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Absolute vs relative improvements in congenital diaphragmatic hernia survival: what happened to "hidden mortality".

https://arctichealth.org/en/permalink/ahliterature151056
Source
J Pediatr Surg. 2009 May;44(5):877-82
Publication Type
Article
Date
May-2009
Author
V Kandice Mah
Mohammed Zamakhshary
Doug Y Mah
Brian Cameron
Juan Bass
Desmond Bohn
Leslie Scott
Sharifa Himidan
Mark Walker
Peter C W Kim
Author Affiliation
Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
Source
J Pediatr Surg. 2009 May;44(5):877-82
Date
May-2009
Language
English
Publication Type
Article
Keywords
Cohort Studies
Death Certificates
Female
Fetal Death - epidemiology
Fetal Diseases - surgery
Hernia, Diaphragmatic - congenital - embryology - mortality - surgery
Hospital Mortality
Hospitals, Pediatric - statistics & numerical data
Humans
Infant, Newborn
Male
Ontario - epidemiology
Selection Bias
Stillbirth - epidemiology
Survival Analysis
Abstract
The aim of this study is to determine if there has been a true, absolute, or apparent relative increase in congenital diaphragmatic hernia (CDH) survival for the last 2 decades.
All neonatal Bochdalek CDH patients admitted to an Ontario pediatric surgical hospital during the period when significant improvements in CDH survival was reported (from January 1, 1992, to December 31, 1999) were analyzed. Patient characteristics were assessed for CDH population homogeneity and differences between institutional and vital statistics-based population survival outcomes. SAS 9.1 (SAS Institute, Cary, NC) was used for analysis.
Of 198 cohorts, demographic parameters including birth weight, gestational age, Apgar scores, sex, and associated congenital anomalies did not change significantly. Preoperative survival was 149 (75.2%) of 198, whereas postoperative survival was 133 (89.3%) of 149, and overall institutional survival was 133 (67.2%) of 198. Comparison of institution and population-based mortality (n = 65 vs 96) during the period yielded 32% of CDH deaths unaccounted for by institutions. Yearly analysis of hidden mortality consistently showed a significantly lower mortality in institution-based reporting than population.
A hidden mortality exists for institutionally reported CDH survival rates. Careful interpretation of research findings and more comprehensive population-based tools are needed for reliable counseling and evaluation of current and future treatments.
PubMed ID
19433161 View in PubMed
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Addressing the hidden mortality in CDH: A population-based study.

https://arctichealth.org/en/permalink/ahliterature283224
Source
J Pediatr Surg. 2017 Apr;52(4):522-525
Publication Type
Article
Date
Apr-2017
Author
Carmen Mesas Burgos
Björn Frenckner
Source
J Pediatr Surg. 2017 Apr;52(4):522-525
Date
Apr-2017
Language
English
Publication Type
Article
Keywords
Abortion, Induced - statistics & numerical data
Cohort Studies
Female
Hernias, Diaphragmatic, Congenital - epidemiology - mortality
Humans
Incidence
Infant, Newborn
Kaplan-Meier Estimate
Male
Registries
Stillbirth - epidemiology
Sweden - epidemiology
Abstract
Improvements in the clinical management of CDH have led to overall improved reported result from single institutions. However, population-based studies have highlighted a hidden mortality.
To explore the incidence in Sweden and to address the hidden mortality for CDH during a 27-year period in a population-based setting.
This is a population based cohort study that includes all patients diagnosed with CDH that were registered in the National Patient Register, the Medical Birth Register, the Register of Congenital Malformations and the Register for Causes of Death between 1987 and 2013. The mortality rates were calculated based on the number deaths divided by the number of live born cases. The hidden mortality was defined as the number of CDH cases that were not born (because of TOP or IUFD), cases of neonatal demise during birth or demise the same day of birth in patients who were in peripheral institutions and who never reached tertiary centers.
In total, 861 CDH patients were born in Sweden between 1987 and 2013, which corresponds to an incidence of 3.0 born CDH per 10,000 live births. When adding the cases of TOP and IUFD, the total incidence of CDH in Sweden was 3.5/10,000 live born. The mortality rate between 1987 and 2013 was 36%: 44% during the first time period 1987-1999 and 27% in the later period 2000-2013. The hidden mortality in the second period was 30%, resulting in a total mortality rate of 45%.
The incidence of CDH during a 27-year period remained unchanged in the population. However, we observed a decrease in the prevalence because of the increasing numbers of TOP. A significant hidden mortality exists, with overall mortality rate of 45% for CDH in this population.
II (cohort).
PubMed ID
27745705 View in PubMed
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Advanced Maternal Age and Stillbirth Risk in Nulliparous and Parous Women.

https://arctichealth.org/en/permalink/ahliterature267363
Source
Obstet Gynecol. 2015 Aug;126(2):355-62
Publication Type
Article
Date
Aug-2015
Author
Ulla Waldenström
Sven Cnattingius
Mikael Norman
Erica Schytt
Source
Obstet Gynecol. 2015 Aug;126(2):355-62
Date
Aug-2015
Language
English
Publication Type
Article
Keywords
Adult
Body mass index
Female
Humans
Maternal Age
Middle Aged
Parity
Population Surveillance
Pregnancy
Registries
Reproductive history
Risk assessment
Risk factors
Stillbirth - epidemiology
Sweden - epidemiology
Abstract
To investigate the association between advanced maternal age and stillbirth risks in first, second, third, and fourth births or more.
A population-based registry study including all women aged 25 years and older with singleton pregnancies at 28 weeks of gestation and later gave birth in Sweden from 1990 to 2011; 1,804,442 pregnancies were analyzed. In each parity group, the risk of stillbirth at age 30-34 years, 35-39 years, and 40 years and older compared with age 25-29 years was investigated by logistic regression analyses adjusted for sociodemographic factors, smoking, body mass index, history of stillbirth, and interdelivery interval. Also, two low-risk groups were investigated: women with a high level of education and nonsmoking women of normal weight.
Stillbirth rates increased by maternal age: 25-29 years 0.27%; 30-34 years 0.31%; 35-39 years 0.40%; and 40 years or older 0.53%. Stillbirth risk increased by maternal age in first births. Compared with age 25-29 years, this increase was approximately 25% at 30-34 years and doubled at age 35 years. In second, third, and fourth birth or more, stillbirth risk increased with maternal age in women with a low and middle level of education, but not in women with high education. In nonsmokers of normal weight, the risk in second births increased from age 35 years or older and in third births or more from age 30 years or older.
Advanced maternal age is an independent risk factor for stillbirth in nulliparous women. This age-related risk is reduced or eliminated in parous women, possibly as a result of physiologic adaptations during the first pregnancy.
II.
PubMed ID
26241426 View in PubMed
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Advanced maternal age: are decisions about the timing of child-bearing a failure to understand the risks?

https://arctichealth.org/en/permalink/ahliterature159336
Source
CMAJ. 2008 Jan 15;178(2):183-4
Publication Type
Article
Date
Jan-15-2008
Author
Karen M Benzies
Author Affiliation
Faculty of Nursing, University of Calgary, Calgary, Alta. benzies@ucalgary.ca
Source
CMAJ. 2008 Jan 15;178(2):183-4
Date
Jan-15-2008
Language
English
Publication Type
Article
Keywords
Adult
Decision Making
Female
Health education
Health Knowledge, Attitudes, Practice
Humans
Infant, Newborn
Maternal Age
Ontario
Pregnancy
Pregnancy Complications - epidemiology
Pregnancy, High-Risk
Prevalence
Reproductive Behavior
Risk assessment
Stillbirth - epidemiology
Time Factors
Notes
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Comment On: CMAJ. 2008 Jan 15;178(2):165-7218195290
PubMed ID
18195294 View in PubMed
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Advanced paternal age and stillbirth rate: a nationwide register-based cohort study of 944,031 pregnancies in Denmark.

https://arctichealth.org/en/permalink/ahliterature289812
Source
Eur J Epidemiol. 2017 03; 32(3):227-234
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
03-2017
Author
Stine Kjaer Urhoj
Per Kragh Andersen
Laust Hvas Mortensen
George Davey Smith
Anne-Marie Nybo Andersen
Author Affiliation
Section of Social Medicine, Department of Public Health, University of Copenhagen, Oster Farimagsgade 5, POB 2099, 1014, Copenhagen K, Denmark. stur@sund.ku.dk.
Source
Eur J Epidemiol. 2017 03; 32(3):227-234
Date
03-2017
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adult
Cohort Studies
Denmark - epidemiology
Female
Humans
Male
Middle Aged
Paternal Age
Pregnancy
Proportional Hazards Models
Registries - statistics & numerical data
Risk factors
Stillbirth - epidemiology
Young Adult
Abstract
Advanced paternal age has been associated with a variety of rare conditions and diseases of great public health impact. An increased number of de novo point mutations in sperm with increasing age have been suggested as a mechanism, which would likely also affect fetal viability. We examined the association between paternal age and stillbirth rate in a large nationwide cohort. We identified all pregnancies in Denmark from 1994 to 2010 carried to a gestational age of at least 22 completed weeks (n = 944,031) as registered in national registers and linked to individual register data about the parents. The hazard ratio of stillbirth according to paternal age was estimated, adjusted for maternal age in 1-year categories, year of outcome, and additionally parental educational levels. The relative rate of stillbirth (n = 4946) according to paternal age was found to be J-shaped with the highest hazard ratio for fathers aged more than 40 years when paternal age was modelled using restricted cubic splines. When modelled categorically, the adjusted hazard ratios of stillbirth were as follows:
Notes
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PubMed ID
28271174 View in PubMed
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Adverse Pregnancy Outcomes among Adolescents in Northwest Russia: A Population Registry-Based Study.

https://arctichealth.org/en/permalink/ahliterature296661
Source
Int J Environ Res Public Health. 2018 02 03; 15(2):
Publication Type
Journal Article
Date
02-03-2018
Author
Anna A Usynina
Vitaly Postoev
Jon Øyvind Odland
Andrej M Grjibovski
Author Affiliation
Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø 9037, Norway. perinat@mail.ru.
Source
Int J Environ Res Public Health. 2018 02 03; 15(2):
Date
02-03-2018
Language
English
Publication Type
Journal Article
Keywords
Adolescent
Adult
Apgar score
Body Weight
Delivery, Obstetric
Dietary Supplements
Female
Folic Acid - administration & dosage
Humans
Infant, Low Birth Weight
Infant, Newborn
Logistic Models
Pregnancy
Pregnancy Outcome - epidemiology
Pregnancy in Adolescence - statistics & numerical data
Premature Birth - epidemiology
Registries
Reproductive Tract Infections - epidemiology
Russia - epidemiology
Smoking - epidemiology
Stillbirth - epidemiology
Young Adult
Abstract
This study aimed to assess whether adolescents have an increased risk of adverse pregnancy outcomes (APO) compared to adult women. We used data on 43,327 births from the population-based Arkhangelsk County Birth Registry, Northwest Russia, for 2012-2014. The perinatal outcomes included stillbirth, preterm birth (
PubMed ID
29401677 View in PubMed
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Adverse pregnancy outcomes related to advanced maternal age compared with smoking and being overweight.

https://arctichealth.org/en/permalink/ahliterature105162
Source
Obstet Gynecol. 2014 Jan;123(1):104-12
Publication Type
Article
Date
Jan-2014
Author
Ulla Waldenström
Vigdis Aasheim
Anne Britt Vika Nilsen
Svein Rasmussen
Hans Järnbert Pettersson
Erica Schytt
Erica Shytt
Author Affiliation
Department of Women's and Children's Health, Division of Reproductive and Perinatal Health Care, and the Department of Clinical Science and Education, Södersjukhuset (KI SÖS), Karolinska Institutet, Stockholm, and the Centre for Clinical Research, Dalarna, Falun, Sweden; and the Center for Evidence Based Practice, Faculty of Health Sciences, Bergen University College, and the Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
Source
Obstet Gynecol. 2014 Jan;123(1):104-12
Date
Jan-2014
Language
English
Publication Type
Article
Keywords
Adult
Apgar score
Female
Humans
Infant mortality
Infant, Newborn
Infant, Small for Gestational Age
Maternal Age
Norway - epidemiology
Overweight - complications
Pregnancy
Premature Birth - epidemiology - etiology
Smoking - adverse effects
Stillbirth - epidemiology
Sweden - epidemiology
Abstract
To investigate the association between advanced maternal age and adverse pregnancy outcomes and to compare the risks related to advanced maternal age with those related to smoking and being overweight or obese.
A population-based register study including all nulliparous women aged 25 years and older with singleton pregnancies at 22 weeks of gestation or greater who gave birth in Sweden and Norway from 1990 to 2010; 955,804 women were analyzed. In each national sample, adjusted odds ratios (ORs) of very preterm birth, moderately preterm birth, small for gestational age, low Apgar score, fetal death, and neonatal death in women aged 30-34 years (n=319,057), 35-39 years (n=94,789), and 40 years or older (n=15,413) were compared with those of women aged 25-29 years (n=526,545). In the Swedish sample, the number of additional cases of each outcome associated with maternal age 30 years or older, smoking, and overweight or obesity, respectively, was estimated in relation to a low-risk group of nonsmokers of normal weight and aged 25-29 years.
The adjusted OR of all outcomes increased by maternal age in a similar way in Sweden and Norway; and the risk of fetal death was increased even in the 30- to 34-year-old age group (Sweden n=826, adjusted OR 1.24, 95% confidence interval [CI] 1.13-1.37; Norway n=472, adjusted OR 1.26, 95% CI 1.12-1.41). Maternal age 30 years or older was associated with the same number of additional cases of fetal deaths (n=251) as overweight or obesity (n=251).
For the individual woman, the absolute risk for each of the outcomes was small, but for society, it may be significant as a result of the large number of women who give birth after the age of 30 years.
II.
Notes
Erratum In: Obstet Gynecol. 2014 Mar;123(3):669Shytt, Erica [corrected to Schytt, Erica]
PubMed ID
24463670 View in PubMed
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Association between different levels of hemoglobin in pregnancy and pregnancy outcomes: a registry-based study in Northwest Russia.

https://arctichealth.org/en/permalink/ahliterature130411
Source
Int J Circumpolar Health. 2011;70(5):457-9
Publication Type
Article
Date
2011
Author
Elena L Chumak
Andrej M Grjibovski
Author Affiliation
International School of Public Health, Northern State Medical University, Arkhangelsk, Russia.
Source
Int J Circumpolar Health. 2011;70(5):457-9
Date
2011
Language
English
Publication Type
Article
Keywords
Adult
Anemia - blood - epidemiology
Arctic Regions - epidemiology
Comorbidity
Female
Hemoglobins - administration & dosage - metabolism
Humans
Maternal Welfare - statistics & numerical data
Pregnancy - blood
Pregnancy Complications, Hematologic - blood - epidemiology
Pregnancy Outcome - epidemiology
Premature Birth - epidemiology
Prenatal Care - methods
Registries
Risk factors
Russia
Stillbirth - epidemiology
Women's health
Young Adult
Abstract
The association between maternal anemia and pregnancy outcomes has been investigated in many epidemiological studies, but the findings remain inconsistent. In our previous study based on the Kola Birth Registry (KBR), we observed that maternal anemia defined as hemoglobin concentration below 120 g/l was negatively associated with the risk of stillbirth and preterm birth and positively associated with foetal growth (1). However, our anemic group was heterogeneous and included women with hemoglobin between 110 and 120 g/l, which cannot be classified as anemic according to the WHO. This study aims to achieve a more detailed analysis of different maternal hemoglobin concentrations and their associations with stillbirth, preterm birth and foetal growth in using the data from the KBR.
PubMed ID
22005726 View in PubMed
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Association between pregnancy losses in women and risk of atherosclerotic disease in their relatives: a nationwide cohort study†.

https://arctichealth.org/en/permalink/ahliterature279215
Source
Eur Heart J. 2016 Mar 14;37(11):900-7
Publication Type
Article
Date
Mar-14-2016
Author
Mattis Flyvholm Ranthe
Lars Jorge Diaz
Ida Behrens
Henning Bundgaard
Jacob Simonsen
Mads Melbye
Heather Allison Boyd
Source
Eur Heart J. 2016 Mar 14;37(11):900-7
Date
Mar-14-2016
Language
English
Publication Type
Article
Keywords
Abortion, Spontaneous - epidemiology - genetics
Atherosclerosis - epidemiology - genetics
Cerebral Infarction - epidemiology - genetics
Cohort Studies
Denmark - epidemiology
Family
Female
Gravidity
Humans
Male
Myocardial Ischemia - epidemiology - genetics
Nuclear Family
Pedigree
Pregnancy
Pregnancy Complications, Cardiovascular - epidemiology - genetics
Siblings
Stillbirth - epidemiology - genetics
Abstract
A common underlying mechanism with a genetic component could link pregnancy losses with vascular disease. We examined whether pregnancy losses (miscarriages and stillbirths) and atherosclerotic outcomes co-aggregated in families.
Using Danish registers, we identified women with pregnancies in 1977-2008, and their parents (>1 million) and brothers (>435 000). We followed parents for incident ischaemic heart disease (IHD), myocardial infarction (MI), and cerebrovascular infarction (CVI), and brothers for a broader combined atherosclerotic endpoint. Using Cox regression, we estimated hazard ratios (HRs) for each outcome by history of pregnancy loss in daughters/sisters. Overall, parents whose daughters had 1, 2, and =3 miscarriages had 1.01 [95% confidence interval (CI) 0.99-1.04], 1.07 (95% CI 1.02-1.11), and 1.10 (95% CI 1.02-1.19) times the rate of MI, respectively, as parents whose daughters had no miscarriages. For parents with =3 daughters, the HRs were 1.12 (95% CI 1.02-1.24), 1.29 (95% CI 1.13-1.48), and 1.33 (95% CI 1.12-1.57). Effect magnitudes did not differ for fathers and mothers. We observed similar patterns for IHD and CVI (parents) and the atherosclerotic endpoint (brothers). Parents whose daughters had stillbirths had 1.14 (95% CI 1.05-1.24) and 1.07 (95% CI 0.96-1.18) times the rates of MI and CVI, respectively, as parents whose daughters had no stillbirths.
Certain pregnancy losses and atherosclerotic diseases in both heart and brain may have a common aetiologic mechanism. Women in families with atherosclerotic disease may be predisposed to pregnancy loss; conversely, pregnancy losses in first-degree relatives may have implications for atherosclerotic disease risk.
PubMed ID
26497162 View in PubMed
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Association Between Year of Birth and 1-Year Survival Among Extremely Preterm Infants in Sweden During 2004-2007 and 2014-2016.

https://arctichealth.org/en/permalink/ahliterature299075
Source
JAMA. 2019 03 26; 321(12):1188-1199
Publication Type
Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Date
03-26-2019
Author
Mikael Norman
Boubou Hallberg
Thomas Abrahamsson
Lars J Björklund
Magnus Domellöf
Aijaz Farooqi
Cathrine Foyn Bruun
Christian Gadsbøll
Lena Hellström-Westas
Fredrik Ingemansson
Karin Källén
David Ley
Karel Maršál
Erik Normann
Fredrik Serenius
Olof Stephansson
Lennart Stigson
Petra Um-Bergström
Stellan Håkansson
Author Affiliation
Division of Pediatrics, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden.
Source
JAMA. 2019 03 26; 321(12):1188-1199
Date
03-26-2019
Language
English
Publication Type
Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Developmental Disabilities - epidemiology
Female
Fetal Viability
Gestational Age
Humans
Infant
Infant Mortality - trends
Infant, Extremely Premature
Infant, Newborn
Infant, Premature, Diseases - epidemiology
Intensive Care, Neonatal
Male
Prospective Studies
Stillbirth - epidemiology
Survival Rate
Sweden - epidemiology
Abstract
Since 2004-2007, national guidelines and recommendations have been developed for the management of extremely preterm births in Sweden. If and how more uniform management has affected infant survival is unknown.
To compare survival of extremely preterm infants born during 2004-2007 with survival of infants born during 2014-2016.
All births at 22-26 weeks' gestational age (n?=?2205) between April 1, 2004, and March 31, 2007, and between January 1, 2014, and December 31, 2016, in Sweden were studied. Prospective data collection was used during 2004-2007. Data were obtained from the Swedish pregnancy, medical birth, and neonatal quality registries during 2014-2016.
Delivery at 22-26 weeks' gestational age.
The primary outcome was infant survival to the age of 1 year. The secondary outcome was 1-year survival among live-born infants who did not have any major neonatal morbidity (specifically, without intraventricular hemorrhage grade 3-4, cystic periventricular leukomalacia, necrotizing enterocolitis, retinopathy of prematurity stage 3-5, or severe bronchopulmonary dysplasia).
During 2004-2007, 1009 births (3.3/1000 of all births) occurred at 22-26 weeks' gestational age compared with 1196 births (3.4/1000 of all births) during 2014-2016 (P?=?.61). One-year survival among live-born infants at 22-26 weeks' gestational age was significantly lower during 2004-2007 (497 of 705 infants [70%]) than during 2014-2016 (711 of 923 infants [77%]) (difference, -7% [95% CI, -11% to -2.2%], P?=?.003). One-year survival among live-born infants at 22-26 weeks' gestational age and without any major neonatal morbidity was significantly lower during 2004-2007 (226 of 705 infants [32%]) than during 2014-2016 (355 of 923 infants [38%]) (difference, -6% [95% CI, -11% to -1.7%], P?=?.008).
Among live births at 22-26 weeks' gestational age in Sweden, 1-year survival improved between 2004-2007 and 2014-2016.
Notes
CommentIn: JAMA. 2019 Mar 26;321(12):1163-1164 PMID 30912817
PubMed ID
30912837 View in PubMed
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148 records – page 1 of 15.