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Adherence to guidelines and suboptimal practice in term breech delivery with perinatal death- a population-based case-control study in Norway.

https://arctichealth.org/en/permalink/ahliterature309107
Source
BMC Pregnancy Childbirth. 2019 Sep 09; 19(1):330
Publication Type
Journal Article
Date
Sep-09-2019
Author
Solveig Bjellmo
Sissel Hjelle
Lone Krebs
Elisabeth Magnussen
Torstein Vik
Author Affiliation
Department of Obstetrics and Gynecology, More and Romsdal Hospital Trust, Postbox 1600, 6026, Aalesund, Norway. solveigbjellmo@gmail.com.
Source
BMC Pregnancy Childbirth. 2019 Sep 09; 19(1):330
Date
Sep-09-2019
Language
English
Publication Type
Journal Article
Keywords
Adult
Breech Presentation
Case-Control Studies
Cesarean Section - methods - statistics & numerical data
Delivery, Obstetric - methods - standards - statistics & numerical data
Female
Guideline Adherence
Humans
Infant, Newborn
Needs Assessment
Norway - epidemiology
Obstetric Labor Complications - diagnosis - etiology - mortality - surgery
Perinatal Death - prevention & control
Perinatal mortality
Practice Guidelines as Topic
Pregnancy
Pregnancy Outcome - epidemiology
Prenatal Care - methods - standards
Quality Improvement
Abstract
In a recent population-based study we reported excess risk of neonatal mortality associated with vaginal breech delivery. In this case-control study we examine whether deviations from Norwegian guidelines are more common in breech deliveries resulting in intrapartum or neonatal deaths than in breech deliveries where the offspring survives, and if these deaths are potentially avoidable.
Case-control study completed as a perinatal audit including term breech deliveries of singleton without congenital anomalies in Norway from 1999 to 2015. Deliveries where the child died intrapartum or in the neonatal period were case deliveries. For each case, two control deliveries who survived were identified. All the included deliveries were reviewed by four obstetricians independently assessing if the deaths in the case group might have been avoided and if the management of the deviations from Norwegian guidelines were more common in case than in control deliveries.
Thirty-one case and 62 control deliveries were identified by the Medical Birth Registry of Norway. After exclusion of non-eligible deliveries, 22 case and 31 control deliveries were studied. Three case and two control deliveries were unplanned home deliveries, while all in-hospital deliveries were in line with national guidelines. Antenatal care and/or management of in-hospital deliveries was assessed as suboptimal in seven (37%) case and two (7%) control deliveries (p?=?0.020). Three case deliveries were completed as planned caesarean delivery and 12 (75%) of the remaining 16 deaths were considered potentially avoidable had planned caesarean delivery been done. In seven of these 16 deliveries, death was associated with cord prolapse or difficult delivery of the head.
All in-hospital breech deliveries were in line with Norwegian guidelines. Seven of twelve potentially avoidable deaths were associated with birth complications related to breech presentation. However, suboptimal care was more common in case than control deliveries. Further improvement of intrapartum care may be obtained through continuous rigorous training and feedback from repeated perinatal audits.
PubMed ID
31500581 View in PubMed
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Apgar Score and Risk of Neonatal Death among Preterm Infants.

https://arctichealth.org/en/permalink/ahliterature305386
Source
N Engl J Med. 2020 07 02; 383(1):49-57
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
07-02-2020
Author
Sven Cnattingius
Stefan Johansson
Neda Razaz
Author Affiliation
From the Division of Clinical Epidemiology, Department of Medicine Solna (S.C., S.J., N.R.), and the Department of Clinical Science and Education (S.J.), Karolinska Institutet, Stockholm.
Source
N Engl J Med. 2020 07 02; 383(1):49-57
Date
07-02-2020
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Apgar score
Female
Gestational Age
Humans
Incidence
Infant, Extremely Premature
Infant, Newborn
Infant, Premature
Male
Perinatal Death
Perinatal mortality
Prognosis
Registries
Sweden - epidemiology
Abstract
Gestational age is the major determinant of neonatal death (death within the first 28 days of life) in preterm infants. The joint effect of gestational age and Apgar score on the risk of neonatal death is unknown.
Using data from the Swedish Medical Birth Register, we identified 113,300 preterm infants (22 weeks 0 days to 36 weeks 6 days of gestation) born from 1992 through 2016. In analyses stratified according to gestational age (22 to 24 weeks, 25 to 27 weeks, 28 to 31 weeks, 32 to 34 weeks, and 35 or 36 weeks), we estimated adjusted relative risks of neonatal death and absolute rate differences in neonatal mortality (i.e., the excess number of neonatal deaths per 100 births) according to the Apgar scores at 5 and 10 minutes and according to the change in the Apgar score between 5 minutes and 10 minutes. Scores range from 0 to 10, with higher scores indicating a better physical condition of the newborn.
There were 1986 neonatal deaths (1.8%). The incidence of neonatal death ranged from 0.2% (at 36 weeks of gestation) to 76.5% (at 22 weeks of gestation). Lower Apgar scores were associated with higher relative risks of neonatal death and greater absolute rate differences in neonatal mortality in all gestational-age strata. For example, among infants born at 28 to 31 weeks, the adjusted absolute rate differences according to the 5-minute Apgar score, with those who had a score of 9 or 10 serving as the reference group, were 51.7 (95% confidence interval [CI], 38.1 to 65.4) for a score of 0 or 1, 25.5 (95% CI, 18.3 to 32.8) for a score of 2 or 3, 7.1 (95% CI, 5.1 to 9.1) for a score of 4 to 6, and 1.2 (95% CI, 0.5 to 1.9) for a score of 7 or 8. An increase in the Apgar score between 5 minutes and 10 minutes was associated with lower neonatal mortality than a stable Apgar score.
In this study, Apgar scores at 5 and 10 minutes provided prognostic information about neonatal survival among preterm infants across gestational-age strata. (Funded by the Swedish Research Council for Health, Working Life, and Welfare and Karolinska Institutet.).
PubMed ID
32609981 View in PubMed
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Country of first birth and neonatal outcomes in migrant and Norwegian-born parous women in Norway: a population-based study.

https://arctichealth.org/en/permalink/ahliterature305589
Source
BMC Health Serv Res. 2020 Jun 15; 20(1):540
Publication Type
Journal Article
Date
Jun-15-2020
Author
Eline S Vik
Roy M Nilsen
Vigdis Aasheim
Rhonda Small
Dag Moster
Erica Schytt
Author Affiliation
Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Campus Kronstad, Inndalsveien 28, 5063, Bergen, Norway. eline.skirnisdottir.vik@hvl.no.
Source
BMC Health Serv Res. 2020 Jun 15; 20(1):540
Date
Jun-15-2020
Language
English
Publication Type
Journal Article
Keywords
Adult
Birth Order
Emigration and Immigration
Female
Gestational Age
Humans
Infant, Newborn
Infant, Small for Gestational Age
Logistic Models
Norway
Odds Ratio
Perinatal Death
Pregnancy
Pregnancy Outcome - epidemiology
Premature Birth - epidemiology
Registries
Reproductive history
Stillbirth - epidemiology
Transients and Migrants - statistics & numerical data
Abstract
This study compares subsequent birth outcomes in migrant women who had already had a child before arriving in Norway with those in migrant women whose first birth occurred in Norway. The aim of this study was to investigate the associations between country of first birth and adverse neonatal outcomes (very preterm birth, moderately preterm birth, post-term birth, small for gestational age, large for gestational age, low Apgar score, stillbirth and neonatal death) in parous migrant and Norwegian-born women.
National population-based study including second and subsequent singleton births in Norway from 1990 to 2016. Data were retrieved from the Medical Birth Registry of Norway and Statistics Norway. Neonatal outcomes were compared between births to: 1) migrant women with a first birth before immigration to Norway (n?=?30,062) versus those with a first birth after immigration (n?=?66,006), and 2) Norwegian-born women with a first birth outside Norway (n?=?6205) versus those with a first birth in Norway (n?=?514,799). Associations were estimated as crude and adjusted odds ratios (aORs) with 95% confidence intervals (CIs) using multiple logistic regression.
Migrant women with a first birth before immigrating to Norway had increased odds of adverse outcomes in subsequent births relative to those with a first birth after immigration: very preterm birth (22-31 gestational weeks; aOR?=?1.27; CI 1.09-1.48), moderately preterm birth (32-36 gestational weeks; aOR?=?1.10; CI 1.02-1.18), post-term birth (=42 gestational weeks; aOR?=?1.19; CI 1.11-1.27), low Apgar score (
PubMed ID
32539855 View in PubMed
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The duration of gestation at previous induced abortion and its impacts on subsequent births: A nationwide registry-based study.

https://arctichealth.org/en/permalink/ahliterature306705
Source
Acta Obstet Gynecol Scand. 2020 05; 99(5):651-659
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
05-2020
Author
Situ Kc
Mika Gissler
Reija Klemetti
Author Affiliation
Faculty of Social Sciences, University of Tampere, Tampere, Finland.
Source
Acta Obstet Gynecol Scand. 2020 05; 99(5):651-659
Date
05-2020
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Abortion, Induced - adverse effects - statistics & numerical data
Adult
Cohort Studies
Female
Finland
Gestational Age
Humans
Infant, Low Birth Weight
Infant, Small for Gestational Age
Obstetric Labor, Premature - etiology
Perinatal Death - etiology
Pregnancy
Pregnancy Outcome - epidemiology
Premature Birth - etiology
Registries
Risk factors
Young Adult
Abstract
Previous induced abortions have been associated with adverse birth outcomes. However, only a few studies have considered the possible influence of gestational age at induced abortion. Therefore, this study aimed to identify the impacts of gestational age during prior induced abortion(s) on subsequent births among first-time mothers in Finland.
First-time mothers (n = 418 690) with singleton births between 1996 and 2013 were identified from the Finnish Medical Birth Register and linked to the Abortion Register. Logistic regression analysis was used to estimate the risk (odds ratio [OR] and 95% confidence interval [CI]) of birth outcomes such as prematurity, low birthweight, perinatal death and small for gestational age (SGA).
Higher risk was determined for extremely preterm birth (OR 2.28; 95% CI 1.53-3.39) and very low birthweight (OR 1.62; 95% CI 1.22-2.16) in women having had late-induced abortion(s) (=12 gestational weeks) compared with women having had early-induced abortion(s) (
PubMed ID
32128786 View in PubMed
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Exposure to antidepressants during pregnancy--prevalences and outcomes.

https://arctichealth.org/en/permalink/ahliterature262966
Source
Dan Med J. 2014 Sep;61(9):B4916
Publication Type
Article
Date
Sep-2014
Author
Espen Jimenez-Solem
Source
Dan Med J. 2014 Sep;61(9):B4916
Date
Sep-2014
Language
English
Publication Type
Article
Keywords
Abnormalities, Drug-Induced - epidemiology - etiology
Adult
Antidepressive Agents, Second-Generation - adverse effects
Cohort Studies
Denmark - epidemiology
Drug Utilization - statistics & numerical data - trends
Female
Humans
Infant
Infant mortality
Infant, Newborn
Maternal Exposure - adverse effects - statistics & numerical data
Perinatal Death - etiology
Pregnancy
Registries
Risk factors
Serotonin Uptake Inhibitors - adverse effects
Stillbirth - epidemiology
Abstract
Pharmacological treatment during pregnancy has been a huge challenge since the establishment of thalidomide's teratogenicity in the early sixties. Analyses of possible risks associated with drug intake during pregnancy are not possible by performing randomized trials, and interspecies extrapolation is challenging. The best available method is through epidemiological studies. During the past decade use of antidepressants during pregnancy has been associated with negative birth outcomes, such as congenital malformations. In spite of a considerable number of studies on the subject, the data are still conflicting. The main challenge is how to discern between the effects of the drug and the effect of the depression itself. We approached this dire problem conducting a nation-wide register based study analyzing the relation between use of antidepressants during pregnancy and the risk of congenital malformations and perinatal mortality. We performed our analysis with focus on women pausing treatment before pregnancy to account for special characteristics associated with women redeeming a prescription for an antidepressant. Furthermore, we reported prevalences of antidepressant use, in Denmark, in relation to pregnancy and over time, between 1997 and 2010. We found that use of antidepressants during pregnancy has increased from 0.2% in 1997 to 3.2% in 2010. This considerable increase is mostly due to exposure to selective serotonin reuptake inhibitors (SSRIs). In addition, at the time of pregnancy recognition we saw a halving in prevalence of antidepressant exposure and a steep increase after delivery. Our analyses showed an association between being in treatment with an SSRI and congenital malformations. However, this increased risk was also found for women pausing treatment before pregnancy. We conclude that the apparent risk associated with use of SSRIs during pregnancy is not related to the drug exposure, but to unknown characteristics associated with mothers redeeming a prescription for an antidepressant. We found no increased risk of stillbirths or neonatal mortality among off-spring exposed in utero to an antidepressant in any of the three trimesters. The overall conclusion is that antidepressants are not associated with increased risks of congenital malformations and perinatal mortality. However, we cannot rule out a possible causal relation, and treatment must therefore be based on an individual assessment of each woman analysing possible risks versus possible benefit.
PubMed ID
25186551 View in PubMed
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High birth weight and perinatal mortality among siblings: A register based study in Norway, 1967-2011.

https://arctichealth.org/en/permalink/ahliterature285376
Source
PLoS One. 2017;12(2):e0172891
Publication Type
Article
Date
2017
Author
Petter Kristensen
Katherine M Keyes
Ezra Susser
Karina Corbett
Ingrid Sivesind Mehlum
Lorentz M Irgens
Source
PLoS One. 2017;12(2):e0172891
Date
2017
Language
English
Publication Type
Article
Keywords
Birth Weight - physiology
Female
Humans
Infant
Infant, Newborn
Infant, Newborn, Diseases - epidemiology - mortality
Male
Mothers
Norway
Perinatal Death
Perinatal mortality
Pregnancy
Siblings
Abstract
Perinatal mortality according to birth weight has an inverse J-pattern. Our aim was to estimate the influence of familial factors on this pattern, applying a cohort sibling design. We focused on excess mortality among macrosomic infants (>2 SD above the mean) and hypothesized that the birth weight-mortality association could be explained by confounding shared family factors. We also estimated how the participant's deviation from mean sibling birth weight influenced the association.
We included 1 925 929 singletons, born term or post-term to mothers with more than one delivery 1967-2011 registered in the Medical Birth Registry of Norway. We examined z-score birth weight and perinatal mortality in random-effects and sibling fixed-effects logistic regression models including measured confounders (e.g. maternal diabetes) as well as unmeasured shared family confounders (through fixed effects models). Birth weight-specific mortality showed an inverse J-pattern, being lowest (2.0 per 1000) at reference weight (z-score +1 to +2) and increasing for higher weights. Mortality in the highest weight category was 15-fold higher than reference. This pattern changed little in multivariable models. Deviance from mean sibling birth weight modified the mortality pattern across the birth weight spectrum: small and medium-sized infants had increased mortality when being smaller than their siblings, and large-sized infants had an increased risk when outweighing their siblings. Maternal diabetes and birth weight acted in a synergistic fashion with mortality among macrosomic infants in diabetic pregnancies in excess of what would be expected for additive effects.
The inverse J-pattern between birth weight and mortality is not explained by measured confounders or unmeasured shared family factors. Infants are at particularly high mortality risk when their birth weight deviates substantially from their siblings. Sensitivity analysis suggests that characteristics related to maternal diabetes could be important in explaining the increased mortality among macrosomic infants.
Notes
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PubMed ID
28245262 View in PubMed
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Higher rate of serious perinatal events in non-Western women in Denmark.

https://arctichealth.org/en/permalink/ahliterature278301
Source
Dan Med J. 2016 Mar;63(3)
Publication Type
Article
Date
Mar-2016
Author
Marianne Brehm Christensen
Sarah Fredsted Villadsen
Tom Weber
Charlotte Wilken-Jensen
Anne-Marie Nybo Andersen
Source
Dan Med J. 2016 Mar;63(3)
Date
Mar-2016
Language
English
Publication Type
Article
Keywords
Case-Control Studies
Denmark - epidemiology
Emigrants and Immigrants - statistics & numerical data
Female
Humans
Infant
Infant Mortality - ethnology
Infant, Newborn
Mothers - statistics & numerical data
Perinatal Death
Pregnancy
Registries
Socioeconomic Factors
Stillbirth - ethnology
Surveys and Questionnaires
Abstract
To elucidate possible mechanisms behind the increased risk of stillbirth and infant mortality among migrants in Denmark, this study aimed to analyse characteristics of perinatal deaths at Hvidovre Hospital 2006-2010 - -according to maternal country of origin.
We identified children born at Hvidovre Hospital who died perinatally and included the patient files in a series of case studies. Our data were linked to data from population-covering registries in Statistics Denmark. Timing, causes of death as well as social, medical and obstetric characteristics of the parents were described according to maternal country of origin.
This study included 125 perinatal deaths. The data indicated that intrapartum death, death caused by maternal disease, lethal malformation and preterm birth may be more frequent among non-Western than among Danish-born women. Obesity and disposition to diabetes may also be more prevalent among the non-Western women.
The role of obesity, gestational diabetes, preeclampsia and severe congenital anomalies should be a main focus in improving our understanding the increased risk of perinatal death among non-Western migrant women in Denmark. Six of 28 perinatal deaths in the non-Western group were intrapartum deaths and warrants further concern.
This project was funded by the Danish Council for Strategic Research as part of the SULIM project.
The linkage of data from patient files to data from Statistics Denmark was approved by the Danish Data Protection Agency. Only anonymised data were used.
PubMed ID
26931191 View in PubMed
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Is vaginal breech delivery associated with higher risk for perinatal death and cerebral palsy compared with vaginal cephalic birth? Registry-based cohort study in Norway.

https://arctichealth.org/en/permalink/ahliterature289935
Source
BMJ Open. 2017 05 04; 7(4):e014979
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
05-04-2017
Author
Solveig Bjellmo
Guro L Andersen
Marit Petra Martinussen
Pål Richard Romundstad
Sissel Hjelle
Dag Moster
Torstein Vik
Author Affiliation
Department of Obstetrics and Gynecology, Helse More og Romsdal HF, Alesund, Norway.
Source
BMJ Open. 2017 05 04; 7(4):e014979
Date
05-04-2017
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adolescent
Adult
Breech Presentation - epidemiology - therapy
Cerebral Palsy - epidemiology - etiology
Cesarean Section
Child, Preschool
Delivery, Obstetric
Female
Humans
Infant
Infant, Newborn
Male
Norway - epidemiology
Odds Ratio
Perinatal Death - etiology
Pregnancy
Prospective Studies
Registries
Risk factors
Time Factors
Abstract
This paper aims to study if vaginal breech delivery is associated with increased risk for neonatal mortality (NNM) or cerebral palsy (CP) in Norway where vaginal delivery accounts for 1/3 of all breech deliveries.
Cohort study using information from the national Medical BirthRegister and Cerebral Palsy Register.
Births in Norway 1999-2009.
520 047 term-born singletons without congenital malformations.
NNM, CP and a composite outcome of these and death during birth.
Compared with cephalic births, breech births had substantially increased risk for NNM but not for CP. Vaginal delivery was planned for 7917 of 16?700 fetuses in breech, while 5561 actually delivered vaginally. Among these, NNM was 0.9 per 1000 compared with 0.3 per 1000 in vaginal cephalic delivery, and 0.8 per 1000 in those actually born by caesarean delivery (CD) in breech. Compared with planned cephalic delivery, planned vaginal delivery was associated with excess risk for NNM (OR 2.4; 95%?CI 1.2 to 4.9), while the OR associated with planned breech CD was 1.6 (95% CI 0.7 to 3.7). These risks were attenuated when NNM was substituted by the composite outcome. Vaginal breech delivery was not associated with excess risk for CP compared with vaginal cephalic delivery.
Vaginal breech delivery, regardless of whether planned or actual, and actual breech CD were associated with excess risk for NNM compared with vaginal cephalic delivery, but not with CP. The risk for NNM and CP in planned breech CD did not differ significantly from planned vaginal cephalic delivery. However, the absolute risk for these outcomes was low, and taking into consideration potential long-term adverse consequences of CD for the child and later deliveries, we therefore conclude that vaginal breech delivery may be recommended, provided competent obstetric care and strict criteria for selection to vaginal delivery.
Notes
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PubMed ID
28473516 View in PubMed
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Outcomes of Pregnancies for Women Undergoing Endoscopy While They Were Pregnant: A Nationwide Cohort Study.

https://arctichealth.org/en/permalink/ahliterature283217
Source
Gastroenterology. 2017 Feb;152(3):554-563.e9
Publication Type
Article
Interactive/Multimedia
Date
Feb-2017
Author
Jonas F Ludvigsson
Benjamin Lebwohl
Anders Ekbom
Ravi Pokala Kiran
Peter H R Green
Jonas Höijer
Olof Stephansson
Source
Gastroenterology. 2017 Feb;152(3):554-563.e9
Date
Feb-2017
Language
English
Publication Type
Article
Interactive/Multimedia
Keywords
Adult
Apgar score
Cesarean Section - statistics & numerical data
Cohort Studies
Congenital Abnormalities - epidemiology
Endoscopy, Digestive System - statistics & numerical data
Female
Humans
Infant, Low Birth Weight
Infant, Newborn
Infant, Small for Gestational Age
Labor, Induced - statistics & numerical data
Male
Perinatal Death
Poisson Distribution
Pregnancy
Pregnancy Outcome - epidemiology
Premature Birth - epidemiology
Registries
Regression Analysis
Stillbirth - epidemiology
Sweden
Young Adult
Abstract
Endoscopy is an integral part of the investigation and management of gastrointestinal disease. We aimed to examine outcomes of pregnancies for women who underwent endoscopy during their pregnancy.
We performed a nationwide population-based cohort study, linking data from the Swedish Medical Birth Registry (for births from 1992 through 2011) with those from the Swedish Patient Registry. We identified 3052 pregnancies exposed to endoscopy (2025 upper endoscopies, 1109 lower endoscopies, and 58 endoscopic retrograde cholangiopancreatographies). Using Poisson regression, we calculated adjusted relative risks (ARRs) for adverse outcomes of pregnancy according to endoscopy status using 1,589,173 unexposed pregnancies as reference. To consider the effects of disease activity, we examined pregnancy outcomes (preterm birth, stillbirth, small for gestational age, or congenital malformations) in women who underwent endoscopy just before or after pregnancy. Secondary outcome measures included induction of labor, low birth weight (
PubMed ID
27773807 View in PubMed
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Parvovirus B19 DNAemia in pregnant women in relation to perinatal death: A nested case-control study within a large population-based pregnancy cohort.

https://arctichealth.org/en/permalink/ahliterature307354
Source
Acta Obstet Gynecol Scand. 2020 07; 99(7):856-864
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
07-2020
Author
Regine Barlinn
Lill Trogstad
Halvor Rollag
Fredrik Frøen
Per Magnus
Susanne G Dudman
Author Affiliation
Department of Microbiology, Oslo University Hospital, Oslo, Norway.
Source
Acta Obstet Gynecol Scand. 2020 07; 99(7):856-864
Date
07-2020
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adult
Age Factors
Body mass index
Case-Control Studies
DNA, Viral - blood
Erythema Infectiosum - mortality - transmission
Female
Humans
Infectious Disease Transmission, Vertical
Norway
Parvovirus B19, Human - isolation & purification
Perinatal Death
Pregnancy
Pregnancy Complications, Infectious - blood - mortality
Risk factors
Smoking
Abstract
Parvovirus B19 (B19V) is the infectious cause of exanthema infectiosum. In Europe around 40% of pregnant women are susceptible to infection. Having small children at home is the main risk factor for contracting an infection during pregnancy. The association between B19V-infection and perinatal death is not yet settled. The aims of the study were to estimate the association between maternal parvovirus B19 infection in pregnancy and perinatal death, and to assess the significance of a positive B19V PCR in pregnancy.
The study population consists of women included in the Norwegian Mother and Child Cohort Study, a prospective population-based pregnancy cohort of nearly 100 000 women. Blood samples were obtained during weeks 17-18 in pregnancy (M1), at birth, and in umbilical cord blood. Within participants in the pregnancy cohort, 138 cases of perinatal death and 1350 controls with live-born children were included in a nested case-control study. Samples were analyzed with B19V serology and B19V PCR according to a predefined test algorithm. For cases, medical records and laboratory results from hospitals were combined with the results of B19V serology and PCR. The reported causes of perinatal death were categorized using the classification system: Causes Of Death and Associated Conditions (CODAC).
The B19V seroconversion rates were 9.8% for cases and 6.8% for control mothers. The odds ratio for maternal B19V infection in cases compared with controls was 1.28 (95% CI 0.35-4.70), adjusted for age, parity, body mass index and tobacco use. B19V-PCR-positive samples were detected at weeks 17-18 of gestation in both cases and controls. The proportion of positive samples was similar in cases and controls, 24% and 28.2%, respectively. Mothers with PCR-positive M1 samples transmitted B19V vertically in 9.1% of cases and in 11.9% of the controls. Of all perinatal deaths, 53% were attributed to placental pathology or unknown causes.
B19V PCR positivity was high and similar in both cases and controls. In our study B19V DNAemia was not seen to be associated with fatal outcome of pregnancy. The clinical significance of B19V DNA detection during pregnancy is uncertain. Caution is needed when diagnosing a B19V infection based only on B19V DNAemia.
PubMed ID
31925774 View in PubMed
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