Risk Of Poor Perinatal Outcome Research Articles

O-093 Infant mortality after assisted reproductive technology – a Nordic collaborative study on 7,947,575 liveborn children

Abstract Study question Is infant mortality, i.e., mortality up to one year of age, higher after assisted reproductive technology (ART) than after natural conception (NC)? Summary answer Infant mortality was increased in ART-singletons vs NC-singletons, with similar increased mortality across ART fertilization methods. Infant mortality was not increased in ART-twins vs NC-twins. What is known already Children born after ART have an increased risk of poor perinatal outcomes such as preterm birth and low birth weight, mainly due to the higher twin birth rates in the ART population. ART singletons also carry an increased risk of poor perinatal outcomes as compared to their NC counterparts. Studies on consequences of being born after ART are mostly sparse and inconclusive which also applies to studies on infant mortality. Study design, size, duration A Nordic registry-based study including all children born alive in Denmark (1994–2014), Finland (1990–2014), Norway (1984–2015) and Sweden (1985–2015) resulting in a cohort of 171,836 ART-children and 7,775,739 NC-children. Among ART-children 127,248 (74%) were singletons and 42,569 (25%) twins, and among NC-children 7,576,396 (97%) were singletons and 194,775 (3%) twins. Multiples with >2 children were excluded (<0.1%). All singletons and twins were followed until death, emigration or one year of age. Participants/materials, setting, methods Data originated from national ART-, birth-, and causes of death registers. Infant mortality was compared for ART vs NC singletons and ART vs NC twins in separate analyses using Cox proportional hazards model yielding hazard ratios (HRs) with 95% confidence intervals (95% CIs). Infant mortality in singletons and twins was compared for IVF, ICSI, fresh and frozen embryo transfer vs NC counterparts. Cause-specific death analysis accounted for other causes of death as a competing risk. Main results and the role of chance Overall, 515 (4‰) ART- and 26,076 (3‰) NC-singletons and 615 (14‰) ART- and 3317 (17‰) NC-twins died during infancy. Median age at death was 3 (IQR 0–195) and 10 days (IQR 0–245) for ART- and NC-singletons, respectively, and 1 (IQR 0–151) and 2 days (IQR 0–161) for ART- and NC-twins, respectively. After adjusting for country, parity, maternal age, and birth year, the adjusted HR (aHR) for infant mortality was 1.75 (95% CI 1.60–1.91) for ART-singletons vs NC-singletons, and 0.94 (95% CI 0.86–1.03) for ART-twins vs NC-twins. A higher mortality was found consistently among ART-singletons born after IVF, ICSI, fresh embryo transfer and frozen embryo transfer vs NC-singletons. Infant mortality was consistently similar between ART-twins and NC-twins across treatment methods. Leading causes of death were conditions originating in the perinatal period (23% and 47% of deaths among singletons and twins) with aHR 1.87 (95% CI 1.65–2.12) for ART-singletons vs NC-singletons, and aHR 0.97 (95% CI 0.86–1.10) for ART-twins vs NC-twins, and congenital malformations (19% and 11% of deaths among singletons and twins) with aHR 1.31 (95% CI 1.09–1.58) for singletons and aHR 1.37 (95% CI 1.08–1.74) for ART-twins vs NC-twins. Limitations, reasons for caution Observational studies are prone to confounding. Despite adjustment for some major confounders, residual confounding from underlying parental conditions cannot be excluded. Causes of death may be more complex than the causes registered. Further, 44% of deaths among NC and 12% of deaths in ART were without an assigned cause. Wider implications of the findings Findings that infant mortality is increased among ART- vs NC-singletons corresponds with previous findings of poorer perinatal outcomes in this group. Risks were similar across ART fertilization methods and cryopreservation status. Trial registration number Not applicable

Ethnoracial Disparities in Perinatal Outcomes among Women Veterans.

Objective: Non-Hispanic Black women have increased rates of preterm birth and low infant birth weight. However, we do not know if these disparities replicate in women veterans, a population that may be at further risk for poor perinatal outcomes. This study sought to examine ethnoracial differences in preterm birth and low infant birth weight in veterans. Methods: A national sample of randomly chosen women veterans (i.e., oversampled for residency in high crime neighborhoods) reported information about all pregnancies they have had in their life, demographic characteristics, and history of childhood trauma exposures. The analytic sample was limited to individuals who identified as Hispanic/Latinx, Black, or White (n = 972). Mixed-effects regression models were used to examine ethnoracial differences in gestational age at delivery and infant birth weight, controlling for age at pregnancy, childhood trauma exposure, pregnancy during military service, income, and education. Results: Both Black and Hispanic/Latinx veterans were significantly more likely to have an infant born at lower gestational age (B = -1.04 and B = -1.11, respectively) and lower infant birth weight (B = -195.83 and B = -144.27, respectively) as compared with White veterans in covariate-adjusted models. Black (odds ratio = 3.24, confidence interval = 1.16, 9.09) veterans were more likely to meet the clinical definition of preterm birth as compared with White veterans. Conclusions: Results align with what is seen in the general population regarding ethnoracial disparities in gestational age at delivery and infant birth weight. Findings highlight the critical need for more research on mechanisms and prevention efforts for ethnoracial disparities in perinatal outcomes.

Umbilical Cord Diseases Affecting Obstetric and Perinatal Outcomes.

(1) The aim of this article is to describe the physiopathology underlying umbilical cord diseases and their relationship with obstetric and perinatal outcomes. (2) Methods: Multicenter case series of umbilical cord diseases with illustrations from contributing institutions are presented. (3) Results: Clinical presentations of prenatal ultrasound findings, clinical prenatal features and postnatal outcomes are described. (4) Conclusions: Analysis of our series presents and discusses how umbilical cord diseases are associated with a wide variety of obstetric complications leading to a higher risk of poor perinatal outcomes in pregnancies. Knowing the physiopathology, prenatal clinical presentations and outcomes related to umbilical diseases allow for better prenatal counseling and management to potentially avoid severe obstetric and perinatal complications.

The social organisation of decision-making about intrapartum fetal monitoring: An Institutional Ethnography

BackgroundInternational guidelines recommend intrapartum cardiotocograph (CTG) monitoring for women at risk for poor perinatal outcome. Research has not previously addressed how midwives and obstetricians enable or hinder women’s decision-making regarding intrapartum fetal monitoring and how this work is structured by external organising factors. AimTo examine impacts of policy and research texts on midwives’ and obstetricians’ work with labouring women related to intrapartum fetal monitoring decision-making. MethodsWe used a critical feminist qualitative methodology known as Institutional Ethnography (IE). The research was conducted in an Australian tertiary maternity service. Data collection included interviews, observation, and texts relating to midwives’ and obstetricians’ work with the fetal monitoring system. Textual mapping was used to explain how midwives’ and obstetricians’ work was organised to happen the way it was. FindingsCTG monitoring was initiated predominantly by midwives applying mandatory policy. Midwives described reluctance to inform labouring women that they had a choice of fetal monitoring method. Discursive approaches used in a national fetal surveillance guideline, a Cochrane systematic review, and the largest randomised controlled trial regarding CTG monitoring in labour generated and reproduced assumptions that clinicians, not labouring women, were the appropriate decision-maker regarding fetal monitoring in labour. Discussion and conclusionGuidelines structured midwives’ and obstetricians’ work in a manner that undermined women’s participation in decisions about fetal monitoring method. Intrapartum fetal monitoring guidelines should be critically reviewed to ensure they encourage and enable midwives and obstetricians to support women to make decisions about intrapartum care.

Perinatal outcomes and maternal complications at a county referral hospital in Kenya

Introduction/Aims Maternal complications during pregnancy and labour are a leading cause of global maternal and neonatal mortality. Despite efforts by the Kenyan Government, the mortality rate in the country is now 22 neonatal deaths per 1000 live births. This study's aims were to observe and compare perinatal outcomes of newborns from women with and without maternal complications. Methods This was a prospective hospital-based paired cohort study of 510 pregnant women, 102 of whom presented with complications. Follow up took place up to 28 days after birth, at which point 132 women with complications and 364 women without complications completed the study (some women developed complications after initial recruitment and crossed over to the complications group). Data were gathered on obstetric characteristics and perinatal outcomes using a structured, researcher-administered questionnaire. Differences between the two groups (with and without complications) in terms of obstetric data were compared using Pearson's Chi-squared test. Associations between complications and obstetric characteristics were tested using relative risk. Results Almost all obstetric characteristics showed significant differences between groups, with the exception of a history of poor obstetric outcomes and known contracted pelvis. A mother with complications was more likely to have a newborn with a low Apgar score (relative risk 8.000, P<0.001), low birth weight (relative risk: 1.838, P<0.001), prematurity (relative risk 9.652, P<0.001), admission to the newborn unit (relative risk 8.000, P<0.001), complications after 28 days (relative risk: 2.186, P=0.017) and admission after 28 days (relative risk: 4.892, P=0.006). Mothers with complications were also more likely to have given birth by caesarean section (relative risk: 13.893, P<0.001). Conclusions The newborns born to women who experienced maternal complications were at a higher risk of poor perinatal outcomes compared to those born to women without maternal complications at the Kitui County Referral Hospital. Newborn care should be scaled up to deal with the most difficult cases brought about by maternal complications. Rural facilities should be well equipped to be able to deal with poor outcomes in newborns.

Impact of Planned Delivery on the Perinatal Outcome of Term Fetuses with Isolated Heart Defects

ObjectivePregnancies complicated by fetal heart defects often undergo a planned delivery prior to term by either induction of labour or cesarean delivery to ensure optimal availability of neonatal care. We aimed to assess whether such planned deliveries achieve their goal of better perinatal care. MethodsWe conducted a retrospective case-control study of pregnancies complicated by isolated fetal cardiac defects, without other fetal comorbidities, managed at a single fetal medicine unit over a 10-year period. Only pregnancies delivered past 37 weeks gestation were included. Patients undergoing elective delivery for care planning reasons only were compared with patients in whom planned delivery was clinically indicated and patients who laboured spontaneously. Obstetric and perinatal outcomes were recorded. ResultsOf the 180 pregnancies included in the study, 59 (32.8%) were in the elective group, 49 (27.2%), in the indicated group, and 72 (40%), in the spontaneous group. Mean gestational age at delivery was 39.0 ± 1.1 weeks overall and did not differ between the groups. For the elective group, only 35.6% of deliveries occurred during office hours, which was similar to the 2 other groups. The rate of adverse obstetric or postnatal outcomes was not statistically significantly different between groups. ConclusionTimed delivery at term does not seem to be associated with an increased risk of poor perinatal outcomes. It may improve perinatal care by providing proximity to a neonatal intensive care unit and convenience for patients and providers.

Prevalence and factors associated with caesarean section in Rwanda: a trend analysis of Rwanda demographic and health survey 2000 to 2019–20

BackgroundCaesarean section (CS) is an important medical intervention for reducing the risk of poor perinatal outcomes. However, CS trends in sub-Saharan Africa (SSA) continue to increase yet maternal and neonatal mortality and morbidity remain high. Rwanda, like many other countries in SSA, has shown an increasing trend in the use of CS. This study assessed the trends and factors associated with CS delivery in Rwanda over the past two decades.MethodsWe used nationally representative child datasets from the Rwanda Demographic and Health Survey 2000 to 2019–20. All births in the preceding 3 years to the survey were assessed for the mode of delivery. The participants’ characteristics, trends and the prevalence of CS were analysed using frequencies and percentages. Unadjusted and adjusted logistic regression analyses were used to assess the factors associated with population and hospital-based CS in Rwanda for each of the surveys.ResultsThe population-based rate of CS in Rwanda significantly increased from 2.2% (95% CI 1.8–2.6) in 2000 to 15.6% (95% CI 13.9–16.5) in 2019–20. Despite increasing in all health facilities over time, the rate of CS was about four times higher in private (60.6%) compared to public health facilities (15.4%) in 2019–20. The rates and odds of CS were disproportionately high among women of high socioeconomic groups, those who resided in Kigali city, had multiple pregnancies, and attended at least four antenatal care visits while the odds of CS were significantly lower among multiparous women and those who had female babies.ConclusionOver the past two decades, the rate of CS use in Rwanda increased significantly at health facility and population level with high regional and socio-economic disparities. There is a need to examine the disparities in CS trends and developing tailored policy guidelines to ensure proper use of CS in Rwanda.

Value of Serum Glycocholic Acid and Total Bile Acids in Predicting Maternal and Perinatal Outcomes in Intrahepatic Cholestasis of Pregnancy.

Objective To see whether serum glycocholic acid (CG) and total bile acids (TBA) can predict maternal and perinatal outcomes in pregnant women with intrahepatic cholestasis (ICP). Method The observation group consisted of 80 women with ICP who were treated in our hospital, whereas the control group consisted of 50 ordinary women who were also treated at our hospital at the same time. The levels of CG and TBA in the two groups were determined independently, and the differences in poor perinatal outcomes were compared. Finally, the predictive diagnostic value of CG and TBA for poor perinatal outcomes in ICP mothers was displayed using the Spearman correlation between CG and TBA and Apgar. The maternal CG and TBA levels in the observation group were substantially higher than in the control group (P0.05). The observation group had more significant maternal-fetal discomfort, neonatal asphyxia, preterm birth, and perinatal death than the control group (P0.05). The risk of poor perinatal outcomes in ICP mothers rose when TBA and CG levels increased (P0.05). Apgar ratings were inversely associated with CG and TBA (r = −0.8251 and r = −0.5969, respectively, P0.05). The CG and TBA diagnostic AUCs for unfavorable perinatal outcomes in ICP mothers were (P0.05). Conclusion CG and TBA have a high diagnostic value for ICP and may better predict and identify poor prenatal outcomes. It is suitable for clinical use.

856A gestational age specific prognostic model for adverse perinatal events in obese women

Abstract Background Obesity is one of the most preventable pre-pregnancy risk factors for adverse perinatal events. Despite this, there are few body-mass-index (BMI) specific prognostic models for timing of delivery associated with the lowest number of adverse perinatal events. Our aim was to build a predictive model to quantify gestational age-specific rates of adverse birth outcomes in obese women with and without additional risk factors. Methods All singleton births at ≥ 34 weeks’ gestation in British Columbia, Canada, 2008-2017 (n = 283,697) were included and data were obtained from the British Columbia Perinatal Database Registry. A multivariable Cox proportional hazards model including demographic and obstetric risk factors was used to estimate gestational age specific risk of composite perinatal mortality and severe morbidity. Results Among all women, 13.1% were obese (pre-pregnancy BMI ≥30m/kg2), 60.1% had normal BMI (18.5-24.9 m/kg2). In high-risk obese women (nulliparous with chronic hypertension, and diabetes), adjusted outcome rates (per 1000 ongoing pregnancies) were 7.5 at 34-36 weeks, 20.4 at 37-39 weeks, and 83.5 at ≥ 40 weeks’ gestation. In all obese women, the rates were 1.93, 6.27, and 18.5 per 1000 ongoing pregnancies, respectively. In contrast, on average these rates were 1.14, 4.03 and 11.6 per 1000 ongoing pregnancies, respectively, among women with normal BMI. Conclusions Obese women are at increased risk of poor perinatal outcomes at all gestational ages. These risks are compounded by other conditions known to effect perinatal outcomes. Key messages Obese women require specific guidelines for timing of optimal delivery.

The fetal cerebroplacental ratio in pregnancies complicated by hypertensive disorders of pregnancy.

Hypertensive disorder in pregnancy is common and the optimal ultrasound surveillance of the fetus in this setting is unclear. The aim of this study is to assess the relationship between the fetal cerebroplacental ratio (CPR) and perinatal outcomes in pregnancies complicated by maternal hypertension. A retrospective cohort study was performed over tenyears at a single centre. All women who had an ultrasound scan between 34 and 37weeks gestation with a non-anomalous singleton pregnancy were included. The hypertensive cohorts were compared to a non-hypertensive cohort. Each cohort was divided into low CPR for gestational age, or normal/high CPR and these were correlated with intrapartum and perinatal outcomes. A low CPR in a hypertensive pregnancy is associated with an increased risk of induction of labour, emergency caesarean section and poor perinatal outcome. This significance persists when adjusted for gestational age and birth weight. The diagnosis of pre-eclampsia combined with a low CPR markedly increases the risk of poor perinatal outcome, with 52.6% (P<0.001) of fetuses in this group having either neonatal intensive care unit admission, respiratory distress, low Apgar score, or acidosis. The odds ratio of a fetus with low CPR in a woman with pre-eclampsia having a poor composite outcome is 4.09 (95% CI: 1.85-9.06). There is an association between low CPR and the perinatal outcomes of pregnancies complicated by a hypertensive disorder. This association appears to be stronger in pregnancies complicated by pre-eclampsia than in other types of hypertensive disorders.

Determining the perinatal outcome among women with high risk pregnancies

Background: Pregnancy is a physiological process and should ideally yield no morbidity and mortality; however, in some instances, pregnancy becomes a high-risk. A high-risk pregnancy carries significant danger to the fetus and mother before, during and after delivery. The objective of the study was to determine the perinatal outcome among women with high-risk pregnancies.&#x0D; Methodology: This cross-sectional study was conducted from June to December 2015, including 287 women with high-risk pregnancies scheduled to undergo delivery at Liaquat University Hospital in Karachi, Pakistan. Data pertaining to sociodemographic details, gestational, obstetric history, Apgar score and the perinatal outcome was recorded using a pre-structured questionnaire and analyzed using SPSS version 16.0..&#x0D; Results: The mean age of the enrolled participants was 29.12 ± 5.46 years. The perinatal outcomes included stillbirths (8%), early neonatal deaths (4.2%), low birth weight (22.6%) and poor Apgar score i.e., &lt; 7 at 1 minute (10.5%) and 5 minutes (3.8%). Stratification revealed a significant risk of poor perinatal outcome (low birth weight) among women aged above 30 years (p-value = 0.002).&#x0D; Conclusion: It is concluded from the study results that high-risk pregnancies yield poor perinatal outcomes, including stillbirths, low birth weight, early neonatal death and poor Apgar scores.

Let's Talk about Placental Sex, Baby: Understanding Mechanisms That Drive Female- and Male-Specific Fetal Growth and Developmental Outcomes.

It is well understood that sex differences exist between females and males even before they are born. These sex-dependent differences may contribute to altered growth and developmental outcomes for the fetus. Based on our initial observations in the human placenta, we hypothesised that the male prioritises growth pathways in order to maximise growth through to adulthood, thereby ensuring the greatest chance of reproductive success. However, this male-specific “evolutionary advantage” likely contributes to males being less adaptable to shifts in the in-utero environment, which then places them at a greater risk for intrauterine morbidities or mortality. Comparatively, females are more adaptable to changes in the in-utero environment at the cost of growth, which may reduce their risk of poor perinatal outcomes. The mechanisms that drive these sex-specific adaptations to a change in the in-utero environment remain unclear, but an increasing body of evidence within the field of developmental biology would suggest that alterations to placental function, as well as the feto-placental hormonal milieu, is an important contributing factor. Herein, we have addressed the current knowledge regarding sex-specific intrauterine growth differences and have examined how certain pregnancy complications may alter these female- and male-specific adaptations.

THIS STUDY ASSESSES THE ROLE OF NST IN DETECTING FETAL COMPROMISE IN CASES OF REDUCED MATERNAL PERCEPTION OF FETAL MOVEMENT

Introduction:In modern era of medicine, antenatal fetal monitoring is an essential way that assess the fetal well being. Aims and objectives: This study was performed to test the association between non-stress test ( NST) results and fetal and perinatal outcomes in pregnant women with perceived decrease in fetal movements attending our hospital. To determine the role of Non stress test on fetal and prenatal outcome of pregnant women with perceived decrease in fetal movements attending labor room. Materials and methods: Study is carried out at 'Imambara District Hospital', at the Dept. Of obstetrics and gynaecology, Hooghly, WB. All the pregnant mother with decreased fetal movement perception in the 3rdtrimester, attending OBG (OPD) and ANC or getting admitted in Dept. OF OBSTETRICS AND GYNAECOLOGY, at IMAMBARADIST. HOSPITAL, Chinsurah, Hooghly, WB. 1st May 2018 – April 30, 2019. Conclusion: The antenatal surveillance of cases with reduced perception of fetal movement by mother with NST can effectively screen for identication of high risk foetuses and segregate the cases that are at risk for poor perinatal outcome.

880 National neonatal outcomes in pregnancies complicated by superobesity

Superobesity (pre-pregnancy body mass index, or BMI, >=50 kg/m2) is increasingly prevalent in the United States. Perinatal outcome data on superobesity is limited. This study sought to determine whether superobesity is associated with adverse neonatal and maternal outcomes. Using the 2016-2018 National Vital Statistics System Birth Data, we compared women with superobesity to those with morbid obesity (BMI 40-49.9), obesity (BMI 30-39.9), overweight (BMI 25-29.9) and normal weight (BMI 20-24.9). Risk of poor neonatal outcomes including low Apgar scores, neonatal seizures, neonatal intensive care unit (NICU) admission, immediate ventilation, and preterm delivery was stratified by obesity class. Risk was evaluated by log linear regression modeling with the primary exposure of obesity, adjusting for age, race, insurance status, diabetes, hypertension, mode of delivery, chorioamnionitis, fetal anomalies and preterm delivery with adjusted risk ratios (aRR) as measures of association. We identified 11.2 million delivery hospitalizations, 3.2% (n=360,742) linked to patients with superobesity. In adjusted analyses, including for mode of delivery, neonates born to patients with superobesity were at significantly higher risk for Apgar score <5 at 5 (aRR 1.74, 95% CI 1.69, 1.79) and 10 minutes (aRR 1.30, 95% CI 1.24, 1.36), neonatal seizures (aRR 1.41, 95% CI 1.20, 1.66), NICU admission (aRR 1.19, 95% CI 1.18, 1.20), and immediate ventilation (aRR 1.12, 95% CI 1.11, 1.14) compared to normal BMI (Figure). In addition, mothers with superobesity were at higher risk for preterm delivery (<28 weeks: aRR 2.62, 95% CI 2.54, 2.71; <34 weeks: aRR 1.74, 95% CI 1.71, 1.77; <37 weeks: aRR 1.35, 95% CI 1.34, 1.36) compared to normal BMI. The effect of BMI obesity class was ‘dose dependent’ (Table). Women with superobesity are at higher risk of poor perinatal outcomes compared to women with lower BMI. These findings confirm the significant risks of superobesity and underscore the importance of pre-conceptional health optimization.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

The Effect of Prenatal Care Delivery Models Targeting Populations with Low Rates of PNC Attendance: A Systematic Review.

People at higher risk of poverty or social exclusion are less likely to receive adequate prenatal care (PNC) and have a higher risk of poor perinatal outcomes. Appropriate PNC may help to reduce adverse outcomes. We conducted a systematic review of randomized controlled trials in high income countries on the impact of PNC delivery models targeting populations with low rates of PNC attendance on maternal and newborn outcomes. Searches in four scientific databases identified seven eligible studies. Interventions included group PNC and augmented PNC. The quality of the evidence was moderate to very low. We found insufficient evidence to conclude whether or not these interventions can reduce rates of PTB and SGA. We conclude there is limited high quality evidence regarding the effectiveness of PNC delivery models targeting populations with low rates of PNC attendance and more high-quality research on promising interventions such as mobile PNC clinics is needed.

Developmental programming of peripheral diseases in offspring exposed to maternal obesity during pregnancy.

Obesity is an increasing global health epidemic that affects all ages, including women of reproductive age. During pregnancy, maternal obesity is associated with adverse pregnancy outcomes that lead to complications for the mother. In addition, maternal obesity can increase the risk of poor perinatal outcomes for the infant due to altered development. Recent research has investigated the effects of maternal obesity on peripheral organ development and health in later life in offspring. In this review, we have summarized studies that investigated the programming effects of maternal obesity before and during pregnancy on metabolic, cardiovascular, immune, and microbiome perturbations in offspring. Epidemiological studies investigating the effects of maternal obesity on offspring development can be complex due to other copathologies and genetic diversity. Animal studies have provided some insights into the specific mechanisms and pathways involved in programming peripheral disease risk. The effects of maternal obesity during pregnancy on offspring development are often sex specific, with sex-specific changes in placental transport and function suggestive that this organ is likely to play a central role. We believe that this review will assist in facilitating future investigations regarding the underlying mechanisms that link maternal obesity and offspring disease risk in peripheral organs.

Interpregnancy intervals and perinatal and child health in Sweden: A comparison within families and across social groups

A large body of research has shown that children born after especially short or long birth intervals experience an elevated risk of poor perinatal outcomes, but recent work suggests this may be explained by confounding by unobserved family characteristics. We use Swedish population data on cohorts born 1981–2010 and sibling fixed effects to examine whether the length of the birth interval preceding the index child influences the risk of preterm birth, low birth weight, and hospitalization during childhood. We also present analyses stratified by salient social characteristics, such as maternal educational level and maternal country of birth. We find few effects of birth intervals on our outcomes, except for very short intervals (less than seven months) and very long intervals (>60 months). We find few differences in the patterns by maternal educational level or maternal country of origin after stratifying by the mother’s highest educational attainment.

Timing of Maternal Asthma Diagnosis in Relation to Adverse Perinatal Outcomes

It is unclear if asthma diagnosed during pregnancy puts the fetus at a higher risk of poor perinatal outcomes than pre-existing asthma. To assess if the risks of prematurity, major malformations, and small-for-gestational age (SGA) are higher in women with asthma diagnosed during versus pre-pregnancy. We retrospectively analyzed a cohort of pregnant women aged ≥15 years with and without incident asthma, constructed from health administrative databases. Follow-up began 24 months before pregnancy onset (cohort entry) and ended at delivery. Incident asthma was defined as a first diagnosis among those without asthma in the 8 years before cohort entry. Time was classified into pre-pregnancy and each trimester until delivery. We fit inverse probability weighted Poisson models to estimate marginal relative risks (RRs) for prematurity (delivery <37th week), major malformations, and SGA (birth weight <10th percentile) comparing women with and without asthma, assessing the asthma timing of diagnosis interaction term via a Wald test. In a cohort of 122,880 deliveries, the increased risk of prematurity, but not SGA, due to incident asthma was higher in those diagnosed during the second (RR, 1.34; 95% confidence interval [CI], 1.08-1.65; Wald P= .05) and third (RR, 1.93; 95% CI, 1.62-2.29; Wald P < .01) trimesters relative to pre-pregnancy (RR, 1.06; 95% CI, 0.98-1.15). A trend toward an increased risk of major malformations was observed in those diagnosed during the first trimester (RR, 1.18; 95% CI, 0.94-1.49; Wald P= .15) than pre-pregnancy (RR, 0.99; 95% CI, 0.92-1.07). Asthma diagnosed during, versus before, pregnancy was associated with a greater prematurity risk, suggesting an important role of preconception and prenatal screening.

Maternal Prepregnancy Body Mass Index, Gestational Weight Gain, and Risk of Adverse Perinatal Outcomes in Taiwan: A Population-Based Birth Cohort Study.

Epidemiological studies have shown that maternal prepregnancy body mass index (BMI) and gestational weight gain (GWG) are associated with increased risk of perinatal outcomes. However, the evidence of such associations in Asian populations is limited. We conducted a secondary data analysis to investigate the relationships of prepregnancy BMI and GWG with the risks of adverse perinatal outcomes, including gestational diabetes (GDM), gestational hypertension (GHTN), preeclampsia, cesarean delivery, preterm birth, low birth weight (LBW), and macrosomia. We categorized prepregnancy BMI by the WHO classification and GWG by the Institute of Medicine guidelines. We performed adjusted logistic regression models to estimate the odds ratios of adverse perinatal outcomes. A total of 19,052 women were included; prepregnancy overweight and obesity were associated with a greater risk of GDM, GHTN, preeclampsia, cesarean delivery, preterm birth, and macrosomia. Women with excessive GWG had a greater risk of GHTN, preeclampsia, cesarean delivery, and macrosomia. In conclusion, regardless of the range of GWG during pregnancy, maternal prepregnancy BMI is significantly associated with the risk of adverse perinatal outcomes in Taiwan. Public health attention regarding obesity reduction before conception and prenatal counseling for optimal GWG is needed to mitigate the risk of poor perinatal outcomes.

Pre-conception blood pressure and evidence of placental malperfusion

BackgroundEvidence of placental maternal vascular malperfusion is associated with significant perinatal outcomes such as preeclampsia, intrauterine growth restriction and preterm birth. Elevations in pre-pregnancy blood pressure increase the risk for poor perinatal outcomes; however, the evidence linking pre-pregnancy blood pressure and placental malperfusion is sparse.Materials and methodsWe conducted a retrospective case-control study of women with singleton gestations with placental evaluations who delivered at Magee-Womens Hospital in 2012. Charts from 100 deliveries with placental malperfusion lesions (vasculopathy, advanced villous maturation, infarct, or fibrin deposition) and 102 deliveries without placental malperfusion were randomly selected for screening. Blood pressure, demographic, and clinical data were abstracted from pre-pregnancy electronic medical records and compared between women with and without subsequent placental malperfusion lesions.ResultsOverall, 48% of women had pre-pregnancy records, and these were similarly available for women with and without placental malperfusion. Women with placental malperfusion demonstrated a reduction in their pre- to early pregnancy decrease in diastolic blood pressure (DBP). Adjusted for race, pre-pregnancy BMI, age, pre-conception interval, and gestational age at the first prenatal visit, the difference in pre- to early pregnancy DBP was significantly less in women with placental malperfusion compared to those without this pathologic finding (− 1.35 mmHg drop vs − 5.6mmg, p < 0.05).ConclusionA blunted early gestation drop in DBP may be a risk factor for placental malperfusion, perhaps related to early pregnancy vascular maladaptation. The ability of the electronic medical record to provide pre-pregnancy data serves as an underutilized approach to study pre-pregnancy health.