Impact of fetal presentation on neurodevelopmental outcome in a trial of preterm vaginal delivery: a nationwide, population-based record linkage study

Toijonen, Anna; Heinonen, Seppo; Gissler, Mika; Seikku, Laura; Macharey, Georg

doi:10.1007/s00404-021-06146-z

Cited by 3 publications

(4 citation statements)

References 26 publications

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“…among extremely pre-term and very pre-term infants with breech presentation; however, among moderate to late pre-term births, breech was associated with an increased risk of ASD compared to children with vertex presentation 52. However, because of the low prevalence of pre-term, breech presentation and ASD, the results of this and most studies have been very imprecise and should be interpreted with caution.…”

mentioning

confidence: 75%

“…While this study does not explore the underlying biology, we hypothesised that malpresentation among term infants may reflect delays in turning associated with early neurodevelopmental differences that later manifest as ASD. A study of vaginal breech delivery that used detailed data from the Finland Medical Birth Register and the Hospital Discharge Register reported no increase in risk of neurodevelopmental outcomes among extremely pre‐term and very pre‐term infants with breech presentation; however, among moderate to late pre‐term births, breech was associated with an increased risk of ASD compared to children with vertex presentation 52 . However, because of the low prevalence of pre‐term, breech presentation and ASD, the results of this and most studies have been very imprecise and should be interpreted with caution.…”

Section: Discussionmentioning

confidence: 99%

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Malpresentation and autism spectrum disorder in the study to explore early development

Zhang,

Delahanty,

Engel

et al. 2024

Paediatric Perinatal Epid

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BackgroundAn infant's presentation at delivery may be an early indicator of developmental differences. Non‐vertex presentation (malpresentation) complicates delivery and often leads to caesarean section, which has been associated with neurodevelopmental delays, including autism spectrum disorder (ASD). However, malpresentation could be an early sign of an existing developmental problem that is also an upstream factor from caesarean delivery. Little research has been done to investigate the association between malpresentation and ASD.ObjectivesWe examine the association between malpresentation at delivery and ASD and whether this association differs by gestational age.MethodsWe used data from the Study to Explore Early Development (SEED), a multi‐site, case–control study of children with ASD compared to population controls. The foetal presentation was determined using medical records, birth records and maternal interviews. We defined malpresentation as a non‐vertex presentation at delivery, then further categorised into breech and other malpresentation. We used multivariable logistic regression to estimate the adjusted odds ratio (aOR) for the association between malpresentation and ASD.ResultsWe included 4047 SEED participants, 1873 children with ASD and 2174 controls. At delivery, most infants presented vertex (n = 3760, 92.9%). Malpresentation was associated with higher odds of ASD (aOR 1.31, 95% confidence interval [CI] 1.02, 1.68) after adjustment for maternal age, poverty level, hypertensive disorder and smoking. The association was similar for breech and other types of malpresentation (aOR 1.28, 95% CI 0.97, 1.70 and aOR 1.40, 95% CI 0.87, 2.26, respectively) and did not differ markedly by gestational age.ConclusionsMalpresentation at delivery was modestly associated with ASD. Early monitoring of the neurodevelopment of children born with malpresentation could identify children with ASD sooner and enhance opportunities to provide support to optimise developmental outcomes.

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confidence: 75%

Section: Discussionmentioning

confidence: 99%

Malpresentation and autism spectrum disorder in the study to explore early development

Zhang,

Delahanty,

Engel

et al. 2024

Paediatric Perinatal Epid

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“…In addition, CS delivery has been supported by studies showing improved survival with less morbidity when compared to vaginal delivery [50]. However, such improvement in VLBW outcomes with the mode of delivery was not consistent and other studies showed no difference in outcomes based on the mode of delivery [48,51]. The CS delivery rate for macrosomic neonates was almost double that observed in NBW neonates, which is consistent with findings from studies both from Saudi Arabia [33] and other countries [52,53].…”

Section: Discussionmentioning

confidence: 99%

Neonatal Birthweight Spectrum: Maternal Risk Factors and Pregnancy Outcomes in Saudi Arabia

Wahabi,

Elmorshedy,

Amer

et al. 2024

Medicina

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Background and Objectives: Low-birth-weight (LBW) neonates are at increased risk of morbidity and mortality which are inversely proportional to birth weight, while macrosomic babies are at risk of birth injuries and other related complications. Many maternal risk factors were associated with the extremes of birthweight. The objectives of this study are to investigate maternal risk factors for low and high birthweight and to report on the neonatal complications associated with abnormal birth weights. Materials and Methods: We conducted a retrospective analysis of medical records of deliveries ≥ 23 weeks. We classified the included participants according to birth weight into normal birth weight (NBW), LBW, very LBW (VLBW), and macrosomia. The following maternal risk factors were included, mother’s age, parity, maternal body mass index (BMI), maternal diabetes, and hypertension. The neonatal outcomes were APGAR scores < 7, admission to neonatal intensive care unit (NICU), respiratory distress (RD), and hyperbilirubinemia. Data were analyzed using SAS Studio, multivariable logistic regression analyses were used to investigate the independent effect of maternal risk factors on birthweight categories and results were reported as an adjusted odds ratio (aOR) and 95% Confidence Interval (CI). Results: A total of 1855 were included in the study. There were 1638 neonates (88.3%) with NBW, 153 (8.2%) with LBW, 27 (1.5%) with VLBW, and 37 (2.0%) with macrosomia. LBW was associated with maternal hypertension (aOR = 3.5, 95% CI = 1.62–7.63), while increasing gestational age was less likely associated with LBW (aOR = 0.51, 95% CI = 0.46–0.57). Macrosomia was associated with maternal diabetes (aOR = 3.75, 95% CI = 1.67–8.41), in addition to maternal obesity (aOR = 3.18, 95% CI = 1.24–8.14). The odds of VLBW were reduced significantly with increasing gestational age (aOR = 0.41, 95% CI = 0.32–0.53). In total, 81.5% of VLBW neonates were admitted to the NICU, compared to 47.7% of LBW and 21.6% of those with macrosomia. RD was diagnosed in 59.3% of VLBW neonates, in 23% of LBW, in 2.7% of macrosomic and in 3% of normal-weight neonates. Hyperbilirubinemia was reported in 37.04%, 34.21%, 22.26%, and 18.92% of VLBW, LBW, NBW, and macrosomic newborns, respectively. Conclusions: Most neonates in this study had normal birthweights. Maternal hypertension and lower gestational age were associated with increased risk of LBW. Additionally, maternal obesity and diabetes increased the risk of macrosomia. Neonatal complications were predominantly concentrated in the LBW and VLBW, with a rising gradient as birthweight decreased. The main complications included respiratory distress and NICU admissions.

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“…The adverse pregnancy outcomes (APOs) that we will focus on in this work -including early gestational age (GA) at delivery (a continuous surrogate for preterm birth), gestational diabetes, severe preeclampsia (severe pree), or preeclampsia superimposed on hypertension (superimposed pree) -are associated with severe short-and long-term consequences for both the mother and infant (1)(2)(3)(4), underscoring the importance of management and prevention (5)(6)(7)(8)(9). Currently, however, highly efficacious therapeutic options to prevent APOs are lacking, highlighting the critical clinical need to identify actionable risk targets and prevent their development (10).…”

Section: Introductionmentioning

confidence: 99%

Revealing the impact of lifestyle stressors on the risk of adverse pregnancy outcomes with multitask machine learning

et al. 2022

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Psychosocial and stress-related factors (PSFs), defined as internal or external stimuli that induce biological changes, are potentially modifiable factors and accessible targets for interventions that are associated with adverse pregnancy outcomes (APOs). Although individual APOs have been shown to be connected to PSFs, they are biologically interconnected, relatively infrequent, and therefore challenging to model. In this context, multi-task machine learning (MML) is an ideal tool for exploring the interconnectedness of APOs on the one hand and building on joint combinatorial outcomes to increase predictive power on the other hand. Additionally, by integrating single cell immunological profiling of underlying biological processes, the effects of stress-based therapeutics may be measurable, facilitating the development of precision medicine approaches.ObjectivesThe primary objectives were to jointly model multiple APOs and their connection to stress early in pregnancy, and to explore the underlying biology to guide development of accessible and measurable interventions.Materials and MethodsIn a prospective cohort study, PSFs were assessed during the first trimester with an extensive self-filled questionnaire for 200 women. We used MML to simultaneously model, and predict APOs (severe preeclampsia, superimposed preeclampsia, gestational diabetes and early gestational age) as well as several risk factors (BMI, diabetes, hypertension) for these patients based on PSFs. Strongly interrelated stressors were categorized to identify potential therapeutic targets. Furthermore, for a subset of 14 women, we modeled the connection of PSFs to the maternal immune system to APOs by building corresponding ML models based on an extensive single cell immune dataset generated by mass cytometry time of flight (CyTOF).ResultsJointly modeling APOs in a MML setting significantly increased modeling capabilities and yielded a highly predictive integrated model of APOs underscoring their interconnectedness. Most APOs were associated with mental health, life stress, and perceived health risks. Biologically, stressors were associated with specific immune characteristics revolving around CD4/CD8 T cells. Immune characteristics predicted based on stress were in turn found to be associated with APOs.ConclusionsElucidating connections among stress, multiple APOs simultaneously, and immune characteristics has the potential to facilitate the implementation of ML-based, individualized, integrative models of pregnancy in clinical decision making. The modifiable nature of stressors may enable the development of accessible interventions, with success tracked through immune characteristics.

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Impact of fetal presentation on neurodevelopmental outcome in a trial of preterm vaginal delivery: a nationwide, population-based record linkage study

Cited by 3 publications

References 26 publications

Malpresentation and autism spectrum disorder in the study to explore early development

Malpresentation and autism spectrum disorder in the study to explore early development

Neonatal Birthweight Spectrum: Maternal Risk Factors and Pregnancy Outcomes in Saudi Arabia

Revealing the impact of lifestyle stressors on the risk of adverse pregnancy outcomes with multitask machine learning

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