Time trends, geographic variation and risk factors for gastroschisis in Canada: A population-based cohort study 2006-2017.

Background: Previous studies showed increases in rates of gastroschisis in Canada in the first decade of the 21st century.

Objective: We sought to examine the epidemiologic characteristics of gastroschisis in Canada in recent years.

Methods: We conducted a retrospective population-based cohort study of all livebirths and stillbirths delivered in Canada (excluding Quebec) from 2006 to 2017, with information obtained from the Canadian Institute for Health Information.

Maternal Mortality in the United States: Recent Trends, Current Status, and Future Considerations.

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.

Stillbirth in Canada: anachronistic definition and registration processes impede public health surveillance and clinical care.

The archaic definition and registration processes for stillbirth currently prevalent in Canada impede both clinical care and public health. The situation is fraught because of definitional problems related to the inclusion of induced abortions at ≥20 weeks' gestation as stillbirths: widespread uptake of prenatal diagnosis and induced abortion for serious congenital anomalies has resulted in an artefactual temporal increase in stillbirth rates in Canada and placed the country in an unfavourable position in international (stillbirth) rankings. Other problems with the Canadian stillbirth definition and registration processes extend to the inclusion of fetal reductions (for multi-fetal pregnancy) as stillbirths, and the use of inconsistent viability criteria for reporting stillbirth.

Database Autopsy: An Efficient and Effective Confidential Enquiry into Maternal Deaths in Canada.

Background: Maternal death surveillance in Canada relies on hospitalization data, which lacks information on the underlying cause of death. We developed a method for identifying underlying causes of maternal death, and quantified the frequency of maternal death by cause.

Methods: We used data from the Discharge Abstract Database for fiscal years 2013 to 2017 to identify women who died in Canadian hospitals (excluding Quebec) while pregnant or within 1 year of the end of pregnancy.

Maternal and Perinatal Morbidity and Mortality Associated With Anemia in Pregnancy.

Objective: To estimate the incidence of anemia in pregnancy and compare the maternal and perinatal outcomes of women with and without anemia.

Methods: We conducted a population-based retrospective cohort study on all pregnant women in British Columbia who had a live birth or stillbirth at or after 20 weeks of gestation between 2004 and 2016. Women were diagnosed with anemia based on two criteria: third-trimester hemoglobin value or a delivery admission diagnosis of anemia (made before delivery).

Association between Apgar scores of 7 to 9 and neonatal mortality and morbidity: population based cohort study of term infants in Sweden.

Objective: To investigate associations between Apgar scores of 7, 8, and 9 (versus 10) at 1, 5, and 10 minutes, and neonatal mortality and morbidity.

Design: Population based cohort study.

Setting: Sweden.

Association of maternal risk factors with the recent rise of neural tube defects in Canada.

Background: We sought to assess the recent trend in NTD prevalence at birth in the post-folic acid food fortification era and to identify the maternal risk factors associated with that trend.

Methods: We carried out a population-based study of all livebirths and stillbirths (including late pregnancy terminations) delivered in hospitals in Canada (excluding Quebec) from 2004 to 2015 (n = 3 439 330). We examined NTD birth prevalence by year, multiple pregnancy, maternal age, parity, pregestational diabetes, chronic illness, and problematic substance use.

Five and 10 minute Apgar scores and risks of cerebral palsy and epilepsy: population based cohort study in Sweden.

Objective: To investigate associations between Apgar score at five and 10 minutes across the entire range of score values (from 0 to 10) and risks of childhood cerebral palsy or epilepsy, and to analyse the effect of changes in Apgar scores from five to 10 minutes after birth in infants born ≥37 completed weeks.

Design, Setting, And Participants: Population based cohort study in Sweden, including 1 213 470 non-malformed live singleton infants, born at term between 1999 and 2012. Data on maternal and pregnancy characteristics and diagnoses of cerebral palsy and epilepsy were obtained by individual record linkages of nationwide Swedish registries.

Time-Varying Effects of Signs and Symptoms on Pregnancy Loss <20 Weeks: Findings from a Preconception Prospective Cohort Study.

Background: Although pregnancy loss affects one-third of pregnancies, the associated signs/symptoms have not been fully described. Given the dynamic nature of maternal physiologic adaptation to early pregnancy, we posited the relationships between signs/symptoms and subsequent loss would vary weekly.

Methods: In a preconception cohort with daily follow-up, pregnancies were ascertained by self-administered sensitive home pregnancy tests on day of expected menses.

Drivers of maternity care in high-income countries: can health systems support woman-centred care?

In high-income countries, medical interventions to address the known risks associated with pregnancy and birth have been largely successful and have resulted in very low levels of maternal and neonatal mortality. In this Series paper, we present the main care delivery models, with case studies of the USA and Sweden, and examine the main drivers of these models. Although nearly all births are attended by a skilled birth attendant and are in an institution, practice, cadre, facility size, and place of birth vary widely; for example, births occur in homes, birth centres, midwifery-led birthing units in hospitals, and in high intervention hospital birthing facilities.

Effect of Folic Acid Food Fortification in Canada on Congenital Heart Disease Subtypes.

Background: Previous studies have yielded inconsistent results for the effects of periconceptional multivitamins containing folic acid and of folic acid food fortification on congenital heart defects (CHDs).

Methods: We carried out a population-based cohort study (N=5 901 701) of all live births and stillbirths (including late-pregnancy terminations) delivered at ≥20 weeks' gestation in Canada (except Québec and Manitoba) from 1990 to 2011. CHD cases were diagnosed at birth and in infancy (n=72 591).

Signs and Symptoms of Early Pregnancy Loss.

Approximately one-third of pregnancies end in loss; however, the natural history of early pregnancy loss, including signs and symptoms preceding loss, has yet to be fully described and its underlying mechanisms fully understood. We searched PubMed/MEDLINE and Embase to identify articles with prospective ascertainment of signs and symptoms, including vaginal bleeding, nausea, and vomiting, of pregnancy loss < 20 weeks gestation in spontaneous conceptions to ascertain existing literature on symptomatology of pregnancy loss. Two preconception and 16 pregnancy cohort studies that ascertained information on bleeding and/or nausea/vomiting prior to pregnancy loss ascertainment were included.

Signs and symptoms associated with early pregnancy loss: findings from a population-based preconception cohort.

Study Question: What is the relationship between signs and symptoms of early pregnancy and pregnancy loss <20 weeks' gestation?

Summary Answer: Vaginal bleeding is associated with increased incidence of early pregnancy loss, with more severe bleeding and bleeding accompanied by lower abdominal cramping associated with greater incidence of loss; conversely, vomiting is associated with decreased incidence of early pregnancy loss, even in the setting of vaginal bleeding, while nausea alone is not.

What Is Known Already: Two previous cohort studies with preconception enrollment suggested that bleeding is associated with loss while nausea is inversely associated with loss though these studies were limited by small study size and reporting after loss ascertainment. No prior preconception cohort study has examined multiple signs and symptoms in relation to pregnancy loss.

Delivery of breech presentation at term gestation in Canada, 2003-2011.

Objective: To examine neonatal mortality and morbidity rates by mode of delivery among women with breech presentation at term gestation.

Methods: We carried out a population-based cohort study examining neonatal outcomes among term, nonanomalous singletons in breech presentation among all hospital deliveries in Canada (excluding Quebec) between 2003 and 2011. Mode of delivery was categorized into vaginal delivery, cesarean delivery in labor, and cesarean delivery without labor.

Effects of socioeconomic position and clinical risk factors on spontaneous and iatrogenic preterm birth.

Background: The literature shows a variable and inconsistent relationship between socioeconomic position and preterm birth. We examined risk factors for spontaneous and iatrogenic preterm birth, with a focus on socioeconomic position and clinical risk factors, in order to explain the observed inconsistency.

Methods: We carried out a retrospective population-based cohort study of all singleton deliveries in Nova Scotia from 1988 to 2003.

Co-bedding between preterm twins attenuates stress response after heel lance: results of a randomized trial.

Objective: To examine the effect of co-bedding between preterm twins on stress response after heel lance.

Methods: Using a multisite randomized controlled trial design, stable preterm twins (67 sets, N=134 infants) between 28 and 36 completed weeks' gestational age, stratified by gestational age (≤ and >32 weeks) and site, were randomly assigned to a co-bedding group, cared for continuously in the same incubator or crib or a standard care group, cared for in a separate incubator or crib, and underwent a medically indicated heel lance after at least 24 hours and no greater than 10 days of group allocation. The reported outcome was cortisol from saliva samples from 89 twins (n=49 co-bedding, n=40 standard care) collected immediately before the heel lance (baseline levels) and 113 twins (n=58 co-bedding, n=55 standard care) collected 20 minutes after heel lance (stress levels) as an index of stress response.

Effect of advanced maternal age on perinatal outcomes in twins: the impact of chorionicity.

Purpose: In contrast to singletons, twins born to older mothers have lower rates of perinatal mortality than twins born to younger mothers. We examined whether differences in chorionicity could explain this unexpected maternal age effect.

Methods: We used population-based data on twins born to mothers aged 20-29 (n = 3702) and ≥35 years (n = 1880) in the North of England, UK, 1998-2007.

Does advanced maternal age confer a survival advantage to infants born at early gestation?

Background: Recent studies have shown that older mothers who deliver at preterm gestation have lower neonatal mortality rates compared with younger mothers who deliver at preterm gestation. We examined the effect of maternal age on gestational age-specific perinatal mortality.

Methods: We compared fetal, neonatal and perinatal mortality rates among singleton births in the United States, 2003-2005, to mothers aged ≥35 versus 20-29 years.

Fetal growth: a review of terms, concepts and issues relevant to obstetrics.

The perinatal literature includes several potentially confusing and controversial terms and concepts related to fetal size and growth. This article discusses fetal growth from an obstetric perspective and addresses various issues including the physiologic mechanisms that determine fetal growth trajectories, known risk factors for abnormal fetal growth, diagnostic and prognostic issues related to restricted and excessive growth and temporal trends in fetal growth. Also addressed are distinctions between fetal growth 'standards' and fetal growth 'references', and between fetal growth charts based on estimated fetal weight vs those based on birth weight.

Temporal trends in clomiphene citrate use: a population-based study.

Objective: To examine temporal trends in clomiphene citrate use and sociodemographic characteristics associated with treatment initiation and duration.

Design: Retrospective cohort study.

Setting: British Columbia, Canada, 1996 to 2008.

Incidence, risk factors, and associated complications of eclampsia.

Objective: To estimate trends in incidence and identify risk factors and maternal and neonatal consequences of eclampsia in Canada.

Methods: We conducted a population-based cohort study of all women and their newborns (N=1,910,729) delivered in the hospital in Canada (excluding Quebec) from 2003 to 2009. The data were obtained from the Canadian Institute for Health Information.