Effect of the Covid-19 Pandemic on Well-Baby Nursery

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic is associated with fewer deliveries and premature births; however, the impact of this pandemic on the well-baby nursery (WBN) is unknown. OBJECTIVE: To evaluate the impact of the COVID-19 pandemic on infants admitted to the WBN by comparing pandemic and pre-pandemic cohorts. STUDY DESIGN: We performed a retrospective study of infants admitted to a WBN during the pandemic period (March 18, 2020-to-March 17, 2021) and compared them to those during the pre-pandemic period (March 18, 2019-to-March 17, 2020). Maternal (age, parity, gestation, method of delivery, and COVID-19 status) and neonatal (sex, weight, Apgar score, feeding pattern, urine toxicology, and neonatal intensive care unit [NICU] admission) data were collected and compared between the two periods. The results were statistically analyzed, and significance was set at P < 0.05. RESULTS: There were 824 and 859 WBN admissions during the pandemic and pre-pandemic periods, respectively; a 4% decrease in WBN admissions during the pandemic period. During the pandemic period, the number of deliveries among nulliparous women increased (from 40.3% to 45.1%; p=0.01), and deliveries among multiparous women decreased (from 59.2% to 53.1%; p=0.01). The number of infants exposed to marijuana in-utero increased (24/149 screened vs. 12/146 screened; p=0.038), and transfers from WBN to NICU decreased (from 9% to 6%; p=0.044) during the pandemic period. CONCLUSIONS: Compared to the pre-pandemic period, the number of WBN admissions, multiparous deliveries, and NICU admissions decreased, while the number of nulliparous deliveries and infants exposed to marijuana in-utero increased during the pandemic period.

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Parity and the risks of adverse birth outcomes: a retrospective study among Chinese

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03718-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Li Lin ◽

Ciyong Lu ◽

Weiqing Chen ◽

Chunrong Li ◽

Vivian Yawei Guo

Keyword(s):

Retrospective Study ◽

Birth Outcomes ◽

Maternal Age ◽

Chinese Women ◽

Complete Information ◽

Adverse Birth Outcomes ◽

Combined Effects ◽

Nulliparous Women ◽

Multiparous Women ◽

The Impact

Abstract Background Nulliparity is considered to be a risk factor of preterm birth (PTB), low birth weight (LBW) and small for gestational age (SGA). With the new two-child policy launched in 2016, more Chinese women have delivered their 2nd baby. Yet few studies have assessed the impact of parity on adverse birth outcomes in China. This study aimed to examine the association between parity and risks of PTB, LBW and SGA in a Chinese population. The combined effects of maternal age and parity on adverse birth outcomes were also assessed. Methods This retrospective study included all non-malformed live births born during January 1, 2014 and December 31, 2018 in Chengdu, China. A total of 746,410 eligible live singletons with complete information were included in the analysis. Parity was classified into nulliparity (i.e. has never delivered a newborn before) and multiparity (i.e. has delivered at least one newborn before). Log-binomial regression analyses were applied to evaluate the association between parity and PTB, LBW and SGA. We further divided maternal age into different groups (< 25 years, 25–29 years, 30–34 years and ≥ 35 years) to assess the combined effects of maternal age and parity on adverse birth outcomes. Results Multiparity was associated with reduced risks of PTB (aRR = 0.91, 95% CI: 0.89–0.93), LBW (aRR = 0.74, 95% CI: 0.72–0.77) and SGA (aRR = 0.67, 95% CI: 0.66–0.69) compared with nulliparity. In each age group, we observed that multiparity was associated with lower risks of adverse birth outcomes. Compared to nulliparous women aged between 25 and 29 years, women aged ≥35 years had greater risks of PTB and LBW, regardless of their parity status. In contrast, multiparous women aged ≥35 years (aRR = 0.73, 95% CI: 0.70–0.77) and those aged < 25 years (aRR = 0.88, 95% CI: 0.84–0.93) were at lower risk of SGA compared with nulliparous women aged between 25 and 29 years. Conclusion Multiparity was associated with lower risks of all adverse birth outcomes. Special attention should be paid to nulliparous mothers and those with advanced age during antenatal care, in order to reduce the risks of adverse birth outcomes.

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Nonmedically Indicated Induction of Labor Compared with Expectant Management in Nulliparous Women Aged 35 Years or Older

American Journal of Perinatology ◽

10.1055/s-0038-1648228 ◽

2018 ◽

Vol 36 (01) ◽

pp. 045-052 ◽

Cited By ~ 2

Author(s):

Katherine Bowers ◽

Jane Khoury ◽

Tetsuya Kawakita

Keyword(s):

Intensive Care Unit ◽

Cesarean Delivery ◽

Retrospective Cohort ◽

Neonatal Intensive Care ◽

Expectant Management ◽

Induction Of Labor ◽

Neonatal Outcomes ◽

Nulliparous Women ◽

Maternal And Neonatal Outcomes ◽

Nicu Admission

Objective This article compares maternal and neonatal outcomes in women aged ≥ 35 years who experienced nonmedically indicated induction of labor (NMII) versus expectant management. Study Design This was a retrospective cohort study of nulliparas aged ≥ 35 years with a singleton and cephalic presentation who delivered at term. Outcomes were compared between women who underwent NMII at 37, 38, 39, and 40 weeks' gestation and those with expectant management that week. Adjusted odds ratios (aORs) with 95% confidence intervals (95% CIs) were calculated, controlling for predefined covariates. Results Of 3,819 nulliparas aged ≥ 35 years, 1,409 (36.9%) women underwent NMII. Overall at 39 weeks' gestation or later, maternal and neonatal outcomes were similar or improved with NMII. At 37, 38, and 39 weeks' gestation, NMII compared with expectant management was associated with decreased odds of cesarean delivery at 37, 38, and 39 weeks' gestation. At 40 weeks' gestation, NMII compared with expectant management was associated with an increased odds of operative vaginal delivery and a decreased odds of neonatal intensive care unit (NICU) admission. Conclusion In nulliparous women aged ≥ 35 years, NMII was associated with decreased odds of cesarean delivery at 37 to 39 weeks' gestation and decreased odds of NICU admission at 40 weeks' gestation compared with expectant management.

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Distensibility and Strength of the Pelvic Floor Muscles of Women in the Third Trimester of Pregnancy

BioMed Research International ◽

10.1155/2014/437867 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 9

Author(s):

Carla Dellabarba Petricelli ◽

Ana Paula Magalhães Resende ◽

Julio Elito Júnior ◽

Edward Araujo Júnior ◽

Sandra Maria Alexandre ◽

...

Keyword(s):

Pelvic Floor ◽

Electrical Activity ◽

Maternal Age ◽

Surface Emg ◽

Voluntary Contraction ◽

Pelvic Floor Muscles ◽

Third Trimester ◽

The Third ◽

Nulliparous Women ◽

Multiparous Women

Objective.The objective of this study was to compare the role of the pelvic floor muscles between nulliparous and multiparous women in the third trimester of pregnancy, by analyzing the relationship between electrical activity (surface electromyography—EMG), vaginal palpation (modified Oxford scale), and perineal distensibility (Epi-no).Methods.This was an observational cross-sectional study on a sample of 60 healthy pregnant women with no cervical dilation, single fetus, gestational age between 35 and 40 weeks, and maternal age ranging from 15 to 40 years. The methods used were bidigital palpation (modified Oxford scale, graded 0–5), surface EMG (electrical activity during maximal voluntary contraction), and perineal distensibility (Epi-no device). The Pearson correlation coefficient (r) was used to analyze the Epi-no values and the surface EMG findings. The Kruskal-Wallis test was used to compare the median values from surface EMG and Epi-no, using the modified Oxford scale scores.Results.Among the 60 patients included in this study, 30 were nulliparous and 30 multiparous. The average maternal age and gestational age were 26.06 (±5.58) and 36.56 (±1.23), respectively. It was observed that nulliparous women had both higher perineal muscle strength (2.53 ± 0.57versus2.06 ± 0.64;P = 0.005) and higher electrical activity (45.35 ± 12.24 μV versus35.79 ± 11.66 μV;P = 0.003), while among the multiparous women, distensibility was higher (19.39 ± 1.92versus18.05 ± 2.14;P = 0.013). We observed that there was no correlation between perineal distensibility and electrical activity during maximal voluntary contraction (r = -0.193;P = 0.140). However, we found a positive relationship between vaginal palpation and surface electromyography (P = 0.008), but none between Epi-no values (P = 0.785).Conclusion.The electrical activity and muscle strength of the pelvic floor muscles of the multiparous women were damaged, in relation to the nulliparous women, while the perineal distensibility was lower in the latter group. There was a positive relationship between surface EMG and the modified Oxford scale.

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Impact of Neonatal Intensive Care Unit Admission on Bacterial Colonization of Donated Human Milk

Journal of Human Lactation ◽

10.1177/0890334417753941 ◽

2018 ◽

Vol 34 (2) ◽

pp. 350-354 ◽

Cited By ~ 2

Author(s):

Amir Elmekkawi ◽

Deborah L. O’Connor ◽

Debbie Stone ◽

Eugene W. Yoon ◽

Michael Larocque ◽

...

Keyword(s):

Intensive Care ◽

Human Milk ◽

Neonatal Intensive Care ◽

Bacterial Contamination ◽

Bacterial Colonization ◽

Commensal Bacteria ◽

Human Donor ◽

Donor Milk ◽

Nicu Admission ◽

The Impact

Background: Unpasteurized human donor milk typically contains a variety of bacteria. The impact of neonatal intensive care unit (NICU) admission of the donor’s infant and duration of lactation on bacterial contamination of human milk is unknown. Research aim: This study aimed (a) to describe the frequency/concentration of skin commensal bacteria and pathogens in unpasteurized human donor milk and (b) to assess the impact of NICU admission and (c) the duration of milk expression on bacterial colonization of donated milk. Methods: The authors conducted a retrospective cohort study of human milk donated to the Rogers Hixon Ontario Human Milk Bank from January 2013 to June 2014. Milk samples from each donor were cultured every 2 weeks. Results: The study included 198 donor mothers, of whom 63 had infants admitted to the NICU. Of 1,289 cultures obtained, 1,031 (80%) had detectable bacterial growth and 363 (28%) yielded bacterial growth in excess of 107 cfu/L, a local threshold for allowable bacteria prior to pasteurization. The mean (standard deviation) donation period per donor was 13.0 (7.5) weeks. Milk from mothers with NICU exposure had significantly higher concentrations of commensals, but not pathogens, at every time period compared with other mothers. For every 1-month increase in donation from all donors, the odds ratio of presence of any commensal in milk increased by 1.13 (95% confidence interval [1.03, 1.23]) and any pathogen by 1.31 (95% confidence interval [1.20, 1.43]). Conclusion: Commensal bacteria were more abundant in donor milk expressed from mothers exposed to neonatal intensive care. Bacterial contamination increased over the milk donation period.

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A preliminary study to assess the impact of maternal age on stress-related variables in healthy nulliparous women

Psychoneuroendocrinology ◽

10.1016/j.psyneuen.2017.01.018 ◽

2017 ◽

Vol 78 ◽

pp. 97-104 ◽

Cited By ~ 12

Author(s):

Ana García-Blanco ◽

Alberto Monferrer ◽

Jorge Grimaldos ◽

David Hervás ◽

Vicent Balanzá-Martínez ◽

...

Keyword(s):

Maternal Age ◽

Nulliparous Women ◽

Preliminary Study ◽

The Impact

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Pregnancy Outcome of Multiparous Women Aged over 40 Years

International Journal of Reproductive Medicine ◽

10.1155/2013/287519 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4 ◽

Cited By ~ 9

Author(s):

Seda Ates ◽

Gonca Batmaz ◽

Osman Sevket ◽

Taner Molla ◽

Cem Dane ◽

...

Keyword(s):

Maternal Age ◽

Neonatal Intensive Care ◽

Advanced Maternal Age ◽

Control Group ◽

Study Group ◽

Retrospective Case ◽

Multiparous Women ◽

The Mean ◽

Over 40 Years ◽

Control Study

Objective. The aim of this study was to evaluate the effect of maternal age on prenatal and obstetric outcome in multiparaous women.Materials and Methods. A retrospective case control study was conducted, including women aged 40 years and over (study group,n=97) who delivered at 20 week’s gestation or beyond and women aged 20–29 years (control group,n=97).Results. The mean age of women in the study group was41.2±1.7years versus25.4±2.3years in the control group. Advanced maternal age was associated with a significantly higher rate of hypertension, diabetes mellitus, fetal complication, and 5-minute Apgar scores <7 (P<0.05). Caeserean section rate, incidence of placental abruption, preterm delivery, and neonatal intensive care unit admission were more common in the older group, but the differences were not statistically significant.Conclusions. Advanced maternal age is related to maternal and neonatal complications.

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The Association between Advanced Maternal Age and Diagnosis of Small for Gestational Age

American Journal of Perinatology ◽

10.1055/s-0039-1694775 ◽

2019 ◽

Vol 37 (01) ◽

pp. 037-043 ◽

Cited By ~ 2

Author(s):

Anna Palatnik ◽

Sarah De Cicco ◽

Liyun Zhang ◽

Pippa Simpson ◽

Judith Hibbard ◽

...

Keyword(s):

Gestational Age ◽

Small For Gestational Age ◽

Maternal Age ◽

Advanced Maternal Age ◽

The United States ◽

Age Group ◽

Nulliparous Women ◽

Increased Risk ◽

Multiparous Women ◽

Multivariable Analyses

Abstract Objectives To identify whether advanced maternal age (AMA), defined as age ≥35 years old, is independently associated with small for gestational age (SGA). Study Design This was a retrospective cohort of births from the National Vital Statistics System in the United States from 2009 to 2013. Women were categorized based on four age groups at the time of delivery: 20 to 29, 30 to 34, 35 to 39, and ≥40 years old. The primary outcome of SGA < 10th and SGA < 5th percentiles was compared between the four groups using both univariable and multivariable analyses to determine whether maternal age was associated with SGA independent of parity. Results A total of 17,031,005 births were eligible for analysis, with 2,705,501 births to AMA women. In multivariable analyses, maternal age of 30 to 34, compared with 20 to 29, was associated with lower rates of SGA < 10th and <5th percentiles (adjusted odds ratio [aOR] = 0.95; 95% confidence interval [CI]: 0.95–0.96 and aOR = 0.97; 95% CI: 0.96–0.98, respectively). The AMA of 35 to 39, compared with 20 to 29, was associated with lower rates of SGA < 10th percentile and unchanged rates of SGA < 5th percentile (aOR = 0.97; 95% CI: 0.96–0.98 and aOR = 1; 95% CI: 0.99–1.01, respectively). In contrast, AMA of ≥40, compared with age 20 to 29, was associated with higher rates of both SGA < 10th and <5th percentiles (aOR = 1.06; 95% CI: 1.04–1.07 and aOR = 1.14; 95% CI: 1.12–1.16, respectively). A significant association was found between maternal age and parity toward the risk of SGA (p < 0.001). Nulliparous women ≥30 years old but not multiparous women had higher rates of SGA < 10th and SGA < 5th percentiles compared with nulliparous women in the age group of 20 to 29. In contrast, both nulliparous and multiparous women age ≥40 years old had an increased risk for SGA < 5th percentile compared with all women in the age group of 20 to 29. Conclusion Nulliparous women aged 30 years and older have higher risk of SGA < 10th and SGA < 5th percentiles compared with nulliparous women age 20 to 29. In contrast, both nulliparous and multiparous women age 40 years and older have an increased risk of SGA < 5th percentile compared with all women in the age group of 20 to 29.

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Advanced maternal age and factors associated with neonatal near miss in nulliparous and multiparous women

Cadernos de Saúde Pública ◽

10.1590/0102-311x00222218 ◽

2019 ◽

Vol 35 (12) ◽

Author(s):

Katrini Guidolini Martinelli ◽

Silvana Granado Nogueira da Gama ◽

André Henrique do Vale de Almeida ◽

Vanessa Eufrauzino Pacheco ◽

Edson Theodoro dos Santos Neto

Keyword(s):

Maternal Age ◽

Advanced Maternal Age ◽

Healthcare Services ◽

Near Miss ◽

Multiple Gestation ◽

Access To Health Services ◽

Maternal Characteristics ◽

Nulliparous Women ◽

Multiparous Women ◽

Neonatal Near Miss

The early neonatal period accounts for approximately half of the deaths of young children under one year of age, and the neonatal near miss can recognize factors causing this high number of deaths. Thus, the aim of this study is to determine whether advanced maternal age increases the chance of neonatal near miss, in addition is to identify which factors are associated with the neonatal near miss, stratified by parity. Data are from the 2011-2012 Birth in Brazil study, which used a national population-based sample of 15,092 newborns of women between 20-29 and 35 years of age or more (advanced maternal age). Multiple logistic regression was performed to test the association between neonatal near miss and prenatal and childbirth variables, pre-gestational diseases, obstetric history and socioeconomic characteristics, stratified by parity. Advanced maternal age was to be statistically associated with neonatal near miss in nulliparous (OR = 1.62; 95%CI: 1.05-2.50) and multiparous (OR = 1.51; 95%CI: 1.20-1.91) when compared to women 20-29 years of age. For nulliparous women, the main variables statistically associated with neonatal near miss were multiple gestation (OR = 8.91) and hypertensive disease (OR = 2.57), whereas forceps-assisted vaginal delivery (OR = 7.19) and multiple gestation (OR = 4.47) were the variables associated for multiparous women. Neonatal near miss has been shown to be connected with access to health services for childbirth, gestational complications and maternal characteristics, mainly advanced maternal age. Therefore, to properly monitor and classify maternal gestational risk, to control gestational complications during prenatal care, and to correctly refer these women to childbirth care should be priority strategies for healthcare services.

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The impact of antenatal care utilization on admissions to neonatal intensive care units and perinatal mortality in Georgia

PLoS ONE ◽

10.1371/journal.pone.0242991 ◽

2020 ◽

Vol 15 (12) ◽

pp. e0242991

Author(s):

Tinatin Manjavidze ◽

Charlotta Rylander ◽

Finn Egil Skjeldestad ◽

Nata Kazakhashvili ◽

Erik Eik Anda

Keyword(s):

Intensive Care ◽

Antenatal Care ◽

Perinatal Mortality ◽

Neonatal Intensive Care ◽

Care Utilization ◽

Birth Registry ◽

Registration System ◽

Inadequate Care ◽

Nicu Admission ◽

The Impact

Introduction Appropriate antenatal care (ANC) utilization has direct, significant effects on perinatal mortality (PM). Georgia has one of the highest PM rates (11.7 per 1000 births) in Europe and launched a more intensive ANC programme in 2018. Aim To evaluate the associations between the Adequacy of Prenatal Care Utilization (APNCU) index and neonatal intensive care unit (NICU) admission and PM in Georgia. Methods The Georgian Birth Registry (GBR), with linkage to the Vital Registration System, was used as the main data source; 148,407 eligible mothers and singleton newborns were identified during the observation period (2017–2019). The main exposure was ANC utilization, measured by the APNCU index, and the hospitalization registry was used to validate NICU admissions. Logistic regression analysis was used to assess the associations between the exposure and outcomes while controlling for potential confounders. Results The overall PM rate was 11.6/1000 births, and the proportion of newborns with a NICU admission was 7.8%. 85% of women initiated ANC before gestational age week 12. According to the APNCU index, 16% of women received inadequate, 10% intermediate, 38% adequate, and 36% intensive care. Women who received intermediate care had the lowest odds of PM (adjusted odds ratio [AOR] = 0.56, 95% confidence interval [CI] 0.45–0.70), and newborns of women who received inadequate care had the highest odds of NICU admission (AOR = 1.16, 95% CI 1.09–1.23) and PM (AOR = 1.18, 95% CI 1.02–1.36). Conclusion ANC utilization is significantly associated with newborn asmissions to NICU and PM in Georgia. Women received inadequate care experienced the highest odds of newborn admissions to NICU and PM.

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Seropositivity of Dengue Antibodies during Pregnancy

The Scientific World JOURNAL ◽

10.1155/2014/436975 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 4

Author(s):

Nor Azlin Mohamed Ismail ◽

Wan Elly Rushima Wan Abd Rahim ◽

Sharifah Azura Salleh ◽

Hui-Min Neoh ◽

Rahman Jamal ◽

...

Keyword(s):

Cord Blood ◽

Maternal Age ◽

Neonatal Intensive Care ◽

Detrimental Effect ◽

Enzyme Linked Immunosorbent Assay ◽

Igg Antibodies ◽

Endemic Country ◽

Blood Samples ◽

Recorded Data ◽

Nicu Admission

Purpose. Malaysia a dengue endemic country with dengue infections in pregnancy on the rise. The present study was aimed at determining dengue seroprevalence (IgG or IgM) during pregnancy and its neonatal transmission in dengue seropositive women.Methods. Maternal with paired cord blood samples were tested for dengue antibodies (IgG and IgM) using an enzyme-linked immunosorbent assay (ELISA). Maternal age, parity, occupation, ethnic group, and gestational age were recorded. Data on neonatal Apgar score and admissions to the Neonatal Intensive Care Unit (NICU) were analyzed.Results. Out of 358 women recruited, about 128 (35.8%) patients were seropositive. Twelve patients (3.4%) had recent infections (IgM positive) and another 116 women (32.4%) were with past infections (IgG positive). All babies born to seropositive mothers had positive IgG paired cord blood; however, no IgM seropositivity was observed. All neonates had good Apgar scores and did not require NICU admission.Conclusion. In this study, 35.8% pregnant women were found to be dengue seropositive. However, transplacental transfer of IgG antibodies had no detrimental effect on the neonatal outcomes.

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