Prevalence Of Adverse Perinatal Outcomes Research Articles

Assessing the Impact of Hematological Changes in Pregnancy on Maternal and Fetal Death: A Narrative Review.

Hematological changes during pregnancy encompass a wide range of alterations in blood composition and function, including variations in hemoglobin levels, red blood cell count, and coagulation factors. These changes can be physiological or pathological and may significantly impact maternal and fetal health outcomes. This narrative review examines the relationship between various hematological changes and disorders during pregnancy and their effects on maternal and fetal mortality and morbidity. We explore conditions such as anemia, sickle cell disease, thrombophilia, and blood-borne infections like malaria, as well as the impact of multiple pregnancies on hematological parameters. The review also discusses the effects of COVID-19 on maternal hematology. Key findings include the high prevalence of adverse perinatal outcomes associated with these conditions, including early miscarriages, preterm birth, low birth weight, intrauterine growth restriction, and increased risk of maternal complications. The importance of early screening, diagnosis, and appropriate management of hematological disorders during pregnancy is emphasized. This review highlights the need for a multidisciplinary approach to managing pregnant women with hematological changes to optimize maternal and fetal outcomes.

Low amniotic fluid index at term as a predictor of adverse perinatal outcome.

Objective: To assess the prevalence of adverse perinatal outcomes in antenatal women with low amniotic fluid index at term. Study Design: Observational Cross-sectional Analysis. Setting: Department of Gynaecology and Obstetrics Hayatabad Medical Complex, Peshawar. Period: 2nd February 2020, to 5th February 2021. Methods: The study involved a total of 165 patients, in 37 to 40-weeks of gestation period, the research included antenatal women with a low amniotic fluid index, with any parity, gravidity, and 18-35 years of age. While Excluded patients with any medical disorders during pregnancy (e.g., PIH, anemia, cardiac disease etc.), and those with gestational period <37 weeks from the study. Thorough history, clinical examination and ultrasound were carried out of all the women included in the study from OPD and emergency department, to confirm a low amniotic fluid index. Patient follow-up was extended to their arrival in the Obstetric suite during established labor, APGAR scores were calculated and recorded at birth, and at the 5-minute of birth for the neonate. Adverse Perinatal Outcome was considered positive if the APGAR Score was <7/10 at five minutes of life of neonate. Data analysis was performed using SPSS 23. Results: Out of 165 patients 57% of the patients were induced while 43% spontaneously delivered, similarly 66.7% were delivered vaginally while 33.3% were delivered via C Section. Low neonatal APGAR score was recorded in 67.9% patients which is a significant percentage, hence our study results showed positive correlation of low AFI with adverse perinatal outcome. We also observed that probability of satisfactory values of AFI is 1.5 times more in spontaneous deliveries (p=0.04, OR=1.5), however no such relation exists for period of gestation or number of parity. Similarly, there is a significant relation of mode of delivery with satisfactory values of AFI (p=0.00), however no such relation exists for period of gestation or number of parity. However, the probability of vaginal deliveries is 1.6 times more with an increased in number of para (p=0.02, OR=1.6). Conclusion: Reduced amniotic fluid index is linked with significant Unfavorable Perinatal Outcomes proved by low APGAR score (<7/10 at five minutes).

Correlation of placental lesions in patients with systemic lupus erythematosus, antiphospholipid syndrome and non-criteria obstetric antiphospholipid syndrome and adverse perinatal outcomes

IntroductionWe aimed to describe the pattern of placental injuries in women with systemic lupus erythematosus (SLE), antiphospholipid antibody syndrome (APS) and non-criteria obstetric APS (NC-OAPS), and to correlate the placental findings with the occurrence of adverse perinatal outcomes. MethodsThe perinatal outcomes and placental findings of pregnancies of women with SLE, APS, and NC-OAPS and gestational-age matched healthy controls were analyzed and classified according to the 2015 Redline - Classification of placental lesions. Results91 women with SLE, APS, and NC-OAPS and 91 controls were included. Mean values of placental weight differed between groups, being significantly lower in NC-OAPS and APS groups compared to controls. Furthermore, 14.3% of placentas in the APS group were under the 3rd percentile, which was significantly higher in comparison with other groups.Regarding histopathological placental findings, maternal-side malperfusion was significantly increased in APS (46.4%) compared to NC-OAPS (14.3%) and SLE (9.5%). Fetal-side maldevelopment was significantly increased in NC-OAPS (19.1%) compared to controls (1.1%) and SLE (2.4%). A significantly increased prevalence of adverse perinatal outcomes (APOs) was observed in all studied groups compared to healthy controls (controls 3.3%, SLE 52.4%, NC-OAPS 57.1%, APS 64.3%). Overall, both maternal (OR 6.8, 95%CI 2.1–22) and fetal-side (OR 4.1, 95%CI 1.3–13.5) lesions were significantly associated with APO. Maternal malperfusion and fetal maldevelopment were the lesions most strongly associated with APOs. DiscussionPregnant women with SLE, APS, or NC-OAPS showed a different pattern of histopathological findings. Compared to controls, SLE, APS, and NC-OAPS conferred an increased risk of APOs that was strongly associated with placental maternal-side malperfusion and fetal-side maldevelopment.

Main sources of exposure to environmental risks in pregnant women from Kinil, Yucatan, Mexico

Objective. To identify main environmental hazards to which pregnant women in Kinil, Yucatan are exposed. Methodology. Cross-sectional study consisting of two parts: 1) review of clinical archieves of women who received prenatal care from 2015 to 2017, registered in the Pregnancy Census of the Kinil Health Center, to obtain prenatal medical records, data on babies and perinatal conditions of their births; 2) the patients were visited in their homes to explain the objective of the study and request the pertinent permits with informed consent, as well as the caregivers in the case of minors. The frequency of major diseases during pregnancy was determined, as well as the prevalence of adverse perinatal outcomes. Contribution. Approach to environmental diagnosis, identify potential sources of risks of disease, characterize positive or negative situations to detect groups in vulnerable situations.

Is the increasing prevalence of labor induction accompanied by changes in pregnancy outcomes? An observational study of all singleton births at gestational weeks 37-42 in Norway during 1999-2019.

Induction of labor is often performed to prevent adverse perinatal and maternal outcomes, and has become increasingly common. We studied whether changes in prevalence of labor induction in gestational weeks 37-42 weeks were accompanied by changes in adverse pregnancy outcomes or mode of delivery. We used data from the Medical Birth Registry of Norway, and included all singleton births in gestational weeks 37-42 in Norway, 1999-2019 (n=1127 945). We calculated the prevalence of labor induction and outcome measures according to year of birth. We repeated these calculations for each gestational week at birth. The prevalence of labor induction increased from 9.7% to 25.9%, and the increase was particularly high in gestational week 41. A modest decline in fetal deaths was observed in all gestational weeks, except gestational week 41. The overall decline was from 0.18% in 1999-2004 to 0.13% during 2015-2019. There were no overall changes in other perinatal outcomes. The prevalence of postpartum hemorrhage ≥500 ml increased from 11.4% in 1999 to 30.1% in 2019, and operative deliveries increased slightly. The prevalence of acute cesarean section increased from 6.5% to 9.3%, whereas vacuum and/or forceps assisted deliveries increased from 7.8% to 10.4%. A high increase in labor inductions was accompanied by a modest decline in fetal deaths, but no decline in other adverse perinatal outcomes. In settings where the prevalence of adverse perinatal outcomes is low, the beneficial effect of increased use of labor induction may not outweigh the side effects or the costs.

Adverse perinatal outcomes in a large United States birth cohort during the COVID-19 pandemic

BACKGROUNDThe impact of coronavirus disease 2019 (COVID-19) on adverse perinatal outcomes remains unclear.OBJECTIVEThis study aimed to investigate whether COVID-19 is associated with adverse perinatal outcomes in a large national dataset and to examine the rates of adverse outcomes during the pandemic compared with the rates of adverse outcomes during the prepandemic period.STUDY DESIGNThis observational cohort study included 683,905 patients, between the ages of 12 and 50, hospitalized for childbirth and abortion between January 1, 2019, and May 31, 2021. During the prepandemic period, 271,444 women were hospitalized for childbirth. During the pandemic, 308,532 women were hospitalized for childbirth, and 2708 women had COVID-19. The associations between COVID-19 and inhospital adverse perinatal outcomes were examined using propensity score–adjusted logistic regression.RESULTSWomen with COVID-19 were more likely to experience both early and late preterm birth (adjusted odds ratios, 1.38 [95% confidence interval, 1.1–1.7] and 1.62 [95% confidence interval, 1.3–1.7], respectively), preeclampsia (adjusted odds ratio, 1.2 [95% confidence interval, 1.0–1.4]), disseminated intravascular coagulopathy (adjusted odds ratio, 1.57 [95% confidence interval, 1.1–2.2]), pulmonary edema (adjusted odds ratio, 2.7 [95% confidence interval, 1.1–6.3]), and need for mechanical ventilation (adjusted odds ratio, 8.1 [95% confidence interval, 3.8–17.3]) than women without COVID-19. There was no significant difference in the prevalence of stillbirth among women with COVID-19 (16/2708) and women without COVID-19 (174/39,562) (P=.257). There was no difference in adverse outcomes among women who delivered during the pandemic vs prepandemic period. Combined inhospital mortality was significantly higher for women with COVID-19 (147 [95% confidence interval, 3.0–292.0] vs 2.5 [95% confidence interval, 0.0–7.5] deaths per 100,000 women). Women diagnosed with COVID-19 within 30 days before hospitalization were more likely to experience early preterm birth, placental abruption, and mechanical ventilation than women diagnosed with COVID-19 >30 days before hospitalization for childbirth (4.0% vs 2.4% for early preterm birth [adjusted odds ratio, 1.7; 95% confidence interval, 1.1–2.7]; 2.2% vs 1.2% for placental abruption [adjusted odds ratio, 1.86; 95% confidence interval, 1.0–3.4]; and 0.9% vs 0.1% for mechanical ventilation [adjusted odds ratio, 13.7; 95% confidence interval, 1.8–107.2]).CONCLUSIONWomen with COVID-19 had a higher prevalence of adverse perinatal outcomes and increased in-hospital mortality, with the highest risk occurring when the diagnosis was within 30 days of hospitalization, raising the possibility of a high-risk period.

Reduced Growth in Non-Small for Gestational Age Fetuses from 35 Weeks of Gestation to Birth and Perinatal Outcomes

Objective: This study aimed to assess reduced fetal growth between 35 weeks of gestation and birth in non-small for gestational age fetuses associated with adverse perinatal outcomes (APOs). Material and Method: It is a retrospective cohort study of 9,164 non-small for gestational age fetuses estimated by ultrasound at 35 weeks. The difference between the birth weight percentile and the estimated percentile weight (EPW) at 35 weeks of gestation was calculated, and we studied the relationship of this difference with the appearance of APO. APOs were defined as cesarean or instrumental delivery rates for nonreassuring fetal status, 5-min Apgar score <7, arterial cord blood pH <7.10, and stillbirth. Fetuses that exhibited a percentile decrease between both moments were classified into 6 categories according to the amount of percentile decrease (0.01–10.0, 10.01–20.0, 20.01–30.0, 30.01–40.0, 40.01–50.0, and >50.0 percentiles). It was evaluated whether the appearance of APO was related to the amount of this percentile decrease. Relative risk (RR) was calculated in these subgroups to predict APOs in general and for each APO in particular. Receiver operating characteristic and area under curves (AUC) for the difference in the percentile was calculated, used as a continuous parameter in the entire study population. Results: The median gestational age at delivery in uncomplicated pregnancies was 40.0 (39.1–40.7) and in pregnancies with APOs 40.3 (49.4–41.0), p < 0.001. The prevalence of APOs was greater in the group of fetuses with a decrease in percentile (7.6%) compared to those with increased percentile (4.8%) (p < 0.001). The RR was 1.63 (95% CI: 1.365–1.944, p < 0.001). Although the differences were significant in all decreased percentile groups, RRs were significantly higher when decreased growth values were >40 points (RR: 2.036, 95% CI: 1.581–2.623, p < 0.001). The estimated value of the AUC for percentile decrease was 0.58 (0.56–0.61, p < 0.001). Conclusion: Fetuses with a decrease in the EPW between the ultrasound at 35 weeks of gestation and birth have a higher risk of APOs, being double in fetuses with a decrease of >40 percentile points.

Effect of grade 3 placenta

The aim of this study was to assess whether the presence of grade 3 placenta <36 weeks of pregnancy is associated with adverse perinatal outcomes. Retrospective cohort study in which patients were separated into the following three groups: 1) grade 3 placenta <36 weeks, 2) grade 3 placenta >36 weeks, 3) no occurrence of grade 3 placenta throughout pregnancy. The χ2 and general linear model tests were used to compare adverse perinatal outcomes. Binary logistic regression model was used to estimate the odds ratio (OR) for adverse perinatal outcomes. Receiver operating characteristic (ROC) curve was used to determine the cut-off of the middle cerebral artery Pulsatility Index (MCA PI) in the detection of births <37 weeks in grade 3 placentas <36 weeks. Significant association was observed between grade 3 placenta <36 weeks and birth <37 weeks (P<0.001), birth weight <10th percentile (P=0.001), 5-min Apgar Score <7 (P=0.014), admission to neonatal intensive care unit (P<0.001), and fetal death (P=0.002). Grade 3 placenta <36 weeks was significant predictor for birth <37 weeks (OR: 2.6; 95% CI: 1.74-3.92), pre-eclampsia (OR: 1.8; 95% CI: 1.02-3.27), birth weight <10th percentile (OR: 2.1; 95% CI: 1.39-3.10), fetal death (OR: 5.6; 95% CI: 1.65-18.78), and composite perinatal outcomes (OR: 2.2; 95% CI: 1.51-3.17). The MCA PI showed an area under ROC curve of 0.641 (95% CI: 0.546-0.728) in the detection of births <37 weeks. Grade 3 placenta <36 weeks was associated with a higher prevalence of adverse perinatal outcomes.

Adverse Perinatal Outcomes Among Grand Multiparous and Low Multiparous Women and Its Associated Factors in North Shewa Zone Public Hospitals: The Role of Parity.

BackgroundAdverse perinatal outcomes are the major cause of neonatal morbidity, mortality, and long-term physical and psychological consequences. Contradicting evidence across studies was reported about the impact of grand multiparity on adverse perinatal outcomes. Older literature reported increased incidence of perinatal complications in grand multiparas, but, recent reports failed to support this finding. In addition, there is a paucity of comparative studies on perinatal outcomes. Thus, the study aimed to compare the perinatal outcomes in grand multiparous (GM) and low multiparous (LM) women who give birth in North Shewa Zone Public Hospitals, Ethiopia, 2021.MethodsA comparative cross-sectional study was done among 540 (180 GM and 360 LM) women from January 1 to March 30, 2021. The data were collected using a structured and pre-tested questionnaire through interviews and reviewing patient charts. SPSS version 25 was used for data analysis. The data were entered using Epi-Data version 4.6. The Hosmer–Lemeshow goodness-of-fit was applied to test for model fitness. The statistical significance level was declared at a p-value of ≤0.05.ResultsIn this study, the prevalence of adverse perinatal outcomes was 14.1% (95% CI: 10.9–17.2). Stillbirth/IUFD (33.3%) and low APGAR score (60%) were frequently occurred complications in grand multiparas. Nevertheless, meconium aspiration (26%), admission to NICU (65.2%), macrosomia (61%), and prematurity (52.2%) were higher in low multiparous women. Age above 35 years (AOR (CI) = 2.61 (1.23–5.53)), rural residence (AOR (CI) = 8.31 (3.05–22.6)), being a government employee (AOR (CI) = 0.19 (0.05–0.69)), lack of antenatal care (AOR (CI) = 9.76 (3.03–31.5)), and previous pregnancy complications (AOR (CI) = 3.10 (1.63–5.90)) were significant predictors of adverse perinatal outcomes. However, parity did not show a statistically significant association with perinatal outcomes.ConclusionMaternal age, residence, occupation, lack of antenatal care, and previous pregnancy complications were significant associates of perinatal outcome. There was no statistically significant difference in perinatal outcome between GM and LM women. Socio-economic development, good antenatal care, and early identification and treatment of complications are needed regardless of parity.

Medicines prescribed for asthma, discontinuation and perinatal outcomes, including breastfeeding: A population cohort analysis.

To explore associations between exposures to medicines prescribed for asthma and their discontinuation in pregnancy and preterm birth [<37 or <32 weeks], SGA [<10th and <3rd centiles], and breastfeeding at 6-8 weeks. Design. A population-based cohort study. Setting. The Secure Anonymised Information Linkage [SAIL] databank in Wales, linking maternal primary care data with infant outcomes. Population. 107,573, 105,331, and 38,725 infants born 2000-2010 with information on premature birth, SGA and breastfeeding respectively, after exclusions. Exposures. maternal prescriptions for asthma medicines or their discontinuation in pregnancy. Methods. Odds ratios for adverse pregnancy outcomes were calculated for the exposed versus the unexposed population, adjusted for smoking, parity, age and socio-economic status. Prescriptions for asthma, whether continued or discontinued during pregnancy, were associated with birth at<32 weeks' gestation, SGA <10th centile, and no breastfeeding (aOR 1.33 [1.10-1.61], 1.10 [1.03-1.18], 0.93 [0.87-1.01]). Discontinuation of asthma medicines in pregnancy was associated with birth at<37 weeks' and <32 weeks' gestation (aOR 1.22 [1.06-1.41], 1.53 [1.11-2.10]). All medicines examined, except ICS and SABA prescribed alone, were associated with SGA <10th centile. Prescription of asthma medicines before or during pregnancy was associated with higher prevalence of adverse perinatal outcomes, particularly if prescriptions were discontinued during pregnancy. Women discontinuing medicines during pregnancy could be identified from prescription records. The impact of targeting close monitoring and breastfeeding support warrants exploration.

Macrosomia as a Marker for Adverse Perinatal Outcomes in Pregnancy Complicated by Diabetes Mellitus [24D

INTRODUCTION: We sought to examine the strength of macrosomia as a marker for adverse perinatal outcomes associated with poor glycemic control in women with a pre-gestational diagnosis of diabetes mellitus. METHODS: A retrospective cohort study of 8,535 women in California with singleton, vertex, non-anomalous gestations was performed to assess prevalence of adverse perinatal outcomes in macrosomic pregnancies complicated by diabetes mellitus. Macrosomia was defined as a birth weight greater than 4000 g. Neonatal outcomes examined included respiratory distress syndrome (RDS), hypoglycemia, jaundice, neonatal death (NND) and intrauterine fetal demise (IUFD). Maternal complications included preeclampsia, post-partum hemorrhage and chorioamnionitis. Confounding variables were controlled for and Chi-squared analyses with a P-value of less than 0.05 were considered statistically significant. RESULTS: Overall, macrosomia in pre-gestational diabetic women proved to be a reliable marker for increased perinatal complications. Neonatal complications were most pronounced, with macrosomic neonates at a significantly increased risk for RDS (3.81% vs 1.81% P&lt;.001), hypoglycemia (1.24% vs 0.66% P=.007), jaundice (29.09% vs 23.06% P&lt;.001), NND (0.19% vs 0.04% P=.024) and IUFD (1.38% vs 0.43% P&lt;.001). Macrosomia characterized by birth weight of greater than 4500 g showed similar statistical significance in increased risk of each complication. Both classifications of macrosomia showed decreased incidence of chorioamnionitis (1.38% vs 2.52% P=.002, 1.06% vs. 2.36% P=.031). CONCLUSION: Macrosomia in diabetic women is a reliable marker for adverse neonatal outcomes, including increased risks for IUFD and neonatal death. Women should be counseled about these risks and managed accordingly throughout their pregnancies.

837: Large-for-gestational-age as a marker for adverse perinatal outcomes in pregnancy complicated by gestational diabetes mellitus

We sought to examine the strength of large-for-gestational-age (LGA) measuring neonates as a marker for adverse perinatal outcomes associated with poor glycemic control in women with gestational diabetes mellitus (GDM). A retrospective cohort study of 141,670 women in California with singleton, vertex, non-anomalous gestations was performed in order to assess prevalence of adverse perinatal outcomes in GDM with LGA neonates. LGA was defined as birth weight greater than or equal to the 90th percentile for a given gestational age. Maternal outcomes examined included preeclampsia, post-partum hemorrhage (PPH) and chorioamnionitis. Neonatal outcomes examined included respiratory distress syndrome (RDS), hypoglycemia, jaundice and intrauterine fetal demise (IUFD). Confounding variables including pre-gestational diabetes mellitus were controlled for and a p-value of less than 0.05 was considered statistically significant. Overall, LGA gestation in women with GDM was a reliable marker for an increased risk of perinatal complications (Table 1). Statistically significant increased complications included neonatal RDS (2.64% vs 1.77% p=0.001), hypoglycemia (1.06% vs 0.05% p< 0.001), jaundice (21.52% vs 19.18% p=0.003), IUFD (0.49% vs 0.14% p< 0.001), PPH (4.07% vs 2.95% p=0.001) and a decreased risk of chorioamnionitis (1.87% vs 2.68% p=0.014). Most notably, the risk of IUFD (Figure 1) and RDS steadily increase as the size of the fetus increases proportional to gestational age. Maternal complications were less statistically significant in the extremes of LGA. Large-for-gestational-age measurements in women with GDM are reliable markers for adverse perinatal outcomes. Of particular concern is the risks of IUFD and RDS, which decidedly increase with LGA centile greater than 90th. Women should be counseled about these risks and providers prepared to give additional respiratory support to neonates at delivery.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Pregnancy outcomes after maternal Zika virus infection in a non-endemic region: prospective cohort study

ObjectivesThe aim was to describe pregnancy outcomes after Zika virus (ZIKV) infection in a non-endemic region. MethodsAccording to the Spanish protocol issued after the ZIKV outbreak in Brazil in 2015, all pregnant women who had travelled to high-burden countries were screened for ZIKV. Serological and molecular tests were used to identify ZIKV-infected pregnant women. They were classified as confirmed ZIKV infection when reverse transcription (RT) PCR tested positive, or probable ZIKV infection when ZIKV immunoglobulin M and/or immunoglobulin G and ZIKV plaque reduction neutralization tests were positive. Women found positive using molecular or serological tests were prospectively followed-up with ultrasound scans and neurosonograms on a monthly basis until delivery; magnetic resonance imaging and amniotic fluid testing were performed after signed informed consent. Samples of placenta, and fetal and neonatal tissues were obtained. ResultsSeventy-two pregnant women tested positive for ZIKV infection: ten were confirmed by RT-PCR, and 62 were probable cases based on serological tests. The prevalence of adverse perinatal outcomes was 33.3% (three out of nine, 95% CI 12.1–64.6%): two cases of congenital ZIKV syndrome (CZS) and one miscarriage, all born to women infected in the first trimester of gestation. All ZIKV-confirmed women had persistent viraemias beyond 2 weeks (median 61.50 days; IQR 35.50–80.75). Amniotic fluid testing was only positive in the two fetuses with anomalies. ConclusionThe prevalence of perinatal adverse outcomes for women with ZIKV-confirmed infection was 33.3%. Amniocentesis for ZIKV RT-PCR is recommended when fetal abnormalities are found. Intensive prenatal and postnatal follow-up of ZIKV-infected pregnancies is advised in confirmed cases.

Child Bearing Age and Pregnancy Outcomes in Bangladesh: A Multilevel Analysis of a Nationwide Population-Based Survey

Background: Delayed childbirth has increased significantly over the past several decades in developed countries while teenage pregnancy is still common in developing countries. Assessing the association between adolescent childbearing and the risk of perinatal and health outcomes may help policy makers to reform or formulate new policies to prevent premature death, disability and other adverse perinatal outcomes. Objectives: To assess the association between adolescent pregnancy and the risk of adverse maternal, obstetrical and neonatal outcomes. Study design: Data was extracted from 2011 Bangladesh Demographic and Health Survey (BDHS). This is a nationally representative population-based survey with a two-stage stratified cluster sample design. Outcomes for adolescent women ≤ 19 years of age were compared with those of women aged 20 to 34 years (young adult) and ≥ 35 years (adult). Multilevel Poisson regression models were used to determine the associated adverse birth and health outcome with maternal age. Results: The mean age at childbearing was 26 years. Prevalence of adverse perinatal outcomes including low birth weight, stillbirths, stunting and perinatal mortality were substantially higher among adolescent mothers compared to the young adults. Multilevel regression models indicated that higher risk of low birth weight (adjusted relative risk (aRR), 1.15; 95% CI, 1.00-1.33), childhood stunting (aRR, 1.06; 95% CI, 0.98-1.14) and early neonatal mortality (aRR, 1.60; 95% CI, 0.85-1.27) were observed among the adolescent mothers compared to young adult mothers. Maternal age 35 years or over found to be a greater risk factor for pregnancy termination (aRR, 1.31; 95% CI, 1.09-1.56), caesarean delivery (aRR, 1.35; 95% CI, 1.02-1.79) and menstrual irregularities (aRR, 1.35; 95% CI, 1.02-1.79) than for young adult mothers. Conclusion: Pregnant women aged ≤ 19 years and ≥ 35 years are at increased risk of different adverse birth and health outcomes. Social awareness needs to be increased about the consequences of early and late childbearing to prevent premature death and disability and adverse perinatal outcomes.

Increases in Caesarean Delivery Rates and Change of Perinatal Outcomes in Low‐ and Middle‐Income Countries: A Hospital‐Level Analysis of Two WHO Surveys

Maternal and neonatal outcomes have improved substantially. During the same period, the caesarean delivery rate soared. The aim of this analysis was to determine whether an increase in caesarean rate was associated with an improvement in perinatal outcome at an institutional level in low- and middle-income countries. The WHO Global Survey on Maternal and Perinatal Health (WHOGS) and the WHO Multi-Country Survey on Maternal and Newborn Health (WHOMCS) were two multi-country, facility-based, cross-sectional surveys conducted in 2004-08 and 2010-11, respectively. The increase in caesarean rate and the change of prevalence of adverse perinatal outcomes were calculated using a two-point estimator of percent change annualized (PCA) method. Maternal, perinatal, and neonatal composite indexes were used as the outcomes. A linear mixed model was used to assess the association between the change of caesarean rate and the change of perinatal outcome. A total of 259 facilities in 20 countries participated in both surveys, with 217 844 women in WHOGS and 227 734 women in WHOMCS. The caesarean rate in these facilities increased, on average, by 4.0% annually, while the prevalence of adverse perinatal outcomes decreased by 4.6% annually. However, after adjustments for potential confounders, no association was found between the increase in caesarean rate and the change of adverse outcome indexes, regardless of whether starting caesarean rates were already high (above 10%) or not. In low- and middle-income countries, the increases in caesarean rates were not associated with improved perinatal outcomes regardless of whether the starting caesarean rate was already high or not.

Worldwide prevalence of adverse pregnancy outcomes among singleton pregnancies after in vitro fertilization/intracytoplasmic sperm injection: a systematic review and meta-analysis.

The worldwide prevalence of adverse pregnancy outcomes (APOs) in singleton pregnancies after in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) is suggested to vary; however, a complete overview is missing. The aim of this review is to estimate the worldwide prevalence of APOs associated with IVF/ICSI singleton pregnancies. PubMed, Google Scholar, Cochrane Libraries, and Chinese databases were searched for studies assessing APOs among IVF/ICSI singleton births through March 2016. The prevalence estimates were summarized and analyzed by meta-analysis. Fifty-two cohort studies, with 181,741 IVF/ICSI singleton births and 4,636,508 spontaneously conceived singleton births, were selected for analysis. Among IVF/ICSI singleton pregnancies, pooled estimates were 10.9% [95% confidence interval (CI) 10.0-11.8] for preterm birth, 2.4% (95% CI 1.9-3.0) for very preterm birth, 8.7% (95% CI 7.4-10.2) for low birth weight, 2.0% (95% CI 1.5-2.6) for very low birth weight, 7.1% (95% CI 5.5-9.2) for small for gestational age, 1.1% (95% CI 0.9-1.3) for perinatal mortality, and 5.7% (95% CI 4.7-6.9) for congenital malformations. The IVF/ICSI singleton pregnancies have higher prevalence of APOs compared with those conceived naturally (all P=0.000). Significant differences in different continents, countries, income groups, and type of assisted conception were found. The IVF/ICSI singleton pregnancies are at a higher prevalence of adverse perinatal outcomes compared with those conceived naturally. Important geographical differences were found. Yet, population-wide prospective APO registries covering the entire world population for IVF/ICSI pregnancies are needed to determine the exact perinatal prevalence.

Prevalence of metabolic syndrome in non-diabetic, pregnant Angolan women according to four diagnostic criteria and its effects on adverse perinatal outcomes.

BackgroundMetabolic syndrome (MetS) is a cluster of risk factors for type 2 diabetes (Type2 DM) and cardiovascular diseases (CVD), and its prevalence varies based on region, population, and sex. Newborns of women with MetS have a greater risk of adverse perinatal outcomes. This study explores the prevalence of metabolic syndrome in non-diabetic, pregnant Angolan women and the adverse perinatal outcomes associated with it.MethodsThis cross-sectional study collected the demographic, anthropometric and clinical data of 675 pregnant women in the maternity ward of General Hospital in Huambo, Angola. Metabolic syndrome was defined using four criteria: the third report of the National Cholesterol Education Program Adult Treatment Panel (ATPIII), the Joint Interim Statement (JIS), and definitions by both Bartha et al. and Chatzi et al.ResultsThe crude prevalence of metabolic syndrome was 36.6 % based on the JIS definition, 29.2 % based on NCEP ATPIII, 12.6 % based on Chatzi et al. and 1.8 % based on Bartha et al. In general, the prevalence of adverse perinatal outcomes was 14.1 %.ConclusionsThere was a high prevalence of metabolic syndrome, depending on the criteria used, and thus a great need to harmonize the criteria and cutoff points. Perinatal adverse outcomes were higher in pregnant women with metabolic syndrome.

Social deprivation and adverse perinatal outcomes among Western and non-Western pregnant women in a Dutch urban population

Social deprivation is considered a key factor in adverse perinatal outcomes. Rotterdam, the second largest city in The Netherlands, has large inequalities in perinatal health and a high number of deprived neighbourhoods. Social deprivation is measured here through a composite variable: ‘Social Index’ (SI). We studied the impact of the SI (2008–2009; 5 categories) in terms of perinatal mortality, congenital anomalies, preterm birth, small for gestational age (SGA) and low 5-minute Apgar score as registered in The Netherlands Perinatal Registry (Rotterdam 2000–2007, n = 56,443 singleton pregnancies). We applied ethnic dichotomisation as Western (European/North-American/Australian) vs. Non-Western (all others) ethnicity was expected to interact with the impact of SI. Tests for trend and multilevel regression analysis were applied. Gradually decreasing prevalence of adverse perinatal outcomes was observed in Western women from the lowest SI category (low social quality) to the highest SI category (high social quality). In Western women the low-high SI gradient for prevalence of spontaneous preterm birth (per 1000) changed from 57.2 to 34.1, for iatrogenic preterm birth from 35.2 to 19.0, for SGA from 119.6 to 59.4, for low Apgar score from 10.9 to 8.2, and for perinatal mortality from 14.9 to 7.6. These trends were statistically confirmed by Chi2-tests for trend (p < 0.001). For non-Western women such trends were absent. These strong effects for Western women were confirmed by significant odds ratios for almost all adverse perinatal outcomes estimated from multilevel regression analysis. We conclude social deprivation to play a different role among Western vs. non-Western women. Our results suggest that improvements in social quality may improve perinatal outcomes in Western women, but alternative approaches may be necessary for non-Western groups. Suggested explanations for non-Western ‘migrant’ groups include the presence of ‘protective’ effects through knowledge systems or intrinsic resilience. Implications concern both general and targeted policies.

The Impact of Agricultural Pesticide Use on the Prevalence of Adverse Perinatal Outcomes in Brazil

ISEE-0893 Background: Epidemiological studies suggest that pesticide exposure may increase the risk of some adverse perinatal outcomes. In Brazil, where pesticide use is rising quickly, studies that evaluate the impact of pesticide exposure on perinatal outcomes prevalence are scarce. Objective: To evaluate the degree of correlation between pesticide consumption in all Brazilian states in 2000 and perinatal outcomes the period between 2001 and 2005. Material and Methods: Information about perinatal outcomes occurred in children born from 2001 to 2005 were collected from National Birth System. Spearman’s correlation coefficients were obtained for pesticide consumption (per capita), total and types (herbicide, acaricide, fungicide, insecticide) and the following types of perinatal outcomes: low birth weight, preterm delivery, sex ratio and congenital abnormalities and twin births. In addition, states were divided into three groups according to their level of pesticide use (tertiles) and prevalence ratios were then calculated using first tertile as reference. Results: Pesticide consumption showed moderate positive correlation with congenital abnormalities (r = 0.469, P = 0.016), low birth weight (r = 0.498, P = 0.010), preterm delivery (r = 0.419, P = 0.033), cryptorchidism (r = 0.452, P = 0.020), spontaneous abortion (r = 0.499, P = 0.009) and twin birth (r = 0.672, P < 0,001). We also observed a weak and non-significant negative correlation between pesticide consumption and sex ratio (r = −0.383, P = 0.053). For most perinatal outcomes, the perinatal outcomes’ prevalence rates were higher in the states of moderate (2nd tertile) and high (3rd tertile) pesticide consumption. Conclusions: Moderate-to-high correlation coefficients between pesticide consumption and some perinatal consumption were observed. The results suggest that population exposure to pesticides in 1999 in Brazilian states may have been associated with selected types of perinatal outcomes in the 2000s.

Short interpregnancy interval and risk of spontaneous preterm delivery

Objectives Short interpregnancy intervals are related to increased prevalence of adverse perinatal outcomes. However, the reported association with preterm birth might be due to confounding by factors such as previous pregnancy outcomes, socioeconomic level or lifestyles. The objective of this study was to evaluate the effect of short interpregnancy interval on the occurrence of spontaneous preterm delivery. Study design The prevalence of a short interpregnancy interval, defined as six or less months between a preceding delivery or abortion and the last menstrual period before index pregnancy, was compared between 263 spontaneous preterm (<37 weeks) and 299 term (37–42 weeks) consecutive births. Separate analyses were performed for early (<34 weeks) and late (34–36 weeks) preterm deliveries. Crude and adjusted odds ratios (ORs) and 95% confidence intervals (CI) were calculated using unconditional logistic regression. Results There was a significant association between short interpregnancy interval and spontaneous early preterm delivery, both crude (OR = 3.9; 95% CI: 1.91–8.10) and adjusted for maternal age, school education, previous birth outcomes, antenatal care, smoking habits, body mass index and gestational weight gain (adj OR = 3.6; 95% CI: 1.41–8.98). No significant effect on spontaneous late preterm delivery was found (crude OR = 0.8; 95% CI: 0.32–1.83). Conclusions This study showed that short interpregnancy intervals significantly increased the risk of early spontaneous preterm birth but no such effect was evident for late preterm deliveries.