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Importance: More than 2 million families face eviction annually, a number likely to increase due to the coronavirus disease 2019 pandemic. The association of eviction with newborns' health remains to be examined., Objective: To determine the association of eviction actions during pregnancy with birth outcomes., Design: This case-control study compared birth outcomes of infants whose mothers were evicted during gestation with those whose mothers were evicted at other times. Participants included infants born to mothers who were evicted in Georgia from January 1, 2000, to December 31, 2016. Data were analyzed from March 1 to October 4, 2020., Exposures: Eviction actions occurring during gestation., Main Outcomes and Measures: Five metrics of neonatal health included birth weight (in grams), gestational age (in weeks), and dichotomized outcomes for low birth weight (LBW) (<2500 g), prematurity (gestational age <37.0 weeks), and infant death., Results: A total of 88 862 births to 45 122 mothers (mean [SD] age, 26.26 [5.76] years) who experienced 99 517 evictions were identified during the study period, including 10 135 births to women who had an eviction action during pregnancy and 78 727 births to mothers who had experienced an eviction action when not pregnant. Compared with mothers who experienced eviction actions at other times, eviction during pregnancy was associated with lower infant birth weight (difference, -26.88 [95% CI, -39.53 to 14.24] g) and gestational age (difference, -0.09 [95% CI, -0.16 to -0.03] weeks), increased rates of LBW (0.88 [95% CI, 0.23-1.54] percentage points) and prematurity (1.14 [95% CI, 0.21-2.06] percentage points), and a nonsignificant increase in mortality (1.85 [95% CI, -0.19 to 3.89] per 1000 births). The association of eviction with birth weight was strongest in the second and third trimesters of pregnancy, with birth weight reductions of 34.74 (95% CI, -57.51 to -11.97) and 35.80 (95% CI, -52.91 to -18.69) g, respectively., Conclusions and Relevance: These findings suggest that eviction actions during pregnancy are associated with adverse birth outcomes, which have been shown to have lifelong and multigenerational consequences. Ensuring housing, social, and medical assistance to pregnant women at risk for eviction may improve infant health.

Background: Pregnancy and childbirth still involve risk for pregnant women and their babies and health in the perinatal period remains an important public health priority. This study addresses the question of perinatal health in Umbria region., Methods: Data were obtained from the administrative source of the regional Standard Certificate of Live Births in Umbria in 2012. We used population data, which merges data from each mother and her baby for a total of 7964 records. To describe perinatal health we considered pathological pregnancy, fetal growth defect, birth weight, gestational age, Apgar scores at 5 minutes and stillbirth such as indicators of Maternal and Neonatal Health in according with population characteristics and risk factors (maternal age, parity, mothers' educational level and mothers' country of birth)., Results: In Umbria, in 2012 we have: - 29 stillbirths corresponding to a rate of stillbirths of 3.52 ‰ (stillbirths per 1000 births) - a perinatal mortality rate ( stillbirths and deaths in the first week of life) of 4.9 per 1000 live births and stillbirths - an Infant mortality rate (within the first year of life) of 2.5 per 1000 live births The 1.4 % of infants underwent neonatal resuscitation. This percentage detects an indicative Apgar score of important neonatal suffering (0-3) in the 1% of neonates. The frequency of infants with birth weight less than 2500 grams (LBW) was 6.4 %, with higher values ​​in females (7.3%) than males (2.7%). The frequency of infants with birth weight less than 1500 grams is 0.8%. The preterm birth (<37 weeks of gestation) rate is 6.3% of the total: 5.6% are pregnancies among the 32 and 36 weeks of gestation and 0.7% are pregnancies under the 32nd week of gestation. The pathological pregnancies are 7.9% and the Fetal Growth Restriction (FGR) is 2.7%. The health perinatal indicators considered were different in different population subgroups. The most representative population was Italian women (76.8%), with maternal age between 25-34 years (56.4%), primiparous (61.9%) and mothers with medium education levels (48.1%)., Conclusions: Results highlight the existence of differences in perinatal health. Worse maternal condition and neonatal status were observed especially for less advantaged social classes (i.e., foreign or poorly educated). Such inequalities should be examined in all areas of public policy and public services, to ensure equal opportunity for all.

The effects of intimate partner violence (IPV) on maternal and neonatal outcomes are multifaceted and largely preventable. During pregnancy, there are many opportunities within the current health care system for screening and early intervention during routine prenatal care or during episodic care in a hospital setting. This article describes the effects of IPV on maternal health (e.g., insufficient or inconsistent prenatal care, poor nutrition, inadequate weight gain, substance use, increased prevalence of depression), as well as adverse neonatal outcomes (e.g., low birth weight [LBW]), preterm birth [PTB], and small for gestational age [SGA]) and maternal and neonatal death. Discussion of the mechanisms of action are explored and include: maternal engagement in health behaviors that are considered "risky," including smoking and alcohol and substance use, and new evidence regarding the alteration of the hypothalamic-pituitary-adrenal axis and resulting changes in hormones that may affect LBW and SGA infants and PTB. Clinical recommendations include a commitment for routine screening of IPV in all pregnant women who present for care using validated screening instruments. In addition, the provision of readily accessible prenatal care and the development of a trusting patient-provider relationship are first steps in addressing the problem of IPV in pregnancy. Early trials of targeted interventions such as a nurse-led home visitation program and the Domestic Violence Enhanced Home Visitation Program show promising results. Brief psychobehavioral interventions are also being explored. The approach of universal screening, patient engagement in prenatal care, and targeted individualized interventions has the ability to reduce the adverse effects of IPV and highlight the importance of this complex social disorder as a top priority in maternal and neonatal health.

Background: Twin pregnancy is a high risk pregnancy with significant implications for both mother and baby. This study is to assess the current status of twin gestation in Port Harcourt in view of the rising incidence worldwide., Objective: To determine the prevalence, fetal and maternal outcomes of twin gestation at the University of Port Harcourt Teaching Hospital (UPTH)., Materials and Methods: This was a 5-year retrospective analysis of hospital records of mothers who had twin gestation and delivered at UPTH between January 1st 2008 and December 31st 2012., Results: The prevalence of twin gestation was 16 per 1000 deliveries. The Mean age and parity were 29.63 ± 4.1 and 1.65 ± 1.3 respetcively. Premature delivery occurred in 30.8% of cases. Antenatal complications were observed in 66.0% with anaemia being the commonest complication. Caesarean section was performed for 51.06% while 47.34% had successful vaginal delivery and discordant delivery accounted for 1.6%. The commonest intrapartum complication was fetal distress in 42.86%. There was no significant difference in the mean birthweight between first and second twin. Unbooked status was significantly associated with birth asphyxia (x2 = 8.25, p = 0.004) and perinatal mortality (x2 = 5.04, p = 0.02). Monochorionic placentation was also significantly associated with perinatal mortality (x2 = 5.52, p = 0.018). The perinatal mortality rate was 55.85/1000 total birth while the maternal mortality ratio was 281.09/100,000 live birth., Conclusion: Twin gestation in Port Harcourt is still associated with significant maternal and perinatal morbidities and mortality. Early initiation of specialist care in the management of twin gestation and improvement in neonatal care facilities will improve the outcome of twin gestation in Port Harcourt.

Introduction: The rate of cesarean sections around the world is steadily rising. The analysis of indications for cesarean section might find the answer to the question whether this trend is a consequence of more liberal indications., Objectives: The aim of the study was to analyze and compare the changes in the indications for cesarean sections (cs) over the years., Material and Methods: Data regarding cesarean sections performed at the 1st Department of Obstetrics and Gynecology Medical University of Warsaw were analyzed and compared: 559 cs between the years 2000-2001 (G1) and 663 cs in 2010 (G2)., Results: The rate of cs was statistically higher in 2010 (30.1% vs. 29.2%; p<0.001), however the rate of preterm cs was lower (25.4% vs. 11.9%; p<0.01). The most frequent indication for cs in 2010 was lack of patient consent for vaginal birth after cs (27.3% vs. 17.9%; p<0.01). Other frequent indications throughout the decade were: fetal distress (G1 18.6% vs. G2 14.2%; p<.01), cervical dystocia (12.3% vs. 11%, respectively), fetal position other than cephalic (12.5% vs. 13.6%) and non-obstetrical indications (14.1% vs. 9.4%; p<0.05)., Conclusions: In the last decade the rate of cesarean sections has risen and there are minor differences in the indications for cs. Previous cesareans delivery seems to be the main cause of an increase in the number of cs nowadays.

Background: The inequity in emergency obstetric care access in Tanzania is unsatisfactory. Despite an existing national obstetric referral system, many birthing women bypass referring facilities and go directly to higher-level care centres. We wanted to compare Caesarean section (CS) rates among women formally referred to a tertiary care centre versus self-referred women, and to assess the effect of referral status on adverse outcomes after CS., Methods: We used data from 21,011 deliveries, drawn from the birth registry of a tertiary hospital in northeastern Tanzania, during 2000-07. Referral status was categorized as self-referred if the woman had bypassed or not accessed referral, or formally-referred if referred by a health worker. Because CS indications were insufficiently registered, we applied the Ten-Group Classification System to determine the CS rate by obstetric group and referral status. Associations between referral status and adverse outcomes after CS delivery were analysed using multiple regression models. Outcome measures were CS, maternal death, obstetric haemorrhage ≥ 750 mL, postpartum stay > 9 days, neonatal death, Apgar score < 7 at 5 min and neonatal ward transfer., Results: Referral status contributed substantially to the CS rate, which was 55.0% in formally-referred and 26.9% in self-referred birthing women. In both groups, term nulliparous singleton cephalic pregnancies and women with previous scar(s) constituted two thirds of CS deliveries. Low Apgar score (adjusted OR 1.42, 95% CI 1.09-1.86) and neonatal ward transfer (adjusted OR 1.18, 95% CI 1.04-1.35) were significantly associated with formal referral. Early neonatal death rates after CS were 1.6% in babies of formally-referred versus 1.2% in babies of self-referred birthing women, a non-significant difference after adjusting for confounding factors (adjusted OR 1.37, 95% CI 0.87-2.16). Absolute neonatal death rates were > 2% after CS in breech, multiple gestation and preterm deliveries in both referral groups., Conclusions: Women referred for delivery had higher CS rates and poorer neonatal outcomes, suggesting that the formal referral system successfully identifies high-risk birth, although low volume suggests underutilization. High absolute rates of post-CS adverse outcomes among breech, multiple gestation and preterm deliveries suggest the need to target self-referred birthing women for earlier professional intrapartum care.

Preconception and interconception care respond to the growing body of evidence that many of the most important determinants of birth outcomes may exist before pregnancy occurs. In this sense, the strategy of extending prenatal care into the preconception and interconception periods marks a useful step in reforming the public health approach to improving birth outcomes. However, although helpful in underscoring the continuity of risk that can ultimately find expression in adverse birth outcomes, the concern is that without greater critical attention these relatively new care constructs have the potential to undermine rather than strengthen a comprehensive system of women's health care.

The number of cases of diabetes worldwide has increased significantly in the last decade. Characteristically, the incidence of gestational diabetes (GDM) reflects the incidence of type 2 diabetes mellitus (T2DM) in the background population, which is a warning that a rapid increase in the incidence is to be expected concomitant with the already observed increase in the incidence of T2DM. Although the majority of all deliveries worldwide take place in the so-called developing world, little is known about the prevalence of diabetes in pregnancy in rural areas of East Africa. Diabetes in pregnancy has effects on prospects for marriage, motherhood, and the role of women in East African society. Furthermore, intrauterine exposure to the metabolic environment of maternal diabetes, or GDM, is associated with increased risk of altered glucose homeostasis in the offspring, beginning in childhood and producing a higher prevalence of GDM in the next generation with all burdens and complications being associated with this disease. It is reasonable to conclude that more newborn infants each year are being exposed to the metabolic environment of diabetes during intrauterine development as a result of changing incidence and demographics of diabetes and pregnancy. We believe that programs and policies have to be established, including organization of the health system to provide care, medicines, and other tools necessary for diabetes in pregnancy management, consideration of accessibility and affordability of care, education for healthcare workers, and education of pregnant and nonpregnant women of reproductive age.

Estimates of intimate partner violence (IPV) during pregnancy vary by population being studied, measures, and other methodological limitations, hindering the ability to gauge the relationship between IPV and negative birth outcomes. The authors report aggregated data from a subsample (n = 148) of the first three waves of the Women's Employment Study. The authors compared groups of women who did and did not give birth to low birth weight infants on demographic, material deprivation, risk behavior, mental health, and IPV factors. The prevalence of domestic violence was more than twice as high for women with low birth weight infants as those women who had a normal weight infant. When considering additional risk factors, including food insufficiency, substance dependence, and depression and/or posttraumatic stress disorder, IPV remained a significant indicator, but it was most strongly associated with low birth weight among women also experiencing depression and/or posttraumatic stress disorder.

Background: The objective of this cohort study was to examine the effect on birth weight of living in a disadvantaged neighbourhood in a Nordic welfare state. Birth weight is a health indicator known to be sensitive to political and welfare state conditions. No former studies on urban neighbourhood differences regarding mean birth weight have been carried out in a Nordic country., Methods: A register based on individual data on children's birth weight and maternal risk factors was used. A neighbourhood characteristic, i.e. an aggregated measure on income was also included. Connections between individual- and neighbourhood-level determinants and the outcome were analysed using multi-level regression technique. The study covered six hundred and ninety-six neighbourhoods in the three major cities of Sweden, Stockholm, Göteborg and Malmö, during 1992-2001. The majority of neighbourhoods had a population of 4 000-10 000 inhabitants. An average of 500 births per neighbourhood were analysed in this study., Results: Differences in mean birth weight in Swedish urban neighbourhoods were minor. However, gestational length, parity and maternal smoking acted as modifiers of the neighbourhood effects. Most of the observed variation in mean birth weight was explained by individual risk factors., Conclusion: Welfare institutions and benefits in Sweden might buffer against negative infant outcomes due to adverse structural organisation of urban neighbourhoods.

Background: Around 80% of intrauterine growth restricted (IUGR) infants are born at term. They have an increase in perinatal mortality and morbidity including behavioral problems, minor developmental delay and spastic cerebral palsy. Management is controversial, in particular the decision whether to induce labour or await spontaneous delivery with strict fetal and maternal surveillance. We propose a randomised trial to compare effectiveness, costs and maternal quality of life for induction of labour versus expectant management in women with a suspected IUGR fetus at term., Methods/design: The proposed trial is a multi-centre randomised study in pregnant women who are suspected on clinical grounds of having an IUGR child at a gestational age between 36+0 and 41+0 weeks. After informed consent women will be randomly allocated to either induction of labour or expectant management with maternal and fetal monitoring. Randomisation will be web-based. The primary outcome measure will be a composite neonatal morbidity and mortality. Secondary outcomes will be severe maternal morbidity, maternal quality of life and costs. Moreover, we aim to assess neurodevelopmental and neurobehavioral outcome at two years as assessed by a postal enquiry (Child Behavioral Check List-CBCL and Ages and Stages Questionnaire-ASQ). Analysis will be by intention to treat. Quality of life analysis and a preference study will also be performed in the same study population. Health technology assessment with an economic analysis is part of this so called Digitat trial (Disproportionate Intrauterine Growth Intervention Trial At Term). The study aims to include 325 patients per arm., Discussion: This trial will provide evidence for which strategy is superior in terms of neonatal and maternal morbidity and mortality, costs and maternal quality of life aspects. This will be the first randomised trial for IUGR at term., Trial Registration: Dutch Trial Register and ISRCTN-Register: ISRCTN10363217.

Objective: To determine whether remoteness category of residence of Indigenous women affects the perinatal outcomes of their newborn infants., Design and Participants: A population-based study of 35 240 mothers identified as Indigenous and their 35 658 babies included in the National Perinatal Data Collection in 2001-2004., Main Outcome Measures: Australian Standard Geographical Classification remoteness category, birthweight, Apgar score at 5 minutes, stillbirth, gestational age and a constructed measure of perinatal outcomes of babies called "healthy baby" (live birth, singleton, 37-41 completed weeks' gestation, 2500-4499 g birthweight, and an Apgar score at 5 minutes >or= 7)., Results: The proportion of healthy babies in remote, regional and city areas was 74.9%, 77.7% and 77.6%, respectively. After adjusting for age, parity, smoking and diabetes or hypertension, babies born to mothers in remote areas were less likely to satisfy the study criteria of being a healthy baby (adjusted odds ratio [AOR], 0.87; 95% CI, 0.81-0.93) compared with those born in cities. Babies born to mothers living in remote areas had higher odds of being of low birthweight (AOR, 1.09; 95% CI, 1.01-1.19) and being born with an Apgar score < 7 at 5 minutes (AOR, 1.63; 95% CI, 1.39-1.92)., Conclusions: Only three in four babies born to Indigenous mothers fell into the "healthy baby" category, and those born in more remote areas were particularly disadvantaged. These findings demonstrate the continuing need for urgent and concerted action to address the persistent perinatal inequity in the Indigenous population.

Background: Modern obstetrics is faced with a serious paradox. Obstetric practice is becoming increasingly interventionist based on empirical evidence but without a theoretical basis for such intervention. Whereas obstetric models of perinatal death show that mortality declines exponentially with increasing gestational duration, temporal increases in medically indicated labour induction and cesarean delivery have resulted in rising rates of preterm birth and declining rates of postterm birth. Other problems include a disconnection between patterns of gestational age-specific growth restriction (constant across gestation) and gestational age-specific perinatal mortality (exponential decline with increasing duration) and the paradox of intersecting perinatal mortality curves (low birth weight infants of smokers have lower neonatal mortality rates than the low birth weight infants of non-smokers)., Discussion: The fetuses at risk approach is a causal model that brings coherence to the various perinatal phenomena. Under this formulation, pregnancy complications (such as preeclampsia), labour induction/cesarean delivery, birth, revealed small-for-gestational age and death show coherent patterns of incidence. The fetuses at risk formulation also provides a theoretical justification for medically indicated early delivery, the cornerstone of modern obstetrics. It permits a conceptualization of the number needed to treat (e.g., as low as 2 for emergency cesarean delivery in preventing perinatal death given placental abruption and fetal bradycardia) and a calculation of the marginal number needed to treat (i.e., the number of additional medically indicated labour inductions/cesarean deliveries required to prevent one perinatal death). Data from the United States showed that between 1995-96 and 1999-2000 rates of labour induction/cesarean delivery increased by 45.1 per 1,000 and perinatal mortality decreased by 0.31 per 1,000 total births among singleton pregnancies at > or = 28 weeks of gestation. The marginal number needed to treat was 145 (45.1/0.31), showing that 145 excess labour inductions/cesarean deliveries in 1999-2000 (relative to 1995-96) were responsible for preventing 1 perinatal death among singleton pregnancies at > or = 28 weeks gestation., Summary: The fetuses at risk approach, with its focus on incidence measures, provides a coherent view of perinatal phenomena. It also provides a theoretical justification for medically indicated early delivery and reconciles the contemporary divide between obstetric theory and obstetric practice.

Objectives: The aim of the study was to analyze the course of labor of grand multiparas (4 deliveries and more) in comparison to multiparas (2 or 3 deliveries)., Materials and Methods: A group of 400 grand multiparas were included in the study and compared with a group of 393 multiparas. All the deliveries took place in the City Hospital in Puck in the years 1998-2002. The age of parturients, duration of pregnancy, pregnancy accompanying pathologies, course and way of delivery, indications for cesarean section, complications of labor and newborns' condition were taken into account and analyzed statistically., Results: It occurred that grand multiparas were significantly more often countryside dwellers, experienced preterm deliveries, gained less weight during pregnancy and amniorrhexis took place in a more advanced 1st stage of labor. Perineal ruptures and episiotomies were significantly less frequent in the study group. Moreover, grand multiparas preferred traditional form of labor, more rarely deciding on water labor, despite its common access. There were no differences as to the duration of labor stages, accompanying pathologies, the use of oxytocin, postpartum curettage and newborns' condition., Conclusions: Grand multiparity seems not to be an independent risk factor of obstetrical complications and should not be considered dangerous in centers with well organized modern perinatal care.

Recognition of a higher than average incidence of low birth weight (LBW) deliveries in areas of Eastern Pennsylvania led to an analysis of more than 5,500 deliveries in one of the region's hospital systems to investigate the predictors of LBW in that population. Results of multivariate analysis indicate key variables that contribute to LBW: in particular, racial/ethnic background and specific medial problems during pregnancy, including preeclampsia, incompetent cervix, bleeding, low BMI and lack of adequate weight gain. Results were incorporated into training in best practices for prenatal care in the city's prenatal clinics.

This study examines the relationship of substance use to birth outcome, infant, and maternal health in a large, nationally representative sample. Multiple regression analyses, accommodating the nature of the survey data using the SUDAAN software package, indicated that drinking and smoking independently and/or interactively with depression account for poor health and serious medical conditions among pregnant women as well as negative birth outcomes or adverse health consequences in those infants who are live births. In addition, African American women and their infants are more likely than those of other racial groups to suffer these adverse outcomes. Given the risk profiles of individual illnesses, this study suggests the need for developing and targeting health education and preventive efforts specific to those groups that are clearly at greater risk.