcare Research and Quality (AHRQ). This paper describes a structured review of the evidence in high-income settings that has been published since the AHRQ review and the literature in high-income settings that has been published since 1980 on outcomes not included in the AHRQ review. Three databases (MEDLINE, EMBASE, and PsycINFO) were searched for relevant studies meeting pre-specified eligible criteria, supplemented by searching of reference lists. Forty-seven studies were identified as meeting the eligibility criteria and included in the structured review. The review suggests that while planned VBAC compared to ERCS is associated with an increased risk of various serious birth-related complications for both the mother and her baby, the absolute risk of these complications is small for either birth approach. The review also found some evidence that planned VBAC compared to ERCS is associated with benefits such as a shorter length of hospital stay and a higher likelihood of breastfeeding. The limited evidence available also suggests that planned mode of birth after previous cesarean section is not associated with the child’s subsequent risk of experiencing adverse neurodevelopmental or health problems in childhood. This information can be used to manage and counsel women with previous cesarean section about their subsequent birth choices. Collectively, the evidence supports existing consensus that there are risks and benefits associated with both planned VBAC and ERCS, and therefore women without contraindications to VBAC should be given an informed choice about planned mode of birth after previous cesarean section. However, further studies into the longer-term effects of planned mode of birth after previous cesarean section are needed along with more research to address the other key limitations and gaps that have been highlighted with the existing evidence.
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Pang R, Mujuni BM, Martinello KA, Webb EL, Nalwoga A, Ssekyewa J, Musoke M, Kurinczuk JJ, Sewegaba M, Cowan FM, Cose S, Nakakeeto M, Elliott AM, Sebire NJ, Klein N, Robertson NJ, Tann CJ. Elevated serum IL-10 is associated with severity of neonatal encephalopathy and adverse early childhood outcomes. Pediatr Res 2022; 92:180-189. [PMID: 33674741 PMCID: PMC9411052 DOI: 10.1038/s41390-021-01438-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/27/2021] [Accepted: 02/01/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Neonatal encephalopathy (NE) contributes substantially to child mortality and disability globally. We compared cytokine profiles in term Ugandan neonates with and without NE, with and without perinatal infection or inflammation and identified biomarkers predicting neonatal and early childhood outcomes. METHODS In this exploratory biomarker study, serum IL-1α, IL-6, IL-8, IL-10, TNFα, and VEGF (<12 h) were compared between NE and non-NE infants with and without perinatal infection/inflammation. Neonatal (severity of NE, mortality) and early childhood (death or neurodevelopmental impairment to 2.5 years) outcomes were assessed. Predictors of outcomes were explored with multivariable linear and logistic regression and receiver-operating characteristic analyses. RESULTS Cytokine assays on 159 NE and 157 non-NE infants were performed; data on early childhood outcomes were available for 150 and 129, respectively. NE infants had higher IL-10 (p < 0.001), higher IL-6 (p < 0.017), and lower VEGF (p < 0.001) levels. Moderate and severe NE was associated with higher IL-10 levels compared to non-NE infants (p < 0.001). Elevated IL-1α was associated with perinatal infection/inflammation (p = 0.013). Among NE infants, IL-10 predicted neonatal mortality (p = 0.01) and adverse early childhood outcome (adjusted OR 2.28, 95% CI 1.35-3.86, p = 0.002). CONCLUSIONS Our findings support a potential role for IL-10 as a biomarker for adverse outcomes after neonatal encephalopathy. IMPACT Neonatal encephalopathy is a common cause of child death and disability globally. Inflammatory cytokines are potential biomarkers of encephalopathy severity and outcome. In this Ugandan health facility-based cohort, neonatal encephalopathy was associated with elevated serum IL-10 and IL-6, and reduced VEGF at birth. Elevated serum IL-10 within 12 h after birth predicted severity of neonatal encephalopathy, neonatal mortality, and adverse early childhood developmental outcomes, independent of perinatal infection or inflammation, and provides evidence to the contribution of the inflammatory processes. Our findings support a role for IL-10 as a biomarker for adverse outcomes after neonatal encephalopathy in a sub-Saharan African cohort.
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Affiliation(s)
- Raymand Pang
- Institute for Women's Health, University College London, London, UK
| | - Brian M Mujuni
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | | | - Emily L Webb
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Angela Nalwoga
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Julius Ssekyewa
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Margaret Musoke
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | | | - Margaret Sewegaba
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Frances M Cowan
- Department of Pediatrics, Imperial College London, London, UK
| | - Stephen Cose
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Margaret Nakakeeto
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Alison M Elliott
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Neil J Sebire
- UCL Institute of Child Health and GOSH BRC, UCL, London, UK
| | - Nigel Klein
- UCL Institute of Child Health and GOSH BRC, UCL, London, UK
| | - Nicola J Robertson
- Institute for Women's Health, University College London, London, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Cally J Tann
- Institute for Women's Health, University College London, London, UK.
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda.
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
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Kelly L, Kurinczuk JJ, Fitzpatrick R, Alderdice F. Correction: Refinement of the Well-being in Pregnancy (WiP) questionnaire: cognitive interviews with women and healthcare professionals and a validation survey. BMC Pregnancy Childbirth 2022; 22:403. [PMID: 35549893 PMCID: PMC9102357 DOI: 10.1186/s12884-022-04730-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Laura Kelly
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.,Harris Manchester College, University of Oxford, Oxford, UK
| | - Jennifer J Kurinczuk
- NIHR Policy Research Unit Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Ray Fitzpatrick
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Fiona Alderdice
- Harris Manchester College, University of Oxford, Oxford, UK. .,NIHR Policy Research Unit Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Headington, Oxford, OX3 7LF, UK.
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Maheshwari A, Bari V, Bell JL, Bhattacharya S, Bhide P, Bowler U, Brison D, Child T, Chong HY, Cheong Y, Cole C, Coomarasamy A, Cutting R, Goodgame F, Hardy P, Hamoda H, Juszczak E, Khalaf Y, King A, Kurinczuk JJ, Lavery S, Lewis-Jones C, Linsell L, Macklon N, Mathur R, Murray D, Pundir J, Raine-Fenning N, Rajkohwa M, Robinson L, Scotland G, Stanbury K, Troup S. Transfer of thawed frozen embryo versus fresh embryo to improve the healthy baby rate in women undergoing IVF: the E-Freeze RCT. Health Technol Assess 2022; 26:1-142. [PMID: 35603917 PMCID: PMC9376799 DOI: 10.3310/aefu1104] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Freezing all embryos, followed by thawing and transferring them into the uterine cavity at a later stage (freeze-all), instead of fresh-embryo transfer may lead to improved pregnancy rates and fewer complications during in vitro fertilisation and pregnancies resulting from it. OBJECTIVE We aimed to evaluate if a policy of freeze-all results in a higher healthy baby rate than the current policy of transferring fresh embryos. DESIGN This was a pragmatic, multicentre, two-arm, parallel-group, non-blinded, randomised controlled trial. SETTING Eighteen in vitro fertilisation clinics across the UK participated from February 2016 to April 2019. PARTICIPANTS Couples undergoing their first, second or third cycle of in vitro fertilisation treatment in which the female partner was aged < 42 years. INTERVENTIONS If at least three good-quality embryos were present on day 3 of embryo development, couples were randomly allocated to either freeze-all (intervention) or fresh-embryo transfer (control). OUTCOMES The primary outcome was a healthy baby, defined as a live, singleton baby born at term, with an appropriate weight for their gestation. Secondary outcomes included ovarian hyperstimulation, live birth and clinical pregnancy rates, complications of pregnancy and childbirth, health economic outcome, and State-Trait Anxiety Inventory scores. RESULTS A total of 1578 couples were consented and 619 couples were randomised. Most non-randomisations were because of the non-availability of at least three good-quality embryos (n = 476). Of the couples randomised, 117 (19%) did not adhere to the allocated intervention. The rate of non-adherence was higher in the freeze-all arm, with the leading reason being patient choice. The intention-to-treat analysis showed a healthy baby rate of 20.3% in the freeze-all arm and 24.4% in the fresh-embryo transfer arm (risk ratio 0.84, 95% confidence interval 0.62 to 1.15). Similar results were obtained using complier-average causal effect analysis (risk ratio 0.77, 95% confidence interval 0.44 to 1.10), per-protocol analysis (risk ratio 0.87, 95% confidence interval 0.59 to 1.26) and as-treated analysis (risk ratio 0.91, 95% confidence interval 0.64 to 1.29). The risk of ovarian hyperstimulation was 3.6% in the freeze-all arm and 8.1% in the fresh-embryo transfer arm (risk ratio 0.44, 99% confidence interval 0.15 to 1.30). There were no statistically significant differences between the freeze-all and the fresh-embryo transfer arms in the live birth rates (28.3% vs. 34.3%; risk ratio 0.83, 99% confidence interval 0.65 to 1.06) and clinical pregnancy rates (33.9% vs. 40.1%; risk ratio 0.85, 99% confidence interval 0.65 to 1.11). There was no statistically significant difference in anxiety scores for male participants (mean difference 0.1, 99% confidence interval -2.4 to 2.6) and female participants (mean difference 0.0, 99% confidence interval -2.2 to 2.2) between the arms. The economic analysis showed that freeze-all had a low probability of being cost-effective in terms of the incremental cost per healthy baby and incremental cost per live birth. LIMITATIONS We were unable to reach the original planned sample size of 1086 and the rate of non-adherence to the allocated intervention was much higher than expected. CONCLUSION When efficacy, safety and costs are considered, freeze-all is not better than fresh-embryo transfer. TRIAL REGISTRATION This trial is registered as ISRCTN61225414. FUNDING This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 25. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Abha Maheshwari
- Aberdeen Fertility Centre, NHS Grampian and University of Aberdeen, Aberdeen, UK
| | - Vasha Bari
- Clinical Trials Unit National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jennifer L Bell
- Clinical Trials Unit National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Priya Bhide
- Assisted Conception Unit, Homerton University Hospital NHS Foundation Trust and Queen Mary University of London, London, UK
| | - Ursula Bowler
- Clinical Trials Unit National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Daniel Brison
- Assisted Conception Unit, Manchester University NHS Foundation Trust, Manchester, UK
| | - Tim Child
- Oxford Fertility, The Fertility Partnership, University of Oxford, Oxford, UK
| | - Huey Yi Chong
- Aberdeen Fertility Centre, NHS Grampian and University of Aberdeen, Aberdeen, UK
| | - Ying Cheong
- Complete Fertility Centre, University of Southampton, Southampton, UK
| | - Christina Cole
- Clinical Trials Unit National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Arri Coomarasamy
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Rachel Cutting
- Human Fertilisation and Embryology Authority, London, UK
| | - Fiona Goodgame
- Clinical Trials Unit National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Pollyanna Hardy
- Clinical Trials Unit National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Haitham Hamoda
- Assisted Conception Unit, King's College Hospital, London, UK
| | - Edmund Juszczak
- Clinical Trials Unit National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.,Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Yacoub Khalaf
- Assisted Conception Unit and Centre for Pre-implantation Genetic Diagnosis, Guy's and St Thomas' Hospital and King's College London, London, UK
| | - Andrew King
- Clinical Trials Unit National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jennifer J Kurinczuk
- Clinical Trials Unit National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Stuart Lavery
- Assisted Conception Unit, Imperial College London, London, UK
| | | | - Louise Linsell
- Clinical Trials Unit National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Nick Macklon
- London Women's Clinic, London, UK.,Gynaecology, University of Copenhagen, Copenhagen, Denmark
| | - Raj Mathur
- Assisted Conception Unit, St Mary's Hospital, Manchester, UK
| | - David Murray
- Clinical Trials Unit National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jyotsna Pundir
- Assisted Conception Unit, St Bartholomew's Hospital, London, UK
| | | | | | - Lynne Robinson
- Gyanecology and Assisted Conception, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Graham Scotland
- Aberdeen Fertility Centre, NHS Grampian and University of Aberdeen, Aberdeen, UK
| | - Kayleigh Stanbury
- Clinical Trials Unit National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Kelly L, Officer R, Kurinczuk JJ, Fitzpatrick R, Alderdice F. Refinement of the Well-being in Pregnancy (WiP) questionnaire: cognitive interviews with women and healthcare professionals and a validation survey. BMC Pregnancy Childbirth 2022; 22:325. [PMID: 35428195 PMCID: PMC9013132 DOI: 10.1186/s12884-022-04626-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 03/27/2022] [Indexed: 01/07/2023] Open
Abstract
Background Measuring positive and negative aspects of well-being during pregnancy and childbirth is important for both healthy women and women who are living with long-term health conditions (LTCs). This study aimed to further refine the Well-being in Pregnancy (WiP) questionnaire and to incorporate LTC specific items where appropriate. Methods A multi-method study. Cognitive interviews with pregnant or postpartum women (n = 11) and consultations with healthcare professionals (n = 11) and public representatives (n = 4) were conducted to explore the acceptability of existing WiP items and content. Items were refined and subsequently administered on an online survey (n = 768). Item reduction steps and exploratory factor analysis were performed on survey data. Convergent validity was examined using Pearson correlation coefficients to compare relationships with other included validated assessments. Results Following amendments to three items, the addition of eight core WiP items and five LTC specific items, a total of 25 items were considered relevant and appropriate for use with pregnant women. Analysis of survey data reduced the questionnaire to 12 items measuring three core WiP scales; 1) Concerns over support after birth, 2) Positive pregnancy and, 3) Confidence about motherhood, and a five item standalone LTC specific scale. All scales demonstrated good validity and internal reliability. Scores for the three core scales moderately correlated with established well-being measures indicating that they were measuring similar, yet distinct concepts. Conclusions Analyses confirmed good psychometric properties of the refined WiP questionnaire. The use of pregnancy specific well-being measures, such as the WiP, provide a route into asking women in more detail about how their care may be tailored to support them and also facilitates positive conversations with women about how care and experience of pregnancy and childbirth may be enhanced further. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04626-x.
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McCall SJ, Deneux-Tharaux C, Sentilhes L, Ramakrishnan R, Collins SL, Seco A, Kurinczuk JJ, Knight M, Kayem G. Placenta accreta spectrum - variations in clinical practice and maternal morbidity between the UK and France: a population-based comparative study. BJOG 2022; 129:1676-1685. [PMID: 35384244 PMCID: PMC9544707 DOI: 10.1111/1471-0528.17169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/15/2022] [Accepted: 03/28/2022] [Indexed: 11/30/2022]
Abstract
Objective To compare the management and outcomes of women with placenta accreta spectrum (PAS) in France and the UK. Design Two population‐based cohorts. Setting All obstetrician‐led hospitals in the UK and maternity hospitals in eight French regions. Population A cohort of 219 women with PAS in France and a cohort of 154 women with PAS in the UK. Methods The management and outcomes of women with PAS were compared between the UK and France. Main outcome measures Median blood loss, severe postpartum haemorrhage (≥3 l), postpartum infection and damage to surrounding organs. Results The management of PAS differed between the two countries: a larger proportion of women with PAS in the UK had a caesarean hysterectomy compared with France (43% vs 26%, p < 0.001), whereas in France a larger proportion of women with PAS received a uterus‐preserving approach compared with the UK (36% vs 19%, p < 0.001). The total median blood loss in the UK was 3 l (IQR 1.7–6.5 l), compared with 1 l (IQR 0.5–2.5 l) in France; more women with PAS had a severe postpartum haemorrhage (PPH) in the UK compared with women with PAS in France (58% vs 21%, p < 0.001) [Correction added on 06 May 2022, after first online publication: ‘24 hour’ has been changed to ‘total’ in the preceding sentence]. There was no difference between the UK and French populations for postpartum infection or organ damage. Conclusions The UK and France have very different approaches to managing PAS, with more women in France receiving a uterine‐conserving approach and more women in the UK undergoing caesarean hysterectomy. A life‐threatening haemorrhage was more common in the UK than in France, which may be the result of differential management and/or the organisation of the healthcare systems. In women with placenta accreta spectrum, severe haemorrhage was more common in the UK than in France. Tweetable abstract In women with placenta accreta spectrum, severe haemorrhage was more common in the UK than in France. In women with placenta accreta spectrum, severe haemorrhage was more common in the UK than in France. Linked article: This article is commented on by Amarnath Bhide, pp. 1686 in this issue. To view this minicommentary visit https://doi.org/10.1111/1471-0528.17170.
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Affiliation(s)
- Stephen J McCall
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.,Université de Paris, CRESS U1153, INSERM, Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé) Research Team, Paris, France.,Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Catherine Deneux-Tharaux
- Université de Paris, CRESS U1153, INSERM, Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé) Research Team, Paris, France
| | - Loïc Sentilhes
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
| | - Rema Ramakrishnan
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Sally L Collins
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK.,Fetal Medicine Unit, John Radcliffe Hospital, Oxford, UK
| | - Aurélien Seco
- Clinical Research Unit, Paris-Descartes Necker/Cochin, Paris, France
| | - Jennifer J Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Gilles Kayem
- Université de Paris, CRESS U1153, INSERM, Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé) Research Team, Paris, France.,Hôpital Trousseau, Assistance Publique -Hôpitaux de Paris (APHP), Sorbonne Université, Paris, France
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Vousden N, Ramakrishnan R, Bunch K, Morris E, Simpson N, Gale C, O'Brien P, Quigley M, Brocklehurst P, Kurinczuk JJ, Knight M. Management and implications of severe COVID-19 in pregnancy in the UK: data from the UK Obstetric Surveillance System national cohort. Acta Obstet Gynecol Scand 2022; 101:461-470. [PMID: 35213734 PMCID: PMC9111211 DOI: 10.1111/aogs.14329] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/09/2021] [Accepted: 01/19/2022] [Indexed: 12/21/2022]
Abstract
Introduction There is a lack of population level data on risk factors and impact of severe COVID‐19 in pregnancy. The aims of this study were to determine the characteristics, and maternal and perinatal outcomes associated with severe COVID‐19 in pregnancy compared with those with mild and moderate COVID‐19 and to explore the impact of timing of birth. Material and methods This was a secondary analysis of a national, prospective cohort study. All pregnant women admitted to hospital in the UK with symptomatic SARS‐CoV‐2 from March 1, 2020 to October 31, 2021 were included. The severity of maternal infection (need for high flow or invasive ventilation, intensive care admission or died), pregnancy and perinatal outcomes, and the impact of timing of birth were analyzed using multivariable logistic regression. Results Of 4436 pregnant women, 13.9% (n = 616) had severe infection. Women with severe infection were more likely to be aged ≥30 years (adjusted odds ratio [aOR] aged 30–39 1.48, 95% confidence interval [CI] 1.20–1.83), be overweight or obese (aOR 1.73, 95% CI 1.34–2.25 and aOR 2.52 95% CI 1.97–3.23, respectively), be of mixed ethnicity (aOR 1.93, 95% CI 1.17–3.21) or have gestational diabetes (aOR 1.43, 95% CI 1.09–1.87) compared with those with mild or moderate infection. Women with severe infection were more likely to have a pre‐labor cesarean birth (aOR 8.84, 95% CI 6.61–11.83), a very or extreme preterm birth (28–31+ weeks’ gestation, aOR 18.97, 95% CI 7.78–14.85; <28 weeks’ gestation, aOR 12.35, 95% CI 6.34–24.05) and their babies were more likely to be stillborn (aOR 2.51, 95% CI 1.35–4.66) or admitted to a neonatal unit (aOR 11.61, 95% CI 9.28–14.52). Of 112 women with severe infection who were discharged and gave birth at a later admission, the majority gave birth ≥36 weeks (85.7%), noting that three women in this group (2.7%) had a stillbirth. Conclusions Severe COVID‐19 in pregnancy increases the risk of adverse outcomes. Information to promote uptake of vaccination should specifically target those at greatest risk of severe outcomes. Decisions about timing of birth should be informed by multidisciplinary team discussion; however, our data suggest that women with severe infection who do not require early delivery have mostly good outcomes but that those with severe infection at term may warrant rapid delivery.
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Affiliation(s)
- Nicola Vousden
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Rema Ramakrishnan
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Kathryn Bunch
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Edward Morris
- Royal College of Obstetricians and Gynaecologists, London, UK
| | - Nigel Simpson
- Department of Women's and Children's Health, School of Medicine, University of Leeds, Leeds, UK
| | - Christopher Gale
- Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Pat O'Brien
- Royal College of Obstetricians and Gynaecologists, London, UK.,Institute for Women's Health, University College London, London, UK
| | - Maria Quigley
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Peter Brocklehurst
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jennifer J Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Aderoba AK, Nasir N, Quigley M, Impey L, Rivero-Arias O, Kurinczuk JJ. Late pregnancy ultrasound parameters identifying fetuses at risk of adverse perinatal outcomes: a protocol for a systematic review of systematic reviews. BMJ Open 2022; 12:e058293. [PMID: 35321896 PMCID: PMC8943771 DOI: 10.1136/bmjopen-2021-058293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Stillbirths and neonatal deaths are leading contributors to the global burden of disease and pregnancy ultrasound has the potential to help decrease this burden. In the absence of high-Grading of Recommendations Assessment, Development and Evaluation (GRADE) evidence on universal obstetric ultrasound screening at or close to term, many different screening strategies have been proposed. Systematic reviews have rapidly increased over the past decade owing to the diverse nature of ultrasound parameters and the wide range of possible adverse perinatal outcomes. This systematic review will summarise the evidence on key ultrasound parameters in the published literature to help develop an obstetric ultrasound protocol that identifies pregnancies at risk of adverse perinatal outcomes at or close to term. METHODS This study will follow the recent Cochrane guidelines for a systematic review of systematic reviews. A comprehensive literature search will be conducted using Embase (OvidSP), Medline (OvidSP), CDSR, CINAHL (EBSCOhost) and Scopus. Systematic reviews evaluating at least one ultrasound parameter in late pregnancy to detect pregnancies at risk of adverse perinatal outcomes will be included. Two independent reviewers will screen, assess the quality including the risk of bias using the ROBIS tool, and extract data from eligible systematic reviews that meet the study inclusion criteria. Overlapping data will be assessed and managed with decision rules, and study evidence including the GRADE assessment of the certainty of results will be presented as a narrative synthesis as described in the Cochrane guidelines for an overview of reviews. ETHICS AND DISSEMINATION This research uses publicly available published data; thus, an ethics committee review is not required. The findings will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42021266108.
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Affiliation(s)
- Adeniyi Kolade Aderoba
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK
- Centre for Population Health and Interdisciplinary Research, HealthMATE 360, Ondo, Nigeria
| | - Naima Nasir
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Univerity of Oxford, Oxford, UK
| | - Maria Quigley
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK
| | - Lawrence Impey
- Department of Fetal Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Oliver Rivero-Arias
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK
| | - Jennifer J Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK
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36
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Maheshwari A, Bell JL, Bhide P, Brison D, Child T, Chong HY, Cheong Y, Cole C, Coomarasamy A, Cutting R, Hardy P, Hamoda H, Juszczak E, Khalaf Y, Kurinczuk JJ, Lavery S, Linsell L, Macklon N, Mathur R, Pundir J, Raine-Fenning N, Rajkohwa M, Scotland G, Stanbury K, Troup S, Bhattacharya S. Elective freezing of embryos versus fresh embryo transfer in IVF: a multicentre randomized controlled trial in the UK (E-Freeze). Hum Reprod 2022; 37:476-487. [PMID: 34999830 PMCID: PMC9206534 DOI: 10.1093/humrep/deab279] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/24/2021] [Indexed: 11/30/2022] Open
Abstract
STUDY QUESTION Does a policy of elective freezing of embryos, followed by frozen embryo transfer result in a higher healthy baby rate, after first embryo transfer, when compared with the current policy of transferring fresh embryos? SUMMARY ANSWER This study, although limited by sample size, provides no evidence to support the adoption of a routine policy of elective freeze in preference to fresh embryo transfer in order to improve IVF effectiveness in obtaining a healthy baby. WHAT IS KNOWN ALREADY The policy of freezing all embryos followed by frozen embryo transfer is associated with a higher live birth rate for high responders but a similar/lower live birth after first embryo transfer and cumulative live birth rate for normal responders. Frozen embryo transfer is associated with a lower risk of ovarian hyperstimulation syndrome (OHSS), preterm delivery and low birthweight babies but a higher risk of large babies and pre-eclampsia. There is also uncertainty about long-term outcomes, hence shifting to a policy of elective freezing for all remains controversial given the delay in treatment and extra costs involved in freezing all embryos. STUDY DESIGN, SIZE, DURATION A pragmatic two-arm parallel randomized controlled trial (E-Freeze) was conducted across 18 clinics in the UK from 2016 to 2019. A total of 619 couples were randomized (309 to elective freeze/310 to fresh). The primary outcome was a healthy baby after first embryo transfer (term, singleton live birth with appropriate weight for gestation); secondary outcomes included OHSS, live birth, clinical pregnancy, pregnancy complications and cost-effectiveness. PARTICIPANTS/MATERIALS, SETTING, METHODS Couples undergoing their first, second or third cycle of IVF/ICSI treatment, with at least three good quality embryos on Day 3 where the female partner was ≥18 and <42 years of age were eligible. Those using donor gametes, undergoing preimplantation genetic testing or planning to freeze all their embryos were excluded. IVF/ICSI treatment was carried out according to local protocols. Women were followed up for pregnancy outcome after first embryo transfer following randomization. MAIN RESULTS AND THE ROLE OF CHANCE Of the 619 couples randomized, 307 and 309 couples in the elective freeze and fresh transfer arms, respectively, were included in the primary analysis. There was no evidence of a statistically significant difference in outcomes in the elective freeze group compared to the fresh embryo transfer group: healthy baby rate {20.3% (62/307) versus 24.4% (75/309); risk ratio (RR), 95% CI: 0.84, 0.62 to 1.15}; OHSS (3.6% versus 8.1%; RR, 99% CI: 0.44, 0.15 to 1.30); live birth rate (28.3% versus 34.3%; RR, 99% CI 0.83, 0.65 to 1.06); and miscarriage (14.3% versus 12.9%; RR, 99% CI: 1.09, 0.72 to 1.66). Adherence to allocation was poor in the elective freeze group. The elective freeze approach was more costly and was unlikely to be cost-effective in a UK National Health Service context. LIMITATIONS, REASONS FOR CAUTION We have only reported on first embryo transfer after randomization; data on the cumulative live birth rate requires further follow-up. Planned target sample size was not obtained and the non-adherence to allocation rate was high among couples in the elective freeze arm owing to patient preference for fresh embryo transfer, but an analysis which took non-adherence into account showed similar results. WIDER IMPLICATIONS OF THE FINDINGS Results from the E-Freeze trial do not lend support to the policy of electively freezing all for everyone, taking both efficacy, safety and costs considerations into account. This method should only be adopted if there is a definite clinical indication. STUDY FUNDING/COMPETING INTEREST(S) NIHR Health Technology Assessment programme (13/115/82). This research was funded by the National Institute for Health Research (NIHR) (NIHR unique award identifier) using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK Department of Health and Social Care. J.L.B., C.C., E.J., P.H., J.J.K., L.L. and G.S. report receipt of funding from NIHR, during the conduct of the study. J.L.B., E.J., P.H., K.S. and L.L. report receipt of funding from NIHR, during the conduct of the study and outside the submitted work. A.M. reports grants from NIHR personal fees from Merck Serono, personal fees for lectures from Merck Serono, Ferring and Cooks outside the submitted work; travel/meeting support from Ferring and Pharmasure and participation in a Ferring advisory board. S.B. reports receipt of royalties and licenses from Cambridge University Press, a board membership role for NHS Grampian and other financial or non-financial interests related to his roles as Editor-in-Chief of Human Reproduction Open and Editor and Contributing Author of Reproductive Medicine for the MRCOG, Cambridge University Press. D.B. reports grants from NIHR, during the conduct of the study; grants from European Commission, grants from Diabetes UK, grants from NIHR, grants from ESHRE, grants from MRC, outside the submitted work. Y.C. reports speaker fees from Merck Serono, and advisory board role for Merck Serono and shares in Complete Fertility. P.H. reports membership of the HTA Commissioning Committee. E.J. reports membership of the NHS England and NIHR Partnership Programme, membership of five Data Monitoring Committees (Chair of two), membership of six Trial Steering Committees (Chair of four), membership of the Northern Ireland Clinical Trials Unit Advisory Group and Chair of the board of Oxford Brain Health Clinical Trials Unit. R.M. reports consulting fees from Gedeon Richter, honorarium from Merck, support fees for attendance at educational events and conferences for Merck, Ferring, Bessins and Gedeon Richter, payments for participation on a Merck Safety or Advisory Board, Chair of the British Fertility Society and payments for an advisory role to the Human Fertilisation and Embryology Authority. G.S. reports travel and accommodation fees for attendance at a health economic advisory board from Merck KGaA, Darmstadt, Germany. N.R.-F. reports shares in Nurture Fertility. Other authors' competing interests: none declared. TRIAL REGISTRATION NUMBER ISRCTN: 61225414. TRIAL REGISTRATION DATE 29 December 2015. DATE OF FIRST PATIENT’S ENROLMENT 16 February 2016.
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Affiliation(s)
- Abha Maheshwari
- Aberdeen Fertility Centre, NHS Grampian and University of Aberdeen, Aberdeen, UK
| | - Jennifer L Bell
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Priya Bhide
- Assisted Conception Unit, Homerton University Hospital NHS Foundation Trust and Queen Mary University of London, London, UK
| | - Daniel Brison
- Assisted Conception Unit, Manchester University NHS Foundation Trust, Manchester, UK
| | - Tim Child
- Oxford Fertility, TFP, University of Oxford, UK
| | - Huey Yi Chong
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Ying Cheong
- Complete Fertility, University of Southampton, Southampton, UK
| | - Christina Cole
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Arri Coomarasamy
- Department of Metabolomics, University of Birmingham, Birmingham, UK
| | | | - Pollyanna Hardy
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Haitham Hamoda
- Assisted Conception Unit, King's College Hospital, London, UK
| | - Edmund Juszczak
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.,Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Yacoub Khalaf
- Assisted Conception Unit and Centre for Pre-implantation Genetic Diagnosis, Guy's and St Thomas' Hospital and King's College London, London, UK
| | - Jennifer J Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Louise Linsell
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Nick Macklon
- London Women's Clinic, London, UK.,University of Copenhagen, Denmark
| | - Raj Mathur
- Assisted Conception Unit, St. Mary's Hospital, Manchester, UK
| | - Jyotsna Pundir
- Assisted Conception Unit, St. Bartholomew's Hospital and Queen Mary University of London, London, UK
| | | | | | - Graham Scotland
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Kayleigh Stanbury
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Ho PSY, Quigley MA, Tucker DF, Kurinczuk JJ. Risk factors for hospitalisation in Welsh infants with a congenital anomaly. BMJ Paediatr Open 2022; 6:10.1136/bmjpo-2021-001238. [PMID: 36053619 PMCID: PMC8845320 DOI: 10.1136/bmjpo-2021-001238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 01/12/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To investigate risk factor associated with hospitalisation of infants with a congenital anomaly in Wales, UK. DESIGN A population-based cohort study. SETTING Data from the Welsh Congenital Anomaly Register and Information Service linked to the Patient Episode Database for Wales and livebirths and deaths from the Office for National Statistics. PATIENTS All livebirths between 1999 and 2015 with a diagnosis of a congenital anomaly, which was defined as a structural, metabolic, endocrine or genetic defect, as well as rare diseases of hereditary origin. MAIN OUTCOME MEASURES Adjusted OR (aOR) associated with 1 or 2+ hospital admissions in infancy versus no admissions were estimated for sociodemographic, maternal and infant factors using multinomial logistic regression for the subgroups of all, isolated, multiple and cardiovascular anomalies. RESULTS 25 523 infants affected by congenital anomalies experienced a total of 50 705 admissions in infancy. Risk factors for ≥2 admissions were younger maternal age ≤24 years (aOR: 1.17; 95% CI 1.06 to 1.30), maternal smoking (aOR: 1.20; 1.10 to 1.31), preterm birth (aOR: 2.52; 2.25 to 2.83) and moderately severe congenital heart defects (aOR: 6.25; 4.47 to 8.74). Girls had an overall decreased risk of 2+ admissions (aOR: 0.84; 0.78 to 0.91). Preterm birth was a significant risk factor for admissions in all anomaly subgroups but the effect of the other characteristics varied according to anomaly subgroup. CONCLUSIONS Over two-thirds of infants with an anomaly are admitted to hospital during infancy. Our findings identified sociodemographic and clinical characteristics contributing to an increased risk of hospitalisation of infants with congenital anomalies.
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Affiliation(s)
- Peter S Y Ho
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Maria A Quigley
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.,National Institute for Health Research (NIHR) Policy Research Unit- Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - David F Tucker
- Public Health Wales, Public Health Knowledge & Research, Congenital Anomaly Register & Information Service for Wales, Public Health Wales, Swansea, UK
| | - Jennifer J Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.,National Institute for Health Research (NIHR) Policy Research Unit- Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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39
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Engjom HM, Ramakrishnan R, Vousden N, Bunch K, Morris E, Simpson NAB, Gale C, O'Brien P, Quigley M, Brocklehurst P, Kurinczuk JJ, Knight M. Severity of maternal SARS-CoV-2 infection and perinatal outcomes of women admitted to hospital during the omicron variant dominant period using UK Obstetric Surveillance System data: prospective, national cohort study. BMJ Med 2022; 1:e000190. [PMID: 36936599 PMCID: PMC10012856 DOI: 10.1136/bmjmed-2022-000190] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/22/2022] [Indexed: 12/15/2022]
Abstract
Objectives To describe the severity of maternal infection when the omicron SARS-CoV-2 variant (B.1.1.529) was dominant (15 December 2021 to 14 March 2022) and describe outcomes by symptoms and vaccination status. Design Prospective, national cohort study using the UK Obstetric Surveillance System. Setting 94 hospitals in the UK with a consultant led maternity unit. Participants Pregnant women admitted to hospital for any cause with a positive SARS-CoV-2 test. Main outcome measures Symptomatic or asymptomatic infection, vaccination status by doses before admission, and severity of maternal infection (moderate or severe infection according to modified World Health Organization's criteria). Results Of 3699 women who were admitted to hospital, 986 (26.7%, 95% confidence interval 25.3% to 28.1%) had symptoms; of these, 144 (14.6%, 12.5% to 17.0%) had a moderate to severe infection, 99 (10.4%, 8.6% to 12.5%) of 953 received respiratory support, and 30 (3.0%, 2.1% to 4.3%) were admitted to an intensive care unit. Covid-19 specific drug treatment was given to 13 (43.3%) of the 30 women in intensive care. Four women with symptoms died (0.4%, 0.1% to 1.1%). Vaccination status was known for 845 (85.6%) women with symptoms; 489 (58.9%) were unvaccinated and only 55 (6.5%) had three doses. Moderate to severe infection was reported for 93 (19.0%) of 489 unvaccinated women with symptoms, decreasing to three (5.5%) of 55 after three doses. Among the 30 women with symptoms who were admitted to intensive care, 23 (76.7%) were unvaccinated and none had received three doses. Conclusion Most women with severe covid-19 disease were unvaccinated and vaccine coverage among pregnant women admitted to hospital with SARS-CoV-2 was low. Ongoing action to prioritise and advocate for vaccine uptake in pregnancy is essential. A better understanding of the persistent low use of drug treatments is an urgent priority. Trial registration ISRCTN 40092247.
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Affiliation(s)
- Hilde M Engjom
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Bergen, Norway
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, Oxfordshire, UK
| | - Rema Ramakrishnan
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, Oxfordshire, UK
| | - Nicola Vousden
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, Oxfordshire, UK
| | - Kathryn Bunch
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, Oxfordshire, UK
| | - Eddie Morris
- Department of Obstetrics and Gynaecology, Norfolk and Norwich University Hospital NHS Trust, Norwich, Norfolk, UK
- Royal College of Obstetricians and Gynaecologists, London, London, UK
| | - Nigel A B Simpson
- Department of Women’s & Children’s Health, University of Leeds, Leeds, West Yorkshire, UK
| | - Chris Gale
- Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Patrick O'Brien
- Royal College of Obstetricians and Gynaecologists, London, London, UK
- Institute for Women's Health, University College London, London, UK
| | - Maria Quigley
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, Oxfordshire, UK
| | - Peter Brocklehurst
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, West Midlands, UK
| | - Jennifer J Kurinczuk
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, Oxfordshire, UK
| | - Marian Knight
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, Oxfordshire, UK
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Knight M, Bunch K, Vousden N, Banerjee A, Cox P, Cross-Sudworth F, Dhanjal MK, Douglas J, Girling J, Kenyon S, Kotnis R, Patel R, Shakespeare J, Tuffnell D, Wilkinson M, Kurinczuk JJ. A national cohort study and confidential enquiry to investigate ethnic disparities in maternal mortality. EClinicalMedicine 2022; 43:101237. [PMID: 34977514 PMCID: PMC8683666 DOI: 10.1016/j.eclinm.2021.101237] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/25/2021] [Accepted: 11/25/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Ethnic disparities in maternal mortality were first documented in the UK in the early 2000s but are known to be widening. This project aimed to describe the women who died in the UK during or up to a year after the end of pregnancy, to compare the quality of care received by women from different aggregated ethnic groups, and to identify any structural or cultural biases or discrimination affecting their care. METHODS National surveillance data was used to identify all 1894 women who died during or up to a year after the end of pregnancy between 2009 and 18 in the UK. Their characteristics and causes of death were described. A Confidential Enquiry was undertaken to describe the quality of care women received. The care of a stratified random sample of 54 women who died during or up to a year after the end of pregnancy between 2009 and 18, (18 from the aggregated group of Black women, 19 from the Asian aggregated group and 17 from the White aggregated group) was re-examined specifically to describe any structural or cultural biases or discrimination identified. FINDINGS There were no major differences causes of death between women from different aggregated ethnic groups, with cardiovascular disease the leading cause of death in all groups. Multiple areas of bias were identified in the care women received, including lack of nuanced care (notable amongst women from Black aggregated ethnic groups who died), microaggressions (most prominent in the care of women from Asian aggregated ethnic groups who died) and clinical, social and cultural complexity (evident across all ethnic groups). INTERPRETATION This confidential enquiry suggests that multiple structural and other biases exist in UK maternity care. Further research on the role of microaggressions is warranted. FUNDING This research is funded by the National Institute for Health Research (NIHR) Policy Research Programme, conducted through the Policy Research Unit in Maternal and Neonatal Health and Care, PR-PRU-1217-21,202. MK is an NIHR Senior Investigator. SK is part funded and FCS fully funded by the National Institute for Health Research (NIHR) Applied Research Centre (ARC) West Midlands. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.
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Affiliation(s)
- Marian Knight
- Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom
- Corresponding author at: Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford, OX3 7LF, United Kingdom.
| | - Kathryn Bunch
- Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom
| | - Nicola Vousden
- Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom
| | - Anita Banerjee
- Guys and St Thomas’ Hospitals NHS Foundation Trust, London, United Kingdom
| | - Philippa Cox
- Homerton University Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Mandish K. Dhanjal
- Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Jenny Douglas
- School of Health, Wellbeing and Social Care, Faculty of Wellbeing, Education and Language Studies, The Open University, United Kingdom
| | - Joanna Girling
- Chelsea and Westminster Hospital NHS FT, London, United Kingdom
| | - Sara Kenyon
- Institute of Applied Health Research, University of Birmingham, United Kingdom
| | | | - Roshni Patel
- Chelsea and Westminster Hospital NHS FT, London, United Kingdom
| | - Judy Shakespeare
- Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom
- Retired GP, Oxford, United Kingdom
| | - Derek Tuffnell
- Bradford Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | - Meg Wilkinson
- University College London Hospitals, London, United Kingdom
| | - Jennifer J. Kurinczuk
- Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom
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Vousden N, Ramakrishnan R, Bunch K, Morris E, Simpson NAB, Gale C, O'Brien P, Quigley M, Brocklehurst P, Kurinczuk JJ, Knight M. Severity of maternal infection and perinatal outcomes during periods of SARS-CoV-2 wildtype, alpha, and delta variant dominance in the UK: prospective cohort study. BMJ Med 2022; 1:e000053. [PMID: 36936566 PMCID: PMC9978672 DOI: 10.1136/bmjmed-2021-000053] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/19/2022] [Indexed: 12/17/2022]
Abstract
Objective To compare the severity of maternal infection and perinatal outcomes during periods in which wildtype, alpha variant, and delta variant of SARS-CoV-2 were dominant in the UK. Design Prospective cohort study. Setting 194 obstetric units across the UK, during the following periods: between 1 March and 30 November 2020 (wildtype dominance), between 1 December 2020 and 15 May 2021 (alpha variant dominance), and between 16 May and 31 October 2021 (delta variant dominance). Participants 4436 pregnant women admitted to hospital with covid-19 related symptoms. Main outcome measures Moderate to severe maternal SARS-CoV-2 infection (indicated by any of the following: oxygen saturation <95% on admission, need for oxygen treatment, evidence of pneumonia on imaging, admission to intensive care, or maternal death), and pregnancy and perinatal outcomes (including mode and gestation of birth, stillbirth, live birth, admission to neonatal intensive care, and neonatal death). Results 1387, 1613, and 1436 pregnant women were admitted to hospital with covid-19 related symptoms during the wildtype, alpha, and delta dominance periods, respectively; of these women, 340, 585, and 614 had moderate to severe infection, respectively. The proportion of pregnant women admitted with moderate to severe infection increased during the subsequent alpha and delta dominance periods, compared with the wildtype dominance period (wildtype 24.5% v alpha 36.2% (adjusted odds ratio 1.98, 95% confidence interval 1.66% to 2.37%); wildtype 24.5% v delta 42.8% (2.66, 2.21 to 3.20)). Compared with the wildtype dominance period, women admitted during the alpha dominance period were significantly more likely to have pneumonia, require respiratory support, and be admitted to intensive care; these three risks were even greater during the delta dominance period (wildtype v delta: pneumonia, adjusted odds ratio 2.52, 95% confidence interval 2.06 to 3.09; respiratory support, 1.90, 1.52 to 2.37; and intensive care, 2.71, 2.06 to 3.56). Of 1761 women whose vaccination status was known, 38 (2.2%) had one dose and 16 (1%) had two doses before their diagnosis (of whom 14 (88%) had mild infection). The proportion of women receiving drug treatment for SARS-CoV-2 management was low, but did increase between the wildtype dominance period and the alpha and delta dominance periods (10.4% wildtype v 14.9% alpha (2.74, 2.08 to 3.60); 10.4% wildtype v 13.6% delta (2.54, 1.90 to 3.38)). Conclusions While limited by the absence of variant sequencing data, these findings suggest that during the periods when the alpha and delta variants of SARS-CoV-2 were dominant, covid-19 was associated with more severe maternal infection and worse pregnancy outcomes than during the wildtype dominance period. Most women admitted with SARS-CoV-2 related symptoms were unvaccinated. Urgent action to prioritise vaccine uptake in pregnancy is essential. Study registration ISRCTN40092247.
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Affiliation(s)
- Nicola Vousden
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Rema Ramakrishnan
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Kathryn Bunch
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Eddie Morris
- Royal College of Obstetricians and Gynaecologists, London, UK
| | - Nigel A B Simpson
- Department of Women’s & Children’s Health, University of Leeds, Leeds, UK
| | - Christopher Gale
- School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Patrick O'Brien
- Royal College of Obstetricians and Gynaecologists, London, UK
- Institute for Women's Health, University College London, London, UK
| | - Maria Quigley
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Peter Brocklehurst
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, West Midlands, UK
| | - Jennifer J Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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42
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Simpson DA, Carson C, Kurinczuk JJ, Quigley MA. Trends and inequalities in breastfeeding continuation from 1 to 6 weeks: findings from six population-based British cohorts, 1985-2010. Eur J Clin Nutr 2022; 76:671-679. [PMID: 34773096 PMCID: PMC9090631 DOI: 10.1038/s41430-021-01031-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 09/26/2021] [Accepted: 10/11/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Understanding inequalities in breastfeeding practices may help to explain the UK's persistently low breastfeeding rates. A recent study using the quinquennial UK Infant Feeding Surveys (IFS) found that sociodemographic inequalities in breastfeeding initiation persisted between 1985 and 2010. The present study investigates the sociodemographic inequalities in breastfeeding continuation at 6 weeks after birth among mothers who initiated and maintained breastfeeding at 1 week in 1985-2010. METHODS Data were drawn from the 1985 to 2010 IFS and restricted to mothers who were breastfeeding at 1 week after birth. Time trends in the proportion of mothers in each sociodemographic group were examined. Logistic regression was used to estimate associations between breastfeeding at 6 weeks and sociodemographic factors, adjusting for confounders. Heterogeneity test was used to assess changes in these associations over time. RESULTS Sociodemographic inequalities in breastfeeding continuation at 6 weeks persisted over the 25-year period. In most survey years, mothers were most likely to breastfeed at 6 weeks if they were 30 or older versus under 25 (OR 1.49-1.99 across survey years, I2 = 0%, heterogeneity P = 0.45); completed full-time education over age 18 compared to 18 or younger (OR 1.56-2.51, I2 = 58.7%, P = 0.03); or of Black, Asian, Mixed, or other ethnicity compared to White (OR 1.45-2.48, I2 = 44.8%, P = 0.16). CONCLUSIONS Among mothers breastfeeding at 1 week, those who were younger, White or had fewer years of full-time education were at greatest risk of discontinuing before 6 weeks. This risk persisted over time and was independent of their high risk of not initiating breastfeeding.
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Affiliation(s)
- Deon A. Simpson
- grid.4991.50000 0004 1936 8948National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Claire Carson
- grid.4991.50000 0004 1936 8948National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jennifer J. Kurinczuk
- grid.4991.50000 0004 1936 8948National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Maria A. Quigley
- grid.4991.50000 0004 1936 8948National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Lokubal P, Frischer SR, Corcuera I, Balil JM, Nalwadda Kayemba C, Kurinczuk JJ, Nair M. Abortion decision-making trajectories and factors influencing such trajectories in low- and middle-income countries: a protocol for mixed-methods systematic review. BMJ Open 2021; 11:e049507. [PMID: 34725075 PMCID: PMC8562532 DOI: 10.1136/bmjopen-2021-049507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Globally, about half of all pregnancies are unintended and/or unwanted and three-fifths of these end in induced abortion. When faced with a choice to terminate pregnancy, women's abortion decision-making processes are often complex and multiphasic and maybe amplified in low- and middle-income countries (LMICs) which bear the major burden of abortion-related morbidity and mortality. Our review aims to (1) describe abortion decision-making trajectories for women in LMICs and (2) investigate factors influencing the choice of abortion decision-making trajectories in LMICs. METHODS AND ANALYSIS We will search and retrieve published and unpublished qualitative, quantitative and mixed-methods, community and/or hospital-based studies conducted in LMICs from 1 January 2000 up to 16 February 2021. We will search Ovid Medline, Ovid EMBASE, Ovid PsycInfo, Ovid Global Health, Web of Science (including Social Science Citation Index), Scopus, IBSS, CINAHL via EBSCO, WHO Global Index Medicus, the Cochrane Library, WHO website, ProQuest and Google Scholar. We will search reference lists of eligible studies and contact experts for additional data/information, if required. We will extract all relevant data to answer our research questions and assess study quality using the appropriate appraisal tools. Depending on the extracted data, our analysis will use sequential or convergent synthesis methods proposed by Hong et al. For qualitative studies, we will synthesise evidence using thematic synthesis, meta-ethnography or 'best-fit' framework synthesis; and for quantitative findings, we will provide a narrative synthesis and/or meta-analysis. We will do sensitivity analyses and assess confidence in our findings using Grades of Recommendation, Assessment, and Evaluation -Confidence in Evidence from Reviews of Qualitative Research (GRADE-CERQUal) for qualitative findings and Grades of Recommednation, Assessment, and Evaluation (GRADE) for quantitative findings. ETHICS AND DISSEMINATION We did not require ethics approval for this systematic review. We will publish our findings in an open-access peer-reviewed journal with global and maternal health readership. We will also present our findings at national and international scientific conferences.
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Affiliation(s)
- Paul Lokubal
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Ines Corcuera
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | - Christine Nalwadda Kayemba
- Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Jennifer J Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Manisha Nair
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Fellmeth G, Kishore MT, Verma A, Desai G, Bharti O, Kanwar P, Singh S, Thippeswamy H, Chandra PS, Kurinczuk JJ, Nair M, Alderdice F. Perinatal mental health in India: protocol for a validation and cohort study. J Public Health (Oxf) 2021; 43:ii35-ii42. [PMID: 34622290 PMCID: PMC8498097 DOI: 10.1093/pubmed/fdab162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/07/2021] [Accepted: 05/05/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Common mental disorders (CMD) are among the largest contributors to global maternal morbidity and mortality. Although research on perinatal mental health in India has grown in recent years, important evidence gaps remain, especially regarding CMD. Our study aims to improve understanding of CMD among perinatal and non-perinatal women of reproductive age across two settings in India: Bangalore (Karnataka) and Tanda (Himachal Pradesh). METHODS The study is embedded within the Maternal and Perinatal Health Research Collaboration India (MaatHRI). This mixed-methods observational study comprises three consecutive phases: (i) focus group discussions and individual interviews to explore women's knowledge and seek feedback on CMD screening tools; (ii) validation of CMD screening tools; and (iii) prospective cohort study to identify CMD incidence, prevalence and risk factors among perinatal and non-perinatal women. Results of the three phases will be analyzed using inductive thematic analysis, psychometric analysis and multivariable regression analysis, respectively. CONCLUSION Improving understanding, detection and management of CMD among women is key to improving women's health and promoting gender equality. This study will provide evidence of CMD screening tools for perinatal and non-perinatal women in two diverse Indian settings, produce data on CMD prevalence, incidence and risk factors and enhance understanding of the specific contribution of the perinatal state to CMD.
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Affiliation(s)
- G Fellmeth
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - M T Kishore
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - A Verma
- Department of Obstetrics and Gynaecology, Dr Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India
| | - G Desai
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - O Bharti
- State Institute of Health and Family Welfare, Department of Health and Family Welfare, Government of Himachal Pradesh, India
| | - P Kanwar
- Department of Psychiatry, Dr Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India
| | - S Singh
- Department of Psychiatry, Dr Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India
| | - H Thippeswamy
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - P S Chandra
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - J J Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - M Nair
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - F Alderdice
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.,School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland
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Nair M, Chhabra S, Choudhury SS, Deka D, Deka G, Kakoty SD, Kumar P, Mahanta P, Medhi R, Rani A, Rao S, Roy I, Solomi V C, Talukdar RK, Zahir F, Kansal N, Arora A, Opondo C, Armitage J, Laffan M, Stanworth S, Quigley M, Baigent C, Knight M, Kurinczuk JJ. Relationship between anaemia, coagulation parameters during pregnancy and postpartum haemorrhage at childbirth: a prospective cohort study. BMJ Open 2021; 11:e050815. [PMID: 34607867 PMCID: PMC8491293 DOI: 10.1136/bmjopen-2021-050815] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 09/17/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To investigate the association between coagulation parameters and severity of anaemia (moderate anaemia: haemoglobin (Hb) 7-9.9 g/dL and severe anaemia: Hb <7 g/dL) during pregnancy and relate these to postpartum haemorrhage (PPH) at childbirth. DESIGN A prospective cohort study of pregnant women recruited in the third trimester and followed-up after childbirth. SETTING Ten hospitals across four states in India. PARTICIPANTS 1342 pregnant women. INTERVENTION Not applicable. METHODS Hb and coagulation parameters: fibrinogen, D-dimer, D-dimer/fibrinogen ratio, platelets and international normalised ratio (INR) were measured at baseline. Participants were followed-up to measure blood loss within 2 hours after childbirth and PPH was defined based on blood loss and clinical assessment. Associations between coagulation parameters, Hb, anaemia and PPH were examined using multivariable logistic regression models. OUTCOMES MEASURES Adjusted OR with 95% CI. RESULTS In women with severe anaemia during the third trimester, the D-dimer was 27% higher, mean fibrinogen 117 mg/dL lower, D-dimer/fibrinogen ratio 69% higher and INR 12% higher compared with women with no/mild anaemia. Mean platelets in severe anaemia was 37.8×109/L lower compared with women with moderate anaemia. Similar relationships with smaller effect sizes were identified for women with moderate anaemia compared with women with no/mild anaemia. Low Hb and high INR at third trimester of pregnancy independently increased the odds of PPH at childbirth, but the other coagulation parameters were not found to be significantly associated with PPH. CONCLUSION Altered blood coagulation profile in pregnant women with severe anaemia could be a risk factor for PPH and requires further evaluation.
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Affiliation(s)
- Manisha Nair
- NPEU, Nuffield Department of Population Health, Oxford University, Oxford, Oxfordshire, UK
| | - Shakuntala Chhabra
- Department of Obstetrics and Gynaecology, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra, India
| | - Saswati Sanyal Choudhury
- Department of Obstetrics and Gynaecology, Gauhati Medical College and Hospital, Guwahati, Assam, India
| | - Dipika Deka
- Srimanta Sankaradeva University of Health Sciences, Guwahati, Assam, India
| | - Gitanjali Deka
- Department of Obstetrics and Gynaecology, Tezpur Medical College, Tezpur, India
| | - Swapna D Kakoty
- Department of Obstetrics and Gynaecology, Fakhruddin Ali Ahmed Medical College and Hospital, Barpeta, Assam, India
| | - Pramod Kumar
- Department of Obstetrics and Gynaecology, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra, India
| | - Pranabika Mahanta
- Department of Obstetrics and Gynaecology, Jorhat Medical College and Hospital, Jorhat, Assam, India
| | - Robin Medhi
- Department of Obstetrics and Gynaecology, Fakhruddin Ali Ahmed Medical College and Hospital, Barpeta, Assam, India
| | - Anjali Rani
- Department of Obstetrics and Gynaecology, Banaras Hindu University Institute of Medical Sciences, Varanasi, Uttar Pradesh, India
| | - Seeresha Rao
- Department of Obstetrics and Gynaecology, Silchar Medical College and Hospital, Silchar, Assam, India
| | - Indrani Roy
- Department of Obstetrics and Gynaecology, Nazareth Hospital, Shillong, Meghalaya, India
| | - Carolin Solomi V
- Department of Obstetrics and Gynaecology, Makunda Christian Leprosy and General Hospital, Karimganj, Assam, India
| | - Ratna Kanta Talukdar
- Department of Obstetrics and Gynaecology, Jorhat Medical College and Hospital, Jorhat, Assam, India
| | - Farzana Zahir
- Department of Obstetrics and Gynaecology, Assam Medical College, Dibrugarh, Assam, India
| | - Nimmi Kansal
- National Reference Laboratory, Dr Lal Pathlabs, New Delhi, India
| | - Anil Arora
- National Reference Laboratory, Dr Lal Pathlabs, New Delhi, India
| | - Charles Opondo
- Nuffield Department of Population Health, Oxford University, Oxford, Oxfordshire, UK
| | - Jane Armitage
- Nuffield Department of Population Health, Oxford University, Oxford, Oxfordshire, UK
| | - Michael Laffan
- Haemostasis and Thrombosis, Imperial College London Faculty of Medicine, London, UK
| | - Simon Stanworth
- Department of Haematology/Transfusion Medicine, Oxford University, Oxford, Oxfordshire, UK
| | - Maria Quigley
- National Perinatal Epidemiology Unit, Oxford University, Oxford, Oxfordshire, UK
| | - Colin Baigent
- Nuffield Department of Population Health, Oxford University, Oxford, Oxfordshire, UK
| | - Marian Knight
- National Perinatal Epidemiology Unit, Oxford University, Oxford, Oxfordshire, UK
| | - Jennifer J Kurinczuk
- National Perinatal Epidemiology Unit, Oxford University, Oxford, Oxfordshire, UK
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Coathup V, Carson C, Kurinczuk JJ, Macfarlane AJ, Boyle E, Johnson S, Petrou S, Quigley MA. Associations between gestational age at birth and infection-related hospital admission rates during childhood in England: Population-based record linkage study. PLoS One 2021; 16:e0257341. [PMID: 34555039 PMCID: PMC8459942 DOI: 10.1371/journal.pone.0257341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 08/30/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Children born preterm (<37 completed weeks' gestation) have a higher risk of infection-related morbidity than those born at term. However, few large, population-based studies have investigated the risk of infection in childhood across the full spectrum of gestational age. The objectives of this study were to explore the association between gestational age at birth and infection-related hospital admissions up to the age of 10 years, how infection-related hospital admission rates change throughout childhood, and whether being born small for gestational age (SGA) modifies this relationship. METHODS AND FINDINGS Using a population-based, record-linkage cohort study design, birth registrations, birth notifications and hospital admissions were linked using a deterministic algorithm. The study population included all live, singleton births occurring in NHS hospitals in England from January 2005 to December 2006 (n = 1,018,136). The primary outcome was all infection-related inpatient hospital admissions from birth to 10 years of age, death or study end (March 2015). The secondary outcome was the type of infection-related hospital admission, grouped into broad categories. Generalised estimating equations were used to estimate adjusted rate ratios (aRRs) with 95% confidence intervals (CIs) for each gestational age category (<28, 28-29, 30-31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41 and 42 weeks) and the models were repeated by age at admission (<1, 1-2, 3-4, 5-6, and 7-10 years). An interaction term was included in the model to test whether SGA status modified the relationship between gestational age and infection-related hospital admissions. Gestational age was strongly associated with rates of infection-related hospital admissions throughout childhood. Whilst the relationship attenuated over time, at 7-10 years of age those born before 40 weeks gestation were still significantly higher in comparison to those born at 40 weeks. Children born <28 weeks had an aRR of 6.53 (5.91-7.22) during infancy, declining to 3.16 (2.50-3.99) at ages 7-10 years, in comparison to those born at 40 weeks; whilst in children born at 38 weeks, the aRRs were 1·24 (1.21-1.27) and 1·18 (1.13-1.23), during infancy and aged 7-10 years, respectively. SGA status modified the effect of gestational age (interaction P<0.0001), with the highest rate among the children born at <28 weeks and SGA. Finally, study findings indicated that the associations with gestational age varied by subgroup of infection. Whilst upper respiratory tract infections were the most common type of infection experienced by children in this cohort, lower respiratory tract infections (LRTIs) (<28 weeks, aRR = 10.61(9.55-11.79)) and invasive bacterial infections (<28 weeks, aRR = 6.02 (4.56-7.95)) were the most strongly associated with gestational age at birth. Of LRTIs experienced, bronchiolitis (<28 weeks, aRR = 11.86 (10.20-13.80)), and pneumonia (<28 weeks, aRR = 9.49 (7.95-11.32)) were the most common causes. CONCLUSIONS Gestational age at birth was strongly associated with rates of infection-related hospital admissions during childhood and even children born a few weeks early remained at higher risk at 7-10 years of age. There was variation between clinical subgroups in the strength of relationships with gestational age. Effective infection prevention strategies should include focus on reducing the number and severity of LRTIs during early childhood.
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Affiliation(s)
- Victoria Coathup
- National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health (NDPH), University of Oxford, Oxford, United Kingdom
| | - Claire Carson
- National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health (NDPH), University of Oxford, Oxford, United Kingdom
| | - Jennifer J. Kurinczuk
- National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health (NDPH), University of Oxford, Oxford, United Kingdom
| | | | - Elaine Boyle
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Samantha Johnson
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Stavros Petrou
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, United Kingdom
| | - Maria A. Quigley
- National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health (NDPH), University of Oxford, Oxford, United Kingdom
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Li Y, Kurinczuk JJ, Gale C, Siassakos D, Carson C. Evidence of disparities in the provision of the maternal postpartum 6-week check in primary care in England, 2015-2018: an observational study using the Clinical Practice Research Datalink (CPRD). J Epidemiol Community Health 2021; 76:239-246. [PMID: 34503988 PMCID: PMC8862061 DOI: 10.1136/jech-2021-216640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 07/30/2021] [Indexed: 11/05/2022]
Abstract
Background A maternal postpartum 6-week check (SWC) with a general practitioner (GP) is now considered an essential service in England, a recent policy change intended to improve women’s health. We aimed to provide an up-to-date snapshot of the prevalence of SWC prior to the policy change as a baseline, and to explore factors associated with having a late or no check. Methods We conducted a cohort study using primary care records in England (Clinical Practice Research Datalink (CPRD)). 34 337 women who gave birth between 1 July 2015 and 30 June 2018 and had ≥12 weeks of follow-up post partum were identified in the CPRD Pregnancy Register. The proportion who had evidence of an SWC with a GP was calculated, and regression analysis was used to assess the association between women’s characteristics and risks of a late or no check. Results Sixty-two per cent (95% CI 58% to 67%) of women had an SWC recorded at their GP practice within 12 weeks post partum, another 27% had other consultations. Forty per cent had an SWC at the recommended 6–8 weeks, 2% earlier and 20% later. A late or no check was more common among younger women, mothers of preterm babies or those registered in more deprived areas. Conclusions Nearly 40% of women did not have a postpartum SWC recorded. Provision or uptake was not equitable; younger women and those in more deprived areas were less likely to have a record of such check, suggesting postpartum care in general practice may be missing some women who need it most.
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Affiliation(s)
- Yangmei Li
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jennifer J Kurinczuk
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Christopher Gale
- Neonatal Medicine, School of Public Health, Faculty of Medicine, Chelsea and Westminster Hospital Campus, Imperial College London, London, UK
| | - Dimitrios Siassakos
- Institute for Women's Health, University College London, London, UK
- University College London Hospitals NIHR Biomedical Research Centre, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, UK
| | - Claire Carson
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Alterman N, Johnson S, Carson C, Petrou S, Rivero-Arias O, Kurinczuk JJ, Macfarlane A, Boyle E, Quigley MA. Gestational age at birth and child special educational needs: a UK representative birth cohort study. Arch Dis Child 2021; 106:842-848. [PMID: 33483377 PMCID: PMC7613205 DOI: 10.1136/archdischild-2020-320213] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 11/09/2020] [Accepted: 12/09/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To examine the association between gestational age at birth across the entire gestational age spectrum and special educational needs (SENs) in UK children at 11 years of age. METHODS The Millennium Cohort Study is a nationally representative longitudinal sample of children born in the UK during 2000-2002. Information about the child's birth, health and sociodemographic factors was collected when children were 9 months old. Information about presence and reasons for SEN was collected from parents at age 11. Adjusted relative risks (aRRs) were estimated using modified Poisson regression, accounting for confounders. RESULTS The sample included 12 081 children with data at both time points. The overall prevalence of SEN was 11.2%, and it was inversely associated with gestational age. Among children born <32 weeks of gestation, the prevalence of SEN was 27.4%, three times higher than among those born at 40 weeks (aRR=2.89; 95% CI 2.02 to 4.13). Children born early term (37-38 weeks) were also at increased risk for SEN (aRR=1.33; 95% CI 1.11 to 1.59); this was the same when the analysis was restricted to births after labour with spontaneous onset. Birth before full term was more strongly associated with having a formal statement of SEN or SEN for multiple reasons. CONCLUSION Children born at earlier gestational ages are more likely to experience SEN, have more complex SEN and require support in multiple facets of learning. This association was observed even among children born early-term and when labour began spontaneously.
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Affiliation(s)
- Neora Alterman
- National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Samantha Johnson
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Claire Carson
- National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Oliver Rivero-Arias
- National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jennifer J Kurinczuk
- National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Elaine Boyle
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Maria A Quigley
- National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Santoro M, Coi A, Barišić I, Pierini A, Addor MC, Baldacci S, Ballardini E, Boban L, Braz P, Cavero-Carbonell C, de Walle HEK, Draper ES, Gatt M, Haeusler M, Klungsøyr K, Kurinczuk JJ, Materna-Kiryluk A, Lanzoni M, Lelong N, Luyt K, Mokoroa O, Mullaney C, Nelen V, O'Mahony MT, Perthus I, Randrianaivo H, Rankin J, Rissmann A, Rouget F, Schaub B, Tucker D, Wellesley D, Zymak-Zakutnia N, Garne E. Epidemiology of Pierre-Robin sequence in Europe: A population-based EUROCAT study. Paediatr Perinat Epidemiol 2021; 35:530-539. [PMID: 34132407 DOI: 10.1111/ppe.12776] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/22/2021] [Accepted: 04/25/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Pierre Robin sequence (PRS) is a rare congenital anomaly. Respiratory disorders and feeding difficulties represent the main burden. OBJECTIVE The aim of this study was to investigate the epidemiology of PRS using a cohort of cases from EUROCAT, the European network of population-based registries of congenital anomalies. METHODS We analysed cases of PRS born in the period 1998-2017 collected by 29 population-based congenital anomaly registries in 17 different countries. We calculated prevalence estimates, prenatal detection rate, survival up to 1 week, and proportions of associated anomalies. The effect of maternal age was tested using a Poisson regression model. RESULTS Out of 11 669 155 surveyed births, a total of 1294 cases of PRS were identified. The estimate of the overall prevalence was 12.0 per 100 000 births (95% CI 9.9, 14.5). There was a total of 882 (68.2%) isolated cases, and the prevalence was 7.8 per 100 000 births (95% CI 6.7, 9.2). A total of 250 cases (19.3%) were associated with other structural congenital anomalies, 77 cases (6.0%) were associated with chromosomal anomalies and 77 (6.0%) with genetic syndromes. The prenatal detection rate in isolated cases was 12.0% (95% CI 9.8, 14.5) and increased to 16.0% (95% CI 12.7, 19.7) in the sub-period 2008-2017. The prevalence rate ratio of non-chromosomal cases with maternal age ≥35 was higher than in cases with maternal age <25 for total (PRR 1.26, 95% CI 1.05, 1.51) and isolated cases (PRR 1.33, 95% CI 1.00, 1.64). Survival of chromosomal cases (94.2%) and multiple anomaly cases (95.3%) were lower than survival of isolated cases (99.4%). CONCLUSIONS This epidemiological study using a large series of cases of PRS provides insights into the epidemiological profile of PRS in Europe. We observed an association with higher maternal age, but further investigations are needed to test potential risk factors for PRS.
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Affiliation(s)
- Michele Santoro
- Unit of Epidemiology of Rare diseases and Congenital anomalies, Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Alessio Coi
- Unit of Epidemiology of Rare diseases and Congenital anomalies, Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Ingeborg Barišić
- Children's Hospital Zagreb, Centre of Excellence for Reproductive and Regenerative Medicine, Medical School University of Zagreb, Zagreb, Croatia
| | - Anna Pierini
- Unit of Epidemiology of Rare diseases and Congenital anomalies, Institute of Clinical Physiology, National Research Council, Pisa, Italy.,Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Marie-Claude Addor
- Department of Woman-Mother-Child University Medical Center CHUV Lausanne, Switzerland
| | - Silvia Baldacci
- Unit of Epidemiology of Rare diseases and Congenital anomalies, Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Elisa Ballardini
- Neonatal Intensive Care Unit, Paediatric Section, IMER Registry (Emilia Romagna Registry of Birth Defects), Dep. of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Ljubica Boban
- Children's Hospital Zagreb, Centre of Excellence for Reproductive and Regenerative Medicine, Medical School University of Zagreb, Zagreb, Croatia
| | - Paula Braz
- Epidemiology Department, National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal
| | - Clara Cavero-Carbonell
- Rare Diseases Research Unit, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region, Valencia, Spain
| | - Hermien E K de Walle
- University Medical Center Groningen, Department of Genetics, University of Groningen, Groningen, the Netherlands
| | - Elizabeth S Draper
- Department Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Miriam Gatt
- Malta Congenital Anomalies Registry, Directorate for Health Information and Research, G'Mangia, Malta
| | | | - Kari Klungsøyr
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
| | - Jennifer J Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Anna Materna-Kiryluk
- Department of Medical Genetics, Poznan University of Medical Sciences, Poznan, Poland
| | - Monica Lanzoni
- European Commission, Joint Research Centre (JRC), Ispra, Italy
| | - Nathalie Lelong
- Epidemiology and Statistics Research Center - CRESS, INSERM, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Université de Paris, Paris, France
| | - Karen Luyt
- South West Congenital Anomaly Register, Bristol Medical School, University of Bristol, Bristol, UK
| | - Olatz Mokoroa
- Public Health Division of Gipuzkoa, Biodonostia Research Institute, Donostia-San Sebastian, Spain
| | - Carmel Mullaney
- Department of Public Health, HSE South East, Lacken, Kilkenny, Ireland
| | - Vera Nelen
- Provincial Institute of Hygiene, Antwerp, Belgium
| | - Mary T O'Mahony
- Department of Public Health, HSE South (Cork & Kerry), Ireland
| | - Isabelle Perthus
- Auvergne registry of congenital anomalies (CEMC-Auvergne), Department of clinical genetics, Centre de Référence des Maladies Rares, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Hanitra Randrianaivo
- Register of Congenital Malformations Isle of Reunion Island, CHU St Pierre, la Reunion, France
| | - Judith Rankin
- Population Health Sciences Institute, Newcastle University/National Congenital Anomaly and Rare Disease Registration Service (NCARDRS), Public Health England, Newcastle upon Tyne, UK
| | - Anke Rissmann
- Malformation Monitoring Centre Saxony-Anhalt, Medical Faculty Otto-von-Guericke University, Magdeburg, Germany
| | - Florence Rouget
- Brittany Registry of Congenital Malformations, CHU Rennes, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, Environnement et Travail) - UMR_S 1085, Rennes, France
| | - Bruno Schaub
- French West Indies Registry, Registre des Malformations des Antilles (REMALAN), Maison de la Femme de la Mère et de l'Enfant, University Hospital of Martinique, Fort-de-France, France
| | - David Tucker
- Congenital Anomaly Register & Information Service for Wales (CARIS), Public Health Wales, Swansea, UK
| | - Diana Wellesley
- Wessex Clinical Genetics Service, University Hospitals Southampton, Southampton, UK
| | | | - Ester Garne
- Paediatric Department, Hospital Lillebaelt, Kolding, Denmark
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Fitzpatrick KE, Kurinczuk JJ, Quigley MA. Planned mode of birth after previous caesarean section and special educational needs in childhood: a population-based record linkage cohort study. BJOG 2021; 128:2158-2168. [PMID: 34216080 PMCID: PMC9291107 DOI: 10.1111/1471-0528.16828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2021] [Indexed: 01/15/2023]
Abstract
Objective To investigate the association between planned mode of birth after previous caesarean section and a child’s risk of having a record of special educational needs (SENs). Design Population‐based cohort study. Setting Scotland. Population A cohort of 44 892 singleton children born at term in Scotland between 2002 and 2011 to women with one or more previous caesarean sections. Methods Linkage of Scottish national health and education data sets. Main outcome measures Any SENs and specific types of SEN recorded when a child was aged 4–11 years and attending a Scottish primary or special school. Results Children born following planned vaginal birth after previous caesarean (VBAC) compared with elective repeat caesarean section (ERCS) had a similar risk of having a record of any SENs (19.24 versus 17.63%, adjusted risk ratio aRR 1.04, 95% CI 0.99–1.09) or specific types of SEN. There was also little evidence that planned VBAC with or without labour induction compared with ERCS was associated with a child’s risk of having a record of any SENs (21.42 versus 17.63%, aRR 1.09, 95% CI 1.01–1.17 and 18.78 versus 17.63%, aRR 1.03, 95% CI 0.98–1.08, respectively) or most types of SEN. However, an increased risk of sensory impairment was seen for planned VBAC with labour induction compared with ERCS (1.18 versus 0.78%, risk difference 0.4%, adjusted odds ratio aOR 1.60, 95% CI 1.09–2.34). Conclusions This study provides little evidence of an association between planned mode of birth after previous caesarean and SENs in childhood beyond a small absolute increased risk of sensory impairment seen for planned VBAC with labour induction. This finding may be the result of performing multiple comparisons or residual confounding. The findings provide valuable information to manage and counsel women with previous caesarean section concerning their future birth choices. Tweetable abstract There is little evidence planned mode of birth after previous caesarean section is associated with special educational needs in childhood. There is little evidence planned mode of birth after previous caesarean section is associated with special educational needs in childhood.
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Affiliation(s)
- K E Fitzpatrick
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - J J Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - M A Quigley
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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