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Objective: To investigate the association between coronavirus disease 2019 (COVID-19) infection during the peripartum period and obstetric anal sphincter injuries (OASIS)., Methods: A retrospective cohort study was conducted, including all singleton vaginal deliveries and cesarean deliveries due to failed vacuum extraction, between June 2020 and January 2022 at a large tertiary medical center. OASIS complication during childbirth was compared between women with and without peripartum diagnosis of COVID-19, defined as a positive polymerase chain reaction test obtained within 1 week before delivery or up to 3 days after delivery. Universal screening for COVID-19 was implemented. A logistic regression model was used to adjust for confounding variables., Results: The study included 22 911 women, among whom 468 (2.0%) tested positive for COVID-19 and 22 443 women had no COVID-19 diagnosis. After adjusting for confounding variables, peripartum infection with COVID-19 was found to be independently associated with OASIS (adjusted odds ratio 4.38, 95% confidence interval 2.00-9.61; P < 0.001)., Conclusion: Infection with COVID-19 during the peripartum period significantly increases the risk for OASIS by more than fourfold. These findings emphasize the importance of understanding the impact of COVID-19 on birth complications, such as OASIS, to improve public health measures and enhance obstetric outcomes during pandemics., (© 2024 The Author(s). International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.)

Background: Breech presentation is a major indication for cesarean delivery (CD); however, the ideal timing of breech CD is debatable., Objectives: To study the influence of gestational age at the time of CD in breech presentation on maternal and fetal complications., Methods: We conducted a retrospective study including term singleton CDs of breech presentation between February 2020 and January 2022 at a tertiary medical center. Maternal and neonatal outcomes were compared by gestational age at the time of CD. Logistic regression models were constructed to adjust for confounders., Results: The study population included 468 CDs, 227 (48.5%) were at 37 + 0 to 38 + 6 weeks, 168 (36%) were at 39 + 0 to 39 + 6 weeks (comparison group), and 73 (15.5%) were at ≥ 40 weeks at the time of delivery. The rate of emergent CDs was significantly higher in both study groups. The composite of maternal adverse outcomes was also significantly higher at ≥ 40 weeks of gestation. Using logistic regression model, associations remained significant. The adjusted odds ratios (OR) for emergent CDs at 37 + 0 to 38 + 6 weeks and at ≥ 40 weeks were 1.65 (P = 0.018) and 2.407 (P = 0.004), respectively. Adjusted OR for maternal adverse outcomes at ≥ 40 weeks was 2.094 (P = 0.018). Higher rates of emergent CDs in both study groups compared to the comparison group was noted. A composite of maternal adverse outcomes was significantly higher at ≥ 40 weeks of gestation. This association remained significant after controlling for potential confounders., Conclusions: CDs at 39 + 0 to 39 + 6 weeks are associated with better maternal outcomes and lower rates of emergent CDs.

Objectives: The timing of planned repeat cesarean delivery (CD) is debateful in clinical practice. Planned repeat CD is typically scheduled before the spontaneous onset of labor to minimize the risk of uterine rupture during labor and the associated risk for fetal compromise. This timing should be balanced with the potential risk of delivering an infant who could benefit from additional maturation in utero. We aim to study the influence of gestational age at the time of repeat CD on maternal and fetal complications., Study Design: A population-based retrospective cohort study including all term singleton third CDs (≥ 37 weeks of gestation), between February-2020 and January-2022 at a tertiary medical center was conducted. Maternal and neonatal adverse outcomes were compared by gestational age at the time of the CD. A logistic regression models were constructed to adjust for confounders., Results: The study population included624 third CDs. Among them, two study groups were defined: 199 were at 37 + 0 to 37 + 6 weeks of gestation, and 44 were at ≥ 39 weeks of gestation at the time of delivery. 381 were at 38 + 0 to 38 + 6 weeks. Since our routine practice is to schedule elective CD at 38 + 0 to 38 + 6 weeks of gestation, we defined this group as the comparison group. In a multivariate analysis, both study groups were associated with significantly higher rates of emergent CDs after adjusting for maternal age, parity, ethnicity, premature rapture of membranes, spontaneous onset of labor and birthweight. After adjusting also for emergent CDs, CDs at 37 + 0 to 37 + 6 weeks of gestation were significantly associated with maternal and neonatal length of stay exceeding 4 days. Additionally, CDs at 37 + 0 to 37 + 6 weeks of gestation were also associated with composite of adverse neonatal and maternal outcomes., Conclusions: Our study demonstrated that scheduling third CD at 38 + 0 to 38 + 6 weeks is associated with reduced risk of emergent CD, as well as beneficial maternal and neonatal outcomes., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: Small for gestational age (SGA) singletons are at increased risk for neurodevelopmental abnormalities. Scarce data exist regarding the long-term implications of SGA in twins. We opted to study the association between SGA of one twin and long-term neurologic related morbidity in dichorionic diamniotic twins., Study Design: A population-based retrospective cohort study including consecutive dichorionic diamniotic twins, born between the years 1991 and 2021 at a tertiary medical center was conducted. Total and subtypes of neurologic related pediatric hospitalizations among SGA versus non-SGA twins were compared. A Kaplan-Meier survival curve was used to compare the cumulative neurologic morbidity incidence, and a Cox proportional hazards model was constructed to adjust for confounders., Results: The study population included 4222 newborns; 180 (4.3%) were SGA. Rate of long-term neurologic related hospitalizations was comparable between the two groups (8.7 vs. 8.0%, p = 0.755; Kaplan-Meier survival curve Log-rank p = 0.652). Using a Cox proportional hazards model, controlling for gender and birth order, no association was found between SGA and the risk for subsequent neurologic pediatric morbidity of the offspring (Adjusted HR = 1.0, 95% CI 0.6-1.8, p = 0.973)., Conclusions: SGA is not associated with an increased risk for long-term pediatric neurologic morbidity in dichorionic diamniotic twins., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: Scarce data exist regarding obstetric complications of short-stature patients. This study aimed to investigate obstetric and perinatal outcomes in women with short stature; specifically, to investigate whether short-stature patients are at an increased risk for cesarean delivery., Methods: A population-based cohort study was conducted, including all singletons born between the years 1991 and 2021 at a tertiary medical center. Obstetric and perinatal outcomes of short-stature patients were compared with those of non-short patients. A generalized estimation equation binary logistic model was constructed to adjust for confounders and maternal recurrence in the cohort., Results: The study population included 356 356 parturient; among them, 14 035 (3.9%) were short-stature patients. Short-stature patients had significantly higher rates of cesarean delivery (20.7% vs 13.7%, odds ratio = 1.64, 95% confidence interval 1.57-1.71, P < 0.001), induction of labor, pathologic presentations, prolonged second stage of labor, non-reassuring fetal monitoring, and meconium-stained amniotic fluid. Newborns of short-stature patients had a significantly higher risk of being small for gestational age as compared with those of non-short patients. In the generalized estimation equation models, the association between short stature and risk of cesarean delivery remained significant (adjusted odds ratio = 1.32, 95% confidence interval 1.27-1.38, P < 0.001), as well as the risk of small for gestational age newborns (adjusted odds ratio = 1.51, 95% confidence interval 1.40-1.63, P < 0.001), but not for the other adverse outcomes., Conclusions: Maternal short stature is an independent risk factor for cesarean delivery and is associated with small for gestational age newborns., (© 2023 International Federation of Gynecology and Obstetrics.)

Objective: We aimed to study the association between fetal gender in twin pregnancies and the risk for childhood infectious morbidity of the offspring., Study Design: A population-based cohort analysis was performed comparing total and subtypes of infectious related pediatric hospitalizations among males versus females offspring of twin pregnancies. The analysis included all dichorionic twins born between the years 1991-2021. A Kaplan-Meier survival curve was used to compare the cumulative infectious morbidity incidence, and a Cox proportional hazards model was constructed to adjust for confounders., Results: The study population included 4222 newborns (2111 males and 2111 females). Males had higher rates of infectious-related hospitalizations using a Cox proportional hazards model, an independent association was shown between male gender and infectious related hospitalizations of the offspring (Adjusted HR = 1.2, 95% CI: 1.1-1.4; p < 0.001)., Conclusion: Male gender in twin pregnancies is associated with an increased risk for long-term pediatric infectious morbidity., (© 2022. The Author(s), under exclusive licence to Springer Nature America, Inc.)

Objectives: One of the most common indications for intrapartum cesarean delivery (CD) is nonreassuring fetal heart rate (NRFHR) patterns. We aimed to study the long-term effect of CD due to NRFHR on the risk for subsequent childhood infectious morbidity-related hospitalizations of the offspring., Study Design: A population-based cohort study was performed, comparing total and different subtypes of infectious morbidity-related pediatric hospitalizations among offspring born by CD due to NRFHR versus labor dystocia (failure of labor to progress during the 1st or 2nd stage). The analysis included all singletons born between the years 1999-2014 at a single tertiary regional medical center. Infectious-related morbidities included hospitalizations involving a predefined set of International Classification of Diseases, 9th revision codes, as recorded in hospital computerized files. Infants with congenital malformations, multiple gestations, vaginal deliveries and vacuum failure were excluded from the analysis. Perinatal mortality cases were excluded from the long-term analysis. A Kaplan-Meier survival curve was used to compare the cumulative morbidity, and a Cox proportional hazards model was constructed to adjust for confounders., Results: The study population included 9956 newborns who met inclusion criteria; among them, 5810 (58%) were born by CD due to NRFHR, and 4146 (42%) were born via CD following labor dystocia with normal fetal heart rate (comparison group). Offspring born following NRFHR had higher rates of infectious morbidity-related hospitalizations (11.4% vs. 9.1%; odds ratio, 1.3; 95% confidence interval, 1.1-1.5; P < 0.01; Kaplan-Meier survival curve P < 0.01). The association remained significant and independent while adjusting for gestational age, maternal age and comorbidities, using a Cox proportional hazards model (adjusted hazard ratio, 1.3; 95% confidence interval, 1.2-1.4; P < 0.01)., Conclusions: In our population, CD due to NRFHR is a risk factor for pediatric infectious morbidity-related hospitalizations of the offspring., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: We aimed to study the long-term effect of non-reassuring fetal heart rate (NRFHR) patterns on the risk for subsequent pediatric cardiovascular morbidity of the offspring., Study Design: A population based cohort study, comparing total and different subtypes of cardiovascular morbidity related pediatric hospitalizations among offspring born by caesarean delivery (CD) due to NRFHR versus labor dystocia (failure of labor to progress during the 1st or 2nd stage). The analysis included all singletons born between the years 1999-2014 at a single tertiary regional medical center. Cardiovascular related morbidities included hospitalizations involving a pre-defined set of ICD-9 codes, as recorded in hospital computerized files. Infants with congenital malformations, multiple gestations, vaginal deliveries and vacuum failure were excluded from the analysis. Perinatal mortality cases were excluded from the long-term analysis. A Kaplan-Meier survival curve was used to compare the cumulative cardiovascular morbidity incidence, and a Cox proportional hazards model was used to adjust for confounders., Results: The study population included 9956 newborns who met inclusion criteria; among them, 5810 (58%) were born by CD due to NRFHR, and 4146 (42%) due to labor dystocia with normal FHR (comparison group). Rate of long- term cardiovascular related hospitalizations was comparable between both groups (0.8% vs. 0.7%, OR 0.9, 95% CI 0.6-1.4, p = 0.664; Kaplan-Meier survival curve p = 0.320(. Using a Cox proportional hazards model, controlling for gestational age, no association was found between NRFHR patterns and the risk for subsequent pediatric cardiovascular morbidity of the offspring (Adjusted HR = 0.8, 95% CI 0.5-1.3, p = 0.376)., Conclusion: In our population, NRFHR patterns do not affect the risk of long- term pediatric cardiovascular morbidity of the offspring., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Objective: We aimed to study the long-term effect of preeclampsia on the risk for subsequent gastrointestinal morbidity of the offspring., Study Design: A population based cohort analysis comparing total and different subtypes of gastrointestinal related pediatric hospitalizations among offspring of preeclamptic mothers versus offspring of mothers without preeclampsia. The analysis included all singletons born between the years 1999-2014 at a single tertiary regional medical center. Gastrointestinal related morbidities included hospitalizations involving a set of ICD-9 codes, as recorded in hospital files. Infants with congenital malformations, multiple gestations, and perinatal deaths were excluded from the analysis. A Kaplan-Meier survival curve was used to compare the cumulative morbidity, and a Cox proportional hazards model was constructed to adjust for confounders., Results: The study population included 239,687 newborns who met inclusion criteria; among them 2222 (0.93%) were born to mothers with severe preeclampsia or eclampsia, and 7279 (3.03%) were born to mothers with mild preeclampsia. Offspring of mothers with severe preeclampsia had significantly higher rates of gastrointestinal-related hospitalizations in comparison to offspring of mothers with mild preeclampsia and offspring of non-preeclamptic mothers (7.7% vs. 5.5% vs. 5.3%, respectively; p < 0.001). The association between exposure to severe preeclampsia and eclampsia and long-term gastrointestinal morbidity of the offspring remained significant and independent while adjusting for confounders (Adjusted HR = 1.2, 95% CI 1.0-1.4; p = 0.019)., Conclusion: Severe preeclampsia and eclampsia are independent risk factors for pediatric gastrointestinal morbidity of the offspring., (Copyright © 2019 International Society for the Study of Hypertension in Pregnancy. Published by Elsevier B.V. All rights reserved.)

Introduction: Low Apgar scores (<7) measured at age 5 minutes can predict short-term infant morbidity and mortality. Although an association exists between low Apgar scores and neuropsychological disorders, other childhood disorders were not thoroughly studied. We aimed to study the possible association between low 5-minute Apgar scores in term newborns and their long-term childhood gastrointestinal (GI) morbidity., Methods: A population-based cohort analysis was performed comparing total and different subtypes of GI-related pediatric hospitalizations among newborns with normal (≥7) and low (<7) 5-minute Apgar scores. The analysis included all term singletons born between the years 1999 and 2014 at a single tertiary regional medical center. Infants with congenital malformations, multiple gestations, and all perinatal deaths were excluded from the analysis. GI-related morbidities included hospitalizations involving a predefined set of ICD-9 codes, as recorded in the hospital computerized files. A Kaplan-Meier survival curve was constructed to compare the cumulative GI morbidity, and a Cox proportional hazards model was used to adjust for confounders., Results: The study population, including 223 244 term singletons, was followed for an average of 10.02 ± 6.0 years (0-18 years, median 10.25) following discharge from birth hospitalization. Low 5-minute Apgar scores were recorded in 585 (0.3%) newborns. Incidence of GI-related hospitalizations was higher among the low versus the normal 5-minute Apgar score group (7.4 versus 5.2%; 8.6/1000 person years (PY) versus 5.2/1000 PY, respectively; p = .02; odds ratio =1.66, 95%CI 1.36-1.96). The association remained significant and independent while adjusting for gestational age, fetal weight, offspring gender, maternal age, maternal smoking, hypertension, and diabetes (Adjusted HR =1.57, 95%CI 1.16-2.12, p = .003)., Conclusions: Low 5 minutes Apgar score is associated with an increased risk for long-term pediatric GI morbidity of the offspring. Our results suggest that Apgar scores can be used as a possible predictor for long-term pediatric morbidities and thus may necessitate appropriate surveillance in this vulnerable group of children.

Aims: The prevalence of gestational diabetes mellitus (GDM) has been increasing worldwide. We aimed to study the effect of GDM on the risk for childhood cardiovascular morbidity of the offspring., Methods: A population-based cohort analysis was performed comparing total and different subtypes of cardiovascular related pediatric diagnoses among offspring of mothers with GDM vs. offspring of mothers with no diabetes. The analysis included all singletons born between the years 1991-2014. Cardiovascular related morbidities included hospitalizations involving a pre-defined set of ICD-9 codes. Mothers with pregestational diabetes, Infants with congenital malformations, multiple gestations, and perinatal deaths were excluded from the analysis. A Cox proportional hazards model was constructed to adjust for confounders., Results: The study population included 216197 newborns which met the inclusion criteria; among them 4.4% (9460) were born to mothers with GDM controlled by diet and exercise (GDM A1) and 0.3% (724) were born to mothers with GDM requiring oral treatment or insulin (GDM A2). A significant association was noted between GDM and the rate of cardiovascular related hospitalizations (0.97 for GDM A2 vs. 0.57 for GDM A1 vs. 0.33 for no GDM, respectively; p < 0.001). The association remained significant and independent for GDM A1 only while adjusting for relevant confounders [adjusted HR = 1.6 (1.2-2.2); p value 0.001]., Conclusions: A significant association is noted between the GDM and the rate of cardiovascular hospitalizations of the offspring. However, in our population GDM A1 is an independent risk factor for pediatric cardiovascular morbidity of the offspring.

Background: Cigarette smoke is a well-known reproductive toxicant. We aimed to study the long-term effect of cigarette smoking during pregnancy on the risk for childhood cardiovascular morbidity of the offspring., Methods: A population-based cohort analysis was performed comparing total and subtypes of cardiovascular related pediatric hospitalizations among offspring of smoking mothers versus offspring of non-smoking mothers. The analysis included all singletons born between the years 1999-2014.A Kaplan-Meier survival curve was used to compare the cumulative cardiovascular morbidity, and a Cox proportional hazards model was constructed to adjust for confounders., Results: The study population included 242,342 newborns which met inclusion criteria; among them 2861 were born to smoking mothers. Offspring of smoking mothers had higher rates of cardiovascular-related hospitalizations (1.3% vs. 0.6%, OR 2.1, 95% CI 1.5-2.9; p < 0.001; Kaplan-Meier log-rank test p < 0.001)., Conclusion: Smoking exposure during pregnancy is associated with an increased risk for long-term pediatric cardiovascular morbidity of the offspring., (Copyright © 2018 Elsevier Inc. All rights reserved.)