Odds Of Adverse Pregnancy Outcomes Research Articles

Correlates of adverse outcomes of adolescent pregnancy in Sidama region, Ethiopia. An unmatched case-control study

IntroductionAdolescent pregnancy has received little attention, despite being it is the leading cause of maternal mortality and morbidity in low-income countries, including Ethiopia. Sidama regional state is one of the regions in Ethiopia that has high rates of adolescent pregnancy. This study aimed to identify factors related to adverse outcomes of adolescent pregnancy, in the Sidama region, Ethiopia. MethodsA hospital-based unmatched case-control study was conducted among 120 cases and 240 controls of pregnant adolescents. Structured interviews and patient record reviews were used to examine the potential correlates and adverse outcomes of adolescent pregnancy. Using binary logistic analysis, adjusted odds ratio (AOR) with 95% confidence intervals, were computed to identify factors related to adverse outcomes of adolescent pregnancies. ResultsA monthly income below the poverty level (AOR: 3.40; 95% CI, 1.21–9.58), lack of antenatal care follow-up (AOR: 4.22; 95% CI, 1.97–9.04), experiencing gender-based violence (AOR: 2.03; 95% CI, 1.16–3.57), and referral to a specialized health facility (AOR: 2.79; 95% CI,1.39, 5.62) were associated with higher odds of adverse pregnancy outcomes. ConclusionSeveral socio-economic and health care system-related determinants are associated with adverse outcomes of adolescent pregnancy. Therefore, it is crucial to improve free and accessible maternal health care services for adolescents, focusing on education, challenging social norms that condone gender-based violence as well as enhancing the referral system to lessen the burden of adverse outcomes of adolescent pregnancy.

Adverse Pregnancy Outcomes of Cervical Cerclage According to the Indications [ID: 1363547

INTRODUCTION: The objective of this study was to examine pregnancy outcomes of patients who underwent cervical cerclage according to cerclage indications. METHODS: This was a retrospective cohort study of patients with a singleton pregnancy who underwent cervical cerclage from 2014 to 2020 at a single academic institution. Patients were categorized according to cervical cerclage indications (history-indicated, ultrasound-indicated [cervical length 1–2.4 cm versus less than 1 cm], and physical exam indicated cerclage). Our primary outcome was spontaneous preterm delivery before 37 weeks of gestation. Outcomes were compared according to cervical cerclage indications. Multivariable logistic regression models were used to calculate adjusted odds ratios (aORs) and 95% CI, adjusting for a history of preterm delivery. Our IRB approved this analysis. RESULTS: Of 501 patients, 240 (47.9%), 115 (23.0%), 50 (10.0%), and 96 (19.2%) had a history-indicated, ultrasound-indicated (1–2.4 cm), ultrasound-indicated (<1 cm), and physical exam-indicated cerclage, respectively. Rates of preterm delivery were statistically different according to the indications. Compared to history-indicated cerclage, physical exam-indicated cerclage was associated with spontaneous preterm delivery (adjusted odds ratio [aOR] 3.97, 95% CI 2.27–6.97), preterm delivery (aOR 3.48, 95% CI 2.23–5.96), spontaneous preterm delivery less than 34 weeks (aOR 5.60, 95% CI 2.92–10.74), and neonatal demise or stillbirth (aOR 3.18, 95% CI 1.35–7.50). Compared to history-indicated cerclage, ultrasound-indicated cerclage (1–2.4 cm) was associated with preterm delivery (aOR 1.70, 95% CI 1.07–2.72) and neonatal intensive care unit (NICU) admission (aOR 1.81, 95% CI 1.11–2.96). Compared to history-indicated cerclage, ultrasound-indicated cerclage (<1 cm) was associated with spontaneous preterm delivery less than 34 weeks (aOR 2.46, 95% CI 1.02–5.94) and NICU admission (aOR 2.51, 95% CI 1.23–3.36). CONCLUSION: Compared to history-indicated cerclage, other cerclage indications were associated with increased odds of adverse pregnancy outcomes.

Allostatic Load and Adverse Pregnancy Outcomes

ABSTRACT Approximately one-fourth of pregnancies experience adverse pregnancy outcomes, such as hypertensive disorders of pregnancy (HDPs), preterm birth, stillbirth, and small-for-gestational age (SGA) neonates. Although an uncertain pathophysiology leading to these outcomes of pregnancy is understood, a major contributing factor may be cumulative stress. Chronic wear and tear on the adaptive system of the body, as well as chronic stress exposure, can be assessed via allostatic load. Chronic stress hailing from circumstances such as food or housing insecurity, racism, unemployment, or a combination of these may contribute to the racial and ethnic disparities observed in pregnancy outcomes. This study aimed to assess the relationship between the allostatic load and adverse pregnancy outcomes, while hypothesizing that higher odds of adverse pregnancy outcomes are directly associated with higher allostatic loads. Second, the authors hypothesized that a significant portion of racial and ethnic disparities in adverse pregnancy outcomes will be accounted for with high allostatic loads. The primary outcome was a composite adverse pregnancy outcome: HDPs, SGA, preterm birth, and stillbirth. Between October 2010 and September 2013, the nuMoM2b study (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be) enrolled 10,038 nulliparous individuals with singleton pregnancies. Eligible individuals were nulliparous, had a viable single gestation with an estimated gestational age of 60/7 and 136/7 weeks, and intended delivery at a participating clinical site. Exclusionary criteria were as follows: unable to provide informed consent, age younger than 13 years, planned termination of pregnancy, 3 or more prior pregnancy losses, fetal malformations or aneuploidy upon enrollment, or having a donor ovum pregnancy. Included within the study were 3 study visits during pregnancy and a final visit at delivery. Baseline clinical assessments, standardized questionnaires by trained chart abstracts, and medical record abstraction were used to ascertain maternal characteristics. Assessment of urine and serum collected between 6 and 14 weeks granted insight into allostatic load biomarkers. A total of 4266 pregnant individuals were included in the primary analysis, with high allostatic load being identified in 35% of the population (≥4 biomarkers in the worst quartile). Some 1171 individuals (27.5%) were identified to have adverse pregnancy outcomes: 386 preterm births (8.6%), 586 HDPs (14.0%), 12 stillbirths (0.3%), and 449 SGA neonates (11%). Adverse pregnancy outcomes occurred in the following numbers: 1 adverse outcome for 967 individuals, 2 for 165, 3 for 38, and 1 for all 4. High allostatic load held significant association with composite adverse pregnancy outcome, whereas HDPs differed by self-reported race. After adjustment for maternal age, gravidity, smoking, bleeding in the first trimester, and health insurance, high allostatic load was associated with the composite adverse pregnancy outcome (adjusted odds ratio [aOR], 1.5; 95% confidence interval [CI], 1.3–1.7) and hypertensive disorders (aOR, 2.5; 95% CI, 2.0–2.9), but not preterm birth or SGA. High allostatic load only partially mediated the association between self-reported race and adverse pregnancy outcomes. The association between allostatic load and hypertensive disorders differed by self-reported race, but it did not differ for the composite adverse pregnancy outcome, preterm birth, or SGA. Limitations of the study included the small number of stillbirths. Furthermore, the study used the 10-factor allostatic load index and did not assess additional cardiovascular and metabolic indicators in the broader allostatic load index. In addition, the cohort only included nulliparous individuals with tertiary care center access, which is not necessarily generalizable to other populations. Strengths of the study included its use of a large, well-characterized prospective cohort, as well as equal weighing of allostatic load biomarkers and a study population that was racially, ethnically, and geographically diverse. In conclusion, the study indicates that early-pregnancy high allostatic loads are associated with subsequent adverse pregnancy outcomes (HDPs in particular). Allostatic load was also a partial mediator between adverse pregnancy outcomes and race. Further evaluation of components of chronic stress and allostatic load as potentially modifiable risk factors is supported by these findings as a means of improving pregnancy outcomes via these potentially modifiable risk factors.

Title: Is Mild Idiopathic Polyhydramnios Associated with an Increased Risk for an Intrauterine Fetal Demise? A Retrospective Cohort Study.

Antenatal fetal surveillance has been recommended for moderate/severe idiopathic polyhydramnios but not for mild idiopathic polyhydramnios. The purpose of this study is to determine if pregnancies with mild idiopathic polyhydramnios have an increased risk for an intrauterine fetal demise (IUFD). Medical records and amniotic fluid volume ultrasound data from 2016 to 2021 at a university medical center were examined. Pregnancies with fetal anomalies, fetal infection, isoimmunization, multiple gestation, maternal diabetes and oligohydramnios were excluded. Normal amniotic fluid volume was defined as an amniotic fluid index (AFI) <24 cm which was compared to mild idiopathic polyhydramnios, AFI of ≥24.0 cm-29.9 cm, and moderate/severe polyhydramnios which is an AFI ≥30 cm. Of 12,725 patients meeting inclusion study criteria, there were 249 with idiopathic polyhydramnios (n = 249) which was associated with an increased odds of IUFD (aOR) of 3.27 (CI 1.50-7.15), NICU admission (aOR 1.28, CI 0.96-1.70), 5-minute APGAR score less than 7 (aOR 2.16, CI 1.52-3.07), and large for gestational age infant (LGA) (aOR 4.04, CI 2.83-5.78) compared to normal amniotic fluid volume (AFV). In the mild polyhydramnios group (n = 204, out of the 249 women with polyhydramnios) compared to the 12,476 pregnancies with normal AFV group, IUFD (aOR 3.38, CI 1.46-7.82), NICU admission (aOR 1.19, CI 0.87-1.64), 5-minute APGAR score less than 7 (aOR 1.68, CI 1.10-2.55) and LGA (aOR 3.87, CI 2.59-5.78). In moderate/severe polyhydramnios group (n = 45) compared to the normal AFV group, there was no increased odds of IUFD (aOR 2.78, CI 0.38-20.29) or NICU admission (aOR 1.74, CI 0.93-3.26) but an increased odds for a 5-minute APGAR score less than 7 (aOR 4.94, CI 2.57-9.53) and LGA fetus (aOR 4.80, CI 2.26-10.22). There is an increased odds of IUFD in pregnancies complicated by mild idiopathic polyhydramnios. Patients should be counseled on an increased odds of adverse pregnancy outcomes associated with idiopathic polyhydramnios, and in those pregnancies with mild idiopathic polyhydramnios, antenatal fetal surveillance should be considered.

In Vitro Fertilization and Adverse Pregnancy Outcomes in the Elective Single Embryo Transfer Era.

Our objective was to estimate the association between in vitro fertilization (IVF) pregnancy and adverse pregnancy outcomes during delivery hospital admission in a contemporary, nation-wide cohort of births in the United States. This retrospective, population-based cohort study used the National Inpatient Sample database to identify patients discharged from the hospital following delivery from 2014 to 2019. IVF pregnancies were identified using the International Classification of Disease-Revision 9/10 codes. Crude and adjusted odds ratios of preterm birth and other clinically significant adverse pregnancy outcomes were evaluated using multivariable logistic regression models. Trends in preterm birth and multiple pregnancy were estimated over the study period. The contribution of multiple pregnancy to preterm birth in IVF pregnancy was estimated in a mediation analysis. Among 4,451,667 delivery-related discharges, IVF pregnancies were associated with 3.25 times the odds of preterm birth (95% confidence interval [CI]: 3.05-3.46, p < 0.001) compared with non-IVF pregnancy deliveries. Odds of preterm birth in IVF pregnancy delivery discharges decreased over the study period (p-value for linear trend = 0.009). The proportion of multiple pregnancies decreased in IVF pregnancy delivery discharges but remained stable in non-IVF pregnancy deliveries. The proportion of the adjusted effect of IVF pregnancy on preterm birth mediated through multiple pregnancy was 67.6% (95% CI: 62.6-72.7%). While the odds of adverse pregnancy outcomes are increased compared with non-IVF pregnancies, the odds of preterm birth and multiple gestation have decreased among IVF pregnancies in the United States. · Pregnancies conceived by in vitro fertilization (IVF) are at significantly higher risk of multiple gestation, preterm birth, and other pregnancy complications.. · Recent guidelines for artificial reproductive treatments recommend single-embryo transfer in IVF.. · Using population-wide data, we demonstrate a significant gradual decline in the rates of preterm birth and other pregnancy complications following IVF in the last decade, mostly mediated by a reduction in multiple pregnancies..

Nonalcoholic Fatty Liver Disease and Adverse Pregnancy Outcomes in Women With Normal Prepregnant Weight.

Existing studies focusing on the effects of nonalcoholic fatty liver disease (NAFLD) combined with normal prepregnant weight on pregnancy outcomes are limited. This study aimed to explore the relationship between maternal NAFLD and adverse pregnancy outcomes in different body mass index (BMI) groups. Using an antenatal care and delivery database, we retrospectively analyzed women who delivered in Minhang Hospital affiliated to Fudan University, Shanghai, China from January 1, 2013, to June 30, 2020. NAFLD was confirmed by ultrasound in early pregnancy. A logistic regression model with adjustment for confounders was used to examine potential associations between NAFLD and pregnancy outcomes. A total of 14 708 pregnant women (mean prepregnant BMI 21.0 [SD, 2.8] kg/m2) were included in our final study, of whom 554 (3.8%) had NAFLD. After fully adjusting for potential confounders, NAFLD significantly increased the risk of gestational diabetes mellitus (adjusted odds ratio 2.477; 95% CI, 1.885-3.254), gestational hypertension (3.054; 2.191-4.257), preeclampsia/eclampsia (3.994; 2.591-6.005), cesarean section (1.569; 1.315-1.872), preterm births (1.831; 1.229-2.727), and macrosomia (1.691; 1.300-2.198). It is notable that 83.9% (12 338) of women were of normal weight at the start of pregnancy (prepregnant 18.5 ≤ BMI < 24 kg/m2), and they still had higher odds of adverse pregnancy outcomes. Women with NAFLD and a normal weight have a higher risk for adverse pregnancy outcomes. Pregnant women with NAFLD, regardless of obesity status, should be offered a more qualified surveillance to optimize pregnancy outcomes.

P-790 Mode of conception and pregnancy outcomes: systematic review and meta-analysis of 110 studies and 33,655,021 singleton pregnancies

Abstract Study question Does mode of conception such as in-vitro fertilisation (IVF), ovulation induction (OI), intra-uterine insemination (IUI) affect singleton pregnancy outcomes when compared to spontaneous conception (SC)? Summary answer Singleton pregnancies resulting from OI, IUI, IVF are associated with higher risks of adverse pregnancy outcomes compared to spontaneous pregnancies. What is known already Several meta-analysis have shown singleton pregnancies resulting from IVF have adverse pregnancy outcomes However, these studies had much smaller sample size and did not compare OI or IUI to SC. Additionally, when matched studies were analysed, the pooled events used were not adjust for medical conditions such as polycystic ovaries (PCO) and chronic hypertension which predispose patients to gestational diabetes(GDM) and pre-eclampsia (PET).he lack of consensus on how PET and GDM was defined was also a cause of bias. Our study is the largest meta-analysis to date and aims to provide clinician with the latest evidence when offering fertility treatment. Study design, size, duration Literature search in MEDLINE, COCHRANE Library, and Scopus was performed, up to November 2021. Randomised controlled trials (RCTs), non-randomised studies, cohort and case control studies, reporting on any association between pregnancy outcome, such as pre-eclampsia (PET), gestational diabetes mellitus (GDM), preterm birth, (&amp;lt;37 weeks (TB), very preterm birth , (&amp;lt;32 weeks (vVPTB), low birthweight (&amp;lt;2500g,LBW), very low birth weight (&amp;lt;1500g,VLBW) and small gestational age (SGA) in relation to mode of conception were included. Participants/materials, setting, methods 110 studies consisting of 31 cohort studies and 79 case control were included comprising a total of 32,463,058spontaneous singleton conception compared to 1,191,963 singleton pregnancies following OI, IUI and IVF treatment .Matching criteria used for adjustment were also identified For PET and GDM, only studies which defined the condition according to international agreed consensus were included Any inconsistency between studies was quantified through Higgins’ Chi-square (Chi2) and I-squared (I2) using statistical software R. Main results and the role of chance Singleton pregnancies following, OI, IUI, or IVF had a higher odds of PET compared to SC (odds ratio [OR]1.95,, 95% confidence interval [CI]1.61-2.31; I2=97%), OR 1.53, 95%CI 1.36 -1.71,, I2=84% and OR1.62, 95%CI 0.94-2.78, I2=11%).respectively. For GDM, pregnancies following, OI, IUI, or IVF had a higher odds compared to SC (OR1.59, 95%CI 1.59 -1.71, I2=83%, OR 1.62, 95%CI 0.94-2.78, I2=11% and OR1.72, 95% CI 1.49–1.98; I2=13%). Higher odds of TB and vPTB were seen in pregnancies following OI and IVF compared to SC (PTB: OR1.80, 95% CI 1.76–1.85; I2=94% and , (OR 1.47, 95% CI 1.22-1.77 I2=66% and vPTB OR 2.92, 95% CI 2.76-3.09; I2=91%). Only one study reported PTB when comparing IUI to SC (OR 1.88, 95% CI 1.40-2.53) and comparing vPTB in OI vs SC (OR 1.73 95% CI 0.71-4.18). Singleton pregnancies following, OI or IVF had a higher odds of LBW and vLBW compared to SC (OR1.98, 95% CI 1.93–2.04; I2=96%),OR1.72, 95% CI 1.49–1.98 I2=13% and OR4.57, 95% CI 4.34–4.81; I2=98% and OR2.32, 95% CI 1.60–3.37; I2=56% respectively. The rate of SGA was comparable in IVF (OR 0.91, 95% CI 0.90–0.93; I2=99%), OI (OR 0.96, 95% CI 0.95-0.97; I2=100%) and IUI (RR 0.92, 95% CI 0.90–0.94; I2=31%). Limitations, reasons for caution In cases of PE and GDM, published definitions differed in various studies and there was limited information given past medical history which increase the risk of such conditions. This made it impossible to separate the baseline confounders which may increase the risk of PE and consequently PTB, SGA and LBW. Wider implications of the findings Our meta-analysis confirmed that IVF/ICSI pregnancies are at higher odds of adverse pregnancy outcomes. This is the largest systematic review to date analysing pregnancy outcomes and mode of conception comparing OI, IUI and IVF respectively. It provides the latest evidence possible for clinicians to choose the safest fertility treatment, Trial registration number Not applicable

A Cluster Randomized Noninferiority Field Trial of Gestational Diabetes Mellitus Screening

Although it is well-acknowledged that gestational diabetes mellitus (GDM) is associated with the increased risks of adverse pregnancy outcomes, the optimal strategy for screening and diagnosis of GDM is still a matter of debate. This study was conducted to demonstrate the noninferiority of less strict GDM screening criteria compared with the strict International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria with respect to maternal and neonatal outcomes. A cluster randomized noninferiority field trial was conducted on 35 528 pregnant women; they were scheduled to have 2 phases of GDM screening based on 5 different prespecified protocols including fasting plasma glucose in the first trimester with threshold of 5.1 mmol/L (92 mg/dL) (protocols A, D) or 5.6 mmol/L (100 mg/dL) (protocols B, C, E) and either a 1-step (GDM is defined if one of the plasma glucose values is exceeded [protocol A and C] or 2 or more exceeded values are needed [protocol B]) or 2-step approach (protocols D, E) in the second trimester. Guidelines for treatment of GDM were consistent with all protocols. Primary outcomes of the study were the prevalence of macrosomia and primary cesarean section (CS). The null hypothesis that less strict protocols are inferior to protocol A (IADPSG) was tested with a noninferiority margin effect (odds ratio) of 1.7. The percentages of pregnant women diagnosed with GDM and assigned to protocols A, B, C, D, and E were 21.9%, 10.5%, 12.1%, 19.4%, and 8.1%, respectively. Intention-to-treat analyses satisfying the noninferiority of the less strict protocols of B, C, D, and E compared with protocol A. However, noninferiority was not shown for primary CS comparing protocol E with A. The odds ratios (95% CI) for macrosomia and CS were: B (1.01 [0.95-1.08]; 0.85 [0.56-1.28], C (1.03 [0.73-1.47]; 1.16 [0.88-1.51]), D (0.89 [0.68-1.17]; 0.94 [0.61-1.44]), and E (1.05 [0.65-1.69]; 1.33 [0.82-2.00]) vs A. There were no statistically significant differences in the adjusted odds of adverse pregnancy outcomes in the 2-step compared with the 1-step screening approaches, considering multiplicity adjustment. The IADPSG GDM definition significantly increased the prevalence of GDM diagnosis. However, the less strict approaches were not inferior to other criteria in terms of adverse maternal and neonatal outcomes.

Abstract 10537: Clinical, Sociodemographic and Neighborhood Characteristics and Adverse Pregnancy Outcomes

Introduction: Adverse pregnancy outcomes (APOs) are risk enhancing factors for future cardiovascular (CV) disease. Our study aims to understand the clinical, sociodemographic and neighborhood factors of patients who suffered APOs in our health system. Methods: We performed a retrospective analysis of 66,136 single-gestation pregnancies from 7 hospitals in the Northwell Health System between March 2018 and June 2020. Pregnancies with known APO status were included in final analysis (n=64,804). Data extracted from EHR included demographics, parity, insurance, hospital of delivery, medical history, and APO outcomes: pre-term birth (PTB), stillbirth (SB), small for gestational age (SGA) and low birth weight (LBW). Median neighborhood household income, percent unemployed, and household size (extracted from census data based on zip code) were used to represent the mean demographics of those living within certain geographic regions. Results: In our study population, the average ±SD age was 31.4 ±5.4 years; 46.9% were white, 12.4% were black, 12.4% were Asian and 52.3% were overweight or obese. The composite incidence of SB, SGA and LBW was 13.8% while incidence of PTB was 7.2%. Being single or having public health insurance had an increased odds of overall APOs, OR 1.4 (95%CI 1.3-1.4) and OR 1.3 (95%CI 1.2-1.3), respectively. Median neighborhood household income was significantly associated with odds of APOs, with lower income categories having increased odds of APOs and odds of PTB compared to higher income categories. Those with a hypertensive disorder (HTN) (during or pre-pregnancy) had increased odds of having an APO compared to those without, OR 2.2 (95%CI 2.1-2.4). Those with HTN, glucose intolerance or obesity (pre-pregnancy BMI ≥ 40) during or pre-pregnancy had increased odds of a PTB compared to those without any of these conditions, OR 3.6 (95%CI 3.4 - 3.9), OR 1.7(95%CI 1.6-1.9) and OR 1.9 (95%CI 1.7-2.2), respectively. Conclusions: CV risk factors, sociodemographic and neighborhood characteristics are likely associated with APOs. These potential relationships may provide useful information for CV prevention in pregnancy. Future research is needed to further elucidate these associations.

Association between neighbourhood deprivation, fetal growth, small-for-gestational age and preterm birth: a population-based prospective cohort study

ObjectiveTo study the associations between neighbourhood deprivation and fetal growth, including growth in the first trimester, and adverse pregnancy outcomes.DesignProspective cohort study.SettingThe Netherlands, Rotterdam.Participants8617 live singleton births from the Generation...

1332Endometriosis, assisted reproductive technology and adverse pregnancy outcomes: a population based data linkage study

Abstract Background Endometriosis is a chronic inflammatory disease characterised by endometrial tissue outside the uterus – pain and infertility are common symptoms. There is a paucity of data on the association between endometriosis and adverse pregnancy outcomes where the contribution of assisted reproductive technology (ART) use is also considered. This study will examine the association between endometriosis, with and without ART use, on adverse pregnancy outcomes. Methods Population data linkage study of all female NSW residents aged 15-45 years with a singleton birth in 2006-2015. Pregnancies were classified into 4 groups based on endometriosis diagnosis (yes/no) and ART use (yes/no). Multinomial logistic regression was used to estimate the odds of adverse pregnancy outcomes with 99% confidence intervals, adjusting for maternal and pregnancy factors. Outcomes assessed included placenta praevia, antepartum haemorrhage, planned birth (induction of labour or caesarean section) and preterm birth. Results Of 889,101 eligible pregnancies, women with endometriosis were more likely to be older while women who used ART were more likely to be nulliparous, birth in a private hospital and less likely to smoke. Adjusted odds ratios for selected study outcomes are outlined below. Conclusions Endometriosis is associated with increased odds of preterm birth, placenta praevia, antepartum haemorrhage and planned birth. In general, the odds of adverse pregnancy outcomes associated with endometriosis were further increased with ART use. Key messages These findings suggest that women with endometriosis, especially those who achieved pregnancy via ART use, represent a high risk obstetric population requiring appropriate surveillance and management.

Associations of Sleep With Sedentary Behavior and Physical Activity Patterns Across Pregnancy Trimesters.

Sleep, sedentary behavior, and moderate-to-vigorous physical activity (MVPA) are altered in pregnancy and may affect pregnancy health; however, how these behaviors are associated with each other is unclear. Pregnant women (N=120) completed the Pittsburgh Sleep Quality Index and wore an activPAL3 micro and ActiGraph GT3X for 7days in each trimester to assess sleep, sedentary behavior, and MVPA, respectively. Latent trajectories described patterns of sleep duration, efficiency, and quality as well as sedentary behavior and MVPA. Multinomial logistic regression examined associations of sleep patterns with sedentary behavior and MVPA patterns and, in exploratory analyses, with adverse pregnancy outcomes. Trajectories were identified for sleep duration (consistently short, 20.7% of sample; consistently adequate, 79.3%), efficiency (consistently low, 17.5%; consistently high, 82.5%), and quality (consistently poor, 15.1%; worsening, 23.5%; and consistently good, 61.5%). Compared with those in more optimal sleep groups, women in the short duration, low efficiency, and worsening quality groups had lower odds of being in the moderate and/or high sedentary behavior group (odds ratio range, 0.21-0.31; 95% confidence interval range, 0.09-0.65). Women in the worsening quality group had greater odds of being in the low MVPA group (odds ratio, 2.51; 95% confidence interval, 1.18-5.38). Trends were observed with women in less optimal sleep groups having greater odds of adverse pregnancy outcomes and lower odds of excessive gestational weight gain. Less optimal sleep patterns in pregnancy are associated with less sedentary behavior and MVPA; additional research is needed to confirm associations between sleep and pregnancy outcomes.

Objectively Measured Sedentary Behavior and Physical Activity Across 3 Trimesters of Pregnancy: The Monitoring Movement and Health Study.

Though moderate- to vigorous-intensity physical activity is recommended, limited research exists on sedentary behavior (SED) during pregnancy. The authors conducted a prospective cohort study to describe objectively measured patterns of SED and activity during each trimester of pregnancy. Women wore thigh- (activPAL3) and waist-mounted (ActiGraph GT3X) activity monitors. SED and activity were compared across trimesters using likelihood ratio tests and described using group-based trajectories. Exploratory analyses associated SED and activity trajectories with adverse pregnancy outcomes and excessive gestational weight gain. Pregnant women (n = 105; mean [SD] age = 31 [5]y; prepregnancy body mass index = 26.2 [6.6]kg/m2) had mean SED of 9.7, 9.5, and 9.5hours per day (P = .062) across trimesters, respectively. Some activities differed across trimesters: standing (increased, P = .01), stepping (highest in second trimester, P = .04), steps per day (highest in second trimester, P = .008), and moderate- to vigorous-intensity physical activity (decreased, P < .001). Prolonged SED (bouts ≥ 30min) and bouted moderate- to vigorous-intensity physical activity (≥10min) were stable (P > .05). In exploratory analyses, higher SED and lower standing, stepping, and steps per day trajectories were associated with increased odds of adverse pregnancy outcomes (P < .05). No trajectories were associated with excessive gestational weight gain. Pregnant women exhibited stable SED of nearly 10hours per day across pregnancy. Future research evaluating SED across pregnancy and adverse pregnancy outcome risk is warranted.

Outcomes associated with anaesthetic techniques for caesarean section in low- and middle-income countries: a secondary analysis of WHO surveys

Associations between anaesthetic techniques and pregnancy outcomes were assessed among 129,742 pregnancies delivered by caesarean section (CS) in low- and middle-income countries (LMICs) using two WHO databases. Anaesthesia was categorized as general anaesthesia (GA) and neuraxial anaesthesia (NA). Outcomes included maternal death (MD), maternal near miss (MNM), severe maternal outcome (SMO), intensive care unit (ICU) admission, early neonatal death (END), neonatal near miss (NNM), severe neonatal outcome (SNO), Apgar score <7 at 5 minutes, and neonatal ICU (NICU) admission. A two‐stage approach of individual participant data meta‐analysis was used to combine the results. Adjusted odds ratio (OR) with 95% confidence intervals (CIs) were presented. Compared to GA, NA were associated with decreased odds of MD (pooled OR 0.28; 95% CI 0.10, 0.78), MNM (pooled OR 0.25; 95% CI 0.21, 0.31), SMO (pooled OR 0.24; 95% CI 0.20,0.28), ICU admission (pooled OR 0.17; 95% CI 0.13, 0.22), NNM (pooled OR 0.63; 95% CI 0.55, 0.73), SNO (pooled OR 0.55; 95% CI 0.48, 0.63), Apgar score <7 at 5 minutes (pooled OR 0.35; 95% CI 0.29, 0.43), and NICU admission (pooled OR 0.53; 95% CI 0.45, 0.62). NA therefore was associated with decreased odds of adverse pregnancy outcomes in LMICs.

Abstract MP13: Prospective Associations of Prenatal Sedentary Behavior and Physical Activity Trajectories With Adverse Pregnancy Outcomes

Background: Adverse pregnancy outcomes (APO) are risk factors for future cardiovascular disease. Though factors such as obesity increase the risk of APO, whether patterns of prenatal sedentary behavior (SED) or physical activity are associated with APO is unclear. Methods: This cohort study measured objective SED, steps, and moderate-vigorous intensity physical activity (MVPA) during each trimester of pregnancy. Women were instructed to wear two monitors for 7 d: a thigh-mounted activPAL3 micro to measure SED and steps, and an Actigraph GT3X on an elastic waist belt to measure MVPA. Women also completed a detailed wear log. Data were considered valid with ≥4 d of ≥10 hr of wear. Physician-diagnosed APO (gestational hypertension, preeclampsia, gestational diabetes, preterm birth, or intrauterine growth restriction) were abstracted from medical records by trained research personnel. Growth mixture modelling was used to construct separate SED, steps, and MVPA trajectories across pregnancy. Associations between trajectory groups and APO were evaluated using logistic regression with adjustment for prepregnancy BMI, race, education, and age. Results: Women (n=100) had mean (SD) age 31.2 (4.8) yr, pregnancy BMI 26.2 (6.8) kg/m 2 , and were 25% non-white. Trajectory analyses revealed three groups within each SED, steps, and MVPA (see Table). Nineteen women (19%) had at least one APO: gestational hypertension and/or preeclampsia (n=13), gestational diabetes (n=3), preterm birth (n=6), or intrauterine growth restriction (n=4). High vs. low SED trajectory was associated with more than 6-fold higher odds of APO. Medium and high vs. low steps trajectory was associated with lower odds of APO, but only medium vs. low trajectories were statistically different. MVPA trajectory was not associated with APO risk (see Table). Conclusion: Reducing SED and increasing daily steps, though not increasing MVPA, could be novel intervention targets for reducing APO and future cardiovascular risk in pregnant women.

Effects of thyroid diseases on pregnancy outcomes.

The current study aimed to analyze the effects of thyroid diseases on pregnancy outcomes and investigate the effects of levothyroxine (L-T4) tablets in the treatment of hypothyroidism. The current study determined the prevalence of thyroid diseases using two diagnostic criteria, the prevalence of thyroid diseases among pregnant women recruited in 2010 and 2014 were initially determined by the 2011 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum (2011 ATA Guidelines). Subjects were categorized into six groups: Normal, hypothyroxinemia, hypothyroidism, subclinical hypothyroidism (SCH), hyperthyroidism and subclinical hyperthyroidism. L-T4 was administered in the thyroid-insufficient groups and the prevalence rates of these categories were obtained using the diagnostic criteria from the 2011 ATA Guidelines and the 2012 Chinese Guidelines for the Diagnosis and Treatment of Thyroid Disease During Pregnancy and Postpartum (2012 Chinese Guidelines). The results of the current study demonstrated that the screening of thyroid function was significantly increased in 2014 (thyroid dysfunction rate, 82.4% vs. 29.1%; P<0.001). Hypothyroxinemia, hypothyroidism, SCH, hyperthyroidism and subclinical hyperthyroidism increased the likelihood of certain adverse outcomes and complications. L-T4 decreased the odds of gestational hypertension, premature birth and low birth weight or very low birth weight in the hypothyroidism group. A statistically significant difference was identified between thyroid disease incidences as determined by the 2011 ATA Guidelines 2012 Chinese Guidelines. In conclusion, abnormal thyroid levels increased the odds of adverse pregnancy outcomes, L-T4 administration improved pregnancy outcomes and the 2012 Chinese Guidelines may provide a better reference for Chinese pregnant women with subclinical hyperthyroidism.

Risk of adverse pregnancy outcomes associated with short and long birth intervals in Bangladesh: evidence from six Bangladesh Demographic and Health Surveys, 1996–2014

ObjectiveTo examine the effect of short (<36 months) and long (≥60 months) birth intervals on adverse pregnancy outcomes in Bangladesh.Design, setting and participantsWe analysed data from six Bangladesh Demographic and...

The Association of Inadequate and Intensive Prenatal Care With Maternal, Fetal, and Infant Outcomes: A Population-Based Study in Manitoba, Canada.

Little is known about how prenatal care influences health outcomes in Canada. The objective of this study was to examine the association of prenatal care utilization with maternal, fetal, and infant outcomes in Manitoba. This retrospective cohort study conducted at the Manitoba Centre for Health Policy investigated all deliveries of singleton births from 2004-2005 to 2008-2009 (N = 67076). The proportion of women receiving inadequate, intermediate/adequate, and intensive prenatal care was calculated. Multivariable logistic regression was used to examine the association of inadequate and intensive prenatal care with maternal and fetal-infant health outcomes, health care use, and maternal health-related behaviours. The distribution of prenatal care utilization was 11.6% inadequate, 84.4% intermediate/adequate, and 4.0% intensive. After adjusting for sociodemographic factors and maternal health conditions, inadequate prenatal care was associated with increased odds of stillbirth, preterm birth, low birth weight, small for gestational age (SGA), admission to the NICU, postpartum depressive/anxiety disorders, and short interpregnancy interval to next birth. Women with inadequate prenatal care had reduced odds of initiating breastfeeding or having their infant immunized. Intensive prenatal care was associated with reduced odds of stillbirth, preterm birth, and low birth weight and increased odds of postpartum depressive/anxiety disorders, initiation of breastfeeding, and infant immunization. Inadequate prenatal care was associated with increased odds of several adverse pregnancy outcomes and lower likelihood of health-related behaviours, whereas intensive prenatal care was associated with reduced odds of some adverse pregnancy outcomes and higher likelihood of health-related behaviours. Ensuring women receive adequate prenatal care may improve pregnancy outcomes.

Maternal and paternal obesity and adverse pregnancy outcomes in China: a cohort study

BackgroundThere is growing concern about the potential effect of parental obesity on the newborn child's birth outcomes and health. However, few studies have examined whether parental obesity before pregnancy affects the risk of adverse pregnancy outcomes. We aimed to systematically evaluate the associations of adverse pregnancy outcomes with prepregnancy body-mass index (BMI) of the mother and the father. MethodsThe China National Free Preconception Health Examination Project (NFPHEP) was a nationwide project beginning in 2010 across China to assess the risk factors for birth defects and other adverse pregnancy outcomes. The cohort included couples living in rural areas who were in the reproductive age and planning pregnancies within 4–6 months. Data on weight, height, and BMI status before pregnancy and birth outcomes were obtained from women and their partners aged 20–49 years who had pregnancies within 1 year after baseline examinations between 2010 and 2015 in selected 220 counties of 31 provinces. Multivariate logistic regression models were used to estimate odds ratios (ORs) and 95% CIs with adjustment for covariates. The current study was approved by the Institutional Research Review Board at the National Health and Family Planning Commission and National Research Institute for Health and Family Planning, and all participants gave written consent. FindingsThe cohort included 1 501 557 women and 1 463 597 men. We included undated data with complete baseline and follow-up data in the cohort. Participants included women and their husband or single women, thus the cohort contained more women than men. We analysed independent association for mothers and fathers using the separate samples, and analysed the combined association using men's samples. Compared with women with normal prepregnancy BMI (18.5–23·9 kg/m2, 74%), the following outcomes were more common in women who were overweight (24–27·9 kg/m2, 10%) or obese women (≥28·0 kg/m2, 2%): preterm birth (OR 1·11; 95% CI 1·09–1·14 vs 1·22; 1·17–1·29), low birth weight (1·11; 1·05–1·18 vs 1·36; 1·22–1·52), macrosomia (1·38; 1·33–1·42 vs 1·65; 1·54–1·74), stillbirth (1·17; 1·04–1·32 vs 1·42; 1·14–1·77), neonatal mortality (1·22; 1·07–1·40 vs 1·31; 1·00–1·70), and birth defects (1·20; 1·02–1·41 vs 1·07; 0·76–1·51). The corresponding ORs for men with high BMI (overweight 24–27·9 kg/m2 [22%]; obese ≥28·0 kg/m2 [5%]) versus men with normal BMI were as follows: preterm birth (1·12; 1·10–1·14 vs 1·24; 1·20–1·28), low birth weight (1·10; 1·05–1·15 vs 1·29; 1·20–1·40), macrosomia (1·19; 1·16–1·22 vs 1·34; 1·28–1·40), stillbirth (1·12; 1·02–1·23 vs 1·19; 1·00–1·41), and birth defects (1·12; 0·99–1·28 vs 1·32; 1·05–1·64). Additionally, couples in which both partners had BMI greater than 24 kg/m2 (5%) had higher odds of adverse pregnancy outcomes than couples with normal BMI. InterpretationThe findings from this large cohort of Chinese couples of reproductive age show that increasing pre-pregnancy maternal and paternal BMI, both independently and combined, increases the risk of adverse pregnancy outcomes such as preterm birth, low weight birth, macrosomia, stillbirth and birth defects. FundingThe National Key Research and Development Program of China (2016YFC1000102, 2016YFC1000307, 2016YFC1000307-6), National Natural Science Foundation of China (81602854), National Scientific Data Sharing Platform for Population and Health (2016NCMIZX06).

Maternal marijuana use, adverse pregnancy outcomes, and neonatal morbidity

The Eunice Kennedy Shriver National Institute of Child Health and Human Development Stillbirth Collaborative Research Network previously demonstrated an association between stillbirth and maternal marijuana use as defined by the presence of 11-nor-delta-9-tetrahydrocannabinol-9-carboxylic acid in the umbilical cord homogenate. However, the relationship between marijuana use and perinatal complications in live births is uncertain. Our aim was to examine if maternal marijuana use is associated with increased odds of adverse pregnancy outcomes and neonatal morbidity among live-born controls in the Stillbirth Collaborative Research Network cohort. We conducted a secondary analysis of singleton, live-born controls in the Stillbirth Collaborative Research Network data set. Marijuana use was measured by self-report and/or the presence of 11-nor-delta-9-tetrahydrocannabinol-9-carboxylic acid in umbilical cord homogenate. Tobacco use was measured by self-report and/or presence of any cotinine in maternal serum. Adverse pregnancy outcome was a composite of small for gestational age, spontaneous preterm birth resulting from preterm labor with or without intact membranes, and hypertensive disorders of pregnancy. Neonatal morbidity included neonatal intensive care unit admission and composite neonatal morbidity (pulmonary morbidity, necrotizing enterocolitis, seizures, retinopathy of prematurity, infection morbidity, anemia requiring blood transfusion, neonatal surgery, hyperbilirubinemia, neurological morbidity, or death prior to hospital discharge). Effect of maternal marijuana use on the probability of an adverse outcome was estimated using weighted methodology to account for oversampling in the original study. 11-nor-delta-9-tetrahydrocannabinol-9-carboxylic acid cord homogenate analysis was performed in the subset of women for whom biospecimens were available. Comparisons using logistic modeling, χ2, and t tests were weighted to account for oversampling of preterm births and non-Hispanic blacks. Results are reported as weighted percent and unweighted frequencies. Maternal marijuana use was identified in 2.7% (unweighted frequency 48/1610) of live births. Use was self-reported by 1.6% (34/1610) and detected by 11-nor-delta-9-tetrahydrocannabinol-9-carboxylic acid in cord homogenate for 1.9% (17/897), n= 3 overlapping. Rate of tobacco use was 12.9% (217/1610), with 10.7% (167/1607) by self-report and 9.5% (141/1313) by serum cotinine. The composite adverse pregnancy outcome was not significantly increased in women with marijuana use compared to nonusers (31.2% vs 21.2%; P= .14). After adjustment for tobacco, clinical, and socioeconomic factors, marijuana use was not associated with the composite adverse pregnancy outcome (adjusted odds ratio, 1.29; 95% confidence interval, 0.56-2.96). Similarly, among women with umbilical cord homogenate and serum cotinine data (n= 765), marijuana use was not associated with adverse pregnancy outcomes (adjusted odds ratio, 1.02; 95% confidence interval, 0.18-5.66). Neonatal intensive care unit admission rates were not statistically different between groups (16.9% users vs 9.5% nonusers, P=.12). Composite neonatal morbidity or death was more frequent among neonates of mothers with marijuana use compared to nonusers (14.1% vs 4.5%; P= .002). In univariate comparisons, the components of the composite outcome that were more frequent in neonates of marijuana users were infection morbidity (9.8% vs 2.4%; P < .001) and neurologic morbidity (1.4% vs 0.3%; P= .002). After adjustment for tobacco, race, and other illicit drug use, marijuana use was still associated with composite neonatal morbidity or death (adjusted odds ratio, 3.11; 95% confidence interval, 1.40-6.91). Maternal marijuana use was not associated with a composite of small for gestational age, spontaneous preterm birth, or hypertensive disorders of pregnancy. However, it was associated with an increased risk of neonatal morbidity.