Trends In Pregnancy Outcomes Research Articles

Trends in Pregnancy Outcomes in People with Sickle Cell Disease and Medicaid Insurance (2006-2018).

Background: Although the risk of pregnancy-related morbidity and mortality in people with sickle cell disease (SCD) is well established, limitations in data sources and heterogeneity in outcome reporting hinder the ability to make meaningful comparisons between historical and contemporary populations. This study used a national administrative claims database to compare pregnancy outcomes in people with SCD between 2006-2011 and 2012-2018. Materials and Methods: Pregnant females aged 16-44 years with SCD were identified from the Centers for Medicare and Medicaid Service Analytic eXtract, along with a control cohort of pregnant people. People were followed from first identified pregnancy until one year postpartum. Outcomes of interest were identified with ICD-9 or 10 codes. Results: We included 6,388 people with SCD and 17,278 controls in analyses. Preeclampsia/eclampsia, hypertension, thrombosis, poor fetal growth, preterm delivery, and postpartum hemorrhage were all more common in people with SCD compared with controls. Maternal death occurred in 0.5% of people with SCD versus <0.1% in those without SCD (p < 0.001). When comparing infant deliveries in 2006-2011 to those occurring in 2012-2018, all pregnancy-related complications except preterm delivery, including maternal death, occurred at similar or higher frequencies in more recent years. Conclusions: Between 2006 and 2018, maternal death occurred in approximately 1 out of every 200 publicly insured people with SCD in the year following infant delivery. Our work confirms, on a national-level, that pregnancy-related outcomes in people with SCD in the United States have not improved with time, and that some complications have in fact increased in frequency.

Longitudinal Trends in Pregnancy Outcomes Among Women With Inflammatory Bowel Disease in the Era of Biologics: A 20-Year Nationwide Analysis.

Many women with inflammatory bowel disease (IBD) are diagnosed by their reproductive years. Prior literature suggests that women with IBD may be at increased risk of adverse pregnancy outcomes. Biologics have revolutionized IBD treatment, and current evidence favors continuation during pregnancy. We sought to examine trends in pregnancy outcomes over 20 years with the evolution of IBD treatment. Using the National Inpatient Sample, IBD and non-IBD obstetric hospitalizations were identified between 1998 and 2018 using International Classification of Diseases 9 and 10 codes. Outcomes of interest included cesarean delivery, gestational diabetes, preeclampsia/eclampsia, premature rupture of membranes (PROM), preterm delivery, fetal growth restriction (FGR), fetal distress, and stillbirth. Stratified by Crohn's disease (CD), ulcerative colitis (UC), and non-IBD deliveries, temporal trends and multivariable logistic regression were analyzed. There were 48 986 CD patients, 30 998 UC patients, and 69 963,805 non-IBD patients. Between 1998 and 2018, CD deliveries increased from 3.3 to 12.9 per 10 000 deliveries (P < 0.001) and UC deliveries increased from 2.3 to 8.6 per 10 000 deliveries (P < 0.001). Cesarean deliveries, gestational diabetes, preeclampsia/eclampsia, PROM, FGR, and fetal distress increased over time for IBD and non-IBD women, while preterm deliveries decreased (P < 0.001). Multivariable analyses demonstrated that IBD patients had higher risk of cesarean delivery, preeclampsia/eclampsia, PROM, and preterm delivery compared with non-IBD patients. Over a 20-year period, live deliveries amongst women with IBD have increased. Trends in pregnancy outcomes have followed a similar trajectory in patients with and without IBD. However, there is still demonstrable risk of adverse pregnancy outcomes in patients with IBD.

Pregnancy outcomes at maternal age over 45 years: a systematic review and meta-analysis.

We aimed to identify trends in pregnancy outcomes, especially delivery mode, among pregnant patients older than 45 years. We performed a literature search using PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials for studies published between 1 January 2010 and 30 June 2022. The primary outcomes were cesarean delivery and assisted delivery; secondary outcomes were preeclampsia, gestational diabetes mellitus, placenta previa, placental abruption, postpartum hemorrhage, and preterm birth. The inclusion criteria were studies examining the relationship between older age pregnancy and pregnancy outcomes, studies that compared pregnancy outcomes at maternal age ≥45 years and <45 years, and at least one of the primary and secondary pregnancy outcomes were included. Study screening was conducted after duplicates were identified and removed. We assessed the quality of each study and publication bias. Forest plots and I2 statistics were calculated for each study outcome for each group. The main analysis was a random-effects analysis. The inverse variance method was used to integrate the results if studies had an adjusted analysis. Among 4209 studies initially retrieved, 24 were included in this review. All studies were retrospective, observational studies. Pregnant patients aged ≥45 years had a significantly higher cesarean delivery rate (odds ratio, 2.87; 95% confidence interval, 2.50-3.30; I2=97%) than those aged <45 years. However, the emergency cesarean delivery rate was lower in older pregnant patients (odds ratio, 0.61; 95% confidence interval, 0.47-0.79; I2=79%). Pregnancy in older individuals was associated with a lower assisted delivery rate than pregnancy in younger individuals (odds ratio, 0.85; 95% confidence interval, 0.75-0.97; I2=48%). Preeclampsia, gestational diabetes mellitus, placenta previa, placental abruption, postpartum hemorrhage, and preterm birth were more likely to occur in pregnant patients aged ≥45 years than in those aged <45 years. Adjusted pooled analyses showed trends similar to those in the unadjusted pooled analyses. Adverse pregnancy outcomes, typically cesarean delivery, were more likely to occur in older (≥45 years) than in younger pregnant patients. However, the assisted delivery rate was lower in older pregnant patients.

Trends in Pregnancy Outcomes in A Large, Contemporary Diverse Integrated Health Care Delivery System

Trends in Pregnancy Outcomes in A Large, Contemporary Diverse Integrated Health Care Delivery System

The Paradoxical Effects of Hurricane Katrina on Births and Adverse Birth Outcomes.

Objectives. To review the trends in pregnancy outcomes after Hurricane Katrina and assess effects of the disaster on research and public health related to pregnant women.Methods. We reexamined the 2004-2006 vital statistics data from Alabama, Louisiana, and Mississippi, assessing what the risk of adverse pregnancy outcomes in the population would have been under varying risk scenarios.Results. We saw a reduction in number of births as well as in low birth weight and preterm birth. If the number of births had stayed constant and the relative higher risk in the "missing" births had been between 17% and 100%, the storm would have been associated with an increased risk instead of a decrease. Because the relative decline in births was larger in Black women, the higher risk in the "missing" births required to create a significant increase associated with the storm was generally not as great as for White women.Conclusions. Higher exposure to Katrina may have produced a reduction in births among high-risk women in the region rather than increasing adverse outcomes among those who did give birth.

Trends in pregnancy outcomes for women with gestational diabetes mellitus in Sweden 1998-2012: a nationwide cohort study.

To assess whether incidence of maternal and neonatal outcomes for women with or without gestational diabetes mellitus (GDM) have changed over time. Population-based cohort study in Sweden including all singleton pregnancies over the period 1998-2012. GDM was diagnosed following Diabetic Pregnancy Study Group 1991 criteria. Poisson regression or negative binomial regression was used to model yearly relative change in numbers of cases and incidence of the outcomes with 95% confidence intervals (CI), and yearly absolute change in birthweight z-score. The study included 1455667 pregnancies. The number of pregnancies increased over time and the overall prevalence of GDM was 1%. For women with GDM there was a significantly decreasing trend in incidence per year for large for gestational age (LGA) (0.986, 95% CI 0.975 to 0.996), birthweight z-score (-0.012, 95% CI -0.017 to -0.007) and birth trauma (0.937, 95% CI 0.907 to 0.968). The trend for small for gestational age (SGA) among women with GDM increased by an odds ratio per year (1.016, 95% CI 1.002 to 1.029). No significant interaction tests for maternal characteristics were found. Trends in outcomes for women without diabetes were similar to those for women with GDM. This study shows that there were improvements in pregnancy outcomes for women with GDM between 1998 and 2012, although the incidence of SGA increased. Improvements followed similar trends in the background population. Inequalities in obstetric outcomes between women with GDM and those without have continued unchanged over 15 years, suggesting that new management strategies are required to reduce this gap.

Diabetes during pregnancy and perinatal outcomes among First Nations women in Ontario, 2002/03-2014/15: a population-based cohort study.

In Canada, increasing numbers of women, especially First Nations women, are affected by diabetes during pregnancy, which is a major risk factor for adverse maternal and neonatal outcomes. The aim of this study was to examine temporal trends in pregnancy outcomes and use of health care services in a population-based cohort of First Nations women compared to other women in Ontario according to diabetes status during pregnancy. Using health administrative databases, we created annual cohorts of pregnant women from 2002/03 to 2014/15 and identified those with preexisting diabetes and gestational diabetes. We used the Indian Register to identify First Nations women. We estimated rates of adverse maternal and infant outcomes, and measures of use of health care services in each population. There were 1 671 337 deliveries among 1 065 950 women during the study period; of these deliveries, 31 417 (1.9%) were in First Nations women, and 1 639 920 (98.1%) were in other women. First Nations women had a higher prevalence of preexisting diabetes and gestational diabetes than other women in Ontario. First Nations women with preexisting diabetes had higher rates of preeclampsia (3.2%-5.6%), labour induction (33.4%-42.9%) and cesarean delivery (47.8%-53.7%) than other women in Ontario, as did First Nations women with gestational diabetes (3.2%-4.7%, 38.5%-46.9% and 41.4%-43.4%, respectively). The rate of preterm birth was similar between First Nations women and other women in Ontario. Although First Nations women had a higher rate of babies who were large for gestational age than other women, regardless of diabetes status, obstructed labour rates were similar for the 2 cohorts. Almost all First Nations women, regardless of diabetes status, were seen by a primary care provider during their pregnancy, but rates of use of specialty care were lower for First Nations women than for other women. Fifteen percent of all pregnant women with preexisting diabetes visited an ophthalmologist during their pregnancy. Our results confirm disparities in maternal and neonatal outcomes between First Nations women and other women in Ontario. Access to primary care for pregnant women seemed adequate, but access to specialized care, especially for women with preexisting diabetes, needs to improve.

Trends in pregnancy outcomes in Malawian adolescents receiving antimalarial and hematinic supplements

To describe pregnancy outcomes of adolescent and adult primigravidae receiving antimalarials and hematinic supplementation and compare findings with a survey in this area a decade earlier. Cross-sectional surveys in intervention and control sites. Community, antenatal and delivery facilities in Chikwawa, Malawi. A rural area with year round malaria transmission. Data on antenatal attendance, uptake of intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP), birthweight, malaria, anaemia, for 2,152 primigravidae. Place of delivery, anaemia, malaria, birthweight. Fewer adolescent than adult primigravidae received >or=2 IPTp-SP doses (66 vs. 77.2%, p < 0.001), although more attended for two or more antenatal visits (92.0 vs. 76.7%, p < 0.001). Only 24.1% of adolescent primigravidae attended for hospital delivery. Women resident in intervention sites receiving IPTp-SP community distribution were more likely to choose a community delivery (p < 0.01), and have higher uptake of IPTp-SP (p = 0.036) than women not resident in these villages. Postnatal malaria prevalence was low and did not differ by age or place of delivery. Postnatal anaemia and low birthweight prevalence were higher in adolescents with community deliveries. Maternal anaemia and low birthweight prevalence were lower amongst adolescents in this study compared to estimates from the same population a decade previously. Adolescents had higher anaemia risk, lower IPTp-SP uptake than adults and under a quarter had a hospital delivery. Pregnancy outcomes improved compared to the survey a decade earlier. Monitoring and surveillance is required to reinforce to policy makers the need to improve adolescent coverage for available interventions.

Trends in Management and Outcome of Pregnancies in HIV-Infected Women in the UK and Ireland, 1990–2006

Changes in the demographic profile of diagnosed HIV-infected pregnant women and trends in pregnancy outcome, interventions, and mother-to-child transmission are followed over time in the United Kingdom and Ireland through active surveillance of obstetric and pediatric HIV in the National Study of HIV in Pregnancy and Childhood. The authors used this database to examine data from a total of 8327 pregnancies between the years 1990 and 2006 in diagnosed HIV-infected pregnant women. The main outcome measures evaluated were maternal characteristics, pregnancy outcome, use of antiretroviral therapy, mode of delivery, and mother-to-child transmission. Reported pregnancies increased from 82 in 1990 to 1394 in 2006. The proportion of pregnant women who probably acquired HIV through injecting drug use declined greatly from 49.2% (185/376) in 1990–1993 to 3.1% (125/4009) in 2004–2006 (P < .001). From 1990–1993 to 2004–2006, the proportion of the women born in sub-Saharan Africa increased by 35% (43.5% to 78.6% [P < .004]). During these same time periods, there was a marked reduction in reported pregnancy terminations: from 30% (111/376) to 3.4% (135/4009) (P < .001). Between 1995 and 2006, most deliveries (56.4%) were by elective caesarean section; rates were highest in 1999. Vaginal deliveries increased from 16.6% (36/217) in 1999 to 28.3% (321/1136) in 2006 (P < .001). With increased use of antiretroviral therapy in pregnancy over time, reaching 98.4% (1092/1110) in 2006, the overall mother-to-child transmission rate declined from 18.5% (35/189) in 1990–1993 to 1.0% (29/2832) in 2004–2006. The authors conclude from these findings that substantial changes in pregnancy management and outcome between 1999 and 2006 reflect the marked improvements in identification of HIV-infected women as well as interventions that markedly reduce the risk of mother-to-child transmission.

Trends in management and outcome of pregnancies in HIV‐infected women in the UK and Ireland, 1990–2006

To describe the changing demographic profile of diagnosed HIV-infected pregnant women over time and trends in pregnancy outcome, uptake of interventions and mother-to-child transmission. National surveillance study. UK and Ireland. Diagnosed HIV-infected pregnant women, 1990-2006. Active surveillance of obstetric and paediatric HIV conducted through the National Study of HIV in Pregnancy and Childhood. Maternal characteristics, pregnancy outcome, use of antiretroviral therapy, mode of delivery and mother-to-child transmission. A total of 8327 pregnancies were reported, increasing from 82 in 1990 to 1394 in 2006, with an increasing proportion from areas outside London. Injecting drug use as the reported risk factor for maternal HIV acquisition declined from 49.2% (185/376) in 1990-1993 to 3.1% (125/4009) in 2004-2006 (P < 0.001), while the proportion of women born in sub-Saharan Africa increased from 43.5% (93/214) in 1990-1993 to 78.6% (3076/3912) in 2004-2006 (P < 0.004). Reported pregnancy terminations decreased from 29.6% (111/376) in 1990-1993 to 3.4% (135/4009) in 2004-2006 (P < 0.001). Most (56.4%, 3717/6593) deliveries were by elective caesarean section, with rates highest in 1999 (66.4%, 144/217). Vaginal deliveries increased from 16.6% (36/217) in 1999 to 28.3% (321/1136) in 2006 (P < 0.001). Use of antiretroviral therapy in pregnancy increased over time, reaching 98.4% (1092/1110) in 2006, and the overall mother-to-child transmission rate declined from 18.5% (35/189) in 1990-1993 to 1.0% (29/2832) in 2004-2006. The annual number of reported pregnancies increased dramatically between 1990 and 2006, with changing demographic and geographic profiles and substantial changes in pregnancy management and outcome.

Secular trends in pregnancy outcomes in 1980–1999 in the Komi Republic, Russia

Objectives. To describe secular trends in selected pregnancy outcomes in the Komi Republic, Russia, in 1980–1999.Study Design. A descriptive study.Methods. Data on all single infants born in Syktyvkar and Vorkuta during the period 1980–1999 were abstracted from the birth journals at maternity homes (n = 69,340). Proportions of stillbirths, preterm and post-term births as well as the mean values for birth weight and length of term infants were estimated in each of the locations over time and summarized in 5-year periods. Multiple logistic and linear regression analyses were used to study independent effects of the time periods on the outcomes, adjusted for maternal age in Syktyvkar and for maternal age, parity and infant gender in Vorkuta.Results. Considerable variations over time were observed for all studied outcomes except for stillbirths. The lowest prevalence of both preterm and post-term births was observed in 1985–1989 in both Syktyvkar (4.3% and 3.2%) and Vorkuta (3.5% and 3.1%). Average birth weight in term infants was significantly lower in 1995-1999 in both Syktyvkar (-33 g, 95% CI: -46,-21) and Vorkuta (-81 g, 95% CI: -100, -62) than in 1980-1984.Conclusions. The proportions of preterm and post-term births increased while the average birth weight in term infants decreased over the 20-year period of observation. Further research should address those factors that could explain the observed pattern of pregnancy outcomes in the Komi Republic.

Temporal trends in pregnancy outcome of Maltese Diabetic patients

Complications attributable to diabetes mellitus account for a significant proportion of pregnancy complications in the Maltesepopulation. The intervention strategies that have been introduced in the last decades in obstetric practice should help tofavourably alter the obstetric outcome of these pregnancies. The study reviewed the outcome indicators of pre-existing andgestational diabetic pregnancies in the Maltese population over a 15-year interval comparing the periods 1983-1986 and1999-2002. The study has shown an increase from 0.22% to 0.35% in the prevalence of pre-existing diabetes mellitus inpregnant women, the increase being more marked in the younger age groups. The incidence of gestational DM also showedan increase from 1.25% to 2.40% reflecting a more active screening policy. In both groups, there has been a definite gain inperinatal survival and a drop in macrosomia rate; however associated with a relative rise in low birth weight resulting fromearlier intervention by induction of labour and caesarian section.

Changing trends in pregnancy outcome among HIV-infected women between 1985 and 1997 in two southern French university hospitals

Objectives: To analyze risk factors for pregnancy outcome among HIV-infected women before and after introduction of AZT prophylaxis in 1994. Study design: A prospective, two-center observational study conducted from 1 January 1985 to 31 December 1997. Patients: Pregnant HIV-infected women followed in one of the obstetrics units during the study period. Main outcome measures: pregnancy outcome (normal delivery, ectopic pregnancy, spontaneous abortion, voluntary termination of pregnancy (TOP) according to year of pregnancy, age at pregnancy professional status, marital status, ethnic origin, mode of contamination, stage of disease, partner’s human immunodeficiency virus (HIV) status and prior pregnancy. Results: One thousand one hundred and three pregnancies among 937 HIV-infected women were studied. Mean age of patients was 28.1±4.9 years. Pregnancy outcomes were distributed as follows: 473 normal deliveries, 589 TOP, 9 ectopic pregnancies and 32 spontaneous abortions. The proportion of TOP decreased from 59.4% before 1994 to 37.5% from 1994 ( P<0.001). In univariate analysis, mode of transmission, marital status, ethnic origin, partner’s HIV status and prior pregnancy were also significantly correlated with pregnancy outcome. However, after adjustment by logistic regression for each period (before and after 1994), mode of transmission no longer appeared to influence pregnancy outcome. Conclusion: Effective prevention of mother-to-child transmission of HIV infection appears to have influenced HIV-infected women’s decisions on continuing their pregnancy to term. Incidence of voluntary TOP has decreased significantly after introduction of AZT.