Risk of Adverse Fetal Outcomes Following Nonobstetric Surgery During Gestation: A Nationwide Population-Based Analysis

Abstract Background: Literature suggests that nonobstetric surgery during gestation is associated with a higher risk of spontaneous abortion, prematurity, and a higher cesarean section rate, but the direct impact on fetal outcomes is still unclear. In this study, we aimed to investigate whether nonobstetric surgery during pregnancy is associated with negative fetal outcomes by analysing a nation-wide database in Taiwan.Methods: This population-based retrospective observational study was based on the linkage of Taiwan’s National Health Insurance Research Database, Birth Reporting Database, and Maternal and Child Health Database between 2004 and 2014. For every pregnancy with nonobstetric surgery during gestation, four controls were randomly matched according to maternal age and delivery year. We estimated adjusted odds ratios (aOR) and 95% confidence intervals (CIs) of adverse fetal outcomes with the non-surgery group as the reference. The primary outcomes involved stillbirth, prematurity, low birth weight, low Apgar scores, and neonatal and infant death.Results: Among 23,721 identified pregnancies, 4,747 underwent nonobstetric surgery. Pregnancies with nonobstetric surgery had significantly higher risks of prematurity (aOR: 1.46; 95% CI: 1.31–1.62), lower birth weight (aOR: 1.49; 95% CI: 1.33–1.67), Apgar scores <7 (1 min, aOR: 1.58; 95% CI: 1.33–1.86; 5 min, aOR: 1.34; 95% CI: 1.03–1.74), neonatal death (aOR: 2.01; 95% CI: 1.18–3.42), and infant death (aOR: 1.69; 95% CI: 1.12–2.54) than those without nonobstetric surgery after adjustment for socioeconomic deprivation, hospital level, and other comorbidities. Surgery performed in the third trimester was associated with a significantly increased rate of prematurity (aOR: 1.38; 95% CI: 1.03–1.85), but lower rates of stillbirth (aOR: 0.1; 95% CI: 0.01–0.75) and Apgar score <7 at the 5th minute (aOR: 0.2; 95% CI: 0.05–0.82), than surgery performed in the first trimester.Conclusions: Pregnancies with nonobstetric surgery during gestation were associated with increased risks of prematurity, low birth weight, low Apgar scores, neonatal and infant death, longer admission, and higher medical expenses than those without surgery. Furthermore, surgery in the third trimester was associated with a higher rate of prematurity than surgery performed in the first trimester.Trial registration: Not applicable

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Hemoglobin Concentration and Pregnancy Outcomes: A Systematic Review and Meta-Analysis

BioMed Research International ◽

10.1155/2013/769057 ◽

2013 ◽

Vol 2013 ◽

pp. 1-9 ◽

Cited By ~ 21

Author(s):

Bunyarit Sukrat ◽

Chumpon Wilasrusmee ◽

Boonying Siribumrungwong ◽

Mark McEvoy ◽

Chusak Okascharoen ◽

...

Keyword(s):

Systematic Review ◽

Birth Weight ◽

Preterm Birth ◽

Low Birth Weight ◽

Gestational Age ◽

Pregnancy Outcomes ◽

Meta Analysis ◽

First Trimester ◽

Third Trimester ◽

The Third

Objective. To conduct a systematic review and meta-analysis of hemoglobin effect on the pregnancy outcomes.Methods. We searched MEDLINE and SCOPUS from January 1, 1990 to April 10, 2011. Observational studies addressing association between hemoglobin and adverse pregnancy outcomes were selected. Two reviewers independently extracted data. A mixed logistic regression was applied to assess the effects of hemoglobin on preterm birth, low birth weight, and small for gestational age.Results. Seventeen studies were included in poolings. Hemoglobin below 11 g/dL was, respectively, 1.10 (95% CI: 1.02–1.19), 1.17 (95% CI: 1.03–1.32), and 1.14 (95% CI: 1.05–1.24) times higher risk of preterm birth, low birth weight, and small for gestational age than normal hemoglobin in the first trimester. In the third trimester, hemoglobin below 11 g/dL was 1.30 (95% CI: 1.08–1.58) times higher risk of low birth weight. Hemoglobin above 14 g/dL in third trimester decreased the risk of preterm term with ORs of 0.50 (95% CI: 0.26–0.97), but it might be affected by publication bias.Conclusions. Our review suggests that hemoglobin below 11 g/dl increases the risk of preterm birth, low birth weight, and small gestational age in the first trimester and the risk of low birth weight in the third trimester.

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Serum Ferritin Concentration in the Early Third Trimester of Pregnancy and Risk of Preterm Birth and Low Birth Weight Based on Gestational Age

JOURNAL OF THE KOREAN SOCIETY OF MATERNAL AND CHILD HEALTH ◽

10.21896/jksmch.2021.25.1.55 ◽

2021 ◽

Vol 25 (1) ◽

pp. 55-62

Author(s):

Tae Gyu Ahn ◽

Lan Li ◽

Se Jin Lee ◽

Yoon Hyeon Hu ◽

Chorong Kim ◽

...

Keyword(s):

Birth Weight ◽

Preterm Birth ◽

Low Birth Weight ◽

Serum Ferritin ◽

Premature Birth ◽

University Hospital ◽

Third Trimester ◽

Ferritin Concentration ◽

The Third ◽

National University

Objective: Although serum ferritin is considered the best measure of total body iron, with low levels indicating iron deficiency, recent studies have shown that high levels are associated with gestational diabetes, premature birth, and low birth weight. This study aimed to analyze the association between serum ferritin levels in the third trimester of pregnancy and low birth weight and preterm birth.Methods: This study included pregnant women who delivered a single fetus at Kangwon National University Hospital between January 2009 and December 2013 and in whom serum ferritin levels were measured between 28 and 34 weeks of gestation. The association between serum ferritin levels measured in the early third trimester of pregnancy and preterm birth and low birth weight infants was analyzed.Results: A total of 1,079 women fulfilled the study criteria and had their serum ferritin level measured during the third trimester (28–33.9 weeks of gestation) and later delivered at Kangwon National University Hospital. Comparison of the group with serum ferritin levels above the 75th percentile and those below the 25th percentile at the beginning of the third trimester revealed that the incidence of preterm births (<34 weeks of gestation, <37 weeks of gestation) and low birth weight were significantly higher in the group with serum ferritin levels above the 75th percentile than those below the 25th percentile (p<0.05). When variable factors were controlled through multiple regression analysis, the group whose serum ferritin levels were above the 75th percentile at 30–31.9 weeks of gestation had the highest risk of preterm birth before 34 weeks of gestation (adjusted odds ratio [OR], 7.85; 95% confidence interval [CI], 1.32–29.9) and low birth weight (adjusted OR, 6.49; 95% CI, 2.10–20.0).Conclusion: In this study, when serum ferritin was high in the third trimester of pregnancy, it was significantly increased with preterm birth (<34 and 37 weeks) and low birth weight. In particular, when serum ferritin levels were high at 30–31.9 weeks of gestation, the risk of premature birth before 34 weeks and low birth weight was statistically highest.

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Prevalence and Initial Diagnosis of Cerebral Palsy in Preterm and Term-Born Children in Taiwan: A Nationwide, Population-Based Cohort Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18178984 ◽

2021 ◽

Vol 18 (17) ◽

pp. 8984

Author(s):

Hsin-Hua Wang ◽

Yea-Shwu Hwang ◽

Chung-Han Ho ◽

Ming-Chi Lai ◽

Yu-Chin Chen ◽

...

Keyword(s):

Cerebral Palsy ◽

Birth Weight ◽

Low Birth Weight ◽

Very Low Birth Weight ◽

Population Based ◽

Initial Diagnosis ◽

Extremely Low Birth Weight ◽

Research Database ◽

Preterm Children

The aim of this long-term longitudinal study in Taiwan was to estimate and compare the prevalence of cerebral palsy (CP) and to identify the age of CP diagnosis of term-born and preterm children with different birthweights. Records of 1494 extremely low birth weight (ELBW, <1000 g), 3961 very low birth weight (VLBW, 1000–1499 g), 19,612 low birth weight (LBW, 1500–2499 g) preterm, and 100,268 matched term-born children were retrieved from Taiwan′s National Health Insurance Research Database. According to a 12-year retrospective data review, the results showed the highest prevalence of CP in preterm ELBW children (147.3 cases per 1000 neonatal survivors), followed by preterm VLBW (97.2 cases), preterm LBW (27.7 cases), with the lowest prevalence in term-born children (2.5 cases). Regardless of the birthweight group, 90% of preterm children with CP were diagnosed by 4 years of age, but it was 7 years before 90% of term-born children with CP were diagnosed. After removing the children whose CP was caused by brain infections, injuries, or cerebrovascular accidents after 4 months of age, there were similar mean ages at the initial CP diagnosis (1.58–1.64 years of age) across birthweight groups born prematurely, but initial diagnosis occurred at an older age (2.41 years of age) in term-born children. The results indicate that birthweight is reversely correlated with the prevalence of CP in preterm children. Although the three preterm birthweight groups received different types of developmental follow-up programs after birth, it did not influence their age at the initial diagnosis of CP. Furthermore, we suggest that follow-up for at least 4 years after birth for preterm children, and 7 years for term-born children, is optimal for estimating CP prevalence. In order to identify and provide early intervention for term-born children with CP earlier, it is suggested that parents routinely fill out a self-reported motor developmental screening questionnaire and pediatricians conduct a motor developmental examination on term-born children at each time of scheduled vaccination injections.

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Anti–TNF-α Use During the Third Trimester of Pregnancy in Women with Moderate–severe Inflammatory Bowel Disease and the Risk of Preterm Birth and Low Birth Weight

Inflammatory Bowel Diseases ◽

10.1097/mib.0000000000001234 ◽

2017 ◽

Vol 23 (11) ◽

pp. 1916-1923 ◽

Cited By ~ 10

Author(s):

Heidi Kammerlander ◽

Jan Nielsen ◽

Torben Knudsen ◽

Jens Kjeldsen ◽

Sonia Friedman ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Birth Weight ◽

Preterm Birth ◽

Low Birth Weight ◽

Bowel Disease ◽

Third Trimester ◽

The Third ◽

Tnf Α ◽

Inflammatory Bowel

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Determinants of neonatal and post-neonatal mortality in the City of São Paulo

Revista Brasileira de Epidemiologia ◽

10.1590/s1415-790x2003000400009 ◽

2003 ◽

Vol 6 (4) ◽

pp. 345-358 ◽

Cited By ~ 12

Author(s):

Carla Jorge Machado ◽

Kenneth Hill

Keyword(s):

Birth Weight ◽

Infant Mortality ◽

Prenatal Care ◽

Low Birth Weight ◽

Neonatal Mortality ◽

Child Mortality ◽

Infant Death ◽

Neonatal Death ◽

Apgar Scores ◽

The City

INTRODUCTION: Child Mortality (mortality of children less than five years) has declined considerably in the developing world in the 1990s, but the Infant Mortality has declined less. Therefore, to further reduce child mortality it is important to understand the determinants of neonatal and post-neonatal mortality. MATERIAL AND METHODS: We probabilistically matched 209628 live births and 3842 infant death records from the City of São Paulo, birth cohort of 1998. Data came from SINASC and SIM. We then used logistic regression to analyze the following risk factors of neonatal and post-neonatal mortality: birth weight, gestational age, Apgar scores at 1 and 5 minutes, delivery mode, plurality, sex, maternal education, maternal age, number of prior losses, prenatal care, race, parity and community development. RESULTS AND CONCLUSION: Infants of older mothers were less likely to die in the neonatal period; infants of adolescent mothers were more likely to die in both periods. Parities four or higher increased the likelihood of post-neonatal death. Cesarean delivery was not found to be associated with infant mortality. Low number of prenatal care visits, low birth weight, preterm birth and low Apgar scores were associated with neonatal death; Low number of prenatal care visits, low birth weight, and low Apgar scores were associated with post-neonatal death. Finally, having a mother live in a highest developed community decreased the likelihood of infant death, suggesting that unmeasured factors are behind such association.

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Can Community-Based, Low-Cost Antenatal Care in the Third Trimester of Pregnancy Reduce the Incidence of Low Birth Weight Newborns?

The Journal of Obstetrics and Gynecology of India ◽

10.1007/s13224-012-0217-x ◽

2012 ◽

Vol 62 (3) ◽

pp. 286-290 ◽

Cited By ~ 1

Author(s):

A. K. Chaudhary ◽

Asha Chaudhary ◽

S. C. Tiwari ◽

R. Dwivedi

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Antenatal Care ◽

Low Cost ◽

Third Trimester ◽

Community Based ◽

The Third

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Patterns of medication use before, during and after pregnancy in women with systemic lupus erythematosus: a population-based cohort study

Lupus ◽

10.1177/0961203319863111 ◽

2019 ◽

Vol 28 (10) ◽

pp. 1205-1213 ◽

Cited By ~ 2

Author(s):

E Z Zusman ◽

E C Sayre ◽

J A Aviña-Zubieta ◽

M A De Vera

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Medication Use ◽

First Trimester ◽

Population Based ◽

Second Trimester ◽

Third Trimester ◽

Systemic Lupus ◽

Start Date ◽

The Third

Objectives This study aimed to characterize the patterns of medication use before, during and after pregnancy in a population-based cohort of women with systemic lupus erythematosus (SLE). Methods Using population-based administrative data in British Columbia, Canada, with valid information on start date of pregnancy, we identified women with SLE who had singleton pregnancies ending in deliveries between January 1, 2002, and December 31, 2012. We assessed the proportion of SLE pregnancies exposed to SLE medications – namely antimalarials and immunosuppressants – as well as glucocorticosteroids, and nonsteroidal anti-inflammatory drugs (NSAIDs) 24 months before pregnancy, each trimester of pregnancy, and 12 months postpregnancy. We also assessed discontinuation of antimalarials and immunosuppressants, defined as no prescriptions in a given window following a prescription in a preceding window. Results Of 376 pregnancies (284 women) with SLE, 24.2% had one or more dispensing for antimalarials, 8.2% for azathioprine, 19.7% for glucocorticosteroids and 4.8% for NSAIDs during pregnancy. We observed a 16.7% discontinuation of antimalarials in the year prior to pregnancy, 29.8% in the first trimester, 9.7% in the second trimester, and 26.0% in the third trimester. We also observed a 29.2% discontinuation of azathioprine in the first trimester, 8.0% in the second trimester, and 9.1% in the third trimester. Conclusions These population-based data show frequent discontinuation of medications, particularly antimalarials, in SLE pregnancies. These findings suggest the importance of educating women with SLE who are pregnant or planning to become pregnant on the benefits and risks of medications during pregnancy.

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Third trimester maternal 1,25-dihydroxyvitamin D and neonatal birth weight

Paediatrica Indonesiana ◽

10.14238/pi57.2.2017.67-9 ◽

2017 ◽

Vol 57 (2) ◽

pp. 67

Author(s):

Yusrawati Yusrawati ◽

Meldafia Idaman ◽

Nur Indrawati Lipoeto

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Active Form ◽

Enzyme Linked Immunosorbent Assay ◽

Third Trimester ◽

Positive Correlation ◽

Dihydroxyvitamin D ◽

The Third ◽

1,25 Dihydroxyvitamin D ◽

Neonatal Birth Weight

AbstractBackground The main cause of neonatal mortality is low birth weight. Active form of vitamin D (1,25-dihydroxyvitamin D) increase the efficiency of calcium and phosphorous absorption in intestinal. Deficiency 1,25-dihydroxyvitamin D in pregnant woman was hipothesized relates with low birth weight in neonate.Objective To determine the relationship between maternal 1,25-dihydroxyvitamin D level and neonatal birth weight.Methods This was an observational study with cohort design to 47 women in the third trimester pregnancy. This study was cond ucted on August to December 2014. Subjects were taken from Ibu dan Anak Hospital, Padang, West Sumatera. Maternal blood from antecubital vein was examined for 1,25-dihydroxyvitamin D concentration using enzyme-linked immunosorbent assay (ELISA). Neonatal birth weights were measured right after delivery. Data were analyzed by Pearson’s correlation and linear regression tests.Results A positive correlation was found between maternal 1,25-dihydroxyvitamin D level and neonatal birth weight (R=0.910; R2=0.821; P=0.000). The 1,25-dihydroxyvitamin D level had an 82.1% contribution to the baby’s birth weight, while other factors not assessed in this study had less of an effect.Conclusion There was positive correlation between maternal 1,25-dihydroxyvitamin D levels in the third trimester of pregnancy and neonatal birth weight

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A correlative study between maternal hemoglobin concentration during third trimester and fetal birth weight of babies born at Kathmandu Medical College and Teaching Hospital

Journal of Pathology of Nepal ◽

10.3126/jpn.v10i2.30108 ◽

2020 ◽

Vol 10 (2) ◽

pp. 1756-1759

Author(s):

Anup Shrestha ◽

Sabina Shrestha

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Antenatal Care ◽

Pregnant Women ◽

Teaching Hospital ◽

Third Trimester ◽

Maternal Anemia ◽

Medical College ◽

The Third ◽

Low Birth Weight Babies

Background: Anemia is one of the commonest health problems faced by pregnant women in both developing and developed countries. Maternal anemia is a potential risk factor for fatal outcomes like low birth weight and preterm delivery. This study intended at comparing the birth weight of the babies who were born to mothers with and without anemia during the third trimesters. Materials and methods: This study is a descriptive, cross-sectional study conducted at Kathmandu Medical College, Teaching Hospital from July 2019 to June 2020. The third-trimester hemoglobin of mothers was recorded along with the birth weight of their respective babies. Mothers with regular antenatal care visits at this hospital were included and the known causes for anemia like renal disorders, twin pregnancies, and others were excluded from the study. The third-trimester hemoglobin level of all pregnant females was correlated with the birth weight of the babies. Results: Out of a total of 2417 pregnant women, 317 (13%) had anemia. The overall prevalence of low birth weight was 12%. Out of 317 anemic mothers, 99 (31%) delivered low birth weight babies. Among those 99 low birth weight babies, 30 (30%) were preterm and 69 (70%) were term babies with the prevalence of low birth weight in anemic mothers being 31%. The correlation between maternal hemoglobin and birth weight was found to be statistically significant. Conclusions: Despite regular antenatal care, maternal anemia still prevails, affecting neonatal birth weight. There was a statistically significant correlation between maternal hemoglobin and birth weight (p-value <0.0001).

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