Changes In Pregnancy Outcomes Research Articles

Implications of abortion legislation on birth defect surveillance

AbstractBackgroundSurveillance of birth defects is critical to track prevalence and inform prevention efforts. Previous studies suggest that restricting abortion may lead to an increase in birth defect prevalence. However, it is unclear how abortion legislation will impact birth defect prevalence estimates reported by state‐based surveillance programs.MethodsWe described current abortion legislation and surveillance program methodology, by state, as a foundation for understanding the program‐level impact on surveillance. We estimated the quantitative effect of abortion legislation on birth defect prevalence for various scenarios using first‐order Monte Carlo simulation. Finally, we discuss the implications for interpreting birth defect prevalence estimates following abortion legislation.ResultsAmong states that restrict abortion ≤18 weeks and have a surveillance program (N = 19), eight programs (42%) capture elective terminations (<20 weeks) and 17 (89%) include fetal deaths (≥20 weeks) in their estimates. Abortion bans increased the prevalence of any birth defect by 16.6%, 15.8%, and 8.7% for systems with live births only, all outcomes ≥20‐weeks, and all outcomes ≥10‐weeks, respectively. We found the largest change in prevalence for anencephaly with an estimated 32.5% increase among systems with live births only.ConclusionsAbortion legislation is likely to further exacerbate the difficulties of multi‐state birth defect research and surveillance, while also hindering analysis of intra‐state prevalence trends. Birth defect surveillance systems in states with abortion bans may wish to consider monitoring and reporting changes in pregnancy outcomes and infant survival, in addition to birth defect prevalence, to inform public health and health care service needs.

Is the Increasing Prevalence of Labor Induction Accompanied by Changes in Pregnancy Outcomes? An Observational Study of All Singleton Births at Gestational Weeks 37-42 in Norway During 1999-2019

(Acta Obstet Gynecol Scand. 2023;102:158–173) While induction of labor (IOL) is implemented with the goal to reduce the risk of maternal and perinatal adverse outcomes, it is uncertain whether risks are decreased. The aim of this study was to determine whether prevalence of IOL in term pregnancies (37 to 42 wk gestation) is accompanied by adverse outcomes or delivery mode.

FETOMATERNAL OUTCOME IN PATIENTS WITH THREATENED ABORTION IN A TERTIARY CARE CENTER IN SOUTH KERALA

Objective: Pregnancy complications due to threatened abortion are related with contrary pregnancy outcomes. The main aim of the present study was to analyze the changes in pregnancy outcomes among the women who experienced threatened abortion and normal pregnant control women. Methods: This retrospective observational study was performed among 117 pregnant women who were attending our Travancore Medical College Hospital, Kollam, during the period from January 2021 to January 2023 (2 years). The control group was developed from an equal number of asymptomatic women who were receiving antenatal care during the same period. Demographic parameters, clinical and ultrasound observations, treatment plans, and pregnancy outcomes were analyzed. Statistical Analyses: Data were analyzed using IBM SPSS Statistics. Results: Spontaneous abortion rate of 15.38% was observed with the threatened abortion group and control group as 5.1% (p=0.005). Women with threatened abortion had higher odds for placenta previa (p=0.048), pre-mature rupture of membranes (p=0.021), post-partum hemorrhage (p=0.001), and pre-term birth. Conclusion: Threatened abortion seems to be an important hazard to fetal survival and may intensify the threat for operational delivery.

Does Quality Certification Work? An Assessment of Manyata, a Childbirth Quality Program in India's Private Sector.

In India, more than 60% of hospital beds are in private facilities, yet several studies have observed suboptimal quality of care in private facilities. We aimed to understand the role of Manyata, a quality improvement initiative in private facilities focused on mentorship and clinical standards, to improve the knowledge and skills of health care providers, their adherence to key childbirth-related clinical practices, and health outcomes for women and newborns. We conducted a secondary analysis of Manyata program data collected from 466 private facilities across 3 states (Jharkhand, Maharashtra, and Uttar Pradesh) in India from October 2016 to February 2019. We calculated means and 95% confidence intervals for knowledge and skills assessment, adherence to facility standards was analyzed by calculating the proportion of facilities passing a given quality standard at baseline and endline, and changes in pregnancy outcomes were assessed with autoregression modeling. From assessments conducted before and after training among providers in Manyata, we observed a significant increase in average knowledge score (6.3 vs. 13.2 of 20) and skill score (8.0 vs. 34.3 of 40). Overall, a significant increase occurred in adherence to clinical standards between baseline and endline assessments (29% vs. 93%). The standards with the greatest improvements were identification and management of eclampsia/preeclampsia, postpartum hemorrhage, and neonatal resuscitation. There were no significant changes over time in absolute rate of reported complications; however, referral rates from private facilities for preeclampsia and newborn sepsis identification and management declined. Our analysis indicates private facilities' adherence to quality standards and nurses' childbirth knowledge and practical skills increased during Manyata. Additional efforts are needed to ensure high-quality care during cesarean deliveries at private facilities. Future studies with rigorous design are required to evaluate the impact of this quality improvement initiative in improving pregnancy outcomes.

Is the increasing prevalence of labor induction accompanied by changes in pregnancy outcomes? An observational study of all singleton births at gestational weeks 37-42 in Norway during 1999-2019.

Induction of labor is often performed to prevent adverse perinatal and maternal outcomes, and has become increasingly common. We studied whether changes in prevalence of labor induction in gestational weeks 37-42 weeks were accompanied by changes in adverse pregnancy outcomes or mode of delivery. We used data from the Medical Birth Registry of Norway, and included all singleton births in gestational weeks 37-42 in Norway, 1999-2019 (n=1127 945). We calculated the prevalence of labor induction and outcome measures according to year of birth. We repeated these calculations for each gestational week at birth. The prevalence of labor induction increased from 9.7% to 25.9%, and the increase was particularly high in gestational week 41. A modest decline in fetal deaths was observed in all gestational weeks, except gestational week 41. The overall decline was from 0.18% in 1999-2004 to 0.13% during 2015-2019. There were no overall changes in other perinatal outcomes. The prevalence of postpartum hemorrhage ≥500 ml increased from 11.4% in 1999 to 30.1% in 2019, and operative deliveries increased slightly. The prevalence of acute cesarean section increased from 6.5% to 9.3%, whereas vacuum and/or forceps assisted deliveries increased from 7.8% to 10.4%. A high increase in labor inductions was accompanied by a modest decline in fetal deaths, but no decline in other adverse perinatal outcomes. In settings where the prevalence of adverse perinatal outcomes is low, the beneficial effect of increased use of labor induction may not outweigh the side effects or the costs.

Prevalence and Pregnancy Outcome of Preeclampsia Using International Society for the Study of Hypertension in Pregnancy 2018 Criteria in Comparison to 2001

Introduction: Criteria of preeclampsia (PE) have evolved over years to increase the prediction of adverse pregnancy outcomes. Revised International Society for the Study of Hypertension in Pregnancy (ISSHP) 2018 criteria incorporates organ system dysfunction with or without proteinuria. This study aims to determine changes in prevalence and pregnancy outcome of PE diagnosed by revised criteria compared to traditional ones. Methods: This was a cross-sectional study conducted in the department of Obstetrics and Gynecology from July to October 2021. Women with hypertensive disorders in pregnancy (HDP) were classified according to ISSHP 2001 and 2018 criteria to study the prevalence and pregnancy outcomes. Data were analyzed using Statistical Package for the Social Sciences version 21. Results: There was an increase in the prevalence of PE applying ISSHP 2018 criteria (12.6% vs 4.6%). The proportion of cases of PE in HDP increased from 19.4% to 52.7%. Preterm delivery was more in the group diagnosed using old criteria compared to revised criteria (52% vs 33.8%). Maternal morbidity like operative delivery, severe hypertension, eclampsia, abruptio, intrauterine growth restriction, were more in women diagnosed only with proteinuria. Low birth weight, Apgar less than 7 at one and five minutes, perinatal morbidity and mortality, were also more in PE diagnosed using old criteria compared to revised criteria. Conclusion: The prevalence of PE increased without changes in the pregnancy outcome when revised ISSHP 2018 criteria were applied over the traditional 2001.

Changes in pregnancy outcomes during the COVID-19 lockdown in Iran

BackgroundThe Covid-19 pandemic response is influencing maternal and neonatal health care services especially in developing countries. However, the indirect effects of Covid-19 on pregnancy outcomes remain unknown. The aim of the present study was to compare pregnancy outcomes before and after the beginning of the Covid-19 pandemic in Iran.MethodsWe performed a retrospective analysis of the medical records of 2,503 pregnant women with singleton pregnancies, admitted to the maternity department of a women’s hospital in Tehran, Iran, during the pre-Covid-19 pandemic (February 19 to April 19, 2019) and the intra-Covid- 19 pandemic (February 19 to April 19, 2020) period.ResultsWe included 2,503 women admitted to the hospital; 1,287 (51.4 %) were admitted before the Covid-19 lockdown and 1,216 (48.6 %) during the Covid-19 lockdown. There were no significant differences in stillbirth rates (p = 0.584) or pregnancy complications (including preeclampsia, pregnancy-induced hypertension and gestational diabetes) (p = 0.115) between pregnant women in the pre- and intra-pandemic periods. However, decreases in preterm births (p = 0.001), and low birth weight (p = 0.005) were observed in the pandemic period compared to the pre-pandemic period. No significant difference in the mode of delivery, and no maternal deaths were observed during the two time periods.ConclusionsIn our study we observed a decrease in preterm births and low birth weight, no change in stillbirths, and a rise in the admission rates of mothers to the ICU during the initial Covid-19 lockdown period compared to pre-Covid-19 lockdown period. Further research will be needed to devise plan for immediate post-pandemic care and future health care crises.

Fructose Consumption During Pregnancy Influences Milk Lipid Composition and Offspring Lipid Profiles in Guinea Pigs.

Excess dietary fructose is a major public health concern (1–4). Evidence shows increased fructose intake can cause insulin resistance, hepatic de novo lipogenesis, hypertriglyceridemia, obesity and non-alcoholic fatty liver disease (NAFLD) (5–9). However, little is known about the effects of fructose during pregnancy and its influence on offspring development and predisposition to later-life disease. To determine whether moderately increased maternal fructose intake could have health consequences on offspring, we have investigated the effects of 10% w/v fructose water intake during preconception and pregnancy. Female Dunkin Hartley guinea pigs were fed a control diet (CD) or fructose diet (FD;10% kcal from fructose) ad-libitum 60 days prior to mating and throughout gestation. Offspring were culled at weaning, day 21 (d21). Compared to CD dams, FD dams had altered glucose metabolism and increased milk free fatty acid content. Matsuda-DeFronzo insulin sensitivity index (M-ISI) from OGTT plasma showed no significant difference in whole-body insulin sensitivity between FD and CD dams 60 days post-dietary intervention and during midgestation. Fetal exposure to increased maternal fructose resulted in offspring with significantly altered serum free fatty acids at days 0, 7, 14, and 21 [including pentadecanoic acid (15:0), dma16:0, margaric acid (17:0) palmitoleic acid, total omega-7 and total saturates], increased levels of uric acid and triglycerides were also observed at d21. We have demonstrated that increased fructose intake during pregnancy can cause significant changes in maternal metabolic function and milk composition, which alters offspring metabolism. Taken together, these changes in pregnancy outcomes and feto-maternal condition may underlie their offspring's predisposition to metabolic dysfunction during later-life.

Association between the introduction of a structured form and the quality of diabetes in pregnancy clinic care.

Pregnancy in women with pre-gestational types 1 (T1DM) and 2 (T2DM) diabetes mellitus can be a clinical challenge. This study assessed the association between introducing a structured diabetes in pregnancy proforma, on the quality of medical record documentation and pregnancy outcomes in women with T1DM and T2DM. To evaluate the impact of a proforma on the quality of documenting medical records and pregnancy/neonatal outcomes in women with pre-gestational diabetes. This was a retrospective two-cycle audit: pre- and post-proforma introduction. The documentation quality was assessed based on the rate of missing pre-pregnancy/first trimester haemoglobin A1c (HbA1c), third trimester HbA1c, folate intake and dose, retinopathy and nephropathy progression. Changes in pregnancy outcomes were assessed by mode of delivery, preterm delivery, mean third trimester HbA1c, pre-eclampsia and foetal outcomes. The pre- and post-proforma periods included 91 and 41 pregnancies, respectively. The quality of documentation improved in the post-proforma phase with the rate of missing data declining from 63.4% to 36.6% (P = 0.005) for pre-pregnancy/first trimester HbA1c, 30.8% to 12.2% (P = 0.009) for periconceptional folate intake, 42.9% to 14.6% (P = 0.001) for folate dose, 100% to 31.7% (P < 0.001) for retinopathy progression, 92.3% to 19.5% (P < 0.001) for nephropathy progression and 31.9% to 7.3% (P = 0.016) for third trimester HbA1c. Macrosomia significantly reduced in the second cycle (49% vs 21% P = 0.003). The quality of documentation improved significantly which is likely attributable to the implementation of the proforma. This study supports the use of structured documentation to reduce variation in care and potentially improve pregnancy outcomes.

Prenatal exposure to TiO2 nanoparticles in mice causes behavioral deficits with relevance to autism spectrum disorder and beyond

Environmental factors are involved in the etiology of autism spectrum disorder (ASD) and may contribute to the raise in its incidence rate. It is currently unknown whether the increasing use of nanoparticles such as titanium dioxide (TiO2 NPs) in consumer products and biomedical applications may play a role in these associations. While nano-sized TiO2 is generally regarded as safe and non-toxic, excessive exposure to TiO2 NPs may be associated with negative health consequences especially when occurring during sensitive developmental periods. To test if prenatal exposure to TiO2 NPs alters fetal development and behavioral functions relevant to ASD, C57Bl6/N dams were subjected to a single intravenous injection of a low (100 µg) or high (1000 µg) dose of TiO2 NPs or vehicle solution on gestation day 9. ASD-related behavioral functions were assessed in the offspring using paradigms that index murine versions of ASD symptoms. Maternal exposure to TiO2 NPs led to subtle and dose-dependent impairments in neonatal vocal communication and juvenile sociability, as well as a dose-dependent increase in prepulse inhibition of the acoustic startle reflex of both sexes. These behavioral alterations emerged in the absence of pregnancy complications. Prenatal exposure to TiO2 NPs did not cause overt fetal malformations or changes in pregnancy outcomes, nor did it affect postnatal growth of the offspring. Taken together, our study provides a first set of preliminary data suggesting that prenatal exposure to nano-sized TiO2 can induce behavioral deficits relevant to ASD and related neurodevelopmental disorders without inducing major changes in physiological development. If extended further, our preclinical findings may provide an incentive for epidemiological studies examining the role of prenatal TiO2 NPs exposure in the etiology of ASD and other neurodevelopmental disorders.

New guidelines for screening, diagnosing, and treating gestational diabetes - evaluation of maternal and neonatal outcomes in Finland from 2006 to 2012.

In this study, we have assessed the changes in pregnancy outcomes following the implementation of national guidelines for gestational diabetes mellitus (GDM). These national guidelines changed the screening policy from risk-based to comprehensive screening. We designed a retrospective register-based cohort study based on the data from the Finnish Medical Birth Register and Hospital Discharge Register including 34 794 singleton births in 2006-2008 and 36 488 in 2010-2012. Maternal characteristics and pregnancy outcomes were analyzed. Overall, 29.6% of mothers underwent an oral glucose tolerance test in 2006-2008 compared with 59.7% in 2010-2012. The prevalence of GDM increased from 7.2 to 11.3% and was highest among obese women (body mass index ≥30 kg/m2 ) (from 30.0 to 34.7%; p < 0.001). The proportion of insulin-treated women remained unchanged (12.5/12.3%; p = 0.70). The main pregnancy outcomes for the women with GDM were the increased usage of oxytocin (19.5/40.0%, p < 0.001), increased number of inductions (27.2/33.0%; p < 0.001) and reduced birthweight (mean ± SD: 3647 ± 575 g/3567 ± 575 g). Healthy and unscreened women displayed similar results. Children of both women with GDM and healthy screened women had fewer admissions to the neonatal intensive care unit (16.3%/12.1%; p < 0.001) and less asphyxia (11.3%/6.3%; p < 0.001). However, the rates of cesarean delivery (26.5%/25.4%, p = 0.31), resuscitation (2.6%/2.0%; p = 0.12), and perinatal mortality (1.2‰/3.1‰, p = 0.11) among women with GDM did not change, whereas the number of hypoglycemia cases increased (2.3%/5.2%; p < 0.001). In conclusion, glucose tolerance tests were performed twice as often as a result of the implementation of the national GDM guidelines, but this comprehensive screening practice did not improve pregnancy and neonatal outcomes.

Effect of Maternal Food Restriction on the Uterus of Female Rats from the First and Second Generation

Postnatal life is affected by changes in fetal development due to adverse events. The present study examined the effect of maternal food restriction on uterine structure and capacity in female rats from the first and second generations (FR1 and FR2) before and after puberty. Pregnant rats were fed ad libitum (Control, C) or maintained under food-restriction conditions (50%FR) during pregnancy. After delivery, all groups were given free access to food. Females from the first generation (FR1) were divided into two subgroups for either uterine dissection or to produce the next generation (FR2). Similar to FR1, FR2 females were exposed to maternal food restriction following the same procedure. FR2 females were also assigned into two subgroups for either uterine dissection or for mating to examine pregnancy outcomes. Uteri from the C, FR1 and FR2 groups were dissected at 4 weeks of age (before puberty) or at 8 weeks of age (after puberty) to evaluate uterine weight and uterine horn length. Tissues were stained with eosin and haematoxylin for examination vialight microscopy. The results showed that food restriction did not affect uterine weight or uterine horn length in FR1 and FR2 females before puberty. However, there were effects of maternal food restriction on uterine weight and length at 8 weeks of age. Uterine weight and uterine horn length were significantly reduced in the FR1 and FR2 groups compared with the values of the controls. This was associated with changes in pregnancy outcomes. Litter size was not affected in the FR1 group; however, litter weight was significantly reduced, leading to an 18% reduction in pup weight at birth. Unlike with FR1 litters, the size of FR2 litters was significantly reduced, leading to a lower degree of pup body weight reduction at birth (only 7%). The gestational length was normal in FR1 females but was significantly decreased in FR2 females. No histopathological changes were observed. These results showed that the uterus was affected by maternal food restriction. It seemed that FR2 females had a different reproductive strategy: they tended to reduce litter size to maintain pup weight at birth. In conclusion, maternal food restriction affects the uteri of the first and second generation. Females from the FR1 and FR2 groups followed different reproductive strategies according to their previous experience with exposure to intrauterine food restriction.

GW25-e3199 Changes in pregnancy outcomes of hypertensive disorder complicating pregnancy in Shanghai between 2001 and 2010

GW25-e3199 Changes in pregnancy outcomes of hypertensive disorder complicating pregnancy in Shanghai between 2001 and 2010

PM.44 Pregnancy Outcomes in Black Women with Chronic Hypertension in the UK

IntroductionWomen with chronic hypertension (CHT) have poor pregnancy outcomes. Black ethnicity is associated with both adverse pregnancy events, and CHT. Data regarding pregnancy outcome for black women in the UK...

Elective Induction: When? Ever?

The frequency of labor induction has increased significantly in recent years. Although medically indicated inductions comprise a portion of this increase, elective inductions have increased in frequency as well. Given that elective inductions, by definition, provide no benefit from a strictly medical standpoint, it is particularly important to evaluate whether women who undergo these inductions incur greater risks than those who labor spontaneously. This article will assess whether elective inductions are associated with changes in pregnancy outcomes, and evaluate how these associations are influenced by parity and cervical ripeness.

Changes in pregnancy outcome after liberalization of the New York State abortion law

A liberalized abortion law became effective in New York State on July 1, 1970. Its effects on the outcome of pregnancy were studied in a population served by six Brooklyn, New York, hospitals, by a comparison of 3½ years preceding the change and 1 year after. The number of elective abortions increased by 5,800 per cent. Despite the increase in abortions, the number of deliveries for the year beginning 6 months after the change in the law rose by 8 per cent. The number of elective abortions equaled 54 per cent of this number of deliveries. The number of spontaneous abortions fell by 20 per cent. The fraction of births made up of immature (500 to 1,000 grams) infants fell by 36 per cent. The rate of abandonment of newborn infants after delivery in Kings County Hospital, a large municipal hospital, fell by 56 per cent in the year beginning 6 months after the change in the law.