Early pregnancy body mass index and spontaneous preterm birth in Northwest Russia: a registry-based study

BACKGROUND: International studies on the association between maternal body mass index (BMI) and spontaneous preterm birth (PTB) yield controversial results warranting large studies from other settings. The aim of this article was to study association between maternal early pregnancy BMI and the risk of spontaneous PTB in Murmansk County (MC), Northwest Russia. METHODS: This is a registry-based cohort study. All women with singleton pregnancies registered at antenatal clinics during the first 12 weeks of gestation and who delivered in MC between January, 1(st) 2006 and December, 31(st) 2011 comprised the study base (n = 29,709). All women were categorized by BMI into four groups: underweight (<18.5 kg/m(2)), normal (18.5–24.9 kg/m(2)), overweight (25.0–29.9 kg/m(2)), and obese (≥30.0 kg/m(2)). Multivariable logistic regression was used to study associations between maternal BMI and PTB (<37 weeks) and very preterm birth (VPTB) (<32 weeks) adjusted for socio-economic factors, biological and lifestyle characteristics. RESULTS: The prevalence of underweight, overweight and obesity were 7.1% (95% CI: 6.8-7.4), 18.3% (95% CI: 17.8-18.7) and 7.1% (95% CI: 6.8-7.4), respectively. Altogether, 5.5% (95% CI: 5.3-5.8) of the births were PTB and 0.8% (95% CI: 0.7-0.9) were VPTB. After adjustment, both underweight (OR = 1.25, 95% CI: 1.03-1.50), overweight (OR = 1.10, 95% CI: 0.97-1.26) and obese (OR = 1.31, 95% CI: 1.08-1.57) women were more likely to deliver preterm. VPTB was associated with overweight (OR = 1.47, 95% CI: 1.056-2.03) and obesity (OR = 1.63, 95% CI: 1.02-2.60). CONCLUSION: The findings demonstrate a J-shaped association between first trimester maternal BMI and spontaneous PTB and VPTB with increased risk among underweight, overweight and obese women

Scoping maternal care through the lens of maternal deaths: A retrospective analysis of maternal mortality in Georgia

Introduction - Reduction of the maternal mortality ratio (MMR) to 12 per 100,000 live births by 2030 is a priority target in Georgia. This study aims to assess and classify MM in Georgia by direct and indirect causes of death from 2014 to 2017, using data from the national surveillance system and in accordance with internationally approved criteria. Material and methods - In this secondary study, MM data was retrieved from the Maternal and Children’s Health Coordinating Committee and validated with data from the Vital Registry System and the Georgian Birth Registry. The study sample comprised 61 eligible MM cases. Relevant information was transferred to case-report forms to review and classify MM cases by direct and indirect causes of maternal death. Results - The MMR during the study period was 26.7 per 100,000 live births. The proportion of direct causes of maternal death exceeded that of indirect causes, at 62% and 38%, respectively. The leading direct cause of maternal death was haemorrhage, while infection was the most frequent indirect cause. 52.5% of MM cases had no pre-existing medical condition, 62.3% had frequent adherence to antenatal care, and 52.5% had emergency caesarean sections. Conclusion - In Georgia, direct causes of maternal death exceed indirect causes in MM cases, with haemorrhage and infections, respectively, being most common. These findings are important to ensure optimal and continuous care and to accelerate progress in the reduction of MM in the country

Changes in cesarean section rates after introduction of a punitive financial policy in Georgia: A population-based registry study 2017-2019

Background There is little research on how financial incentives and penalties impact national cesarean section rates. In January 2018, Georgia introduced a national cesarean section reduction policy, which imposes a financial penalty on hospitals that do not meet their reduction targets. The aim of this study was to assess the impact of this policy on cesarean section rates, subgroups of women, and selected perinatal outcomes. Methods We included women who gave birth from 2017 to 2019 registered in the Georgian Birth Registry (n = 150 534, nearly 100% of all births in the country during this time). We then divided the time period into pre-policy (January 1, 2017, to December 31, 2017) and post-policy (January 1, 2018, to December 31, 2019). An interrupted time series analysis was used to compare the cesarean section rates (both overall and stratified by parity), neonatal intensive care unit transfer rates, and perinatal mortality rates in the two time periods. Descriptive statistics were used to assess differences in maternal socio-demographic characteristics. Results The mean cesarean section rate in Georgia decreased from 44.7% in the pre-policy period to 40.8% in the post-policy period, mainly among primiparous women. The largest decrease in cesarean section births was found among women <25 years of age and those with higher education. There were no significant differences in the neonatal intensive care unit transfer rate or the perinatal mortality rate between vaginal and cesarean section births in the post-policy period. Conclusion The cesarean section rate in Georgia decreased during the 2-year post-policy period. The reduction mainly took place among primiparous women. The policy had no impact on the neonatal intensive care unit transfer rate or the perinatal mortality rate. The impact of the national cesarean section reduction policy on other outcomes is not known

Factors Associated with Cesarean Section among Primiparous Women in Georgia: A Registry-based Study

Cesarean section rates remain high in Georgia. As a cesarean section in the first pregnancy generally lead to a cesarean section in subsequent pregnancies, primiparous women should be targeted for prevention strategies. The aim of the study was to assess factors associated with cesarean section among primiparous women. The study comprised 17,065 primiparous women with singleton, cephalic deliveries at 37–43 weeks of gestation registered in the Georgian Birth Registry in 2017. The main outcome was cesarean section. Descriptive statistics and logistic regression analysis were used to identify factors associated with cesarean section. The proportion of cesarean section was 37.1% with regional variations from 14.2% to 57.4%. Increased maternal age, obesity and having a baby weighing ≥4000 g were all associated with higher odds of cesarean section. Of serious concern for newborn well-being is the high proportion of cesarean section at 37–38 weeks of gestation. Further research should focus on organizational and economical aspects of maternity care to uncover the underlying causes of the high cesarean section rate in Georgia

Under-reporting of major birth defects in Northwest Russia: a registry-based study

Source at https://doi.org/10.1080/22423982.2017.1366785 .The objective was to assess the prevalence of selected major birth defects, based on data from two medical registries in Murmansk County, and compare the observed rates with those available for Norway and Arkhangelsk County, Northwest Russia. It included all newborns (≥22 completed weeks of gestation) registered in the Murmansk County Birth Registry (MCBR) and born between 1 January 2006 and 31 December 2009 (n=35,417). The infants were followed-up post-partum for 2 years through direct linkage to the Murmansk Regional Congenital Defects Registry (MRCDR). Birth defects identified and confirmed in both registries constituted the “cases” and corresponded to one or more of the 21 birth defect types reportable to health authorities in Moscow. The overall prevalence of major birth defects recorded in the MRCDR was 50/10,000 before linkage and 77/10,000 after linkage with the MCBR. Routine under-reporting to the MRCDR of 40% cases was evident. This study demonstrates that birth registry data improved case ascertainment and official prevalence assessments and reduced the potential of under-reporting by physicians. The direct linkage of the two registries revealed that hypospadias cases were the most prevalent among the major birth defects in Murmansk County. Abbreviations: ICD-10, International Classification of Diseases, 10th revision; MCBR, Murmansk County Birth Registry; MRCDR, Murmansk Regional Congenital Defects Registry; MGC, Murmansk Genetics Cente

Risk Factors for hypospadias in Northwest Russia: A Murmansk County Birth Registry Study

Source at https://doi.org/10.1371/journal.pone.0214213. Background - Hypospadias is the most common congenital anomaly of the penis, but its causes are mainly unknown. Of the risk factors identified, the most plausible are hormonal and genetic. The aim of this study was to identify risk factors for hypospadias in Northwest Russia based on registry data. Methods - The study population included male infants registered in the Murmansk County Birth Registry between 1 January 2006 and 31 December 2011 (n = 25 475). These infants were followed-up for 2 years using the Murmansk Regional Congenital Defects Registry to identify cases of hypospadias not diagnosed at birth. We used logistic regression analysis to examine the contributions of hypospadias risk factors. Results - Out of 25 475 male infants born during the study period, 148 had isolated hypospadias. The overall prevalence rate was 54.2 (95% CI 53.6–54.8) per 10 000 male infants. Those born to mothers with preeclampsia (OR = 1.65; 95% CI 1.03–2.66) or infant birthweight < 2500 g (OR = 2.06; 95% CI 1.18–3.60) exhibited increased risk for hypospadias. Maternal age, smoking during pregnancy, folic acid intake during pregnancy or hepatitis B surface antigen positivity did not associate with increased risk of hypospadias. Conclusions Combining data from a birth registry with those from a congenital defects registry provided optimal information about the prevalence of hypospadias and its association with low infant birthweight and preeclampsia. These factors have in common changes in hormone levels during pregnancy, which in turn may have contributed to hypospadias development

Health and environmental impacts in the Norwegian border area related to local Russian industrial emissions. Knowledge status.

© NILU – Norsk institutt for luftforskning. Publikasjonen kan siteres fritt med kildeangivelse.The contaminant situation in the Norwegian-Russian border has caused concern for several decades and considerable amount of data has been gathered during the Pasvik programme (Stebel et al., 2007; Pasvik programme, 2008) for the environmental pollution, but not in this extent for food safety and potential human health risks in this region. Through the compiling of the available literature the authors of this report have identified a number of issues that need further attention

Risk factors for perinatal mortality in Murmansk County, Russia: a registry-based study

Source at http://dx.doi.org/10.1080/16549716.2017.1270536 Background: Factors contributing to perinatalmortality (PM) in Northwest Russia remain unclear. This study investigated possible associations between selected maternal and fetal characteristics and PM based on data from the population-based Murmansk County Birth Registry. Objective: This study investigated possible associations between selected maternal and fetal characteristics and PM based on data from the population-based Murmansk County Birth Registry. Methods: The study population consisted of all live- and stillbirths registered in the Murmansk County Birth Registry during 2006–2011 (n = 52,806). We excluded multiple births, births prior to 22 and after 45 completed weeks of gestation, infants with congenital malformations, and births with missing information regarding gestational age (a total of n = 3,666) and/or the studied characteristics (n = 2,356). Possible associations between maternal socio-demographic and lifestyle characteristics, maternal pre-pregnancy characteristics, pregnancy characteristics, and PM were studied by multivariable logistic regression. Crude and adjusted odds ratios with 95% confidence intervals were calculated. Results: Of the 49,140 births eligible for prevalence analysis, 338 were identified as perinatal deaths (6.9 per 1,000 births). After adjustment for other factors, maternal low education level, prior preterm delivery, spontaneous or induced abortions, antepartum hemorrhage, antenatally detected or suspected fetal growth retardation, and alcohol abuse during pregnancy all significantly increased the risk of PM. We observed a higher risk of PM in unmarried women, as well as overweight or obese mothers. Maternal underweight reduced the risk of PM. Conclusions: Our results suggest that both social and medical factors are important correlates of perinatal mortality in Northwest Russia

Changes in maternal risk factors and their association with changes in cesarean sections in Norway between 1999 and 2016: A descriptive population-based registry study

Background - Increases in the proportion of the population with increased likelihood of cesarean section (CS) have been postulated as a driving force behind the rise in CS rates worldwide. The aim of the study was to assess if changes in selected maternal risk factors for CS are associated with changes in CS births from 1999 to 2016 in Norway. Methods and findings - This national population-based registry study utilizes data from 1,055,006 births registered in the Norwegian Medical Birth Registry from 1999 to 2016. The following maternal risk factors for CS were included: nulliparous/≥35 years, multiparous/≥35 years, pregestational diabetes, gestational diabetes, hypertensive disorders, previous CS, assisted reproductive technology, and multiple births. The proportion of CS births in 1999 was used to predict the number of CS births in 2016. The observed and predicted numbers of CS births were compared to determine the number of excess CS births, before and after considering the selected risk factors, for all births, and for births stratified by 0, 1, or >1 of the selected risk factors. The proportion of CS births increased from 12.9% to 16.1% (+24.8%) during the study period. The proportion of births with 1 selected risk factor increased from 21.3% to 26.3% (+23.5%), while the proportion with >1 risk factor increased from 4.5% to 8.8% (+95.6%). Stratification by the presence of selected risk factors reduced the number of excess CS births observed in 2016 compared to 1999 by 67.9%. Study limitations include lack of access to other important maternal risk factors and only comparing the first and the last year of the study period. Conclusions - In this study, we observed that after an initial increase, proportions of CS births remained stable from 2005 to 2016. Instead, both the size of the risk population and the mean number of risk factors per birth continued to increase. We observed a possible association between the increase in size of risk population and the additional CS births observed in 2016 compared to 1999. The increase in size of risk population and the stable CS rate from 2005 and onward may indicate consistent adherence to obstetric evidence-based practice in Norway

The Murmansk county birth registry (MCBR) : the implementation and applicability of a population-based medical birth registry in the Russian Arctic

The Murmansk County Birth Registry (MCBR) was initiated on January 1. 2006. Currently (April 2009) the MCBR has registered over 26 000 births. The registry covers a geographical area known as the Kola Peninsula in Northwest Russia, which is almost entirely located above the Arctic Circle. Murmansk County is about half the size of Norway and had 857 000 inhabitants in 2008. All the 15 delivery departments in the county are involved and their locations stretch from Nikel in the Northwest to Kandalaksha in the south. The Registry Office is located in the city of Murmansk with a trusted staff of four. The MCBR annually registers over 99% of all deliveries in the region. Based on several measures such as quality control exercises and regional workshops, the registry seems to exhibit adequate validity. The registration of births in the MCBR is obligatory and embedded in regional legislation. It is a cooperative effort between the University of Tromsø and the Murmansk County Health Department. Together they have defined four major guidelines, or tasks for the registry: • Monitor the health condition of mothers and their newborn; • Monitor the availability of maternal and perinatal health care; • Develop standards and guidelines for maternal and perinatal health care; • Spawn new hypotheses and provide knowledge related to causal relationships for reproductive health risk factors. Comparisons of selected pregnancy outcomes from Murmansk County with the northern regions of other Nordic countries (Norway, Sweden and Finland) revealed several interesting differences. First of all, there was the divergence of the demographic composition of the respective delivering populations. The pregnant women were much younger in Murmansk County (about 3.5 years), and the percentage of teenage mothers was about twice that of Northern Norway and 5 times higher than in Northern Sweden. Further each woman tended to have fewer children in Murmansk County, the babies were lighter on average (about 200 g), and the proportion of children with a birth weight over 4500 g was 4.5 times higher in Northern Norway. A study comparing the birth weights, perinatal mortality and gestational ages between Northern Norway and Murmansk County disclosed valuable information. Based on WHO-guideline-calculations, the perinatal mortality among the women with a known gestational age was 11.0/1000 in Murmansk County (2006-2007) and 5.4/1000 in Northern Norway (2004-2006). The risk of perinatal mortality was higher at all gestational ages and at all birth weight increments in Murmansk County. There were large disparities between the two regions in the optimal perinatal-survival weights and the small-for-gestationalage 10 percent cut-off weight for term deliveries. Two further studies aimed to map out challenges related to the collection of human tissue samples in the Russian Arctic for the analyses of environmental contaminants. After all, a relevant and effective protocol is the core of any viable epidemiological study. It was concluded that relative to cord blood and breast milk, maternal plasma/blood is the most fundamental biomonitoring medium for organochlorines and toxic metals. Also, complicated statistical analyses will require a detection frequency of the individual contaminant levels in each sample to exceed 80%. And finally, the correlations between concentrations of different organochlorines in the body fluids (with a few exceptions) were sufficiently high so that measuring the levels of a few with high detection frequencies would give a suitable picture of the combined body burden of these contaminants. In conclusion, the MCBR constitutes an invaluable tool for reproductive health studies in the future such as the studies of adverse effects of environmental contaminants