Sexual inequality starts in utero. The contribution of biological sex to the developmental origins of health and disease is increasingly recognized. The aim of this study was to assess and interpret ...sexual dimorphisms for three major adverse pregnancy outcomes which affect the health of the neonate, child and potentially adult.
Retrospective population-based study of 574,358 South Australian singleton live births during 1981-2011. The incidence of three major adverse pregnancy outcomes preterm birth (PTB), pregnancy induced hypertensive disorders (PIHD) and gestational diabetes mellitus (GDM) in relation to fetal sex was compared according to traditional and fetus-at-risk (FAR) approaches.
The traditional approach showed male predominance for PTB 20-24 weeks: Relative Risk (RR) M/F 1.351, 95%-CI 1.274-1.445, spontaneous PTB 25-29 weeks: RR M/F 1.118, 95%-CI 1.044-1.197%, GDM RR M/F 1.042, 95%-CI 1.011-1.074, overall PIHD RR M/F 1.053, 95%-CI 1.034-1.072 and PIHD with term birth RR M/F 1.074, 95%-CI 1.044-1.105. The FAR approach showed that males were at increased risk for PTB 20-24 weeks: RR M/F 1.273, 95%-CI 1.087-1.490, for spontaneous PTB 25-29 weeks: RR M/F 1.269, 95%-CI 1.143-1.410 and PIHD with term birth RR M/F 1.074, 95%-CI 1.044-1.105%. The traditional approach demonstrated female predominance for iatrogenic PTB 25-29 weeks: RR M/F 0.857, 95%-CI 0.780-0.941 and PIHD associated with PTB 25-29 weeks: RR M/F 0.686, 95%-CI 0.581-0.811. The FAR approach showed that females were at increased risk for PIHD with PTB 25-29 weeks: RR M/F 0.779, 95%-CI 0.648-0.937.
This study confirms the presence of sexual dimorphisms and presents a coherent framework based on two analytical approaches to assess and interpret the sexual dimorphisms for major adverse pregnancy outcomes. The mechanisms by which these occur remain elusive, but sex differences in placental gene expression and function are likely to play a key role. Further research on sex differences in placental function and maternal adaptation to pregnancy is required to delineate the causal molecular mechanisms in sex-specific pregnancy outcome. Identifying these mechanisms may inform fetal sex specific tailored antenatal and neonatal care.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Objectives: To review evidence for the increased incidence of late diagnosed developmental dysplasia of the hip (DDH) in South Australia; to identify perinatal risk factors associated with late DDH ...in babies born between 2003 and 2009 in SA.
Design: Linkage study of data collected prospectively by the South Australian Birth Defects Register (SABDR) and the Pregnancy Outcome Statistics Unit (SA Department of Health), supplemented by medical records review.
Participants: All children born 2003–2009 in whom DDH was diagnosed between 3 months and 5 years of age and notified to the SABDR (data inclusion range, 2003–2014). Children with teratological hip dislocations and other major congenital abnormalities were excluded.
Main outcome measures: Uni‐ and multivariable analyses were performed to identify perinatal risk factors for late diagnosed DDH.
Results: The incidence of late diagnosed DDH in babies born 2003–2009 was 0.77 per 1000 live births, contrasting with the figure of 0.22 per 1000 live births during 1988–2003. Significant perinatal risk factors were birth in a rural hospital (v metropolitan public hospital: odds ratio OR, 2.47; CI, 1.37–4.46; P = 0.003), and being the second child (v being the first‐born: OR, 1.69; CI, 1.08–2.66; P = 0.023). Breech presentation was highly significant as a protective factor when compared with cephalic presentation (OR, 0.25; CI, 0.12–0.54; P < 0.001).
Conclusions: The incidence of late DDH has increased in SA despite an ongoing clinical screening program. Increased awareness, education, and avoidance of inappropriate lower limb swaddling are necessary to reverse this trend.
Gestational Diabetes Mellitus (GDM) increases the risk of type 2 diabetes. A register can be used to follow-up high risk women for early intervention to prevent progression to type 2 diabetes. We ...evaluate the performance of the world's first national gestational diabetes register.
Observational study that used data linkage to merge: (1) pathology data from the Australian states of Victoria (VIC) and South Australia (SA); (2) birth records from the Consultative Council on Obstetric and Paediatric Mortality and Morbidity (CCOPMM, VIC) and the South Australian Perinatal Statistics Collection (SAPSC, SA); (3) GDM and type 2 diabetes register data from the National Gestational Diabetes Register (NGDR). All pregnancies registered on CCOPMM and SAPSC for 2012 and 2013 were included-other data back to 2008 were used to support the analyses. Rates of screening for GDM, rates of registration on the NGDR, and rates of follow-up laboratory screening for type 2 diabetes are reported.
Estimated GDM screening rates were 86% in SA and 97% in VIC. Rates of registration on the NGDR ranged from 73% in SA (2013) to 91% in VIC (2013). During the study period rates of screening at six weeks postpartum ranged from 43% in SA (2012) to 58% in VIC (2013). There was little evidence of recall letters resulting in screening 12 months follow-up.
GDM Screening and NGDR registration was effective in Australia. Recall by mail-out to young mothers and their GP's for type 2 diabetes follow-up testing proved ineffective.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Objective: Using unbiased population data, to examine whether having a positive Pap smear, and thus a high probability of Human Papilloma Virus (HPV) infection, is a significant risk factor for ...intrauterine growth restriction (IUGR) in a subsequent pregnancy.
Study design and methods: Two independent population-based databases, namely the South Australian Perinatal Statistics Collection and the South Australian Cervical Screening Database, were deidentified and linked by the SANT Datalinkage Service. Analyses were performed on cases where Pap smear screening data was available for up to 2 years prior to a singleton live birth. Population characteristics and pregnancy related data were compared statistically by normal birth weight versus IUGR (10th percentile - known as small for gestational age (SGA), small for gestational age) and (3rd percentile birth weight - known as VLBW, very low birth weight). The association between cervical screening results and IUGR was assessed using generalized linear log binomial regression models.
Results: A total of 31,827 women met the criteria. Of these, 1311 women (4.1%) had a positive Pap smear within 2 years of the current pregnancy. Those having a positive Pap smear were more likely to have a baby with IUGR than those with negative smear results. For SGA, 5.8% babies were from mothers with positive Pap smears compared to 4.0% with negative smears indicating a 40% higher risk of having an SGA baby (95%CI 20-70%) among women with positive Pap smears. For VLBW, 7.6% mothers had positive Pap smears compared with 4.0% with negative smears (p < .001), which reflects a 90% increased risk (95%CI 40-150%). These associations reduced to 20% (95%CI 1-40%) and 50% (95%CI 10-100%) for SGA and VLBW, respectively, after adjusting for all other significant covariates including maternal age, ethnicity, marital status, occupation, smoking, pregnancy history, and maternal health during pregnancy.
Conclusions: Mothers with a positive Pap smear have an increased risk of IUGR, especially for VLBW, which is independent of other risk factors. The results confirm previous findings in a small study and emphasise the need to consider the risks of both cancer and IUGR in all HPV vaccination programs.
To evaluate implementation and outcomes of the Aboriginal Family Birthing Program (AFBP), which provides culturally competent antenatal, intrapartum and early postnatal care for Aboriginal families ...across South Australia (SA).
Analysis of births to Aboriginal women in SA 2010–2012; interviews with health professionals and AFBP clients.
Around a third of all Aboriginal women giving birth in SA 2010–2012 (n=486) attended AFBP services. AFBP women were more likely to be more socially disadvantaged, have poorer pregnancy health and to have inadequate numbers of antenatal visits than Aboriginal women attending other services. Even with greater social disadvantage and higher clinical complexity, pregnancy outcomes were similar for AFBP and other Aboriginal women. Interviews with 107 health professionals (including 20 Aboriginal Maternal and Infant Care (AMIC) workers) indicated differing levels of commitment to the model, with some lack of clarity about AMIC workers and midwives roles. Interviews with 20 AFBP clients showed they highly valued care from another Aboriginal woman.
Despite challenges, the AFBP reaches out to women with the greatest need, providing culturally appropriate, effective care through partnerships.
Programs like the AFBP need to be expanded and supported to improve maternal and child health outcomes for Aboriginal families.
Objective: To assess the impact of Aboriginal status, active cigarette smoking and smoking cessation during pregnancy on perinatal outcomes.
Design: Retrospective cohort study from 1 January 1999 to ...31 December 2008.
Setting: All singleton births in South Australia.
Participants: Population‐based birth records of pregnancies to Aboriginal women (n = 4245) and non‐Aboriginal women (n = 167 746).
Main outcome measures: Adjusted odds ratios (aORs) and 95% CIs for adverse maternal and neonatal outcomes according to Aboriginal status and maternal smoking in pregnancy.
Results: Active cigarette smoking during pregnancy was associated with an increased risk of adverse perinatal outcomes, including premature labour (Aboriginal, 1–10 cigarettes per day: aOR, 1.69; 95% CI, 1.28–2.23; non‐Aboriginal, 1–10 cigarettes per day: aOR, 1.46; 95% CI, 1.34–1.58), preterm birth (Aboriginal, 1–10 cigarettes per day: aOR, 1.40; 95% CI, 1.14–1.73; non‐Aboriginal, 1–10 cigarettes per day: aOR, 1.48; 95% CI, 1.39–1.57), intrauterine growth restriction (Aboriginal, 1–10 cigarettes per day: aOR, 2.33; 95% CI, 1.77–3.08; non‐Aboriginal, 1–10 cigarettes per day: aOR, 2.65; 95% CI, 2.48–2.83) and small for gestational age (Aboriginal, 1–10 cigarettes per day: aOR, 2.49; 95% CI, 2.06–3.00; non‐Aboriginal, 1–10 cigarettes per day: aOR, 2.29; 95% CI, 2.20–2.40). For both Aboriginal and non‐Aboriginal women who smoked 11 or more cigarettes per day the aOR for these outcomes increased. Smoking cessation in the first trimester reduced these risks to levels comparable with non‐smokers. The risk of each adverse outcome was greater in Aboriginal than non‐Aboriginal women for all smoking categories; however, interactions between Aboriginal status and smoking were not significant, indicating an equal contribution of smoking to poor outcomes in both populations.
Conclusions: Smoking cessation or reduction during pregnancy would significantly improve outcomes in both Aboriginal and non‐Aboriginal women. This should be made a clear priority to improve pregnancy outcomes for all women.
Background
Child bearing in the later reproductive years has become increasingly common in Australia with potential implications for clinical practice.
Aim
To examine pregnancy outcomes for ...nulliparous women of advanced maternal age with singleton pregnancies.
Methods
A retrospective population‐based cohort study was conducted to compare the pregnancy outcomes for women aged 35–39 years and ≥40 years with women aged 25–29 years, analysing 34 695 records from the South Australian Perinatal Database between 1998 and 2008.
Results
Pre‐existing hypertension relative risks (RR) 1.98 and 2.94 for women aged 35–39 years and ≥40 years, respectively, placenta praevia (RR 2.88 and 3.68), suspected intrauterine growth restriction (RR 1.33 and 1.77) and gestational diabetes (RR 1.97 and 2.53) increased with age. Women of advanced maternal age were more likely to have not laboured prior to birth (RR 2.19 and 3.28), be induced (RR 1.12 and 1.27) and have a breech presentation (RR 1.57 and 1.60). The likelihood of fetal distress increased with advancing maternal age (RR 1.15 and 1.24). Regression analyses revealed women of advanced maternal age were significantly more likely to have small for gestational age infants adjusted odds ratios (AOR) 1.26 and 1.50, preterm birth (AOR 1.26 and 1.43), elective caesarean relative risk ratios (RRR) 2.55 and 4.52, emergency caesarean (RRR 1.59 and 2.21) and experience a perinatal death (RRR 1.94 and 2.18).
Conclusions
The likelihood of pre‐existing medical conditions, obstetric complications, adverse labour and birth outcomes and complications increased with advancing maternal age. Advanced maternal age was also independently associated with selected adverse pregnancy and infant outcomes.
This article aims to describe the rates of middle ear disease in Aboriginal children living in metropolitan Adelaide.
Data from the Under 8s Ear Health Program (population-based outreach screening) ...were analysed to identify rates of ear disease and the referral outcomes for children identified with ear conditions during screening.
In total, 1598 children participated in at least one screening between May 2013 and May 2017. Males and females were equally represented; 73.2% had one or more abnormal findings on otoscopy at the first screening visit, 42% had abnormal tympanometry, and 20% registered a “fail” on otoacoustic emission testing. The referral pathway for children with abnormal findings included referrals to their GP, Audiology, and Ear Nose Throat (ENT) Departments. Also, 35% (562/1598) of the children screened required referral either to a GP or Audiology, and 28% of those referred (158/562) or 9.8% (158/1598) of the total number of children screened required further ENT management.
High rates of ear disease and hearing problems in urban Aboriginal children were detected in this study. Existing social, environmental, and clinical interventions need to be evaluated. Closer monitoring including data linkage may assist to better understand the effectiveness, timeliness, and challenges of public health interventions and follow-up clinical services to a population-based screening program.
Aboriginal-led population-based outreach programs such as the Under 8s Ear Health Program augmented by seamless integration with education, allied health and tertiary health services should be prioritised for expansion and continued funding.
In South Australia, reporting of live births, stillbirths of at least 20 weeks or 400 g birth weight, termination of pregnancies and congenital anomalies is mandated. We describe the investigation of ...an increase in notifications of neural tube defects (NTDs) in South Australia in 2009 and 2010 using data from several surveillance systems.
NTD trend data from 1966 to 2010 were reviewed. Comparisons of pregnancies affected by an NTD in 2009 and 2010 were made with pregnancies affected by an NTD in the period 2003-2008 and with all pregnancies in 2009 and 2010. Statistical analysis was undertaken using Poisson regression, χ(2) or Fisher's exact tests.
The prevalence of NTD-affected pregnancies was 1.95 per 1000 births (39 cases) in 2010 and 1.91 per 1000 births in 2009 (38 cases), the highest annual rates since 1991. Case series comparisons indicated women with NTD-affected pregnancies in 2009 and 2010 were less likely to be Caucasian compared with women who had NTD-affected pregnancies in the period 2003-2008. Women born in the Middle East and African region (n = 7) were significantly more likely to have NTD-affected pregnancies in the years 2009 and 2010 (relative risk: 3.03; 95% confidence interval: 1.39-6.62) compared with women born in the Oceania region.
The increased notifications of NTDs can only be partially explained by the increase in numbers of women from the Middle East and African region, with no other contributory causes revealed. This analysis highlighted areas where prevention efforts should be strengthened and surveillance data improved.
Does cigarette smoking in pregnancy explain the increased risk of adverse perinatal outcomes that occur with maternal asthma or does it compound the effect? Using population based birth records, a ...retrospective analysis was conducted of all singleton pregnancies in South Australia over 10 years (1999-2008; n=172 305), examining maternal asthma, cigarette smoking and quantity of smoking to estimate odds ratios. Compared with nonasthmatic females who did not smoke during pregnancy, both asthmatic females who smoked and those who did not smoke during pregnancy had a significantly increased risk of gestational diabetes, antepartum haemorrhage, polyhydramnios, premature rupture of membranes, emergency Caesarean section, and the child being small for gestational age and having congenital abnormalities. These associations suggest that asthma, independently of maternal smoking, increases the risk of these adverse perinatal outcomes. Maternal smoking was itself associated with an increased risk of a number of poor neonatal outcomes, with a dose-response relationship observed. Notably, maternal asthma combined with cigarette smoking significantly increased the risk of preterm birth and urinary tract infections to a greater degree than with either exposure alone. Maternal asthma and cigarette smoking during pregnancy are both independently associated with adverse perinatal outcomes and, combined, compound the risk of preterm birth and urinary tract infections.
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