Establishment of a nomogram model for predicting adverse outcomes in advanced-age pregnant women with preterm preeclampsia.

AIM: To establish a model for predicting adverse outcomes in advanced-age pregnant women with preterm preeclampsia in China. METHODS: We retrospectively collected the medical records of 896 pregnant women with preterm preeclampsia who were older than 35 years and delivered at the Affiliated Hospital of Qingdao University from June 2018 to December 2020. The pregnant women were divided into an adverse outcome group and a non-adverse outcome group according to the occurrence of adverse outcomes. The data were divided into a training set and a verification set at a ratio of 8:2. A nomogram model was developed according to a binary logistic regression model created to predict the adverse outcomes in advanced-age pregnant women with preterm preeclampsia. ROC curves and their AUCs were used to evaluate the predictive ability of the model. The model was internally verified by using 1000 bootstrap samples, and a calibration diagram was drawn. RESULTS: Binary logistic regression analysis showed that platelet count (PLT), uric acid (UA), blood urea nitrogen (BUN), prothrombin time (PT), and lactate dehydrogenase (LDH) were the factors that independently influenced adverse outcomes (P < 0.05). The AUCs of the internal and external verification of the model were 0.788 (95% CI: 0.737 ~ 0.764) and 0.742 (95% CI: 0.565 ~ 0.847), respectively. The calibration curve was close to the diagonal. CONCLUSIONS: The model we constructed can accurately predict the risk of adverse outcomes of pregnant women of advanced age with preterm preeclampsia, providing corresponding guidance and serving as a basis for preventing adverse outcomes and improving clinical treatment and maternal and infant prognosis.

The relationship between internal migration and the likelihood of high-risk pregnancy: Hukou system and high-risk pregnancies in China.

BACKGROUND: China has one of the world's largest internal migrant populations. The Chinese Hukou system is a unique household registration system that limits internal migrants in their access to basic urban public services, such as public health insurance and social assistance of their host city. In the case of female internal migrants, this may lead to high-risk pregnancies. The objective of this study is to assess the relationship between internal migrant status (Hukou) and the likelihood of high-risk pregnancies that occur in one large municipal-level obstetrics hospital in Shanghai, China. METHODS: Medical records data from the Shanghai First Maternity and Infant Hospital from January 1, 2013, to May 31, 2018, were used to analyze 133,358 live births for Shanghai natives (n = 83,872) and internal migrant women (n = 49,486). A propensity score matching approach was used in conjunction with logistic regression analysis to identify the role of internal migrant status (Hukou) on the likelihood of high-risk pregnancies. RESULTS: A greater likelihood of high-risk pregnancies were found among internal migrant women who moved from other parts of China to Shanghai. This effect was more obvious for women who gave birth for the first time and internal migrant women who were employed. CONCLUSION: The results show the effects of internal migrant status (Hukou) and the elevated likelihood of high-risk pregnancies among internal migrant women relative to their urban counterparts in Shanghai even after accounting for self-selection by employing the propensity score matching method. China's unique Hukou household registration system limits access to public services for internal migrant women and accordingly may account for the elevated likelihood of high-risk pregnancies.

Reproductive health of Roma women in Slovakia.

OBJECTIVE: In most indicators of the way of life, the Roma community is generally different from the majority population and dominant culture. The objective of the study was to describe factors affecting the health of the Roma living in Slovakia, with an emphasis on the sexual and reproductive health of Roma women, and report on the results of analysis of high-risk pregnancies of Roma women in the district of Rimavská Sobota, Slovakia. METHODS: A retrospective study of medical documentation was used. The results were analyzed using the absolute and relative frequencies. Statistical methods were used. RESULTS: A total of 1,256 high-risk pregnancies were analyzed, of which 622 (49.52%) were in Roma women. The average age of Roma respondents was lower by 5 years compared to non-Roma. The age of Roma women at the first pregnancy was statistically significantly lower compared to non-Roma (p < 0.001). The Roma respondents achieved statistically significantly lower levels of education than non-Roma. There was a demonstrably higher number of pregnancies as well as a higher number of artificial and spontaneous abortions per Roma woman. These results were statistically significant. For Roma women, pregnancy began to be risky demonstrably earlier than for non-Roma (p < 0.001). There was a statistically significant difference in attending prenatal counselling. Roma women attended prenatal counselling statistically significantly less frequently than non-Roma (p < 0.001). A significant statistical dependence was found between attending prenatal counselling and the onset of pregnancy problems in Roma women. There was no significant difference in the incidence of other diseases associated with high-risk pregnancy among Roma and non-Roma respondents. CONCLUSION: The findings indicate that Roma women are exposed to health problems in the area of sexual and reproductive health in Slovakia. In the approach to the Roma, it is essential to focus on improving accessibility to health care, prevention, knowledgeableness and effectively preventing, eradicating and strongly penalizing all forms of discrimination in access to health care, especially for Roma women, who are more likely to receive health care.

[Clinical characteristics and pregnancy outcomes of pregnant women in different age groups in Beijing].

Objective: To investigate the influence of maternal age on the health status of pregnant women and the pregnant outcomes. Methods: Data obtained from "Beijing perinatal health management registration system" was analyzed, 263 157 pregnant women with age information were included from October 1st, 2015 to September 30th, 2016, in which 43 594 women delivered at the age of 35 or above (advanced age) . According to the age of maternal age, there were 5 groups. (1) Proper age: 219 563 (83.43%, 219 563/263 157) cases of the age of 18-34 years, including 122 735 cases (46.64%, 122 735/263 157) in the ≤29 years old group and 96 828 cases (36.79%, 96 828/263 157) in 30-34 years old group. (2) Advanced age: there were 43 594 cases (16.57%, 43 594/263 157) ≥35 years old, including 37 395 cases (14.21%, 37 395/263 157) in the 35-39 years old group, 5 790 cases (2.20%, 5 790/263 157) in the 40-44 years old group and 409 cases (0.16%, 409/263 157) in the ≥45 years old group. The trend-based chi-square test and logistic regression were used to analyze the effects of different age groups on maternal complications and pregnant outcomes. Results: (1) The total incidence of high risk pregnancy (HRP) : in advanced age women, the incidence of HRP was 67.83% (29 571/43 594) which was 56.73% (124 550/219 563) in proper age women, the difference was statistically significant (χ(2)=1 848.91, P<0.000) . In advanced age women, the incidence of severe HRP was 7.64% (3 329/43 594) which was 6.18% (13 571/219 563) in proper age women, the difference was statistically significant (χ(2)=128.211, P<0.000) . In advanced age women, the incidence of very severe HRP was 1.76% (769/43 594) which was 0.84% (1 838/219 563) in proper age women, the difference was statistically significant (χ(2)=318.58, P<0.000) . (2) Comparison of the incidence of HRP in 5 groups:the total incidence of HRP increased through the following age group ≤29 years, 30-34 years, 35-39 years, 40-44 years, ≥45 years (53.28%, 61.09%, 67.41%、70.09%, 74.57% respectively) , the difference was statistically significant (linear by linear χ(2)=3 165.72, P<0.000) . The incidence of very severe HPR increased (0.66%, 1.06%, 1.66%, 2.35%, 2.93% respectively) , the difference was statistically significant (linear by linear χ(2)=218.31, P<0.000) . The incidence of severe HPR increased (5.77%, 6.70%, 7.48%, 8.34%, 11.49% respectively) , the difference was statistically significant (linear by linear χ(2)=422.20, P<0.000) . The incidence of general HPR increased (46.84%, 53.34%, 58.26%, 59.40%, 60.15% respectively) , the difference was statistically significant (linear by linear χ(2)=1 947.51, P<0.000) . (3) As the maternal age group increased, the incidence of adverse pregnancy outcomes increased (5.54%, 6.85%, 8.77%, 9.90%, 18.09%, linear by linear χ(2)=674.57, P<0.000) . The incidence of perinatal death, premature birth and low birth weight also presented the above trends (perinatal death: linear by linear χ(2)=34.79, P<0.000; premature birth: linear by linear χ(2)=692.87, P<0.000; low birth weight: linear by linear χ(2)=379.20, P<0.000) . (4) Logistic regression analysis with the assisted reproductive technology and multiple pregnancy considered showed the same trend (P<0.000) . Conclusion: The maternal age has an impact on the maternal health status and pregnancy outcomes, and the risk of various types of pregnancy complications and adverse pregnancy outcomes increase with the maternal age group, antenatal care and management should be emphasized in women with advanced maternal age, especially for women ≥40 years old.

The association of maternal country of birth and education with hypertensive disorders of pregnancy: A population-based study of 960 516 deliveries in Norway.

INTRODUCTION: Previous studies estimating the association of maternal country of birth and education with hypertensive disorders of pregnancy (HDP) have shown conflicting results. The aim of the study was to assess the prevalence of HDP and estimate the association of maternal country of birth and education level with preeclampsia/eclampsia and gestational hypertension in Norway. MATERIAL AND METHODS: We performed a population-based observational cohort study linking two population datasets: The Medical Birth Registry of Norway and Statistics Norway (SSB). Singleton deliveries in Norway between 1999 and 2014 (907 048 deliveries) were stratified by parity. Multiple regression analysis was performed. RESULTS: In 20% of the deliveries the woman was born outside of Norway. Foreign-born women had lower risk of preeclampsia/eclampsia and gestational hypertension compared with Norwegian-born women. High education reduced the risk for preeclampsia/eclampsia by 34% (adjusted odds ratio 0.66, 95% CI 0.62-0.69), compared with women with secondary education among nulliparous women, and by 39% (adjusted odds ratio 0.61, 95% CI 0.57-0.65) among parous women. Poorly educated women had no increased risk of HDP compared with women with secondary education. Among highly educated nulliparous women the risk of preeclampsia/eclampsia was lower but the risk of gestational hypertension higher compared with women of similar parity with secondary education. Adjustment for confounding variables had minimal effect on these estimates. CONCLUSIONS: Maternal country of birth and education were associated with HDP. Women with higher education had the lowest risk of HDP, and Norwegian-born women had the highest risk of HDP, regardless of parity and other confounding factors.

Progesterone for Prevention of Preterm Birth: Shortcomings and Unintended Consequences of the Orphan Drug Act.

Preterm birth is a problem of major public health significance that continues to plague our country despite the existence of a therapy, 17α-hydroxyprogesterone caproate, with known efficacy in reducing the risk of spontaneous preterm birth among high-risk women. Over the past several years, the Louisiana Department of Health has undertaken a robust, multifaceted initiative to improve access to 17α-hydroxyprogesterone caproate, which resulted in a 3.5-fold increase in the percentage of eligible high-risk pregnant women in the Medicaid program who received the therapy between 2013 and 2016. Yet despite Louisiana's progress, the vast majority of the eligible population still fails to receive 17α-hydroxyprogesterone caproate. In this Current Commentary, we argue that the high price of progesterone since U.S. Food and Drug Administration approval has unnecessarily complicated access, and our nation has potentially suffered nearly 60,000 avoidable premature births as a consequence. We present the history of the orphan drug approval and manufacturer-imposed price increase for injectable progesterone, the interplay between the drug's high price and the persistence of racial and ethnic disparities in preterm birth, which are particularly germane in Louisiana, and Louisiana's broad-reaching efforts to improve progesterone coverage. The story of 17α-hydroxyprogesterone caproate highlights the durable barriers that high prices place in the way of access and helps illuminate the shortcomings and unintended consequences of the Orphan Drug Act. This case, however, is not an outlier; it is the far-too-common product of monopoly pricing in the U.S. pharmaceutical market, inadvertently bolstered by existing law, at the expense of affordability and patient access.

Women with an HbA1c of 41-49 mmol/mol (5.9-6.6%): a higher risk subgroup that may benefit from early pregnancy intervention.

AIMS: To examine whether women with an HbA1c of 41-49 mmol/mol (5.9-6.6%) at diagnosis of gestational diabetes are higher risk than women with an HbA1c of < 41 mmol/mol (5.9%) and whether pregnancy outcomes are improved if treated at < 24 weeks' gestation. METHODS: This was an observational study of women with gestational diabetes diagnosed by early HbA1c screening or subsequent oral glucose tolerance test at < 34 weeks' gestation who delivered at National Women's Health, Auckland, from July 2012 to June 2014. Data were extracted from the hospital database. Women with HbA1c 41-49 mmol/mol (5.9-6.6%) were divided into those seen < 24 weeks (Early, n = 134) and those seen ≥ 24 weeks (Later, n = 151). Those with HbA1c < 41 mmol/mol (5.9%) were labelled Other GDM (n = 661). RESULTS: The Early and Later groups, compared with Other GDM, had more Polynesian and fewer (non-Indian) Asian women, higher BMI and more required medication (P < 0.001). More were smokers (P = 0.007, 0.02) and more had chronic hypertension (P < 0.001, 0.02). There were higher rates of adverse outcomes in the Later group than the Other GDM group (pre-eclampsia 8.0% vs. 2.4%, P = 0.001, preterm birth 16.6% vs. 8.2%, P = 0.002, neonatal admission 15.5% vs. 9.2%, P = 0.02). Outcomes were similar between the Early group and Other GDM group (pre-eclampsia 1.5% vs. 2.4%, P = 0.5, preterm birth 10.5% vs. 8.2% P = 0.4, neonatal admission 13.6% vs. 9.2%, P = 0.12). Comparing the Early and Later groups, the Early group had less pre-eclampsia, 1.5% vs. 8.0%, adjusted P = 0.03. Other outcomes were not statistically different. CONCLUSIONS: An HbA1c of 41-49 mmol/mol (5.9-6.7%) identifies a higher-risk group of women with gestational diabetes. Overall, our data support early treatment of women with an HbA1c ≥ 41 mmol/mol (5.9%).

Specific antenatal interventions for Black, Asian and Minority Ethnic (BAME) pregnant women at high risk of poor birth outcomes in the United Kingdom: a scoping review.

BACKGROUND: Disparity exists in maternal and infant birth outcomes of Black and Minority Ethnic (BAME) women giving birth in the United Kingdom (UK) compared to the majority. There is therefore a need to reconsider existing maternity service provision to ensure culturally competent services. The purpose of this scoping review was to ascertain what specific maternity interventions have been implemented in the UK for BAME women (2004-2014) so that increased awareness of the need and scope of specific maternity interventions for BAME women can be identified. METHODS: A scoping review was conducted in order to determine the evidence base. It was determined that no prior systematic reviews had been conducted and it was apparent that literature in this field was sparse. Scoping review is an ideal method when literature is likely to be heterogeneous and the research field relatively unexplored. A keyword strategy was used implementing population (P), intervention (I), comparison (C) and outcomes (O). RESULTS: An initial 2188 papers were identified. Following screening and review, only 5 heterogeneous papers remained suitable and were included. The included interventions employed sample sizes of N = 160-1441, examined a range of different outcome measures and were delivered across different parts of the UK with high numbers of BAME residents. CONCLUSIONS: There is a lack of rigorous research interventions and practice interventions which are currently documented, of specific maternity interventions which are aimed to address culturally competent maternity services and the sharing of best practice addressing the increased risks of BAME women delivering in the UK.

The East Timorese: a high-risk ethnic minority in UK obstetrics: a cohort study.

OBJECTIVE: To observe the incidence of antenatal risk-factors and adverse maternal outcome in women of East Timorese origin within a UK population. METHODS: This retrospective cohort study assessed a sample of women of East Timorese Origin (N = 42) attending UK maternity services from 01/2011 to 09/2012 compared to a control group of a standard UK maternity population (N = 7210). Data on the rate of pregnancy related risk-factors and complications were obtained from a computerized patient note database (NIMATS). RESULTS: The East Timorese were at significant risk antenatally of anaemia (OR 19.5 (95% CI 10.2-37.2) (p < 0.001)), gestational diabetes (OR 10.6 (95% CI 4.6-24.4) (p < 0.001)) and hypertension in pregnancy (OR 4.6 (95% CI 1.4-15.3) (p < 0.01)) as well as late booking for care (OR 19.5 (95% CI 10.2-37.2) p < 0.001). In terms of post-partum complications there was a significant risk of admission to the intensive-care unit (OR 20.0 (95% CI 4.5-89.0) p < 0.001) and of postpartum hemorrhage (OR 15.9 (95% CI 7.7-33.0) p < 0.001). In 72 documented occasions an interpreter could not be obtained. CONCLUSIONS: Women from East Timor are a high-risk ethnic minority who, with added risk-factors of late booking and difficulty in obtaining interpreters are at greater risk of complications in pregnancy and the puerperium.

Vaginal birth after cesarean success in high-risk women: a population-based study.

OBJECTIVE: The study aim was to identify factors associated with vaginal birth after cesarean (VBAC) in high-risk women. STUDY DESIGN: This is a population-based retrospective cohort study of all births in Ohio during 2006 and 2007. High-risk patients were defined as singleton gestations in women with one previous cesarean who had ⩾1 of the following risk factors: body mass index (BMI)⩾30, hypertension, or diabetes. Multivariate logistic regression was utilized to estimate the relative influence of each factor on successful VBAC. RESULT: A total of 280 882 births were analyzed: of them, 79 084 (27.1%) were high-risk pregnancies and 8658 (10.9%) women had undergone one previous cesarean; 1433 (16.6%) underwent a trial of labor after cesarean (TOLAC). Of them, 974 (68.0%) had a successful VBAC, whereas 459 (32.0%) did not. Factors significantly associated with VBAC success were as follows: a prior vaginal delivery; pregnancy weight gain ⩽30 lbs; Caucasian race; and labor augmentation. CONCLUSION: High-risk women with one prior cesarean are unlikely to undergo a TOLAC, but have a high rate of VBAC.

Use of monetary and nonmonetary incentives to increase response rates among African Americans in the Wisconsin Pregnancy Risk Assessment Monitoring System.

From 2009 to 2010, an experiment was conducted to increase response rates among African American mothers in the Wisconsin Pregnancy Risk Assessment Monitoring System (PRAMS). Sample members were randomly assigned to groups that received a prepaid, cash incentive of $5 (n = 219); a coupon for diapers valued at $6 (n = 210); or no incentive (n = 209). Incentives were included with the questionnaire, which was mailed to respondents. We examined the effects of the incentives on several outcomes, including response rates, cost effectiveness, survey response distributions, and item nonresponse. Response rates were significantly higher for the cash group than for the coupon (42.5 vs. 32.4%, P < .05) or no incentive group (42.5 vs. 30.1%, P < .01); the coupon and no incentive groups performed similarly. While absolute costs were the highest for the cash group, the cost per completed survey was the lowest. The incentives had limited effects on response distributions for specific survey questions. Although respondents completing the survey by mail in the cash and coupon groups exhibited a trend toward being less likely to have missing data, the effect was not significant. Compared to a coupon or no incentive, a small cash incentive significantly improved response rates and was cost effective among African American respondents in Wisconsin PRAMS. Incentives had only limited effects, however, on survey response distributions, and no significant effects on item nonresponse.

Association between maternal age and pregnancy outcome: implications for the Pakistani society.

Maternal age at conception has long been demonstrated to have a significant correlation with pregnancy outcome and maternal health. Classically, very young (<20 years old) and old (= or >35 years) women have been classified as high-risk categories for child bearing. Recently, career, education, financial, and other goals have coerced women to delay childbearing all over the world. This trend is also becoming apparent in Pakistan, especially in the upper middle class, wealthy and educated women, as they become increasingly empowered. This review presents the association between maternal age and pregnancy outcome, particularly in the context of statistics of Pakistan, and its possible repercussions. On one hand, physicians need to develop effective counseling strategies for their patients in this regard, and on the other, more studies are required to ascertain the attitudes of Pakistani women, particularly those belonging to the upper and middle classes, regarding delayed childbearing, that can aid physicians in formulating effective counseling strategies.

Women's opinions about mode of birth in Brazil: a qualitative study in a public teaching hospital.

OBJECTIVE: to describe women's feelings about mode of birth. DESIGN: exploratory descriptive design. Semi-structured interviews were conducted using a questionnaire that had been developed previously (categorical data and open- and closed-ended questions). Qualitative analysis of the results was performed through a context analysis technique. SETTING: the largest public university hospital in Brazil. PARTICIPANTS: 48 women in their third trimester of pregnancy. FINDINGS: most women expressed a preference for vaginal birth, as they perceived that they would have a faster recovery. Women who expressed a preference for caesarean section did so because of lack of pain during the birth and the need for tubal sterilisation. The majority of women considered it important to have experience with a mode of birth in order to choose a preference. Complications associated with maternal illness were very influential in the decision-making process. KEY CONCLUSIONS: these results provide a useful first step towards the identification of aspects of women's feelings about modes of birth. Most women expressed a preference for vaginal birth. Further exploration of women's feelings regarding parturition and the decision-making process is required.

Using the Pregnancy Perception of Risk Questionnaire to assess health care literacy gaps in maternal perception of prenatal risk.

In order to make appropriate decisions, patients must be able to understand and use the context-specific health information with which they have been provided, and health providers must be able to convey information to patients who possess varying degrees of health literacy. Adherence to medical recommendations often depends on patient perception of their medical risks and the importance they attach to those risks. In obstetrics, maternity patients are generally identified as high risk or non-high risk (routine). Conferring the designation of "high risk" may confer additional benefits in educational efforts, literacy evaluation, and relief of educational barriers to care that are reflected in high-risk patients' higher assessments of their risks. In this study, medically identified risk factors were reviewed for patients in the high-risk and routine obstetrical clinics. Patients labeled as "routine" might still possess significant numbers and types of medically identified risk factors (MIFs) due to patients' socioeconomic status and health risks. If prenatal risk is a spectrum, adaptation of obstetrical health care materials and culturally appropriate counseling may mitigate gaps between patient understanding of their MIF number and type and patient risk perception in order to reach the goal of universally improved patient adherence to medical recommendations.

Maternal and neonatal outcomes following diabetes in pregnancy in Far North Queensland, Australia.

BACKGROUND: Diabetes in pregnancy (DIP) is increasing and is associated with a number of adverse consequences for both the mother and the child. AIMS: To compare local maternal and neonatal outcomes with state and national data. METHODS: Chart audit of all DIP delivered during 2004 at a regional teaching hospital and compare outcomes with national benchmark, Queensland and national Indigenous data. RESULTS: The local DIP frequency was 6.7%. The local compared to benchmark and state data demonstrated a higher frequency of Indigenous mothers (43.6% vs 6.8% vs 5.5%), caesarean sections (50.7% vs 26% vs 32.0%), hypoglycaemia (40.7% vs 19.5% vs 2.7%) and respiratory distress (16.6% vs 4.5% vs 2.3%) in infants, fewer normal birthweights (64.8% vs 82.6% vs 80.4%) and full-term deliveries. More local mothers compared to benchmark had type 2 diabetes mellitus (T2DM) (15.4% vs 8.7%) but fewer used insulin (31.0% vs 46.6%); compared to state data, fewer women had gestational diabetes (79.5% vs 91.2%), however, insulin use was higher (22.8%). Furthermore, Aborigines had fewer pregnancies compared to Torres Strait Islanders (3.0 vs 5.0) and less insulin use (21.9% vs 59.3%) (P = 0.008-0.024). In contrast, non-Indigenous versus Indigenous women showed fewer pregnancies, less T2DM (7.8% vs 23.7%), better glycaemic control, longer babies, more full-term deliveries and less severe neonatal hypoglycaemia. Comparing local and national Indigenous data, local showed poorer outcomes, however, only 11.8% had diabetes or hypertension nationally. CONCLUSION: The local cohort had poorer outcomes probably reflecting a more disadvantaged. Few differences were found between local Indigenous groups.

Racial disparity in hypertensive disorders of pregnancy in New York State: a 10-year longitudinal population-based study.

OBJECTIVES: We studied trends of hypertensive disorders of pregnancy by residential socioeconomic status (SES) and racial/ethnic subgroups in New York State over a 10-year period. METHODS: We merged New York State discharge data for 2.5 million women hospitalized with delivery from 1993 through 2002 with 2000 US Census data. RESULTS: Rates of diagnoses for all hypertensive disorders combined and for preeclampsia individually were highest among Black women across all regions and neighborhood poverty levels. Although hospitalization rates for preeclampsia decreased over time for most groups, differences in rates between White and Black women increased over the 10-year period. The proportion of women living in poor areas remained relatively constant over the same period. Black and Hispanic women were more likely than White women to have a form of diabetes and were at higher risk of preeclampsia; preeclampsia rates were higher in these groups both with and without diabetes than in corresponding groups of White women. CONCLUSIONS: An increasing trend of racial/ethnic disparity in maternal hypertension rates occurred in New York State during the past decade. This trend was persistent after stratification according to SES and other risk factors. Additional research is needed to understand the factors contributing to this growing disparity.

Promising practices in preconception care for women at risk for poor health and pregnancy outcomes.

OBJECTIVES: Two programs targeting urban African-American women are presented as promising models for preconception care, which includes interconception care. METHODS: The Grady Memorial Hospital Interpregnancy Care (IPC) Program in Atlanta, Georgia, and the Magnolia Project in Jacksonville, Florida, are described. The IPC program aims to investigate whether IPC can improve the health status, pregnancy planning and child spacing of women at risk of recurrent very low birthweight (VLBW). The Magnolia Project aims to reduce key risks in women of childbearing age, such as lack of family planning and repeat sexually transmitted diseases (STDs), through its case management activities. RESULTS: Seven out of 21 women in the IPC were identified as having a previously unrecognized or poorly managed chronic disease. 21/21 women developed a reproductive plan for themselves, and none of the 21 women became pregnant within nine months following the birth of their VLBW baby. The Magnolia Project had a success rate of greater than 70% in resolving the key risks (lack of family planning, repeat STDs) among case management participants. The black to white infant mortality (IM) ratio was better for the babies born to women managed in the Magnolia Project compared to the same ration for the United States. CONCLUSIONS: Preconception care targeted to African-American women at risk for poor birth outcomes appears to be effective when specific risk factors are identified and interventions are appropriate. Outreach to women at risk and case management can be effective in optimizing the woman's health and subsequent reproductive health outcomes.

Childhood pregnancy (10-14 years old) and risk of stillbirth in singletons and twins.

OBJECTIVE: To clarify the association between childhood pregnancy and risk of stillbirth. STUDY DESIGN: We analyzed singleton and twin pregnancies that occurred in children (10-14 years old) in the United States from 1989 to 2000. We estimated the absolute and relative risks of stillbirth by using 15- to19-year-old and 20- to 24-year-old mothers as comparison groups. RESULTS: The analysis involved 17.8 million singletons and 337,904 individual twins. The rate of stillbirth was highest in pediatric mothers for both singletons (12.8/1000) and twins (56/1000) compared with adolescent (6.8/1000 in singletons and 29/1000 in twins) and mature (5.5/1000 in singletons and 20/1000 in twins) mothers. After adjusting for confounding characteristics, pediatric mothers continued to exhibit significantly elevated risk for stillbirth in both singletons (odds ratio, 1.57; 95%CI, 1.49-1.66) and twins (odds ratio, 1.97; 95%CI, 1.42-2.73). Preterm birth rather than small size for gestational age was revealed by means of sequential modeling to account for the excess risk of stillbirth observed in pediatric gravidas. CONCLUSION: Pregnancy in childhood is a risk factor for stillbirth; shortened gestation rather than reduction in fetal growth is the mediating pathway.

Risk factors for adverse perinatal outcomes in imprisoned pregnant women: a systematic review.

BACKGROUND: Imprisoned pregnant women constitute an important obstetric group about whom relatively little is known. This systematic review was conducted to identify the risk factors associated with adverse pregnancy outcome present in this group of women. METHODS: The review was conducted according to a prespecified protocol. Studies of any design were included if they described information on any of the pre-specified risk factors. We calculated the results as summary percentages or odds ratios where data was available on both cases and population controls. RESULTS: The search strategy identified 27 relevant papers of which 13 met the inclusion criteria, involving 1504 imprisoned pregnant women and 4571 population control women. Imprisoned women are more likely to be single, from an ethnic minority, and not to have completed high school. They are more likely to have a medical problem which could affect the pregnancy outcome and yet less likely to receive adequate antenatal care. They are also more likely to smoke, drink alcohol to excess and take illegal drugs. CONCLUSION: Imprisoned women are clearly a high risk obstetric group. These findings have important implications for the provision of care to this important group of women.