scholarly journals Exposure-response analysis of the association of maternal smoking and use of electronic cigarettes (vaping) in relation to preterm birth and small-for-gestational-age in a national US sample, 2016-2018

2021 ◽  
Author(s):  
Xi Wang ◽  
Nora L Lee ◽  
Igor Burstyn
Keyword(s):  
Preterm Birth ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Preterm Births ◽  
Excess Risk ◽  
Response Analysis ◽  
List Type ◽  
Exposure Response ◽  
Increase Risk ◽  
Heavy Smokers

AbstractWe aimed to estimate exposure-response associations between smoking or vaping, and preterm and small-for-gestational age (SGA) births. We included 99,201 mothers who delivered live singletons in 2016-2018 from the Pregnancy Risk Assessment Monitoring System. We created exposure categories based on participants’ self-reported average number of cigarettes smoked per day and vaping frequency. Dual users in late pregnancy were a heterogeneous group: 36% heavily smoked and occasionally vaped; 29% lightly smoked and frequently vaped; 19% lightly smoked and frequently vaped; and 15% both heavily smoked and frequently vaped. While dual users who heavily smoked and occasionally vaped had the highest adjusted OR for SGA (3.4, 95% CI 1.7-6.6), all the dual users were on average at about twice the odds of having SGA than non-users. While the risks of preterm birth were higher among sole light smokers (adjusted OR 1.3, 95% CI 1.1-1.5) and sole heavy smokers (adjusted OR 1.4. 95 CI 1.2-1.8) than non-users, the adjusted odds of preterm births for dual users were not noticeably higher than those of non-users, unless they were also heavy smokers. Excess of preterm births among heavy vapers was suggested. Among younger non-Hispanic white women (where vaping is most common), only excess risk of SGA, not preterm, with vaping was apparent. Relative to non-users, both smoking and vaping during pregnancy appear to increase risk of SGA, but excess risk of preterm births appears to be primarily attributable to smoking alone. Higher levels of exposure tended to confer more risk.HighlightsNo observable change in prevalence of vaping during pregnancy from 2016 to 2018Both smoking and vaping during pregnancy appear to increase risk of SGA birthsExcess risk of preterm births appears to be primarily attributable to smoking alone

scholarly journals Interrupted time series study found mixed effects of the impact of the Bavarian smoke-free legislation on pregnancy outcomes

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Stephanie Polus ◽  
Jacob Burns ◽  
Sabine Hoffmann ◽  
Tim Mathes ◽  
Ulrich Mansmann ◽  
...  
Keyword(s):  
Time Series ◽  
Preterm Birth ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Pregnancy Outcomes ◽  
Preterm Births ◽  
Interrupted Time Series ◽  
Federal States ◽  
Very Preterm ◽  
The Impact

AbstractIn 2007 the German government passed smoke-free legislation, leaving the details of implementation to the individual federal states. In January 2008 Bavaria implemented one of the strictest laws in Germany. We investigated its impact on pregnancy outcomes and applied an interrupted time series (ITS) study design to assess any changes in preterm birth, small for gestational age (primary outcomes), and low birth weight, stillbirth and very preterm birth. We included 1,236,992 singleton births, comprising 83,691 preterm births and 112,143 small for gestational age newborns. For most outcomes we observed unclear effects. For very preterm births, we found an immediate drop of 10.4% (95%CI − 15.8, − 4.6%; p = 0.0006) and a gradual decrease of 0.5% (95%CI − 0.7, − 0.2%, p = 0.0010) after implementation of the legislation. The majority of subgroup and sensitivity analyses confirm these results. Although we found no statistically significant effect of the Bavarian smoke-free legislation on most pregnancy outcomes, a substantial decrease in very preterm births was observed. We cannot rule out that despite our rigorous methods and robustness checks, design-inherent limitations of the ITS study as well as country-specific factors, such as the ambivalent German policy context have influenced our estimation of the effects of the legislation.

scholarly journals Influence of the Adequacy of the Prenatal Care Utilization Index on Small-For-Gestational-Age Infants and Preterm Births in the United States

2019 ◽  
Vol 8 (6) ◽  
pp. 838 ◽  
Author(s):  
Dayeon Shin ◽  
Won O. Song
Keyword(s):  
Preterm Birth ◽  
Prenatal Care ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Preterm Births ◽  
The United States ◽  
Care Utilization ◽  
Prenatal Care Utilization ◽  
Adequacy Of Prenatal Care ◽  
Adequate Prenatal Care

Little is known about the associations of Adequacy of Prenatal Care Utilization (APNCU) index with small-for-gestational-age (SGA) infants and preterm births. This study investigated the association between the Adequacy of Prenatal Care Utilization (APNCU) index in relation to small-for-gestational-age (SGA) infants and preterm births. We used data from 212,050 pregnant women from the Pregnancy Risk Assessment Monitoring System (PRAMS) between 2004 and 2011. Multivariable logistic regression analyses were performed to examine the effect of the APNCU index on SGA infants and preterm births after controlling for maternal sociodemographic factors. Women who received adequate-plus prenatal care in reference to adequate prenatal care had increased odds for delivering SGA infants (adjusted odds ratio (AOR) = 1.08, 95% confidence interval (CI) = 1.03–1.15). Women with 9–11 prenatal care visits had increased odds of delivering SGA infants (AOR = 1.07, 95% CI = 1.02–1.14) compared to those with more than 12 visits. Among the four APNCU index categories, the highest rate of preterm births was observed in the adequate-plus group. Compared to those with adequate prenatal care, women who received adequate-plus prenatal care had increased odds of preterm birth (AOR = 1.69, 95% CI = 1.55–1.84). Compared to those with more than 12 visits, women with fewer than eight prenatal care visits had increased odds of preterm birth (AOR = 1.29, 95% CI = 1.13–1.48). In conclusion, women in the adequate-plus APNCU index category were more likely to deliver SGA infants and to have preterm births compared to those in the adequate APNCU index category. Women in the U.S. with high-risk pregnancies were prone to receiving adequate-plus prenatal care. Future prospective studies are warranted to investigate the influence of APNCU index in relation to pregnancy and birth outcomes.

scholarly journals A birth population-based survey of preterm morbidity and mortality by gestational age

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xiaojing Guo ◽  
Xiaoqiong Li ◽  
Tingting Qi ◽  
Zhaojun Pan ◽  
Xiaoqin Zhu ◽  
...  
Keyword(s):  
Birth Weight ◽  
Preterm Birth ◽  
Preterm Infants ◽  
Birth Defects ◽  
Gestational Age ◽  
Death Rate ◽  
Preterm Births ◽  
Mortality Rates ◽  
Morbidity And Mortality ◽  
Hospital Death

Abstract Background Despite 15–17 millions of annual births in China, there is a paucity of information on prevalence and outcome of preterm birth. We characterized the outcome of preterm births and hospitalized preterm infants by gestational age (GA) in Huai’an in 2015, an emerging prefectural region of China. Methods Of 59,245 regional total births, clinical data on 2651 preterm births and 1941 hospitalized preterm neonates were extracted from Huai’an Women and Children’s Hospital (HWCH) and non-HWCH hospitals in 2018–2020. Preterm prevalence, morbidity and mortality rates were characterized and compared by hospital categories and GA spectra. Death risks of preterm births and hospitalized preterm infants in the whole region were analyzed with multivariable Poisson regression. Results The prevalence of extreme, very, moderate, late and total preterm of the regional total births were 0.14, 0.53, 0.72, 3.08 and 4.47%, with GA-specific neonatal mortality rates being 44.4, 15.8, 3.7, 1.5 and 4.3%, respectively. There were 1025 (52.8% of whole region) preterm admissions in HWCH, with significantly lower in-hospital death rate of inborn (33 of 802, 4.1%) than out-born (23 of 223, 10.3%) infants. Compared to non-HWCH, three-fold more neonates in HWCH were under critical care with higher death rate, including most extremely preterm infants. Significantly all-death risks were found for the total preterm births in birth weight <  1000 g, GA < 32 weeks, amniotic fluid contamination, Apgar-5 min < 7, and birth defects. For the hospitalized preterm infants, significantly in-hospital death risks were found in out-born of HWCH, GA < 32 weeks, birth weight <  1000 g, Apgar-5 min < 7, birth defects, respiratory distress syndrome, necrotizing enterocolitis and ventilation, whereas born in HWCH, antenatal glucocorticoids, cesarean delivery and surfactant use decreased the death risks. Conclusions The integrated data revealed the prevalence, GA-specific morbidity and mortality rate of total preterm births and their hospitalization, demonstrating the efficiency of leading referral center and whole regional perinatal-neonatal network in China. The concept and protocol should be validated in further studies for prevention of preterm birth.

Impact of smoking and fetal gender on preterm delivery

2020 ◽  
pp. 1-6
Author(s):  
Veronika Günther ◽  
Ibrahim Alkatout ◽  
Alexandra Stein ◽  
Nicolai Maass ◽  
Alexander Strauss ◽  
...  
Keyword(s):  
Risk Factors ◽  
Preterm Birth ◽  
Preterm Delivery ◽  
Preterm Infants ◽  
Preterm Births ◽  
World Health ◽  
Smoking During Pregnancy ◽  
Fetal Gender ◽  
Extremely Preterm ◽  
Heavy Smokers

Abstract According to the World Health Organization, smoking is the most important risk factor for adverse pregnancy outcomes in industrialized nations. We aimed to establish how fetal gender and smoking interact with regard to perinatal outcomes, especially preterm delivery. Data from 220,339 singleton pregnancies, obtained from the German Perinatal Survey in Schleswig-Holstein and registered between 2004 and 2017 were analyzed in regard to smoking behavior, fetal gender, and preterm delivery. The rate of preterm births was directly proportional to the women’s consumption of nicotine. The rate of preterm deliveries was 6.8% among nonsmokers, and 13.2% in women who were very heavy smokers (≥22 cigarettes/day). Very heavy smoking (≥22 cigarettes/day) had a marked impact on extremely preterm births (<28 weeks of gestation) and very preterm births (28–31 weeks of gestation). Preterm births increased by 1.2% from heavy smokers to very heavy smokers; the differences between the other groups ranged between 0.1% and 0.4%. Fetal gender also had an impact on preterm birth: male infants were predominant in nearly all groups of women who delivered preterm infants. Smoking during pregnancy and male gender are both risk factors for preterm delivery. Fetal gender should be given greater attention as one of the several risk factors of preterm birth. Due to the high rate of morbidity among preterm infants and enormous costs for the healthcare system, women should be encouraged to cease or at least reduce smoking during pregnancy.

scholarly journals Maternal exposure to airborne polychlorinated biphenyls (PCBs) and risk of adverse birth outcomes

2021 ◽  
Author(s):  
Ane Bungum Kofoed ◽  
Laura Deen ◽  
Karin Sørig Hougaard ◽  
Kajsa Ugelvig Petersen ◽  
Harald William Meyer ◽  
...  
Keyword(s):  
Birth Weight ◽  
Preterm Birth ◽  
Sex Ratio ◽  
Polychlorinated Biphenyls ◽  
Birth Outcomes ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Maternal Exposure ◽  
Adverse Birth Outcomes ◽  
Secondary Sex Ratio

AbstractHuman health effects of airborne lower-chlorinated polychlorinated biphenyls (LC-PCBs) are largely unexplored. Since PCBs may cross the placenta, maternal exposure could potentially have negative consequences for fetal development. We aimed to determine if exposure to airborne PCB during pregnancy was associated with adverse birth outcomes. In this cohort study, exposed women had lived in PCB contaminated apartments at least one year during the 3.6 years before conception or the entire first trimester of pregnancy. The women and their children were followed for birth outcomes in Danish health registers. Logistic regression was performed to estimate odds ratios (OR) for changes in secondary sex ratio, preterm birth, major congenital malformations, cryptorchidism, and being born small for gestational age. We performed linear regression to estimate difference in birth weight among children of exposed and unexposed mothers. All models were adjusted for maternal age, educational level, ethnicity, and calendar time. We identified 885 exposed pregnancies and 3327 unexposed pregnancies. Relative to unexposed women, exposed women had OR 0.97 (95% CI 0.82, 1.15) for secondary sex ratio, OR 1.13 (95% CI 0.76, 1.67) for preterm birth, OR 1.28 (95% CI 0.81, 2.01) for having a child with major malformations, OR 1.73 (95% CI 1.01, 2.95) for cryptorchidism and OR 1.23 (95% CI 0.88, 1.72) for giving birth to a child born small for gestational age. The difference in birth weight for children of exposed compared to unexposed women was − 32 g (95% CI—79, 14). We observed an increased risk of cryptorchidism among boys after maternal airborne LC-PCB exposure, but due to the proxy measure of exposure, inability to perform dose–response analyses, and the lack of comparable literature, larger cohort studies with direct measures of exposure are needed to investigate the safety of airborne LC-PCB exposure during pregnancy

Preterm birth, low birthweight, and small for gestational age among women with preeclampsia: Does maternal age matter?

2018 ◽  
Vol 13 ◽  
pp. 260-266 ◽  
Author(s):  
Xun Li ◽  
Weishe Zhang ◽  
Jianhua Lin ◽  
Huai Liu ◽  
Zujing Yang ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Maternal Age ◽  
Low Birthweight

scholarly journals Perinatal Outcomes of Small for Gestational Age in Twin Pregnancies: Twin vs. Singleton Charts

2021 ◽  
Vol 10 (4) ◽  
pp. 643
Author(s):  
Veronica Giorgione ◽  
Corey Briffa ◽  
Carolina Di Fabrizio ◽  
Rohan Bhate ◽  
Asma Khalil
Keyword(s):  
Birth Weight ◽  
Preterm Birth ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Perinatal Death ◽  
Perinatal Outcomes ◽  
Adverse Outcomes ◽  
Chi Square ◽  
Increased Risk ◽  
Twin Pregnancies

Twin pregnancies are commonly assessed using singleton growth and birth weight reference charts. This practice has led to a significant number of twins labelled as small for gestational age (SGA), causing unnecessary interventions and increased risk of iatrogenic preterm birth. However, the use of twin-specific charts remains controversial. This study aims to assess whether twin-specific estimated fetal weight (EFW) and birth weight (BW) charts are more predictive of adverse outcomes compared to singleton charts. Centiles of EFW and BW were calculated using previously published singleton and twin charts. Categorical data were compared using Chi-square or McNemar tests. The study included 1740 twin pregnancies, with the following perinatal adverse outcomes recorded: perinatal death, preterm birth <34 weeks, hypertensive disorders of pregnancy (HDP) and admissions to the neonatal unit (NNU). Twin-specific charts identified prenatally and postnatally a smaller proportion of infants as SGA compared to singleton charts. However, twin charts showed a higher percentage of adverse neonatal outcomes in SGA infants than singleton charts. For example, perinatal death (SGA 7.2% vs. appropriate for gestational age (AGA) 2%, p < 0.0001), preterm birth <34 weeks (SGA 42.1% vs. AGA 16.4%, p < 0.0001), HDP (SGA 21.2% vs. AGA 13.5%, p = 0.015) and NNU admissions (SGA 69% vs. AGA 24%, p < 0.0001), when compared to singleton charts (perinatal death: SGA 2% vs. AGA 1%, p = 0.029), preterm birth <34 weeks: (SGA 20.6% vs. AGA 17.4%, p = 0.020), NNU admission: (SGA 34.5% vs. AGA 23.9%, p < 0.000). There was no significant association between HDP and SGA using the singleton charts (p = 0.696). In SGA infants, according to the twin charts, the incidence of abnormal umbilical artery Doppler was significantly more common than in SGA using the singleton chart (27.0% vs. 8.1%, p < 0.001). In conclusion, singleton charts misclassify a large number of twins as at risk of fetal growth restriction. The evidence suggests that the following twin-specific charts could reduce unnecessary medical interventions prenatally and postnatally.

scholarly journals Reduced prevalence of small-for-gestational-age and preterm birth for women of low socioeconomic position: a population-based cohort study comparing antenatal midwifery and physician models of care

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e022220 ◽  
Author(s):  
Daphne N McRae ◽  
Patricia A Janssen ◽  
Saraswathi Vedam ◽  
Maureen Mayhew ◽  
Deborah Mpofu ◽  
...  
Keyword(s):  
British Columbia ◽  
Cohort Study ◽  
Preterm Birth ◽  
Gestational Age ◽  
Socioeconomic Position ◽  
Small For Gestational Age ◽  
Models Of Care ◽  
Midwifery Care ◽  
Low Socioeconomic ◽  
Lower Odds

ObjectiveOur aim was to investigate if antenatal midwifery care was associated with lower odds of small-for-gestational-age (SGA) birth, preterm birth (PTB) or low birth weight (LBW) compared with general practitioner (GP) or obstetrician (OB) models of care for women of low socioeconomic position.SettingThis population-level, retrospective cohort study used province-wide maternity, medical billing and demographic data from British Columbia, Canada.ParticipantsOur study included 57 872 pregnant women, with low socioeconomic position, who: were residents of British Columbia, Canada, carried a singleton fetus, had low to moderate medical/obstetric risk, delivered between 2005 and 2012 and received medical insurance premium assistance.Primary and secondary outcome measuresWe report rates, adjusted ORs (aOR), and 95% CIs for the primary outcome, SGA birth (<the 10th percentile), and secondary outcomes, PTB (<37 weeks’ completed gestation) and LBW (<2500 g).ResultsOur sample included 4705 midwifery patients, 45 114 GP patients and 8053 OB patients. Odds of SGA birth were reduced for patients receiving antenatal midwifery versus GP (aOR 0.71, 95% CI 0.62 to 0.82) or OB care (aOR 0.59, 95% CI 0.50 to 0.69). Odds of PTB were lower for antenatal midwifery versus GP (aOR 0.74, 95% CI 0.63 to 0.86) or OB patients (aOR 0.53, 95% CI 0.45 to 0.62). Odds of LBW were reduced for midwifery versus GP (aOR 0.66, 95% CI 0.53 to 0.82) or OB patients (aOR 0.43, 95% CI 0.34 to 0.54).ConclusionAntenatal midwifery care in British Columbia, Canada, was associated with lower odds of SGA birth, PTB and LBW, for women of low socioeconomic position, compared with physician models of care. Results support the development of policy to ensure antenatal midwifery care is available and accessible for women of low socioeconomic position. Future research is needed to determine the underlying mechanisms linking midwifery care to better birth outcomes for women of low socioeconomic position.

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