Estimating the risk of adverse birth outcomes in pregnant women undergoing non-obstetric surgery using routinely collected NHS data: an observational study

BackgroundPrevious research suggests that non-obstetric surgery is carried out in 1–2% of all pregnancies. However, there is limited evidence quantifying the associated risks. Furthermore, of the evidence available, none relates directly to outcomes in the UK, and there are no current NHS guidelines regarding non-obstetric surgery in pregnant women.ObjectivesTo estimate the risk of adverse birth outcomes of pregnancies in which non-obstetric surgery was or was not carried out. To further analyse common procedure groups.Data SourceHospital Episode Statistics (HES) maternity data collected between 2002–3 and 2011–12.Main outcomesSpontaneous abortion, preterm delivery, maternal death, caesarean delivery, long inpatient stay, stillbirth and low birthweight.MethodsWe utilised HES, an administrative database that includes records of all patient admissions and day cases in all English NHS hospitals. We analysed HES maternity data collected between 2002–3 and 2011–12, and identified pregnancies in which non-obstetric surgery was carried out. We used logistic regression models to determine the adjusted relative risk and attributable risk of non-obstetric surgical procedures for adverse birth outcomes and the number needed to harm.ResultsWe identified 6,486,280 pregnancies, in 47,628 of which non-obstetric surgery was carried out. In comparison with pregnancies in which surgery was not carried out, we found that non-obstetric surgery was associated with a higher risk of adverse birth outcomes, although the attributable risk was generally low. We estimated that for every 287 pregnancies in which a surgical operation was carried out there was one additional stillbirth; for every 31 operations there was one additional preterm delivery; for every 25 operations there was one additional caesarean section; for every 50 operations there was one additional long inpatient stay; and for every 39 operations there was one additional low-birthweight baby.LimitationsWe have no means of disentangling the effect of the surgery from the effect of the underlying condition itself. Many spontaneous abortions will not be associated with a hospital admission and, therefore, will not be included in our analysis. A spontaneous abortion may be more likely to be reported if it occurs during the same hospital admission as the procedure, and this could account for the associated increased risk with surgery during pregnancy. There are missing values of key data items to determine parity, gestational age, birthweight and stillbirth.ConclusionsThis is the first study to report the risk of adverse birth outcomes following non-obstetric surgery during pregnancy across NHS hospitals in England. We have no means of disentangling the effect of the surgery from the effect of the underlying condition itself. Our observational study can never attribute a causal relationship between surgery and adverse birth outcomes, and we were unable to determine the risk of not undergoing surgery where surgery was clinically indicated. We have some reservations over associations of risk factors with spontaneous abortion because of potential ascertainment bias. However, we believe that our findings and, in particular, the numbers needed to harm improve on previous research, utilise a more recent and larger data set based on UK practices, and are useful reference points for any discussion of risk with prospective patients. The risk of adverse birth outcomes in pregnant women undergoing non-obstetric surgery is relatively low, confirming that surgical procedures during pregnancy are generally safe.Future workFurther evaluation of the association of non-obstetric surgery and spontaneous abortion. Evaluation of the impact of non-obstetric surgery on the newborn (e.g. neonatal intensive care unit admission, prolonged length of neonatal stay, neonatal death).FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Interventions to improve birth outcomes of pregnant women living in low- and middle-income countries: a systematic review and network meta-analysis

Gates Open Research ◽

10.12688/gatesopenres.13081.2 ◽

2020 ◽

Vol 3 ◽

pp. 1657

Author(s):

Jay J. H. Park ◽

Ofir Harari ◽

Ellie Siden ◽

Michael Zoratti ◽

Louis Dron ◽

...

Keyword(s):

Clinical Trials ◽

Preterm Birth ◽

Pregnant Women ◽

Birth Outcomes ◽

Low Birthweight ◽

Meta Analysis ◽

Standard Of Care ◽

Adverse Birth Outcomes ◽

Middle Income ◽

Middle Income Countries

Background: Improving the health of pregnant women is important to prevent adverse birth outcomes, such as preterm birth and low birthweight. We evaluated the comparative effectiveness of interventions under the domains of micronutrient, balanced energy protein, deworming, maternal education, and water sanitation and hygiene (WASH) for their effects on these adverse birth outcomes. Methods: For this network meta-analysis, we searched for randomized clinical trials (RCTs) of interventions provided to pregnant women in low- and middle-income countries (LMICs). We searched for reports published until September 17, 2019 and hand-searched bibliographies of existing reviews. We extracted data from eligible studies for study characteristics, interventions, participants’ characteristics at baseline, and birth outcomes. We compared effects on preterm birth (<37 gestational week), low birthweight (LBW; <2500 g), and birthweight (continuous) using studies conducted in LMICs. Results: Our network meta-analyses were based on 101 RCTs (132 papers) pertaining to 206,531 participants. Several micronutrients and balanced energy food supplement interventions demonstrated effectiveness over standard-of-care. For instance, versus standard-of-care, micronutrient supplements for pregnant women, such as iron and calcium, decreased risks of preterm birth (iron: RR=0.70, 95% credible interval [Crl] 0.47, 1.01; calcium: RR=0.76, 95%Crl 0.56, 0.99). Daily intake of 1500kcal of local food decreased the risks of preterm birth (RR=0.36, 95%Crl 0.16, 0.77) and LBW (RR=0.17, 95%Crl 0.09, 0.29), respectively when compared to standard-of-care. Educational and deworming interventions did not show improvements in birth outcomes, and no WASH intervention trials reported on these adverse birth outcomes. Conclusion: We found several pregnancy interventions that improve birth outcomes. However, most clinical trials have only evaluated interventions under a single domain (e.g. micronutrients) even though the causes of adverse birth outcomes are multi-faceted. There is a need to combine interventions that of different domains as packages and test for their effectiveness. Registration: PROSPERO CRD42018110446; registered on 17 October 2018.

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1096. Effect of Diarrheal Illness During Pregnancy on Adverse Birth Outcomes in Nepal

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.931 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S328-S329

Author(s):

Kira Newman ◽

Katie Gustafson ◽

Janet Englund ◽

Joanne Katz ◽

Amalia Magaret ◽

...

Keyword(s):

Preterm Birth ◽

Medical Care ◽

Pregnant Women ◽

Birth Outcomes ◽

Low Birthweight ◽

Published Data ◽

Adverse Birth Outcomes ◽

South Asian Population ◽

Adjusted Risk ◽

Diarrheal Illness

Abstract Background Adverse birth outcomes, including low birthweight (LBW), small-for-gestational-age (SGA) and preterm birth, contribute to 60–80% of infant mortality worldwide. Little published data exist on the association between diarrhea during pregnancy and adverse birth outcomes. We sought to identify whether diarrhea during pregnancy was associated with adverse birth outcomes. Methods We used data from a community-based, prospective randomized trial of maternal influenza immunization of pregnant women and their infants conducted in rural Nepal from 2011 to 2014. Illness episodes were defined as at least three watery bowel movements per day for one or more days with 7 diarrhea-free days between episodes. Diarrheal illnesses were identified through longitudinal household-based weekly symptom surveillance. The c2 test, two-sample t-test, and log-binomial regression were performed to evaluate baseline characteristics and the association between diarrhea during pregnancy and adverse birth outcomes. Results Of 3,682 women in the study, 527 (14.3%) experienced one or more episodes of diarrhea during pregnancy. Diarrhea incidence was not seasonal. Women with diarrhea had a median of one episode of diarrhea (interquartile range (IQR) 1–2 episodes) and two cumulative days of diarrhea (IQR 1–3 days). Of women with diarrhea, 16.1% (85) sought medical care. Mean maternal age, parity, biomass cook stove use, home latrine, water source, caste, and smoking did not differ in pregnant women with and without diarrhea. In crude and adjusted analyses, women with diarrhea during pregnancy were significantly more likely to have SGA infants (42.6% vs. 36.8%; adjusted risk ratio=1.20, 95% CI 1.06–1.36, P = 0.005). LBW and preterm birth incidence did not significantly differ between women with diarrhea during pregnancy and those without. There was no significant association between seeking medical care for diarrhea and birth outcomes. Conclusion Diarrheal illness during pregnancy was associated with a significantly higher risk of SGA infants in this rural South Asian population. Interventions to reduce the burden of diarrheal illness during pregnancy may have an impact on SGA births in resource-limited settings. Disclosures All authors: No reported disclosures.

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Electronic cigarettes may not be a “safer alternative” of conventional cigarettes during pregnancy: evidence from the nationally representative PRAMS data

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03247-6 ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Sooyong Kim ◽

Sanda Cristina Oancea

Keyword(s):

Pregnant Women ◽

Birth Outcomes ◽

Low Birthweight ◽

Electronic Cigarettes ◽

Adverse Outcomes ◽

Adverse Birth Outcomes ◽

Third Trimester ◽

Pregnancy Risk ◽

The Third ◽

Shared Risk

Abstract Background Conventional cigarette (CC) smoking is one of the most preventable causes of adverse birth outcomes. Although electronic cigarettes (ECs) are considered to be safer than CCs during pregnancy, the evidence is yet to be presented. This study examines the effects of prenatal EC use on neonatal birth outcomes compared to those of CC smokers and complete tobacco abstainers. Methods Data was extracted from 55,251 pregnant women who participated in the Phase 8 survey of the Pregnancy Risk Assessment Monitoring System between 2016 and 2018. Participants were classified into three groups based on their smoking behaviors in the third trimester: complete tobacco abstinence, exclusive CC smoking, or exclusive EC use. Adverse outcomes included infants being small-for-gestational-age (SGA), having low birthweight (LBW), and being born at preterm. EC users were matched to complete abstainers and CC smokers who share the same baseline characteristics in race/ethnicity, age, educational attainment, income, prenatal care adequacy, and first- and second-trimester CC smoking statuses. The association between EC use and adverse birth outcomes were examined by survey-weighted logistic regression analyses in the matched population. Results Among participants, 1.0% of women reported having used ECs during the third trimester, 60% of which reported using ECs exclusively. Neonates of EC users were significantly more likely to be SGA (OR 1.76; 95% CI 1.04, 2.96), have LBW (OR 1.53; 95% CI 1.06, 2.22), or be born preterm (OR 1.86; 95% CI 1.11, 3.12) compared to tobacco abstainers. However, odds of EC users’ pregnancies resulting in SGA (OR 0.67; 95% CI 0.30, 1.47), LBW (OR 0.71; 95% CI 0.37, 1.37), or preterm birth (OR 1.06; 95% CI 0.46, 2.48) were not significantly lower than those of CC smokers. Conclusions Even after accounting for shared risk factors between prenatal tobacco use and adverse birth outcomes, EC use remains an independent risk factor for neonatal complications and is not a safer alternative to CC smoking during pregnancy. Until further research is completed, all pregnant women are encouraged to abstain from all tobacco products including ECs.

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Interventions to improve birth outcomes of pregnant women living in low- and middle-income countries: a systematic review and network meta-analysis

Gates Open Research ◽

10.12688/gatesopenres.13081.1 ◽

2019 ◽

Vol 3 ◽

pp. 1657 ◽

Cited By ~ 2

Author(s):

Jay J. H. Park ◽

Ofir Harari ◽

Ellie Siden ◽

Michael Zoratti ◽

Louis Dron ◽

...

Keyword(s):

Clinical Trials ◽

Preterm Birth ◽

Pregnant Women ◽

Birth Outcomes ◽

Low Birthweight ◽

Meta Analysis ◽

Standard Of Care ◽

Adverse Birth Outcomes ◽

Middle Income ◽

Middle Income Countries

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Utilization of preconception care and associated factors in Hosanna Town, Southern Ethiopia

PLoS ONE ◽

10.1371/journal.pone.0261895 ◽

2022 ◽

Vol 17 (1) ◽

pp. e0261895

Author(s):

Meron Admasu Wegene ◽

Negeso Gebeyehu Gejo ◽

Daniel Yohannes Bedecha ◽

Amene Abebe Kerbo ◽

Shemsu Nuriye Hagisso ◽

...

Keyword(s):

Child Health ◽

Pregnant Women ◽

Birth Outcomes ◽

Preconception Care ◽

Previous History ◽

Care Utilization ◽

Adverse Birth Outcomes ◽

Care Services ◽

History Of ◽

And Child Health

Introduction There is substantial body of evidence that portrays gap in the existing maternal and child health continuum of care; one is less attention given to adolescent girls and young women until they get pregnant. Besides, antenatal care is too late to reduce the harmful effects that a woman’s may have on the fetus during the critical period of organogenesis. Fortunately, preconception care can fill these gaps, enhance well-being of women and couples and improve subsequent pregnancy and child health outcomes. Therefore, the main aim of the current study was to assess preconception care utilization and associated factors among pregnant women attending antenatal care clinics of public health facilities in Hosanna town. Methods A facility based cross-sectional study design was carried out from July 30, 2020 to August 30, 2020. Data were collected through face-to-face interview among 400 eligible pregnant women through systematic sampling technique. Epi-data version 3.1 and SPSS version 24 was used for data entry and analysis respectively. Both bivariable and multivariable logistic regression analysis was conducted to identify association between dependent and independent variables. Crude and adjusted odds ratio with respective 95% confidence intervals was computed and statistical significance was declared at p-value <0.05. Result This study revealed that 76 (19%, 95% Cl (15.3, 23.2) study participants had utilized preconception care. History of family planning use before the current pregnancy (AOR = 2.45; 95% Cl (1.270, 4.741), previous history of adverse birth outcomes (AOR = 3.15; 95% Cl (1.650, 6.005), poor knowledge on preconception care (AOR = 0.18; 95% Cl (0.084, 0.379) and receiving counseling on preconception care previously (AOR = 2.82; 95% Cl (1.221, 6.493) were significantly associated with preconception care utilization. Conclusions The present study revealed that nearly one-fifth of pregnant women have utilized preconception care services. History of family planning use before the current pregnancy, previous history of adverse birth outcomes, poor knowledge on preconception care and receiving counseling on preconception care previously were significantly associated with preconception care utilization. Integrating preconception care services with other maternal neonatal child health, improving women’s/couples knowledge & strengthening counseling services is pivotal.

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Insurance Differences in Preventive Care Use and Adverse Birth Outcomes Among Pregnant Women in a Medicaid Nonexpansion State: A Retrospective Cohort Study

Journal of Women s Health ◽

10.1089/jwh.2019.7658 ◽

2020 ◽

Vol 29 (1) ◽

pp. 29-37 ◽

Cited By ~ 5

Author(s):

Yhenneko J. Taylor ◽

Tsai-Ling Liu ◽

Elizabeth A. Howell

Keyword(s):

Cohort Study ◽

Pregnant Women ◽

Birth Outcomes ◽

Preventive Care ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Adverse Birth Outcomes

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Maternal exposure to Wenchuan earthquake and prolonged risk of offspring birth outcomes: a natural experiment study

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03206-1 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Qiguo Lian ◽

Jiaying Ni ◽

Jun Zhang ◽

Julian Little ◽

Shan Luo ◽

...

Keyword(s):

Wenchuan Earthquake ◽

Birth Outcomes ◽

Low Birthweight ◽

Maternal Exposure ◽

Adverse Birth Outcomes ◽

Reproductive Outcomes ◽

2008 Wenchuan Earthquake ◽

The 2008 Wenchuan Earthquake ◽

Stratified Analysis

Abstract Background The prolonged effects of disasters on reproductive outcomes among the survivors are less studied, and the findings are inconsistent. We examined the associations of maternal exposure to the 2008 Wenchuan earthquake years before conception with adverse birth outcomes. Methods We included 73,493 women who delivered in 96 hospitals in 24 provinces and autonomous regions from the 2015/16 China Labor and Delivery Survey. We weighted the multivariable logistic models based on the combination of coarsened exact matching (CEM) weight and survey weight, and performed sex-stratified analysis to test whether associations of maternal earthquake exposure with adverse birth outcomes (Stillbirth, preterm birth [PTB], low birthweight [LBW], and small for gestational age [SGA]) varied by sex. Results The bivariate models showed that the weighted incidence of each adverse birth outcome was higher in exposed group than unexposed group: stillbirth (2.00% vs. 1.33%), PTB (14.14% vs. 7.32%), LBW (10.82% vs. 5.76%), and SGA (11.32% vs. 9.52%). The multivariable models showed maternal earthquake exposure was only associated significantly with a higher risk of PTB in offspring among all births (adjusted risk ratio [aRR](95%CI):1.25(1.06–1.48), P = 0.010). The sex-stratified analysis showed the association was significant among male births (aRR (95%CI): 1.40(1.12–1.75),P = 0.002),but unsignificant among female births. The sensitivity analysis reported similar findings. Conclusions The 2008 Wenchuan earthquake exposure has a long-term effect on PTB. Maternal acute exposure to disasters could be a major monitor for long-term reproductive outcomes. More attention should be paid to the underlining reasons for disaster-related adverse birth outcomes.

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Influence of Prenatal Exposure to Mercury, Perceived Stress, and Depression on Birth Outcomes in Suriname: Results from the MeKiTamara Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17124444 ◽

2020 ◽

Vol 17 (12) ◽

pp. 4444

Author(s):

Anisma R. Gokoel ◽

Wilco C. W. R. Zijlmans ◽

Hannah H. Covert ◽

Firoz Abdoel Wahid ◽

Arti Shankar ◽

...

Keyword(s):

Preterm Birth ◽

Birth Outcomes ◽

Prenatal Exposure ◽

Perceived Stress ◽

Apgar Score ◽

Low Birthweight ◽

Depression Scale ◽

Study Cohort ◽

Adverse Birth Outcomes ◽

Probable Depression

Prenatal exposure to mercury, stress, and depression may have adverse effects on birth outcomes. Little is known on the influence of chemical and non-chemical stressors on birth outcomes in the country of Suriname. We assessed the influence of prenatal exposure to mercury, perceived stress, and depression on adverse birth outcomes in 1143 pregnant Surinamese women who participated in the Caribbean Consortium for Research in Environmental and Occupational Health-MeKiTamara prospective cohort study. Associations between mercury (≥1.1 μg/g hair, USEPA action level/top versus bottom quartile), probable depression (Edinburgh Depression Scale ≥12), high perceived stress (Cohen’s Perceived Stress Scale ≥20), and adverse birth outcomes (low birthweight (<2500 g), preterm birth (<37 completed weeks of gestation), and low Apgar score (<7 at 5 min)) were assessed using bivariate and multivariate logistic regressions. Prevalence of elevated mercury levels, high perceived stress, and probable depression were 37.5%, 27.2%, and 22.4%, respectively. Mercury exposure was significantly associated with preterm birth in the overall study cohort (OR 2.47; 95% CI 1.05–5.83) and perceived stress with a low Apgar score (OR 9.73; 95% CI 2.03–46.70). Depression was not associated with any birth outcomes. These findings can inform policy- and practice-oriented solutions to improve maternal and child health in Suriname.

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Blood pressure trajectories during pregnancy and associations with adverse birth outcomes among HIV-infected and HIV-uninfected women in South Africa: a group-based trajectory modelling approach

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03411-y ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Thokozile R. Malaba ◽

◽

Annibale Cois ◽

Hlengiwe P. Madlala ◽

Mushi Matjila ◽

...

Keyword(s):

Blood Pressure ◽

Birth Outcomes ◽

Low Birthweight ◽

Care Facility ◽

Adverse Birth Outcomes ◽

Multinomial Regression ◽

Increased Risk ◽

Trajectory Group ◽

The Relationship ◽

Trajectory Modelling

Abstract Background High blood pressure (BP) late in pregnancy is associated with preterm delivery (PTD); BP has also been associated with HIV and antiretroviral therapy (ART), but whether the relationship between BP assessed longitudinally over pregnancy and PTD and low birthweight (LBW) is modified by HIV/ART is unclear. We hypothesise the presence of distinctive BP trajectories and their association with adverse birth outcomes may be mediated by HIV/ART status. Methods We recruited pregnant women at a large primary care facility in Cape Town. BP was measured throughout pregnancy using automated monitors. Group-based trajectory modelling in women with ≥3 BP measurements identified distinct joint systolic and diastolic BP trajectory groups. Multinomial regression assessed BP trajectory group associations with HIV/ART status, and Poisson regression with robust error variance was used to assess risk of PTD and LBW. Results Of the 1583 women in this analysis, 37% were HIV-infected. Seven joint trajectory group combinations were identified, which were categorised as normal (50%), low normal (25%), high normal (20%), and abnormal (5%). A higher proportion of women in the low normal group were HIV-infected than HIV-uninfected (28% vs. 23%), however differences were not statistically significant (RR 1.27, 95% CI 0.98–1.63, reference category: normal). In multivariable analyses, low normal trajectory (aRR0.59, 0.41–0.85) was associated with decreased risk of PTD, while high normal (aRR1.48, 1.12–1.95) and abnormal trajectories (aRR3.18, 2.32–4.37) were associated with increased risk of PTD, and abnormal with increased risk of LBW (RR2.81, 1.90–4.15). Conclusions While HIV/ART did not appear to mediate the BP trajectories and adverse birth outcomes association, they did provide more detailed insights into the relationship between BP, PTD and LBW for HIV-infected and uninfected women.

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