Large-Scale Data Harmonization Across Prospective Studies.

The Preconception Period Analysis of Risks and Exposures Influencing Health and Development (PrePARED) Consortium creates a novel resource for addressing preconception health by merging data from numerous cohort studies. In this paper, we describe our data harmonization methods and results. Individual-level data from 12 prospective studies were pooled. The crosswalk-cataloging-harmonization procedure was used. The index pregnancy was defined as the first postbaseline pregnancy lasting more than 20 weeks. We assessed heterogeneity across studies by comparing preconception characteristics in different types of studies. The pooled data set included 114,762 women, and 25,531 (22%) reported at least 1 pregnancy of more than 20 weeks' gestation during the study period. Babies from the index pregnancies were delivered between 1976 and 2021 (median, 2008), at a mean maternal age of 29.7 (standard deviation, 4.6) years. Before the index pregnancy, 60% of women were nulligravid, 58% had a college degree or more, and 37% were overweight or obese. Other harmonized variables included race/ethnicity, household income, substance use, chronic conditions, and perinatal outcomes. Participants from pregnancy-planning studies had more education and were healthier. The prevalence of preexisting medical conditions did not vary substantially based on whether studies relied on self-reported data. Use of harmonized data presents opportunities to study uncommon preconception risk factors and pregnancy-related events. This harmonization effort laid the groundwork for future analyses and additional data harmonization.

Mode of delivery and short-term infant health outcomes: a prospective cohort study in a peri-urban Indian population.

BACKGROUND: Previous studies have found a relationship between cesarean section delivery and adverse outcomes in the offspring, partially attributing these findings to differential development of immunity in infants delivered by cesarean compared to vaginal delivery. The purpose of this study is to determine whether cesarean section delivery is associated with higher reports of adverse short-term infant health outcomes in a peri-urban Indian population. METHODS: Data from a prospective pregnancy cohort study in a peri-urban region of Telangana State, India, were analyzed to assess the association between mode of delivery, cesarean section or vaginal, and maternal report of recent infant diarrhea and/or respiratory symptoms at a 6 month follow-up visit. Inverse probability weights were applied to log-binomial regression models to account for maternal pre-pregnancy, prenatal, and labor and delivery factors. RESULTS: Of the 851 singleton infants delivered between 2010 and 2015, 46.7% were delivered by cesarean. Cesarean delivery was not associated with an increased report of infants having one or more of the outcomes (diarrhea, respiratory infection, or difficulty breathing) at 6 months (adjusted risk ratio 0.89, 95% confidence interval 0.76-1.03), nor was it associated with infants having a more severe outcome of comorbid diarrhea and respiratory infection (adjusted risk ratio 1.08, 95% confidence interval 0.58-2.04). CONCLUSION: Unlike findings in Western populations, in this peri-urban Indian population, cesarean delivery was not associated with higher reports of short-term adverse gastrointestinal or respiratory infant outcomes after accounting for pre-delivery maternal factors. Future research in this cohort could elucidate whether mode of delivery is associated with other adverse outcomes later in childhood.

Prevalence of Chlamydia trachomatis among Childbearing Age Women in India: A Systematic Review.

Background. Infection with Chlamydia trachomatis (CT) can lead to reproductive sequelae. Information on the general population of childbearing age women in India is sparse. We reviewed the literature on CT prevalence within the general population of reproductive aged women in order to improve the efforts of public health screening programs and interventions. Objective. To conduct a literature review to determine the prevalence of Chlamydia trachomatis among childbearing age women in India. Search Strategy. Ovid Medline and PubMed databases were searched for articles from January 1, 2003, through December 31, 2014. Search terms included "Chlamydia trachomatis", "CT", "prevalence", "India", and "sexually transmitted infections". Selection Criteria. Studies on prevalence data for CT among women of childbearing age (15-45) living in India were included. Data Collection and Analysis. Articles that met the inclusion criteria were extracted by two readers and discrepancies solved through discussion. Results. Reported prevalence of active CT infection among lower risk groups ranged from 0.1% to 1.1% and in higher risk group from 2.7% to 28.5%. Conclusion. CT prevalence among women in India is comparable to other countries. Screening programs to prevent adverse outcomes among Indian women of childbearing age and their offspring are warranted.

Prevalence of preterm birth and perinatal outcome: A rural tertiary teaching hospital-based study.

Context: Preterm birth is defined as births before 37 weeks of gestational age. Preterm birth is a major challenge in obstetric health care and leading cause of perinatal mortality and long-term morbidity. Complications arising from preterm births are the leading cause of deaths among children less than 5 years of age. Seventy-five percent of them could be saved with current, cost-effective interventions. The rate of preterm births worldwide is 5-18% with the developing countries accounting for the maximum deaths. Aims: This study was undertaken to evaluate the prevalence of preterm births and risk factors associated with it among women delivered at a rural tertiary teaching hospital in Telangana and further assess its impact on perinatal outcome. Settings and design: This was a retrospective case control study conducted at Mediciti Institute of Medical Sciences from January 2019 to December 2019. Methods and material: Of the 1243 deliveries during the study period, 135 births that occurred at <37 weeks were taken as cases and 248 term neonates were taken as control group. Data were collected retrospectively through review of prenatal and hospital delivery records. Statistical analysis used: Data were collected and tabulated as shown in the results. Statistical analysis was done using Microsoft Excel. Frequency and percentage of each parameter were calculated and analyzed. The risk estimates were analyzed between the cases and controls by calculating the odds ratio, 95% confidence interval, and P value. P Value of <0.05 was considered significant. Results: The prevalence rate of preterm birth was 10.86%. History of previous preterm birth (OR = 4.88, C.I: 1.50-15.87, P = 0.0084), previous LSCS (OR = 2.16, C.I: 1.36-3.44, P = 0.001), inter-pregnancy interval <12 months (OR = 2.78, C.I: 1.13-6.84, P = 0.026), hypertension (OR = 3.10, C.I: 1.78-5.42, P = 0.0001), PROM (OR =0.73, C.I: 2.36-9.49, P < 0.0001), Oligohydramnios (OR = 3.58, C.I: 1.29-9.9, P = 0.01), and multiple pregnancy (OR = 24.09, C.I: 3.09-187.46, P = 0.0024) were found to be significant risk factors for preterm birth. Though the NICU admission rate was high (52%), neonatal outcome was found to be satisfactory. Conclusions: Some of the risk factors that contributed to preterm birth were modifiable. Preventive strategies addressing the risk factors such as hypertension, oligohydramnios, and also improving health care quality to pregnant women will reduce the prevalence of preterm births and outcomes.

Adverse infant outcomes associated with caesarean section delivery in India.

BACKGROUND: Caesarean section delivery is increasing worldwide and in India, yet little is known about the effect on infants. We examined the association between caesarean delivery and adverse infant outcomes in an Indian national survey, accounting for factors related to the mode of delivery. METHODS: Inverse probability weighted logistic regression analysis of the 2015-2016 India National Family Health Survey obtained adjusted ORs (aORs) and 95% CIs. Infant outcomes were maternal report of recent concomitant diarrhoea and acute respiratory infection (ARI) in infants age ≤6 mo and neonatal death. RESULTS: Of the 189 143 reported most recent singleton births, 15.4% were delivered by caesarean, 860 (3.2%) of all infants age ≤6 mo had concomitant diarrhoea and ARI and 3480 (1.8%) neonatal deaths were reported. In adjusted analysis, caesarean delivery was not associated with concomitant diarrhoea and ARI (aOR 0.96 [95% CI 0.71 to 1.32]) but was associated with neonatal death (aOR 1.19 [95% CI 1.02 to 1.39]). CONCLUSIONS: Using nationally representative cross-sectional data for India, caesarean section delivery was found to be associated with neonatal death after accounting for factors associated with the mode of delivery. Prospective exploration of the relationship between caesarean delivery and adverse infant outcomes is warranted.

Maternal Factors Associated with Mode of Delivery in a Population with a High Cesarean Section Rate.

We sought to identify factors associated with mode of delivery in a peri-urban Indian population with a high cesarean section rate. Poisson regression with robust error variance was applied to model factors associated with cesarean compared to vaginal delivery in a prospective, preconception pregnancy cohort study in Telangana State, India. Adjusted relative risks and 95% confidence intervals from multivariable models are presented. Among 1164 singleton births between 2010 and 2015, 46% were delivered by cesarean. In multiparous women (n = 674), prior cesarean delivery (4.2, 3.2-5.6), prior twin delivery (1.4, 1.1-1.9), diagnosis of hypertension (1.4, 1.0-2.0), or preeclampsia (3.5, 2.1-5.7) in a prior pregnancy independently increased the risk of cesarean. Prepregnancy overweight/obesity (1.4, 1.0-1.9), a composite of prenatal complications (1.3, 1.0-1.7), a composite of labor complications (1.5, 1.0-2.3), nonreassuring fetal heart rate (2.3, 1.3-4.1), and breech position (2.6, 1.4-5.0) also increased the cesarean risk. Among nulliparous women (n = 233), cephalo-pelvic disproportion (1.9, 1.2-3.0), a composite of labor complications (2.9, 1.8-4.9), and breech position (3.4, 1.9-6.2) increased the risk of cesarean. The high rate of cesarean delivery in this peri-urban Indian population is attributed to history of pregnancy complications, history of prior cesarean, prepregnancy body mass index, and medical indications at delivery.

Cord Blood IgG Antibodies Against SARS CoV-2 in Pregnant Women at a Rural Teaching Hospital

Introduction: The significant risks posed to mothers and fetus by COVID-19 in pregnancy have sparked a worldwide debate surrounding the antenatal SARS-CoV-2 infection and vaccination. ACOG and CDC recognize pregnancy as a risk factor, Recent data demonstrated that pregnant women with COVID-19 infection are at increased risk for intensive care unit (ICU) admission, mechanical ventilation, and death, compared with properly matched nonpregnant women. Moreover, COVID-19 illness increases the risk for pregnancy complications such as preterm birth, pregnancy-induced hypertensive diseases, and thromboembolic diseases. Maternal IgG antibodies to SARS-CoV-2 where transferred across the placenta after asymptomatic as well as symptomatic infection during pregnancy. Proper transfer of neutralizing antibodies may be critical during pregnancy, as a greater proportion of neonates and infants have severe or critical illness upon COVID-19 infection than older pediatric counterparts. To detect cord bloodAims and Objectives: IgG antibodies against SARS CoV-2 in pregnant women. To assess the association between maternal and fetal SARS-CoV- 2 specific antibodies. A brief questionnaire was administered to 42 antenatal women attending for delivery atMethods: Mediciti Institute of Medical Sciences, Hyderabad, Telangana State. The questionnaire included information such as vaccination status, previous history of Covid infection, presence of any symptoms at the time of admission, comorbid conditions like DM, HTN, Thyroid disorders, etc. Following delivery, 2ml cord blood sample has been collected. Serum has been separated and used for detection of SARS CoV-2 IgG antibody titers by quantitative ELISA. Among 42Results: antenatal cases,4 were controls among them two were positive control and two were negative controls. Out of remaining 38, the SARS-CoV-2 IgG antibodies are detected in 14 cases. IgG was detected in the cord blood for 33.3% of the total cases. Among those detected positive for antibodies, 50% had preterm deliveries. IgG antibodies haveConclusion: been detected in the cord blood collected from the vaccinated women as well as the women affected with SARS-Co-2 and even increased the risk for pregnancy complications such as preterm birth, pregnancy-induced hypertensive diseases, Gestational Diabetes.

Relationship of serum uric acid, serum creatinine and serum cystatin C with maternal and fetal outcomes in rural Indian pregnant women.

BACKGROUND: Hypertensive disorders are the most common in pregnancy. Several studies showed a positive correlation between elevated maternal serum uric acid (UA), serum creatinine and adverse maternal and fetal outcomes, but only a few studies are available on serum cystatin C and maternal and fetal outcomes. The present study was undertaken to study the association of serum UA, creatinine and cystatin C with maternal and fetal outcomes. METHODS: Out of 116 pregnant women 69 women had no hypertension and 47 had hypertension with or without proteinuria. Serum UA, creatinine and cystatin C was measured by modified Uricase method, modified kinetic Jaffe's reaction and particle-enhanced immunonephelometric assay respectively. Multivariate logistic regression was performed to determine the independent effects of serum UA, creatinine and cystatin C on maternal and fetal outcomes using stata 13.1. RESULTS: The adjusted odds ratio (OR) was 3.73 (95% CI: 1.18-11.75; P=0.024) for UA; 15.79 (95% CI: 3.04-81.94; P=0.001) for creatinine and 2.03 (95% CI: 0.70-5.87; P=0.192) for cystatin C in hypertensive disorders of pregnancy. All the three renal parameters were not significantly associated with birth weight, gestational age of delivery and mode of delivery after adjusting for the confounding factors. CONCLUSIONS: Serum creatinine and uric acid are independent risk factors for hypertensive disorders of pregnancy. High serum uric acid is associated with low birth weight and delivery by caesarian section whereas high serum creatinine with preterm delivery only before adjustment for confounding factors and not after adjustment. Serum cystatin C was not significantly associated with the maternal and fetal outcomes.

Forceps deliveries and fetomaternal outcome in modern obstetrics

Background: In modern obstetrics practice has witnessed an increase in the caesarean section rates everywhere. The incidence of instrumental deliveries varies between 10-12% in UK. The incidence of instrumental deliveries varies between 2.7-5% in India. There is an urgent need to reintroduce instrumental need in the modern obstetrics. Instrumental delivery is one of the basic functions of emergency care according to WHO. This study was done to know the prevalence, indications and fetal outcomes of forceps deliveries.Methods: A retrospective study was conducted at a tertiary teaching hospital, India from January 2014 to December 2018. All cephalic singleton pregnant mothers who underwent forceps delivery after 28 weeks were included. All the forceps delivery done in twins and breech vaginal delivery were excluded. Demographic data, Indication of forceps delivery, maternal complications of forceps delivery like episiotomy extension, cervical tear, vaginal wall tear, PPH and neonatal outcome like low birth weight, NICU admissions, stillbirth, APGAR score at 1 and 5 minutes were recorded. Equal number of mothers of reproductive age group 20-45 ages who underwent normal non breech vaginal deliveries were randomly selected as control.Results: The prevalence of forceps delivery was 5.25%. The most common indication was fetal distress (55%). Most of the mothers were primigravidas in age group 20-30 years (p<0.001). Regarding the neonatal outcome, 72% of the babies were having weight >2.5 kgs.  APGAR <7 at 1 and 5 min was not significant.Conclusions: As fetal distress is the most common indication, every obstetrician should learn the skill of forceps delivery and it should not be a dying art.

Prevalence of teenage pregnancy and pregnancy outcome at a rural teaching hospital in India

Background: Teenage pregnancy accounts for 11% of births worldwide and 95% of these occur in low middle income countries. Pregnancy and its complications are leading cause of death among these girls. This study was done to know the prevalence and to determine whether teenage mothers are at risk of adverse pregnancy outcome.Methods: A retrospective study was conducted at a tertiary teaching hospital, India between July 2015 to Dec, 2017. All teenage mothers delivered after 28 weeks of gestation were included. Women with Diabetes mellitus, renal disease, thyroid disorders were excluded. Demographic data, maternal complications like anaemia, hypertensive disorders of pregnancy, preterm birth, mode of delivery, low birth weight, NICU admissions, stillbirth and early neonatal death were recorded.Results: In the present study, the prevalence was 7% which is less than that of other studies. Incidence of caesarean-Section in the present study was 31%. Amongst the complications oligohydramnious was found to be significantly associated with teenage pregnancy. NICU admissions were needed for 43% of the cases and 31% were LBW.Conclusions: High NICU admission and high LBW in newborns of teenage mothers were noted in the current study. Hence, there is urgent need to focus on the teenage pregnancy.

Prevalence and determinants of caesarean section in a rural tertiary teaching hospital: a 6-year retrospective study

Background: Caesarean section is the most commonly performed surgery in obstetrics and there is a rise in caesarean section rates in recent times. This study was undertaken to know the changing trends in caesarean section rate in a rural hospital and to examine the indications contributing to it. The objective of the present study was to know the prevalence and changing trends in caesarean section over the last 6 years (April 2012-March 2018).Methods: Demographic data for all the deliveries, mode of delivery and indications of caesarean sections performed from April 2012 to March 2018 that occurred at MIMS were collected in a retrospective manner.Results: Among a total of 12,522 women delivered during the study period of 6 years, 44.93%, 48.49%, 48.41%, 50.9%, 45.48% and 49.62% were delivered by caesarean section during 2012-2013, 2013-2014, 2014-2015, 2015-2016, 2016-2017 and 2017-2018 respectively. Increase in repeat caesarean section is the primary reason for these increased rates followed by fetal distress. There is a rise in the repeat caesarean section from 44.36% in 2012-2013 to 55.67% in 2016-2017 and 47% in 2017-2018. Whereas primary caesarean section rate reduced from 55.63% in 2012-2013 to 44.32% in 2016-2017 and 53% in 2017-2018.Conclusions: As repeat caesarean section and fetal distress are the most common causes of caesarean section we need to address these to bring down the caesarean section rate.