Preterm Low Birth Weight Research Articles

Prenatal homelessness, food insecurity, and unemployment and adverse infant outcomes in a California cohort, 2007-2020.

Characterize the relationship between infant outcomes and prenatal homelessness, food insecurity and unemployment. California live births between 22- and 44-weeks' gestation comprised 6,089,327 pregnancies (2007-2020). Data were collected from linked Vital Statistics and hospital discharge records. Prenatal homelessness, food insecurity, and unemployment were classified as health-related social needs (HRSN) using International Classification of Disease codes in delivery records. Risk ratios for preterm birth, low birthweight, small for gestational age, neonatal intensive care unit admission, emergency department admission, rehospitalization, and death were estimated using log-linear Poisson regression adjusted for birthing person race, payer, and education. 65.7 per 100,000 births had HRSN. These infants had a higher risk of preterm birth (aRR 2.7), low birthweight (aRR 2.7), SGA (aRR 1.5), NICU admission (aRR 3.5), and death (aRR 3.0). HRSN increase the risk of infant morbidity and mortality but remain underreported in administrative records, making definitive conclusions difficult.

Effects of Preoperative Nutritional Conditions on Postoperative Recovery in Neonates with Congenital Heart Disease

Objective: The effects of preoperative nutritional conditions on postoperative recovery in neonates with congenital heart disease (CHD) were evaluated in this study. Methods: A retrospective analysis of data from neonates with CHD who underwent surgery at our hospital from January 2020 to December 2022 was conducted. The relationships between preoperative nutritional conditions and neonatal postoperative recovery were analyzed. Results: Eighty neonates were included in this study. The average gestational age was 38.4 (37, 39.2) weeks, the average birth weight was 3.1 (2.7, 3.4) kg, the average age at surgery was 23 (21, 26) days, and the average preoperative weight was 3.5 (3.0, 3.9) kg. The postoperative mechanical ventilation duration, length of intensive care unit stay, and length of hospital stay of preterm neonates were much longer than those of full-term neonates (p < 0.05). In addition, these values were notably greater for neonates with birth weights ≤3 kg than for neonates with birth weights >3 kg (p < 0.05). The correlation analysis suggested that gestational age, birth weight, preoperative weight-for-age z-score (WAZ) and preoperative height-for-age z-score (HAZ) were negatively correlated with postoperative mechanical ventilation duration, length of intensive care unit stay, and length of hospital stay. Conclusions: Preterm birth and low birth weight significantly prolong the duration of mechanical ventilation and postoperative intensive care unit and hospital length of stay. More attention should be given to nutritional management during the perioperative period for premature or low-birth-weight neonates with CHD. For neonates with CHD requiring surgery, the time available for nutritional support before surgery is very limited; thus, more attention and guidance are needed for prenatal nutritional strategies.

Analysis of the relationship between the quality of antenatal care examinations and the incidence of preterm birth and low birth weight.

Antenatal care (ANC) plays a crucial role in ensuring maternal and child safety and reducing adverse delivery outcomes. This study aimed to analyze the association between the quality of ANC and the occurrence of preterm birth and low birth weight in a sample of the population from 16 regions in 8 provinces in China. Data from all closed cases of pregnant women and newborns reported in the Maternal and Child Health Monitoring System from January 1, 2018, to December 31, 2018, in 16 monitoring regions across 8 provinces in China were collected and included in the analysis, resulting in a total of 49,084 pregnant women and 49,026 newborns. The mean number of ANC visits was 6.95 ± 3.45. By percentage, 78.79% of the women received ANC examinations at least five times. The percentage of normative ANC examinations and the percentage of qualified ANC examinations was 30.98% and 8.0% respectively. The gestational age(χ2 = 229.305, p<0.001), birth weight (χ2 = 171.990, p<0.001) and the occurrence of neonatal complications (χ2 = 53.112, p<0.001) were all significantly related to the number of ANC visits to mothers. There was a correlation between gestational age (χ2 = 1021.362, p<0.001;χ2 = 194.931, p<0.001) and birth weight (χ2 = 259.009, p<0.001; χ2 = 70.042, p<0.001) with normative ANC and qualified ANC examinations. As the number of ANC examinations increased, the rates of preterm birth and low birth weight decreased. Pregnant women who did not receive normative ANC examinations had a higher risk of preterm birth and neonatal low birth weight compared to those who did; Adjusted Odds Ratio (95%CI) was 23.33(16.97~32.07)and 1.61(1.37~1.90) respectively. Pregnant women who did not receive qualified ANC examinations had a higher risk of preterm birth and neonatal low birth weight compared to those who did; Adjusted Odds Ratio (95%CI) was 15.05(8.45~26.79)and 1.36 (1.02~1.82) respectively. The percentage of women who received normative ANC examination and qualified ANC examination is still low in China, and the quality of antenatal care significantly affects the occurrence of preterm birth and low birth weight in newborns.

The impact of scaling and root planning combined with mouthwash during pregnancy on preterm birth and low birth weight: a systematic review and meta-analysis

BackgroundThe effect of treating periodontal disease (PD) during pregnancy on adverse birth outcomes, such as preterm birth (PTB) and/or low birth weight (LBW), remains unclear. This is partially due to the fact that Randomized Controlled Trials (RCTs) have used different combinations of treatment approaches to test this hypothesis. In this meta-analysis of RCTs, we assessed the impact of treating PD during pregnancy with scaling and root planning (SRP) and mouthwash use on PTB and LBW.MethodsA systematic review with meta-analysis was conducted following PRISMA guidelines. A comprehensive search strategy was employed across electronic databases, including PubMed/Medline, Embase, and Google Scholar. Quality assessment was performed using the Cochrane Risk of Bias 2 Tool. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using random-effect models.ResultsOut of 133 initially identified reports, 9 RCTs involving 3,985 pregnant women met the inclusion criteria. Periodontal treatment with SRP and mouthwash use in pregnancy was associated with a lower risk of PTB and LBW in meta-analysis with random effects models (pooled RR for PTB = 0.44, 95% CI: 0.22–0.88) and (pooled RR for LBW = 0.33, 95% CI: 0.13–0.84). Substantial heterogeneity was observed among studies (I2 = 91% and 90% for PTB and LBW, respectively), with sensitivity analysis suggesting potential sources of heterogeneity. Funnel plot assessment for publication bias showed evidence of asymmetry.ConclusionSRP with mouthwash use during pregnancy were associated with significantly lower risks of PTB and LBW. Larger, well-conducted RCTs are warranted to address this issue, as existing trials are small and exhibit methodological and statistical heterogeneity.

Yoga-based lifestyle intervention for antenatal depression (YOGA-D): study protocol for a pilot randomized controlled trial

Background Depression during pregnancy is associated with pre-term labor, low birthweight, post-partum depression and adverse child outcomes. There are concerns about the safety of anti-depressant medications during pregnancy. Many pregnant women with antenatal depression are neither aware about their depression nor do they have access to non-pharmacological interventions for depression. Evidence suggests that pre-natal yoga can improve antenatal depression. Yoga is native to the Indian culture and women can practice yoga as a ‘self-care’ intervention with minimal training. There is no study till date on the efficacy of yoga on antenatal depression in pregnant women in a low resource (rural) setting in India. This pilot randomized controlled trial aims to study the feasibility, acceptability, and preliminary efficacy of a YOGA -based lifestyle intervention for Antenatal D epression (YOGA-D) in Maharashtra, India. Methods We will undertake a single-blind individual randomized parallel group-controlled pilot trial with 1:1 allocation ratio. Adult women with 12–26 weeks of pregnancy, without any obstetric or medical complications will be randomly allocated to either the active intervention group (Yoga-Sanskar (YS)) or the Enhanced Usual Care (EUC) group. Trained yoga instructors will teach a pre-defined yoga sequence to the participants in the YS arm. In the EUC arm, participants will receive a single session of health education. We will assess trial feasibility using the recruitment, retention, and study completion rates. The primary outcome of depression will be measured using the translated Marathi version of the Patient Health Questionnaire-9. Assessments will be at the baseline, three-months post-randomization, and post-delivery. Discussion This study will help us to understand the barriers in implementation of a yoga-based intervention for antenatal depression in a low-resource/rural setting in Maharashtra, India. Based on the learnings of this pilot trial, we plan to undertake an explanatory randomized controlled trial in the next few months. Registration CTRI (CTRI/2024/05/067176; 10/05/2024).

A study of autoimmune thyroid disease in pregnant women and its effect on fetal and maternal outcome

ABSTRACT Introduction: Anti-thyroid antibodies not only cause thyroid dysfunction but have independent adverse outcomes in the fetus and mother during pregnancy and after birth. Chronic lymphocytic thyroiditis as a presentation of immune system deregulation may be associated with a generalized activation of the immune system at the fetus–maternal unit, the placenta. This interference could be associated with pregnancy morbidities in m o t h e r a n d fetus. This study was done to find out the frequency of autoimmune thyroid disease and its effect on maternal and fetal outcomes in a tertiary care facility in Jharkhand. Method: This is an Observational Prospective Study done during an 18-month period on 254 pregnant women in their second trimester who came to the antenatal clinic (ANC) clinic with singleton pregnancy at RIMS Ranchi. Result: 222 (87.4%) out of the 254 pregnant women had anti- TPO antibodies less than 35 IU/ml. Anti-thyroid peroxidase (anti-TPO) antibody positivity with values greater than 35 IU/ml was found in 32 patients (12.6%). Anti-TPO antibody mean value was 22.54 ± 19.67 IU/ml. Among the 222 individuals who tested negative for the anti-TPO antibody, 7 (3.3%) had miscarriages, 182 (88.3%) gave birth vaginally, and 33 (14.9%) underwent a cesarean section. Of the 32 individuals who tested positive for the anti-TPO antibody, 2 (6.3%) had miscarriages, 24 (75.0%) had vaginal deliveries, and 6 (18.8%) had cesarean sections. Using the Chi-square test, a P value of 0.549 was calculated, indicating statistical insignificance (Pearson Chi-square test value = 0.200a). Conclusion: Anti-TPO antibody positivity was significantly related to miscarriage and anemia. Other complications like preterm delivery, pre-eclampsia, and low birth weight were higher in anti-TPO antibody-positive patients as compared to anti-TPO antibody-negative patients. However, these findings were not statistically significant.

The Link between Racial, Ethnic, and Socioeconomic Disparities, Maternal Mental Health, and Birth Outcomes

This study sought to understand the link between maternal mental health and birth outcomes, exacerbated by ethnic and socioeconomic disparities among women in the U.S. It was hypothesized that minorities experienced adverse birth outcomes, specifically preterm birth and low birth weight, due to a higher risk for mental health disorders. The study used a data set consisting of 38 participants, two of whom had twins, who utilized a pregnancy and postpartum assessment application called vidaRPM, to produce 41 sets of data. Data from this application were collected and examined for potential relationships between mood alerts (moments of concern for a participant’s mental health) and preterm birth, low birth weight, and high blood pressure. The results did not indicate any significant relationships between mood alerts and any of the physical health indicators analyzed in this project, suggesting that there are more aspects to consider than just ethnicity when conducting a study of this magnitude.

Tenant Right-to-Counsel and Adverse Birth Outcomes in New York, New York

In 2017, New York, New York, launched the United States' first right-to-counsel program, guaranteeing lawyers to low-income tenants in select zip codes, which was associated with reducing eviction risk by half. Given documented associations between evictions during pregnancy and adverse birth outcomes, the right-to-counsel program may be associated with improved birth outcomes. To measure associations between zip code-level right-to-counsel access and risk of adverse birth outcomes, including preterm birth and low birth weight, among infants born to Medicaid-insured birthing parents. This retrospective cohort study leveraged the staggered rollout of New York's right-to-counsel program from January 2016 to February 2020 as a natural experiment using a population-based sample of live births to Medicaid-insured birthing parents residing in New York, New York. Data were analyzed from February 2022 to September 2024. Zip code right-to-counsel status 9 months prior to birth. Adverse birth outcomes were measured using individual birth records from the New York Bureau of Vital Statistics. Outcomes included dichotomous indicators of low birth weight (<2500 g), preterm birth (<37 weeks' gestation), and a composite of both. Difference-in-differences linear probability models controlled for year, month, and zip code and included clustered standard errors. Among 260 493 live births (mean [SD] birthing parent age, 29 [6] years) from January 2016 to February 2020, 43 081 births (17%) were to birthing parents residing in zip codes where right-to-counsel was available during pregnancy. Exposure to right-to-counsel during pregnancy was associated with statistically significant reductions in infants' probability of adverse birth outcomes, with reductions of 0.73 (95% CI, 0.06-1.41) percentage points in low birth weight, 0.91 (95% CI, 0.10-1.71) percentage points in preterm birth, and 0.96 (95% CI, 0.09-1.84) percentage points in the composite outcome in treated vs untreated zip codes. This cohort study found that right-to-counsel was associated with reduced risk of adverse birth outcomes among Medicaid-insured birthing parents. These findings suggest that eviction prevention via right-to-counsel may have benefits that extend beyond the courtroom and across the life-course.

Effects of mechanical ventilation on neurodevelopment at 12 months in preterm low birth weight pediatric patients: a systematic review.

The objective of this review is to know the existing scientific evidence about the effects of mechanical ventilation (MV) on neurological development in low-birth-weight premature pediatric patients after 12 months of life, taking as background the direct impact that ventilation has on the central nervous system in the newborn during the first days of life. A systematic search was carried out between 2003 and 2024 in the data bases of: PUBMED, Cochrane Library Plus, PEDro, CINAHL, and SciELO, and two investigators scored the articles according to the Newcastle-Ottawa Assessment scale. Were found 129 non-replicated articles, and 10 cohort and cross-sectional studies were selected that performed an assessment of neurodevelopment in the three spheres after 12 months of life in corrected age of premature infants exposed to ventilator support and related the two variables independently. Mechanical ventilation is an independent neurodevelopmental risk factor in low-birth-weight preterm infants. The time of exposure and the type of ventilation were the variables with the most scientific evidence. https://www.crd.york.ac.uk/, Identifier CRD42023446797.

Factors associated with low birth at the Georgetown Public Hospital Corporation in Guyana: an institution-based cross-sectional study

ABSTRACT Low birth weight (LBW) is a global health issue. We conducted a cross-sectional study to assess factors associated with LBW at Georgetown Public Hospital Corporation (GPHC). We used data from all women who delivered a single live baby as of 28 weeks of gestational age from July to September 2022. 1,304 mothers and their respective live-born babies were included. Logistic regression was used to identify LBW-associated factors at p < .05. The prevalence of LBW was 13.3 percent (95 percent IC: [11.6–15.3]). Women who were primigravida (AOR: 2.18, 95 percent CI = [1.40–3.38]), smoked during pregnancy (AOR: 3.41, 95 percent CI: [1.05–11.03]), had fewer than eight antenatal care visits (AOR: 2.43, 95 percent CI = [1.54–3.83]) were significantly associated with LBW. Similarly, those who had gestational hypertension (AOR: 2.30, 95 percent CI = [1.36–3.80]), urinary tract infections during pregnancy (AOR: 2.91, 95 percent CI = [1.22–2.97]), and gave birth before 37 weeks of gestational age (AOR: 22.65, 95 percent CI = [14.32–35.83]) were more likely to have their babies born with LBW. These findings are crucial for guiding health policies to improve prenatal care access, provide smoking cessation programs, control gestational hypertension, and prioritize early detection and treatment of urinary tract infections, ultimately aiming to reduce preterm births and LBW at GPHC.

Birth Outcomes After Pertussis and Influenza Diagnosed in Pregnancy: A Retrospective, Population-Based Study.

Adverse birth outcomes and the maternal severity of influenza in pregnancy are well documented but information on pertussis is limited. Population-based linkage data were collected during 2001-2016. New South Wales, Australia. A total of 1 453 037 singleton births. Cox regression was used to estimate the associations between pertussis or influenza during pregnancy and birth outcomes with adjustment of covariates. Adverse birth outcomes (preterm birth and low birth weight). Among 1 453 037 singleton births over 16 years, we identified pertussis in 925 (49; 5.3% hospitalised) and influenza in 2850 (1092; 38.3% hospitalised) women during pregnancy. Cases of pertussis were similarly distributed by trimester (32% 3rd) whereas 46% of influenza cases were in the 3rd trimester. Younger age, previous birth, and being overseas-born were associated with both pertussis and influenza, whereas identifying as Aboriginal or Torres Strait Islander, hypertension or diabetes before and during pregnancy, and a number of other factors were only associated with influenza. Both pertussis and influenza in pregnancy were associated with increased risk of preterm birth (pertussis: aHR = 1.30, 95% CI 1.01-1.68; influenza: aHR = 1.56, 95% CI 1.36-1.79) and these increased risks were greater when infections in the period within 2 weeks of birth were considered (pertussis: aHR = 2.36, 95% CI 1.26-4.41; influenza: aHR = 2.29, 95% CI 1.78-2.96). Maternal pertussis and influenza infections close to the time of birth were associated with adverse birth outcomes. These findings highlight the benefits of vaccination during pregnancy.

Don’t omit a urine culture when a urinalysis is suspicious for asymptomatic bacteriuria during pregnancy

Abstract Introduction/Objective Investigation of a clinical problem using steps of evidence-based practice (EBP) led to the development of a recommendation submitted for Choosing Wisely consideration. The prevalence of asymptomatic bacteriuria (ASB) in pregnancy is between 2-15%. ASB may be a concern in pregnancy because of its capacity for association with adverse outcomes, namely preterm delivery, low birthweight, and possible progression to pyelonephritis. Screening and treatment may reduce the risks of adverse outcomes, but data is not current. A point-of-care urine dipstick is low cost and commonly used at routine obstetrician clinic visits to screen for ASB. The urinalysis dipstick is associated with high false-positive and false-negative rates as compared to the gold standard urine culture. Some providers make the decision to treat ASB given a positive urinalysis screen without ordering a follow-up culture. Such practice could lead to overtreatment of the patient and poor antibiotic stewardship. Research question Is a urinalysis without culture sufficient for diagnosis and treatment of ASB during pregnancy? Methods/Case Report Laboratory Medicine Best Practices A-6 steps of Ask, Acquire, Appraise, Apply, Analyze, and Assess were utilized to develop an appropriate and relevant clinical question, collect literature, determine evidence value, assign ratings, implement into practice, and evaluate outcomes. During appraisal, six selected articles were graded according to study rating, practice, measures, and results, further including the final rating and effect size rating. Consistency and overall strength of the evidence were analyzed. Results (if a Case Study enter NA) Each evidence study demonstrated final ratings between 8 and 10, a rating of “Good,” and an effect size rating of “Substantial.” Consistency leads to a “High” overall strength among the body of evidence. Conclusion Obtain a urine culture if routine prenatal point-of-care dipstick urinalyses have findings consistent with asymptomatic bacteriuria. Urinalyses are limited as screening due to low sensitivity and specificity for bacteriuria. Positive urinalysis dipstick results should be neither the sole basis for diagnosis nor decision to treat.

State Social Expenditures and Preterm Birth and Low Birth Weight in the US

Adverse birth outcomes in the US, including preterm birth and low birth weight, are strongly tied to socioeconomic disadvantage and disproportionately impact infants of Black mothers. Increasing investments in social programs represents a potential policy approach to addressing disparities in birth outcomes. To examine state-level associations of government expenditures on social programs with rates of preterm birth and low birth weight both overall and by race. This cross-sectional, ecological study was conducted among liveborn infants in the 50 US states between January 1, 2011, and December 31, 2019. Data analysis was performed from May 2022 to May 2024. Yearly state and local government expenditures per low-income person on social programs in the following categories: state refundable Earned Income Tax Credit; cash assistance; childcare assistance; housing and community development; and public health. Yearly state-level rates of preterm birth (gestational age <37 weeks) and low birth weight (<2500 g). From January 1, 2011, to December 31, 2019, there were 35.1 million live births in the US, of which 3.4 million (9.8%) were preterm and 2.8 million (8.1%) were low birth weight. Median (IQR) state social expenditures per low-income person were $1546 ($1074-$2323). Greater total state social expenditures were associated with lower overall rates of preterm birth (adjusted prevalence ratio [aPR] for every increase of $1000 per low-income person, 0.99; 95% CI, 0.97-0.999) but not with overall rates of low birth weight. In secondary analyses, greater state social expenditures were associated with lower preterm birth rates for infants of Black mothers (aPR, 0.96; 95% CI, 0.92-0.999). Greater state expenditures specifically on cash assistance (aPR, 0.64; 95% CI, 0.43-0.94) and housing and community development (aPR, 0.91; 95% CI, 0.84-0.98) were associated with lower preterm birth rates for infants of Black mothers. In this cross-sectional, ecological study, greater state-level expenditures on social programs were associated with reduced rates of preterm birth, particularly for infants of Black mothers. State and local governments may consider bolstering investments in cash assistance and housing and community development to address maternal and infant health disparities.

Mapping the scientific literature on obstetric and perinatal health among sexual and gender minoritized (SGM) childbearing people and their infants: a scoping review

BackgroundEvidence suggests sexual and gender minoritized (SGM) childbearing individuals and their infants experience more adverse obstetric and perinatal outcomes compared to their cisgender, heterosexual counterparts. This study aimed to comprehensively map obstetric and perinatal physical health literature among SGM populations and their infants and identify knowledge gaps.MethodsPubMed, Embase, CINAHL, and Web of Science Core Collection were systematically searched to identify published studies reporting obstetric and perinatal outcomes in SGM individuals or their infants. Study characteristics, sample characteristics, and outcome findings were systematically extracted and analyzed.ResultsOur search yielded 8,740 records; 55 studies (1981–2023) were included. Sexual orientation was measured by self-identification (72%), behavior (55%), and attraction (9%). Only one study captured all three dimensions. Inconsistent measures of sexual orientation and gender identity (SOGI) were common, and 68% conflated sex and gender. Most (85%) focused on sexual minorities, while 31% addressed gender minorities. Demographic measures employed varied widely and were inconsistent; 35% lacked race/ethnicity data, and 44% lacked socioeconomic data. Most studies (78%) examined outcomes among SGM individuals, primarily focusing on morbidity and pregnancy outcomes. Pregnancy termination was most frequently studied, while pregnancy and childbirth complications (e.g., gestational hypertension, postpartum hemorrhage) were rarely examined. Evidence of disparities were mixed. Infant outcomes were investigated in 60% of the studies, focusing on preterm birth and low birthweight. Disparities were noted among different sexual orientation and racial/ethnic groups. Qualitative insights highlighted how stigma and discriminatory care settings can lead to adverse pregnancy and birth outcomes.ConclusionsFrequent conflation of sex and gender and a lack of standardized SOGI measures hinder the comparison and synthesis of existing evidence. Nuanced sociodemographic data should be collected to understand the implications of intersecting identities. Findings on perinatal health disparities were mixed, highlighting the need for standardized SOGI measures and comprehensive sociodemographic data. The impact of stigma and discriminatory care on adverse outcomes underscores the need for inclusive healthcare environments. Future research should address these gaps; research on SGM perinatal outcomes remains urgently lacking.Trial registrationThe review protocol was developed a priori in February 2023, registered on Open Science Framework (https://doi.org/10.17605/OSF.IO/5DQV4) and published in BMJ Open (https://bmjopen.bmj.com/content/13/11/e075443).

The Supplemental Nutrition Program for Women, Infants, and Children and Birth Outcomes Among Hispanic Mothers in California: A Sibling Control Design.

Participation in the Supplemental Nutrition Program for Women, Infants, and Children (WIC) during pregnancy appears to reduce risks of preterm birth and low birthweight. Many pregnant women who receive WIC benefits, however, also participate in Medicaid (Medi-Cal in California). This co-participation raises the question of whether WIC per se confers these perinatal health benefits. We use a unique, sibling-linked dataset of California births to estimate birth outcomes relating to program receipt (i.e., No WIC or Medi-Cal; WIC alone; Medi-Cal alone; and WIC and Medi-Cal). We also contribute to the literature by focusing on Hispanic mothers who represent the largest fraction of births in California, as well as the highest proportion of WIC recipients in the state. We specifically assessed the relation of differential program receipt on preterm birth (< 37weeks) and low birthweight (< 2500g). We restrict our analytic sample to births between 2007 and 2015 (n = 942,274). Our sibling-control results show lower odds of low birthweight (OR: 0.82, 95% CI: 0.77, 0.87) and preterm birth (OR: 0.87, 95% CI: 0.83, 0.90) when Hispanic mothers receive WIC benefits during pregnancy compared to when the mothers do not receive WIC benefits. While births associated with receipt of both WIC and Medi-Cal also exhibit lower odds of preterm birth (OR: 0.86, 95% CI: 0.79, 0.92), the protective findings do not extend to low birthweight. Our results extend previous work in other states and should stimulate additional research on whether participation in multiple means-tested programs reduce racial/ethnic disparities in adverse birth outcomes.

Adverse perinatal outcomes associated with different classes of antiretroviral drugs in pregnant women living with HIV: a systematic review and meta-analysis.

Women living with HIV (WLHIV) are at increased risk of adverse perinatal outcomes compared to HIV-negative women, despite antiretroviral therapy (ART). There is evidence that the risk of adverse perinatal outcomes may differ according to ART regimen. We aimed to assess the risk of adverse perinatal outcomes among WLHIV receiving different classes of ART, compared to HIV-negative women. Systematic review and meta-analysis. We searched Medline, CINAHL, Global Health and EMBASE for studies published between 1 January 1980 and 14 July 2023. We included studies which assessed the risk of 11 predefined adverse perinatal outcomes among WLHIV receiving non-nucleoside reverse transcriptase inhibitor (NNRTI)-based ART, protease inhibitor (PI)-based ART or integrase strand transfer inhibitor (INSTI)-based ART, compared to HIV-negative women. The perinatal outcomes assessed were preterm birth (PTB), very PTB (VPTB), spontaneous PTB (sPTB), low birthweight (LBW), very LBW (VLBW), term LBW, preterm LBW, small for gestational age (SGA), very SGA (VSGA), stillbirth and neonatal death (NND). Random effects meta-analyses examined the risk of each adverse outcome in WLHIV receiving either NNRTI-based, PI-based or INSTI-based ART, compared with HIV-negative women. Subgroup and sensitivity analyses were conducted based on country income status, study quality, and timing of ART initiation. The protocol is registered with PROSPERO, CRD42021248987. Of 108,720 identified citations, 22 cohort studies including 191,857 women were eligible for analysis. We found that WLHIV receiving NNRTI-based ART (mainly efavirenz or nevirapine) are at increased risk of PTB (risk ratio (RR) 1.40, 95% confidence interval 1.27-1.56), VPTB (1.94, 1.25-3.01), LBW (1.63, 1.30-2.04), SGA (1.53, 1.17-1.99) and VSGA (1.48, 1.16-1.87), compared with HIV-negative women. WLHIV receiving PI-based ART (mainly lopinavir/ritonavir or unspecified) are at increased risk of PTB (1.88, 1.55-2.28), VPTB (2.06, 1.01-4.18), sPTB (16.96, 1.01-284.08), LBW (2.90, 2.41-3.50), VLBW (4.35, 2.67-7.09) and VSGA (2.37, 1.84-3.05), compared with HIV-negative women. WLHIV receiving INSTI-based ART (mainly dolutegravir) are at increased risk of PTB (1.17, 1.06-1.30) and SGA (1.20, 1.08-1.33), compared with HIV-negative women. The risks of adverse perinatal outcomes are higher among WLHIV receiving ART compared with HIV-negative women, irrespective of the class of ART drugs. This underlines the need to further optimise ART in pregnancy and improve perinatal outcomes of WLHIV.

Sexual Orientation-Related Disparities in Neonatal Outcomes.

To evaluate whether disparities exist in adverse neonatal outcomes among the offspring of lesbian, gay, bisexual, and other sexually minoritized (LGB+) birthing people. We used longitudinal data from 1995 to 2017 from the Nurses' Health Study II, a cohort of nurses across the United States. We restricted analyses to those who reported live births (N=70,642) in the 2001 or 2009 lifetime pregnancy questionnaires. Participants were asked about sexual orientation identity (current and past) and same-sex attractions and partners. We examined preterm birth, low birth weight, and macrosomia among 1) completely heterosexual; 2) heterosexual with past same-sex attractions, partners, or identity; 3) mostly heterosexual; 4) bisexual; and 5) lesbian or gay participants. We used log-binomial models to estimate risk ratios for each outcome and weighted generalized estimating equations to account for multiple pregnancies per person over time and informative cluster sizes. Compared with completely heterosexual participants, offspring born to parents in all LGB+ groups combined (groups 2-5) had higher estimated risks of preterm birth (risk ratio 1.22, 95% CI, 1.15-1.30) and low birth weight (1.27, 95% CI, 1.15-1.40) but not macrosomia (0.98, 95% CI, 0.94-1.02). In the subgroup analysis, risk ratios were statistically significant for heterosexual participants with past same-sex attractions, partners, or identity (preterm birth 1.25, 95% CI, 1.13-1.37; low birth weight 1.32, 95% CI, 1.18-1.47). Risk ratios were elevated but not statistically significant for lesbian or gay participants (preterm birth 1.37, 95% CI, 0.98-1.93; low birth weight 1.46, 95% CI, 0.96-2.21) and bisexual participants (preterm birth 1.29, 95% CI, 0.85-1.93; low birth weight 1.24, 95% CI, 0.74-2.08). The offspring of LGB+ birthing people experience adverse neonatal outcomes, specifically preterm birth and low birth weight. These findings highlight the need to better understand health risks, social inequities, and health care experiences that drive these adverse outcomes.

A National Study of the Associations between Hormonal Modulators in Hydraulic Fracturing Fluid Chemicals and Birth Outcomes in the United States of America: A County-Level Analysis.

Risk of preterm birth (PTB) and low birth weight (LBW) due to hydraulic fracturing (HF) exposure is a growing concern. Regional studies have demonstrated links, but results are often contradictory among studies. This is the first US national study to our knowledge linking fracturing fluid ingredients to the human hormone pathways targeted-estrogen, testosterone, or other hormones (e.g., thyroid hormone)-to assess the effect of HF ingredients on rates of PTB and LBW. We constructed generalized linear regression models of the impact of HF well density and hormone targeting chemicals in HF fluids (2001-2018) on the county-level average period prevalence rates of PTB and LBW (2015-2018) with each outcome measured in separate models. Our data sources consisted of publicly available datasets, including the WellExplorer database, which uses data from FracFocus, the March of Dimes Peristats, the US Census Bureau, the US Department of Agriculture, and the Centers for Disease Control and Prevention. We conducted additional stratified analyses to address issues of confounding. We used stratification to address issues regarding outcomes in rural vs. urban communities by assessing whether our models achieved similar results in nonmetro counties, as well as farming and mining counties. We also stratified by the year of the HF data to include HF data that was closer to the time of the birth outcomes. We also added covariate adjustment to address other important factors linked to adverse birth outcomes, including the proportion of the population belonging to various racial and ethnic minority populations (each modeled as a separate variable); education (bachelor's degree and high school); use of fertilizers, herbicides, and insecticides, acres of agricultural land per square mile; poverty; insurance status; marital status; population per square mile; maternal care deserts; and drug deaths per 100,000 people. We found that the density of HF wells in a county was significantly associated with both PTB and LBW rates (percentage of live births) in our fully adjusted models. We report the results from our more restrictive stratified analysis with a subset including only the 2014-2018 data, because this resulted in the most meaningful time frame for comparison. Across all models, the magnitude of effect was highest for wells with ingredients that include estrogen targeting chemicals (ETCs), testosterone targeting chemicals (TTCs) and other hormone targeting chemicals (OHTCs), and, finally, all wells grouped regardless of chemical type. For every unit increase in well density per square mile of wells that use chemicals that include an ETC, we observed a 3.789-higher PTB rate (95% CI: 1.83, 5.74) compared with counties with no ETC wells from 2014 to 2018 and likewise, we observed a 1.964-higher LBW rate (95% CI: 0.41, 3.52). Similarly, for every unit increase in well density per square mile of wells that use TTC, we observed a 3.192-higher PTB rate (95% CI: 1.62, 4.77) compared with counties with no TTC wells. Likewise, for LBW, we found a 1.619-higher LBW rate (95% CI: 0.37, 2.87). We also found that an increase in well density per square mile among wells that use chemicals that include an OHTC resulting in a 2.276-higher PTB rate (95% CI: 1.25, 3.30) compared with counties with no OHTC wells, and for LBW, we found a 1.244-higher LBW rate (95% CI: 0.43, 2.06). We also explored the role of HF well exposure in general (regardless of the chemicals used) and found that an increase in total well density (grouped regardless of hormonal targeting status of the chemicals used) resulted in a 1.228-higher PTB rate (95% CI: 0.66, 1.80) compared with counties with no wells, and for LBW, we found a 0.602-higher LBW rate (95% CI: 0.15, 1.05) compared with counties with no wells. We found similar results in our primary analysis that used all data without any exclusions and the statistical significance did not change. Our findings reinforce previously identified regional associations between HF and PTB and LBW, but on a national scale. Our findings point to dysregulation of hormonal pathways underpinning HF exposure risk on birth outcomes, which warrants further exploration. Future research must consider the specific ingredients used in HF fluids to properly understand the differential effects of exposure. https://doi.org/10.1289/EHP12628.

Clinical Profile and Outcome of Twin Babies Delivered at a Tertiary Care Center in Eastern Nepal

Introduction: Twin pregnancies are often associated with higher risks of complications for both the mother and the neonates, particularly in resource-limited settings. This study was conducted at a tertiary care center in Eastern Nepal to assess the clinical profile and outcomes of twin pregnancies. Methods: A descriptive cross-sectional study was carried out in the department of Pediatric and neonatology at Nobel Medical College Teaching Hospital, Biratnagar, Nepal over the period of 6 month (December 2023 to May 2024). Total of 32 twin pregnancies of gestational age of ≥28 weeks, where both twins were alive at delivery were included. Data were collected on maternal and neonatal characteristics, including birth weight, gestational age, Apgar scores, and clinical outcomes. Statistical analyses were performed to compare the outcomes between the first and second twins. Results: In the present, study total of 32 eligible twin were analyzed. The majority of twins were (53.1%) delivered between 32 to &lt;37 weeks of gestation rest 46.87% delivering between 28 to &lt;32 weeks. The average Apgar scores were 6.5 at 1 minute and 8.6 at 5 minutes. The most common clinical feature seen in twin neonates was lethargy which was seen in 32 neonates (50%). NICU admission was required for 70.3% of the neonates. There were no significant differences between groups twin 1 and twin 2 in most health indicators, such as clinical symptoms, hemoglobin, PCV, serum calcium level, jaundice, TTTS, chest X-ray findings, NICU admissions, or overall outcomes (P &gt; 0.05). However, twin 1 had a higher rate of neonatal sepsis (P = 0.048). notable difference was observed in the incidence of neonatal sepsis between the first and second twins, with the first twin being more affected. Neonatal mortality rate in twin in the present study was 7.8%. Conclusion: Twin pregnancies have high incidence of preterm delivery and low birth weight. Requirement of NICU care is more in case of first twin.

Effect of Interpregnancy Interval on Pregnancy Outcome in a Tertiary Care Centre: A Descriptive Cross-sectional Study

Introduction: Interpregnancy interval has a major impact on the maternal and fetal health worldwide. Women with short interpregnancy interval show higher rates of low birth weight and preterm babies. So this study aimed to study the effect of interpregnancy interval on pregnancy outcomes.Methods: This descriptive cross-sectional study was conducted in the Department of Obstetrics and Gynaecology of a tertiary care center after taking ethical approval from Institutional Review Committee (Reference number:229/080/081(6-11)E2). Data from September 1st, 2023 to January 30th, 2024 was collected. All multigravida women with singleton pregnancy after 28 weeks of gestation who delivered in our hospital with previous birth were enrolled in the study. Convenience sampling method was done. Point estimate and 95% Confidence Interval were calculated. The data was entered and analyzed using IBM SPSS Statistics version 26.0Results: Among the women , 31 (3.57%) women had short interpregnancy interval ≤18 months whereas 836 (96.43%) had interpregnancy interval of &gt;18 months. The mean age of the women was 28 years. Previous cesarean section was common indication of cesarean section 27 (87.09%) among women with short interpregnancy interval. These women had higher rates of preterm and low birth weight babies 11(35.58%) &amp; 15(48.38%).Conclusions: Women with short interpregnancy interval ≤18 months had higher preterm births and low birth weight babies. Pregnancy induced hypertension, hypothyroidism and gestational diabetes were increased in women with interpregnancy interval of &gt;18 months.