Birth Certificate Research Articles

Association between maternal benzodiazepine or Z-hypnotic use in early pregnancy and the risk of stillbirth, preterm birth, and small for gestational age: a nationwide, population-based cohort study in Taiwan

Benzodiazepines and Z-hypnotics are commonly prescribed for anxiety and insomnia during pregnancy, but the evidence regarding potential adverse neonatal outcomes is insufficient because of poor control for confounding factors in previous studies. We therefore aimed to evaluate the association between the use of benzodiazepines or Z-hypnotics during early pregnancy and adverse neonatal outcomes (stillbirth, preterm birth, and small for gestational age). We did a nationwide, population-based cohort study in Taiwan using three data sources: Taiwan's National Birth Certificate Application database, the National Health Insurance database, and the Maternal and Child Health Database. The study cohort included all singleton pregnancies of females aged 15-50 years who gave birth between Jan 1, 2004, and Dec 31, 2018. Pregnancies without valid information were excluded. Benzodiazepine and Z-hypnotic use was defined as at least one benzodiazepine or Z-hypnotic prescription during early pregnancy (the first 20 weeks of pregnancy). The primary outcomes were stillbirth (fetal death at or after 20 weeks' gestation), preterm birth (<37 weeks' gestation), and small for gestational age (birthweight below the 10th percentile for gestational age by sex). Logistic regression models with propensity score fine stratification weighting were used to control for potential confounders and examine the association between benzodiazepines or Z-hypnotics use during early pregnancy and the risk of adverse neonatal outcomes. Odds ratios (ORs) and 95% CIs were reported. We used confounding by indication control analyses, a sibling control study, and a paternal negative control design to account for unmeasured confounders. The risk associated with exposure during late pregnancy was also assessed. Between Oct 7, 2021, and June 10, 2022, we analysed the study data. The cohort included 2 882 292 singleton pregnancies; of which, 75 655 (2·6%) of the mothers were dispensed one or more benzodiazepines or Z-hypnotics during early pregnancy. Women exposed during pregnancy were older (mean age at delivery was 31·0 years [SD 5·3] for exposed women vs 30·6 years [4·9] for unexposed women), had a higher prevalence of psychiatric disorders, and were more likely to have unhealthy lifestyle behaviours than unexposed women. Information about ethnicity was not available. Early pregnancy exposure was associated with adverse neonatal outcomes compared with non-exposure. The propensity score-weighted OR was 1·19 (95% CI 1·10-1·28) for stillbirth, 1·19 (1·16-1·23) for preterm birth, and 1·16 (1·13-1·19) for small for gestational age. After controlling for confounding by indication, there was no significant association between drug exposure and stillbirth risk; however, this attenuation was not observed for preterm birth and small for gestational age. In models with sibling controls that accounted for familial confounding and genetic factors, early exposure to benzodiazepines or Z-hypnotics was not associated with an increased risk of stillbirth and preterm birth, but it remained significantly associated with small for gestational age. The paternal negative control analyses with point estimates close to the null indicated no strong evidence of unmeasured confounding shared by the mother and the father. Substantially increased risks of stillbirth and preterm birth were observed for late pregnancy exposure. Benzodiazepine or Z-hypnotic use in early pregnancy is not associated with a substantial increase in the risk of stillbirth and preterm birth after accounting for unmeasured confounding factors. Clinicians should be aware of the increased risk of small for gestational age and caution should be taken when prescribing these medications during late pregnancy. National Science and Technology Council, Taiwan. For the Taiwanese translation of the abstract see Supplementary Materials section.

Medicaid expansion and risk of eclampsia

Eclampsia is an indicator of severe maternal morbidity and can be prevented through increased prenatal care access and early prenatal care utilization. The 2014 Medicaid expansion under the Patient Protection and Affordable Care Act allowed states to expand Medicaid coverage to nonelderly adults with incomes up to 138% of the federal poverty level. Its implementation has led to a significant increase in prenatal care access and utilization. This study aimed to assess the association of Medicaid expansion under the Affordable Care Act with eclampsia incidence. This natural experiment study was based on US birth certificate data from January 2010 to December 2018 in 16 states that expanded Medicaid in January 2014 and in 13 states that did not expand Medicaid during the study period. The outcome was eclampsia incidence, the intervention was the implementation of the Medicaid expansion, and the exposure was state expansion status. Using the interrupted time series method, we compared temporal trends in the incidence of eclampsia before and after the intervention in expansion vs non-expansion states with adjustments for patient and hospital county characteristics. Of the 21,570,021 birth certificates analyzed, 11,433,862 (53.0%) were in expansion states and 12,035,159 (55.8%) were in the postintervention period. The diagnosis of eclampsia was recorded in 42,677 birth certificates or 19.8 per 10,000 (95% confidence interval, 19.6-20.0). The incidence of eclampsia was higher for Black people (29.1 per 10,000) than for White (20.7 per 10,000), Hispanic (15.3 per 10,000), and birthing people of other race and ethnicity (15.4 per 10,000). In the expansion states, the incidence of eclampsia increased during the preintervention period and decreased during the postintervention period; in the nonexpansion states, a reverse pattern was observed. A statistically significant difference was observed between expansion and nonexpansion states in temporal trends between the pre- and postintervention periods, with an overall 1.6% decrease (95% confidence interval, 1.3-1.9) in the incidence of eclampsia in expansion states compared with nonexpansion states. The results were consistent in subgroup analyses according to maternal race and ethnicity, education level (less than high school or high school and higher), parity (nulliparous or parous), delivery mode (vaginal or cesarean delivery), and poverty in the residence county (high or low). Implementation of the Affordable Care Act Medicaid expansion was associated with a small statistically significant reduction in the incidence of eclampsia. Its clinical significance and cost-effectiveness remain to be determined.

Assessing hospital differences in low-risk cesarean delivery metrics in Florida

Unnecessary cesarean deliveries lead to increased maternal and neonatal morbidities and mortalities. In 2020, Florida had a cesarean delivery rate of 35.9%, the third highest in the nation. An effective quality improvement strategy to reduce overall cesarean delivery rates is to decrease primary cesarean deliveries in low-risk births (nulliparous, term, singleton, vertex). Of note, 3 nationally accepted hospital measures of low-risk cesarean delivery rates include the nulliparous, term, singleton, vertex; Joint Commission; and Society for Maternal-Fetal Medicine metrics. Comparing metrics is necessary because accurate and timely measurement is essential to support multihospital quality improvement efforts to reduce low-risk cesarean delivery rates and improve the quality of maternal care. This study aimed to assess differences in hospital low-risk cesarean delivery rates in Florida using 5 different metrics of low-risk cesarean delivery rate based on (1) risk methodology, nulliparous, term, singleton, vertex; Joint Commission; and Society for Maternal-Fetal Medicine metrics, and (2) data source, linked birth certificate and hospital discharge records and hospital discharge records only. This was a population-based study of live Florida births from 2016 to 2019 to compare 5 approaches to calculating low-risk cesarean delivery rates. Analyses were performed using linked birth certificate data and inpatient hospital discharge data. The 5 low-risk cesarean delivery measures were defined as follows: nulliparous, term, singleton, vertex birth certificate; Joint Commission-linked used Joint Commission exclusions; Society for Maternal-Fetal Medicine-linked used Society for Maternal-Fetal Medicine exclusions; Joint Commission hospital discharge with Joint Commission exclusions; and Society for Maternal-Fetal Medicine hospital discharge with Society for Maternal-Fetal Medicine exclusions. Nulliparous, term, singleton, vertex birth certificate was based on data from birth certificates and not using linked hospital discharge data. Designated as nulliparous, term, singleton, vertex, it does not exclude other high-risk conditions. The second and third measures (Joint Commission-linked used Joint Commission exclusions and Society for Maternal-Fetal Medicine-linked used Society for Maternal-Fetal Medicine exclusions) use data elements from the full-linked dataset to designate nulliparous, term, singleton, vertex and excluded several high-risk conditions. The last 2 measures (Joint Commission hospital discharge with Joint Commission exclusions; and Society for Maternal-Fetal Medicine hospital discharge with Society for Maternal-Fetal Medicine exclusions) were based on data from hospital discharge data only and not using linked birth certificate data. These measures generally reflect term, singleton, and vertex because parity could not be assessed adequately on hospital discharge data. Hospital differences between these 5 measures were calculated overall and by neonatal intensive care unit level. Overall, the median of hospital low-risk cesarean rates decreased across the measures, from NTSV-BC 30.7%, to Joint Commission linked 29.1%, and Society for Maternal Fetal Medicine hospital discharge 29.2% with a large decrease to Joint Commission hospital discharge 19.4% and Society for Maternal Fetal Medicine hospital discharge 18.1%. A similar trend was seen by neonatal intensive care unit level. For each of the measures, level II had the highest median low-risk cesarean rates (nulliparous. term, singleton, vertex birth certificate) 32.7%, Joint Commission linked (31.4%), Society for Maternal Fetal Medicine linked: 31.1%, Society for Maternal Fetal Medicine hospital discharge 19.3%), except for level III Joint Commission hospital discharge (20.0%). A comparison of the median number of low-risk births overall and by neonatal intensive care unit level showed a decreasing number across the linked and hospital discharge measures. Again, a wide gap in low-risk cesarean delivery rates was identified between linked measures and hospital discharge measures. However, this gap narrowed as hospital rates increased. Quality monitoring of low-risk cesarean delivery rates measured by the nulliparous, term, singleton, vertex metric using the birth certificate was fairly accurate and provided timely assessment for use by Florida hospitals. The nulliparous, term, singleton, vertex birth certificate rates were comparable with low-risk metrics using the linked data source. Overall, metrics used within the same data source had similar rates, with the Society for Maternal-Fetal Medicine metric having the lowest rates. Across data sources, metrics using hospital discharge data only resulted in substantially underestimated rates because of the inclusion of multiparous women and should be interpreted with caution.

Oleksa Novakivskyi: Unknown pages of study and life from Archival Materials of the Krakow Academy of Arts

The paper aims to study and publicize educational activities and exhibitions in Krakow by Oleksa Novakivskyi (1872– 1935), an outstanding Ukrainian artist — symbolist, expressionist, graphic artist, and educator, who over 20 years lived in Krakow (1892–1913) and Lviv (1913–1935) and founded his own art school in Lviv (1923–1935) for 100 students. The archival documents of the 1890s–1900s from the Archives of the Krakow Academy of Arts about Oleksa Novakivskyi’s studies in 1892–1904 were investigated. Oleksa Novakivskyi’sreport cards of 1892–1904 from the Krakow School and the Academy of Fine Arts were first introduced into scientific circulation. It was discovered that in 1892–1898 Oleksa Novakivskyi studied at the Department of Drawing of the Krakow School of Fine Arts (with a pause in 1893–1895) and received an “award in the competition” (1896), silver medals on July 15, 1897 and July 23, 1898 at the course of prof. Unierzyski, Stanislawski. In 1898–1901 Oleksa Novakivskyi studied at the Department of Fine Art, where he received a silver medal (1899) and a gold medal on July 15, 1900, on the course of Prof. Wyczółkowski, Stanislawski. In 1901–1904 Novakivskyi continued his studies at the Department of Fine Art at the School of Prof. Wyczółkowski at the Krakow Academy of Arts. It was established that Novakivski’s teachers in Krakow were the professors Florian Cynk, Jozef Unierzyski, Leon Wyczółkowski, Jan Stanislawski. In addition, personal documents of the painter’sspouse (whom the researchers previously listed as Anna-Maria) from the archives of Lviv and Krakow were introduced into scientific circulation (the identity card of Maryanna Rozalia Nowakowska, 1916; Birth Certificate of Maryanna Rosalia Palmowska, 1888), as well as the Polish specialized and popular periodicals of the 1890s–1930s that mentioned Oleksa Novakivskyi’s exhibitions participation in Krakow and Warsaw.

The burden of inappropriate birth weight on neonatal survival in term newborns: a population-based study in a middle-income setting.

Premature birth, perinatal asphyxia, and infections are the main causes of neonatal death. Growth deviations at birth also affect neonatal survival according to week of gestation at birth, particularly in developing countries. The purpose of this study was to verify the association between inappropriate birth weight and neonatal death in term live births. This is an observational follow-up study with all term live births from 2004 to 2013 in Sao Paulo State, Brazil. Data were retrieved with the deterministic linkage of death and birth certificates. The definition of very small for gestational age (VSGA) and very large for gestational age (VLGA) used the 10th percentile of 37 weeks and the 90th percentile of 41 weeks + 6 days, respectively, based on the Intergrowth-21st. We measured the outcome in terms of time to death and the status of each subject (death or censorship) in the neonatal period (0-27 days). Survival functions were calculated using the Kaplan-Meier method stratified according to the adequacy of birth weight into three groups (normal, very small, or very large). We used multivariate Cox regression to adjust for proportional hazard ratios (HRs). The neonatal death rate during the study period was 12.03/10,000 live births. We found 1.8% newborns with VSGA and 2.7% with VLGA. The adjusted analysis showed a significant increase in mortality risk for VSGA infants (HR = 4.25; 95% CI: 3.89-4.65), independent of sex, 1-min Apgar score, and five maternal factors. The risk of neonatal death in full-term live births was approximately four times greater in those with birth weight restriction. The development of strategies to control the factors that determine fetal growth restriction through planned and structured prenatal care can substantially reduce the risk of neonatal death in full-term live births, especially in developing countries such as Brazil.

“Don’t Tell Them What You Told Me”: Negotiating Paperwork in Mexico City

This article examines how participants in literacy events mediate the validation and legitimacy of official documents. Through articulating the perspectives of literacy as a social practice, paperwork studies, and the analysis of administrative burdens, we argue that the value of official documents is unstable and can fluctuate between valid and invalid each time applicants and frontline workers redefine the context of use. Through ethnographic observation, we gathered data on the historical production of birth certificates and the social construction of their meaning. We documented a participant’s unsuccessful efforts to renew her voter’s ID card over several years and in different government offices. We show how government employees rejected or accepted the same official birth certificate she presented, depending on how she framed her paperwork. Its meaning relied on the articulation of the negotiated administrative purpose, the definition of the context of use, and the document’s materiality.

LINKS. A System for Historical Family Reconstruction in the Netherlands

LINKS stands for 'LINKing System for historical family reconstruction' and is a software system to link nominal data from the Dutch archives and ultimately reconstruct historical individuals and families. We present the background and philosophy of this matching system and explain its data structure and functioning. Currently the core data of the LINKS system consists of indexed civil certificates. These certificates are available from 1812 — the start of the Dutch Vital Registration — until the year they are confidential based on privacy laws. For more than 20 years, thousands of volunteers have been working to build this index, which contains not only the names of newborn, married and deceased persons, but also the names of their parents, places of birth, ages and sometimes their occupational titles. The software system LINKS includes the standardization of all input before linking, nominal record linkage procedures and identification of all unique persons involved in the system. All processes are repeatable and a strict distinction is maintained between source data, standardized, linked and enriched data and released data. Moreover, LINKS also informs archives about all kinds of errors and inconsistencies found during the cleaning and matching process. We will discuss two matching systems, the first is the original querying system that runs within a MySQL database environment and the second is a newly developed system, called burgerLinker, which is based on knowledge graphs and which is designed as a system that can be used independently from LINKS and is made available as open source software. Finally, we present the most important releases of LINKS data so far: two national releases that link birth and parental marriage certificates, creating families and pedigrees and an integrated dataset of persons, families and family trees in four provinces.

Neonatal Depression Is Associated With 1-Year Mortality in Critical Congenital Heart Disease.

Background Low 5-minute Apgar scores (AS) are predictive of term and preterm neonatal mortality but have not been well studied in the critical congenital heart disease (CCHD) population. We analyzed US national vital statistics data to evaluate the association between neonatal depression (AS 0-3) and 1-year mortality in CCHD. Methods and Results We performed a retrospective cohort study using 2014 to 2018 Centers for Disease Control and Prevention cohort-linked birth certificate and infant death records. Five-minute AS were categorized as ≤3, 4 to 6, or ≥7. We calculated birth rates and associated mortality rates by AS group in infants with and without CCHD. Multivariable logistic regression analyzed neonatal, maternal, and pregnancy-related risk factors for neonatal depression and 1-year mortality. Of 11 642 neonates with CCHD (0.06% of all births), the 5.8% with AS 0 to 3 accounted for 23.3% of all 1-year CCHD mortality, with 69.9% of deaths occurring within 1 month of life. Gestational age at birth, growth restriction, extracardiac defects, race, and low maternal education were associated with an increased odds of AS 0 to 3 in neonates with CCHD relative to those with AS 7 to 10 on multivariable analysis. AS 0 to 3 was associated with 1-year CCHD mortality after adjusting for these factors, prenatal care, and delivery location (adjusted odds ratio, 14.57 [95% CI, 11.73-18.10]). Conclusions The AS is a routine clinical measure providing important prognostic information in CCHD. These findings suggest that prenatal and perinatal factors, beyond those included in current risk stratification tools, are important for CCHD outcomes. Multidisciplinary collaboration to understand the pathophysiology underlying neonatal depression may help identify interventions to improve CCHD mortality rates.

Postpartum Contraceptive Use, Pregnancy Intentions in Women With and Without a Delivery of a NAS-Affected Infant in Delaware, 2012-2018.

Assess differences in postpartum contraceptive use and pregnancy intentions in women with a recent live birth who delivered a neonatal abstinence syndrome (NAS) affected infant. Using linked Delaware Birth Certificate Data, Hospital Discharge Data and PRAMS data for 2012-2018 (n = 6,358 singleton births), we assessed differences among women with and without a delivery of an NAS-affected infant by effective postpartum contraceptive use and pregnancy intentions. We calculated prevalence estimates, crude (cPOR), and prevalence odds ratios adjusted (aPOR) for NAS by maternal characteristics. We used alpha ≤ 0.05 to determine statistical significance. Prevalence of NAS was 2.2% (95% CI: 1.8 - 2.6). Effective postpartum contraceptive use was 60.4% (95% CI: 51.9-69.0) among women with delivery of an NAS-affected infant compared with a non-NAS delivery 56.4% (95% CI: 55.1-57.8%) and cPOR was 1.2 (95% CI: 0.8-1.7). Prevalence of intended pregnancy was 26.5% (95% CI: 18.9-34.0) among women with delivery of an NAS-affected infant compared with a non-NAS delivery 53.0% (95% CI: 51.7-54.4) and cPOR was 0.3 (95% CI: 0.2-0.5). After adjustment, women who delivered an NAS-affected infant had lower odds (aPOR = 0.5; 95% CI: 0.3-0.8) of indicating that their pregnancy was intended as compared to those who did not deliver an NAS-affected infant. Our study found no association between delivery of an NAS-affected infant and use of an effective postpartum contraceptive method. However, we found that pregnancy intendedness was lower among women delivering an NAS-affected infant compared with women without an NAS delivery even after accounting for maternal characteristics.

LEGAL PROTECTION OF CHILDREN OUT OF MARRIAGE REGARDING THE ACQUISITION OF INHERITANCE RIGHTS BASED ON CUSTOM MARRIAGE ACCORDING TO INDONESIAN LEGAL PERSPECTIVE

Marriages are carried out in accordance with applicable customary provisions and the religion adopted is legal according to the Indonesian law. The research method that was used was a qualitative research method. However, this customary and religious marriage without registering it in the Civil Registration is still legal under the law, but it will have an impact on the legal consequences of the child being born. These children will be born with the status of illegitimate child for law administration. This will cause problems in the distribution of inheritance to these children. These children still have thev thev opportunityv to inherit thev propertyv ofv theirv parentsv, if v they varevrecognizedvbyvtheirvfathervand mother. At the same time, they can inherit their mother's property directly in accordance with the law without any acknowledgment at all, because the name listed on their Birth Certificate is a valid proof of heir. Even though they were born as illegitimate children, they are the heirs who are prioritized as the First Class of Heirs. Therefore, legal protection for illegitimate children is needed for their right to receive their parents' inheritance. The result inheritance law protection for children out of wedlock is regulated carefully in the Civil Code, which then the status of children out of wedlock becomes stronger with the existence of Article 43 UUP. The status of this illegitimate child becomes the same as the heir to the first class.

Social and Health Determinants of the Families of Children Under Two Years of Age with Stunting in Sigi District

Social aspect is a determinant of stunting. Stunting in children is an indicator of well-being and an accurate reflection of social inequality. This study aims to analyze the social and health determinants of the families of children under two years of age with stunting in Sigi District. This was an analytical study with cross sectional design which involved a population of children aged 6-23 months. A sample size consisted of 380 people were selected through cluster simple random sampling technique. Respondents involved the mothers of children under two years of age. Data collection was conducted in February-June 2022. The dependent variables was stunting incidence. The independent variables were maternal age, parity, birth spacing, maternal education, child's gender, child's age in months, length of birth, early initiation of breastfeeding, exclusive breastfeeding, breastfeeding status, child condition at the time of study, history of ARI, diarrhea, pulmonary tuberculosis, measles, Helminth Infection, utilization of health facilities, growth and development stimulation, complementary food, water sources, ownership of family latrines, food insecurity, housing, and smoking family members. Stunting data was obtained by measuring body length using the Length Measuring Board (LMB) and measuring age by reading the birth certificate or MCH book of the child. Other data were obtained by filling out the kobocollect questionnaire. Data were analyzed using SPSS version 22.00. The WHO-Antro 2005 software was applied to determine the Z-Score. Height-for-Age data were analyzed using univariate, bivariate and multivariate analysis using Backward logistic regression method. Ethical clearance was obtained from the ethics committee of Palu Health Polytechnic number 0011/KEPK-KPK/IV/2022. The results showed that children aged 12-24 months had a 4.1 times higher risk of experiencing stunting compared to children aged 0-6 months (AOR=4.1; 95% CI: 2.0-8.4). Furthermore, children aged 7-11 months had a 2.2 times higher risk of experiencing stunting compared to children aged 0-6 months (AOR=2.2;95%CI: 1.2-3.9). Children who had a length of birth of &lt;48 cm had a 2.1 times higher risk of experiencing stunting compared to children who had a length of birth of ≥48 cm (AOR=2.1; 95% CI: 1.2-3.6). Children of women with education of &lt;9 years had a 2.7 times higher risk of experiencing stunting compared to children of women with education of ≥9 years (AOR=2.7; 95% CI: 1.4-5.0). Children from families with food insecurity had a 1.6 times higher risk of experiencing stunting compared to children from families with no food insecurity (AOR=1.6; 95% CI: 0.9-2.7). Social and health determinants of children under two years of age with stunting in Sigi District were child's age, length of birth of &lt;48 cm, maternal education and food insecurity.

Tata Cara Pelayanan dan Penerbitan Akta Kelahiran pada Dinas Kependudukan dan Catatan Sipil Kabupaten Aceh Timur

.This research aims to investigate the procedures for servicing and issuing birth certificates at the Population and Civil Registry Service of East Aceh Regency. Descriptive research methods are used to describe and analyze the population administration process. The research population involved Department officials and the community who administer birth certificates, with samples selected purposively. Interviews and document analysis were used as data collection techniques. The research results show that there are two ways to process a birth certificate, namely directly at the Department office and through online services. Technical, administrative, and social barriers were identified, including limited technological infrastructure, high printing costs, and public misunderstanding. Recommendations include improving technological infrastructure, revising tariff policies, and more intensive outreach campaigns

Factors associated with hepatitis C treatment uptake among females of childbearing age in New South Wales, Australia: A population-based study.

Females of childbearing age with hepatitis C virus (HCV) face increased marginalisation with intersecting, sex-specific barriers to direct acting antiviral (DAA) therapy. We assessed the factors associated with uptake of DAA therapy among females of childbearing age, including those with evidence of recent drug dependence. HCV notifications in New South Wales, Australia (1995-2017) were linked to opioid agonist therapy (OAT), hospitalisations, incarcerations, perinatal, HIV notifications, deaths and prescription databases. Recent drug dependence was defined as hospitalisation due to injectable drugs or receipt of OAT occurring in the DAA era (2016-2018). Logistic regression was used to analyse factors associated with DAA uptake among females of childbearing age (18-44), including those with recent drug dependence. Among 57,467 people with evidence of chronic HCV in the DAA era (2016-2018), 20,161 (35%) were female, including 33% (n = 6563/20,161) of childbearing age (18-44). Among all females of childbearing age (n = 6563) and those with evidence of recent drug dependence (n = 2278/6563, 35%), DAA uptake was lower among those who had given birth in the DAA era (vs. no birth record, all females of childbearing age; aOR: 0.74, 95% CI 0.61, 0.89; those with recent drug dependence; aOR 0.69, 95% CI 0.51, 0.93) and Aboriginal and Torres Strait Islander peoples (all females of childbearing age; aOR 0.81, 95% CI 0.71, 0.93; those with recent drug dependence aOR 0.75, 95% CI 0.62, 0.90). Females of childbearing age should be considered a key population for DAA therapy. Enhancing antenatal and postnatal HCV care may be critical in the pursuit towards elimination.

Demographics, Birth Parameters, and Social Determinants of Health Among Opioid-Exposed Mother-Infant Dyads Affected by Neonatal Abstinence Syndrome in Pennsylvania, 2018–2019

ObjectivesTo characterize demographics, birth parameters, and social determinants of health among mother-infant dyads affected by neonatal abstinence syndrome (NAS) in Pennsylvania.MethodsWe linked 2018–2019 NAS surveillance data to birth record data using probabilistic methods and then geospatially linked to local social determinants of health data based on residential address. We generated descriptive statistics and used multivariable mixed-effects logistic regression to model the association between maternal characteristics, birth parameters, social determinants of health, and NAS.ResultsIn adjusted models maternal age > 24, non-Hispanic white race/ethnicity, low educational attainment, Medicaid as payor at delivery, inadequate or no prenatal care, smoking during pregnancy, and low median household income were associated with NAS. We found no significant associations between NAS and county-level measures of clinician supply, number of substance use treatment facilities, or urban/rural designation.Conclusions for PracticeThis study characterizes mother-infant dyads affected by NAS using linked non-administrative, population data for Pennsylvania. Results demonstrate a social gradient in NAS and inequity in prenatal care receipt among mothers of infants with NAS. Findings may inform implementation of state-based public health interventions.

Association of the United States Affordable Care Act Dependent Coverage Provision with Labor Neuraxial Analgesia Use.

Providing continuous health insurance coverage during the perinatal period may increase access to and utilization of labor neuraxial analgesia. This study tested the hypothesis that implementation of the 2010 Dependent Coverage Provision of the Patient Protection and Affordable Care Act, requiring private health insurers to allow young adults to remain on their parent's plan until age 26 yr, was associated with increased labor neuraxial analgesia use. This study used a natural experiment design and birth certificate data for spontaneous vaginal deliveries in 28 U.S. states between 2009 and 2013. The intervention was the Dependent Coverage Provision, categorized into pre- and postintervention periods (January 2009 to August 2010 and September 2010 to December 2013, respectively). The exposure was women's age, categorized as exposed (21 to 25 yr) and unexposed (27 to 31 yr). The outcome was the labor neuraxial analgesia utilization rate. Of the 4,515,667 birth certificates analyzed, 3,033,129 (67.2%) indicated labor neuraxial analgesia use. For women aged 21 to 25 yr, labor neuraxial analgesia utilization rates were 64.9% during the preintervention period and 68.9% during the postintervention period (difference, 4.0%; 95% CI, 3.9 to 4.2). For women aged 27 to 31 yr, labor neuraxial analgesia utilization rates were 64.9% during the preintervention period and 67.7% during the postintervention period (difference, 2.8%; 95% CI, 2.7 to 2.9). After adjustment, implementation of the Dependent Coverage Provision was associated with a 1.0% (95% CI, 0.8 to 1.2) absolute increase in labor neuraxial analgesia utilization rate among women aged 21 to 25 yr compared with women aged 27 to 31 yr. The increase was statistically significant for White and Hispanic women but not for Black and Other race and ethnicity women. Implementation of the Dependent Coverage Provision was associated with a statistically significant increase in labor neuraxial analgesia use, but the small effect size is unlikely of clinical significance.

Risk of type 2 diabetes after diagnosed gestational diabetes is enhanced by exposure to PM2.5.

Air pollution and gestational diabetes mellitus (GDM) are both associated with increased diabetes mellitus (DM) occurrence. However, whether air pollutants modify the effects of GDM on the occurrence of DM has been unknown. This study aims to determine whether the effect of GDM on DM development can be modified by exposure to ambient air pollutants. Women with one singleton birth delivery during 2004-14 according to the Taiwan Birth Certificate Database (TBCD) were included as the study cohort. Those newly diagnosed as having DM 1 year or later after childbirth were identified as DM cases. Controls were selected among women without DM diagnosis during follow-up. Personal residence was geocoded and linked with interpolated concentrations of air pollutants into township levels. Conditional logistic regression was used to determine the odds ratio (OR) of pollutant exposure and GDM, adjusting for age, smoking and meteorological variables. There were 9846 women who were newly diagnosed as having DM over a mean follow-up period of 10.2 years. We involved them and the 10-fold matching controls involved in our final analysis. The OR (odds ratio) (95% confidence interval, 95% CI) of DM occurrence per interquartile range increased in particulate matter (PM) smaller than or equal to 2.5 µm (PM2.5) and ozone (O3) was 1.31 (1.22-1.41) and 1.20 (1.16-1.25), respectively. The effects of PM exposure on DM development were significantly higher in the GDM group (OR: 2.46, 95% CI: 1.84-3.30) than in the non-GDM group (OR: 1.30, 95% CI: 1.21-1.40). Exposure to high levels of PM2.5 and O3 elevates the risk of DM. GDM acted synergistically in DM development with exposure to PM2.5 but not with that to O3.

Inequities in birth registration, violent discipline, and child labour by disability status and sex: Evidence from the Multiple Indicator Cluster Surveys in 24 countries.

Nearly 240 million children are estimated to have a disability globally. We describe inequities by disability status and sex in birth registration, child labour, and violent discipline outcomes. Data come from Round 6 of the Multiple Indicator Cluster Survey programme and includes 323,436 children, aged 2-17 years in 24 countries. We estimated non-registration of birth, child labour, and violent discipline, stratified by sex and disability in each country. We estimated age-adjusted prevalence ratios and prevalence differences, accounting for survey design, to calculate inequities by disability. There was large variation across countries in the percentage of children with disabilities (range: 4% to 28%), in non-registration (range: 0% to73%), child labour (range: 2% to 40%), and violent discipline (range: 48% to 95%). We found relative inequities by disability in birth registration in two countries among girls and one country among boys, and in birth certification in two countries among girls and among boys. Child labour was higher among girls with disabilities in two countries and among boys in three countries. We found larger and more prevalent inequities by disability in hazardous labour in six countries among girls (aPR range: 1.23 to 1.95) and in seven countries among boys (aPR range: 1.24 to 1.80). Inequities in the prevalence of violent discipline by disability were significant in four countries among girls (aPR range: 1.02 to 1.18) and among boys (aPRs: 1.02 to 1.15) and we found inequities in severe punishment nine countries among girls (aPR range: 1.12 to 2.27) and in 13 countries among boys (aPRs: 1.13 to 1.95). Context specific research is needed to understand the large variations in inequities by disability status and sex within and across countries. Monitoring inequities in child rights by disability status and sex is important to achieve the SDGs and ensure child protection programs reduce inequities.

Changes in birth outcomes and utilization of prenatal care during the COVID-19 pandemic in 2020: a secondary analysis of vital statistics in Colombia

BackgroundBirth outcomes could have been affected by the COVID-19 pandemic through changes in access to prenatal services and other pathways. The aim of this study was to examine the effects of the COVID-19 pandemic on fetal death, birth weight, gestational age, number of prenatal visits, and caesarean delivery in 2020 in Colombia.MethodsWe conducted a secondary analysis of data on 3,140,010 pregnancies and 2,993,534 live births from population-based birth certificate and fetal death certificate records in Colombia between 2016 and 2020. Outcomes were compared separately for each month during 2020 with the same month in 2019 and pre-pandemic trends were examined in regression models controlling for maternal age, educational level, marital status, type of health insurance, place of residence (urban/rural), municipality of birth, and the number of pregnancies the mother has had before last pregnancy.ResultsWe found some evidence for a decline in miscarriage risk in some months after the pandemic start, while there was an apparent lagging increase in stillbirth risk, although not statistically significant after correction for multiple comparisons. Birth weight increased during the onset of the pandemic, a change that does not appear to be driven by pre-pandemic trends. Specifically, mean birth weight was higher in 2020 than 2019 for births in April through December by about 12 to 21 g (p < 0.01). There was also a lower risk of gestational age at/below 37 weeks in 2020 for two months following the pandemic (April, June), but a higher risk in October. Finally, there was a decline in prenatal visits in 2020 especially in June-October, but no evidence of a change in C-section delivery.ConclusionsThe study findings suggest mixed early effects of the pandemic on perinatal outcomes and prenatal care utilization in Colombia. While there was a significant decline in prenatal visits, other factors may have had counter effects on perinatal health including an increase in birth weight on average.

Associations of Prenatal Agricultural Farm Work with Fetal Overgrowth and Pregnancy Complications in State of Arizona Birth Records.

The purpose of this study is to examine fetal growth outcomes from agricultural worker households. Using Arizona 2006 to 2013 birth certificates with parental occupation, we identified N = 623,185 live births by agricultural household status. Logistic regression models estimated adjusted odds ratios (aORs) for macrosomia (>4000 g), postterm birth (>41 weeks), low birth weight (<2500 g), preterm birth (<37 weeks), large for GA, small for GA, and 5-minute APGAR (<7). Newborns of agricultural households (n = 6371) had a higher risk of macrosomia (aOR, 1.15; 95% CI, 1.05-1.26), large for GA (aOR, 1.12; 95% CI, 1.03-1.22), postterm birth (aOR, 1.20; 95% CI, 1.09-1.33), and low 5-minute APGAR (aOR, 1.39; 95% CI, 1.07-1.81), whereas low birth weight (aOR, 0.85; 95% CI, 0.76-0.96) and preterm birth (aOR, 0.82; 95% CI, 0.74-0.92) were inversely related. Having an agriculture working parent increased the likelihood of fetal overgrowth and low APGAR.

Macrosomia is associated with overweight in childhood: a follow-back of a cohort established in the early years of the obesity epidemic

Objective: Interventions currently recommended to control and prevent obesity have not been successful. Recent research has shifted toward the transgenerational cycle of obesity. We assessed the association between fetal macrosomia and early childhood body weight. Methods: We conducted a follow-back study to link birth certificate data to the Third National Health and Nutrition Examination Survey (1988–1994) of 2621 United States-born singletons aged 2–6 years. Birth weight and gestational age data were collected from birth certificates. Fetal macrosomia was defined as ≥90th percentile of gestational age-race-sex-parity specific body weight distribution in 1989 vital statistics. Results: With 12.7% (standard error = 0.85%) of participants born macrosomic, the prevalence of obesity and overweight (BMI percentiles ≥85th in the CDC growth chart) among children was 17.8% (1.17%). When the body weight was measured against age-sex-specific height (BMI percentiles), macrosomia was significantly associated with overweight and obesity (odds ratio [OR] = 1.64, 95% confidence interval = 1.07–2.50) adjusted for family income, maternal age and marital status, race, maternal smoking during pregnancy, and breastfeeding. The association became insignificant after adjusting for postnatal lifestyle and parental body mass index (OR = 1.38 [0.84-2.26]]. When body weight was measured against age, children who were too heavy for their age were more likely to be born macrosomically (OR = 2.64 [1.66-4.22]) than their peers with healthy age-specific body weight. Conclusion: Fetal macrosomia was significantly associated with a doubled risk of heavy body weight in children aged 2–6 years.