Lisa Oddy

Sickle cell disease and pregnancy outcomes: population-based study on 8.8 million births

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

Incidence and determinants of sudden infant death syndrome: a population-based study on 37 million births

BackgroundThe objective of our study is to measure the incidence of sudden infant death syndrome (SIDS), estimate the birth to death interval, and identify associated maternal and infant risk factors.MethodsWe carried out a population-based cohort study on 37 418 280 births using data from the Centers for Disease Control and Prevention’s “Linked Birth-Infant Death” and “Fetal Death” data files from 1995 to 2004. Descriptive statistics and cox-proportional hazard models were used to estimate the adjusted effect of maternal and newborn characteristics on the risk of SIDS.ResultsThere were 24 101 cases of SIDS identified for an overall 10-year incidence of 6.4 cases per 10 000 births. Over the study period, the incidence decreased from 8.1 to 5.6 per 10 000 and appeared to be most common among infants aged 2–4 months. Risk factors included maternal age <20 years, black, non-Hispanic race, smoking, increasing parity, inadequate prenatal care, prematurity and growth restriction.ConclusionsWhile the incidence of SIDS in the US has declined, it currently remains the leading cause of post-neonatal mortality, highlighting an important public health priority. Educational campaigns should be targeted towards mothers at increased risk in order to raise their awareness of modifiable risk factors for SIDS such as maternal smoking and inadequate prenatal care.

Pregnancy outcomes in Marfan syndrome: a retrospective cohort study.

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

Obstetrical and neonatal outcomes in renal transplant recipients

Abstract Objective: To measure the incidence and outcomes of pregnancies in renal transplant (RT) patients and to identify risk factors of adverse pregnancy outcomes. Methods: We conducted a population-based retrospective cohort study using the United States Nationwide Inpatient Sample from 2003–2010. The incidence of pregnancies in women with RT was measured and logistic regression analysis was used to estimate the adjusted effect of RT on maternal and fetal outcomes. Results: We identified 375 deliveries in patients with a RT among 7 094 300 births for an overall incidence of 5.3 cases per 100 000 births over 8 years. Maternal complications, including preeclampsia OR = 9.87 (7.76, 12.55) and blood transfusion OR = 2.29 (1.69, 3.12) were more common in women with RT as compared to in women without. RT pregnancies were also complicated by an increased risk of preterm birth OR = 4.65 (3.72, 5.81), intrauterine fetal death OR = 3.67 (1.89, 7.15) and fetal congenital anomalies OR = 5.28 (2.81, 9.90). Among women with RT and pre-existing hypertension, the risk of intrauterine growth restriction (IUGR) was considerably increased from 4.3% to 21.8%, OR = 3.79 (1.67, 8.62). Conclusion: Pregnancies in RT patients are associated with an increased risk of maternal and fetal morbidities. Among women with RT, pre-existing hypertension strongly increases the risk of IUGR.

Effect of Borderline Personality Disorder on Obstetrical and Neonatal Outcomes.

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

Motor vehicle collision‐related accidents in pregnancy

Motor vehicle accidents (MVA) are a major contributor of worldwide morbidity and mortality; however, relatively little is known about the incidence and consequences of traffic accidents on pregnant women. Our aim is to compare rates and outcomes of motor vehicle collision‐related accidents in pregnant women.

Sarcoidosis and pregnancy: obstetrical and neonatal outcomes in a population-based cohort of 7 million births

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

Motor Vehicle Collision–Related Accidents in Pregnancy [310]

INTRODUCTION: Motor vehicle accidents (MVAs) are a major contributor of worldwide morbidity and mortality; however, relatively little is known about the incidence and consequences of traffic accidents on pregnant women. Our aim is to compare rates and outcomes of motor vehicle collision-related accidents in pregnant women. METHODS: We conducted a population-based retrospective cohort study using the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database from 2003 to 2011. The risk of different motor vehicle accidents and injuries were compared among pregnant and non-pregnant subjects using conditional logistic regression. RESULTS: We identified 5,936 cases of collision-related motor vehicle accidents in pregnancy and aged-matched them at a one-to-10 ratio to 59,360 nonpregnant women with collision-related motor vehicle accidents. As compared with nonpregnant women, pregnant women admitted after a motor vehicle accident suffered less severe injuries and consequently required fewer therapeutic interventions and a shorter hospital stay. Pregnant women who had a collision-related motor vehicle accident were however at increased risk of requiring genitourinary surgery (odds ratio [OR] 1.45, 95% confidence interval [CI] 1.24–1.69). When restricted to women with a fracture, pregnant women were even more likely to require genitourinary surgery (OR 2.93, 95% CI 2.32–3.71) as well as require a blood transfusion (OR 1.21, 95% CI 1.01–1.44). CONCLUSION: Pregnant women admitted to hospital after a collision-related motor vehicle accident tend to sustain less severe injuries compared with non-pregnant women. However, the influence of admissions for fetal monitoring, rather than maternal injury, cannot be determined from our dataset. Pregnant women who experienced a collision-related motor vehicle accident also require less surgical intervention, with the exception of genitourinary surgery, which may be indicative of more cesarean deliveries.

News Media Coverage on the Risks and Benefits of Home Births

INTRODUCTION: News media is an important source of information for expectant mothers. The purpose of our study was to evaluate the content and influence of the lay press in reporting of home birth. METHODS: We carried out a search of the Lexis-Nexis news database using “home births” and “hospital births” keywords for all articles published between 2009 and 2013. Articles were excluded if they were: unrelated to the subject, letters to the editor, corrections to original story, or stories on unplanned home births. Two independent reviewers analyzed each of the eligible articles for content and overall article impression. Content parameters included story perspective, discussion of eligibility criteria for home birth, and whether scientific journals or expert opinions were cited. A five-point scale was used to rate the overall impression (positive or negative) of home births, hospital births, or both. RESULTS: One hundred ninety articles were identified of which 67 met eligibility criteria. A total of 79.1% discussed home birth, 64.2% discussed hospital birth, and 41.8% discussed both. A total of 61.2% emphasized a personal birth story, 62.7% cited expert opinion, and 31.3% referenced a scientific study. Of the articles describing home birth, 47% did not mention safety concerns and 83% did not address specific eligibility criteria. The overall impression of news articles was more favorable toward home birth compared with hospital birth (mean score 3.66 compared with 2.79 with a P<.001). CONCLUSION: News media articles about home births overemphasize personal birth stories and provide inadequate information about the relative risks associated with home births.

Pregnancy Outcomes in Marfanʼs Syndrome: A Retrospective Cohort Study

INTRODUCTION: Marfans syndrome is a rare connective tissue disease with significant risk for adverse cardiovascular outcomes. Our objective was to evaluate pregnancy and cardiovascular outcomes in pregnant women with Marfans syndrome. METHODS: We conducted a population-based retrospective cohort study using the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database from 2003 to 2010. We used unconditional regression analyses to compare maternal and fetal outcomes among pregnancies in women with Marfans syndrome with pregnancies without to estimate the adjusted relative risk. RESULTS: Among 7,094,400 births in our cohort, 339 deliveries were to women with Marfans syndrome. There was one maternal death and six aortic dissections or ruptures among births to women with Marfans syndrome. Births to women with Marfans syndrome were more likely to be premature (odds ratio [OR] 2.15, 95% confidence interval [CI] 1.60–2.89) and have intrauterine growth-restricted and small-for-gestational-age neonates (OR 2.06, 95% CI 1.24–3.43). Births among women with Marfans syndrome were more commonly by cesarean delivery (OR 1.91, 95% CI 1.53–2.38) with an increased risk of forceps deliveries (OR 6.35, 95% CI 4.10–9.83) and vacuum deliveries (OR 2.01, 95% CI 1.36–2.96). Women with Marfans syndrome were at higher risk of major morbidities including cardiac arrhythmias (OR 10.64, 95% CI 5.49–20.61), venous thromboembolisms (OR 5.24, 95% CI 1.96–14.04), disseminated intravascular coagulation (OR 7.33, 95% CI 1.83–29.38), and pneumothorax (OR 51.95, 95% CI 6.18–437.10). CONCLUSION: Women with Marfans syndrome are at particularly high risk of adverse pregnancy and cardiovascular events during pregnancy. Preconceptional counseling should take into consideration these risks and appropriate pregnancy care in tertiary centers should be considered.