Birth Registry Research Articles

Family Matters: Enhancing Insight in Linked Administrative Data Through Familial Linkage

ObjectiveFamilial relationships can provide researchers with important insight into genetic, environmental, and social influences across many domains of research. While most administrative datasets do not collect information about relationships, familial linkage is an approach which seeks to identify such relationships among individuals within a linked data environment. We sought to develop a familial linkage resource which permits researchers access to relationship information otherwise not available in unlinked disparate administrative collections. ApproachLeveraging birth and marriage registration data, we sought to identify relationships between Victorians. Familial links were formed by summarising relationships that were either explicit in the data (e.g. Parent and Child), or implied (e.g. A parent of a parent is a grandparent). Resulting relationship data was stored in a data asset which interfaces with our linkage infrastructure for easy access and use by linked data end-users. ResultsThrough familial linkage, we have identified over 8.8 million unique relationships for Victorians, spanning 24 relationship subtypes which include both biological and non-biological connections. This data can be linked to all administrative datasets within our linkage environment, however representation varies across sources. Overall, the highest coverage of known relationships is found in datasets which specialise in child services, while older Victorians remain a gap. Conclusion and ImplicationsFamilial linkage offers new dimensions of insight to researchers than what is accessible in source data alone. This information enables our data end-users to gain critical insights into the complex interplay between biological and social influences on Victorians’ health and well-being.

Birth Weight, Gestational Age, and Risk of Pediatric-Onset MASLD

Metabolic dysfunction-associated steatotic liver disease (MASLD) has become the most common chronic liver disease worldwide and is increasingly being diagnosed at younger ages, affecting more than one-third of young people with obesity. To evaluate associations between perinatal conditions and risk of MASLD and associated progressive liver disease. This nationwide, population-based case-control study included all biopsy-confirmed cases of MASLD in Sweden. Individuals aged 25 years or younger (hereafter, young individuals) with biopsy-proven MASLD between January 1, 1992, and December 31, 2016, were matched to up to 5 general population control individuals. Granular data on maternal and perinatal characteristics were retrieved from the Swedish Medical Birth Register. Data were analyzed from June 2023 to June 2024. Birth weight (low [<2500 g], reference [2500 to <4000 g], or high [≥4000 g]), gestational age (GA), and birth weight for GA (small for GA [SGA; <10th percentile], appropriate for GA [10th-90th percentile], or large for GA [LGA; >90th percentile]), compared between patients and matched controls. The main outcome was odds of biopsy-proven MASLD and MASLD-associated progressive liver disease (ie, liver fibrosis or cirrhosis) according to birth weight, GA, and birth weight for GA, adjusted for matching factors. In total, 165 young individuals with biopsy-proven MASLD (median age at diagnosis: 12.0 years [IQR, 4.4-16.9 years]; 100 [60.6%] male) were matched with 717 controls. There was an association between low birth weight and future development of MASLD (adjusted odds ratio [AOR], 4.05; 95% CI, 1.85-8.88) but no association between high birth weight and odds of MASLD (AOR, 0.64; 95% CI, 0.38-1.08) compared with the reference birth weight. An association was seen for SGA (AOR, 3.36; 95% CI, 2.00-5.64) compared with appropriate size for GA (reference category) but not for LGA (AOR, 0.57; 95% CI, 0.27-1.20). Progressive liver disease was more common in individuals born with low birth weight (AOR, 6.03; 95% CI, 1.66-21.87) or SGA (AOR, 4.90; 95% CI, 2.15-11.14). In this nationwide study of young individuals with biopsy-proven MASLD, low birth weight and SGA were associated with development of MASLD and progressive liver disease, suggesting a need for structured screening measures to diagnose these conditions early in high-risk individuals.

Identifying substance misuse related foetal anomaly cases in routinely collected data

ObjectiveFoetal Alcohol Syndrome Disorder (FASD) and substance misuse (SM) related foetal anomalies are among the most severe consequences of SM during pregnancy. These are preventable lifelong developmental disorders that affect children’s health, education, and future prospects. Despite the adverse effects of these disorders, epidemiological research in this population remains challenging due to clinical and administrative underreporting. For the first time, SM-related foetal anomaly prevalence in Wales are reported using linked routine data. ApproachWe combined birth register data with primary and secondary healthcare records to identify infants diagnosed with SM-related foetal anomaly. To compare, we identified mothers referred for SM treatment during pregnancy. The frequency and type of maternal SM-related healthcare interactions preceding birth (within three years prior) were described. ConclusionsA novel method to identify SM-related foetal anomaly cases using routinely collected data in Wales is provided. The published code to identify mothers and children exposed to SM-related events can also be reused in future projects. When compared with published estimates, cases of SM-related foetal anomaly derived from primary and secondary care diagnoses in Wales are likely underreported, along with the scale of the harm. ImplicationsWe highlight an unmet need, by counting mothers who were not in SM treatment but had SM-related health events in Wales before giving birth. By further understanding of the risks of SM on unborn children, this body of work provides insight to develop policy and clinical interventions to help future generations. We advocate introducing a SM foetal anomaly database for the UK.

Establishing a linked administrative data sampling frame to recruit families into a new UK-wide birth cohort study: findings from the Early Life Cohort Feasibility (ELC-FS) Study

Objective and ApproachFunded by the Economic and Social Research Council (2021-2024), a core aim of the ELC-FS was to establish a sampling frame by linking birth registrations and maternity records in the four UK nations (England, Wales, Scotland and Northern Ireland) to facilitate recruitment of ~2000 families into a new birth cohort study. An opt-out recruitment approach was essential. Widespread public dialogue work was undertaken to glean the attitudes and perspectives of stakeholders including data controllers, data users, and parents of young children, as to the acceptability of this recruitment model. ResultsAchieving the sampling frame required nation-specific approaches due to differences in existing legislation governing secondary use of administrative data. Complex and protracted negotiations with data controller approval panels were necessary. Public dialogue work revealed that stakeholders were: (i) excited by the prospect of a new UK-wide birth cohort study to provide invaluable insights into the lives of a new generation; and (ii) broadly accepting of the proposed use of administrative data for generating a sampling frame, particularly in terms of ensuring that the ELC-FS study has diverse and inclusive representation of family life in the UK today. ConclusionsELC-FS fieldwork will be completed by mid-2024. Preliminary analyses to be presented at the conference will assess the suitability of the sampling frame for achieving the target ELC-FS sample. ImplicationsWith careful engagement with stakeholders at a national level, access to linked administrative data as a sampling frame for a UK-wide birth cohort study is achievable, but not straightforward.

Population-Based Estimates of the Prevalence of Children With Congenital Heart Disease and Associated Comorbidities in the United States.

Congenital heart defects (CHD) are the most common birth defects and previous estimates report the disease affects 1% of births annually in the United States. To date, CHD prevalence estimates are inconsistent due to varied definitions, data reliant on birth registries, and are geographically limited. These data sources may not be representative of the total prevalence of the CHD population. It is therefore important to derive high-quality, population-based estimates of the prevalence of CHD to help care for this vulnerable population. We performed a descriptive, retrospective 8-year analysis using all-payer claims data from Colorado from 2012 to 2019. Children with CHD were identified by applying International Classification of Diseases-Ninth Revision (ICD-9) and International Classification of Diseases-Tenth Revision (ICD-10) diagnosis codes from the American Heart Association-American College of Cardiology harmonized cardiac codes. We included children with CHD <18 years of age who resided in Colorado, had a documented zip code, and had at least 1 health care claim. CHD type was categorized as simple, moderate, and severe disease. Association with comorbid conditions and genetic diagnoses were analyzed using χ2 test. We used direct standardization to calculate adjusted prevalence rates, controlling for age, sex, primary insurance provider, and urban-rural residence. We identified 1 566 328 children receiving care in Colorado from 2012 to 2019. Of those, 30 512 children had at least 1 CHD diagnosis, comprising 1.95% (95% CI, 1.93-1.97) of the pediatric population. Over half of the children with CHD also had at least 1 complex chronic condition. After direct standardization, the adjusted prevalence rates show a small increase in simple severity diagnoses across the study period (adjusted rate of 11.5 [2012]-14.4 [2019]; P<0.001). The current study is the first population-level analysis of pediatric CHD in the United States. Using administrative claims data, our study found a higher CHD prevalence and comorbidity burden compared with previous estimates.

Pregnancy complications and long-term risk of cardiovascular events in women with structural heart disease

BackgroundTo determine the frequency of pregnancy complications and their association with the risk of cardiovascular outcomes in women with structural heart disease (SHD).MethodsThis nationwide registry-based cohort study included women in...

The Historical Sustainable Cities In India: A Survey Of Sustainable Practices Followed In Cities Of India In Ancient And Medieval Times

The role played by India in achieving the sustainable development goals by 2030 is extremely crucial owning to its large but impoverished population. It is necessary for India to achieve these goals so that the world can achieve them. India is currently lagging in many of the goals, targets and sub-targets. But there was a time when India was the centre of sustainable lifestyle. Indian cities were well planned with remarkable sanitation and cleanliness. The excellent drainage system of Harappan cities is well known to everyone. The cities were divided into various layers with the most important structures located on citadel. The great bath of Mohenjodaro, the great granary of Harappa, the water conservation tank of Dholavira and the dockyard of Lothal are living examples of sustainable practices in those sustainable cities. The imperial city of Pataliputra is another example of a sustainable city. The city administration comprised of thirty members which was divided into six committees. There was a separate committee for registration of births and deaths. Similarly, the life of Kanyakubja as described by Hiuen Tsang reflects the sustainable lifestyle of the ruler as well as the people of the city. The early medieval age was categorized as dark age by many historians. But these ages have also produced remarkable cities. Anhilwada (present day Patan, Gujarat) was capital of Solanki dynasty of Gujarat in which we can find Rani-ki-Vaav which is an excellent water conservation tank accessible to the population of the city. Similarly, Bhoj of Parmar dynasty constructed several lakes, tanks and ponds in his capital city Dhar. It was the imperial city of Vijayanagar that can be described as textbook example of a sustainable city. The city was surrounded by seven walls. The agricultural farms in the vicinity which fed the city were fortified. The city was well planned into residential, commercial and military areas. This paper analyses the sustainable structures, practices and lifestyle that existed in the prominent cities of ancient and medieval India.

Pregnancy outcomes in patients with systemic lupus erythematosus compared to a high-risk tertiary cohort andtostandard population from the Austrian birth registry.

Women with systemic lupus erythematosus (SLE) have a higher risk for fetal and maternal complications. We aimed to investigate maternal and fetal complications in pregnant women with SLE compared to a high-risk pregnancy cohort (HR) from a tertiary university center and a standard-risk general population (SR) from the Austrian Birth Registry. In this retrospective data analysis, we compared the incidence of fetal/neonatal and maternal complications of pregnancies and deliveries of women with SLE to age, body mass index and delivery date-matched high-risk pregnancies from the same department, a progressive tertiary obstetric center and to a group of women, who represent pregnancies with standard obstetric risk from the Austrian Birth Registry. One hundred women with SLE were compared to 300 women with high-risk pregnancies and 207 039 women with standard-risk pregnancies. The incidence of composite maternal complications (preeclampsia, Hemolysis, Elevated Liver enzymes and Low Platelets [HELLP] syndrome, pregnancy-related hypertension, gestational diabetes mellitus, maternal death, thromboembolic events) was significantly higher in the SLE as compared to the SR group (28% vs. 6.28% SLE vs. SR, p = 0.001). There was no difference between the SLE and the HR groups (28% vs. 29.6% SLE vs. HR group, p = 0.80). The incidence of composite fetal complications (preterm birth before 37 weeks of gestation, stillbirths, birthweight less than 2500 g, fetal growth restriction, large for gestational age, admission to neonatal intensive care unit, 5-min Apgar <7) was also higher in the SLE than in the SR group (55% vs. 25.54% SLE vs. SR p < 0.001) while the higher incidence of adverse fetal outcome was detected in the HR than in the SLE group (55% vs. 75% SLE vs. HR group, p = 0.0005). Although composite fetal risk is higher in the SLE group than in the general population, it is still significantly lower as compared to high-risk pregnant women at a tertiary obstetric center. Prepregnancy counseling of women with SLE should put fetal and maternal risk in perspective, not only in relation to healthy, low risk cohorts, but also compared to mixed HR populations.

Maternal Exposure to Heavy Metals From Industrial Sources During Pregnancy and Childhood Cancer Risk in California.

The study investigated maternal exposure to heavy metals from industrial sources during pregnancy as potential risk factors for childhood cancer. Cases ages 0-19 were identified from California Cancer Registry. Controls (20:1 ratio) were randomly selected from California Birth Registry, frequency-matched by birth year (1998-2016). We estimated maternal exposure to lead, nickel, and cobalt in ambient air from the Toxics Release Inventory. We examined "ever/never" and "high/low" exposures categorized by median exposure. Models were adjusted for maternal age, race/ethnicity, method of payment for prenatal care, neighborhood socioeconomic status, and urban/rural residence. Among highly exposed persons, lead was associated with an increased teratoma risk (adjusted odds ratio [aOR]: 1.52; 95% confidence interval [CI]: 0.97, 2.37), whereas nickel was associated with an increased rhabdomyosarcoma risk (aOR: 1.45; 95% CI: 1.03, 2.04). Cobalt was associated with an increased glioma risk (aOR: 2.25; 95% CI: 1.39, 3.65) among ever-exposed persons. Inverse associations were found between Wilms tumor and nickel among the ever exposed and highly exposed (ever: aOR: 0.75; 95% CI: 0.59, 0.96; high: aOR: 0.64; 95% CI: 0.45, 0.93). Findings suggest that air pollution from heavy metals released by industrial sources may elevate childhood cancer risk.

Obstetric anal sphincter injury in the second birth after perineal wound complication in the first birth: A nationwide register cohort study.

To investigate whether perineal wound complications in the first birth, alone or in conjunction with obstetric anal sphincter injury (OASI), is associated with an increased risk of OASI in the second birth. Nationwide population-based cohort study. Sweden. Women (n = 411 317) with first and second singleton vaginal births in Sweden, 2001-2019. Data on diagnostic codes and surgical procedures were retrieved from the Swedish Medical Birth Register and the Swedish Patient Register. A perineal wound complication was defined as wound infection, dehiscence or perineal haematoma within 2 months of childbirth. Associations between wound complications in the first birth and OASI in the second birth were investigated with logistic regression and presented as adjusted odds ratios (aORs) with 95% confidence intervals (95% CIs). In total, 2619 (0.6%) women had a wound complication in the first birth, and 5318 (1.3%) had an OASI in the second birth. Women with a wound complication but no OASI in the first birth had more than doubled odds of OASI in the second birth (aOR 2.73, 95% CI 2.11-3.53). Women with OASI and a wound complication in the first birth had almost tenfold odds (aOR 9.97, 95% CI 6.53-15.24) of recurrent OASI. Perineal wound complication in the first birth increases the likelihood of OASI in a subsequent birth.

Effects of pre-pregnancy maternal underweight on pregnancy and perinatal outcomes of the foetus

Background: Maternal underweight, defined as a body mass index (BMI) less than 18.5 kg/m², poses significant challenges in maternal and fetal health. Despite being prevalent worldwide, particularly in low- and middle-income countries, the effects of pre-pregnancy underweight on pregnancy and perinatal outcomes remain under-researched compared to maternal obesity. This study aims to explore the complex interactions between pre-pregnancy maternal underweight and adverse pregnancy outcomes such as low birth weight (LBW), preterm birth (PTB), and intrauterine growth restriction (IUGR), with a focus on Nigeria's diverse socioeconomic landscape. Materials and Methods: This study employed a retrospective analysis method, leveraging data from national health surveys, birth registries, and healthcare databases across six Nigerian states (Lagos, Osun, Anambra, Imo, Kano, and Kaduna). The study examined pre-pregnancy BMI, maternal demographics, socioeconomic factors, and pregnancy outcomes. The analysis included the systematisation setback technique to assess the relationship between pre-pregnancy underweight and pregnancy outcomes, considering regional nutritional disparities. Results: The findings indicated a significant association between maternal underweight before pregnancy and adverse pregnancy outcomes. Underweight mothers were more likely to experience LBW, PTB, and SGA infants. Socioeconomic and demographic factors, such as low educational attainment and rural residence, were identified as significant predictors of maternal underweight. The study highlighted regional differences, with higher rates of underweight mothers in economically disadvantaged areas. Conclusion: Addressing pre-pregnancy maternal underweight is crucial for improving perinatal outcomes. The study underscores the need for targeted public health interventions, including nutritional support, education, and enhanced healthcare access, particularly in low-resource settings. By mitigating the risks associated with maternal underweight, healthcare professionals can promote healthier pregnancies and better developmental trajectories for infants.

Fear of Childbirth After Major Orthopedic Traumas: A Nationwide Multi-Register Analysis.

The aim of this study was to evaluate the association between previous major traumas and the prevalence of fear of childbirth (FOC) and the subsequent effects of FOC on the intended mode of delivery. In this nationwide retrospective register-based cohort study, data from the Care Register for Health Care were linked with the National Medical Birth Register (MBR) to evaluate the prevalence of FOC after major traumas. A total of 18,573 pregnancies met the inclusion criteria. A multivariable logistic regression model was used to assess the effects of FOC on the intended mode of delivery. Women with major traumas before pregnancy were compared to individuals with wrist fractures. Adjusted odds ratios (aORs) with 95% CIs between the groups were compared. Of those pregnancies that occurred after major traumas, 785 (6.2%) women were diagnosed with FOC after traumatic brain injury (TBI), 111 (6.1%) women after spine fracture, 38 (5.0%) women after pelvic fracture, 22 (3.2%) women after hip or thigh fracture, and 399 (5.2%) women in the control group. Among those women diagnosed with FOC, the adjusted odds for elective CB as an intended mode of delivery were highest among women with previous spine fractures (aOR 2.28, CI 1.45-3.60) when compared to the control group. We found no evidence of differences in maternal FOC in patients with preceding major traumas when compared to the control group. Therefore, it seems highly likely that the major trauma itself is the explanatory factor for the increased rate of elective CB.

Non-index hospital re-admissions after hospitalisation with acute myocardial infarction and geographic remoteness, New South Wales, 2005-2020: a retrospective cohort study.

To examine the frequency of re-admissions to non-index hospitals (hospitals other than the initial discharging hospital) within 30 days of admission with acute myocardial infarction in New South Wales; to examine the relationship between non-index hospital re-admissions and 30-day mortality. Retrospective cohort study; analysis of hospital admissions (Admitted Patient Data Collection) and mortality data (Registry of Births, Deaths and Marriages). Adults admitted to NSW hospitals with acute myocardial infarction re-admitted to any hospital within 30 days of discharge from the initial hospitalisation, 1 January 2005 - 31 December 2020. Proportion of re-admissions within 30 days of discharge to non-index hospitals, and associations of non-index hospital re-admissions with demographic and initial hospitalisation characteristics and with 30-day and 12-month mortality, each by residential remoteness category. Of 168 097 people with acute myocardial infarction discharged alive, 28 309 (16.8%) were re-admitted to hospital within 30 days of discharge, including 11 986 to non-index hospitals (42.3%); the proportion was larger for people from regional or remote areas (50.1%) than for people from major cities (38.3%). The odds of non-index hospital re-admission were higher for people with ST-elevation myocardial infarction, for people whose index admissions were to private hospitals, who were transferred between hospitals or had undergone revascularisation during the initial admission, were under 65 years of age, or had private health insurance; the influence of these factors was generally larger for people from regional or remote areas than for those from large cities. After adjustment for potential confounders, non-index hospital re-admission did not influence mortality among people from major cities (30-day: adjusted odds ratio [aOR], 1.09; 95% confidence interval [CI], 0.99-1.20; 12-month: aOR, 0.98, 95% CI, 0.93-1.03), but was associated with reduced mortality for people from regional or remote areas (30-day: aOR, 0.81; 95% CI, 0.70-0.95; 12-month: aOR, 0.88; 95% CI, 0.81-0.96). The geographically dispersed Australian population and the mixed public and private provision of specialist services means that re-admission to a non-index hospital can be unavoidable for people with acute myocardial infarction who are initially transferred to specialised facilities. Non-index hospital re-admission is associated with better mortality outcomes for people from regional or remote areas.

Increased risk of bacterial pneumonia before and after respiratory syncytial virus infection in young children.

The burden of respiratory disease is great among children. This study aimed to examine the temporal relationship between hospitalisation for respiratory syncytial virus (RSV) and bacterial pneumonia. A Swedish population-based cohort was created by combining data from the Swedish Medical Birth Register, the National Inpatient Register, the Cause of Death Register, the Total Population Register, and the Longitudinal Integration Database for Health Insurance and Labour Market Studies. Children born between 1998 and 2015 were included and followed for 2 years. We examined the temporal relationship between RSV hospitalisation and bacterial pneumonia using piecewise exponential models. The final cohort comprised 1 641 747 children, 48.5% were females. There were 23 632 RSV and 4722 bacterial pneumonia hospitalisations, with mean age of 137.8 and 424.2 days, respectively. RSV hospitalisation was associated with bacterial pneumonia with an adjusted incidence rate ratio (aIRR) of 3.18. The risk was highest in the first month after RSV hospitalisation, aIRR 11.19. The risk of bacterial pneumonia was elevated for 4 months after RSV hospitalisation and before RSV hospitalisation. We found an increased risk for bacterial pneumonia hospitalisation in children hospitalised for RSV both before and after RSV hospitalisation, indicating a bidirectional relationship.

Growth Restriction in the Offspring of Mothers With Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is a common endocrine disorder, characterized by subfertility, increased risk of metabolic diseases, and pregnancy complications. Previous studies diverge regarding the association between maternal PCOS and newborn anthropometrics. To explore the association between maternal PCOS and newborn anthropometrics and the modifying effects of maternal body mass index, PCOS phenotype, and gestational diabetes. This cohort study followed up women from the first half of pregnancy to birth and combined data from 3 clinical trials of pregnant women with PCOS and a reference population consisting of participants in the Norwegian Mother, Father, and Child Cohort (MoBa) Study, with data from the Medical Birth Registry of Norway. The recruitment period for the clinical trials was between October 1, 2000, and August 31, 2017, and for MoBa, between July 1, 1999, and December 31, 2008. Participants included women with singleton pregnancies and live-born children. Data were analyzed from January 1 to June 15, 2023. Maternal PCOS status. Newborn birth weight, birth length, and head circumference as continuous variables and z scores, and ponderal index (calculated as the birth weight in grams × 100 divided by the birth length in centimeters cubed), placenta weight, and ratio of birth weight to placenta weight (BWPW). The cohort included 390 pregnant women with PCOS (mean [SD] age, 29.6 [4.2] years) and 68 708 women in the reference group (mean [SD] age, 30.4 [4.5] years). Offspring in the PCOS group had lower birth weight, birth length, and head circumference than in the reference group offspring. The estimated mean differences in z scores were -0.26 (95% CI, -0.38 to -0.14) for birth weight, -0.19 (95% CI, -0.33 to -0.05) for birth length, and -0.13 (95% CI, -0.26 to -0.01) for head circumference. The PCOS group also had a lower ponderal index (-0.04 [95% CI, -0.07 to -0.004] g × 100/cm3) and placenta weight (-24 [95% CI, -43 to -5)] g), and higher BWPW ratio (0.4 [95% CI, 0.3 to 0.5]). The association between growth restriction and PCOS was more apparent when additionally adjusting for body mass index. Neither PCOS phenotype nor gestational diabetes diagnosis was associated with neonatal anthropometry in women with PCOS. In this cohort of mother-infant pairs, maternal PCOS status was associated with lower birth weight, shorter birth length, and smaller head circumference in the offspring. This growth restriction was more pronounced when adjusting for BMI, providing insight into the association between PCOS and body mass index. The study contributed to the understanding of how PCOS affects the offspring.

Peripartum heart failure in Finland: A population-based record linkage study.

Heart failure in late pregnancy and the postpartum period (HFPP) is a rare but potentially life-threatening condition, with peripartum cardiomyopathy (PPCM) being the most common subtype. This study aims to comprehensively investigate the prevalence of HFPP in the Finnish population and identify the underlying risk factors associated with its occurrence. We conducted a retrospective analysis using data from the Finnish Medical Birth Register and the Finnish Care Register for Health Care, covering 1996 to 2021. The dataset comprised 1387457 deliveries. HFPP cases were identified based on specific ICD-10 codes. To ensure the accuracy of our findings, we excluded cases with pre-existing cardiomyopathies and other significant cardiac diseases diagnosed before pregnancy. We employed logistic regression models to evaluate the associations between maternal factors and the incidence of HFPP. We identified 159 cases of HFPP, resulting in an incidence rate of 11.5 per 100000 deliveries. This incidence is comparable with rates reported in other Scandinavian countries and lower than those observed in Germany. Consistent with findings from European cohorts, our study confirmed that pregnancy-associated hypertensive disorders, particularly preeclampsia, as well as complications such as preterm delivery, twin pregnancy and elective caesarean section, are substantial risk factors for HFPP. These results support previous research linking angiogenic imbalance to the pathogenesis of PPCM. Significant risk factors for HFPP included maternal pre-pregnancy body mass index ≥35 [adjusted odds ratio (aOR) 2.04, 95% confidence interval (CI) 1.28-3.25, P=0.003], history of maternal hypertensive disorder (aOR 2.44, 95% CI 1.22-4.88, P=0.012), gestational hypertension without significant proteinuria (aOR 2.14, 95% CI 1.27-3.61, P=0.004), preeclampsia (aOR 2.43, 95% CI 1.39-4.23, P=0.002), type 1 or type 2 diabetes (aOR 3.27, 95% CI 1.66-6.45, P<0.001) and twin pregnancy (aOR 2.74, 95% CI 1.37-5.49, P=0.005). Additionally, extensive prepartum [odds ratio (OR) 2.86, 95% CI 1.18-6.98, P=0.018] and postpartum blood loss (OR 2.50, 95% CI 1.44-5.02, P=0.001) and maternal mental disorders (OR 7.39, 95% CI 4.10-13.31, P<0.001) were significantly more common among HFPP patients. The incidence of HFPP among women in Finland from 1996 to 2021 was low. HFPP exhibited a strong association with several risk factors, including preeclampsia, obesity, preterm delivery, twin pregnancy, elective caesarean section, multifoetal births, type 1 and type 2 diabetes, significant prepartum and postpartum blood loss and maternal mental health disorders. These findings underscore the importance of targeted interventions and careful monitoring in high-risk groups to mitigate the impact of HFPP on maternal health.

A Population-Based Study on Women Who Used Alcohol during Pregnancy and Their Neonates in Ontario, Canada.

Data from birth registries can be studied to assess the prevalence of prenatal alcohol use and associated maternal and neonatal outcomes. Linked maternal and neonatal data (2015-2018) for alcohol-exposed pregnancies were obtained from the Better Outcomes Registry and Network (BORN) Ontario. Descriptive statistics were generated for maternal demographics, prenatal substance use, mental health/substance use history, and neonatal outcomes. Logistic regression models were performed to assess the odds of prenatal heavy (binge or weekly) alcohol and other substance use based on mental health/substance use history and other maternal demographics, and the impacts of heavy alcohol use and other prenatal substance exposures on neonatal outcomes. A total of 10,172 (2.4%) women reported alcohol use during pregnancy. One-third had pre-existing or current mental health and/or substance use problems, which was associated with significantly higher odds of heavy alcohol use during pregnancy. Prenatal exposure to heavy alcohol use was associated with increased odds of neonatal abstinence syndrome (2.5 times); respiratory distress syndrome (2.3 times); neonatal intensive care unit (NICU) admission (58%); and hyperbilirubinemia (57%). Prenatal exposure to one or more substances in addition to alcohol was associated with significantly higher odds of fetal/maternal/placental pregnancy complications; preterm birth; NICU admission; low APGAR scores; one or more confirmed congenital anomalies at birth; respiratory distress syndrome; and intrauterine growth restriction. It is crucial to routinely screen childbearing-age and pregnant women for alcohol and other substance use as well as mental health problems in order to prevent adverse maternal and neonatal outcomes.

Harmonizing Norwegian registries onto OMOP common data model: Mapping challenges and opportunities for pregnancy and COVID-19 research

ObjectiveNorwegian health registries covering entire population are used for administration, research, and emergency preparedness. We harmonized these data onto the Observational Medical Outcomes Partnership common data model (OMOP CDM) and enrich real-world data in OMOP format with COVID-19 related data. MethodsData from six registries (2018–2021) covering birth registrations, selected primary and secondary care events, vaccinations, and communicable disease notifications were mapped onto the OMOP CDM v5.3. An Extract-Transform-Load (ETL) pipeline was developed on simulated data using data characterization documents and scanning tools. We ran dashboard quality checks, cohort generations, investigated differences between source and mapped data, and refined the ETL accordingly. ResultsWe mapped 1.5 billion rows of data of 5,673,845 individuals. Among these, there were 804,277 pregnancies, 483,585 mothers together with 792,477 children, and 472,948 fathers. We identified 382,516 positive tests for COVID-19 in 380,794 patients. These figures are consistent with results from source data. In addition to 11 million source codes mapped automatically, we mapped 237 non-standard codes to standard concepts and introduced 38 custom concepts to accommodate pregnancy-related terminologies that were not supported by OMOP CDM vocabularies. A total of 3,700/3,705 (99.8%) checks passed. The 5 failed checks could be explained by the nature of the data and only represent a small number of records. Discussion and conclusionNorwegian registry data were successfully harmonized onto OMOP CDM with high level of concordance and provides valuable source for federated COVID-19 related research. Our mapping experience is highly valuable for data partners with Nordic health registries.

Congenital Hypothyroidism and School Achievement in Adolescence: A Population-Based Sibling Control Study

To study school achievement in grade 9 of compulsory school in children with congenital hypothyroidism (CH), both those detected by the national screening program and those with a normal screening result and thus diagnosed later. Nationwide study of children in the Swedish Medical Birth Register (n=1 547 927) from 1982 through 1997, linked to the neonatal screening CH cohort and the National School Register. Dried blood spot (DBS) samples are collected from all newborn infants, according to the neonatal screening program. Thyroid-stimulating hormone was used for CH screening. CH was defined as either having an abnormal screening result (DBS+) and treatment with levothyroxine (LT4+) or having a normal screening result but a CH diagnosis in the National Patient Register and treatment with LT4 (DBS-/ICD+/LT4+). Regression models were used to study school performance, which as measured as grade point sum and national test results. Sibling analysis also was performed to account for unmeasured familial factors. There were 448 children who were DBS+/LT4+ and 475 children who were DBS-/ICD+/LT4+. Children with CH had lower grade point sum, adjusted β=- 6.34 (95% CI -11.7 to -1.01) and adjusted β=-10.3 (95% CI -15.5 to -5.20) for those with abnormal (DBS+/LT4+) and normal screening (DBS-/ICD+/LT4+) results, respectively. CH also was associated with lower result on the national tests, especially in mathematics. These associations remained in the sibling analyses. Youth with CH had slightly lower school achievements compared with those without CH and compared with their siblings. CH children with a normal screening result, and thus diagnosed later, presented the lowest results on grade point sum and national tests.

Chi-Squared Automatic Interaction Detection Decision Tree Analysis of Social Determinants for Low Birth Weight in Virginia.

This study provides additional context to the literature regarding the social inequities that impact birth outcomes in Virginia using a decision tree analysis. Chi-squared automatic interaction detection data analysis (CHAID) was performed using data from the Virginia birth registry for the years 2015-2019. Birth weight was the outcome variable, while sociodemographic factors and maternity care deserts were the explanatory variables. The prevalence of low birth weight in Virginia was of 8.1%. The CHAID decision tree model demonstrated multilevel interaction among risk factors with three levels, with a total of 34 nodes. All the variables reached significance in the model, with race/ethnicity being the first major predictor variable, each category of race and ethnicity having different significant predictors, followed by prenatal care and maternal education in the next levels. These findings signify modifiable risk factors for low birth weight, in prioritizing efforts such as programs and policies. CHAID decision tree analysis provides an effective approach to detect target populations for further intervention as pathways derived from this decision tree shed light on the different predictors of high-risk population in each of the race/ethnicity demographic categories in Virginia.