The effects of labor on infant mortality among small-for-gestational-age infants in the USA

Maternal and fetal factors have been associated with small for gestational age (SGA) and cardiometabolic disease in adulthood. Acculturation in US Latino population has been correlated with negative effects on health, including during perinatal period. We hypothesized that acculturated Hispanic pregnant women have higher risk of SGA. Methods: Retrospective study from PeriBank participants born in Latin America. Length of stay (LOS) as proxy for acculturation. SGA defined as birth weight for gestational age <10 th . Results: We included 13,613 women with 15,376 deliveries. Women with LOS >6y showed higher gestational diabetes rates. (Table1) After adjustment, risk of SGA was lower for LOS 4-6y vs. 0-3y; risk was also lower for LOS >6y vs. 0-3y. (Table2) Women with LOS 4-6y had a 1.12kg/m 2 [95% CI 0.84 - 1.39; p-value <0.001] and >6y 3.06kg/m 2 [95% CI 2.78 - 3.32; p<0.001] higher BMI compared to LOS of 0-3 after adjustment. Conclusions: Highly acculturated Hispanic women born outside the US, do not have higher risk for having SGA offspring. Likely masked by higher pre-pregnancy BMI and gestational diabetes, alternative pathways for adverse perinatal outcomes.

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One-year outcomes of infants born with congenital diaphragmatic hernia: a national population cohort study

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2018-316396 ◽

2019 ◽

Vol 104 (6) ◽

pp. F643-F647 ◽

Cited By ~ 4

Author(s):

Anna-May Long ◽

Kathryn J Bunch ◽

Marian Knight ◽

Jennifer J Kurinczuk ◽

Paul Damian Losty

Keyword(s):

Cohort Study ◽

Infant Mortality ◽

Congenital Diaphragmatic Hernia ◽

Gestational Age ◽

Small For Gestational Age ◽

Primary Closure ◽

Postoperative Morbidity ◽

Patch Repair ◽

Factors Associated ◽

High Incidence

ObjectiveTo report outcomes to 1 year, in infants born with congenital diaphragmatic hernia (CDH), explore factors associated with infant mortality and examine the relationship between surgical techniques and postoperative morbidity.DesignProspective national population cohort study.SettingPaediatric surgical centres in the UK and Ireland.MethodData were collected to 1 year for infants with CDH live-born between 1 April 2009 to 30 September 2010. Factors associated with infant mortality are explored using logistic regression. Postoperative morbidity following patch versus primary closure, minimally invasive versus open surgery and biological versus synthetic patch material is described. Data are presented as n (%) and median (IQR).ResultsOverall known survival to 1 year was 75%, 95% CI 68% to 81% (138/184) and postoperative survival 93%, 95% CI 88% to 97% (138/148). Female sex, antenatal diagnosis, use of vasodilators or inotropes, being small for gestational age, patch repair and use of surfactant were all associated with infant death. Infants undergoing patch repair had a high incidence of postoperative chylothorax (11/54 vs 2/96 in infants undergoing primary closure) and a long length of hospital stay (41 days, IQR 24–68 vs 16 days, IQR 10–25 in primary closure group). Infants managed with synthetic patch material had a high incidence of chylothorax (11/34 vs 0/19 with biological patch).ConclusionThe majority of infant deaths in babies born with CDH occur before surgical correction. Female sex, being born small for gestational age, surfactant use, patch repair and receipt of cardiovascular support were associated with a higher risk of death. The optimum surgical approach, timing of operation and choice of patch material to achieve lowest morbidity warrants further evaluation.

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Vegetarian diets during pregnancy, and maternal and neonatal outcomes

International Journal of Epidemiology ◽

10.1093/ije/dyaa200 ◽

2020 ◽

Author(s):

Samrawit F Yisahak ◽

Stefanie N Hinkle ◽

Sunni L Mumford ◽

Mengying Li ◽

Victoria C Andriessen ◽

...

Keyword(s):

Weight Gain ◽

Gestational Weight Gain ◽

Gestational Age ◽

Small For Gestational Age ◽

Neonatal Outcomes ◽

Maternal Outcomes ◽

Gestational Weight ◽

The Usa ◽

Maternal And Neonatal Outcomes ◽

Vegetarian Diets

Abstract Background Vegetarian diets are becoming increasingly popular in the USA. Limited research has examined the health consequences of vegetarian diets during pregnancy. We comprehensively examined associations of vegetarianism during pregnancy with maternal and neonatal outcomes. Methods We used data from the Eunice Kennedy Shriver National Institute of Child Health and Human Development’s Fetal Growth Studies–Singletons, a prospective multi-site cohort of 1948 low-risk pregnant women of four races/ethnicities (White, Black, Hispanic, Asian/Pacific Islander) in the USA (2009–2013). Vegetarianism was self-reported and also defined based on dietary patterns measured using a self-administered first-trimester food-frequency questionnaire (full [lacto-ovo and vegan], pesco-, semi- and non-vegetarians). Neonatal outcomes included birthweight and neonatal anthropometric measures, small for gestational age, small for gestational age with neonatal morbidity and preterm delivery. Maternal outcomes included gestational weight gain, gestational diabetes, hypertensive disorders of pregnancy and gestational anaemia. Results Ninety-nine (6.2%) women self-reported being vegetarian. The diet-based definition identified 32 (2.0%) full vegetarians, 7 (0.6%) pesco-vegetarians and 301 (17.6%) semi-vegetarians. Neonates of diet-based full vegetarians had higher odds of being small for gestational age [adjusted odds ratio (ORadj) = 2.51, 95% confidence interval: 1.01, 6.21], but not of being small for gestational age with a postnatal morbidity. Full vegetarians had marginally increased the odds of inadequate second-trimester gestational weight gain (ORadj = 2.24, 95% confidence interval: 0.95, 5.27). Conclusion Vegetarian diets during pregnancy were associated with constitutionally smaller neonatal size, potentially via the mothers’ reduced gestational weight gain. Notably, vegetarianism was not associated with small-for-gestational-age-related morbidities or other adverse maternal outcomes.

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Father’s Lifetime Socioeconomic Status, Small for Gestational Age Infants, and Infant Mortality: A Population-Based Study

Ethnicity & Disease ◽

10.18865/ed.29.1.9 ◽

2019 ◽

Vol 29 (1) ◽

pp. 9-16 ◽

Cited By ~ 1

Author(s):

Samantha Ensted ◽

Kristin Rankin ◽

Carla Desisto ◽

James W. Collins

Keyword(s):

Socioeconomic Status ◽

Mortality Rate ◽

Infant Mortality ◽

Gestational Age ◽

Small For Gestational Age ◽

Population Based ◽

Infant Mortality Rate ◽

Low Ses ◽

Income Data ◽

Mother’S Age

Objective: To ascertain the association between father’s lifetime socioeconomic status (SES) and rates of small for gestational age (SGA, defined as weight for gestational age <10th percentile) and infant mortality (defined as <365 days).Methods: The study sample was limited to the singleton births of African American (n=8,331), non-Latina White (n=18,200), and Latina (n=2,637) women. Stratified and multilevel, multivariable logistic regression analyses were conducted on the Illinois transgenerational dataset of infants (1989-1991) and their Chicago-born parents (1956-1976) with appended US census income data (n=29,168). The median family income of father’s census tract residence during childhood and parenthood were used to assess lifetime SES.Results: Births (n=8,113) to fathers with a lifetime low SES had a SGA rate of 13.3% compared with 6.6% for those (n=10,329) born to fathers with a lifetime high SES, RR = 1.97 (1.79, 2.17). The infant mortality rate of births to fathers with a lifetime low SES exceeded that of infant mortality rate of births to fathers with a lifetime high SES: 13/1,000 vs 5/1,000, respectively; RR = 2.71 (1.94, 3.77). The adjusted (controlling for mother’s age, education, marital status, and race/ethnicity) OR of SGA for fathers with childhood, parenthood, and lifetime low (vs high) SES were 1.15 (1.01, 1.31), 1.13 (1.02, 1.26), and 1.19 (1.05, 1.34), respectively. The adjusted OR of infant mortality for births to fathers with childhood, parenthood, and lifetime low (vs high) SES were 1.14 (.78, 1.67), 1.40 (.90, 2.18), and 1.31 (.90, 1.92), respectively.Conclusions: Low paternal socioeconomic status is a previously unrecognized determinant of SGA birth regardless of mother’s demographic status.Ethn Dis. 2019;29(1):9-16; doi:10.18865/ed.29.1.9

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