Higher Rates Of Preterm Birth Research Articles

A comparison of obstetric outcomes in adolescent pregnancies and adult pregnancies

Introduction: Adolescent pregnancies are associated with adverse maternal and fetal outcomes including preeclampsia, preterm birth, and fetal growth restriction compared to adult pregnancies. The purpose of our study is to compare the incidents of obstetric outcomes between the adolescent pregnancies and adult pregnancies.Materials and methods: This retrospective case-control study was conducted between January 2013 and January 2018 at Kanuni Sultan Suleyman Research and Training Hospital, Istanbul, Turkey. The institutions’ medical records were screened for women with pregnancies after 24 weeks of gestation. Women under 19 years of age were included as the adolescent group and women between the ages of 20 and 29 were included as the control group. Obstetric outcomes were compared between the groups.Results: There were 3875 adolescent pregnancies in the case group and 3875 adult pregnancies in the control group. Even after adjusting for confounders in our adolescent pregnant cohort, the odds of intrauterine growth restriction, preterm birth and premature rupture of membranes were higher than in our adult pregnant cohort. On the other hand, we found low incidents of preeclampsia and gestational diabetes mellitus in pregnant women younger than 19 years of age.Conclusions: Adolescent pregnancies should be closely followed up as they have higher preterm birth rates as well as the risk of intrauterine growth restriction.

Congenital Factor X deficiency in women: A systematic review of the literature.

Factor X deficiency (FXD) is a rare autosomal recessive bleeding disorder with a variable phenotypic severity. In women, heavy menstrual bleeding (HMB), recurrent ovulation bleeding with haemoperitoneum and bleeding complications in pregnancy such as retroplacental haematoma and postpartum haemorrhage have been reported. The aim of this review was to examine gynaecological problems and obstetric complications in women with congenital FXD. A total number of 49 relevant articles were identified, including 332 women, dating from 1960 to 2018. Heavy menstrual bleeding was reported in 72/284 (25%) women in total, 14/30 (47%) in case reports and 58/254 (23%) in 11 case series, 64% and 10% required blood products and blood transfusion, respectively. Haemoperitoneum from ovulation bleeding or ruptured haemorrhagic ovarian cyst requiring blood transfusion occurred in 8/322 (2.4%) women, six required surgical intervention, including oophorectomy in two. 31 pregnancies were reported in 19 women. There were four miscarriages (including a late miscarriage at 21weeks). There was a high rate of preterm birth and neonatal death occurring in eight (30%) and three (11%) of pregnancies reaching viability stage. Postpartum haemorrhage (PPH) occurred in six (22%) of deliveries, one requiring hysterectomy. In conclusion, women with FXD are at an increased risk of heavy bleeding during menstruation and ovulation as well as adverse pregnancy outcome and postpartum haemorrhage. Collaboration in a multidisciplinary team including an obstetrician/gynaecologist, a perinatologist and a haematologist is necessary for the prevention and management of these complications.

Risk of singleton preterm birth after prior twin preterm birth: a cohort study

Objective: To determine whether preterm birth in a twin pregnancy increases the risk of subsequent preterm birth (PTB) in a singleton pregnancy and to identify predictors for singleton PTB in women with previous twin PTB.Method: A retrospective cohort study of women with prior twin birth followed by a singleton birth in two tertiary referral centres between 2000 and 2016 was conducted. Rate of PTB in subsequent singleton pregnancy was compared between women who experienced previous preterm versus term twin birth. Analysis was further stratified by gestational age at twin and singleton birth, etiology for PTB and chorionicity in the twin pregnancy.Results: A total of 378 women met the inclusion criteria, of whom 252 (66.7%) experienced PTB in the index twin pregnancy. The overall rate of PTB in the subsequent singleton pregnancy was 11.6% (44/378). Women with prior twin PTB had a higher rate of PTB in the subsequent singleton pregnancy compared with women with prior term twin birth (17.5 versus 6.3%, p = .003, or 3.12, 95%-CI 1.42–6.85), mainly due to a higher rate of late singleton preterm birth (13.1 versus 4.0%, p = .005). Findings of higher odds of PTB in the subsequent singleton pregnancy was limited to women who gave birth before 340/7 weeks in the twin pregnancy and was related to the degree of prematurity (prior twin PTB at 300/7–336/7 weeks: OR 3.09, 95%-CI 1.12–8.51; prior twin PTB at <300/7 weeks: OR 5.8, 95%-CI 2.46–13.68). The association between previous twin PTB and subsequent singleton PTB was limited to women with prior spontaneous twin PTB (OR 3.34, 95%-CI 1.50–7.45).Conclusion: Women with a history of spontaneous PTB in a twin pregnancy are at increased odds of PTB in subsequent singleton pregnancies compared to women with prior term twin birth, and the risk is related to the severity of prematurity in the index twin pregnancy.

The placenta: A site of end-organ damage after Fontan operation. A case series

BackgroundPlacental insufficiency may be the cause of the high preterm birth rate in women after Fontan operation. In this study we reviewed the clinical course and pregnancy outcome of women with Fontan physiology with a focus on placental pathology. MethodsWe reviewed clinical charts and placental pathology from 7 women with Fontan physiology who had pregnancies at Mayo Clinic, Rochester, Minnesota. The review was limited to cases where placental pathologic specimens were rigorously examined. ResultsSeven women had 13 deliveries between 2002 and 2018. Only 2 of 13 deliveries were at term (>37 weeks). Mean maternal age at time of last delivery was 27.5 ± 3.2 years. Preeclampsia was noted during 2 pregnancies and 2 women had preterm premature rupture of membranes at 24 and 35 weeks gestation, respectively. Placental abruption with bleeding occurred in 2 pregnancies. An additional 4 pregnancies were complicated by intrauterine growth restriction (IUGR). Median placental weight was 441.5 g (IQR 305.5–622.5 g). Median placental weight percentile for gestational age was 10th to 25th, but varied greatly; two placentas were <10th percentile and 5 were >90th percentile for gestational age. Two umbilical cords contained a single umbilical artery. Prominent subchorionic fibrin deposition was a consistent feature in all placentas. Villous hypermaturity was noted in 4 placentas. ConclusionsFontan physiology may be associated with poor placental health. High systemic venous pressure and low cardiac output may contribute to stagnation of placental blood flow and result in subchorionic fibrin deposition and variable villous hypoplasia. This may explain the high preterm birth rate in women with Fontan physiology. Preterm deliveries and small-for-gestational-age (SGA) newborns should be anticipated in this patient population. Analysis of placental pathology may help determine both candidacy for future pregnancy and long-term effects of pregnancy for women with Fontan physiology.

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

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

Perinatal bone and calcium metabolism in the patient complicated with renal dysfunction.

The incidence of pregnancy complicated with renal dysfunction has tended to increase due to aging and progress in the treatment methods. Generally, pregnancy is allowed only in women with normal renal function and in patients with mild renal insufficiency; therefore, the incidence of osteoporosis and the resulting fragile fracture is rare during pregnancy complicated with renal dysfunction. In recent years, the incidence of pregnancy in dialysis patients and in patients who have undergone kidney transplantation has been increasing due to the progress in treatment methods. Eventually, it has become possible for patients with renal dysfunction to give birth as long as they fulfill certain conditions for pregnancy; however, the rate of preterm births has remained high. The incidence of femoral neck fracture has been about 5 times more in dialysis patients than in healthy individuals; however, the prevention and treatment of osteoporosis in pregnant dialysis patients have been difficult, since many osteoporosis medications are contraindicated in pregnant women and also their pregnancy period is not long due to the higher rate of preterm births.

Maternal Exposure to Particulate Matter during Pregnancy and Adverse Birth Outcomes in the Republic of Korea.

Air pollution has become a global concern due to its association with numerous health effects. We aimed to assess associations between birth outcomes in Korea, such as preterm births and birth weight in term infants, and particulate matter < 10 µm (PM10). Records from 1,742,183 single births in 2010–2013 were evaluated. Mean PM10 concentrations during pregnancy were calculated and matched to birth data by registered regions. We analyzed the frequency of birth outcomes between groups using WHO criteria for PM10 concentrations with effect sizes estimated using multivariate logistic regression. Women exposed to PM10 > 70 µg/m3 during pregnancy had a higher rate of preterm births than women exposed to PM10 ≤ 70 µg/m3 (7.4% vs. 4.7%, P < 0.001; adjusted odds ratio (aOR) 1.570; 95% confidence interval (CI): 1.487–1.656). The rate of low birth weight in term infants increased when women were exposed to PM10 > 70 µg/m3 (1.9% vs. 1.7%, P = 0.278), but this difference was not statistically significant (aOR 1.060, 95% CI: 0.953–1.178). In conclusion, PM10 exposure > 70 µg/m3 was associated with preterm births. Further studies are needed to explore the pathophysiologic mechanisms and guide policy development to prevent future adverse effects on birth outcomes.

Landfills and preterm birth in the Guadeloupe archipelago (French West Indies): a spatial cluster analysis

BackgroundA high rate of preterm birth is observed in the Guadeloupe archipelago (French West Indies), raising the hypothesis of harmful environmental exposures, including landfilling. Our aim was to evaluate whether preterm births cluster around the three main open landfills located in this area.MethodsThe study population consisted of 911 women enrolled in the Timoun mother-child cohort (2004–2007). Home addresses during pregnancy and locations of landfills were geocoded. To test for the presence of preterm birth clusters around each dumpsite, we used a focused cluster test specifically designed to detect spatial clustering around point sources.ResultsA total of 144 (15.8%) preterm births were observed among 911 births. Using the term births (n = 767) as controls, a significant cluster was identified within 2 km around the Saint-François landfill with a relative risk (RR) of 4.82 (p = 0.04). No clusters were found around the other two landfills (RR = 2.01, p = 0.26 and RR = 1.06, p = 0.64, for La Gabarre and Baillif, respectively).ConclusionThe paucity of data available on open landfill sites regarding waste quantities, composition, and changes over time precludes any site-specific interpretation because of the variable degree of possible emissions. This result has to be confirmed in other tropical island environments where waste management has become a major concern with the potential to negatively impact the environment and public health.

Preterm birth disparities between states in the United States: an opportunity for public health interventions

Objective: To examine associations between statelevel characteristics and state-level preterm birth rates.Study design: We conducted a retrospective ecological cross-sectional study using statelevel data from 2013 to 2014 extracted from publicly available sources –the March of Dimes PeriStats database, the U.S. Census Bureau, the US Department of Education, and the US Department of Justice.Results: State-level preterm birth rates correlated with the following state characteristics: poverty rate, obesity rate, percentage of non-Hispanic Black women residents, smoking rate, percent of C − section deliveries, percent of births to women <20 years old, pregnancies receiving late/no prenatal care, and violent crimes per capita. Linear regression analysis found that only the percent of non-Hispanic Black women by state remained a significant predictor of state-level preterm birth rates after adjusting for other risk factors.Conclusions: States with higher percentages of non-Hispanic Black women had higher rates of preterm birth, even after adjusting for sociodemographic characteristics, prenatal care, and maternal health by state. These findings suggest that public health interventions that target contextual and environmental risk factors affecting non-Hispanic Black women may help to curb rising rates of preterm birth in the United States.

908: Preterm birth etiologies in Marfan syndrome and Loeys-Dietz syndrome

Women with Marfan syndrome (MFS) and Loeys-Dietz syndrome (LDS), connective tissue disorders with genetic- predisposition for aortic dissection, have been reported to have a higher rates of preterm birth, but it is unclear whether this is due to iatrogenic or spontaneous causes. The objective of this study was to evaluate the etiology of preterm birth in a cohort of women with MFS and LDS. We conducted a retrospective observational cohort study of women with a clinical and genetic diagnosis of MFS or LDS who had previously been pregnant. Women were recruited through the National Marfan Foundation website and through the connective tissue clinic at Johns Hopkins Hospital. A woman’s first singleton pregnancy was included. Women with incomplete information and those who delivered before 1990 were excluded. The primary outcome was the cause of preterm birth. Women who were diagnosed with MFS/LDS after their pregnancy were also compared to women who received the diagnosis prior to pregnancy in an attempt to identify how medical management changes due to disease diagnosis. A total of 128 pregnancies in women with MFS/LDS were included in the analysis (MFS=104, LDS=24). The total preterm rate in this cohort was 48% (N=61). There was a higher rate of spontaneous preterm birth as compared to iatrogenic preterm birth (87% vs. 13%). Even among women who were not diagnosed with MFS/LDS until after their pregnancy (n= 35), there was a high rate of preterm birth, 45% (N=16), and the majority was spontaneous (94%). As compared to women diagnosed after their pregnancy, those diagnosed prior to their pregnancy were more likely to deliver at an earlier gestational age (36.8 vs. 38.4 weeks, p<0.001), receive general anesthesia (14% vs 3%, p<0.001) and have a cesarean delivery (54% vs 20%, p<0.001). The primary reason for 80% of the cesarean deliveries in the group diagnosed prior to pregnancy was listed as connective tissue disorder. In agreement with previous literature, this study highlights that women with MFS and LDS are at higher risk for preterm birth. This risk appears to be driven by spontaneous rather than iatrogenic preterm birth.

641: Preconceptional antiretroviral therapy reduces local and systemic inflammation in pregnant women with human immunodeficiency virus

HIV-infected pregnant women have high rates of preterm birth (PTB). Multiple recent reports have suggested, counterintuitively, that women who start antiretroviral therapy (ART) prior to conception have higher rates of PTB than women who initiate ART in pregnancy. We hypothesized that this association, if real, is not mediated through inflammation and immune activation in the vagina and peripheral blood. We analyzed specimens from an ongoing prospective cohort study in Lusaka, Zambia. At the time of analysis, paired (vaginal, plasma) mid-trimester (16-20 weeks) samples from 494 women were available. To maximize information with available budget for this sub-study, we analyzed all specimens from HIV seropositive women and a random sample of HIV negative women, accounting for this with probability weighting in analyses. We further divided HIV-infected women into those on preconceptional ART versus those who started ART during pregnancy (after samples obtained). We measured a panel of 13 maternal plasma and 14 maternal vaginal fluid analytes using a multiplex immunoassay (MilliporeSigma, Darmstadt, Germany). We log-transformed concentrations and compared them across exposure categories with ANOVA. We analyzed 244 plasma specimens (153 HIV-uninfected, 51 HIV-infected on preconceptional ART, and 40 HIV- infected without preconceptional ART exposure) and 255 vaginal swabs (160 HIV-uninfected, 54 HIV-infected on preconceptional ART, and 41 HIV-infected without preconceptional ART exposure). When compared to HIV- uninfected women and HIV-infected women on preconceptional ART, women not on preconceptional ART had significantly higher concentrations of inflammatory plasma (IP10, IL-8, IFN-ɣ, IL-12p40, and sCD14) and vaginal (IL-1β, IL-10, sCD14) biomarkers as well as significantly lower concentrations of anti-inflammatory TGF-β in plasma and vaginal SLPI, an enzyme with anti-HIV properties (p< 0.05; no adjustment for multiple comparisons; Table). HIV-infected pregnant women without preconceptional ART exposure exhibited increased systemic and local inflammation in the second trimester of pregnancy. If recent reports associating preconceptional ART with PTB are correct, our study suggests the mechanism is not early local or systemic inflammation. Additional analyses to understand the interaction between these inflammatory markers, other PTB risk factors, and the vaginal microbiota are ongoing.

524: Preterm birth occurrence among Asian women relative to their place of birth

To investigate preterm birth (PTB) rates between United States (US-born) vs. foreign-born Asian women. We hypothesized that foreign-born Asian women would have lower PTB rates compared to their US-born counterparts, irrespective of women’s specific country of origin. Linked birth certificate and maternal discharge data were used to identify nulliparous women with a singleton livebirth and Asian race in California between 2007-2011. PTB was defined as a delivery at less than 37 weeks gestation and further divided into spontaneous and medically indicated PTB. The rate of PTB was examined by self-reported race and place of birth among the following Asian subgroups: Chinese, Japanese, Korean, Vietnamese, Cambodian, Thai, Laotian, Hmong, Indian and Filipino. We observed lower overall PTB rates among foreign-born compared to US-born Asian women in nine out of ten subgroups, whereas, foreign-born Hmong women had a higher PTB rate compared to US-born Hmong women. There were marked differences in PTB rates between the individual Asian subgroups: Korean women had a very low PTB rate (4.2% foreign-born vs. 5.2% US-born Korean) whereas both foreign-born and US-born Filipino women had almost twice as high PTB rates (10.2% foreign-born vs. 10.8% US-born Filipino). Spontaneous PTB also occurred less frequently among foreign-born Asian women compared to US-born Asian women across all other Asian subgroups except among Hmong women. The rates of medically indicated PTB were similar among the foreign-born vs. US- born Asian women. (Table) Among specific Asian subgroups examined, women who were foreign-born had lower overall PTB rate and spontaneous PTB rate compared to US-born Asian women. We observed wide variation in PTB rates between Asian subgroups. Further inquiry is needed to assess factors contributing to such differences.

Challenges and prospects of preterm birth prediction in multiple pregnancies

For today, twins make up about 1.5% of the population of our planet. It is more than one hundred million people, which in number corresponds to the population of two Frances. The number of twins born relative to the total number of newborns in different countries and on different continents is different, but the overall trend is that it continues to grow. In recent years, the percentage of multiple pregnancy has increased almost 2.5 times, which is associated with the widespread use of assisted reproductive technologies.At the same time, pregnancy in multiple births is an extremely important problem in modern obstetrics, as it is accompanied by a high level of complications for both the mother and the fetuses. Multiple pregnancy contributes significantly to the formation of adverse perinatal outcomes, which is primarily due to the high rate of preterm birth. Premature twins are at high risk of neurological and neuropsychiatric disorders, respiratory distress, endocrine and metabolic disorders, which subsequently become the cause of disability and social maladaptation of children. In this regard, the reduction in the number of premature births is today a priority task, the solution of which is possible only through timely and correct forecasting. The multifactority of pathogenic mechanisms determines the necessity of diagnostic search strategies that can identify markers of various pathogenetic ways of preterm birth. (For citation: Kosyakova OV, Bespalova ОN. Challenges and prospects of preterm birth prediction in multiple pregnancies. Journal of Obstetrics and Women’s Diseases. 2018;67(4):48-59. doi: 10.17816/JOWD67448-59).

Exposure to ambient PM2.5 during pregnancy and preterm birth in metropolitan areas of the state of Georgia.

A number of studies has pointed to air pollution as an additional factor that could be associated with preterm birth. We assessed in this study the association between exposure to PM2.5 in ambient air during pregnancy and preterm birth in metropolitan areas of the state of Georgia, where the rate of preterm birth has been among the highest in the nation over the years. Birth data were obtained from the National Center for Health Statistics natality dataset. The study population consisted of 53,094 singleton live births between January 1 and December 31, 2004 in nine metropolitan counties of Georgia. Preterm birth was defined as birth, which occurs before 37weeks of gestation. County-level daily air quality index (AQI) data obtained from the US Environmental Protection Agency (EPA) was used to estimate individual exposure levels of PM2.5 for each study participant based on the county of residence for the duration of the pregnancy. A multivariate logistic regression analysis was conducted to assess the association, adjusting for potential confounders. Of the infants whose mothers resided in the nine metropolitan counties of Georgia, 4543 (8.6%) were born preterm. A higher rate of preterm birth (9.8%) was observed in infants whose mothers were exposed to ambient PM2.5 with AQI values > 50 than the ones with AQI ≤50 (EPA standard for good air quality conditions). Mothers with exposure to PM2.5 at average AQI values greater than 50 during the entire pregnancy were at increased risk of preterm birth (odds ratio 1.15; 95% CI 1.07, 1.25), after adjusting for sex of infant, mother's age, race/ethnicity, education, marital status, prenatal care, cigarette smoking, alcohol consumption, and season of conception. The study provides more evidence on the role of PM2.5 in preterm birth. Reducing exposure to ambient particulate matter, especially in urban areas, for pregnant women would be necessary to improve the health of infants.

Cervical funneling or intra-amniotic debris and preterm birth in nulliparous women with midtrimester cervical length less than 30 mm.

To evaluate whether the presence of cervical funneling or intra-amniotic debris identified in the second trimester is associated with a higher rate of preterm birth (PTB) in asymptomatic nulliparous pregnant women with a midtrimester cervical length (CL) less than 30 mm (i.e. below the 10th percentile). This was a secondary cohort analysis of data from a multicenter trial in nulliparous women between 16 and 22 weeks' gestation with a singleton gestation and CL less than 30 mm on transvaginal ultrasound, randomized to treatment with either 17-alpha-hydroxyprogesterone caproate or placebo. Sonographers were centrally certified in CL measurement, as well as in identification of intra-amniotic debris and cervical funneling. Univariable and multivariable analysis was performed to assess the associations of cervical funneling and intra-amniotic debris with PTB. Of the 657 women randomized, 112 (17%) had cervical funneling only, 33 (5%) had intra-amniotic debris only and 45 (7%) had both on second-trimester ultrasound. Women with either of these findings had a shorter median CL than those without (21.0 mm vs 26.4 mm; P < 0.001). PTB prior to 37 weeks was more likely in women with cervical funneling (37% vs 21%; odds ratio (OR), 2.2 (95% CI, 1.5-3.3)) or intra-amniotic debris (35% vs 23%; OR, 1.7 (95% CI, 1.1-2.9)). Results were similar for PTB before 34 and before 32 weeks' gestation. After multivariable adjustment that included CL, PTB < 34 and < 32 weeks continued to be associated with the presence of intra-amniotic debris (adjusted OR (aOR), 1.85 (95% CI, 1.00-3.44) and aOR, 2.78 (95% CI, 1.42-5.45), respectively), but not cervical funneling (aOR, 1.17 (95% CI, 0.63-2.17) and aOR, 1.45 (95% CI, 0.71-2.96), respectively). Among asymptomatic nulliparous women with midtrimester CL less than 30 mm, the presence of intra-amniotic debris, but not cervical funneling, is associated with an increased risk for PTB before 34 and 32 weeks' gestation, independently of CL. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Pregnancy outcome after first trimester exposure to bisoprolol: an observational cohort study.

Beta-blockers are frequently used during pregnancy, with labetalol and metoprolol being considered as drugs of choice. As there are no prospective pregnancy studies for bisoprolol yet, our aim was to analyze pregnancy outcomes after bisoprolol exposure. Pregnancies exposed to bisoprolol during the first trimester were retrieved from the German Embryotox pharmacovigilance database. Pregnancy outcomes of prospectively ascertained pregnancies were compared with women neither exposed to beta-blockers nor other antihypertensives. In addition, retrospective reports on adverse drug reactions were screened for patterns of birth defects. Inclusion criteria for the prospective study were met by 339 bisoprolol-treated women and 678 patients in the comparison cohort. Neither the risk for spontaneous abortions [adjusted hazard ratio (HRadj.) 1.06; 95% confidence interval (CI) 0.66-1.70] nor for major congenital malformations [adjusted odds ratio (ORadj.) 0.77; 95% CI 0.34-1.75] was increased after first trimester bisoprolol treatment. However, higher rates of preterm births [ORadj. 1.90; 95% CI 1.17-3.11] and reduced birthweights in singleton pregnancies (adjusted standard deviation score difference -0.48; 95% CI -0.62 to -0.34) were noted. Continued treatment with beta-blockers until birth was found to be associated with a higher risk for growth restriction than first trimester exposure only. A sensitivity analysis did not suggest higher rates of adverse pregnancy outcomes in hypertensive women on bisoprolol compared with nonhypertensive bisoprolol-exposed women. Our study supports the hypothesis that first trimester bisoprolol treatment does not increase the risk for spontaneous abortions or major birth defects. However, an influence of prolonged bisoprolol exposure on fetal growth cannot be ruled out.

141. Neighbourhood deprivation and foetal growth: The Generation R study

Introduction Embryonic development is affected by multiple parental lifestyle factors and environmental exposures. Neighbourhood deprivation is associated with lower birth weight and higher preterm birth rates. However, the effects of living in a deprived neighbourhood on embryonic and foetal growth have not been explored yet. Hypothesis We hypothesized that living in a deprived neighbourhood is negatively associated with embryonic and foetal growth. Therefore, our objective was to assess the association between neighbourhood deprivation and embryonic and foetal growth parameters. Methods We evaluated the association between living in a deprived neighbourhood and embryonic and foetal growth parameters in 1614 mothers with a reliable first day of last menstrual period and a regular menstrual cycle. Foetal measurements included crown rump length (CRL), head circumference (HC), femur length (FL), biparietal diameter (BPD), abdominal circumference (AC) and estimated foetal weight (EFW). Results A total of 1614 pregnant women were included. Most were of Western ethnicity (70.7%) and nulliparous (59.0%). Almost every pregnancy was spontaneously conceived (95.7%). The score for neighbourhood deprivation is determined for all 4-digit zip codes and takes income, education and employment into account. A low score represents a deprived neighbourhood. Using linear mixed models, we found a statistically significant association between the neighbourhood deprivation score and FL (adjusted β −1.06 [95% CI: −1.98, −0.15]) and EFW (adjusted β −0.96 [95% CI: −1.89, −0.04]), but not with CRL, HC, AC and BPD. Discussion This population-based study shows that residing in a deprived neighbourhood is statistically associated with some, but not all, foetal growth parameters. Possibly, foetal growth parameters have different degrees of receptivity to external factors such neighbourhood deprivation. The effects we found remained above and beyond individual SES, for which we adjusted. This suggests a separate neighbourhood level effect on embryonic and foetal growth.

Preterm birth, unplanned hospital contact and mortality in infants born to teenage mothers in five countries: a cross-country comparison using linked administrative data

IntroductionChildren born to teenage mothers have greater healthcare needs than those born to mothers in their 20s and older, including higher rates of childhood hospitalisations. We performed a direct cross-country comparison of maternal age-related inequalities in infant outcomes in England, Scotland, Sweden, New South Wales (NSW; Australia) and Ontario (Canada).&#x0D; Objectives and ApproachWe used administrative hospital data capturing 3,002,749 singleton births surviving to discharge between 2010-2014 (2008-2012 for Sweden). We derived risk ratios and risk differences to compare rates of preterm birth (24-37 weeks of gestation), unplanned hospital admissions, emergency department (ED) visits, and mortality within 12 months of postnatal discharge, for infants born to mothers aged 15-19, 20-24, 25-29 and 30-34 years.&#x0D; ResultsInfants born to teenage mothers experienced higher rates of preterm birth, unplanned admissions, ED visits, and mortality compared with older mothers in all countries. Despite variation in the distribution of maternal characteristics between countries, inequalities according to maternal age were similar. Infants of teenage mothers were between 1.37 (95% CI for risk ratio 1.28-1.47, Sweden) and 1.56 (95% CI 1.49-1.64, NSW) times more likely to have ≥1 unplanned hospital admission and between 2.25 (95% CI 1.92-2.64, England) and 3.87 (95% CI 2.07-7.36, Sweden) times more likely to die, compared with those born to mothers aged 30-34.&#x0D; Conclusion/ImplicationsA similar excess of adverse outcomes was observed for teenage mothers in all five countries, despite different prevalence rates and support for young families. Public health strategies are needed to address these inequalities, which may be due to social risk factors associated with both young motherhood and adverse infant outcomes.

Neonatal outcomes among twins following assisted reproductive technology: an Australian population-based retrospective cohort study

BackgroundWhile their incidence is on the rise, twin pregnancies are associated with risks to the mothers and their babies. This study aims to investigate the likelihood of adverse neonatal outcomes of twins following assisted reproductive technology (ART) compared to non-ART twins.MethodsA retrospective population study using the Australian National Perinatal Data Collections (NPDC) which included 19,662 twins of ≥20 weeks gestational age or ≥ 400 g birthweight in Australia. Maternal outcomes and neonatal outcomes (preterm birth, low birth weight, resuscitation and neonatal death) were compared. Generalized Estimating Equations were used to assess the likelihood of any neonatal outcomes, with adjusted odds ratio (AOR) and 95% confidence intervals (CI) presented. Weinberg’s differential rule was used to estimate monozygotic twin rate.ResultsART mothers were 3.3 years older than non-ART mothers. The rates of pregnancy-induced hypertension and gestational diabetes were significantly higher for ART mothers than non-ART mothers (12.2% vs. 8.4%, p < 0.01) and (9.7% vs. 7.5%, p < 0.01) respectively. The incidence of monozygotic twins was 2.0% for ART twins and 1.1% for non-ART twins. Compared with non-ART twins, ART twins had higher rates of preterm birth (AOR 1.13, 95% CI: 1.05–1.22), low birth weight (AOR 1.13, 95% CI: 1.05–1.22), and resuscitation (AOR 1.26, 95% CI: 1.17–1.36). Liveborn ART twins had 28% (AOR 1.28, 95% CI 1.09–1.50) increased odds of having any adverse neonatal outcome compared to liveborn non-ART twins, especially for opposite-sex ART twins (AOR 1.42, 95% CI 1.11–1.82).ConclusionAs ART twins had higher rates of adverse outcome, special prenatal care is recommended. Couples accessing ART should be fully informed of the risk of adverse outcome of twin pregnancies.

Caesarean sections and the prevalence of preterm and early-term births in Brazil: secondary analyses of national birth registration

ObjectivesTo investigate whether the high rates of caesarean sections (CSs) in Brazil have impacted on the prevalence of preterm and early-term births.DesignIndividual-level, cross-sectional analyses of a national database.SettingAll hospital births...