Risk of Severe Maternal Morbidity or Death in Relation to Prenatal Biochemical Screening: Population-Based Cohort Study

2019 ◽  
Vol 38 (01) ◽  
pp. 044-059 ◽  
Author(s):  
Eric J.M. Lentz ◽  
Alison L. Park ◽  
Alec W.R. Langlois ◽  
Tianhua Huang ◽  
Wendy S. Meschino ◽  
...  
Keyword(s):  
Cohort Study ◽  
Maternal Mortality ◽  
Maternal Morbidity ◽  
Protein A ◽  
Population Based ◽  
Severe Maternal Morbidity ◽  
Adjusted Relative Risk ◽  
Biochemical Screening ◽  
High Concentration ◽  
Increased Risk

Abstract Objective This study aimed to examine whether prenatal biochemical screening analytes are associated with an increased risk of severe maternal morbidity (SMM) or maternal mortality. Study Design This population-based cohort study includes all women in Ontario, Canada, who underwent prenatal screening from 2001 to 2011. Increasing fifth percentiles of the multiple of the median (MoM) for alphafetoprotein (AFP), total human chorionic gonadotropin, unconjugated estriol (uE3), dimeric inhibin-A (DIA), and pregnancy-associated plasma protein A were evaluated. An abnormally high concentration (>95th percentile MoM) for each analyte, individually and combined, was also evaluated. The main outcome assessed was the adjusted relative risk (aRR) of SMM or maternal mortality from 20 weeks' gestation up to 26 weeks thereafter. Results Among 748,972 pregnancies, 11,177 resulted in SMM or maternal mortality (1.5%). Except for uE3, the aRR of SMM or maternal mortality increased in association with increasing fifth percentiles of the MoM for all analytes. AFP (aRR: 2.10; 95% confidence interval [CI]: 1.97–2.25) and DIA (aRR: 2.33; 95% CI: 1.98–2.74) > 95th versus ≤ 5th percentile of the MoM were especially associated with SMM or death. Conclusion Women with abnormally high concentrations of certain prenatal biochemical analytes may be at a higher risk of SMM or death in pregnancy or postpartum.

scholarly journals Risk of severe maternal morbidity or death in relation to elevated hemoglobin A1c preconception, and in early pregnancy: A population-based cohort study

PLoS Medicine ◽  
2020 ◽  
Vol 17 (5) ◽  
pp. e1003104
Author(s):  
Alexander J. F. Davidson ◽  
Alison L. Park ◽  
Howard Berger ◽  
Kazuyoshi Aoyama ◽  
Ziv Harel ◽  
...  
Keyword(s):  
Cohort Study ◽  
Early Pregnancy ◽  
Maternal Morbidity ◽  
Hemoglobin A1c ◽  
Population Based ◽  
Severe Maternal Morbidity

scholarly journals Severe maternal morbidity among migrants with insecure residency status in Sweden 2000–2014: a population-based cohort study

2020 ◽  
Vol 1-2 ◽  
pp. 100006
Author(s):  
Can Liu ◽  
Elizabeth Wall-Wieler ◽  
Marcelo Urquia ◽  
Suzan L. Carmichael ◽  
Olof Stephansson
Keyword(s):  
Cohort Study ◽  
Maternal Morbidity ◽  
Population Based ◽  
Severe Maternal Morbidity ◽  
Residency Status

scholarly journals Interpregnancy Interval and Subsequent Severe Maternal Morbidity: A Population-based Study from California over 16 years

2021 ◽  
Author(s):  
Can Liu ◽  
Jonathan M Snowden ◽  
Deirdre J Lyell ◽  
Elizabeth Wall-Wieler ◽  
Barbara Abrams ◽  
...  
Keyword(s):  
Maternal Age ◽  
Maternal Morbidity ◽  
Perinatal Outcomes ◽  
Population Based ◽  
Subsequent Pregnancy ◽  
Severe Maternal Morbidity ◽  
Interpregnancy Interval ◽  
Adjusted Risk ◽  
Index Pregnancy ◽  
Increased Risk

Abstract Interpregnancy interval (IPI) associates with adverse perinatal outcomes, but its contribution to severe maternal morbidity (SMM) remains unclear. We examined the association between IPI and SMM, using data linked across sequential pregnancies to women in California 1997-2012. Adjusting for confounders measured at the index pregnancy (i.e. the first in a pair of consecutive pregnancies), we estimated adjusted risk ratios (aRRs) of SMM related to the subsequent pregnancy. We further conducted within-mother comparisons and analyses stratified by parity and maternal age at the index pregnancy. Compared to 18-23 months, IPI<6 months had same risk for SMM in between-mother comparison (aRR=0.96, 95%CI 0.91, 1.02) but lower risk in within-mother comparison (aRR=0.76, 95% confidence interval (CI) 0.67, 0.86). IPI 24-59 months and IPI≥60 months associated with increased risk of SMM in both between-mother (aRR=1.18, 95%CI 1.13, 1.23 and aRR=1.76, 95% CI 1.68, 1.85 respectively) and within-mother comparisons (aRR=1.22, 95%CI 1.11, 1.34 and aRR=1.88, 95% CI 1.66, 2.13 respectively). The association between IPI and SMM did not substantially differ by maternal age and parity. Longer IPI was associated with increased risk of SMM, which may be partly attributed to interpregnancy health.

Haemoglobin Levels in Early Pregnancy and Severe Maternal Morbidity: Population-based Cohort Study

2021 ◽  
Vol 41 (2) ◽  
pp. 62-62
Author(s):  
J.G. Ray ◽  
A.J.F. Davidson ◽  
H. Berger ◽  
N. Dayan ◽  
A.L. Parka
Keyword(s):  
Cohort Study ◽  
Early Pregnancy ◽  
Maternal Morbidity ◽  
Population Based ◽  
Severe Maternal Morbidity

scholarly journals Postpartum Severe Acute Maternal Morbidity According to Gestational Age at Delivery in Twin Pregnancies: A Prospective Cohort Study

2021 ◽  
Author(s):  
Lola Loussert ◽  
Catherine Deneux-Tharaux ◽  
Aurélien Seco ◽  
Francois Goffinet ◽  
diane korb ◽  
...  
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Gestational Age ◽  
Prospective Cohort ◽  
Maternal Morbidity ◽  
Population Based ◽  
Severe Acute Maternal Morbidity ◽  
Increased Risk ◽  
Gestational Age At Delivery ◽  
Twin Pregnancies

Objective: To assess the association between gestational age at delivery and postpartum severe acute maternal morbidity (SAMM) in twin pregnancies. Design: Population-based, national, prospective, cohort study Setting: From 02/2014 to 03/2015 in France Population: Women with twin pregnancies who gave birth after 32 weeks of gestation. We excluded women with fetal death or medical termination of either twin, with antepartum SAMM, with antepartum conditions responsible for postpartum SAMM. Methods: Gestational age at delivery was studied as the number of completed weeks of gestation. We assessed the association between gestational age at delivery and postpartum SAMM by using multivariable multilevel modified Poisson regression modelling. Main Outcome Measures: Composite criteria of postpartum severe acute maternal morbidity Results: Among the 7,713 women included, 410 (5.3%) developed postpartum SAMM, mainly (88.5%) postpartum haemorrhage. Compared with the reference category of 37 weeks, the risk of postpartum SAMM was significantly lower for all categories of earlier gestational age at delivery (from aRR=0.34, 95% CI 0.17-0.68 at 32 weeks to aRR=0.71, 95% CI 0.54-0.94 at 36 weeks), and did not differ for later categories. Conclusion: In twin pregnancies, compared with delivery at 37 weeks, delivery at earlier gestational ages is associated with a lower risk of postpartum SAMM. Continuing pregnancy beyond 37 weeks is not associated with an increased risk of postpartum SAMM. Funding: Supported by a grant from the French Ministry of Health (Programme Hospitalier de Recherche Clinique, AOM2012) and a grant from Université Toulouse III. Keywords: severe acute maternal morbidity, twin pregnancy, timing of delivery

scholarly journals Association between interpregnancy interval and pregnancy complications by history of complications: a population-based cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e046962
Author(s):  
Amanuel Tesfay Gebremedhin ◽  
Gizachew Assefa Tessema ◽  
Annette K Regan ◽  
Gavin F Pereira
Keyword(s):  
Cohort Study ◽  
Pregnancy Complications ◽  
Lower Risk ◽  
Population Based ◽  
Adjusted Relative Risk ◽  
Interpregnancy Interval ◽  
Recurrence Rates ◽  
Increased Risk ◽  
History Of ◽  
Restricted Cubic Splines

ObjectiveTo examine if the association between interpregnancy interval (IPI) and pregnancy complications varies by the presence or absence of previous complications.Design and settingPopulation-based longitudinally linked cohort study in Western Australia (WA).ParticipantsMothers who had their first two (n=252 368) and three (n=96 315) consecutive singleton births in WA between 1980 and 2015.Outcome measuresWe estimated absolute risks (AR) of preeclampsia (PE) and gestational diabetes (GDM) for 3–60 months of IPI according to history of each outcome. We modelled IPI using restricted cubic splines and reported adjusted relative risk (RRs) with 95% CI at 3, 6, 12, 24, 36, 48 and 60 months, with 18 months as reference.ResultsRisks of PE and GDM were 9.5%, 2.6% in first pregnancies, with recurrence rates of 19.3% and 41.5% in second pregnancy for PE and GDM, respectively. The AR of GDM ranged from 30% to 43% across the IPI range for mothers with previous GDM compared with 2%–8% for mothers without previous GDM. For mothers with no previous PE, greater risks were observed for IPIs at 3 months (RR 1.24, 95% CI 1.07 to 1.43) and 60 months (RR 1.40, 95% CI 1.29 to 1.53) compared with 18 months. There was insufficient evidence for increased risk of PE at shorter IPIs of <18 months for mothers with previous PE. Shorter IPIs of <18 months were associated with lower risk than at IPIs of 18 months for mothers with no previous GDM.ConclusionsThe associations between IPIs and risk of PE or GDM on subsequent pregnancies are modified by previous experience with these conditions. Mothers with previous complications had higher absolute, but lower RRs than mothers with no previous complications. However, IPI remains a potentially modifiable risk factor for mothers with previous complicated pregnancies.

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