Nationwide Population-based Datasets Research Articles

Predictors and Assessment of Hospice Use for End-Stage Renal Disease Patients in Taiwan.

Objectives: Hospice and early palliative care are generally considered as an alternative and supportive care to offer symptoms relief and optimize the quality of life among end-stage renal disease (ESRD) patients, but hospice care remains underutilized. This study aimed to examine patient and health system characteristics and develop a patient assessment scale to evaluate ESRD patients for hospice care after the implementation of non-cancer hospice care reimbursement policy in 2009 in Taiwan. Method: We conducted a retrospective cohort study using nationwide population-based datasets. Adult long-term dialysis patients between 2009 and 2012 were included. Multivariable logistic regression and the Firth penalized likelihood estimation were used to estimate the likelihood of receiving hospice care. A receiver operating characteristic curve (ROC) analysis and C-statistic were calculated to determine the optimal models for a patient assessment of hospice use. Results: Patients who were older, comorbid with anemia (odds ratio [OR] 3.53, 95% CI 1.43–8.70) or sepsis (OR 1.62, 95% CI 1.08–2.44), with longer dialysis durations, more hospitalizations (OR 4.68, 95% CI 2.56–8.55), or primary provider care with hospice (OR 5.15, 95% CI 2.80–9.45) were more likely to receive hospice care. The total score of the patient assessment scale of hospice care was 0–28 with a cut-off value of 19 based on the results of the receiver operating characteristic curve. Conclusion: Given the “Patient Right to Autonomy Act” implemented in Taiwan in 2019 to promote the concept of a “good quality of death”, this patient assessment scale may help health professionals target ESRD patients for hospice care and engage in shared decision making and the advance care planning process.

Comparisons of the risk of medication noncompliance and suicidal behavior among patients with depressive disorders using different monotherapy antidepressants in Taiwan: A nationwide population-based retrospective cohort study

BackgroundThe aim of this study was to assess the association between various classes of antidepressants and the risk of medication noncompliance as well as suicidal behavior among depressed patients. MethodsA retrospective cohort study was conducted utilizing two nationwide population-based datasets in Taiwan from 2010 to 2016. The outcome measures included the risk of medication noncompliance, attempted suicide, and completed suicide. Cox proportional hazards models with stratification of the propensity score deciles were performed. ResultsA total of 447,411 new antidepressant users were identified. Compared to SSRIs, patients who received SARIs [adjusted hazard ratio (aHR) = 1.124, 95% confidence interval (CI) = 1.108–1.142], SNRIs (aHR = 1.049, 95% CI = 1.033–1.065), and other classes of antidepressants (aHR = 1.037, 95% CI = 1.024–1.051) were more likely to exhibit poor medication noncompliance. Patients who received SNRIs had a higher risk of attempted suicide (aHR = 1.294, 95% CI = 1.114–1.513), compared to SSRIs. However, patents in the TCAs group revealed the opposite result (aHR = 0.543, 95% CI = 0.387–0.762). Concerning the risk of completed suicide, this analysis detected no statistical significance across different types of antidepressants. LimitationsAlthough the universal coverage of Taiwan's national health insurance program tends to minimize the risk of selection and recall bias, it is difficult to rule out medical surveillance bias by using claim data. ConclusionsThis study demonstrated that classes of antidepressants exert different degrees of impact on the risk of medication noncompliance and attempted suicide, but not completed suicide, among depressed patients.

Do stillbirth, miscarriage, and termination of pregnancy increase risks of attempted and completed suicide within a year? A population-based nested case-control study.

To investigate the risks of attempted and completed suicide in women who experienced a stillbirth, miscarriage, or termination of pregnancy within 1 year postnatally and compare this risk with that in women who experienced a live birth. A nested case-control study. Linking three nationwide population-based data sets in Taiwan: the National Health Insurance Research Database, the National Birth Registry and the National Death Registry. In all, 485 and 350 cases of attempted and completed suicide, respectively, were identified during 2001-11; for each case, ten controls were randomly selected and matched to the cases according to the age and year of delivery. Conditional logistic regression. Attempted and completed suicidal statuses were determined. The rates of attempted suicide increased in the women who experienced fetal loss. The risk of completed suicide was higher in women who experienced a stillbirth [adjusted odds ratio (aOR) 5.2; 95% CI 1.77-15.32], miscarriage (aOR 3.81; 95% CI 2.81-5.15), or termination of pregnancy (aOR 3.12; 95% CI 1.77-5.5) than in those who had a live birth. Furthermore, the risk of attempted suicide was significantly higher in women who experienced a miscarriage (aOR 2.1; 95% CI 1.66-2.65) or termination of pregnancy (aOR 2.5; 95% CI 1.63-3.82). In addition to marital and educational statuses, psychological illness increased the risk of suicidal behaviour. The risk of suicide might increase in women who experience fetal loss within 1 year postnatally. Healthcare professionals and family members should enhance their sensitivity to care for possible mental distress, particularly for women who have experienced a stillbirth. Suicide risk increased in women who had a stillbirth, miscarriage, or termination of pregnancy within 1 year postnatally.

Pre-existing diabetes mellitus and all-cause mortality in cancer patients: a register-based study in Latvia

Background: Most studies from high income countries consistently report that preexisting diabetes reduces overall survival of cancer patients. We examined this association in a retrospective cohort study using two nation-wide population-based data sets in Latvia.Material and methods: The Cancer Register, linked with the Diabetes Register and Causes of Death Database, was the first data source used to select 22,936 men and 25,338 women with cancer diagnosed from 2009 to 2013. The follow-up period ended on 28 February 2015. The National Health Service data served as a second data source, which was used to select 10,130 men and 13,236 women with cancer as the main diagnosis, who were discharged from oncology hospitals from 2009 to 2012. Prescriptions of reimbursed antidiabetic medications indicated prior diabetes status. The follow-up period started at the date of discharge and ended on 31 December 2013. A Cox proportional hazards model was used to assess association between preexisting diabetes and all-cause mortality, adjusted for age.Results: Men with preexisting diabetes had better overall short-term survival: the age-adjusted hazard ratios (95% CI) were 0.86 (0.79–0.93) for the first year and 0.89 (0.80–0.98) for the first two years after cancer diagnosis according to the disease register and health service data, respectively. After three full follow-up years, their relative mortality increased, with an age-adjusted hazard ratio of 1.60 (1.28–1.99). Among women, preexisting diabetes was associated with slightly higher all-cause mortality during the entire follow-up period, with age-adjusted hazard ratios of 1.17 (1.10–1.24) for the disease register data and 1.11 (1.02–1.21) for the health service data.Conclusion: Interestingly, we found better overall survival of diabetic men during the first years after cancer diagnosis. We hypothesize that access to health services may be advantageous to diabetic patients who are in close contact with the healthcare system.

Economic evaluation of a pre-ESRD pay-for-performance programme in advanced chronic kidney disease patients.

The National Health Insurance Administration in Taiwan initiated a nationwide pre-end-stage renal disease (ESRD) pay-for-performance (P4P) programme at the end of 2006 to improve quality of care for chronic kidney disease (CKD) patients. This study aimed to examine this programme's effect on patients' clinical outcomes and its cost-effectiveness among advanced CKD patients. We conducted a longitudinal observational matched cohort study using two nationwide population-based datasets. The major outcomes of interests were incidence of dialysis, all-cause mortality, direct medical costs, life years (LYs) and incremental cost-effectiveness ratio comparing matched P4P and non-P4P advanced CKD patients. Competing-risk analysis, general linear regression and bootstrapping statistical methods were used for the analysis. Subdistribution hazard ratio (95% confidence intervals) for advanced CKD patients enrolled in the P4P programme, compared with those who did not enrol, were 0.845 (0.779-0.916) for incidence of dialysis and 0.792 (0.673-0.932) for all-cause mortality. LYs for P4P and non-P4P patients who initiated dialysis were 2.83 and 2.74, respectively. The adjusted incremental CKD-related costs and other-cause-related costs were NT$114 704 (US$3823) and NT$32 420 (US$1080) for P4P and non-P4P patients who initiated dialysis, respectively, and NT$-3434 (US$114) and NT$45 836 (US$1572) for P4P and non-P4P patients who did not initiate dialysis, respectively, during the 3-year follow-up period. P4P patients had lower risks of both incidence of dialysis initiation and death. In addition, our empirical findings suggest that the P4P pre-ESRD programme in Taiwan provided a long-term cost-effective use of resources and cost savings for advanced CKD patients.

Pregnancy-associated mortality in Taiwan, 2004–2011

ObjectivePregnancy-associated death is defined by the American College of Obstetricians and Gynecologists as “a death of a woman while pregnant or within 1 year of termination of pregnancy, irrespective of the cause of death.” We sought to determine pregnancy-associated mortality ratio (PAMR) in Taiwan and to compare the cause of death pattern with other countries to assess the national health status of Taiwanese women. Materials and methodsWe linked four nationwide population-based data sets (birth registration, birth notification, National Health Insurance claims, and cause of death mortality) from 2004 to 2011 to identify women aged 15–49 years that died from pregnancy-associated deaths. We then calculated the PAMR and cause of death distribution by maternal age. ResultsA total of 559 pregnancy-associated deaths were identified with an overall PAMR of 36 (deaths per 100,000 live births). The J-shaped age-specific PAMR mortality pattern was noted, in which the PAMR was 32, 25, 24, 36, 71, 143, and 369 for women aged 15–19 years, 20–24 years, 25–29 years, 30–34 years, 35–39 years, 40–44 years, and 45–49 years, respectively. The age-standardized PAMR decreased drastically from 45 in 2004–2005 to 36 in 2006–2007 and 30 in 2008–2009, but leveled off to 33 in 2010–2011. The proportion of indirect causes increased from 2004–2007 to 2008–2011 among women aged 15–29 years and 35–49 years. ConclusionCompared with previous studies, the PAMR of Taiwan is moderate. However, the proportion of external causes of pregnancy-associated deaths in Taiwan is the lowest compared with other regions. Further studies (such as death review) are needed to explore possible preventable factors.

The Correlation between Cholecystectomy and Seasonal Impact in Taiwan

Many diseases and illnesses are known to be induced by changes in season and have seasonal fluctuations, and are affected by meteorological factors. Cholecystectomy is a very common surgical procedure used to treat gallstone disease and related complications. This study aimed to examine possible impacts of the seasons on the incidence of cholecystectomy with respect to gender and age as well as whether meteorological variables showed an association with incidences of cholecystectomy. The study was retrospectively conducted using the nationwide population-based datasets of National Health Insurance System in Taiwan. Patients who had undergone cholecystectomy were identified according to the International Classification of Diseases version 9 codes and categorized in terms of age and gender. Autoregression integrated moving average (ARIMA) multivariate models were applied to investigate the association of cholecystectomy incidence rates, time and meteorological variables. A total of 192,833 patients who underwent cholecystectomy between 1996 and 2008 were identified for the analysis. A trend indicating an overall increase was observed for the incidence rate of cholecystectomy over the study period. There were more females who underwent cholecystectomy than males. The highest incidence was found to occur during the summer and the lowest during the winter correlating with the cyclic pattern of temperature in Taiwan. Overall, the cholecystectomy incidence rate increased steadily over the 13-year study period for all age groups. In conclusion, the incidence of cholecystectomy was found to be correlated with the seasons. Temperature is the most notable variable among the relevant meteorological factors. Culture may also play a role in these correlations.

Oligohydramnios increases the risk of respiratory hospitalization in childhood: a population-based study

Pulmonary hypoplasia is associated with reduced lung function in infancy. The aim of this study was to evaluate the hypothesis that children exposed to oligohydramnios display an increased risk of hospitalization for respiratory illness by using a population-based matched-cohort design. We used three nationwide population-based data sets to identify 5,228 women who gave birth during 2004 to 2007 and were diagnosed with oligohydramnios during the third trimester of pregnancy. A cohort of 20,912 unaffected pregnant women was matched with these cases, according to neonatal sex and gestational age, maternal age and education, and level of prenatal care. Respiratory hospitalization and respiratory failure were defined using discharge diagnostic codes. Oligohydramnios-exposed children had an 8% higher incidence rate of respiratory hospitalization and an 80% higher incidence rate of respiratory failure, compared with children without oligohydramnios exposure. This risk remained after adjusting for all potential risk factors. Cox regression analyses indicated that the adjusted hazard ratios of respiratory hospitalization and respiratory failure were 1.07 (95% confidence interval (CI): 1.01-1.15; P = 0.030) and 2.20 (95% CI: 1.26-3.84; P = 0.005), respectively. Children exposed to oligohydramnios during the third trimester of pregnancy display an increased risk of hospitalization for respiratory illness.

Adequate Prenatal Care Reduces the Risk of Adverse Pregnancy Outcomes in Women with History of Infertility: A Nationwide Population-Based Study

ObjectivesTo investigate the effects of various measures of prenatal care on adverse pregnancy outcomes in women with a history of infertility.Study DesignA retrospective cohort study.MethodsData were derived by linking 2 large nationwide population-based datasets, the National Health Insurance Research Database and Taiwan Birth Certificate Registry. The study sample included 15,056 women with an infertility diagnosis and 60,224 randomly selected women without infertility matched to the study sample by maternal age. A conditional logistic regression analysis was performed for the analysis.ResultsWomen diagnosed with infertility respectively had 1.39 (95% CI, 1.06~1.83), 1.15 (95% CI, 1.08~1.24), 1.13 (95% CI, 1.08~1.18), and 1.08 (95% CI, 1.05~1.12) higher odds of having very low birth weight (VLBW) babies, preterm births, labor complications, and cesarean sections (CSs) compared to women without infertility. Inadequate numbers of total and major prenatal visits and late initiation of prenatal care increased the risks of adverse pregnancy outcomes in women with infertility, especially the risk of a VLBW baby. However, no significant associations were found for the risks of adverse birth outcomes in infertile women with adequate prenatal care compared to fertile women with adequate care.ConclusionsStudy findings suggest that adequate prenatal care can reduce the risk of adverse pregnancy outcomes in women with infertility.

Urinary calculi increase the risk for adverse pregnancy outcomes: a nationwide study

Using two large-scale nationwide population-based data sets, this study aimed to assess the risk of adverse pregnancy outcomes between mothers with and without urinary calculi. Cross-sectional study. Taiwan. This study included 3694 women who had live singleton births and received a diagnosis of urinary calculi (UC) in the year prior to their delivery, as well as 18 470 matched women without UC, who were used as a comparison group. Conditional logistic regression analyses were performed. Low birthweight, preterm birth, small for gestational age, cesarean section, lower Apgar score and pre-eclampsia/eclampsia. Women with UC had a higher prevalence of low-birthweight neonates (7.4 vs. 6.0%, p = 0.003), preterm births (9.5 vs. 7.3%, p < 0.001) and cesarean sections (43.1 vs. 35.4%, p < 0.001) than women without UC. After adjusting for potential confounding factors, women with UC were more likely than women without UC to have low-birthweight neonates (odds ratio 1.21, 95% confidence interval 1.05-1.39), preterm birth (odds ratio 1.28, 95% confidence interval 1.13-1.43) and cesarean sections (odds ratio 1.37, 95% confidence interval 1.28-1.48). There were increased risks for having low-birthweight, preterm infants and for experiencing cesarean section among women with UC in comparison to women without UC.

Acute Appendicitis and Adverse Pregnancy Outcomes: A Nationwide Population-Based Study

Background/objectiveAcute appendicitis is the most common non-obstetric surgical procedure in pregnant women. Using two large-scale nationwide population-based datasets, this study aimed to assess the risk of adverse pregnancy outcomes between mothers with and without appendicitis in Taiwan. MethodsThis study used two nationwide population-based datasets: the Taiwan National Health Insurance Research Dataset and the Taiwan national birth certificate registry. This study included 908 women who had live singleton births and who had been hospitalized with a diagnosis of acute appendicitis, and another randomly selected 4,540 women as a comparison group. Conditional logistic regression analyses were performed to calculate the risk of adverse pregnancy outcomes including low birth weight (LBW), preterm birth, small for gestational age (SGA), cesarean section (CS), congenital anomalies, Apgar scores at 5 min (<7), and pre-eclampsia/eclampsia. ResultsThe adjusted odds ratios for LBW, preterm birth, SGA, CS, and congenital anomalies in women with acute appendicitis were 1.82 (95 % CI = 1.43–2.30), 1.59 (95 % CI = 1.25–2.02), 1.33 (95 % CI = 1.12–1.60), 1.24 (95 % CI = 1.07–1.44), and 2.07 (95 % CI = 1.07–4.03), respectively, compared with women without acute appendicitis after adjusting for highest maternal educational level, marital status, geographic region, gestational diabetes, gestational hypertension, coronary heart disease, anemia, hyperlipidemia, obesity, and alcohol abuse/alcohol dependence syndrome, infant sex and parity, and paternal age. ConclusionsThere were increased risks for having LBW, preterm infants, SGA, congenital anomalies, and for experiencing CS among women with acute appendicitis than comparison women.

Possible effects of anaesthetic management on the 1 yr followed-up risk of herpes zoster after Caesarean deliveries

As general anaesthesia may compromise the immune system, it has been hypothesized that latent varicella-zoster virus is more likely to be reactivated and cause herpes zoster in mothers after Caesarean deliveries under general anaesthesia. Our study was thus aimed at investigating the risk of herpes zoster among women during the first year after Caesarean deliveries under either general or regional anaesthesia. Two nationwide population-based data sets were utilized, including the Taiwan birth certificate registry and the Taiwan National Health Insurance Research Dataset. From 2001 to 2003, a total of 162 495 women underwent Caesarean delivery. Among them, 21 454 women received general anaesthesia, whereas 141 041 patients received regional anaesthesia. Each individual was followed for 1 yr to identify the subsequent occurrence of herpes zoster. Cox's proportional hazards regressions were performed for analysis. During the 1 yr follow-up period, 0.46% of the women receiving general anaesthesia experienced an episode of herpes zoster, compared with 0.34% of women receiving regional anaesthesia. In Caesarean deliveries, the use of general anaesthesia compared with regional anaesthesia was independently associated with a 1.29-fold (95% confidence interval=1.04-1.61) increase in the 1 yr risk of herpes zoster, after adjusting for maternal and infant characteristics. In this series, there was a small increased risk of herpes zoster in the year after Caesarean delivery with general anaesthesia. Future studies are needed to further investigate these findings.

Risk of adverse perinatal outcomes with antithyroid treatment during pregnancy: a nationwide population-based study

To compare, using two large nationwide population-based data sets, the risk of adverse pregnancy outcomes (low birthweight [LBW], preterm birth, small for gestational age [SGA] and congenital anomalies) among pregnant women with hyperthyroidism classified into three groups: receiving propylthiouracil (PTU) treatment during pregnancy, receiving methimazole/carbimazole (MMI) treatment, and no antithyroid treatment during pregnancy. A matched case-control study. Taiwan. A total of 2830 mothers with hyperthyroidism and 14,150 age-matched randomly selected mothers without hyperthyroidism were included. Conditional logistic regression analyses were performed to examine the risk of adverse pregnancy outcomes (LBW, preterm birth, SGA and major congenital anomalies) among these three groups. LBW, preterm birth, SGA and major congenital anomalies. Women receiving PTU treatment during pregnancy had a higher risk of giving birth to LBW infants than those not receiving antithyroid treatment (odds ratio = 1.40; 95% CI 1.00-1.96), after adjusting for maternal education, anaemia, hyperlipidaemia, pregestational diabetes, pregestational hypertension, hyperemesis gravidarum and infant's gender and birth order. However, children of women receiving MMI treatment did not have increased risks of any adverse fetal outcome relative to mothers not receiving antithyroid treatment. Our study finds an increased risk of LBW among babies of mothers with hyperthyroidism receiving PTU treatment during pregnancy relative to untreated mothers with hyperthyroidism.

Increased mortality risk among offspring of mothers with postnatal depression: a nationwide population-based study in Taiwan

There is compelling evidence that children of mothers with postnatal depression (PD) experience poor developmental outcomes. However, no studies have specifically ascertained the risk of mortality for offspring during preschool years, the most catastrophic outcome in the vulnerable period. This nationwide population-based study aimed to investigate whether maternal depression in the first year after giving birth was associated with increased mortality risk among their preschool children aged up to 5 years. Three nationwide population-based datasets [the National Health Insurance Research Database (NHIRD), birth certificate registry and death certificate registry] were linked in this study. A total of 10 236 offspring of mothers with PD were recruited, together with a comparison cohort of 81 888 births matched with the affected women in terms of maternal age and year of delivery. Each child was traced for 5 years from delivery between 2001 and 2003 until the end of 2008 to determine mortality during preschool years. During preschool years, 98 (0.96%) deaths were identified among the offspring of mothers with PD and 470 (0.57%) children in the comparison cohort died. For children up to 5 years old, exposure to maternal PD was independently associated with a 1.47-fold [95% confidence interval (CI) 1.16-1.87] increased mortality risk, after adjusting for family income, urbanization level and the characteristics of mother, father and infant. The risk of death by unnatural causes was even higher (about 2.23 times the risk, 95% CI 1.34-3.70) among exposed offspring. PD places preschool children at significantly increased risk of mortality, especially from unnatural causes of death.

Affect of Seizures during Gestation on Pregnancy Outcomes in Women with Epilepsy

Affect of Seizures During Gestation on Pregnancy Outcomes in Women with Epilepsy. Chen YH, Chiou HY, Lin HC, Lin HL. Arch Neurol 2009;66(8):979–984. OBJECTIVE: To assess whether seizures in women with epilepsy during pregnancy contribute to adverse pregnancy outcomes. DESIGN: A retrospective cross-sectional study. SETTING: Taiwan. PATIENTS: This study linked 2 nationwide population-based data sets: Taiwan's birth certificate registry and the Taiwan National Health Insurance Research Data set. A total of 1,016 women with epilepsy were selected who had single births from 2001 to 2003 and who had been diagnosed with epilepsy within 2 years prior to their index delivery, together with 8,128 matched women without chronic disease as a comparison cohort. Women with epilepsy were further stratified into 2 groups for analysis: women who did and did not have seizures during pregnancy. MAIN OUTCOME MEASURES: Low-birth-weight infants, preterm delivery, and infants who are small for gestational age (SGA). RESULTS: Compared with women without epilepsy, epileptic seizures during pregnancy were independently associated with a 1.36-fold (95% confidence interval [CI], 1.01–1.88), 1.63-fold (95% CI, 1.21–2.19), and 1.37-fold (95% CI, 1.09–1.70) increased risk of low-birth-weight infants, preterm delivery, and SGA, respectively, after adjusting for family income and parental and infant characteristics. Further, the risk of SGA increased significantly (odds ratio, 1.34; 95% CI, 1.01–1.84) for women with seizures during pregnancy compared with women with epilepsy who did not have seizures during pregnancy. CONCLUSION: We suggest preventing seizures during pregnancy as an essential step to reduce risk of adverse pregnancy outcomes.

Risk of Death by Unnatural Causes During Early Childhood in Offspring of Parents With Mental Illness

Limited evidence reveals an elevated mortality risk in offspring of psychiatric patients after infancy. This nationwide population-based study in Taiwan aimed to investigate mortality risk in preschool children up to age 5 whose parents have severe mental illness. Three nationwide population-based data sets were linked. A total of 3,166 children with one or both parents having schizophrenia or an affective disorder were identified, together with a comparison cohort of 25,328 children matched with the study group in terms of maternal age and year of delivery. Cox proportional hazard regressions were performed to compute hazard ratios, with adjustment for sociodemographic characteristics and maternal medical comorbidities. During the preschool years, 54 (1.7%) deaths were documented among offspring of parents with severe mental illness and 155 (0.6%) in the comparison cohort. Parental mental illness was independently associated with a risk of death nearly 2.4 times higher (95% CI=1.72-3.28) than in the comparison cohort. The association was even more marked for unnatural causes of death, in which the mortality risk was 8.35 times greater (95% CI=4.04-17.24) in children of affected parents than in the comparison cohort. The proportional mortality rates were as high as 20.4% and 11.1% for accident and homicide, respectively, among offspring exposed to parental mental illness. An elevated mortality risk, especially from unnatural causes of death, was identified for offspring of parents with severe mental illness during the preschool years in an Asian society. There is an urgent need for multidisciplinary team approaches and risk management strategies to support psychiatric patients who are having difficulty with the transition to parenthood.

Affect of Seizures During Gestation on Pregnancy Outcomes in Women With Epilepsy

To assess whether seizures in women with epilepsy during pregnancy contribute to adverse pregnancy outcomes. A retrospective cross-sectional study. Taiwan. Patients This study linked 2 nationwide population-based data sets: Taiwan's birth certificate registry and the Taiwan National Health Insurance Research Data set. A total of 1016 women with epilepsy were selected who had single births from 2001 to 2003 and who had been diagnosed with epilepsy within 2 years prior to their index delivery, together with 8128 matched women without chronic disease as a comparison cohort. Women with epilepsy were further stratified into 2 groups for analysis: women who did and did not have seizures during pregnancy. Low-birth-weight infants, preterm delivery, and infants who are small for gestational age (SGA). Compared with women without epilepsy, epileptic seizures during pregnancy were independently associated with a 1.36-fold (95% confidence interval [CI], 1.01-1.88), 1.63-fold (95% CI, 1.21-2.19), and 1.37-fold (95% CI, 1.09-1.70) increased risk of low-birth-weight infants, preterm delivery, and SGA, respectively, after adjusting for family income and parental and infant characteristics. Further, the risk of SGA increased significantly (odds ratio, 1.34; 95% CI, 1.01-1.84) for women with seizures during pregnancy compared with women with epilepsy who did not have seizures during pregnancy. We suggest preventing seizures during pregnancy as an essential step to reduce risk of adverse pregnancy outcomes.

No increased risk of adverse pregnancy outcomes for women with myasthenia gravis: a nationwide population‐based study

This study aims to examine the risk of adverse pregnancy outcomes [low birthweight (LBW), preterm birth, cesarean sections (CS) and babies born small for gestational age (SGA)] in pregnant women with myasthenia gravis (MG), using a 3-year population-based database, taking characteristics of infant and mother into consideration. This study used two nationwide population-based datasets: the Taiwan National Health Insurance Research Dataset and the Taiwan birth certificate registry. We identified 163 pregnant women with MG during 2001-2003 as the study cohort and 815 randomly selected pregnant women as a comparison cohort. Conditional logistic regression analyses were performed. The results showed that, although these patterns did not reach a statistically significant level, mothers with MG had higher percentages of LBW (6.8%, vs. 5.6%), SGA (17.8%, vs. 14.1%) and cesarean deliveries (44.8%, vs. 37.4%), except for preterm births (8.1%, vs. 8.1%). After adjusting for highest maternal education level, marital status, family monthly income and infant gender and parity, the odds ratios (OR) of LBW, preterm birth, SGA infants, and cesarean delivery for mothers with MG were 1.19 (95% CI = 0.60-2.38), 1.00 (95% CI = 0.54-1.87), 1.30 (95% CI = 0.83-2.04), and 1.33 (95% CI = 0.94-1.88), respectively, as compared to unaffected mothers. We conclude that there were no statistically significant differences in the risk of having preterm, LBW, SGA infants and cesarean deliveries between women with and without MG.

Pregnancy outcomes among women with panic disorder — Do panic attacks during pregnancy matter?

Purpose To assess the risks that maternal panic disorder (PD) during pregnancy contribute to adverse pregnancy outcomes, with the effects further specifically differentiated into mothers who experienced a panic attack during pregnancy and those who did not. Method This study linked two nationwide population-based datasets: the birth certificate registry and the Taiwan National Health Insurance Research Dataset. We identified a total of 371 women who gave birth from 2001 to 2003, who had been diagnosed with PD within 2 years prior to the index delivery, together with 1585 matched women without this chronic disease as a comparison cohort. Multivariate logistic regression analyses were performed to estimate odds ratios. Results Results indicated that compared to women without chronic disease, PD mothers who experienced panic manifestations during pregnancy and those who did not were independently associated with respective 2.29- (95% confidence interval (CI) = 1.14–4.60) and 1.45-fold (95% CI = 1.03–2.04) increased risks of having small-for-gestational-age infants. Further, for PD mothers who experienced a panic attack during gestation, the adjusted odds ratio for having a preterm delivery was 2.54 (95% CI = 1.09–5.93), whereas no significant difference was identified between PD women who did not have a panic attack during pregnancy and women without PD. Limitation Our study was unable to investigate the effects of such risk factors as dietary habits, cigarette smoking, and alcohol use in the regression model. Conclusion We conclude that prenatal PD, particularly the occurrence of panic attacks during pregnancy, was associated with adverse birth outcomes.

Does multiple sclerosis increase risk of adverse pregnancy outcomes? A population-based study

Objective To determine whether maternal multiple sclerosis (MS) is associated with increased risk of adverse pregnancy outcomes in an East Asian country by using a nationwide population-based dataset. Method This study linked two nationwide population-based datasets, the birth certificate registry and the Taiwan National Health Insurance Research Dataset. We identified a total of 174 women who gave birth from 2001 to 2003, who were diagnosed with MS within the 2 years preceding the index deliveries, together with 1,392 matched women without chronic disease as a comparison cohort. Multivariate logistic regression analyses were performed for estimation. Results We found that compared with healthy mothers, MS was independently associated with a 2.25-fold risk of preterm birth (95% CI = 1.37–3.70) and a 1.89-fold (95% CI = 1.30–2.76) higher risk of babies small for gestational age, after adjusting for family income and maternal, paternal, and infant characteristics. Mothers with MS were also more likely to have cesarean deliveries. Conclusion Our study documents increased the risk of adverse pregnancy outcomes for mothers with MS, highlighting a need for more intensive monitoring and obstetric care during pregnancy. Future studies should explore the distinct manifestations and mechanisms of MS in diverse ethnic groups, so more complete information can be provided to affected women concerning pregnancy.