Publications by authors named "Sid John"
Article Synopsis
- Maternal mortality ratios (MMR) in the U.S. increased significantly from 1999-2021, rising from 9.60 to 23.5 per 100,000 live births, with higher increases noted in states with already high MMRs.
- The study found that decreases in MMRs due to clear obstetric causes were similar across low and high MMR states, but the rise in deaths from less specific causes was much more pronounced in high-MMR states like Texas than in lower-MMR ones like California.
- Overall, increases in MMRs from less-specific/potentially incidental causes were observed across all racial and ethnic groups, indicating a troubling trend in maternal health disparities.
Background: In vitro fertilization (IVF) as a fertility treatment is associated with adverse perinatal outcomes. Racial/ethnic disparity in severe maternal morbidity (SMM) in women who conceived by IVF is understudied.
Objective: To examine differences in the association between race/ethnicity and SMM between women who conceived spontaneously and those who conceived using IVF.
Article Synopsis
- Maternal mortality rates in the U.S. have nearly doubled from 2018 to 2021, rising from 17.4 to 32.9 deaths per 100,000 live births, potentially influenced by factors beyond obstetrical issues.
- This study examines whether these rising rates are due to changes in obstetrical factors, maternal health conditions, or shifts in how maternal mortality is tracked and reported.
- Results show a 144% increase in maternal deaths from 1999-2002 to 2018-2021 across all racial and ethnic groups, with notable rises in both direct and indirect obstetrical deaths.
Article Synopsis
- The study investigates the link between body mass index (BMI) and twin births, noting that higher BMIs are associated with increased twin delivery rates, particularly in women using assisted reproductive technology (ART).
- It analyzes data from over half a million births in British Columbia from 2008 to 2020, focusing on the impact of prepregnancy BMI and ART use on twin birth rates.
- Results show that as BMI increases, the rate of twin deliveries rises, with the highest rates observed in women with obesity class III, suggesting a need for further exploration of these associations and the role of ART in twin pregnancies.
Effect of the COVID-19 Pandemic on Stillbirths in Canada and the United States.
J Obstet Gynaecol Can
April 2024
Objective: There is uncertainty regarding the effect of the COVID-19 pandemic on population rates of stillbirth. We quantified pandemic-associated changes in stillbirth rates in Canada and the United States.
Methods: We carried out a retrospective study that included all live births and stillbirths in Canada and the United States from 2015 to 2020.
Article Synopsis
- The study aimed to analyze how the COVID-19 pandemic affected obstetric interventions and perinatal outcomes in the U.S. from 2015 to 2021.
- It found significant changes during the pandemic, including decreases in preterm birth and labor induction rates, while rates of macrosomia (larger than average babies), postterm births, and perinatal deaths increased.
- High-risk groups, such as those with prepregnancy diabetes, experienced even more pronounced effects, with substantial decreases in preterm birth and labor interventions related to the pandemic onset.
A flexible approach to modelling stillbirths using the foetuses at risk approach.
Paediatr Perinat Epidemiol
August 2023
Background: Survival analysis methods are increasingly used to model the gestational age-specific risk of perinatal phenomena such as stillbirth.
Objectives: To compare two types of survival analysis models, and highlight differences by estimating the relationships between pre-pregnancy BMI and gestational age-specific rates of stillbirth.
Methods: The study was based on singleton live births and stillbirths in the United States in 2016-2017, with data obtained from the natality and fetal death files of the National Center for Health Statistics.
The clinical performance and population health impact of birthweight-for-gestational age indices at term gestation.
Paediatr Perinat Epidemiol
January 2024
Background: The assessment of birthweight for gestational age and the identification of small- and large-for-gestational age (SGA and LGA) infants remain contentious, despite the recent creation of the Intergrowth 21st Project and World Health Organisation (WHO) birthweight-for-gestational age standards.
Objective: We carried out a study to identify birthweight-for-gestational age cut-offs, and corresponding population-based, Intergrowth 21st and WHO centiles associated with higher risks of adverse neonatal outcomes, and to evaluate their ability to predict serious neonatal morbidity and neonatal mortality (SNMM) at term gestation.
Methods: The study population was based on non-anomalous, singleton live births between 37 and 41 weeks' gestation in the United States from 2003 to 2017.
Background: Recommendations for deliveries of pregnant patients with a previous cesarean delivery and the type of hospitals deemed safe for these deliveries have evolved in recent years, although no studies have examined hospital factors and associated safety. We sought to evaluate maternal and neonatal outcomes among patients with a previous cesarean delivery by hospital tier and volume.
Methods: We carried out an ecological study of singleton live births delivered at term gestation to patients with a previous cesarean delivery in all Canadian hospitals (excluding Quebec), 2013-2019.
Background And Objectives: Although racial and ethnic disparities in adverse birth outcomes have been well documented, it is unknown whether such disparities diminish in women who use medically assisted reproduction (MAR). We examined differences in the association between maternal race and ethnicity and adverse birth outcomes among women who conceived spontaneously and those who used MAR, including assisted reproduction technology (ART), eg, in-vitro fertilization, and also non-ART MAR, eg, fertility drugs.
Methods: We conducted a population-based retrospective cohort study using data on all singleton births (N = 7 545 805) in the United States from 2016 to 2017.
Article Synopsis
- This study analyzes the impact of gestational age at delivery on long-term outcomes like stillbirth, infant mortality, cerebral palsy, and epilepsy in low-risk pregnancies in Sweden.
- The research included 1,773,269 singleton infants born between 1998 and 2019, using statistical models to compare risks associated with different gestational ages.
- Findings suggest that births at 37 or 38 weeks pose higher risks for adverse outcomes, while delivering at 39-40 weeks is linked to reduced risks, highlighting the importance of timing in obstetric management.
Article Synopsis
- Operative vaginal delivery (OVD) is generally safe, but training opportunities have decreased, leading to concerns about safety and trauma rates in Canada.
- A study on over 1.3 million deliveries revealed that trauma rates for both mothers and babies were higher than previously thought, particularly after forceps deliveries compared to vacuum deliveries.
- Findings suggest a need to re-evaluate the safety of OVD practices in Canada, as trauma rates varied by region but not by the level of obstetric care.
Rigorous studies carried out by the National Center for Health Statistics show that previously reported increases in maternal mortality rates in the United States were an artifact of changes in surveillance. The pregnancy checkbox, introduced in the revised 2003 death certificate and implemented by the states in a staggered manner, resulted in increased identification of maternal deaths and in reported maternal mortality rates. This Commentary summarizes the findings of the National Center for Health Statistics reports, describes temporal trends and the current status of maternal mortality in the United States, and discusses future concerns.
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