Birth Database Research Articles

Inter-delivery Time Interval and the Likelihood of Successful Vaginal Birth After Cesarean Delivery [21P

INTRODUCTION: The most commonly utilized prediction models to assist in the prediction of vaginal birth after cesarean delivery (VBAC) have not included inter-delivery time interval as a contributing variable. Therefore, we sought to determine the association of inter-delivery time interval and rate of successful VBAC. METHODS: This retrospective cohort study utilized the United States Natality Live Births database from the Center for Disease Control and Prevention for the years 2016–2017. Singleton patients at term with their second pregnancy and live birth undergoing a trial of labor after one prior cesarean delivery (TOLAC) were eligible for inclusion. The inter-delivery time interval, defined as the time elapsed between live births, was divided into 7 groups by months: 12–17, 18–23, 24–35, 36–47, 48–59, 60–71, 72 and beyond. Pearson's Chi-Squared test was used to compare rates of successful VBAC across the different inter-delivery time interval groups. Statistical significance was determined as P<.05. RESULTS: Of the 60,526 women who underwent TOLAC, 39,948 (66%) had a VBAC. The highest rate of VBAC success was seen with an inter-delivery time interval of 24 to 35 months (12,368/17,760; 69.6%). The differences in rates of VBAC between the different time intervals were statistically significant (P<.0001). CONCLUSION: Overall, the rate of successful VBAC in the United States among cases from 2016–2017 was 66%. Our data indicate that the rate of successful VBAC is affected by the inter-delivery time interval, with the optimal time for VBAC being 24–35 months after cesarean delivery. The clinical implication of this statistical finding requires further study.

Tobacco use by pregnant Medicaid beneficiaries: Validating a claims-based measure in Oregon.

In Oregon, more than 4 in 5 pregnant women who smoke are covered by Medicaid. Although birth certificate data for smoking during pregnancy are not accessible in a timely manner, Medicaid claims data are available monthly and provide person-level data. This study utilized an individually linked database of Medicaid claims and birth certificate data to compare the prevalence of tobacco use diagnosis codes in Medicaid claims data to self-reported smoking during pregnancy reported on birth certificates. We computed the sensitivity and specificity of Medicaid claims data to ascertain tobacco use during pregnancy compared to self-report on linked birth certificates. Using logistic regression models, we also examined demographic, prenatal care, and behavioral health factors that predicted agreement between claims and birth certificates. From 2008 to 2013, 17.9% of women with Medicaid births reported smoking during pregnancy on birth certificates compared to 3.8% of non-Medicaid births. Tobacco-related claims during pregnancy were present for 12.6% of Medicaid births. Overall agreement between claims and birth certificates rose from 87.0% in 2008 to 90.2% in 2013; sensitivity rose from 43.0% to 62.2%. Sensitivity was lowest for Hispanic women and highest for White women, and declined as maternal education increased. Sensitivity was 33.9 percentage points higher for women with any mental illness diagnosis and 27.3 percentage points higher for women with any substance use disorder diagnosis. Specificity was greater than 95% in all years. Medicaid claims data may help in surveillance of maternal smoking rates and assessment of smoking cessation programs for female Medicaid beneficiaries of reproductive age.

Health of adolescents in the 1997/1998 birth cohort in São Luís, Maranhão State, Brazil

The study aimed to estimate the prevalence of health indicators among adolescents in São Luís, Maranhão State, Brazil, in 2016. The analysis included sociodemographic conditions, life habits, body composition, sleep quality, physical activity, cognitive performance, and suicide risk in 2,515 adolescents 18 to 19 years of age. The adolescents belonged to the 1997/1998 birth cohort or were included retrospectively using the SINASC (Brazilian Information System on Live Births) database. The adolescents were mainly from economic class C (50.1%), 69.5% were in school, 40.3% were working, and 25.2% were neither studying nor working; 60.3% had been robbed, and 48.7% had parents who were separated or divorced; 19.4% showed harmful or excessive alcohol consumption or probable addiction, 19.1% had used or were using illicit drugs, 53.7% reported poor sleep quality, 40.8% reported frequent headaches, 34.3% reported more than five hours of daily screen time, and 4.1% showed high suicide risk. Prevalence of high blood pressure was 12%, and 6% were obese. Girls were more physically inactive (80.7%) and showed greater percentage of high (15.8%) and very high body fat (21.5%), while boys showed greater prevalence of high blood pressure (21.2%) and lower prevalence of physical inactivity (40.9%). High prevalence rates of health risk factors increase the adolescents' vulnerability, exposing these individuals earlier to factors leading to diseases and other health problems.

869: Evaluating social determinants of obstetric outcomes at the intersection of birth databases and "big data"

To characterize the influence of community characteristics on obstetric outcome disparities in a large, modern obstetric cohort. While emerging evidence suggests that racial, socioeconomic status (SES), and environmental health disparities likely contribute to obstetric outcome disparities, correlates between patient- level obstetric outcome data and community socioeconomic databases have yet to be fully explored. Retrospective, ecological cohort study of a 9-county birth database from 2004-2017 merged with publically available community resource data. Patient level data from the birth database used to allocate to zip code cohorts. Cohorts were associated with income, poverty, and educational attainment data from the U.S. Census Bureau. This fused database was analyzed for the primary outcome of preterm birth (PTB) and the secondary outcomes of additional obstetric and medical complications of pregnancy descriptively, with ANOVA, and with multi-variable regression addressing potential confounders. A total of 199,088 pregnancies were allocated to 120 zip code cohorts. The primary outcome of PTB as well as secondary outcomes concentrated in a non-random fashion (Figure 1). Zip code groups binned by similar SES demonstrated non-random variance with PTB that was statistically significant for extremely PTB (Figure 2). On multivariable regression, differences between zip codes were significantly associated with maternal and paternal race but demonstrated stability over time. In particular, when controlling for within zip code variability, families of color and lesser educated mothers were more likely to experience PTB. In an era of worsening obstetric outcomes in the United States, modern data fusion approaches merging obstetric with community datasets have the potential to draw attention to critical socio-economic factors driving disparate health outcomes. These data reveal community SES correlates with rates of extreme PTB. Policies supporting economic vibrancy across our communities may act to facilitate improved obstetric outcomes for our patients and their families.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

The effectiveness of maternal pertussis vaccination in protecting newborn infants in Brazil: A case-control study

IntroductionIn 2014, the Brazilian Ministry of Health (MoH) recommended Tdap to pregnant women in response to a significant increase in the incidence of pertussis among infants. The present study assessed the effectiveness of maternal immunization in preventing pertussis in infants. MethodsAn unmatched case-control study was undertaken in São Paulo State, Brazil from February 2015 to July 2016. Cases were infants aged <8 weeks at onset of pertussis reported to the Surveillance System and confirmed by real-time polymerase chain reaction or culture. Four to six healthy infants were selected as controls per case from birth certificates in the Information System on Live Births database. General characteristics and mother’s vaccination status were compared between cases and controls. The vaccine effectiveness (VE) was calculated as 1 – odds ratio (OR). For the adjusted VE, the OR was calculated using logistic regression analysis. ResultsForty-two cases and 248 controls were enrolled in the study. Mothers of 8 cases (19.1%) and 143 controls (57.4%) were vaccinated during pregnancy, resulting in an unadjusted VE of 82.6% (95% confidence interval [CI], 60.8–92.3%). The VE was unchanged after adjusting for maternal age and monthly household income. ConclusionMaternal pertussis vaccination during pregnancy was effective in protecting infants aged <8 weeks from pertussis.

Implementation of an individual patient prospective database of hospital births in Sri Lanka and its use for improving quality of care

ObjectivesThis study was aimed at piloting a prospective individual patient database on hospital deliveries in Colombo, Sri Lanka, and at exploring its use for developing recommendations for improving quality of...

Interracial couples and breastfeeding initiation in the United States

In the past decade, the prevalence of interracial couples has steadily increased. Recent reports state that nearly one in five marriages are between spouses of different races. Interracial couples receive less social support and are more likely to separate. As a result, children born to these couples may be at an increased risk of poor health outcomes. This study aims to investigate the relationship between interracial couples and breastfeeding initiation. Data from the 2014 Vital Statistics Natality Birth database were analyzed. Data were restricted to singleton births and infants with no congenital malformations. Racial composition of parents was categorized as non-Hispanic (NH) white, NH black; Hispanic; NH white/NH black; NH white/Hispanic; and NH black/Hispanic. Breastfeeding initiation (yes; no) was categorized according to information from the child's birth certificate file. Multiple logistic regression was used to generate crude and adjusted odds ratios and 99% confidence intervals. After adjusting for confounders, all interracial couples with at least one Hispanic parent had increased odds of breastfeeding initiation. Interracial white and black parents had 18% lower odds of breastfeeding initiation. The lowest odds of breastfeeding initiation were observed among intraracial black parents, who had 43% lower odds of breastfeeding initiation compared to intraracial white parents. Breastfeeding non-initiation continues to pose the greatest risk for infants with at least one black parent. Nurses, midwives, physicians, and other medical staff should discuss potential barriers that may be unique to interracial couples and provide additional breastfeeding education and support.

Trends in the leading causes of childhood mortality from 2004 to 2016 in Qatar.

IntroductionChildhood mortality is an important health indicator that reflects the overall health status of a population. Despite the decrease in global childhood mortality rates over the past decades, it still remains an important public health issue in Qatar.MethodsThe data from 2004–2016 were extracted from the Qatar Ministry of Public Health Birth and Death Database. International Classification of Diseases (ICD-10) was used for coding the causes of death. The childhood mortality rate was defined as the probability of a child dying between the first and the fifth birthday, expressed as the number of deaths per 1,000 children surviving to 12 months of age. The sex ratio was calculated by dividing the mortality rate of males by that of females. Mann-Kendall trend test was performed to examine time trends. Relative risks were calculated to examine differences by nationality (Qatari and non-Qatari) and sex.ResultsA significant decrease in mortality rate of children aged one to five was observed from 1.76 to 1.05 per 1000 children between 2004 and 2016 (Kendall tau=−0.6, p=0.004). Three prominent causes of mortality were motor vehicle accidents, congenital malformations of the circulatory system, and accidental drowning/submersion. A statistically non-significant decrease in childhood mortality from motor vehicle accidents was oberved for all nationalities (total (Kendall tau=−0.03), Qatari (Kendall tau=−0.14), and non-Qatari (Kendall tau=−0.12)). A significant decrease was seen for total accidental drowning and submersion (Kendall tau=−0.54, p=0.012), while no statistically significant decrease was seen for total congenital malformations of the circulatory system (Kendall tau=−0.36, NS). The Qatari population did have a significant decrease in childhood mortality due to congenital malformations of the circulatory system (Kendall tau=−0.67, p=0.003) and accidental drowning and submersion (Kendall tau=−0.55, p=0.016).ConclusionThe study is a first attempt to evaluate childhood mortality statistics from Qatar and could be useful in supporting Qatar’s ongoing national health strategy programs.

Epidemiology of Hirschsprung disease in California from 1995 to 2013.

This study seeks to update current epidemiology of Hirschsprung disease (HD) in California. Using data from the California Office of Statewide Health Planning and Development Linked Birth (1995-2012) and Patient Discharge Databases (1995-2013), patients from either dataset with an ICD-9 diagnosis code of HD (751.3) or procedure code of Soave (48.41), Duhamel (48.65), or Swenson/other pull-through (48.49) were included. Patients > age 18 during their first admission were excluded. Of 9.3million births, 2,464 patients were identified. Incidence was 2.2 cases/10,000 live births, with rates peaking at 2.9/10,000 births in 2002. Incidence was highest among African American (4.1/10,000) and Asian/Pacific Islander (2.5/10,000) births. Most were male (n = 1652, 67.1%). Sixty patients (2.4%) had Down syndrome. The median gestational age at birth was 38 weeks 6days (interquartile range [IQR] 37 weeks 1day-40 weeks 1day). Mortality during the first year of life was 1.7%. Median age at death was 14.5days (IQR 0-113days). This is one of the largest population-based studies of HD. In California, the incidence of HD is stable, risk is highest among African American children, and the mortality rate is < 2%.

Epidemiology of gastroschisis: A population-based study in California from 1995 to 2012

BackgroundAlthough the incidence of gastroschisis is increasing, risk factors are not clearly identified. MethodsUsing the Linked Birth Database from the California Office of Statewide Health Planning and Development from 1995 to 2012, patients with gastroschisis were identified by ICD-9 diagnosis/procedure code or birth certificate designation. Logistic regressions examined demographics, birth factors, and maternal exposures on risk of gastroschisis. ResultsThe prevalence of gastroschisis was 2.7 cases per 10,000 live births. Patients with gastroschisis had no difference in fetal exposure to alcohol (p = 0.609), narcotics (p = 0.072), hallucinogenics (p = 0.239), or cocaine (p = 0.777), but had higher exposure to unspecified/other noxious substances (OR 3.27, p = 0.040; OR 2.02, p = 0.002). Gastroschisis was associated with low/very low birthweight (OR 5.08–16.21, p < 0.001) and preterm birth (OR 3.26–10.0, p < 0.001). Multivariable analysis showed lower risk in black (OR 0.44, p < 0.001), Asian/Pacific Islander (OR 0.76, p = 0.003), and Hispanic patients (OR 0.72, p < 0.001) compared to white patients. Risk was higher in rural areas (OR 1.24–1.76, p = 0.001). Compared to women age < 20, risk decreased with advancing maternal age (OR 0.49-OR 0.03, p < 0.001). Patients with gastroschisis had increased total charges ($336,270 vs. $9012, p < 0.001) and length of stay (38.1 vs. 2.9 days, p < 0.001). Mortality was 4.6%. ConclusionsThis is the largest population-based study summarizing current epidemiology of gastroschisis in California. Type of studyRetrospective comparative cohort study. Level of evidenceIII.

Outcomes associated with transfusion in low-risk women with obstetric haemorrhage.

Obstetric haemorrhage is associated with increased blood transfusion, morbidity and health service usage in women. While the use of transfusion in actively bleeding patients is supported, there is little evidence for the use of blood as treatment in the nonbleeding patient following obstetric haemorrhage. Transfusion may expose women to increased morbidity. This study aims to compare outcomes between low-risk women receiving no or 1-2 units of blood in the context of obstetric haemorrhage. The study population included women giving birth in hospital in New South Wales, Australia, between July 2006 and December 2010, with a diagnosis of obstetric haemorrhage. Women with medical or obstetric conditions making them high risk were excluded, as were women receiving more than 2 units of blood. Data were obtained from linked hospital, birth and blood bank databases. Propensity score matching was used to compare outcomes between transfused and nontransfused women in order to estimate the impact of the transfusion itself on outcomes. There were 14989 women with obstetric haemorrhage, of whom, 1702 received a transfusion, including 1069 receiving a transfusion of 1-2 units. Women receiving transfusion were more likely to experience severe maternal morbidity (relative risk 7·0, 95% Confidence interval (2·8, 17·8)), be admitted to intensive care (RR 2·1 95% CI(1·2, 3·8)), and have a length of stay >5 days (RR 2·0, 95% CI (1·6, 2·5)). Small volume transfusion in the context of obstetric haemorrhage among low-risk women is associated with poorer maternal outcomes and increased healthcare utilisation.

Hospital surveillance for respiratory syncytial virus (RSV) in the main metropolitan area of Lyon, France, using birth databases and data on hospitalization for clinical bronchiolitis from 2012 to 2017

Background RSV is a leading cause of lower respiratory infections, particularly in infants and elderly. Morbidity and mortality are comparable to those of influenza infections in the high-risk population. Several RSV vaccine candidates and antibodies for prevention are currently in development, some of those already at phase III clinical trial stage. However, surveillance data on virus circulation and disease burden in high-risk groups are still incomplete, thus, hindering evidence-based recommendations on RSV vaccine policy and introduction. The main objective of this proof-of-concept (POC) study is to illustrate the feasibility of RSV surveillance in a main metropolitan area using birth databases and data on hospitalization for clinical bronchiolitis. Our concept would allow continuous monitoring and surveillance of RSV in infants and produce comparable data for main metropolitan areas in Europe in a practical and cost-efficient manner. Methods For this POC study, a case was defined as a hospitalized patient ( Results In total, 45,820 children were born in the study period of which 663 met the case definition. Incidence rates for birth cohorts of 2012 to 2016 were 16.3 (95% CI 13.7–18.9), 10.8 (95% CI 8.7–12.9), 15 (95% CI 12.5–17.5), 18.1 (95% CI 15.4–20.8) and 12.1 (95% CI 9.9–14.3) per 1000 newborns, respectively. No significant difference was found between hospitalization of male and female infants. The most predictive independent risk factor for RSV hospitalization was month of birth. Odd ratios gradually increased from 0.31 (95% CI 0.18–0.49) in May to 3.73 (95% CI 3.11–4.48) in November and were lowest in March with 0.26 (95% CI 0.14–0.43). Significant differences were found for duration of pregnancy and weight at birth between hospitalized and non-hospitalized children. Children born before week 38 or with a birth weight of 3000 g or less were more likely to be hospitalized due to RSV infection. Conclusion Seasonal RSV circulation is known to peak in December with younger infants being at higher risk of infection. Besides prematurity, month of birth is shown to be the greatest risk factor for hospitalization due to RSV infection. This results demonstrate that our concept of using already existing routine hospital databases, such as birth database and virological database, can produce reliable results to estimate the burden of RSV in the high risk group of under one year old children. This surveillance system could be implemented in other metropolitan areas to produce comparable dataset at no extra cost therefore, enabling data collection for evidence-based RSV vaccine recommendations.

The Placenta in Neonatal Encephalopathy: A Case–Control Study

We assessed whether specific histologic placental lesions were associated with risk for neonatal encephalopathy, a strong predictor of death or cerebral palsy. Case-control study of singletons with gestational ages ≥35 weeks. Data were abstracted from a prospectively collected database of consecutive births at a hospital in which placental samples from specified sites are collected and stored for all inborn infants. Placentas of infants with neonatal encephalopathy were compared with randomly selected control infants (ratio of 1:3). Placental histologic slides were read by a single experienced perinatal pathologist unaware of case status, using internationally recommended definitions and terminology. Findings were grouped into inflammatory, maternal, or fetal vascular malperfusion (FVM) and other lesions. Placental samples were available for 73 of 87 (84%) cases and 253 of 261 (97%) controls. Delivery complications and gross placental abnormalities were more common in cases, of whom 4 died. Inflammation and maternal vascular malperfusion did not differ, and findings consistent with global FVM were more frequent in case (20%) than control (7%) placentas (P = .001). There was a trend toward more segmental FVM and high-grade FVM (fetal thrombotic vasculopathy) among cases. Some type of FVM was observed in 24% of placentas with neonatal encephalopathy. In infants with both neonatal encephalopathy and placental FVM, more often than in infants with neonatal encephalopathy without FVM, electronic fetal monitoring tracings were considered possibly or definitely abnormal (P = .028). Vascular malperfusion of subacute or chronic origin on the fetal side of the placenta was associated with increased risk of neonatal encephalopathy.

Obesity, gestational diabetes and macrosomia are associated with increasing rates of early-term induction of labour at The Canberra Hospital.

Early-term delivery is an important cause of short-term neonatal morbidity and associated high healthcare costs, with possible additional long-term developmental ramifications. As a form of 'iatrogenic' delivery, induction of labour (IOL) is a potentially modifiable contributor to this burden. To determine patterns of, and primary indication for, early-term IOL, as well as temporal trends in this primary indication and differences from other modes of delivery with respect to maternal factors and maternal/neonatal outcomes. The Canberra Hospital births database (2012-2016) was queried; patients who underwent IOL were included in the analysis. Total deliveries and the proportion of early-term IOL procedures rose markedly over the time period. Gestational diabetes mellitus (GDM) was the most frequent and an increasing main indication for IOL. GDM was associated with significantly higher body mass index, an increased proportion of obesity, and a greater incidence of labour complications related to macrosomia. Birthweight of neonates of diabetic mothers was significantly higher, which was associated with decreased rates of admission to the special care nursery/neonatal intensive care unit (SCN/NICU) compared to all other babies. GDM increased relative risk of early-term IOL in obese women by 1.8 times. The burden of GDM and early-term IOL have increased at The Canberra Hospital although adverse short-term neonatal outcomes have not, possibly suggesting appropriate management of these patients. Nonetheless, effort should be made to identify patients who can safely continue pregnancy to full term, given the higher proportion of SCN/NICU admissions among early-term neonates.

The Role of Paternity Acknowledgment in Breastfeeding Noninitiation.

In the United States, less than a quarter of mothers breastfeed in accordance with national recommendations. To date, researchers have demonstrated that paternal support directly influences breastfeeding outcomes; however, healthcare practitioners may not be able to quantify a lack of support in the immediate postpartum period. Research aim: The aim is to investigate the relationship between breastfeeding noninitiation and paternity acknowledgment, a factor that can be easily identified in the immediate postpartum period. Data from the 2014 Vital Statistics Natality Birth database were analyzed. Analysis included primiparous singleton births with no health complications ( N = 1,127,861). Based on the birth certificate data, paternity acknowledgment was categorized as married with paternity acknowledged, unmarried with paternity acknowledged, and unmarried without paternity acknowledged. Breastfeeding initiation was dichotomized (yes or no). Multiple logistic regression analyses were conducted to obtain crude and adjusted odds ratios and 99% confidence intervals (α = .01). Approximately one in seven births had no paternity acknowledgment on their birth certificate. After adjusting for confounders, mothers who were not married but the paternity of the infant was acknowledged had 50% higher odds of breastfeeding noninitiation compared with mothers who were married and their infants' paternity was acknowledged (adjusted odds ratio = 1.50, 99% confidence interval [1.47, 1.53]). Furthermore, women who were unmarried and without paternity acknowledgment had 135% higher odds of breastfeeding noninitiation compared with married women with paternity acknowledgment (adjusted odds ratio = 2.35, 99% confidence interval [2.30, 2.41]). Women whose births were not acknowledged by the fathers may need additional breastfeeding support from healthcare practitioners.

Short interpregnancy interval increases the risk of preterm premature rupture of membranes and early delivery

Objectives: Preterm premature rupture of membranes (PPROM) is a major contributor to overall preterm birth (PTB) rates. A short interpregnancy interval (IPI) is a well-known risk factor for PTB. It is unknown if a short IPI specifically affects the risk of developing PPROM in a subsequent pregnancy. We sought to determine the association between IPI and the risk of PPROM in a subsequent pregnancy. Methods: A retrospective cohort study using the Missouri birth certificate database of singleton births from 2003 to 2013 was conducted. A short IPI (delivery of the prior pregnancy to conception of the index pregnancy) was defined as ≤6 months. IPI >6 months was categorized into two groups: IPI 7–23 months and IPI ≥24 months. PPROM was defined as premature rupture of membranes between 160 and 366 weeks. Multivariable logistic regression was conducted to determine the association between IPI and PPROM while controlling for maternal age, race, body mass index (BMI), education level, use of social services (Medicaid insurance, food stamps, or participation in the WIC [Women, Infants, and Children] program), tobacco use, and history of PTB. Secondary outcome included the gestational age at delivery, categorized into five subgroups (≤240, 241−280, 281−320, 321−340, and 341−366 weeks). Results: 474,957 subjects with singleton gestations had data available to calculate the IPI. Of these, 1.4% (n = 6797) experienced PPROM. IPI ≤6 months was significantly associated with an increased risk of developing PPROM compared with patients with IPI ≥24 months (odds ratio (OR) 1.80, 95% CI 1.70–1.90, p < .001). A higher proportion of women with IPI ≤6 months delivered between 281 and 320 weeks compared to the other two IPI groups (27.0 versus 15.0 and 16.4%, p < .001). Individual maternal factors associated with an increased risk of PPROM included advanced maternal age, African American race, BMI <18.5 kg/m2, BMI ≥30 kg/m2, use of social services, tobacco use, and a prior PTB. Conclusion: Our data demonstrate that an IPI of ≤6 months is significantly associated with an increased risk of developing PPROM in the subsequent pregnancy. Of greater clinical relevance is that these women were more likely to deliver between 281 and 320 weeks as compared with women with a longer IPI. Novel to this study is the establishment of a specific link between a short IPI and PPROM with subsequent early delivery. Several maternal demographic factors known to be associated with PTB risk were also found to be associated with an increased risk of PPROM. Further studies are necessary to elucidate plausible biologic mechanisms ultimately leading to the development and implementation of preventive and therapeutic strategies for this high-risk cohort.

Patterns of glucose-lowering therapies and neonatal outcomes in the treatment of gestational diabetes in Canada, 2009-2014.

To examine patterns of use of different glycaemic control agents for treating gestational diabetes mellitus. This was a large, retrospective, population-based cohort study of pregnant women with gestational diabetes from Alberta, Canada. We linked data from the Alberta Vital Statistics - Birth database with administrative claims data. Alberta Vital Statistics - Birth data were used to identify births that occurred between 1 January 2009 and 31 December 2014. We used International Classification of Diseases version 9/10 codes to identify women with gestational diabetes, and we excluded women with pre-existing diabetes. Our cohort consisted of 16 857 women with gestational diabetes, with a total of 18 761 birth events between 2009 and 2014. Over the study period, the proportion of women with gestational diabetes who were treated with glycaemic control therapies increased from 25.0% to 31.4% (P<0.0001). The number of pregnancies treated with insulin only increased (from 23.6% to 28.3%; P<0.0001), as did the number treated with metformin, +/- insulin (from 1.4% to 3.2%; P<0.0001). Rates of large-for-gestational-age infants were significantly higher among pregnancies treated with insulin only (17%) or metformin (16.5%) than among pregnancies that did not receive any pharmacological treatment (12.8%). Our findings show increasing use of insulin and metformin in women with gestational diabetes. Rates of large-for-gestational-age infants were similar among pregnant women receiving either pharmacological treatment, and higher than among pregnant women who did not receive any pharmacological treatment. Future research should explore the long-term outcomes and safety of metformin as an alternative for treating gestational diabetes.

Regular monitoring of breast-feeding rates: feasible and sustainable. The Emilia-Romagna experience.

An efficient breast-feeding monitoring system should be in place in every country to assist policy makers and health professionals plan activities to reach optimal breast-feeding rates. Design/Setting/Subjects From March to June 2015, breast-feeding rates at 3 and 5 months of age were monitored in Emilia-Romagna, an Italian region, using four questions added to a newly developed paediatric immunization database with single records for each individual. Data were collected at primary-care centres. Breast-feeding definitions and 24 h recall as recommended by the WHO were used. Direct age standardization was applied to breast-feeding rates. Record linkage with the medical birth database was attempted to identify maternal, pregnancy and delivery factors associated with full breast-feeding rates at 3 and 5 months of age. Data on breast-feeding were collected for 14044 infants. The mean regional full breast-feeding rate at 3 months was 52 %; differences between local health authorities ranged from 42 to 62 %. At 5 months of age, the mean regional full breast-feeding rate dropped to 33 % (range between local health authorities: 26 to 46 %). Record linkage with the birth certificate database was successful for 93 % of records. Total observations more than doubled with respect to the previous regional survey. The new monitoring system implemented in 2015 in Emilia-Romagna region, totally integrated with the immunization database, has proved to be feasible, sustainable and more efficient than the previous one. This system can be a model for other regions and countries where the vast majority of mothers obtain vaccinations from public health facilities and that already have an immunization database in place.

Term admissions to neonatal units in England: a role for transitional care? A retrospective cohort study

ObjectiveTo identify the primary reasons for term admissions to neonatal units in England, to determine risk factors for admissions for jaundice and to estimate the proportion who can be cared...

Match quality of a linkage strategy based on the combined use of a statistical linkage key and the Levenshtein distance to link birth to death records in Brazil.

ABSTRACTObjectivesTo assess the match quality of a linkage strategy based on the combined use of a statistical linkage key and the Levenshtein distance to link birth to death records in Brazil. ApproachFirst we evaluated the discrimination power of a statistical linkage key adapted from the Australian SLK-581. The modified statistical linkage key (MSLK-781) was based on the concatenation of the 2nd, 3rd and 5th letters of the mother's family name, the 2nd and 3rd letters of the mother's given name, the 2nd and 3rd letters of the mother's middle name, the child's date of birth and sex. We calculated the proportion of records that have a unique value for the MSLK-781 within the 2013 live births (N=224,038 records) and mortality (N=132,646 records) databases for Rio de Janeiro state. We also calculated the joint unique proportion measure based on the product of these two proportions. Second we evaluated the match quality of a linkage strategy based on the combined use of the MSLK-781 and the Levenshtein distance of the mother's name to link the live births database to death records of singleton children younger than one year of age (N=1,488). To assess the match quality we calculated the sensitivity, the predictive positive value (PPV) and the F-measure. ResultsThe proportion of records that have a unique value for the MSLK-781 within the live birth and the mortality databases were, respectively, 97.5% and 98.8%, which yields a joint unique proportion of 96.1%. The match quality measures of the linkage strategy based only on the MSLK-781 were: sensitivity=83.6%; PPV=98.3%; F-measure=90.4%. Combining the agreement on the MSLK-781 with a Levenshtein distance of the mother's name of less than 4 for the record pairs classification eliminated the false-positive matches (PPV=100%) with a small decline in the sensitivity (81.7%) and the F-measure (89.9%). ConclusionUsing the MSLK-781 combined with the Levenshtein distance can be used as a first pass for linking birth to death records in Brazil without having to send pairs of records to clerical review.