Population versus Customized Growth Curves: Prediction of Composite Neonatal Morbidity

2018 ◽  
Vol 36 (08) ◽  
pp. 818-827 ◽  
Author(s):  
Hector Mendez-Figueroa ◽  
Suneet P. Chauhan ◽  
Tyisha Barrett ◽  
Van Thi Thanh Truong ◽  
Claudia Pedroza ◽  
...  
Keyword(s):  
Gestational Age ◽  
Random Effect ◽  
Perinatal Outcomes ◽  
Growth Curves ◽  
Neonatal Morbidity ◽  
Adverse Outcomes ◽  
Large For Gestational Age ◽  
Likelihood Ratios ◽  
Maternal Fetal Medicine ◽  
Adverse Perinatal Outcomes

Objective To assess the ability of customized and population growth nomograms in identifying newborns with composite neonatal morbidity (CNM). Study Design This study included women who participated in the 10 Maternal-Fetal Medicine Units (MFMU) trials and delivered a nonanomalous singleton with a known gestational age (GA) of 24 weeks or more and documented birthweight. Population nomograms were based on Alexander's nomogram, whereas customized nomograms used publicly available softwares. Random-effect logistic regression was used to estimate the adjusted odds ratio (aOR). Positive and negative likelihood ratios (LRs) were calculated to assess nomogram performance. Results Of 92,225 women, 85% met the inclusion criteria. Using the population nomogram, 12% were small for gestational age (SGA) and 10% were large for gestational age (LGA), and using customized nomograms, 15% were SGA and 16% LGA. SGA newborns had a higher likelihood of CNM (aOR: 2.62; 95% confidence interval [CI]: 2.48–2.76) for population nomograms and 3.22 (95% CI: 3.07–3.39) for customized nomograms. LGA newborns had a similar CNM with population nomogram but significantly higher with customized nomogram (aOR: 1.42; 95% CI: 1.34–1.50). For the adverse outcomes among SGA and LGA, the positive LRs for the two nomograms were similar with overlapping 95% CI. Conclusion Though both SGA and LGA are associated with adverse perinatal outcomes, the detection using both nomograms was similar.

Maternal Thinness and Obesity and Customized Fetal Weight Charts

2021 ◽  
pp. 1-9
Author(s):  
Nieves L. González González ◽  
Enrique González Dávila ◽  
Agustina González Martín ◽  
Erika Padrón ◽  
José Ángel García Hernández
Keyword(s):  
At Risk ◽  
Gestational Age ◽  
Neonatal Intensive Care ◽  
Perinatal Outcomes ◽  
Adverse Outcomes ◽  
Analysis Of Covariance ◽  
Large For Gestational Age ◽  
Perinatal Morbidity ◽  
Accurate Identification ◽  
Cephalopelvic Disproportion

<b><i>Objective:</i></b> The aim of the study was to determine if customized fetal growth charts developed excluding obese and underweight mothers (CC<sub>(18.5–25)</sub>) are better than customized curves (CC) at identifying pregnancies at risk of perinatal morbidity. <b><i>Material and Methods:</i></b> Data from 20,331 infants were used to construct CC and from 11,604 for CC<sub>(18.5–25)</sub>, after excluding the cases with abnormal maternal BMI. The 2 models were applied to 27,507 newborns and the perinatal outcomes were compared between large for gestational age (LGA) or small for gestational age (SGA) according to each model. Logistic regression was used to calculate the OR of outcomes by the group, with gestational age (GA) as covariable. The confidence intervals of pH were calculated by analysis of covariance. <b><i>Results:</i></b> The rate of cesarean and cephalopelvic disproportion (CPD) were higher in LGA<sub>only by CC</sub><sub><sub>(18.5−25)</sub></sub> than in LGA<sub>only by CC</sub>. In SGA<sub>only by CC</sub><sub><sub>(18.5−25)</sub></sub>, neonatal intensive care unit (NICU) and perinatal mortality rates were higher than in SGA<sub>only by CC</sub>. Adverse outcomes rate was higher in LGA<sub>only by CC</sub><sub><sub>(18.5−25)</sub></sub> than in LGA<sub>only by CC</sub> (21.6%; OR = 1.61, [1.34–193]) vs. (13.5%; OR = 0.84, [0.66–1.07]), and in SGA <sub>only by CC</sub><sub><sub>(18.5−25)</sub></sub> than in SGA<sub>only by CC</sub> (9.6%; OR = 1.62, [1.25–2.10] vs. 6.3%; OR = 1.18, [0.85–1.66]). <b><i>Conclusion:</i></b> The use of CC<sub>(18.5–25)</sub> allows a more accurate identification of LGA and SGA infants at risk of perinatal morbidity than conventional CC. This benefit increase and decrease, respectively, with GA.

Association between the Degree of Twin Birthweight Discordance and Perinatal Outcomes

2018 ◽  
Vol 36 (09) ◽  
pp. 969-974 ◽  
Author(s):  
Lena H. Kim ◽  
Aaron B. Caughey ◽  
Lynn M. Yee ◽  
Yvonne W. Cheng
Keyword(s):  
Neonatal Intensive Care ◽  
Primary Outcome ◽  
Random Effect ◽  
Birth Certificate ◽  
Perinatal Outcomes ◽  
Neonatal Morbidity ◽  
Vital Statistics ◽  
Adverse Outcomes ◽  
Neonatal Seizure ◽  
Breech Delivery

Background Twin birthweight discordance is associated with adverse outcomes. Objective To determine what degree of twin birthweight discordance is associated with adverse outcomes. Study Design This is a retrospective cohort study of twins with vertex twin A delivered vaginally at 36 to 40 weeks (U.S. Vital Statistics Natality birth certificate registry data 2012–2014). The primary outcome was a composite of neonatal morbidity: 5-minute Apgar < 7, neonatal intensive care unit admission, neonatal mechanical ventilation > 6 hours, neonatal seizure, and/or neonatal transport to a higher level of care. Effect estimates were expressed as incidence rate and adjusted odds ratio (aOR) controlling for confounding using multivariate clustered analysis for between-pair effects, and multilevel random effect generalized estimating equation regressions to account for within-pair effects. We adjusted for sex discordance, breech delivery of the second twin, maternal race/ethnicity, nulliparity, age, marital status, obesity, and socioeconomic status. Results In comparison to birthweight discordance of ≤20%, aORs with 95% confidence intervals (CIs) by weight discordance of the primary outcome among 27,276 twin deliveries were as follows: 20.01 to 25% (aOR: 1.46 [95% CI: 1.29–1.65]); 25.01 to 30% (aOR: 1.96 [95% CI: 1.68–2.29]); and 30.01 to 60% (aOR: 2.97 [95% CI: 2.52–3.50]). Conclusion Twin birthweight discordance >20% was associated with increased odds of adverse neonatal outcome.

Growth among Twins: Use of Singleton versus Twin-Specific Growth Nomograms

2017 ◽  
Vol 35 (02) ◽  
pp. 184-191 ◽  
Author(s):  
Hector Mendez-Figueroa ◽  
Van Truong ◽  
Claudia Pedroza ◽  
Suneet Chauhan
Keyword(s):  
Neonatal Mortality ◽  
Gestational Age ◽  
Neonatal Morbidity ◽  
Large For Gestational Age ◽  
Maternal Fetal Medicine ◽  
Logistic Regression Models ◽  
Abnormal Growth ◽  
Birth Weight Percentile ◽  
Appropriate For Gestational Age ◽  
Study Population

Objective We hypothesized that utilization of a twin-specific nomograms, when compared with one based on singleton data, is less likely to classify twins as having abnormal growth and more likely to identify perinatal morbidity and mortality. Materials and Methods Data were culled from seven Maternal-Fetal Medicine Units (MFMU) studies, the included twin gestations in their study population. Each newborn twin's birth weight percentile was categorized using Alexander et al (singleton data) and Ananth et al (twin data) nomogram. Logistic regression models were adjusted for maternal race and body mass index, neonatal sex, study, and twin correlation. Results More twins were categorized as small for gestational age (SGA) when singleton nomogram was used (33%) compared with twin nomogram (4%). The use of singleton nomogram revealed a higher composite neonatal morbidity (CNM) and stillbirth rates among SGA twins but a similar neonatal mortality rate when compared with appropriate for gestational age. Correspondingly, when twin-specific nomogram was utilized, the CNM, odds of stillbirth, and neonatal mortality were higher among SGA twins. The rate of large for gestational age among twins was increased with the use of twin-specific nomograms. Conclusion Utilization of twin-specific nomogram is less likely to categorize twins as SGA and more likely to identify those at risk for stillbirth and neonatal mortality.

scholarly journals Customized large-for-gestational-age birthweight at term and the association with adverse perinatal outcomes

2014 ◽  
Vol 210 (1) ◽  
pp. 63.e1-63.e11 ◽  
Author(s):  
Lindsey A. Sjaarda ◽  
Paul S. Albert ◽  
Sunni L. Mumford ◽  
Stefanie N. Hinkle ◽  
Pauline Mendola ◽  
...  
Keyword(s):  
Gestational Age ◽  
Perinatal Outcomes ◽  
Large For Gestational Age ◽  
Adverse Perinatal Outcomes

scholarly journals Adverse perinatal outcomes of pregnancies among adolescents vs women of advanced age in the Brazilian public health system

2019 ◽  
Vol 19 (3) ◽  
pp. 601-609
Author(s):  
Larissa de Lima Pessoa Veiga ◽  
Micaely Cristina dos Santos Tenório ◽  
Raphaela Costa Ferreira ◽  
Marilene Brandão Tenório ◽  
Sandra Mary Lima Vasconcelos ◽  
...  
Keyword(s):  
Public Health ◽  
Pregnant Women ◽  
Gestational Age ◽  
Elderly Women ◽  
Perinatal Outcomes ◽  
Reproductive Age ◽  
Advanced Age ◽  
Large For Gestational Age ◽  
Cesarean Deliveries ◽  
Adverse Perinatal Outcomes

Abstract Objectives: to compare the adverse perinatal outcomes in pregnancies of adolescents and elderly women of public health network. Methods: a cross-sectional study carried out with pregnant women at the extremes of reproductive age according to the classification of the Brazilian Ministry of Health (adolescents those aged ≤19 years and those who were older than 35 years) and their newborns. Socioeconomic data (income, schooling, occupation and marital status), as well as clinical (diseases), anthropometric (maternal BMI) and perinatal (gender, weight, length, Apgar and gestational age) data were collected, and Poisson regression in hierarchical model was performed, with the results in Ratio of Prevalence (PR) and its respective Confidence Interval at 95% (95% CI). Results: when comparing adolescent and elderly women, 38.7% vs 54.6% (PR=0.71, CI=0.54-0.94, p=0.002) were observed, respectively, cesarean deliveries; 37.8% vs 25.2% (PR=0.83, CI=0.58-1.19, p=0.332) preterm births; 16.6% vs 20.5% (RP=1.07, CI=0.78-1.46, p=0.666) births of small infants for gestational age (SGA); 18.0% vs 15.3% (RP=1.01, CI=0.69-1.47, p=0.948) births of large-for-gestational-age newborns (LGA); 32.2% vs 34.7% (RP=1.08, CI=0.82-1.42, p=0.578), low birth weight infants and 28.5% vs 42.9% (RP=1.18, CI=0.91-1.54, p=0.201) with high birth length. Conclusions: When compared with adolescent women, pregnant women of advanced age presented a higher frequency of cesarean deliveries.

scholarly journals Adjusting growth standards for fetal sex improves correlation of small babies with stillbirth and adverse perinatal outcomes: A state-wide population study

2021 ◽  
Author(s):  
Natasha Pritchard ◽  
Susan Walker ◽  
Stephen Tong ◽  
Anthea C. Lindquist
Keyword(s):  
Gestational Age ◽  
Perinatal Outcomes ◽  
Adverse Outcomes ◽  
Fetal Sex ◽  
Growth Standards ◽  
Increased Risk ◽  
Appropriate For Gestational Age ◽  
Adverse Perinatal Outcomes ◽  
Wide Population ◽  
High Risk Cohort

Objective: Identify the proportion of infants reclassified if sex-specific birthweight charts were used, and if this reclassification has an impact on the correlation between birthweight centile and adverse perinatal outcome. Design: Retrospective cohort study Setting: Victoria, Australia. Population: All infants born from 2005-2015 (529,261) Methods: We applied GROW centiles, either adjusted or unadjusted for fetal sex. We compared proportions of small for gestational age (SGA, <10th centile) infants, then the populations of males considered small only by sex-specific charts and females considered small only by unadjusted charts. Main Outcome Measures: Stillbirth, combined perinatal mortality, NICU admissions, Apgars <7 at 5 minutes, emergency caesarean sections. Results: Of those <10th centile by unadjusted charts, 39.6% were male, and 60.5% female. Using sex-specific charts, 50.3% <10th centile were male and 49.7% female. 9,449 (19.2%) females that were SGA according to unadjusted charts were appropriate for gestational age (AGA,>10th-<90th centile) using sex-specific charts. These reclassified newborn females were not at increased risk of adverse outcomes compared with an AGA infant, but were at increased risk of being iatrogenically delivered for suspected growth restriction (RR 4.90, 95%CI 4.39–5.48). 8,048 male infants were reclassified as SGA by sex-specific charts (25% SGA increase). Compared with AGA infants, these reclassified male newborns were at greater risk of stillbirth (RR 1.94, 95%CI 1.30-2.90) and all other adverse perinatal outcomes. Conclusions: Sex-specific growth standards classify a new high-risk cohort of male infants as SGA, and exclude a cohort of females, whose risk is no greater than appropriately grown infants.

scholarly journals Oocyte exposure to supraphysiological estradiol during ovarian stimulation increased the risk of adverse perinatal outcomes after frozen-thawed embryo transfer: a retrospective cohort study

2019 ◽  
Vol 11 (4) ◽  
pp. 392-402 ◽  
Author(s):  
Chen-Chi Duan ◽  
Cheng Li ◽  
Yi-Chen He ◽  
Jing-Jing Xu ◽  
Chao-Yi Shi ◽  
...  
Keyword(s):  
Cohort Study ◽  
Embryo Transfer ◽  
Gestational Age ◽  
Retrospective Cohort Study ◽  
Ovarian Stimulation ◽  
Retrospective Cohort ◽  
Perinatal Outcomes ◽  
Large For Gestational Age ◽  
Lower Percentage ◽  
Adverse Perinatal Outcomes

AbstractMaternal supraphysiological estradiol (E2) environment during pregnancy leads to adverse perinatal outcomes. However, the influence of oocyte exposure to high E2 levels on perinatal outcomes remains unknown. Thus, a retrospective cohort study was conducted to explore the effect of high E2 level induced by controlled ovarian stimulation (COH) on further outcomes after frozen embryo transfer (FET). The study included all FET cycles (n = 10,581) between 2014 and 2017. All cycles were categorized into three groups according to the E2 level on the day of the human Chorionic Gonadotropin trigger. Odds ratios (ORs) and their confidence intervals (CIs) were calculated to evaluate the association between E2 level during COH and pregnancy outcomes and subsequent neonatal outcomes. From our findings, higher E2 level was associated with lower percentage of chemical pregnancy, clinical pregnancy, ongoing pregnancy, and live birth as well as increased frequency of early miscarriage. Preterm births were more common among singletons in women with higher E2 level during COH (aOR1 = 1.93, 95% CI: 1.22–3.06; aOR2 = 2.05, 95% CI: 1.33–3.06). Incidence of small for gestational age (SGA) was more common in both singletons (aOR1 = 2.01, 95% CI: 1.30–3.11; aOR2 = 2.51, 95% CI: 1.69–3.74) and multiples (aOR1 = 1.58, 95% CI: 1.03–2.45; aOR2 = 1.99, 95% CI: 1.05–3.84) among women with relatively higher E2 level. No association was found between high E2 level during COH and the percentage of macrosomia or large for gestational age. In summary, oocyte exposure to high E2 level during COH should be brought to our attention, since the pregnancy rate decreasing and the risk of preterm birth and SGA increasing following FET.

scholarly journals Characteristics and adverse outcomes of Chinese adolescent pregnancies between 2012 and 2019

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yanxia Xie ◽  
Xiaodong Wang ◽  
Yi Mu ◽  
Zheng Liu ◽  
Yanping Wang ◽  
...  
Keyword(s):  
Adolescent Pregnancy ◽  
Gestational Age ◽  
Rural Areas ◽  
Reference Group ◽  
Perinatal Outcomes ◽  
Severe Anaemia ◽  
Adverse Outcomes ◽  
Near Miss ◽  
Adolescent Women ◽  
Adolescent Pregnancies

AbstractWe aimed to describe the characteristics of adolescent pregnancy, determine its effect on adverse maternal and perinatal outcomes and explore whether that association varies with gestational age with the goal of proposing specific recommendations for adolescent health in China. This study included 2,366,559 women aged 10–24 years who had singleton pregnancies between 2012 and 2019 at 438 hospitals. Adolescent pregnancy was defined as younger than 20 years of age. We used multivariable logistic regression to estimate the effects. Women aged 20–24 years served as the reference group in all analyses. The proportion of rural girls with adolescent pregnancies rebounded after 2015 even though common-law marriage in rural areas decreased. Higher risks of eclampsia (adjusted odds ratio (aOR) 1.87, 95% confidence interval (CI) 1.57 ~ 2.23), severe anaemia (aOR 1.18, 95% CI 1.09 ~ 1.28), maternal near miss (MNM; aOR 1.24, 95% CI 1.12 ~ 1.37), and small for gestational age (SGA; aOR 1.30, 95% CI 1.28 ~ 1.33) were observed when gestational age was > 37 weeks. Adolescent pregnancy was independently associated with increased risks of other perinatal outcomes. Further implementation of pregnancy prevention strategies and improved health care interventions are needed to reduce adolescent pregnancies and prevent adverse fertility outcomes among adolescent women in China at a time when adolescent fertility rate is rebounding.

scholarly journals Comparison of adverse perinatal outcomes between Asians and Caucasians: a population-based retrospective cohort study in Ontario

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Na Zeng ◽  
Erica Erwin ◽  
Wendy Wen ◽  
Daniel J. Corsi ◽  
Shi Wu Wen ◽  
...  
Keyword(s):  
Cohort Study ◽  
Birth Weight ◽  
Preterm Birth ◽  
Cesarean Section ◽  
Gestational Age ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Perinatal Outcomes ◽  
Population Based ◽  
Adverse Perinatal Outcomes

Abstract Background Racial disparities in adverse perinatal outcomes have been studied in other countries, but little has been done for the Canadian population. In this study, we sought to examine the disparities in adverse perinatal outcomes between Asians and Caucasians in Ontario, Canada. Methods We conducted a population-based retrospective cohort study that included all Asian and Caucasian women who attended a prenatal screening and resulted in a singleton birth in an Ontario hospital (April 1st, 2015-March 31st, 2017). Generalized estimating equation models were used to estimate the independent adjusted relative risks and adjusted risk difference of adverse perinatal outcomes for Asians compared with Caucasians. Results Among 237,293 eligible women, 31% were Asian and 69% were Caucasian. Asians were at an increased risk of gestational diabetes mellitus, placental previa, early preterm birth (< 32 weeks), preterm birth, emergency cesarean section, 3rd and 4th degree perineal tears, low birth weight (< 2500 g, < 1500 g), small-for-gestational-age (<10th percentile, <3rd percentile), neonatal intensive care unit admission, and hyperbilirubinemia requiring treatment, but had lower risks of preeclampsia, macrosomia (birth weight > 4000 g), large-for-gestational-age neonates, 5-min Apgar score < 7, and arterial cord pH ≤7.1, as compared with Caucasians. No difference in risk of elective cesarean section was observed between Asians and Caucasians. Conclusion There are significant differences in several adverse perinatal outcomes between Asians and Caucasians. These differences should be taken into consideration for clinical practices due to the large Asian population in Canada.

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