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Background and Objectives Methods Results Discussion and Conclusions Scientific Significance Prenatal cannabis use prevalence in the United States has increased. Relaxation of state‐level cannabis policy may be contributing to the diminished risk perception of using cannabis. The main psychoactive constituent of cannabis, delta‐9‐tetrahydrocannabinol, crosses the placenta, interacting with functional cannabinoid receptors in the fetus. Here, we assess the association between prenatal cannabis exposure (PCE) and a set of birth outcomes.Using the Michigan Archive for Research on Child Health, a prospective pregnancy cohort, we linked prenatal survey data with neonatal data from state‐archived birth records. Recruitment occurred in 23 clinics across Michigan. Pregnant participants with live birth records between October 2017 and January 2022, after exclusion for missing data on cannabis use, birth outcomes, and covariates, were included in the final analytic sample (n = 584). Analyses involved generalized linear models.An estimated 15% (95% confidence interval [CI]: 12%, 18%) of participants reported using cannabis during pregnancy. Covariate‐adjusted models revealed an association between PCE and birth size (ß = −0.3; 95% CI: −0.5, −0.003).Findings suggest a relationship between PCE and smaller birth size. Clinicians should follow guidelines outlined by the American College of Obstetricians and Gynecologists when counseling pregnant patients on cannabis use.We detected a significant association between PCE and birth size. Most studies focus only on the extremes of birth size, however, use of z‐scores allow for assessment of the sex‐specific birth weight‐for‐gestational age distribution, increasing the accuracy of detecting an effect of cannabis exposure on birth size. [ABSTRACT FROM AUTHOR]

ABSTRACT Introduction Methods Results Conclusion In the context of adverse in utero environments, the fetal brain might be preserved at the expense of other tissues. This trade‐off, brain sparing, has not been studied in the context of maternal infection. We investigated cases of maternal syphilis in the early 20th century and influenza during the 1918–1920 pandemic, in the Swiss city of Lausanne, a relatively high‐income setting. We tested the brain sparing hypothesis, that head circumference is protected at the expense of birth weight.A total of 8530 individual birth records from 1911 to 1922 from the University Maternity Hospital of Lausanne were used. We fitted generalized linear and additive linear models to explain how neonatal size varies under disease exposure.Influenza reduced head circumference and birth weight among livebirths similarly, by −0.11 and −0.14 standard deviation (SD) units respectively. Conversely, for syphilis‐exposed infants, head circumference was affected more than birth weight (−0.61 SD vs. −0.46 SD). Stillborn infants exposed to syphilis experienced a much greater reduction in head circumference (−1.92 SD) than liveborn infants. After adjustment for gestational age, these findings persisted in the case of influenza, but the effects of syphilis were reduced. Furthermore, half of syphilis‐exposed infants were born before term, suggesting that lower infant size was partly mediated by shorter gestation. Nevertheless, head circumference among stillbirths exposed to syphilis was still substantially reduced, even after adjustment for gestational age (−1.26 SD).Our findings do not support the brain sparing hypothesis. Moreover, the substantial reduction in head circumference among syphilis‐exposed fetuses might help explain why a quarter of them were stillborn. [ABSTRACT FROM AUTHOR]

Background Objective Search Strategy Selection Criteria Data Collection and Analysis Main Results Conclusion Around half of preterm births lack identifiable causes, indicating the need for further investigation to understand preterm birth risk factors. Existing studies on the intergenerational association of preterm birth showed inconsistency in effect size and direction.This systematic review and meta‐analysis aimed to review existing studies and provide comprehensive evidence on the intergenerational association of preterm births.We searched MEDLINE, Embase and Maternity and Infant Care databases, from the inception of each database to 04 April 2024.Eligibility criteria included studies that reported on women who had given birth and had recorded information about a family history of preterm birth in one or both of the child's biological parents.Data were extracted by two independent reviewers. A random‐effects model was used to compute pooled estimates using odds ratios.Sixteen eligible studies with a total of 2 271 612 mothers were included. The findings indicated a 1.44 (OR = 1.44, 95% CI: 1.34, 1.54) fold increase in odds of giving preterm births among women who were born preterm. Additionally, having a sibling born preterm (OR = 1.53, 95% CI: 1.24, 1.87) and having a partner born preterm (OR = 1.12, 95% CI: 1.01, 1.25) were associated with increased likelihood of giving preterm births among women.The study revealed that women with a family history of preterm birth face an increased risk of giving preterm births. Screening pregnant women for a family history of preterm birth is essential, with those having a positive family history requiring closer follow‐up. [ABSTRACT FROM AUTHOR]

Introduction Material and Methods Results Conclusions Cesarean section at full dilatation has been associated with an increased risk of subsequent preterm birth. We hypothesized that there may be an increased risk of miscarriage in pregnancies that follow cesarean section at full dilatation. This study aimed to determine if a first‐term (≥37 weeks) cesarean section at full dilatation is associated with an increased risk of miscarriage in the next pregnancy.A historical cohort study was conducted using routinely collected hospital data within the Aberdeen Maternity and Neonatal Databank (AMND). The population included were women who had a first‐term birth and who had a second birth recorded within the AMND. Logistic and multinomial regression was used to determine any association with miscarriage at any gestation and for early (<13 weeks gestation) and late (13–23 + 6 weeks gestation) miscarriage, with cesarean section at full dilatation defined as the exposure. Miscarriage in the second pregnancy (spontaneous loss of intrauterine pregnancy prior to 24 weeks gestation) was the primary outcome.In total, 33 452 women were included. Women who had a first cesarean section at full dilatation were no more likely to have a miscarriage at any gestation than women with all other modes of first birth (including all vaginal births, planned CS, and the first stage of labor (<10 cm dilated CS)) [adjusted OR 0.84 (0.66–1.08); p = 0.18]. There was no association with early or late miscarriage after a CSfd, though the sample size for late miscarriage was small.This is the first observational study to investigate the risk of miscarriage following first‐term CSfd. We found no association between miscarriage at any gestation following a first‐term CSfd compared to all other modes of first birth. [ABSTRACT FROM AUTHOR]

Summary Background Methods Results Conclusion Re‐exploration following caesarean birth and the associated maternal morbidity has not been investigated in the UK. Our aims were to determine the national incidence and identify the associated risk factors.We conducted a prospective observational case–control study across 194 UK consultant‐led maternity units in women whose caesarean birth was complicated by a re‐exploration. Independent factors for re‐exploration were analysed using multivariable multi‐level mixed effects logistic regression.Over the study period (1 June 2021 and 31 May 2022) 238,423 caesarean births were recorded across the UK of which 187 women underwent re‐exploration, giving an incidence of one re‐exploration per 1282 caesarean births (95%CI 1:1099–1:1471). Haemorrhage (124/187, 66.3%) and sepsis (31/187, 16.6%) were the most common findings at re‐exploration. Median (IQR [range]) time interval to re‐exploration following the caesarean birth was 1 (0–4 [0–28]) day. Mechanical ventilation was required in 34 (18.6%) women, cardiac arrest was reported in 5 (2.7%) and 3 (1.6%) women died. Independent preceding factors associated with a re‐exploration included: receipt of blood transfusion (adjusted OR (95%CI) 8.25 (2.66–25.61)); use of a general anaesthetic (adjusted OR (95%CI) 3.33 (1.61–6.88)); pre‐eclampsia (adjusted OR (95%CI) 3.27 (1.55–6.91)); black ethnicity (adjusted OR (95%CI) 3.14 (1.39–7.11)); postpartum haemorrhage (adjusted OR (95%CI) 2.82 (1.81–4.37)); use of anticoagulants or antiplatelet drugs pre‐caesarean birth (adjusted OR (95%CI) 2.26 (1.35–3.81)); and emergency caesarean birth (adjusted OR (95%CI) 1.89 (1.01–3.57)).Re‐exploration following caesarean birth in the UK is uncommon but is associated with significant maternal morbidity and mortality. These study findings will help guide informed consent and encourage appropriate surveillance of high‐risk women postpartum. [ABSTRACT FROM AUTHOR]

Background: An infant's presentation at delivery may be an early indicator of developmental differences. Non‐vertex presentation (malpresentation) complicates delivery and often leads to caesarean section, which has been associated with neurodevelopmental delays, including autism spectrum disorder (ASD). However, malpresentation could be an early sign of an existing developmental problem that is also an upstream factor from caesarean delivery. Little research has been done to investigate the association between malpresentation and ASD. Objectives: We examine the association between malpresentation at delivery and ASD and whether this association differs by gestational age. Methods: We used data from the Study to Explore Early Development (SEED), a multi‐site, case–control study of children with ASD compared to population controls. The foetal presentation was determined using medical records, birth records and maternal interviews. We defined malpresentation as a non‐vertex presentation at delivery, then further categorised into breech and other malpresentation. We used multivariable logistic regression to estimate the adjusted odds ratio (aOR) for the association between malpresentation and ASD. Results: We included 4047 SEED participants, 1873 children with ASD and 2174 controls. At delivery, most infants presented vertex (n = 3760, 92.9%). Malpresentation was associated with higher odds of ASD (aOR 1.31, 95% confidence interval [CI] 1.02, 1.68) after adjustment for maternal age, poverty level, hypertensive disorder and smoking. The association was similar for breech and other types of malpresentation (aOR 1.28, 95% CI 0.97, 1.70 and aOR 1.40, 95% CI 0.87, 2.26, respectively) and did not differ markedly by gestational age. Conclusions: Malpresentation at delivery was modestly associated with ASD. Early monitoring of the neurodevelopment of children born with malpresentation could identify children with ASD sooner and enhance opportunities to provide support to optimise developmental outcomes. [ABSTRACT FROM AUTHOR]

Objective Design Setting Population Methods Main Outcome Measures Results Conclusions To investigate the association between postpartum haemorrhage (PPH) and subsequent cardiovascular disease.Population‐based retrospective cohort study, using record linkage between Aberdeen Maternity and Neonatal Databank (AMND) and Scottish healthcare data sets.Grampian region, Scotland.A cohort of 70 904 women who gave birth after 24 weeks of gestation in the period 1986–2016.We used extended Cox regression models to investigate the association between having had one or more occurrences of PPH in any (first or subsequent) births (exposure) and subsequent cardiovascular disease, adjusted for sociodemographic, medical, and pregnancy and birth‐related factors.Cardiovascular disease identified from the prescription of selected cardiovascular medications, hospital discharge records or death from cardiovascular disease.In our cohort of 70 904 women (with 124 795 birth records), 25 177 women (36%) had at least one PPH. Compared with not having a PPH, having at least one PPH was associated with an increased risk of developing cardiovascular disease, as defined above, in the first year after birth (adjusted hazard ratio, aHR 1.96; 95% confidence interval, 95% CI 1.51–2.53; p < 0.001). The association was attenuated over time, but strong evidence of increased risk remained at 2–5 years (aHR 1.19, 95% CI 1.11–1.30, P < 0.001) and at 6–15 years after giving birth (aHR 1.17, 95% CI 1.05–1.30, p = 0.005).Compared with women who have never had a PPH, women who have had at least one episode of PPH are twice as likely to develop cardiovascular disease in the first year after birth, and some increased risk persists for up to 15 years. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Previous research has linked prenatal maternal infections to later childhood developmental outcomes and socioemotional difficulties. However, existing studies have relied on retrospectively self‐reported survey data, or data on hospital‐recorded infections only, resulting in gaps in data collection.This study used a large linked administrative health dataset, bringing together data from birth records, hospital records, prescriptions and routine child health reviews for 55,856 children born in Greater Glasgow & Clyde, Scotland, 2011–2015, and their mothers. Logistic regression models examined associations between prenatal infections, measured as both hospital‐diagnosed prenatal infections and receipt of infection‐related prescription(s) during pregnancy, and childhood developmental concern(s) identified by health visitors during 6‐8 week or 27‐30 month health reviews. Secondary analyses examined whether results varied by (a) specific developmental outcome types (gross‐motor‐skills, hearing‐communication, vision‐social‐awareness, personal‐social, emotional‐behavioural‐attention and speech‐language‐communication) and (b) the trimester(s) in which infections occurred.After confounder/covariate adjustment, hospital‐diagnosed infections were associated with increased odds of having at least one developmental concern (OR: 1.30; 95% CI: 1.19–1.42). This was broadly consistent across all developmental outcome types and appeared to be specifically linked to infections occurring in pregnancy trimesters 2 (OR: 1.34; 95% CI: 1.07–1.67) and 3 (OR: 1.33; 95% CI: 1.21–1.47), that is the trimesters in which foetal brain myelination occurs. Infection‐related prescriptions were not associated with any clear increase in odds of having at least one developmental concern after confounder/covariate adjustment (OR: 1.03; 95% CI: 0.98–1.08), but were associated with slightly increased odds of concerns specifically related to personal‐social (OR: 1.12; 95% CI: 1.03–1.22) and emotional‐behavioural‐attention (OR: 1.15; 95% CI: 1.08–1.22) development.Prenatal infections, particularly those which are hospital‐diagnosed (and likely more severe), are associated with early childhood developmental outcomes. Prevention of prenatal infections, and monitoring of support needs of affected children, may improve childhood development, but causality remains to be established. [ABSTRACT FROM AUTHOR]

Objective: To describe utilization of prenatal care and outcomes of low birth weight and preterm birth among adolescent births in Mexico. Methods: We used birth certificate data and included live births to individuals 10–24 years, 2008–2019. Our outcomes were binary measures of adequate prenatal care, low birth weight, and preterm birth. We compared adolescents (10–14 years, 15–16, and 17–19) to those 20–24 years. We included individual‐, clinical‐, and municipality‐level variables, used multivariable logistic regression, and calculated adjusted predicted probabilities. We also tested whether receipt of prenatal care moderated the relationship of age with preterm birth and low birth weight. Results: We included a total of 12 106 710 births to women 10–24 years. The adjusted predicted probability of adequate prenatal care increased with age: 56.07% (95% CI 55.82–56.31%) adjusted probability among adolescents 10–14 years compared with 65.51% (95% CI 65.48%–65.55%) among individuals 20–24 years. Receipt of adequate prenatal care in part mitigated disparities in preterm birth and low birthweight across all age groups: 7.30% (95% CI 7.17%–7.43%) adjusted probability of delivering a preterm infant among those 10–14 years who received adequate prenatal care compared with 9.37% (95% CI 9.20%–9.53%) among those 10–14 years without adequate prenatal care. Conclusion: In Mexico, adolescent pregnancies are associated with inadequate prenatal care as well as higher odds of preterm delivery and low birth weight. Youngest adolescents (10–14 years) have the highest probability of adverse outcomes. Adequate prenatal care may help partially mitigate disparities in poor perinatal outcomes. Synopsis: In Mexico, adolescent pregnancies have higher odds of prematurity and low birthweight. Adequate prenatal care may partially mitigate these disparities. [ABSTRACT FROM AUTHOR]

Background: Poland has one of the highest cesarean birth (CB) rates in Europe. For this study, we used the Robson Ten‐Group Classification System (TGCS) to analyze trends in the induction and CB rates in one hospital in Poland over a period of 11 years. We compare these trends with changes in National Legislative and Medical Guidelines introduced during this time that were aimed at lowering rates of unnecessary medical interventions. Methods: We conducted a retrospective study including all births after 24 weeks' gestation between 2010 and 2020 from one tertiary hospital (n = 66,716 births). After the deletion of records with missing data, 66,678 births were included in the analysis. All births were classified according to the Robson TGCS. The size, CB rate, and contribution of each group for every year were calculated. Linear regression analyses were used to analyze trends over time. Results: The total CB rate varied from 29.6% to 33.0% during the study period, with a linear increase of 0.045 percentage points annually (R2 = 0.021; F(1) = 0.189; p = 0.674). This study was considerably lower than the total CB rate for Poland, which rose from 33.9% in 2010 to 45.1% in 2020, increasing at a rate of 1.13 percentage points per year (R2 = 0.93; F(1) = 61.88; p < 0.001). Induction rates among both nulliparous (R1 + R2) and multiparous (R3 + R4) women at term also increased. Study groups R5 (previous cesarean birth), R2 (nulliparous in induced or prelabor cesarean delivery), and R1 (nulliparous women at term with single cephalic pregnancy in spontaneous labor) were the highest contributors to the overall CB rate. The greatest decrease in the CB rate was detected in group R5b (more than one previous CB). None of the groups showed statistically significant increases in CB rates over the study period. Conclusions: The CB rate in the hospital where the study was conducted was considerably lower than the total CB rate in Poland. When compared with countries with similar CB rates, group R2b (women with nulliparous, prelabor cesarean birth) in our study was considerably larger. More comparisons across different hospital settings in Poland are needed. However, as hospitals are not encouraged to routinely collect the data needed to construct TGCS, such comparisons are very difficult to conduct. [ABSTRACT FROM AUTHOR]

Aim: To evaluate umbilical arterial lactate concentrations after spontaneous vaginal delivery and after elective Cesarean delivery, and to study the simultaneous effects of maternal and obstetric variables in high lactate levels in vaginally delivered healthy term singletons. Methods: The birth register study included information about the umbilical artery lactate values and clinical perinatal data from 7723 women and their singleton newborns (7301 spontaneous vaginal and 422 elective cesareans) from Kuopio University Hospital, Finland. High lactate levels were evaluated more extensively among healthy term neonates (N = 6541), to evaluate high levels after normal vaginal labors. Results: The mean lactate level was significantly lower after elective cesarean compared to vaginal delivery (2.42 [0.94] vs. 3.56 [1.62] mmol/l; p < 0.0001). Consequently, the 90th percentile limit values were 3.60 and 5.80 mmol/L. Among healthy term newborns born vaginally, higher lactate values (≥5.80 mmol/L) were independently associated with a longer duration of the active second stage of labor (ORs 1.91–10.97) and duration of ruptured fetal membranes (ORs 1.36–2.46), higher gestational age at birth (ORs 1.41–1.86), null parity (OR 2.17), maternal infection (OR 1.81) and short maternal stature (OR 1.45). We report 90th/95th limits for umbilical arterial lactate values in relation to the various durations of labors for term newborns who are delivered by the vaginal route. Conclusions: Even though the high umbilical lactate levels may indicate serious birth asphyxia, levels after vaginal birth reflect the physiological stress and subclinical transient asphyxia frequently seen in normal vaginal deliveries. [ABSTRACT FROM AUTHOR]

Birth registration, especially the birth certificate, is consistently framed as something which has always operated to document a person's parents and their (biogenetic) 'origins'. This framing has become more prominent in recent years with the rise in (often queer) families challenging how law should register their families, often being unsuccessful. Analysing the history of birth registration, though, suggests this framing of birth registration is inaccurate. It is only in recent years that birth registration has supposedly taken on a new (or additional) policy aim of facilitating parent‐child relationships. This policy also arguably facilitates a particular type of relationship and trans‐parent families are focused upon as an example of where such facilitation does not occur. Through documenting the recent resurgence of interest in birth registration, this article aims to clarify the history and purpose(s) of birth registration showing how many assumptions surrounding the function of birth registration are misguided, and to open up discussion as to what its legal purpose(s) should be. [ABSTRACT FROM AUTHOR]

Background: Systematically recorded smoking data are not always available in vital statistics records, and even when available it can underestimate true smoking rates. Objective: To develop a prediction model for maternal tobacco smoking in late pregnancy based on birth certificate information using a combination of self‐ or provider‐reported smoking and biomarkers (smoking metabolites) in neonatal blood spots as the alloyed gold standard. Methods: We designed a case–control study where childhood cancer cases were identified from the California Cancer Registry and controls were from the California birth rolls between 1983 and 2011 who were cancer‐free by the age of six. In this analysis, we included 894 control participants and performed high‐resolution metabolomics analyses in their neonatal dried blood spots, where we extracted cotinine [mass‐to‐charge ratio (m/z) = 177.1023] and hydroxycotinine (m/z = 193.0973). Potential predictors of smoking were selected from California birth certificates. Logistic regression with stepwise backward selection was used to build a prediction model. Model performance was evaluated in a training sample, a bootstrapped sample, and an external validation sample. Results: Out of seven predictor variables entered into the logistic model, five were selected by the stepwise procedure: maternal race/ethnicity, maternal education, child's birth year, parity, and child's birth weight. We calculated an overall discrimination accuracy of 0.72 and an area under the receiver operating characteristic curve (AUC) of 0.81 (95% confidence interval [CI] 0.77, 0.84) in the training set. Similar accuracies were achieved in the internal (AUC 0.81, 95% CI 0.77, 0.84) and external (AUC 0.69, 95% CI 0.64, 0.74) validation sets. Conclusions: This easy‐to‐apply model may benefit future birth registry‐based studies when there is missing maternal smoking information; however, some smoking status misclassification remains a concern when only variables from the birth certificate are used to predict maternal smoking. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the performance of different approaches for identifying live births using Transformed Medicaid Statistical Information System Analytic Files (TAF). Data Sources: The primary data source for this study were TAF inpatient (IP), other services (OT), and demographic and eligibility files. These data contain administrative claims for Medicaid enrollees in all 50 states and the District of Columbia from January 1, 2018 to December 31, 2018. Study Design: We compared five approaches for identifying live birth counts obtained from the TAF IP and OT data with the Centers for Disease Control and Prevention (CDC) Natality data—the gold standard for birth counts at the state level. Data Collection/Extraction Methods: The five approaches used varying combinations of diagnosis and procedure, revenue, and place of service codes to identify live births. Approaches 1 and 2 follow guidance developed by the Centers for Medicare and Medicaid Services (CMS). Approaches 3 and 4 build on the approaches developed by CMS by including all inpatient hospital claims in the OT file and excluding codes related to delivery services for infants, respectively. Approach 5 applied Approach 4 to only the IP file. Principal Findings: Approach 4, which included all inpatient hospital claims in the OT file and excluded codes related to infants to identify deliveries, achieved the best match of birth counts relative to CDC birth record data, identifying 1,656,794 live births—a national overcount of 3.6%. Approaches 1 and 3 resulted in larger overcounts of births (20.5% and 4.5%), while Approaches 2 and 5 resulted in undercounts of births (−3.4% and −6.8%). Conclusions: Including claims from both the IP and OT files, and excluding codes unrelated to the delivery episode and those specific to services rendered to infants improves accuracy of live birth identification in the TAF data. [ABSTRACT FROM AUTHOR]

Background: Fetal alcohol syndrome (FAS) can have adverse effects on health outcomes throughout the life course. Adults with FAS have an increased risk of chronic and infectious diseases. Although these conditions can affect reproductive health, few have described perinatal outcomes among individuals with an FAS diagnosis. Methods: We analyzed data from the Study of Mothers and Infants, an administrative birth cohort derived from California birth certificates linked with a hospital discharge database. The cohort consisted of 7.3 million singleton, live births between 2005 and 2021. FAS was identified by International Classification of Diseases (ICD) codes in maternal hospital discharge records. Pregnancy and birth outcomes were captured via ICD codes in maternal or infant records. We performed descriptive analyses for pregnancy and birth outcomes by maternal FAS diagnosis. Results: There were 35 babies born to 30 individuals with an FAS diagnosis between 2005 and 2021 (0.5/100,000 live births). The prevalence of births to individuals with an FAS diagnosis increased over the period. Individuals with an FAS diagnosis were more likely to identify as non‐Hispanic White, or "other/multiple" race, and less likely to be Hispanic than those without FAS. They were also more likely to be publicly insured and less than 18 years old. Birthing individuals with FAS were also more likely to use nicotine during pregnancy and to have diagnoses of mental health disorders, epilepsy, substance use disorders, preexisting or gestational hypertension, and sexually transmitted infections or other infections complicating pregnancy. Infants of individuals with FAS were more likely to be born prematurely or small for gestational age and be admitted to the neonatal intensive care unit. Conclusions: These findings highlight the need for improved recognition of FAS among birthing people. The results suggest that individuals with FAS would benefit from early and sustained medical care prior to pregnancy to optimize perinatal outcomes. [ABSTRACT FROM AUTHOR]

A mobile phone app was used by 59 veterinary practitioners to collect case histories and images of 191 cattle with congenital defects distributed nationally over a 3‐year period. The majority of cases were recorded during the spring calving season (57.6%) in pluriparous dairy dams. The majority of calves were recorded at birth or within the first week (66.5%) in singletons born at full‐term. On the majority of farms (75.9%), this was the only congenitally deformed bovine recorded up to that point in the year and on the majority of farms, there were no congenitally deformed cattle recorded in the previous 5 years. The majority of congenital defects (83.5%) were recorded in the musculoskeletal or digestive systems. The three most commonly recorded individual defects were intestinal atresia (24.1%), schistosomus reflexus (20.4%) and ankylosis (6.8%); multiple defects were recorded in 13.1% of cases. These findings highlight the relatively high prevalence of intestinal atresia and schistosomus reflexus in calves attended by veterinary practitioners, which warrants implementation of preventive measures. The project highlights the potential benefits of veterinary‐practitioner apps to detect changing trends in endemic, or the emergence of novel, congenital or other conditions. [ABSTRACT FROM AUTHOR]

This work contributes to the current understanding of the heterogeneous impact of the Covid‐19 pandemic on fertility. Using more than 36.4 million birth and death records for Brazil and Colombia (2015–2021), we document state‐level correlations between the intensity of the pandemic, measured by the current and 9‐month lagged excess mortality, and the observed number of births relative to a Covid‐19‐free hypothetical scenario. We disaggregate these correlations according to maternal age and years of schooling to test the hypothesis that the influence of the Covid‐19 pandemic on births interacted with pre‐existing forms of social inequality. Results from multivariate linear models suggest that the association between the intensity of the pandemic and the relative number of births was negative for women with at least 8 years of schooling, while it was positive or null for women with fewer years of education. This result means that in subnational areas severely hit by the Covid‐19 pandemic, women with few years of schooling did not delay fertility as most women potentially did. These results suggest that disadvantaged groups in Latin America and potentially in other contexts may suffer more acutely the consequences of the Covid‐19 pandemic, which has been largely neglected by studies that assume homogeneous impacts of Covid‐19 on population dynamics. [ABSTRACT FROM AUTHOR]

Background: The study aims to assess agreement between data obtained from interviews with postpartum women and their health records about labor and birth characteristics, newborn care, and reasons for cesarean birth. Methods: The present study analyzes the Birth in Brazil study dataset, a nationwide hospital‐based survey that included 23,894 postpartum women. Reliability was assessed using kappa coefficients and 95% confidence intervals. We also calculated the proportion of specific agreement: the observed proportion of positive agreement (Ppos) and the observed proportion of negative agreement (Pneg). Results: In terms of labor and birth characteristics, more significant discrepancies in prevalence were observed for fundal pressure (1.4%–42.6%), followed by amniotomy, and augmentation. All of these variables were reported more frequently by women. Reliability was nearly perfect only for mode of delivery (kappa 0.99–1.00, Ppos and Pneg >99.0%). Higher discrepancies in reasons for cesarean prevalence were observed for previous cesarean birth (CB) (3.9%–10.4%) and diabetes mellitus (0.5%–8.5%). Most kappa coefficients for CB reasons were moderate to substantial. Lower coefficients were seen for diabetes mellitus, induction failure, and prelabor rupture of membranes and Pneg was consistently higher than Ppos. Discussion: Our findings raise relevant questions about the quality of information shared with women during and after the process of care for labor and birth, as well as the information recorded in medical charts. Not having access to full information about their own health status at birth may impair women's health promotion behaviors or clear disclosure of risk factors in future interactions with the healthcare system. [ABSTRACT FROM AUTHOR]

Premise: There is mounting evidence that age matters in plant demography, but also indications that relationships between age and demographic rates may vary significantly among species. Age‐based plant demographic data, however, are time‐consuming to collect and still lacking for most species, and little is known about general patterns across species or what may drive differences. Methods: We used individual birth and death records for 12 Rhododendron species from botanic gardens and conducted Bayesian survival trajectory analyses to assess how mortality changed with age. We calculated the demographic measures of aging rate, life‐span equality, and life expectancy for each species, and assessed their relationships with the climatic conditions at species' sites of ancestral origin and with taxonomic group (subgenus). Results: We found substantial among‐species variation in survival trajectories, with mortality increasing, decreasing, or remaining constant with advancing age. Moreover, we found no relationships between demographic measures and ancestral climatic conditions but there were statistically significant differences among taxonomic groups in the rate of change in mortality with age (aging rate). Conclusions: We conclude that demographic consequences of aging can differ qualitatively, even among species in the same genus. In addition, taxonomic trends in aging rates indicate they may be genetically determined, though evolutionary drivers are still unclear. Furthermore, we suggest there is untapped potential in using botanic garden records in future studies on plant life history. [ABSTRACT FROM AUTHOR]

This is a first focused examination of age misreporting in military recruitment. We take advantage of an original dataset comprised of New Zealand military personnel records in the Second Boer War matched with birth historical records. First, we find that age misrepresentation is common: about one third of soldiers on our dataset misreport their ages. Second, we find that soldiers the estimated age‐specific mean heights do not change significantly when we change from using reported ages to using true ages. Researchers can prioritise the investigation of true ages on those reporting to be 21 or younger. [ABSTRACT FROM AUTHOR]

Purpose: Closure of rural Labor & Delivery (L&D) units can impact timely access to hospital‐based obstetrical care. Iowa has lost over a quarter of its L&D units in the previous decade. Assessing the effect of these closures on prenatal care in those rural communities is important to understanding the full effect of unit closures on maternal health care. Methods: Using birth certificate data in Iowa from 2017 to 2019, the initiation of prenatal care and adequacy of prenatal visits were assessed for 47 rural counties in Iowa. Of these, 7 experienced a closure of the only L&D unit between 1/1/2018 and 1/1/2019. The impact of these closures is modeled for all birthing parents and compared for Medicaid versus non‐Medicaid recipients. Findings: All 7 counties that experienced the loss of their only L&D unit continued to have prenatal care services available. Experiencing a closure of an L&D unit was associated with a lower likelihood of overall adequate prenatal care but not significantly associated with a lower rate of first‐trimester prenatal care utilization. Among Medicaid recipients of the communities where an L&D unit closed, there was an association of closure with both a lower likelihood of adequate prenatal care and entry to prenatal care after the first trimester. Conclusions: Utilization of prenatal care is lower in rural communities following L&D unit closure, especially among Medicaid recipients. This suggests that the overall maternal health systems were disrupted by the closure of the L&D unit, impacting the utilization of services that remained available to the community. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effect of maternal characteristics on the odds of severe maternal morbidity (SMM) through 42 days postpartum. Study Design: We conducted a retrospective observational study of 77 172 births using birth certificate and insurance claims data from the Arkansas All Payers Claims Database, years 2013‐2017, to identify racial disparities associated with SMM for births between April 1, 2014, and November 19, 2017. Methods: Multiple logistic regression was used to examine the effect of sociodemographic factors and clinical comorbidities on the odds of SMM among non‐Hispanic white ("white"), non‐Hispanic Black ("Black"), and Hispanic women. Results: The rate of SMM was 227.41 per 10 000 births, with Black women (330 per 10 000 births; 95% CI: 296.16‐366.38), having a significantly higher rates than white women (197; 95% CI: 171.72‐225.84) and Hispanic women (180; 95% CI: 155.86‐207.54). After adjusting for maternal demographics, birth‐related clinical variables, and comorbidities, SMM remained higher among Black women (aOR 1.37; 95% CI 1.11‐1.70) relative to white women. Conclusions: Comorbidities, socioeconomic factors, and other factors did not fully explain the Black–white disparities in SMM. Persistent disparities in the rates of SMM throughout 42 days postpartum among Black women relative to white women points to the need for higher quality, more equitable care for women of color in the fist months postpartum. [ABSTRACT FROM AUTHOR]

Objective: To evaluate whether the expansion of Federally Qualified Health Centers (FQHCs) improved late prenatal care initiation, low birth weight, and preterm birth among Medicaid‐covered or uninsured individuals. Data Sources and Study Setting: We identified all FQHCs in California using the Health Resources and Services Administration's Uniform Data System from 2000 to 2019. We used data from the U.S. Census American Community Survey to describe area characteristics. We measured outcomes in California birth certificate data from 2007 to 2019. Study Design: We compared areas that received their first FQHC between 2011 and 2016 to areas that received it later or that had never had an FQHC. Specifically, we used a synthetic control with a staggered adoption approach to calculate non‐parametric estimates of the average treatment effects on the treated areas. The key outcome variables were the rate of Medicaid or uninsured births with late prenatal care initiation (>3 months' gestation), with low birth weight (<2500 grams), or with preterm birth (<37 weeks' gestation). Data Collection/Extraction Methods: The analysis was limited to births covered by Medicaid or that were uninsured, as indicated on the birth certificate. Principal Findings: The 55 areas in California that received their first FQHC in 2011–2016 were more populous; their residents were more likely to be covered by Medicaid, to be low‐income, or to be Hispanic than residents of the 48 areas that did not have an FQHC by the end of the study period. We found no statistically significant impact of the first FQHC on rates of late prenatal care initiation (ATT: −10.4 [95% CI −38.1, 15.0]), low birth weight (ATT: 0.2 [95% CI −7.1, 5.4]), or preterm birth (ATT: −7.0 [95% CI −15.5, 2.3]). Conclusions: Our results from California suggest that access to primary and prenatal care may not be enough to improve these outcomes. Future work should evaluate the impact of ongoing initiatives to increase access to maternal health care at FQHCs through targeted workforce investments. [ABSTRACT FROM AUTHOR]

Introduction: The incidence of induction of labor, for both medical reasons and as an elective procedure, has been rising and a further increase in induction of labor following the ARRIVE trial may be expected. The effects of induction of labor at term on childhood neurodevelopment, however, are not well studied. We aimed to study the influence of elective induction of labor for each week of gestation separately from 37 to 42 weeks on offspring school performance at 12 years of age after uncomplicated pregnancies. Material and methods: We performed a population‐based study among 226 684 liveborn children from uncomplicated singleton pregnancies, born from 37+0 to 42+0 weeks of gestation in cephalic presentation in 2003–2008 (no hypertensive disorders, diabetes or birthweight ≤p5) in the Netherlands. Children with congenital anomalies, of non‐white mothers and born after planned cesarean section were excluded. Birth records were linked with national data on school achievement. We compared, using a fetus‐at‐risk approach and per week of gestation, school performance score and secondary school level at age 12 in those born after induction of labor to those born after non‐intervention, ie spontaneous onset of labor in the same week plus all those born at later gestations. Education scores were standardized to a mean of 0 and a standard deviation of 1 and adjusted in the regression analyses. Results: For each gestational age up to 41 weeks, induction of labor was associated with decreased school performance scores compared with non‐intervention (at 37 weeks −0.05 SD, 95% confidence interval [CI] −0.10 to −0.01 SD; adjusted for confounding factors). After induction of labor, fewer children reached higher secondary school level (at 38 weeks 48% vs 54%; adjusted odds ratio [aOR] 0.88, 95% CI 0.82–0.94). Conclusions: In women with uncomplicated pregnancies at term, consistently, at every week of gestation from 37 to 41 weeks, induction of labor is associated with lower offspring school performance at age 12 and lower secondary school level compared with non‐intervention, although residual confounding may remain. These long‐term effects of induction of labor should be incorporated in counseling and decision making. [ABSTRACT FROM AUTHOR]

Objectives: We aim to contribute to the literature reporting tests of selection in utero. The theory of reproductive suppression predicts that natural selection would conserve mechanisms, referred to collectively as selection in utero, that spontaneously abort fetuses unlikely to thrive as infants in the prevailing environment. Tests of this prediction include reports that women give birth to fewer than expected male twins, historically among the frailest of infants, during stressful times. The onset of the COVID-19 pandemic in the United States in Spring 2020 demonstrably stressed the population. We test the hypothesis that conception cohorts in gestation at the onset of the pandemic in the United States yielded fewer than expected live male twin births. Methods: We retrieved deidentified data on the universe of live births in the United States from the National Center for Health Statistics birth certificate records. We applied Box-Jenkins time-series methods to the twin secondary sex ratio computed for 77 monthly conception cohorts spanning August 2013 to December 2019 to detect outlying cohorts in gestation at the onset of the pandemic. Results: The twin secondary sex ratio fell below expected values in three conception cohorts (i.e., July, September, and October 2019, all p < .05) exposed in utero to the onset of the pandemic. Conclusions: Our results add to prior findings consistent with selection in utero. The role of selection in utero in shaping the characteristics of live births cohorts, especially during the COVID-19 pandemic, warrants further scrutiny. [ABSTRACT FROM AUTHOR]

Background: We assessed whether participation in Healthy Start Brooklyn's By My Side Birth Support Program—a maternal‐health program providing community‐based doula support during pregnancy, labor and delivery, and the early postpartum period—was associated with improved birth outcomes. By My Side takes a strength‐based approach that aligns with the doula principles of respecting the client's autonomy, providing culturally appropriate care without judgment or conditions, and promoting informed decision making. Methods: Using a matched cohort design, birth certificate records for By My Side participants from 2010 through 2017 (n = 603) were each matched to three controls who also lived in the program area (n = 1809). Controls were matched on maternal age, race/ethnicity, education level, and trimester of prenatal‐care initiation, using the simple random sampling method. The sample was restricted to singleton births. The odds of preterm birth, low birthweight, and cesarean birth were estimated, using conditional logistic regression. Results: By My Side participants had lower odds of having a preterm birth (5.6% vs 11.9%, P <.0001) or a low‐birthweight baby (5.8% vs 9.7%, P =.0031) than controls. There was no statistically significant difference in the odds of cesarean delivery. Conclusion: Participation in the By My Side Birth Support Program was associated with lower odds of preterm birth and low birthweight for participants, who were predominantly Black and Hispanic. Investing in doula services is an important way to address birth inequities among higher risk populations such as birthing people of color and those living in poverty. It could also help shape a new vision of the maternal‐health system, placing the needs and well‐being of birthing people at the center. [ABSTRACT FROM AUTHOR]

Background: Nearly 40% of pregnant women in 2016 were enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Prior studies have investigated nutritional behaviors among WIC participants and access to WIC breastfeeding counseling services. However, there are no (few?) nationally representative, large‐scale analyses of WIC users and pregnancy behaviors. Thus, the present study aims to examine associations between WIC use and select pregnancy outcomes among Medicaid enrollees. Methods: We examined pregnancy‐related behaviors and outcomes using 2018 U.S. Birth Certificates for Medicaid patients aged 18–45 years (N = 1 159 263). Outcomes included prenatal care (PNC) adequacy, breastfeeding initiation, cigarette use, and gestational weight gain. Standard binary and multinomial logistic regressions were used to estimate odds ratios (OR) and 95% confidence intervals (CIs). Results: After adjustment, WIC users had statistically significant increased odds of adequate PNC (adjusted OR [AOR] = 1.31 [95% CI 1.30, 1.32]), cigarette use (quit smoking during pregnancy 1.09 [1.07, 1.11]; smoked throughout pregnancy 1.16 [1.14, 1.18], and exceeding recommendations of weight gain 1.07 [1.06, 1.08]) compared with non‐WIC users. WIC enrollees also experienced decreased odds of breastfeeding initiation (0.85 [0.85, 0.86]) compared with non‐WIC users. Conclusions: The study underscores the value of the WIC program in improving access to PNC. Yet, low‐income women remain at risk for smoking during pregnancy and exceeding the recommended amount of weight gain. Breastfeeding initiation is lower than anticipated among WIC participants. Additional studies are needed to investigate WIC program efficacy. [ABSTRACT FROM AUTHOR]

Background: Missing and noncodable parental industry and occupation (I/O) information on birth certificates (BCs) can bias analyses informing parental worksite exposures and family economic stability. Methods: We used the National Institute for Occupational Safety and Health (NIOSH) software to code parental I/O in 1989–2019 California BC data (N = 21,739,406). We assessed I/O missingness and codability by reporting period, parental sex, race/ethnicity, age, and education. Results: During 1989–2019, records missing I/O increased from 4.4% to 9.4%. I/O was missing more frequently from parents who were male (7.8% vs. 4.4%), Black or American Indian/Alaska Native (AIAN) (9.3% and 8.9% vs. 3.2%–4.7% in others), and had high school or less education (4.0%–5.9% vs. 1.4%–2.6% in others). Of records with I/O, less than 2% were noncodable by NIOSH software. Noncodable entries were more common for parents who were male (industry (1.9% vs. 1.0%); occupation (1.5% vs. 0.7%)), Asian/Pacific Islander (industry (2.4% vs. 1.2%–1.6% in other groups); occupation (1.7% vs. 0.7%–1.5% in other groups)), age 40 and older (industry (2.1% vs. 0.4%–1.7% in younger groups); occupation (1.7% vs. 0.3%–1.3% in younger groups)), and 4‐year college graduates (industry (2.0% vs. 1.0%–1.9% in other groups); occupation (1.7% vs. 0.5%–1.4%)). Conclusions: In California BC, I/O missingness was systematically higher among parents who are male, Black, AIAN, less than 20 years old, and report no college education. I/O codability is high when information is reported, with small percentage disparities. Improving data collection is vital to equitably describe economic contexts that determine important family outcomes. [ABSTRACT FROM AUTHOR]

Background: Trends in the prevalence of hepatitis C virus (HCV) infection among women delivering live births may differ in rural vs. urban areas of the United States, but estimation of trends based on observed counts may lead to unstable estimates in rural counties due to small numbers. Objectives: The objective of the study was to use small area estimation methods to provide updated county‐level prevalence estimates and, for the first time, trends in maternal HCV infection among live births by county‐level rurality. Methods: Cross‐sectional natality data from 2016 to 2020 were used to estimate maternal hepatitis C prevalence using hierarchical Bayesian models with spatiotemporal random effects to produce annual county‐level estimates of maternal HCV infection and trends over time. Models included a 6‐level rural–urban county classification, year, maternal characteristics and county‐specific covariates. Data were analysed in 2022. Results: There were 90,764/18,905,314 live births (4.8 per 1000) with HCV infection reported on the birth certificate. Hepatitis C prevalence was higher among rural counties as compared to urban counties. Rural counties had the largest annual increases in maternal hepatitis C prevalence (per 1000 births) from 2016 to 2020 (micropolitan: 0.39; noncore: 0.40), with smaller increases among less densely populated urban counties (medium metro: 0.28; small metro: 0.28) and urban counties (large central metro:0.11; large fringe metro: 0.14). Conclusions: The prevalence of maternal HCV infection was the highest in rural counties, and rural counties saw the greatest average prevalence increase during 2016–2020. County‐level data can help in monitoring rural–urban trends in maternal HCV infection to reduce geographic disparities. [ABSTRACT FROM AUTHOR]

Background: The United States (US) data suggest fewer‐than‐expected preterm births in 2020, but no study has examined the impact of exposure to the early COVID‐19 pandemic at different points in gestation on preterm birth. Objective: Our objective was to determine—among cohorts exposed to the early COVID‐19 pandemic—whether observed counts of overall, early and moderately preterm birth fell outside the expected range. Methods: We used de‐identified, cross‐sectional, national birth certificate data from 2014 to 2020. We used month and year of birth and gestational age to estimate month of conception for birth. We calculated the count of overall (<37 weeks gestation), early (<33 weeks gestation) and moderately (33 to <37 weeks gestation) preterm birth by month of conception. We employed time series methods to estimate expected counts of preterm birth for exposed conception cohorts and identified cohorts for whom the observed counts of preterm birth fell outside the 95% detection interval of the expected value. Results: Among the 23,731,146 births in our study, the mean prevalence of preterm birth among monthly conception cohorts was 9.7 per 100 live births. Gestations conceived in July, August or December of 2019—that is exposed to the early COVID‐19 pandemic in the first or third trimester—yielded approximately 3245 fewer moderately preterm and 3627 fewer overall preterm births than the expected values for moderate and overall preterm. Gestations conceived in August and October of 2019—that is exposed to the early COVID‐19 pandemic in the late second to third trimester—produced approximately 498 fewer early preterm births than the expected count for early preterm. Conclusions: Exposure to the early COVID‐19 pandemic may have promoted longer gestation among close‐to‐term pregnancies, reduced risk of later preterm delivery among gestations exposed in the first trimester or induced selective loss of gestations. [ABSTRACT FROM AUTHOR]

We present ComBiNet, a visualization, query, and comparison system for exploring bipartite multivariate dynamic social networks. Historians and sociologists study social networks constructed from textual sources mentioning events related to people, such as marriage acts, birth certificates and contracts. We model this type of data using bipartite multivariate dynamic networks to maintain a representation faithful to the original sources while not too complex. Relying on this data model, ComBiNet allows exploring networks using both visual and textual queries using the Cypher language, the two being synchronized to specify queries using the most suitable modality; simple queries are easy to express visually and can be refined textually when they become complex. These queries are used for applying topological and attribute‐based selection on the network. Query results are visualized in the context of the whole network and over a geographical map for geolocalized entities. We also present the design of our interaction techniques for querying social networks to visually compare the selections in terms of topology, measures and attribute distributions. We validate the query and comparison systems by showing how they have been used to answer historical questions and by explaining how they have been improved through a usability study conducted with historians. [ABSTRACT FROM AUTHOR]

Aim: There is little evidence regarding women who cannot register live births after pregnancy. We aimed to clarify the difference in baseline characteristics between women who registered live births and those who did not (i.e., dropout). Methods: We assessed the birth cohort data of 1976 Japanese women who registered their pregnancies between July 2013 and March 2014 in Naha and Urasoe City, Okinawa, Japan. The database consisted of anthropometric data, reproductive history, sociodemographic characteristics, and dietary intake. We estimated the prevalence ratio to examine the associations of baseline characteristics with dropout by multivariable‐adjusted Poisson regression with robust standard error estimation. Results: We identified 272 dropouts (13.8%) in the pregnancy registry. About 15% of women reported experience of alcohol drinking preceding 1 month of pregnancy registration. Most participants' vitamin B1 (92.1%) and folate (74.7%) consumption was inadequate considering the dietary reference intake for Japanese pregnant women, but it was not associated with a high prevalence of dropout. The prevalence of dropout was significantly higher in teenagers (prevalence ratio [PR] = 2.06, 95% confidence interval [CI] 1.38–3.07) and early 20s (PR = 1.42, 95% CI 1.04–1.93) than in women in late 20s. In addition, alcohol consumption was potentially associated with a high prevalence of dropout (adjusted prevalence ratio [aPR] = 1.31, 95% CI 0.99–1.73). Participants who experienced one or more live births (aPR = 0.43, 95% CI 0.28–0.66) were less likely to dropout. Conclusion: We found that the potential risk factors for dropout from pregnancy registration were young maternal age, no childbirth experience, and alcohol consumption. [ABSTRACT FROM AUTHOR]

Objectives: A male is less adaptable to biological stressors than a female fetus with consequent higher morbidity and mortality. Adverse birth outcomes increase and male livebirths decrease after environmental disasters, economic crises, and terrorist events. We hypothesized the ratio of male to female livebirths would decrease in areas affected by severe tropical cyclones (TCs) in Queensland, Australia. Additionally, in male livebirths, there would be an increase in preterm and low birthweight births. Lastly, we hypothesized that the pregnancy stage at which exposure occurred would modify the association between TC exposure and observed outcomes. Methods: Interrupted time series analysis was used to analyze Queensland administrative birth records from July 2007 to June 2018 for significant changes in the sex ratio at birth, measured as the proportion of male livebirths. Adjusted generalized linear models were fitted to births in areas affected by two category five TCs: cyclones Yasi (February 2011) and Marcia (February 2015). To explore male mortality and morbidity risk, additional analysis was conducted on the proportion of male stillborn, low birthweight, and preterm births. The association between estimated pregnancy stage during the TC and the proportion of male births was also analyzed. Results: Contrary to our hypothesis, increases in the proportion of male livebirths were observed following early‐pregnancy exposure to cyclone Yasi and mid‐pregnancy exposure to Marcia, although the latter was not statistically significant. No significant changes were observed in proportions of male stillborn, low birthweight, and preterm births. Conclusions: This study found a significant association between severe TCs and sex ratio at birth. The stage of pregnancy at which maternal stressors were experienced modified this association. Among people exposed in early to mid‐pregnancy, the proportion of male births was higher. This may be because of differential loss of females in utero. Studying sex differences in birth outcomes provides insight into in utero vulnerabilities associated with environmental stressors. Climate change is increasing the intensity and frequency of natural disasters. Understanding fetal vulnerability to environmental stressors will provide crucial information supporting early life health interventions that mitigate the immediate and long‐term effects. [ABSTRACT FROM AUTHOR]

Women and children suffer worse health outcomes during armed conflicts. For more than a decade, Northern Nigeria has been facing one of the most violent armed conflicts in sub‐Saharan Africa. Studies on the conflict's impact on healthcare utilization in the area are few. The aim of this study is to explore the effect of the protracted armed conflicts on healthcare utilization, measured by maternal care and child immunization, in Northern Nigeria. Data from the Armed Conflict Location and Events Data set are spatially merged to birth records from the Nigerian Demographic and Health Survey. An area is classified to be a conflict cluster if it is within a 5–10 km radius of conflict event(s) with at least one fatality. The difference‐in‐differences method is applied to estimate the effect of the armed conflicts on healthcare utilization in the area. We find that residing within a conflict cluster significantly reduces the probability of utilization of healthcare services. We conclude that robust policies and strategies to mitigate the adverse effects of the armed conflicts on healthcare delivery are necessary for the short run. In the long run, systematic efforts to identify and address the root causes of the conflict with a view to finding a lasting solution are necessary to improve health‐care utilization in conflict‐affected areas. Highlights: Armed conflict has an adverse effect on healthcare utilization in Northern Nigeria.Living in a rural area reduces the possibility of utilization of healthcare services in Northern Nigeria.Compared to their Muslim counterparts, Christian mothers are more likely to give birth in a health unit in Northern Nigeria.Armed conflict reduces the chances of child immunization in Northern Nigeria.Armed conflict hinders expectant mothers from attaining the minimum antenatal care visits. [ABSTRACT FROM AUTHOR]

This research reports on qualitative interviews with 31 participants who are Irish parents, identify as lesbian, gay, bisexual, queer (LGBQ), and who expressed difficulty in the process of obtaining birth certificates for their children. Our aim was to use personal information management (PIM) and personal digital archiving (PDA) as a lens to explore the invisible work that the Irish government requires of a sexual minority parent group to obtain "equal" treatment in the birth registration and birth certificate process. Our findings suggest overlap with existing information behavior research (IB) that explore invisible information work, IB as a burden, information marginalization, information vulnerability, and information overload, and the everyday in IB. We propose a new framework: personal information burden (PIM‐B) which is characterized by additional PIM activities, negative affect, lack of identity self extension to the personal information, and additional information seeking. We propose that a PIM‐B may be used as an indicator of inequality in future research. [ABSTRACT FROM AUTHOR]

We applied a child‐focused, longitudinal approach to characterising academically at‐risk elementary school students using linked birth and educational records. Following a statewide cohort of children born in California in public school records through grade 5 (n = 722 072) to document identification as a homeless, foster and/or special education (i.e. academically at‐risk) student, we found that one in every six students were classified as academically at‐risk at least once during elementary school––two times annual counts. Strong associations between sociodemographic characteristics observable at birth and future adversities recorded in school records suggest these vulnerabilities should be considered together when providing supports. [ABSTRACT FROM AUTHOR]

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This article explores the definitions of Eurasian identity utilising the authority‐defined, everyday‐defined, and national identity concepts by Shamsul Amri. The authority‐defined explains the influence of authority figures such as the British administration during the colonial era and the Malaysian government during the postcolonial era via established bumiputera‐based policies that have impacted the Eurasian community, alongside the Eurasian Associations in Malaysia, which acts as an authority in preserving and curating Eurasian culture and identity. The everyday‐defined concept focuses on personal experiences of Eurasians, specifically on the hybridity of culture, religion and language that shifts as newer generations emerge. Findings show that Eurasians defined according to the authority‐defined concept is based on the governmental documentation such as their birth certificate whereas the everyday‐defined concept is based on ancestral lineage and peranakan heritage that has been established by Malaysian society. [ABSTRACT FROM AUTHOR]

Background: The effect of epidural/spinal anesthesia during labor on breastfeeding is unclear. Few studies had assessed whether or how medically assisted delivery (operative vaginal delivery or unscheduled cesarean birth) plays a mediating role. We aimed to examine whether the relationship between using epidural/spinal anesthesia and breastfeeding is mediated by increased medically assisted delivery among healthy nulliparous women. Methods: A secondary, cross‐sectional analysis was conducted using US birth certificate data from 2016 (n = 381 199). Logistic regression was used to examine associations between factors. Structural equation modeling (SEM) was used to analyze the model fit of the path models and to quantify the direct, indirect, and total effect of anesthesia on breastfeeding at discharge, considering medically assisted delivery as a mediator. Results: Women who were administered epidural/spinal anesthesia were more likely to experience medically assisted delivery (adjusted odds ratio [AOR]: 95% confidence interval [CI] 3.01 (2.91‐3.12)) and less likely to be breastfeeding at discharge (0.95 [0.92‐0.98]). Operative vaginal and unscheduled cesarean deliveries were significantly associated with nonbreastfeeding at discharge (0.81 [0.77‐0.84] and 0.81 [0.79‐0.84], respectively). SEM revealed excellent model fit for our model. The indirect effect was significant (β = −0.038; 95% CI, −0.043 to −0.033), as was the total effect (β = −0.038; 95% CI, −0.043 to −0.033). Conclusions: Epidural/spinal anesthesia is associated with nonbreastfeeding at discharge, mediated through medically assisted delivery. Health care providers should consider these risks and provide adequate support to help all parents attain their breastfeeding goals. [ABSTRACT FROM AUTHOR]

Aim: This study investigated childhood diagnoses in children born extremely preterm before 24 weeks of gestation. Methods: Diagnoses of neurodevelopmental disorders and selected somatic diagnoses were retrospectively retrieved from national Swedish registries for children born before 24 weeks from 2007 to 2018. Their individual medical files were also examined. Results: We studied 383 children born at a median of 23.3 (range 21.9–23.9) weeks, with a median birthweight of 565 (range 340–874) grams. Three‐quarters (75%) had neurodevelopmental disorders, including speech disorders (52%), intellectual disabilities (40%), attention deficit hyperactivity disorder (30%), autism spectrum disorders (24%), visual impairment (22%), cerebral palsy (17%), epilepsy (10%) and hearing impairment (5%). More boys than girls born at 23 weeks had intellectual disabilities (45% vs. 27%, p < 0.01) and visual impairment (25% vs. 14%, p < 0.01). Just over half of the cohort (55%) received habilitation care. The majority (88%) had somatic diagnoses, including asthma (63%) and failure to thrive/short stature (39%). Conclusion: Most children born before 24 weeks had neurodevelopmental disorders and/or additional somatic diagnoses in childhood and were referred to habilitation services. Clinicians should be aware of the multiple health and developmental problems affecting these children. Resources are needed to identify their long‐term support needs at an early stage. [ABSTRACT FROM AUTHOR]

In retrospective cohort studies of interventions disseminated to communities, it is challenging to find comparison groups with high‐quality data for evaluation. We present one methodological approach as part of our study of birth outcomes of second‐born children in a home visiting (HV) program targeting first‐time mothers. We used probabilistic record linkage to link Connecticut's Nurturing Families Network (NFN) HV program and birth‐certificate data for children born from 2005 to 2015. We identified two potential comparison groups: a propensity‐score‐matched group from the remaining birth certificate sample and eligible‐but‐unenrolled families. An analysis of interpregnancy interval (IPI) is presented to exemplify the approach. We identified the birth certificates of 4822 NFN families. The propensity‐score‐matched group had 14,219 families (3‐to‐1 matching) and we identified 1101 eligible‐but‐unenrolled families. Covariates were well balanced for the propensity‐score‐matched group, but poorly balanced for the eligible‐but‐unenrolled group. No program effect on IPI was found. By combining propensity‐score matching and probabilistic record linkage, we were able to retrospectively identify relatively large comparison groups for quasi‐experimental research. Using birth certificate data, we accessed outcomes for all of these individuals from a single data source. Multiple comparison groups allow us to confirm findings when each method has some limitations. Other researchers seeking community‐based comparison groups could consider a similar approach. [ABSTRACT FROM AUTHOR]

Objective: Women with systemic lupus erythematosus (SLE) may experience adverse perinatal outcomes in the years before an SLE diagnosis. Overall, there is limited research on perinatal outcomes among African American women with SLE. We undertook this study to examine the risk of preterm and small‐for‐gestational age births among African American women with SLE compared to the general population of African American women in a large metropolitan area. Methods: Information about women with SLE was identified from the Georgia Lupus Registry and the Georgians Organized Against Lupus Cohort and was linked with birth certificates by the Georgia Department of Public Health. Births were categorized into occurring more than 3 years before SLE diagnosis, 0–3 years before SLE diagnosis, 0–3 years after SLE diagnosis, or more than 3 years after SLE diagnosis. Comparison birth certificates to African American women in the same geographic area were obtained from the National Center for Health Statistics. We used log‐risk models to compare the risk of preterm or small‐for‐gestational age births among SLE births in each diagnosis timing category to the general population, adjusting for maternal age and education and parity. Results: Births to women with SLE were more likely to occur preterm at 0–3 years before SLE diagnosis (risk ratio [RR] 1.71, 95% confidence interval [95% CI] 1.24–2.35), 0–3 years after SLE diagnosis (RR 2.29, 95% CI 1.70–3.09), and 3 or more years after SLE diagnosis (RR 2.83, 95% CI 2.36–3.38), but not 3 or more years before SLE diagnosis compared to the general population (RR 1.03, 95% CI 0.77–1.38). Similar results were observed for small‐for‐gestational age births. Conclusion: Our analysis, conducted among African American women, demonstrates an increased risk of adverse perinatal outcomes even before a clinical diagnosis of SLE. [ABSTRACT FROM AUTHOR]

Objective: Accurate vital statistics data are critical for monitoring population health and strategizing public health interventions. Previous analyses of statewide birth data have identified several factors that may reduce birth certificate accuracy including systematic errors and limited data review by clinicians. The aim of this initiative was to increase the proportion of hospitals in Alabama reporting accurate birth certificate data from 67% to 87% within 1 year. Methods: The Alabama Perinatal Quality Collaborative led this statewide collaborative effort. Process measures included monthly monitoring of 11 variables across 5–10 patient birth certificates per month per hospital. Accuracy determination, defined as ≥95% accuracy of the variables analyzed, was performed by health care specialists at each hospital by comparing birth certificate variables from vital statistics with data obtained from original hospital source materials. Three months of retrospective, baseline accuracy data were collected before project initiation from which actionable drivers and change ideas were identified at individual hospitals. Data were analyzed using statistical process control measures. Results: Thirty‐one hospitals entered data throughout the course of the initiative, accounting for 850 chart analyses and 9350 variable assessments. The least accurately reported variables included birth weight, maternal hypertension, and antenatal corticosteroid exposure. At baseline, 67% of hospitals reported birth certificate accuracy rates ≥ 95%, which increased to 90% of hospitals within 2 months and was sustained for the remainder of the initiative. Conclusion: Statewide, multidisciplinary quality improvement efforts increased birth certificate accuracy vital to public health surveillance. [ABSTRACT FROM AUTHOR]

The authors describe the challenges they encountered, having attempted to retrospectively complete a home birth outcome data set for New York State. In addition, they provide a compelling argument for a midwifery data collective that would bring together health record data for all midwife‐attended births nationwide, regardless of setting. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives: Low‐income women disproportionately experience preventable, adverse neonatal outcomes. Prior to the Affordable Care Act (ACA) Medicaid expansion, many low‐income women became eligible for coverage only after becoming pregnant, reducing their access to healthcare before pregnancy and creating discontinuities in care that may delay Medicaid enrollment. The objective of this study was to examine the impact of the ACA Medicaid expansion on neonatal outcomes among low‐income populations in Oregon. Method: We used linked Oregon birth certificate and Medicaid data from 2008‐2016 to identify control and policy groups of women who gave birth both before and after implementation of the ACA Medicaid expansion (n = 21 204 births to N = 10 602 women). We conducted a difference‐in‐differences analysis of the effect of Medicaid expansion on preterm birth, low birthweight (LBW), neonatal intensive care unit (NICU) admissions, and neonatal mortality. Results: We found policy effects on reducing LBW (interaction aOR = 0.71, 95% CI: 0.57‐0.90) and preterm birth (interaction aOR 0.77, 95% CI: 0.62 = 0.96) but not on NICU admissions or neonatal mortality. Conclusions: This study provides evidence that expanding Medicaid coverage may have positive effects on LBW and preterm birth, which could lead to important long‐term impacts on childhood and later‐life health outcomes. States that have not expanded their Medicaid programs might improve neonatal outcomes among low‐income populations by extending insurance coverage to low‐income adults. [ABSTRACT FROM AUTHOR]

Background: The accuracy of birth outcome data provided by Internet‐based cohort study participants has not been well studied. Methods: We compared self‐reported data on birth characteristics in Pregnancy Study Online (PRESTO), an Internet‐based prospective cohort study of North American pregnancy planners, with birth certificate data. At enrolment, participants were aged 21‐45 years, attempting conception, and not using fertility treatment. Women completed online questionnaires during preconception, early and late pregnancy, and postpartum. We requested birth certificate data during 2014‐2019 from seven health departments in states with the most participants. After restricting to singleton births, we assessed specificity, sensitivity, and agreement comparing self‐reported data from postpartum questionnaires with birth certificate data for gestational age at delivery (GA) and birthweight (grams). Our primary measure of self‐reported GA (weeks) was calculated as [280‐(due date‐birth date)]/7. We used log‐binomial regression to assess predictors of agreement. Results: We linked 85% (771/909) of women in selected states. Median age of women was 30 years (range: 21‐42), 84% had ≥ 16 years of education, nearly 96% were married, 12% had household incomes <$50 000, 32% were parous, and 85% identified as non‐Hispanic White. Median recall interval was 6 months. Among those with self‐reported data, 89% reported the same GA as the birth certificate and 98% reported GA within 1 week of the birth certificate. Self‐report of preterm birth (GA < 37 weeks) agreed with information from birth certificates for 100% of women; sensitivity was 100%, and specificity was 99%. Self‐reported low birthweight (<2500 grams) agreed with birth certificates for 93% of women; sensitivity and specificity were 93% and ≥99%, respectively. Predictors of poorer agreement included higher parity and longer pregnancy attempt time for GA, and lower education and longer recall interval for birthweight. Conclusion: Self‐reported data on GA and birthweight from an Internet‐based cohort showed high accuracy compared with birth certificates. [ABSTRACT FROM AUTHOR]

Between 2016 and 2018, we observe in Uruguay a steep decline of almost 20 percent in the number of total births, leading to the collapse of the adolescent fertility rate after decades of relative stagnation. We estimate the quantitative contribution on birth rates, especially teen births, of a policy of expanded availability of subdermal contraceptive implants. We exploit the expansion schedule of a large‐scale policy of free‐of‐charge access to subdermal implants in the country's public health system through an event study to capture causal effects. We use detailed birth administrative records for the past 20 years. We document an average reduction of 3 percent in the birth rate in public health facilities across the two years after the policy was implemented in each department. These reductions were notably higher among teens and first births. Although changes in women's fertility decisions are a multicausal phenomenon, we claim that the expanded availability of subdermal contraceptive implants accounted for one‐third of the teen and young women's birth collapse. [ABSTRACT FROM AUTHOR]

Background: Asian Americans are among the fastest growing subpopulations in the United States. However, evidence about maternal prepregnancy body mass index (BMI) and preterm birth among Asian Americans is lacking. Methods: This population‐based study used nationwide birth certificate data from the US National Vital Statistics System 2014 to 2018. All Asian American mothers who had a singleton live birth were included. According to Asian‐specific cutoffs, maternal prepregnancy BMI was classified into underweight (BMI < 18.5 kg/m2), normal weight (BMI 18.5‐22.9 kg/m2), overweight (BMI 23.0‐27.4 kg/m2), class I obesity (BMI 27.5‐32.4 kg/m2), class II obesity (BMI 32.5‐37.4 kg/m2), and class III obesity (BMI ≥37.5 kg/m2). Preterm birth was defined as gestational age less than 37 weeks. Multivariable logistic regression models were used to estimate the odds ratio (OR) of preterm birth. Results: We included 1 081 341 Asian American mother‐infant pairs. The rate of preterm birth was 6.51% (n = 70 434). The rate of maternal prepregnancy overweight and obesity was 46.80% (n = 506 042). Compared with mothers with normal weight, the adjusted OR of preterm delivery was 1.04 (95% CI, 1.01‐1.07) for underweight mothers, 1.18 (95% CI, 1.16‐1.20) for overweight mothers, 1.41 (95% CI, 1.37‐1.44) for mothers with class I obesity, 1.69 (95% CI, 1.63‐1.76) for mothers with class II obesity, and 1.78 (95% CI, 1.66‐1.90) for mothers with class III obesity. Similar patterns of associations were observed in Asian American mothers across different country origins. Conclusions: Among Asian American mothers, maternal prepregnancy overweight or obesity, defined by Asian‐specific, lower BMI cutoffs, was significantly associated with an increased risk of preterm birth. The risk of preterm birth increased with increasing obesity severity. These findings highlight the importance of using Asian‐specific BMI cutoffs in assessing risk of preterm birth among Asian American mothers. [ABSTRACT FROM AUTHOR]

Objective: To examine the variability in the cesarean delivery (CD) rates of individual labor and delivery nurses compared with physicians at three attribution time points. Data Sources: Medical record data from nine hospitals in Washington State from January 2016 through September 2018. Study Design: Retrospective, observational cohort design using an aggregated database of birth records. Data Collection/Extraction Methods: Chart-abstracted clinical data from a subset of nulliparous, term, singleton, vertex births attributed at admission, labor management, and delivery to nurses and physicians. Two classification methods were used to categorize nurse- and physician-level CD rates at three attribution time points and the reliability of these methods compared. Principal Findings: The sample included 12 556 births, 319 nurses, and 126 physicians. Overall, variation in nurse-level CD rates did not differ significantly across the three attribution time points, and the extent of variation was similar to that observed in physicians. However, agreement between attribution time points varied between 35 percent and 65 percent when classifying individual nurses into the top and bottom deciles. The average reliability of nurse-level CD rates was 32 percent at admission (IQR 22.0 percent to 38.7 percent), 32.6 percent at labor (IQR 23.1 percent to 40.9 percent), and 29.3 percent (IQR 20.9 percent to 35.8 percent) at delivery. The average reliability of physician-level CD rates was higher: 54.2 percent (IQR 38.7 percent to 71.4 percent) at admission, 62.5 percent (IQR 49.0 percent to 79.6 percent) at labor management, and 66.1 percent (IQR 53.7 percent to 81.2 percent) at delivery. Conclusion: Feedback on nurse-level CD rates as part of routine clinical quality audits can provide insight into nurse performance in the context of other individual-level and unit-level information. To reliably distinguish individual nurse performance, larger sample sizes are needed. [ABSTRACT FROM AUTHOR]

Purpose: Closures of rural labor and delivery (L/D) units have prompted national and state‐based efforts to assess the impact on birth outcomes. This study explores local effects of L/D closures in rural areas of North Carolina (NC). Methods: This is a retrospective cohort study of birth outcomes of 4,065 women in 5 rural areas of NC with L/D unit closures between 2013 and 2017. Outcomes were abstracted from birth certificate data from the NC Vital Statistics Reporting System. Localized outcomes 1 year prior to L/D unit closure were compared with outcomes 1 and 2 years post closure, including: (1) birth location and demographics, (2) change in travel patterns for birth, and (3) birth outcomes, including rates of labor induction, cesarean deliveries, maternal morbidity, and neonatal outcomes. Findings: Before closures, 25%‐56% of deliveries occurred outside county of residence. Commercially insured and college‐educated women were more likely to deliver out‐of‐area. Closures increased travel distance to delivery hospital an average of 7‐27 miles. In 2 areas, cesarean delivery rates decreased despite an increase in labor inductions. There was also variability between areas in prenatal care adequacy and breastfeeding. Conclusions: We found that L/D unit closures in rural NC disproportionately affected women on Medicaid. The impact showed area‐specific variability, highlighting effects potentially masked by statewide or national analyses. Implications for future L/D closures would be eased by regional coordination and planning to mitigate negative effects, and state and national policies should address the excess burden placed on vulnerable populations. [ABSTRACT FROM AUTHOR]