scholarly journals Interpregnancy Interval and Subsequent Severe Maternal Morbidity: A Population-based Study from California over 16 years

2021 ◽  
Author(s):  
Can Liu ◽  
Jonathan M Snowden ◽  
Deirdre J Lyell ◽  
Elizabeth Wall-Wieler ◽  
Barbara Abrams ◽  
...  
Keyword(s):  
Maternal Age ◽  
Maternal Morbidity ◽  
Perinatal Outcomes ◽  
Population Based ◽  
Subsequent Pregnancy ◽  
Severe Maternal Morbidity ◽  
Interpregnancy Interval ◽  
Adjusted Risk ◽  
Index Pregnancy ◽  
Increased Risk

Abstract Interpregnancy interval (IPI) associates with adverse perinatal outcomes, but its contribution to severe maternal morbidity (SMM) remains unclear. We examined the association between IPI and SMM, using data linked across sequential pregnancies to women in California 1997-2012. Adjusting for confounders measured at the index pregnancy (i.e. the first in a pair of consecutive pregnancies), we estimated adjusted risk ratios (aRRs) of SMM related to the subsequent pregnancy. We further conducted within-mother comparisons and analyses stratified by parity and maternal age at the index pregnancy. Compared to 18-23 months, IPI<6 months had same risk for SMM in between-mother comparison (aRR=0.96, 95%CI 0.91, 1.02) but lower risk in within-mother comparison (aRR=0.76, 95% confidence interval (CI) 0.67, 0.86). IPI 24-59 months and IPI≥60 months associated with increased risk of SMM in both between-mother (aRR=1.18, 95%CI 1.13, 1.23 and aRR=1.76, 95% CI 1.68, 1.85 respectively) and within-mother comparisons (aRR=1.22, 95%CI 1.11, 1.34 and aRR=1.88, 95% CI 1.66, 2.13 respectively). The association between IPI and SMM did not substantially differ by maternal age and parity. Longer IPI was associated with increased risk of SMM, which may be partly attributed to interpregnancy health.

scholarly journals Can We Predict Preterm Delivery Based on the Previous Pregnancy?

2021 ◽  
Vol 10 (7) ◽  
pp. 1517
Author(s):  
Tamar Wainstock ◽  
Ruslan Sergienko ◽  
Eyal Sheiner
Keyword(s):  
Risk Factors ◽  
Pregnancy Complications ◽  
Maternal Age ◽  
Population Based ◽  
Subsequent Pregnancy ◽  
Interpregnancy Interval ◽  
Multivariable Logistic Regression Model ◽  
Increased Risk ◽  
Nested Case Control

(1) Background: Preterm deliveries (PTD, <37 gestational weeks) which occur in 5–18% of deliveries across the world, are associated with immediate and long-term offspring morbidity, as well as high costs to health systems. Our aim was to identify risk factors during the first pregnancy ending at term for PTD in the subsequent pregnancy. (2) Methods: A retrospective population- based nested case−control study was conducted, including all women with two first singleton consecutive deliveries. Women with PTD in the first pregnancy were excluded. Characteristics and complications of the first pregnancy were compared among cases, defined as women with PTD in their second pregnancy, and the controls, defined as women delivering at term in their second pregnancy. A multivariable logistic regression model was used to study the association between pregnancy complications (in the first pregnancy) and PTD (in the subsequent pregnancy), while adjusting for maternal age and the interpregnancy interval. (3) Results: A total of 39,780 women were included in the study, 5.2% (n = 2088) had PTD in their second pregnancy. Women with PTD, as compared to controls (i.e., delivered at term in second pregnancy), were more likely to have the following complications in their first pregnancy: perinatal mortality (0.4% vs. 1.0%), small for gestational age (12.4% vs. 8.1%), and preeclampsia (7.6% vs. 5.7%). In the multivariable model, after adjusting for maternal age, interpregnancy interval and co-morbidities, having any one of these first pregnancy complications was independently associated with an increased risk for PTD (adjusted OR = 1.44; 95%CI 1.28–1.62), and the risk was greater if two or more complications were diagnosed (adjusted OR = 2.09; 95%CI 1.47–3.00). These complications were also risk factors for early PTD (<34 gestational weeks), PTD with a systematic infectious disease in the background, and possibly with spontaneous PTD. (4) Conclusions: First pregnancy complications are associated with an increased risk for PTD in the subsequent pregnancy. First pregnancy, although ending at term, may serve as a window of opportunity to identify women at risk for future PTD.

Risk of Severe Maternal Morbidity or Death in Relation to Prenatal Biochemical Screening: Population-Based Cohort Study

2019 ◽  
Vol 38 (01) ◽  
pp. 044-059 ◽  
Author(s):  
Eric J.M. Lentz ◽  
Alison L. Park ◽  
Alec W.R. Langlois ◽  
Tianhua Huang ◽  
Wendy S. Meschino ◽  
...  
Keyword(s):  
Cohort Study ◽  
Maternal Mortality ◽  
Maternal Morbidity ◽  
Protein A ◽  
Population Based ◽  
Severe Maternal Morbidity ◽  
Adjusted Relative Risk ◽  
Biochemical Screening ◽  
High Concentration ◽  
Increased Risk

Abstract Objective This study aimed to examine whether prenatal biochemical screening analytes are associated with an increased risk of severe maternal morbidity (SMM) or maternal mortality. Study Design This population-based cohort study includes all women in Ontario, Canada, who underwent prenatal screening from 2001 to 2011. Increasing fifth percentiles of the multiple of the median (MoM) for alphafetoprotein (AFP), total human chorionic gonadotropin, unconjugated estriol (uE3), dimeric inhibin-A (DIA), and pregnancy-associated plasma protein A were evaluated. An abnormally high concentration (>95th percentile MoM) for each analyte, individually and combined, was also evaluated. The main outcome assessed was the adjusted relative risk (aRR) of SMM or maternal mortality from 20 weeks' gestation up to 26 weeks thereafter. Results Among 748,972 pregnancies, 11,177 resulted in SMM or maternal mortality (1.5%). Except for uE3, the aRR of SMM or maternal mortality increased in association with increasing fifth percentiles of the MoM for all analytes. AFP (aRR: 2.10; 95% confidence interval [CI]: 1.97–2.25) and DIA (aRR: 2.33; 95% CI: 1.98–2.74) > 95th versus ≤ 5th percentile of the MoM were especially associated with SMM or death. Conclusion Women with abnormally high concentrations of certain prenatal biochemical analytes may be at a higher risk of SMM or death in pregnancy or postpartum.

scholarly journals Risk of severe maternal morbidity associated with cesarean delivery and the role of maternal age: a population-based propensity score analysis

2019 ◽  
Vol 191 (13) ◽  
pp. E352-E360 ◽  
Author(s):  
Diane Korb ◽  
François Goffinet ◽  
Aurélien Seco ◽  
Sylvie Chevret ◽  
Catherine Deneux-Tharaux ◽  
...  
Keyword(s):  
Propensity Score ◽  
Cesarean Delivery ◽  
Maternal Age ◽  
Maternal Morbidity ◽  
Propensity Score Analysis ◽  
Population Based ◽  
Severe Maternal Morbidity ◽  
Score Analysis

scholarly journals The Burden of Indirect Causes of Maternal Morbidity and Mortality in the Process of Obstetric Transition: A Cross-Sectional Multicenter Study

2018 ◽  
Vol 40 (03) ◽  
pp. 106-114 ◽  
Author(s):  
Jessica Cirelli ◽  
Fernanda Surita ◽  
Maria Costa ◽  
Mary Parpinelli ◽  
Samira Haddad ◽  
...  
Keyword(s):  
Maternal Death ◽  
Maternal Morbidity ◽  
Kidney Diseases ◽  
Secondary Analysis ◽  
Perinatal Outcomes ◽  
Prevalence Ratio ◽  
H1n1 Influenza ◽  
Severe Maternal Morbidity ◽  
Cross Sectional ◽  
Increased Risk

Objective The aim of this study is to evaluate the burden of indirect causes of maternal morbidity/mortality in Brazil. Methods Secondary analysis of a multicenter cross-sectional study conducted in 27 referral obstetric units within the Brazilian Network for Surveillance of Severe Maternal Morbidity. Results A total of 82,388 women were surveilled: 9,555 women with severe maternal morbidity were included, and 942 (9.9%) of them had indirect causes of morbidity/mortality. There was an increased risk of higher severity among the indirect causes group, which presented 7.56 times increased risk of maternal death (prevalence ratio [PR]: 7.56; 95% confidence interval [95%CI]: 4.99–11.45). The main indirect causes of maternal death were H1N1 influenza, sepsis, cancer and cardiovascular disease. Non-public antenatal care (PR: 2.52; 95%CI: 1.70–3.74), diabetes (PR: 1.90; 95%CI: 1.24–2.90), neoplasia (PR: 1.98; 95%CI: 1.25–3.14), kidney diseases (PR: 1.99; 95%CI: 1.14–3.49), sickle cell anemia (PR: 2.50; 95%CI: 1.16–5.41) and drug addiction (PR: 1.98; 95%CI: 1.03–3.80) were independently associated with worse results in the indirect causes group. Some procedures for the management of severity were more common for the indirect causes group. Conclusion Indirect causes were present in less than 10% of the overall cases, but they represented over 40% of maternal deaths in the current study. Indirect causes of maternal morbidity/mortality were also responsible for an increased risk of higher severity, and they were associated with worse maternal and perinatal outcomes. In middle-income countries there is a mix of indirect causes of maternal morbidity/mortality that points to some advances in the scale of obstetric transition, but also reveals the fragility of health systems.

Perinatal Outcomes of Women Aged 50 Years and Above

2019 ◽  
Vol 37 (01) ◽  
pp. 079-085 ◽  
Author(s):  
Erez Maoz-Halevy ◽  
Gali Pariente ◽  
Eyal Sheiner ◽  
Tamar Wainstock
Keyword(s):  
Cesarean Delivery ◽  
Pregnancy Outcomes ◽  
Maternal Age ◽  
Medical Center ◽  
Perinatal Outcomes ◽  
Population Based ◽  
Perinatal Complications ◽  
Apgar Scores ◽  
Logistic Regression Models ◽  
Increased Risk

Abstract Objective Pregnancies among women aged 40 and above are increasing in frequency. Nevertheless, little is known about the perinatal outcomes of women aged 50 years and above. The purpose of the study was to evaluate pregnancy outcomes in women at an extremely advanced maternal age of 50 years or above. Study Design In a population-based cohort study, perinatal outcomes of women aged 50 years and above were compared with pregnancies in women according to maternal age. All singleton deliveries that occurred between the years 1991 and 2014 in a tertiary medical center were included. We excluded fetuses with congenital anomalies and chromosomal abnormality. Logistic regression models were used to control for confounders. Results During the study period, 242,771 deliveries were included, of which 234,824 (96.7%) occurred in women aged < 40 years, 7,321 (3.0%) in women aged 40 to 44 years, 558 (0.2%) in women aged 45 to 49 years, and 68 (0.03%) in women aged 50 years and above. Maternal age of 50 years and above was noted as an independent risk factor for gestational diabetes mellitus (GDM), low Apgar scores, and cesarean delivery. Nevertheless, among pregnancies of women aged 50, pregnancy outcomes including GDM, preterm delivery, cesarean delivery, lower Apgar scores at 5 minutes (<7), and perinatal mortality were not significantly different than pregnancy outcomes of women aged 40 to 49 years. Conclusion Pregnancy at the maternal age of 50 years and older is independently associated with higher rates of GDM, cesarean delivery, and lower Apgar scores at 5 minutes; however, most perinatal complications were not higher compared with pregnant women aged 40 to 49 years. These findings suggest that while there is an increased risk of perinatal complications in pregnancies of women aged 40 years or above compared with younger women, there are no significant increased risks in women aged over 50 years.

scholarly journals Maternal age and severe maternal morbidity: A population-based retrospective cohort study

PLoS Medicine ◽  
2017 ◽  
Vol 14 (5) ◽  
pp. e1002307 ◽  
Author(s):  
Sarka Lisonkova ◽  
Jayson Potts ◽  
Giulia M. Muraca ◽  
Neda Razaz ◽  
Yasser Sabr ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Maternal Age ◽  
Maternal Morbidity ◽  
Population Based ◽  
Severe Maternal Morbidity

scholarly journals 588: The effect of maternal age on severe maternal morbidity and perinatal outcomes

2017 ◽  
Vol 216 (1) ◽  
pp. S347
Author(s):  
Sarka Lisonkova ◽  
Jayson Potts ◽  
Giulia M. Muraca ◽  
Neda Razaz ◽  
Yasser Sabr ◽  
...  
Keyword(s):  
Maternal Age ◽  
Maternal Morbidity ◽  
Perinatal Outcomes ◽  
Severe Maternal Morbidity

scholarly journals Adolescent, Pregnant, and HIV-Infected: Risk of Adverse Pregnancy and Perinatal Outcomes in Young Women from Southern Mozambique

2021 ◽  
Vol 10 (8) ◽  
pp. 1564
Author(s):  
Clara Pons-Duran ◽  
Aina Casellas ◽  
Azucena Bardají ◽  
Anifa Valá ◽  
Esperança Sevene ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Maternal Morbidity ◽  
Low Birthweight ◽  
Negative Binomial ◽  
Perinatal Outcomes ◽  
Sub Saharan Africa ◽  
P Value ◽  
Increased Risk ◽  
Adverse Pregnancy ◽  
The Impact

Sub-Saharan Africa concentrates the burden of HIV and the highest adolescent fertility rates. However, there is limited information about the impact of the interaction between adolescence and HIV infection on maternal health in the region. Data collected prospectively from three clinical trials conducted between 2003 and 2014 were analysed to evaluate the association between age, HIV infection, and their interaction, with the risk of maternal morbidity and adverse pregnancy and perinatal outcomes in women from southern Mozambique. Logistic regression and negative binomial models were used. A total of 2352 women were included in the analyses; 31% were adolescents (≤19 years) and 29% HIV-infected women. The effect of age on maternal morbidity and pregnancy and perinatal adverse outcomes was not modified by HIV status. Adolescence was associated with an increased incidence of hospital admissions (IRR 0.55, 95%CI 0.37–0.80 for women 20–24 years; IRR 0.60, 95%CI 0.42–0.85 for women >25 years compared to adolescents; p-value < 0.01) and outpatient visits (IRR 0.86, 95%CI 0.71–1.04; IRR 0.76, 95%CI 0.63–0.92; p-value = 0.02), and an increased likelihood of having a small-for-gestational age newborn (OR 0.50, 95%CI 0.38–0.65; OR 0.43, 95%CI 0.34–0.56; p-value < 0.001), a low birthweight (OR 0.40, 95%CI 0.27–0.59; OR 0.37, 95%CI 0.26–0.53; p-value <0.001) and a premature birth (OR 0.42, 95%CI 0.24–0.72; OR 0.51, 95%CI 0.32–0.82; p-value < 0.01). Adolescence was associated with an increased risk of poor morbidity, pregnancy and perinatal outcomes, irrespective of HIV infection. In addition to provision of a specific maternity care package for this vulnerable group interventions are imperative to prevent adolescent pregnancy.

scholarly journals Multidimensional assessment of women after severe maternal morbidity: the COMMAG cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e041138
Author(s):  
Elton C Ferreira ◽  
Maria Laura Costa ◽  
Rodolfo C Pacagnella ◽  
Carla Silveira ◽  
Carla B Andreucci ◽  
...  
Keyword(s):  
Cohort Study ◽  
Sexual Function ◽  
Screening Test ◽  
Maternal Morbidity ◽  
Severe Maternal Morbidity ◽  
Medium Term ◽  
Short Term ◽  
Multidimensional Assessment ◽  
Index Pregnancy ◽  
Sf 36

ObjectivesTo perform a multidimensional assessment of women who experienced severe maternal morbidity (SMM) and its short-term and medium-term impact on the lives and health of women and their children.DesignA retrospective cohort study.SettingA tertiary maternity hospital from the southeast region of Brazil.ParticipantsThe exposed population was selected from intensive care unit admissions if presenting any diagnostic criteria for SMM. Controls were randomly selected among women without SMM admitted to the same maternity and same time of childbirth.Primary and secondary outcome variablesValidated tools were applied, addressing post-traumatic stress disorder (PTSD) and quality of life (SF-36) by phone, and then general and reproductive health, functioning (WHO Disability Assessment Schedule), sexual function (Female Sexual Function Index (FSFI)), substance abuse (Alcohol, Smoking and Substance Involvement Screening Test 2.0) and growth/development (Denver Developmental Screening Test) of children born in the index pregnancy in a face-to-face interview.ResultsAll instruments were applied to 638 women (315 had SMM; 323 were controls, with the assessment of 264 and 307 children, respectively). SF-36 score was significantly lower in the SMM group, while PTSD score was similar between groups. Women who had SMM became more frequently sterile, had more abnormal clinical conditions after the index pregnancy and a higher score for altered functioning, while proportions of FSFI score or any drug use were similar between groups. Furthermore, children from the SMM group were more likely to have weight (threefold) and height (1.5 fold) for age deficits and also impaired development (1.5-fold).ConclusionSMM impairs some aspects of the lives of women and their children. The focus should be directed towards monitoring these women and their children after birth, ensuring accessibility to health services and reducing short-term and medium-term repercussions on physical, reproductive and psychosocial health.

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