Implementing a birth registry in a developing country - experiences from Georgia

The impact of COVID-19-related restrictions on pregnancy and abortion rates in the Republic of Georgia

BACKGROUND

The Republic of Georgia implemented COVID-19-related restrictions starting on 31 March 2020, when it imposed a 1-month strict lockdown, after which the country continued with some form of restrictions for 1 year. These restrictions created barriers to healthcare access, affected healthcare services, caused severe economic degradation, and changed reproductive behavior. The aim of this study was to explore the impact of COVID-19-related restrictions on pregnancy and abortion rates in Georgia.

METHODS

Information on pregnancy, abortion, and related variables was extracted from the Georgian Birth Registry from January 2018 through April 2022. The final study sample included 232,594 pregnancies and 86,729 abortions. We used interrupted time series analysis to study the impact of COVID-19-related restrictions.

RESULTS

There were slightly decreasing trends in pregnancy and abortion rates in the pre-pandemic period (1 January 2018-31 March 2020). During the 1-month strict lockdown (1 April-30 April 2020), pregnancy and abortion rates decreased in all investigated age groups. There were no substantial differences in pregnancy or abortion rates in the pandemic period (for pregnancies: 1 April 2020-30 June 2021; for abortions: 1 April 2020-30 April 2022) compared to the pre-pandemic period. The precision of all estimates suggested that both small increases and decreases in pregnancy and abortion rates are reasonably compatible with our data.

CONCLUSIONS

Despite the 1-year-long COVID-19-related restrictions, our results did not indicate substantial long-term changes in pregnancy or abortion rates during the study period for any age group. This may indicate that the restrictions did not substantially influence access to contraception, abortion services, or reproductive behavior.

Guidance to develop a multidisciplinary, international, pediatric registry: a systematic review

AIM

The European Reference Network for craniofacial anomalies and ear, nose and throat disorders (ERN-CRANIO) aims to improve craniofacial care on a European scale. Within ERN-CRANIO, the cleft lip and palate (CL/P) work stream seeks to ameliorate health outcomes for patients with CL/P. This work stream acknowledged the need for a European wide registry for comparable outcome measures and therapy endpoints to achieve this goal. This review aimed to provide a scientific basis for the conceptualization of this registry by studying previous registry initiatives.

METHODS

This review performed thematic analysis on twenty-four articles through narrative synthesis. An iterative process was used to identify key-themes required for prolonged registry success.

RESULTS

Analysis of the literature resulted in twenty-one distinct headings including quantitative and qualitative data. Quantitative data including registry characteristics were visualized in a table. The analysis of qualitative data resulted in the identification of fourteen key-themes, which have been summarized and visualized in a guidance.

CONCLUSION

This review has successfully identified key-themes required for the development of an international, multidisciplinary, pediatric registry for pan-European cleft care. The guidance provided by this review applies to the goals of ERN-CRANIO, but can be used by any initiative developing a registry.

Factors Associated with Cesarean Section among Primiparous Women in Georgia: A Registry-based Study

Cesarean section rates remain high in Georgia. As a cesarean section in the first pregnancy generally lead to a cesarean section in subsequent pregnancies, primiparous women should be targeted for prevention strategies. The aim of the study was to assess factors associated with cesarean section among primiparous women. The study comprised 17,065 primiparous women with singleton, cephalic deliveries at 37–43 weeks of gestation registered in the Georgian Birth Registry in 2017. The main outcome was cesarean section. Descriptive statistics and logistic regression analysis were used to identify factors associated with cesarean section. The proportion of cesarean section was 37.1% with regional variations from 14.2% to 57.4%. Increased maternal age, obesity and having a baby weighing ≥4000 g were all associated with higher odds of cesarean section. Of serious concern for newborn well-being is the high proportion of cesarean section at 37–38 weeks of gestation. Further research should focus on organizational and economical aspects of maternity care to uncover the underlying causes of the high cesarean section rate in Georgia.

Incidence and Causes of Perinatal Mortality in Georgia

Georgia has one of the highest perinatal mortality rates (i.e., stillbirths and early neonatal deaths combined) in Europe. The Georgian Birth Registry was started in 2016 to provide data for preventive measures of maternal and child health. In this study, we aim to determine the incidence of perinatal mortality, assess the distribution of stillbirths and early neonatal deaths, and to determine the major causes of perinatal mortality in Georgia. Data sources were the Georgian Birth Registry and the vital registration system for the year 2017. Causes of early neonatal deaths were assigned into five categories, using the Wigglesworth classification with the Neonatal and Intrauterine deaths Classification according to Etiology modification. The study used descriptive statistics only, specifically counts, means, proportions, and rates, using the statistical software STATA version 15.0. (StataCorp, College Station, TX, USA). In 2017, 489 stillbirths and 238 early neonatal deaths were recorded, resulting in a perinatal mortality rate of 13.6 per 1000 births. About 80% of stillbirths had an unknown cause of death. The majority of stillbirths occurred before the start of labor (85%), and almost one-third were delivered by caesarean section (28%). Prematurity (58%) and congenital malformations (23%) were the main causes of early neonatal deaths, and 70% of early neonatal deaths occurred after the first day of life. The perinatal mortality rate in Georgia remained high in 2017. The major causes of early neonatal deaths were comparable to those of many high-income countries. Contrary to global data, most early neonatal deaths occurred after the first day of life.

Factors associated with exclusive breastfeeding at hospital discharge: a study using data from the Georgian Birth Registry

BACKGROUND

The World Health Organization recommends exclusive breastfeeding for six months, defined as no other solids or liquids besides breast milk and essential vitamins or medicines. Data about exclusive breastfeeding are limited in Georgia, and the information that exist are provided by national surveys, that present inconsistent numbers. Georgia has recently established a national birth registry, which includes information about early postpartum breastfeeding. The objective of this study was to identify factors associated with exclusive breastfeeding of term newborns at hospital discharge in Georgia, using national registry data.

METHODS

All live, singleton, term births registered in the Georgian Birth Registry in November and December 2017 were included, with a final study sample of 7134 newborns. Newborns exclusively breastfed at hospital discharge were compared with those who were not, and potential factors were assessed with logistic regression analysis. Hospital discharge normally occurred between 2 and 5 days postpartum.

RESULTS

The study identified several factors associated with nonexclusive breastfeeding of term newborns at hospital discharge in Georgia: maternal higher education compared to secondary education or less (Adjusted Odds Ratio [AOR] 0.75; 95% CI 0.59, 0.97), caesarean delivery compared to vaginal or assisted vaginal delivery (AOR 0.47; 95% CI 0.37, 0.60), birthweight < 2500 g compared to 3000-3499 g (AOR 0.51; 95% CI 0.27, 0.97), and admission to neonatal intensive care unit after delivery (AOR 0.02; 95% CI 0.02, 0.03). None of the following factors were associated with exclusive breastfeeding at discharge: mother's age, marital status, Body Mass Index (BMI), parity, in vitro fertilization, maternal intrapartum complications and the sex of the newborn.

CONCLUSIONS

To the authors' knowledge, this is the first time determinants of exclusive breastfeeding at hospital discharge have been studied in Georgia. Several factors associated with nonexclusive breastfeeding at discharge were identified, most noteworthy were caesarean delivery and admission to neonatal intensive care unit. These findings are of importance to the Georgian health authorities and maternal/child non-governmental organizations.