scholarly journals High and Low Haemoglobin Levels in Early Pregnancy Are Associated to a Higher Risk of Miscarriage: A Population-Based Cohort Study

Nutrients ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 1578
Author(s):  
Andrés Díaz-López ◽  
Blanca Ribot ◽  
Josep Basora ◽  
Victoria Arija
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Early Pregnancy ◽  
Dose Response ◽  
First Trimester ◽  
Population Based ◽  
Cubic Spline ◽  
Maternal Characteristics ◽  
Spline Models

To evaluate whether women with anaemia or high haemoglobin (Hb) in early pregnancy would be at higher risk of miscarriage, this population-based cohort study involved 9453 women whose pregnancies were monitored at primary care centres between 2007 and 2012. The computerised clinical histories were used to collect: Hb measurements (up to 14 weeks of gestation), miscarriage before or by 24 weeks of gestation, and other maternal characteristics. The relation between anaemia (Hb < 110 g/L), normal Hb (110–140 g/L, reference), and high Hb concentrations (≥140 g/L) with miscarriage were expressed as adjusted OR with 95%CI. Restricted cubic spline models were applied to evaluate the dose-response relationships. A total of 520 (5.5%) women were recorded as having a miscarriage. The rate of miscarriage in anaemia, normal Hb, and high Hb concentrations was 8.4%, 5.1%, and 10.2%, respectively. Compared with women with normal Hb at the first trimester, the multivariable-adjusted OR for miscarriage was 2.11 (95%CI, 1.38–3.21) for women with anaemia and 1.83 (95%CI, 1.29–2.58) for women with high Hb. Hb concentrations showed a U-shaped association with miscarriage, with the lowest incidence among women with Hb of 120–130 g/L. These data highlight the importance of considering anaemia and high Hb levels in early pregnancy as harmful indicators for miscarriage.

scholarly journals Reference ranges of AMH in early pregnancy: the Generation R Study, a population-based prospective cohort study

2021 ◽  
Author(s):  
Ramon Dykgraaf ◽  
Joop Laven ◽  
Sarah Timmermans ◽  
Maria Adank ◽  
Sjoerd van den Berg ◽  
...  
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Early Pregnancy ◽  
Gestational Age ◽  
Prospective Cohort ◽  
Hospital Setting ◽  
First Trimester ◽  
Population Based ◽  
Reference Ranges ◽  
Placental Development

Objective: The objective of this study is to establish maternal reference values of AMH in a fertile multi-ethnic urban pregnant population and to evaluate the effect of gestational age. Design: The Generation R Study is an ongoing population-based prospective cohort study from early pregnancy onwards. Setting: Rotterdam, the Netherlands, out of hospital setting. Population: In 5806 women serum AMH levels were determined in early pregnancy (median 13.5 weeks; 95% range 10.5-17.2). Methods: The model-based AMH reference ranges for maternal age and gestational age were created using GAMLSS. Associations between AMH and several first trimester biomarkers were analyzed using multivariate linear regression analyses. Main outcome measures: AMH levels in early pregnancy and the association with placental biomarkers, hCG, sFLT, and PLGF. Results: A nomogram of AMH in early pregnancy was developed. Serum AMH levels showed a decline with advancing gestational age. Higher AMH levels were associated with a higher level of hCG and sFLT. This last association was predominantly mediated by hCG. AMH levels were negatively associated with PLGF levels. Conclusion: In this large study we show that AMH levels in the first trimester decrease with advancing gestational age. The association between AMH and the placental biomarkers hCG, sFLT and PLGF suggests a better placental development with a lower vascular resistance in mothers with higher AMH levels. AMH might be useful in predicting adverse pregnancy outcome due to impaired placental development. Keywords: Ovarian reserve, placental biomarker, nomogram, first trimester, human Choriogonadotrophin (hCG), soluble FMS-Like Tyrosine kinase-1 (sFLT), Placental Growth Factor (PLGF).

scholarly journals Preconception Hb concentration and risk of preterm birth in over 2·7 million Chinese women aged 20–49 years: a population-based cohort study

2018 ◽  
Vol 120 (5) ◽  
pp. 508-516 ◽  
Author(s):  
Xiuli Zhang ◽  
Qin Xu ◽  
Ying Yang ◽  
Long Wang ◽  
Fangchao Liu ◽  
...  
Keyword(s):  
Cohort Study ◽  
Preterm Birth ◽  
Dose Response ◽  
Chinese Women ◽  
Rural China ◽  
Logistic Models ◽  
Population Based ◽  
Spline Models ◽  
Confounding Variables ◽  
Hb Concentration

AbstractEvidence on the association between maternal Hb concentration and preterm birth (PTB) risk is inconclusive. This paper aimed to explore whether women with anaemia or high Hb level before pregnancy would be at higher risk of PTB. We conducted a population-based cohort study with 2 722 274 women aged 20–49 years, who participated in National Free Pre-Pregnancy Checkups Project between 2013 and 2015 and delivered a singleton before 2016 in rural China. Logistic models were used to estimate OR and 95 % CI after adjusting for confounding variables. Restricted cubic spline models were applied to evaluate the dose–response relationships. A total of 192 819 (7·08 %) women had preterm deliveries. Compared with women with Hb of 110–149 g/l, the multivariable-adjusted OR for PTB was 1·19 (95 % CI 0·98, 1·44) for women with Hb<70 g/l, 1·01 (95 % CI 0·97, 1·03) for 70–99 g/l, 0·96 (95 % CI 0·95, 0·98) for 100–109 g/l, 1·04 (95 % CI 1·01, 1·06) for 150–159 g/l, 1·11 (95 % CI 1·05, 1·17) for 160–169 g/l and 1·19 (95 % CI 1·11, 1·27) for ≥170 g/l, respectively. The multivariable-adjusted OR for very PTB (VPTB) was 1·07 (95 % CI 1·03, 1·12) and 1·06 (95 % CI 1·01, 1·12) for women with Hb <110 and ≥150 g/l, compared with those with Hb of 110–149 g/l, respectively. Our study identified a U-shaped relationship between maternal preconception Hb concentration and PTB risk. Both preconception anaemia and high Hb level can significantly increase VPTB risk. Appropriate intervention for women with abnormal Hb levels before pregnancy is very necessary.

scholarly journals Primary Care Consultations after Hospitalisation for Pneumonia: A Large Population-based Cohort Study

2020 ◽  
pp. BJGP.2020.0890
Author(s):  
Vadsala Baskaran ◽  
Fiona Pearce ◽  
Rowan H Harwood ◽  
Tricia McKeever ◽  
Wei Shen Lim
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Large Population ◽  
Significant Proportion ◽  
Antibiotic Use ◽  
Population Based ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Respiratory Disorder ◽  
The Impact

Background: Up to 70% of patients report ongoing symptoms four weeks after hospitalisation for pneumonia, and the impact on primary care is poorly understood. Aim: To investigate the frequency of primary care consultations after hospitalisation for pneumonia, and the reasons for consultation. Design: Population-based cohort study. Setting: UK primary care database of anonymised medical records (Clinical Practice Research Datalink, CPRD) linked to Hospital Episode Statistics (HES), England. Methods: Adults with the first ICD-10 code for pneumonia (J12-J18) recorded in HES between July 2002-June 2017 were included. Primary care consultation within 30 days of discharge was identified as the recording of any medical Read code (excluding administration-related codes) in CPRD. Competing-risks regression analyses were conducted to determine the predictors of consultation and antibiotic use at consultation; death and readmission were competing events. Reasons for consultation were examined. Results: Of 56,396 adults, 55.9% (n=31,542) consulted primary care within 30 days of discharge. The rate of consultation was highest within 7 days (4.7 per 100 person-days). The strongest predictor for consultation was a higher number of primary care consultations in the year prior to index admission (adjusted sHR 8.98, 95% CI 6.42-12.55). The commonest reason for consultation was for a respiratory disorder (40.7%, n=12,840), 12% for pneumonia specifically. At consultation, 31.1% (n=9,823) received further antibiotics. Penicillins (41.6%, n=5,753) and macrolides (21.9%, n=3,029) were the commonest antibiotics prescribed. Conclusion: Following hospitalisation for pneumonia, a significant proportion of patients consulted primary care within 30 days, highlighting the morbidity experienced by patients during recovery from pneumonia.

scholarly journals Attendance of routine childcare visits in primary care for children of mothers with depression: a nationwide population-based cohort study

2018 ◽  
Vol 68 (667) ◽  
pp. e97-e104 ◽  
Author(s):  
Bente Kjær Lyngsøe ◽  
Claus Høstrup Vestergaard ◽  
Dorte Rytter ◽  
Mogens Vestergaard ◽  
Trine Munk-Olsen ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Relative Risk ◽  
Confidence Interval ◽  
Maternal Depression ◽  
Vaccination Programme ◽  
Population Based ◽  
Point Of Interest ◽  
Vulnerable Families

BackgroundDepression is a common and potentially debilitating illness worldwide. Attendance to routine childcare appointments is a key point of interest in the effort to improve the health and care for families facing depression.AimTo evaluate the association between maternal depression and offspring non-attendance to the Danish childcare and vaccination programme (CCP) for children from 0–5 years of age. The CCP consists of seven separate visits and several vaccinations. To investigate if exposure to recent and previous depression may affect attendance differently.Design and settingPopulation-based cohort study using Danish nationwide registers.MethodParticipants were all live-born children (n = 853 315) in Denmark in the period from 1 January 2000 until 31 August 2013, and their mothers. The outcome of interest was non-attendance of each one of the seven scheduled childcare visits and two vaccination entities in the CCP. Exposure was maternal (both previous and recent) depression. All information was obtained from Danish national registries.ResultsThe risk of not attending CCP was higher for children of mothers with depression. For children of mothers with previous depression, the relative risk (RR) was 1.01 (95% confidence interval [CI] = 0.98 to 1.03) at the 5-week childcare visit, and 1.12 (95% CI = 1.09 to 1.14) at the 5-year childcare visit. For children of mothers with recent depression, the RR was 1.07 (95% CI = 1.03 to 1.13) at the 5-week visit, and 1.15 (95% CI = 1.13 to 1.17) at the 5-year visit. Furthermore, the risk of missing at least four of the seven childcare visits was higher for children of females with maternal depression (RR = 1.16, 95% CI = 1.13 to 1.19).ConclusionMaternal depression seems to compromise CCP attendance. These findings suggest a need for careful clinical attention to these vulnerable families, even years after a diagnosis of depression.

scholarly journals Vitamin D prescribing in children in UK primary care practices: a population-based cohort study

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e031870 ◽  
Author(s):  
Mandy Wan ◽  
Laura J Horsfall ◽  
Emre Basatemur ◽  
Jignesh Prakash Patel ◽  
Rukshana Shroff ◽  
...  
Keyword(s):  
Primary Care ◽  
Vitamin D ◽  
Cohort Study ◽  
Clinical Symptoms ◽  
Population Based ◽  
Vitamin D Supplementation ◽  
Annual Incidence ◽  
Health Improvement ◽  
Laboratory Test Results ◽  
General Practices

ObjectiveTo examine temporal changes in the incidence and patterns of vitamin D supplementation prescribing by general practitioners (GPs) between 2008 and 2016.DesignPopulation-based cohort study.SettingUK general practice health records from The Health Improvement Network.ParticipantsChildren aged 0 to 17 years who were registered with their general practices for at least 3 months.Outcome measuresAnnual incidence rates of vitamin D prescriptions were calculated, and rate ratios were estimated using multivariable Poisson regression to explore differences by sociodemographic factors. Data on the type of supplementation, dose, dosing schedule, linked 25-hydroxyvitamin D (25(OH)D) laboratory test results and clinical symptoms suggestive of vitamin D deficiency were analysed.ResultsAmong 2 million children, the crude annual incidence of vitamin D prescribing increased by 26-fold between 2008 and 2016 rising from 10.8 (95% CI: 8.9 to 13.1) to 276.8 (95% CI: 264.3 to 289.9) per 100 000 person-years. Older children, non-white ethnicity and general practices in England (compared with Wales/Scotland/Northern Ireland) were independently associated with higher rates of prescribing. Analyses of incident prescriptions showed inconsistent supplementation regimens with an absence of pre-supplementation 25(OH)D concentrations in 28.7% to 56.4% of prescriptions annually. There was an increasing trend in prescribing at pharmacological doses irrespective of 25(OH)D concentrations, deviating in part from UK recommendations. Prescribing at pharmacological doses for children with deficient status increased from 3.8% to 79.4%, but the rise was also observed in children for whom guidelines recommended prevention doses (0% to 53%). Vitamin D supplementation at pharmacological doses was also prescribed in at least 40% of children with no pre-supplementation 25(OH)D concentrations annually.ConclusionsThere has been a marked and sustained increase in vitamin D supplementation prescribing in children in UK primary care. Our data suggests that national guidelines on vitamin D supplementation for children are not consistently followed by GPs.

scholarly journals Risk of severe maternal morbidity or death in relation to elevated hemoglobin A1c preconception, and in early pregnancy: A population-based cohort study

PLoS Medicine ◽  
2020 ◽  
Vol 17 (5) ◽  
pp. e1003104
Author(s):  
Alexander J. F. Davidson ◽  
Alison L. Park ◽  
Howard Berger ◽  
Kazuyoshi Aoyama ◽  
Ziv Harel ◽  
...  
Keyword(s):  
Cohort Study ◽  
Early Pregnancy ◽  
Maternal Morbidity ◽  
Hemoglobin A1c ◽  
Population Based ◽  
Severe Maternal Morbidity
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