Linked article: This is a mini commentary on Bottemanne et al., pp. 412–419 in this issue. To view this article visit https://doi.org/10.1111/1471-0528.18306.
To determine the association of self-assessed caffeine consumption with adverse pregnancy outcomes (APO).
Secondary analysis of births in the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be (nuMoM2b). Caffeine intake was assessed by the self-reported Food Frequency Questionnaire reflecting consumption in the three months prior to the first trimester visit.
nuMoM2b was a prospectively collected cohort.
This is a large US-based cohort of pregnant patients.
High caffeine intake was defined as ≥ 200 mg/day. Logistic models assessed associations between high intake and APO, adjusted for confounders. We also grouped caffeine intake in 50 mg increments and tested whether increased consumption was associated with increased odds of APO.
APO were defined as a composite of intrauterine foetal demise > 20 weeks' gestation, hypertensive disorders of pregnancy, preterm birth and small for gestational age infant.
The primary analysis included 7345 participants with live births or pregnancy loss > 20 weeks' gestation, for whom the median daily caffeine intake was 63.28 mg/day. 841 (11.4%) of patients had high intake and 2168 (29.5%) had an APO. When adjusted for confounders, high intake was not associated with increased odds of APO (aOR 0.99, 95% CI 0.84–1.16), nor was it associated with any individual APO. We found no significant increased odds of APO per 50 mg increase in caffeine intake.
High caffeine intake assessed in the periconceptual period was not associated with the risk of APO. Further research exploring biomarkers and longitudinal childhood outcomes is needed to clarify limitations with regard to intake.
Linked article: This is a mini commentary on Hutcheon et al., pp. 263–271 in this issue. To view this article, visit https://doi.org/10.1111/1471-0528.18252.
To evaluate similarities in pathways leading to preterm stillbirth and preterm neonatal death.
Prospective observational study.
Study hospitals in India and Pakistan.
Preterm stillbirths and neonatal deaths ≥ 1000 g delivered in a study facility and evaluated by an expert panel for cause of death.
An observational study of stillbirths and preterm neonatal deaths.
Asphyxia, placental maternal vascular malperfusion (MVM), maternal hypertension, fetal growth restriction (FGR).
There were 398 preterm stillbirths and 582 preterm neonatal deaths in our study population. Of these, the panel determined asphyxia as a cause of death for 80.2% of the preterm stillbirths and 57.4% of the preterm neonatal deaths. Of the 319 preterm stillbirths with asphyxia, 62.4% also had placental MVM, while only 38.0% of the preterm stillbirths without birth asphyxia had MVM. Maternal hypertension was present among 44.5% of the stillbirths and FGR in 35.2%. Among the stillbirths with hypertension, 64.4% had asphyxia and MVM compared to 38.5% among those without hypertension. Similar patterns were seen among neonatal deaths.
Both MVM and birth asphyxia were commonly present among stillbirths and neonatal deaths, especially those associated with hypertension and FGR compared to stillbirths and neonatal deaths without those conditions. These findings suggest that MVM and fetal asphyxia are part of a common pathway for stillbirth and preterm neonatal deaths.
Bellad MB, Hoffman MK, Mallapur AA, Charantimath US, Katageri GM, Ganachari MS, Kavi A, Ramdurg UY, Bannale SG, Revankar AP, Sloan NL, Kodkany BS, Goudar SS, Derman RJ. “Clindamycin to Reduce Preterm Birth in a Low Resource Setting: A Randomised Placebo-Controlled Clinical Trial.” BJOG 2018; 125: 1601–1609. https://doi.org/10.1111/1471-0528.15290.
We note that for both Tables 1 and 2, the continuous data presented is not labelled as to whether it means with standard errors or with standard deviations. This should be added as means with standard errors to prevent confusion with means with standard deviations.
We apologise for this error.
C. Burden, A. Merriel, D. Bakhbakhi, A. Heazell, D. Siassakos. Care of late intrauterine fetal death and stillbirth, BJOG: An International Journal of Obstetrics & Gynaecology 132, no. 1 (2025): e1–e41. https://doi.org/10.1111/1471-0528.17844.
In Table 2, Column 4 (A summary of the investigations for late Intra-uterine fetal death (IUFD) and their indications), the text ‘Treponemal serology – usually known already’ was incorrect. This should have read: ‘Treponemal serology—repeated at presentation with an IUFD regardless of maternal status at booking’.
We apologise for this error.
To investigate the morbidity associated with assisted vaginal birth (AVB) and an occipito-posterior (OP) fetal head position.
Observational study based on secondary analyses of a randomised controlled trial and cohort study.
Two university affiliated maternity hospitals in Ireland.
A combined cohort of 1081 nulliparous women at term who were assessed for AVB in the second stage of labour.
Univariable and multivariable logistic regression analyses were performed.
Postpartum haemorrhage (PPH), obstetric anal sphincter injury (OASI), fetal acidosis, neonatal trauma, failed or abandoned AVB leading to caesarean section (CS).
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%).
This study highlights the associated morbidity when attempting an AVB with a non-rotated OP position rather than rotating to OA.
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.
Retrospective population-based cohort study.
Nineteen maternity units in the Republic of Ireland, 2011–2021.
4314 perinatal mortalities (3711 in white women; 603 in women in MEG) were reported to the National Perinatal Epidemiology Centre (NPEC).
Chi-square testing was used to assess differences between groups.
PM outcomes and socio-demographic, obstetric, and medical characteristics for mothers and infants were collected.
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).
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.
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