Recognizing Excellence in Maternal and Child Health (MCH) Epidemiology: The National MCH Epidemiology Awards.

Purpose: Professionals in the field of maternal and child health (MCH) epidemiology are publicly recognized by the Coalition for Excellence in MCH Epidemiology representing 16 national MCH agencies and organizations. Description: During the CityMatCH Leadership and MCH Epidemiology Conference, the national awards are presented to public health professionals for improving the health of women, children, and families. The awards have evolved over the last two decades with focus on awardees that represent more types of MCH public health professionals. Assessment: Since 2000, the Coalition has presented 111 national awards in the areas of advancing knowledge, effective practice, outstanding leadership, excellence in teaching and mentoring, early career professional achievement, and lifetime achievement. Effective practice awards were most often presented at 45 awards, followed by early career professional achievement with 20. The awardees varied by place of employment with 37 employed at academic institutions, 33 in federal government positions, 32 in state or county government, seven in non-profit and two in clinical organizations. Awards were almost equally distributed by gender with 49 presented to women and 48 to men. Assessment of career advancement among previous awardees and acknowledging workforce challenges are gaps identified within the national awards process. Conclusion: Recognition of deserving MCH professionals sets the standard for those entering the field of MCH epidemiology and offers opportunity to recognize those who have built capacity and improved the health of women, children, and families.

Considering pregnancies as repeated vs independent events: an empirical comparison of common approaches across selected perinatal outcomes.

BACKGROUND: In population-based research, pregnancy may be a repeated event. Despite published guidance on how to address repeated pregnancies to the same individual, a variety of approaches are observed in perinatal epidemiological studies. While some of these approaches are supported by the chosen research question, others are consequences of constraints inherent to a given dataset (eg, missing parity information). These decisions determine how appropriately a given research question can be answered and overall generalizability. OBJECTIVE: To compare common cohort selection and analytic approaches used for perinatal epidemiological research by assessing the prevalence of two perinatal outcomes and their association with a clinical and a social independent variable. STUDY DESIGN: Using vital records linked to maternal hospital discharge records for singleton births, we created four cohorts: (1) all-births (2) randomly selected one birth per individual (3) first-observed birth per individual (4) primiparous-births (parity 1). Sampling of births was not conditional on cluster (ie, we did not sample all births by a given mother, but rather sampled individual births). Study outcomes were severe maternal morbidity (SMM) and preeclampsia/eclampsia, and the independent variables were self-reported race/ethnicity (as a social factor) and systemic lupus erythematosus. Comparing the four cohorts, we assessed the distribution of maternal characteristics, the prevalence of outcomes, overall and stratified by parity, and risk ratios (RR) for the associations of outcomes with independent variables. Among all-births, we then compared RR from three analytic strategies: with standard inference that assumes independently sampled births to the same mother in the model, with cluster-robust inference, and adjusting for parity. RESULTS: We observed minor differences in the population characteristics between the all-birth (N=2736,693), random-selection, and first-observed birth cohorts (both N=2284,660), with more substantial differences between these cohorts and the primiparous-births cohort (N=1054,684). Outcome prevalence was consistently lowest among all-births and highest among primiparous-births (eg, SMM 18.9 per 1000 births among primiparous-births vs 16.6 per 1000 births among all-births). When stratified by parity, outcome prevalence was always the lowest in births of parity 2 and highest among births of parity 1 for both outcomes. RR differed for study outcomes across all four cohorts, with the most pronounced differences between the primiparous-birth cohort and other cohorts. Among all-births, robust inference minimally impacted the confidence bounds of estimates, compared to the standard inference, that is, crude estimates (eg, lupus-SMM association: 4.01, 95% confidence intervals [CI] 3.54-4.55 vs 4.01, 95% CI 3.53-4.56 for crude estimate), while adjusting for parity slightly shifted estimates, toward the null for SMM and away from the null for preeclampsia/eclampsia. CONCLUSION: Researchers should consider the alignment between the methods they use, their sampling strategy, and their research question. This could include refining the research question to better match inference possible for available data, considering alternative data sources, and appropriately noting data limitations and resulting bias, as well as the generalizability of findings. If parity is an established effect modifier, stratified results should be presented.

Estimating Gestational Age and Prediction of Preterm Birth Using Metabolomics Biomarkers.

Preterm birth (PTB) is a leading cause of morbidity and mortality in children aged under 5 years globally, especially in low-resource settings. It remains a challenge in many low-income and middle-income countries to accurately measure the true burden of PTB due to limited availability of accurate measures of gestational age (GA), first trimester ultrasound dating being the gold standard. Metabolomics biomarkers are a promising area of research that could provide tools for both early identification of high-risk pregnancies and for the estimation of GA and preterm status of newborns postnatally.

Hospital Factors Associated with the Survival of Infants Born at Periviable Gestation: The USA National Database.

Background: Reports on the survival of infants born at periviable gestation (GA of ≤24 weeks and birth weight of <500 gm) vary significantly. We aimed to determine hospital factors associated with their survival and to assess the trend for the timing of postnatal mortality in these periviable infants. Methods: We utilized the de-identified National Inpatient Sample (NIS) dataset of the Healthcare Cost and Utilization Project (HCUP) from the Agency for Healthcare Research and Quality (AHRQ). National data were analyzed for the years 2010-2018. Hospitals were categorized according to delivery volume, USA regions, and teaching status. Results: We identified 33,998,014 infants born during the study period; 76,231 infants were ≤24 weeks. Survival at birth and first 2 days of life was greatest in urban teaching hospitals in infants <24 weeks and those who completed 24 weeks, respectively. The Northeast region has the lowest survival rate. There was a significant delay in the postnatal day of mortality in periviable infants. Conclusions: Hospital factors are associated with increased survival rates. Improved survival in large teaching hospitals supports the need for the regionalization of care in infants born at the limits of viability. There was a significant delay in the postnatal mortality day.

Association between prenatal care adequacy indexes and low birth weight outcome / Associação entre índices de adequação de cuidado prénatal e desfecho de baixo peso ao nascer

Abstract Objective To investigate the association between prenatal care (PNC) adequacy indexes and the low birth weigth (LBW) outcome. Methods A total of 368,093 live term singleton births in the state of Rio de Janeiro (Brazil) from 2015 to 2016 were investigated using data from the Brazilian Live Birth Information System (Sistema de Informações sobre Nascidos Vivos, SINASC, in Portuguese). Seven PNC adequacy indexes were evaluated: four developed by Brazilian authors (Ciari Jr. et al., Coutinho et al., Takeda, and an index developed and used by the Brazilian Ministry of Health - MS) and three by authors from other countries (Kessner et al., the Adequacy of Prenatal Care Utilization index - APNCU, and the Graduated Prenatal Care Utilization Index - GINDEX). Adjusted odds ratios were estimated for the PNC adequacy indexes by means of multivariate logistic regression models using maternal, gestational and newborn characteristics as covariates. Results When the PNC is classified as "inadequate", the adjusted odds ratios to the LBWoutcome increase between 42% and 132%, depending on which adequacy index is evaluated. Younger (15 to 17 years old) and older (35 to 45 years old) mothers, those not married, of black or brown ethnicity, with low schooling (who did not finish Elementary School), primiparous, with preterm births, as well as female newborns had increasing odds for LBW. The models presented areas under the receiver operating characteristic (ROC) curve between 80.4% and 81.0%, and sensitivity and specificity that varied, respectively, between 57.7% and 58.6% and 94.3% and 94.5%. Conclusion Considering all PNC adequacy indexes evaluated, the APNCU had the best discriminatory power and the best ability to predict the LBW outcome.

Resumo Objetivo Investigar a associação entre diferentes índices de adequação do cuidado pré-natal (PN) e o desfecho de nascimentos com baixo peso (BP). Métodos Foram investigados 368.093 nascimentos ocorridos no estado do Rio de Janeiro entre 2015 e 2016, utilizando-se as informações do Sistema de Informações sobre Nascidos Vivos (Sinasc). Sete índices de adequação do cuidado PN foram avaliados: quatro propostos por autores nacionais (Ciari Jr et al., Coutinho et al., Takeda, e um índice atualmente em uso pelo Ministério da Saúde - MS), e três, por autores internacionais (Kessner et al., Adequacy of Prenatal Care Utilization index - APNCU, e Graduated Prenatal Care Utilization Index - GINDEX). As razões de chance ajustadas para BP foram estimadas considerando os índices de adequação do cuidado PN por meio de modelos de regressão logística, utilizando características maternas, da gravidez e do recém-nascido como variáveis de controle. Resultados As chances ajustadas para ocorrência de BP ao nascer aumentam de 42% a 132%, a depender do índice empregado, quando o cuidado PN é considerado inadequado. Mães entre 15 e 17 anos e entre 35 e 45 anos, sem companheiro, de cor parda ou preta, com ensino fundamental incompleto, e primíparas, com gestações pré-termo, além de bebês do sexo feminino são fatores de risco para os nascimentos com BP. Conclusão Entre os índices avaliados, o APNCU foi o que apresentou melhor poder discriminatório e capacidade de prever o desfecho de BP ao nascer.