scholarly journals Interrupted time series study found mixed effects of the impact of the Bavarian smoke-free legislation on pregnancy outcomes

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Stephanie Polus ◽  
Jacob Burns ◽  
Sabine Hoffmann ◽  
Tim Mathes ◽  
Ulrich Mansmann ◽  
...  
Keyword(s):  
Time Series ◽  
Preterm Birth ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Pregnancy Outcomes ◽  
Preterm Births ◽  
Interrupted Time Series ◽  
Federal States ◽  
Very Preterm ◽  
The Impact

AbstractIn 2007 the German government passed smoke-free legislation, leaving the details of implementation to the individual federal states. In January 2008 Bavaria implemented one of the strictest laws in Germany. We investigated its impact on pregnancy outcomes and applied an interrupted time series (ITS) study design to assess any changes in preterm birth, small for gestational age (primary outcomes), and low birth weight, stillbirth and very preterm birth. We included 1,236,992 singleton births, comprising 83,691 preterm births and 112,143 small for gestational age newborns. For most outcomes we observed unclear effects. For very preterm births, we found an immediate drop of 10.4% (95%CI − 15.8, − 4.6%; p = 0.0006) and a gradual decrease of 0.5% (95%CI − 0.7, − 0.2%, p = 0.0010) after implementation of the legislation. The majority of subgroup and sensitivity analyses confirm these results. Although we found no statistically significant effect of the Bavarian smoke-free legislation on most pregnancy outcomes, a substantial decrease in very preterm births was observed. We cannot rule out that despite our rigorous methods and robustness checks, design-inherent limitations of the ITS study as well as country-specific factors, such as the ambivalent German policy context have influenced our estimation of the effects of the legislation.

scholarly journals Birth outcomes, pregnancy complications, and postpartum mental health after the 2013 Calgary flood: A difference in difference analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0246670
Author(s):  
Erin Hetherington ◽  
Kamala Adhikari ◽  
Lianne Tomfohr-Madsen ◽  
Scott Patten ◽  
Amy Metcalfe
Keyword(s):  
Mental Health ◽  
Preterm Birth ◽  
Birth Outcomes ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Gestational Hypertension ◽  
Difference In Difference ◽  
Postpartum Mental Health ◽  
Nulliparous Women ◽  
The Impact

Background In June 2013, the city of Calgary, Alberta and surrounding areas sustained significant flooding which resulted in large scale evacuations and closure of businesses and schools. Floods can increase stress which may negatively impact perinatal outcomes and mental health, but previous research is inconsistent. The objectives of this study are to examine the impact of the flood on pregnancy health, birth outcomes and postpartum mental health. Methods Linked administrative data from the province of Alberta were used. Outcomes included preterm birth, small for gestational age, a new diagnoses of preeclampsia or gestational hypertension, and a diagnosis of, or drug prescription for, depression or anxiety. Data were analyzed using a quasi-experimental difference in difference design, comparing flooded and non-flooded areas and in affected and unaffected time periods. Multivariable log binomial regression models were used to estimate risk ratios, adjusted for maternal age. Marginal probabilities for the difference in difference term were used to show the potential effect of the flood. Results Participants included 18,266 nulliparous women for the pregnancy outcomes, and 26,956 women with infants for the mental health analysis. There were no effects for preterm birth (DID 0.00, CI: -0.02, 0.02), small for gestational age (DID 0.00, CI: -0.02, 0.02), or new cases of preeclampsia (DID 0.00, CI: -0.01, 0.01). There was a small increase in new cases of gestational hypertension (DID 0.02, CI: 0.01, 0.03) in flood affected areas. There were no differences in postpartum anxiety or depression prescriptions or diagnoses. Conclusion The Calgary 2013 flood was associated with a minor increase in gestational hypertension and not other health outcomes. Universal prenatal care and magnitude of the disaster may have minimized impacts of the flood on pregnant women.

Has Human Papillomavirus (HPV) Vaccination Prevented Adverse Pregnancy Outcomes? Population-Level Analysis After 8 Years of a National HPV Vaccination Program in Australia

2020 ◽  
Vol 222 (3) ◽  
pp. 499-508
Author(s):  
Susan Yuill ◽  
Sam Egger ◽  
Megan Smith ◽  
Louiza Velentzis ◽  
C David Wrede ◽  
...  
Keyword(s):  
Human Papillomavirus ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Pregnancy Outcomes ◽  
Maternal Age ◽  
Hpv Vaccination ◽  
Preterm Births ◽  
Population Level ◽  
Adverse Pregnancy Outcomes ◽  
Adverse Pregnancy

Abstract Background Human papillomavirus (HPV) infection, and its sequelae of precancerous cervical lesions and their subsequent treatment, have been linked with an increased risk of adverse pregnancy outcomes. Publicly funded HPV vaccination of female adolescents began in Australia in 2007 with initial catch-up to age 26 years. Methods Using data from the National Perinatal Data Collection we compared rates of preterm births and small-for-gestational-age infants born in Australia 2000–2015. We used generalized linear models, assuming a Poisson distribution and log link function, with single-year categories of infant birth year, maternal age, and age-specific HPV vaccination coverage as independent variables. Results In maternal cohorts with 60%–80% HPV vaccination coverage as achieved in Australia, there was a relative rate reduction of 3.2% (95% confidence interval, 1.1%–5.3%) in preterm births and 9.8% (8.2% to 11.4%) in small-for-gestational-age infants, after adjustment for infant’s birth year and maternal age. Conclusion This analysis provides provisional population-level evidence of a reduction in adverse pregnancy outcomes in cohorts of women offered HPV vaccination. Confounding by smoking or other variables and/or ecological analysis limitations, however, cannot be excluded. These findings indicate potential broader benefits of HPV vaccination than have been documented to date.

scholarly journals FRI0305 FERTILITY AND PREGNANCY OUTCOMES IN WOMEN WITH SPONDYLOARTHRITIS: A SYSTEMATIC REVIEW AND META-ANALYSIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 742.2-743
Author(s):  
S. Hamroun ◽  
A. Hamroun ◽  
J. J. Bigna ◽  
E. Allado ◽  
F. Förger ◽  
...  
Keyword(s):  
Systematic Review ◽  
Caesarean Section ◽  
Disease Activity ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Pregnancy Outcomes ◽  
Meta Analysis ◽  
Research Support ◽  
Increased Risk ◽  
The Impact

Background:Women with spondyloarthritis (SpA) are often affected by the disease during their reproductive years1. However, little is known about the impact of the disease and its treatments on fertility and pregnancy outcomes, as well as the effect of pregnancy itself on disease activity2.Objectives:The aim of the study was to determine the effects of spondyloarthritis on fertility and pregnancy outcomes in women with SpA.Methods:We searched Pubmed, Embase, and Web of Science until 1 November 2019, without any language restriction. All studies assessing fertility, pregnancy outcomes and disease activity during pregnancy in women with spondyloarthritis (axial SpA (axSpA) but also peripheral SpA, including psoriatic arthritis (PsA)) were eligible. The heterogeneity between studies was quantified (I2), and multiple meta-regressions were carried out to identify potential sources of heterogeneity. In case I2was < 50%, a random-effects model was used to pool the available data. Prevalence of events was described as percentages. The odds ratio (OR) and corresponding 95% confidence interval (CI) were used to assess the associations between the disease and the pregnancy outcomes.Results:Within 4397 eligible studies, 21 articles fulfilling the selection criteria were included in the review, assessing overall 3306 patients (2578 with axSpA and 728 with PsA) and 4104 pregnancies compared to 42248 healthy controls (in 11 studies with a control group). Among the included studies, the risk of bias was evaluated as high, moderate and low in respectively 12, 1 and 8 studies. Regarding pregnancy outcomes, several studies report an increased risk of preterm birth, small for gestational age (pooled OR 2,05, [1,09-3,89],I2=5,8% in axSpA) and caesarean section (pooled OR 1,77 [1,45-2,17],I2=27,5% in axSpA and pooled OR 1,47 [1,22-1,76],I2=0,0% in PsA), without any other unfavourable pregnancy outcome (miscarriage, stillbirth, gestational diabetes or preeclampsia). Further analysis found a significant higher risk for elective caesarean (pooled OR 2,64, [1,92-3,62],I2=0,0% in axSpA and pooled OR 1,47, [1,15-1,88],I2=0,0% in PsA), without increased risk for emergency caesarean. There was no substantial heterogeneity in the majority of meta-analyses.Conclusion:Although based on observational data, this work is to our knowledge, the first systematic review and meta-analysis concerned with this subject. SpA and PsA seem to be associated with an increased risk of preterm birth, small for gestational age and elective caesarean section. The analysis of the impact of pregnancy on disease activity in this setting is currently ongoing.References:[1]Van den Brandt S. Arthritis Res Ther 2017;19(1):64.[2]Ursin K. Rheumatology. 201;57(6):1064-1071.Fig. 1.Association between caesarean section and axSpAFig. 2.Association between small for gestational age and axSpADisclosure of Interests:SABRINA HAMROUN: None declared, Aghilès Hamroun: None declared, Jean Joël Bigna: None declared, Edem Allado: None declared, Frauke Förger Grant/research support from: Unrestricted grant from UCB, Consultant of: UCB, GSK, Roche, Speakers bureau: UCB, GSK, Anna Moltó Grant/research support from: Pfizer, UCB, Consultant of: Abbvie, BMS, MSD, Novartis, Pfizer, UCB

scholarly journals Burden of soil-transmitted helminth infection in pregnant refugees and migrants on the Thailand-Myanmar border: Results from a retrospective cohort

2021 ◽  
Vol 15 (3) ◽  
pp. e0009219 ◽  
Author(s):  
Tobias Brummaier ◽  
Nay Win Tun ◽  
Aung Myat Min ◽  
Mary Ellen Gilder ◽  
Laypaw Archasuksan ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Pregnant Women ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Pregnancy Outcomes ◽  
Research Unit ◽  
Migrant Population ◽  
Maternal Anaemia ◽  
Concentration Method ◽  
Faecal Samples

Background Soil-transmitted helminth (STH) infections are widespread in tropical and subtropical regions. While many STH infections are asymptomatic, vulnerable populations such as pregnant women face repercussions such as aggravation of maternal anaemia. However, data on prevalence and the effect of STH infections in pregnancy are limited. The aim of this analysis was to describe the burden of STH infections within and between populations of pregnant women from a local refugee camp to a mobile migrant population, and to explore possible associations between STH infection and pregnancy outcomes. Methodology This is a retrospective review of records from pregnant refugee and migrant women who attended Shoklo Malaria Research Unit antenatal care (ANC) clinics along the Thailand-Myanmar border between July 2013 and December 2017. Inclusion was based on provision of a stool sample during routine antenatal screening. A semi-quantitative formalin concentration method was employed for examination of faecal samples. The associations between STH mono-infections and maternal anaemia and pregnancy outcomes (i.e., miscarriage, stillbirth, preterm birth, and small for gestational age) were estimated using regression analysis. Principal findings Overall, 12,742 pregnant women were included, of whom 2,702 (21.2%) had a confirmed infection with either Ascaris lumbricoides, hookworm, Trichuris trichiura, or a combination of these. The occurrence of STH infections in the refugee population (30.8%; 1,246/4,041) was higher than in the migrant population (16.7%; 1,456/8,701). A. lumbricoides was the predominant STH species in refugees and hookworm in migrants. A. lumbricoides and hookworm infection were associated with maternal anaemia at the first ANC consultation with adjusted odds ratios of 1.37 (95% confidence interval (CI) 1.08–1.72) and 1.65 (95% CI 1.19–2.24), respectively. Pregnant women with A. lumbricoides infection were less likely to miscarry when compared to women with negative stool samples (adjusted hazard ratio 0.63, 95% CI 0.48–0.84). STH infections were not significantly associated with stillbirth, preterm birth or being born too small for gestational age. One in five pregnant women in this cohort had STH infection. Association of STH infection with maternal anaemia, in particular in the event of late ANC enrolment, underlines the importance of early detection and treatment of STH infection. A potential protective effect of A. lumbricoides infection on miscarriage needs confirmation in prospective studies.

scholarly journals Impact of COVID-19 mitigation measures on the incidence of preterm birth: a national quasi-experimental study

2020 ◽  
Author(s):  
Jasper V Been ◽  
Lizbeth Burgos Ochoa ◽  
Loes CM Bertens ◽  
Sam Schoenmakers ◽  
Eric AP Steegers ◽  
...  
Keyword(s):  
Experimental Study ◽  
Preterm Birth ◽  
Gestational Age ◽  
Time Windows ◽  
Preterm Births ◽  
Effect Modification ◽  
Sensitivity Analyses ◽  
Mitigation Measures ◽  
Quasi Experimental ◽  
The Impact

Introduction Preterm birth is the leading cause of child mortality globally, with many survivors experiencing long-term adverse consequences. Preliminary evidence suggests that preterm births dropped dramatically following implementation of policy measures aimed at mitigating the impact of the COVID-19 pandemic. Methods We undertook a national quasi-experimental difference-in-regression-discontinuity approach to study the impact of the COVID-19 mitigation measures implemented in the Netherlands in a stepwise fashion on 9, 15, and 23 March 2020 on the incidence of preterm birth. We used data from the neonatal dried blood spot screening programme (2010-2020) and cross-validated these against national perinatal registry data. Stratified analyses were conducted according to gestational age subgroups, and sensitivity analyses to assess robustness of the findings. We explored potential effect modification by neighbourhood socio-economic status. Results Data on 1,599,549 singleton newborns were available, including 56,720 post-implementation births. Consistent reductions in preterm birth were seen across various time windows surrounding implementation of the 9 March COVID-19 mitigation measures: +/- 2 months (n=531,823): odds ratio 0.77 (95% confidence interval 0.66-0.91), p=0.002; +/- 3 months (n=796,531): 0.85 (0.73-0.98), p=0.028; +/- 4 months (n=1,066,872): 0.84 (0.73-0.97), p=0.023. Decreases observed following the 15 March measures were of smaller magnitude and not statistically significant. No changes were observed after 23 March. Preterm birth reductions after 9 March were consistent across gestational age strata and robust in sensitivity analyses. They appeared confined to high-socioeconomic status neighbourhoods, but effect modification was not statistically significant. Conclusion In this national quasi-experimental study, initial implementation of COVID-19 mitigation measures was associated with a 15-23% drop in preterm births in the following months, in agreement with preliminary observations in other countries. It is now of pivotal importance that integration of comparable data from across the globe is undertaken to further substantiate these findings and start exploring the underlying mechanisms.

scholarly journals Pre-conceptional intake of folic acid supplements is inversely associated with risk of preterm birth and small-for-gestational-age birth: a prospective cohort study

2015 ◽  
Vol 115 (3) ◽  
pp. 509-516 ◽  
Author(s):  
Ju-Sheng Zheng ◽  
Yuhong Guan ◽  
Yimin Zhao ◽  
Wei Zhao ◽  
Xuejuan Tang ◽  
...  
Keyword(s):  
Cohort Study ◽  
Folic Acid ◽  
Preterm Birth ◽  
Birth Cohort ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Pregnancy Outcomes ◽  
Lower Risk ◽  
Folic Acid Supplementation ◽  
Acid Supplementation

AbstractAssociations of folic acid supplementation with risk of preterm birth (PTB) and small-for-gestational-age (SGA) birth were unclear for the Chinese populations. The aim of the present study was to investigate the associations in a large Chinese prospective cohort study: the Jiaxing Birth Cohort. In the Jiaxing Birth Cohort, 240 954 pregnant women visited local clinics or hospitals within their first trimester in Southeast China during 1999–2012. Information on anthropometric parameters, folic acid supplementation and other maternal characteristics were collected by in-person interviews during their first visit. Pregnancy outcomes were recorded during the follow-up of these participants. Multinomial logistic regression was used to examine the association of folic acid supplementation with pregnancy outcomes. The prevalence of folic acid supplementation was 24·9 % in the cohort. The prevalence of PTB and SGA birth was 3·48 and 9·2 %, respectively. Pre-conceptional folic acid supplementation was associated with 8 % lower risk of PTB (relative risk (RR) 0·92; 95 % CI 0·85, 1·00; P=0·04) and 19 % lower risk of SGA birth (RR 0·81; 95 % CI 0·70, 0·95; P=0·008), compared with non-users. Higher frequency of pre-conceptional folic acid use was associated with lower risk of PTB (Ptrend=0·032) and SGA birth (Ptrend=0·046). No significant association between post-conceptional initiation of folic acid supplementation and either outcome was observed. In conclusion, the present study suggests an association between pre-conceptional, but not post-conceptional, folic acid supplementation and lower risk of PTB and SGA birth in the Jiaxing Birth Cohort. Further research in other cohorts of large sample size is needed to replicate these findings.

Impact of Lockdown Measures during COVID-19 Pandemic on Pregnancy and Preterm Birth

2021 ◽  
Author(s):  
Belal Alshaikh ◽  
Po-Yin Cheung ◽  
Nancy Soliman ◽  
Marie-Anne Brundler ◽  
Kamran Yusuf
Keyword(s):  
Birth Weight ◽  
Preterm Birth ◽  
Low Birth Weight ◽  
Pregnancy Outcomes ◽  
Very Low Birth Weight ◽  
Gestational Hypertension ◽  
Cohort Analysis ◽  
Preterm Births ◽  
Live Births ◽  
Very Preterm

Objective The objective of this study is to assess the effect of the lockdown measures during the coronavirus disease 2019 (COVID-19) pandemic on pregnancy outcomes of women who were not affected by severe acute respiratory syndrome coronavirus 2 infection. Study Design We used data from the perinatal health program and neonatal databases to conduct a cohort analysis of pregnancy outcomes during the COVID-19 lockdown in the Calgary region, Canada. Rates of preterm birth were compared between the lockdown period (March 16 to June 15, 2020) and the corresponding pre-COVID period of 2015 to 2019. We also compared maternal and neonatal characteristics of preterm infants admitted to neonatal intensive care units (NICUs) in Calgary between the two periods. Findings A total of 4,357 and 24,160 live births occurred in the lockdown and corresponding pre-COVID period, respectively. There were 366 (84.0 per 1,000 live births) and 2,240 (92.7 per 1,000 live births) preterm births in the lockdown and corresponding pre-COVID period, respectively (p = 0.07). Rates of very preterm and very-low-birth-weight births were lower in the lockdown period compared with the corresponding pre-COVID period (11.0 vs. 15.6 and 9.0 vs. 14.4 per 1,000 live births, p = 0.02 and p = 0.005, respectively). There was no difference in spontaneous stillbirth between the two periods (3.7 vs. 4.1 per 1,000 live birth, p = 0.71). During the lockdown period, the likelihood of multiple births was lower (risk ratio [RR] 0.73, 95% confidence interval [CI]: 0.60–0.88), while gestational hypertension and clinical chorioamnionitis increased (RR 1.24, 95%CI: 1.10–1.40; RR 1.33, 95%CI 1.10–1.61, respectively). Conclusion Observed rates of very preterm and very-low-birth-weight births decreased during the COVID-19 lockdown. Pregnant women who delivered during the lockdown period were diagnosed with gestational hypertension and chorioamnionitis more frequently than mothers in the corresponding pre-COVID period. Key Points

scholarly journals Adverse pregnancy outcomes during the COVID-19 lockdown. A descriptive study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Eman F. Badran ◽  
Rula M. Darwish ◽  
Yousef Khader ◽  
Rama AlMasri ◽  
Mira Al Jaberi ◽  
...  
Keyword(s):  
Birth Weight ◽  
Preterm Birth ◽  
Low Birth Weight ◽  
Perinatal Mortality ◽  
Gestational Age ◽  
Pregnancy Outcomes ◽  
Neonatal Death ◽  
Lifestyle Changes ◽  
The Impact ◽  
Extreme Low Birth Weight

Abstract Background The ongoing spread coronavirus disease worldwide has caused major disruptions and led to lockdowns. Everyday lifestyle changes and antenatal care inaccessibility during the coronavirus disease 2019 (COVID-19) pandemic have variable results that affect pregnancy outcomes. This study aimed to assess the alterations in stillbirth, neonatal-perinatal mortality, preterm birth, and birth weight during the COVID-19 national lockdown. Methods We used the data from the Jordan stillbirths and neonatal death surveillance system to compare pregnancy outcomes (gestational age, birth weight, small for gestational age, stillbirth, neonatal death, and perinatal death) between two studied periods (11 months before the pandemic (May 2019 to March 2020) vs. 9 months during the pandemic (April 2020 to March 1st 2020). Separate multinomial logistic and binary logistic regression models were used to compare the studied outcomes between the two studied periods after adjusting for the effects of mother’s age, income, education, occupation, nationality, health sector, and multiplicity. Results There were 31106 registered babies during the study period; among them, 15311 (49.2%) and 15795 (50.8%) births occurred before and during the COVID-19 lockdown, respectively. We found no significant differences in preterm birth and stillbirth rates, neonatal mortality, or perinatal mortality before and during the COVID-19 lockdown. Our findings report a significantly lower incidence of extreme low birth weight (ELBW) infants (<1kg) during the COVID-19 lockdown period than that before the lockdown (adjusted OR 0.39, 95% CI 0.3-0.5: P value <0.001) Conclusions During the COVID-19 lockdown period, the number of infants born with extreme low birth weight (ELBW) decreased significantly. More research is needed to determine the impact of cumulative socio-environmental and maternal behavioral changes that occurred during the pandemic on the factors that contribute to ELBW infants.

scholarly journals Exposure-response analysis of the association of maternal smoking and use of electronic cigarettes (vaping) in relation to preterm birth and small-for-gestational-age in a national US sample, 2016-2018

2021 ◽  
Author(s):  
Xi Wang ◽  
Nora L Lee ◽  
Igor Burstyn
Keyword(s):  
Preterm Birth ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Preterm Births ◽  
Excess Risk ◽  
Response Analysis ◽  
List Type ◽  
Exposure Response ◽  
Increase Risk ◽  
Heavy Smokers

AbstractWe aimed to estimate exposure-response associations between smoking or vaping, and preterm and small-for-gestational age (SGA) births. We included 99,201 mothers who delivered live singletons in 2016-2018 from the Pregnancy Risk Assessment Monitoring System. We created exposure categories based on participants’ self-reported average number of cigarettes smoked per day and vaping frequency. Dual users in late pregnancy were a heterogeneous group: 36% heavily smoked and occasionally vaped; 29% lightly smoked and frequently vaped; 19% lightly smoked and frequently vaped; and 15% both heavily smoked and frequently vaped. While dual users who heavily smoked and occasionally vaped had the highest adjusted OR for SGA (3.4, 95% CI 1.7-6.6), all the dual users were on average at about twice the odds of having SGA than non-users. While the risks of preterm birth were higher among sole light smokers (adjusted OR 1.3, 95% CI 1.1-1.5) and sole heavy smokers (adjusted OR 1.4. 95 CI 1.2-1.8) than non-users, the adjusted odds of preterm births for dual users were not noticeably higher than those of non-users, unless they were also heavy smokers. Excess of preterm births among heavy vapers was suggested. Among younger non-Hispanic white women (where vaping is most common), only excess risk of SGA, not preterm, with vaping was apparent. Relative to non-users, both smoking and vaping during pregnancy appear to increase risk of SGA, but excess risk of preterm births appears to be primarily attributable to smoking alone. Higher levels of exposure tended to confer more risk.HighlightsNo observable change in prevalence of vaping during pregnancy from 2016 to 2018Both smoking and vaping during pregnancy appear to increase risk of SGA birthsExcess risk of preterm births appears to be primarily attributable to smoking alone

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