Neonatal Birth Outcomes Research Articles

Project20: Does continuity of care and community-based antenatal care improve maternal and neonatal birth outcomes for women with social risk factors? A prospective, observational study.

Social factors associated with poor childbirth outcomes and experiences of maternity care include minority ethnicity, poverty, young motherhood, homelessness, difficulty speaking or understanding English, migrant or refugee status, domestic violence, mental illness and substance abuse. It is not known what specific aspects of maternity care work to improve the maternal and neonatal outcomes for these under-served, complex populations. This study aimed to compare maternal and neonatal clinical birth outcomes for women with social risk factors accessing different models of maternity care. Quantitative data on pregnancy and birth outcome measures for 1000 women accessing standard care, group practice and specialist models of care at two large, inner-city maternity services were prospectively collected and analysed using multinominal regression. The level of continuity of care and place of antenatal care were used as independent variables to explore these potentially influential aspects of care. Outcomes adjusted for women's social and medical risk factors and the service attended. Women who received standard maternity care were significantly less likely to use water for pain relief in labour (RR 0.11, CI 0.02-0.62) and have skin to skin contact with their baby shortly after birth (RR 0.34, CI 0.14-0.80) compared to the specialist model of care. Antenatal care based in the hospital setting was associated with a significant increase in preterm birth (RR 2.38, CI 1.32-4.27) and low birth weight (RR 2.31, CI 1.24-4.32), and a decrease in induction of labour (RR 0.65, CI 0.45-0.95) compared to community-based antenatal care, this was despite women's medical risk factors. A subgroup analysis found that preterm birth was increased further for women with the highest level of social risk accessing hospital-based antenatal care (RR 3.11, CI1.49-6.50), demonstrating the protective nature of community-based antenatal care. This research highlights how community-based antenatal care, with a focus on continuity of carer reduced health inequalities and improved maternal and neonatal clinical outcomes for women with social risk factors. The findings support the current policy drive to increase continuity of midwife-led care, whilst adding that community-based care may further improve outcomes for women at increased risk of health inequalities. The relationship between community-based models of care and neonatal outcomes require further testing in future research. The identification of specific mechanisms such as help-seeking and reduced anxiety, to explain these findings are explored in a wider evaluation.

Oxytocin Administration in Low-Risk Women, a Retrospective Analysis of Birth and Neonatal Outcomes.

Background: In recent years, higher than the recommended rate of oxytocin use has been observed among low-risk women. This study examines the relationship between oxytocin administration and birth outcomes in women and neonates. Methods: A retrospective analysis of birth and neonatal outcomes for women who received oxytocin versus those who did not. The sample included 322 women with a low-risk pregnancy. Results: Oxytocin administration was associated with cesarean section (aOR 4.81, 95% CI: 1.80–12.81), instrumental birth (aOR 3.34, 95% CI: 1.45–7.67), episiotomy (aOR 3.79, 95% CI: 2.20–6.52) and length of the second stage (aOR 00:18, 95% CI: 00:04–00:31). In neonatal outcomes, oxytocin in labor was associated with umbilical artery pH ≤ 7.20 (OR 3.29, 95% CI: 1.33–8.14). Admission to neonatal intensive care unit (OR 0.56, 95% CI: 0.22–1.42), neonatal resuscitation (OR 1.04, 95% CI: 0.22–1.42), and Apgar score <7 (OR 0.48, 95% CI: 0.17–1.33) were not associated with oxytocin administration during labor. Conclusions: Oxytocin administration during labor for low-risk women may lead to worse birth outcomes with an increased risk of instrumental birth and cesarean, episiotomy and the use of epidural analgesia for pain relief. Neonatal results may be also worse with an increased proportion of neonates displaying an umbilical arterial pH ≤ 7.20.

Nonobstetric Abdominal Surgery During Pregnancy and Birth Outcomes: A Danish Registry-based Cohort Study

(Acta Obstet Gynecol Scand. 2020;99:469–476) When considering nonobstetric abdominal surgery during pregnancy, a balance must be found between the need for the procedure and maternal and fetal safety. A number of previous studies have helped define the risk of adverse birth outcomes in this setting. This study aims to add to the existing body of literature by examining the association between nonobstetric abdominal surgery and small-for-gestational-age (SGA) neonatal status, preterm birth, and miscarriage outcomes.

781 Association between leptin, C-Peptide, Vascular-Endothelial-Growth-Factor (VEGF), Placental-Growth-Factor (PIGF) and hypertensive disease in women with Type-2-Diabetes-Mellitus

To determine the association between maternal third trimester leptin, c-peptide, VEGF, and PIGF and hypertensive disorders of pregnancy (HDOP) among women with type 2-diabetes mellitus (T2DM). Case-control study of data from a multicenter RCT of pregnant women with T2DM randomized to insulin plus metformin or insulin alone. Women were enrolled between 10 and 23 weeks’ gestation and blood collected between 24 and 30 weeks’ gestation. We measured maternal serum leptin, c-peptide, VEGF, and PIGF levels and defined our primary outcome of hypertensive disorder of pregnancy (HDOP) as new onset systolic BP above 140, or diastolic BP above 90 at least 4 hours apart. We determined the association between third trimester maternal serum levels and HDOP, delivery, and neonatal outcomes using t-test, chi-square, and multivariable logistic regression as appropriate and considered P<0.05 statistically significant. We have data on 236 women, 84 (36%) cases and 152 (64%) controls. Compared to controls, cases were more likely to identify as African American (44.1% vs. 29.6%, p=0.03) or have chronic hypertension (33.3% vs. 19.7%, p=0.02) (Table 1). Additionally, cases delivered earlier (mean 36.2 (SD 2.6) vs. 37.0 (SD 2.7) weeks, p=0.03) and were more likely to have 5 minute APGAR <7 (31% vs. 15.8%, p=0.006). Serum leptin, c-peptide, VEGF, and PIGF were not significantly different between cases and controls (Table 1). In regression models, serum leptin, c-peptide, VEGF, or PIGF were not significantly associated with HDOP. Within the cohort overall, mothers of newborns requiring NICU admission or oxygen supplementation had significantly higher leptin levels (p=0.005, p=0.004, respectively). C-Peptide levels were significantly higher among mothers of neonates with 5 minute APGAR <7 (p=0.02) (Table 2). In women with T2DM, third trimester leptin and c-peptide levels may impact immediate neonatal birth outcomes, particularly respiratory drive. A larger sample size (n=352) would be powered to detect a leptin-mediated difference in outcomes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Maternal and neonatal anthropometric analyses: Determining birth outcomes in low-risk pregnancies at Alex Ekwueme Federal University Teaching Hospital, Abakaliki.

To assess the input of maternal and neonatal body physique anthropometries to birth outcomes. A prospective study of 177 full-term births at Alex Ekwueme Federal Teaching Hospital Abakaliki from July to December, 2019. Maternal and neonatal anthropometric parameters and birth outcomes: mode of delivery and Apgar score were considered in this study. The measurements followed the guidelines outlined by the Institute of Medicine. The prevalence of low birth weight (6.21%), cesarean delivery (14.12%), and abnormal Apgar score (9.04%) was relatively low in the study. Birth weight was dependent on maternal age, weight, body mass index, percentage body fat, and waist and hip circumference (P<0.05). Normal Apgar score at 1min after birth of male neonates was dependent on maternal BMI and neonatal head circumference whereas abnormal Apgar score in male and female neonates was dependent on maternal age and waist:hip ratio, respectively (P<0.05). Maternal and neonatal body physique anthropometries can be used to identify mothers and neonates at risk of having birth complications. This provided a practical alternative means to know the possible risk of undesirable birth outcomes with spontaneous vaginal delivery in low-risk pregnancies.

Maternal and neonatal outcomes among incarcerated women who gave birth in custody.

BackgroundIn the United States, the population of incarcerated women has increased by more than 600% since the 1980s. With this rise, correctional facilities have faced new challenges meeting the health care needs of women, especially those who are pregnant. This retrospective cohort study sought to describe five indicators of maternal and neonatal health among women who gave birth in custody, and to compare outcomes among incarcerated women who did and did not receive enhanced pregnancy support.MethodsWe used deidentified electronic health records (EHRs) to examine maternal and neonatal birth outcomes (ie, mode of birth, low birthweight, preterm birth, APGAR score, NICU admission) among women who gave birth in custody. Regression models examined differences in outcomes between women who received enhanced pregnancy support—group prenatal education and one‐on‐one doula visits—and a historical control group of women who received standard prenatal care.ResultsAdverse maternal and neonatal birth outcomes in this sample were rare. No differences in outcomes were found between incarcerated women who received enhanced pregnancy support and the historical control group.ConclusionsDespite evidence for the benefits of enhanced pregnancy support in the general population, this study did not find differences in outcomes between incarcerated women who did and did not receive support. Integrated data from prison and hospital records are innovative, but effect measurement is limited by sample size. Future research should include primary data collection on maternal, neonatal, and dyadic outcomes longitudinally and across prisons.

Maternal Opioid Abuse and Neonatal Abstinence Syndrome in the United States

In the past decade, the United States has experienced an increase in deaths related to nonmedical and medical opioid overdose. This is due to a number of factors including an increase in recreational opioid use, and the over prescription of opioids for various conditions such as during pregnancy, injury, and illness. The over utilization of opioids during pregnancy in the United States has led to an increase in adverse neonatal birth outcomes including poor fetal growth, preterm birth, stillbirth, neonatal abstinence syndrome in neonates, and an increase in maternal mortality among mothers. These are dire consequences that should not be ignored. This paper discusses opioid abuse during pregnancy and its effects on neonates in the United States. It also discusses some challenges associated with the diagnosis of neonatal abstinence syndrome and provides recommendations for addressing the issue Additionally, it discusses what mothers can do to prevent neonatal abstinence syndrome.

The Effects of Parent Ages on Birth Defects.

Men and women, in the United States, are having children at considerably older ages. This changing demographic has been associated with multiple neonatal adverse birth outcomes that are currently considered to constitute a major public health crisis. The objective of this study was to evaluate the risk of parent age on birth defects and to provide results that can serve as a starting point for more specific mediation modeling. The modeling estimated the effects of parent age on birth defects controlling for confounding between maternal and paternal age and separated the mediating effect of chromosomal disorders, including Down syndrome. Data containing approximately 15,000,000 birth records were obtained from the United States Natality database for the years 2014 to 2018. A Bayesian modeling approach was used to estimate adjusted risks of parent ages both unadjusted and adjusted for the other parent's age and for the mediational effect of chromosomal disorders, including Down syndrome. Increasing maternal age was associated with increased risks for hypospadias and cyanotic congenital heart disease. Increasing maternal and paternal ages were associated with decreasing risks for gastroschisis. For limb reduction defect, cleft lip and all defects combined, the risk of maternal age was U-shaped with the lowest risks observed at approximately age 35y. Paternal age was not associated with an increase in the birth prevalence of birth defects. Advancing maternal age was associated with increased birth prevalence of hypospadias and cyanotic congenital heart disease and associated with a lower birth prevalence for gastroschisis. Both older and younger maternal ages were related to limb reduction defect and cleft lip. Advancing paternal age was not associated with an increased birth prevalence of birth defects but was associated with a decreased birth prevalence of gastroschisis.

Electronic cigarettes may not be a \u201csafer alternative\u201d of conventional cigarettes during pregnancy: evidence from the nationally representative PRAMS data

BackgroundConventional cigarette (CC) smoking is one of the most preventable causes of adverse birth outcomes. Although electronic cigarettes (ECs) are considered to be safer than CCs during pregnancy, the evidence is yet to be presented. This study examines the effects of prenatal EC use on neonatal birth outcomes compared to those of CC smokers and complete tobacco abstainers.MethodsData was extracted from 55,251 pregnant women who participated in the Phase 8 survey of the Pregnancy Risk Assessment Monitoring System between 2016 and 2018. Participants were classified into three groups based on their smoking behaviors in the third trimester: complete tobacco abstinence, exclusive CC smoking, or exclusive EC use. Adverse outcomes included infants being small-for-gestational-age (SGA), having low birthweight (LBW), and being born at preterm. EC users were matched to complete abstainers and CC smokers who share the same baseline characteristics in race/ethnicity, age, educational attainment, income, prenatal care adequacy, and first- and second-trimester CC smoking statuses. The association between EC use and adverse birth outcomes were examined by survey-weighted logistic regression analyses in the matched population.ResultsAmong participants, 1.0% of women reported having used ECs during the third trimester, 60% of which reported using ECs exclusively. Neonates of EC users were significantly more likely to be SGA (OR 1.76; 95% CI 1.04, 2.96), have LBW (OR 1.53; 95% CI 1.06, 2.22), or be born preterm (OR 1.86; 95% CI 1.11, 3.12) compared to tobacco abstainers. However, odds of EC users’ pregnancies resulting in SGA (OR 0.67; 95% CI 0.30, 1.47), LBW (OR 0.71; 95% CI 0.37, 1.37), or preterm birth (OR 1.06; 95% CI 0.46, 2.48) were not significantly lower than those of CC smokers.ConclusionsEven after accounting for shared risk factors between prenatal tobacco use and adverse birth outcomes, EC use remains an independent risk factor for neonatal complications and is not a safer alternative to CC smoking during pregnancy. Until further research is completed, all pregnant women are encouraged to abstain from all tobacco products including ECs.

DOES TROPHECTODERM BIOPSY FOR PREIMPLANTATION GENETIC TESTING AFFECT FETAL BIRTH WEIGHT OR RATE OF PRETERM DELIVERY? A SART CORS STUDY

Preimplantation genetic testing for aneuploidy (PGT-A) is used as part of IVF treatment to select euploid embryos, and involves trophectoderm biopsy of blastocysts. The effects of possible trauma caused by biopsy of the blastocyst and implications on placental development are unknown. Therefore, the goal of our study was to evaluate if PGT-A is associated with adverse neonatal birth outcomes, including birthweight, small for gestational age (SGA), and preterm birth (PTB).

Using Electronic Health Record and Administrative Data to Analyze Maternal and Neonatal Delivery Complications

Obstetric quality of care measures have largely focused on severe maternal morbidity (SMM), with little consensus about measures of less severe but more prevalent delivery and neonatal complications. This study analyzes risk-adjusted maternal and neonatal outcomes using both ICD-10 coding and electronic health record (EHR) data. Complication rates at seven health system hospitals from January 2016 to August 2019 were analyzed. EHR data and ICD-10 codes were used to identify the incidence of SMM as well as other route-specific maternal and neonatal complications. Researchers tested the association of maternal sociodemographic and clinical risk markers with the likelihood of maternal and neonatal complications using multiple logistic and Poisson regression. Among 42,681 deliveries, the SMM rate was 1.3%, and other complication rates were 12.9% for vaginal and 19.7% for cesarean deliveries. The neonatal complication rate was 20.2%. Risk factors for all complications included multiple gestation and hypertensive disorders of pregnancy. Risk factors for SMM included nulliparity, cesarean delivery, and preexisting conditions; risks for neonatal complications included academic medical center admission, cesarean delivery, higher maternal body mass index, and preterm birth. There were significant racial disparities in maternal and neonatal outcomes. This study is among the first to combine EHR and administrative discharge data to describe a wide range of maternal and neonatal birth outcomes, including associations with established risk factors. Although SMM was rare, route-specific and neonatal complications were much more common and may offer a better focus for obstetric quality improvement efforts.

Calcium, Phosphorus, and Niacin Intakes During Late Pregnancy Are Positively Associated with Maternal Bone Mineral Density: A Pilot Study

Abstract Objectives The adequate calcium intake during pregnancy on postpartum bone mineral density (BMD) and neonatal outcomes are unknown as results of recent intervention trials are inconsistent. We investigated the relationship between maternal nutrient intake and maternal BMD at delivery, newborn birth outcomes, and maternal bone loss during lactation in Korean mothers. Methods Thirty Korean pregnant women (mean age: 34 years) were enrolled before delivery. Maternal food and supplement intake and BMD were assessed twice: at delivery (T1) and at weaning or 6 months postpartum (T2). Third trimester and postpartum food intake was assessed by food frequency questionnaire at T1 and T2, respectively, and analyzed for intake of calcium and 22 major nutrients. Calcium intake was assessed as a continuous variable or categorized as &amp;lt; or ≥500 mg/d. Maternal lumbar spine (LS), femoral neck (FN), trochanter, and intertrochanter BMD were measured by dual energy X-ray absorptiometry. Birth length, birth weight, and head circumference of neonates were collected. Participants were categorized according to duration of lactation. General linear models were adjusted for covariates. Results Mean ± STD calcium intake was 905 ± 430 mg/d at T1 and 608 ± 227 at T2 (change: P = 0.05). Women with calcium intakes &amp;lt;500 mg/d had lower LS BMD at T1 (P = 0.026). No difference was detected at other study sites. Phosphorus and niacin intakes during the third trimester were positively correlated with T1 LS BMD (ß: 0.162 and 0.088, respectively; both P &amp;lt; 0.05). Birth weight and head circumference were negatively associated with T1 iron intake(ß: −9.065 and −0.0292, respectively; both P &amp;lt; 0.05). Intake of other nutrients during late pregnancy were not associated with maternal T1 BMD or neonatal outcomes. Among the 10 participants that completed the second visit, 6 women breastfed. Postpartum bone change was not associated with breastfeeding. Energy intake at T2 was negatively associated with change in FN BMD (ß: −0.007, P &amp;lt; 0.001). Postpartum intake of other nutrients was not associated with change of BMD at any site. Conclusions Intakes of calcium, phosphorus, and niacin during the third trimester are positively associated with maternal LS BMD, but not neonatal birth outcomes, in Koreans. Breastfeeding and postpartum calcium intake may not affect bone after birth. Funding Sources National Research Foundation of Korea.

Adolescent Trichomonas vaginalis in a High-burdened Region of the Southern United States.

We evaluated the clinical management and risk factors for Trichomonas vaginalis-positive adolescents in upstate South Carolina. An Epic electronic medical record report was generated to identify any physician-ordered T. vaginalis test from February 2016 to December 2017 for patients aged 12 to 18 years within the Prisma Health Upstate system. Utilizing a case-control study design of patients with a documented T. vaginalis diagnostic result, we reviewed records of patients with physician-ordered T. vaginalis tests for demographics, clinical disease course, sexually transmitted infection test results, treatment order and dosage, infection risk factors, comorbidities, pregnancy term, and neonatal birth outcomes. Of 789 male and female adolescents with physician-ordered T. vaginalis tests, 44% had a documented result. Of those with a document test result, 13% were T. vaginalis positive. Cases (n = 45) and randomly selected negative controls (n = 45) were all girls. Cases were more likely to be African American, symptomatic, and present with vaginal discharge, pain, and vulvar itch. T. vaginalis patients were more likely to have documented histories of chlamydia (P < 0.0001) and gonorrhea (P = 0.0191), with 18% having concurrent triple infections (T. vaginalis, chlamydia, and gonorrhea). All 26 pregnant girls with T. vaginalis delivered full-term, healthy infants. We identified a disproportionally high burden of T. vaginalis infection, with an alarmingly high rate of triple infections, among a population of suspected high-risk adolescents. Our results indicate the need to clarify infection prevalence, develop pediatrician-focused education campaigns, and elucidate potentially modifiable risk factors for these high-risk patients.

Perinatal Outcomes in a Longitudinal Birth Cohort of First Nations Mothers With Pregestational Type 2 Diabetes and Their Offspring: The Next Generation Study

ObjectivesThere is emerging evidence that First Nations women with diabetes in pregnancy and their offspring have poorer health outcomes than non-First Nations women. The aim of this study was to describe the perinatal outcomes of pregnancies complicated by type 2 diabetes. MethodsThe Next Generation longitudinal study is a First Nations birth cohort of children born to mothers diagnosed in childhood with type 2 diabetes. Pregnant women were prospectively enrolled in the birth cohort, and a review of medical records (including stored fetal ultrasound images) was performed to determine perinatal outcomes for 112 child-mother pairs between 2005 and 2015. Maternal demographics, antenatal variables, fetal ultrasound findings, obstetric and delivery information and neonatal birth outcomes were collected and analyzed. ResultsMothers in our cohort were young and most were overweight at the start of pregnancy. Most had suboptimal glycemic control in the first trimester (median glycated hemoglobin, 9.3%). The cesarean section rate was high at 41%. Over one-half of newborns had macrosomia at birth, and almost 1 in 5 were born with a structural anomaly, mainly renal. Fetal ultrasound significantly underestimated the proportion of infants born with macrosomia (p<0.05) and missed 3 of 7 cardiac defects in this cohort. ConclusionsHigh rates of anomalies, macrosomia and cesarean deliveries provide insight into pregnancy management and disease processes for First Nations women with pregestational type 2 diabetes and their offspring, and highlights opportunities for improvement in prenatal care of these women.

The changing situation about maternal age, risk factors and pregnancy outcomes after the two-child policy: a retrospective cohort study.

To evaluate the relationship between gestational age, risk factors, pregnancy outcomes, and the causes and trends of the changes in the incidence of pregnancy in different years after the two-child policy. The study enrolled all of the childbirth women (n=7,016) from January 1st, 2015 to December 31th, 2017 in the Zhujiang Hospital. According to the age of all childbirth women, they were divided into four groups: ≤24, 25-29, 30-34 and ≥35 years old. While 20-29 years old group regarded as the control group (OR =1). Pregnancy complications and outcomes data of 4 groups were collected. χ 2 test and binarylogistic regression used as the analyze method. Stratified chi-square used to compare the rates between the pregnancy risk factors, childbirth modes and pregnancy outcomes in different years, which may be affected by the age. Compared with the other groups, women in ≥35 years old showed the highest incidences of chronic medical complications and pregnancy induced complications, so as the abnormal neonatal birth outcomes. While women in ≤24 years old displayed a high risk of preeclampsia. After the childbearing policy change, the maternal age ratio increased year by year. The incidences of various risk factors, delivery modes and adverse pregnancy outcomes were also changed between different years and different age groups. The differences of annual incidence showed a statistical significance besides oligohydramnios. The study indicated that the changes in childbearing policy lead to the changes of age distribution proportion, which finally caused the changes of risk factors incidence. Furthermore, the advance of medical technology and society also affected the changes of pregnancy risk factors, delivery modes and the pregnancy outcomes in different years.

Impact of Perinatal Depression and Anxiety on Birth Outcomes: A Retrospective Data Analysis.

During the perinatal period, 10-20% of women experience anxiety and/or depression. Untreated perinatal depression has the potential for adverse effects on the family and infant resulting in long-term deleterious consequences. This study measured the association between self-reported depression using the Edinburgh Postnatal Depression Scale scores, self-reported anxiety and neonatal birth outcomes. A retrospective design was used with ObstetriX™ data retrieved from 16 metropolitan and rural hospitals in NSW, Australia during 2009-2014. Data were available for 53,646 singleton births. The Edinburgh Postnatal Depression Scale was used to identify self-reported depression while women self-reported pregnancy related anxiety. Regression modelling measured the effects of self-reported depression and self-reported pregnancy related anxiety on neonatal birth outcomes. Linear regression and logistic regression were used to model the effect on birth weight, gestational age, admission to NICU or the SCN, outcome (stillborn vs livebirth), and Apgar scores. Cox proportional hazards regression was used to estimate the effect on neonatal length of stay. Babies born to women self-reporting anxiety were more likely to have birth complications, be admitted to the nursery, had lower Apgar scores and longer hospital stays. Babies born to women self-identifying as experiencing a level of depression were more likely to have a lower birth weight, shorter gestational age, and, lower Apgar score. These babies were more likely to be admitted to the nursery with an increased length of stay. Perinatal anxiety and depression contribute to poor birth outcomes. Early detection of maternal perinatal anxiety and depression is an important step towards treatment interventions. More research is needed to identify models of care that are effective in identifying and managing perinatal depression and anxiety to improve birth outcomes for women and their babies.

Assessment of an Updated Neonatal Research Network Extremely Preterm Birth Outcome Model in the Vermont Oxford Network

The Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network (NRN) extremely preterm birth outcome model is widely used for prognostication by practitioners caring for families expecting extremely preterm birth. The model provides information on mean outcomes from 1998 to 2003 and does not account for substantial variation in outcomes among US hospitals. To update and validate the NRN extremely preterm birth outcome model for most extremely preterm infants in the United States. This prognostic study included 3 observational cohorts from January 1, 2006, to December 31, 2016, at 19 US centers in the NRN (derivation cohort) and 637 US centers in Vermont Oxford Network (VON) (validation cohorts). Actively treated infants born at 22 weeks' 0 days' to 25 weeks' 6 days' gestation and weighing 401 to 1000 g, including 4176 in the NRN for 2006 to 2012, 45 179 in VON for 2006 to 2012, and 25 969 in VON for 2013 to 2016, were studied. VON cohorts comprised more than 85% of eligible US births. Data analysis was performed from May 1, 2017, to March 31, 2019. Predictive variables used in the original model, including infant sex, birth weight, plurality, gestational age at birth, and exposure to antenatal corticosteroids. The main outcome was death before discharge. Secondary outcomes included neurodevelopmental impairment at 18 to 26 months' corrected age and measures of hospital resource use (days of hospitalization and ventilator use). Among 4176 actively treated infants in the NRN cohort (48% female; mean [SD] gestational age, 24.2 [0.8] weeks), survival was 63% vs 62% among 3702 infants in the era of the original model (47% female; mean [SD] gestational age, 24.2 [0.8] weeks). In the concurrent (2006-2012) VON cohort, survival was 66% among 45 179 actively treated infants (47% female; mean [SD] gestational age, 24.1 [0.8] weeks) and 70% among 25 969 infants from 2013 to 2016 (48% female; mean [SD] gestational age, 24.1 [0.8] weeks). Model C statistics were 0.74 in the 2006-2012 validation cohort and 0.73 in the 2013-2016 validation cohort. With the use of decision curve analysis to compare the model with a gestational age-only approach to prognostication, the updated model showed a predictive advantage. The birth hospital contributed equally as much to prediction of survival as gestational age (20%) but less than the other factors combined (60%). An updated model using well-known factors to predict survival for extremely preterm infants performed moderately well when applied to large US cohorts. Because survival rates change over time, the model requires periodic updating. The hospital of birth contributed substantially to outcome prediction.

Outcomes of Pregnancies Affected by Gestational Diabetes and Type 2 Diabetes in a Rural First Nations Obstetrical Program in Northwest Ontario

ObjectivesIn this work, we describe diabetes prevalence and birth outcomes in a primarily First Nations obstetrical population in northwest Ontario. MethodsThis retrospective, observational study of maternal and neonatal characteristics and birth outcomes was performed at the Sioux Lookout Meno Ya Win Health Centre between April 1, 2012 and March 31, 2017. ResultsThe prevalence of pre-existing type 2 diabetes mellitus was 3.7% and gestational diabetes mellitus was 7.9%. Mothers with diabetes, compared to those without diabetes, were, on average, 5 years older and were of greater parity. Average prepregnancy weight was higher, with an increased incidence of hypertension, inductions and caesarean sections. Neonates had increased incidence of macrosomia, hypoglycemia and hyperbilirubinemia. All maternal cohorts had high rates of alcohol, tobacco and illicit opioid use. ConclusionsWe have identified a high prevalence of diabetes in this First Nations obstetrical population, with associated adverse maternal and neonatal outcomes.

Trajectories of antenatal maternal psychological stress and their association with gestational age and neonatal anthropometry: A prospective cohort study of multi-ethnic Asian women in an urban setting.

To determine common temporal change patterns (i.e., trajectories) of perceived antenatal psychological stress throughout the pregnancy, and to examine associations between these identified trajectories and neonatal birth outcomes. 926 participants from a prospective cohort study of multi-ethnic Asian women from an urban setting with uncomplicated singleton pregnancies completed the Perceived Stress Scale in their first, second, and third trimesters, and just prior to parturition. Gestational age, neonatal weight, length, and head circumference were recorded at birth. Longitudinal trajectories of antenatal psychological stress were characterized with group-based trajectory modelling; associations between trajectories and neonatal outcomes were assessed with analyses of covariance and covariate-adjusted linear regressions. Three distinct non-fluctuating trajectories of antenatal psychological stress were identified, with 43 % of women experiencing significant levels of stress throughout the pregnancy. Women in this persistently-higher stress trajectory delivered neonates who were 57.5 g lighter and with head circumferences of 20 mm less than their counterparts in the other trajectories. Each one-point increase on the Perceived Stress Scale was associated with a decrease of 5.64 g in birthweight and a decrease of 0.4 mm in head circumference. This study delineated three meaningful trajectories of antenatal psychological stress. The persistently-higher antenatal psychological stress trajectory, experienced by two in five women, was associated with lower birthweight and possibly smaller head circumference. While further research is needed to better appreciate the clinical relevance of these findings, it highlights the importance of psychosocial support even for healthy pregnant women with uncomplicated pregnancies in Asian settings.

When to Consider Episiotomy at Vaginal Birth

After the recommendation that episiotomy only be used when necessary to improve maternal or neonatal birth outcomes, U.S. episiotomy rates fell from