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Rigorous perinatal epidemiologic research depends on population-based parental and neonatal sociodemographic and clinical data. Here we describe the creation of linked birth cohort files, an enriched data source that combines information from vital records with maternal delivery and infant hospital encounter records. Probabilistic linkage techniques were used to link vital records (i.e., birth and fetal death certificates) from the California Department of Public Health with hospital inpatient, ambulatory surgery and emergency department encounter data for mothers and infants from the California Department of Health Care Access and Information. From 2012 to 2018, 95% of live birth records were successfully linked to maternal and newborn hospital records while 85% of fetal death records were linked to a maternal delivery record. Overall, 93% of postnatal hospital encounters of infants (i.e., <1 year old) were matched to a linked record. The linked birth cohort files is a rich resource opening many possibilities for understanding perinatal health outcomes and opportunities for linkage to longitudinal, social determinant, and environmental data. To optimally use this file for research, analysts should evaluate possible shortcomings or biases of the data sources being linked. [ABSTRACT FROM AUTHOR]

Objective: To describe variation in payer and outcomes in Veterans' births.Data/setting: Secondary data analyses of deliveries in California, 2000-2012.Study Design: We performed a retrospective, population-based study of all live births to Veterans (confirmed via U.S. Department of Veterans Affairs (VA) enrollment records), to identify payer and variations in outcomes among: (1) Veterans using VA coverage and (2) Veteran vs. all other births. We calculated odds ratios (aOR) adjusted for age, race, ethnicity, education, and obstetric demographics.Methods: We anonymously linked VA administrative data for all female VA enrollees with California birth records.Principal Findings: From 2000 to 2012, we identified 17,495 births to Veterans. VA covered 8.6 percent (1,508), Medicaid 17.3 percent, and Private insurance 47.6 percent. Veterans who relied on VA health coverage had more preeclampsia (aOR 1.4, CI 1.0-1.8) and more cesarean births (aOR 1.2, CI 1.0-1.3), and, despite similar prematurity, trended toward more neonatal intensive care (NICU) admissions (aOR 1.2, CI 1.0-1.4) compared to Veterans using other (non-Medicaid) coverage. Overall, Veterans' birth outcomes (all-payer) mirrored California's birth outcomes, with the exception of excess NICU care (aOR 1.15, CI 1.1-1.2).Conclusions: VA covers a higher risk fraction of Veterans' births, justifying maternal care coordination and attention to the maternal-fetal impacts of Veterans' comorbidities. [ABSTRACT FROM AUTHOR]

Objective. Assess the impact of colorectal cancer on maternal and neonatal outcomes. Methods. Cases were identified using several computer-generated linkage analyses. Maternal and newborn hospital discharges in California were linked to birth and if applicable infant death certificate records. This database was then linked to the California Cancer Registry, to create a cohort of women with pregnancy-associated colon and rectal cancer. This cohort was compared to pregnant women in California without colorectal cancer. Our secondary comparison was to non-pregnant, Californian women with colorectal cancer who could be aged-matched. Results. Women with pregnancy-associated colorectal cancer were more likely to undergo cesarean section (OR: 1.9) and to develop puerperal infections (OR: 2.8). In addition, higher rates of preterm delivery were found both secondary to scheduled deliveries and preterm labor (OR for preterm labor, 2.8). Neonatal outcomes were fairly similar between the two groups. Pregnancy was not found to have a significant effect on survival (HR: 0.73). Conclusions. We found that women with pregnancy-associated colorectal cancer had excellent maternal and neonatal outcomes. This is likely secondary to the fact that most women are diagnosed after delivery. In addition, survival is similar between pregnancy-associated and non-pregnancy associated cases. [ABSTRACT FROM AUTHOR]

Objective. To compare maternal and neonatal outcomes among grandmultiparous women to those of multiparous women 30 years or older. Methods. A database of the vast majority of maternal and newborn hospital discharge records linked to birth/death certificates was queried to obtain information on all multiparous women with a singleton delivery in the state of California from January 1, 1997 through December 31, 1998. Maternal and neonatal pregnancy outcomes of grandmultiparous women were compared to multiparous women who were 30 years or older at the time of their last birth. Results. The study population included 25,512 grandmultiparous and 265,060 multiparous women 30 years or older as controls. Grandmultiparous women were predominantly Hispanic (56%). After controlling for potential confounding factors, grandmultiparous women were at significantly higher risk for abruptio placentae (odds ratio OR: 1.3; 95% confidence intervals CI: 1.2–1.5), preterm delivery (OR: 1.3; 95% CI: 1.2–1.4), fetal macrosomia (OR: 1.5; 95% CI: 1.4–1.6), neonatal death (OR: 1.5; 95% CI: 1.3–1.8), postpartum hemorrhage (OR: 1.2; 95% CI: 1.1–1.3) and blood transfusion (OR: 1.5; 95% CI: 1.3–1.8). Conclusion. Grandmultiparous women had increased maternal and neonatal morbidity, and neonatal mortality even after controlling for confounders, suggesting a need for closer observation than regular multiparous patients during labor and delivery. [ABSTRACT FROM AUTHOR]

Objective. Describe the obstetric outcomes among women in California with pregnancy associated cervical cancer. Methods. Cases were identified utilizing computer-linked infant birth/death certificates, discharge records, and cancer registry files, and then assigned to a prenatal or post-partum cancer diagnosis group. Outcomes included cesarean delivery, hospitalizations, birth weight, prematurity, and infant mortality. Results. Among 434 cases identified, those diagnosed prenatally (136 cases) had higher rates of cesarean section (odds ratio 3.7; 95% CI 2.6, 5.2), hospitalization >?5 days (maternal: odds ratio 14.1; 95% CI 9.2, 21.5 neonatal: odds ratio 5.2; 95% CI 3.6, 7.5), low birth weight (LBW) (odds ratio 5.5; 95% CI 3.7, 8.1), very LBW (odds ratio 6.9; 95% CI 3.7, 12.8), prematurity (odds ratio 4.7; 95% CI 3.2, 6.7), and fetal deaths (odds ratio 5.5; 95% CI 2.0, 14.8) compared to non-cancer pregnant controls. Very LBW (odds ratio 2.6; 95% CI 1.4, 4.8), prematurity (odds ratio 1.5; 95% CI 1.1, 2.1), and fetal death rates (odds ratio 3.0; 95% CI 1.2, 7.4) remained elevated among those diagnosed post-partum. No neonatal deaths were attributable to elective premature delivery. Conclusions. We observed higher rates of fetal death and spontaneous prematurity among women with pregnancy-associated cervical cancer. [ABSTRACT FROM AUTHOR]

Objective: This study was undertaken to determine the occurrence rates, outcomes, risk factors, and timing of obstetric delivery for trauma sustained during pregnancy. Study design: This is a retrospective cohort study of women hospitalized for trauma in California (1991-1999). International Classification of Disease, ninth revision, Clinical Modification codes, and external causation codes for injury were identified. Maternal and fetal/neonatal outcomes were analyzed for women delivering at the trauma hospitalization (group 1), and women sustaining trauma prenatally (group 2), compared with nontrauma controls. Injury severity scores and injury types were used to stratify risk in relation to outcome. Statistical comparisons are expressed as odds ratios (ORs) with 95% CIs. Results: A total of 10,316 deliveries fulfilling study criteria were identified in 4,833,286 total deliveries. Fractures, dislocations, sprains, and strains were the most common type of injury. Group 1 was associated with the worst outcomes: maternal death OR 69 (95% CI 42-115), fetal death OR 4.7 (95% CI 3.4-6.4), uterine rupture OR 43 (95% CI 19-97), and placental abruption OR 9.2 (95% CI 7.8-11). Group 2 also resulted in increased risks at delivery: placental abruption OR 1.6 (95% CI 1.3-1.9), preterm labor OR 2.7 (95% CI 2.5-2.9), maternal death OR 4.4 (95% CI 1.4-14). As injury severity scores increased, outcomes worsened, yet were statistically nonpredictive. The type of injury most commonly leading to maternal death was internal injury. The risk of fetal, neonatal, and infant death was strongly influenced by gestational age at the time of delivery. Conclusion: Women delivering at the trauma hospitalization (group 1) had the worst outcomes, regardless of the severity of the injury. Group 2 women (prenatal injury) had an increased risk of adverse outcomes at delivery, and therefore should be monitored closely during the subsequent course of the pregnancy. This study highlights the need to optimize education in trauma prevention during pregnancy. [ABSTRACT FROM AUTHOR]

The article discusses a study which examines survival in pregnancy-associated breast cancer. The California Cancer Registry was linked with the California Patient Discharge Data Set to identify women with breast cancer occurring within 9 months before or 1 year after giving birth. The study found that pregnancy-associated breast cancer presented with more advanced disease, larger tumors and increased percentage of hormone receptor-negative tumors.