Living in a deprived neighborhood is associated with an increased risk of severe maternal morbidity (SMM), but the specific deprivation factors or individual SMM conditions driving this risk remain unclear. This study examined how different domains and subdomains of the Index of Multiple Deprivation (IMD) are associated with SMM, identifying key contributors.
We conducted a nationwide, population-based cohort study using English Hospital Episode Statistics Admitted Patient Care (HES APC) data. The cohort included 4 040 106 women aged 10–55 years who gave birth in NHS facilities in England between January 1, 2013, and March 31, 2023, with pregnancies of ≥20 weeks' gestation. Multilevel multivariable Poisson regression estimated adjusted risk ratios (aRR) and 95% confidence intervals (CI) of composite SMM and key individual SMM conditions for each IMD quintile compared to the least deprived quintile, and aRR (95% CI) of composite SMM in each IMD domain/subdomain quintile compared to the least deprived quintile.
IMD domains showed varying associations with SMM. Income and employment deprivation had the strongest associations, with women living in the most deprived quintile having aRRs of 1.16 (95% CI 1.12–1.20) and 1.15 (95% CI 1.11–1.19) compared to those living in the least deprived quintile, respectively. Contrastingly, high geographical barriers to services were associated with a lower risk of SMM (aRR: 0.92 (95% CI 0.88–0.95)). Sepsis, acute cardiac events, and embolism play a key role in the association between composite deprivation and SMM, with women living in the most deprived areas having risk ratios of 1.43 (95% CI 1.36–1.50), 1.24 (95% CI 1.09–1.41), and 1.97 (95% CI 1.69–2.29), respectively, for each of the conditions, compared to women living in the least deprived areas.
There appears to be a widening gap in the risk of SMM between women living in the least and most deprived areas in England, with sepsis, cardiac events, and embolism having the strongest association with deprivation. Composite measures of area-level deprivation may obscure the diverse impacts of specific deprivation factors, and individual-level socioeconomic measures are needed to clarify pathways contributing to SMM risk.
Bell's palsy appears to be more common in pregnancy, but incidence numbers differ. Risk factors for pregnancy-associated Bell's palsy have been discussed, but larger studies are needed to receive significant results.
This study aimed to investigate the incidence and maternal risk factors of pregnancy-associated Bell's palsy. It is a nationwide register-based cohort study. Women with Bell's palsy in Sweden from 2005 to 2015 were identified in the National Patient Register. Women giving birth at ≥22 gestational weeks during the same period were identified in the Medical Birth Register. Pregnancy-associated Bell's palsy was defined as the first diagnosis of Bell's palsy during pregnancy or within the first 2 months postpartum, identified by linking the data sets. Childbirths in women without a history of Bell's palsy were used as a comparison group. Risk factors were identified using backward conditional multivariable logistic regression and presented with adjusted odds ratios (aOR) with 95% confidence intervals (CIs).
A total of 2051 childbirths in women with pregnancy-associated Bell's palsy were identified. For a comparison 1 188 489 childbirths in women without a history of Bell's palsy were used. The incidence of pregnancy-associated Bell's palsy was 171.6 per 100 000 childbirths. Pregnancy-associated Bell's palsy was associated with high BMI (e.g., BMI 30–34.9, aOR 1.30, 95% CI 1.12–1.50), being born in Asia (aOR 1.19, 95% CI 1.04–1.37), Africa (aOR 1.76, 95% CI 1.47–2.11), or South America (aOR 1.85, 95% CI 1.35–2.55), multiple pregnancy (aOR 1.83, 95% CI 1.48–2.26), and a diagnosis of herpes zoster (aOR 6.55, 95% CI 2.93–14.67), borreliosis (aOR 3.70, 95% CI 1.38–9.89), gestational diabetes (aOR 1.68, 95% CI 1.31–2.15), or preeclampsia (aOR 2.02, 95% CI 1.74–2.35).
The incidence of pregnancy-associated Bell's palsy was 171.6 per 100 000 childbirths. Risk factors related to metabolic stress were associated with pregnancy-associated Bell's palsy, although the causal pathway remains unclear.
Persistent tumor after combined chemoradiation for locally advanced cervical cancer is an established prognostic factor. Detection may include magnetic resonance imaging, positron emission tomography (PET) combined with CT scan, ultrasound, or biopsies; however, no agreement about the best method and time point has been reached. In our institution, a standardized biopsy protocol of at least four punch biopsies is routinely performed at the last brachytherapy with re-biopsies 6 weeks later in cases not showing histologic complete response (hCR). This study aims to assess the prognostic relevance of these biopsies, especially with respect to the time point of hCR.
This investigation was a retrospective single-center observational cohort study that included all patients treated for locally advanced or node-positive cervical cancer with combined chemoradiation at the University Hospital Innsbruck between 2008 and 2023. Patients with a hCR at the end of radiotherapy were classified as primary negative and otherwise as primary positive. Primary positive patients that achieved complete response at a control biopsy 6 weeks later were classified as secondary negative, and the remaining patients with residual tumor as secondary positive. Progression-free survival (PFS) and overall survival (OS) were compared between all these groups.
We included 184 patients in this study, from which 46 (25%) were classified as primary positive. These patients experienced a significantly worse PFS compared to primary negative patients (p = 0.008, HR = 2.03, 95% CI [1.20, 3.45]). The difference in PFS was also evidenced when comparing primary negative patients to those who had a hCR 6 weeks after radiotherapy (secondary negative) (p = 0.018, HR = 2.00, 95% CI [1.13, 3.56]). However, in primary positive patients, OS was not significantly reduced (p = 0.29, HR = 1.45, 95% CI [0.73, 2.86]).
Early response evaluation using punch biopsies at the time of the last brachytherapy can identify patients with residual tumor, which exhibit a statistically significant and clinically meaningful risk of disease progression. This risk was not reversed even in the case of a delayed hCR 6 weeks after completion of chemoradiation.
Premenstrual dysphoric disorder (PMDD) and premenstrual syndrome, collectively referred to as premenstrual mood disorders (PMDs), are common among working women and can significantly impact their well-being and productivity. This study investigated the prevalence of PMDs and identified sociodemographic and occupational factors that contribute to the risk of PMDs among Japanese working women.
This was a cross-sectional study based on a two-wave online survey conducted between January and June 2023. The study targeted individuals who were biologically female, aged 20–44 years, and currently employed in Japan. Data were collected on sociodemographic characteristics (e.g., age, marital status, education, income), occupational factors (e.g., working hours, job type), and health-related variables. The primary outcome was the presence of premenstrual disorders (PMDs), assessed using the Premenstrual Dysphoric Disorder Scale. Participants were classified as having PMDs if they met criteria for either PMDD or moderate-to-severe premenstrual syndrome (PMS). Those reporting no or only mild symptoms were categorized as not having PMDs. The secondary outcome was the identification of sociodemographic and occupational factors associated with the presence of PMDs. To examine these associations, logistic regression analysis was performed, comparing individuals with and without PMDs.
Among 908 participants (mean age = 33.48, SD = 6.20), 13.66% had PMDD, and 30.51% had moderate-to-severe premenstrual syndrome. Greater PMD risk was associated with younger age, non-regular employment, working ≥60 h weekly, employment in small companies, the presence of children, and lower educational attainment. In contrast, a lower PMD risk was associated with having a manufacturing job.
Sociodemographic and occupational factors have a strong impact on PMDs among Japanese female workers. Promoting work–life balance and providing tailored mental health support in the workplace can help reduce PMDs. Future studies should further investigate these complex relationships.
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