Maternity leave duration and adverse pregnancy outcomes: An international country-level comparison

2017 ◽  
Vol 46 (8) ◽  
pp. 798-804 ◽  
Author(s):  
Emma Kwegyir-Afful ◽  
George Adu ◽  
Evelien R. Spelten ◽  
Kimmo Räsänen ◽  
Jos Verbeek
Keyword(s):  
Preterm Birth ◽  
Birth Outcomes ◽  
Low Birthweight ◽  
Maternity Leave ◽  
Seemingly Unrelated Regression ◽  
Country Level ◽  
Income Status ◽  
Unrelated Regression ◽  
Level Method ◽  
Adverse Pregnancy

Aim: Preterm birth and low birthweight (LBW) lead to infant morbidity and mortality. The causes are unknown. This study evaluates the association between duration of maternity leave and birth outcomes at country level. Method: We compiled data on duration of maternity leave for 180 countries of which 36 specified prenatal leave, 190 specified income, 183 specified preterm birth rates and 185 specified the LBW rate. Multivariate and seemingly unrelated regression analyses were done in STATA. Results: Mean maternity leave duration was 15.4 weeks ( SD=7.7; range 4–52 weeks). One additional week of maternity leave was associated with a 0.09% lower preterm rate (95% confidence interval [CI] –0.15 to −0.04) adjusting for income and being an African country. An additional week of maternity leave was associated with a 0.14% lower rate of LBW (95% CI –0.24 to −0.05). Mean prenatal maternity leave across 36 countries was six weeks ( SD=2.7; range 2–14 weeks). One week of prenatal maternity leave was associated with a 0.07% lower preterm rate (95% CI –0.10 to 0.24) and a 0.06% lower rate of LBW (95% CI –0.14 to 0.27), but these results were not statistically significant. By adjusting for income status categories, the preterm birth rate was 1.53% higher and the LBW rate was 2.17% higher in Africa compared to the rest of the world. Conclusions: Maternity leave duration is significantly associated with birth outcomes. However, the association was not significant among 36 countries that specified prenatal maternity leave. Studies are needed to evaluate the correlation between prenatal leave and birth outcomes.

scholarly journals Maternal and Neonatal Outcomes Associated with Psychostimulant Use in Pregnancy

2020 ◽  
Vol 5 (5) ◽  
Author(s):  
Ximena Camacho ◽  
Alys Havard ◽  
Helga Zoega ◽  
Margaret Wilson ◽  
Tara Gomes ◽  
...  
Keyword(s):  
Birth Outcomes ◽  
Neonatal Intensive Care ◽  
Low Birthweight ◽  
Cohort Analysis ◽  
Neonatal Outcomes ◽  
Increased Risk ◽  
The Usa ◽  
Maternal And Neonatal Outcomes ◽  
Adverse Pregnancy ◽  
In Pregnancy

IntroductionRecent evidence from the USA and Nordic countries suggests a possible association between psychostimulant use during gestation and adverse pregnancy and birth outcomes. Objectives and ApproachWe employed a distributed cohort analysis using linked administrative data for women who gave birth in New South Wales (NSW; Australia) and Ontario (Canada), whereby a common protocol was implemented separately in each jurisdiction. The study population comprised women who were hospitalized for a singleton delivery over an 8 (NSW) and 4 (Ontario) year period, respectively, with the NSW cohort restricted to social security beneficiaries. Psychostimulant exposure was defined as at least one dispensing of methylphenidate, amphetamine, dextroamphetamine or lisdexamfetamine during pregnancy. We examined the risk of maternal and neonatal outcomes among psychostimulant exposed mothers compared with unexposed mothers. ResultsThere were 140,356 eligible deliveries in NSW and 449,499 in Ontario during the respective study periods. Fewer than 1% of these pregnancies were exposed to psychostimulants during gestation, although use was higher in Ontario (0.30% vs 0.11% in NSW). Preliminary unadjusted analyses indicated possible associations between psychostimulant use in pregnancy and higher risks of pre-term birth (relative risk [RR] 1.7, 95% confidence interval [CI] 1.4-2.0 (Ontario); RR 1.8, 95% CI 1.2-2.6 (NSW)) and pre-eclampsia (RR 2.0, 95% CI 1.5-2.6 (Ontario); RR 2.0, 95% CI 1.2-3.5 (NSW)). Similarly, psychostimulant use was associated with higher risks of low birthweight (RR 1.6, 95% CI 1.3-1.9 (Ontario); RR 2.0, 95% CI 1.3-3.0 (NSW)) and admission to neonatal intensive care (RR 2.1, 95% CI 1.9-2.3 (Ontario); RR 1.5, 95% CI 1.1-1.9 (NSW)). Conclusion / ImplicationsUnadjusted analyses indicate an increased risk of adverse maternal and birth outcomes associated with psychostimulant exposure during pregnancy, potentially representing a placental effect. We are currently refining the analyses, employing propensity score methods to adjust for confounding.

scholarly journals Adverse childhood experiences and poor birth outcomes in a diverse, low-income sample

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Joshua P. Mersky ◽  
ChienTi Plummer Lee
Keyword(s):  
Preterm Birth ◽  
Birth Outcomes ◽  
Low Income ◽  
Adverse Childhood Experiences ◽  
Pregnancy Loss ◽  
Low Birthweight ◽  
Childhood Adversity ◽  
Risk Models ◽  
Childhood Experiences ◽  
Adverse Childhood

Abstract Background Adverse childhood experiences (ACE) are associated with an array of health consequences in later life, but few studies have examined the effects of ACEs on women’s birth outcomes. Methods We analyzed data gathered from a sample of 1848 low-income women who received services from home visiting programs in Wisconsin. Archival program records from a public health database were used to create three birth outcomes reflecting each participant’s reproductive health history: any pregnancy loss; any preterm birth; any low birthweight. Multivariate logistic regressions were performed to test the linear and non-linear effects of ACEs on birth outcomes, controlling for age, race/ethnicity, and education. Results Descriptive analyses showed that 84.4% of women had at least one ACE, and that 68.2% reported multiple ACEs. Multivariate logistic regression analyses showed that cumulative ACE scores were associated with an increased likelihood of pregnancy loss (OR = 1.12; 95% CI = 1.08–1.17), preterm birth (OR = 1.07; 95% CI = 1.01–1.12), and low birthweight (OR = 1.08; 95% CI = 1.03–1.15). Additional analyses revealed that the ACE-birthweight association deviated from a linear, dose-response pattern. Conclusions Findings confirmed that high levels of childhood adversity are associated with poor birth outcomes. Alongside additive risk models, future ACE research should test interactive risk models and causal mechanisms through which childhood adversity compromises reproductive health.

scholarly journals Influence of Prenatal Exposure to Mercury, Perceived Stress, and Depression on Birth Outcomes in Suriname: Results from the MeKiTamara Study

2020 ◽  
Vol 17 (12) ◽  
pp. 4444
Author(s):  
Anisma R. Gokoel ◽  
Wilco C. W. R. Zijlmans ◽  
Hannah H. Covert ◽  
Firoz Abdoel Wahid ◽  
Arti Shankar ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Birth Outcomes ◽  
Prenatal Exposure ◽  
Perceived Stress ◽  
Apgar Score ◽  
Low Birthweight ◽  
Depression Scale ◽  
Study Cohort ◽  
Adverse Birth Outcomes ◽  
Probable Depression

Prenatal exposure to mercury, stress, and depression may have adverse effects on birth outcomes. Little is known on the influence of chemical and non-chemical stressors on birth outcomes in the country of Suriname. We assessed the influence of prenatal exposure to mercury, perceived stress, and depression on adverse birth outcomes in 1143 pregnant Surinamese women who participated in the Caribbean Consortium for Research in Environmental and Occupational Health-MeKiTamara prospective cohort study. Associations between mercury (≥1.1 μg/g hair, USEPA action level/top versus bottom quartile), probable depression (Edinburgh Depression Scale ≥12), high perceived stress (Cohen’s Perceived Stress Scale ≥20), and adverse birth outcomes (low birthweight (<2500 g), preterm birth (<37 completed weeks of gestation), and low Apgar score (<7 at 5 min)) were assessed using bivariate and multivariate logistic regressions. Prevalence of elevated mercury levels, high perceived stress, and probable depression were 37.5%, 27.2%, and 22.4%, respectively. Mercury exposure was significantly associated with preterm birth in the overall study cohort (OR 2.47; 95% CI 1.05–5.83) and perceived stress with a low Apgar score (OR 9.73; 95% CI 2.03–46.70). Depression was not associated with any birth outcomes. These findings can inform policy- and practice-oriented solutions to improve maternal and child health in Suriname.

scholarly journals Economies of Scope between Research and Teaching in European Universities

Mathematics ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 42
Author(s):  
Andrea Bonaccorsi ◽  
Paola Belingheri ◽  
Luca Secondi
Keyword(s):  
Higher Education ◽  
Efficiency Analysis ◽  
Seemingly Unrelated Regression ◽  
Economies Of Scope ◽  
Country Level ◽  
European Universities ◽  
Research And Teaching ◽  
Unrelated Regression ◽  
Efficiency Estimation ◽  
Educational Field

The estimation of economies of scope between research and teaching has been the object of a large literature in economics of education and efficiency analysis, with parametric and non-parametric specifications. The paper contributes to the literature by building a pan-European dataset that integrates official statistics on higher education at country level with bibliometric indicators. The dataset allows a breakdown by scientific and educational field, accounting for the heterogeneity among disciplines. We applied a technique which has not been used for the efficiency estimation of economies of scope in higher education, namely seemingly unrelated regression (SUR) applied to separate input–output equations describing the production of education and research. We found confirmation for economies of scope in some fields and with some specifications, or no relation between the equations. In no case did we find diseconomies of scope between teaching and research.

scholarly journals Interventions to improve birth outcomes of pregnant women living in low- and middle-income countries: a systematic review and network meta-analysis

2020 ◽  
Vol 3 ◽  
pp. 1657
Author(s):  
Jay J. H. Park ◽  
Ofir Harari ◽  
Ellie Siden ◽  
Michael Zoratti ◽  
Louis Dron ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Preterm Birth ◽  
Pregnant Women ◽  
Birth Outcomes ◽  
Low Birthweight ◽  
Meta Analysis ◽  
Standard Of Care ◽  
Adverse Birth Outcomes ◽  
Middle Income ◽  
Middle Income Countries

Background: Improving the health of pregnant women is important to prevent adverse birth outcomes, such as preterm birth and low birthweight. We evaluated the comparative effectiveness of interventions under the domains of micronutrient, balanced energy protein, deworming, maternal education, and water sanitation and hygiene (WASH) for their effects on these adverse birth outcomes. Methods: For this network meta-analysis, we searched for randomized clinical trials (RCTs) of interventions provided to pregnant women in low- and middle-income countries (LMICs). We searched for reports published until September 17, 2019 and hand-searched bibliographies of existing reviews. We extracted data from eligible studies for study characteristics, interventions, participants’ characteristics at baseline, and birth outcomes. We compared effects on preterm birth (<37 gestational week), low birthweight (LBW; <2500 g), and birthweight (continuous) using studies conducted in LMICs. Results: Our network meta-analyses were based on 101 RCTs (132 papers) pertaining to 206,531 participants. Several micronutrients and balanced energy food supplement interventions demonstrated effectiveness over standard-of-care. For instance, versus standard-of-care, micronutrient supplements for pregnant women, such as iron and calcium, decreased risks of preterm birth (iron: RR=0.70, 95% credible interval [Crl] 0.47, 1.01; calcium: RR=0.76, 95%Crl 0.56, 0.99). Daily intake of 1500kcal of local food decreased the risks of preterm birth (RR=0.36, 95%Crl 0.16, 0.77) and LBW (RR=0.17, 95%Crl 0.09, 0.29), respectively when compared to standard-of-care. Educational and deworming interventions did not show improvements in birth outcomes, and no WASH intervention trials reported on these adverse birth outcomes. Conclusion: We found several pregnancy interventions that improve birth outcomes. However, most clinical trials have only evaluated interventions under a single domain (e.g. micronutrients) even though the causes of adverse birth outcomes are multi-faceted. There is a need to combine interventions that of different domains as packages and test for their effectiveness. Registration: PROSPERO CRD42018110446; registered on 17 October 2018.

scholarly journals 1096. Effect of Diarrheal Illness During Pregnancy on Adverse Birth Outcomes in Nepal

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S328-S329
Author(s):  
Kira Newman ◽  
Katie Gustafson ◽  
Janet Englund ◽  
Joanne Katz ◽  
Amalia Magaret ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Medical Care ◽  
Pregnant Women ◽  
Birth Outcomes ◽  
Low Birthweight ◽  
Published Data ◽  
Adverse Birth Outcomes ◽  
South Asian Population ◽  
Adjusted Risk ◽  
Diarrheal Illness

Abstract Background Adverse birth outcomes, including low birthweight (LBW), small-for-gestational-age (SGA) and preterm birth, contribute to 60–80% of infant mortality worldwide. Little published data exist on the association between diarrhea during pregnancy and adverse birth outcomes. We sought to identify whether diarrhea during pregnancy was associated with adverse birth outcomes. Methods We used data from a community-based, prospective randomized trial of maternal influenza immunization of pregnant women and their infants conducted in rural Nepal from 2011 to 2014. Illness episodes were defined as at least three watery bowel movements per day for one or more days with 7 diarrhea-free days between episodes. Diarrheal illnesses were identified through longitudinal household-based weekly symptom surveillance. The c2 test, two-sample t-test, and log-binomial regression were performed to evaluate baseline characteristics and the association between diarrhea during pregnancy and adverse birth outcomes. Results Of 3,682 women in the study, 527 (14.3%) experienced one or more episodes of diarrhea during pregnancy. Diarrhea incidence was not seasonal. Women with diarrhea had a median of one episode of diarrhea (interquartile range (IQR) 1–2 episodes) and two cumulative days of diarrhea (IQR 1–3 days). Of women with diarrhea, 16.1% (85) sought medical care. Mean maternal age, parity, biomass cook stove use, home latrine, water source, caste, and smoking did not differ in pregnant women with and without diarrhea. In crude and adjusted analyses, women with diarrhea during pregnancy were significantly more likely to have SGA infants (42.6% vs. 36.8%; adjusted risk ratio=1.20, 95% CI 1.06–1.36, P = 0.005). LBW and preterm birth incidence did not significantly differ between women with diarrhea during pregnancy and those without. There was no significant association between seeking medical care for diarrhea and birth outcomes. Conclusion Diarrheal illness during pregnancy was associated with a significantly higher risk of SGA infants in this rural South Asian population. Interventions to reduce the burden of diarrheal illness during pregnancy may have an impact on SGA births in resource-limited settings. Disclosures All authors: No reported disclosures.

Assisted reproductive technologies and birth outcomes: overview of recent systematic reviews

2005 ◽  
Vol 17 (3) ◽  
pp. 329 ◽  
Author(s):  
Carol Bower ◽  
Michèle Hansen
Keyword(s):  
Preterm Birth ◽  
Perinatal Mortality ◽  
Birth Outcomes ◽  
Birth Defects ◽  
Systematic Reviews ◽  
Low Birthweight ◽  
Assisted Reproductive Technologies ◽  
Reproductive Technologies ◽  
Sound Studies

Several systematic reviews have been published recently on birth outcomes of infants conceived through assisted reproductive technologies (ART), compared with infants conceived spontaneously. These outcomes include perinatal mortality, preterm birth, low birthweight and birth defects. Methodological limitations of many of the individual studies (including small sample size, potential for bias in ascertainment of outcomes and considering singletons and multiples together) were obviated in these reviews by excluding studies where methods were considered inadequate, by conducting meta-analyses using data from all methodologically sound studies (small and large) and by examining singletons separately. Overall, the reviews indicate few differences between outcomes in ART twins compared with twins conceived spontaneously. However, in singleton ART infants, there are around two-fold increases in risk of perinatal mortality, low birthweight and preterm birth, about a 50% increase in small for gestational age and a 30–35% increase in birth defects, compared with singletons conceived spontaneously. Couples considering ART should be counselled about the increased risk of adverse outcomes. Epidemiologists, in conjunction with clinical and laboratory colleagues, should now focus on large, methodologically sound studies with long-term follow up that seek to identify the reasons for these increased risks and their long-term consequences, whether they are associated with particular technologies and causes of infertility, and how they might be reduced.

scholarly journals Risk of Preterm Birth and Newborn Low Birthweight in Military Women with Increased Pregnancy-Specific Anxiety

2019 ◽  
Vol 185 (5-6) ◽  
pp. e678-e685 ◽  
Author(s):  
Karen L Weis ◽  
Katherine C Walker ◽  
Wenyaw Chan ◽  
Tony T Yuan ◽  
Regina P Lederman
Keyword(s):  
Preterm Birth ◽  
Birth Outcomes ◽  
Low Birthweight ◽  
Active Duty ◽  
Maternal Anxiety ◽  
Anxiety And Depression ◽  
Diagnostic Code ◽  
Military Population ◽  
Pregnancy Anxiety ◽  
The Impact

Abstract Introduction Prenatal maternal anxiety and depression have been implicated as possible risk factors for preterm birth (PTB) and other poor birth outcomes. Within the military, maternal conditions account for 15.3% of all hospital bed days, and it is the most common diagnostic code for active duty females after mental disorders. The majority of women (97.6%) serving on active duty are women of childbearing potential. Understanding the impact that prenatal maternal anxiety and depression can have on PTB and low birthweight (LBW) in a military population is critical to providing insight into biological pathways that alter fetal development and growth. The purpose of the study was to determine the impact of pregnancy-specific anxiety and depression on PTB and LBW within a military population. Material and Methods Pregnancy-specific anxiety and depression were measured for 246 pregnant women in each trimester. Individual slopes for seven different measures of pregnancy anxiety and one depression scale were calculated using linear mixed models. Logistic regression, adjusted and unadjusted models, were applied to determine the impact on PTB and LBW. Results For each 1/10 unit increase in the anxiety slope as it related to well-being, the risk of LBW increased by 83% after controlling for parity, PTB, and active duty status. Similarly, a 1/10 unit rise in the anxiety slope related to accepting pregnancy, labor fears, and helplessness increased the risk of PTB by 37%, 60%, and 54%, respectively. Conclusions Pregnancy-specific anxiety was found to significantly increase the risk of PTB and LBW in a military population. Understanding this relationship is essential in developing effective assessments and interventions. Results emphasize the importance of prenatal maternal mental health to fetal health and birth outcomes. Further research is needed to determine the specific physiological pathways that link prenatal anxiety and depression with poor birth outcomes.

scholarly journals Adverse birth outcomes and associated factors among mothers who delivered in Bale zone hospitals, Oromia Region, Southeast Ethiopia

2021 ◽  
Vol 49 (5) ◽  
pp. 030006052110132
Author(s):  
Sisay Degno ◽  
Bikila Lencha ◽  
Ramato Aman ◽  
Daniel Atlaw ◽  
Ashenafi Mekonnen ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Antenatal Care ◽  
Birth Outcomes ◽  
Associated Factors ◽  
Low Birthweight ◽  
Multiple Pregnancy ◽  
Bivariate Analysis ◽  
Adverse Birth Outcomes ◽  
Southeast Ethiopia ◽  
Bale Zone

Objective Adverse birth outcomes, which include stillbirth, preterm birth, low birthweight, congenital abnormalities, and stillbirth, are the leading cause of neonatal and infant mortality worldwide. We assessed adverse birth outcomes and associated factors among mothers who gave birth in Bale zone hospitals, Oromia, Southeast Ethiopia. Methods We used systematic random sampling in this cross-sectional study. We identified factors associated with adverse birth outcomes using bivariate analysis and multivariable logistic regression analysis. Results The proportion of adverse birth outcomes among participants was 21%. Of 576 births, 70 (12.2%) were low birthweight, 49 (8.5%) were preterm birth, 45 (7.8%) were stillbirth, and 18 (3.1%) infants had congenital anomalies. Inadequate antenatal care (adjusted odds ratio [AOR] = 6.58, 95% confidence interval [CI] 3.25–13.32), multiple pregnancy (AOR  =  4.74, 95% CI 1.55–14.45), premature rupture of membranes in the current pregnancy (AOR = 2.31, 95% CI 1.26–4.21), hemoglobin level  < 11 g/dL (AOR = 3.22, 95% CI 1.85–5.58), and mid-upper arm circumference less than 23 cm (AOR = 5.93, 95% CI 3.49–10.08) were all significantly associated with adverse birth outcomes. Conclusions Approximately one in five study participants had adverse birth outcomes. Increasing antenatal care uptake, ferrous supplementation during pregnancy, and improving the quality of maternal health services are recommended.

scholarly journals Effect of Diarrheal Illness During Pregnancy on Adverse Birth Outcomes in Nepal

2019 ◽  
Vol 6 (2) ◽  
Author(s):  
Kira L Newman ◽  
Kathryn Gustafson ◽  
Janet A Englund ◽  
Amalia Magaret ◽  
Subarna Khatry ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Birth Outcomes ◽  
Low Birthweight ◽  
Asian Population ◽  
Published Data ◽  
Adverse Birth Outcomes ◽  
South Asian Population ◽  
Adjusted Risk ◽  
Diarrheal Illness ◽  
Bowel Movements

Abstract Background Adverse birth outcomes, including low birthweight, small for gestational age (SGA), and preterm birth, contribute to 60%–80% of infant mortality worldwide. Little published data exist on the association between diarrhea during pregnancy and adverse birth outcomes. Methods Data were used from 2 community-based, prospective randomized trials of maternal influenza immunization during pregnancy conducted in rural Nepal from 2011 to 2014. Diarrheal illnesses were identified through longitudinal household-based weekly symptom surveillance. Diarrhea episodes were defined as at least 3 watery bowel movements per day for 1 or more days with 7 diarrhea-free days between episodes. The Poisson and log-binomial regression were performed to evaluate baseline characteristics and association between diarrhea during pregnancy and adverse birth outcomes. Results A total of 527 of 3693 women in the study (14.3%) experienced diarrhea during pregnancy. Women with diarrhea had a median of 1 episode of diarrhea (interquartile range [IQR], 1–2 episodes) and 2 cumulative days of diarrhea (IQR, 1–3 days). Of women with diarrhea, 85 (16.1%) sought medical care. In crude and adjusted analyses, women with diarrhea during pregnancy were more likely to have SGA infants (42.6% vs 36.8%; adjusted risk ratio = 1.20; 95% confidence interval, 1.06–1.36; P = .005). Birthweight and preterm birth incidence did not substantially differ between women with diarrhea during pregnancy and those without. Conclusions Diarrheal illness during pregnancy was associated with a higher risk of SGA infants in this rural South Asian population. Interventions to reduce the burden of diarrheal illness during pregnancy may have an impact on SGA births in resource-limited settings.

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