To investigate the morbidity associated with assisted vaginal birth (AVB) and an occipito-posterior (OP) fetal head position.
Design
Observational study based on secondary analyses of a randomised controlled trial and cohort study.
Setting
Two university affiliated maternity hospitals in Ireland.
Population
A combined cohort of 1081 nulliparous women at term who were assessed for AVB in the second stage of labour.
Methods
Univariable and multivariable logistic regression analyses were performed.
Main Outcome Measures
Postpartum haemorrhage (PPH), obstetric anal sphincter injury (OASI), fetal acidosis, neonatal trauma, failed or abandoned AVB leading to caesarean section (CS).
Results
Of the 1081 AVBs, a total of 192 (17.8%) had an OP position at the outset, with 103 of these (53.6%) rotated to occipito-anterior (OA) prior to AVB and 89 (46.4%) remaining OP. AVB completed in a non-rotated OP position compared with OP rotated to OA was associated with an increased risk of PPH (34% [30/89] vs. 15% [15/103], adjusted Odds Ratio (adj OR) 3.57; 95% Confidence Interval (CI) 1.68 to 7.58), OASI (22% [14/65] vs. 2% [2/98], adj OR: 12.62; 95% CI: 2.65 to 60.12) and CS (27% [24/89] vs. 5% [5/103], adj OR: 8.99; 95% CI: 3.14 to 25.74). There were no significant differences in neonatal outcomes. The diagnosis of OP was incorrectly assigned as either OA or occipito-transverse (OT) in 35 of the 192 cases (18.2%).
Conclusions
This study highlights the associated morbidity when attempting an AVB with a non-rotated OP position rather than rotating to OA.
{"title":"Birth Outcomes Associated With Assisted Vaginal Birth in an Occipito-Posterior Position: Secondary Analyses of a Randomised Controlled Trial and Cohort Study","authors":"Lauren Hayes, Meena Ramphul, Deirdre J. Murphy","doi":"10.1111/1471-0528.70002","DOIUrl":"10.1111/1471-0528.70002","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To investigate the morbidity associated with assisted vaginal birth (AVB) and an occipito-posterior (OP) fetal head position.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Observational study based on secondary analyses of a randomised controlled trial and cohort study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Two university affiliated maternity hospitals in Ireland.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>A combined cohort of 1081 nulliparous women at term who were assessed for AVB in the second stage of labour.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Univariable and multivariable logistic regression analyses were performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Postpartum haemorrhage (PPH), obstetric anal sphincter injury (OASI), fetal acidosis, neonatal trauma, failed or abandoned AVB leading to caesarean section (CS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 1081 AVBs, a total of 192 (17.8%) had an OP position at the outset, with 103 of these (53.6%) rotated to occipito-anterior (OA) prior to AVB and 89 (46.4%) remaining OP. AVB completed in a non-rotated OP position compared with OP rotated to OA was associated with an increased risk of PPH (34% [30/89] vs. 15% [15/103], adjusted Odds Ratio (adj OR) 3.57; 95% Confidence Interval (CI) 1.68 to 7.58), OASI (22% [14/65] vs. 2% [2/98], adj OR: 12.62; 95% CI: 2.65 to 60.12) and CS (27% [24/89] vs. 5% [5/103], adj OR: 8.99; 95% CI: 3.14 to 25.74). There were no significant differences in neonatal outcomes. The diagnosis of OP was incorrectly assigned as either OA or occipito-transverse (OT) in 35 of the 192 cases (18.2%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study highlights the associated morbidity when attempting an AVB with a non-rotated OP position rather than rotating to OA.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"133 2","pages":"311-319"},"PeriodicalIF":4.3,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.70002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To examine factors associated with perinatal mortality (PM) in women in minority ethnic groups (MEG) in Ireland and assess differences between them and their white counterparts.
Design
Retrospective population-based cohort study.
Setting
Nineteen maternity units in the Republic of Ireland, 2011–2021.
Population
4314 perinatal mortalities (3711 in white women; 603 in women in MEG) were reported to the National Perinatal Epidemiology Centre (NPEC).
Methods
Chi-square testing was used to assess differences between groups.
Main Outcome Measures
PM outcomes and socio-demographic, obstetric, and medical characteristics for mothers and infants were collected.
Results
Women in MEG who experienced PM were younger (p < 0.001) and 46% were employed (vs. 75% of white women, p < 0.001). More women in MEG had previous pregnancies (77% vs. 68%, p < 0.001), and more than double had ≥ 3 previous completed pregnancies versus white women (26% vs. 12%, p < 0.001). Women in MEG also had more previous pregnancy medical issues (49% vs. 38%, p = 0.001). Twice as many women in MEG had booking appointments after 20 weeks' gestation or never received prenatal care (p < 0.001). Women in MEG experienced more placental conditions and obstetric factors as causes of PM, but fewer congenital anomalies than white women (p = 0.047).
Conclusions
The overrepresentation of women in MEG in PM data may be explained by factors such as employment status, parity, body mass index (BMI), and prenatal care access. Actionable measures are needed to address these issues, which could include initiatives to increase maternal health literacy, optimise maternal health preconception, and ensure prenatal care is accessible and culturally competent.
{"title":"Ethnic Disparities in Perinatal Mortality and Associated Factors: A Nationwide Cohort Study","authors":"Laura Robinson, Keelin O'Donoghue, Sara Leitao","doi":"10.1111/1471-0528.18361","DOIUrl":"10.1111/1471-0528.18361","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To examine factors associated with perinatal mortality (PM) in women in minority ethnic groups (MEG) in Ireland and assess differences between them and their white counterparts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Retrospective population-based cohort study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Nineteen maternity units in the Republic of Ireland, 2011–2021.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>4314 perinatal mortalities (3711 in white women; 603 in women in MEG) were reported to the National Perinatal Epidemiology Centre (NPEC).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Chi-square testing was used to assess differences between groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>PM outcomes and socio-demographic, obstetric, and medical characteristics for mothers and infants were collected.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Women in MEG who experienced PM were younger (<i>p</i> < 0.001) and 46% were employed (vs. 75% of white women, <i>p</i> < 0.001). More women in MEG had previous pregnancies (77% vs. 68%, <i>p</i> < 0.001), and more than double had ≥ 3 previous completed pregnancies versus white women (26% vs. 12%, <i>p</i> < 0.001). Women in MEG also had more previous pregnancy medical issues (49% vs. 38%, <i>p</i> = 0.001). Twice as many women in MEG had booking appointments after 20 weeks' gestation or never received prenatal care (<i>p</i> < 0.001). Women in MEG experienced more placental conditions and obstetric factors as causes of PM, but fewer congenital anomalies than white women (<i>p</i> = 0.047).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The overrepresentation of women in MEG in PM data may be explained by factors such as employment status, parity, body mass index (BMI), and prenatal care access. Actionable measures are needed to address these issues, which could include initiatives to increase maternal health literacy, optimise maternal health preconception, and ensure prenatal care is accessible and culturally competent.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 13","pages":"2233-2245"},"PeriodicalIF":4.3,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18361","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145035538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bolanle Olapeju, Anna Maria van Eijk, Michael Bride, Anna Passaniti, Saade Ahmed Abdallah, Gabrielle C. Hunter, Safia Mohammed, Leila Kaze, Judith Nalukwago, Zoé Mistrale Hendrickson
Objective
This study explores the relationship between pregnancy intentions and maternal health behaviours.
Design and Setting
Secondary data analysis of recent (2018–2023), cross-sectional demographic and health surveys from 18 sub-Saharan African countries.
Population
Survey respondents were women aged 15–49 years old with a child less than a year old who responded to survey questions about their pregnancy intentions for that child (N = 39 936).
Methods
Logistic regressions and meta-analysis using fixed effects explored the relationship between pregnancy intentions and maternal health behaviours across study countries adjusting for sociodemographic and contextual variables.
Measures
Pregnancy intentions were defined as intended versus unintended. Maternal health behaviours included (i) early ANC, (ii) 4+ ANC contacts (ANC4+), (iii) 3+ doses of intermittent preventive treatment of malaria in pregnancy (IPTp3+), (iv) Mosquito net use in pregnancy, (v) receipt of tetanus toxoid and (vi) immediate breastfeeding.
Results
Overall, 25% of women did not want their index pregnancy (ranging from 13% in Burkina Faso to 49% in Gabon). Unintended pregnancies were associated with reduced odds of early ANC (aOR: 0.68, 95% CI: 0.63, 0.73), ANC4+ (AOR: 0.70; 95% CI: 0.65, 0.75), IPTp3+ (AOR: 0.87; 95% CI: 0.81, 0.94), receiving tetanus toxoid (AOR: 0.74; 95% CI: 0.68, 0.80) and immediate breastfeeding (AOR: 0.83; 95% CI: 0.80, 0.87).
Conclusions
Study findings corroborate the role of reproductive health agency and pregnancy preparedness in optimising maternal health behaviours and subsequent outcomes. Integration of reproductive health services, malaria service delivery and social and behaviour change interventions can help to improve pregnancy outcomes.
{"title":"Pregnancy Intentions and Maternal Health Behaviours: Observational Study in 18 African Countries","authors":"Bolanle Olapeju, Anna Maria van Eijk, Michael Bride, Anna Passaniti, Saade Ahmed Abdallah, Gabrielle C. Hunter, Safia Mohammed, Leila Kaze, Judith Nalukwago, Zoé Mistrale Hendrickson","doi":"10.1111/1471-0528.18367","DOIUrl":"10.1111/1471-0528.18367","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study explores the relationship between pregnancy intentions and maternal health behaviours.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design and Setting</h3>\u0000 \u0000 <p>Secondary data analysis of recent (2018–2023), cross-sectional demographic and health surveys from 18 sub-Saharan African countries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>Survey respondents were women aged 15–49 years old with a child less than a year old who responded to survey questions about their pregnancy intentions for that child (<i>N</i> = 39 936).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Logistic regressions and meta-analysis using fixed effects explored the relationship between pregnancy intentions and maternal health behaviours across study countries adjusting for sociodemographic and contextual variables.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Measures</h3>\u0000 \u0000 <p>Pregnancy intentions were defined as intended versus unintended. Maternal health behaviours included (i) early ANC, (ii) 4+ ANC contacts (ANC4+), (iii) 3+ doses of intermittent preventive treatment of malaria in pregnancy (IPTp3+), (iv) Mosquito net use in pregnancy, (v) receipt of tetanus toxoid and (vi) immediate breastfeeding.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, 25% of women did not want their index pregnancy (ranging from 13% in Burkina Faso to 49% in Gabon). Unintended pregnancies were associated with reduced odds of early ANC (aOR: 0.68, 95% CI: 0.63, 0.73), ANC4+ (AOR: 0.70; 95% CI: 0.65, 0.75), IPTp3+ (AOR: 0.87; 95% CI: 0.81, 0.94), receiving tetanus toxoid (AOR: 0.74; 95% CI: 0.68, 0.80) and immediate breastfeeding (AOR: 0.83; 95% CI: 0.80, 0.87).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Study findings corroborate the role of reproductive health agency and pregnancy preparedness in optimising maternal health behaviours and subsequent outcomes. Integration of reproductive health services, malaria service delivery and social and behaviour change interventions can help to improve pregnancy outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 13","pages":"2246-2255"},"PeriodicalIF":4.3,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18367","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145025623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Linked article: Outpatient Versus Inpatient Induction of Labour With Oral Misoprostol: A Multicentre Randomised-Controlled Trial. https://doi.org/10.1111/1471-0528.18296
{"title":"Outpatient Induction With Oral Misoprostol: Trial Considerations","authors":"Abdelrahman M. Makram","doi":"10.1111/1471-0528.18370","DOIUrl":"10.1111/1471-0528.18370","url":null,"abstract":"<p><b>Linked article:</b> Outpatient Versus Inpatient Induction of Labour With Oral Misoprostol: A Multicentre Randomised-Controlled Trial. https://doi.org/10.1111/1471-0528.18296</p>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"133 1","pages":"189-190"},"PeriodicalIF":4.3,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Albert Salas-Huetos, Makiko Mitsunami, Maryam Kazemi, Eduardo Ortiz-Panozo, Lidia Mínguez-Alarcón, Irene Souter, Jorge E. Chavarro, the EARTH Study Team
Objective
To evaluate whether maternal intake of sugar-sweetened beverages (SSB) and artificially sweetened beverages (ASB) affects medically assisted reproduction outcomes (MAR).
Design
Prospective cohort study.
Settings
Fertility centre at an academic hospital.
Population
This study includes 612 women who underwent 1572 MAR cycles, including 804 intrauterine insemination (IUI) cycles and 768 in vitro fertilisation (IVF) cycles.
Methods
A 131-item food frequency questionnaire assessed women's pretreatment SSB and ASB intake.
Main Outcome Measures
Live birth per treatment cycle was considered the primary outcome. Secondary outcomes included estradiol trigger levels, endometrial thickness, total oocyte yield, fertilisation, implantation, clinical pregnancy, and pregnancy loss probabilities.
Results
A total of 112 (18.3%) women did not consume SSB, and 171 (27.9%) did not consume ASB. SSB and ASB intake were unrelated to the likelihood of success in infertility treatment cycles. The adjusted predicted marginal probability (95% CI) of live birth among women in the lowest and highest category of intake of SSBs was 0.41 (0.32, 0.50) and 0.41 (0.34, 0.49) in couples undergoing IVF/ICSI and 0.10 (0.06, 0.17) and 0.11 (0.07, 0.17) in couples undergoing IUI. The corresponding results for the lowest and highest categories of intake of ASB and live birth were 0.40 (0.33, 0.48) and 0.41 (0.33, 0.49) for IVF/ICSI cycles and 0.09 (0.06, 0.15) and 0.08 (0.05, 0.13) for IUI cycles. There were inconsistent associations in secondary analyses focused on intakes of individual beverages.
Conclusions
Our findings suggest that, in couples seeking MAR, women's intake of SSB or ASB is unrelated to the likelihood of success in infertility treatment with IUI or IVF.
{"title":"Maternal Intake of Sugar- and Artificially Sweetened Beverages and Outcomes of Assisted Reproduction: A Prospective Cohort Study","authors":"Albert Salas-Huetos, Makiko Mitsunami, Maryam Kazemi, Eduardo Ortiz-Panozo, Lidia Mínguez-Alarcón, Irene Souter, Jorge E. Chavarro, the EARTH Study Team","doi":"10.1111/1471-0528.18360","DOIUrl":"10.1111/1471-0528.18360","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate whether maternal intake of sugar-sweetened beverages (SSB) and artificially sweetened beverages (ASB) affects medically assisted reproduction outcomes (MAR).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Prospective cohort study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Settings</h3>\u0000 \u0000 <p>Fertility centre at an academic hospital.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>This study includes 612 women who underwent 1572 MAR cycles, including 804 intrauterine insemination (IUI) cycles and 768 in vitro fertilisation (IVF) cycles.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A 131-item food frequency questionnaire assessed women's pretreatment SSB and ASB intake.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Live birth per treatment cycle was considered the primary outcome. Secondary outcomes included estradiol trigger levels, endometrial thickness, total oocyte yield, fertilisation, implantation, clinical pregnancy, and pregnancy loss probabilities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 112 (18.3%) women did not consume SSB, and 171 (27.9%) did not consume ASB. SSB and ASB intake were unrelated to the likelihood of success in infertility treatment cycles. The adjusted predicted marginal probability (95% CI) of live birth among women in the lowest and highest category of intake of SSBs was 0.41 (0.32, 0.50) and 0.41 (0.34, 0.49) in couples undergoing IVF/ICSI and 0.10 (0.06, 0.17) and 0.11 (0.07, 0.17) in couples undergoing IUI. The corresponding results for the lowest and highest categories of intake of ASB and live birth were 0.40 (0.33, 0.48) and 0.41 (0.33, 0.49) for IVF/ICSI cycles and 0.09 (0.06, 0.15) and 0.08 (0.05, 0.13) for IUI cycles. There were inconsistent associations in secondary analyses focused on intakes of individual beverages.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our findings suggest that, in couples seeking MAR, women's intake of SSB or ASB is unrelated to the likelihood of success in infertility treatment with IUI or IVF.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"133 2","pages":"302-310"},"PeriodicalIF":4.3,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145018230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Valerie Melson, Benjamin G. Gorman, Sanjna Rajput, Lauren Lu, Caitlin J. VanLith, Megan E. Branda, Leslie Carranza, Regan N. Theiler
Objective
To compare maternal and neonatal adverse outcomes between women who are English proficient (EP) and those who have limited English proficiency (LEP).
Design
Retrospective cohort study.
Setting
Single US academic medical centre with interpreter services.
Population
All pregnant women with deliveries during the study period.
Methods
We retrospectively identified EP and LEP individuals (categorised by self-report) who delivered at Mayo Clinic, Rochester, Minnesota, USA, from 2015 to 2019. Overall composite adverse outcomes, as well as maternal and neonatal composite outcomes, were measured with generalised linear models and logistic regression, reporting estimates and 95% CIs. Multivariable logistic regression analysis was used to assess associations between language proficiency and outcome measures while controlling for other clinical factors.
Main Outcome Measures
Composite overall, maternal and neonatal adverse outcomes.
Results
Among 10 427 EP and 900 LEP participants, the LEP group had a higher incidence of gestational diabetes, unplanned intensive care unit admission, uterine rupture, postpartum haemorrhage with transfusion, neonatal death and 5-min Apgar score less than 7. The composite overall, maternal and neonatal adverse outcomes were more prevalent in the LEP group than the EP group in unadjusted analysis. Of these, the composite adverse outcome remained significant when the model was adjusted (odds ratio, 1.40; 95% CI, 1.03–1.90).
Conclusions
Pregnant women with LEP had increased incidence of adverse delivery outcomes, even in a setting with universal availability of medical interpreters.
{"title":"Language Proficiency and Maternal and Neonatal Adverse Outcomes: A Retrospective Cohort Study","authors":"Valerie Melson, Benjamin G. Gorman, Sanjna Rajput, Lauren Lu, Caitlin J. VanLith, Megan E. Branda, Leslie Carranza, Regan N. Theiler","doi":"10.1111/1471-0528.18354","DOIUrl":"10.1111/1471-0528.18354","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To compare maternal and neonatal adverse outcomes between women who are English proficient (EP) and those who have limited English proficiency (LEP).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Retrospective cohort study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Single US academic medical centre with interpreter services.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>All pregnant women with deliveries during the study period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively identified EP and LEP individuals (categorised by self-report) who delivered at Mayo Clinic, Rochester, Minnesota, USA, from 2015 to 2019. Overall composite adverse outcomes, as well as maternal and neonatal composite outcomes, were measured with generalised linear models and logistic regression, reporting estimates and 95% CIs. Multivariable logistic regression analysis was used to assess associations between language proficiency and outcome measures while controlling for other clinical factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Composite overall, maternal and neonatal adverse outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 10 427 EP and 900 LEP participants, the LEP group had a higher incidence of gestational diabetes, unplanned intensive care unit admission, uterine rupture, postpartum haemorrhage with transfusion, neonatal death and 5-min Apgar score less than 7. The composite overall, maternal and neonatal adverse outcomes were more prevalent in the LEP group than the EP group in unadjusted analysis. Of these, the composite adverse outcome remained significant when the model was adjusted (odds ratio, 1.40; 95% CI, 1.03–1.90).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Pregnant women with LEP had increased incidence of adverse delivery outcomes, even in a setting with universal availability of medical interpreters.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 13","pages":"2226-2232"},"PeriodicalIF":4.3,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Martin G. Frasch, Sheehan D. Fisher, Donna Russell, Philip J. Steer
{"title":"Global Challenges in Data Collection to Reduce Adverse Perinatal Outcomes, Including Hypoxic Ischaemic Encephalopathy","authors":"Martin G. Frasch, Sheehan D. Fisher, Donna Russell, Philip J. Steer","doi":"10.1111/1471-0528.18371","DOIUrl":"10.1111/1471-0528.18371","url":null,"abstract":"","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"133 2","pages":"205-207"},"PeriodicalIF":4.3,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Melvin B. Marzan, Daniel L. Rolnik, Heng Jiang, Joanne M. Said, Kirsten R. Palmer, Stephanie Potenza, Natasha Pritchard, Clare L. Whitehead, Penelope M. Sheehan, Jolyon Ford, Ben W. Mol, Susan P. Walker, Lisa Hui
Objectives
To examine the combined influence of food environment, built environment, socio-economic status and individual factors (maternal age, parity, smoking status and need for an interpreter) on maternal overweight, gestational diabetes mellitus (GDM) and large-for-gestational age (LGA) births in Australia.
Design
Retrospective cohort study.
Setting
Melbourne, Australia.
Population
163 760 singleton pregnancies/births.
Main Outcomes Measures
Primary outcomes: maternal overweight, GDM and LGA births.
Methods
Structural equation modelling (SEM) assessed direct and indirect associations, with maternal overweight as a mediator. LCA was used to classify risk variation across socio-economic strata.
Results
Among 163 760 births, a higher density of unhealthy food outlets, lower liveability scores and greater socio-economic disadvantage were associated with maternal overweight. Maternal overweight strongly predicted GDM (c = 0.118, 95% CI: 0.113–0.124; p < 0.001) LGA births (c = 0.058, 95% CI: 0.053–0.059; p < 0.001), while higher liveability and walkability environments were protective against maternal overweight (c = −0.011, 95% CI: −0.019 to −0.002; p < 0.05). LCA identified a high-risk subgroup (85.1% overweight, 34.4% GDM) concentrated in socio-economically disadvantaged areas with poor access to healthy food and more walkable neighbourhoods.
Conclusions
Environmental and socio-economic factors have significant independent influences on maternal overweight, GDM and LGA births. Addressing food access disparities, improving the walkability and liveability of residential areas and ensuring equitable healthcare infrastructure could reduce maternal health risks and promote better pregnancy outcomes.
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Annika W. Terpstra, Romy Bosvelt, Mallory D. Woiski, Marleen M. H. J. van Gelder
<p>Over the last decades, the incidence of postpartum haemorrhage (PPH) has increased in high-income countries, which cannot be explained by known risk factors [<span>1</span>]. As PPH substantially contributes to maternal morbidity and mortality worldwide, identification of risk factors is warranted to halt this trend. Some registries and healthcare databases contain data on the amount of blood loss within 24 h postpartum that may be used for this purpose. In addition, PPH may be self-reported in questionnaires in birth cohort studies. Two previous small-scale studies, however, indicated that maternal recall of PPH is inaccurate [<span>2, 3</span>], but evidence on the validity of maternal self-report on PPH using web-based questionnaires is lacking. Therefore, we aimed to assess the validity of a self-completed web-based questionnaire on PPH within a birth cohort study.</p><p>This study used data collected in the PRIDE Study, an ongoing cohort study among pregnant women and their offspring in The Netherlands [<span>4</span>]. We included all PRIDE Study participants with an estimated date of delivery between January 2018 and December 2019 for whom data on PPH were available from both questionnaires and obstetric records (<i>N</i> = 799). PPH was assessed with a closed-ended question requesting a single answer (blood loss after delivery: less than 500 mL, 500–1000 mL or more than 1000 mL) in the first postpartum questionnaire, which was administered two months after the estimated date of delivery. We calculated level of agreement, Cohen's kappa and measures of validity (sensitivity, specificity, positive predictive value [PPV], and negative predictive value [NPV]) for self-reported PPH with cut-off values of ≥ 500 mL and > 1000 mL with obstetric records as the reference standard for the total population, as well as stratified by level of education, parity and mode of delivery.</p><p>The results are presented in Table 1. Overall, values for agreement and validity measures were high (> 0.85) for both cut-off values, with the exception of the PPV, which was 0.73 (95% confidence interval [CI] 0.67–0.78) for ≥ 500 mL and 0.71 (95% CI 0.60–0.81) for > 1000 mL. This was due to the relatively high number of false-positive reports in relation to the number of true-positive reports. For the PPH cut-off value of ≥ 500 mL, women with a high level of education seemed to have higher agreement, sensitivity and PPV compared to women with a low/intermediate level of education (differences in validity measures > 0.05). We also observed differences in agreement, specificity and PPV by mode of delivery, with lower values for caesarean sections than for vaginal deliveries, as well as a higher sensitivity for primiparae. Cohen's kappa ranged between 0.48 (95% CI 0.30–0.67) for the PPH cut-off value of ≥ 500 mL among women with a caesarean section to 0.83 (95% CI 0.76–0.91) for the PPH cut-off value of ≥ 1000 mL among women with a high level of education.<
{"title":"Validity of Self-Reported Data on Postpartum Haemorrhage","authors":"Annika W. Terpstra, Romy Bosvelt, Mallory D. Woiski, Marleen M. H. J. van Gelder","doi":"10.1111/1471-0528.18359","DOIUrl":"10.1111/1471-0528.18359","url":null,"abstract":"<p>Over the last decades, the incidence of postpartum haemorrhage (PPH) has increased in high-income countries, which cannot be explained by known risk factors [<span>1</span>]. As PPH substantially contributes to maternal morbidity and mortality worldwide, identification of risk factors is warranted to halt this trend. Some registries and healthcare databases contain data on the amount of blood loss within 24 h postpartum that may be used for this purpose. In addition, PPH may be self-reported in questionnaires in birth cohort studies. Two previous small-scale studies, however, indicated that maternal recall of PPH is inaccurate [<span>2, 3</span>], but evidence on the validity of maternal self-report on PPH using web-based questionnaires is lacking. Therefore, we aimed to assess the validity of a self-completed web-based questionnaire on PPH within a birth cohort study.</p><p>This study used data collected in the PRIDE Study, an ongoing cohort study among pregnant women and their offspring in The Netherlands [<span>4</span>]. We included all PRIDE Study participants with an estimated date of delivery between January 2018 and December 2019 for whom data on PPH were available from both questionnaires and obstetric records (<i>N</i> = 799). PPH was assessed with a closed-ended question requesting a single answer (blood loss after delivery: less than 500 mL, 500–1000 mL or more than 1000 mL) in the first postpartum questionnaire, which was administered two months after the estimated date of delivery. We calculated level of agreement, Cohen's kappa and measures of validity (sensitivity, specificity, positive predictive value [PPV], and negative predictive value [NPV]) for self-reported PPH with cut-off values of ≥ 500 mL and > 1000 mL with obstetric records as the reference standard for the total population, as well as stratified by level of education, parity and mode of delivery.</p><p>The results are presented in Table 1. Overall, values for agreement and validity measures were high (> 0.85) for both cut-off values, with the exception of the PPV, which was 0.73 (95% confidence interval [CI] 0.67–0.78) for ≥ 500 mL and 0.71 (95% CI 0.60–0.81) for > 1000 mL. This was due to the relatively high number of false-positive reports in relation to the number of true-positive reports. For the PPH cut-off value of ≥ 500 mL, women with a high level of education seemed to have higher agreement, sensitivity and PPV compared to women with a low/intermediate level of education (differences in validity measures > 0.05). We also observed differences in agreement, specificity and PPV by mode of delivery, with lower values for caesarean sections than for vaginal deliveries, as well as a higher sensitivity for primiparae. Cohen's kappa ranged between 0.48 (95% CI 0.30–0.67) for the PPH cut-off value of ≥ 500 mL among women with a caesarean section to 0.83 (95% CI 0.76–0.91) for the PPH cut-off value of ≥ 1000 mL among women with a high level of education.<","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"133 2","pages":"345-347"},"PeriodicalIF":4.3,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18359","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144995634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aurora Oftedal, Anne Kaasen, Taran Karlsen, Guttorm Haugen, Mona Bekkhus
Objective
To assess mental health throughout pregnancy among women with a history of diagnosis of fetal anomaly.
Design
Prospective observational study.
Setting
Tertiary referral centre for fetal medicine.
Population
Pregnant women with a history of fetal anomaly (study group; n = 75) and women without such a history (comparison group; n = 111). A subgroup of women in the study group (n = 28) participated in two different pregnancies, where the first had a diagnosis of fetal anomaly and the second did not.
Methods
Women completed the Edinburgh Postnatal Depression Scale (EPDS) and Impact of Events Scale (IES) at four timepoints between gestational age 18 weeks and 36 weeks.
Main Outcomes
Trajectories of EPDS and IES across time in the study group and comparison group, as well as differences in EPDS and IES in the healthy pregnancy and the pregnancy with a diagnosis of fetal anomaly in the subgroup.
Results
Having a history of previous diagnosis of fetal anomaly was associated with elevated levels of depression and traumatic stress throughout pregnancy, even in healthy pregnancies (e.g., EPDS mean difference = 2.65, 95% CI [1.91, 3.21]). The difference between groups was largest early in pregnancy and decreased with increasing gestational age. Furthermore, women in the subgroup experienced much higher levels of distress in the pregnancy with a diagnosis of fetal anomaly than in their healthy pregnancy (e.g., EPDS mean difference = 8.7, 95% CI [6.40, 11.15]).
Conclusion
The results highlight the importance of considering women's history of fetal anomaly and prenatal loss even in healthy pregnancies.
{"title":"Maternal Distress in Pregnancies After Previous Fetal Anomaly: A Longitudinal Cohort Study","authors":"Aurora Oftedal, Anne Kaasen, Taran Karlsen, Guttorm Haugen, Mona Bekkhus","doi":"10.1111/1471-0528.18343","DOIUrl":"10.1111/1471-0528.18343","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To assess mental health throughout pregnancy among women with a history of diagnosis of fetal anomaly.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Prospective observational study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Tertiary referral centre for fetal medicine.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>Pregnant women with a history of fetal anomaly (study group; <i>n</i> = 75) and women without such a history (comparison group; <i>n</i> = 111). A subgroup of women in the study group (<i>n</i> = 28) participated in two different pregnancies, where the first had a diagnosis of fetal anomaly and the second did not.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Women completed the Edinburgh Postnatal Depression Scale (EPDS) and Impact of Events Scale (IES) at four timepoints between gestational age 18 weeks and 36 weeks.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcomes</h3>\u0000 \u0000 <p>Trajectories of EPDS and IES across time in the study group and comparison group, as well as differences in EPDS and IES in the healthy pregnancy and the pregnancy with a diagnosis of fetal anomaly in the subgroup.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Having a history of previous diagnosis of fetal anomaly was associated with elevated levels of depression and traumatic stress throughout pregnancy, even in healthy pregnancies (e.g., EPDS mean difference = 2.65, 95% CI [1.91, 3.21]). The difference between groups was largest early in pregnancy and decreased with increasing gestational age. Furthermore, women in the subgroup experienced much higher levels of distress in the pregnancy with a diagnosis of fetal anomaly than in their healthy pregnancy (e.g., EPDS mean difference = 8.7, 95% CI [6.40, 11.15]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The results highlight the importance of considering women's history of fetal anomaly and prenatal loss even in healthy pregnancies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"133 1","pages":"116-122"},"PeriodicalIF":4.3,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144995633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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