Prevalence Of Maternal Risk Factors Research Articles

Study on prevalence of maternal risk factors, morbidity and mortality in very low birth weight neonates

Background: Very low birth weight babies with respiratory complications are the commonest reason for admission in NICU. We wanted to identify maternal risk factors associated with it and ways to prevent it. The objective of the current study was to study the prevalence of maternal risk factors, morbidity and mortality in VLBW babies admitted in tertiary care hospital NICU.Methods: Cross sectional observational study performed on all very low birth weight (VLBW) neonates admitted in neonatal intensive care unit of tertiary care hospital attached with Smt. Kashibai Navale medical college, Pune from January 2019 to March 2020.Results: In our study VLBW babies were 2.2% (78/3545). Mean gestational age was 31.15±3.21 weeks; mean birth weight was 1226.24±250.95 grams. Small for gestational age (SGA) babies were 41% and 96% were preterm. Maternal risk factors were present in 61.53% of deliveries, commonest were anaemia in 30.06 % and preeclampsia in 24.35%. Resuscitation at birth was required in 30.76% babies. Morbidity profile showed respiratory distress syndrome in 46.15%, neonatal sepsis in 19.23% and patent ductus arteriosus in 16.66% babies. Overall survival was 74.35%. Prematurity and its complications like RDS requiring surfactant therapy and mechanical ventilation were significant contributors for mortality but only 23.07% mothers were found to have received antenatal steroids in the hospital .Conclusions: Anaemia and preeclampsia were commonly found risk factors present in 61.53% of mothers of VLBW babies. Use of antenatal steroids in mothers should be made compulsory to decrease mortality in VLBW preterm newborns.

Changes in the Frequency of Cesarean Delivery in Nulliparous Women in Labor in a Canadian Population, 1992-2018.

To examine the relative contribution of changes in patient demographics and physician management to changes in the cesarean delivery rate in labor among nulliparous women. We conducted a retrospective cohort study of 485,451 births to nulliparous women who experienced labor at or beyond 35 weeks of gestation in Alberta, Canada, from 1992 to 2018. The data were from a province-wide perinatal database. The primary outcome was cesarean delivery. Multivariate logistic regression and calculation of population attributable risk for identified risk factors were performed. The cesarean delivery rate increased from 12.5% in 1992 to 24% in 2018. The prevalence of maternal risk factors for cesarean delivery such as obesity, maternal age 35 years or older at delivery, and comorbidities increased over the study period. However, this did not account for the increase in cesarean delivery, because the frequency of cesarean delivery increased irrespective of risk status. Additionally, the population-attributable risk for each risk factor was stable across the study period. For example, for maternal age 35 years or older at delivery, the number of cesarean deliveries attributable to this factor (the population-attributable risk) was 0.9 per 100 deliveries in 1992-1998 and 1 per 100 in 2014-2018. The proportion of cesarean deliveries in which nonreassuring fetal status was the indication increased from 30.1% in 1992 to 51.1% in 2018. The absolute rate of cesarean delivery in the second stage of labor increased from 3.1% in 1992 to 5.9% in 2018. This was due to a significant increase, among those who entered the second stage, in cesarean delivery without a trial of forceps, from 2.5% in 1992 to 7.0% in 2018. The observed doubling of the rate of cesarean delivery in labor in first-time mothers was not driven by patient risk factors. Increases in the rate of cesarean delivery for nonreassuring fetal status and decreased operative vaginal deliveries were important factors.

Prevalencia de Factores de Riesgo Materno Perinatal que Influyen en Asfixia Perinatal Intraparto en Parturientas Atendidas en Centro Obstetrico en el INMP periodo 2011

Objetivos. Identificar la prevalencia de factores de riesgo materno y perinatal que influyen en la asfixia perinatal intraparto. Materiales y métodos. Estudio descriptivo, transversal, observacional. Se seleccionaron 81 historias clínicas de madres cuyos recién nacidos fueron diagnosticados como asfixia perinatal en el Instituto Nacional Materno Perinatal durante el periodo 2011. Resultados. Durante el periodo de estudio se registraron 15176 recién nacidos vivos de los cuales el 2,5 % tuvieron puntaje de Apgar < de 3 a los 5 minutos. Encontrándose que de 81 casos estudiados el 32% ( 26 casos) tenían ausencia de control prenatal. Dentro de los factores de riesgo maternos encontrados fueron anemia en el 17,77% (8 casos), añosa en 13,33% ( 6 casos), preeclampsia en 8,88% ( 4 casos) y diabetes mellitus en 6,66% ( 3 casos). El 28,4% de parturientas ( 23 casos) presentaron antecedentes de rotura prematura de membranas , el 19,8% (16 casos) trabajo de parto prolongado, el 28,4% ( 23 casos) presencia de meconio y 37,77% (17 casos) circular de cordón. Entre los factores de riesgo del recién nacido se tiene que el 53,1 % (43 casos) presentaron Apgar < 3 al minuto de los cuales posteriormente solo un 37,1%( 30 casos) presentan Apgar <3 a los 5 minutos. Asimismo, el 51,9% (42 casos) presentaron peso al nacer dentro de los límites normales sin embrago, el 11,1% (9 casos) tuvieron bajo peso al nacer 6,2% ( 5 casos) tienen muy bajo peso al nacer y el 30,9% ( 25 casos) presentaron extremadamente bajo peso al nacer . La mayoría de los partos vaginales 47,1% (41 casos) fueron atendidos por el profesional Obstetra, seguida en el 39,1% (34 casos) por el Médico Residente. Conclusiones. Estos datos nos sugieren que los factores de riesgo predominantes son madre añosa sin control prenatal, presencia de meconio, circular de cordón y bajo peso al nacer.

Maternal Risk Factors in a Cohort Study of Mexican Americans Living Near the U.S.-Mexico Border [10R

INTRODUCTION: Preterm and early term births are higher in border versus non-border regions of Texas, though the prevalence of maternal risk factors contributing to negative birth outcomes in this region is not well understood. METHODS: Weighted descriptive analyses were conducted on self-reported medical history and information on first pregnancy collected from 384 women ages 19-49 at enrollment into the Cameron County Hispanic Cohort, a prospective study of Mexican Americans residing in South Texas near the U.S.-Mexico border. RESULTS: Women in the sample were predominantly Hispanic (89.8%), married (69.5%), and born outside the U.S. (57.5%), with average age of 36.7 years. Nearly one-quarter (23.1%) smoked 100 cigarettes or more in their lifetime. A majority (83.3%) of participants were obese or overweight, and sizeable proportions reported having high blood pressure (22.4%) or high cholesterol (11.1%). During their first pregnancy, most participants (79.0%) reported attending at least 6 prenatal visits. Prevalence of high blood pressure, diabetes, and preeclampsia during pregnancy was 7.6%, 3.2%, and 7.1%, respectively. Approximately 27% had cesarean delivery for the first pregnancy. Self-reported outcomes of the first pregnancy included preterm delivery (11.3%), miscarriage (9.7%), abortion (3.9%), and infant death (3.0%). CONCLUSION: Findings from this study indicate a higher burden of overweight/obesity and hypertensive disorders, as well as cesarean and preterm delivery, among Mexican American women of reproductive age in the South Texas border region compared to state averages. Interventions aimed at mitigating maternal risk factors may help improve birth outcomes and the long term health of women in this population.

447: Increased in planned deliveries contribute to a reduction pregnancy hypertension rates in Australia

To explore whether increases in planned deliveries explain declining rates of pregnancy hypertension in Australia. Population-based record linkage cohort study. From 2001 through 2012, among 1,076,122 deliveries, the rate of pregnancy hypertension (including gestational hypertension, preeclampsia and eclampsia) declined by 22% from 9.9% to 7.7% and preeclampsia by 27% from 3.3% to 2.4% (trend P<0.001). Contemporaneously, planned deliveries (labor induction and prelabor cesarean) increased from 38% to 46% of all deliveries and the proportion occurring at 37-39 weeks increased from 47% to 59%. During the study period, changes in the maternal risk factors for pregnancy hypertension were mostly in a direction that would likely increase the rate of pregnancy hypertension, including increased (P<0.01) nulliparity, age ≥35 years, diabetes, overweight/obesity, and use of assisted reproductive technologies. However trends that might decrease pregnancy hypertension rates also occurred with a decrease in multi-fetal pregnancies, age <20 years, autoimmune diseases and previous pregnancy hypertension. Among women who did not develop pregnancy hypertension, the established risk factors for pregnancy hypertension were positively associated with planned births at 37-39 weeks. An overall left shift in the gestational age distribution was not observed among women with pregnancy hypertension, rather a decline in birth rates at all gestations was seen from 38 weeks. Gestational age-specific pregnancy hypertension rates declined from 38 weeks onwards, most steeply at ≥41 weeks (see Figure). Based on changes in the prevalence of maternal risk factors, the pregnancy hypertension rate was predicted to increase to 10.5%. At least 36% of the decline in pregnancy hypertension was explained by early planned births. Increases in early planned delivery for reasons other than hypertension explain part of the observed decline in pregnancy hypertension rates in Australia.

Influence of Maternal Dysmetabolic Conditions During Pregnancy on Cardiovascular Disease

Pathogenic factors associated with maternal hypercholesterolemia, obesity, and diabetic conditions during pregnancy influence fetal development and predispose offspring to cardiovascular disease. Animal models have established cause–effect relationships consistent with epidemiological findings in humans and have demonstrated, in principle, that interventions before or during pregnancy can reduce or prevent pathogenic in utero programming. However, little is known about the mechanisms by which maternal dysmetabolic conditions enhance disease susceptibility in offspring. Identification of these mechanisms is rendered more difficult by the fact that programming effects in offspring may be latent and may require conventional risk factors and inherited genetic co-factors to become clinically manifest. Given the increasing prevalence of maternal risk factors, which is expected to lead to a wave of cardiovascular disease in the coming decades, and the length of prospective studies on developmental programming in humans, greater-than-usual emphasis on experimental models and translational studies is necessary.

Mothers and their pregnancies: a comparison of three population-based cohorts in Southern Brazil

Mothers from the 1982, 1993 and 2004 Pelotas birth cohorts were compared across biological, socioeconomic, demographic and reproductive characteristics. Women in the 2004 cohort had higher levels of education, gained more weight during pregnancy, and were heavier at the beginning and end of their pregnancy than mothers who gave birth in 1993 and 1982. There was an important increase in obesity rates (body mass index > 30kg/m(2)) over the 22 years of the study. Mean parity decreased from 1.3 in 1982 to 1.1 in 2004, with a growing proportion of primiparas and a decline in the proportion of women with > or = 4 children. The mean birth interval increased from 33.5 months in 1982 to 65.7 in 2004. Smoking during pregnancy decreased from 35.6% in 1982 to 25.1% in 2004. As with other characteristics, the change in smoking status differed according to income, with higher reductions among the wealthiest (from 24.9% to 8.7%) than among the poorest mothers (from 43.7% to 33.6%). In general terms, between 1993 and 2004 there was a decrease in the prevalence of maternal risk factors for unfavorable perinatal outcomes.

The effectiveness of risk-based intrapartum chemoprophylaxis for the prevention of early-onset neonatal group B streptococcal disease

Objective: Our purpose was to evaluate the effectiveness of a risk-based intrapartum antibiotic prophylaxis strategy for the prevention of early-onset neonatal group B streptococcal disease. Study Design: Cases and controls were selected from infants born to women with one or more risk factors: preterm labor or rupture of membranes, prolonged rupture of membranes (>18 hours), fever during labor, or previous child with group B streptococcal disease. Cases were matched with controls by birth hospital and gestational age. Data abstracted from medical records were analyzed to estimate the effectiveness of intrapartum antibiotic prophylaxis. Results: We analyzed data from 109 cases and 207 controls. Nineteen (17%) case versus 69 (33%) control mothers received an acceptable regimen of intrapartum antibiotic prophylaxis. In adjusted analyses, the effectiveness of intrapartum antibiotic prophylaxis was 86% (95% confidence interval, 66%-94%). When the first dose of antibiotics was given ≥2 hours before delivery, the effectiveness increased to 89% (95% confidence interval, 70%-96%); when it was given within 2 hours of delivery, the effectiveness was 71% (95% confidence interval, –8%-92%). Effectiveness was lowest in mothers with intrapartum fever (72%, 95% confidence interval, –9%-93%). On the basis of a 70% prevalence of maternal risk factors expected among cases in the absence of intrapartum antibiotic prophylaxis, we estimate that the risk-based strategy could reduce early-onset group B streptococcal disease by 60%. Conclusions: The risk-based approach to intrapartum antibiotic prophylaxis is effective in preventing early-onset group B streptococcal disease. To achieve the maximum preventive effect, the first dose of antibiotics should be administered at least 2 hours before delivery. (Am J Obstet Gynecol 2001;184:1204-10.)

Maternal Risks for Very Low Birth Weight Infant Mortality

To determine whether known maternal risk factors for low birth weight directly contribute to infant mortality among very low birth weight infants. Retrospective population-based, case-control study. Four hospitals in the Oakland, California, area: one community, two private, one health maintenance organization. All live-born singleton very low birth weight ( < 1500 g) infants born to Oakland residents over a 3-year period. Cases were infants who died before their first birthday, identified by computerized linkage of birth and death certificates. For each case, a surviving control was selected to match for birth weight, sex, and race. Forty matched pairs were identified in total. Prevalence of maternal risk factors among cases versus controls. After controlling for other factors known to influence either birth weight or infant mortality, maternal cocaine use (odds ratio [OR] = 5.43), prior infant death (OR = 27.14), and planned pregnancy (OR = 6.33) were significantly associated with the survival of very low birth weight infants. Some maternal risk factors for low birth weight confer a survival advantage to very low birth weight infants. Our data reveal that maternal cocaine use is independently associated with survival among this subset of infants. Prior research supports the observed relationship as well as the scientific plausibility of a cocaine-mediated survival advantage among premature infants. Our study also showed both planned pregnancy and prior infant death to be independently associated with infant survival among this subset of infants, suggesting that maternal behaviors may play a role in determining birth weight-specific mortality. These data should be systematically evaluated to better define their relationship to infant mortality.