The Zambian Preterm Birth Prevention Study (ZAPPS): Cohort characteristics at enrollment

Background: Sub-Saharan Africa bears a disproportionate burden of preterm birth and other adverse outcomes. Not only is the background rate of preterm birth higher than in North America and Europe, but many facilities lack essential equipment and personnel resources to care for preterm neonates. A better understanding of the demographic, clinical, and biologic underpinnings of preterm birth is urgently needed to plan interventions and inform new discovery. Methods: The Zambian Preterm Birth Prevention Study (ZAPPS) is a prospective antenatal cohort established at the Women and Newborn Hospital of the University Teaching Hospital (UTH) in Lusaka, Zambia. We recruit pregnant women from the antenatal clinics of district health centers and the UTH for study participation. Women undergo ultrasound examination to determine eligibility by gestational age criteria. Enrolled participants receive routine antenatal and postnatal care, lab testing, midtrimester cervical length measurement, serial fetal growth monitoring and careful assessment of birth outcomes. Results: Between August 2015 and September 2017, we screened 1784 women, of whom 1450 (81.2%) met inclusion criteria and were enrolled. The median age at enrollment of study participants is 27 years (IQR 23–32). Participants are enrolled at a median gestational age of 16 weeks (IQR 13–18). Among all parous participants (N=866; 64%), 21% (N=182) reported a prior miscarriage, 49% (N=424) reported a prior preterm birth, and 13% (N=116) reported a prior stillbirth. The HIV seroprevalence in our cohort is 24%. Discussion: We have established a large antenatal cohort to characterize the epidemiological and biological determinants of adverse birth outcomes in Lusaka, Zambia. Findings from this cohort will help guide future studies, clinical care, and policy in the prevention and treatment of adverse birth outcomes.

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The Zambian Preterm Birth Prevention Study (ZAPPS): Cohort characteristics at enrollment

Gates Open Research ◽

10.12688/gatesopenres.12820.3 ◽

2019 ◽

Vol 2 ◽

pp. 25

Author(s):

Marcela C. Castillo ◽

Nurain M. Fuseini ◽

Katelyn Rittenhouse ◽

Joan T. Price ◽

Bethany L. Freeman ◽

...

Keyword(s):

Preterm Birth ◽

Pregnant Women ◽

Gestational Age ◽

Clinical Care ◽

Phase 1 ◽

Adverse Outcomes ◽

Sub Saharan Africa ◽

Growth Monitoring ◽

Prevention Study ◽

District Health

Background: Sub-Saharan Africa bears a disproportionate burden of preterm birth and other adverse outcomes. A better understanding of the demographic, clinical, and biologic underpinnings of these adverse outcomes is urgently needed to plan interventions and inform new discovery. Methods: The Zambian Preterm Birth Prevention Study (ZAPPS) is a prospective observational cohort established at the Women and Newborn Hospital (WNH) in Lusaka, Zambia. We recruit pregnant women from district health centers and the WNH and offer ultrasound examination to determine eligibility. Participants receive routine obstetrical care, lab testing, midtrimester cervical length measurement, and serial fetal growth monitoring. At delivery, we assess gestational age, birthweight, vital status, and sex and assign a delivery phenotype. We collect blood, urine, and vaginal swab specimens at scheduled visits and store them in an on-site biorepository. In September 2017, enrollment of the ZAPPS Phase 1—the subject of this report—was completed. Phase 2, which is limited to HIV-uninfected women, reopened in January 2018. Results: Between August 2015 and September 2017, we screened 1784 women, of whom 1450 (81.2%) met inclusion criteria and were enrolled. The median age at enrollment was 27 years (IQR 23–32) and median gestational age was 16 weeks (IQR 13–18). Among women with a previous pregnancy (n=1042), 19% (n=194) reported a prior miscarriage. Among parous women (n=992), 41% (n=411) reported a prior preterm birth and 14% (n=126) reported a prior stillbirth. The HIV seroprevalence was 24%. Discussion: We have established a large cohort of pregnant women and newborns at the WNH to characterize the determinants of adverse birth outcomes in Lusaka, Zambia. Our overarching goal is to elucidate biological mechanisms in an effort to identify new strategies for early detection and prevention of adverse outcomes. We hope that findings from this cohort will help guide future studies, clinical care, and policy.

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The Zambian Preterm Birth Prevention Study (ZAPPS): Cohort characteristics at enrollment

Gates Open Research ◽

10.12688/gatesopenres.12820.2 ◽

2018 ◽

Vol 2 ◽

pp. 25 ◽

Cited By ~ 4

Author(s):

Marcela C. Castillo ◽

Nurain M. Fuseini ◽

Katelyn Rittenhouse ◽

Joan T. Price ◽

Bethany L. Freeman ◽

...

Keyword(s):

Preterm Birth ◽

Pregnant Women ◽

Gestational Age ◽

Clinical Care ◽

Phase 1 ◽

Adverse Outcomes ◽

Sub Saharan Africa ◽

Growth Monitoring ◽

Prevention Study ◽

District Health

Background:Sub-Saharan Africa bears a disproportionate burden of preterm birth and other adverse outcomes. A better understanding of the demographic, clinical, and biologic underpinnings of these adverse outcomes is urgently needed to plan interventions and inform new discovery. Methods:The Zambian Preterm Birth Prevention Study (ZAPPS) is a prospective observational cohort established at the Women and Newborn Hospital (WNH) in Lusaka, Zambia. We recruit pregnant women from district health centers and the WNH and offer ultrasound examination to determine eligibility. Participants receive routine obstetrical care, lab testing, midtrimester cervical length measurement, and serial fetal growth monitoring. At delivery, we assess gestational age, birthweight, vital status, and sex and assign a delivery phenotype. We collect blood, urine, and vaginal swab specimens at scheduled visits and store them in an on-site biorepository. In September 2017, enrollment of the ZAPPS Phase 1 – the subject of this report – was completed. Phase 2 – which is limited to HIV-uninfected women – reopened in January 2018. Results:Between August 2015 and September 2017, we screened 1784 women, of whom 1450 (81.2%) met inclusion criteria and were enrolled. The median age at enrollment was 27 years (IQR 23–32) and thee median gestational age was 16 weeks (IQR 13–18). Among parous women (N=866; 64%), 21% (N=182) reported a prior miscarriage, 49% (N=424) reported a prior preterm birth, and 13% (N=116) reported a prior stillbirth. The HIV seroprevalence was 24%. Discussion:We have established a large cohort of pregnant women and newborns at the WHN to characterize the determinants of adverse birth outcomes in Lusaka, Zambia. Our overarching goal is to elucidate biological mechanisms in an effort to identify new strategies for early detection and prevention of adverse outcomes. We hope that findings from this cohort will help guide future studies, clinical care, and policy.

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Adverse birth outcomes and their clinical phenotypes in an urban Zambian cohort

Gates Open Research ◽

10.12688/gatesopenres.13046.1 ◽

2019 ◽

Vol 3 ◽

pp. 1533

Author(s):

Joan T Price ◽

Bellington Vwalika ◽

Katelyn J Rittenhouse ◽

Humphrey Mwape ◽

Jennifer Winston ◽

...

Keyword(s):

Preterm Birth ◽

Phase I ◽

Birth Outcomes ◽

Gestational Age ◽

Small For Gestational Age ◽

Sub Saharan Africa ◽

Age Dating ◽

Adverse Birth Outcomes ◽

Short Cervix ◽

Sub Saharan

Background: Few cohort studies of pregnancy in sub-Saharan Africa use rigorous gestational age dating and clinical phenotyping. As a result, incidence and risk factors of adverse birth outcomes are inadequately characterized. Methods: The Zambian Preterm Birth Prevention Study (ZAPPS) is a prospective observational cohort established to investigate adverse birth outcomes at a referral hospital in urban Lusaka. This report describes ZAPPS phase I, enrolled August 2015 to September 2017. Women were followed through pregnancy and 42 days postpartum. At delivery, study staff assessed neonatal vital status, birthweight, sex, and assigned a delivery phenotype. Primary outcomes were: (1) preterm birth (PTB; delivery <37 weeks), (2) small-for-gestational-age (SGA; <10th percentile weight-for-age at birth), and (3) stillbirth (SB; delivery of an infant without signs of life). Results: ZAPPS phase I enrolled 1450 women with median age 27 years (IQR 23–32). Most participants (68%) were multiparous, of whom 41% reported a prior PTB and 14% reported a prior stillbirth. Twins were present in 3% of pregnancies, 3% of women had short cervix (<25mm), 24% of women were HIV seropositive, and 5% were syphilis seropositive. Of 1216 (84%) retained at delivery, 15% were preterm, 18% small-for-gestational-age, and 4% stillborn. PTB risk was higher with prior PTB (aRR 1.88; 95%CI 1.32–2.68), short cervix (aRR 2.62; 95%CI 1.68–4.09), twins (aRR 5.22; 95%CI 3.67–7.43), and antenatal hypertension (aRR 2.04; 95%CI 1.43–2.91). SGA risk was higher with twins (aRR 2.75; 95%CI 1.81–4.18) and antenatal hypertension (aRR 1.62; 95%CI 1.16–2.26). SB risk was higher with short cervix (aRR 6.42; 95%CI 2.56–16.1). Conclusions: This study confirms high rates of PTB, SGA, and SB among pregnant women in Lusaka, Zambia. Accurate gestational age dating and careful ascertainment of delivery data are critical to understanding the scope of adverse birth outcomes in low-resource settings.

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Adverse birth outcomes and their clinical phenotypes in an urban Zambian cohort

Gates Open Research ◽

10.12688/gatesopenres.13046.2 ◽

2020 ◽

Vol 3 ◽

pp. 1533

Author(s):

Joan T Price ◽

Bellington Vwalika ◽

Katelyn J Rittenhouse ◽

Humphrey Mwape ◽

Jennifer Winston ◽

...

Keyword(s):

Preterm Birth ◽

Phase I ◽

Birth Outcomes ◽

Gestational Age ◽

Small For Gestational Age ◽

Sub Saharan Africa ◽

Age Dating ◽

Adverse Birth Outcomes ◽

Short Cervix ◽

Sub Saharan

Background: Few cohort studies of pregnancy in sub-Saharan Africa use rigorous gestational age dating and clinical phenotyping. As a result, incidence and risk factors of adverse birth outcomes are inadequately characterized. Methods: The Zambian Preterm Birth Prevention Study (ZAPPS) is a prospective observational cohort established to investigate adverse birth outcomes at a referral hospital in urban Lusaka. This report describes ZAPPS phase I, enrolled August 2015 to September 2017. Women were followed through pregnancy and 42 days postpartum. At delivery, study staff assessed neonatal vital status, birthweight, and sex, and assigned a delivery phenotype. Primary outcomes were: (1) preterm birth (PTB; delivery <37 weeks), (2) small-for-gestational-age (SGA; <10th percentile weight-for-age at birth), and (3) stillbirth (SB; delivery of an infant without signs of life). Results: ZAPPS phase I enrolled 1450 women with median age 27 years (IQR 23–32). Most participants (68%) were multiparous, of whom 41% reported a prior PTB and 14% reported a prior stillbirth. Twins were present in 3% of pregnancies, 3% of women had short cervix (<25mm), 24% of women were HIV seropositive, and 5% were syphilis seropositive. Of 1216 (84%) retained at delivery, 15% were preterm, 18% small-for-gestational-age, and 4% stillborn. PTB risk was higher with prior PTB (aRR 1.88; 95%CI 1.32–2.68), short cervix (aRR 2.62; 95%CI 1.68–4.09), twins (aRR 5.22; 95%CI 3.67–7.43), and antenatal hypertension (aRR 2.04; 95%CI 1.43–2.91). SGA risk was higher with twins (aRR 2.75; 95%CI 1.81–4.18) and antenatal hypertension (aRR 1.62; 95%CI 1.16–2.26). SB risk was higher with short cervix (aRR 6.42; 95%CI 2.56–16.1). Conclusions: This study confirms high rates of PTB, SGA, and SB among pregnant women in Lusaka, Zambia. Accurate gestational age dating and careful ascertainment of delivery data are critical to understanding the scope of adverse birth outcomes in low-resource settings.

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

European Journal of Epidemiology ◽

10.1007/s10654-021-00793-x ◽

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

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Formulating a Meaningful and Comprehensive Placental Phenotypic Classification

Pediatric and Developmental Pathology ◽

10.1177/10935266211008444 ◽

2021 ◽

pp. 109352662110084

Author(s):

Alexa A Freedman ◽

Lauren S Keenan-Devlin ◽

Ann Borders ◽

Gregory E Miller ◽

Linda M Ernst

Keyword(s):

Preterm Birth ◽

Birth Outcomes ◽

Gestational Age ◽

Web Application ◽

Acute Inflammation ◽

Low Grade ◽

Adverse Birth Outcomes ◽

High Grade ◽

Placental Pathology ◽

Pathology Reports

Introduction While many placental lesions have been identified and defined, the significance of multiple overlapping lesions has not been addressed. The purpose of our analysis was to evaluate overlapping patterns of placental pathology and determine meaningful phenotypes associated with adverse birth outcomes. Methods Placental pathology reports were obtained from a single hospital between 2009 and 2018. Placental lesions were grouped into four major categories: acute inflammation (AI), chronic inflammation (CI), maternal vascular malperfusion (MVM), and fetal vascular malperfusion (FVM). Within each category, lesions were classified as not present, low grade or high grade. Combinations of pathologies were evaluated in relation to preterm birth (<37 weeks) and small for gestational age (SGA) infant (birthweight <10th percentile). Results During the study period, 19,027 placentas were reviewed by pathologists. Results from interaction models indicate that MVM and MVM in combination with CI and/or FVM are associated with the greatest odds of SGA infant and PTB. When incorporating grade, we identified 21 phenotype groups, each with characteristic associations with the SGA infant and patterns of PTB. Discussion We have developed a comprehensive and meaningful placental phenotype that incorporates severity and multiplicity of placental lesions. We have also developed a web application to facilitate phenotype determination ( https://placentaexpression.shinyapps.io/phenotype ).

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Dietary iron and calcium intakes during pregnancy are associated with lower risk of prematurity, stillbirth and neonatal mortality among women in Tanzania

Public Health Nutrition ◽

10.1017/s1368980016002809 ◽

2016 ◽

Vol 20 (4) ◽

pp. 678-686 ◽

Cited By ~ 9

Author(s):

Dominic Mosha ◽

Enju Liu ◽

Ellen Hertzmark ◽

Grace Chan ◽

Christopher Sudfeld ◽

...

Keyword(s):

Preterm Birth ◽

Dietary Intake ◽

Pregnant Women ◽

Neonatal Mortality ◽

Birth Outcomes ◽

Perinatal Care ◽

Adverse Outcomes ◽

Adverse Birth Outcomes ◽

Increased Risk ◽

Reduced Risk

AbstractObjectivePrematurity, stillbirth and other adverse birth outcomes remain major concerns in resource-limited settings. Poor dietary intake of micronutrients during pregnancy has been associated with increased risk of adverse outcomes. We determined the relationships between dietary Fe and Ca intakes during pregnancy and risks of adverse birth outcomes among HIV-negative women.DesignWomen’s diet was assessed through repeated 24 h diet recalls in pregnancy. Mean intakes of total Fe, Fe from animal sources and Ca during pregnancy were examined in relation to adverse birth outcomes and neonatal mortality. Women were prescribed daily Fe supplements as per standard perinatal care.SettingDar es Salaam, Tanzania.SubjectsA cohort of 7634 pregnant women.ResultsMedian (interquartile range) daily dietary intake of total Fe, animal Fe and Ca was 11·9 (9·3–14·7), 0·5 (0–1·1) and 383·9 (187·4–741·2) mg, respectively. Total Fe intake was significantly associated with reduced risk of stillbirth (trend over quartiles, P=0·010). Animal Fe intake was significantly associated with reduced risk of preterm birth and extreme preterm birth. Animal Fe intake was inversely related to neonatal mortality risk; compared with women in the lowest intake quartile, those in the top quartile were 0·51 times as likely to have neonatal death (95 % CI 0·33, 0·77). Higher Ca intake was associated with reduced risk of preterm birth (relative risk; 95 % CI: 0·76; 0·65, 0·88) and extreme preterm birth (0·63; 0·47, 0·86). Women in the highest Ca intake quartile had reduced risk of neonatal mortality (0·59; 0·37, 0·92).ConclusionsDaily dietary Fe and Ca intakes among pregnant women are very low. Improvement of women’s diet quality during gestation is likely to improve the risks of adverse birth outcomes.

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Cohort Profile: Prematurity Immunology in HIV-infected Mothers and their infants Study (PIMS)

10.1101/2020.03.18.20033654 ◽

2020 ◽

Cited By ~ 1

Author(s):

Thokozile R Malaba ◽

Clive M Gray ◽

Landon Myer ◽

Marie-Louise Newell ◽

Keyword(s):

Immune Responses ◽

Birth Outcomes ◽

Gestational Age ◽

Mononuclear Cells ◽

Clinical Care ◽

Blood Pressure Measurement ◽

Hiv Care ◽

Adverse Birth Outcomes ◽

Clinical Records ◽

The Relationship

AbstractPurposePIMS, is a prospective cohort study in South Africa investigating the association between antiretroviral therapy (ART) use, preterm delivery (PTD)and small-for gestational age (SGA) live births. PIMS main hypotheses are that ART initiation in pregnancy and ART-induced hypertension are associated with PTD and SGA respectively and that reconstitution of cellular immune responses in women on ART from before pregnancy results in increases in PTD of appropriate-for-gestational age (AGA) infants.ParticipantsPregnant women (n=3972) aged ≥18 years regardless of HIV status recruited from 2015 to 2016 into the overall PIMS cohort (2517 HIV-uninfected, 1455 HIV-infected). A nested cohort contained 551 HIV-infected women who were ≤24 weeks’ GA on ultrasound: 261 initiated ART before pregnancy, 290 initiated during pregnancy.Findings to dateWomen in the overall cohort were followed antenatally through to delivery using routine clinical records; further women in the nested cohort were actively followed up until 12 months postpartum, with data were collected on maternal health (HIV care and ART use, clinical care and inter-current clinical history). Other procedures conducted on the nested cohort included physical examinations (anthropometry, blood pressure measurement), assessment of fetal growth (ultrasound), maternal and infant phlebotomy for storage of plasma, RNA and peripheral blood mononuclear cells, collection of delivery specimens (placenta and cord blood), and infant 12 month developmental assessment. Preliminary findings have contributed to our understanding of risk factors for adverse birth outcomes, and the relationship between pregnancy immunology, HIV/ART and adverse birth outcomes.Future plansUsing specimens collected from HIV-infected study participants throughout pregnancy and first year of life, the PIMS provides a valuable platform for answering a variety of research questions focused on temporal changes of immunology markers in women whose immune status is altered by HIV infection, and how ART initiated during pregnancy affects immune responses. The relationship between these immunological changes with adverse birth outcomes as well as possible longer-term impact of exposure to ART in fetal and early life will be explored. Additionally, further active and passive follow-up of mothers and their infants is planned at school-going age and beyond to chart growth, morbidity and development, as well as changes in family circumstances.

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Mass incarceration and public health: the association between black jail incarceration and adverse birth outcomes among black women in Louisiana

BMC Pregnancy and Childbirth ◽

10.1186/s12884-019-2690-z ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Lauren Dyer ◽

Rachel Hardeman ◽

Dovile Vilda ◽

Katherine Theall ◽

Maeve Wallace

Keyword(s):

Birth Weight ◽

Preterm Birth ◽

Black Women ◽

Low Birth Weight ◽

Racial Disparities ◽

Population Health ◽

Birth Outcomes ◽

Mass Incarceration ◽

Interquartile Range ◽

Adverse Birth Outcomes

Abstract Background A growing body of evidence is beginning to highlight how mass incarceration shapes inequalities in population health. Non-Hispanic blacks are disproportionately affected by incarceration and criminal law enforcement, an enduring legacy of a racially-biased criminal justice system with broad health implications for black families and communities. Louisiana has consistently maintained one of the highest rates of black incarceration in the nation. Concurrently, large racial disparities in population health persist. Methods We conducted a cross-sectional analysis of all births among non-Hispanic black women in Louisiana in 2014 to identify associations between parish-level (county equivalent) prevalence of jail incarceration within the black population and adverse birth outcomes (N = 23,954). We fit a log-Poisson model with generalized estimating equations to approximate the relative risk of preterm birth and low birth weight associated with an interquartile range increase in incarceration, controlling for confounders. In sensitivity analyses, we additionally adjusted for the parish-level index crime prevalence and analyzed regression models wherein white incarceration was used to predict the risk of adverse birth outcomes in order to quantify the degree to which mass incarceration may harm health above and beyond living in a high crime area. Results There was a significant 3% higher risk of preterm birth among black women associated with an interquartile range increase in the parish-level incarceration prevalence of black individuals, independent of other factors. Adjusting for the prevalence of index crimes did not substantively change the results of the models. Conclusion Due to the positive significant associations between the prevalence of black individuals incarcerated in Louisiana jails and estimated risk of preterm birth, mass incarceration may be an underlying cause of the persistent inequities in reproductive health outcomes experienced by black women in Louisiana. Not only are there economic and social impacts stemming from mass incarceration, but there may also be implications for population health and health inequities, including the persistence of racial disparities in preterm birth and low birth weight.

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POS0719 ADVERSE OUTCOMES AND REHOSPITALIZATION AFTER DELIVERY AMONG WOMEN WITH SYSTEMIC LUPUS ERYTHEMATOSUS OR RHEUMATOID ARTHRITIS AND THEIR INFANTS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.1127 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 609.1-609

Author(s):

J. Sabo ◽

N. Singh ◽

D. A. Crane ◽

D. R. Doody ◽

M. A. Schiff ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Systemic Lupus Erythematosus ◽

Hospital Discharge ◽

Birth Outcomes ◽

Gestational Age ◽

Small For Gestational Age ◽

Lupus Erythematosus ◽

Adverse Outcomes ◽

Systemic Lupus ◽

Cesarean Deliveries

Background:Women with rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE) have greater risk of adverse obstetric and birth outcomes than women without these conditions. Infant outcomes are less well-studied. It is unknown whether re-hospitalization after delivery occurs more often for affected mothers and their infants.Objectives:We compared obstetric outcomes among women with and without RA or SLE, and birth outcomes among their infants. Maternal and infant rehospitalizations <2 years of delivery were also compared.Methods:This population-based cohort study used linked birth-hospital discharge data from Washington State for 1987-2014. International Classification of Disease 9th revision (ICD9) codes identified all women with RA (ICD9 714.X, 725.X) and SLE (ICD9 710, 710.0, 710.1) in the hospital discharge record at delivery, and a 10:1 comparison group of women without these codes. Analyses were restricted to singleton live births (1,223 RA; 1,354 SLE). Poisson regression with robust standard errors estimated relative risks (RR) and 95% confidence intervals (CI) for selected outcomes, accounting for delivery year, maternal age, and parity.Results:Many adverse outcomes were more common among RA and SLE cases than among comparison women. Preeclampsia occurred more often during pregnancies of women with RA (RR 1.42, 95% CI 1.17-1.71) or SLE (RR 2.33, 95% CI 2.01-2.70), as did preterm rupture of membranes (PROM, RR 2.85, 95% CI 2.20-3.72 for RA; RR 3.28, 95% CI 2.54-4.23 for SLE). Cesarean deliveries were more common among nulliparous women in both groups (RR 1.32, 95% CI 1.18-1.48 for both conditions). Infants of women with RA or SLE were more likely to weigh <2500 g (RR 2.08, 95% CI 1.72-2.52 for RA; RR 4.88, 95% CI 4.27-5.58 for SLE), be small for gestational age (RR 1.25, 95% CI 1.07-2.50; RR 2.30; 2.04-2.59, respectively), delivered at <32 weeks gestation (RR 1.83, 95% CI 1.13-2.97; RR 5.13, 95% CI 3.75-7.01, respectively), and require neonatal intensive care unit admission (NICU, RR 1.89, 95% CI 1.56-2.30; RR 2.71, 95% CI 2.25-3.28, respectively). Infants of women with SLE were more likely to have a malformation (RR 1.46, 95% CI 1.21-1.75) or die within 2 years (RR 2.11, 95% CI 1.21-3.67). Rehospitalization levels among both women with RA (RR 2.22; 1.62-3.04) and SLE (RR 2.78, 95% CI 2.15-3.59) were greatest <6 months of delivery and declined over time. Infants of women with SLE had increased rehospitalization <6 months (RR 1.64, 95% CI 1.36-1.98).Conclusion:Consistent with prior literature, we found women with RA or SLE experienced many adverse outcomes. In our data, these included preeclampsia, PROM, and cesarean deliveries, with increased risks more notable among women with SLE. Infants of women with either condition were more likely to weigh <2500g, be <32 weeks gestation, small for gestational age, and require NICU admission than infants of comparison women. Only infants of women with SLE had increased malformations. Maternal rehospitalization after delivery was more common in both groups; most marked at <6 months. Infant rehospitalizations were increased in both cohorts to a lesser extent. Close follow-up during this time period is crucial to minimize adverse outcomes.Disclosure of Interests:Julianna Sabo: None declared, Namrata Singh: None declared, Deborah A. Crane: None declared, David R. Doody: None declared, Melissa A. Schiff: None declared, Beth A. Mueller Shareholder of: Household owns shares in AstraZeneca

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