Maternal pregestational glucose level and adverse neonatal outcomes: a population-based retrospective cohort study

Abstract Background: Women with diabetes or hyperglycemia during the pregnancy have been proved to be at increased risk for adverse outcomes such as primary cesarean section rate and macrosomia. However, a lack of studies have focused on the maternal glucose level prior to the pregnancy and the effect of maternal pregestational hyperglycemia or hypoglycemia on pregnancy outcomes is unclear. Hence, we conducted this study to investigate the association between maternal pregestational fasting blood glucose level and adverse neonatal outcomes.Methods: A retrospective cohort study was conducted in the Chongqing Municipality of China between April 2010 and December 2016. A total of 54365 women with their live birth singletons from all 39 counties of Chongqing who participated in the National Free Preconception Health Examination Project were included. They all took a once fasting glucose testing within one year prior to pregnancy and without a definite diagnosis of diabetes at that point. Our primary outcomes were preterm birth, very preterm birth, macrosomia, large for gestational age (LGA), low birth weight (LBW) and small for gestational age (SGA). Results: Of the 54365 women, 2813 (5.17%) were hypoglycemia, 48400 (89.03%) were normoglycemia, 2582 (4.75%) had impaired fasting glucose (IFG) and 570 (1.05%) were diabetic hyperglycemia. Compared to the normoglycemia group, women with pregestational glucose at the diabetic level had a higher rate of macrosomia (4.16% vs. 6.18%), while impaired fasting glucose group seemed to be associated with decreased risks for preterm birth (7.38% vs. 5.78%), very preterm birth (1.25% vs. 0.74%), LBW (1.18% vs. 0.59%) and SGA (5.92% vs. 4.29%), p<.05 for all. No significant difference was found between hypoglycemia and normoglycemia in the neonatal outcomes. After adjusting for potential confounders, pregestational diabetic hyperglycemia was remained significantly associated with an increased risk for macrosomia (aRR, 1.49; 95%CI, 1.07-2.09). Conclusion: Though without an overt diabetes mellitus, women with once diabetic fasting glucose level during their preconception examinations were still associated with an increased risk for macrosomia. Once fasting glucose within one year before pregnancy might also be considered as an early sign to help the obstetricians to prejudge and control the risk of macrosomia in advance.

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Country of first birth and neonatal outcomes in migrant and Norwegian-born parous women in Norway: a population-based study

10.21203/rs.2.19047/v1 ◽

2019 ◽

Author(s):

Eline Skirnisdottir Vik ◽

Roy Miodini Nilsen ◽

Vigdis Aasheim ◽

Rhonda Small ◽

Dag Moster ◽

...

Keyword(s):

Preterm Birth ◽

Population Based ◽

Neonatal Outcomes ◽

Migrant Women ◽

First Birth ◽

Population Based Study ◽

Very Preterm ◽

Very Preterm Birth ◽

Adverse Neonatal Outcomes ◽

Moderately Preterm

Abstract Background: This study compares subsequent birth outcomes in migrant women who had already had a child before arriving in Norway with those in migrant women whose first birth occurred in Norway. The aim of this study was to investigate the associations between country of first birth and adverse neonatal outcomes (very preterm birth, moderately preterm birth, post-term birth, small for gestational age, large for gestational age, low Apgar score, stillbirth and neonatal death) in parous migrant and Norwegian-born women. Methods: National population-based study including second and subsequent singleton births in Norway from 1990-2016. Data were retrieved from the Medical Birth Registry of Norway and Statistics Norway. Neonatal outcomes were compared between births to: 1) migrant women with a first birth before immigration to Norway (n=30,062) versus those with a first birth after immigration (n=66,006), and 2) Norwegian-born women with a first birth outside Norway (n=6,205) versus those with a first birth in Norway (n=514,799). Associations were estimated as crude and adjusted odds ratios (aORs) with 95% confidence intervals (CIs) using multiple logistic regression. Results: Migrant women with a first birth before immigrating to Norway had increased odds of adverse outcomes in subsequent births relative to those with a first birth after immigration: very preterm birth (22-31 gestational weeks (gwks); aOR=1.27; CI 1.09-1.48), moderately preterm birth (32-36 gwks; aOR=1.10; CI 1.02-1.18), post-term birth (≥42 gwks; aOR=1.19; CI 1.11-1.27), low Apgar score (<7 at 5 minutes; aOR=1.27; CI 1.16-1.39) and stillbirth (aOR=1.29; CI 1.05-1.58). Similar results were found in the sample of births to Norwegian-born women. Conclusions: The increased odds of adverse neonatal outcomes for migrant and Norwegian-born women who had their first births outside Norway should serve as a reminder of the importance of taking a careful obstetric history in these parous women to ensure appropriate care for their subsequent pregnancies and births in Norway. Keywords: immigration, parous women, neonatal outcomes, obstetric history, predictor

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Cholestasis after very preterm birth was associated with adverse neonatal outcomes but no significant long‐term liver disease: A population‐based study

Acta Paediatrica ◽

10.1111/apa.15408 ◽

2020 ◽

Vol 110 (1) ◽

pp. 141-148

Author(s):

Jonas Teng ◽

Kajsa Bohlin ◽

Antal Nemeth ◽

Björn Fischler

Keyword(s):

Liver Disease ◽

Preterm Birth ◽

Population Based ◽

Neonatal Outcomes ◽

Population Based Study ◽

Very Preterm ◽

Very Preterm Birth ◽

Adverse Neonatal Outcomes

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Low First Trimester Pregnancy-Associated Plasma Protein-A Levels Are Not Associated with an Increased Risk of Intrapartum Fetal Compromise or Adverse Neonatal Outcomes: A Retrospective Cohort Study

Journal of Clinical Medicine ◽

10.3390/jcm9041108 ◽

2020 ◽

Vol 9 (4) ◽

pp. 1108 ◽

Cited By ~ 1

Author(s):

Jessica M. Turner ◽

Sailesh Kumar

Keyword(s):

Cohort Study ◽

Preterm Birth ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Protein A ◽

First Trimester ◽

Neonatal Outcomes ◽

Increased Risk ◽

Adverse Neonatal Outcomes ◽

Fetal Compromise

The aim of this study was to assess if women with a low first trimester maternal pregnancy-associated plasma protein-A (PAPP-A) level are at increased risk of emergency cesarean (EmCS) for intrapartum fetal compromise (IFC) and/or adverse neonatal outcomes. This was a retrospective cohort study performed at Mater Mother’s Hospital, Brisbane, Australia, between 2016 and 2018. All women with a singleton, euploid, non-anomalous fetus with a documented PAPP-A level measured between 10 +0 and 13 +6 weeks gestation during the study period were included. Data were extracted from the institution’s perinatal database and dichotomized according to PAPP-A level (≤0.4 Multiples of Medium (MoM) vs. >0.4 MoM). The primary outcomes were EmCS-IFC and a composite of severe adverse neonatal outcomes (SCNO). Nine thousand sixty-one pregnancies were included, 3.3% with a PAPP-A ≤ 0.4 MoM. Low maternal PAPP-A was not associated with an increased risk of EmCS-IFC (adjusted odds ratio (aOR) 0.77, 95% confidence interval (CI) 0.24–2.46, p = 0.66) or SCNO (aOR 0.65, 95% CI 0.39–1.07, p = 0.09). Low PAPP-A was associated with increased odds of pre-eclampsia, preterm birth and birthweight < 10th centile. In conclusion, low maternal PAPP-A level is not associated with an increased risk of EmCS IFC or adverse neonatal outcomes despite greater odds of low-birthweight infants and preterm birth.

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Country of first birth and neonatal outcomes in migrant and Norwegian-born parous women in Norway: a population-based study

10.21203/rs.2.19047/v2 ◽

2020 ◽

Author(s):

Eline Skirnisdottir Vik ◽

Roy Miodini Nilsen ◽

Vigdis Aasheim ◽

Rhonda Small ◽

Dag Moster ◽

...

Keyword(s):

Preterm Birth ◽

Population Based ◽

Neonatal Outcomes ◽

Migrant Women ◽

First Birth ◽

Population Based Study ◽

Very Preterm ◽

Very Preterm Birth ◽

Adverse Neonatal Outcomes ◽

Moderately Preterm

Abstract Background: This study compares subsequent birth outcomes in migrant women who had already had a child before arriving in Norway with those in migrant women whose first birth occurred in Norway. The aim of this study was to investigate the associations between country of first birth and adverse neonatal outcomes (very preterm birth, moderately preterm birth, post-term birth, small for gestational age, large for gestational age, low Apgar score, stillbirth and neonatal death) in parous migrant and Norwegian-born women.Methods: National population-based study including second and subsequent singleton births in Norway from 1990-2016. Data were retrieved from the Medical Birth Registry of Norway and Statistics Norway. Neonatal outcomes were compared between births to: 1) migrant women with a first birth before immigration to Norway (n=30,062) versus those with a first birth after immigration (n=66,006), and 2) Norwegian-born women with a first birth outside Norway (n=6,205) versus those with a first birth in Norway (n=514,799). Associations were estimated as crude and adjusted odds ratios (aORs) with 95% confidence intervals (CIs) using multiple logistic regression. Results: Migrant women with a first birth before immigrating to Norway had increased odds of adverse outcomes in subsequent births relative to those with a first birth after immigration: very preterm birth (22-31 gestational weeks; aOR=1.27; CI 1.09-1.48), moderately preterm birth (32-36 gestational weeks; aOR=1.10; CI 1.02-1.18), post-term birth (≥42 gestational weeks; aOR=1.19; CI 1.11-1.27), low Apgar score (<7 at 5 minutes; aOR=1.27; CI 1.16-1.39) and stillbirth (aOR=1.29; CI 1.05-1.58). Similar results were found in the sample of births to Norwegian-born women.Conclusions: The increased odds of adverse neonatal outcomes for migrant and Norwegian-born women who had their first births outside Norway should serve as a reminder of the importance of taking a careful obstetric history in these parous women to ensure appropriate care for their subsequent pregnancies and births in Norway.

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The effect of perinatal brain injury on dopaminergic function and hippocampal volume in adult life

10.1101/128710 ◽

2017 ◽

Author(s):

Sean Froudist-Walsh ◽

Michael A.P. Bloomfield ◽

Mattia Veronese ◽

Jasmin Kroll ◽

Vyacheslav Karolis ◽

...

Keyword(s):

Preterm Birth ◽

Brain Injury ◽

Hippocampal Volume ◽

Dopamine Synthesis ◽

Control Group ◽

Perinatal Brain Injury ◽

Very Preterm ◽

Very Preterm Birth ◽

Injury Group ◽

Increased Risk

AbstractBackgroundVery preterm birth (<32 weeks of gestation) is associated with long-lasting brain alterations and an increased risk of psychiatric disorders associated with dopaminergic abnormalities. Preclinical studies have shown perinatal brain injuries, including hippocampal lesions, cause lasting changes in dopamine function, but it is not known if this occurs in humans. The purpose of this study was to determine whether very preterm birth and perinatal brain injury were associated with altered dopamine synthesis and reduced hippocampal volume in humans in adulthood.MethodsWe compared adults who were born very preterm with associated perinatal brain injury to adults born very preterm without perinatal brain injury, and age-matched controls born at full term using [18F]-DOPA PET and structural MRI imaging.ResultsDopamine synthesis capacity was significantly reduced in the perinatal brain injury group relative to both the group born very preterm without brain injury (Cohen’s d=1.36, p=0.02) and the control group (Cohen’s d=1.07, p=0.01). Hippocampal volume was reduced in the perinatal brain injury group relative to controls (Cohen’s d = 1.17, p = 0.01). There was a significant correlation between hippocampal volume and striatal dopamine synthesis capacity (r = 0.344, p= 0.03).ConclusionsPerinatal brain injury, but not very preterm birth without macroscopic brain injury, is associated with persistent alterations in dopaminergic function and reductions in hippocampal volume. This is the first evidence in humans linking neonatal hippocampal injury to adult dopamine dysfunction, and has implications for understanding the mechanism underlying cognitive impairments and neuropsychiatric disorders following very preterm birth.

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A220 A COMPREHENSIVE SYSTEMATIC REVIEW AND META-ANALYSIS OF THE RISK OF ADVERSE NEONATAL OUTCOME IN INFLAMMATORY BOWEL DISEASE AND PREGNANCY

Journal of the Canadian Association of Gastroenterology ◽

10.1093/jcag/gwz047.219 ◽

2020 ◽

Vol 3 (Supplement_1) ◽

pp. 94-95

Author(s):

K Leung ◽

P Tandon ◽

V Govardhanam ◽

C Maxwell ◽

V Huang

Keyword(s):

Risk Factors ◽

Inflammatory Bowel Disease ◽

Preterm Birth ◽

Bowel Disease ◽

Neonatal Outcomes ◽

Healthy Controls ◽

Increased Risk ◽

Adverse Neonatal Outcomes ◽

Inflammatory Bowel ◽

Active Disease

Abstract Background Inflammatory bowel disease (IBD) often affects women in their child-bearing years. These women may be at an increased risk of adverse neonatal outcomes. Aims The aim of this study was to evaluate the risk of these outcomes in this population of patients, with an emphasis of determining risk factors for development of these conditions. Methods Medline, Embase, and Cochrane library were searched through to May 2019 for studies reporting adverse neonatal outcomes in IBD patients. Weighted odds ratios (OR) with 95% confidence intervals (CI) were calculated to assess the risk of these outcomes in patients with IBD compared to healthy controls, with risk factors such as disease activity and medication exposure also being assessed. Results Sixty studies were included (8194 pregnancies with inflammatory bowel disease and 3253 healthy pregnancies). Compared to healthy controls, patients with inflammatory bowel disease were more likely to deliver infants with low birth weight (LBW) (OR 2.78, 95% CI 1.16–6.66) and infants who were admitted to the neonatal intensive care unit (NICU) (OR 3.33, 95% CI 1.83–6.05). Patients with Crohn’s disease had an increased risk of infants born with congenital anomalies (OR 3.03, 95% CI, 1.43–6.42), whereas patients with ulcerative colitis had an increased risk of preterm delivery (OR 2.68, 95% CI, 1.12–6.43). Active disease increased the risk of preterm birth (OR 2.06, 95% CI 1.21–3.51), LBW (OR 2.96, 95% CI 1.54–5.70), and small for gestation age (OR 2.62, 95% CI 1.18–5.83) compared to disease in remission. Tumor necrosis factor antagonists was associated with increased risk of NICU admission (OR 2.42, 95% CI 1.31–4.45) and LBW (OR 1.54, 95% CI, 1.01–2.35). Conclusions Patients with inflammatory bowel disease are at an increased risk of developing adverse neonatal outcomes such as preterm birth, LBW, congenital anomalies, and NICU admissions. Patients with clinically active disease and those exposed to anti-TNF therapy may be at higher risk of developing these adverse outcomes. The findings of this study are important to communicate to patients and healthcare providers alike. Furthermore, this information may help to mitigate these risks through collaborative specialized care during pregnancy in order to reduce the overall morbidity and mortality for both mother and baby. Funding Agencies None

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The influence of obesity on perinatal outcomes in pregnancies achieved with assisted reproductive technology: A population-based retrospective cohort study

Obstetric Medicine ◽

10.1177/1753495x15621152 ◽

2016 ◽

Vol 9 (1) ◽

pp. 34-39 ◽

Cited By ~ 4

Author(s):

Amy M Valent ◽

Eric S Hall ◽

Emily A DeFranco

Keyword(s):

Cohort Study ◽

Assisted Reproductive Technology ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Tertiary Care ◽

Population Based ◽

Reproductive Technology ◽

Neonatal Outcomes ◽

Increased Risk ◽

Adverse Neonatal Outcomes

Objective To determine the influence of obesity on neonatal outcomes of pregnancies resulting from assisted reproductive technology. Methods Population-based retrospective cohort study of all non-anomalous, live births in Ohio from 2007 to 2011, comparing differences in the frequency of adverse neonatal outcomes of women who conceived with assisted reproductive technology versus spontaneously conceived pregnancies and stratified by obesity status. Primary outcome was a composite of neonatal morbidities defined as ≥1 of the following: neonatal death, Apgar score of <7 at 5 min, assisted ventilation, neonatal intensive care unit admission, or transport to a tertiary care facility. Results Rates of adverse neonatal outcomes were significantly higher for assisted reproductive technology pregnancies than spontaneously conceived neonates; non-obese 25% versus 8% and obese 27% versus 10%, p < 0.001. Assisted reproductive technology was associated with a similar increased risk for adverse outcomes in both obese (adjusted odds ratio (aOR): 1.33, 95% confidence interval (CI): 1.11–1.59) and non-obese women (aOR: 1.34, 95% CI: 1.18–1.51) even after adjustment for coexisting risk factors. This increased risk was driven by higher preterm births in assisted reproductive technology pregnancies; obese (aOR: 1.06, 95% CI: 0.86–1.31) and non-obese (aOR: 1.15, 95% CI: 1.00–1.32). Discussion Assisted reproductive technology is associated with a higher risk of adverse neonatal outcomes. Obesity does not appear to adversely modify perinatal risks associated with assisted reproductive technology.

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NEONATAL OUTCOMES FOLLOWING LATE PRETERM BIRTH

Fetal and Maternal Medicine Review ◽

10.1017/s0965539512000071 ◽

2012 ◽

Vol 23 (2) ◽

pp. 97-119 ◽

Cited By ~ 2

Author(s):

ELAINE M BOYLE

Keyword(s):

Preterm Birth ◽

Preterm Delivery ◽

Preterm Infants ◽

Neonatal Morbidity ◽

Neonatal Outcomes ◽

Late Preterm ◽

Very Preterm ◽

Late Preterm Birth ◽

Extremely Preterm ◽

Adverse Neonatal Outcomes

It is well recognised that birth before 32 weeks of gestation is associated with substantial neonatal morbidity and mortality and these risks have been extensively reported. The focus of perinatal research for many years has therefore been very preterm and extremely preterm delivery, since the likelihood and severity of adverse neonatal outcomes are highest within this group. In contrast, until recently, more mature preterm infants have been understudied and indeed, almost ignored by researchers.

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