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Prelabour caesarean section and neurodevelopmental outcome at 4 and 12?months of age: an observational study.

ABSTRACT: BACKGROUND:With prelabour caesarean section rates growing globally, there is direct and indirect evidence of negative cognitive outcomes in childhood. The objective of this study was to assess the short-term neurodevelopmental outcomes after prelabour caesarean section as compared to vaginally born infants. METHODS:We conducted a prospective, observational study of infants delivered by prelabour caesarean section at the Hospital of Halland, Halmstad, Sweden and compared their development with an historical group of infants born by non-instrumental vaginal delivery. RESULTS:Infants born by prelabour caesarean section were compared with a group of vaginally born infants. Follow-up assessments were performed at 4 and 12?months. Prelabour caesarean infants (n?=?66) had significantly lower Ages and Stages Questionnaire, second edition (ASQ-II) scores in all domains (communication, gross motor, fine motor, problem solving and personal-social) at 4?months of age with an adjusted mean difference (95% CI) of -?20.7 (-?28.7 to -?12.6) in ASQ-II total score as compared to vaginally born infants (n?=?352). These differences remained for gross-motor skills at the 12?month assessment, adjusted mean difference (95% CI) -4.7 (-?8.8 to -?0.7), n?=?62 and 336. CONCLUSIONS:Adverse neurodevelopmental outcomes in infants born by prelabour caesarean section may be apparent already a few months after birth. Additional studies are warranted to explore this relationship further.

SUBMITTER: Zaigham M

PROVIDER: S-EPMC7517619 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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Prelabour caesarean section and neurodevelopmental outcome at 4 and 12 months of age: an observational study.

Zaigham Mehreen M Hellström-Westas Lena L Domellöf Magnus M Andersson Ola O

BMC pregnancy and childbirth 20200925 1

<h4>Background</h4>With prelabour caesarean section rates growing globally, there is direct and indirect evidence of negative cognitive outcomes in childhood. The objective of this study was to assess the short-term neurodevelopmental outcomes after prelabour caesarean section as compared to vaginally born infants.<h4>Methods</h4>We conducted a prospective, observational study of infants delivered by prelabour caesarean section at the Hospital of Halland, Halmstad, Sweden and compared their deve ...[more]

PMID: 32977763

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Project description:To provide an update on economic related inequalities in caesarean section rates within countries.Secondary analysis of demographic and health surveys and multiple indicator cluster surveys.72 low and middle income countries with a survey conducted between 2010 and 2014 for analysis of the latest situation of inequality, and 28 countries with a survey also conducted between 2000 and 2004 for analysis of the change in inequality over time.Women aged 15-49 years with a live birth during the two or three years preceding the survey.Data on caesarean section were disaggregated by asset based household wealth status and presented separately for five subgroups, ranging from the poorest to the richest fifth. Absolute and relative inequalities were measured using difference and ratio measures. The pace of change in the poorest and richest fifths was compared using a measure of excess change.National caesarean section rates ranged from 0.6% in South Sudan to 58.9% in the Dominican Republic. Within countries, caesarean section rates were lowest in the poorest fifth (median 3.7%) and highest in the richest fifth (median 18.4%). 18 out of 72 study countries reported a difference of 20 percentage points or higher between the richest and poorest fifth. The highest caesarean section rates and greatest levels of absolute inequality were observed in countries from the region of the Americas, whereas countries from the African region had low levels of caesarean use and comparatively lower levels of absolute inequality, although relative inequality was quite high in some countries. 26 out of 28 countries reported increases in caesarean section rates over time. Rates tended to increase faster in the richest fifth (median 0.9 percentage points per year) compared with the poorest fifth (median 0.2 percentage points per year), indicating an increase in inequality over time in most of these countries.Substantial within country economic inequalities in caesarean deliveries remain. These inequalities might be due to a combination of inadequate access to emergency obstetric care among the poorest subgroups and high levels of caesarean use without medical indication in the richest subgroups, especially in middle income countries. Country specific strategies should address these inequalities to improve maternal and newborn health.

Project description:ObjectivesTo investigate associations between maternal body mass index (BMI) at delivery (using pregnancy-specific BMI cut-off values 5?kg/m2 higher in each of the WHO groups) and clinical, theatre utilisation and health economic outcomes for women undergoing caesarean section (CS).DesignA prospective multicentre observational study.SettingSeven secondary or tertiary referral obstetric hospitals.ParticipantsOne thousand and four hundred and fifty-seven women undergoing all categories of CS.Data collectionHeight and weight were recorded at the initial antenatal visit and at delivery. We analysed the associations between delivery BMI (continuous and pregnancy-specific cut-off values) and total theatre time, surgical time, anaesthesia time, maternal and neonatal adverse outcomes, total hospital admission and theatre costs.ResultsMean participant characteristics were: age 32 years, gestation at delivery 38.4 weeks and delivery BMI 32.2?kg/m2. Fifty-five per cent of participants were overweight, obese or super-obese using delivery pregnancy-specific BMI cut-off values. As BMI increased, total theatre time, surgical time and anaesthesia time increased. Super-obese participants had approximately 27% (17 min, p<0.001) longer total theatre time, 20% (9 min, p<0.001), longer surgical time and 40% (11 min, p<0.001) longer anaesthesia time when compared with normal BMI participants. Increased BMI at delivery was associated with increased risk of maternal intensive care unit admission (relative risk 1.07, p=0.045), but no increased risk of neonatal admission to higher acuity care. Total hospital admission costs were 15% higher in super-obese women compared with normal BMI women and theatre costs were 27% higher in super-obese women.ConclusionsIncreased maternal BMI was associated with increased total theatre time, surgical and anaesthesia time, increased total hospital admission costs and theatre costs. Clinicians and health administrators should consider these clinical risks, time implications and financial costs when managing pregnant women.

Project description:BackgroundThe rise in disability due to back pain has been exponential with escalating medical and societal costs. The relative contribution of individual prognostic indicators to the pattern of recovery remains unclear. The objective of this study was to determine the prognostic value of demographic, psychosocial, employment and clinical factors on outcome in patients with low back painMethodsA prospective cohort study with six-month follow-up was undertaken at a multidisciplinary back pain clinic in central London employing physiotherapists, osteopaths, clinical psychologists and physicians, receiving referrals from 123 general practitioners. Over a twelve-month period, 593 consecutive patients referred from general practice with simple low back pain were recruited. A baseline questionnaire was developed to elicit information on potential prognostic variables. The primary outcome measures were change in 24-item Roland Morris disability questionnaire score at six months as a measure of low back related functional disability and the physical functioning scale of the SF-36, adjusted for baseline scores.ResultsRoland Morris scores improved by 3.8 index points (95% confidence interval 3.23 to 4.32) at six months and SF-36 physical functioning score by 10.7 points (95% confidence interval 8.36 to 12.95). Ten factors were linked to outcome yet in a multiple regression model only two remained predictive. Those with episodic rather than continuous pain were more likely to have recovered at six months (odds ratio 2.64 confidence interval 1.25 to 5.60), while those that classified themselves as non-white were less likely to have recovered (0.41 confidence interval 0.18 to 0.96).ConclusionsAnalysis controlling for confounding variables, demonstrated that participants showed greater improvement if their episodes of pain during the previous year were short-lived while those with Middle Eastern, North African and Chinese ethnicity demonstrated minimal improvement. The study did not support previous findings that a wide range of factors could predict outcome.

Dataset Information

Prelabour caesarean section and neurodevelopmental outcome at 4 and 12?months of age: an observational study.

Publications

Prelabour caesarean section and neurodevelopmental outcome at 4 and 12 months of age: an observational study.

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