A Swedish Population-based Study of Adverse Birth Outcomes among Pregnant Women Treated with Buprenorphine or Methadone: Preliminary Findings

Background Untreated opioid dependence in pregnant women is associated with adverse birth outcomes. Buprenorphine and methadone are options for opioid agonist medication-assisted treatment during pregnancy. Objective The aim of this study was to describe adverse birth outcomes observed with buprenorphine or methadone treatment compared to the general population in Sweden. Methods Pregnant women and their corresponding births during 2005–2011 were identified in the Swedish Medical Birth Register. Data on stillbirth, neonatal/infant death, mode of delivery, gestational age at birth, Apgar score, growth outcomes, neonatal abstinence syndrome, and congenital malformations were examined. Frequencies were compared using two-sided Fisher's exact tests. Unadjusted estimates of birth outcomes for women treated with buprenorphine or methadone were compared to the registered general population. Results A total of 746,257 pregnancies among 538,178 unique women resulted in 746,485 live births. Among the 194 women treated with buprenorphine ( N = 176) or methadone ( N = 52), no stillbirths or neonatal/infant deaths occurred. Neonatal abstinence syndrome developed in 23.3% and 38.5% of infants born to mothers treated with buprenorphine and methadone, respectively. The frequency of the selected adverse birth outcomes assessed in women treated with buprenorphine as compared to the general population was not significantly different. However, a significantly higher frequency of preterm birth and congenital malformations was observed in women treated with methadone as compared to the general population. Compared with the general population, methadone-treated women were significantly older than buprenorphine-treated women, and both treatment groups began prenatal care later, were more likely to smoke cigarettes, and did not cohabitate with the baby's father. Conclusions An increased frequency of the selected adverse birth outcomes was not observed with buprenorphine treatment during pregnancy. Twofold increased frequency of preterm birth [2.21 (1.11, 4,41)] and congenital malformations [2.05 (1.08, 3.87)] was observed in the methadone group, which may be partly explained by older average maternal age and differences in other measured and unmeasured confounders.

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Birth and Neonatal Outcomes following Opioid Use in Pregnancy: A Danish Population-Based Study

Substance Abuse Research and Treatment ◽

10.4137/sart.s23547 ◽

2015 ◽

Vol 9s2 ◽

pp. SART.S23547 ◽

Cited By ~ 6

Author(s):

Mette Nørgaard ◽

Malene Schou Nielsson ◽

Uffe Heide-Jørgensen

Keyword(s):

Preterm Birth ◽

Birth Outcomes ◽

Congenital Malformations ◽

Maintenance Treatment ◽

Population Based ◽

Adverse Birth Outcomes ◽

Opioid Use ◽

Opioid Maintenance Treatment ◽

Opioid Substitution Treatment ◽

Gestational Week

Background Few population-based data exist on birth outcomes in women who received opioid maintenance treatment during pregnancy. We therefore examined adverse birth outcomes in women exposed to methadone or buprenorphine during pregnancy and the risk of neonatal abstinence syndrome (NAS) among neonates exposed to buprenorphine, methadone, and/or heroin in utero. Patients and Methods This study included all female Danish residents with a live birth or a stillbirth from 1997 to 211. We identified the study population, use of opioids and opioid substitution treatment, birth outcomes, and NAS through medical registers. Birth outcomes included preterm birth (born before 38th gestational week), low-birth weight (LBW) (<2,500 g, restricted to term births), small for gestational age (SGA) (weight <2 standard deviations from the sex- and gestational-week-specific mean), congenital malformations, and stillbirths. We used log-binomial regression to estimate the prevalence ratio (PR) for birth outcomes. Results Among 95,172 pregnancies in a total of 571,823 women, we identified 557 pregnancies exposed to buprenorphine, methadone, and/or heroin (167 to buprenorphine, 197 to methadone, 28 to self-reported heroin, and 165 to combinations). Compared with nonexposed pregnancies, prenatal opioid use was associated with greater prevalence of preterm birth (PR of 2.8 (95% confidence interval (CI), 2.3–3.4)), LBW among infants born at term (PR of 4.3 (95% CI, 3.0–6.1)), and being SGA (PR of 2.7 (95% CI, 1.9–4.3)). Restricting the analyses to women who smoked slightly lowered these estimates. The prevalence of congenital malformations was 8.3% in opioid-exposed women compared with 4.2% in nonexposed women (PR of 2.0 (95% CI, 1.5–2.6)). The risk of NAS ranged from 7% in neonates exposed to buprenorphine only to 55% in neonates exposed to methadone only or to opioid combinations. Conclusion The maternal use of buprenorphine and methadone during pregnancy was associated with increased prevalence of adverse birth outcomes, and this increase could only be explained to a smaller extent by increased prevalence of smoking. The risk of NAS was eight-fold higher in methadone-exposed neonates than that in buprenorphine-exposed neonates, but this difference may at least partly be explained by differences in underlying indications (analgesic versus opioid maintenance treatment) between the two groups.

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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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Pregnant women with COVID-19 and risk of adverse birth outcomes and maternal-fetal vertical transmission: a population-based cohort study in Wuhan, China

BMC Medicine ◽

10.1186/s12916-020-01798-1 ◽

2020 ◽

Vol 18 (1) ◽

Author(s):

Rong Yang ◽

Hui Mei ◽

Tongzhang Zheng ◽

Qiang Fu ◽

Yiming Zhang ◽

...

Keyword(s):

Cohort Study ◽

Birth Weight ◽

Preterm Birth ◽

Cesarean Section ◽

Pregnant Women ◽

Birth Outcomes ◽

Population Based ◽

Adverse Birth Outcomes ◽

Cesarean Section Delivery ◽

Increased Risk

Abstract Background The coronavirus disease 2019 (COVID-19) outbreak is evolving rapidly worldwide. However, little is known about the association between pregnant women with COVID-19 and the risk of adverse birth outcomes. Method We conducted a retrospective cohort study based on the Maternal and Child Health Information System (MCHIMS) of Wuhan, China. All pregnant women with singleton live birth recorded by the system between January 13 and March 18, 2020, were included. The adverse birth outcomes were preterm birth, low birth weight, neonatal asphyxia, premature rupture of membrane (PROM), and cesarean section delivery. Multivariate logistic regression was used to evaluate the associations between maternal COVID-19 diagnosis and adverse birth outcomes. Results Out of 11,078 pregnant women, 65 were confirmed with coronavirus disease 2019 (COVID-19). No deaths occurred from these confirmed cases or their newborns. Compared to pregnant women without COVID-19, pregnant women with a confirmed COVID-19 diagnosis had an increased risk of preterm birth (OR 3.34, 95% CI 1.60–7.00) and cesarean section (OR 3.63, 95% CI 1.95–6.76). There was no statistical difference in low birth weight, neonatal asphyxia, and PROM between the mothers with and without COVID-19. Among these newborns that were born to mothers with confirmed COVID-19, none was tested severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive or had abnormal CT results. Only one had diarrhea and three had a fever. Conclusions This population-based cohort study suggests that COVID-19 during the later pregnancy is associated with an increased risk of adverse birth outcomes, including iatrogenic preterm birth and cesarean section delivery. Our data provide little evidence for maternal-fetal vertical transmission of SARS-CoV-2. It is important to monitor the long-term health effects of SARS-CoV-2 infection on pregnant women and their children.

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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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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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Nausea, vomiting and poor appetite during pregnancy and adverse birth outcomes in rural Nepal: an observational cohort study

10.21203/rs.2.15484/v1 ◽

2019 ◽

Author(s):

Amanda Regodón Wallin ◽

James M Tielsch ◽

Subarna K Khatry ◽

Luke C Mullany ◽

Janet A Englund ◽

...

Keyword(s):

Preterm Birth ◽

Pregnant Women ◽

Birth Outcomes ◽

First Trimester ◽

Observational Cohort Study ◽

Limited Resources ◽

Adverse Birth Outcomes ◽

Poor Appetite ◽

Observational Cohort ◽

Rural Nepal

Abstract Background: Nausea and vomiting are experienced by a majority of pregnant women worldwide. Previous studies have yielded conflicting results regarding their impact on birth outcomes and few studies have examined this relationship in settings with limited resources. We aimed to determine the effect of nausea, vomiting and poor appetite (NVP) during pregnancy on birth outcomes in rural Nepal. Methods: Observational cohort study using data collected in two randomized, community-based trials to assess the effect of influenza immunization during pregnancy on reproductive and respiratory outcomes among pregnant women and their offspring. Pregnant women in Sarlahi District, Nepal were recruited from 2011-2013. Symptoms of NVP were recorded monthly throughout pregnancy; exposure was defined as NVP at any point during pregnancy and by trimester. Adverse outcomes were low birth weight (LBW), preterm birth, and small for gestational age (SGA). Adjusted relative risk (RR) with 95% CIs is reported from Poisson regressions with robust variance. Results: Among 3,623 pregnant women, the prevalence of NVP was 49.5% (n=1793) any time during pregnancy and 60.6% (n=731) in the first trimester. Significantly higher RRs of LBW and SGA were observed among women experiencing symptoms during pregnancy as compared to symptom free women (LBW: aRR 1.20; 95% CI 1.05 1.28; SGA: aRR 1.16; 95% CI 1.05 1.28). Symptoms in the first trimester were not significantly associated with any of the outcomes. In the second trimester, we observed significantly higher RRs for LBW and SGA (LBW: aRR 1.17; 95% CI 1.01 1.36; SGA: aRR 1.16; 95% CI 1.05 1.29) and a significantly lower RR for preterm birth (aRR 0.75; 95% CI 0.59 0.96). In the third trimester, we observed significantly higher RRs for LBW and SGA (LBW: aRR 1.20; 95% CI 1.01 1.43; SGA: aRR 1.14; 95% CI 1.01 1.29). Conclusions: NVP during pregnancy is associated with birth outcomes in a setting with limited resources, especially beyond the first trimester. Trial registration: ClinicalTrials.gov number (NCT01034254) Keywords: Nausea and vomiting in pregnancy, adverse birth outcomes, pregnancy, birthweight, low birth weight, small for gestational age, preterm birth, Nepal

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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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