Dataset Information

Discharge time after birth is associated with parity - A retrospective cohort study.

ABSTRACT:

Background

All healthy mothers with uncomplicated births are recommended to be discharged directly from the labour ward a few hours after birth as a change in practice in three hospitals in Denmark. However, despite this practice, there is limited knowledge about when mothers leave the hospital after birth in clinical practice.

Objective

The aim of this study is to examine 1) when mothers are discharged from hospital after birth, 2) if discharge time from the hospital after birth is associated with parity, and 3) which factors are associated with discharge time.

Methods

This retrospective study is based on data from the North Denmark Regional Hospital and included mothers giving vaginal birth from March 25, 2019 to April 10, 2021.

Results

A total of 1990 mothers were included. Nearly 50% of the new mothers stayed at the hospital less than 6 h after birth (26% of primiparous women vs 64% of multiparous women). Primiparous women had an adjusted RR 0.44 (95% CI 0.39-0.49) for discharge ≤6 h, RR 1.71 (95% CI 1.15-2.54) for discharge >6-12 h, and RR 3.76 (95% CI 3.03-4.67) for discharge >48 h after birth compared to multiparous women. Multiparous women's adjusted RR for discharge >6-12 h was 0.15 (95% CI 0.12-0.20) and for discharge >48 h 0.16 (95% CI 0.14-0.20) compared to discharge less than 6 h after birth. Furthermore, smoking, low education level, and younger age were associated with early discharge.

Conclusion

There is a significant association with parity and discharge time after birth and factors related to discharge time which healthcare professionals should be aware of when planning inpatient and outpatient care. In addition, healthcare professionals should be aware of mothers discharged early who are smoking, of younger age, lower education level or multiparity.

SUBMITTER: Lindblad V

PROVIDER: S-EPMC10006520 | biostudies-literature | 2023 Mar

REPOSITORIES: biostudies-literature

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Discharge time after birth is associated with parity - A retrospective cohort study.

Lindblad Victoria V Kragholm Kristian Hay KH Eidhammer Anya A Melgaard Dorte D

Heliyon 20230226 3

<h4>Background</h4>All healthy mothers with uncomplicated births are recommended to be discharged directly from the labour ward a few hours after birth as a change in practice in three hospitals in Denmark. However, despite this practice, there is limited knowledge about when mothers leave the hospital after birth in clinical practice.<h4>Objective</h4>The aim of this study is to examine 1) when mothers are discharged from hospital after birth, 2) if discharge time from the hospital after birth ...[more]

PMID: 36915540

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Project description:BackgroundNulliparity is considered to be a risk factor of preterm birth (PTB), low birth weight (LBW) and small for gestational age (SGA). With the new two-child policy launched in 2016, more Chinese women have delivered their 2nd baby. Yet few studies have assessed the impact of parity on adverse birth outcomes in China. This study aimed to examine the association between parity and risks of PTB, LBW and SGA in a Chinese population. The combined effects of maternal age and parity on adverse birth outcomes were also assessed.MethodsThis retrospective study included all non-malformed live births born during January 1, 2014 and December 31, 2018 in Chengdu, China. A total of 746,410 eligible live singletons with complete information were included in the analysis. Parity was classified into nulliparity (i.e. has never delivered a newborn before) and multiparity (i.e. has delivered at least one newborn before). Log-binomial regression analyses were applied to evaluate the association between parity and PTB, LBW and SGA. We further divided maternal age into different groups (< 25 years, 25-29 years, 30-34 years and ≥ 35 years) to assess the combined effects of maternal age and parity on adverse birth outcomes.ResultsMultiparity was associated with reduced risks of PTB (aRR = 0.91, 95% CI: 0.89-0.93), LBW (aRR = 0.74, 95% CI: 0.72-0.77) and SGA (aRR = 0.67, 95% CI: 0.66-0.69) compared with nulliparity. In each age group, we observed that multiparity was associated with lower risks of adverse birth outcomes. Compared to nulliparous women aged between 25 and 29 years, women aged ≥35 years had greater risks of PTB and LBW, regardless of their parity status. In contrast, multiparous women aged ≥35 years (aRR = 0.73, 95% CI: 0.70-0.77) and those aged < 25 years (aRR = 0.88, 95% CI: 0.84-0.93) were at lower risk of SGA compared with nulliparous women aged between 25 and 29 years.ConclusionMultiparity was associated with lower risks of all adverse birth outcomes. Special attention should be paid to nulliparous mothers and those with advanced age during antenatal care, in order to reduce the risks of adverse birth outcomes.

Project description:BackgroundA key target of the 2030 Sustainable Development Goals is to eliminate preventable deaths in newborns and children under 5. This study aimed to estimate the effect of time of birth on early neonatal mortality (ENM) and low Apgar scores at 5 min (LA5) in newborns.MethodsA retrospective cohort study was conducted using vital statistics data on live births, maternal morbidity, congenital defects and perinatal mortality in Cauca-Colombia (2017-2021) excluding out-of-hospital, multiple and major defect cases. A directed acyclic graph was constructed to define the confounder adjustment set. Multivariable logistic, linear and propensity score models evaluated the effect of birth timing on neonatal outcomes, estimating crude and adjusted incidence rate ratios (IRRa).ResultsWe assessed 65 182 live births, finding similar baseline characteristics for daytime and night-time births. ENM was 0.2% (95% CI 0.19% to 0.26%) at 7 days of follow-up, absolute mortality difference 0.1% (95% CI -0.01% to 0.12%). Night-time births increased the incidence of ENM in the primary analysis IRRa 1.27 (95% CI 0.90 to 1.82), in the secondary IRRa 1.45 (95% CI 0.94 to 2.20), and in the primary and secondary sensitivity analysis, respectively, IRRa 1.48 (95% CI 1.06 to 2.07) and 1.70 (95% CI 1.16 to 2.59). LA5 was present in 0.7% (95% CI 0.60% to 0.72%) of birth, with absolute LA5 difference 0.1% (95% CI -0.02% to 0.22%). Night-time births increased the incidence of LA5 in the primary analysis IRRa 1.31 (95% CI 1.00 to 1.49), in the secondary IRRa 1.44 (95% CI 1.13 to 1.83), and in the primary and secondary sensitivity analysis, respectively, IRRa 1.31 (95% CI 1.08 to 1.59) and IRRa 1.54 (95% CI 1.23 to 1.92).ConclusionsBirth at night-time is associated with worse neonatal outcomes, ENM and low Apgar scores in Colombia's diverse population, highlighting the need for optimised prenatal care, revised work schedules and improved referral systems in maternal health.

Project description:BackgroundNon-communicable diseases are the leading cause of death, worldwide. Obesity is one of the factors that is associated with the development of such diseases. The role of reproductive factors on women body composition has been evaluated, but the findings are controversial. This study was aimed at assessing the association of parity with body composition among women.MethodsIn 1982, the maternity hospital of Pelotas, a southern Brazilian city, were visited daily and all deliveries were identified. Those livebirths whose family lived in the urban area of the city have been prospectively followed (n = 5914). In 2012-13, we tried to follow the whole cohort, the subjects were interviewed and examined. We evaluated the association of parity with the following body composition variables: body mass index, waist circumference and fat mass %. Estimates were adjusted for family income, skin color, maternal schooling, occupational status, alcohol, smoking, physical activity, and consumption of processed and ultraprocessed foods. All these analyses were replicated among the cohort men as a comparison. We also assessed whether duration of breastfeeding moderated the association.ResultsIn the 2012-13 visit, 3701 subjects were evaluated (mean age of 30.2 years). In the present analysis, we included 1620 women and 1653 men. 33% of women were nulliparous and 48% of men were without children. Even after controlling for confounding, parous women had a BMI 0.96 kg/m2 (95% CI: 0.30; 1.62) higher than nulliparous and for men the regression coefficient was 0.79 kg/m2 (95% CI: 0.29; 1.29). Waist circumference was also higher among parous women. Among men, the association was not linear and the regression coefficients were lower than that observed among women [3.41 cm (95% CI: -0.91; 7.73) among men and 4.83 cm (95% CI: 2.43; 7.24) among women with more than 3 children when compared with those without children], but this difference was not statistically significant (interaction p value = 0.58). Fat mass % was not associated with parity. Breastfeeding did not modify the association between parity and body composition.ConclusionsParity was positively associated with body mass index and waist circumference among women. However, similar results among men suggest that there is no causal effect of parity.

Project description:BackgroundFollow-up with a primary care provider within 1-2 weeks of discharge from hospital has been associated with reduced readmissions. We sought to determine appointment attendance with primary care providers postdischarge and identify factors associated with attendance.MethodsWe conducted a retrospective cohort study involving general medicine patients who had been discharged from hospital between Sept. 1, 2014, and Dec. 30, 2015, from 2 Ontario academic hospitals, and who had been supported by a transitional care specialist and advised to see a primary care provider within 1 week. Attendance was determined by self-report during follow-up by telephone. We used multivariable logistic regression to assess whether patient factors (e.g., comorbidity) or system factors (e.g., booking the appointment before discharge) predicted attendance. We used Cox proportional hazards modelling to assess whether attendance predicted readmission within 30 days.ResultsOf the 214 patients included in our study, 35% (n = 75) attended a primary care appointment within 1 week of discharge; 52% (n = 124) of patients attended an appointment within 2 weeks. After adjusting for age, sex and comorbidity, significant predictors of attendance were booking the appointment before discharge (odds ratio [OR] 2.14, 95% confidence interval [CI] 1.07-4.40), familiarity with the primary care provider (OR 5.43, 95% CI 2.25-14.1) and inclusion of a reminder, callback number and appointment time in the discharge summary (OR 15.3, 95% CI 2.09-326). Predictors of nonattendance were the presence of a home support worker (OR 0.38, 95% CI 0.17-0.80) and a booked specialist appointment before discharge (OR 0.37, 95% CI 0.18-0.73). Attendance was not associated with reduced readmissions (hazard ratio 0.66, 95% CI 0.40-1.09).InterpretationTimely follow-up with PCPs postdischarge remains challenging. Efforts to improve attendance should focus on reinforcing need for follow-up and coordinating follow-up before discharge, particularly for those poorly connected with the health care system.

Project description:OBJECTIVE: To determine whether a short interval between pregnancies is an independent risk factor for adverse obstetric outcome. DESIGN: Retrospective cohort study. SETTING: Scotland. SUBJECTS: 89 143 women having second births in 1992-8 who conceived within five years of their first birth. MAIN OUTCOME MEASURES: Intrauterine growth restriction (birth weight less than the 5th centile for gestational age), extremely preterm birth (24-32 weeks), moderately preterm birth (33-36 weeks), and perinatal death. RESULTS: Women whose subsequent interpregnancy interval was less than six months were more likely than other women to have had a first birth complicated by intrauterine growth restriction (odds ratio 1.3, 95% confidence interval 1.1 to 1.5), extremely preterm birth (4.1, 3.2 to 5.3), moderately preterm birth (1.5, 1.3 to 1.7), or perinatal death (24.4, 18.9 to 31.5). They were also shorter, less likely to be married, and more likely to be aged less than 20 years at the time of the second birth, to smoke, and to live in an area of high socioeconomic deprivation. When the outcome of the second birth was analysed in relation to the preceding interpregnancy interval and the analysis confined to women whose first birth was a term live birth (n = 69 055), no significant association occurred (adjusted for age, marital status, height, socioeconomic deprivation, smoking, previous birth weight vigesimal, and previous caesarean delivery) between interpregnancy interval and intrauterine growth restriction or stillbirth. However, a short interpregnancy interval (< 6 months) was an independent risk factor for extremely preterm birth (adjusted odds ratio 2.2, 1.3 to 3.6), moderately preterm birth (1.6, 1.3 to 2.0), and neonatal death unrelated to congenital abnormality (3.6, 1.2 to 10.7). The adjusted attributable fractions for these associations were 6.1%, 3.9%, and 13.8%. The associations were very similar when the analysis was confined to married non-smokers aged 25 and above. CONCLUSIONS: A short interpregnancy interval is an independent risk factor for preterm delivery and neonatal death in the second birth.

Project description:BackgroundPrevious studies have investigated the associations between perfluoroalkyl acids (PFAAs) in women and time to pregnancy (TTP). Inconsistent results may be explained by differences in conditioning on parity.ObjectivesWe used causal directed acyclic graphs to illustrate potential confounding related to previous pregnancies and exposure measurement error due to differences in the interpregnancy interval in pregnancy-based studies that include parous women. We exemplified the potential importance of these issues using data from the Danish National Birth Cohort.MethodsWe used discrete time survival models to estimate associations between maternal plasma PFAAs in early pregnancy and TTP in 638 nulliparous and 613 parous women.ResultsPFAA quartiles were not associated with the TTP in nulliparous women. In parous women, higher PFAA quartiles were associated with longer TTP. The strongest associations were estimated for perfluorohexane sulfonate and perfluorooctane sulfonate. PFAA concentrations were higher in women with longer interpregnancy intervals. Accounting for the interpregnancy interval attenuated the estimated associations.ConclusionsAssociations between PFAAs and TTP in parous women may be biased by confounders related to previous pregnancies and exposure measurement error. To avoid these biases, studies that include parous women may need to condition on a) common causes of PFAAs and the TTP in the index pregnancy, b) previous births (a descendant of a collider), c) PFAA levels or common causes of PFAA levels and the TTP in the previous pregnancy (to alleviate collider stratification bias caused by conditioning on previous births), and d) the interpregnancy interval (in pregnancy-based studies). Alternatives would be to restrict studies to nulliparous women or to use toxicokinetic modeling to correct exposure estimates in parous women. These recommendations may be extended to studies of other chemicals with similar toxicokinetic properties. https://doi.org/10.1289/EHP1493.

Dataset Information

Discharge time after birth is associated with parity - A retrospective cohort study.

Background

Objective

Methods

Results

Conclusion

Publications

Discharge time after birth is associated with parity - A retrospective cohort study.

Similar Datasets

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