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Assessing the value of customized birth weight percentiles.

https://arctichealth.org/en/permalink/ahliterature138819
Source
Am J Epidemiol. 2011 Feb 15;173(4):459-67
Publication Type
Article
Date
Feb-15-2011
Author
Jennifer A Hutcheon
Mark Walker
Robert W Platt
Author Affiliation
Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada. jhutcheon@cfri.ca
Source
Am J Epidemiol. 2011 Feb 15;173(4):459-67
Date
Feb-15-2011
Language
English
Publication Type
Article
Keywords
Birth weight
Female
Fetal Growth Retardation - diagnosis
Gestational Age
Humans
Infant, Newborn
Predictive value of tests
Pregnancy
Pregnancy Trimester, Third
Prenatal Diagnosis - methods
Quebec
Reference Values
Abstract
Customized birth weight percentiles are weight-for-gestational-age percentiles that account for the influence of maternal characteristics on fetal growth. Although intuitively appealing, the incremental value they provide in the identification of intrauterine growth restriction (IUGR) over conventional birth weight percentiles is controversial. The objective of this study was to assess the value of customized birth weight percentiles in a simulated cohort of 100,000 infants aged 37 weeks whose IUGR status was known. A cohort of infants with a range of healthy birth weights was first simulated on the basis of the distributions of maternal/fetal characteristics observed in births at the Royal Victoria Hospital in Montreal, Canada, between 2000 and 2006. The occurrence of IUGR was re-created by reducing the observed birth weights of a small percentage of these infants. The value of customized percentiles was assessed by calculating true and false positive rates. Customizing birth weight percentiles for maternal characteristics added very little information to the identification of IUGR beyond that obtained from conventional weight-for-gestational-age percentiles (true positive rates of 61.8% and 61.1%, respectively, and false positive rates of 7.9% and 8.5%, respectively). For the process of customization to be worthwhile, maternal characteristics in the customization model were shown through simulation to require an unrealistically strong association with birth weight.
PubMed ID
21135027 View in PubMed
Less detail

The bias in current measures of gestational weight gain.

https://arctichealth.org/en/permalink/ahliterature127108
Source
Paediatr Perinat Epidemiol. 2012 Mar;26(2):109-16
Publication Type
Article
Date
Mar-2012
Author
Jennifer A Hutcheon
Lisa M Bodnar
K S Joseph
Barbara Abrams
Hyagriv N Simhan
Robert W Platt
Author Affiliation
Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, Canada. jhutcheon@cfri.ca
Source
Paediatr Perinat Epidemiol. 2012 Mar;26(2):109-16
Date
Mar-2012
Language
English
Publication Type
Article
Keywords
Adult
Bias (epidemiology)
Birth weight
Body mass index
British Columbia
Female
Gestational Age
Humans
Infant, Newborn
Models, Theoretical
Pregnancy
Pregnancy Complications
Premature Birth - etiology
Risk factors
Weight Gain
Young Adult
Abstract
Conventional measures of gestational weight gain (GWG), such as average rate of weight gain, are likely to be correlated with gestational duration. Such a correlation could introduce bias to epidemiological studies of GWG and adverse perinatal outcomes because many perinatal outcomes are also correlated with gestational duration. This study aimed to quantify the extent to which currently used GWG measures may bias the apparent relationship between maternal weight gain and risk of preterm birth. For each woman in a provincial perinatal database registry (British Columbia, Canada, 2000-2009), a total GWG was simulated such that it was uncorrelated with risk of preterm birth. The simulation was based on serial antenatal GWG measurements from a sample of term pregnancies. Simulated GWGs were classified using three approaches: total weight gain (kg), average rate of weight gain (kg/week) or adequacy of GWG in relation to Institute of Medicine recommendations. Their association with preterm birth =32 weeks was explored using logistic regression. All measures of GWG induced an apparent association between GWG and preterm birth =32 weeks even when, by design, none existed. Odds ratios in the lowest fifths of each GWG measure compared with the middle fifths ranged from 4.4 [95% confidence interval (CI) 3.6, 5.4] (total weight gain) to 1.6 [95% CI 1.3, 2.0] (Institute of Medicine adequacy ratio). Conventional measures of GWG introduce serious bias to the study of maternal weight gain and preterm birth. A new measure of GWG that is uncorrelated with gestational duration is needed.
Notes
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PubMed ID
22324496 View in PubMed
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The case for universal cervical length screening to prevent preterm birth: is it strong enough to change practice in Canada?

https://arctichealth.org/en/permalink/ahliterature256612
Source
J Obstet Gynaecol Can. 2012 Dec;34(12):1184-7
Publication Type
Article
Date
Dec-2012

Determinants of increases in stillbirth rates from 2000 to 2010.

https://arctichealth.org/en/permalink/ahliterature114885
Source
CMAJ. 2013 May 14;185(8):E345-51
Publication Type
Article
Date
May-14-2013
Author
K S Joseph
Brooke Kinniburgh
Jennifer A Hutcheon
Azar Mehrabadi
Melanie Basso
Cheryl Davies
Lily Lee
Author Affiliation
Perinatal Services BC, Vancouver, BC. kjoseph@cw.bc.ca
Source
CMAJ. 2013 May 14;185(8):E345-51
Date
May-14-2013
Language
English
Publication Type
Article
Keywords
Birth weight
British Columbia - epidemiology
Cohort Studies
Female
Fetal Death - epidemiology
Gestational Age
Humans
Logistic Models
Pregnancy
Retrospective Studies
Stillbirth - epidemiology
Abstract
After decades of decline, stillbirth rates have increased in several industrialized countries in recent years. We examined data from the province of British Columbia, Canada, in an attempt to explain this unexpected phenomenon.
We carried out a retrospective population-based cohort study of all births in British Columbia from 2000 to 2010. Outcomes of interest included overall stillbirth rates, birth weight-and gestational age-specific stillbirth rates, rates of spontaneous stillbirths (excluding pregnancy terminations that satisfied the definition of stillbirth [fetal death with a birth weight = 500 g or gestational age at delivery = 20 wk], hereafter referred to as "pregnancy terminations") and rates of congenital anomalies among live-born infants. We used logistic regression to adjust for changes in maternal age, parity, weight before pregnancy and multiple births.
Overall, stillbirth rates increased by 31% (95% confidence interval [CI] 13% to 50%), from 8.08 per 1000 total births in 2000 to 10.55 per 1000 in 2010. The rate of stillbirths with a birth weight of less than 500 g increased significantly (p(trend) = 0.03), whereas the rate of stillbirths with a birth weight of 1000 g or more decreased significantly (p(trend) = 0.009). The rate of spontaneous stillbirths decreased nonsignificantly by 16%, from 5.7 per 1000 total births in 2000 to 4.8 per 1000 in 2010. There was a significant decline of 30% (95% CI 6% to 47%) in the rate of spontaneous stillbirth with a birth weight of 1000 g or more between 2000 and 2010; adjustment for maternal factors did not appreciably change this temporal effect. The prevalence of congenital anomalies among live-born infants decreased significantly, from 5.21 per 100 live births during the first 3 years (2000-02) to 4.77 per 100 during the final 3 years (2008-10).
Increases in pregnancy terminations were responsible for the increases observed in stillbirth rates and were associated with declines in the prevalence of congenital anomalies among live-born infants.
Notes
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PubMed ID
23569166 View in PubMed
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The impact of past pregnancy experience on subsequent perinatal outcomes.

https://arctichealth.org/en/permalink/ahliterature156487
Source
Paediatr Perinat Epidemiol. 2008 Jul;22(4):400-8
Publication Type
Article
Date
Jul-2008
Author
Jennifer A Hutcheon
Robert W Platt
Author Affiliation
Department of Epidemiology and Biostatistics, McGill University Faculty of Medicine, Montreal, Canada. jennifer.hutcheon@mail.mcgill.ca
Source
Paediatr Perinat Epidemiol. 2008 Jul;22(4):400-8
Date
Jul-2008
Language
English
Publication Type
Article
Keywords
Adult
Birth Weight - physiology
Body mass index
Female
Fetal Macrosomia - etiology
Humans
Infant, Newborn
Models, Biological
Parity - physiology
Pregnancy
Pregnancy Complications
Pregnancy outcome
Quebec
Risk factors
Statistics as Topic
Weight Gain - physiology
Abstract
In perinatal epidemiology, the basic unit of analysis has traditionally been the individual pregnancy. In this study, we sought to explore the idea of a 'reproductive life'-based approach to modelling the effects of reproductive exposures and outcomes, where the basic unit of analysis is a woman's entire reproductive experience. Our objective was to explore whether a first pregnancy risk factor, excess gestational weight gain, has a direct effect on the birthweight outcomes of a subsequent pregnancy, independent of the weight gain and other risk factors of the second pregnancy. A study population was created by linking the obstetric records of 1220 women who delivered their first and second offspring at a McGill University teaching hospital in Montreal, Canada. Multivariable linear and logistic regression analyses were used to model the effects of gestational weight gain above recommendation on the birthweight Z-score and risk of large-for-gestational age (LGA) subsequent offspring. After adjusting for the risk factors of the second pregnancy, an independent effect from the first pregnancy was seen on the birthweight Z-score, (effect size OR 0.17 [95% CI 0.05, 0.28] but not risk of LGA of the second pregnancy 1.30 [95% CI 0.89, 1.89]). We concluded that a pregnancy-centred approach to research that conceptualizes pregnancies as self-contained and interchangeable events may not always be appropriate, and propose that analytical methods for some perinatal research questions may need to consider a given pregnancy in the context of a woman's past reproductive experiences.
PubMed ID
18578754 View in PubMed
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Modeling fetal weight for gestational age: a comparison of a flexible multi-level spline-based model with other approaches.

https://arctichealth.org/en/permalink/ahliterature131165
Source
Int J Biostat. 2011;7(1)
Publication Type
Article
Date
2011
Author
Luc Villandré
Jennifer A Hutcheon
Maria Esther Perez Trejo
Haim Abenhaim
Geir Jacobsen
Robert W Platt
Author Affiliation
McGill University Health Centre, Canada.
Source
Int J Biostat. 2011;7(1)
Date
2011
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Female
Fetal Weight
Gestational Age
Health Surveys
Humans
Longitudinal Studies
Models, Statistical
Pregnancy
Scandinavia - epidemiology
Sex Factors
Ultrasonography, Prenatal - methods - statistics & numerical data
Abstract
We present a model for longitudinal measures of fetal weight as a function of gestational age. We use a linear mixed model, with a Box-Cox transformation of fetal weight values, and restricted cubic splines, in order to flexibly but parsimoniously model median fetal weight. We systematically compare our model to other proposed approaches. All proposed methods are shown to yield similar median estimates, as evidenced by overlapping pointwise confidence bands, except after 40 completed weeks, where our method seems to produce estimates more consistent with observed data. Sex-based stratification affects the estimates of the random effects variance-covariance structure, without significantly changing sex-specific fitted median values. We illustrate the benefits of including sex-gestational age interaction terms in the model over stratification. The comparison leads to the conclusion that the selection of a model for fetal weight for gestational age can be based on the specific goals and configuration of a given study without affecting the precision or value of median estimates for most gestational ages of interest.
Notes
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PubMed ID
21931571 View in PubMed
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Placental weight for gestational age and adverse perinatal outcomes.

https://arctichealth.org/en/permalink/ahliterature124146
Source
Obstet Gynecol. 2012 Jun;119(6):1251-8
Publication Type
Article
Date
Jun-2012
Author
Jennifer A Hutcheon
Helen McNamara
Robert W Platt
Alice Benjamin
Michael S Kramer
Author Affiliation
Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, British Columbia. jhutcheon@cfri.ca
Source
Obstet Gynecol. 2012 Jun;119(6):1251-8
Date
Jun-2012
Language
English
Publication Type
Article
Keywords
Adult
Apgar score
Cohort Studies
Female
Gestational Age
Humans
Infant mortality
Infant, Newborn
Male
Organ Size - physiology
Perinatal mortality
Placenta - anatomy & histology
Pregnancy
Pregnancy Complications - mortality
Pregnancy outcome
Quebec - epidemiology
Young Adult
Abstract
The fetoplacental ratio has been used conventionally to study the contribution of the placenta to fetal growth restriction. However, this measure is problematic because a normal fetoplacental ratio can reflect birth weight and placental weight that are both normal, both low, or both high. The objective of this study was to examine the independent association between placental weight for gestational age and perinatal mortality or serious neonatal morbidity.
A sex- and gestational age-specific placental weight z score was calculated for a cohort of 87,600 singleton births at the Royal Victoria Hospital in Montreal, Canada, 1978-2007. The relationship between placental weight z score and adverse perinatal outcomes (stillbirth, neonatal death, 5-minute Apgar score lower than 7, seizures, or respiratory morbidity) was examined using logistic regression. Multivariable models examined whether the relationship was independent of birth weight and other pregnancy risk factors.
: After controlling for birth weight, fetuses with a low placental weight z score were at significantly increased risk of stillbirth (odds ratio [OR] 2.0, 95% confidence interval [CI] 1.4-2.6, percent population attributable risk 17.8%). In contrast, adverse neonatal outcomes were significantly more likely among those with high placental weight z scores (OR 1.4, 95% CI 1.2-1.7, percent population attributable risk 5% for any serious neonatal morbidity). Similar trends were observed after further adjusting for pregnancy risk factors.
Placental weight for gestational age is an independent risk factor for adverse perinatal outcomes, above and beyond the known association with birth weight. The mechanisms behind the opposing effects of placental weight z score on risk of stillbirth compared with adverse neonatal outcomes require further elucidation.
III.
PubMed ID
22617591 View in PubMed
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A population-based study of antenatal corticosteroid prophylaxis for preterm birth.

https://arctichealth.org/en/permalink/ahliterature256622
Source
J Obstet Gynaecol Can. 2012 Sep;34(9):842-8
Publication Type
Article
Date
Sep-2012
Author
Mikameh Kazem
Jennifer A Hutcheon
K S Joseph
Author Affiliation
Faculty of Medicine, University of British Columbia, Vancouver BC.
Source
J Obstet Gynaecol Can. 2012 Sep;34(9):842-8
Date
Sep-2012
Language
English
Publication Type
Article
Keywords
Adrenal Cortex Hormones - administration & dosage
British Columbia
Diabetes, gestational
Female
Gestational Age
Humans
Hypertension, Pregnancy-Induced
Perinatal care
Pregnancy
Premature Birth - prevention & control
Prenatal Care
Registries
Abstract
National and international clinical practice guidelines, based on the meta-analysis of randomized trials, recommend antenatal corticosteroid (ACS) prophylaxis for threatened preterm delivery. We carried out a study to determine the extent to which current clinical practice in British Columbia adheres to these guidelines with a focus on preterm deliveries at 33 to 34 weeks of gestation.
Data were obtained from the British Columbia Perinatal Database Registry, a comprehensive provincial registry containing detailed information on all births in the province. All preterm live births between 2000 and 2009 were included in the study. The rate of ACS administration was assessed in different gestational age groups. Determinants of ACS administration (such as maternal characteristics and obstetric factors) were also studied. The frequency of ACS prophylaxis was estimated using rates and exact 95% confidence intervals, and associations were assessed using odds ratios and 95% confidence intervals.
Among 35 862 preterm births in British Columbia, the rate of ACS administration was 56.0% in the 26- to 32-week group (95% CI 54.7% to 57.4%) and 19.4% in the 33- to 34-week group (95% CI 18.5% to 20.4%). Rates were reasonably consistent between 2000 and 2009 and by region of residence in British Columbia. Women with hypertension (OR 1.51; 95% CI 1.32 to 1.72), gestational diabetes (OR 1.21; 95% CI 1.05 t01.40), and iatrogenic deliveries (OR 1.34; 95% CI 1.22 to 1.47) were significantly more likely to receive ACS.
Despite explicit clinical guidelines, ACS usage in preterm deliveries at 33 to 34 weeks of gestation appears to be suboptimal.
PubMed ID
22971453 View in PubMed
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The predictive ability of conditional fetal growth percentiles.

https://arctichealth.org/en/permalink/ahliterature144030
Source
Paediatr Perinat Epidemiol. 2010 Mar;24(2):131-9
Publication Type
Article
Date
Mar-2010
Author
Jennifer A Hutcheon
Grace M Egeland
Lucie Morin
Sara J Meltzer
Geir Jacobsen
Robert W Platt
Author Affiliation
Department of Epidemiology & Biostatistics, McGill University, Montreal, Quebec, Canada.
Source
Paediatr Perinat Epidemiol. 2010 Mar;24(2):131-9
Date
Mar-2010
Language
English
Publication Type
Article
Keywords
Adult
Birth weight
Canada
Female
Fetal Development
Fetal Growth Retardation - ultrasonography
Humans
Predictive value of tests
Pregnancy
Pregnancy Complications - ultrasonography
Reference Values
Abstract
Conditional fetal growth percentiles are percentiles that are calculated taking into account (conditional on) an infant's weight earlier in pregnancy. Although they have been proposed in the statistical literature as a more methodologically appropriate method of measuring fetal growth, their ability to predict adverse perinatal outcomes due to fetal growth restriction is unknown. Using a large, unselected clinical ultrasound database at the Royal Victoria Hospital in Montreal, Canada, we calculated conditional growth percentiles for infants' weight at birth, given their weight at the time of a routine 32- or 33-week ultrasound. The risk of adverse perinatal outcome (perinatal mortality, low Apgar, acidaemia, or seizures/organ failure due to asphyxia) among small-for-gestational-age infants (SGA) as established by conditional growth percentiles was calculated as well as the risk among infants classified as SGA by conventional weight-for-gestational-age percentiles. Regardless of the threshold used to define SGA (fifth, 10th, 15th, 20th), conditional percentiles did not appear to improve the identification of adverse perinatal outcomes compared with conventional weight-for-gestational-age charts. Further work is needed to confirm our results as well as to explore potential reasons for the lack of benefits from using a measure of growth instead of size to identify fetal growth restriction.
PubMed ID
20415768 View in PubMed
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Pregnancy weight gain by gestational age and BMI in Sweden: a population-based cohort study.

https://arctichealth.org/en/permalink/ahliterature283075
Source
Am J Clin Nutr. 2016 May;103(5):1278-84
Publication Type
Article
Date
May-2016
Author
Kari Johansson
Jennifer A Hutcheon
Olof Stephansson
Sven Cnattingius
Source
Am J Clin Nutr. 2016 May;103(5):1278-84
Date
May-2016
Language
English
Publication Type
Article
Keywords
Adult
Body mass index
Cohort Studies
Female
Gestational Age
Humans
Linear Models
Obesity - metabolism
Overweight - metabolism
Pregnancy
Risk factors
Sweden
Thinness - metabolism
Weight Gain
Abstract
Pregnancy weight-gain z score charts have recently been proposed as a new tool for classifying gestational weight gain and establishing the link between weight gain and adverse maternal and infant outcomes. However, existing charts are few in number, were based on small sample sizes, and were not population based.
We created population-based pregnancy weight-gain-for-gestational-age z score charts for Swedish women who were stratified by early pregnancy body mass index (BMI).
Serial prenatal electronic medical records were obtained from women who were receiving obstetrical care in the Swedish counties of Gotland and Stockholm. The study population was restricted to nonanomalous, singleton, term pregnancies with no prepregnancy hypertension or diabetes. A multilevel linear regression was used to express the repeated weight-gain measurements as a function of gestational age in underweight, normal-weight, overweight, and obese class I-III women. Observed weight-gain ranges were contrasted with current Institute of Medicine (IOM) pregnancy weight-gain recommendations.
A total of 711,615 serial prenatal weight measurements from 141,767 pregnant women were included. The smoothed means, SDs, and selected percentiles (3rd, 10th, 50th, 90th, and 97th) of weight gain were estimated for each week of gestation. The total weight gain and rate of weight gain decreased with increasing prepregnancy BMI. In all BMI categories, the observed range of pregnancy weight gain was considerably broader than the range currently recommended by the IOM.
The presented population-based pregnancy weight-gain charts can be used to express maternal weight gain as gestational age-standardized z scores with early pregnancy BMI taken into consideration. The z scores can be used to obtain a better understanding of the relation between pregnancy weight gain and maternal and infant health complications.
PubMed ID
27009753 View in PubMed
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12 records – page 1 of 2.