Eligible Live Births Research Articles

Can machine learning methods be used for identification of at-risk neonates in low-resource settings? A prospective cohort study

IntroductionTimely identification of at-risk neonates (ARNs) in the community is essential to reduce mortality in low-resource settings. Tools such as American Academy of Pediatrics pulse oximetry (POx) and WHO Young...

Physical Fitness in Relationship to Depression and Post-Traumatic Stress Disorder During Pregnancy Among U.S. Army Soldiers.

Background: Depression and post-traumatic stress disorder (PTSD) are prevalent in pregnancy, especially among military members. These conditions can lead to adverse birth outcomes, yet, there's a paucity of evidence for prevention strategies. Optimizing physical fitness is one understudied potential intervention. We explored associations between prepregnancy physical fitness and antenatal depression and PTSD in soldiers. Materials and Methods: This was a retrospective cohort study of active-duty U.S. Army soldiers with live births between 2011 and 2014, identified with diagnosis codes from inpatient and outpatient care. The exposure was each individual's mean Army physical fitness score from 10 to 24 months before childbirth. The primary outcome was a composite of active depression or PTSD during pregnancy, defined using the presence of a code within 10 months before childbirth. Demographic variables were compared across four quartiles of fitness scores. Multivariable logistic regression models were conducted adjusting for potential confounders selected a priori. A stratified analysis was conducted for depression and PTSD separately. Results: Among 4,583 eligible live births, 352 (7.7%) had active depression or PTSD during pregnancy. Soldiers with the highest fitness scores (Quartile 4) were less likely to have active depression or PTSD in pregnancy (Quartile 4 vs. Quartile 1 adjusted odds ratio 0.55, 95% confidence interval 0.39-0.79). Findings were similar in stratified analyses. Conclusion: In this cohort, the odds of active depression or PTSD during pregnancy were significantly reduced among soldiers with higher prepregnancy fitness scores. Optimizing physical fitness may be a useful tool to reduce mental health burden on pregnancy.

Temporal changes in rates of active management and infant survival following live birth at 22-24 weeks' gestation in Victoria.

Management of livebirths at 22-24weeks' gestation in high-income countries varies widely and has changed over time. Our aim was to determine how rates of active management and infant survival of livebirths at 22-24weeks varied with perinatal variables known at birth, and over time in Victoria, Australia. We conducted a population-based cohort study of all 22-24weeks' gestation live births, free of lethal congenital anomalies in 2009-2017. Rates of active management and survival to one year of age were reported. 'Active management' was defined as receiving resuscitation at birth or nursery admission for intensive care. Over the nine-year period, there were 796 eligible live births. Overall, 438 (55%) were actively managed: 5% at 22weeks, 45% at 23weeks and 90% at 24weeks' gestation, but rates of active management did not vary substantially over time. Of livebirths actively managed, 263 (60%) survived to one year: 0% at 22weeks, 50% at 23weeks and 66% at 24weeks. Apart from gestational age, being born in a tertiary perinatal centre and increased size at birth were associated with survival in those actively managed, but sex and plurality were not. Survival rates of actively managed infants rose over time (adjusted odds ratio 1.09 per year; 95% CI 1.01-1.18; P=0.03). Although active management rates did not change substantially over time in Victoria, an overall increase in infant survival was observed. With increasing gestational age, rates of active management and infant survival rapidly rose.

Induction of Labor and Risk of Third- and Fourth-Degree Perineal Tears [18P

INTRODUCTION: The rate of induction of labor (IOL) at term has been increasing over the years. Our objective was to evaluate the risk of third- and fourth-degree perineal tears associated with term induction of labor. METHODS: We conducted a population-based, retrospective cohort study using the United States' Nationwide Inpatient Sample to evaluate the risk of third- and fourth-degree perineal tears in women who underwent IOL at term between 2005 and 2014. We included all term livebirths and excluded, preterm births, previous cesarean deliveries, multifetal gestations, and non-cephalic presentation. Women who underwent an IOL at term were identified using ICD-9 coding. Patient characteristics were compared between those women being induced at term with those who weren't, and logistic regression analysis were carried out to estimate the adjusted effect of IOL at term with risk of 3rd and 4th perineal tears RESULTS: Among 5,982,945 eligible live births, 1,035,003 (17.3%) underwent an IOL at term, increasing from 15.7% to 18.5%. Women with an IOL were more likely to be older, Caucasian, and with comorbid illnesses. Compared with women who did not undergo an IOL, women in the IOL group had lower risk of cesarean deliveries, 0.89 (0.88–0.89), 2nd degree tears, 0.89 (0.89–0.90), 3rd degree tears, OR 0.81 (95% CI 0.79–0.82) and 4th degree tears, OR 0.84 (95% CI 0.82–0.87). CONCLUSION: Induction of labor at term results in significantly lower risk of third- and fourth-degree perineal tears among all deliveries as well as among women with vaginal deliveries.

Spatial epidemiology of gestational age and birth weight in Switzerland: census-based linkage study

BackgroundGestational age and birth weight are strong predictors of infant morbidity and mortality. Understanding spatial variation can inform policies to reduce health inequalities. We examined small-area variation in gestational age...

Fetal, neonatal, and post-neonatal mortality in the 2015 Pelotas (Brazil) birth cohort and associated factors.

This study aimed to describe fetal, neonatal, and post-neonatal mortality and associated factors in participants of the 2015 Pelotas (Brazil) birth cohort. The child mortality sub-study followed up all deaths in the first year of life. Data were collected on intrauterine fetal deaths (weight ≥ 500g and/or gestational age ≥ 20 weeks), neonatal deaths (< 28 days of life), and post-neonatal deaths (from 28 days to the end of the first year of life). Descriptive analyses using the Pearson chi-square test and a multinomial logistic regression to estimate the risk of fetal, neonatal, and post-neonatal deaths compared to live infants in the cohort (reference group) were performed. Data from 4,329 eligible births were collected, of which 54 died during the fetal period. Of the 4,275 eligible live births, 59 died in the first year of life. An association between fetal, neonatal, and post-neonatal deaths (OR = 15.60, 7.63, and 5.51 respectively) was found, as well as less than six prenatal consultations. Compared to live infants, fetal deaths were more likely to occur in non-white mothers, and neonatal deaths were 14.09 times more likely to occur in a preterm gestational age (< 37 weeks). Compared to live infants, infants that were born in a C-section delivery had 3.71 increased odds of post-neonatal death. Additionally, neonatal deaths were 102.37 times more likely to have a low Apgar score on the fifth minute after birth. These findings show the need for early interventions during pregnancy, ensuring access to adequate prenatal care.

Abstract P6-10-07: The birth outcomes of pre-menopausal breast cancer survivors: Do they have a greater prevalence of delivering a preterm infant?

Abstract BACKGROUND: Due to the advancement of screening and treatment options for cancer, more people are able to live fruitful lives after a cancer diagnosis, yet for pre-menopausal breast cancer survivors the effects of disease and treatment on birth outcomes is not well documented. POPULATION: Linked North Carolina birth record-cancer registry data were used to examine the birth outcomes of pre-menopausal breast cancer survivors. Out of the 2,213,464 eligible live births that occurred between 1990 and 2009 in North Carolina, 539 of the mothers are breast cancer survivors and 10.6% (n=235,262) of the mothers experienced a preterm birth (which is below the national average of 12%). A vast majority of the women have a high school diploma or are college educated (81.4%; n=1,796,594), 14.0% (n=309,208) of the women reported that they smoked during pregnancy, and about two-thirds of the women were not married at the time of the birth of their child (67.7%; n=1,499,053). A majority of the study population is non-Hispanic White (62.6%; n=1,385,393) followed by non-Hispanic Blacks (24.0%; n=531,584), Hispanics/Latinos (9.7%; 215,224), and non-Hispanics of other races (3.7%; n=81,250). METHODS: The aim of this study was to determine if breast cancer survivors of reproductive age (ages 18-49) who had a live birth after their diagnosis have a greater prevalence of preterm birth than women who were not diagnosed with breast cancer. Binomial regression was used to estimate the exposure-outcome association in this case-cohort study. FINDINGS: The crude prevalence of preterm birth for pre-menopausal breast cancer survivors is 2.01 (95% CI: 1.71-2.36) times the crude prevalence of preterm birth for women who were not diagnosed with breast cancer. When the data were stratified by race/ethnicity, the prevalence of preterm birth for pre-menopausal breast cancer survivors compared to women not diagnosed with breast cancer within each racial/ethnic group is 2.27 (1.85-2.79) for Whites, 1.45 (1.10-1.91) for Blacks, 2.23 (0.64-7.81) for Hispanics/Latinos, and 1.83 (0.52-6.50) for other races. Controlling for the mother’s education level, marital status, and smoking status during pregnancy, the prevalence of preterm birth for pre-menopausal breast cancer survivors compared to women not diagnosed with breast cancer within each racial/ethnic group is 2.37 (1.93-2.91) for Whites, 1.50 (1.14-1.98) for Blacks, 2.28 (0.65-7.97) for Hispanics/Latinos, and 1.79 (0.51-6.31) for other races. CONCLUSION: Women diagnosed with breast cancer during their reproductive years are potentially at greater risk of experiencing a preterm birth and may benefit from targeted preconception health interventions. Citation Format: Kristin Z Black, Diane L Rowley. The birth outcomes of pre-menopausal breast cancer survivors: Do they have a greater prevalence of delivering a preterm infant? [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P6-10-07.

Apgar score and the risk of cause-specific infant mortality: a population-based cohort study

The Apgar score has been used worldwide as an index of early neonatal condition for more than 60 years. With advances in health-care service provision, neonatal resuscitation, and infant care, its present relevance is unclear. The aim of the study was to establish the strength of the relation between Apgar score at 5 min and the risk of neonatal and infant mortality, subdivided by specific causes. We linked routine discharge and mortality data for all births in Scotland, UK between 1992 and 2010. We restricted our analyses to singleton livebirths, in women aged over 10 years, with a gestational age at delivery between 22 and 44 weeks, and excluded deaths due to congenital anomalies or isoimmunisation. We calculated the relative risks (RRs) of neonatal and infant death of neonates with low (0-3) and intermediate (4-6) Apgar scores at 5 min referent to neonates with normal Apgar score (7-10) using binomial log-linear modelling with adjustment for confounders. Analyses were stratified by gestational age at birth because it was a significant effect modifier. Missing covariate data were imputed. Complete data were available for 1,029,207 eligible livebirths. Across all gestational strata, low Apgar score at 5 min was associated with an increased risk of neonatal and infant death. However, the strength of the association (adjusted RR, 95% CI referent to Apgar 7-10) was strongest at term (p<0·0001). A low Apgar (0-3) was associated with an adjusted RR of 359·4 (95% CI 277·3-465·9) for early neonatal death, 30·5 (18·0-51·6) for late neonatal death, and 50·2 (42·8-59·0) for infant death. We noted similar associations of a lower magnitude for intermediate Apgar (4-6). The strongest associations were for deaths attributed to anoxia and low Apgar (0-3) for term infants (RR 961·7, 95% CI 681·3-1357·5) and preterm infants (141·7, 90·1-222·8). No association between Apgar score at 5 min and the risk of sudden infant death syndrome was noted at any gestational age (RR 0·6, 95% CI 0·1-4·6 at term; 1·2, 0·3-4·8 at preterm). Low Apgar score at 5 min was strongly associated with the risk of neonatal and infant death. Our findings support its continued usefulness in contemporary practice. None.

Validation on the elimination of neonatal tetanus programs through Lot Quality Assurance-Cluster Sample Survey in China

Field surveys were performed under WHO recommended validation procedures, using the Lot Quality Assurance-Cluster Sample(LQA-CS)method to validate the elimination status regarding neonatal tetanus in China. LQA-CS surveys were conducted in two areas under the highest risk of neonatal tetanus-Jiangmen prefecture in Guangdong and Hechi in Guangxi. Random sampling method was conducted on 96 survey clusters in each prefecture with 12 eligible live births(live birth born one year before the survey)for each cluster, by trained investigators. There were 1 153 eligible live births from 23 465 families surveyed in Jiangmen and 1 152 eligible live births from 21 623 families being studied in Hechi. All the indices on quality control were strictly followed. There was no neonatal tetanus case which met the criteria of neonatal elimination found in either of the areas. Data showed that neonatal tetanus had been eliminated in both Jiangmen and Hechi cities. Since both Jiangmen and Hechi were cities having the highest-risk in China, it was most likely that neonatal tetanus had also been eliminated in other prefectures at lower risk. Elimination programs on MNT was therefore considered validate in China when the study was carried out. However, the achievements needed to be maintained.

Birth at hospitals with co‐located paediatric units for infants with correctable birth defects

To determine the percentage of liveborn infants with selected antenatally identifiable and correctable birth defects who were delivered at hospitals with co-located paediatric surgical units (co-located hospitals). Additionally, to determine the survival rates for these infants. Data were from linked New South Wales hospital discharge records from 2001 to 2004. Livebirths with one of the selected defects were included if they underwent an appropriate surgical repair, or died during the first year of life. Infants with multiple lethal birth defects were excluded. Deliveries at co-located hospitals were identified, but no data on antenatal diagnosis were available. The study identified 287 eligible livebirths with the selected defects. The highest rates of delivery at co-located hospitals were for gastroschisis (88%), exomphalos (71%), spina bifida (63%) and diaphragmatic hernia (61%), and the lowest for transposition of the great arteries (43%) and oesophageal atresia (40%). Mothers resident outside of metropolitan areas, where the co-located hospitals are located, had a similar rate of delivery at co-located hospitals as metropolitan women. For the non-metropolitan mothers of infants with a birth defect, this represented a 30-fold increase over the baseline delivery rate of 1.8%. Post-surgery survival rates were 87% or higher. Overall survival rates were > or = 86% except for infants with a diaphragmatic hernia. Delivery rates at co-located hospitals were high for mothers of infants with these correctable birth defects. Regionalised health care appears to work well for these pregnancies, as women living outside metropolitan areas had a similar rate of delivery at co-located hospitals to that of urban women.

Neonatal and postneonatal mortality by maternal education—a population-based study of trends in the Nordic countries, 1981–2000

This study examined changes in the educational gradients in neonatal and postneonatal mortality over a 20-year period in the four largest Nordic countries. The study populations were all live-born singleton infants with gestational age of at least 22 weeks from 1981 to 2000 (Finland 1987-2000). Information on births and infant deaths from the Medical Birth Registries was linked to information from census statistics. Numbers of eligible live-births were: Denmark 1 179 831, Finland 834 299 (1987-2000), Norway 1 017 168 and Sweden 1 971 645. Differences in mortality between education groups were estimated as risk differences (RD), relative risks (RR) and index of inequality ratio (RII). Overall, rates of infant mortality were in Denmark 5.9 per 1000 live-births, in Finland 4.2 (1987-2000), in Norway 5.3 and in Sweden 4.7. Overall the mortality decreased in all educational groups, and the educational level increased in the study period. The time-trends differed between neonatal and postneonatal death. For neonatal death, both the absolute and relative educational differences decreased in Finland and Sweden, increased in Denmark, whereas in Norway a decrease in absolute differences and a slight increase in relative differences occurred. For postneonatal death, the relative educational differences increased in all countries, whereas the absolute differences decreased. All educational groups experienced a decline in infant mortality during the period under study. Still, the inverse association between maternal education and RR of postneonatal death has become more pronounced in all Nordic countries.

Socioeconomic status and risk of infant death. A population-based study of trends in Norway, 1967-1998.

The aim of this study was to examine the association between socioeconomic status and risk of infant death in Norway from 1967 to 1998. Information from the Medical Birth Registry of Norway on all live births and infant deaths was linked to information from Statistics Norway on parents' education. There were 1777364 eligible live births and 15517 infant deaths. Differences between education groups were estimated as risk differences, relative risks, population attributable fractions, and index of inequality ratios. The risk of infant death decreased in all education groups, and the level of education increased over time. The trends differed for neonatal and postneonatal death. For neonatal death the risk difference between infants whose mothers had high and low education was reduced from 3.5/1000 in the 1970s to 0.9/1000 in the 1990s. The relative index of inequality (RII) for maternal education decreased from 1.72 to1.32. The proportion of neonatal deaths that could be attributed to <13 years of education decreased from 22.3 to 8.4. For postneonatal death the risk difference between infants whose mothers had high and low education increased from 0.7/1000 in the 1970s to 2.0/1000 in the 1990s. The RII for maternal education increased from 1.31 to 4.00. The population attributable fraction increased from 9.7 to 39.5. An inverse association between socioeconomic status and risk of postneonatal death persists, albeit there was a considerable reduction in risk between 1967 and 1998.