The association between temporal changes in the use of obstetrical intervention and small- for-gestational age live births

Background:Chronic inflammatory rheumatic diseases are often associated with a negative effect on pregnancy outcome. Most obstetrical complications are placenta-mediated such as preterm delivery and growths restrictions. In women with Sjögren syndrome, data on placenta- mediated complications are scarce and conflicting (1,2).Objectives:To analyse neonatal outcome in women with Sjögren syndrome with focus on preterm delivery and growth restriction.Methods:We retrospectively analysed 23 pregnancies of 16 patients with Sjögren syndrome that were followed at our centre with regard to pregnancy outcome, medication and disease characteristics. Small for gestational age was defined as birthweight percentile <10th. Preterm delivery was defined as delivery before 37, early term as delivery between 37-39 and term as delivery between 39-42 weeks of gestation.Results:Of 23 pregnancies, one ended in a miscarriage and 22 resulted in live births including one set of twins. Treatment used during pregnancy was hydroxychloroquine (20 pregnancies), prednisone (8), azathioprine (5) and cyclosporine (2). Concomitant treatment with low-dose aspirin was used in 9 pregnancies.Of the 22 live births, 17 were born at early term and 5 at term. There were no preterm deliveries. Median birth weight was 2820g (range 2095-3845g). Nine newborns (40.9%) were small for gestational age (SGA). Maternal treatment during these pregnancies was hydroxychloroquine in all cases and additional low-dose aspirin in three cases. Elevated CRP levels during pregnancy were found in 57% of the cases with SGA outcome. Only one woman with an SGA infant had positive anti-phospholipid antibodies.Regarding delivery mode, most patients had caesarean sections.Conclusion:In our cohort of women with Sjögren syndrome the prevalence of small for gestational age infants was high despite maternal treatment with hydroxychloroquine. Inflammatory markers could help to identify the patients at risk for placental insufficiency, yet prospective studies of larger cohorts are needed.References:[1]Gupta S et al; Sjögren Syndrome and Pregnancy: A literature review. Perm J 2017; 21:16-047[2]De Carolis S et al; The impact of primary Sjögren’s syndrome on pregnancy outcome: Our series and review of the literature. Autoimmun Rev 2014; 13(2):103-7Disclosure of Interests:Isabella Troester: None declared, Florian Kollert Employee of: Novartis, Astrid Zbinden: None declared, Luigi Raio: None declared, Frauke Foerger Grant/research support from: unrestricted grant from UCB, Consultant of: UCB, GSK, Roche, Speakers bureau: UCB, GSK

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Contribution of socioeconomic status to the risk of small for gestational age infants – a population-based study of 1,390,165 singleton live births in Finland

International Journal for Equity in Health ◽

10.1186/1475-9276-12-28 ◽

2013 ◽

Vol 12 (1) ◽

pp. 28 ◽

Cited By ~ 29

Author(s):

Sari Räisänen ◽

Mika Gissler ◽

Ulla Sankilampi ◽

Juho Saari ◽

Michael R Kramer ◽

...

Keyword(s):

Socioeconomic Status ◽

Gestational Age ◽

Small For Gestational Age ◽

Population Based ◽

Population Based Study ◽

Live Births

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P–773 Infertility treatment and the risk of small for gestational age births: a population-based study in the United States

Human Reproduction ◽

10.1093/humrep/deab130.772 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

H Glatthorn ◽

M Sauer ◽

J Brandt ◽

C Ananth

Keyword(s):

United States ◽

Gestational Age ◽

Small For Gestational Age ◽

The United States ◽

Infertility Treatment ◽

Unmeasured Confounding ◽

Live Births ◽

The Us ◽

Infertility Treatments ◽

The Impact

Abstract Study question What is the association between infertility treatments and small for gestational age (SGA) births? Summary answer Women who conceived pregnancies with any infertility treatment had a decreased risk of SGA <10th, <5th and <3rd percentiles compared to naturally conceived pregnancies. What is known already Assisted reproductive technology (ART) and other infertility treatments have long been associated with an increased risk of SGA births, which confers a greater risk of perinatal morbidity and mortality compared to appropriate for gestational age births. Study design, size, duration This is a cross-sectional study of 16,836,228 births in the United States (US) between 2015–2019. The exposure group included women who underwent any infertility treatment, including ART and prescribed fertility enhancing medications. The comparison group included those who had naturally conceived pregnancies. The primary outcome was SGA birth, defined as sex-specific birthweight <10th percentile for gestational age. Secondary outcomes included SGA <5th and <3rd percentile births. Participants/materials, setting, methods Pregnant subjects (n = 16,836,228) in the US who delivered non-malformed, singleton live births between 24–44 weeks’ gestational age. We estimated risk of SGA births in relation to any infertility treatment from fitting log-linear Poisson regression models with robust variance. Risk ratios (RR) and 95% confidence intervals (CI) were estimated as the effect measure before and after adjusting for confounders. We also performed a sensitivity analysis to correct for potential non-differential exposure misclassification and unmeasured confounding biases. Main results and the role of chance During the study period, 1.4% (n = 231,177) of non-malformed singleton live births resulted from infertility treatments (0.8% ART and 0.6% fertility enhancing medications). Of these, 9.4% (n = 21,771) of pregnancies conceived with infertility treatment were complicated by SGA <10th percentile compared to 11.9% (n = 1,755,925) of naturally conceived pregnancies. For pregnancies conceived with infertility treatment versus naturally conceived pregnancies, the adjusted RR for SGA <10th percentile was 1.07 (95% CI 1.06, 1.08). However, after correction for misclassification bias and unmeasured confounding, infertility treatment was found to be protective for SGA and conferred a 27% reduced risk of SGA <10th percentile (bias-corrected RR 0.73, 95% CI 0.53, 0.85). These trends were similar for analyses stratified by exposure to ART and fertility enhancing medications and secondary SGA outcomes, including SGA <5th and <3rd percentile. Limitations, reasons for caution All information collected on infertility treatment relies on self-reporting by patients and recording by hospital staff at the time of delivery, which likely resulted in underreporting of infertility treatments. Additionally, we cannot determine the impact of interventions that were not recorded, such as intrauterine insemination (IUI). Wider implications of the findings: Compared to naturally conceived pregnancies, exposure to infertility treatment is associated with reduction in the risk of SGA births. These findings, which are contrary to some published reports, likely reflect changes in the modern practice of infertility care in the US, and importantly, robust analysis of the national data. Trial registration number Not applicable

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Trends in live birth rates and adverse neonatal outcomes among HIV-positive women in Ontario, Canada, 2002–2009: a descriptive population-based study

International Journal of STD & AIDS ◽

10.1177/0956462414526861 ◽

2014 ◽

Vol 25 (13) ◽

pp. 960-966 ◽

Cited By ~ 8

Author(s):

Tony Antoniou ◽

Brandon Zagorski ◽

Erin M Macdonald ◽

Ahmed M Bayoumi ◽

Janet Raboud ◽

...

Keyword(s):

Confidence Interval ◽

Gestational Age ◽

Small For Gestational Age ◽

Population Based ◽

Demographic Characteristics ◽

Hiv Positive ◽

Population Based Study ◽

Live Births ◽

Live Birth Rates ◽

Adverse Neonatal Outcomes

To characterise trends in live birth rates, adverse neonatal outcomes and socio-demographic characteristics of pregnant women with diagnosed HIV between the ages of 18 and 49 in Ontario, Canada from 1 April 2002 to 31 March 2010, we conducted a population-based study. Utilising linked administrative healthcare databases we used generalised estimating equations to characterise secular trends and examine the association between live births and socio-demographic characteristics, including age, region of birth and neighbourhood income quintile. Between 2002/2003 and 2009/2010, there were 551 live births during 15,610 person-years of follow-up. The proportion of HIV-positive mothers originally from Africa or the Caribbean increased from 26.7% to 51.6% over the study period. The risk of pre-term (risk ratio 2.13, 95% confidence interval 1.74 to 2.61) and small for gestational age births (risk ratio 1.53, 95% confidence interval 1.20 to 1.94) was higher in women with HIV compared with provincial estimates for these outcomes. Women with HIV have rates of pre-term and small for gestational age births that exceed provincial estimates for these outcomes. Further research is required to identify factors mediating these disparities that are amenable to pre-natal risk reduction initiatives.

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