Pregnancy In Scotland Research Articles

A Cohort Tree-based Representation and a Multimorbidity Progression Across Pregnancies in Scotland

Pregnancy-related research using routinely collected data is increasing. Electronic Health Records (EHR) are a robust resource because they can provide information on a large population of pregnant women covering prolonged periods at a reasonable cost. Moreover, information is collected prospectively and is thus free from recall bias. However, these data sources also present challenges. Information is gathered for clinical purposes and often recorded in different datasets (prescriptions, hospital admission, demography, birth records, etc.). Therefore, a significant data management effort must be made to convert all the information into structured and meaningful datasets in which identifying the timing of conception, outcomes of interest, multiple pregnancies, and interpregnancy periods can easily be done. In this study, we linked Scottish Maternity Records between 2007 and 2021 (1,575,153 pregnancies, 493,629 women) to demographics data, datasets with International Classification of Diseases (ICD) diagnostic codes for all inpatient stays and day cases in hospitals, and Prescribing Information System (PIS) for data on all medications from primary care. After combining these datasets using R codes, we developed a simple tree-based algorithm that visually represents each woman at each pregnancy and the related health conditions. Presenting data in this way helps identify relevant clinical questions and the temporal relation of different pregnancies. As an example, we identified the progression of multimorbidity through pregnancies and characterised how multimorbidity changes from one pregnancy to another, considering the woman's health conditions and social class.

Cohort Profile: The COVID-19 in Pregnancy in Scotland (COPS) dynamic cohort of pregnant women to assess effects of viral and vaccine exposures on pregnancy.

Cohort Profile: The COVID-19 in Pregnancy in Scotland (COPS) dynamic cohort of pregnant women to assess effects of viral and vaccine exposures on pregnancy.

COVID-19 in Pregnancy in Scotland (COPS): protocol for an observational study using linked Scottish national data

IntroductionThe effects of SARS-CoV-2 in pregnancy are not fully delineated. We will describe the incidence of COVID-19 in pregnancy at population level in Scotland, in a prospective cohort study using...

Self assessment questions

Concerning termination of pregnancy in the UK, which of the following is true:A.In the UK, women can now self-administer at home all the drugs for medical termination of pregnancy.B.In 2018 50% of all terminations of pregnancy in Scotland involved self-administration of misoprostol at home.C.In 2018, 71% of terminations in England and wales were medically induced.D.In 2018, 91% of terminations in England and Wales were funded by the NHS.

The relationship between area deprivation and prescription of long-acting reversible contraception in women of reproductive age in Lothian, Scotland, UK

BackgroundReducing unplanned pregnancy in Scotland is a key government objective. Long-acting reversible contraception (LARC) is a cost-effective way to reduce unintended pregnancy. Abortion and teenage pregnancy rates are highest in...

A population-based study of venous thrombosis in pregnancy in Scotland 1980–2005

ObjectivesData on time trends in the incidence of pregnancy-related venous thromboembolism (VTE) are sparse. This report charts the incidence of pregnancy-related VTE over the period 1980–2005 in Scotland, and discusses the results in relation to potential risk factors. Study design1475301 maternity discharges from Scottish hospitals recorded on the Scottish Morbidity Record 2 (SMR2) were included. Incidences of pregnancy-related VTE, antenatal deep venous thromboembolism (DVT), postnatal DVT and pulmonary embolism (PTE) were derived relative to the number of deliveries, and risk factors were analysed using Poisson regression. ResultsOver the period, VTE incidence rose from 13.7 to 18.3 per 10000 deliveries, antenatal DVTs from 8.8 to 12.2 per 10000 deliveries and PTE from 1.5 to 3.0 per 10000 deliveries. Postnatal DVTs, on the other hand, declined from 4.2 to 2.7 per 10000 deliveries. Risk factors were: age over 35 years; three or more previous pregnancies; previous VTE; obstetric haemorrhage; and preeclampsia. Antenatal DVT risk was highest in the most deprived areas, where events started increasing before those in less deprived areas. Postnatal DVT risk was increased following caesarean delivery, especially when unplanned, although after 1996, events following emergency caesarean decreased. ConclusionDuring the 26-year period, pregnancy-related VTEs increased, with the greatest rise for antenatal DVTs. Postnatal DVTs, on the other hand, declined over the period, particularly following emergency section. Thromboprophylaxis use following emergency delivery may have led to the postpartum reduction. To continue to prevent events, risk assessment and intervention are required, particularly antenatally.

PP.13 Previous Caesarean Delivery and the Risk of Unexplained Stillbirth: Analysis of 128,585 Second Pregnancies in Scotland, 1999–2008

BackgroundA previous study (Lancet 2003; 362:1779–84) reported an increased risk of unexplained stillbirth in women with previous caesarean delivery among women having second births in Scotland, 1992–1998. Subsequent studies have...

Maternal obesity is independently associated with increased antenatal admissions and health service costs

AimTo determine the effect of maternal body mass index (BMI) on inpatient costs for all pregnancies in Scotland, and outpatient costs for a separate cohort.MethodsAll women with singleton pregnancies, and...

Recurrence risk of stillbirth in a second pregnancy

To examine the risk of recurrence of stillbirth in a second pregnancy. Retrospective cohort study. Scotland, UK. All women who delivered their first and second pregnancies in Scotland between 1981 and 2005. All women delivering for the first time between 1981 and 2000 were linked to records of their second pregnancy using routinely collected data from the Scottish Morbidity Returns. Women who had an intrauterine death in their first pregnancy formed the exposed cohort, whereas those who had a live birth formed the unexposed cohort. Stillbirth in a second pregnancy. After adjusting for confounding factors, the odds of recurrence of stillbirth in a second pregnancy were found to be 1.94 (99% CI 1.29-2.92) compared with women who had had a live birth in their first pregnancy. Other factors associated with recurrence of stillbirth in a second pregnancy included placental abruption (adjusted OR 1.96; 99% CI 1.60-2.41), preterm delivery (adjusted OR 7.45; 99% CI 5.91-9.39) and low birthweight (adjusted OR 6.69; 99% CI 5.31-8.42). A Bayesian analysis using minimally informative normal priors found the risk of recurrence of stillbirth in a second pregnancy to be 1.59 (99% CI 1.10-2.33). Women who have stillbirth in their first pregnancy have a higher risk of recurrence in their next pregnancy.

1B.1 Risk factors and diagnosis of VTE in pregancy

Pulmonary thromboembolism is the major cause of maternal death in the UK. In addition to mortality and acute morbidity, these women are also at risk of future deep venous thrombosis (DVT), venous insufficiency and pulmonary hypertension. In pregnancy DVT is usually left sided (85% versus 55% in the non pregnant) and ilio-femoral (72% iliofemoral in pregnancy versus 9% in non pregnant). Furthermnore, VTE can occur at any time in the antenatal period with 50% of events occurring in the first 15 weeks. Previous thrombotic event(s), age, obesity, thrombophilia and operative delivery are arguably the most important risk factors (Table 1). In a ten year review of 650,000 pregnancies in Scotland the incidence of antenatal DVT was greater than postnatal DVT although the rate was higher in the postpartum period. Furthermore, the rate doubled with age over 35 years and also with operative delivery. The pathophysiology of venous thrombosis in pregnancy is associated with the procoagulant changes of pregnancy, venous stasis and trauma to the pelvic veins at delivery. Thus it is not surprising that heritable thrombophilias, including antithrombin (AT), protein C or S deficiencies, factor V Leiden and the prothrombin G20210A, underlie up to 50% of pregnancy related thromboses. Acquired thrombophilic traits such as antiphospholipid antibody syndrome also place the patient at risk. Objective diagnosis is essential when VTE is suspected and duplex ultrasound venography and ventilationperfusion lung scans remain first line investigations. However investigations such as CTPA are increasingly being used for PTE, although they are associated with significant radiation exposure to the maternal breast, CTPA is associated with an even lower dose of radiation to the fetus than VQ scans. Thus, there are particular problems with regard to venous thromboembolic disease in pregnancy and its management, which present a challenge to the obstetric physician.

Scottish audit of ectopic pregnancy

ObjectiveTo evaluate the use of laparoscopic procedures in the treatment of ectopic pregnancies by a cross‐section of gynaecologists in ScotlandDesignA prospective registration of cases of laparoscopically treated ectopic pregnancy by gynaecologists. Case‐note review was also performed in selected hospitals.Setting13 hospitals in seven Scottish Health Board areas.SubjectsWomen having laparoscopic treatment of ectopic pregnancy.ResultsBetween April 1994 and March 1996, 85 ectopic pregnancies were treated laparoscopically. Contraindications for laparoscopic surgery were most commonly size of the ectopic gestation (53%), presence of intraperitoneal bleeding (42%) and tubal rupture (44%). Salpingotomy was performed in 16% overall with only 86% of consultants monitoring serial human chorionic gonadotrophin levels.ConclusionsLaparoscopic treatment of ectopic pregnancies in Scotland is infrequent. Lack of availability of adequate equipment and trained staff was often quoted as the reason preventing surgeons from developing their skills in these techniques. Complication rates were low and patient satisfaction high.

Depression and smoking in pregnancy in Scotland.

The aim was to examine the association between depressive symptoms and smoking in pregnancy and to investigate the part played by social and psychosocial factors. A single Glasgow hospital. Prospective survey by postal questionnaires at 20 and 30 weeks' gestation. A total of 395 women (69% of the 572 eligible) parity 1 who booked for delivery between November 1988 and February 1990 took part. Depressive symptoms were measured using the Hospital Anxiety and Depression Scale. Smoking was self reported. The Life Events Inventory and measures of role specific strain and stress in domestic roles were used to assess psychosocial well being. Smokers were more likely than non-smokers to experience depressive symptoms at 20 and 30 weeks' gestation and on both occasions. The excess risk remained substantial and significant after adjustment for social and psychosocial factors. Smoking is a significant risk factor for depression in pregnancy. The association of smoking with depression and psychosocial difficulty represents a major problem for interventions intended to reduce smoking in pregnancy.

Teenage Pregnancy in Scotland: Trends and Risks

Teenage pregnancy, considered to be associated with social and medical risks, is seen as a growing problem. Population based information from the Registrar General (Scotland) and Notification of Abortion permitted an analysis of the trends in the numbers, rates and outcomes of pregnancies among women aged less than 20 years. In addition, clinical information is available on all deliveries in Scottish hospitals from the standard hospital discharge document permitting analysis of the association of defined complications with age. Contrary to current perceptions, pregnancies and births among teenagers are not more frequent in 1988 when compared to 1975. There has been, however, a large increase in births to single women, a group with particular problems. The obstetric risks when compared to older women, are small and probably socially, not age related. These include a slightly higher rate of pre-term delivery and low birthweight and a later presentation for specialist antenatal care. The proportion of pregnancies affected by neural tube defects which are terminated is lower among women under 20. These medical risks are small, however, compared to the well-documented social and economic problems which will have long term and indirect effects on health.

Dietary variety during and after pregnancy in Scotland and England

Interviews were carried out with 265 Scottish and English women from all social groups during and after pregnancy. Their consumption frequency of 123 food categories was elicited, with details of brands and types used. A simple ‘food groups’ concept of dietary variety did not differentiate any subgroup. When dietary variety was defined as numbers of different foods used within categories, the English ‘non‐manual’ group in early pregnancy ranked highest, and the Scottish ‘manual’ group lowest. During pregnancy about 30% of Scots and 25% of English reported a high consumption frequency of several processed foods. Generally, ‘fresh’ foods were more popular in England, and with the ‘non‐manual’ group. Regional and social class differences in dietary variety correspond broadly with differences in micronutrient intake and in knowledge of nutritional ‘messages’.

COMPARATIVE INCIDENCE OF GOITRE IN PREGNANCY IN ICELAND AND SCOTLAND

<h2>Abstract</h2> Two female populations in Iceland were screened for enlargement of the thyroid gland. The frequency of thyroid enlargement was the same in the two groups of women, pregnant and non-pregnant. A comparison with the figures for North-East Scotland, arrived at in a previous survey, is compatible with the conclusion that the thyroid gland enlarges during pregnancy in Scotland, but not in Iceland. The Icelandic diet based on fish contains a lot of iodine; and estimations of plasma-inorganic-iodine confirmed this, values being significantly higher than those found earlier in Scotland.