National Cohort Of Pregnant Women Research Articles

Belgian medication exposure during pregnancy (BeMeP), a new nationwide linked database: Linkage methods and prevalence of medication use.

This study aimed to describe the implementation of a new retrospective Belgian national cohort of pregnant women, the Belgian Medication Exposure during Pregnancy (BeMeP). We linked the national dispensing data to birth and death certificates and hospital stay data for a 7-year period between 2010 and 2016 for the first time in Belgium. We presented the characteristics of pregnancy events associated with the mothers enrolled in the linkage study. Next, we constructed a cohort of pregnancies and compared some characteristics computed using the BeMeP database with the national statistics. Finally, we described the use of medications during pregnancy based on the first level of the Anatomical Therapeutic Chemical (ATC) classification. We included 630 457 pregnant women with 900 024 pregnancy-related events (843 780 livebirths, 1937 stillbirths, 6402 ectopic events, and 47 905 abortions) linked to medication exposure information. Overall, 96.3% of live births and 83.5% of stillbirths (national statistics as reference) were captured from the BeMeP. During pregnancy, excluding the week of birth, 78.9% of live birth pregnancies and 79.6% of stillbirth pregnancies were exposed to at least one medication. The most frequently dispensed medications were anti-infectives (ATC code J = 50.2%) for live births and for stillbirths (44.0%). We linked information on pregnancies, all reimbursed medications dispensed by community pharmacists, all medications dispensed during hospitalization, sociodemographic status, and infant health to create the BeMeP database. The database represents a valuable potential resource for studying exposure-outcome associations for medication use during pregnancy.

P.19 Characteristics of SARS-CoV-2 positive obstetric patients within one UK health board

Introduction: The obstetric impact of COVID-19 remains undetermined, with case series scarce and reported outcomes variable. The UK Obstetric Surveillance System (UKOSS) recently reported on a national cohort of pregnant women who required hospital admission due to COVID-19 between March and April 2020.1 We aimed to assess the demographics and outcomes for obstetric patients with COVID-19 infection within our Scottish, inner-city health board and compare this against that reported by UKOSS.

Characteristics and Outcomes of Pregnant Women Admitted to Hospital With Confirmed SARS-CoV-2 Infection in the UK: National Population-based Cohort Study

(BMJ. 2020;369:m2107) Although cases of coronavirus disease 2019 (COVID-19) continue to rise, information on the transmission, effect, and prevalence of the disease in pregnant women and their newborns is still emerging. This study aimed to describe the characteristics and outcomes of a national cohort of pregnant women in the UK hospitalized with COVID-19, the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

The South African National HIV Pregnancy Cohort: evaluating continuity of care among women living with HIV

BackgroundSouth Africa is home to more people living with HIV than any other country, including nearly one in three pregnant women attending antenatal care. Access to antiretroviral therapy (ART) has increased substantially since the start of the national ART program in 2004, with > 95% ART coverage during pregnancy and delivery, and vertical transmission of HIV greatly reduced. However, women who initiate ART during pregnancy are at heightened risk of dropping out of care, particularly after delivery, leading to the potential for viral transmission, morbidity and mortality. It is difficult to evaluate the success of policies of expanded access to ART care, and assess continuity of care, due to the lack of a national longitudinal HIV care database. Also, patient movement between unlinked facilities. For the first time on a national level, we propose to utilize routinely-collected laboratory data to develop and validate a cohort of pregnant women living with HIV in South Africa in a way that is uniquely robust to facility transfer.MethodsUsing laboratory test data matched to facility type, we will identify entry to antenatal care to build the cohort, then describe key treatment milestones, including 1) engagement in antenatal care, 2) initiation of ART, 3) HIV viremia, and 4) continuity of HIV care in the postpartum period. Second, we will measure the effect of system-wide factors impacting continuity of care among pregnant women. We will assess policies of expanded treatment access on continuity of care using regression-discontinuity analyses. We then will assess mobility and its effect on continuity of care during and after pregnancy. Third, we will identify individual-level risk factors for loss from HIV care in order to develop targeted interventions to improve engagement in HIV care.DiscussionThis work will create the world’s largest national cohort of pregnant women living with HIV. This novel cohort will be a powerful tool available to policymakers, clinicians and researchers for improving our understanding of engagement in care among pregnant women in South Africa and assessing the performance of the South African national ART program in caring for pregnant women living with HIV.Trial registrationN/A (not a clinical trial).

Characteristics and outcomes of pregnant women admitted to hospital with confirmed SARS-CoV-2 infection in UK: national population based cohort study.

ObjectivesTo describe a national cohort of pregnant women admitted to hospital with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the UK, identify factors associated with infection, and describe outcomes, including transmission of infection, for mothers and infants.DesignProspective national population based cohort study using the UK Obstetric Surveillance System (UKOSS).SettingAll 194 obstetric units in the UK.Participants427 pregnant women admitted to hospital with confirmed SARS-CoV-2 infection between 1 March 2020 and 14 April 2020.Main outcome measuresIncidence of maternal hospital admission and infant infection. Rates of maternal death, level 3 critical care unit admission, fetal loss, caesarean birth, preterm birth, stillbirth, early neonatal death, and neonatal unit admission.ResultsThe estimated incidence of admission to hospital with confirmed SARS-CoV-2 infection in pregnancy was 4.9 (95% confidence interval 4.5 to 5.4) per 1000 maternities. 233 (56%) pregnant women admitted to hospital with SARS-CoV-2 infection in pregnancy were from black or other ethnic minority groups, 281 (69%) were overweight or obese, 175 (41%) were aged 35 or over, and 145 (34%) had pre-existing comorbidities. 266 (62%) women gave birth or had a pregnancy loss; 196 (73%) gave birth at term. Forty one (10%) women admitted to hospital needed respiratory support, and five (1%) women died. Twelve (5%) of 265 infants tested positive for SARS-CoV-2 RNA, six of them within the first 12 hours after birth.ConclusionsMost pregnant women admitted to hospital with SARS-CoV-2 infection were in the late second or third trimester, supporting guidance for continued social distancing measures in later pregnancy. Most had good outcomes, and transmission of SARS-CoV-2 to infants was uncommon. The high proportion of women from black or minority ethnic groups admitted with infection needs urgent investigation and explanation.Study registrationISRCTN 40092247.

Prevalence and impact of pre-pregnancy body mass index on pregnancy outcome: a cross-sectional study in Croatia

The aim of this study was to determine the association of maternal pre-pregnancy body mass index (BMI) and pregnancy outcome among pregnant women in Croatia. Women who gave birth in Croatia in 2017 were categorised into four groups according to pre-pregnancy BMI and analysed regarding maternal characteristics and perinatal outcomes. Among 32,051 pregnant women, 5.3% were underweight, 65.5% had normal BMI, 20.4% were overweight and 8.8% were obese. Overweight and obese women had a higher prevalence of induction of labour and delivery by caesarean section compared to normal-BMI women (p < .001), while underweight and obese women had a higher prevalence of preterm birth (p < .001). Gestational diabetes (GD), gestational hypertension and preeclampsia were higher in overweight and obese group. Multivariate logistic regression model showed that older maternal age, higher BMI, GD, gestational hypertension and preeclampsia were significant predictors of having non-spontaneous onset of labour and of not delivering vaginally. Impact statement What is already known on this subject? Women with abnormal body mass index (BMI) compared to women with normal BMI have an increased risk of various complications during pregnancy and labour such as preterm birth and low birth weight for underweight women, and foetal macrosomia, labour induction and delivery by caesarean section for obese women. What do the results of this study add? This study was performed on a large national cohort of pregnant women and its results show that the majority of adverse perinatal outcomes present in obese women are also present among overweight women. Additional attention should be paid to women with a modest increase in BMI who present the majority of women with abnormal BMI. What are the implications of these findings for clinical practice and/or further research? Risks identified in this study must be acknowledged and taken into account when counselling and managing women before and during pregnancy and labour. Women must be encouraged throughout pregnancy to either gain weight or limit weight gain if they are in adverse BMI group.

Divergent associations of adaptive and maladaptive emotion regulation strategies with inflammation.

Recent work suggests effective emotion regulation may protect against risk of developing coronary heart disease (CHD), but the mechanisms remain unknown. Strategies for regulating emotions vary in how effectively they mitigate potentially toxic effects of stressful life experiences, and therefore may be differentially associated with CHD risk. In this study, we examined the emotion regulation strategies of reappraisal and suppression in relation to inflammation, a biological state associated with both stress and CHD. We hypothesized that suppression would be associated with elevated inflammation and reappraisal would be associated with lower levels of inflammation. We studied adult offspring (n = 379; mean age = 42.2 years) of Collaborative Perinatal Project participants, a national cohort of pregnant women enrolled in 1959-1966. Validated measures of two emotion regulation strategies were examined: reappraisal and suppression. Inflammation was measured as plasma C-reactive protein (CRP) levels. We fit multiple linear regression models predicting CRP while controlling for demographic, socioeconomic, and health factors, including depressive symptoms, measured across the life course. A 1 standard deviation increase in reappraisal was associated with significantly lower CRP (b = -0.18, SE = 0.06, p < .01) controlling for demographics. This relation was somewhat attenuated in life course models, with adulthood body mass index partially explaining the association. A 1 standard deviation increase in suppression was associated with significantly higher CRP (b = 0.21, SE = 0.05, p < .001), and this association was not substantively attenuated with further covariate adjustment. Adaptive emotion regulation was associated with lower levels of inflammation and maladaptive emotion regulation was associated with higher levels of inflammation. If these associations are confirmed by prospective and experimental studies, such evidence may provide insight into novel targets for interventions to promote health and reduce cardiovascular risk.

Birth defects in a national cohort of pregnant women with HIV infection in Italy, 2001–2011

We used data from a national study of pregnant women with HIV to evaluate the prevalence of congenital abnormalities in newborns from women with HIV infection. Observational study. University and hospital clinics. Pregnant women with HIV exposed to antiretroviral treatment at any time during pregnancy. The total prevalence of birth defects was assessed on live births, stillbirths, and elective terminations for fetal anomaly. The associations between potentially predictive variables and the occurrence of birth defects were expressed as odds ratios (ORs) with 95% confidence intervals (95% CIs) for exposed versus unexposed cases, calculated in univariate and multivariate logistic regression analyses. Birth defects, defined according to the Antiretroviral Pregnancy Registry criteria. A total of 1257 pregnancies with exposure at any time to antiretroviral therapy were evaluated. Forty-two cases with major defects were observed. The total prevalence was 3.2% (95% CI 1.9-4.5) for exposure to any antiretroviral drug during the first trimester (23 cases with defects) and 3.4% (95% CI 1.9-4.9) for no antiretroviral exposure during the first trimester (19 cases). No associations were found between major birth defects and first-trimester exposure to any antiretroviral treatment (OR 0.94, 95% CI 0.51-1.75), main drug classes (nucleoside reverse transcriptase inhibitors, OR 0.95, 95% CI 0.51-1.76; non-nucleoside reverse transcriptase inhibitors, OR 1.20, 95% CI 0.56-2.55; protease inhibitors, OR 0.92, 95% CI 0.43-1.95), and individual drugs, including efavirenz (prevalence for efavirenz, 2.5%). This study adds further support to the assumption that first-trimester exposure to antiretroviral treatment does not increase the risk of congenital abnormalities.

A 2-year prospective study of psychological distress among a national cohort of pregnant women in opioid maintenance treatment and their partners

Background: The prevalence of psychological distress among persons in opioid maintenance treatments (OMT) is high. It is important to assess psychological distress among OMT mothers and their partners because such psychological distress increases the risk of relapse to substance use.Methods: A national cohort of pregnant women in OMT (n = 37) and their partners (n = 23) were taking part in a prospective study. They were interviewed during third trimester of pregnancy and 1 year after giving birth with the European Addiction Severity Index and completed Symptom Checklist 25 during the last month of pregnancy, 6 months and 2 years after the children were born.Results: Among the women there was a significant reduction in depressive symptoms from pregnancy to 6 months after giving birth (p < 0.01) and an increase in depressive symptoms from 6 months to 2 years after giving birth. Among the partners there was a significant decrease in psychological distress from pregnancy to 1 year after the children were born (p < 0.05).Conclusion: The overall results indicate a reduction in psychological distress for both OMT women and their male partners during the first period after birth, probably affecting parenting abilities and treatment outcome in a positive way.

Substance use during and after pregnancy among a national cohort of pregnant women in opioid maintenance treatment and their partners

Background: Most individuals in opioid maintenance treatment (OMT) have had serious polydrug problems in addition to opiate addiction. Prospective studies on substance use among pregnant women in OMT and their male partners on a national level have been scarce and therefore deserve attention.Methods: The European Addiction Severity Index was used to map substance use history among a Norwegian national cohort (2005–2006) of pregnant OMT women (n = 37) and their partners (n = 23), as well as substance use during the last month of pregnancy and 1 year later.Results: Lifetime substance use indicated an average of 8 years of heroin abuse before entering OMT. During the last month of pregnancy one woman and two partners reported using illegal substances, while 1 year later, one women and one partner reported having used illegal substances. The use of legal substances among the partners was significantly reduced from pregnancy to 1 year later (38–20%, p < 0.01), while the use of legal substances among the women increased from 8% to 19%.Conclusion: The results suggest that a majority of OMT mothers in Norway and their partners are able to abstain from most illegal substances 1 year after pregnancy, but the tendency of problem drinking among the women is a concern.

Emotional Functioning at Age 7 Years is Associated With C-Reactive Protein in Middle Adulthood

Few have considered whether and how child emotional functioning is associated with inflammation later in life. Therefore, we evaluated whether child emotional functioning at age 7 years is associated with C-reactive protein (CRP), an indicator of systemic inflammation, in middle adulthood. We studied adult offspring (mean age 42.2 years) of participants in the National Collaborative Perinatal Project, a national cohort of pregnant women enrolled between 1959 and 1966. Three measures of child emotional functioning were derived from psychologist ratings of child behavior at age 7 years: inappropriate self-regulation (ISR), distress proneness, and behavioral inhibition. Multiple linear regression models were fit to investigate the association between childhood emotional functioning and adulthood CRP and also to evaluate potential mediators of this association. Model n's were from 400 for Model 1 to 379 for Model 4 depending on covariates included and missing data on those covariates. Children with high ISR and distress proneness at age 7 years had significantly higher CRP as adults (ISR: β = 0.86; standard error [SE] = 0.28; p = .002; distress proneness: β = 1.23; SE = 0.57; p = .03). In contrast, children with high levels of behavioral inhibition had lower CRP as adults (β = -0.58; SE = 0.38; p = .04). Furthermore, there was evidence that associations of ISR and distress proneness with CRP may be mediated in part by adulthood body mass index (Sobel significance tests of mediation: ISR: p = .003; distress proneness: p = .07). Findings suggest that poor childhood emotional functioning is associated with inflammation in adulthood. These results suggest a potential childhood origin of adult inflammatory risk.

Pregnancy outcomes and antiretroviral treatment in a national cohort of pregnant women with HIV: overall rates and differences according to nationality

We used data from the main surveillance study of HIV and pregnancy in Italy to evaluate possible differences in pregnancy care and outcomes according to nationality. Among 960 women followed in 2001-06, 33.5% were of foreign nationality, mostly from African countries. Foreign women had lower rates of preconception counselling and planning of pregnancy. They had more frequently HIV diagnosed during pregnancy, with a later start of antiretroviral treatment and lower treatment rates at all trimesters but not when the entire pregnancy, including delivery, was considered. No differences were observed between the two groups in ultrasonography assessments, hospitalisations, AIDS events, intrauterine or neonatal deaths, and mode and complications of delivery. Foreign women had a slightly lower occurrence of preterm delivery and infants with low birthweight. The results indicate good standards of care and low rates of adverse outcomes in pregnant women with HIV in Italy, irrespective of nationality. Specific interventions, however, are needed to increase the rates of counselling and HIV testing before pregnancy in foreign women.

Diagnosis of HIV infection in pregnancy: data from a national cohort of pregnant women with HIV in Italy.

We analysed the characteristics of the pregnancies with a previously undetected HIV infection in a national observational study of pregnant women with HIV in Italy. In a total of 443 pregnancies with available date of HIV diagnosis, 118 were characterized by a previously undetected HIV infection (26.6%, 95% CI 22.5-30.8). The following factors were independently associated with this occurrence in a multivariate analysis (adjusted odds ratios; 95% CIs): foreign nationality (5.1, 2.8-9.3); no pre-conception counselling (35.9, 4.8-266.1); first pregnancy (2.1, 1.2-4.0); asymptomatic status (6.8, 1.5-30.6). Women with previously undetected infection started antiretroviral treatment significantly later during pregnancy (P < 0.001). Missed diagnosis was responsible for one case of transmission. A high rate of previously undetected HIV infection was observed. This suggests a good HIV detection during pregnancy, but also the need to reinforce HIV testing strategies among women of childbearing age. We identified some determinants which may be considered for intervention measures.