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Births in the United States, 2014
Abstract
For the first year since 2007, childbearing rose in the United States in 2014, albeit slightly. Trends differed by race and Hispanic origin, with the GFR up among non-Hispanic white and API women but down or unchanged among other groups for 2013–2014. Historical lows in teen childbearing were seen in the U.S. overall in 2014, and for each of the race and Hispanic origin groups. Following years of steady increases that totaled nearly 60% (3), the U.S. cesarean delivery rate declined for the second straight year. Cesarean delivery rates had been on the decline for several years for non-Hispanic white and API women, but 2014 marks the first year of decline in cesarean deliveries among non-Hispanic black and Hispanic women. Preterm birth rates continued to trend downward in 2014 (2), overall and among most race and Hispanic origin groups, but large differences among groups in the risk of preterm birth were observed. The forthcoming report, "Births: Final data for 2014" (4), will present more information on the topics addressed in this report and selected others. All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.
... While the overall teen birth rate in the United States has declined recently, rates among Hispanic adolescents remain high [1]. Indeed, national data indicate that proportionally more Hispanic teens give birth compared to their same-aged, non-Hispanic peers [1]. ...
... While the overall teen birth rate in the United States has declined recently, rates among Hispanic adolescents remain high [1]. Indeed, national data indicate that proportionally more Hispanic teens give birth compared to their same-aged, non-Hispanic peers [1]. To effectively reduce teen pregnancies among this population, programs should be genderspecific and culturally reflective of Hispanic/Latino cultural values [2,3]. ...
... Note. 1 Group means compared using the Student's t-test. Group proportions (i.e., percentages) were compared using the chi-square test. ...
Background/Objectives: Test efficacy of the social emotional learning (SEL)-based Mighty Girls program, a program culturally tailored for English-speaking Hispanic/Latino girls in seventh grade comprised of classroom sessions and a virtual reality computer game. We hypothesized that the curriculum would decrease risky sexual behaviors in a program that can be used as part of a comprehensive sex education curriculum or as a stand-alone program. Methods: A randomized group trial was conducted in which 22 low-income, predominately Hispanic schools within the Miami-Dade County Public School System were randomly assigned to intervention (consented n = 335) and control (consented n = 217) conditions. All study activities occurred after school. Primary outcome measures were resistance self-efficacy, acceptance of dating violence, sexual intentions, and sexual behavior. Assessments occurred at baseline, immediately post-intervention, 3-, 12-, and 24-months post-intervention. Changes in outcomes from baseline to 24 months were modeled using multi-level models to account for nesting of students within schools with full information maximum likelihood to account for missing data and baseline school attendance and enrollment in free and reduced lunch as covariates. Analyses are also controlled for multiple testing. Results: The program had a significant effect on reducing acceptance of dating violence at 24 months post-intervention (estimate = −0.083, p ≤ 0.05), but no effect on resistance self-efficacy, sexual intentions, or sexual behavior (p ≥ 0.58). Conclusion: Study findings demonstrate that a social emotional learning (SEL) curriculum can impact sexual behaviors such as susceptibility to dating violence. Low baseline levels for sexual intentions and behaviors as well as a high baseline of efficacy may have impacted findings for the other outcomes.
... The effect measure was de ned as the rate/frequency of adolescent pregnancy and early childbearing before and after the onset of the COVID-19 pandemic (post March 2020). This could be captured via the adolescent fertility rate, de ned as births per 1,000 women aged [15][16][17][18][19]. Data on conceptions to women aged under 18, de ned as conceptions per 1,000 women aged under 18 were also eligible. ...
... Martin et al examined the National Centre for Health Statistics to review birth records from 2020 and 2021 to assess pregnancy rates in girls aged 15-19 [15]. ...
... Importantly, only two studies [13,15] provided data for two or more consecutive time periods preceding the COVID-19 in order to put any change in adolescent pregnancy rate in relation to an ongoing trend. These studies respectively saw an increase [13] and decrease [15] in adolescent pregnancy rates during the pandemic but in both cases this was consistent with a trend that started in the years prior to the pandemic. ...
Background: Education is known to protect adolescent girls from unplanned pregnancy. School closures were component of COVID-19 "lockdown measures".
... The effect measure was de ned as the rate/frequency of adolescent pregnancy and early childbearing before and after the onset of the COVID-19 pandemic (post March 2020). This could be captured via the adolescent fertility rate, de ned as births per 1,000 women aged [15][16][17][18][19]. Data on conceptions to women aged under 18, de ned as conceptions per 1,000 women aged under 18 were also eligible. ...
... Martin et al examined the National Centre for Health Statistics to review birth records from 2020 and 2021 to assess pregnancy rates in girls aged 15-19 [15]. ...
... Importantly, only two studies [13,15] provided data for two or more consecutive time periods preceding the COVID-19 in order to put any change in adolescent pregnancy rate in relation to an ongoing trend. These studies respectively saw an increase [13] and decrease [15] in adolescent pregnancy rates during the pandemic but in both cases this was consistent with a trend that started in the years prior to the pandemic. ...
... Subsequently, the greater vulnerability of births delivered at 37-38 weeks (referred to as early term) compared with those born at 39-40 weeks (full term) also became evident (4) and national organizations such as the March of Dimes, the National Institute for Child Health and Human Development, the Society for Maternal-Fetal Medicine, and the American College of Obstetricians and Gynecologists began to champion the prevention of nonmedically indicated preterm and early-term deliveries (4). Late preterm and early-term births declined for several years from 2007 to 2014, but have been on the rise in recent years (1,5,6). ...
... Rates are calculated per 100 births. Relative percent changes are shown in Table and Tables 1 and 2 for the full reporting period of 2014-2022 and for each year between 2019 and 2022 (2019 to 2020, 2020 to 2021, and 2021 to 2022) to better describe changes for the year before and each year during the COVID-19 pandemic, as changes in birth outcomes have been shown over this period (6). Gestational age was missing for less than 1% of all births and for births to Black non-Hispanic (subsequently, Black), Hispanic, and White non-Hispanic (subsequently, White) mothers for each year of the study period of 2014-2022. ...
... Recent changes in preterm birth rates in the United States have been documented (5,6,9,10); less has been published on trends in early-term births. Analysis of early-term births by single week of gestation reveals that the largest changes occurred among births at 37 weeks, up 42% from 2014 to 2022. ...
Objectives-This report presents changes in the distribution of singleton births by gestational age in the United States for 2014-2022, by maternal age and race and Hispanic origin. Methods-Data are based on all birth certificates for singleton births registered in the United States from 2014 to 2022. Gestational age is measured in completed weeks using the obstetric estimate and categorized as early preterm (less than 34 weeks), late preterm (34-36 weeks), total preterm (less than 37 weeks), early term (37-38 weeks), full term (39-40 weeks), and late- and post-term (41 and later weeks). Data are shown by maternal age and race and Hispanic origin. Single weeks of gestation at term (37-41 weeks) are also examined. Results-Despite some fluctuation in most gestational age categories during the pandemic years of 2020-2022, trends from 2014 to 2022 demonstrate a shift towards shorter gestational ages. Preterm and early-term birth rates rose from 2014 to 2022 (by 12% and 20%, respectively), while full-term and lateand post-term births declined (by 6% and 28%, respectively). Similar shifts for each gestational age category were seen across maternal age and race and Hispanic-origin groups. By single week of gestation at term, the largest change was for births at 37 weeks (an increase of 42%).
... [1,2] They account for more than 10% of all deliveries and almost 75% of all premature infants. [3] The increasing rate of LPI delivery is related to the increasing conception with assisted reproduction technology (ART) interventions, induction of labor, and elective Cesarean section (CS) delivery at premature GA. [4,5] Due to their functional immaturity, LPIs are at higher risk of mortality and morbidity than term babies and should not be treated as "near term." [6] Several studies were conducted in the past two decades focusing on the LPI outcomes. ...
... [8,9] These rates reached nearly 40% in USA and Europe. [3,30] Although a previous CS and fetal distress have been consistently reported as the main obstetric indications for CS delivery, other non-medical factors such as maternal request, increasing multiple pregnancies after ART, concerns about potential complications after VD have all contributed significantly to this dramatic rise. [23,31] In the past two decades, LPIs have been the target population of interest for research worldwide. ...
Background
Late preterm infants (LPIs) account for most preterm births and are at high risk of developing prematurity-related morbidities. Due to the increasing rate of cesarean section delivery, it is expected that more LPIs with respiratory complications will be admitted to neonatal intensive care units (NICU).
Objectives
To assess the rate of NICU admission and respiratory complications among LPIs and to compare their outcomes based on the mode of delivery.
Patients and Methods
The list of all LPIs who were admitted in the period 2015–2020 was reviewed. Data collected about demographic characteristics, delivery information, NICU admission, respiratory complications, respiratory support, length of stay, and readmission. Infants were classified according to their mode of delivery into: vaginal delivery group (VD) and cesarean section group (CS).
Results
Out of 2236 LPIs included, 321 (14%) were born at 34-week gestation, 1137 (51%) were males. 1243 (56%) were admitted to NICU. The CS group comprised 77% (1719) while the VD group 23% (517).
Compared to the VD group, infants in the CS group had a higher rate of NICU admission (57.1% vs. 50.7%, P = 0.006), respiratory distress syndrome (RDS) (22% vs. 17%, P = 0.000), and transient tachypnea of newborn (TTN) (17% vs. 11%, P = 0.019). Also, more babies in the CS group received CPAP (36.2% vs. 24.6%, P = 0.000) and surfactant therapy (6.6% vs. 4.6%, P = 0.02). After logistic regression analysis, CS remains an independent factor for NICU admission (OR 1.3, 95% confidence intervals [CI] 1.1–1.6, P = 0.01), respiratory complications (OR 1.6, 95% CI 1.2–2.2, P = 0.001), CPAP requirement (OR 1.6, 95% CI 1.3–2, P = 0.000), and a longer length of stay > 3 days (OR 1.5, 95% CI 1.2–1.8, P = 0.000).
Conclusion
The rate of CS delivery among late preterm gestation is very high and alarming. CS delivery of LPI increases the rate of NICU admission, respiratory complications, and the need for respiratory support.
... Late preterm birth (LPTB), defined as birth between 34 + 0 and 36 + 6 weeks' gestation, accounts for 75% of all preterm births [1]. Despite efforts to reduce the rates of these births, particularly those that are iatrogenic, their incidence has been rising steadily since the 1990s [2]. ...
... Aside from this current study and that by Koulalli [32], to our knowledge no other studies have evaluated the effect of parity on late spontaneous preterm birth. Although neonates born in the late preterm have improved outcomes compared to those born at earlier gestational ages [6], they constitute the majority of preterm births [1] and therefore their contribution to overall neonatal outcomes is not insignificant. Ascertaining risk factors underlying these births is critical for several reasons as patients at risk might benefit from counselling as well as targeted prevention strategies to reduce this risk. ...
Most preterm births occur in the late preterm period. While prematurity-related adverse outcomes are significantly diminished when birth occurs during this period, these infants are still at increased risk of complications. Parity affects the incidence of obstetric complications. The purpose of this study was to determine whether parity impacts the risk of spontaneous late preterm birth (SLPTB) and associated complications. A retrospective observational cohort study was conducted. Patients were divided into three study groups according to parity. The primary outcome was the rate of SLPTB in each group. Secondary outcomes were unplanned cesarean delivery (UCD), prolonged third stage of labor respiratory distress syndrome (RDS), transient tachypnea of the newborn (TTN), intraventricular hemorrhage (IVH), neonatal hypoglycemia, duration of NICU admission, neonatal death, and composite adverse neonatal outcome (CANO). Primiparas were more likely to have SLPTB, UCD, and CANO compared to multiparas (2.6% vs. 1.9% OR 1.5 [1.3–1.7] p < 0.01) (4.1% vs. 1.3% OR 2.7 [1.2, 5.9] p < 0.01) (8.5% vs. 4.2 OR 2.1 [1.3–3.5] p = 0.002) and grandmultiparas (2.6% vs. 1.7% OR 1.4 [1.2–1.5] p < 0.001) 8.5% vs. 4.4% OR 2.0 [1.1, 3.8], p = 0.01) but no difference in UCD compared to grandmultiparas (4.1% vs. 3.3% OR 1.2 [0.6–2.7] p = 0.28). Primiparas are at increased risk of SLPTB and UCD, and this is accompanied by an increased risk of adverse neonatal outcomes.
... The Quadruple Test (QT) is a sensitive screening [1][2][3] test for pregnant women [4][5][6][7] to detect the risk of spina bifida, anencephaly, trisomy 21, and other fetal defects. [6,7] A positive QT usually leads to amniotic fluid testing or amniocentesis to confirm results. ...
Background
The decision and experience of high-risk pregnant women to undergo amniocentesis can depend on their setting, context, social structures, and significant others, including cultural values and beliefs. What is less understood is women’s experience with decision-making, which may contribute to their anxiety during and after amniocentesis. This study aimed to explore the decision-making experiences of Thai pregnant women undergoing amniocentesis.
Materials and Methods
A qualitative content analysis approach was employed to collect and analyze data. Purposive sampling and in-depth interviews were conducted between July and October 2021 with 15 Thai high-risk pregnant women after undergoing amniocentesis. Data analysis involved multiple readings of transcriptions to discern themes and understanding of the women’s stories.
Results
Four themes of decision-making experiences were identified: (1) “Shocked, worried, and questioned why the risk was high”; (2) “Does my baby have Down syndrome? I want to know”; (3) “Worried”; and (4) “Relief from anxiety.”
Conclusions
Women’s experiences with amniocentesis involved uncertain positive and negative feelings through the journey of undergoing, waiting, and receiving the test results. The nurses and nurse-midwives played an important role in counseling Thai pregnant women about whether to undergo amniocentesis.
... The national racial disparities in birth weight were reflected in our diverse Southwest U.S. metropolitan population, with a significant proportion of Black women having lowerbirth-weight babies than White women [24,25]. On the other hand, as supported by prior research [26], Hispanic women were less likely to have lower-birth-weight babies relative to non-Hispanic women (even in similarly deprived neighborhoods). This paradox of Hispanic women, who face similar disparities regarding access to care, socioeconomic, education, and language barriers to Black women yet have higher-birth-weight infants, highlights the need to identify factors that negatively and positively impact maternal and child health. ...
Background: Health inequities begin before birth and are influenced by pregnancy conditions, race/ethnicity, social class, and environment. Research indicates that, in the United States, Black women are significantly more likely to have low-birth-weight babies compared to White women. Interestingly, Hispanic women in the United States do not experience this birth weight inequity. The reasons for this disparity remain unclear. Both Hispanic and Black women face discrimination, and this is often cited as a primary reason for the higher prevalence of low-birth-weight babies among Black women. One type of discrimination that is less examined is neighborhood deprivation. Method: This study systematically examined the impact of various sociodemographic and pregnancy predictors among 9607 women in Phoenix, Arizona. Using multilevel modeling, we analyzed whether neighborhood deprivation (using the Area Deprivation Index) influenced the association between demographic and pregnancy risk and protective factors on birth weight outcomes. Results: Consistent with prior research, we found that Black and Asian women had lower-birth-weight babies than White women, while Hispanic women did not show a significant difference from non-Hispanic women. Additionally, multilevel modeling suggested that increased neighborhood deprivation tends to exacerbate the impact of some risk factors (e.g., race) and reduce the impact of specific protective factors (e.g., gestational age) on birth weight. Conclusion: These findings suggest that both place and individual factors synergistically influence birth weight outcomes. Moreover, the results underscore the importance of targeting interventions to enhance resources among those who live in the most deprived neighborhoods.
... Nearly 400,000 neonates are born prematurely every year in the United States [1]. The complications of prematurity represent a major cause of immediate and long-term morbidity and mortality in children under five years of age [2][3][4][5]. ...
Purpose of the Review
To review the literature regarding the efficacy of vaginal progesterone to prevent preterm birth in pregnancies diagnosed with a short cervix, and to provide evidence-based recommendations to delineate the management of these patients.
Recent Findings
Multiple randomized trials have attempted to address this clinical question. Most studies are in singleton pregnancies and a few included twin gestations. Studies are heterogeneous in design with different populations, primary outcomes, cervical length thresholds, and vaginal progesterone formulations. Results have been inconsistent, leading to individual-patient data meta-analyses to corroborate previous results. Recently, two trials that evaluated the effect of vaginal progesterone to prevent preterm labor and were included in these meta-analyses have been retracted from publication due to methodological concerns, further complicating the analysis.
Summary
Available evidence suggest that the use of daily vaginal micronized progesterone 200 mg or vaginal progesterone gel 90 mg may reduce preterm birth rates in singleton pregnancies with a mid-trimester cervical length < 20 mm regardless of history of obstetrical history. In contrast, the evidence to support the efficacy of vaginal progesterone to reduce preterm births in multifetal gestations with short cervices remain insufficient to support a recommendation for its use.
... In a study by Mehra et al. (2020), Black pregnant women described how various assumptions made by health care providers impeded their ability to access resources needed to support a healthy pregnancy. These women were more than twice as likely to use federal assistance such as Medicaid for their insurance (65.1%) compared to White pregnant women (29.4%; Martin et al., 2020). In addition, Black pregnant women who relied on government assistance reported experiencing stigmatization and feeling devalued when interacting with health care providers (Altman et al., 2019;Mehra et al., 2020). ...
... Most individuals have multiple ultrasound examinations during pregnancy, and abnormalities of fluid may affect upward of 10% of births. Thus, considering that there were~3.66 million births in 2021 in the US, we estimate that annually, there are approximately 366,000 cases of oligo-or polyhydramnios [80]. Previously, the National Institute of Child Health and Human Development funded multi-center prospective longitudinal data collection to develop contemporary fetal growth and amniotic fluid standards for four self-identified US racial/ethnic groups [75,81]. ...
Objective: The purpose of this review is to examine the evidence that defines normal and abnormal amniotic fluid volumes (AFVs) and current recommendations on the management of abnormalities of AFV. Methods: The studies establishing normal actual AFVs and the ultrasound estimates used to identify normal and abnormal AFVs were evaluated. Recommendations from national and international organizations were reviewed for guidance on the definitions and management of abnormal AFVs. Results: A timeline of the development of the thresholds that define abnormal AFVs was created. Recommendations from 13 national and international guidelines were identified, but the definitions and management recommendations for abnormal AFVs varied considerably between groups. An algorithm for the management of oligohydramnios and polyhydramnios was developed. Knowledge gaps and the structure of future studies were examined. Conclusions: Assessment of AFV is performed multiple times per day in antenatal clinics and hospitals. Current recommendations on defining and managing abnormal AFVs differ between national and international organizations. We have proposed algorithms to assist in the management of abnormal AFVs until further studies can be undertaken.
... Further, non-incarcerated Black women face greater barriers to visiting their incarcerated loved ones, for example, due to less flexible employment schedules (Swanberg et al., 2005), making it challenging to accommodate strict visitation policies. They also tend to live further away from rural facility locations (Cochran et al., 2016), often have limited disposable income to travel or pay for phone calls (United States Department of Labor, 2017-2019), and have greater childcare responsibilities (Martin et al., 2020). Given these additional challenges they face, Black women may be less inclined or less able to engage in relational maintenance when their partner is incarcerated. ...
Purpose
This study examines whether male-to-female IPV victimization is associated with the relational maintenance efforts that women undertake in relationships in which their partner is incarcerated.
Method
Multinomial logistic regression models were used to analyze patterns of phone calls, sending mail, and visitation among 1001 women experiencing partner incarceration. Within-group models by race for Black and White women were examined in recognition that shared historical oppression or trauma and related factors may shape survivors’ behavior.
Results
Findings suggest that IPV victimization (physical violence, emotional violence, or being made to feel inadequate by their partner) during the months before their partner’s incarceration has little impact on women’s relational maintenance efforts for either Black or White women. Barriers to communication, including the high cost of calls and visits, were better predictors of behavior.
Conclusion
This study provides critical insight into women’s behavior after victimization and during a volatile time for families– when a partner and coparent to shared children is in prison. It reinforces the need for carceral facilities to adopt and implement violence prevention and family-strengthening programming, while also reducing high costs and other barriers that may prevent family involvement.
... Over the past 2 decades, there has been a global increase in the incidence of PTB, resulting in a global PTB rate of 11% [5]. In 2022, data from the US National Vital Statistics indicated that the rate of PTB for singletons was 10.38% [6]. Twins constitute 20% of all preterm deliveries, with 60% and 10.7% of twins delivered before 37 and 32 weeks of gestation, respectively [7]. ...
Background
The worldwide incidence of preterm births is increasing, and the risks of adverse outcomes for preterm infants significantly increase with shorter gestation, resulting in a substantial socioeconomic burden. Limited epidemiological studies have been conducted in China regarding the incidence and spatiotemporal trends of preterm births. Seasonal variations in risk indicate the presence of possible modifiable factors. Gender influences the risk of preterm birth.
Objective
This study aims to assess the incidence rates of preterm birth, very preterm birth, and extremely preterm birth; elucidate their spatiotemporal distribution; and investigate the risk factors associated with preterm birth.
Methods
We obtained data from the Guangdong Provincial Maternal and Child Health Information System, spanning from January 1, 2014, to December 31, 2021, pertaining to neonates with gestational ages ranging from 24 weeks to 42 weeks. The primary outcome measures assessed variations in the rates of different preterm birth subtypes over the course of the study, such as by year, region, and season. Furthermore, we examined the relationship between preterm birth incidence and per capita gross domestic product (GDP), simultaneously analyzing the contributing risk factors.
Results
The analysis incorporated data from 13,256,743 live births. We identified 754,268 preterm infants and 12,502,475 full-term infants. The incidences of preterm birth, very preterm birth, and extremely preterm birth were 5.69 per 100 births, 4.46 per 1000 births, and 4.83 per 10,000 births, respectively. The overall incidence of preterm birth increased from 5.12% in 2014 to 6.38% in 2021. The incidence of extremely preterm birth increased from 4.10 per 10,000 births in 2014 to 8.09 per 10,000 births in 2021. There was a positive correlation between the incidence of preterm infants and GDP per capita. In more developed economic regions, the incidence of preterm births was higher. Furthermore, adjusted odds ratios revealed that advanced maternal age, multiple pregnancies, and male infants were associated with an increased risk of preterm birth, whereas childbirth in the autumn season was associated with a protective effect against preterm birth.
Conclusions
The incidence of preterm birth in southern China exhibited an upward trend, closely linked to enhancements in the care capabilities for high-risk pregnant women and critically ill newborns. With the recent relaxation of China's 3-child policy, coupled with a temporary surge in advanced maternal age and multiple pregnancies, the risk of preterm birth has risen. Consequently, there is a pressing need to augment public health investments aimed at mitigating the risk factors associated with preterm birth, thereby alleviating the socioeconomic burden it imposes.
... Te extracted prescription data were cleaned. Te inclusion criteria were (1) women aged 18 and above; (2) women at 20 to 36 +6 weeks of gestation; (3) women with "premature delivery" or "abortion" or "premature rupture of membranes" or "pregnancy" as the primary diagnosis; and (4) prescriptions with "magnesium sulfate" or "nifedipine" or "indomethacin" or "ritodrine" or "atosiban" as the primary generic drug name. ...
What Is Known and Objective. Tocolytic agents are used to prolong gestational age and prevent immediate preterm birth (PTB). This study aims to provide an overview of the use of tocolytics among patients with PTB in China through retrospectively analyzing trends in application, influencing factors, and inappropriate prescriptions. Methods. The prescription data of five tocolytic agents from 2016 to 2021 were extracted from the database of the Hospital Prescription Analysis Cooperation Project. Drug consumption was expressed as number of prescriptions, cost of prescriptions, and DDDs (defined daily doses). Pearson correlation analysis was used to examine the association between DDDs and DDC (defined daily cost). The appropriateness of prescriptions was analyzed in terms of drug dosage form, administration, clinical diagnosis, and combined medication. Results. The total number of tocolytic prescriptions and the total cost of tocolytic agents increased by 6.12% and 387.58%, respectively, over the six-year duration of the study. From 2016 to 2021, the ranking of the number of prescriptions and DDDs of tocolytic agents was magnesium sulfate > ritodrine > nifedipine > indomethacin > atosiban. During the study period, the cost of tocolytic agents increased significantly, which was mainly related to the increased costs of magnesium sulfate in 2017 and atosiban in 2018 and 2019. The ranking of DDCs was atosiban > ritodrine > magnesium sulfate > nifedipine = indomethacin from 2016 to 2021. For atosiban, the DDC was negatively correlated with the DDDs. Inappropriate prescription, which accounted for 14.84% of all prescriptions, was mainly manifested in the inappropriate selection of nifedipine dosage form, low frequency of nifedipine and indomethacin, and overdosing of ritodrine. Furthermore, 22.87% of tocolytic prescriptions remained active after 34 weeks of gestation, and 7.24% of the prescriptions authorized the use of combination drugs, with magnesium sulfate and nifedipine being the most commonly prescribed combination. What Is New and Conclusion. Magnesium sulfate, ritodrine, and nifedipine were the top three tocolytic agents. As the inappropriate use of tocolytic agents continues to persist, it is important to intensify efforts to ensure the safety and the appropriateness of maternal medication.
... There were 3,605,201 births recorded in the U.S. in 2020 (Martin et al., 2021). For NCANDS 2020, 27 states included infants reported by medical providers with alcohol of drug exposure (USDHHS, 2022b, Table 3-10, p. 48). ...
Amid the COVID-19 global pandemic, substance abuse has increased. Consistent with this increase has been an increase in the incidence of infants with prenatal substance exposure (IPSE). Prenatal exposure to illicit drugs, licit drugs used illicitly, and alcohol have a range of negative health effects on newborns. This article reviews these effects and federal and state policies in this area, using child maltreatment report data to characterize associations with state statutes. We then review courts' rationales for prohibiting agency action to protect IPSEs and re-frame and re-conceptualize these cases within the existing "aggravated circumstances" framework in federal law.
... Racial and ethnic disparities extend to FMLA eligibility; studies have found that more Black and Hispanic/Latino workforce members (60.2% and 66.9%, respectively) reported being ineligible for or unable to afford unpaid leave than White workers (55.3%) [39]. Because Black women experience higher rates of pregnancy complications and preterm delivery compared to other races, current federal FMLA policies, which count time from pregnancy complications as part of leave, may further exacerbate racial inequities [50][51][52]. We also found that Hispanic/Latino respondents had higher rates of late mixed feeding but lower rates of exclusive breastfeeding compared with non-Hispanic White women. ...
Background
Paid parental leave policies may promote breastfeeding, which can have short- and long-term health benefits for both members of the birthing person-infant dyad. In the United States, where 56% of the workforce qualifies for unpaid federal medical leave, certain states have recently enacted paid parental and family leave policies. We aimed to assess the extent to which living in states with versus without paid family leave was associated with feeding regimens that included breastfeeding.
Methods
In this cross-sectional analysis of the 2021 National Immunization Survey-Child, we assessed feeding outcomes: (1) exclusively breastfed (only fed breastmilk—never infant formula—both before and after six months of age), (2) late mixed breastfeeding (formula after six months), (3) early mixed breastfeeding (breastfed, formula before six months), and (4) never breastfed. We conducted Pearson χ² to compare social-demographic characteristics and multivariable nominal regression to assess extent to paid family leave was associated with breastfeeding regimens, compared with never breastfeeding.
Results
Of the 35,995 respondents, 5,806 (25% of weighted respondents) were from states with paid family leave policies. Compared with never breastfeeding, all feeding that incorporated breastfeeding—exclusive breastfeeding, late mixed feeding (breastfed, formula introduced after six months), and early mixed feeding (breastfed, formula introduced before six months)—were more prevalent in states with paid family leave policies. The adjusted prevalence ratio (aPR) and differences in adjusted prevalence compared with never breastfeeding in states with versus without paid family leave policies were: aPR 1.41 (95% CI 1.15, 1.73), 5.36% difference for exclusive breastfeeding; aPR 1.25 (95% CI 1.01, 1.53), 3.19% difference for late mixed feeding, aPR 1.32 (95% CI 1.32, 1.97), 5.42% difference for early mixed feeding.
Conclusion
States with paid family leave policies have higher rates of any breastfeeding and of exclusive breastfeeding than states without such policies. Because all feeding types that incorporate breastfeeding were higher in states with paid family leave policies, expansion of paid family leave may improve breastfeeding rates.
... Late preterm delivery is the delivery of a neonate between 34 + 0 weeks to 36 + 6 weeks after the beginning of a woman's last menstrual period [1]. It accounts for 73% of preterm deliveries [2]. They have similar birth weight with term babies, and are usually assumed to be developmentally mature by parents and caregivers, hence are often managed in nurseries or remain with their mothers after birth, [3] but these late preterm infants Shittu et al. ...
Background
The aim of this study is to determine the effectiveness of antenatal corticosteroid in reducing respiratory morbidity in babies born in the late preterm period.
Methods
Two hundred and eighty-six pregnant women at risk of having a late preterm delivery were studied. One hundred and forty-three (143) served as the cases and were given 2 doses of 12 mg intramuscular dexamethasone 12 h apart, while 143 served as the controls and were given a similar quantity of placebo. The women were followed up prospectively and data were collected on the pregnant women and their newborns on a standardized form. The neonates were assessed for acute respiratory distress syndrome and transient tachypnea of the newborn based on clinical signs, symptoms, and chest x-ray results (when indicated). The primary outcome was the occurrence of neonatal respiratory morbidity.
Results
The primary outcome occurred in 5 out of 130 infants (3.8%) in the dexamethasone group and 31 out of 122 (25.4%) in the placebo group (P value = 0.000003). Birth asphyxia, neonatal intensive care admission and need for active resuscitation at birth also occurred significantly less frequently in the dexamethasone group (P value 0.004, 0.009, 0.014 respectively). There were no significant group differences in the incidence of neonatal sepsis, neonatal jaundice, hypoglycemia and feeding difficulties.
Conclusions
Administration of dexamethasone to women at risk for late preterm delivery significantly reduced the rate of neonatal respiratory complications, neonatal intensive care unit admission, and need for active resuscitation at birth.
Trial registration
PACTR (www.pactr.org) Registration Number: PACTR202304579281358. The study was retrospectively registered on April 19, 2023.
... Efforts are being made to reduce the rates of caesarean section to the WHO recommended rate of 15% by employing strategies such as the trial of labour after caesarean (TOLAC), but still an increase to 21% has been observed in the rates of caesarean section worldwide in the last two decades with a projected rate at 29% by 2030. 17,18 One of the most important contributing causes to the overall increasing Caesarean Section incidence is repeated caesarean after a prior caesarean section. 19 Although a failed VBAC attempt carries a higher risk of complications than an elective repeat CS, VBAC is still considered to be generally safe when compared to the morbidity and financial burden associated with repeat CS. 20,21 VBAC offers the last chance for a woman who has had a previous caesarean delivery to have a normal birth. ...
Background:
Vaginal birth after caesarean section (VBAC) is associated with reduced blood loss and transfusions, fewer infections, and fewer thromboembolic events as compared to caesarean delivery. The current rate of repeat caesarean after one previous caesarean is above the WHO standard of 15%. We aimed to determine the occurrence of VBAC and to determine the occurrence of feto-maternal outcomes in successful VBAC cases so that trials of VBAC can be given to carefully selected patients to reduce the rate of repeat caesarean section.
Methods:
The Combined Military Hospital (CMH) Rawalpindi's Obstetrics and Gynaecology department conducted this cross-sectional study from March 20 to September 19, 2021. After obtaining ethical committee approval, data was collected using a non-probability, consecutive sampling technique from 150 patients on a self-developed structured proforma. Patients between the age range of 20-35 years with a history of previous lower segment caesarean section, having gestational age between 37-41 weeks and who presented in spontaneous labour were included in this study. After taking informed consent, all women were given a trial of labour and the outcome of the trial was noted. Women were followed for the feto-maternal outcomes. The gathered information was analysed using SPSS version 25.0. Post-stratification, a p-value of 0.05 or lower on the chi-square test was deemed statistically significant.
Results:
Following a C-section, 28.67% of patients experienced successful vaginal births. PPH was found in 2.32%, scar dehiscence in 0.0%, low birth weight babies in 16.28%, APGAR score <7 at 1 minute was 23.26% and NICU admission as 9.30% in women undergoing vaginal birth after caesarean section.
Conclusions:
Appropriate selection of patients for the trial of VBAC can help reduce the higher rate of repeat caesarean section after a previous caesarean section and increase the chances of successful vaginal birth.
... ach day in the United States, more than 10,000 women and birthing people give birth. 1 While most parents and infants remain healthy through this experience, each day about 136 people will have some severe complication, such as cardiac arrest, acute renal failure, sepsis, the need for a blood transfusion, or respiratory distress syndrome, 2 and three people will die. 3 In the United States, more birthing people die because of pregnancy and childbirth than in other comparable countries. ...
Every day, two or three women die because of pregnancy or childbirth. Nearly 80% of these deaths are preventable. These outcomes disproportionately impact racialized populations, including Black and Indigenous women, who are two to three times more likely to die. The Practical Playbook III: Working Together to Improve Maternal Health is a guide for maternal health stakeholders (like researchers, community activists, providers, and advocates) offering practical tools and strategies to address inequities in maternal health services and outcomes. With contributions from more than 150 authors, each chapter offers a different strategy that stakeholders can apply to improve maternal health in their community. The 50 chapters are divided into six main sections: Section I, Introduction; Section II, Collaborations; Section III, Equity; Section IV, Data; Section V, Innovations; and Section VI, Systems and Scalability. The chapters focus on ways to save mothers by centering equity, collaborating with people with lived experience, building better data systems, piloting and expanding innovations, and leveraging resources to scale and sustain what works. Throughout the book, readers encounter stories from women and birthing people that bring the problems and solutions into better focus. The editors are committed to continuing to share information about initiatives that are moving the needle through our online platforms.
... Collectively, they are referred to as spontaneous preterm birth (SPB) (1,2). According to data, the preterm birth rate in the United States in 2019 was 10.2% (3). In China, the rate of preterm birth is also on the rise (4). ...
Introduction
Spontaneous preterm birth (SPB) is a significant cause of neonatal mortality, yet its etiology remains unclear. Cobalt, an essential trace element, might be a risk factor for SPB. This study aims to investigate the relationship between maternal serum cobalt concentration and SPB, and to clarify the role of blood lipids and fasting blood glucose (FBG) in this relationship.
Methods
We conducted a nested case-control study within the Beijing Birth Cohort Study. Serum samples were obtained from 222 pregnant women with SPB and 224 controls during the first (7–13 weeks of pregnancy) and third trimesters (32–42 weeks of pregnancy). Serum cobalt concentration was determined using inductively coupled plasma mass spectrometry (ICP-MS). Fasting blood glucose and lipids levels were detected using a fully automated biochemical immunoassay instrument. Logistic regression models and linear regression models were established to explore the association between serum cobalt concentration and the risk of SPB in pregnant women, and to test the mediating effect of fasting blood glucose (FBG) and lipids.
Results
We found that the serum cobalt concentration in mothers with SPB and controls was similar in the first trimester, with values of 0.79 (0.58–1.10) ng/mL and 0.75 (0.51–1.07) ng/mL, respectively. However, in the third trimester, the cobalt concentration increased to 0.88 (0.59–1.14) ng/mL and 0.84 (0.52–1.19) ng/mL, respectively. In the logistic regression model, when considering the third trimester of pregnancy, after adjusting for ethnicity, pre-pregnancy body mass index (BMI), maternal age, education, income, and parity, it was observed that the medium level of cobalt concentration (0.63–1.07 ng/ml) had a negative correlation with the risk of SPB. The odds ratio (OR) was 0.56, with a 95% confidence interval of 0.34–0.90 ng/mL and a p-value of 0.02. This suggests that cobalt in this concentration range played a protective role against SPB. Additionally, it was found that FBG in the third trimester of pregnancy had a partial intermediary role, accounting for 9.12% of the association. However, no relationship between cobalt and SPB risk was found in the first trimester.
Conclusion
During the third trimester, intermediate levels of maternal cobalt appear to offer protection against SPB, with FBG playing a partial mediating role. To further clarify the optimal cobalt concentrations during pregnancy for different populations, a multi-center study with a larger sample size is necessary. Additionally, exploring the specific mechanism of FBG’s mediating role could provide valuable insights for improving the prevention of SPB.
... Failure of induction of labour has been supported by Sondgeroth et al in his study. 11 The success rate in our study is more in women who went into spontaneous labour with favourable Bishop score 6 at the time of admission, implying that modified Bishop score is an important contributor for success. 12,13 Another study found that the successful trial group had a considerably lower mean gestational age then the unsuccessful group. ...
Objective: To determine the successful pregnancy outcome in women who opted for trial of labour after one lower segment transverse caesarean section (TOLAC). Study Design and Setting: Descriptive cross-sectional study. Department of Obstetrics and Gynaecology, Combined Military Hospital Abbottabad, from Nov 2022 to April 2023. Methodology: 54 pregnant women were included in our study who had previously undergone one lower segment caesarean section more than 18 months back. They were booked at their first visit, briefed and counselled for trial of labour after caesarean section (TOLAC ), and were advised to await spontaneous labour till 40 completed weeks of gestation and in case of failure of onset of labour then for induction of labour. Data was collected in terms of successful vaginal birth/repeat caesarean section and fetomaternal outcome. Results: In our study, 54 women agreed for trial of labour who had one caesarean section more than 18 months back. Vaginal birth was successful in 39 women (72.22%). Gestational age, BMI, and age of the woman did not show any significant effect on trial of labour. Factors leading to successful outcome include previous vaginal delivery, spontaneous onset of labour, favourable bishop score, women who are keen for vaginal delivery. Conclusion: The study concluded that most pregnant women prefer labour trial after one CS. Adequate counselling and briefing of women reduce their anxiety, and help them to make decisions about their preferred mode of delivery
... After remaining relatively stable between 46.3% and 48.8% from 2010 to 2018, the cesarean delivery rate in Puerto Rico increased every year from 2019 to 2022, reaching a high of about 50% of all births in 2022. In comparison, the cesarean delivery rate for the U.S. mainland varied only slightly at around 32% from 2019 to 2022 (6,7). ...
Cesarean delivery is major surgery associated with higher costs and adverse outcomes, such as surgical complications, compared with vaginal delivery (1-3). The cesarean delivery rate in Puerto Rico rose from just over 30% in the early to mid-1990s to over 40% by the early 2000s (4,5). During this time, cesarean delivery rates in Puerto Rico were 40%-70% higher than rates in the U.S. mainland and up to 78% higher than rates for Hispanic women in the U.S. mainland (4,5). This report describes trends in Puerto Rico's cesarean delivery rate from 2010 to 2022 and explores changes by maternal age, gestational age, and municipality from 2018 to 2022.
... Delayed childbearing has become more prevalent over the years. In 1990, 5 per 1,000 women in the United States aged 40-44 gave birth, and in 2018, this number climbed to 11.8 per 1,000 women [10,11]. The upper age limit for IVF treatments varies across countries. ...
The trend of delaying childbirth has resulted in a growing number of advanced-aged women who are opting for preimplantation genetic testing (PGT) to screen for monogenic diseases or structural chromosomal rearrangements (PGT-M and PGT-SR). This increase in demand necessitates the development of a clinical predictive model for live birth outcomes in these women. Therefore, the objective of this study is to construct a comprehensive predictive model that assesses the likelihood of achieving a successful live birth in advanced-aged women undergoing PGT-M and PGT-SR treatments.
A retrospective cohort study of 37–45-year-old women undergoing preimplantation genetic testing for monogenic disease or structural chromosomal rearrangement cycles from 2010 to 2021 was conducted at a university hospital reproductive centre. The purpose was to develop a clinical predictive model for live birth in these women. The main outcome studied was the cumulative live birth rate in the first or subsequent cycles. Developing a decision tree enabled a comprehensive study of clinical parameters and expected outcomes.
The analysis included 158 women undergoing 753 preimplantation genetic testing cycles. The cumulative live birth rate was 37.342% (59/158). Decision tree analysis revealed that women aged ≤ 40.1 or women > 40.1 with one or more top-quality transferable embryos in their first cycle had the best chance for a live baby (56% and 41%, respectively). Those older than 40.1 without top-quality embryos and seven or fewer dominant follicles had no live births. A Kaplan–Meier curve showed that for autosomal dominant diseases, there was a negligible increase in live birth rate after three cycles, compared to six cycles in autosomal recessive inheritance.
In older women, the chance of delivering after repeated cycles is higher in those with at least one top-quality unaffected embryo in their first preimplantation genetic testing cycle. Additional preimplantation genetic testing cycles after three in carriers of an autosomal dominant disorder and six in those with an autosomal recessive disorder should be considered prudently.
... In 2022 and 2023, the United States received a March of Dimes preterm birth grade of Dþ with 1 in 10 babies born prematurely. 2,3 The interruption of intrauterine development and associated postnatal complications experienced by these infants contribute to permanent structural and functional alterations in developing organs, resulting in lasting adverse effects. ...
... [16][17][18] Thus, longitudinal postpartum care is critical for both reducing current and future maternal disease severity and optimizing health for future pregnancies. 19 Longitudinal postpartum and interpregnancy care serves as a compelling strategy to prevent recurrent adverse pregnancy outcomes, including PTB. 20,21 For example, the American College of Obstetrics and Gynecology (ACOG) consensus guidelines recommend ongoing, multiepisode longitudinal postpartum and interpregnancy care, personalized to meet individual needs. 16,22 Per ACOG, optimal interpregnancy care should be delivered by a multidisciplinary team of obstetric, primary care, and subspecialty clinicians, as a continuation of postpartum care to improve short and long-term health outcomes for individuals and their infants. ...
... 7,16 Results from our study, in which 80.1% of pregnancies occurred more than 2 years after diagnosis, provide evidence in the specific cohort of young BRCA carriers with a rate of pregnancy complications that are in line with the expectations in a population of women with similar age and no history of breast cancer. [17][18][19] The majority of information for this analysis was extracted from oncology medical records. These records are not specifically designed for recording maternal or fetal outcomes; hence, there is a potential risk of underreporting of adverse pregnancy outcomes and the data should be considered with caution. ...
Importance
Young women with breast cancer who have germline pathogenic variants in BRCA1 or BRCA2 face unique challenges regarding fertility. Previous studies demonstrating the feasibility and safety of pregnancy in breast cancer survivors included limited data regarding BRCA carriers.
Objective
To investigate cumulative incidence of pregnancy and disease-free survival in young women who are BRCA carriers.
Design, Setting, and Participants
International, multicenter, hospital-based, retrospective cohort study conducted at 78 participating centers worldwide. The study included female participants diagnosed with invasive breast cancer at age 40 years or younger between January 2000 and December 2020 carrying germline pathogenic variants in BRCA1 and/or BRCA2 . Last delivery was October 7, 2022; last follow-up was February 20, 2023.
Exposure
Pregnancy after breast cancer.
Main Outcomes and Measures
Primary end points were cumulative incidence of pregnancy after breast cancer and disease-free survival. Secondary end points were breast cancer–specific survival, overall survival, pregnancy, and fetal and obstetric outcomes.
Results
Of 4732 BRCA carriers included, 659 had at least 1 pregnancy after breast cancer and 4073 did not. Median age at diagnosis in the overall cohort was 35 years (IQR, 31-38 years). Cumulative incidence of pregnancy at 10 years was 22% (95% CI, 21%-24%), with a median time from breast cancer diagnosis to conception of 3.5 years (IQR, 2.2-5.3 years). Among the 659 patients who had a pregnancy, 45 (6.9%) and 63 (9.7%) had an induced abortion or a miscarriage, respectively. Of the 517 patients (79.7%) with a completed pregnancy, 406 (91.0%) delivered at term (≥37 weeks) and 54 (10.4%) had twins. Among the 470 infants born with known information on pregnancy complications, 4 (0.9%) had documented congenital anomalies. Median follow-up was 7.8 years (IQR, 4.5-12.6 years). No significant difference in disease-free survival was observed between patients with or without a pregnancy after breast cancer (adjusted hazard ratio, 0.99; 95% CI, 0.81-1.20). Patients who had a pregnancy had significantly better breast cancer–specific survival and overall survival.
Conclusions and Relevance
In this global study, 1 in 5 young BRCA carriers conceived within 10 years after breast cancer diagnosis. Pregnancy following breast cancer in BRCA carriers was not associated with decreased disease-free survival.
Trial Registration
ClinicalTrials.gov Identifier: NCT03673306
... There has been a steady decline in the total number of births and more specifically births among mothers <25 years of age in recent years [10]. This decrease is associated with an increased proportion of births among mothers >35 years [11]. ...
Objective
To describe the number of US births, maternal age at birth and NICU admissions by maternal age cohorts. Our study aims to measure NICU utilization by maternal age over time.
Study design
We queried the CDC WONDER Natality database for births, NICU admissions, and maternal age at delivery from 2016 to 2021. Births and NICU admissions were analyzed by maternal age.
Results
Between 2016 and 2021, US births decreased by 7% (3,945,875 to 3,664,292/year). NICU admissions increased from 344,454 to 351,775 (+2%) and admit rate from 8.7% to 9.6%. The proportion of births by maternal age declined each year for ≤29 y but increased for ≥30 y. NICU admission rates were lowest at maternal age 20–29 y and increased with age ≥30 y.
Conclusions
US NICUs have demonstrated a 2% increase in admissions despite a 7% decrease in births. Higher rates of NICU admissions among infants born at maternal age ≥30 y warrants investigation.
... The Hispanic population has increased 20 times within the last 50 years [2], and current predictions indicate that Hispanics will comprise one-third of the entire US population by 2060. Birthrates are the highest among Hispanics compared with any other ethnicity or race and Hispanic women accounted for nearly 17% of US births in 2018 [3,4]. ...
There has been a concerning surge in maternal mortality among Hispanic women in recent years. Compromised mental health is present in nearly half of all maternal deaths, and risk factors include poor social support and depression.
Among Hispanic women who were born in the USA versus those not born in the USA, we sought to describe and compare social determinants of health and maternal psychological outcomes.
Hispanic pregnant women (n = 579) were recruited from two clinics in Tampa, FL, and completed various questionnaires related to social determinants of health, depression, stress, and social support.
Descriptive statistics, t-tests, and chi-square analyses were used to compare relationships between maternal nativity and subsequent psychosocial outcomes. Pearson correlations were used to explore associations between variables.
Hispanic pregnant women who were not born in the USA had lower incomes (χ2 = 5.68, p = 0.018, df = 1), were more likely to be unemployed (χ2 = 8.12, p = 0.004, df = 1), and were more likely to be married (χ2 = 4.79, p = 0.029, df = 1) when compared with those born in the USA. Those not born in the USA reported lower social support (t = 3.92, p<0.001), specifically the tangible (t = 4.18, p < 0.001) and emotional support subscales (t = 4.4, p<0.001). When compared with those born in the USA, foreign-born Hispanic women reported less stress (t = 3.23, p = 0.001) and depression (t = 3.3, p = 0.002).
Pregnant Hispanic women not born in the USA are at increased risk for suboptimal social determinants of health, including less social support. US-born women were more stressed and depressed and had higher BMIs.
... The molecular mechanisms underlying the HPA regulation of stress pathways in pregnancy, however, are not completely understood. Further, there is marked heterogeneity in pregnancy-related morbidity and adverse birth outcomes among Latino subgroups [14], highlighting the need for studies examining within-group differences in a well characterized study sample. Improved knowledge of how stressors are associated with Latina pregnancy health is crucial to (1) create more refined risk stratification and screening approaches in pregnancy and (2) develop translational precision health treatment approaches to reduce preventable maternal morbidity in pregnancy. ...
Latinas experience physical and psychological stressors in pregnancy leading to increased morbidity and higher risk for adverse birth outcomes. Epigenetic changes, including DNA methylation (DNAm), have been proposed as markers to create more refined risk stratification, yet few of these studies have examined these changes in Latinas. We conducted a secondary analysis of stored blood leukocytes of Latina women (n = 58) enrolled in a larger National Institutes of Health funded R01 project (2011–2016). We examined DNAm on eight candidate stress genes to compare physically and psychologically stressed participants to healthy (low stress) participants. We found unique CpGs that were differentially methylated in stressed women early- and mid-pregnancy compared to the healthy group, though none remained significant after FDR correction. Both physical and psychological stress were associated with hypomethylation at two consecutive CpG sites on NR3C1 in early pregnancy and one CpG site on NR3C1 in mid-pregnancy before adjustment. Stress was also associated with hypomethylation at two CpG sites on FKBP5 in early and mid-pregnancy but were no longer significant after FDR adjustment. Though we did not find statistically significant differences in DNAm during pregnancy between stressed and healthy women in this sample, signals were consistent with previous findings. Future work in larger samples should further examine the associations between stress and DNAm in pregnancy as this mechanism may explain underlying perinatal health inequities.
In this work, the spread of crime dynamics in the US is analyzed from a mathematical perspective. An epidemiological model is established, including five compartments: Susceptible (S), Latent 1 (), Latent 2 (, Incarcerated (I), and Recovered (R). A system of differential equations is used to model the spread of crime. A result demonstrating the positivity of the solutions for the system is included. The basic reproduction number and the stability of the disease-free equilibrium are calculated following epidemiological theories. Numerical simulations are performed with US-specific parameter values. Understanding the dynamics of the spread of crime helps to determine what factors may work best to reduce violent crime effectively.
People today are choosing to have children later in life, often in their thirties and forties, when their fertility is in decline. We sought to identify and compile effective methods for improving either male or female fertility in this context of advanced reproductive age. We found few clinical studies with strong evidence for therapeutics that mitigate reproductive aging or extend fertility; however, this Perspective summarizes the range of emerging experimental strategies under development. Preclinical studies, in mouse models of aging, have identified pharmaceutical candidates that improve egg and sperm quality. Further, a diverse array of medically assisted reproduction methodologies, including those that stimulate rare ovarian follicles and rejuvenate egg quality using mitochondria, may have future utility for older patients. Finally, we highlight the many knowledge gaps and possible future directions in the field of therapeutics to extend the age of healthy human reproduction.
(Abstracted from JAMA 2024;331(1):49–59
Individuals who are diagnosed with breast cancer at a young age are often carriers of a pathogenic variant in the BRCA1 or BRCA2 genes, and many young women in this situation are interested in preserving future fertility, if possible. Reproductive counseling in this situation can be complex due to the risk of passing on the variant, as well as the implications on their own fertility, as the mutation can impact ovarian reserve, fertility potential, and other factors.
The purpose of this study was to investigate the associations between multilevel racism and gestational age at birth among nulliparous women. We conducted a secondary analysis of data of the nuMoM2b Study (2010–2013) to examine the associations between individual- and structural-level experiences of racism and discrimination and gestational age at birth among nulliparous women (n = 9148) at eight sites across the U.S. Measures included the individual Experiences of Discrimination (EOD) scale and the Index of Concentration at the Extremes (ICE) to measure structural racism. After adjustment, we observed a significant individual and structural racism interaction on gestational length (p = 0.012). In subgroup analyses, we found that among those with high EOD scores, women who were from households concentrated in the more privileged group had significantly longer gestations (β = 1.27, 95% CI: 0.48, 2.06). Women who reported higher EOD scores and more economic privilege had longer gestations, demonstrating the moderating effect of ICE as a measure of structural racism. In conclusion, ICE may represent a modifiable factor in the prevention of adverse birth outcomes in nulliparas.
Introduction. Chronic kidney disease (CKD) in pregnancy poses certain risks of both gestational complications and adverse perinatal outcomes, which increase with the decline of renal function.
Aim to access pregnancy outcomes in patients who underwent nephrotransplantation.
Materials and methods. Retrospective study of pregnant women who gave birth at Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology in the period from 2005 to 2021: 102 pregnancies in 97 patients were analyzed: five recipients had two successful pregnancies.
Results. The average age of pregnant women was 31 ± 4.03 years. In equal proportions, patients underwent related or cadaveric kidney transplantation – 52% (n = 53) and 48% (n = 49) of cases, respectively. The average delivery time was 35.5 ± 2.7 weeks. The average weight of newborns was 2545 ± 655 grams. Premature birth (PB) occurred in 47.1%, the average period of birth was 33.4 ± 2.87 weeks, of which early birth (<32 weeks) was 22.5%. The average period of pregnancy after transplantation was 5 ± 3.31 (1–18) years, this period was not associated with obstetric complications or deterioration of graft function. A significant increase in the following parameters was noted during pregnancy: serum creatinine level (p = 0.006), proteinuria (p = 0.003). The glomerular filtration rate also decreased significantly by the end of pregnancy (p = 0.011). Preeclampsia was the leading cause of decreased graft function during pregnancy (32.4%).
Conclusions. In general, pregnancy outcomes after nephrotransplantation are favorable, but there is an increased risk of preeclampsia, preterm birth, including operative delivery, urinary tract infection and anemia.
Birth outcomes are worse for birthing people and infants in the USA than other high-income economies and worse still for underprivileged communities. Historically, the Latine community has experienced positive birth outcomes, despite low socioeconomic status and other socio-political disadvantages, leading to what has been termed as the Hispanic birth paradox. However, this perinatal advantage and protective effect appears to have been shattered by unfavorable policies, structural conditions, societal attitudes, and traumatic events impacting Latine immigrants, leading to negative effects on the health and well-being of birthing Latines—regardless of citizenship status and increasing rates of preterm birth and low birth weight infants.
We conducted a comprehensive literature review and identified two pathways through which birth outcomes among Latine birthing persons may be compromised regardless of citizenship status: (1) a biological pathway as toxic levels of fear and anxiety created by racialized stressors accumulate in the bodies of Latines and (2) a social pathway as Latines disconnect from formal and informal sources of support including family, friends, health care, public health programs, and social services during the course of the pregnancy.
Future research needs to examine the impact of immigration climate and policies on health and racial equity in birth outcomes among Latines regardless of citizenship status. Attaining health and racial equity necessitates increased awareness among health providers, public health practitioners, and policy makers of the impact of larger socio-political pressures on the health of Latine birthing persons.
Elevated perinatal depressive symptoms are more common among disadvantaged African American women, and they are almost four times as likely to have postpartum posttraumatic stress compared to white women. For new mothers, depressive symptoms and posttraumatic stress can lead to negative parenting, poor mother-infant bonding, and delayed infant development. For African American women, a culturally adapted mindfulness-based intervention offers great potential as an acceptable approach to reduce psycho-behavioral symptoms and improve mother-infant interactions (i.e., bonding). Additionally, it is critical that mindfulness interventions consider time constraints of new mothers, provide accessible intervention delivery, address parenting, and consider the challenges of caring for an infant. Given these considerations, we describe a pilot research protocol in which we evaluate a culturally adapted mindfulness program: Mindfulness for African Americans Postpartum (MAAP). The intervention is based upon Kabat-Zinn’s Mindfulness Based Stress Reduction program, but is adapted to include culturally relevant concepts of spirituality, inter-dependence, self-empowerment, and storytelling, which are salient to African American culture. To accommodate the needs of new mothers, a certified mindfulness interventionist delivers each session virtually using Zoom. The investigation uses a randomized controlled design in which African American women within 12 months of giving birth are randomized either to the MAAP intervention or to an Education Program. The primary aim is to determine the extent to which the MAAP intervention decreases maternal psycho-behavioral symptoms (perceived stress, depressive symptoms, anxiety, poor sleep, posttraumatic stress, and fatigue) and improves mother-infant bonding. A secondary aim is to explore the effects of MAAP on proinflammatory cytokines and oxytocin. Culturally adapted mindfulness interventions delivered virtually will make mindfulness more accessible and meaningful to populations, like African American new mothers, who are at higher risk for postpartum mood disorders and poor infant outcomes.
Objective
To compare the outcomes of termination of pregnancy with live fetuses in the second trimester (14–28 weeks), using misoprostol 400 mcg intravaginal every 6 h, between women with previous cesarean section (PCS) and no previous cesarean section (no PCS).
Methods
A comparative study was conducted on a prospective database of pregnancy termination in the second trimester, Chiang Mai university hospital. Inclusion criteria included: (1) singleton pregnancy; (2) gestational age between 14 and 28 weeks; and (3) pregnancy with a live fetus and medically indicated for termination. The participants were categorized into two groups; PCS and no PCS group. All were terminated using misoprostol 400 mcg intravaginal every 6 h. The main outcomes were induction to fetal delivery interval and success rate, defined as fetal delivery within 48 h.
Results
A total of 238 women, including 80 PCS and 158 no PCS, were recruited. The success rate of fetal delivery within 48 h between both groups was not significantly different (91.3% vs. 93.0%; p-value 0.622). The induction to fetal delivery interval were not significantly different (1531 vs. 1279 min; p-value > 0.05). Gestational age was an independent factor for the success rate and required dosage of misoprostol. The rates of most adverse effects of misoprostol were similar. One case (1.3%) in the PCS group developed uterine rupture during termination, ending up with safe and successful surgical removal and uterine repair.
Conclusion
Intravaginal misoprostol is highly effective for second trimester termination of pregnancy with PCS and those with no PCS, with similar success rate and induction to fetal delivery interval. Gestational age was an independent factor for the success rate and required dosage of misoprostol. Uterine rupture could occur in 1.3% of PCS, implying that high precaution must be taken for early detection and proper management.
Synopsis
Intravaginal misoprostol is highly effective for termination of second trimester pregnancy with a live fetus, with a comparable success rate between women with and without previous cesarean section, with a 1.3% risk of uterine rupture among women with previous cesarean section.
Objective
To determine whether preterm birth of 32–36 6/7 weeks gestation affected school performance from kindergarten through fifth grade.
Study design
We assessed 14350 term infants and 1195 32–36 6/7 weeks gestation infants followed in the Early Childhood Longitudinal Study Kindergarten 2011 cohort for classroom performance in kindergarten-fifth grade. Multivariable regression was performed for comparisons, and data were weighted to be representative of the US population.
Results
Children born 35–36 6/7 weeks gestation had no significant difference in their academic scores or performance, while 32–34 6/7 weeks’ children had lower academic scores and teacher performance scores when compared to term children. Children born between 32 and 36 6/7 weeks gestation had higher odds of individualized education plan needs and had learning disability diagnoses compared to term children.
Conclusions
Children born between 32 and 34 6/7 weeks gestation have poor school performance compared to term children. Children born between 32 and 36 6/7 weeks gestation are at risk for learning disabilities and likely benefit from continued support and services to improve achievement throughout school.
Purpose of Review
Highlight the importance of exploring nutritional interventions that could be applied as alternative or supplementary therapeutic strategies to enhance men’s fertility.
Recent Findings
Lifestyle choices have prompted extensive discussions regarding its implications and applications as a complementary therapy. The growing concern over the decline in sperm quality underscores the urgency of investigating these alternative interventions. Calorie restriction (CR) has emerged as a promising strategy to improve male fertility. The efficacy of CR depends on factors like age, ethnicity and genetics. Clinical studies, such as CALERIE, have shown an improvement in serum testosterone level and sexual drive in men with or without obesity. Additionally, CR has been shown to positively impact sperm count and motility; however, its effects on sperm morphology and DNA fragmentation remain less clear, and the literature has shown discrepancies, mainly due to the nature of technically dependent assessment tools.
Summary
The review advocates a personalized approach to CR, considering individual health profiles to maximize its benefits. It underscores the need for routine, accessible diagnostic techniques in male reproductive health. It suggests that future research should focus on personalized dietary interventions to improve male fertility and overall well-being in individuals with or without obesity and unravel CR’s immediate and lasting effects on semen parameters in men without obesity.
Background:
Bronchopulmonary dysplasia (BPD), a common morbidity among very preterm infants, is associated with chronic disease and neurodevelopmental impairments. A hypothesized mechanism for these outcomes lies in altered glucocorticoid (GC) activity. We hypothesized that BPD and its treatments may result in epigenetic differences in the hypothalamic-pituitary-adrenal (HPA) axis, which is modulated by GC, and could be ascertained using an established GC risk score and DNA methylation (DNAm) of HPA axis genes.
Methods:
DNAm was quantified from buccal tissue (ECHO-NOVI) and from neonatal blood spots (ELGAN ECHO) via the EPIC microarray. Prenatal maternal characteristics, pregnancy complication, and neonatal medical complication data were collected from medical record review and maternal interviews.
Results:
The GC score was not associated with steroid exposure or BPD. However, six HPA genes involved in stress response regulation demonstrated differential methylation with antenatal steroid exposure; two CpGs within FKBP5 and POMC were differentially methylated with BPD severity. These findings were sex-specific in both cohorts; males had greater magnitude of differential methylation within these genes.
Conclusions:
These findings suggest that BPD severity and antenatal steroids are associated with DNAm at some HPA genes in very preterm infants and the effects appear to be sex-, tissue-, and age-specific.
Impact:
This study addresses bronchopulmonary dysplasia (BPD), an important health outcome among preterm neonates, and interrogates a commonly studied pathway, the hypothalamic-pituitary-adrenal (HPA) axis. The combination of BPD, the HPA axis, and epigenetic markers has not been previously reported. In this study, we found that BPD itself was not associated with epigenetic responses in the HPA axis in infants born very preterm; however, antenatal treatment with steroids was associated with epigenetic responses.
Background: The risk of preterm birth (PTB) and stillbirth increases after a SARS-CoV-2 infection during gestation. We aimed to estimate the risk depending on gestational age at infection (early <28 + 0 and late ≥28 weeks of gestation, WoG), virus variants, severity of infection, and vaccination. Methods: PTB was divided into early PTB (<32 + 0) and late PTB (32 + 0–36 + 6 WoG). The prospective register COVID-19 Related Obstetrics and Neonatal Outcome Study (CRONOS) included 8032 pregnant women with a confirmed SARS-CoV-2 infection from 3 April 2020 to 31 December 2022, in Germany and Austria. Results: Stillbirth and early preterm births rates were higher during the Alpha (1.56% and 3.13%) and Delta (1.56% and 3.44%) waves than during the Omicron wave (0.53% and 1.39%). Early SARS-CoV-2 infection increased the risk for stillbirth (aRR 5.76, 95% CI 3.07–10.83) and early PTB before 32 + 0 (aRR, 6.07, 95% CI 3.65–10.09). Hospital admission increased the risks further, especially in the case of ICU admission. Vaccination against SARS-CoV-2 significantly reduced the risk of stillbirth (aRR 0.32, 95% CI 0.16–0.83). Conclusions: This multicentric prospective study shows an increased risk of stillbirth and preterm birth after infection early in pregnancy and therefore the importance of obstetrical surveillance thereafter. Vaccination offers effective protection.
Purpose
To estimate the societal costs of untreated perinatal mood and anxiety disorders (PMADs) in Vermont for the 2018–2020 average annual birth cohort from conception through five years postpartum.
Methods
We developed a cost analysis model to calculate the excess cases of outcomes attributed to PMADs in the state of Vermont. Then, we modeled the associated costs of each outcome incurred by birthing parents and their children, projected five years for birthing parents who do not achieve remission by the end of the first year postpartum.
Results
We estimated that the total societal cost of untreated PMADs in Vermont could reach 35,910 in excess societal costs per birthing parent with an untreated PMAD and their child.
Conclusion
Our model provides evidence of the high costs of untreated PMADs for birthing parents and their children in Vermont. Our estimates for Vermont are slightly higher but comparable to national estimates, which are $35,500 per birthing parent–child pair, adjusted to 2021 US dollars. Investing in perinatal mental health prevention and treatment could improve health outcomes and reduce economic burden of PMADs on individuals, families, employers, and the state.
Postpartum women experience multiple, co-occurring postpartum symptoms. It is unknown if social determinants of health (SDOH) influence postpartum symptom typologies. This secondary analysis used the Community and Child Health Network study data. Participants included for analysis varied depending on the availability of the SDOH data (N = 851 to 1784). Bivariate and multiple regression analyses were conducted to examine the association between SDOH and previously identified postpartum symptom typologies. Area under the receiver operating characteristics curve (AUROC) was calculated to examine if adding SDOH variables contributes to predicting postpartum symptom typologies. The adjusted odds (aOR) of being in high symptom severity or occurrence typologies were greater for participants who had less than high school education (aOR = 2.29), experienced healthcare discrimination (aOR = 2.21), used governmental aid (aOR = 2.11), or were food insecure (aOR = 2.04). AUROC improved after adding SDOH. Considering experiences of different social-economic hardships influence postpartum symptom typologies, future practice and research should address SDOH to improve postpartum symptom experiences.
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