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Objective: To evaluate whether the increased risk of breast cancer is dependent on the formulation of menopausal hormone therapy (HT) used.Methods: We performed a population-based case-control study of women aged 50 years or older using data from the U.K. Clinical Practice Research Datalink. Women with incident cases of breast cancer were age-matched (1:10) with a control group of women with comparable follow-up time with no history of breast cancer. Exposures were classified as ever or never for the following menopausal HT formulations: bioidentical estrogens, animal-derived estrogens, micronized progesterone, and synthetic progestin. Logistic regression analyses were performed to estimate the adjusted effect of menopausal HT formulation on breast cancer risk.Results: Between 1995 and 2014, 43,183 cases of breast cancer were identified and matched to 431,830 women in a control group. In adjusted analyses, compared with women who never used menopausal HT, its use was associated with an increased risk of breast cancer (odds ratio [OR] 1.12, 95% CI 1.09-1.15). Compared with never users, estrogens were not associated with breast cancer (bioidentical estrogens: OR 1.04, 95% CI 1.00-1.09; animal-derived estrogens: OR 1.01, 95% CI 0.96-1.06; both: OR 0.96, 95% CI 0.89-1.03). Progestogens appeared to be differentially associated with breast cancer (micronized progesterone: OR 0.99, 95% CI 0.55-1.79; synthetic progestin: OR 1.28, 95% CI 1.22-1.35; both OR 1.31, 0.30-5.73).Conclusion: Although menopausal HT use appears to be associated with an overall increased risk of breast cancer, this risk appears predominantly mediated through formulations containing synthetic progestins. When prescribing menopausal HT, micronized progesterone may be the safer progestogen to be used. [ABSTRACT FROM AUTHOR]

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]

Purpose: Diabetic ketoacidosis (DKA) is a critical diagnosis that can cause severe morbidity and mortality in the diabetic population. Although it is rare in pregnancy, the aim of this study is to compare DKA in pregnant women with age-matched non-pregnant women to determine if outcomes are influenced by pregnancy.Materials and Methods: A population-based age-matched retrospective cohort was carried out using data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample from 1999 to 2013. Pregnant patients with DKA were age-matched with non-pregnant controls also admitted with DKA at a ratio of 1:10. Severe morbidities and mortality were compared among the two groups. Logistic regression was used to adjust for baseline characteristics and comorbidities.Results: We identified 4661 cases of DKA in pregnancy during our study period, which were age-matched to 46,610 non-pregnant controls. Pregnant women with DKA were more likely to stay in hospital for >3 d (odds ratios (OR) 2.15, 95% CI 2.06-2.25) and had more associated renal failure (OR 2.86, 95% CI 1.76-4.55); however, they were less likely to require ventilation (OR 0.70, 95% CI 0.62-0.79), experience systemic inflammatory response syndrome (OR 0.53, 95% CI 0.38-0.73), or seizures (OR 0.49, 95% CI 0.42-0.57). Among pregnant women, rates of coma (0.04%) and death (0.17%, OR 0.23, 95% CI 0.14-0.39) were lower than previously reported and lower than non-pregnant women.Conclusion: Pregnant women with DKA are admitted to hospital for longer periods than non-pregnant controls and are at higher risk for renal failure but otherwise have better outcomes and less mortality than non-pregnant controls. [ABSTRACT FROM AUTHOR]

Purpose: In the United States (US), deaths during pregnancy and childbirth have increased over the past 2 decades compared to other high-income countries, and there have been reports that racial disparities in maternal mortality have widened. The study objective was to examine recent trends in maternal mortality in the US by race. Methods: Our population-based cross-sectional study used data from the Centers for Disease Control and Prevention's 2000–2019 "Birth Data" and "Mortality Multiple Cause" data files from the US to calculate maternal mortality during pregnancy, childbirth, and puerperium across race. Logistic regression models estimated the effects of race on the risk of maternal mortality and examined temporal changes in risk across race. Results: A total of 21,241 women died during pregnancy and childbirth, with 65.5% caused by obstetrical complications and 34.5% by non-obstetrical causes. Black women, compared with White women, had greater risk of maternal mortality (OR 2.13, 95% CI 2.06–2.20), as did American Indian women (2.02, 1.83–2.24). Overall maternal mortality risk increased during the 20-year study period, with an annual increase of 2.4 and 4.7/100,000 among Black and American Indian women, respectively. Conclusions: Between 2000 and 2019, maternal mortality in the US increased, overall and especially in American Indian and Black women. Targeted public health interventions to improve maternal health outcomes should become a priority. [ABSTRACT FROM AUTHOR]

• Incidence of amniotic fluid embolisms remained stable between 2000 and 2019 in the USA. • The case-fatality rate due to amniotic fluid embolisms declined over this period. • Highest incidence and fatality rates were in women ≥ 35 years and African-Americans. To estimate incidence and case-fatality rates of amniotic fluid embolism (AFE) and to examine their temporal trends. Population-based retrospective cohort study using the 2000–2019 Health Care Cost and Utilization Project, Nationwide Inpatient Sample (HCUP-NIS). Annual population rates were estimated using HCUP-NIS specific weighting. Descriptive analyses and logistic regression described trends within the cohort. Over the study period, AFE incidence rate remained stable (mean 4.9 cases/100,000 deliveries) and the case-fatality rate declined (mean 17.7 %,95 % CI 16.40–10.09). Highest AFE incidence rates and fatality rates were in women ≥ 35 years, African-Americans, and in urban-teaching hospitals. AFE mortality rates decreased among Hispanics. AFE rates remained stable and fatality rates declined over time. Highest rates of AFE occurrence and death were in women who typically have greater risk of experiencing adverse obstetrical outcomes. Continued research into early diagnostic methods and effective treatments are needed to further improve AFE incidence and mortality rates. [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]

INTRODUCTION: Adenomyosis is a common gynecologic disease involving the uterus with effect on pregnancy being poorly understood. This study aimed to evaluate the associations between adenomyosis and obstetrical and newborn outcomes. METHODS: Using the Healthcare Cost and Utilization Project–National Inpatient Sample from the United States, we conducted a retrospective cohort study of all birth-related admissions from 2016 to 2019. Pregnancies with adenomyosis were identified using the ICD-10 code N80.0, with the remaining pregnancies being the reference group. Multivariate logistic regression models, adjusting for baseline maternal demographics, were used to determine the effect of adenomyosis on pregnancy outcomes. In light of the diagnosis bias inherent in births by cesarean delivery, adjustment for mode of delivery was performed on all outcome analyses. RESULTS: Among the 2,943,532 women who delivered between 2016 and 2019, 1,084 had adenomyosis, for an overall prevalence of 36 cases per 100,000 births, which was stable throughout the study period. Adenomyosis in pregnancy was associated with increased frequency of placenta abruptio (odds ratio 1.67, 95% CI 1.17–2.39), preterm delivery (1.36, 1.16–1.59), preterm premature rupture of membranes (1.31, 1.07–1.61), postpartum hemorrhage (2.65, 2.14–3.27), postpartum transfusion (2.20, 1.62–2.99), disseminated intravascular coagulation (9.31, 4.15–20.92), sepsis (2.67, 1.60–4.45), congenital anomalies (1.95, 1.34–2.84), and intrauterine fetal demise (1.98, 1.02–3.84). CONCLUSION: Adenomyosis in pregnancy is associated with adverse obstetric and fetal outcomes. Pregnancies in patients with adenomyosis should be considered at higher risk and may benefit from delivering in centers capable of managing postpartum hemorrhage. [ABSTRACT FROM AUTHOR]

INTRODUCTION: The incidence of Lyme disease (LD) infections has risen in recent decades. Gestational LD has been associated with adverse pregnancy outcomes; however, the results have been contradictory. The objective of this study was to examine the effects of gestational LD on obstetrical and neonatal outcomes. METHODS: Using the Healthcare Cost and Utilization Project–National Inpatient Sample database from the United States, we conducted a retrospective cohort study of pregnant women who were admitted to hospital between 2016 and 2019. The exposed group consisted of pregnant women with gestational LD infection (ICD-10 code of A692x), whereas the comparison group consisted of pregnant women without gestational LD. Descriptive statistics and multivariate logistic regression models, adjusted for baseline maternal characteristics, were used to determine the associations between gestational LD and obstetrical and neonatal outcomes. RESULTS: Our cohort included 2,943,575 women, 226 of whom were diagnosed with LD during pregnancy. The overall incidence of gestational LD was 7.67 per 100,000 pregnancy admissions. The incidence of gestational LD was stable during the study period. Women with gestational LD were more likely to be Caucasian, older, have private health insurance, and earn higher incomes than the comparison group. Gestational LD was associated with an increased risk of placental abruption (adjusted odds ratio [aOR] 3.45, 95% CI 1.53–7.80) and preterm birth (aOR 1.58, 95% CI 1.03–2.42). CONCLUSION: Gestational LD is associated with a higher risk of placental abruption and preterm birth. Pregnancies complicated by LD may benefit from being closely monitored in tertiary care settings. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Over the past two decades, there has been a trend toward increasing maternal age in the United States. The study objective was to examine the association of maternal age with maternal mortality in the United States and examine temporal trends in mortality by maternal age. METHODS: A nationwide population-based cross-sectional study in the United States between 2000 and 2019 was conducted using data from the Centers for Disease Control and Prevention's "Birth Data" and "Mortality Multiple Cause" data files. Annual incidence and period trends in maternal deaths were calculated using the annual maternal deaths over annual live births across age groups. Multivariate logistic regression models were used to estimate the association between maternal age and risk of maternal mortality and calculate temporal changes in risk of mortality over the study period. RESULTS: Between 2000 and 2019, 21,241 deaths were observed in women during pregnancy and childbirth for an average incidence of 26.3 maternal deaths/100,000 births (95% CI 21.8–31.2). Of all deaths, 6,870 (32.3%) were in women 35 years or older, while only 15.1% of live births were attributed to women 35 years or older. Compared with women 25–29 years of age, there was a significantly greater risk of maternal mortality among women 35–39 (odds ratio 1.60, 95% CI 1.53–1.67), 40–44 (3.78, 3.60–3.99), 45–49 (28.49, 26.49–30.65), and 50–54 (343.50, 319.44–369.37). Risk of mortality increased over time, with the greatest rise in women 35 years or older. CONCLUSION: In the United States, maternal mortality increased during the past two decades, especially in women 35 years or older. Given these findings, targeted strategies to reduce the increasing maternal mortality should become a priority. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Public health interventions to reduce maternal mortality have focused on direct and indirect obstetric causes, while neglecting nonobstetric causes of death. The study objective was to examine recent trends in maternal deaths from nonobstetric causes in the United States. METHODS: A population-based cross-sectional study was conducted in the United States 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 nonobstetric causes per 100,00 live births were calculated across racial groups using official death certificates, while the effects of race on the risk of nonobstetric maternal mortality and temporal changes over the study period were examined using logistic regression models. RESULTS: From 2000 to 2019, a total of 7,334 women died during pregnancy and childbirth from nonobstetric causes, where 31.3% of these deaths were caused by transport accidents and 27.3% by accidental poisoning. American Indian women were found to be at the highest risk of nonobstetric maternal mortality (odds ratio 2.20, 95% CI 1.90–2.56), and 46.1% of all deaths among pregnant American Indian women were caused by nonobstetric complications. The risk of nonobstetric maternal mortality increased overall during the 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: Nonobstetric causes of death have become increasingly prevalent in the United States, overall and especially in American Indian women. Novel interventions to address these nonobstetric factors should especially target American Indian women to improve maternal outcomes. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the association of cesarean deliveries on the incidence of small bowel obstruction.Methods: We formed a population-based cohort of all women with a first live birth between 1998 and 2007 using the U.K. Clinical Practice Research Datalink. Women were followed until 2015, the occurrence of a small bowel obstruction, or loss to follow-up. Cesarean delivery was identified from the Hospital Episode Statistics and small bowel obstruction events were identified using the Classification of Interventions and Procedures and International Classification of Diseases, 10th Revision codes. Cox proportional hazard models, with cesarean delivery defined as a time-dependent exposure, estimated the adjusted hazard ratios and 95% CIs of small bowel obstruction associated with cesarean delivery.Results: The cohort included 81,480 women with a median follow-up of 8.0 years (range 6 months to 16.6 years), during which 575 new small bowel obstructions occurred (incidence 9.1/10,000 person-years). Risk of small bowel obstruction was higher among women with a cesarean delivery compared with women without (16.3 vs 6.4 patients/10,000 person-years, odds ratio [OR] 2.54, 95% CI 2.15-3.00). Increasing number of cesarean deliveries was associated with an increasing risk of small bowel obstruction (OR 1.61, 95% CI 1.46-1.78, per additional cesarean delivery). Repeated small bowel obstructions were more common among women with a cesarean delivery and the association remained when restricting to small bowel obstruction requiring surgical management.Conclusion: Although rare, small bowel obstructions are increased among women who have undergone a cesarean delivery. With increasing rates of cesarean deliveries worldwide, small bowel obstructions and related morbidities may become a more prevalent women's health concern. [ABSTRACT FROM AUTHOR]

Purpose: Vulvodynia and vaginismus are common chronic vulvar pain disorders for which there is a paucity of literature on pregnancy outcomes of affected women. The study objective was to evaluate the associations between vulvodynia and vaginismus and obstetric outcomes. Methods: We performed a retrospective cohort study including all birth-related admissions from 1999 to October 2015 extracted from the Healthcare Cost and Utilization Project-National Inpatient Sample from the United States. Women with vulvodynia or vaginismus were identified using the appropriate ICD-9 codes. Multivariate logistic regression models, adjusted for baseline maternal characteristics, were performed to evaluate the effect of vulvodynia and vaginismus on obstetrical and neonatal outcomes. Results: A total of 879 obstetrical patients with vulvodynia or vaginismus were identified in our cohort of 13,792,544 patients admitted for delivery in US hospitals between 1999 and 2015, leading to an overall prevalence of 6 cases per 100,000 births. Between 1999 and 2015, the annual prevalence of vulvodynia or vaginismus rose from 2 to 16 cases per 100,000. Vulvodynia and vaginismus were associated with increased risks of eclampsia, chorioamnionitis, post-term pregnancy, cesarean delivery, instrumental vaginal delivery, blood transfusions, prolonged hospital stays, congenital anomalies and intrauterine growth restriction. Conclusion: Vulvodynia and vaginismus in pregnancy appears underreported in pregnancy compared to reported population rates. Prevalence of reporting seems to have increased in the last decades and is associated with increased risks of maternal and newborn morbidities. Obstetrical caregivers should be aware of the underreporting of these conditions and the associated adverse effects when counseling obstetrical patients. [ABSTRACT FROM AUTHOR]

Objective: Pregnancies among morbidly obese women are associated with serious adverse maternal and neonatal outcomes. Our study objective is to evaluate the effect of bariatric surgery on obstetrical outcomes.Methods: We carried out a retrospective cohort study using the healthcare cost and utilization project - Nationwide Inpatient Sample from 2003 to 2011 comparing outcome of births among women who had undergone bariatric surgery with births among women with morbid obesity. Logistic regression was used to estimate the adjusted effect of bariatric surgery on maternal and newborn outcomes.Results: There were 8 475 831 births during the study period (221 580 (2.6%) in morbidly obese women and 9587 (0.1%) in women with bariatric surgery). Women with bariatric surgery were more likely to be Caucasian and ≥35 years old as compared with morbidly obese women. As compared with women with morbid obesity, women with bariatric surgery had lower rates of hypertensive disorders, premature rupture of membrane, chorioamnionitis, cesarean delivery, instrumental delivery, postpartum hemorrhage, and postpartum infection. Induction of labor, postpartum blood transfusions, venous thromboembolisms, and intrauterine fetal growth restriction were more common in the bariatric surgery group. There were no differences observed in preterm births, fetal deaths, or reported congenital anomalies.Conclusion: In general, women who undergo bariatric surgery have improved pregnancy outcomes as compared with morbidly obese women. However, the bariatric surgery group was more likely to have venous thromboembolisms, to require a blood transfusion, to have their labor induced and to experience fetal growth restriction. [ABSTRACT FROM AUTHOR]

Objectives The United States has one of the highest teen birth rates among developed countries. Interstate birth rates and abortion rates vary widely, as do policies on abortion and sex education. The objective of our study is to assess whether US state-level policies regarding abortion and sexual education are associated with different teen birth and teen abortion rates. Methods We carried out a state-level (N = 51 [50 states plus the District of Columbia]) retrospective observational cross-sectional study, using data imported from the National Vital Statistics System. State policies were obtained from the Guttmacher Institute. We used descriptive statistics and regression analysis to study the association of different state policies with teen birth and teen abortion rates. Results The state-level mean birth rates, when stratifying between policies protective and nonprotective of teen births, were not statistically different—for sex education policies, 39.8 of 1000 vs 45.1 of 1000 ( P = .2187); for mandatory parents' consent to abortion 45 of 1000, vs 38 of 1000 when the minor could consent ( P = .0721); and for deterrents to abortion, 45.4 of 1000 vs 37.4 of 1000 ( P = .0448). Political affiliation (35.1 of 1000 vs 49.6 of 1000, P < .0001) and ethnic distribution of the population were the only variables associated with a difference between mean teen births. Lower teen abortion rates were, however, associated with restrictive abortion policies, specifically lower in states with financial barriers, deterrents to abortion, and requirement for parental consent. Conclusion While teen birth rates do not appear to be influenced by state-level sex education policies, state-level policies that restrict abortion appear to be associated with lower state teen abortion rates. [ABSTRACT FROM AUTHOR]

INTRODUCTION: First-trimester bleeding is associated with miscarriage and preterm birth, for which progesterone has been suggested to improve outcomes. Our study objective was to evaluate the effect of progesterone treatment throughout pregnancy on preventing miscarriage and preterm birth in pregnancies with first trimester bleeding. METHODS: This was a multicenter, double-blind, placebo-controlled, randomized trial comparing 200 mg micronized progesterone, vaginally administered nightly from presentation to 34 weeks of gestation, with an identically appearing placebo. Subjects with vaginal bleeding and live intrauterine pregnancy <14 weeks of gestation were eligible. Multifetal gestations, cervical insufficiency, recurrent pregnancy loss, or bleeding unrelated to placentation were excluded. Primary outcome was occurrence of live term pregnancy. Secondary outcomes included adverse maternal/newborn events and time to miscarriage or birth. Chi-square analyses compared proportions and Mann-Whitney tests compared time-to-event outcomes. RESULTS: A total of 549 patients were randomized, of whom 16 withdrew or were lost to follow-up, leaving 264 patients in the progesterone group and 269 patients in the placebo group. Baseline characteristics were comparable in both groups. The number of patients having a live term birth among those in the progesterone group was 197 (74.6%), compared with 190 (70.6%) in the placebo group (P =.30). Compared to the placebo group, those in the progesterone group had comparable risks of abortion <20 weeks (38 (14.4%) versus 43 (16.0%), P =.94), preterm birth (27 [10.2%] versus 33 [12.3%], P =.46), and stillbirth (2 [0.9%] versus 3 [1.3%], P =.65). There were no differences in adverse maternal or newborn outcomes, or in time-to-event for miscarriage or birth between the groups. CONCLUSION: Progesterone prescribed throughout pregnancy is not effective in preventing miscarriage or prematurity in subjects presenting with first-trimester vaginal bleeding in context of a live intrauterine pregnancy. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Induction of labor (IOL) at 39 weeks has been associated with decreased risk of cesarean delivery. The study objective was to evaluate the effect of IOL at 39 weeks on perinatal death in low-risk pregnancies. METHODS: We used the National Center for Health Statistics Linked Birth/Infant Deaths data from 2013 to 2017 to carry out a propensity score matched cohort study to test the influence of IOL at 39 weeks on risk of stillbirth and infant death. Low-risk singleton pregnancies with a live fetus at 39 weeks with no known congenital malformations who underwent an IOL were matched with comparable pregnancies that were not induced at 39 weeks and that delivered no later than 42 weeks. RESULTS: From >20 million births, 825,323 (4%) low-risk pregnancies that were induced at 39 weeks were propensity score matched (5:1 ratio) to a comparable group of pregnancies that were not induced at 39 weeks. Compared to pregnancies that were not induced at 39 weeks, IOL at 39 weeks was associated with increased risk of perinatal death (10.8 versus 5.8/10,000; OR, 3.83.5–4.2; P <.0001), which consisted of a decreased risk of stillbirth (0 versus 0.7/10,000) and an increased risk of infant death (10.8 versus 5.1/10,000; OR, 4.2; 95% CI, 3.8–4.6; P <.0001). Among live-born infants, the risk of sudden infant death syndrome was more common among pregnancies induced at 39 weeks (OR, 4.3; 95% CI, 3.6–5.2; P <.0001). CONCLUSION: IOL at 39 weeks in low-risk singleton pregnancies is associated with an increased risk of perinatal death. While this may not have a material effect on risk to an individual patient, adoption of widespread practices of inducing low-risk pregnancies at 39 weeks may lead to increases in perinatal deaths on a population level. [ABSTRACT FROM AUTHOR]

Aim Little is known about outcomes of cardiopulmonary resuscitation (CPR) in pregnancy. The purpose of this study was to determine the prognostic value of pregnancy in women receiving CPR in the emergency department (ED). Methods We conducted a population-based, matched cohort study using the Nationwide Emergency Department Sample (NEDS) from 2006 to 2010. A cohort of pregnant women receiving CPR in the ED was compared to an age-matched cohort of non-pregnant women at a 1:10 ratio. Conditional logistic regression was used to calculate the odds ratio (OR) and corresponding 95% confidence intervals (95% CIs) for variables of interest and survival. Results Among 8162 women requiring CPR in the ED, we identified 157 pregnant women. Pregnancy was associated with better overall survival of 36.9% compared to 25.9% in non-pregnant women, OR 1.89 (1.32–2.70), p < 0.01. Traumatic injury was identified as a significant predictor of outcome in pregnancy. In non-trauma patients, pregnant women had significantly better odds of surviving CPR than non-pregnant women, OR 2.10 (1.41–3.13), p < 0.01. In cases of trauma, no significant difference was observed between groups. Conclusion Although further studies are needed, CPR in pregnancy is associated with a better prognosis compared to non-pregnant women, with trauma status being a key factor predicting outcome in the pregnant patient. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the incidence, risk factors and neonatal outcomes associated with a congenital diaphragmatic hernia (CDH). Study design: We conducted a population-based cohort study using the CDC's Linked Birth-Infant Death and Fetal Death data files on all births and foetal deaths in USA between 1995 and 2002. We estimated the yearly incidence of CDH and measured its adjusted effect on various outcomes using unconditional logistic regression analysis. Results: About 32 145 448 births during the 8-year study period met the study's inclusion criteria. The incidence of CDH was 1.93/10 000 births. Risk factors for the development of CDH included foetal male gender [OR 1.12, 95% CI: 1.06, 1.17], maternal age beyond 40 [OR 1.51, 95% CI: 1.26, 1.80], Caucasian ethnicity [OR 1.15, 95% CI: 1.10, 1.21], smoking [OR 1.34, 95% CI: 1.22, 1.46] and alcohol use during pregnancy [OR 1.37, 95% CI: 1.05, 1.79]. As compared to foetuses with no CDH, foetuses with CDH were at an increased risk of preterm birth [OR 2.90, 95% CI: 2.72, 3.11], intrauterine growth restriction [OR 3.84, 95% CI: 3.51, 4.18], stillbirth [OR 9.65, 95% CI: 8.20, 11.37] and overall infant death [OR: 94.80, 95% CI: 88.78, 101.23]. The 1-year mortality was 45.89%. Conclusion: Congenital diaphragmatic hernia is strongly associated with an increased risk of adverse pregnancy, foetal and neonatal outcomes. These findings may be helpful in counselling pregnancies affected by CDH, and may aid in the understanding of the burden of this condition at the public health level. [ABSTRACT FROM AUTHOR]

Purpose: With improvement in cancer care and fertility preservation, increasing numbers of cancer survivors are requiring obstetrical care. The objective of our study was to evaluate the effect of history of chemotherapy exposure on maternal and neonatal outcomes. Methods: A retrospective population-based cohort study was conducted using the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS) to obtain data on maternal and newborn outcomes in a cohort of births occurring between the years 2006 and 2015. The annual and overall prevalence of chemotherapy exposure was calculated among pregnant women, and multivariate logistic regression models were used to estimate the effect of history of exposure to chemotherapy on the risk of adverse maternal and newborn outcomes. Results: Of 7,907,139 birth admissions, 613 had a history of chemotherapy exposure for an overall incidence of 7.75 per 100,000 admissions. The prevalence of chemotherapy exposure in pregnancy increased during the study period (P < 0.001). Women with a history of chemotherapy were more likely to suffer from obstetric and medical complications including pre-eclampsia, chorioamnionitis, postpartum hemorrhage, and venous thromboembolism as well as an increased risk in overall mortality (OR 9.39, 95% CI 1.31–67.32). No differences were observed in the incidence of adverse neonatal outcomes, including stillbirth, intra-uterine growth restriction, or preterm birth. Conclusion: Women with history of chemotherapy have higher incidence of pregnancy complications and maternal death, with no differences in fetal or newborn outcomes. [ABSTRACT FROM AUTHOR]

Sudden infant death syndrome (SIDS) is the leading cause of death among infants aged 1 to 12 months. In this article, we review risk factors that may predispose infants to increased vulnerability. Maternal characteristics, including nonmodifiable and modifiable factors, antenatal medical conditions, labor and delivery events, and infant characteristics, are reviewed, with the purpose of helping obstetric care providers target risk reduction efforts. We have reviewed over 85 case-control, retrospective, and prospective cohort studies published between 1975 and 2011. Major modifiable risk factors include maternal and paternal smoking, drug use, alcohol use, and insufficient prenatal care. Infants at increased risk include males, premature infants, infants of low birth weight or growth-restricted infants, and infants in multiple gestations. By targeting modifiable and nonmodifiable risk factors, it may be possible to decrease the incidence of SIDS. Efforts should be put on decreasing high-risk behaviors and encouraging sufficient antenatal follow-up. In view of recent increases in ethnic and social disparity with SIDS, it is essential that risk reduction guidelines, which have recently been expanded by the American Association of Pediatrics, be explained in a culturally sensitive manner. [ABSTRACT FROM AUTHOR]

Background Amniotic fluid embolism ( AFE) is a rare but serious cause of maternal mortality whose aetiology remains obscure. Previous population-based studies have reported associations with labour induction and caesarean delivery. Methods We updated a previous analysis based on the US Nationwide Inpatient Sample from 1999 to 2008. We adapted a diagnostic validation algorithm to minimise false-positive diagnoses, along with statistical methods that account for the stratified random sampling design. Results Of the 8 571 209 deliveries recorded in the database, 276 met our case definition of AFE, of which 62 (22.9% of the 274 with known vital status) were fatal. Significant associations with AFE were observed for medical induction {adjusted odds ratio [ aOR] = 1.7 [95% confidence interval ( CI) 1.2, 2.5]}, caesarean delivery [ aOR = 15.0; 95% CI 9.4, 23.9], instrumental vaginal delivery [ aOR = 6.6; 95% CI 4.0, 11.1], and cervical/uterine trauma [ aOR = 7.4; 95% CI 3.6, 14.9]. AFE was associated with increases in risk of stillbirth, hysterectomy, maternal death, and prolonged maternal length of delivery hospital stay. Conclusions AFE remains an extremely serious obstetric complication with high risks of maternal and fetal mortality. The increased risks of AFE associated with labour induction and caesarean delivery have implications for elective use of these interventions. [ABSTRACT FROM AUTHOR]

Purpose: Increased body mass index (BMI) is an independent risk factor for stillbirth. The purpose of this study was to determine an optimal time of delivery at term in obese women in order to decrease the risk of stillbirth in this population. Methods: We conducted a retrospective population-based cohort study using the CDC’s Period Linked Birth-Infant Death and Fetal Death data. The study population included all singleton, term births with a recorded pre-pregnancy BMI that occurred between 2014 and 2017. Unconditional logistic regression analyses were used to estimate the risk of stillbirth in each BMI class at each gestational week from 37 weeks and onwards comparing with births to normal-weight women at 41 weeks. Results: Of 12,742,980 births in our cohort, 46.8% were to women with a normal BMI, 26.9% were to women who were classified as overweight, 14.5% were to women in obesity class I, 7.3% in obesity class II, and 4.8% in obesity class III. Within each BMI class, the risk of stillbirth increased with gestational age, with the most pronounced rises in risk occurring at later gestational ages. In a dose-response relationship, the risk of stillbirth exceeded that of a normal BMI pregnancy at 41 weeks at the following gestational age and BMI category: obese class 1 at 39 weeks (OR 1.15 95% CI 1.00–1.31), obese class II at 38 weeks (OR 1.21 95% CI 1.04–1.41) and obese class III at 37 weeks (OR 1.30 95% CI 1.11–1.52). Conclusion: Compared to women with a normal BMI at 41 weeks, there was a higher risk of stillbirth at term in women with each increase in BMI class. Consideration should be given to early induction among these women to reduce the risk of stillbirth. [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]

Historically, placement of a cervical cerclage was based almost entirely on the obstetrical history. Over the past two decades however, we have recognised that history alone may not be the only indication for cerclage but rather, complementing the obstetrical history with ultrasonographic and biochemical findings may better identify those women who may benefit most from the placement of a cervical cerclage. Review of the literature appears to suggest that the best approach towards the management of a cervical insufficiency is to first categorise women as being either high risk of low risk-based on obstetrical history. Although women with an obstetrical history of at least three 2nd trimester losses are likely to benefit from a prophylactic cerclage than those without this history may better be managed with progesterone and serial cervical length measurements. This approach can in turn be used to identify those women with early cervical shortening that may require an emergency cerclage. Although randomised controlled trials are still lacking, recent studies suggests that this approach may be more effective especially when combined with markers of intra-amniotic inflammation. As for the prophylactic cerclage itself, with the abdominal cerclage being less invasive given the possibility of a laparoscopic placement, it may prove to be a more effective alternative to the conventionally placed McDonald cerclage. This however, remains to be evaluated more carefully. [ABSTRACT FROM AUTHOR]

Aims: Whether or not women with a previous cesarean section should be considered for an external cephalic version remains unclear. In our study, we sought to examine the relationship between a history of previous cesarean section and outcomes of external cephalic version for pregnancies at 36 completed weeks of gestation or more. Methods: Data on obstetrical history and on external cephalic version outcomes was obtained from the C.H.U. Sainte-Justine External Cephalic Version Database. Baseline clinical characteristics were compared among women with and without a history of previous cesarean section. We used logistic regression analysis to evaluate the effect of previous cesarean section on success of external cephalic version while adjusting for parity, maternal body mass index, gestational age, estimated fetal weight, and amniotic fluid index. Results: Over a 15-year period, 1425 external cephalic versions were attempted of which 36 (2.5%) were performed on women with a previous cesarean section. Although women with a history of previous cesarean section were more likely to be older and para >2 (38.93% vs. 15.0%), there were no difference in gestational age, estimated fetal weight, and amniotic fluid index. Women with a prior cesarean section had a success rate similar to women without [50.0% vs. 51.6%, adjusted OR: 1.31 (0.48–3.59)]. Conclusion: Women with a previous cesarean section who undergo an external cephalic version have similar success rates than do women without. Concern about procedural success in women with a previous cesarean section is unwarranted and should not deter attempting an external cephalic version. [ABSTRACT FROM AUTHOR]

Background. Evaluating the effect of restricted activity on the development of preeclampsia under experimental clinical settings has been compromised by inherent selection bias and differential misclassification. The aim of our study was to overcome such limitations by using hospitalized bedrest for preterm labor/birth-related indications as an unbiased measure of restricted activity and evaluate its effect on the development of hypertensive diseases of pregnancy. Methods. We conducted a retrospective cohort study using data from the McGill Obstetrical and Neonatal Database on all pregnancies that took place between 1991 and 2001. We defined “exposure” as hospitalized bed rest for preterm labor/birth related indications and used unconditional logistic regression models to estimate its adjusted effect on the development of hypertensive diseases of pregnancy. Results. Data were available on 36,140 pregnancies. 677 women were hospitalized and prescribed bedrest for either preterm contractions (71%), preterm premature rupture of membranes (18%), an incompetent cervix (8%), or other indications. Among all women, bedrest was associated with a significant reduced risk for developing preeclampsia, 0.27 (0.16-0.48). In a stratified analysis, women delivering prior to 34 weeks of gestation had an even more pronounced reduced risk for developing preeclampsia 0.12 (0.03-0.50) as well as a reduced risk for developing intrauterine growth restriction 0.38 (0.18-0.84). Conclusion. When strictly adhered to, bedrest may be an effective measure in the prevention of preeclampsia and early intrauterine growth restriction. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To examine the relationship between physicians’ instrument preference and obstetrical and neonatal outcomes. Study design: A retrospective cohort study comparing obstetrical and neonatal outcomes of second stage deliveries between obstetricians who prefer forceps (forceps ≥90%) with obstetricians with no preference to forceps (either instrument <90%) was completed using the McGill Obstetrical and Neonatal Database. Logistic regression analysis was used to obtain an adjusted odds ratio controlling for maternal, intrapartum and neonatal confounders. Results: Two thousand and three hundred thirteen infants were delivered by 5 obstetricians who preferred forceps, and 9261 infants were delivered by 15 obstetricians with no instrument preference. Baseline characteristics were similar between the two groups. As compared to obstetricians who preferred forceps, obstetricians with no instrument preference had a higher rate of operative vaginal deliveries 1.5 (1.1–2.0), a higher cesarean section rate 2.5 (1.3–4.9) and a higher episiotomy rate in non-operative vaginal deliveries 3.4 (2.7–4.3). Infants delivered by obstetricians with no instrument preference were less likely to have significant bruising 0.3 (0.2–0.6) but more likely to have a cephalohematoma 3.0 (1.1–8.3). Conclusion: Physician instrument preference is an important determinant of outcomes that should be considered in studies evaluating instrumental deliveries. [Copyright &y& Elsevier]

Background: The question "will you be delivering my baby?" is one that pregnant women frequently ask their physicians. We sought to determine whether obstetric outcomes differed between women whose babies were delivered by their own obstetrician (regular-care obstetrician) and those attended by an on-call obstetrician who did not provide antenatal care. Methods: We performed a cohort study of all live singleton term births between 1991 and 2001 at the Royal Victoria Hospital in Montreal. We excluded breech deliveries, elective cesarean sections and deliveries with placenta previa or prolapse of the umbilical cord. Logistic regression analysis was used to compare obstetric outcomes (e.g., cesarean delivery, instrumental vaginal delivery and episiotomy) between the regular-care and on-call obstetricians after adjustment for potential confounders. Results: A total of 28 332 eligible deliveries were attended by 26 obstetricians: 21 779 (76.9%) by the patient's own obstetrician and 6553 (23.1%) by the on-call obstetrician. Compared with women attended by their regular-care obstetrician, those attended by an on-call obstetrician had higher rates of cesarean delivery (11.9% v. 11.4%, adjusted odds ratio [OR] 1.13, 95% confidence interval [CI] 1.03-1.24, p < 0.01) and of third- or fourth-degree tears (7.9% v. 6.4%, adjusted OR 1.21, 95% Cl 1.07-1.36, p < 0.01) but lower rates of episiotomy (38.5% v. 42.9%, OR 0.77, 95% CI 0.72-0.82, p < 0.001). No differences were observed between the groups in the rate of instrumental vaginal delivery. The increase in the overall rate of cesarean delivery among women attended by an on-call obstetrician was due mainly to an increase in cesarean deliveries during the first stage of labour because of nonreassuring fetal heart tracing (2.9% v. 1.7%, adjusted OR 1.79, 95% CI 1.49-2.15, p < 0.001). The time of day of delivery did not modify the observed effects. [ABSTRACT FROM AUTHOR]

Background: The question "will you be delivering my baby?" is one that pregnant women frequently ask their physicians. We sought to determine whether obstetric outcomes differed between women whose babies were delivered by their own obstetrician (regular-care obstetrician) and those attended by an on-call obstetrician who did not provide antenatal care. Methods: We performed a cohort study of all live singleton term births between 1991 and 2001 at the Royal Victoria Hospital in Montréal. We excluded breech deliveries, elective cesarean sections and deliveries with placenta previa or prolapse of the umbilical cord. Logistic regression analysis was used to compare obstetric outcomes (e.g., cesarean delivery, instrumental vaginal delivery and episiotomy) between the regular-care and on-call obstetricians after adjustment for potential confounders. Results: A total of 28 332 eligible deliveries were attended by 26 obstetricians: 21 779 (76.9%) by the patient's own obstetrician and 6553 (23.1%) by the on-call obstetrician. Compared with women attended by their regular-care obstetrician, those attended by an on-call obstetrician had higher rates of cesarean delivery (11.9% v. 11.4%, adjusted odds ratio [OR] 1.13, 95% confidence interval [CI] 1.03-1.24, p< 0.01) and of third- or fourth-degree tears (7.9% v. 6.4%, adjusted OR 1.21, 95% CI 1.07-1.36, p< 0.01) but lower rates of episiotomy (38.5% v. 42.9%, OR 0.77, 95% CI 0.72-0.82, p < 0.001). No differences were observed between the groups in the rate of instrumental vaginal delivery. The increase in the overall rate of cesarean delivery among women attended by an on-call obstetrician was due mainly to an increase in cesarean deliveries during the first stage of labour because of nonreassuring fetal heart tracing (2.9% v. 1.7%, adjusted OR 1.79, 95% CI 1.49-2.15, p< 0.001). The time of day of delivery did not modify the observed effects. Interpretation: The type of attending obstetrician (regular care v. on call) had a minor effect on obstetric outcomes. [ABSTRACT FROM AUTHOR]

Aims: Nifedipine is believed to be a superior tocolytic agent on the basis of efficacy and side-effect profile, but was never prospectively evaluated in a placebo-controlled randomized clinical trial (RCT). In our study, we sought to identify limitations in participation for a would-be RCT comparing nifedipine to placebo. Methods: A prospective feasibility study was conducted at Ste-Justine Hospital, a tertiary care center, on women between 24 and 34 weeks' gestation, presenting to the labor and delivery room with obstetrical complaints. Patient information was collected and would-be participants were identified on the basis of pre-established clinical and ultrasound criteria as well as on willingness to participate, as determined by the study research nurse. Results: During a 6-month period, 483 women presenting with signs and symptoms of preterm labor (PTL) were eligible for further evaluation. A total of 321 (66.5%) women were excluded for obstetrical and medical reasons whereas 125 (25.9%) did not meet strict inclusion criteria (cervical length <25 mm or positive fetal fibronectin). When using strict criteria, only 37 women (7.6%) were found to be eligible for study participation. Subject willingness to participate as assessed by the research nurse was 50%. Conclusions: If adhering to strict inclusion/exclusion criteria, the feasibility of an appropriately sampled RCT testing tocolytic therapy against a placebo would require a large concerted multicenter effort to meet sample size demands. [ABSTRACT FROM AUTHOR]

Abstract Background Whether the current recommendations for ovarian cancer prevention and screening (annual history and physical examination) are effective has not been evaluated. We examined the relation between health care use and the risk of ovarian cancer. Methods Using a case-control study design, we recorded the frequency of medical visits and pelvic examinations and the type of health care provider visited during a 5-year period from interviews with women with and without ovarian cancer between between July 1998 and July 2003. We used multivariable logistic regression analysis to calculate the adjusted odds ratio of ovarian cancer associated with the frequency of medical visits and pelvic examinations and the type of health care provider. In addition, we stratified cases and controls by menopausal status and cancer histologic subtype and grade. Results A total of 668 cases and 721 age-matched controls agreed to participate in the study. We observed an increased risk of ovarian cancer among women who, during the 5-year study period, did not have a medical visit (odds ratio &lsqb;OR&rsqb; 2.8, 95% confidence interval &lsqb;CI&rsqb; 1.5-5.0) or pelvic examination (OR 3.9, 95% CI 2.2-6.9) or who had no regular health care provider (OR 2.7, 95% CI 1.3-5.7). This increase in risk was most pronounced among women who were postmenopausal (no medical visit, OR 7.7, 95% CI 2.6-23.0; no pelvic examination, OR 3.3, 95% CI 1.7-6.0; no health care provider, OR 12.5, 95% CI 2.7-57.5). Interpretation Although the exact mechanism underlying the association between medical visits, pelvic examinations and type of health care provider and ovarian cancer is unknown, women should be encouraged to maintain regular medical care. [ABSTRACT FROM AUTHOR]

To examine the association between body mass index (BMI) and obstetrical and neonatal outcomes. We conducted a cohort study comparing prepregnant BMI categories with obstetrical and neonatal outcomes using the McGill Obstetrical and Neonatal Database on all deliveries in 10 year period (1987–1997). Prepregnant BMI was categorized into underweight (<20), normal (20–24.9), overweight (25–29.9), obese (30–39.9), and morbidly obese (40+). Logistic regression analysis was used to adjust for age, smoking, parity, and preexisting diabetes using normal BMI as the reference. The population consisted of underweight 4,312 (23.1%), normal weight 10,021 (53.8%), overweight 3,069 (16.5%), obese 1,137 (6.1%), and morbidly obese 104 (0.6%). As compared to women with normal BMIs, overweight, obese, and morbidly obese women had an increased risk of preeclampsia 2.28 (1.88–2.77), 4.65 (3.71–5.83), 6.26 (3.48–11.26); gestational hypertension 1.56 (1.35–1.81), 2.01 (1.64–2.45), 2.77 (1.60–4.78); gestational diabetes 1.89 (1.63–2.19), 3.22 (2.68–3.87), 4.71 (2.89–7.67); preterm birth 1.20 (1.04–1.38), 1.60 (1.32–1.94), 2.43 (1.46–4.05); cesarean section 1.48 (1.35–1.62), 1.85 (1.62–2.11), 2.92 (1.97–4.34); and macrosomia 1.66 (1.23–2.24), 2.32 (1.58–3.41), 2.10 (0.64–6.86). Underweight women were less likely to have: preeclampsia 0.67 (0.52–0.86), gestational hypertension 0.71 (0.60–0.83), gestational diabetes 0.82 (0.69–0.97), cesarean section 0.89 (0.81–0.97), shoulder dystocia 0.88 (0.80–0.96), birth injuries 0.40 (0.21–0.77), and macrosomia 0.43 (0.28–0.68) but more likely to have small for gestational age infants 1.54 (1.37–1.72) and intrauterine growth restricted infants 1.33 (1.07–1.67). In a large Canadian teaching hospital, increasing prepregnancy BMI category was associated with an increasing risk of adverse pregnancy outcomes. Underweight prepregnancy BMI was associated with a reduced risk of adverse pregnancy outcomes. [ABSTRACT FROM AUTHOR]

Compares the six-month outcomes of percutaneous transluminal coronary angioplasty (PTCA) in patients who are 75 years and above. Patient population; Higher incidence of clinical events among patients undergoing a successful PTCA; Factor associated with adverse clinical events; Study limitations.

Reviews the hospital-run medical short-stay unit (MSSU) created in a hospital in Montreal in 1989. Aim of the unit which was to provide efficient and high-quality care to patients requiring a brief stay in a hospital for short-lived medical conditions; Difficulty of ensuring the admission of appropriate patients during non-daytime hours; Comparison of the efficiency and outcomes of care directly with that provided by the traditional clinical teaching unit.

Objective: The incidence of Lyme disease (LD) infections has risen in recent decades. Gestational LD has been associated with adverse pregnancy outcomes; however, the results have been contradictory. The study objective was to examine the effects of gestational LD on obstetrical and neonatal outcomes. Methods: Using the Healthcare Cost & Utilization Project National (Nationwide) Inpatient Sample from the United States, we conducted a retrospective cohort study of pregnant patients admitted to the hospital between 2016 and 2019. The exposed group consisted of pregnant patients with gestational LD infection (International Classification of Diseases, Tenth Revision [ICD‐10] code A692x), while the comparison group consisted of pregnant patients without gestational LD. Descriptive statistics and multivariate logistic regression models, adjusted for baseline maternal characteristics, were used to determine the associations between gestational LD and obstetrical and neonatal outcomes. Results: The cohort included 2 943 575 women, 226 of whom were diagnosed with LD during pregnancy. The incidence of LD was 7.67 per 100 000 pregnancy admissions. The incidence of gestational LD was stable over the study period. Pregnant patients with LD were more likely white, older, to have private health insurance, and to belong to a higher income quartile. Gestational LD was associated with an increased risk of placental abruption (adjusted odds ratio [aOR], 3.45 [95% confidence interval (CI), 1.53–7.80]) and preterm birth (aOR, 1.58 [95% CI, 1.03–2.42]). Conclusion: Gestational LD is associated with a higher risk of placental abruption and preterm birth. Pregnancies complicated by LD, while associated with a higher risk of certain adverse outcomes, can be followed in most healthcare settings. Synopsis: Lyme disease in pregnancy is associated with an increased risk of placental abruption and preterm birth. [ABSTRACT FROM AUTHOR]

Pregnancy outcomes in women with inflammatory myopathies (IM) are not well studied. The purpose of this study is to evaluate the effects of IM on maternal and neonatal outcomes. We conducted a retrospective cohort study using data from the Healthcare Cost and Utilization Project – Nationwide Inpatient Sample (HCUP-NIS) from 1999 to 2015. Among all pregnant women who delivered during this period, those with a diagnosis of IM were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) coding, which included all patients with dermatomyositis and polymyositis. Maternal and neonatal outcomes were compared in pregnant women with and without IM. Multivariate logistic regression analysis was used to estimate the adjusted effects of IM on these outcomes. A total of 13,792,544 pregnant women delivered between 1999 and 2015, of which 308 had a diagnosis of IM, for an overall prevalence of 2 per 100,000 pregnant women, with rates increasing over the study period. Pregnant women with IM were more likely to be older, African American and suffer from other autoimmune connective tissue diseases. IM in pregnancy was associated with greater risk of preeclampsia, caesarean delivery, major postpartum infections, urinary tract infections and longer hospital stay. Neonates born to mothers with IM had greater risk of prematurity, small for gestational age and intrauterine fetal demise. Pregnant women with IM are at higher risk of adverse maternal and neonatal outcomes and should be closely followed in specialized centers with collaboration between maternal-fetal medicine and rheumatology. [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]

Obsessive–compulsive disorder (OCD) is a mental disorder linked to functional impairments and adverse health outcomes. We sought to examine the association between pregnant women with OCD and obstetrical and neonatal outcomes in the USA. A retrospective population-based cohort study was conducted using data provided by pregnant women from the Nationwide Inpatient Sample, a nationally representative database of hospitalizations in the USA, from 1999 to 2015. Using diagnostic and procedure codes from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), we identified births and classified women by OCD status. Demographic and clinical characteristics were compared for women with and without OCD and multivariate logistic regressions were used to obtain odds ratios (OR) to compare obstetrical and neonatal outcomes between the two groups, adjusting for relevant demographic and clinical variables. Between 1999 and 2015, there were 3365 births to women with OCD, corresponding to an overall prevalence of 24.40 per 100,000 births. Women with OCD were more likely to be older than 25, Caucasian, of higher socioeconomic status, smokers or used drugs and alcohol, and have other comorbid psychiatric conditions. In adjusted models, OCD was associated with a higher risk of gestational hypertension, preeclampsia, premature rupture of membranes, caesarean and instrumental deliveries, venous thromboembolisms and preterm birth. Pregnancies in women with OCD are at high risk of adverse obstetrical and neonatal outcomes. A multidisciplinary approach should be used to identify high risk behaviours and ensure adequate prenatal follow-up and care be available for those with high risk pregnancies. [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]

Concerns have been raised about the potential association between selective serotonin reuptake inhibitors (SSRIs)/serotonin-norepinephrine reuptake inhibitors (SNRIs) and the risk of abnormal uterine bleeding (AUB), which may be influenced by the affinity of SSRIs/SNRIs for serotonin transporter. Thus, we assessed whether SSRIs/SNRIs with high-affinity for serotonin transporter are associated with AUB compared to SSRIs/SNRIs with low-affinity in non-pregnant women. Using the UK Clinical Practice Research Datalink, we identified a cohort of women aged 15–24 years, newly prescribed a high- or low-affinity SSRI/SNRI between 1990 and 2019. Confounding was addressed using standardized morbidity ratio weighting. We used weighted Cox proportional hazards models to estimate the hazard ratio (HR) and 95 % confidence interval (CI) of AUB associated with high-affinity compared with low-affinity SSRIs/SNRIs. We assessed the risk of anemia as a secondary outcome. The cohort included 156,307 users of high-affinity SSRIs/SNRIs and 102,631 users of low-affinity SSRIs/SNRIs. High-affinity SSRIs/SNRIs were not associated with an increased risk of AUB compared with low-affinity SSRIs/SNRIs (incidence rates: 46.3 versus 42.4 per 1000 person-years, respectively; HR 1.01, 95 % CI 0.93–1.09). Duration of use, age, and comorbidities did not modify the risk. However, high-affinity SSRIs/SNRIs were associated with an increased risk of anemia (HR 1.29, 95 % CI 1.04–1.61) compared with low-affinity SSRIs/SNRIs. Residual confounding may still be present. The risk of AUB did not differ between high- and low-affinity SSRIs/SNRIs. However, the potential risk of anemia suggests the need for monitoring and further investigation of the risk of AUB with these medications. • SSRIs/SNRIs affinity to receptors may influence risk of abnormal uterine bleeding. • Strong-affinity SSRIs/SNRIs were not associated with risk of abnormal uterine bleeding. • Strong-affinity SSRIs/SNRIs were associated with a higher risk of anemia. • Monitoring of these potential side effects may be considered when prescribing SSRIs/SNRIs. [ABSTRACT FROM AUTHOR]

Purpose: Leukemia is the most common cancer among children and young adults and an increasing number of affected patients can expect a full recovery and long-term survival. The study objective was to determine the prevalence of leukemia survivors among pregnant women and to examine the maternal and fetal outcomes of this population.Materials and Methods: We conducted a retrospective population-based cohort study on all births recorded in the Health - Care Cost and Utilization Project - Nationwide Inpatient Sample between 1999 and 2014. We measured the prevalence of leukemia survivors in pregnancy and performed multivariate logistic regression to calculate adjusted odds ratios for maternal and fetal outcomes among this group compared to a nonaffected one.Results: Our cohort consisted of 14,513,587 births, of which 1,269 were to women with a history of leukemia or leukemia in remission, corresponding to a prevalence of 8.74 per 100,000 births. The prevalence rose steadily over the 16-year study period. Pregnant women who were leukemia survivors were more likely to experience gestational diabetes (OR 1.36, 95% CI 1.08-1.70), threatened preterm labor (1.50, 1.09-2.08), venous thromboembolism (4.40, 2.86-6.78), and to require blood transfusions (1.89, 1.24-2.88). Preterm deliveries (1.25, 1.02-1.54) and congenital anomalies (2.32, 1.39-3.86) among their newborns were also more common.Conclusion: The prevalence of leukemia survivors among pregnant women has been steadily rising. While the disease may no longer be active during their pregnancy, leukemia survivors appeared to have increased risks of several adverse outcomes and as such, should be monitored closely in centers with access to specialized care. [ABSTRACT FROM AUTHOR]

Purpose: Increased body mass index (BMI) is an independent risk factor for stillbirth. The purpose of this study was to determine an optimal time of delivery at term in obese women in order to decrease the risk of stillbirth in this population.Methods: We conducted a retrospective population-based cohort study using the CDC's Period Linked Birth-Infant Death and Fetal Death data. The study population included all singleton, term births with a recorded pre-pregnancy BMI that occurred between 2014 and 2017. Unconditional logistic regression analyses were used to estimate the risk of stillbirth in each BMI class at each gestational week from 37 weeks and onwards comparing with births to normal-weight women at 41 weeks.Results: Of 12,742,980 births in our cohort, 46.8% were to women with a normal BMI, 26.9% were to women who were classified as overweight, 14.5% were to women in obesity class I, 7.3% in obesity class II, and 4.8% in obesity class III. Within each BMI class, the risk of stillbirth increased with gestational age, with the most pronounced rises in risk occurring at later gestational ages. In a dose-response relationship, the risk of stillbirth exceeded that of a normal BMI pregnancy at 41 weeks at the following gestational age and BMI category: obese class 1 at 39 weeks (OR 1.15 95% CI 1.00-1.31), obese class II at 38 weeks (OR 1.21 95% CI 1.04-1.41) and obese class III at 37 weeks (OR 1.30 95% CI 1.11-1.52).Conclusion: Compared to women with a normal BMI at 41 weeks, there was a higher risk of stillbirth at term in women with each increase in BMI class. Consideration should be given to early induction among these women to reduce the risk of stillbirth. [ABSTRACT FROM AUTHOR]

Purpose: Long-term corticosteroids are administered in pregnant patients with an array of autoimmune and inflammatory disorders. Our objective is to determine whether long-term corticosteroid use is associated with increased maternal and neonatal adverse outcomes.Materials and Methods: We performed a retrospective cohort study using the Healthcare Cost and Utilization Project-national Inpatient Sample from the USA. All pregnant patients on long-term corticosteroids were identified using International Classification of Disease-9 coding from 2003 to 2015. The effect of long-term corticosteroid use on maternal and neonatal outcomes was evaluated using multivariate logistic regression.Results: Out of the 10,491,798 births included in our study, 3999 were among women with long-term use of steroids, for an overall prevalence of 38 per 100,000 births. There was a steady increase in chronic steroid use from 2 to 81 per 100,000 births over the 13-year study period (p < .0001). Women on long-term steroids were more likely to have pregnancies complicated by preeclampsia, 1.72 (1.30-2.29) and were at greater risk of preterm premature rupture of membranes, 1.63 (1.01-2.44), pyelonephritis, 4.81 (1.18-19.61), and venous thromboembolisms, 2.50 (1.32-4.73). Neonates born from mothers on long-term steroids were more likely to suffer from prematurity, 1.51 (1.13-2.05), and lower weight for gestational age, 2.10 (1.34-3.30).Conclusion: Long-term corticosteroids use in pregnancy is associated with maternal and fetal adverse outcomes. These patients would benefit from close follow-up throughout their pregnancy to minimize complications. [ABSTRACT FROM AUTHOR]

We estimated the degree to which the association between race and spontaneous recurrent preterm delivery is mediated by the timing of the first prenatal care visit. A retrospective population-based cohort study was conducted using the U.S. National Center for Health Statistics Natality Files. We identified 644,576 women with a prior PTB who delivered singleton live neonates between 2011 and 2017. A mediation analysis was conducted using log-binomial regression to evaluate the mediating effect of timing of first prenatal care visit. During the seven-year period, 349,293 (54.2%) White non-Hispanic women, 131,296 (20.4%) Black non-Hispanic women, 132,367 (20.5%) Hispanic women, and 31,620 (4.9%) Other women had a prior preterm delivery. The risk of late prenatal care initiation was higher in Black non-Hispanic women, Hispanic women, and Other women (women of other racial/ethnic backgrounds) compared to White non-Hispanic women, and the risk of preterm delivery was higher in women with late prenatal care initiation. Between 8 and 15% of the association between race and spontaneous recurrent preterm delivery acted through the delayed timing of the first prenatal care visit. Racial disparities in spontaneous recurrent preterm delivery rates can be partly, but not primarily, attributed to timing of first prenatal care visit. [ABSTRACT FROM AUTHOR]

Women with a previous caesarean delivery face a difficult choice in their next pregnancy: planning another caesarean or attempting vaginal delivery, both of which are associated with potential maternal and perinatal complications. This trial aimed to assess whether a multifaceted intervention, which promoted person-centred decision making and best practices, would reduce the risk of major perinatal morbidity among women with one previous caesarean delivery. We conducted an open, multicentre, cluster-randomised, controlled trial of a multifaceted 2-year intervention in 40 hospitals in Quebec among women with one previous caesarean delivery, in which hospitals were the units of randomisation and women the units of analysis. Randomisation was stratified according to level of care, using blocked randomisation. Hospitals were randomly assigned (1:1) to the intervention group (implementation of best practices and provision of tools that aimed to support decision making about mode of delivery, including an estimation of the probability of vaginal delivery and an ultrasound estimation of the risk of uterine rupture), or the control group (no intervention). The primary outcome was a composite risk of major perinatal morbidity. This trial was registered with ISRCTN, ISRCTN15346559. 21 281 eligible women delivered during the study period, from April 1, 2016 to Dec 13, 2019 (10 514 in the intervention group and 10 767 in the control group). None were lost to follow-up. There was a significant reduction in the rate of major perinatal morbidity from the baseline period to the intervention period in the intervention group as compared with the control group (adjusted odds ratio [OR] for incremental change over time, 0·72 [95% CI 0·52–0·99]; p=0·042; adjusted risk difference –1·2% [95% CI –2·0 to –0·1]). Major maternal morbidity was significantly reduced in the intervention group as compared with the control group (adjusted OR 0·54 [95% CI 0·33–0·89]; p=0·016). Minor perinatal and maternal morbidity, caesarean delivery, and uterine rupture rates did not differ significantly between groups. A multifaceted intervention supporting women in their choice of mode of delivery and promoting best practices resulted in a significant reduction in rates of major perinatal and maternal morbidity, without an increase in the rate of caesarean or uterine rupture. Canadian Institutes of Health Research (CIHR, MOP-142448). [ABSTRACT FROM AUTHOR]

Race/ethnicity is associated with intrauterine growth restriction (IUGR) and small-for-gestational age (SGA) birth. We evaluated the extent to which this association is mediated by adequacy of prenatal care (PNC). A retrospective cohort study was conducted using US National Center for Health Statistics natality files for the years 2011–2017. We performed mediation analyses using a statistical approach that allows for exposure-mediator interaction, and we estimated natural direct effects, natural indirect effects, and proportions mediated. All effects were estimated as risk ratios. Among 23,118,656 singleton live births, the excess risk of IUGR among Black women, Hispanic women, and women of other race/ethnicity as compared with White women was partly mediated by PNC adequacy: 13% of the association between non-Hispanic Black race/ethnicity and IUGR, 12% of the association in Hispanic women, and 10% in other women was attributable to PNC inadequacy. The percentage of excess risk of SGA birth that was mediated was 7% in Black women, 6% in Hispanic women, and 5% in other women. Our findings suggest that PNC adequacy may partly mediate the association between race/ethnicity and fetal growth restriction. In future research, investigators should employ causal mediation frameworks to consider additional factors and mediators that could help us better understand this association. [ABSTRACT FROM AUTHOR]

Purpose: Acute leukemias (ALs) are rare but aggressive malignancies. The goal of our study was to determine the incidence, obstetrical, and newborn outcomes of ALs in pregnancy.Materials and methods: We performed a retrospective population-based cohort study on all births reported in the Health-Care Cost and Utilization Project-Nationwide Inpatient Sample between 1999 and 2014. We calculated the incidence of ALs in pregnancy and conducted multivariate logistic regression to obtain adjusted odds ratios for various maternal and newborn outcomes among this population compared to a nonaffected one.Results: We identified 291 maternal cases of ALs among 14,513,587 births, yielding an incidence of 2.01 per 100,000 births over the 15-year study period. There were approximately twice as many diagnoses of acute myeloid leukemia (AML) as compared to acute lymphoid leukemia (ALL). After adjusting for differing baseline characteristics and maternal and fetal deaths, we found that pregnant women with ALs were more likely to experience post-partum hemorrhage, to suffer from disseminated intravascular coagulation (DIC), to require transfusions, to have wound complications, and to experience venous thromboembolism (VTEs). Maternal death, preterm delivery, and intrauterine fetal death (IUFD) were more common in pregnant women with ALs.Conclusion: The incidence of ALs in pregnancy appears to be greater than what was previously believed. As it is associated with several adverse maternal and fetal outcomes, affected patients should be cared for in tertiary care institutions with access to high-risk obstetrical specialists, hematologists, and neonatologists. [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]

Purpose: Gastroschisis is a rare congenital anomaly consisting of an abdominal wall defect resulting in extrusion of the abnormal organs. Survival of these infants exceeds 90%. Few large-scale studies have examined the predictors of mortality for these infants. Our objective was to conduct a population-based study to determine prevalence and predictors of mortality among infants born with gastroschisis.Materials and methods: We used the "Period Linked Birth-Infant Death" database to create a cohort of all births occurring between 2009 and 2013. Infants were categorized by the presence of gastroschisis, excluding infants born at <24-week gestation. Baseline maternal and newborn characteristics were compared for infants who survived and those who died. Multivariate logistic regression models were used to estimate the effect of maternal and fetal factors on mortality, while adjusting for appropriate baseline characteristics.Results: There were 4803 cases of gastroschisis, with 287 deaths. The prevalence of gastroschisis increased from 2.04 to 2.49/10,000 births over the study period. The rate of death stayed constant at about 5.9%. We found that 38.1% of these infants died on day 0 of life. Statistically significant predictors of mortality were the presence of an additional congenital anomaly, birth weight <2500 g, prepregnancy diabetes, gestational age <34 weeks, paying out of pocket for healthcare, and maternal obesity.Conclusions: The prevalence of gastroschisis in the USA increased, yet the mortality rate remained stable. Infants born preterm <34 weeks, with birth weights <2500 g, or with an additional congenital anomaly were at the highest risk of death. [ABSTRACT FROM AUTHOR]

Background: Behcet's disease (BD) is a rare, multi-systemic inflammatory disorder for which only limited and contradictory data exists in the context of pregnancy. Our objective was to estimate the prevalence of BD in pregnancy and to evaluate maternal and fetal outcomes associated with pregnant women living with BD. Methods: Using the 1999--2013 Healthcare Cost and Utilization Project-Nationwide Inpatient Sample from the United States, we performed a population-based retrospective cohort study consisting of pregnancies that occurred during this time period. ICD-9 codes were used to identify delivery admissions to women with or without BD. Multivariate logistic regression was used to estimate the adjusted effects of BD on maternal and fetal outcomes. Results: Among the 12,592,676 pregnancies in our cohort, 144 were to women with BD, for an overall prevalence of 1.14 cases/100,000 births between 1999 and 2013. Over the study period, the prevalence of BD rose from 0.5 to 2.4/100,000 births. Women with BD demonstrated a two-fold greater frequency of non-delivery hospital admissions during pregnancy, and were more likely to be Caucasian, have private medical insurance, be of the upper income quartiles, and deliver at an urban teaching hospital. Women with BD were at greater risk for preterm labor and postpartum venous thromboembolism, while their newborns were more likely to be born premature. Conclusion: BD-associated pregnancies are increasing in prevalence and are associated with a greater risk for adverse maternal and fetal outcomes in pregnancy. Appropriate thromboprophylaxis during pregnancy should be considered given the increased risk for venous thromboembolism. [ABSTRACT FROM AUTHOR]