4 research outputs found
Association Between Number of In-Person Health Care Visits and SARS-CoV-2 Infection in Obstetrical Patients
Intended delivery mode and neonatal outcomes in pregnancies with fetal growth restriction
Objective: To compare neonatal outcomes in pregnancies with fetal growth restriction (FGR) by intended delivery mode. Methods: This is a retrospective cohort study of singleton pregnancies with FGR that were delivered â„34.0âweeks gestation. Neonatal outcomes were compared according to the intended delivery mode, which the attending obstetrician determined. Of note, none of the subjects had a contraindication to labor. Crude and adjusted odds ratios (ORs) and corresponding confidence intervals (CIs) were calculated via logistic regression models to assess the potential association between intended delivery mode and neonatal morbidity defined as a composite outcome (i.e. umbilical artery pH â€7.1, 5-min Apgar score â€7, admission to the neonatal intensive care unit, hypoglycemia, intrapartum fetal distress requiring expedited delivery, and perinatal death). A sensitivity analysis excluded intrapartum fetal distress requiring emergency cesarean delivery from the composite outcome since only patients with spontaneous labor or labor induction could meet this criterion. Potential confounders in the adjusted effects models included maternal age, body mass index, hypertensive disorders, diabetes, FGR type (i.e. early or late), and oligohydramnios. Results: Seventy-two (34%) patients had an elective cesarean delivery, 73 (34%) had spontaneous labor and were expected to deliver vaginally, and 67 (32%) underwent labor induction. The composite outcome was observed in 65.3%, 89%, and 88.1% of the groups mentioned above, respectively (pâpâ=â0.001; aOR 4.85 [95% CI 1.85, 12.66], pâ=â0.001), and labor induction (OR 3.92 [95% CI 1.62, 9.49] pâ=â0.002; aOR 5.29 [95% CI 2.01, 13.87], pâ=â0.001) had higher odds of adverse neonatal outcomes. Conclusion: In this cohort of FGR, delivering at â„34âweeks of gestation, pregnancies with spontaneous labor, and those that underwent labor induction had higher odds of neonatal morbidity than elective cesarean delivery.</p
Vulnerable newborn types: analysis of subnational, populationâbased birth cohorts for 541 285 live births in 23 countries, 2000â2021
Objective: To examine prevalence of novel newborn types among 541â285 live births in 23 countries from 2000 to 2021. Design: Descriptive multi-country secondary data analysis. Setting: Subnational, population-based birth cohort studies (nâ=â45) in 23 low- and middle-income countries (LMICs) spanning 2000â2021. Population: Liveborn infants. Methods: Subnational, population-based studies with high-quality birth outcome data from LMICs were invited to join the Vulnerable Newborn Measurement Collaboration. We defined distinct newborn types using gestational age (preterm [PT], term [T]), birthweight for gestational age using INTERGROWTH-21st standards (small for gestational age [SGA], appropriate for gestational age [AGA] or large for gestational age [LGA]), and birthweight (low birthweight, LBW [<2500âg], nonLBW) as ten types (using all three outcomes), six types (by excluding the birthweight categorisation), and four types (by collapsing the AGA and LGA categories). We defined small types as those with at least one classification of LBW, PT or SGA. We presented study characteristics, participant characteristics, data missingness, and prevalence of newborn types by region and study. Results: Among 541â285 live births, 476â939 (88.1%) had non-missing and plausible values for gestational age, birthweight and sex required to construct the newborn types. The median prevalences of ten types across studies were T+AGA+nonLBW (58.0%), T+LGA+nonLBW (3.3%), T+AGA+LBW (0.5%), T+SGA+nonLBW (14.2%), T+SGA+LBW (7.1%), PT+LGA+nonLBW (1.6%), PT+LGA+LBW (0.2%), PT+AGA+nonLBW (3.7%), PT+AGA+LBW (3.6%) and PT+SGA+LBW (1.0%). The median prevalence of small types (six types, 37.6%) varied across studies and within regions and was higher in Southern Asia (52.4%) than in Sub-Saharan Africa (34.9%). Conclusions: Further investigation is needed to describe the mortality risks associated with newborn types and understand the implications of this framework for local targeting of interventions to prevent adverse pregnancy outcomes in LMICs
Vulnerable newborn types: analysis of subnational, populationâbased birth cohorts for 541 285 live births in 23 countries, 2000â2021
Setting: Subnational, population-based
birth cohort studies (n = 45) in 23 low-and
middle-income
countries (LMICs) spanning 2000â2021.
Population: Liveborn infants.
Methods: Subnational, population-based
studies with high-quality
birth outcome
data from LMICs were invited to join the Vulnerable Newborn Measurement
Collaboration. We defined distinct newborn types using gestational age (preterm
[PT], term [T]), birthweight for gestational age using INTERGROWTH-21st
standards
(small for gestational age [SGA], appropriate for gestational age [AGA] or large
for gestational age [LGA]), and birthweight (low birthweight, LBW [<2500 g], non-
LBW) as ten types (using all three outcomes), six types (by excluding the birthweight
categorisation), and four types (by collapsing the AGA and LGA categories). We defined
small types as those with at least one classification of LBW, PT or SGA. We
presented study characteristics, participant characteristics, data missingness, and
prevalence of newborn types by region and study.
Results: Among 541 285 live births, 476 939 (88.1%) had non-missing
and plausible
values for gestational age, birthweight and sex required to construct the newborn
types. The median prevalences of ten types across studies were T+AGA+nonLBW
(58.0%), T+LGA+nonLBW (3.3%), T+AGA+LBW (0.5%), T+SGA+nonLBW
(14.2%), T+SGA+LBW (7.1%), PT+LGA+nonLBW (1.6%), PT+LGA+LBW (0.2%),
PT+AGA+nonLBW (3.7%), PT+AGA+LBW (3.6%) and PT+SGA+LBW (1.0%). The
median prevalence of small types (six types, 37.6%) varied across studies and within
regions and was higher in Southern Asia (52.4%) than in Sub-Saharan
Africa (34.9%).
Conclusions: Further investigation is needed to describe the mortality risks associated
with newborn types and understand the implications of this framework for local
targeting of interventions to prevent adverse pregnancy outcomes in LMICs