Emergency department visits by pregnant women, either before or during gestation, are associated with poorer obstetrical consequences, originating from underlying medical conditions and difficulties in gaining access to healthcare. The question of whether a mother's emergency department (ED) utilization prior to pregnancy is associated with a higher rate of emergency department (ED) visits for her infant remains unresolved.
Investigating the correlation between a mother's pre-pregnancy emergency department utilization and the risk of infant emergency department use during their first year.
A population-based cohort study encompassing all singleton live births throughout Ontario, Canada, from June 2003 to January 2020 was undertaken.
Any maternal emergency department presentation within 90 days before the start of the index pregnancy.
Up to 365 days following the discharge date of the index birth hospitalization, any emergency department visit for an infant. Relative risks (RR) and absolute risk differences (ARD) were calculated, taking into account characteristics such as maternal age, income, rural residence, immigrant status, parity, having a primary care physician, and the number of pre-pregnancy comorbidities.
Amongst the 2,088,111 singleton live births, the average maternal age was 295 years, with a standard deviation of 54 years. A complete 208,356 (100%) were from rural locales, and an unusually high 487,773 (234%) had three or more comorbidities. Within 90 days of their index pregnancy, 206,539 mothers (99%) of singleton live births visited the ED. Emergency department (ED) use in the first year of life was significantly more frequent among infants whose mothers had visited the ED before becoming pregnant (570 per 1000) than among those whose mothers had not (388 per 1000). The relative risk (RR) was 1.19 (95% confidence interval [CI], 1.18-1.20), and the attributable risk difference (ARD) was 911 per 1000 (95% CI, 886-936 per 1000). Pre-pregnancy emergency department (ED) visits by the mother were strongly correlated with a higher risk of infant ED use in the first year. A relative risk of 119 (95% CI, 118-120) was found for mothers with one visit, 118 (95% CI, 117-120) for mothers with two visits, and 122 (95% CI, 120-123) for those with at least three visits, when compared to mothers with no pre-pregnancy ED visits. The odds of a low-acuity infant emergency department visit were 552 times higher (95% CI, 516-590) when the mother had a prior low-acuity pre-pregnancy emergency department visit. This was a greater association than a high-acuity emergency department visit for both mother and infant (aOR, 143; 95% CI, 138-149).
Pregnant mothers' emergency department (ED) utilization patterns prior to conception were found, in a cohort study of singleton live births, to predict a higher rate of infant ED use during the first year, notably for less severe presentations. read more The implications of this study's results might be a helpful trigger for health system strategies to decrease emergency department use in newborns and infants.
This study, a cohort of singleton live births, indicated that pre-pregnancy maternal ED visits were associated with a higher incidence of infant ED utilization within the first year, with a pronounced effect for less severe situations. The results of this research could potentially identify a beneficial driver for healthcare system approaches intended to curtail emergency department utilization in the infant population.
Congenital heart diseases (CHDs) in offspring have been linked to maternal hepatitis B virus (HBV) infection during early pregnancy stages. Despite the absence of prior investigations, the link between maternal hepatitis B infection before conception and childhood heart conditions in the offspring remains unexplored.
To investigate the relationship between a mother's hepatitis B virus infection prior to conception and congenital heart defects in her child.
A retrospective cohort study on 2013-2019 data from the National Free Preconception Checkup Project (NFPCP), a national free healthcare service for childbearing-aged women in mainland China intending to conceive, used the method of nearest-neighbor propensity score matching. This study focused on women, 20-49 years of age, who became pregnant within one year of a preconception examination; cases of multiple births were not included. Data analysis encompassing the months of September through December 2022 was undertaken.
The hepatitis B virus infection statuses of mothers before they conceived, including those who were not infected, those with a history of infection, and those with a new infection.
The primary finding was congenital heart defects (CHDs), documented prospectively from the birth defect registry maintained by the National Fetal and Neonatal Program Coordinating Center (NFPCP). read more The relationship between maternal hepatitis B virus (HBV) infection prior to conception and the chance of their offspring developing congenital heart disease (CHD) was evaluated using robust error variance logistic regression, with adjustments for confounding variables.
In the final analysis, a total of 3,690,427 participants were selected after a 14-to-one participant matching. Among them, 738,945 women had HBV infection, consisting of 393,332 women with previous infection and 345,613 with new infection. A statistically significant difference was found in the rates of congenital heart defects (CHDs) in infants born to women with different HBV infection statuses prior to pregnancy. Approximately 0.003% (800 out of 2,951,482) of women uninfected with HBV preconception or newly infected had infants with CHDs, whereas the rate among women with pre-existing HBV infections was 0.004% (141 out of 393,332). After multivariable analysis, a higher risk of CHDs in offspring was noted among women who had HBV infection prior to pregnancy, when compared with women without the infection (adjusted relative risk ratio [aRR], 123; 95% confidence interval [CI], 102-149). Moreover, when comparing couples where neither parent had prior HBV infection with those where one partner had a prior infection, a significantly higher rate of CHDs was found in offspring. Among pregnancies involving a previously infected mother and an uninfected father, the incidence of CHDs was 0.037% (93 of 252,919). This rate was likewise elevated in pregnancies with a previously infected father and an uninfected mother, standing at 0.045% (43 of 95,735). In contrast, pregnancies with both parents HBV-uninfected exhibited a lower incidence of CHDs at 0.026% (680 of 2,610,968). Adjusted risk ratios (aRRs) further solidified these associations: 136 (95% CI, 109-169) for mother/uninfected father pairs, and 151 (95% CI, 109-209) for father/uninfected mother pairs. Importantly, no notable link was established between a new maternal HBV infection during pregnancy and CHD development in the offspring.
This matched retrospective cohort study specifically examined the relationship between maternal HBV infection prior to conception and CHDs in the children, finding a significant association. Subsequently, a noticeably higher risk of CHDs was also observed among women whose husbands did not have HBV infection, particularly those with pre-pregnancy infections. Therefore, mandatory HBV screening and vaccination for couples before pregnancy are critical, and individuals with prior HBV infection before conception must be proactively managed to reduce the likelihood of CHDs in their offspring.
In a matched, retrospective cohort analysis, a history of hepatitis B virus (HBV) infection in mothers prior to conception was strongly linked to congenital heart defects (CHDs) in their children. Subsequently, the risk of CHDs was markedly higher in women who had contracted HBV before pregnancy, particularly those with HBV-uninfected husbands. In consequence, HBV screening and the development of immunity through HBV vaccination for couples before pregnancy are indispensable, and couples with prior HBV infection prior to pregnancy must also be given the necessary attention to minimize the risk of congenital heart disease in their child.
Surveillance of previous colon polyps represents the most frequent justification for colonoscopy in the elderly population. The current body of research, to our knowledge, has not addressed the association between surveillance colonoscopies, their impact on clinical outcomes and follow-up recommendations, and life expectancy, specifically considering age and comorbid conditions.
Investigating the association of projected life expectancy with colonoscopy results and subsequent treatment advice in the elderly population.
In this registry-based cohort study, data from the New Hampshire Colonoscopy Registry (NHCR) were combined with Medicare claims to investigate adults over 65 within the NHCR who had undergone surveillance colonoscopy after previous polyps between April 1, 2009 and December 31, 2018. Full Medicare Parts A and B coverage, and no Medicare managed care plan enrollment in the year prior to the colonoscopy, were also criteria for inclusion. Data analysis was performed on data collected from December 2019 to March 2021 inclusive.
A validated prediction model's output estimates life expectancy, categorized into intervals: less than five years, five to less than ten years, or greater than or equal to ten years.
The investigation yielded clinical outcomes of colon polyps or colorectal cancer (CRC), followed by the necessary recommendations for future colonoscopy procedures.
From the 9831 adults included in the research, the mean age (SD) was 732 (50) years, and 5285, comprising 538% of the group, were male. In terms of life expectancy, 5649 patients (575% of the total) were estimated to live for at least 10 years, a further 3443 patients (350%) were anticipated to live between 5 and under 10 years. Finally, 739 patients (75%) were predicted to live less than 5 years. read more The majority of the 791 patients (80%) displayed advanced polyps (768 patients, or 78%), or colorectal cancer (CRC) in 23 patients (2%). In the cohort of 5281 patients with pertinent recommendations (537%), a total of 4588 (869%) were instructed to schedule a future colonoscopy. A higher probability of returning was observed in individuals with a prolonged expected lifespan or individuals displaying more pronounced clinical characteristics.