Sociodemographic Characteristics and Clinical Outcomes of People Receiving Inadequate Prenatal Care: A Retrospective Cohort Study

ObjectiveThis study sought to describe the incidence inadequate prenatal care (IPNC) at an urban level II hospital in Hamilton, Ontario, and to compare the characteristics and outcomes of mothers who received IPNC and their newborns with those who received adequate prenatal care (APNC). This study is the first part of a mixed-methods research program aimed at informing the development of an interdisciplinary, patient-centred, prenatal care program for people who struggle to access conventional modes of care.MethodsThis retrospective cohort study compared mothers and neonates born at St. Joseph's Health Care Hamilton in 2016 with IPNC (fewer than or equal to four antenatal visits, or first visit in third trimester) with those born with APNC (five or more prenatal visits and initial visit before the third trimester). Cases and controls matched 3:1 for age and parity were identified through a retrospective chart review.ResultsIn total 3235 charts were reviewed, and 69 cases of IPNC were identified (2.1%). The IPNC group had lower education and higher unemployment levels, as well as higher rates of smoking and drug use. Our primary and secondary outcomes of newborn custody loss, neonatal intensive care unit admission, and neonatal length of stay were significantly higher in the IPNC group.ConclusionPatients delivering with IPNC represent a high-risk group with increased rates of adverse neonatal outcomes and newborn custody loss. This quantitative study will inform future research and innovative interdisciplinary program development aimed at increasing access to prenatal care in an effort to improve maternal and neonatal outcomes.     

Retrospective Review of Prenatal Care and Perinatal Outcomes in a Group of Uninsured Pregnant Women

ObjectiveTo assess the adequacy of prenatal care and perinatal outcomes for uninsured pregnant women at two primary care centres in Canada.MethodsWe conducted a retrospective case comparison study of uninsured women presenting for prenatal care between 2004 and 2007 (n = 71). Control subjects (n = 72) were chosen from provincially insured women presenting for prenatal care during the same period. A modified Kotelchuck Index was used to assess adequacy of care. Frequency of routine prenatal testing (blood tests, ultrasound, cervical swabs, Pap testing, and genetic screening) was compared. Perinatal outcomes assessed included gestational age and birth weight.ResultsUninsured pregnant women presented for initial care 13.6 weeks later than insured women (at 25.6 weeks vs. 12.0 weeks, P < 0.001). Uninsured women had fewer blood tests (93.7% vs. 100%, P = 0.045), ultrasound screenings (82.5% vs. 98.4%, P = 0.003), cervical swabs (69.8% vs. 85.2%, P = 0.04), Paptests (38.1% vs. 75.4%, P < 0.001), genetic screenings (12.7% vs. 44.3%, P < 0.001), and visits with health care providers (6.6 vs. 10.7, P = 0.05). Using a modified Kotelchuck Adequacy of Prenatal Care Utilization Index, uninsured women were more likely to be categorized as receiving “inadequate care” (uninsured 61.9% vs. insured 11.7%, P < 0.001).ConclusionThis study begins to document the care of uninsured pregnant women in Canada. Women in this category presented late for prenatal care, were less likely to have adequate screening tests, and were more likely to receive “inadequate care” as defined by the modified Kotelchuck Index. This information may be valuable in helping to plan programs to improve access to timely and adequate medical care for uninsured pregnant women.     

Infant and Maternal Outcomes for Women Who Experience Imprisonment in Ontario,Canada: A Retrospective Cohort Study

ObjectiveTo describe the population-level risk of infant and maternal outcomes for women who experience imprisonment and compare outcomes with the general population.MethodsWe conducted a retrospective cohort study. We used linked correctional and health data for women released from provincial prisons in 2010. We defined three exposure groups for Ontario singleton deliveries from 2005-2015: deliveries to women who were in prison during pregnancy but not necessarily for delivery, prison pregnancies; deliveries to women who had been in prison but not while pregnant, prison controls; and general population deliveries. We compared groups using generalized estimating equations. Primary outcomes were preterm birth, low birth weight, and small for gestational age birth weight. Secondary outcomes included NICU admission, neonatal abstinence syndrome, placental abruption, and preterm prelabour rupture of membranes.ResultsIn prison pregnancies (n = 544) and prison controls (n = 2156), respectively, preterm birth risk was 15.5% and 12.5%, low birth weight risk was 13.0% and 11.6%, and small for gestational age birth weight risk was 18.1% and 19.2%. Adjusted for maternal age and parity and compared with general population deliveries (N = 1 284 949), odds ratios were increased for prison pregnancies and prison controls, respectively, at 2.7 (95% CI 2.2–3.4) and 2.1 (95% CI 1.9–2.4) for preterm birth, 3.1 (95% CI 2.4–3.9) and 2.7 (95% CI 2.3–3.1) for low birth weight, and 1.6 (95% CI 1.3–2.1) and 1.8 (95% CI 1.6–2.0) for small for gestational age birth weight.ConclusionThere is an increased risk of adverse infant outcomes in women who experience imprisonment compared with the general population, whether they are in prison during pregnancy or not.     

Water Birth and Perinatal Outcomes in British Columbia: A Retrospective Cohort Study

ObjectiveThis study aimed to quantify adverse neonatal outcomes in a cohort of registered midwife (RM)–attended conventional and water births in British Columbia.MethodsThe study included all term singleton births in British Columbia between January 1, 2005 and March 31, 2016 attended by RMs. Births were allocated to a conventional birth cohort or a water birth cohort according to where the actual birth of the neonate took place. The primary outcome was a composite adverse neonatal outcome (Apgar <7 at 5 minutes, resuscitation need, neonatal intensive care unit admission). Secondary outcomes included individual components of the primary outcome, maternal length of labour, and degree of perineal laceration (Canadian Task Force Classification Level II-2).ResultsThe population included 25 798 births. Of these, 23 201 were conventional, and 2567 were water births. The rate of the composite adverse neonatal outcome was not higher in water births compared with conventional births (hospital conventional, 5.0%; hospital water, 4.2%; home conventional, 3.4%; and home water, 2.9%). Rates of individual components of the composite adverse neonatal score were not greater in the water birth cohort. Maternal outcomes included statistically shorter labours in the water birth cohort and no difference between the cohorts in incidence of third- and fourth-degree lacerations.ConclusionWater births attended by RMs in British Columbia are not associated with higher rates of adverse neonatal outcomes than conventional births attended by midwives.     

Characteristics and Outcomes of Adolescent Births in Nova Scotia: A Retrospective Cohort Study

Objective

This study sought to examine the maternal characteristics and outcomes of adolescent births in Nova Scotia.

Integrated Prenatal Care for Women Living With HIV: Primary Care Outcomes in Saskatoon,Saskatchewan

Saskatchewan has the highest rate of new human immunodeficiency virus (HIV) infections in Canada. Of those newly diagnosed, 56% identify as female, 76% identify as Indigenous, and 71% report a history of intravenous drug use. These statistics are strikingly different compared with Canadian data. This brief communication describes prenatal care provided to women living with HIV at an interdisciplinary primary care clinic in Saskatchewan, demonstrating that, despite facing great barriers such as housing insecurity, substance use, and institutionalized racism, women living with HIV can have positive outcomes, including engagement in care and the prevention of perinatal HIV infection.     

Surgeon Gender and Performance Outcomes for Hysterectomies: Retrospective Cohort Study

Study ObjectiveTo evaluate whether there are differences in several performance metrics between male and female surgeons for hysterectomies.DesignMulticenter retrospective cohort study. We matched surgeries performed by female surgeons to those by male surgeons using a propensity score and compared outcomes by gender after adjusting for years in practice and fellowship training.SettingA total of 6 hospitals (3 academic, 3 community) in Ontario, Canada, between July 2016 and December 2019.PatientsAll consecutive patients.InterventionsHysterectomy.Measurements and Main ResultsPrimary outcome was a composite of any complication or return to emergency room (ER) within 30 days. Secondary outcomes were grade II or greater complications, return to ER, and operative time. We included 2664 hysterectomies performed by 77 surgeons. After propensity matching, 963 surgeries performed by females were compared with 963 performed by males. There were no differences in the primary (relative risk [RR], 0.92; 95% confidence interval [CI], 0.71–1.20; p = .56) or secondary outcomes of grade II or greater complication (RR, 1.01; 95% CI, 0.71–1.45; p = .96) or return to ER (RR, 0.81; 95% CI, 0.55–1.20; p = .30). However, surgeries performed by males were 24.72 minutes shorter (95% CI, 18.09–31.34 minutes; p <.001). Entire cohort post hoc regression analysis confirmed these findings. E-value analysis indicated that it is unlikely for an unmeasured confounder to undo the observed difference.ConclusionAlthough complication and readmission rates are similar, male surgeons may have a shorter operating time than female surgeons for hysterectomies, which may have implications for health systems and inequalities in surgeon renumeration.     

The Association of Statin Use and Gonado‐Sexual Function in Women: A Retrospective Cohort Analysis

IntroductionIt has been hypothesized that statins reduce sex hormone biosynthesis through hepatic inhibition of cholesterol synthesis, which is a precursor of androstenedione and estradiol. Such a reduction has been associated with menstrual irregularities, menopausal disorders, infertility, and low libido, but studies are conflicting. Few studies have evaluated the clinical effects of statins on gonadal‐sexual function in women.AimTo compare the risk of gonado‐sexual dysfunction in statin users vs. nonusers.MethodsThis was a retrospective cohort study of all female, adult patients (30–85 years) enrolled in the Tricare Prime/Plus San Antonio catchment area. Using 79 baseline characteristics, we created a propensity score‐matched cohort of statin users and nonusers. The study duration was divided into a baseline period (October 1, 2003 to September 30, 2005) to describe patient baseline characteristics and a follow‐up period (October 1, 2005 to March 1, 2012) to determine patient outcomes. Statin users were defined as those prescribed a statin for ≥3 months between October 1, 2004 and September 30, 2005. Logistic regression was used to determine the association of statin use with patient outcomes.Main Outcome MeasuresOutcomes included menstrual disorders, menopausal disorders, infertility, and ovarian/sexual dysfunction during the follow‐up period. Outcomes were identified using inpatient or outpatient International Classification of Diseases, Ninth Revision, Clinical Modification codes as defined by the Agency for Healthcare Research and Quality's Clinical Classifications Software.ResultsOf 22,706 women who met study criteria, we propensity score‐matched 2,890 statin users with 2,890 nonusers; mean age 58 ± 12 years. Statin use was not significantly associated with menstrual disorders (OR 0.97; 95% CI 0.81–1.16), menopausal disorders (OR 0.92; 95% CI 0.83–1.02), infertility (OR 0.79; 95% CI 0.36–1.73), or ovarian/sexual dysfunction (OR 1.18; 95% CI 0.83–1.70).ConclusionsStatin use was not associated with higher risk of gonado‐sexual dysfunction in women. Ali SK, Reveles KR, Davis R, Mortensen EM, Frei CR, and Mansi I. The association of statin use and gonado‐sexual function in women: A retrospective cohort analysis. J Sex Med 2015;12:83–92.     

Use of Cytomegalovirus-Specific Hyperimmunoglobulins in Pregnancy: A Retrospective Cohort

Objective

There is no consensus on the use of cytomegalovirus (CMV)–specific hyperimmunoglobulins (CSHIGs) for suspected congenital CMV infections during pregnancy, but this therapy is currently used in some countries. The objectives of this study were to describe tolerability and pregnancy outcome following treatment with monthly intravenous CSHIG and compare rates of positive PCR and postnatal symptoms according to whether CSHIGs were given or not.

Incisional Outcomes of Umbilical vs Suprapubic Mini-laparotomy for Tissue Extraction: A Retrospective Cohort Study

Study Objective

To compare outcomes following umbilical minilaparotomy and suprapubic minilaparotomy for tissue extraction.