Search

Objectives: Public health interventions to reduce maternal mortality have largely focused on obstetric causes of death. However, previous studies have noted that non-obstetrics factors, such as motor vehicle accidents, substance overdoses, homicides, and suicides, may account for a large proportion of maternal deaths. The study objective was to examine trends in maternal deaths from non-obstetric causes across races in the United States (US). Methods: A population-based cross-sectional study was conducted on 80,710,348 live births using data from the "Birth Data" and "Mortality Multiple Cause" files compiled by the Centers for Disease Control and Prevention from 2000 to 2019. The annual incidence of maternal deaths attributed to non-obstetric causes (/100,000 live-births) during pregnancy and up to 42 days postpartum were calculated across racial groups. Then the effects of race on the risk of non-obstetric maternal mortality and temporal changes over the study period were examined using logistic regression models. Results: From 2000 to 2019, a total 7,334 women died during pregnancy, childbirth, and within 42 days postpartum from non-obstetric causes, representing 34.5% (7,334/21,241) of all maternal mortality. Of non-obstetric deaths, 31.3% were caused by transport accidents and 27.3% by accidental poisoning. American Indian women were found to have the highest risk of non-obstetric maternal mortality (OR 2.20,95% CI 1.90–2.56), and 46.1% (176/382) of all deaths among pregnant American Indian women were caused by non-obstetric complications. Risk of non-obstetric maternal mortality increased overall during the 20-year study period, with a greater increase among Black (1.15, 1.13–1.17) and American Indian women (1.17, 1.13–1.21). Conclusion: Non-obstetric causes of death have become increasingly prevalent in the US, especially in American Indian women. Novel interventions to address these non-obstetric factors should especially target American Indian women to improve maternal outcomes. Significance: What is Already Known on this Subject?: Black women and American Indian women have the highest maternal mortality rates in the United States. Few studies have considered non-obstetric causes of maternal death. What this Study adds?: Non-obstetric causes of maternal mortality have become increasingly prevalent in the US within the past two decades, with more than one-third of all deaths in pregnant women being non-obstetric in nature. American Indian women and Black women were found to be at the highest risk of non-obstetric mortality, with an upward trend over time. Maternal deaths due to non-obstetric causes was also elevated among Black women compared to white women. [ABSTRACT FROM AUTHOR]

Background: As the age at first pregnancy continues to rise in the United States so does the incidence of breast cancer diagnosed during pregnancy. Our objective was to evaluate temporal trends in the incidence of pregnancy‐associated breast cancer (PABC) and to measure neonatal outcomes associated with PABC. Methods: We conducted a population‐based cohort study using the 1999‐2012 Healthcare Cost and Utilization Project—Nationwide Inpatient Sample (HCUP‐NIS) from the United States. Logistic regression models, adjusted for maternal baseline characteristics, examined the effect of PABC on neonatal outcomes. Results: There were 11 846 300 deliveries between 1999 and 2012, of which 772 cases of PABC were identified, resulting in an overall incidence of 6.5 cases/100 000 pregnancies. There was a significant increase in the incidence of PABC during the study period (P < 0.05). Women with PABC tended to be older, of white ethnicity, belong to a higher income quartile and to be treated in an urban teaching hospital. In pregnancies complicated by breast cancer, there was a greater risk of preterm delivery (OR 4.84, 95% CI 4.05‐5.79) and preterm premature rupture of membranes (OR 1.79, 95% CI 1.06‐3.05). No associations were observed between PABC and intrauterine growth restriction, congenital anomalies or intrauterine fetal demise. Conclusion: There is an uptrend in the incidence of PABC and therefore, the need for counseling these patients is also increasing. Although pregnancies with the diagnosis of maternal breast cancer are more prone to premature births, it is encouraging that these babies do not appear to be at increased risk for congenital anomalies, growth restriction, or fetal demise. [ABSTRACT FROM AUTHOR]

Aims: To examine the effect of a prior cesarean delivery on neonatal outcomes. Methods: We conducted a retrospective cohort study on all women with a prior livebirth who delivered at the Royal Victoria Hospital between 2001 and 2006. We defined our exposure as a positive history for cesarean delivery and used unconditional logistic regression analysis to estimate the adjusted effect of a previous cesarean delivery on adverse neonatal outcomes. Results: A total of 18,673 births took place of which 9708 were in women with a prior livebirth (77.0% with no previous cesarean delivery and 23.0% with a previous cesarean delivery). As compared to newborns delivered by mothers with no prior cesarean delivery, increasing number of prior cesarean deliveries was associated with an increasing risk of preterm birth [odds ratio (OR) 1.23, 95% confidence interval (CI) 1.09-1.39]; respiratory distress syndrome (OR 3.54, 95% CI 2.02-5.91); and admission to the neonatal intensive care unit (OR 1.41, 95% CI 1.25-1.60). These findings were predominantly due to differences in gestational age and mode of delivery. Conclusion: Having a prior cesarean delivery is associated with an increased risk of adverse neonatal outcomes. Adverse neonatal outcomes in subsequent pregnancies is additional evidence to suggest that unless specifically indicated, cesarean delivery should be avoided. [ABSTRACT FROM AUTHOR]

Acute pancreatitis is a rare condition that can be associated with significant complications. The objective of this study is to evaluate the maternal and newborn outcomes associated with acute pancreatitis in pregnancy. A retrospective cohort study using the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample from the United States was performed. All pregnant patients with acute pancreatitis were identified using International Classification of Disease-9 coding from 1999 to 2015. The effect of acute pancreatitis on maternal and neonatal outcomes in pregnancy was evaluated using multivariate logistic regression, while adjusting for baseline maternal characteristics. From 1999 to 2015, there were a total of 13,815,919 women who gave birth. There were a total of 14,258 admissions of women diagnosed with acute pancreatitis, including 1,756 who delivered during their admission and 12,502 women who were admitted in the antepartum period and did not deliver during the same admission. Acute pancreatitis was associated with increased risk of prematurity, OR 3.78 (95% CI 3.38–4.22), preeclampsia, 3.81(3.33–4.36), postpartum hemorrhage, 1.90(1.55–2.33), maternal death, 9.15(6.05–13.85), and fetal demise, 2.60(1.86–3.62) among women diagnosed with acute pancreatitis. Among women with acute pancreatitis, delivery was associated with increased risk of requiring transfusions, 6.06(4.87–7.54), developing venous thromboembolisms, 2.77(1.83–4.18), acute respiratory failure, 3.66(2.73–4.91), and disseminated intravascular coagulation, 8.12(4.12–16.03). Acute pancreatitis in pregnancy is associated with severe complications, such as maternal and fetal death. Understanding the risk factors that may lead to these complications can help prevent or minimize them through close fetal and maternal monitoring. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnea (OSA) is linked to many health comorbidities. We aimed to ascertain if OSA correlates with a rise in poor obstetrical outcomes. Employing the United States' Healthcare Cost and Utilization Project – National Inpatient Sample, we performed our retrospective cohort study including all women who delivered between 2006 and 2015. ICD-9 codes were used to characterize women as having a diagnosis of OSA. Temporal trends in pregnancies with OSA were studied, baseline features were evaluated among gravidities in the presence and absence of OSA, and multivariate logistic regression analysis was utilized in assessing consequences of OSA on patient and newborn outcomes. Of a total 7,907,139 deliveries, 3,115 belonged to patients suffering from OSA, resulting in a prevalence of 39 per 100,000 deliveries. Rates rose from 10.14 to 78.12 per 100,000 deliveries during the study interval (p<0.0001). Patients diagnosed with OSA were at higher risk of having pregnancies with preeclampsia, OR 2.2 (95% CI 2.0–2.4), eclampsia, 4.1 (2.4–7.0), chorioamnionitis, 1.4 (1.2–1.8), postpartum hemorrhage, 1.4 (1.2–1.7), venous thromboembolisms, 2.7 (2.1–3.4), and to deliver by caesarean section, 2.1 (1.9–2.3). Cardiovascular and respiratory complications were also more common among these women, as was maternal death, 4.2 (2.2–8.0). Newborns of OSA patients were at elevated risk of being premature, 1.3 (1.2–1.5) and having congenital abnormalities, 2.3 (1.7–3.0). Pregnancies with OSA were linked to an elevated risk of poor maternal and neonatal outcomes. During pregnancy, OSA patients should receive attentive follow-up care in a tertiary hospital. [ABSTRACT FROM AUTHOR]

Objectives: Myasthenia gravis (MG) is an autoimmune disease affecting the neuromuscular junction marked by weakness and fatiguability of skeletal muscle. MG has an unpredictable course in pregnancy. Our purpose was to evaluate the effect of MG on maternal and neonatal outcomes. Methods: Using the United States' Healthcare Cost and Utilization Project Nationwide Inpatient Sample from 2005 to 2015, we conducted a retrospective cohort study consisting of women who delivered during that period. Multivariate logistic regression models, adjusted for baseline maternal demographics and comorbidities, were used to compare maternal and neonatal outcomes among pregnancies in women with and without MG. Results: During the study period, 974 deliveries were to women diagnosed with MG. Women with MG were more likely to be older, African American, obese, have Medicare insurance and be discharged from an urban teaching hospital. Women with MG were also more likely to have chronic hypertension, pre-gestational diabetes, hypothyroidism, and chronic steroid use. Women with MG were at greater risk for acute respiratory failure (OR 13.7, 95% CI 8.9–21.2) and increased length of hospital stay (OR 2.5, 95% CI 1.9–3.3). No significant difference was observed in the risk of preterm premature rupture of membranes, caesarean section or instrumental vaginal delivery. Neonates of women with MG were more likely to be premature (OR 1.4, 95% CI 1.2–1.8). Conclusions: MG in pregnancy is a high-risk condition associated with greater risk of maternal respiratory failure and preterm birth. Management in a tertiary care center with obstetrical, neurological, anesthesia and neonatology collaboration is recommended. [ABSTRACT FROM AUTHOR]

Breast cancer in pregnancy is a rare condition. The objective of our study was to describe the incidence, risk factors, and obstetrical outcomes of breast cancer in pregnancy. We conducted a population-based cohort study on 8.8 million births using data from the Healthcare Cost and Utilization Project - Nationwide Inpatient Sample from 1999-2008. The incidence of breast cancer was calculated and logistic regression analysis was used to evaluate the independent effects of demographic determinants on the diagnosis of breast cancer and to estimate the adjusted effect of breast cancer on obstetrical outcomes. There were 8,826,137 births in our cohort of which 573 cases of breast cancer were identified for an overall 10-year incidence of 6.5 cases per 100,000 births with the incidence slightly increasing over the 10-year period. Breast cancer appeared to be more common among women >35 years of age, odds ratio (OR) = 3.36 (2.84-3.97); women with private insurance plans, OR = 1.39 (1.10-1.76); and women who delivered in an urban teaching hospital, OR = 2.10 (1.44-3.06). After adjusting for baseline characteristics, women with pregnancy-associated breast cancer were more likely to have an induction of labor, OR = 2.25 (1.88, 2.70), but similar rates of gestational diabetes, preeclampsia, instrumental deliveries, and placental abruption. The incidence of breast cancer in pregnancy appears higher than previously reported with women over 35 being at greatest risk. Aside from an increased risk for induction of labor, women with breast cancer in pregnancy have similar obstetrical outcomes. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to determine the prognostic value of planned primary elective cesarean section versus planned vaginal delivery in women with advanced maternal age. Methods: We conducted a population-based, retrospective cohort study using the United States' Health Care Cost and Utilization Project's Nationwide Inpatient Sample to evaluate maternal outcomes in women with advanced maternal age delivering from 2003 to 2012. Healthy women who underwent primary elective cesarean section constituted a surrogate for low-risk planned cesarean delivery. Logistic regression was used to compare outcomes between women with planned cesarean and planned vaginal delivery. Results: Among seven million births, we identified 442,067 deliveries in healthy women with advanced maternal age. The planned cesarean group comprised 7.96 % of women in the cohort. When compared to healthy women in the planned vaginal group, women in the planned cesarean group had a significantly higher mortality ratio (2.56/10,000 vs. 0.44/10,000, p < 0.01). The planned cesarean group was also at higher odds of numerous complications, including peripartum hysterectomy OR 1.81 (1.36-2.40), p < 0.01, cardiac arrest OR 5.39 (4.54-6.38), p < 0.01, acute renal failure OR 3.39 (1.78-6.46), p < 0.01 and sepsis OR 2.27 (1.25-4.14), p < 0.01. Conclusions for Practice: Planned cesarean section is a key factor significantly influencing maternal morbidity and mortality in healthy women with advanced maternal age. When possible, planned cesarean deliveries should be avoided in this population. [ABSTRACT FROM AUTHOR]

Aim: The purpose of our study is to compare pregnancy outcomes between women with a functioning renal transplant and women with end-stage renal disease (ESRD). Methods: We carried out a population-based retrospective cohort study using the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database from 2006 to 2011. Logistic regression analysis was used to estimate the age-adjusted effect of functioning renal transplant vs. ESRD requiring dialysis on pregnancy outcomes. Results: We identified 264 birth records to women with a functional renal transplant and 267 birth records to women with ESRD on dialysis among 5,245,452 births. As compared to women with ESRD on dialysis, renal transplant recipients were less likely to have placental abruption [odds ratio, OR 0.23 (95% confidence interval, CI 0.08-0.70)], to receive blood transfusions [OR 0.17 (95% CI 0.09-0.30)], and to have growth-restricted and small-for-gestational-age babies [OR 0.45 (95% CI 0.23-0.85)]. Renal transplant recipients were more likely to have an instrumental delivery [OR 15.38 (95% CI 1.92-123.3)]. Among renal transplant women, there was a trend towards delivery by cesarean section as compared to patients with ESRD [OR 1.31 (95% CI 0.93-1.85)]. However, these results were not statistically significant. Fetal deaths were less likely to occur in women with a renal transplant [OR 0.41 (95% CI 0.17-0.96)]. There were four maternal deaths among patients with ESRD on dialysis and no maternal deaths among renal transplant patients. Conclusion: Patients with a functional renal graft had an overall lower rate of morbidity and adverse pregnancy complications when compared to patients with ESRD on dialysis. [ABSTRACT FROM AUTHOR]

Aim Non- Hodgkin's lymphoma ( NHL) is a rare malignancy that can affect women of all ages. The purpose of our study was to estimate the incidence, maternal and fetal outcomes of pregnancy-associated non-Hodgkin's lymphoma ( PANHL). Material and Methods We conducted a population-based cohort study on all births identified in the Healthcare Cost and Utilization Project - Nationwide Inpatient Sample from 2003 to 2011. Disease incidence was calculated and logistic regression was used to estimate the adjusted effect of NHL on maternal and fetal outcomes. Results Of 7 917 453 births, there were 427 cases of PANHL for an overall incidence of 5.39 per 100 000 births, increasing from 4.44 per 100 000 births to 7.17 per 100 000 births over the 9-year period. Relative to controls, PANHL was more common among Caucasians and women aged 25-34 years. Non-specified PANHL was most commonly coded in >81% of cases, with mycosis fungoides and Burkitt's lymphoma being the other two most common. After adjusting for baseline characteristics, women with PANHL were more likely to have pre-eclampsia, odds ratio ( OR) 1.57 (95% confidence interval [ CI] 1.06-2.32), cesarean section, OR 1.37 (95% CI 1.13-1.67), preterm births OR 2.50 (95% CI 1.94-3.22), postpartum blood transfusions, OR 2.73 (2.10-3.55), and infectious morbidity, OR 2.81 (95% CI 1.16-6.79). Maternal and fetal mortality rates were significantly increased among women with PANHL. Conclusion The incidence of PANHL is increasing and is associated with an increased risk of maternal and neonatal morbidity and mortality, and as such, women with PANHL may best be managed in specialized centers. [ABSTRACT FROM AUTHOR]

Aim Previous estimates of the incidence of varicella zoster virus ( VZV) pneumonia and maternal death associated with VZV infection among the pregnant population have varied considerably and been based predominantly on reports from case series. We sought to measure the incidence of VZV-related morbidity and mortality to provide more representative population estimates. Methods We carried out a large cohort study on all births using the United States Healthcare Cost and Utilization Project- Nationwide Inpatient Sample database between 2003 and 2010. Descriptive statistics were used to measure baseline characteristics and outcomes of women with VZV infection. Multivariate logistic regression analyses were used to identify risk factors for the development of VZV-related morbidity and mortality. Results We identified 935 patients admitted for VZV infection among 7.7 million pregnancy admissions, representing an incidence of 1.21 cases/10 000 pregnancies (95% confidence interval [ CI], 1.13-1.29). The incidence of VZV pneumonia was 2.5% (95% CI, 1.6-3.7). No maternal deaths were recorded during the 8-year study period. There were no significant risk factors identified for those who developed VZV pneumonia compared to those who had an uncomplicated VZV infection during pregnancy. Conclusion The incidence of VZV pneumonia and VZV infection associated with maternal death is significantly lower than previously estimated and may reflect better immunization and earlier interventions. [ABSTRACT FROM AUTHOR]

Objective: Acute pancreatitis is a rare condition in pregnancy. The aim of this study is to compare associated conditions, treatments and complications of pancreatitis in pregnant and age-matched non-pregnant controls. Methods: We carried out a population-based retrospective cohort study using the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP-NIS) from 2003 to 2010. A cohort of pregnant women with acute pancreatitis was created and compared to a created age-matched cohort of non-pregnant women with acute pancreatitis at a 1:4 ratio. Comparisons of associated conditions, treatment types, and complications were carried out using unconditional logistic regression. Results: We identified 7725 cases of acute pancreatitis in pregnancy. As compared to non-pregnant controls, pancreatitis in pregnancy was more likely to be associated with cholelithiasis and less likely with hyperlipidemia and alcohol abuse. Pancreatitis in pregnancy was more likely to be treated with parenteral nutrition and less likely to undergo endoscopic sphincterotomy. As compared to non-pregnant controls, pregnant women with pancreatitis were less likely to have pancreatic pseudocysts/hemorrhage/necrosis, generalized peritonitis, adult respiratory distress syndrome, disseminated intravascular coagulation, and death. Conclusion: Pancreatitis in pregnancy is predominantly caused by cholelithiasis, and unlike in the non-pregnant state, usually has a milder course. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the risk of developing pulmonary edema in women exposed to nifedipine, magnesium sulfate (MgSO4), or both in a preterm setting. Study design: We carried out a retrospective case-control study at a large tertiary care center from 2007 to 2012. Cases of pulmonary edema were age, and gestational age matched to controls at a ratio of 1 case to 4 controls. Logistic regression analysis was used to estimate the effect of nifedipine and/or MgSO4 on the development of pulmonary edema while controlling for predetermined confounding variables. Stepwise logistic regression analysis was used to evaluate additional risk factors of pulmonary edema. Results: A total of 150 charts were reviewed (28 cases and 122 controls). Nifedipine did not increase the odds of developing pulmonary edema [adjusted odds ratio (OR)=1.22 (confidence interval (CI) 0.50, 3.01), P=0.67], whereas exposure to MgSO4, or both MgSO4 and nifedipine, significantly increased the risk of developing pulmonary edema [adjusted OR=3.91 (CI 1.44, 10.65), P=0.008 and adjusted OR=4.75 (CI 1.15, 19.71), P=0.032, respectively]. In the stratified analysis, this association persisted even in nonpreeclamptic women [nifedipine: adjusted OR=0.91 (CI 0.33, 2.52), P=0.852; MgSO4: adjusted OR=3.51 (CI 1.26, 9.76), P=0.016; both: adjusted OR=3.39 (0.76, 15.07), P=0.108]. Other independent risk factors for pulmonary edema were multi-fetal pregnancy, azithromycin, and erythromycin administration. Conclusion: MgSO4 treatment is strongly associated with the development of pulmonary edema when used either as a tocolytic agent or for seizure prophylaxis. In light of the availability of safer alternatives, MgSO4 should be used for tocolysis only in cases whereby the benefits clearly outweigh the risks. [ABSTRACT FROM AUTHOR]

Objective To examine the effect of cigarette smoking during pregnancy on the development of preterm premature rupture of membranes (PPROM) categorized by gestational age. Methods We conducted a retrospective cohort study of 17,961 births using data from the McGill Obstetric and Neonatal Database between years 2001 and 2006. Our exposure was defined according to self-reported maternal cigarette smoking status categorized as nonsmoker, smoker of 1 to 10 cigarettes per day, and smoker of > 10 cigarettes per day. The outcome was measured as incidence of premature rupture of membranes (PROM) among gestational age categories of < 28, < 32, < 37, and > 37 weeks. Unconditional logistic regression analysis and Wald test for trend were used to estimate the adjusted risk of PPROM according to smoking status. Results Among the study population, 640 cases of PPROM (<37 weeks) and 40 cases of PROM (>37 weeks). After adjusting for confounding variables, smoking > 10 cigarettes per day was associated with an increased risk of PPROM at < 28 weeks (odds ratio [OR] 5.28; 95% confidence interval [CI] 2.20 to 12.7); < 32 weeks (OR 2.36; 95% CI 1.09 to 5.11; < 37 weeks (OR 1.97; 95% CI 1.32 to 2.94); and > 37 weeks (OR 3.19; 95% CI 0.92 to 11.0). Smoking 1 to 10 cigarettes per day was not associated with a significant risk of PPROM at any gestational age. Conclusion Heavy cigarette smoking increases the risk of PPROM more so at early gestational age than at term. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The objective of our study was to evaluate the association between maternal marital status and the risk of fetal and infant death, including sudden infant death syndrome (SIDS). Methods: We conducted a population-based cohort study using the Centers for Disease Control and Prevention’s Linked Birth–Infant Death and Fetal Death data on all births in the United States between 1995 and 2004. Marital status was obtained from the birth certificate. The adjusted effect of marital status on the risk of fetal and infant mortalities was estimated using unconditional logistic regression analysis. Results: The cohort consisted of 40,529,306 births, of which 37,461,715 met study criteria. There were 130,353 stillbirths (3.5/1,000 births) and 140,175 infant deaths (3.8/1,000 births), of which 24,066 were due to SIDS (0.6/1,000 births). Rates of nonmarital births increased from 31.3% to 35.4% over the study period. As compared with births from married women, births from unmarried women were at an increased risk of stillbirths (relative rise [RR], 1.24; 95% confidence interval [CI], 1.21–1.26), total infant deaths (RR, 1.45; 95% CI, 1.42–1.47), and SIDS (RR, 1.70; 95% CI, 1.63–1.78). Among unmarried women, those at a higher risk of fetal and infant death were women under 15 or over 40 years of age, African-American women, and those who received no prenatal care. Conclusion: Nonmarital childbearing seems to be associated with an increased risk of fetal and infant death, including SIDS. Promoting access to care and targeting unmarried mothers-to-be with the goal of educating, increasing awareness, and providing resources for proper obstetrical and maternal care may be of great benefit to their pregnancies. [Copyright &y& Elsevier]

The aim of our study was to investigate the influence of malpractice premiums paid by obstetricians on obstetric care across the United States. We conducted a retrospective cross-sectional population-based study using patient-level data obtained from the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample on every woman who delivered in 2006. Mode of delivery was compared with the average state medical liability insurance premium paid by obstetricians (Medical Liability Monitor and the National Association of Insurance Commissioners) using a generalized estimating equation to calculate crude and adjusted odds ratios. Our cohort included 890,266 women who delivered across 37 states in 2006. Average state malpractice premium of over $100,000 was associated with higher incidences of total cesarean deliveries (odds ratio [OR] 1.17, 95% confidence interval [CI]: 1.02, 1.35); lower incidences of vaginal births after cesarean deliveries (OR 0.60, 95% CI: 0.37, 0.98); and lower rates of instrumental deliveries (OR 0.72, 95% CI: 0.63, 0.83) compared with when the average state malpractice premium was less than $50,000. Fear of litigation appears to have a marked effect on obstetric practice, particularly total cesarean delivery, vaginal birth after cesarean, and instrumental delivery, when malpractice premiums rise above $100,000 per annum. [ABSTRACT FROM AUTHOR]

Background: Little is known about the impact of peptic ulcer disease (PUD) on pregnancy. Our objective was to evaluate the effect of PUD on pregnancy and newborn outcomes. Methods: A retrospective cohort study was carried out using the Healthcare Cost and Utilization Project (HCUP)-National Inpatient Sample (NIS) from the United States. The cohort consisted of all births that took place from 1999 to 2015. PUD was classified on the basis of the International Classification of Diseases-Ninth Revision (ICD-9) coding. Multivariate logistic regression was used to evaluate the adjusted effect of PUD on maternal and neonatal outcomes. Results: Of the 13,792,544 births in this cohort, 1005 were to women with PUD (7/100,000 births). Between 1999 and 2015, prevalence of PUD in pregnancy increased from 4/100,000 to 11/100,000, respectively. Women with PUD were more commonly older and more likely to have comorbid illnesses. Women with PUD were at greater risk of preeclampsia [odds ratio (OR) 2.11, 95% confidence interval (CI) 1.67–2.66], preterm premature rupture of membranes (PPROM; OR 2.16, 95% CI 1.30–3.59), cesarean delivery (OR 1.60, 95% CI 1.40–1.82), venous thromboembolism (OR 3.77, 95% CI 2.08–6.85) and maternal death (OR 24.50, 95% CI 10.12–59.32). Births to women with PUD were at increased risk of intrauterine growth restriction (IUGR; OR 1.54, 95% CI 1.11–2.14), preterm birth (OR 1.84, 95% CI 1.54–2.21), intrauterine fetal death (OR 2.18, 95% CI 1.35–3.52) and congenital anomalies (OR 2.69, 95% CI 1.59–4.56). Conclusion: The prevalence of PUD in pregnancy has risen over the last several years. PUD in pregnancy should be considered a high-risk condition associated with important adverse maternal and neonatal outcomes. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the effect of intrauterine growth restriction (IUGR) on the success rate of labor induction of preterm pregnancies complicated by hypertensive disorders. Methods: A retrospective cohort study conducted using data from the Centers for Disease Control and Prevention's Linked Birth‐Infant Death File in the United States from 2009 to 2013. Our cohort included live normal singleton cephalic pregnancies complicated by hypertensive disorders that underwent induction of labor and delivered between 24 and 35.6 weeks' gestation. Study subjects were categorized by the presence or absence of IUGR. Multivariate logistic regression was used to estimate the adjusted effect of IUGR on risk of caesarean deliveries. Results: Of 41 640 births meeting study criteria, 39 890 had no IUGR and 1750 had IUGR infants. The overall caesarean delivery rate was 22.2%, with caesarean delivery risk being higher among pregnancies complicated by IUGR versus those not complicated by IUGR (33.2% vs 21.7%, respectively) (odds ratio 2.00, 95% confidence interval 1.78–2.25). The effect of IUGR on risk of caesarean sections was most pronounced for gestational ages between 28 and 36 weeks. The effect of IUGR was highest among obese women, with the risk of caesarean in IUGR vs non‐IUGR pregnancies being 62.8% vs 41.4%, respectively (odds ratio 2.53, 95% confidence interval 1.98–3.24). Conclusion: Induction of labor of preterm pregnancy complicated by hypertensive disorders should be considered a reasonable option for delivery; however, in the context of IUGR, women should be informed of the considerable higher risk of caesarean delivery. [ABSTRACT FROM AUTHOR]

Background: Sjögren's syndrome (SS) is an autoimmune connective tissue disease affecting the body's moisture-producing glands. Some studies have linked SS to adverse maternal/neonatal outcomes, but sample sizes have tended to be small, with few outcomes examined. The purpose of this study was to evaluate the effect of SS on pregnancy outcomes for mother and neonate using a large dataset. Methods: We carried out a retrospective cohort study of women who delivered between 1999 and 2014 using data from the Nationwide Inpatient Sample from the United States. SS categorization is based on ICD-9 coding. Baseline characteristics were compared in both groups and multivariate logistic regression was used to compare maternal and fetal outcomes of pregnancies in women with and without SS. Results: The prevalence of SS in our population was 1.34 cases/10,000 births, with the rate increasing over the study period. Women with SS tended to be older, Caucasian and to have pre-existing comorbidities. Births to women with SS were at greater risk of pre-eclampsia [odds ratio (OR) 1.63, 95% confidence interval (CI) 1.34–1.99]; premature rupture of membranes (OR 1.28, 95% CI 1.04–1.57); preterm delivery (OR 1.56, 95% CI 1.34–1.81); cesarean delivery (OR 1.29, 95% CI 1.17–1.41); and venous thromboembolic events (OR 3.71, 95% CI 2.57–5.35). Infants of women with SS were more likely to have intrauterine growth restriction (IUGR) (OR 3.00, 95% CI 2.46–3.65); and congenital malformations (OR 3.26, 95% CI 2.30–4.62). Conclusion: SS is a high-risk pregnancy condition associated with significant comorbidities and adverse maternal and fetal outcomes. Women with SS may benefit from increased surveillance during their pregnancies. [ABSTRACT FROM AUTHOR]

Background Borderline personality disorder (BPD) is a serious mental disorder commonly associated with functional impairments and adverse health outcomes. Very little is known about BPD in pregnant women; hence, our study objective was to evaluate the effect of BPD on obstetrical and neonatal outcomes. Methods We carried out a retrospective cohort study using the Healthcare Cost and Utilization Project, Nationwide Inpatient Sample from 2003 to 2012. We identified births using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic and procedure codes and classified women by BPD status. Multivariate logistic regression was used to evaluate the effect of BPD on obstetrical and neonatal outcomes, adjusted for subject baseline characteristics. Findings During the study period, there were 989 births to women with BPD with an overall incidence of 11.65 in 100,000 births. Women with BPD were more likely younger, of lower socioeconomic status, smoked or used drugs, and had an underlying mental disorder. Unadjusted models revealed that BPD was associated with an increased risk of almost all adverse maternal and fetal outcomes we examined, the exception being post partum hemorrhage and instrumental delivery, which both had a null association with BPD, and induction of labor, which was negatively associated with BPD. Upon full adjustment, BPD was found to be associated with the following obstetrical and neonatal outcomes: gestational diabetes (odds ratio [OR], 1.45; 95% CI, 1.13–1.85), premature rupture of the membranes (OR, 1.40; 95% CI, 1.07–1.83), chorioamnionitis (OR, 1.65; 95% CI, 1.14–2.39), venous thromboembolism (OR, 2.11; 95% CI, 1.12–3.96), caesarian delivery (OR, 1.44; 95% CI, 1.26–1.64), and preterm birth (OR, 1.54; 95% CI, 1.29–1.83). Conclusion BPD is associated with several adverse obstetrical and neonatal outcomes. Hence, pregnant women who suffer from BPD should be monitored closely by a multidisciplinary health care team both before and during their pregnancies. This oversight would allow for the receipt of treatment for BPD and also interventions to help them to cease tobacco and drug use, which may ultimately decrease the incidence of poor obstetrical and neonatal outcomes. [ABSTRACT FROM AUTHOR]

Objective: The purpose of our study was to estimate the incidence and maternal and fetal outcomes of Hodgkin's lymphoma (HL) in pregnancy. Methods: We carried out a population-based cohort study on all births identified in the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample from 2003 to 2011. We calculated disease incidence and used logistic regression analysis to estimate the adjusted effect of HL on maternal and neonatal outcomes. Results: There were 638 cases of HL in pregnancy among 7,916,388 births, for an overall incidence of 8.06 per 100,000 births, with no perceivable trend over the 8-year study period. Relative to controls, HL in pregnancy was more common among Caucasians and women aged 25-34 years. After adjusting for baseline characteristics, women with HL in pregnancy were more likely to have preterm births, odds ratio (OR) 1.93 (1.53, 2.42) require postpartum blood transfusion, OR 1.38 (1.05, 1.82), and have venous thromboembolism (VTE), OR 7.93 (2.97, 21.22). Conclusion: The incidence of HL in pregnancy appears to be higher than previously reported with no temporal trend over an 8-year period. Although there is a greater risk of preterm birth and maternal postpartum blood transfusion and VTE, overall maternal and neonatal major morbidity and mortality does not appear to be increased. [ABSTRACT FROM AUTHOR]

Aim Maternal sepsis is one of the leading causes of maternal mortality around the world. The aim of this study was to estimate the incidence and mortality rate of sepsis, and the associated risk factors for their development during pregnancy, labor, delivery and the post-partum period. Methods We conducted a population-based cohort study consisting of 5 million births that occurred in the USA. Data were obtained from the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS) database from 1998 to 2008. Logistic regression was used to calculate the adjusted odds ratio and corresponding 95% confidence intervals (95%CI) for sepsis development and sepsis-related death during admission for delivery. Results The overall incidence of maternal sepsis was 29.4 per 100 000 births (95%CI: 28.0-30.9) with a sepsis case fatality rate of 4.4 per 100 births (95%CI: 3.5-5.6). Both the incidence of maternal sepsis and sepsis-related death rate have increased over the last decade. Women who are black, older than 35 years and who smoke were more likely to experience maternal sepsis. An association was also found between maternal sepsis and diabetes mellitus, cardiovascular disease, eclampsia, preterm birth, hysterectomy, puerperal infection, post-partum hemorrhage, transfusion and chorioamnionitis. Conclusions Mortality from maternal sepsis during labor and delivery is an increasing and important problem in westernized countries. Initiatives aimed at improving early recognition and effective management may help reduce the occurrence and outcomes of maternal sepsis at time of labor and delivery. [ABSTRACT FROM AUTHOR]

Objectives: Data on sarcoidosis in pregnancy is sparse and limited to a few case reports and series. Our aim is to determine the prevalence of sarcoidosis at delivery, and related maternal and newborn outcomes. Study design: Using the United States Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP-NIS) from 2003 to 2010, we conducted a population-based retrospective cohort study to compare women with and without sarcoidosis at delivery. We calculated the prevalence of sarcoidosis in pregnancy and used logistic regression analyses to estimate the associated risks of maternal and neonatal outcomes. Results: There were 678 cases of sarcoidosis in 7,094,400 births over an 8-year period for an overall prevalence of nine and six-tenths cases per 100,000 births. Compared with controls, women with sarcoidosis were older, more likely to be African American and to report being smokers. Women with sarcoidosis were more likely to have preec-lampsia odds ratio (OR) 1.62 (95% CI 1.18-2.22), eclampsia OR 5.27 (95% CI 1.69-16.40), deep vein thrombosis OR 4.92 (95% CI 1.58-15.33), pulmonary embolism OR 6.68 (95% CI 3.99-11.21), and premature delivery OR 1.73 (95% CI 1.40-2.15). There was also an increased risk of cesarean deliveries and postpartum hemorrhages. There were no cases of maternal death reported. Conclusions: Sarcoidosis in pregnancy is a rare disease associated with an increased risk of adverse obstetrical outcomes. Women with sarcoidosis can carry out successful pregnancies, however should be made aware of the higher risk of adverse events. Given the higher risk of venous thromboembolic events, consideration should be given to thromboprophylaxis in pregnancy. [ABSTRACT FROM AUTHOR]

Objective Marfan syndrome (MFS) is a rare connective tissue disease with significant risk for adverse cardiovascular outcomes. Our objective was to evaluate pregnancy and cardiovascular outcomes in pregnant women with MFS. Study Design We conducted a population-based retrospective cohort study using the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP NIS) database from 2003 to 2010. We used unconditional regression analyses to compare maternal and fetal outcomes among pregnancies in women with and without MFS. Results Out of the 7,094,400 births in our cohort, 339 deliveries were to women with MFS. There was one maternal death and six aortic dissections among women with MFS. Births to women withMFS were more likely to be premature, odds ratio (OR) 2.15 (1.60- 2.89), have intrauterine growth restricted and small for gestational age infants, OR 2.06 (1.24-3.43). Women with MFS were more likely to deliver by cesarean section, OR 1.91 (1.53-2.38) and were at higher risk of major morbidities including cardiac arrhythmias, OR 10.64 (5.49-20.61) and pneumothorax, OR 51.95 (6.18, 437.10). Conclusion Pregnant women with MFS are at a particularly high risk of adverse pregnancy and cardiovascular events. Preconception counseling should take these risks into consideration and appropriate pregnancy care in tertiary centers should be considered. [ABSTRACT FROM AUTHOR]

Objective: To estimate the prevalence of sickle cell disease (SCD) in pregnancy, and to measure risk factors, morbidity, and mortality among women with SCD with and without crisis at the time of birth. Methods: We conducted a population-based, retrospective cohort study on all births in the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP-NIS) from 1999 to 2008. Births to SCD with and without crisis were identified using ICD-9 codes. Adjusted effects of risk factors and outcomes were estimated using logistic regression analyses. Effect of hemoglobin variants among women with SCD was analyzed as a predictor of crisis. Results: There were 4262 births to women with SCD for an overall prevalence of 4.83 per 10,000 deliveries. 28.5% of women with SCD developed crisis at the time of delivery. The maternal mortality rate was 1.6 per 1000 deliveries in women with SCD, compared to 0.1 per 1000 in women without SCD. Pregnant women with SCD had a higher risk of developing preeclampsia, eclampsia, venous thromboembolism, cardiomyopathy, intrauterine fetal demise, and intrauterine growth restriction. Cesarean delivery rates were higher in women with SCD. Among the 1898 SCD women with identified hemoglobin variants, homozygous SS was the greatest risk factor for sickle cell crisis, accounting for 89.8% of all women who developed crisis. Conclusion: Pregnant women with SCD have a high risk of morbidity and mortality. Developing acute sickle cell crisis worsened perinatal outcomes. [ABSTRACT FROM AUTHOR]

Objective To evaluate the association between adequacy of prenatal care utilization and risk of fetal and neonatal mortality and adverse outcomes. Methods We conducted a population-based cohort study using the Center for Disease Control and Prevention's Linked Birth-Infant Death and Fetal Death data on all deliveries in the United States between 1995 and 2002. Inclusion criteria were singleton births ≥22 weeks of gestation with no known congenital malformation. Inadequate prenatal care was defined according to the Adequacy of Prenatal Care Utilization Index, and its effect on fetal and neonatal death was estimated using unconditional logistic regression analysis adjusting for maternal age, race, education, and other confounding variables. Results During our 8-year study period, 32,206,417 births occurred, 28,729,765 (89.2%) of which met inclusion criteria. Inadequate prenatal care utilization occurred in 11.2% of expectant mothers, more commonly among women ≤20 years, black non- Hispanic and Hispanic women, and those without high school education. Relative to adequate care, inadequate care was associated with increased risk of prematurity 3.75 (3.73 to 3.77), stillbirth 1.94 (1.89 to 1.99), early neonatal dearth 2.03 (1.97 to 2.09), late neonatal death 1.67 (1.59 to 1.76), and infant death 1.79 (1.76 to 1.82). Conclusion Risk of prematurity, stillbirth, early and late neonatal death, and infant death increased linearly with decreasing care. Given the population effect of this association, public health initiatives should target program expansion to ensure timely and adequate access, particularly for women ≤20 years, Black non-Hispanic and Hispanic women, and those without high school education. [ABSTRACT FROM AUTHOR]

The objective of our study was to evaluate the incidence and effect of maternal age on the risk of stillbirth. We conducted a population-based cohort study using the Centers for Disease Control and Prevention's ''Linked Birth-Infant Death'' and ''Fetal Death'' data files. We excluded all births of gestational age under 24 weeks and those with reported congenital malformations. We estimated the adjusted effect of maternal age on the risk of stillbirth using logistic regression analysis. There were 37,504,230 births that met study criteria, of which 130,353 (3.5/1,000) were stillbirths. Rates of stillbirth remained constant throughout the 10 years. As compared with women between the ages of 25 and 30, decreasing maternal age was associated with the following risk of stillbirth: odds ratio (OR) 0.95 (95% confidence interval [CI] 0.93 to 0.97) for ages 20 to 25; OR 0.97 (95% CI 0.94 to 0.99) for ages 15 to 20; and OR 1.32 (95% CI 1.18 to 1.47) for ages <15. Increasing maternal age was associated with an increasing risk of stillbirth: OR 1.02 (95% CI 0.99 to 1.04) for ages 30 to 35, OR 1.25 (95% CI 1.21 to 1.28) for ages 35 to 40, OR 1.60 (95% CI 1.53 to 1.67) for ages 40 to 45, and OR 2.22 (95% CI 1.91 to 2.53) for ages >45. Although the overall risk is low, the risk of stillbirth increases considerably in women at the extremes of the reproductive age spectrum. Antenatal surveillance may be justified in these women. [ABSTRACT FROM AUTHOR]

Objective: To identify risk factors for postpartum hemorrhage (PPH) in low risk patients. Methods: All deliveries between 2001 and 2007 were retrieved. Women with well-established preexisting risk factors for PPH were excluded. Among the remaining women (n=15,198) considered at low risk, various factors were assessed to evaluate their role in PPH. Results: Rates of PPH increased from 1.03 in 2001 to 2.45% in 2007. Gestational age at delivery, induction of labor with oxytocin, cesarean section and regional analgesia were not associated with PPH. Logistic regression analysis demonstrated that the following factors were significantly associated with PPH: increased birth weight (P<0.001), female gender (P=0.006), duration of membrane rupture (P=0.002), duration of second stage (P<0.001), chorioamnionitis (P=0.02), and use of prostaglandins (P=0.041). Conclusion: Early recognition of the specific factors presented as associated with PPH should prompt early intervention to reduce the PPH and maternal morbidity. [ABSTRACT FROM AUTHOR]