Incidence of obese parturients and the outcomes of their pregnancies: A nationwide register study in Finland

Neonatal outcomes in twin pregnancies in Finland from 2008 to 2023

Twin pregnancies are associated with higher risks of adverse maternal and neonatal outcomes compared to singleton pregnancies. This retrospective nationwide cohort study analyzed trends in twin pregnancy outcomes in Finland from 2008 to 2023 using data from the Finnish Medical Birth Register. Outcomes assessed included perinatal mortality, stillbirths, neonatal mortality, neonatal intensive care unit (NICU) admissions, and hospitalization rates at one week of age. A total of 23,588 twin births were included, with an overall stillbirth rate of 9.0 per 1000 and a perinatal mortality rate of 16.0 per 1000. Neonatal mortality rates declined significantly, with term twins showing a rate of 0.9 per 1000 and preterm twins 4.6 per 1000 in the latest years of 2022-2023. NICU admission rates remained stable for preterm twins but showed an increasing trend for term twins. The rate of hospitalized neonates at the age of seven days decreased over time.

CONCLUSION

These trends align with improved antenatal care and Finland's reputation for low neonatal mortality. However, increasing maternal age and obesity rates may contribute to rising NICU admissions in term twins. The study highlights the need for continuous monitoring of neonatal outcomes to ensure high standards of care in the context of declining fertility and delivery rates in Finland.

WHAT IS KNOWN

• Twin pregnancies are associated with higher risks of adverse maternal and neonatal outcomes compared to singleton pregnancies. • Finland has one of the lowest neonatal mortality rates globally.

WHAT IS NEW

• Neonatal mortality rates declined significantly both in term and preterm twins from 2008 to 2023. • NICU admission rates remained stable for preterm twins but showed an increasing trend for term twins.

Risk of childhood neoplasms related to neonatal phototherapy- a systematic review and meta-analysis

CONTEXT

Observational studies have shown conflicting results as to whether exposure to neonatal phototherapy is associated with increased rates of childhood cancer.

OBJECTIVE

To describe the rates of childhood neoplasms and cancer after neonatal phototherapy.

DATA SOURCES

The CENTRAL, PubMed, Scopus, and Web of Science databases.

STUDY SELECTION

Observational studies regardless of design were included.

DATA EXTRACTION

The data were extracted by one author and validated by another. The risk-of-bias assessment was performed using the ROBINS-E and Joanna Briggs Institute critical appraisal tools.

RESULTS

Six cohort and 10 case-control studies were included. The overall risk of bias was high in seven and low in nine studies. In cohort studies, the odds ratio (OR) was increased for hematopoietic cancer (1.44; confidence interval [CI]: 1.16-1.80) and solid tumors (OR: 1.18; CI: 1.00-1.40). In case-control studies, the OR was 1.63 (CI: 0.99-2.67) for hematopoietic cancers and 1.18 (CI: 1.04-1.34) for solid tumors.

CONCLUSIONS

Children with a history of neonatal phototherapy had increased risk of hematopoietic cancer and solid tumors. The evidence quality was limited due to the high risk of bias and potential residual confounding.

IMPACT STATEMENT

Exposure to neonatal phototherapy increased later risk of hematopoietic cancer and solid tumors. This is the most comprehensive study on the association between phototherapy and cancer, but the evidence quality was limited due risk of bias and residual confounding. Future large scale well conducted studies are still needed to better estimate the association and.

Obesity at term: What to consider? How to deliver?

Obesity presents significant challenges during pregnancy, increasing the risk of complications and adverse outcomes for both mother and baby. With the rising prevalence of obesity among pregnant women, questions arise regarding optimal management, including timing of delivery and choice of delivery mode. Labour induction in obese women may require a combination of mechanical and pharmacological methods due to increased risk of failed induction. Caesarean section in obese women presents unique challenges, requiring comprehensive perioperative planning and specialized care to optimize outcomes. However, specific guidelines tailored to obese patients undergoing caesarean sections are lacking. Postpartum care should include vigilant monitoring for complications. Addressing obesity in pregnancy necessitates a multidisciplinary approach and specialized care to ensure the best outcomes.

Prevalence of pre-eclampsia in 265 patients with an intracranial aneurysm, 393 female relatives versus a control cohort: A case-control study

BACKGROUND AND OBJECTIVES

There is emerging evidence on the connection between pre-eclampsia and saccular intracranial aneurysms (sIAs). Our aim was to study the prevalence of pre-eclampsia in sIA patients, their female relatives, and matched controls, and to examine familial sIA disease and familial pre-eclampsia in sIA patients' families.

METHODS

We included all female sIA patients in the Kuopio Intracranial Aneurysm Patient and Family Database from 1995 to 2018. First, we identified the sIA patients, their female relatives, and matched population controls with the first birth in 1987 or later and studied the prevalence of pre-eclampsia. Second, all female sIA patients and all female relatives were analyzed for familial sIA disease and familial pre-eclampsia. Using the Finnish nationwide health registries, we obtained data on drug purchases, hospital diagnoses, and causes of death.

RESULTS

In total, 265 sIA patients, 57 daughters, 167 sisters, 169 nieces, and 546 matched controls had the first birth in 1987 or later. Among them, 29 (11%) sIA patients, 5 (9%) daughters, 10 (6%) sisters, 10 (6%) nieces, and 32 (6%) controls had pre-eclampsia. Of all the 1895 female sIA patients and 12,141 female relatives, 68 sIA patients and 375 relatives had pre-eclampsia, including 32 families with familial pre-eclampsia.

CONCLUSIONS

Pre-eclampsia was significantly more common in the sIA patients than in their matched controls. Familial sIA disease and familial pre-eclampsia co-occurred in seven families. Further studies of the mechanisms by which pre-eclampsia could affect the walls of brain arteries and increase the rupture risk in sIA disease are indicated.

Traumatic brain injury during pregnancy is associated with increased rate of cesarean section: a nationwide multi-register study in Finland

OBJECTIVE

The literature on the incidence of traumatic brain injury (TBI) during pregnancy is lacking. Furthermore, only studies with small sample size have analyzed the impact of TBI during pregnancy to maternal and fetal outcomes. Thus, we aim to report the incidence of TBIs during pregnancy and study the pregnancy outcomes using nationwide high-quality registers.

METHODS

This nationwide retrospective register-based matched cohort study utilized two national registers. All fertile-aged (15-49 years) women with a TBI hospitalization period during pregnancy were retrieved the Care Register for Health Care. Data were then linked with the data from the National Medical Birth Register (MBR). Propensity score matching was conducted according to maternal age during pregnancy, previous cesarean section (CS), maternal smoking status, maternal body mass index, and maternal gestational diabetes. The matching was conducted using the nearest neighbor methods with a caliber width if 0.15, and with a ratio 1:3 (patients/references). Adverse maternal and fetal outcomes were compared between patient group and reference group using Chi-squared tests.

RESULTS

A total of 392 women having a TBI during pregnancy were found. The control group consisted of 722,497 women without TBI during pregnancy. Of the TBIs occurring during pregnancy, the most common types of TBIs were concussion (S06.0) (n = 359, 91.6%), diffuse traumatic brain injury (S06.2) (n = 11, 2.8%), traumatic subdural hemorrhage (n = 7, 1.8%), and unspecified intracranial injury S06.9 (n = 6, 1.5%). The incidence rates of pregnancies with a TBI have remained similar during pregnancy in Finland, peaking at 0.8 per 1000 pregnancies in 2016. The Chi-squared test showed higher rate for CS among women with TBI than for their matched references (21.4% vs. 15.5%, p = .008). Especially, women with TBI during 3rd trimester had higher rate for CS (29.0 vs. 15.0%, p = .016).

CONCLUSIONS

The main findings of this study were that the incidence rates for TBI during pregnancy have remained similar during our study period (2004-2018). TBI during pregnancy, even a mild one, is associated with an increased rate for CS. Especially, TBI during the 3rd trimester was associated with high rate for CS, but the etiology behind this remains unknown. In addition, we found no evidence of difference in fetal outcomes, such as preterm birth, low birth weight, or need for intensive care unit. Future studies should focus on the indications for elective CS, and reasons for unplanned CS among women with TBI during pregnancy, as these could possibly provide important information on the effects of TBI on the course of childbirth.

Prediction of cesarean delivery in class III obese nulliparous women: An externally validated model using machine learning

BACKGROUND

class III obese women, are at a higher risk of cesarean section during labor, and cesarean section is responsible for increased maternal and neonatal morbidity in this population.

OBJECTIVE

the objective of this project was to develop a method with which to quantify cesarean section risk before labor.

METHODS

this is a multicentric retrospective cohort study conducted on 410 nulliparous class III obese pregnant women who attempted vaginal delivery in two French university hospitals. We developed two predictive algorithms (a logistic regression and a random forest models) and assessed performance levels and compared them.

RESULTS

the logistic regression model found that only initial weight and labor induction were significant in the prediction of unplanned cesarean section. The probability forest was able to predict cesarean section probability using only two pre-labor characteristics: initial weight and labor induction. Its performances were higher and were calculated for a cut-point of 49.5% risk and the results were (with 95% confidence intervals): area under the curve 0.70 (0.62,0.78), accuracy 0.66 (0.58, 0.73), specificity 0.87 (0.77, 0.93), and sensitivity 0.44 (0.32, 0.55).

CONCLUSIONS

this is an innovative and effective approach to predicting unplanned CS risk in this population and could play a role in the choice of a trial of labor versus planned cesarean section. Further studies are needed, especially a prospective clinical trial.

FUNDING

French state funds "Plan Investissements d'Avenir" and Agence Nationale de la Recherche.

Trends in the epidemiology of fear of childbirth and association with intended mode of delivery: A nationwide register-based cohort study in Finland

INTRODUCTION

Fear of childbirth (FOC) is a common obstetrical challenge that affects the health of women. The epidemiology of FOC has not been studied in Finland for the last decade. The aim of this study was to analyze the epidemiology and risk factors for FOC and to evaluate the association between FOC and the rate of elective cesarean section (CS) as an intended mode of delivery.

MATERIAL AND METHODS

Data from the National Medical Birth Register were used to evaluate the epidemiology of FOC and to determine the main risk factors for FOC in Finland between 2004 and 2018. Nulliparous and multiparous women were analyzed separately. Logistic regression model was used to determine the main risk factors for FOC. Multivariable logistic regression model was used to assess the intended mode of delivery in those pregnancies with diagnosed maternal FOC. Adjusted odds ratios (aOR) with 95% confidence intervals (CIs) were calculated.

RESULTS

A total of 1 million pregnancies were included. The annual rate of pregnancies with maternal FOC increased from 1.5% (CI: 1.4-1.6) in 2004 to 9.1% (CI: 8.7-9.3) in 2018 for all women. For nulliparous women, the rate increased from 1.1% (CI: 1.0-1.3) in 2004 to 7.1% (CI: 6.7-7.5) in 2018, and from 1.8% (CI: 1.7-2.0) in 2004 to 10.3% (10.0-10.7) in 2018 for multiparous women. The strongest risk factors for maternal FOC were higher maternal age and gestational diabetes. For multiparous women, the strongest risk factors were gestational diabetes and previous CS. The total odds for elective CS were notably higher among women with FOC (aOR 8.63, CI: 8.39-8.88).

CONCLUSIONS

The incidence of maternal FOC rose six-fold during our study period. However, the numbers of elective CS among women with this diagnosis, which had earlier risen in parallel, leveled off in 2014.

Obesity increases the odds of multiple pregnancies: A nationwide register-based cohort study in Finland

OBJECTIVE

To investigate the effects of increased pre-pregnancy body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) on the risk of having spontaneous multiple pregnancies using a nationwide register-based study sample.

METHODS

Data from the National Medical Birth Register (MBR) (2004-2018) were used to evaluate the effects of a higher pre-pregnancy BMI on the risk of multiple pregnancies. Lower and higher pre-pregnancy BMI classes, using the WHO classification, were compared with a normal weight class. A logistic regression model was used to assess the primary outcomes. Adjusted odds ratios (aOR) with 95% confidence intervals (CI) between the groups were compared. The model was adjusted by maternal age, maternal height, and maternal smoking status.

RESULTS

The odds of multiple pregnancies were higher among women in the overweight group (aOR 1.07, 95% CI 1.02-1.12), obesity class I group (aOR 1.11, 95% CI 1.04-1.18), and obesity class II group (aOR 1.15, 95% CI 1.03-1.28) compared with women in the non-overweight BMI class. Women in the underweight group had lower odds for multiple pregnancies (aOR 0.82, 95% CI 0.73-0.93).

CONCLUSION

The odds of multiple pregnancies slightly increase with pre-pregnancy obesity, and this should be acknowledged as a minor risk factor for multiple pregnancies.

High BMI and the risk of lower extremity fractures in fertile-aged women: A nationwide register-based study in Finland

OBJECTIVES

Both high and low body mass index (BMI) is known to be associated with increased risk for osteoporotic fractures in the postmenopausal population. However, the association between BMI and risk for fracture in the fertile-aged (15-49 years) population is not well studied. We aim to examine how increased BMI affects the risk for fracture leading to hospitalization after delivery in fertile-aged women.

MATERIAL AND METHODS

In this nationwide registry-based study, data on all women aged 15-49 years with fractures leading to hospitalization were retrieved from the Care Register for Health Care for the years 2004-2018. The data were linked with data from the National Birth Register, where the BMI status is collected for each pregnancy. Cox regression was used to examine the effect of increased BMI on the risk for fracture within five years after delivery. Risks were analyzed separately for upper extremity, spine and pelvis, and lower extremity fractures. The results were interpreted with hazard ratios (HR), adjusted hazard ratios (aHR), and 95% confidence intervals (CI).

RESULTS

A total of 529 992 pregnant women with 3276 fractures leading to hospitalization within 5-year follow-up were included in this study. Of these, a total of 548 fractures required surgical treatment. Patients with BMI of 30 kg/m² or more had a higher rate of fractures in the lower extremity (≥50%). In lower extremity fractures, risk for fracture increased with increasing BMI. The risk fracture was highest in the group with BMI of 35-40 kg/m² (overall lower extremity aHR 2.43 95% CI 1.92-3.06; knee aHR 2.04, 95% CI 1.45-2.87; ankle aHR 3.01, 95% CI 2.16-4.20).

CONCLUSIONS

Higher BMI was associated to the increased risk for lower extremity fractures, especially ankle fractures, within five years of delivery. Information gained from this study is important in the clinical setting, as patients can be informed of the negative effect of obesity on the post-delivery risk for fractures.