DATA LINKAGE FOR EVALUATING MATERNAL INFLUENCES ON INFANT MORTALITY AND MALTREATMENT IN CANADA

Abstract BACKGROUND A number of social risk factors are reported to increase infant mortality rates and child maltreatment. Public health programs attempt to mitigate risk factors and improve outcomes for infants. This study aimed to explore the association of exposure factors in mothers with infant mortality and maltreatment in Ontario. OBJECTIVES Objectives for this study included: 1. Describe prevalence of infant mortality and maltreatment in Ontario. 2. Explore how maternal risk factors influence infant mortality and maltreatment. DESIGN/METHODS This was a population-based study of 845, 567 infants born between April 1, 2005 and March 31, 2015 using administrative and healthcare databases available at the Institute of Clinical Evaluative Sciences (ICES). Maternal risk factors were selected based on public health home visiting referral criteria. These exposures included, maternal adversity (substance abuse, intimate partner violence, homelessness), newcomer status (new to Canada in past 3 years) and young maternal age (less than 22 years of age). The primary outcome measure was all-cause mortality of infants less than 12 months age. The secondary outcome measures were combined fatal and non-fatal child maltreatment outcomes and were defined using International Classification of Diseases for maltreatment diagnoses. Baseline characteristics and outcomes were described. The association between maternal risk factors and infant mortality and maltreatment was analysed using multivariable logistic modelling, including analysis by type of maternal risk factors and number of risk factors. RESULTS All-cause deaths were present in 0.14% and combined fatal and non-fatal maltreatment outcomes were present in 0.05% of the study population. Young maternal age increased the risk of all-cause mortality 2.4 times (n 171, OR 2.4, 95% CI 2.0–3.0) and maltreatment 6.3 times (n 292, OR 6.3, 95% CI 5.0–7.8). Mental health diagnosis increased the odds of maltreatment by 90% (n 209, OR 1.9, 95% CI 1.5–2.4). Adversity increased the odds of maltreatment by 63% (n 40, OR 1.63, 95% CI 1.0–2.6). The risk of maltreatment also increased as the number of risk factors increased with an OR of 3.5 (95% CI 2.9–4.4) with one risk factor, an OR of 8.2 (95% CI 5.9–11.4) with two risk factors, and an OR of 10.9 (95% CI 5.7 20.7) with three or more risk factors. Newcomer status was not associated with increased risk of maltreatment and mortality. Gestational age showed increasing ORs as prematurity increased. Material deprivation was included as a covariate and was associated with increased risk of maltreatment with increased level of deprivation. CONCLUSION Young maternal age carried the greatest risk of death and maltreatment in infants. There was also an increasing risk of infant mortality and maltreatment with increasing number of risk factors. These findings are important for ensuring public health interventions are targeting the most vulnerable populations with the aim of preventing maltreatment.

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Maternal Risk Factors of Placenta Praevia and Its Effects on Maternal and Fetal Outcome

Bangladesh Medical Journal ◽

10.3329/bmj.v48i2.51259 ◽

2019 ◽

Vol 48 (2) ◽

pp. 7-12

Author(s):

Alpana Adhikary ◽

Anwara Begum ◽

Fahmida Sharmin Joty ◽

Nihar Ranjan Sarker ◽

Rifat Sultana

Keyword(s):

Risk Factors ◽

Maternal Age ◽

Advanced Maternal Age ◽

Fetal Outcome ◽

Placenta Praevia ◽

Maternal Risk Factors ◽

High Parity ◽

Maternal Risk ◽

Antepartum Haemorrhage ◽

History Of

Placenta praevia is one of the most serious obstetric emergencies, which continues to be an important contributor to perinatal mortality and is responsible for leading maternal and infant morbidity. Very few data on etiology of placenta praevia are available till now. This study aims to explore the maternal risk factors related to occurrence of placenta praevia and its effects on maternal and fetal outcome. This cross-sectional observational study was carried out among 3279 obstetrics patients admitted in labour ward in the Department of Obstetrics and Gynecology, Sher-e-Bangla Medical College Hospital from January to December 2006. Out of 3279 obstetrics patients 93 placenta praevia cases were identified purposively as study subjects. The patients of placenta praevia were selected either diagnosed clinically by painless antepartum haemorrhage or asymptomatic placenta praevia diagnosed by ultrasonography irrespective of age, gestational age, parity, booking status. Pregnant woman admitted with painful antepartum haemorrhage were excluded from the study. With the ethical approval from the Institutional Ethical Committee (IEC), patients were selected after taking their written consent. A structured questionnaire and a chick list were designed with considering all the variables of interest. Out of 93 respondents, 73.88% were associated with risk factors in addition to advanced maternal age and high parity. Among them 24.73%, 33.33% and 7.52% had history of previous caesarean section (CS), MR and abortion and both CS & abortion previously. Patients aged above 30 years were 47% and 35.48% were in their 5th gravid and more; whereas, 31.18% patients were asymptomatic, 68.82% patients presented with varying degree of vaginal bleeding, among them 12.08% were in shock. Active management at presentation was done on 76.34% patients and 23.66% were managed expectantly. CS was done o 82.79% patients and only 17.2% were delivered vaginally. Case fatality rate was 1.07% and about 22% perinatal death was recorded, majority belonged to low birth weight (<1500 gm). About 10% patients required caesarean hysterectomy, 3.22% required bladder repair. Advanced maternal age, high parity, history of previous CS and abortion found to be common with the subsequent development of placenta praevia. Proper diagnosis, early referral and expectant management of patients will reduce prematurity, thereby improvised foetal outcome but to improve maternal outcome rate of primary CS have to be reduced and increase practice of contraception among women of reproductive age. Bangladesh Med J. 2019 May; 48 (2): 7-12

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Maternal risk factors for low birth weight of neonates in al- diwaniyah province, iraq

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v10i3.1391 ◽

2019 ◽

Vol 10 (3) ◽

pp. 1904-1909

Author(s):

Adel J. Hussein

Keyword(s):

Risk Factors ◽

Birth Weight ◽

Prenatal Care ◽

Low Birth Weight ◽

Cesarean Section ◽

Teaching Hospital ◽

Maternal Age ◽

Maternal Risk Factors ◽

Socioeconomic Condition ◽

Maternal Risk

The LBW infants as weighting less than 2.5kg at birth. Infants with low birth weight are probable to suffer medical troubles and delay development from the time of delivery to adult life. This study was planned to discover the prevalence of LBW infants in Ad-Diwaniyah city (Iraq) and the maternal risk factors, which contribute to the occurrence of low birth weight, and it is rated and what the suitable recommendations can be made to prevent this problem. Unfortunately, in Iraq, several studies reveal an increase in the delivery of LBW infants in the last years. The present study was aimed to identify the prevalence of LBW and possible maternal factors in children, teaching hospital in Al-Diwaniyah city during the period of the beginning of February 2017 to February 2018. This is a cross-sectional survey held out in Pediatric, teaching hospital through 1012 pregnant mothers giving a live LBW. Whole children weight on a weighing machine. Data was collected through the interview of mothers. Maternal age and education level, socioeconomic condition, number of prenatal visits, interpregnancy interval and maternal diseases, and infant gender were registered in questionnaire format. The result of the current study detects that the rate of LBW was 20.2%. The highest percentage of them (LBW) was preterm 67.4% and full, term (IUGR) 32.5%. 61.5% of the children in the LBW group were male, and 38.4% were female. Besides the outcome indicates that there are many important risk factors contributed to the incidence of LBW, these are; multiple pregnancies were found to be 66.8% of LBW infants, maternal age 21 – 35 years (39.7%), lack of Prenatal Care (60.3%), delivery by cesarean section (70.6%), mothers who illiterate (64.8%), a large number of mothers from the rural area (68.6%), the presence of maternal diseases (63.5%), all these are considered a risk factor. The current study demonstrates the essential elements give rise to low birth weight in neonates are gestational age (preterm delivery), maternal education and age, multiple births, regular prenatal care, cesarean section, and bad obstetric history.

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Maternal risk factors and fetal outcome in patients of abruption placentae.

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.03.3744 ◽

2020 ◽

Vol 27 (03) ◽

pp. 613-617

Author(s):

Humaira Tabassum ◽

Memoona Faiyaz ◽

Aasma Hanif ◽

Uzma Fahim ◽

Areeba Aftab

Keyword(s):

Risk Factors ◽

Perinatal Mortality ◽

Placental Abruption ◽

Tertiary Care ◽

Case Series ◽

Fetal Mortality ◽

Maternal Risk Factors ◽

Maternal Risk ◽

Increased Risk ◽

Fetal Complications

Abruption placentae are a major cause of maternal and perinatal morbidity and mortality. Placental abruption is due to the rupture of the uterine spiral artery. Bleeding into decidua leads to separation of the placenta. There are many major maternal and fetal complications associated with placental abruption. Objectives: To assess the maternal risk factors, perinatal mortality and morbidity in relation to the severity of placental abruption. Study Design: Descriptive case series. Setting: Department of Obstetrics and Gynecology, Jinnah Hospital, Lahore for one year. Period: From Jan 2016 to Dec 2016. Material & Methods: Hundred females were included with placental abruption and were followed-up till delivery. At the time of delivery maternal and fetal complications were noted. Results: Mean age of females was 29.24 + 3.58years. The mean gestational age at delivery was 32.95+3.12 weeks. About 64% underwent vaginal delivery while 36% underwent cesarean section. Among pre-disposing factors increased risk of anemia i.e. 46%, hypertension was found in 28%, multiple pregnancies with 18% and polyhydromnias were found in 8%. The incidence of fetal mortality was 58% and only 42% were born alive at time of delivery. Fetal morbidity is analyzed, 95.23% were in need of resuscitation, admission to nursery was done in 95.23%, neonatal jaundice was seen in 80.95%, anemia in 71.42% and respiratory problems were found in 85.71%. APGAR score at 5 minutes among 21 alive born fetuses was <8 in 85.71%. Conclusion: Resultantly maternal morbidity and perinatal mortality is significant, and this calls for early detection, regular visits, and special surveillance. There should be timely referral to tertiary care center where antenatal care plays an important role in decreasing the incidence of abruption placenta.

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MATERNAL RISK FACTORS OF LOW BIRTH WEIGHT (LBW): SYSTEMATIC REVIEW

Indonesian Midwifery and Health Sciences Journal ◽

10.20473/imhsj.v4i1.2020.73-81 ◽

2021 ◽

Vol 4 (1) ◽

pp. 73

Author(s):

Jianti Fina Lestari ◽

Risa Etika ◽

Pudji Lestari

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Birth Weight ◽

Low Birth Weight ◽

Gestational Age ◽

Maternal Age ◽

Cochrane Library ◽

Maternal Risk Factors ◽

Maternal Risk ◽

Arm Circumference

Abstract Background: Low Birth Weight Babies (LBW) accounts for 60 - 80% of all neonatal deaths in the world. Not the only major predictor of mortality and morbidity in neonates, individuals with a history of LBW have a greater risk of experiencing various diseases such as hypertension, heart disease, and diabetes later in life. This systematic review study aims to identify maternal risk factors that contributing to LBW Method: Articles published between 2015 - 2020 in the Science Direct, Scopus and Cochrane library databases are systematically reviewed. Eleven articles that met the inclusion and exclusion criteria were included as samples for further review. Results regarding maternal risk factors for LBW events are synthesized systematically .Results: From the search results, there were 818 articles, after the screening process, the final results were 11 articles. Risk factors that are significantly related to LBW incidence in the article, are grouped in the subtheme, include: maternal age (<20 years, and each increase in age), parity (primipara and grandemultipara), low maternal upper arm circumference, hemoglobin levels less than 11 gr / dl, gestational age below 37 weeks, and complications during pregnancy. Conclusion: maternal age, parity, arm circumference, hemoglobin level, gestational age, and complications during pregnancy were significaly found to be maternal risk factors for LBW.

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Maternal determinants affecting perinatal mortality: a multivariate statistical approach

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20170583 ◽

2017 ◽

Vol 6 (3) ◽

pp. 1052

Author(s):

Manish Agrawal ◽

Kriti Bhatnagar

Keyword(s):

Risk Factors ◽

High Risk ◽

Child Health ◽

Pregnant Women ◽

Perinatal Outcome ◽

Maternal Age ◽

Maternal Risk Factors ◽

Maternal Risk ◽

Grass Root ◽

Antenatal Visits

Background: India has made considerable progress over the last two decades in the area of maternal and child health, through innovative and comprehensive health packages that covers the spectrum of Reproductive Child Health (RCH). Awareness of the special vulnerability of the cohort of mothers with ‘high risk factor’ has led to the popular recognition of ‘risk approach’, involving the optimal use of existing MCH services, providing essential obstetrical care for all with early detection of complications and emergency services for those who need it, thus reducing the need for intensive care along with reduction in perinantal mortality. The objective was to assess the prevalence of various maternal risk factors in pregnant women in hospital admissions and their correlation with perinatal mortality.Methods: The present study was carried out on 2050 consecutive deliveries from 1st April 2015 to 31st March 2016 at Department of Obstetrics and Gynecology and Department of Pediatrics, Muzaffarnagar Medical College, Muzaffarnagar Uttar Pradesh, India. All the pregnant women were interviewed and examined in detail at the onset of labor regarding various biosocio-economic characteristics, history of past and present medical and obstetrical complications.Results: The PNMR (93.66/1000 birth) observed in present study was still at a higher level and comparable to that in other studies done by various authors in past in this region. A significantly higher PNMR was observed with increase in maternal age and parity (3 times higher PNMR at >35 years and 2 ½ times higher PNMR at parity >5). Similarly, medical illnesses (3 times higher PNMR) and obstetrical complications (1.5 times higher PNMR) during present pregnancy were showing significant effect on perinatal outcome. In a multivariate analysis, residence (rural /urban), place and number of antenatal visits, gestational age and type of delivery remained as most significant maternal risk factors (p<0.005) after multiple logistic regression of other factors viz. maternal age, height, weight, parity, education, socio-economic status and antepartum anemia.Conclusions: It is heartening to observe that highest risk is associated with simple and easily identifiable factors like, unbooked cases, <3 antenatal visits, severe anemia, age >35 years, parity >5, weight <40 kg, height < 140cm , poor dietary calories, medical and obstetrical complications. These can identified from history only by grass root workers like traditional birth attendants and even elderly female family members. These risk determinants, labeled as simple but ‘high’ high risk are associated with poor perinatal outcome. If these factors are timely identified at community level and appropriately referred by grass root workers, it will significantly reduce perinatal mortality and improve neonatal survival.

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Maternal Risk Factors for Potential Maltreatment Deaths Among Healthy Singleton and Twin Infants

Twin Research and Human Genetics ◽

10.1375/twin.10.5.778 ◽

2007 ◽

Vol 10 (5) ◽

pp. 778-785 ◽

Cited By ~ 14

Author(s):

Barbara Luke ◽

Morton B. Brown

Keyword(s):

Risk Factors ◽

Infant Mortality ◽

Maternal Age ◽

Low Birthweight ◽

Reference Group ◽

Multinomial Logistic Regression ◽

Birth Certificate ◽

The Body ◽

Maternal Risk ◽

Risk Of Death

AbstractOur aim was to evaluate the risk of death among healthy infants due to maltreatment, using national linked vital statistics data. The study population included all nonanomalous, full-term (≥ 37 weeks), non-low birthweight (> 2500 grams) infants born between 1995 and 2000 and their linked death certificates: 18,673,439 singleton pregnancies (36,864 deaths) and 77,800 twin pregnancies (356 pregnancies with a death). The underlying cause of death was characterized as due to maltreatment, sudden infant death syndrome (SIDS), and other causes, based on ICD-9 and ICD-10 codes, and modeled by maternal age using multinomial logistic regression; mothers aged 25 to 29 were the reference group. The highest risk for infant mortality was among the youngest mothers for maltreatment (AOR 2.45 and 1.95 for singleton mothers < 20 and aged 20 to 24, respectively; AOR 4.34 and 2.25 for twin mothers < 20 and aged 20 to 24, respectively). The risk of death overall and for each category was modeled by maternal age < 20, aged 20 to 24, and ≥ 25, with and without the father's age present on the birth certificate, with mothers ≥ 25 and father's age present as the reference group. All risks of death were significantly increased for mothers younger than age 25, with the highest risks among the youngest mothers and missing father's age. The pattern for twins was similar, with elevated risks among younger mothers with or without father's age present on the birth certificate. These results add to the body of knowledge regarding risk factors for infant mortality among healthy singletons and twins.

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SARS-CoV-2: an imperative maternal-fetal concern

Iranian Journal of Microbiology ◽

10.18502/ijm.v13i4.6963 ◽

2021 ◽

Author(s):

Zahra Heydarifard ◽

Jila Yavarian ◽

Somayeh Shatizadeh Malekshahi ◽

Sevrin Zadheidar ◽

Talat Mokhtari-Azad ◽

...

Keyword(s):

Public Health ◽

Risk Factors ◽

Severe Acute Respiratory Syndrome ◽

Human Population ◽

Adverse Outcomes ◽

Health Concern ◽

Maternal Risk Factors ◽

Public Health Concern ◽

Maternal Risk ◽

Second Year

Severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) is a newly emerged virus which belongs to Coronaviridae family within the betacoronavirus genus. Previous reports demonstrated that other betacoronaviruses were responsible for adverse outcomes during pregnancy in human. Due to inadequate data, the consequences of a SARS-CoV-2 infection during pregnancy is still a public health concern in the second year of SARS-CoV-2 circulation in human population. Herein, we aimed to review the probable risk of intrauterine vertical transmission of SARS-CoV-2 infection to the fetus, its adverse outcomes during pregnancy for both mother and the fetus and maternal risk factors which affect the severity Coronavirus disease 2019 (COVID-19.

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Maternal Risk Factors of Low Birth Weight Neonates in a Military Hospital of Bangladesh

Journal of Armed Forces Medical College Bangladesh ◽

10.3329/jafmc.v16i2.55300 ◽

2021 ◽

Vol 16 (2) ◽

pp. 55-58

Author(s):

Munshi Sariful Islam ◽

Jesmin Sultana ◽

Homayra Akter ◽

Suraya Akter

Keyword(s):

Public Health ◽

Risk Factors ◽

Birth Weight ◽

Low Birth Weight ◽

Normal Weight ◽

Military Hospital ◽

Maternal Risk Factors ◽

Cross Sectional ◽

Maternal Risk ◽

Birth Space

Introduction: Low birth weight (LBW) is an index of our status of public health, maternal health and nutrition. LBW is a multi-factorial problem. The major challenge in the field of public health is to identify the factors influencing LBW and to institute remedial measures. Objective: To find out the maternal risk factors of low birth weight neonates. Materials and Methods: A descriptive cross sectional study was conducted at Combined Military Hospital (CMH), Ghatail from January 2018 to June 2019. A total of 707 mothers were included in this study who delivered live infants during study period; among them, 122 were LBW neonates. All the mothers of LBW neonates were evaluated and data were collected by using structured questionnaire. Results: A total 707 live birth occurred during the study period of which 122 were LBW and the incidence of LBW was 17.3%. Out of 122 mothers 18(14.8%) were <20 years, 69 (56.6%) were between 20-30 years and 35(28.7%) were >30 years of age; 19(15.6%) were underweight, 83 (68.0%) were normal weight and 20(16.4%) were overweight and obese; 34(27.9%) took inadequate antenatal check up and 88(72.1%) mother took adequate antenatal check up. Among 122 mothers 25(20.5%) were para 01, 47(38.5%) were para 02 and 50(41%) were para ≥ 03; 16(13.1%) had birth space <2 years and 106(86.9%) had birth space >2 years; 09(7.4%) educated upto primary school, 73(59.8%) educated upto high school and 40(32.8%) educated upto college & above. Regarding maternal illness 30(24.6%) mothers had premature rupture of membranes (PROM), 20(16.4%) had hypertension (HTN), 12(9.8%) had diabetes mellitus (DM), 05(4.1%) had severe oligohydramnios, 05(4.1%) had chronic anaemia and 06 had other illness (4.9%). Conclusion: The risk factors for LBW babies identified in this study are modifiable. In order to reduce this menace, holistic approaches such as health education, maternal nutrition and increasing the quality and quantity of the antenatal care services are of paramount importance. JAFMC Bangladesh. Vol 16, No 2 (December) 2020: 55-58

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The Association of Fetal Congenital Cardiac Defects and Placental Vascular Malperfusion

Pediatric and Developmental Pathology ◽

10.1177/1093526620986497 ◽

2021 ◽

pp. 109352662098649

Author(s):

Tulin Ozcan ◽

Sandra Kikano ◽

Sarah Plummer ◽

James Strainic ◽

Sanjita Ravishankar

Keyword(s):

Risk Factors ◽

Heart Defects ◽

Maternal Risk Factors ◽

Placental Perfusion ◽

Maternal Risk ◽

Increased Risk ◽

Great Vessels ◽

Perfusion Defects ◽

Group 2 ◽

Group 1

Objectives Abnormal early angiogenesis appears to impact both placental disorders and fetal congenital heart defects (CHD). We sought to assess the association of placental perfusion defects (PPD) and fetal (CHD). Methods Singleton pregnancies with isolated severe fetal CHD were compared to controls without congenital anomalies or maternal malperfusion (MVM) risk factors. CHD was categorized into group 1: single left ventricle morphology and transposition of the great vessels (TGA) and group 2: single right ventricle and two ventricle morphology. Malperfusion was defined as fetal vascular malperfusion (FVM), MVM, and both FVM and MVM. Results PPD was increased for all CHD (n = 47), CHD with or without risk factors, and CHD groups compared to controls (n = 92). Overall CHD cases and CHD with risk factors had an increased risk of FVM (30% and 80% vs 14%), and MVM (43% and 50% vs 21%), respectively. MVM rates were similar in CHD with and without maternal risk factors. FVM (38% vs 14%) and MVM (44% vs 21%) were increased in Group 1. MVM (42% vs 21%) and both FVM and MVM (16% vs 3%) were increased in Group 2. Conclusions PPD risk is increased in severe isolated fetal CHD. The highest risk is seen in fetal CHD with maternal risk factors.

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