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Background: African refugee women in the United States are at risk of poor reproductive health outcomes; however, examination of reproductive health outcomes in this population remains inadequate. We compared: (1) prepregnancy health and prenatal behavior; (2) prenatal history and prenatal care utilization; and (3) labor and birth outcomes between African refugee women and U.S.-born Black and White women. Methods: A secondary data analysis of enhanced electronic birth certificate data was used. Univariate comparisons using chi-squared tests for dichotomous variables and analysis of variance and/or Kruskal–Wallis tests for continuous variables were conducted for Refugee versus Black versus White women. A p-value <0.05 was considered statistically significant. Results: From 2007 to 2016, 789 African refugee, 17,487 Black, and 59,615 White women in our population gave birth. African refugees experienced more favorable health outcomes than U.S.-born groups on variables examined. Compared to U.S.-born women, African refugee women had fewer prepregnancy health risks (p < 0.001), fewer preterm births (p < 0.001), fewer low birth weight infants (p < 0.001), and higher rates of vaginal deliveries (p < 0.001). These favorable outcomes occurred despite later initiation of prenatal care (p < 0.001) and lower scores of prenatal care adequacy among refugee women compared to U.S.-born groups (p < 0.001). Conclusions: The healthy immigrant effect appears to extend to reproductive health outcomes in our studied population of African refugee women. However, based on our data, targeted, culturally-congruent education surrounding family planning and prenatal care is recommended. Insight from reproductive health care experiences of African refugee women can provide understanding of the protective factors contributing to the healthy immigrant effect in reproductive health outcomes, and knowledge gained can be utilized to improve outcomes in other at-risk groups. [ABSTRACT FROM AUTHOR]

Background: The incidence of pregnancy-associated cancer (PAC) is expected to increase as more women delay childbearing until later ages. However, information on frequency and incidence of PAC is scarce in the United States. Methods: We identified pregnancies among women aged 10–54 years during 2001–2013 from five U.S. health plans participating in the Cancer Research Network (CRN) and the Medication Exposure in Pregnancy Risk Evaluation Program (MEPREP). We extracted information from the health plans' administrative claims and electronic health record databases, tumor registries, and infants' birth certificate files to estimate the frequency and incidence of PAC, defined as cancer diagnosed during pregnancy and up to 1 year postpartum. Results: We identified 846 PAC events among 775,709 pregnancies from 2001 to 2013. The overall incidence estimate was 109.1 (95% confidence interval [CI] = 101.8–116.7) per 100,000 pregnancies. There was an increase in the incidence between 2002 and 2012 (the period during which complete data were available), from 75.0 (95% CI = 54.9–100.0) per 100,000 pregnancies in 2002 to 138.5 (95% CI = 109.1–173.3) per 100,000 pregnancies in 2012. The most common invasive cancers diagnosed were breast (n = 208, 24.6%), thyroid (n = 168, 19.9%), melanoma (n = 93, 11.0%), hematologic (n = 87, 10.3%), and cervix/uterus (n = 74, 8.7%). Conclusions: Our study provides contemporary incidence estimates of PAC from a population-based cohort of U.S. women. These estimates provide the data needed to help develop clinical and public health policies aimed at diagnosing PAC at an early stage and initiating appropriate therapeutic interventions in a timely manner. [ABSTRACT FROM AUTHOR]

Abstract: This paper explores racial disparities and risk factors of adverse pregnancy outcomes in Black and White pregnant women in the US. The study uses a cross‐sectional approach to explore Black and White disparities using data from the 2012 National Survey on Drug Use and Health (NSDUH), which collects interview data from approximately 70,000 randomly selected participants. We included several self‐reported conditions that we categorised as individual and social stressors (e.g. measures of institutionalised racism, individual health behaviours, access to quality care and social context factors). We used descriptive statistics, univariate and multivariate analyses in risk factors of adverse pregnancy outcomes between Black and White women. Black women who were pregnant had a lower socioeconomic status and experienced more measures of institutionalised racism compared to White women who were pregnant. More white women who were pregnant were married, had higher levels of educational attainment, higher income levels, and greater employment opportunities. White pregnant women also had higher levels of private health insurance and less dependency on government programmes for access to healthcare. Results from the regressions indicated that Black pregnant women were less likely to be married (OR = 0.01), less likely to have higher income levels (OR = 0.31) and less likely to be employed (OR = 0.52). However, Black pregnant women were more likely to be younger (OR = 1.82). For the health‐eroding behaviours, Black pregnant women were less likely to smoke (OR = 0.53) and use alcohol (0.52). After assessing the SES Household‐level stressors (access to healthcare), Black pregnant women were more likely to have Medicaid/CHIP (OR = 3.21) and health coverage through government assistant programmes (OR = 3.80); however, less likely to have private health insurance (OR = 0.38). There are differences in risk factors of adverse pregnancy outcomes between White and Black pregnant women based on measures of individual level/social stressors, institutionalised racism, health behaviours and access to care. [ABSTRACT FROM AUTHOR]

Objectives: To estimate the incidence and risk of complications associated with a fetal scalp electrode and to determine whether its application in the setting of operative vaginal delivery was associated with increased neonatal morbidity.Design: Retrospective cohort study.Setting: Twelve clinical centers with 19 hospitals across nine American Congress of Obstetricians and Gynecologists US districts.Population: Women in the USA.Methods: We evaluated 171 698 women with singleton deliveries ≥ 23 weeks of gestation in a secondary analysis of the Consortium on Safe Labor study between 2002 and 2008, after excluding conditions that precluded fetal scalp electrode application such as prelabour caesarean delivery. Secondary analysis limited to operative vaginal deliveries ≥ 34 weeks of gestation was also performed.Main Outcome Measures: Incidences and adjusted odds ratios with 95% confidence intervals of neonatal complications were calculated, controlling for maternal characteristics, delivery mode and pregnancy complications.Results: Fetal scalp electrode was used in 37 492 (22%) of deliveries. In non-operative vaginal delivery, fetal scalp electrode was associated with increased risk of injury to scalp due to birth trauma (1.2% versus 0.9%; adjusted odds ratios 1.62; 95% confidence intervals 1.41-1.86) and cephalohaematoma (1.0% versus 0.9%; adjusted odds ratios 1.57; 95% confidence intervals 1.36-1.83). Neonatal complications were not significantly different comparing fetal scalp electrode with vacuum-assisted vaginal delivery and vacuum-assisted vaginal delivery alone or comparing fetal scalp electrode with forceps-assisted vaginal delivery and forceps-assisted vaginal delivery alone.Conclusions: We found increased neonatal morbidity with fetal scalp electrode though the absolute risk was very low. It is possible that these findings reflect an underlying indication for its use. Our findings support the use of fetal scalp electrodes when clinically indicated.Tweetable Abstract: Neonatal risks associated with fetal scalp electrode use were low (injury to scalp 1.2% and cephalohaematoma 1.0%). [ABSTRACT FROM AUTHOR]

The article discusses the World Health Organization (WHO) reporting that the maternal mortality ratio is at least four times higher in the U.S. than leading European countries, with causes such as cardiovascular disease and stroke. Topics discussed include realigning Rhode Island Maternal Mortality Review Committee with recommendation of the Centers for Disease Control and Prevention (CDC), and the role of the Rhode Island Department of Health (DOH).

Background: Reproductive life planning has become an essential element in programs designed to promote preconceptional care and increase utilization of effective contraceptive methods. This study sought to determine if women have reproductive life plans and what they think women should do to prepare for pregnancy. Materials and Methods: Indigent English-speaking women in a family planning clinic were asked individually about their reproductive life plans, preparations needed for pregnancy, and the relative health risks of pregnancy compared to oral contraceptives. Results: Of the 250 women interviewed, only 53% were confident how many pregnancies they wanted in their lifetime; 46.3% were confident about when they desired their next pregnancy. Although virtually all agreed that women should plan and prepare for pregnancy, only 25.8% of women mentioned that any medical preparations were necessary before pregnancy. Women's choice of contraception did not match their pregnancy intentions. Over 60% of women thought that the pill was at least as hazardous to a woman's health as pregnancy. Conclusions: In this study, many English-speaking women had no distinct reproductive life plans. Most did not think that medical preparations are needed before pregnancy. New approaches may be useful to more productively identify women who need individualized counseling, preconception care, and/or more effective contraceptive methods. [ABSTRACT FROM AUTHOR]

Suicide is one of the leading causes of maternal mortality in many countries, but little is known about the epidemiology of suicide and suicidal behavior among pregnant women in the USA. We sought to examine trends and provide nationally representative estimates for suicidal behavior (including suicidal ideation and suicide and self-inflicted injury) among pregnant women from 2006 to 2012 in the USA. Pregnant women aged 12-55 years were identified through pregnancy- and delivery-related hospitalization records from the National (Nationwide) Inpatient Sample. Suicidal behavior was identified by the International Classification of Diseases, Ninth Revision, Clinical Modification codes. Annual, nationwide estimates and trends were determined using discharge and hospital weights. The prevalence of suicidal ideation more than doubled from 2006 to 2012 (47.5 to 115.0 per 100,000 pregnancy- and delivery-related hospitalizations), whereas the prevalence of suicide and self-inflicted injury remained stable. Nearly 10 % of suicidal behavior occurred in the 12-18-year group, showing the highest prevalence per 100,000 pregnancy- and delivery-related hospitalizations (158.8 in 2006 and 308.7 in 2012) over the study period. For suicidal ideation, blacks had higher prevalence than whites; women in the lowest income quartile had the highest prevalence. Although the prevalence of suicidal behavior was higher among hospitalizations with depression diagnoses, more than 30 % of hospitalizations were for suicidal behavior without depression diagnoses. Our findings highlight the increasing burden and racial differences in suicidal ideation among US pregnant women. Targeted suicide prevention efforts are needed for high-risk pregnant women including teens, blacks, and low-income women. [ABSTRACT FROM AUTHOR]

Listeriosis and toxoplasmosis are foodborne illnesses that can have long-term consequences when contracted during pregnancy. Listeriosis is implicated in stillbirth, preterm labor, newborn sepsis, and meningitis, among other complications. Toxoplasmosis is associated with blindness, cognitive delays, seizures, and hearing loss, among other significant disabilities. Healthcare providers who understand the fundamentals of Listeria and Toxoplasma infection will have the tools to identify symptoms and high-risk behaviors, educate women to make safer decisions, and provide anticipatory guidance if a pregnant woman would become infected with either of these foodborne illnesses. [ABSTRACT FROM AUTHOR]

Background The life course perspective suggests a pathway may exist among maternal exposure to stressful life events prior to conception (PSLEs), infant birth weight and subsequent offspring health, whereby PSLEs are part of a 'chains-of-risk' that set children on a certain health pathway. No prior study has examined the link between PSLEs and offspring health in a nationally representative sample of US mothers and their children. We used longitudinal, nationally representative data to evaluate the relation between maternal exposure to PSLEs and subsequent measures of infant and toddler health, taking both maternal and obstetric characteristics into account. Methods We examined 6900 mother-child dyads participating in 2 waves of the nationally representative Early Childhood Longitudinal Study-Birth Cohort (n=6900). Infant and toddler health outcomes assessed at 9 and 24 months included overall health status, special healthcare needs and severe health conditions. Adjusted path analyses examined associations between PSLEs, birth weight and child health outcomes. Results In adjusted analyses, PSLEs increased the risk for very low birth weight (VLBW, <1500 g), which, in turn, predicted poor health at both 9 and 24 months of age. Path analyses demonstrated that PSLEs had small indirect effects on children's subsequent health that operated through VLBW. Conclusions Our analysis suggests a chains-of-risk model in which women's exposure to PSLEs increases the risk for giving birth to a VLBW infant, which, in turn, adversely affects infant and toddler health. Addressing women's preconception health may have important downstream benefits for their children, although more research is needed to replicate these findings. [ABSTRACT FROM AUTHOR]

The author discusses fertility treatment policies that could help enhance affordability and outcomes and benefit both patients and the public. Topics include the practice of in vitro fertilisation (IVF) which is associated with increased risk of multifetal gestational, the high cost of fertility treatment without insurance coverage, and how fertility treatment policy in the U.S. through insurance coverage and legislative efforts could help reduce multiple births and improve birth outcomes.

Evaluate homelessness during pregnancy as a unique, time-dependent risk factor for adverse birth outcomes. 9,995 mothers of children <48 months old surveyed at emergency departments and primary care clinics in five US cities. Mothers were classified as either homeless during pregnancy with the index child, homeless only after the index child's birth, or consistently housed. Outcomes included birth weight as a continuous variable, as well as categorical outcomes of low birth weight (LBW; <2,500 g) and preterm delivery (<37 weeks). Multiple logistic regression and adjusted linear regression analyses were performed, comparing prenatal and postnatal homelessness with the referent group of consistently housed mothers, controlling for maternal demographic characteristics, smoking, and child age at interview. Prenatal homelessness was associated with higher adjusted odds of LBW (AOR 1.43, 95 % CI 1.14, 1.80, p < 0.01) and preterm delivery (AOR 1.24, 95 % CI 0.98, 1.56, p = 0.08), and a 53 g lower adjusted mean birth weight ( p = 0.08). Postnatal homelessness was not associated with these outcomes. Prenatal homelessness is an independent risk factor for LBW, rather than merely a marker of adverse maternal and social characteristics associated with homelessness. Targeted interventions to provide housing and health care to homeless women during pregnancy may result in improved birth outcomes. [ABSTRACT FROM AUTHOR]

We utilized an updated nationally representative database to examine associations between maternal age and prevalence of maternal morbidity during complications of labor and delivery. We used hospital inpatient billing data from the 2009 United States Nationwide Inpatient Sample, part of the Healthcare Cost and Utilization Project. To determine whether the likelihood that maternal morbidity during complications of labor and delivery differed among age groups, separate logistic regression models were run for each complication. Age was the main independent variable of interest. In analyses that controlled for demographics and clinical confounders, we found that complications with the highest odds among women, 11-18 years of age, compared to 25-29 year old women, included preterm delivery, chorioamnionitis, endometritis, and mild preeclampsia. Pregnant women who were 15-19 years old had greater odds for severe preeclampsia, eclampsia, postpartum hemorrhage, poor fetal growth, and fetal distress. Pregnant women who were ≥35 years old had greater odds for preterm delivery, hypertension, superimposed preeclampsia, severe preeclampsia, and decreased risk for chorioamnionitis. Older women (≥40 years old) had increased odds for mild preeclampsia, fetal distress, and poor fetal growth. Our findings underscore the need for pregnant women to be aware of the risks associated with extremes of age so that they can watch for signs and symptoms of such complications. [ABSTRACT FROM AUTHOR]

Family planning and reproductive health services are uniquely impacted by policy and politics in the United States. Recent years have witnessed an unprecedented number of abortion restrictions, and research funding has decreased in related areas. Despite this, both the science and the implementation of improved family planning and abortion methods have progressed in the past decade. This article reviews the current state of family planning, as well as technologies and patient care opportunities for the future. [ABSTRACT FROM AUTHOR]

The article discusses various factors related to the cesarean delivery (CD in the U.S. including its increased rate, its impact on postpartum hemorrhage and decreased use of operative vaginal delivery. As mentioned, rate of CD has increased to 60 percent from 20 percent in the U.S. Other topics discussed includes improved neonatal results of CD, amnioinfusion and trial of labor after cesarean (TOLAC).

Maternal age at first pregnancy and age-related infertility are steadily increasing, and the demand for assisted reproductive technologies (ART) to treat age-related infertility is also on the rise. The latest registry findings from Europe and the United States show that the meager results of ART in women above 43 years of age have not improved much over the past 10 years. The latest evidence shows that the demand for oocyte donation (OD) is steadily increasing. Contrary to previous belief-attributing increased perinatal complications in OD recipients to advanced maternal age and multifetal pregnancy-accumulating evidence from the past few years suggests that OD itself is a significant and independent risk factor for pregnancy complications, mostly for pre-eclampsia. The increased rate of chronic maternal disease and medical complications in pregnancy observed in advanced maternal age, coupled with the growing demand for OD, with its independent association with pre-eclampsia, create an urgent need to adopt a clear policy taking these risks into account. We present recent evidence showing that OD is an independent risk factor for pre-eclampsia and suggest recommendations for women approaching OD treatment in advanced age. [ABSTRACT FROM AUTHOR]

Objectives. To investigate the effects of precursor chemical regulation aimed at reducing cocaine production on cocaine-related maternal and newborn hospital stays in the United States. Methods. We analyzed monthly counts of maternal and neonatal stays from January 2002 through December 2013 by using a quasi-experimental interrupted time series design. We estimated the preregulation linear trend, postregulation change in linear trend, and abrupt change in level. Results. The number of monthly cocaine-related maternal and neonatal stays decreased by 221 and 128 stays, respectively, following the cocaine precursor regulation change. We also observed a further decline in per-month maternal and neonatal stays of 18 and 8 stays, respectively. Conclusions. A supply-side disruption in the United States cocaine market was associated with reduced hospital stays for 2 vulnerable populations: pregnant women and newborns. Results support findings that federal precursor regulation can positively reduce cocaine availability in the United States. [ABSTRACT FROM AUTHOR]

Approaches for analyzing the risks of adverse pregnancy outcomes have been the source of much debate and many publications. Much of the problem, in our view, is the conflation of time at risk with gestational age at birth (or birth weight, a proxy for gestational age). We consider the causal questions underlying such analyses with the help of a generic directed acyclic graph. We discuss competing risks and populations at risk in the context of appropriate numerators and denominators, respectively. We summarize 3 different approaches to quantifying risks with respect to gestational age, each of which addresses a distinct etiological or prognostic question (i.e., cumulative risk, prospective risk, or instantaneous risk (hazard)) and suggest the appropriate denominators for each. We show how the gestational age–specific risk of perinatal death (PND) can be decomposed as the product of the gestational age–specific risk of birth and the risk of PND conditional on birth at a given gestational age. Finally, we demonstrate how failure to consider the first of these 2 risks leads to selection bias. This selection bias creates the well-known crossover paradox, thus obviating the need to posit common causes of early birth and PND other than the study exposure. [ABSTRACT FROM PUBLISHER]

Ethnic minorities living in the US have lower utilization and access to prenatal care, resulting in an increased risk of adverse pregnancy outcomes. The present study examines utilization of prenatal care, perceived pregnancy related health, and perceived risk of adverse pregnancy outcomes among Arab women living in the USA cross-sectional study was conducted, consisting of a convenience sample of 170 Arab women. A structured questionnaire was administered by a face-to-face or telephone interview. Multivariable logistic regression was used to calculate adjusted Odds Ratios and 95% Confidence Intervals, controlling for potential confounders. All study participants had received prenatal care during their most recent pregnancy, and 90% had their first prenatal care visit before the 12th gestational week. The Arab women who were older ( P = 0.02), those with 12 years of education or less ( P = 0.002), and those who had lived in the US more than five years ( P = 0.0002) were more likely to report four or more pregnancies. In addition, more than one-third of the women reported having experienced a miscarriage (35.4%), which was significantly associated with gravida status ( P < 0.001). An association between perceived susceptibility for spontaneous abortion and stillbirth was also demonstrated ( P < 0.0001). Although Arab women reported good coverage of prenatal care, they perceived themselves as susceptible for several pregnancy complications and adverse pregnancy outcomes. Clinical guidelines for prenatal care to Arab women should therefore focus on their high parity and likelihood of miscarriages, in an attempt to reduce their risk of adverse pregnancy outcomes. [ABSTRACT FROM AUTHOR]

Background: Severe maternal morbidity (SMM) is a serious health condition potentially resulting in death without immediate medical attention, including organ failure, obstetric shock and eclampsia. SMM affects 20 000 US women every year; however, few population-based studies have examined SMM risk factors. Methods: We conducted a population-based case-control study linking birth certificate and hospital discharge data from Washington State (1987-2008), identifying 9485 women with an antepartum, intrapartum or postpartum SMM with ≥3-day hospitalisation or transfer from another facility and 41 112 random controls. Maternal age, race, smoking during pregnancy, parity, pre-existing medical condition, multiple birth, prior caesarean delivery, and body mass index were assessed as risk factors with logistic regression to estimate odds ratios (OR) and 95% confidence intervals [CI], adjusted for education and delivery payer source. Results: Older women (35-39: OR 1.65 [CI 1.52, 1.79]; 40+: OR 2.48 [CI 2.16, 2.81]), non-White women (Black: OR 1.82 [CI 1.64, 2.01]; American Indian: OR 1.52 [CI 1.32, 1.73]; Asian/Pacific Islander: OR 1.30 [CI 1.19, 1.41]; Hispanic: OR 1.17 [CI 1.07, 1.27]) and women at parity extremes (nulliparous: OR 1.83 [CI 1.72, 1.95]; parity 3+: OR 1.34 [CI 1.23, 1.45]) were at greater risk of SMM. Women with a pre-existing medical condition (OR 2.10 [CI 1.88, 2.33]), a multiple birth (OR 2.54 [CI 2.26, 2.82]) and a prior caesarean delivery (OR 2.08 [CI 1.93, 2.23]) were also at increased risk. Conclusion: The risk factors identified are not modifiable at the individual level; therefore, provider and system-level factors may be the most appropriate target for preventing SMM. [ABSTRACT FROM AUTHOR]

The article focuses on the Institute of Medicine (IOM) gestational weight gain recommendations. It states that the IOM recommendations of single standard weight gain for obese women are in question due to its basis of a non-evident theoretical relation of gestational weight gain and birth weight. It says that the recommendation was suggested to be more individualized, particular to obese women, due to complication risks pose by excessive gestational weight gain during pregnancy.

An increasing proportion of women in the US and other countries delay initiation of childbearing until their thirties. Little is known about their subsequent pregnancies, particularly with regard to pregnancy spacing. To determine interpregnancy interval (IPI) patterns, factors associated with IPI among women delaying initiation of childbearing until their thirties, and ascertain if delay in initiation of childbearing is associated with increased likelihood for short interpregnancy interval of less than 6 months. A retrospective cohort study was performed using the Missouri maternal linked file for 1978–1997, inclusive. Analysis was limited to mothers aged 20–50 years at first pregnancy, having a first and second pregnancy during the study period; the sample size included 242,559 mother–infant pairs. Analysis strategies included stratified analysis, and multivariable logistic regression. Interpregnancy interval was main outcome variable, and was grouped in seven categories: 0–5, 6–11, 12–17, 18–23, 24–59, 60–119, ≥120 months. The mean interpregnancy interval was significantly shorter for women delaying start of childbearing (≥30 years) compared to 20–29 year olds. Observed intervals are 31 (±24) months for mothers aged 20–29 years, 25 (±17) months for mothers aged 30–34 years, 21 (± 14) for 35–39 year olds, and 19 (±16) for 40–50 year olds ( P < 0.0001). A significant trend for shorter intervals was noted as maternal age at first pregnancy increased ( P < 0.0001). Factors associated with interpregnancy interval for women delaying initiation of childbearing included adverse outcome in preceding pregnancy, and low educational status. Mothers aged 35 and above at first pregnancy had increased odds for a second pregnancy following short IPI <6 months; (35–39 years OR = 1.26 95% CI 1.11–1.44; 40–50 OR = 1.91 95% CI 1.13–3.24). Mothers aged 30–34 years have lower odds for short IPI (OR = 0.93 95% CI 0.87–0.99). First time mothers aged 35 and above have higher odds of having a second pregnancy shortly after their first pregnancy. Given the increasing number of first time mothers aged 35 and above, these findings are of relevance for preconception counseling for this unique population of women. [ABSTRACT FROM AUTHOR]

BACKGROUND: Widespread residential pesticide use throughout the United States has resulted in ubiquitous, low-level pesticide exposure. The mix of active pesticide ingredients is changing in response to 2000--2001 regulations restricting use of the organophosphorus insecticides chlorpyrifos and diazinon. OBJECTIVES: We aimed to determine the impact of U.S. Environmental Protection Agency regulations on pest infestation levels, pesticide use, and pesticides measured in indoor air samples. METHODOLOGY: 511 pregnant women from inner-city New York were enrolled between 2000 and 2006. Permethrin, a pyrethroid insecticide; piperonyl butoxide (PBO), a pyrethroid synergist; chlorpyrifos; and diazinon were measured in 48-hr prenatal personal air samples. Data on pest infestation and pesticide use were collected via questionnaire. RESULTS: Eighty-eight percent of women reported using pesticides during pregnancy; 55% reported using higher-exposure pesticide applications (spray cans, pest bombs and/or professional pesticide applicators). Self-reported pest sightings and use of higher-exposure applications increased significantly after the regulations were implemented (p < 0.001). PBO, cis-, and trans-permethrin were detected in 75, 19, and 18% of personal air samples, respectively. Detection frequencies of PBO and cis- and trans-permethrin increased significantly over time (p < 0.05 controlling for potential confounders). Levels and/or detection frequencies of these compounds were significantly higher among mothers reporting use of high exposure pesticide applications (p ≤ 0.05). Chlorpyrifos and diazinon levels decreased significantly over time (p < 0.001). CONCLUSION: In this cohort, pest infestations, use of pesticides, and use of permethrin appear to increase after the residential restriction of organophosphorus insecticides. This is one of the first studies to document widespread residential exposure to PBO. [ABSTRACT FROM AUTHOR]

Objectives The accuracy of maternal morbidity estimates from hospital discharge data may be influenced by incomplete identification of deliveries. In maternal/infant health studies, obstetric deliveries are often identified only by the maternal outcome of delivery code (International Classification of Diseases code = V27). We developed an enhanced delivery identification method based on additional delivery-related codes and compared the performance of the enhanced method with the V27 method in identifying estimates of deliveries as well as estimates of maternal morbidity. Methods The enhanced and standard V27 methods for identifying deliveries were applied to data from the 1998–2004 Healthcare Cost and Utilization Project Nationwide Inpatient Sample, an annual nationwide representative survey of U.S. hospitalizations. Odds ratios (ORs) and 95% confidence intervals (CIs) from logistic regression were used to examine predictors of deliveries not identified using the V27 method. Results The enhanced method identified 958,868 (3.4%) more deliveries than the 27,128,539 identified using the V27 code alone. Severe complications including major puerperal infections (OR = 3.1, 95% CI 2.8–3.4), hysterectomy (OR = 6.0, 95% CI 5.3–6.8), sepsis (OR = 11.9, 95% CI 10.3–13.6) and respiratory distress syndrome (OR = 16.6, 95% CI 14.4–19.2) were strongly associated with deliveries not identified by the V27 method. Nationwide prevalence rates of severe maternal complications were underestimated with the V27 method compared to the enhanced method, ranging from 9% underestimation for major puerperal infections to 40% underestimation for respiratory distress syndrome. Conclusion Deliveries with severe obstetric complications may be more likely to be missed using the V27 code. Researchers should be aware that selecting deliveries from hospital stay records by V27 codes alone may affect the accuracy of their findings. [ABSTRACT FROM AUTHOR]

Health care practitioners and researchers commonly call for greater reliance on evidence as a means to achieve improvement in quality of care. Systematic reviews provide a means to accelerate the use of evidence-based clinical interventions and public health practices. The extent to which these time- and resource-intensive systematic reviews currently address critical maternal health priorities in the intrapartum period is unclear. This analysis summarises key maternal health and research priorities, maps these priorities to existing reviews, identifies gaps in the literature that can be addressed with systematic reviews, and highlights key methodological concerns in conducting systematic reviews. The analysis draws on published data on maternal morbidities and an overview of 108 systematic reviews in Medline in the past 5 years using the MeSH terms ‘Delivery, Obstetric,’ to draw the links between health priorities, research priorities, existing evidence and missing evidence. Key causes of morbidity during labour and delivery in the United States include haemorrhage, pre-eclampsia and eclampsia, obstetric trauma and infection. Analyses of maternal morbidity and mortality suggest that key concerns include racial and ethnic disparities in health outcomes and the prevention of adverse events. Systematic reviews, however, generally tend to focus on the reduction of harms associated with interventions, are frequently limited to randomised designs, and do not address issues of health disparities. The results suggest that advances in evidence-based care in maternal health require that systematic reviews address issues of prevention of adverse events, include a larger variety of study designs when necessary and pay closer attention to health disparities. [ABSTRACT FROM AUTHOR]

The article explores the complex relationship between celebrity-driven magazines and depictions of fertility at advanced reproductive ages. It mentions the use of assisted reproductive technology (ART), and pregnancy related risks associated with advanced maternal age (AMA) and also highlights an important viewpoint related to the impact of media on reproductive perceptions.

Presents a study which compared the occurrence of pregnancy-related deaths among Hispanic, Asian/Pacific Islander and American Indian/Alaska Native Women in the United States from 1991 to 1997. Reasons for pregnancy-related deaths; Calculation of pregnancy-related mortality ratios; Results and discussion.

The author discusses a study related to reproductive health outcomes in African refugee women by K. Agbemenu and colleagues. Topics discussed include ensure that African refugee women continue to have optimal reproductive outcomes; provide culturally congruent reproductive health education, including prenatal care and family planning; and monitor the health status of women in the African refugee community.

The article presents a summary of the results of a passive and active surveillance conducted by the New York City Department of Health and Mental Hygiene for cases of H1N1 infection in pregnant women in 2009. It was found that there was an increased risk for several illness and complications from infection with seasonal influenza among pregnant women. Several illustrative case reports are discussed, and an editorial note from the U.S. Centers for Disease Control and Prevention (CDC) is also presented. INSET: What is already known on this topic?.

Questions regarding sleep position safety are often posed for any OB/GYN or midwife practicing obstetrics. [ABSTRACT FROM AUTHOR]

Background: Postpartum hemorrhage is a major cause of maternal morbidity and mortality, but the association between postpartum hemorrhage and hospital length of stay has not been rigorously investigated.Objective: We explored the impact of postpartum hemorrhage on hospital length of stay and inpatient mortality, as these outcomes have both clinical and economic significance.Study Design: We performed a retrospective analysis using data from the National Inpatient Sample database during the 2012 through 2013 time period. Deliveries were classified as postpartum hemorrhage due to uterine atony, nonatonic postpartum hemorrhage, or not complicated by postpartum hemorrhage (nonpostpartum hemorrhage). Average length of stay and inpatient mortality rates were compared between groups.Results: Over the study interval, postpartum hemorrhage occurred in 3% of deliveries. Among deliveries complicated by postpartum hemorrhage, 76.6% were attributed to uterine atony and 23.4% were nonatonic. Women with nonatonic postpartum hemorrhage had the highest average length of stay (3.67 days) followed by atonic postpartum hemorrhage (2.98 days) and nonpostpartum hemorrhage (2.63 days); P < .001, all comparisons. Inpatient mortality rate of nonatonic postpartum hemorrhage over the entire study period was 104 per 100,000 compared to 019 per 100,000 for atonic postpartum hemorrhage and 3 per 100,000 for nonpostpartum hemorrhage deliveries (P < .001).Conclusion: From 2012 through 2013, women with postpartum hemorrhage experienced significantly longer length of stay and higher inpatient mortality rates than women without postpartum hemorrhage, largely attributable to nonatonic causes of postpartum hemorrhage. As hospital length of stay and inpatient mortality are important outcomes from both clinical and societal perspectives, interventions to reduce morbidity and mortality related to postpartum hemorrhage may simultaneously facilitate delivery of more cost-effective care and improve both maternal and population health. [ABSTRACT FROM AUTHOR]

In 2008 there were an estimated 259,000 people living in the USA with spinal cord injuries (SCI). The majority of these people are in their reproductive years, and over 19% are estimated to be women. Advances in medical management have allowed many women to live successfully with congenital defects or injuries resulting in SCI that even a few years ago would have been fatal. Although many of these women may be classified as 'disabled', fertility is not usually affected in SCI and many of these women desire children of their own. It is important to counsel these women regarding the range of issues related to pregnancy. These include conception issues, parenting with a disability, emotional concerns of the family, nutrition and exercise in pregnancy, risks in pregnancy, labour and delivery, postpartum care, and breastfeeding. For health-care providers it is important to know and understand your patient's disability and be able to provide the best patient-centred quality care, understanding that each patient's circumstance may be unlike any other patient. [ABSTRACT FROM AUTHOR]

The article reports a study which revealed that severe complications during and after childbirth increased significantly in the U.S. between 1998 and 2009. The researchers analyzed the rate of complications, including stroke, and kidney failure in women. Serious complications occurring during delivery included acute renal failure, shock, and need for blood transfusion; the number of cardiac surgeries also increased; poor outcomes were attributed to older maternal age and poor health.

Objective: We estimated the prevalence and patterns of herbal use among US women before and during pregnancy. Study Design: The National Birth Defects Prevention Study is an ongoing, population-based, case-control study. This analysis included 4239 women from 10 centers in the United States who delivered infants without major birth defects from 1998–2004. Results: The prevalence of reported herbal use 3 months before or during pregnancy was 10.9%. During pregnancy, prevalence was 9.4% and was highest in the first trimester. Higher prevalence was associated with age greater than 30 years and education greater than 12 years. Use varied considerably by state (5–17%). Ginger and ephedra were the most commonly reported products early in pregnancy; teas and chamomile were most commonly reported throughout pregnancy. Conclusion: Potentially 395,000 US births annually involve antenatal exposure to herbal products. Health care providers should inquire routinely about herbal use and educate patients about what little is known regarding risks of these products. [Copyright &y& Elsevier]

Objective: The objective of the study was to examine whether the risk of perinatal complications increases with increasing gestational age among term pregnancies. Study Design: This is a retrospective cohort study of low-risk women with term, singleton births in 2003 in the United States. Gestational age was subgrouped into 37, 38, 39, 40, and 41 completed weeks. Statistical comparison was performed using χ2 test and multivariable logistic regression models, with 39 weeks'' gestation as the referent. Results: There were 2,527,766 women meeting study criteria. Compared with 39 weeks, delivery at 37 or 38 weeks had lower risk of febrile morbidity but slightly higher risk of cesarean delivery. Delivery at 40 or 41 weeks was also associated with higher overall maternal morbidity. For neonates, delivery at 40 or 41 weeks had higher risk of birthweight greater than 4500 g, neonatal injury (40 weeks: adjusted odds ratio [aOR] 1.11 [95% confidence interval (CI), 1.05-1.18]; 41 weeks: aOR 1.27 [95% CI, 1.17-1.37]) and meconium aspiration (40 weeks: aOR 1.55 [95% CI, 1.43-1.69]; 41 weeks: aOR 2.12 [95% CI, 1.91-2.35]). Delivery at 37 or 38 weeks had higher risk of hyaline membrane disease (37 weeks: aOR 3.12 [95% CI, 2.90-3.38]); 38 weeks: aOR 1.30 [95% CI, 1.19-1.43]) but lower risk of meconium aspiration. Conclusion: The risk of cesarean delivery and neonatal morbidity in low-risk women increases at 40 weeks and beyond, whereas the odds of serious neonatal pulmonary disease were highest at 37 weeks. Recognition of such variation in term outcomes should lead providers to avoid iatrogenic morbidity and consider interventions to prevent complications of late-term pregnancy. [Copyright &y& Elsevier]

The article discusses findings from a study conducted by University of Texas Southwestern Medical Center researchers suggesting that pregnant women reporting abuse are at increased risk for adverse pregnancy outcomes. The researchers also tried to account for data from a previous U.S. observational study suggesting that pregnant women who do not wish to discuss domestic violence may be at greater risk for pregnancy complications and adverse infant outcomes than those who consent to such discussions.

Examines the disparities in exposure to air pollution during pregnancy in United States. Definition of high- and low-risk births using composite measure from maternal age, education, parity and marital status; Association between air quality and birth outcomes; Percentage of unadjusted odds of preterm birth and small-for-gestational age in polluted counties.

Examines the maternal smoking during pregnancy in the Family Health and Development Project (FHDP) in Chicago, Illinois. Categories of amount smoked in FHDP; Fluctuations in overall smoking status of pregnancy; Determinants of smoking fluctuation.