Vulnerable newborn phenotypes in Peru: a population-based study of 3,841,531 births at national and subnational levels from 2012 to 2021

Background

We aimed to examine the national and subnational prevalence of vulnerable newborn phenotypes in Peru, 2012-2021.

Methods

Newborn phenotypes were defined using gestational age (preterm [PT], term [T]), birthweight for gestational age using INTERGROWTH-21st standards (small for gestational age [SGA], appropriate for gestational age [AGA] or large for gestational age [LGA]), and birthweight (low birthweight [LBW], non-LBW) using the Peruvian National Birth Registry as six (by excluding birthweight) and ten newborn phenotypes (using all three outcomes). Small phenotypes (with at least one classification of PT, SGA, or LBW) were further considered. Using individual-level data, we stratified the phenotypes by maternal educational level, maternal age, healthcare insurance, altitude of residence, and geographic region (Coast, Andes, and Amazon).

Findings

The prevalence of the five vulnerable newborn phenotypes for the study period was LGA+T (15.2%), AGA+PT (5.2%), SGA+T (4.6%), LGA+PT (0.8%), and SGA+PT (0.7%). The Coast had a higher prevalence of newborns with large phenotypes (19.4%) and the Highlands a higher prevalence of newborns with small phenotypes (12.5%). Mothers with poor socioeconomic status, extreme ages and living at high altitude had a higher prevalence of newborns with small phenotypes, and mothers who were wealthier, more educated, and older had a higher prevalence of infants with large phenotypes.

Interpretation

Our findings cautiously suggest that socioeconomic and geographic disparities may play a crucial role in shaping vulnerable newborn phenotypes at national and subnational level in Peru. Further studies using longitudinal data are needed to corroborate our findings and to identify individual-level risk factors.

Funding

Ter Meulen Grant from the KNAW Medical Sciences Fund of the Royal Netherlands Academy of Arts and Sciences (KNAWWF/1085/TMB406, KNAWWF/1327/TMB202116), Fogarty Program (D43TW011502).

The impact of COVID-19-related restrictions on pregnancy and abortion rates in the Republic of Georgia

BACKGROUND

The Republic of Georgia implemented COVID-19-related restrictions starting on 31 March 2020, when it imposed a 1-month strict lockdown, after which the country continued with some form of restrictions for 1 year. These restrictions created barriers to healthcare access, affected healthcare services, caused severe economic degradation, and changed reproductive behavior. The aim of this study was to explore the impact of COVID-19-related restrictions on pregnancy and abortion rates in Georgia.

METHODS

Information on pregnancy, abortion, and related variables was extracted from the Georgian Birth Registry from January 2018 through April 2022. The final study sample included 232,594 pregnancies and 86,729 abortions. We used interrupted time series analysis to study the impact of COVID-19-related restrictions.

RESULTS

There were slightly decreasing trends in pregnancy and abortion rates in the pre-pandemic period (1 January 2018-31 March 2020). During the 1-month strict lockdown (1 April-30 April 2020), pregnancy and abortion rates decreased in all investigated age groups. There were no substantial differences in pregnancy or abortion rates in the pandemic period (for pregnancies: 1 April 2020-30 June 2021; for abortions: 1 April 2020-30 April 2022) compared to the pre-pandemic period. The precision of all estimates suggested that both small increases and decreases in pregnancy and abortion rates are reasonably compatible with our data.

CONCLUSIONS

Despite the 1-year-long COVID-19-related restrictions, our results did not indicate substantial long-term changes in pregnancy or abortion rates during the study period for any age group. This may indicate that the restrictions did not substantially influence access to contraception, abortion services, or reproductive behavior.

Secular trends of socio-demographic and lifestyle characteristics among delivering women in Arctic Russia, 1973-2017

The aim of this study was to describe temporal trends in socio-demographic and lifestyle characteristics among delivering women in two Northern provinces of Russia from 1973 to 2017. Totally 161,730 births were registered in three birth registries. Changes in the distribution of maternal age, education, marital status, smoking during pregnancy were studied using Pearson's chi-squared tests and one-way ANOVA. The logistic regression models were used to assess factors, contributing to the variations in the prevalence of maternal smoking. The mean age of primiparous mothers increased from 22.1 years in 1973-1980 to 25.4 years in 2012-2017 (p < 0.001). The proportion of primiparous mothers with higher education increased from 26.2% in 2006 to 38.3% in 2017 (p < 0.001). The proportion of cohabiting primiparous women increased from 5.0% to 15.2% over the study period (p < 0.001). The proportion of mothers smoking during pregnancy decreased from 18.9% in 2006-2011 to 14.8% in 2012-2017 (p < 0.001). Downward in the prevalence of smoking was revealed in 2012-2017 compared to 2006-2011 (OR = 137.76; 95%CI:71.62-264.96, OR = 183.74; 95%CI:95.52-353.41, respectively). Over the past decades, women postpone childbearing until receiving higher education, continue living in cohabitation during pregnancy and smoke less.

Exploring associations between residential exposure to pesticides and birth outcomes using the Dutch birth registry

BACKGROUND

Maternal occupational exposure to pesticides has been linked to adverse birth outcomes but associations with residential pesticide exposures are inconclusive.

OBJECTIVES

To explore associations between residential exposure to specific pesticides and birth outcomes using individual level exposure and pregnancy/birth data.

METHODS

From all 2009-2013 singleton births in the Dutch birth registry, we selected mothers > 16 years old living in non-urban areas, who had complete address history and changed addresses at most once during pregnancy (N = 339,947). We estimated amount (kg) of 139 active ingredients (AI) used within buffers of 50, 100, 250 and 500 m around each mother's home during pregnancy. We used generalized linear models to investigate associations between 12 AIs with evidence of reproductive toxicity and gestational age (GA), birth weight (BW), perinatal mortality, child́s sex, prematurity, low birth weight (LBW), small for gestational age (SGA) and large for gestational age (LGA), adjusting for individual and area-level confounders. For the remainder 127 AIs, we used minimax concave penalty with a stability selection step to identify those that could be related to birth outcomes.

RESULTS

Regression analyses showed that maternal residential exposure to fluroxypyr-meptyl was associated with longer GA, glufosinate-ammonium with higher risk of LBW, linuron with higher BW and higher odds of LGA, thiacloprid with lower odds of perinatal mortality and vinclozolin with longer GA. Variable selection analysis revealed that picoxystrobin was associated with higher odds of LGA. We found no evidence of associations with other AIs. Sensitivity and additional analysis supported these results except for thiacloprid.

DISCUSSION

In this exploratory study, pregnant women residing near crops where fluroxypyr-meptyl, glufosinate-ammonium, linuron, vinclozolin and picoxystrobin were applied had higher risk for certain potentially adverse birth outcomes. Our findings provide leads for confirmatory investigations on these compounds and/or compounds with similar modes of action.

Incidence and Causes of Perinatal Mortality in Georgia

Georgia has one of the highest perinatal mortality rates (i.e., stillbirths and early neonatal deaths combined) in Europe. The Georgian Birth Registry was started in 2016 to provide data for preventive measures of maternal and child health. In this study, we aim to determine the incidence of perinatal mortality, assess the distribution of stillbirths and early neonatal deaths, and to determine the major causes of perinatal mortality in Georgia. Data sources were the Georgian Birth Registry and the vital registration system for the year 2017. Causes of early neonatal deaths were assigned into five categories, using the Wigglesworth classification with the Neonatal and Intrauterine deaths Classification according to Etiology modification. The study used descriptive statistics only, specifically counts, means, proportions, and rates, using the statistical software STATA version 15.0. (StataCorp, College Station, TX, USA). In 2017, 489 stillbirths and 238 early neonatal deaths were recorded, resulting in a perinatal mortality rate of 13.6 per 1000 births. About 80% of stillbirths had an unknown cause of death. The majority of stillbirths occurred before the start of labor (85%), and almost one-third were delivered by caesarean section (28%). Prematurity (58%) and congenital malformations (23%) were the main causes of early neonatal deaths, and 70% of early neonatal deaths occurred after the first day of life. The perinatal mortality rate in Georgia remained high in 2017. The major causes of early neonatal deaths were comparable to those of many high-income countries. Contrary to global data, most early neonatal deaths occurred after the first day of life.

Caesarean section rates from Malaysian tertiary hospitals using Robson's 10-group classification

Background

Rising caesarean section rates is a concern worldwide. This study aimed to use Robson’s ten group classification to identify which groups of women were contributing most to the rising caesarean section rates in Malaysian tertiary hospitals and to compare between hospitals, using a common standard set of variables.

Methods

A 5-year (2011–2015) cross-sectional study was conducted using data from the Malaysian National Obstetrics Registry (NOR). A total of 608,747 deliveries were recorded from 11 tertiary state hospitals and 1 tertiary hospital from the Federal territory.

Results

During the study period, there were 141,257 Caesarean sections (23.2%). Caesarean sections in Group 1 (nulliparous term pregnancy in spontaneous labour) and Group 3 (multiparous term pregnancy in spontaneous labour) had an increasing trend from 2011 to 2015. The group that contributed most to the overall caesarean section rates was Group 5 (multiparous, singleton, cephalic≥37 weeks with previous caesarean section) and the rates remained high during the 5-year study period. Groups 6, 7 and 9 had the highest caesarean section rates but they made the smallest contribution to the overall rates.

Conclusions

Like many countries, the rate of caesarean section has risen over time, and the rise is driven by caesarean section in low-risk groups. There was an important hospital to hospital variation. The rise in caesarean section rates reflects a globally disturbing trend, and changes in policy and training that creates a uniform standard across hospitals should be considered.

A population-based study of maternal and infant factors influencing influenza vaccination among young children born in Colorado from 2008 to 2016

INTRODUCTION

Influenza causes significant morbidity among young children, and vaccination remains the best strategy to prevent disease. Understanding factors influencing early influenza vaccination uptake are important to identify strategies to increase vaccination rates.

OBJECTIVE

To assess maternal and neonatal factors associated with influenza vaccination among first-born children within the first two years of life.

METHODS

We conducted a retrospective population-based cohort study linking Colorado Birth Registry data and state immunization data of all live births between 2008 and 2016. The cohort was limited to singleton, first births. Multivariable logistic regression was used to assess associations between maternal and neonatal factors and influenza vaccination.

RESULTS

Among 126,763 births meeting criteria for inclusion, 50.2% were vaccinated against influenza by two years of age. Mothers of unvaccinated children were older (27 vs 26 years, p < 0.0001), married (67.8% vs 66.8%, p < 0.0001), with a college education (38.8% vs 37.2%, p < 0.0001). Influenza vaccination rates declined over time by birth year (30.5% in 2009 vs 6.8% in 2013, p < 0.0001). Children admitted to the NICU receiving oxygen with 72 h of birth were 20% less likely to be vaccinated (RR = 0.8, 95% CI: 0.67-0.96) after adjusting for maternal age, race/ethnicity, education and preterm birth. Conversely, premature births were associated with an increase in influenza vaccination by age two years (RR = 1.1, 95%CI: 1.05, 1.15).

CONCLUSIONS

Among a large population-based cohort of mother-infant pairs in Colorado using birth and immunization registry data, there were statistically significant differences in maternal factors between unvaccinated and vaccinated children with influenza in the first 2 years of life, but the differences were too small to be clinically significant. Children admitted to the NICU were 20% less likely to be vaccinated, highlighting the need to target influenza vaccination in this population once eligible. Ongoing studies are needed to explore factors associated with early influenza vaccination.

Risk factors for perinatal mortality in Murmansk County, Russia: a registry-based study

Background: Factors contributing to perinatal mortality (PM) in Northwest Russia remain unclear. This study investigated possible associations between selected maternal and fetal characteristics and PM based on data from the population-based Murmansk County Birth Registry.

Objective: This study investigated possible associations between selected maternal and fetal characteristics and PM based on data from the population-based Murmansk County Birth Registry.

Methods: The study population consisted of all live- and stillbirths registered in the Murmansk County Birth Registry during 2006–2011 (n = 52,806). We excluded multiple births, births prior to 22 and after 45 completed weeks of gestation, infants with congenital malformations, and births with missing information regarding gestational age (a total of n = 3,666) and/or the studied characteristics (n = 2,356). Possible associations between maternal socio-demographic and lifestyle characteristics, maternal pre-pregnancy characteristics, pregnancy characteristics, and PM were studied by multivariable logistic regression. Crude and adjusted odds ratios with 95% confidence intervals were calculated.

Results: Of the 49,140 births eligible for prevalence analysis, 338 were identified as perinatal deaths (6.9 per 1,000 births). After adjustment for other factors, maternal low education level, prior preterm delivery, spontaneous or induced abortions, antepartum hemorrhage, antenatally detected or suspected fetal growth retardation, and alcohol abuse during pregnancy all significantly increased the risk of PM. We observed a higher risk of PM in unmarried women, as well as overweight or obese mothers. Maternal underweight reduced the risk of PM.

Conclusions: Our results suggest that both social and medical factors are important correlates of perinatal mortality in Northwest Russia.

Monitoring of birth registry coverage and data quality utilizing lot quality assurance sampling methodology: A pilot study

Background:

Effectively monitoring the coverage and quality of data in low-resource settings is challenging. Lot quality assurance sampling (LQAS) is a method to classify coverage as adequate or inadequate. The aim of this pilot study is sought to determine the coverage and quality of a birth registry in a rural district in Pakistan.

Methods:

This survey was conducted in 14 clusters of Thatta, Pakistan. LQAS methodology was used to monitor the birth registry from December 2015 to February 2016. We randomly selected 19 villages from each cluster. We used a short questionnaire to review the quality of data collection for select variables. Frequency and percentages were reported for categorical variables. For data validation, Kappa statistics (κ) were applied to assess the agreement between categorical observations, and the Bland–Altman test was used to assess agreement for continuous data.

Results:

Of the 14 clusters sampled, 12 clusters had adequate coverage. Agreement of hemoglobin performance between the women's response and information in birth registry data was good (κ = 0.718) (95% confidence interval [CI]: 0.58–0.82); agreement on birth outcome recorded by the workers in the registry and as mentioned by women was very good (κ = 1.0); and agreement whether birth weight was assessed within 48 h of delivery was good (κ = 0.648) (0.37–0.92).

Conclusion:

LQAS is a powerful tool to monitor coverage and data quality of the birth registry maintained by the global network for women's and children's health in Pakistan and potentially for data from other surveillance systems.

Quality of IVF status registration in the Estonian Medical Birth Registry: a national record linkage study

Background

Information regarding in vitro fertilization (IVF) as a pregnancy risk factor (yes/ no) is stored in each birth record of the Estonian Medical Birth Registry (EMBR). This study aimed to assess the validity of registration of newborns’ IVF status in the EMBR.

Methods

To identify the newborns conceived by IVF, the birth records in the EMBR were compared to individual records on the embryo transfer procedures in the Estonian Health Insurance Fund (EHIF) database as a reference. Maternal age was restricted to 40 years, the age limit for IVF treatment covered by the EHIF. The embryo transfer procedures, that dated up to eight weeks before pregnancy, were additionally checked in the infertility treatment clinics. The validity of IVF status was measured by sensitivity, specificity, positive and negative predictive values (PPV and NPV). Relative risk (RR) of unrecorded IVF status among IVF mothers by socio-demographic characteristics and birth plurality was estimated using modified Poisson regression models.

Results

There were 3198 newborns identified as conceived by IVF in the EMBR in 2005–2014. Eight of them were incorrectly entered as born after IVF. The record linkage with the EHIF database revealed 1014 newborns with unrecorded IVF status in the EMBR. A total of 4204 newborns were verified as conceived by IVF, 24.1% of them were not categorized as born after IVF. The sensitivity of the IVF status registration was poor (75.9%), specificity (100.0%), PPV (99.8%) and NPV (99.3%) were high. The misclassifications were significantly more common among mothers of younger age or non-Estonians or with singleton birth.

Conclusion

Information based on mother’s self-report or her antenatal chart does not accurately identify the newborn’s IVF status. The lack of a specialized country-wide assisted reproductive technology register in Estonia requires routine record linkage of the EMBR, EHIF and the infertility treatment clinics’ databases to obtain adequate information regarding IVF status in the EMBR. Electronic record linkages between databases would help considerably to improve the validity of data to be used in medical decision making, in research and for statistical purposes.

The association between pre pregnancy body mass index and risk of preeclampsia: a registry based study from Tanzania

Background

Preeclampsia is among the leading causes of maternal mortality and morbidity worldwide, occurs in 2-8% of all pregnancies, and is estimated to account for at least 9 % of maternal deaths in Africa. Studies from developed countries show that high pre pregnancy body mass index (BMI) increases the risk of preeclampsia. We examined the association between pre pregnancy BMI and the risk of preeclampsia in Tanzania, a low income country.

Methods

Data from the Kilimanjaro Christian Medical Center (KCMC) Medical Birth Registry recorded between July 2000 and May 2013 were used. We restricted the study population to singleton deliveries among women with no or one previous pregnancy. Pre pregnancy BMI (kg/m²⁾ was categorized according to the WHO categories of underweight (less than 18.5), normal (18.5 – 24.9), overweight (25.0 – 29.9) and obese (30 or more). Potential confounders were adjusted for in multivariable analyses.

Results

Among the 17,738 singleton births, 6.6% of the mothers were underweight, 62.1% were of normal BMI, 24.0% were overweight, and 7.3% were obese. Five hundred and eighty-two pregnancies (3.3%) were affected by preeclampsia. Compared to those with normal BMI, overweight and obese women had a higher risk of preeclampsia (aOR (95% CI) 1.4 (1.2 – 1.8) and 1.8 (1.3 – 2.4)), respectively, while underweight women had a lower risk (0.7 (0.4-1.1)).

Conclusions

Pre pregnancy maternal overweight and obesity were associated with an increased risk of preeclampsia in Tanzania. Risks were similar to those reported in high income countries.

Administrative Claims Data Versus Augmented Pregnancy Data for the Study of Pharmaceutical Treatments in Pregnancy

Purpose of Review

Administrative claims databases, which collect reimbursement-related information generated from healthcare encounters, are increasingly used to evaluate medication safety in pregnancy. We reviewed the strengths and limitations of claims-only databases and how other data sources may be used to improve the accuracy and completeness of information critical for studying medication safety in pregnancy.

Recent Findings

Research on medication safety in pregnancy requires information on pregnancy episodes, mother-infant linkage, medication exposure, gestational age, maternal and birth outcomes, confounding factors, and (in some studies) long-term follow-up data. Claims data reliably identifies live births and possibly other pregnancies. It allows mother-infant linkage and has prospectively collected prescription medication information. Its diagnosis and procedure information allows estimation of gestational age. It captures maternal medical conditions but generally has incomplete data on reproductive and lifestyle factors. It has information on certain, typically short-term maternal and infant outcomes that may require chart review confirmation. Other data sources including electronic health records and birth registries can augment claims data or be analyzed alone. Interviews, surveys, or biological samples provide additional information. Nationwide and regional birth and pregnancy registries, such as those in several European and North American countries, generally contain more complete information essential for pregnancy research compared to claims-only databases.

Summary

Claims data offers several advantages in medication safety in pregnancy research. Its limitations can be partially addressed by linking it with other data sources or supplementing with primary data collection. Rigorous assessment of data quality and completeness is recommended regardless of data sources.

Reproductive trends in females with inflammatory joint disease

Background

The study assessed birth trends per decade in offspring of females with inflammatory joint diseases (IJD) compared with women without IJD.

Methods

This retrospective cohort study is based on data from the Medical Birth Registry of Norway from 1967 to 2009. We investigated singleton births in females with IJD (n = 7502) and compared with births from the general population (n = 2 437 110). Four periods were examined: 1967–79, 1980–89, 1990–99 and 2000–09. In the logistic regression analysis adjustments were made for maternal age at delivery and birth order. Odds ratios were obtained for the associations between IJD and birth outcome for each period.

Results

Females with IJD had in average 65 deliveries / year (0.08 % of all births) in the 1970ies and 274 deliveries / year (0.5 % of all births) from 2000 to 2009. Adjusted Odds ratios (aOR) for newborns small for gestational age were 1.5 (95 % CI 1.2, 1.9) in the earliest and 1.1 (95 % CI 0.9, 1.2) in the last period. Correspondingly, for birth weight < 2500 grams aOR decreased from 1.4 (95 % CI 1.0, 1.9) to 1.1 (95 % CI 0.9, 1.4). For preterm birth aOR was 1.1 (95 % CI 0.8, 1.5) in the first and 1.3 (95 % CI (1.1, 1.5) in the last period.

Conclusion

An increasing number of births among females with IJD were observed in the study period. Birth weights of newborns of IJD women approached to birth weights in the general population, but preterm birth remained a problem.

Electronic supplementary material

The online version of this article (doi:10.1186/s12884-016-0919-7) contains supplementary material, which is available to authorized users.

Rheumatoid arthritis and outcomes in first and subsequent births based on data from a national birth registry

OBJECTIVE

To examine associations between rheumatoid arthritis (RA) and pregnancy outcomes in first and subsequent births.

DESIGN

Cohort study.

SETTING

Study based on data registered in the Medical Birth Registry of Norway from the period 1 December 1998 to 31 December 2009.

POPULATION

Singleton births in women recorded with RA (n = 1496) and reference deliveries from the general population (n = 625,642).

METHODS

Outcomes of first and subsequent births were analyzed separately. First birth was defined as the first delivery of nulliparous women. Associations between RA and maternal and perinatal outcomes were assessed in logistic regression analyses and adjusted for maternal age at delivery, gestational age, smoking habits and for previous cesarean section when relevant.

MAIN OUTCOME MEASURES

Maternal and perinatal outcomes.

RESULTS

Vaginal bleeding was observed more often among women with RA both in first pregnancy [adjusted odds ratio (aOR) 1.8, 95% CI 1.3-2.4] and in subsequent pregnancies (aOR 1.4, 95% CI 1.1-1.9). Elective cesarean section was more common among women with RA both in the first birth (aOR 2.0, 95% CI 1.4-2.8) and in subsequent births (aOR 1.5, 95% CI 1.2-2.0). Preterm delivery was more frequent among women with RA than the reference population in first pregnancy (aOR 1.5, 95% CI 1.1-2.0) and in subsequent pregnancies (aOR 1.5, 95% CI 1.1-1.9).

CONCLUSION

Complications and poor pregnancy outcomes were more often observed in women with RA and the greatest differences were observed in the first pregnancy.