scholarly journals Conflict violence reduction and pregnancy outcomes: A regression discontinuity design in Colombia

PLoS Medicine ◽  
2021 ◽  
Vol 18 (7) ◽  
pp. e1003684
Author(s):  
Giancarlo Buitrago ◽  
Rodrigo Moreno-Serra
Keyword(s):  
Perinatal Mortality ◽  
Pregnancy Outcomes ◽  
Regression Discontinuity ◽  
Peace Process ◽  
Armed Conflicts ◽  
Sensitivity Analyses ◽  
Exposure Misclassification ◽  
Violence During Pregnancy ◽  
Adverse Pregnancy ◽  
Violent Events

Background The relationship between exposure to conflict violence during pregnancy and the risks of miscarriage, stillbirth, and perinatal mortality has not been studied empirically using rigorous methods and appropriate data. We investigated the association between reduced exposure to conflict violence during pregnancy and the risks of adverse pregnancy outcomes in Colombia. Methods and findings We adopted a regression discontinuity (RD) design using the July 20, 2015 cease-fire declared during the Colombian peace process as an exogenous discontinuous change in exposure to conflict events during pregnancy, comparing women with conception dates before and after the cease-fire date. We constructed the cohorts of all pregnant women in Colombia for each day between January 1, 2013 and December 31, 2017 using birth and death certificates. A total of 3,254,696 women were followed until the end of pregnancy. We measured conflict exposure as the total number of conflict events that occurred in the municipality where a pregnant woman lived during her pregnancy. We first assessed whether the cease-fire did induce a discontinuous fall in conflict exposure for women with conception dates after the cease-fire to then estimate the association of this reduced exposure with the risks of miscarriage, stillbirth, and perinatal mortality. We found that the July 20, 2015 cease-fire was associated with a reduction of the average number of conflict events (from 2.64 to 2.40) to which women were exposed during pregnancy in their municipalities of residence (mean differences −0.24; 95% confidence interval [CI] −0.35 to −0.13; p < 0.001). This association was greater in municipalities where Fuerzas Armadas Revolucionarias de Colombia (FARC) had a greater presence historically. The reduction in average exposure to conflict violence was, in turn, associated with a decrease of 9.53 stillbirths per 1,000 pregnancies (95% CI −16.13 to −2.93; p = 0.005) for municipalities with total number of FARC-related violent events above the 90th percentile of the distribution of FARC-related conflict events and a decrease of 7.57 stillbirths per 1,000 pregnancies (95% CI −13.14 to −2.00; p = 0.01) for municipalities with total number of FARC-related violent events above the 75th percentile of FARC-related events. For perinatal mortality, we found associated reductions of 10.69 (95% CI −18.32 to −3.05; p = 0.01) and 6.86 (95% CI −13.24 to −0.48; p = 0.04) deaths per 1,000 pregnancies for the 2 types of municipalities, respectively. We found no association with miscarriages. Formal tests support the validity of the key RD assumptions in our data, while a battery of sensitivity analyses and falsification tests confirm the robustness of our empirical results. The main limitations of the study are the retrospective nature of the information sources and the potential for conflict exposure misclassification. Conclusions Our study offers evidence that reduced exposure to conflict violence during pregnancy is associated with important (previously unmeasured) benefits in terms of reducing the risk of stillbirth and perinatal deaths. The findings are consistent with such beneficial associations manifesting themselves mainly through reduced violence exposure during the early stages of pregnancy. Beyond the relevance of this evidence for other countries beset by chronic armed conflicts, our results suggest that the fledgling Colombian peace process may be already contributing to better population health.

scholarly journals The Impact of Exposure Misclassification on Associations Between Prepregnancy BMI and Adverse Pregnancy Outcomes

Obesity ◽  
2010 ◽  
Vol 18 (11) ◽  
pp. 2184-2190 ◽  
Author(s):  
Lisa M. Bodnar ◽  
Anna Maria Siega-Riz ◽  
Hyagriv N. Simhan ◽  
Jill C. Diesel ◽  
Barbara Abrams
Keyword(s):  
Pregnancy Outcomes ◽  
Adverse Pregnancy Outcomes ◽  
Exposure Misclassification ◽  
Prepregnancy Bmi ◽  
Adverse Pregnancy ◽  
The Impact

Regression Discontinuity Design and Policy Evaluation: an Evaluation of Smoke Free Legislation on Adverse Pregnancy Outcomes

2014 ◽  
Vol 2014 (1) ◽  
pp. 2495
Author(s):  
Ioannis Bakolis* ◽  
Nicky Best ◽  
Daniela Fecht ◽  
Anna Hansell ◽  
Christopher Millett ◽  
...  
Keyword(s):  
Policy Evaluation ◽  
Pregnancy Outcomes ◽  
Regression Discontinuity ◽  
Adverse Pregnancy Outcomes ◽  
Regression Discontinuity Design ◽  
Adverse Pregnancy

scholarly journals Perinatal mortality and adverse pregnancy outcomes in a low-income rural population of women who smoke

2012 ◽  
Vol 94 (4) ◽  
pp. 223-229 ◽  
Author(s):  
Jane A. McElroy ◽  
Tina Bloom ◽  
Kelly Moore ◽  
Beth Geden ◽  
Kevin Everett ◽  
...  
Keyword(s):  
Perinatal Mortality ◽  
Low Income ◽  
Pregnancy Outcomes ◽  
Rural Population ◽  
Adverse Pregnancy Outcomes ◽  
Adverse Pregnancy

scholarly journals Periodontal Disease and Pregnancy Outcomes: Overview of Systematic Reviews

2017 ◽  
Vol 3 (1) ◽  
pp. 10-27 ◽  
Author(s):  
L.A. Daalderop ◽  
B.V. Wieland ◽  
K. Tomsin ◽  
L. Reyes ◽  
B.W. Kramer ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Relative Risk ◽  
Periodontal Disease ◽  
Perinatal Mortality ◽  
Systematic Reviews ◽  
Pregnancy Outcomes ◽  
Risk Of Bias ◽  
Adverse Pregnancy Outcomes ◽  
Overview Of Systematic Reviews ◽  
Adverse Pregnancy

Periodontal disease is very common during pregnancy. Although it has been linked to adverse pregnancy outcomes, systematic reviews have reached discrepant conclusions on these links. Therefore, we conducted a systematic overview of systematic reviews studying the association between periodontal disease and adverse pregnancy outcomes. We searched 6 online databases up to November 2016 and hand-searched references and citations of eligible papers. Systematic reviews of studies comparing pregnancy outcomes among women with and without periodontal disease were eligible for inclusion. Primary outcomes were maternal mortality, preterm birth, and perinatal mortality. Two reviewers extracted data and assessed risk of bias of individual systematic reviews. Findings are described in tabular and narrative form. Twenty-three systematic reviews (including between 3 and 45 studies) were included. None reported the association between periodontal disease and maternal or perinatal mortality. Systematic reviews with the lowest risk of bias consistently demonstrated positive associations between periodontal disease and preterm birth (relative risk, 1.6; 95% confidence interval, 1.3 to 2.0; 17 studies, 6,741 participants), low birth weight (LBW; relative risk, 1.7; 95% CI, 1.3 to 2.1; 10 studies, 5,693 participants), preeclampsia (odds ratio, 2.2; 95% CI, 1.4 to 3.4; 15 studies, 5,111 participants), and preterm LBW (relative risk 3.4; 95% CI, 1.3 to 8.8; 4 studies, 2,263 participants). Based on these figures, estimated population-attributable fractions for periodontal disease were 5% to 38% for preterm birth, 6% to 41% for LBW, and 10% to 55% for preeclampsia. In terms of limitations, as several primary studies did not adjust for confounding, meta-analyses may have overestimated the strength of the associations under study. Due to substantial overlap in included primary studies, we could not aggregate results across reviews. Consistent evidence from systematic reviews with low risk of bias indicates that pregnant women with periodontal disease are at increased risk of developing preeclampsia and delivering a preterm and/or LBW baby (PROSPERO: CRD42015030132). Knowledge Transfer Statement: This study highlights that periodontal disease is an important risk factor for several common adverse pregnancy outcomes. Clinicians should be aware of this link to guide risk selection. Research is needed to develop novel preventive and treatment strategies.

scholarly journals Assessing the Effects of Maternal HIV Infection on Pregnancy Outcomes using Cross-sectional Data in Malawi

2020 ◽  
Author(s):  
Halima Sumayya Twabi ◽  
Samuel O Manda ◽  
Dylan S Small
Keyword(s):  
Birth Weight ◽  
Hiv Infection ◽  
Perinatal Mortality ◽  
Pregnancy Outcomes ◽  
Demographic And Health Surveys ◽  
Cross Sectional ◽  
Hiv Test ◽  
Maternal Hiv ◽  
Maternal Hiv Infection ◽  
Adverse Pregnancy

Abstract Background : Several studies have shown that maternal HIV infection is associated with adverse pregnancy outcomes such as low birth weight and perinatal mortality. However, the association is conflicted with the effect of antiretroviral therapy (ART) on the pregnancy outcomes and it remains unexamined. Using methods for matching possible confounders, the objectives of the study were to assess the effect of maternal HIV on birth weight and perinatal mortality and to investigate the effect of ART on these two pregnancy outcomes in HIV-infected women. Methods: Data on 4111 and 4759 children, born within five years of the 2010 and 2015-16 Malawi Demographic and Health Surveys (MDHS) respectively, whose mothers had an HIV test result, were analysed. A best balancing method was chosen from a set of covariate balance methods namely, the 1:1 nearest neighbour (NN) matching, matching on the propensity score (PS) and inverse weighting on the PS. HIV and ART data were only available in the MDHS 2010, permitting an assessment of the moderating effect of ART on the association between maternal HIV infection and birth weight and perinatal mortality. Results: In 2010, maternal HIV infection was negatively associated with birth weight (-25.3g, 95% CI:(-95.5, -7.4)) and in 2015-16 it was positively associated with birth weight (116.3g, 95 % CI:(27.8, 204.7)). Perinatal mortality was higher in infants of HIV-infected mothers compared to infants of HIV-uninfected mothers (OR = 1.5, 95% CI:(1.1 - 3.1)) in 2010, while there was no difference in the rate in 2015-16 (OR = 1.0, 95% CI:(0.4, 1.6)). ART was not associated with birth weight, however, it was associated with perinatal mortality (OR=3.9, 95% CI:(1.1, 14.8)). Conclusion: The study has found that maternal HIV infection had an adverse effect on birth weight and perinatal mortality in 2010. Birth weight was not dependent on ART uptake but perinatal mortality was higher among infants of HIV-infected mothers who were not on ART. The higher birth weight among HIV-infected mothers and similarity in perinatal mortality with HIV-uninfected mothers in 2015-16 may be indicative of successes of interventions within the PMTCT program in Malawi.

Reproductive health issues in patients with psoriasis (literature review)

2019 ◽  
Vol 1 (7) ◽  
pp. 5-8
Author(s):  
L. S. Kruglova ◽  
A. A. Osina ◽  
A. A. Khotko
Keyword(s):  
Drug Therapy ◽  
Reproductive Health ◽  
Literature Review ◽  
Pregnancy Outcomes ◽  
Adverse Pregnancy Outcome ◽  
Certolizumab Pegol ◽  
Genetically Engineered ◽  
Health Issues ◽  
Degree Of Confidence ◽  
Adverse Pregnancy

Among patients with psoriasis, approximately 50% are women and almost 75 % of them are under the age of 40 years. Thus, most women with psoriasis have childbearing potential. When pregnancy occurs in 22 % of patients, the activity of psoriasis persists, characteristic of the course before pregnancy, in 23 % of women, the course of the disease worsens. The article provides up-to-date data on the management of pregnant patients with psoriasis. To improve pregnancy outcomes in patients with psoriasis, it is important to prevent exacerbation of the disease. The choice of drug therapy in this case is based on an assessment of the ratio of the risk of undesirable effects of the drugs on the developing fetus and the risk of the development of exacerbation of psoriasis, which can cause an adverse pregnancy outcome. Despite the fact that the available clinical experience of using genetically engineered drugs is still limited, with a certain degree of confidence we can say that there is no increase in the risk of adverse pregnancy outcomes associated with therapy with certolizumab pegol.

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