scholarly journals Multidimensional assessment of women after severe maternal morbidity: the COMMAG cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e041138
Author(s):  
Elton C Ferreira ◽  
Maria Laura Costa ◽  
Rodolfo C Pacagnella ◽  
Carla Silveira ◽  
Carla B Andreucci ◽  
...  
Keyword(s):  
Cohort Study ◽  
Sexual Function ◽  
Screening Test ◽  
Maternal Morbidity ◽  
Severe Maternal Morbidity ◽  
Medium Term ◽  
Short Term ◽  
Multidimensional Assessment ◽  
Index Pregnancy ◽  
Sf 36

ObjectivesTo perform a multidimensional assessment of women who experienced severe maternal morbidity (SMM) and its short-term and medium-term impact on the lives and health of women and their children.DesignA retrospective cohort study.SettingA tertiary maternity hospital from the southeast region of Brazil.ParticipantsThe exposed population was selected from intensive care unit admissions if presenting any diagnostic criteria for SMM. Controls were randomly selected among women without SMM admitted to the same maternity and same time of childbirth.Primary and secondary outcome variablesValidated tools were applied, addressing post-traumatic stress disorder (PTSD) and quality of life (SF-36) by phone, and then general and reproductive health, functioning (WHO Disability Assessment Schedule), sexual function (Female Sexual Function Index (FSFI)), substance abuse (Alcohol, Smoking and Substance Involvement Screening Test 2.0) and growth/development (Denver Developmental Screening Test) of children born in the index pregnancy in a face-to-face interview.ResultsAll instruments were applied to 638 women (315 had SMM; 323 were controls, with the assessment of 264 and 307 children, respectively). SF-36 score was significantly lower in the SMM group, while PTSD score was similar between groups. Women who had SMM became more frequently sterile, had more abnormal clinical conditions after the index pregnancy and a higher score for altered functioning, while proportions of FSFI score or any drug use were similar between groups. Furthermore, children from the SMM group were more likely to have weight (threefold) and height (1.5 fold) for age deficits and also impaired development (1.5-fold).ConclusionSMM impairs some aspects of the lives of women and their children. The focus should be directed towards monitoring these women and their children after birth, ensuring accessibility to health services and reducing short-term and medium-term repercussions on physical, reproductive and psychosocial health.

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 Does contemporary exercise-based cardiac rehabilitation improve quality of life for people with coronary artery disease? A systematic review and meta-analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e036089
Author(s):  
Gordon McGregor ◽  
Richard Powell ◽  
Peter Kimani ◽  
Martin Underwood
Keyword(s):  
Quality Of Life ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Cardiac Rehabilitation ◽  
Risk Of Bias ◽  
Medium Term ◽  
Short Term ◽  
Sf 36 ◽  
Artery Disease

ObjectivesTo determine the effect of contemporary exercise-based cardiac rehabilitation on generic and disease-specific health related quality of life for people with coronary artery disease.DesignSystematic review and meta-analysis.Study eligibility criteriaRandomised controlled trials testing exercise-based cardiac rehabilitation versus no exercise control that recruited after 31 December 1999. On 30 July 2019, we searched the Cochrane Central Register of Controlled Trials, MEDLINE (Ovid), Embase (Ovid) and CINAHL (EBSCO) databases.Study appraisal and synthesisStudies were screened for inclusion by two independent reviewers. Risk of bias was assessed using the Cochrane risk of bias tool. Data were reported as pooled means (95% CI for between-group difference.ResultsWe identified 24 studies (n=4890). We performed meta-analyses for 15 short-term and 9 medium-term outcomes (36-Item Short Form Survey Instrument (SF-36), EuroQol-5D (EQ-5D) and MacNew, a cardiac-specific outcome). Six short-term and five medium-term SF-36 domains statistically favoured exercise-based cardiac rehabilitation. Only for two short-term SF-36 outcomes, ‘physical function’ (mean difference 12.0, 95% CI 4.4 to 19.6) and ‘role physical’ (mean difference 16.9, 95% CI 2.4 to 31.3), did the benefit appear to be clinically important. Meta-analyses of the short-term SF-36 physical and mental component scores, EQ-5D and MacNew and the medium-term SF-36 physical component score, did not show statistically significant benefits. Only two studies had a low risk of bias (n=463 participants).Conclusions and implications of key findingsThere is some evidence of a short-term benefit of contemporary exercise-based cardiac rehabilitation on quality of life for people with coronary artery disease. However, the contemporary data presented in this review are insufficient to support its routine use.

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.

scholarly journals Infertility treatment and risk of severe maternal morbidity: a propensity score–matched cohort study

2019 ◽  
Vol 191 (5) ◽  
pp. E118-E127 ◽  
Author(s):  
Natalie Dayan ◽  
K.S. Joseph ◽  
Deshayne B. Fell ◽  
Carl A. Laskin ◽  
Olga Basso ◽  
...  
Keyword(s):  
Cohort Study ◽  
Propensity Score ◽  
Maternal Morbidity ◽  
Infertility Treatment ◽  
Severe Maternal Morbidity ◽  
Matched Cohort ◽  
Matched Cohort Study

Association of Maternal Comorbidity With Severe Maternal Morbidity: A Cohort Study of California Mothers Delivering Between 1997 and 2014

2020 ◽  
Vol 173 (11_Supplement) ◽  
pp. S11-S18 ◽  
Author(s):  
Elliott K. Main ◽  
Stephanie A. Leonard ◽  
M. Kathryn Menard
Keyword(s):  
Cohort Study ◽  
Maternal Morbidity ◽  
Severe Maternal Morbidity
Sign in / Sign up

Export Citation Format

Share Document