Trends and risk factors of stillbirths and neonatal deaths in Eastern Uganda (1982-2011): a cross-sectional, population-based study.

Short birth intervals have been associated with adverse birth outcomes. This study examines the association between preceding interval and risk of stillbirth or neonatal death in rural north India (n = 80 164). Adjusted odds ratios (OR) and 95% confidence interval (CI) of stillbirth and neonatal mortality were calculated. The odds of stillbirth were significantly greater among birth intervals of <18 months (OR 3.10; CI: 2.69-3.57), 18-35 months (OR 1.47; CI 1.30-1.68) and >59 months (OR 1.44; CI 1.19-1.73), compared with intervals of 36-59 months. Neonatal death was associated with birth intervals of <18 months (OR 4.12; CI 3.74-4.55) and 18-35 months (OR 1.78; CI 1.63-1.94), compared to births spaced 36-59 months. Previous history of either stillbirth or neonatal death was significantly associated with risk of stillbirth and neonatal death, respectively, as were multiple births.

To investigate causes of and contributors to newborn deaths in eastern Uganda using a three delays audit approach. Methods Data collected on 64 neonatal deaths from a demographic surveillance site were coded for causes of deaths using a hierarchical model and analysed using a modified three delays model to determine contributing delays. A survey was conducted in 16 health facilities to determine capacity for newborn care. Of the newborn babies, 33% died in a hospital/health centre, 13% in a private clinic and 54% died away from a health facility. 47% of the deaths occurred on the day of birth and 78% in the first week. Major contributing delays to newborn death were caretaker delay in problem recognition or in deciding to seek care (50%, 32/64); delay to receive quality care at a health facility (30%; 19/64); and transport delay (20%; 13/64). The median time to seeking care outside the home was 3 days from onset of illness (IQR 1-6). The leading causes of death were sepsis or pneumonia (31%), birth asphyxia (30%) and preterm birth (25%). Health facilities did not have capacity for newborn care, and health workers had correct knowledge on only 31% of the survey questions related to newborn care. Household and health facility-related delays were the major contributors to newborn deaths, and efforts to improve newborn survival need to address both concurrently. Understanding why newborn babies die can be improved by using the three delays model, originally developed for understanding maternal death.

Long-term use of oral contraceptives increases the risk of miscarriage

Perinatal mortality is a major global public health concern, especially in sub-Saharan Africa (SSA). Despite perinatal mortality being a major public health concern in SSA, there are very limited studies on the incidence and factors associated with perinatal mortality. Therefore, we aimed to investigate the factors associated with perinatal mortality in SSA. A secondary data analysis was conducted based on the Demographic and Health Survey (DHS) data of 27 SSA countries. About 314,099 births in the preceding five years of the surveys were considered for the analysis. A multilevel binary logistic regression model was fitted to identify factors associated with perinatal mortality. Deviance (-2Log-Likelihood Ratio (LLR)) was used for model comparison. The Adjusted Odds Ratio (AOR) with the 5% Confidence Interval (CI) of the best-fitted model was used to verify the significant association between factors and perinatal mortality. The perinatal mortality rate in sub-Saharan Africa (SSA) was 37.31 per 1,000 births (95% CI: 36.65, 37.98). In the final best-fit model, factors significantly associated with higher perinatal mortality included media exposure (AOR: 1.12, 95% CI: 1.08, 1.17), maternal age ≥ 35 years (AOR: 1.13, 95% CI: 1.06, 1.21), health facility delivery (AOR: 1.10, 95% CI: 1.06, 1.15), having 2-4 births (AOR: 1.35, 95% CI: 1.25, 1.47), five or more births (AOR: 1.69, 95% CI: 1.53, 1.86), residence in West Africa (AOR: 1.30, 95% CI: 1.24, 1.36) or Central Africa (AOR: 1.05, 95% CI: 1.00, 1.11), rural residency (AOR: 1.08, 95% CI: 1.02, 1.13), and difficulty accessing a health facility (AOR: 1.06, 95% CI: 1.02, 1.10). In contrast, factors significantly associated with lower perinatal mortality were a preceding birth interval of 2-4 years (AOR: 0.70, 95% CI: 0.67, 0.74) or five or more years (AOR: 0.91, 95% CI: 0.84, 0.97), Antenatal Care (ANC) visit (AOR: 0.66, 95% CI: 0.63, 0.69), higher education levels (AOR: 0.82, 95% CI: 0.73, 0.93), middle household wealth (AOR: 0.93, 95% CI: 0.88, 0.98), and richer household wealth (AOR: 0.93, 95% CI: 0.87, 0.99). Perinatal mortality was a major public health problem in SSA. Maternal socio-demographic, obstetrical, and healthcare-related factors are significantly associated with perinatal mortality. The findings of this study highlighted the need for holistic healthcare interventions targeting enhancing maternal healthcare services to reduce the incidence of perinatal mortality.

Female overweight is not associated with a higher embryo euploidy rate in first trimester miscarriages karyotyped by hysteroembryoscopy

To study the current status and risk factors of spontaneous abortion of women with Tibetan ethnicity at reproductive age in rural areas. Pregnant women who lived in Tibet were interviewed on their former reproductive history and being followed on the outcomes of pregnant from 2006 to 2012. Generalized Poisson regression model was used to explore the influencing factors of spontaneous abortion. OR value of the research factors was estimated and its 95% confidence interval counted. There were 1 557 pregnant women under this study, with a total number of 2 687 pregnancies and 2 382 productions. 171 women underwent spontaneous abortion, with a total number of 204 times, 93 women had histories of abortion, with a total number of 101 times. Among all the Tibetan pregnant women, the ratio between spontaneous abortion and pregnant women was 7.6% while the rate of spontaneous abortion was 7.9% . Ratio between the number of women who had experienced spontaneous abortion and the total number of women under survey was 11.0% . Pregnancy appeared the important reason on spontaneous abortion. The risk of having spontaneous abortion would increase among women who had more than 3 pregnancies. Results from Poisson regression analysis revealed that the odds ratio (OR) value before the adjustment was 3.921 (95% CI:2.553-6.021) but after the adjustment, it increased to 4.722 (95% CI:2.834-7.866). The increase of production time could reduce the risk of spontaneous abortion in women of childbearing age. Risks related to spontaneous abortion were associated with the number of pregnancies. Women seemed to have lower risk for spontaneous abortion after 2009, with OR value as 0.419 (95%CI:0.285-0.616) before, compared to aOR value as 0.580 (95%CI:0.380-0.885) after the adjustment Social-demographic characteristics was not found to be particularly associated with the occurrence of spontaneous abortion. Rate of spontaneous abortion among Tibetan women at childbearing age was not particularly high when comparing to those women living in the plain area such as Shanxi. However, in order to further reduce the incidence of spontaneous abortion among Tibetan women, approaches should include the following items:strengthening maternal health care, extending the spacing of pregnancy and reducing the frequency of pregnancy.

Sub-Saharan African (SSA) countries have high stillbirth rates compared with high-income countries, yet research on risk factors for stillbirth in SSA remain scant. To identify the modifiable risk factors of stillbirths in SSA and investigate their strength of association using a systematic review. CINAHL Plus, EMBASE, Global Health and MEDLINE databases were searched for literature. Observational population- and facility-level studies exploring stillbirth risk factors, published in 2013-2019 were included. A narrative synthesis of data was undertaken and the potential risk factors were classified into subgroups. Thirty-seven studies were included, encompassing 20 264 stillbirths. The risk factors were categorised as: maternal antepartum factors (0-4 antenatal care visits, multiple gestations, hypertension, birth interval of >3 years, history of perinatal death); socio-economic factors (maternal lower wealth index and basic education, advanced maternal age, grand multiparity of ≥5); intrapartum factors (direct obstetric complication); fetal factors (low birthweight and gestational age of <37 weeks) and health systems factors (poor quality of antenatal care, emergency referrals, ill-equipped facility). The proportion of unexplained stillbirths remained very high. No association was found between stillbirths and body mass index, diabetes, distance from the facility or HIV. The overall quality of evidence was low, as many studies were facility based and did not adjust for confounding factors. This review identified preventable risk factors for stillbirth. Focused programmatic strategies to improve antenatal care, emergency obstetric care, maternal perinatal education, referral and outreach systems, and birth attendant training should be developed. More population-based, high-quality research is needed.

In industrialized countries, many couples are choosing to delay childbearing, and the proportion of couples having children after age 30–35 years has increased. This has highlighted the effect of age on reproductive failure (van Balen et al, 1997). The effects of maternal age have been thoroughly investigated in the past few decades, and a major effect of maternal age over 35 years has been demonstrated on infertility, ectopic pregnancy, and miscarriage (van Noord-Zaadstra et al, 1991; van Balen et al, 1997; Nybo Andersen et al, 2000). In contrast, little attention has been paid to the possible effects of paternal age. Most studies that have dealt with this factor have focused on changes in sperm characteristics with age, and physicians have tried to set an upper age limit for sperm donors. The American Society for Reproductive Medicine (1998) and the British Andrology Society (1999) have fixed the upper age limit for sperm donation at 40 years old on the basis of the increased risk of genetic abnormalities in children of older fathers (Bordson and Leonardo, 1991). In discussions of the effects of paternal age with a view toward setting age limits for sperm donors, the possibility that paternal age affects the likelihood of reproductive failure was not considered. In other respects, some demographic studies have analyzed the effects of paternal age on effective fecundity, which is the probability of initiating a pregnancy leading to a live birth (Anderson, 1975; Mineau and Trussell, 1982; Goldman and Montgomery, 1989; Strassmann and Warner, 1998). These studies, based on large data sets from populations not using birth control methods, showed

Methods The community-based cross sectional study was conducted in the Arba Minch Health and Demographic Surveillance Site, Southern Ethiopia. The simple random sampling method was used to recruit 656 mother-child pairs. Height for age Z score was computed using WHO Anthro version 3.2.2 software. Multivariable logistic regression model was fitted, and adjusted odds ratio (AOR) at p value <0.05 was used to determine statistically significant association between predictors and outcome variable. Result The prevalence of stunting among children of 6–59 months in the study area was 47.9% (95% CI; 44.0–51.7). The likelihood of stunting was significantly higher among children who live in households with medium (AOR 2.20, 95% CI: 1.43–3.37) and poor (AOR 2.87, 95% CI: 1.72–4.81) wealth status. In addition, children who were not exclusively breast fed (AOR 1.55, 95% CI: 1.07–2.24), whose mothers had not participated in decision of major household purchases (AOR 2.27, 95% CI: 1.21–4.26), and whose mothers lacked decision on freedom of mobility (AOR 1.96, 95% CI: 1.05–3.66) were significantly stunted compared with counterparts. Conclusion Stunting is a severe public health problem in the area. Therefore, efforts should be taken to enhance maternal empowerment, household wealth, and infant and young child feeding practice for reducing stunting among children.

STUDY QUESTIONDoes the rate of miscarriage increase in the setting of adenomyosis independent of other known risk factors for miscarriage such as maternal age, BMI, embryo genetic status?SUMMARY ANSWERAdenomyosis and high BMI both significantly increase miscarriage risk independent of each other, maternal age and embryo health. This study is the first to suggest that ultra-long down regulation GnRH agonist treatment may reduce the rate of early pregnancy loss in adenomyosis patients.WHAT IS KNOWN ALREADYThe presence of adenomyosis is known to be associated with lower rates of successful implantation and increased risk of early pregnancy loss. However, it is presently unclear whether this reproductive impairment is directly mediated by adenomyosis itself, or indirectly caused by adenomyosis association with known risk factors for miscarriage such as obesity and advancing maternal age/foetal aneuploidy.STUDY DESIGN, SIZE, DURATIONA retrospective cohort study was undertaken in a private infertility (IVF) clinic examining the outcome for women (n = 345) undergoing the transfer of a genetically screened frozen–thawed embryo between 2012 and 2015.PARTICIPANTS/MATERIALS, SETTING AND METHODA total of 171 women who successfully conceived (positive serum βhCG) following the transfer of a single euploid good morphology frozen–thawed embryo were included in analysis after meeting the inclusion criteria. Only the first conception cycle for each patient was included in the study. Patients with known pre-existing medical risk factors for miscarriage (e.g. thrombophilia, poorly controlled diabetes, coeliac disease, SLE, uterine septum, chromosomal abnormalities) and those women undergoing treatment using donated oocytes and surrogacy were excluded. Patients were then classified as having adenomyosis or not based on a high-quality pelvic ultrasound or MRI. The direct and indirect effects of adenomyosis and BMI on overall miscarriage rate by 12 weeks gestation was then assessed using multivariate logistic regression and mediation analysis. Furthermore, the data were also analysed to elucidate the influence of GnRH ultra-long down-regulation therapy on miscarriage rates.MAIN RESULTS AND ROLE OF CHANCEOverall, the adjusted rate of miscarriage was higher in those patients with adenomyosis compared to those without (44.1 vs 15.3%, P < 0.0001), with most of these miscarriages occurring at the early biochemical stage. The rate of miscarriage was especially high in adenomyosis patients not receiving GnRH agonist pre-treatment (82.4%), compared to those patients who did receive GnRH pre-treatment (35.7%, P = 0.0089).LIMITATIONS, REASONS FOR CAUTIONThe study is mainly limited by its small sample size and retrospective design which carries inherent potential for bias (i.e. misclassification and errors due to inadequate clinical notes). The small sample size precluded analysis to distinguish how the extent of adenomyosis disease may modify miscarriage risk (i.e. focal or diffuse disease). Furthermore, the relatively low number of adenomyosis patients not receiving GnRH agonist treatment, plus the non-randomized nature of the decision not to offer such treatment, precludes definitive conclusions on the benefit of GnRH agonist therapy to reduce miscarriage risk.WIDER IMPLICATIONS OF THE FINDINGSConsidering the significant emotional and financial impact of miscarriage, we suggest screening of all women undergoing IVF treatment for the presence of adenomyosis, with consideration given to ultra-long down regulation GnRH agonist treatment in any woman identified as having adenomyosis. Furthermore, given the persistent and often progressive nature of the disease, adenomyosis should also be considered as a potential uterine cause of recurrent miscarriage. Finally, we hope our study highlights the need for high-quality prospective RCT to be undertaken to provide superior evidence for the potential benefit of GnRH agonist pre-treatment.STUDY FUNDING/COMPETING INTEREST(S)K.T. is a practicing IVF gynaecologist and holds a minority stake in the publicly listed company Monash IVF. The other authors declare that they have no conflict of interest. This study was financially supported by Flinders University Medical School.

We aimed to determine the Stillbirth Rates (SRs) for monozygotic (MZ) and dizygotic (DZ) twins, with the risk factors for stillbirth. SRs were estimated using Japanese vital statistics from 1995 to 2008. The SRs of zygotic twins significantly decreased during the period. The SR was the lowest at maternal age (MA) of 30-34 years for MZ (66) and DZ twins (18) and significantly higher at MA <20 years than the other MA groups for both zygosities. The SR was the lowest at Gestational Age (GA) of 37 weeks for MZ (5.7) and DZ twins (1.8). The SR was significantly higher for MZ than for DZ twins at each GA group except for those born at GA 39 and GA ≥ 40 weeks. The SR significantly decreased from 1995-1998 to 2004-2008 except GA ≥ 40 for both zygotic twins and 32-35 weeks for DZ twins. Incidences of preterm delivery increased from 1995 (43% for MZ and 38% for DZ twins) to 2008 (62% and 55%, respectively). The SRs were significantly higher in like-sexed twins than in unlike-sexed twins in every birth weight (BW) group. The SR was similar between BW 2000–2499 g and ≥ 2500 g in each twin group. The SR increased progressively when the percentage of BW discordance exceeds 10% for MZ twins and exceeds 20% for DZ twins. The SR due to twin–twin transfusion syndrome was 14% among spontaneous stillbirths in MZ twins. In conclusion, declining SR attributed to medical care during twin pregnancies less than 40 weeks for MZ and DZ twins. Excess BW discordance of 10% for MZ twins lead to higher SRs compared with those in DZ twins. The increased premature rate in twins might bring severe problems such as cardiovascular risk in their future life.

Background: Perinatal mortality is the sum of stillbirth and early neonatal death. Perinatal mortality accounts for threequarters of the deaths during the neonatal period. Ethiopia is one of the sub-Saharan countries with high perinatal mortality, which accounts for 4% of the world's perinatal mortality. Objective: To assess the determinants of perinatal mortality among the public hospital deliveries in Hadiya Zone, South Ethiopia. Methods: An unmatched case-control study was conducted in public hospitals in Hadiya Zone, south Ethiopia, from January 1 to March 30, 2023. cases were stillbirths or early neonatal deaths. Controls were those newborns that were alive until their 7th day of life. Five hundred eighty-two study subjects (194 cases and 388 controls) from delivery registration and the neonatology logbook were recruited for this study. Data were collected using KoboCollect software version 1.29.3 and exported to SPSS version 25 for analysis. Candidate variables with a p-value of less than 0.25 were selected for multivariable analysis by using bivariate analysis. An adjusted odds ratio (AOR) with a 95% confidence interval (CI) was calculated, and variables with a P-value of &lt;0.05 were identified as potential determinants of perinatal mortality. Result: A total of 582 (194 cases and 388 controls) were reviewed. This study identified that maternal age 21-35 years [AOR=0.38; 95% CI (0.17, 0.84)], rural residence [AOR=2.88: 95% CI (1.29, 6.46)], birth interval less than two years [AOR=5.34: 95% CI (2.59, 10.99)], history of perinatal mortality [AOR=3.2: 95% CI (1.38, 7.43)], less than eight hour duration of labour [AOR=0.19: 95% CI (0.09, 0.40)], obstetric complication [AOR=7.92: 95% CI (3.81, 16.46)], low birth weight [AOR=7.75: 95% CI (3.27, 18.39)], and use of partograph [AOR=0.14: 95% CI (0.07, 0.30)] as factors that determine perinatal mortality. Conclusion: maternal age, residence, birth interval, history of perinatal mortality, duration of labour, obstetric complication, birth weight, and not the use of a partograph were independent determinants of perinatal mortality. Furthermore, the use of a partograph is recommended for early detection of obstetric complications so that action can be taken during labour follow-up.

Miscarriage karyotype and its relationship with maternal body mass index, age, and mode of conception

BackgroundTobacco use is one of the world-leading preventable killers. There was a varied prevalence of tobacco use and cigarette smoking across different areas. The aim of the study was to assess the prevalence and factors associated with current tobacco use among adults residing in Arba Minch health and demographic surveillance site (HDSS).MethodsA community-based cross-sectional study was conducted among adults residing in Arba Minch HDSS in 2017. The estimated sample size was 3368 individuals which were selected by simple random sampling techniques using Arba Minch HDSS dataset. Data collection tools were obtained from the WHO STEPwise. Current use of tobacco, which defined as the current use of smoked and/or smokeless tobacco, was considered as the dependent variable. A binary logistic regression model was used to identify candidate variables for the multivariable logistic regression model. An adjusted odds ratio (AOR) at a p-value of less than 0.05 was used to determine a statistically significant association between independent and dependent variables.ResultThe prevalence of tobacco use among adults was 20.2% (95% CI: 18.9–21.6%). The current use of smoked and smokeless tobacco were 17.1% (95%CI: 15.8–18.4%) and 9.7% (95%CI: 8.8–10.8%), respectively. The current use of tobacco was significantly associated with sex (female [AOR 0.54; 95%CI: 0.42–0.68] compared to men), age group (35–44 [AOR 1.57; 95%CI: 1.14–2.17], 45–54 [AOR 1.99; 95%CI: 1.45–2.74], and 55–64 [AOR 3.26; 95%CI: 2.37–4.48] years old compared to 25–35 years old), physical activity (moderate physical activity level [AOR 0.65; 95%CI: 0.44–0.96] compared with low) and residency (highland [AOR 4.39; 95% CI: 3.21–6.01] compared with at lowlander). Also, heavy alcohol consumption (AOR 3.97; 95% CI: 3.07–5.12), and Khat chewing (AOR 3.07(95%CI: 1.64–5.77) were also associated with the use of tobacco among the study participants.ConclusionNearly one in five adults used tobacco currently in the study area, which is more than the national reports. Interventions for the reduction of tobacco use need to give due attention to men, older adults, uneducated, poor, and highlanders.

To determine the risk factors for stillbirth, a case-control study was carried out in a rural community of Haryana. Stillbirths (cases) were identified retrospectively from a household survey, while the controls, matched individually with each case for the month of birth, were live born infants from the same neighbourhood as the case. The stillbirth rate in the study population was 26.8 per 1000 (68/2539) births. The distribution of socio-economic and environmental factors was similar in the cases and the controls (P > 0.05). Multivariate analysis indicated higher risk of stillbirth for first order births (Odds Ratio [OR] 7.9, Confidence Interval [CI] 2.1-29.2, P 0.002), history of prior stillbirths/child deaths (OR 15.2, CI 2.3-98.2, P 0.004), and absence of antenatal care (OR 3.3, CI 0.9-14.3, P 0.07). Mothers' age, birth interval (< 24 months), delivery place (hospital or home) and type of birth attendant (trained vs untrained) did not show significant influence on the risk of stillbirth. An improvement in the coverage of antenatal care in socio-economically weaker rural community is suggested as the most appropriate strategy for reducing the high stillbirth rate.