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Objective The aim of the study is to determine the relation between education and adverse outcomes in individuals with pregestational or gestational diabetes. Study Design This population-based cohort study, using the U.S. vital statistics datasets, evaluated individuals with pregestational or gestational diabetes who delivered between 2016 and 2019. The primary outcome was composite neonatal adverse outcome including any of the following: large for gestational age (LGA), Apgar's score 6 hours, neonatal seizure, or neonatal death. The secondary outcome was composite maternal adverse outcomes including any of the following: admission to intensive care unit, transfusion, uterine rupture, or unplanned hysterectomy. Multivariable analysis was used to estimate adjusted relative risks (aRR) and 95% confidence intervals (CIs). Results Of 15,390,962 live births in the United States, 858,934 (5.6%) were eligible for this analysis. Compared with individuals with a college education and above, the risk of composite neonatal adverse outcome was higher in individuals with some college (aRR = 1.08, 95% CI = 1.07–1.09), high school (aRR = 1.06, 95% CI = 1.04–1.07), and less than high school (aRR = 1.05, 95% CI = 1.03–1.07) education. The components of composite neonatal adverse outcome that differed significantly between the groups were LGA, Apgar's score 6 hours. Infant death differed when stratified by education level. An increased risk of composite maternal adverse outcome was also found with a lower level of education. Conclusion Among individuals with diabetes, lower education was associated with a modestly higher risk of adverse neonatal and maternal outcomes. Key Points Education levels were associated with adverse outcomes among individuals with diabetes. Lower education is associated with multiple neonatal complications, including infant death. Individuals with varying levels of education are at higher risk for adverse maternal outcomes. [ABSTRACT FROM AUTHOR]

Background: Better understanding of the factors associated with formula feeding during the hospital stay can help in identifying potential lactation problems and promote early intervention. Our aim was to ascertain factors associated with exclusive formula feeding in newborns of low‐risk pregnancies. Methods: A population‐based, retrospective study using the United States vital statistics datasets (2014‐2018) evaluating low‐risk pregnancies with a nonanomalous singleton delivery from 37 to 41 weeks. People with hypertensive disorders, or diabetes, were excluded. Primary outcome was newborn feeding (breast vs exclusive formula feeding) during hospital stay. Adjusted relative risks (aRRs) with 95% confidence intervals (CI) were calculated. Results: Of the 19 623 195 live births during the study period, 11 605 242 (59.1%) met inclusion criteria and among them, 1 929 526 (16.6%) were formula fed. Factors associated with formula feeding included: age < 20 years (aRR 1.31 [95% CI 1.31‐1.32]), non‐Hispanic Black (1.42, 1.41‐1.42), high school education (1.69, 1.69‐1.70) or less than high school education (1.94, 1.93, 1.95), Medicaid insurance (1.52, 1.51, 1.52), body mass index (BMI) < 18.5 (1.10, 1.09‐1.10), BMI 25‐29.9 (1.09, 1.09‐1.09), BMI 30‐34.9 (1.19, 1.19‐1.20), BMI 35‐39.9 (1.31, 1.30‐1.31), BMI ≥ 40 (1.43, 1.42‐1.44), multiparity (1.29, 1.29‐1.30), lack of prenatal care (1.49, 1.48‐1.50), smoking (1.75, 1.74‐1.75), and gestational age (ranged from 37 weeks [1.44, 1.43‐1.45] to 40 weeks [1.11, 1.11‐1.12]). Conclusions: Using a large cohort of low‐risk pregnancies, we identified several modifiable factors associated with newborn feeding (eg, prepregnancy BMI, access to prenatal care, and smoking cessation). Improving the breast feeding initiation rate should be a priority in our current practice to ensure equitable care for all neonates. [ABSTRACT FROM AUTHOR]

Objective: To compare trend of primary cesarean delivery rate and composite neonatal and maternal adverse outcomes in low-risk pregnancies among racial and ethnic groups: non-Hispanic White, non-Hispanic Black, and Hispanic.Methods: This population-based cohort study used U.S. vital statistics data (2015-2019) to evaluate low-risk, nulliparous patients with nonanomalous singletons who labored and delivered at 37-41 weeks of gestation. The primary outcome was the primary cesarean delivery rate. Secondary outcomes included composite neonatal adverse outcome (Apgar score less than 5 at 5 minutes, assisted ventilation for more than 6 hours, seizure, or death), and composite maternal adverse outcome (intensive care unit admission, blood transfusion, uterine rupture, or unplanned hysterectomy), as well as infant death. Multivariable Poisson regression models were used to estimate adjusted relative risks (aRR) and 95% CIs.Results: Among 4.3 million births, 60.6% identified as non-Hispanic White, 14.6% identified as non-Hispanic Black, and 24.8% identified as Hispanic. The rate of primary cesarean delivery was 18.5% (n=804,155). An increased risk for cesarean delivery was found in non-Hispanic Black (21.7%, aRR 1.24, 95% CI 1.23-1.25) and Hispanic (17.3%, aRR 1.09, 95% CI 1.09-1.10) individuals, compared with non-Hispanic White individuals (18.1%) after multivariable adjustment. There was an upward trend in the rate of primary cesarean delivery in all racial and ethnic groups ( P for linear trend<0.001 for all groups). However, the racial and ethnic disparity in the rate of primary cesarean delivery remained stable during the study period. The composite neonatal adverse outcome was lower in Hispanic individuals in all newborns (10.7 vs 8.3 per 1,000 live births, aRR 0.74, 95% CI 0.72-0.75), and in newborns delivered by primary cesarean delivery (18.5 vs 15.0 per 1,000 live births, aRR 0.73, 95% CI 0.70-0.76), compared with non-Hispanic White individuals.Conclusion: Using a nationally representative sample in the United States, we found racial and ethnic disparities in the primary cesarean delivery rate in low-risk nulliparous patients, which persisted throughout the study period. [ABSTRACT FROM AUTHOR]

Objective: To examine risk factors and adverse outcomes for neonatal-maternal dyads among low-risk pregnancies at term with subsequent neonatal seizures.Methods: United States vital statistics data sets were used for this retrospective study. Inclusion criteria were low-risk women (without hypertensive disease or diabetes) with nonanomalous singleton pregnancies, who delivered after labor at 37-41 weeks of gestation. The primary composite neonatal adverse outcome included 5-minute Apgar score less than 5, assisted ventilation longer than 6 hours, and neonatal death. A secondary outcome was composite maternal adverse outcome. Multivariable Poisson regression models with robust error variance were used, with adjusted relative risk (aRR) and 95% CI reported.Results: Of 19.76 million live births during the study interval, 11.7 million (59.4%) met inclusion criteria. The rate of neonatal seizures after low-risk pregnancies delivered at term was 0.2 per 1,000 live births. The maternal risks factors associated with neonatal seizures included no prenatal care, smoking during pregnancy, being overweight or obese, and gestational age of 41 weeks. The strongest risk factors for neonatal seizures were chorioamnionitis (relative risk [RR] 5.04, 95% CI 4.40-5.77; aRR 3.27, 95% CI 2.84-3.76) and route of delivery, with operative vaginal (RR 3.62, 95% CI 3.20-4.09; aRR 3.02, 95% CI 2.66-3.43) and cesarean (RR 4.13, 95% CI 3.81-4.48; aRR 3.14, 95% CI 2.86-3.45) higher than spontaneous vaginal. Compared with neonates without seizures, those with seizures had higher risk of composite neonatal adverse outcome (RR 64.55, 95% CI 61.83-67.39; aRR 37.09, 95% CI 35.20-39.08). Compared with women who delivered neonates without seizures, those who delivered neonates with seizures had higher risk of composite maternal adverse outcome (RR 16.27, 95% CI 13.66-19.37; aRR 9.70, 95% CI 8.15-11.53).Conclusion: We identified modifiable maternal risk factors associated with neonatal seizures among low-risk pregnancies at term. Though infrequent, neonatal seizures are associated with higher risk of adverse outcomes in neonatal-maternal dyads. [ABSTRACT FROM AUTHOR]

Objective: To use a large national database to compare composite maternal or neonatal morbidity among low-risk, full-term women.Methods: This cohort study, using the U.S. vital statistics datasets (2011-2015), evaluated low-risk nulliparous women with nonanomalous singleton gestations who labored at 39, 40, or 41 weeks of gestation (as reported in completed weeks of gestation; eg, 39 weeks include 39 0/7 to 39 6/7 weeks). The primary outcome, composite neonatal morbidity, included any of the following: Apgar score below 5 at 5 minutes, assisted ventilation longer than 6 hours, seizure, or mortality. The secondary outcome, composite maternal morbidity, included any of the following: intensive care unit admission, blood transfusion, uterine rupture, or unplanned hysterectomy. Multivariable Poisson regression was used to estimate the association between gestational age and morbidity (using adjusted relative risk [aRR] and 95% CI).Results: Of 19.8 million live births during the study interval, 3.3 million met inclusion criteria: 43.5% were delivered at 39 weeks of gestation, 41.4% at 40 weeks, and 15.1% at 41 weeks. The overall rates of composite neonatal and maternal morbidity were 8.8 and 2.8 per 1,000 live births, respectively. Composite neonatal morbidity was higher for those delivered at 40 (aRR 1.22; 95% CI 1.19-1.25) and 41 (aRR 1.53; 95% CI 1.49-1.58) weeks of gestation when compared with 39 weeks. Composite maternal morbidity was also significantly higher with delivery at 40 (aRR 1.19; 95% CI 1.14-1.25) and 41 weeks of gestation (aRR 1.56; 95% CI 1.47-1.65).Conclusion: Among low-risk nulliparous women, the rate of composite neonatal and maternal morbidity increases, albeit modestly, from 39 through 41 weeks of gestation. [ABSTRACT FROM AUTHOR]

Objective: To assess whether racial and ethnic disparities in adverse infant and maternal outcomes exist among low-risk term pregnancies.Methods: This population-based retrospective cohort study used U.S. vital statistics data from 2014 to 2017. Women with low-risk, nonanomalous singleton pregnancies who labored and delivered at 37-41 weeks of gestation were included and categorized by maternal race and ethnicity: non-Hispanic white (white), non-Hispanic black (black), Hispanic, and non-Hispanic Asian (Asian). Multivariable Poisson regression models were used to estimate the associations of composite neonatal adverse outcome (Apgar score less than 5 at 5 minutes, assisted ventilation for more than 6 hours, neonatal seizure, or neonatal death), infant mortality, and composite maternal adverse outcome (blood transfusion, admission to the intensive care unit, uterine rupture, or unplanned hysterectomy) with maternal race and ethnicity.Results: Of 9,205,873 women included, 55.5% were white, 13.7% were black, 24.3% were Hispanic, and 6.5% were Asian. Risk for the composite neonatal adverse outcome was higher among neonates of black women (unadjusted relative risk [uRR] 1.16, 95% CI 1.13-1.18; adjusted relative risk [aRR] 1.07, 95% CI 1.05-1.10), and lower for neonates of Hispanic and Asian women compared with neonates of white women. A similar pattern of disparity was observed for infant mortality; the risk for infants of black women was significantly increased (uRR 1.89, 95% CI 1.81-1.98; aRR 1.33, 95% CI 1.26-1.39). For the composite maternal adverse outcome, the risk was highest for Asian mothers (uRR 1.09, 95% CI 1.03-1.14; aRR 1.12, 95% CI 1.06-1.18), lowest for Hispanic mothers, and similar for black mothers when compared with white mothers after adjustment for confounders.Conclusion: Among low-risk term pregnancies, the risk for adverse outcomes varied by maternal race and ethnicity. Infants of black women were at the highest risk for neonatal morbidity and infant mortality, and Asian mothers were most likely to experience maternal adverse outcomes. [ABSTRACT FROM AUTHOR]