Vital considerations for the use of vital statistics in obstetrical research

Washington University in St. Louis, San Luis, Missouri, United States
American journal of obstetrics and gynecology (Impact Factor: 4.7). 05/2006; 194(4):909-10. DOI: 10.1016/j.ajog.2006.02.031
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    • "Further, obesity has been linked to an increased risk of early-onset neonatal GBS disease [12]. Most of the prior studies were based on population-based data with intrinsic limitations and some did not adequately control for potential confounders [13]. With the increasing rates of obesity, establishing an association with GBS colonization may inform risk-based intrapartum prophylaxis for women with unknown GBS status in labor. "
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    ABSTRACT: Objective. To test the hypothesis that maternal obesity is an independent risk factor for rectovaginal group B streptococcus (GBS) colonization at term. Study Design. Retrospective cohort study of consecutive women with singleton term pregnancies admitted in labor at Barnes-Jewish Hospital (2004-2008). Maternal BMI ≥ 30 Kg/m(2) (obese) or <30 Kg/m(2) (nonobese) defined the two comparison groups. The outcome of interest was GBS colonization from a positive culture. Baseline characteristics were compared using Student's t-test and Chi-squared or Fisher's exact test. The association between obesity and GBS colonization was assessed using univariable and multivariable analyses. Results. Of the 10,564 women eligible, 7,711 met inclusion criteria. The prevalence of GBS colonization in the entire cohort was relatively high (25.8%). Obese gravidas were significantly more likely to be colonized by GBS when compared with nonobese gravidas (28.4% versus 22.2%, P < 0.001). Obese gravidas were still 35% more likely than nonobese women to test positive for GBS after adjusting for race, parity, smoking, and diabetes (adjusted OR 1.35 [95% CI 1.21-1.50]). Conclusion. Maternal obesity is a significant risk factor for GBS colonization at term. Further research is needed to evaluate the impact of this finding on risk-based management strategies.
    Infectious Diseases in Obstetrics and Gynecology 08/2015; 2015(2):1-5. DOI:10.1155/2015/586767
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    ABSTRACT: IntroductionAn increasing proportion of women in the US and other countries delay initiation of childbearing until their thirties. Little is known about their subsequent pregnancies, particularly with regard to pregnancy spacing. ObjectivesTo determine interpregnancy interval (IPI) patterns, factors associated with IPI among women delaying initiation of childbearing until their thirties, and ascertain if delay in initiation of childbearing is associated with increased likelihood for short interpregnancy interval of less than 6months. MethodsA retrospective cohort study was performed using the Missouri maternal linked file for 1978–1997, inclusive. Analysis was limited to mothers aged 20–50years at first pregnancy, having a first and second pregnancy during the study period; the sample size included 242,559 mother–infant pairs. Analysis strategies included stratified analysis, and multivariable logistic regression. Interpregnancy interval was main outcome variable, and was grouped in seven categories: 0–5, 6–11, 12–17, 18–23, 24–59, 60–119, ≥120months. ResultsThe mean interpregnancy interval was significantly shorter for women delaying start of childbearing (≥30years) compared to 20–29year olds. Observed intervals are 31 (±24)months for mothers aged 20–29years, 25 (±17) months for mothers aged 30–34years, 21 (±14) for 35–39year olds, and 19 (±16) for 40–50year olds (P<0.0001). A significant trend for shorter intervals was noted as maternal age at first pregnancy increased (P<0.0001). Factors associated with interpregnancy interval for women delaying initiation of childbearing included adverse outcome in preceding pregnancy, and low educational status. Mothers aged 35 and above at first pregnancy had increased odds for a second pregnancy following short IPI <6months; (35–39years OR=1.26 95% CI 1.11–1.44; 40–50 OR=1.91 95% CI 1.13–3.24). Mothers aged 30–34years have lower odds for short IPI (OR=0.93 95% CI 0.87–0.99). ConclusionFirst time mothers aged 35 and above have higher odds of having a second pregnancy shortly after their first pregnancy. Given the increasing number of first time mothers aged 35 and above, these findings are of relevance for preconception counseling for this unique population of women.
    Archives of Gynecology and Obstetrics 05/2009; 279(5):677-684. DOI:10.1007/s00404-008-0793-2 · 1.36 Impact Factor

  • American Journal of Obstetrics and Gynecology 02/2007; 196(2):189-190. DOI:10.1016/j.ajog.2006.12.035 · 4.70 Impact Factor
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