Birth Outcomes Research Articles

Distinct Trajectories of Prescription Opioid Exposure in Pregnancy and Risk of Adverse Birth Outcomes.

The aim of this study was to identify distinct trajectories of prescription opioid exposure in pregnancy-encompassing both medication for opioid use disorder (MOUD) and opioid analgesics-and explore their associations with birth outcomes. Trajectories were identified using latent class analysis among Wisconsin Medicaid-insured live births 2011-2019. Logistic regression estimated associations between these trajectories and neonatal opioid withdrawal syndrome (NOWS), small for gestational age, preterm birth, birth weight, and gestational age. Of 138,123 births, 27,293 (19.8%) had prenatal opioid exposure. Five trajectory classes were identified: (1) stable MOUD treatment (5.8%), (2) inconsistent MOUD treatment (3.9%), (3) chronic analgesic use (4.2%), (4) intermittent analgesic use (7.8%), and (5) low-level use of MOUD and analgesics (78.3%). NOWS incidence per 1000 infants was 667 for class 1 (adjusted odds ratio [aOR]: 21.74, 95% confidence interval [CI]: 17.89, 26.41), 570 for class 2 (aOR: 15.35, 95% CI: 12.49, 18.87), 235 for class 3 (aOR: 19.42, 95% CI: 15.93, 23.68), 67 for class 4 (aOR: 6.23, 95% CI: 4.99, 7.76), and 12 for class 5 (aOR: 1.73, 95% CI: 1.47, 2.02). Classes 1-4 had elevated risk of small for gestational age, preterm birth, lower birth weight, and shorter gestational age, with no significant differences among these classes. Among individuals with opioid use disorder, stable MOUD treatment was associated with higher birth weights and longer gestational ages compared to inconsistent treatment, despite higher odds of NOWS. Early initiation and consistent MOUD treatment may improve birth weight and gestational age. For pregnant individuals with opioid use disorder using chronic analgesics, transition to MOUD may promote birth outcomes.

Impact of fetal spine alignment according to maternal lateralization during early labor on maternal comfort and birth outcomes: A prospective cohort study in Kelantan, Malaysia.

Maternal positioning during labor significantly influences maternal comfort. This study aims to identify the preferred maternal lateral position during the latent phase and examine the impact of alignment between maternal lateralization and fetal spine positioning during the active phase of the first stage of labor on maternal comfort. Pregnant women in the first stage of labor beyond 37 weeks of gestation were recruited over six months from March to August 2020 for this prospective cohort study at Hospital Raja Perempuan Zainab II, Kota Bharu, Kelantan, Malaysia. Eligible individuals were randomly allocated to align with the fetal spine (n=180) or oppose it (n=180). Fetal spine positions were confirmed via transabdominal ultrasound. Maternal mean comfort scores were assessed using the established Maternal Comfort Assessment Tool. Statistical analysis was performed using IBM SPSS version 27, with a p<0.05 considered significant. There was a significant association between the preferred maternal position during the latent phase and concordance with the same maternal lateralization-fetal spine alignment (p<0.001). Higher mean comfort scores were observed when the maternal lateral position matched the fetal spine alignment during the active phase of labor. There was a significant association of normal CTG tracings when the maternal position was aligned with the fetal spine (p<0.001). Parturients preferred lying in alignment with the fetal spine lateralization during the latent phase. This position also offers increased comfort during the active phase of labor. It highlights the importance of considering maternal-fetal alignment as a critical factor in intrapartum care.

Adiponectin and Leptin during Pregnancy: A Systematic Review of Their Association with Pregnancy Disorders, Fetal Growth and Placental Function

During pregnancy, the adipokines leptin and adiponectin can affect placental nutrient transport and inflammatory pathways, potentially leading to altered fetal growth and pregnancy complications including gestational diabetes mellitus (GDM) and preeclampsia (PE). The aim of this systematic review is to gather and analyze research on maternal circulating leptin and adiponectin levels and their relationship to adverse pregnancy and birth outcomes. Additionally, it seeks to determine whether these hormones are linked to alterations in placental transporters and cell signaling pathways. PubMed and MEDLINE were systematically searched to include studies published between 2012 and 2022. All primary data studies reporting serum adiponectin and/or leptin, placental mRNA and protein levels of related transporters, and adverse birth outcomes were eligible. The current systematic review encompasses a total of 14 articles. Abnormal serum maternal leptin and adiponectin levels were associated with changes in fetal growth and placental cellular signaling and nutrient transporters. A majority of studies associated elevated maternal leptin and reduced adiponectin with fetal overgrowth, although this relationship was not consistent and may be complicated when other pathologies are present. The effects of maternal leptin and adiponectin on fetal growth may be driven by placental adaptation in nutrient transporters and mitochondria. Future studies should determine if the placental effects of leptin and adiponectin that have been found in models have mechanistic roles in human pregnancy.

The costs and benefits of scaling up interventions to prevent poor birth outcomes in low-income and middle-income countries: a modelling study

We estimated the benefits and costs of a set of preventive interventions that could be delivered during antenatal care to prevent poor birth outcomes, including small-for-gestational-age and preterm births. We built on the assumptions and analyses underlying the Lancet Series on small vulnerable newborns (SVNs) and extended that work by incorporating more recent data, focusing only on the subset of preventive interventions, and examining a broader range of effects. A primary aim of the study was to provide a framework that decision makers could use to design programmes for women and children. The analyses used the Lives Saved Tool (LiST) to estimate the effects and costs of scaling up the 11 preventive interventions identified in the SVN Series to improve birth outcomes. We used LiST estimates of effects and costs to estimate benefit-cost ratios (BCRs) for two intervention packages (one with interventions proven to improve birth outcomes and one with proven interventions plus interventions with potential to improve birth outcomes) and for the individual interventions in these packages for 80 low-income and middle-income countries (LMICs). Both packages of interventions had BCRs more than 1, with a proven package BCR of 7·3 (IQR 5·3-9·1) and a proven plus potential package BCR of 5·8 (4·4-6·9). We found that in all cases the individual interventions had BCRs more than 1, there was a wide range of BCR values for the different interventions, and the BCR varied depending on package and country. The analyses presented in this Article provide evidence that there are preventive interventions that, if scaled up in LMICs, could have a large effect on child health and provide benefits that greatly exceed the costs. Global Affairs Canada.

O14 - Induction of labour improvement initiative: impact on birth outcomes and satisfaction among women and clinicians

O14 - Induction of labour improvement initiative: impact on birth outcomes and satisfaction among women and clinicians

Effect of Utilizing Virtual Reality Technology for Pushing during Second Stage of Labour on Birth Outcomes among Primiparous Women

Effect of Utilizing Virtual Reality Technology for Pushing during Second Stage of Labour on Birth Outcomes among Primiparous Women

Maternal Risk Factors and Birth Outcomes of Pregnancies Complicated by Preeclampsia: A Case–control Study in a Tertiary Care Hospital of Central India

Background: Preeclampsia contributes substantially to maternal and perinatal mortality. Reduction of maternal and perinatal mortality is a global priority, particularly in low- and middle-income countries like India. Preeclampsia is often overlooked during pregnancy and emerges as a significant contributor to mortality if not addressed proactively. Hence, the present study planned to explore maternal risk factors and birth outcomes in women with preeclampsia admitted for delivery in a tertiary care hospital. Materials and Methods: The present case–control study, including 100 matched cases and a similar number of controls, was carried out. For cases, pregnant women admitted for delivery, diagnosed with preeclampsia, while controls included all pregnant women admitted for delivery without preeclampsia were interviewed. A structured interview questionnaire, patient documents, and maternal and child protection (MCP) cards were used for data collection. Results: Family history of hypertension (odds ratio [OR] = 2.90, 95% confidence interval [CI] = 1.65–5.31), history of chronic hypertension (OR = 6.00, 95% CI = 1.97–18.27), and primiparity (OR = 1.28, 95% CI = 0.72–2.26) were significantly associated with preeclampsia. Preterm birth occurred in 58.1% of cases and 41.8% of controls. No associations were found between preeclampsia and the mode of delivery, gender, and birth weight of the baby. Conclusion: Women with a family history of hypertension, primiparous women, and those with a chronic history of hypertension have more tendency to adverse consequences of pregnancy and its outcomes like preterm births. Recognizing high-risk cases promptly and implementing effective management strategies are essential for planning and executing women’s health programs ultimately enhancing nationwide maternal and child health-care delivery.

RidStress 2 randomised controlled trial protocol: an Australian phase III clinical trial of intrapartum sildenafil citrate or placebo to reduce emergency caesarean birth for fetal distress in women with small or suboptimally grown infants at term (≥37 weeks)

IntroductionSmall for gestational age (SGA) infants are at increased risk of fetal distress in labour requiring emergency operative birth (by caesarean section (CS), vacuum or forceps). We have previously shown...

RSV Prefusion F Protein–Based Maternal Vaccine—Preterm Birth and Other Outcomes

RSV Prefusion F Protein–Based Maternal Vaccine—Preterm Birth and Other Outcomes

Risk factors and birth outcomes of preterm birth subtypes: a case-control study of singleton natural pregnancy

ObjectiveThe objective of the study was to identify the risk factors correlated with spontaneous preterm birth (SPTB) and iatrogenic preterm birth (IPTB), as well as to compare the pregnancy outcomes...

Effect of paternal overweight or obesity on semen parameters, clinical pregnancy and live birth outcomes in men treated with intrauterine insemination (IUI).

Overweight and obese individuals are steadily increasing in recent years. Male overweight or obesity has adverse impact on reproductive functions. The study aimed to evaluate the potential impact of paternal overweight or obesity on sperm quality and clinical pregnancy outcome in patients undergoing intrauterine insemination (IUI) treatment. This retrospective study included 1,036 couples from our reproductive center between July 2019 and August 2022. All males were categorized into normal weight, overweight, or obese groups according to their body mass index (BMI). Baseline characteristics and reproductive hormones were analyzed. Semen parameters, clinical pregnancy and live birth outcomes were compared among the different BMI groups. There were no significant differences in sperm concentration, total sperm motility, progressive sperm motility, normal sperm morphology and sperm DNA fragmentation index (DFI) among the three groups. However, the obese group exhibited a significantly decreased semen volume compared to the other two groups (P<0.01). No differences were found in clinical pregnancy rate (CPR), abortion rate (AR) and live birth rate (LBR) among the groups (P>0.05). Slight higher ARs were observed in overweight and obese groups compared to normal group (13.64%, 21.05% vs. 11.11%, P=0.49). These data suggest that male obesity leads to a significant decrease in semen volume. It is thus recommended that male BMI should be regarded as one of the predictors for IUI treatment to avoid a decrease in semen volume.

Women's Health Across the Lifespan: A Sex- and Gender-Focused Perspective.

Women's health in physical therapy has historically focused on sexual and reproductive health. The biological and social constructs of sex and gender, respectively, are determinants of health, including pathophysiology of disease and therapeutic outcomes, and an expansion of the concept of "women's health" is warranted. This Perspective explores the role of sex and gender as key determinants of women's and girls' health and highlights the factors pertinent to physical therapist practice. The Scale for the Assessment for Narrative Review Articles (SANRA), a 6-point assessment to evaluate the quality of narrative reviews, was used a priori and consulted throughout. Across the lifespan, sex- and gender-based health disparities exist. These include sex-based disparities in maternal-fetal outcomes linking female fetal sex to maternal hypertensive disorders of pregnancy, along with a sex-based female advantage in birth outcomes and the emergence of gender differences in motor development. A complex interplay of biological and socially influenced factors contributes to an increased care burden for women throughout adulthood and specific risks for the development of cardiovascular and pelvic floor conditions, decreased function, and increased disability. Sex- and gender-disaggregated data are lacking in outcomes literature. A sex- and gender-informed approach in physical therapy, including analyzing data by sex and gender, may better meet the needs of patients and better prepare physical therapist professionals to contribute to women's health across the lifespan. Success will take coordinated effort involving many stakeholders within and adjacent to the physical therapist community. The influence of sex and gender are lifelong determinants of health, making them critically important to consider in physical therapist practice, education, research, advocacy, and policy. In women's health, focusing on sexual and reproductive health is limiting and insufficient.

Proportion and Associated Factors of Adverse Birth Outcomes Among Women Who Gave Birth at Debre Markos General Hospital, East Gojjam Zone, Ethiopia, 2022: A Cross-Sectional Study

Background: Adverse birth outcomes are a common public health problem in the developing world, including Ethiopia. There are several indices of adverse birth outcomes, such as stillbirth, preterm birth, low birth weight, small for gestational age and congenital anomalies. Objective: This study aimed to determine the proportion and associated factors of adverse birth outcomes among women who gave birth at Debre Markos General Hospital. Methods: A health facility-based cross-sectional study was conducted from July 1 to August 1/2022 on laboring women who attended Debre Markos General Hospital. A total of 337 study participants were selected using a systematic sampling method. Data were collected through interviews with a structured questionnaire. Epi Data version 3.1 was used for data entry and analyzed using Statical Package for Social Sciences software. Bivariable and multivariable logistic regression analyses were employed; a P value of less than 0.05 was considered a statistically significant factor. Result: The overall proportion of this study showed that 26.1% of women had adverse birth outcomes; 7.7% stillbirths and 9.2% each preterm and low birth weights. Rural residence, no antenatal care, antepartum hemorrhage, pregnancy-induced hypertension, illiteracy, post term pregnancy, birth interval less than two years, and age less than 20 years were independently associated with adverse birth outcomes. Conclusion: In this study, the overall proportion of adverse birth outcomes was low compared to previous studies. Residence, no antenatal care follow-up, antepartum hemorrhage, pregnancy-induced hypertension, post term pregnancy, birth interval less than two years, illiteracy, and age less than 20 years were associated with adverse birth outcomes.

Association of Preterm Delivery with Urinary Tract Infection and Preventive Role of Ceftriaxone

Urinary tract infections (UTIs) are the leading cause of maternal morbidity and poor birth outcomes. Pregnancy changes increase UTI risk. A larger bladder, less tone, and a shift in vaginal flora are changes. Eradicating pathogens in the urogenital tract can lower the risk of infection-related preterm labor by stopping the progression of asymptomatic bacteriuria into a more serious infection. Objective: To determine the association of preterm labor with urinary tract infection and the preventive role of ceftriaxone. Methods: A case-control study was conducted at the Department of Obstetrics and Gynecology, Khyber Teaching Hospital, Peshawar, from 14 December 2021 to 10 June 2022. 130 pregnant women who met the selection criteria were recruited from the hospital's post-delivery wards. The participants were then separated into a case group and a control group. Protocols for treating UTIs in female were followed. Ceftriaxone was administered to the group of participants who were UTI-positive. Results: The mean age of female in the case group was 28.88 ± 7.18 and in the controls group was 28.97 ± 6.85 years. The mean gestational age at delivery in cases was 34.28 ± 1.34 weeks and in controls 39.4 ± 1.11 weeks. There was a significant association between preterm labor and urinary tract infection (p= &lt;0.05). Administration of ceftriaxone reduced the risk of preterm labor (p=0.001). Conclusions: It was concluded that there is a significant correlation between UTIs and premature labor and ceftriaxone plays an important role in reducing preterm delivery of UTI patients.

Determinants of Risk Factors Associated with Low Birth Weight in Nigeria

Low birth weight (LBW) remains a significant public health challenge with profound implications for neonatal and child health, particularly in low-income countries. Defined by the World Health Organization as a birth weight of less than 2.5 kilograms, LBW contributes to increased neonatal mortality and long-term developmental issues. This study examines the prevalence and determinants of LBW in Nigeria, leveraging data from the 2018 Nigeria Demographic and Health Survey (NDHS). The study employs a cross-sectional design and a stratified two-stage sampling technique, analyzing 7,728 recorded birth weights. Key findings indicate that maternal age, education, and socio-economic status significantly influence birth weight. Optimal reproductive ages (25-34 years) and higher educational attainment are associated with healthier birth weights, whereas younger (below 20 years) and older mothers (above 40 years), and those with lower education levels, face higher LBW risks. Employment and wealth are positively correlated with better birth outcomes, underscoring the importance of financial stability. Environmental factors such as urban residence, access to improved water sources, and sanitation facilities also play crucial roles in determining birth weight. The study compares frequentist logistic regression and Bayesian structured additive logistic regression models to identify and predict LBW risk factors, highlighting regional disparities within Nigeria. The findings emphasize the need for targeted interventions addressing socio-demographic, socio-economic, and environmental determinants to reduce the prevalence of LBW and improve maternal and child health outcomes. Enhanced understanding of these factors through advanced statistical modeling can inform policy and health interventions, ultimately contributing to achieving global health targets and improving neonatal health in Nigeria.

Effect of ART treatments on maternal and neonatal outcomes in singleton live births: A large-scale retrospective cohort study

BackgroundThe increased risk of pregnancy complications in the ART population has been reported, but the source of these risks remains controversial. The study aims to evaluate the association between ART treatments and patient characteristics with maternal and neonatal outcomes. MethodsThis was a retrospective analysis of 45,159 singleton pregnant women at a hospital between 2018 and 2021. The maternal and neonatal outcomes included pregnancy-induced hypertension (PIH), preeclampsia (PE), gestational diabetes mellitus (GDM), placental abruption (PA), placenta accreta spectrum (PAS), postpartum hemorrhage (PPH), cesarean section, iatrogenic and spontaneous preterm birth, small for gestational age (SGA), low birth weight (LBW), macrosomia, and birth defects. We assessed the outcomes among the fresh embryo transfer (ET), frozen embryo transfer (FET), and spontaneous conception (SC) groups. Potential risk factors were further analyzed in the ART population. ResultsFET was associated with higher risks for PIH (SC: AOR, 1.97(1.51–2.57); fresh ET: AOR, 1.68(1.03–2.72)), PE (SC: 2.28(1.86–2.80); fresh ET: AOR, 1.61(1.11–2.33)), PAS (SC: AOR, 3.89(3.39–4.46); fresh ET: AOR, 2.23(1.70–2.92)), PPH (SC: AOR, 3.46(2.76–4.34)); fresh ET: 2.09(1.39–3.14)), and macrosomia (SC: 1.53(1.25–1.86); fresh ET: AOR, 2.87(1.89–4.35). Fresh ET was associated with higher risks for PA (SC: AOR, 2.19(1.51–3.18); FET: AOR, 0.39(0.17–0.90)), SGA (SC: AOR, 1.56(1.06–2.31), FET: AOR, 0.42(0.19–0.91)), and LBW (SC: AOR, 2.24(1.82–2.77), FET: AOR, 0.63 (0.44–0.89)), and fresh ET is an independent risk factor for PA and SGA. Furthermore, the risk of GDM was associated with the biological characteristic of low-fertility patients. ConclusionsEmbryo status (fresh or frozen) is a key factor affecting the maternal and neonatal outcomes in ART treatments, while biological characteristics of infertile patients also play a certain role.

Antenatal education incorporating complementary medicine techniques for labour and birth to reduce the rates of epidural in primiparous women: A randomised control trial

ProblemGlobally medical management of labour and birth has significantly increased, with epidurals attributed to the cascade of interventions. BackgroundThere are few randomised control trials that evaluate the effectiveness of antenatal education programs. A previous trial at two Australian hospitals found an antenatal program of integrative complementary therapies significantly reduced rates of interventions for low-risk primiparous women. AimTo reduce rates of intervention in labour and birth, with a primary outcome of decreased epidural use during labour. MethodsLow to moderate risk primiparous women were randomised at 24–36 weeks’ gestation to the intervention group and standard care, or standard care alone. Clinical and psychological measures were analysed by intention-to-treat. Trial registration ACTRN12618001353280 FindingsIn total, 178 women participated (n = 88 intervention, n = 90 Standard care), demographic characteristics were similar between groups, almost half (49 %) reported a pre-existing medical condition, and wellbeing scores fell within the average range. Epidural use was lower in the intervention group (47.7% vs 56.7 %) with higher rates of vaginal birth (52.3% vs 42.2 %), however, no statistical differences for birth outcomes were found between groups. Attitude to childbirth scores were statistically higher for women who attended the intervention (59.1 vs 54.3 p00.001). DiscussionHigher psychometric scores demonstrated women in the intervention group felt an increased sense of coping and control. Antenatal education that includes complementary therapies can reduce fear and improve attitudes about childbirth. ConclusionsReplicating study protocols enabled the generalisability of findings to a more diverse group of women, and data will contribute to a larger meta-analysis design to detect smaller treatment effects for operative birth.

Sandwich enzyme-linked aptamer-based assay for the detection of Trichomonas vaginalis

Trichomoniasis is the most prevalent curable, non-viral sexually transmitted infection (STI), with an estimated 156 million new infections in 2020. It can potentially result in adverse birth outcomes as well as infertility in men, whilst it also increases the risk of acquiring HIV and contracting other vaginal infections. It is mostly prevalent among women in low-income countries and especially in Africa and the Americas. This STI is caused by Trichomonas vaginalis (TV) and a robust, cost-effective, sensitive, specific and rapid diagnostic test is urgently required. We report the screening of 6 full-length and 4 truncated aptamers previously selected in our group for use in a microplate-based sandwich assay. The combination of dual aptamers comprising a short 14-mer truncated capture aptamer (termed A1_14mer) and a full-length non-truncated reporter aptamer (A6) was elucidated to be the optimum pair for a sensitive sandwich enzyme-linked aptamer assay (ELAA) for the detection of TV achieving a detection limit of 3.02 × 104 TV cells/mL. The results obtained with the A1_14mer-A6 ELAA correlate excellently with wet-mount microscopy for the detection of TV in clinical specimens, cervicovaginal lavages and vaginal swabs, highlighting the potential clinical application of this assay for cost-effective population screening and subsequent prevention of the onset of complications associated with undiagnosed and untreated TV.

Estimating the Effect of a Universal Cash Transfer on Birth Outcomes

Babies in the United States fare worse than their peers in other high-income countries, and their well-being is starkly unequal along socioeconomic and racialized lines. Newborn health predicts adult well-being, making these inequalities consequential. Policymakers and scholars seeking to improve newborn health and reduce inequality have recently looked to direct cash transfers as a viable intervention. We examine the only unconditional cash transfer in the United States, the Alaska Permanent Fund Dividend (PFD), to learn if giving pregnant people money improves their newborns’ health. Alaska has paid its residents a significant dividend annually since 1982. The dividend’s size varies yearly and is exogenous to Alaskans and the local economy, permitting us to make causal claims. After accounting for fertility selection, we find that receiving cash during pregnancy has no meaningful effect on newborn health. Current theory focuses on purchasing power and status mechanisms to delineate how money translates into health. It cannot illuminate this null finding. This case illustrates a weakness with current theory: it does not provide clear expectations for interventions. We propose four components that must be considered in tandem to predict whether proposed interventions will work.

Perinatal outcomes of antenatally diagnosed omphalocele and gastroschisis: a survey from a university hospital.

To evaluate the clinical features and perinatal outcomes of antenatally diagnosed fetuses with omphalocele and gastroschisis. This was a retrospective, single-center, cohort study of prenatally diagnosed fetuses with omphalocele and gastroschisis followed-up and delivered at a university hospital. Demographic, pregnancy, birth and perinatal outcomes were compared between gastroschisis and omphalocele. A total of 75 fetuses with omphalocele and 21 cases with gastroschisis were evaluated. The mean maternal age of women carrying a fetus with omphalocele was significantly higher than the women with gastroschisis (p=0.001). Associated structural anomalies were found in 53.3% and 4.7% of fetuses with omphalocele and gastroschisis, respectively (p<0.001). The rate of chromosomal anomaly was 8.3% in pregnancies with omphalocele. In liveborn pregnancies, the mean gestational age at delivery and birth weight did not differ between the study groups. Time to postoperative oral intake, duration of parenteral nutrition and length of hospital stay were significantly longer in babies with gastroschisis than omphalocele (p<0.01). Rates of termination, intrauterine, neonatal and infant death of fetuses with omphalocele were 25.3%, 6.7%, 10.7% and 2.7% respectively. Time to postoperative oral intake, duration of parenteral nutrition and duration of hospitalization were significantly longer in babies with complex compared to simple gastroschisis (p<0.01). Survival rates were 95.2%, 82.9% and 20% in fetuses with gastroschisis, isolated and non-isolated omphalocele, respectively. Associated structural and chromosomal anomalies were significantly more common in fetuses with omphalocele compared to those with gastroschisis. Prognosis of fetuses with omphalocele depended on the associated structural and chromosomal anomalies, whereas bowel compromise was the main determining factor in gastroschisis.