Tara Haelle

Children receiving common urgent surgeries on the weekend face greater risks of death, blood transfusions, and surgical complications, according to a recent study.

"Our results are consistent with a growing body of evidence that mortality is overall increased during weekend hospitalizations," Dr. Seth Goldstein and his associates at Johns Hopkins University, Baltimore, reported. They noted that adult diverticulitis, stroke, pneumonia, traumatic brain injury, and ICU admissions have all also shown a "detrimental weekend effect" in past research (J. Pediatr. Surg. 2014;49:1087-91).

© STEFANOLUNARDI/ thinkstockphotos.com

Dr. Goldstein’s team analyzed rates of death, blood transfusions, and surgical complications – including hemorrhage, accidental puncture or laceration, infections and wound-related complications – in 439,457 pediatric cases admitted to the hospital and requiring same-day procedures between 1988 and 2010.

Data on the 112,064 weekend admissions (25.5%) and 327,393 weekday admissions (74.5%) were pulled from the Nationwide Inpatient Sample and the Kid's Inpatient Database and included the following procedures: abscess drainage, appendectomy, inguinal hernia repair, open reduction with internal fixation of bone fracture, and placement or revision of ventricular shunt.

Admissions were more likely to be emergent on the weekend (60.9%) than on the weekday (52.6%), and children admitted on the weekends were slightly older and more often male, white, and uninsured but had less comorbidity when discharged. Rates of death were not statistically significant before adjustment for confounders, with deaths occurring among 0.11% of children admitted on weekdays and 0.14% of children admitted on weekends.

Preadjusted rates of blood transfusion were greater for weekend admissions (0.71%) than for weekday admissions (0.60%, P = .002), as were accidental punctures or lacerations, with 0.21% among weekend cases and 0.18% among weekday cases (P = .018). Yet wound complications were less common among children admitted on the weekend (0.11%) than on weekdays (0.13%, P = .044). Hemorrhage and wound infections did not differ between the groups before adjustment.

After adjusting for age, sex, race, insurance status, comorbidities, geographic region, hospital type (rural and urban teaching or nonteaching), admission type, and procedure type, the researchers found children admitted on the weekend had 1.63 greater odds of death than children admitted on weekdays. Children admitted on the weekend also had 1.4 times greater odds of an accidental puncture or laceration and 1.14 times greater odds of a blood transfusion, despite similar rates of hemorrhage. Wound infections and other wound-related complications did not differ between the groups after adjustment.

"We believe these findings to be predominately a result of systems issues such as decreased availability of staff and other hospital resources that contribute to patient care in a manner that is multifactorial and difficult to individually ascertain," the researchers wrote.

"While the exact etiology of these findings is not clear, these findings motivate a careful search for systems-based deficiencies that may be a detriment to pediatric surgical care provided on the weekend," they wrote.

With regard to mortality, the researchers wrote, "The mortality associated with pediatric surgical procedures is generally very low, requiring the large patient numbers included in these cohorts to detect potential differences. As an illustration, the significant adjusted odds ratio for mortality of 1.63 represents an increase in actual unadjusted death rate of only 0.03% (0.14% from 0.11%)." Nonetheless, they estimated that reducing weekend mortality rates to those of weekdays would have prevented the deaths of approximately 30 patients during the study period, a 20% reduction of inpatient deaths.

The study was internally funded, and the authors had no disclosures.

Children receiving common urgent surgeries on the weekend face greater risks of death, blood transfusions, and surgical complications, according to a recent study.

"Our results are consistent with a growing body of evidence that mortality is overall increased during weekend hospitalizations," Dr. Seth Goldstein and his associates at Johns Hopkins University, Baltimore, reported. They noted that adult diverticulitis, stroke, pneumonia, traumatic brain injury, and ICU admissions have all also shown a "detrimental weekend effect" in past research (J. Pediatr. Surg. 2014;49:1087-91).

© STEFANOLUNARDI/ thinkstockphotos.com

Dr. Goldstein’s team analyzed rates of death, blood transfusions, and surgical complications – including hemorrhage, accidental puncture or laceration, infections and wound-related complications – in 439,457 pediatric cases admitted to the hospital and requiring same-day procedures between 1988 and 2010.

Data on the 112,064 weekend admissions (25.5%) and 327,393 weekday admissions (74.5%) were pulled from the Nationwide Inpatient Sample and the Kid's Inpatient Database and included the following procedures: abscess drainage, appendectomy, inguinal hernia repair, open reduction with internal fixation of bone fracture, and placement or revision of ventricular shunt.

Admissions were more likely to be emergent on the weekend (60.9%) than on the weekday (52.6%), and children admitted on the weekends were slightly older and more often male, white, and uninsured but had less comorbidity when discharged. Rates of death were not statistically significant before adjustment for confounders, with deaths occurring among 0.11% of children admitted on weekdays and 0.14% of children admitted on weekends.

Preadjusted rates of blood transfusion were greater for weekend admissions (0.71%) than for weekday admissions (0.60%, P = .002), as were accidental punctures or lacerations, with 0.21% among weekend cases and 0.18% among weekday cases (P = .018). Yet wound complications were less common among children admitted on the weekend (0.11%) than on weekdays (0.13%, P = .044). Hemorrhage and wound infections did not differ between the groups before adjustment.

After adjusting for age, sex, race, insurance status, comorbidities, geographic region, hospital type (rural and urban teaching or nonteaching), admission type, and procedure type, the researchers found children admitted on the weekend had 1.63 greater odds of death than children admitted on weekdays. Children admitted on the weekend also had 1.4 times greater odds of an accidental puncture or laceration and 1.14 times greater odds of a blood transfusion, despite similar rates of hemorrhage. Wound infections and other wound-related complications did not differ between the groups after adjustment.

"We believe these findings to be predominately a result of systems issues such as decreased availability of staff and other hospital resources that contribute to patient care in a manner that is multifactorial and difficult to individually ascertain," the researchers wrote.

"While the exact etiology of these findings is not clear, these findings motivate a careful search for systems-based deficiencies that may be a detriment to pediatric surgical care provided on the weekend," they wrote.

With regard to mortality, the researchers wrote, "The mortality associated with pediatric surgical procedures is generally very low, requiring the large patient numbers included in these cohorts to detect potential differences. As an illustration, the significant adjusted odds ratio for mortality of 1.63 represents an increase in actual unadjusted death rate of only 0.03% (0.14% from 0.11%)." Nonetheless, they estimated that reducing weekend mortality rates to those of weekdays would have prevented the deaths of approximately 30 patients during the study period, a 20% reduction of inpatient deaths.

The study was internally funded, and the authors had no disclosures.

Children receiving common urgent surgeries on the weekend face greater risks of death, blood transfusions, and surgical complications, according to a recent study.

"Our results are consistent with a growing body of evidence that mortality is overall increased during weekend hospitalizations," Dr. Seth Goldstein and his associates at Johns Hopkins University, Baltimore, reported. They noted that adult diverticulitis, stroke, pneumonia, traumatic brain injury, and ICU admissions have all also shown a "detrimental weekend effect" in past research (J. Pediatr. Surg. 2014;49:1087-91).

© STEFANOLUNARDI/ thinkstockphotos.com

Dr. Goldstein’s team analyzed rates of death, blood transfusions, and surgical complications – including hemorrhage, accidental puncture or laceration, infections and wound-related complications – in 439,457 pediatric cases admitted to the hospital and requiring same-day procedures between 1988 and 2010.

Data on the 112,064 weekend admissions (25.5%) and 327,393 weekday admissions (74.5%) were pulled from the Nationwide Inpatient Sample and the Kid's Inpatient Database and included the following procedures: abscess drainage, appendectomy, inguinal hernia repair, open reduction with internal fixation of bone fracture, and placement or revision of ventricular shunt.

Admissions were more likely to be emergent on the weekend (60.9%) than on the weekday (52.6%), and children admitted on the weekends were slightly older and more often male, white, and uninsured but had less comorbidity when discharged. Rates of death were not statistically significant before adjustment for confounders, with deaths occurring among 0.11% of children admitted on weekdays and 0.14% of children admitted on weekends.

Preadjusted rates of blood transfusion were greater for weekend admissions (0.71%) than for weekday admissions (0.60%, P = .002), as were accidental punctures or lacerations, with 0.21% among weekend cases and 0.18% among weekday cases (P = .018). Yet wound complications were less common among children admitted on the weekend (0.11%) than on weekdays (0.13%, P = .044). Hemorrhage and wound infections did not differ between the groups before adjustment.

After adjusting for age, sex, race, insurance status, comorbidities, geographic region, hospital type (rural and urban teaching or nonteaching), admission type, and procedure type, the researchers found children admitted on the weekend had 1.63 greater odds of death than children admitted on weekdays. Children admitted on the weekend also had 1.4 times greater odds of an accidental puncture or laceration and 1.14 times greater odds of a blood transfusion, despite similar rates of hemorrhage. Wound infections and other wound-related complications did not differ between the groups after adjustment.

"We believe these findings to be predominately a result of systems issues such as decreased availability of staff and other hospital resources that contribute to patient care in a manner that is multifactorial and difficult to individually ascertain," the researchers wrote.

"While the exact etiology of these findings is not clear, these findings motivate a careful search for systems-based deficiencies that may be a detriment to pediatric surgical care provided on the weekend," they wrote.

With regard to mortality, the researchers wrote, "The mortality associated with pediatric surgical procedures is generally very low, requiring the large patient numbers included in these cohorts to detect potential differences. As an illustration, the significant adjusted odds ratio for mortality of 1.63 represents an increase in actual unadjusted death rate of only 0.03% (0.14% from 0.11%)." Nonetheless, they estimated that reducing weekend mortality rates to those of weekdays would have prevented the deaths of approximately 30 patients during the study period, a 20% reduction of inpatient deaths.

The study was internally funded, and the authors had no disclosures.

Children receiving common urgent surgeries on the weekend face greater risks of death, blood transfusions, and surgical complications, according to a recent study.

"Our results are consistent with a growing body of evidence that mortality is overall increased during weekend hospitalizations," Dr. Seth Goldstein and his associates at Johns Hopkins University, Baltimore, reported. They noted that adult diverticulitis, stroke, pneumonia, traumatic brain injury, and ICU admissions have all also shown a "detrimental weekend effect" in past research (J. Pediatr. Surg. 2014;49:1087-91).

© STEFANOLUNARDI/ thinkstockphotos.com

Dr. Goldstein’s team analyzed rates of death, blood transfusions, and surgical complications – including hemorrhage, accidental puncture or laceration, infections and wound-related complications – in 439,457 pediatric cases admitted to the hospital and requiring same-day procedures between 1988 and 2010.

Data on the 112,064 weekend admissions (25.5%) and 327,393 weekday admissions (74.5%) were pulled from the Nationwide Inpatient Sample and the Kid's Inpatient Database and included the following procedures: abscess drainage, appendectomy, inguinal hernia repair, open reduction with internal fixation of bone fracture, and placement or revision of ventricular shunt.

Admissions were more likely to be emergent on the weekend (60.9%) than on the weekday (52.6%), and children admitted on the weekends were slightly older and more often male, white, and uninsured but had less comorbidity when discharged. Rates of death were not statistically significant before adjustment for confounders, with deaths occurring among 0.11% of children admitted on weekdays and 0.14% of children admitted on weekends.

Preadjusted rates of blood transfusion were greater for weekend admissions (0.71%) than for weekday admissions (0.60%, P = .002), as were accidental punctures or lacerations, with 0.21% among weekend cases and 0.18% among weekday cases (P = .018). Yet wound complications were less common among children admitted on the weekend (0.11%) than on weekdays (0.13%, P = .044). Hemorrhage and wound infections did not differ between the groups before adjustment.

After adjusting for age, sex, race, insurance status, comorbidities, geographic region, hospital type (rural and urban teaching or nonteaching), admission type, and procedure type, the researchers found children admitted on the weekend had 1.63 greater odds of death than children admitted on weekdays. Children admitted on the weekend also had 1.4 times greater odds of an accidental puncture or laceration and 1.14 times greater odds of a blood transfusion, despite similar rates of hemorrhage. Wound infections and other wound-related complications did not differ between the groups after adjustment.

"We believe these findings to be predominately a result of systems issues such as decreased availability of staff and other hospital resources that contribute to patient care in a manner that is multifactorial and difficult to individually ascertain," the researchers wrote.

"While the exact etiology of these findings is not clear, these findings motivate a careful search for systems-based deficiencies that may be a detriment to pediatric surgical care provided on the weekend," they wrote.

With regard to mortality, the researchers wrote, "The mortality associated with pediatric surgical procedures is generally very low, requiring the large patient numbers included in these cohorts to detect potential differences. As an illustration, the significant adjusted odds ratio for mortality of 1.63 represents an increase in actual unadjusted death rate of only 0.03% (0.14% from 0.11%)." Nonetheless, they estimated that reducing weekend mortality rates to those of weekdays would have prevented the deaths of approximately 30 patients during the study period, a 20% reduction of inpatient deaths.

The study was internally funded, and the authors had no disclosures.

Children receiving common urgent surgeries on the weekend face greater risks of death, blood transfusions, and surgical complications, according to a recent study.

"Our results are consistent with a growing body of evidence that mortality is overall increased during weekend hospitalizations," Dr. Seth Goldstein and his associates at Johns Hopkins University, Baltimore, reported. They noted that adult diverticulitis, stroke, pneumonia, traumatic brain injury, and ICU admissions have all also shown a "detrimental weekend effect" in past research (J. Pediatr. Surg. 2014;49:1087-91).

© STEFANOLUNARDI/ thinkstockphotos.com

Dr. Goldstein’s team analyzed rates of death, blood transfusions, and surgical complications – including hemorrhage, accidental puncture or laceration, infections and wound-related complications – in 439,457 pediatric cases admitted to the hospital and requiring same-day procedures between 1988 and 2010.

Data on the 112,064 weekend admissions (25.5%) and 327,393 weekday admissions (74.5%) were pulled from the Nationwide Inpatient Sample and the Kid's Inpatient Database and included the following procedures: abscess drainage, appendectomy, inguinal hernia repair, open reduction with internal fixation of bone fracture, and placement or revision of ventricular shunt.

Admissions were more likely to be emergent on the weekend (60.9%) than on the weekday (52.6%), and children admitted on the weekends were slightly older and more often male, white, and uninsured but had less comorbidity when discharged. Rates of death were not statistically significant before adjustment for confounders, with deaths occurring among 0.11% of children admitted on weekdays and 0.14% of children admitted on weekends.

Preadjusted rates of blood transfusion were greater for weekend admissions (0.71%) than for weekday admissions (0.60%, P = .002), as were accidental punctures or lacerations, with 0.21% among weekend cases and 0.18% among weekday cases (P = .018). Yet wound complications were less common among children admitted on the weekend (0.11%) than on weekdays (0.13%, P = .044). Hemorrhage and wound infections did not differ between the groups before adjustment.

After adjusting for age, sex, race, insurance status, comorbidities, geographic region, hospital type (rural and urban teaching or nonteaching), admission type, and procedure type, the researchers found children admitted on the weekend had 1.63 greater odds of death than children admitted on weekdays. Children admitted on the weekend also had 1.4 times greater odds of an accidental puncture or laceration and 1.14 times greater odds of a blood transfusion, despite similar rates of hemorrhage. Wound infections and other wound-related complications did not differ between the groups after adjustment.

"We believe these findings to be predominately a result of systems issues such as decreased availability of staff and other hospital resources that contribute to patient care in a manner that is multifactorial and difficult to individually ascertain," the researchers wrote.

"While the exact etiology of these findings is not clear, these findings motivate a careful search for systems-based deficiencies that may be a detriment to pediatric surgical care provided on the weekend," they wrote.

With regard to mortality, the researchers wrote, "The mortality associated with pediatric surgical procedures is generally very low, requiring the large patient numbers included in these cohorts to detect potential differences. As an illustration, the significant adjusted odds ratio for mortality of 1.63 represents an increase in actual unadjusted death rate of only 0.03% (0.14% from 0.11%)." Nonetheless, they estimated that reducing weekend mortality rates to those of weekdays would have prevented the deaths of approximately 30 patients during the study period, a 20% reduction of inpatient deaths.

The study was internally funded, and the authors had no disclosures.

Children receiving common urgent surgeries on the weekend face greater risks of death, blood transfusions, and surgical complications, according to a recent study.

"Our results are consistent with a growing body of evidence that mortality is overall increased during weekend hospitalizations," Dr. Seth Goldstein and his associates at Johns Hopkins University, Baltimore, reported. They noted that adult diverticulitis, stroke, pneumonia, traumatic brain injury, and ICU admissions have all also shown a "detrimental weekend effect" in past research (J. Pediatr. Surg. 2014;49:1087-91).

© STEFANOLUNARDI/ thinkstockphotos.com

Dr. Goldstein’s team analyzed rates of death, blood transfusions, and surgical complications – including hemorrhage, accidental puncture or laceration, infections and wound-related complications – in 439,457 pediatric cases admitted to the hospital and requiring same-day procedures between 1988 and 2010.

Data on the 112,064 weekend admissions (25.5%) and 327,393 weekday admissions (74.5%) were pulled from the Nationwide Inpatient Sample and the Kid's Inpatient Database and included the following procedures: abscess drainage, appendectomy, inguinal hernia repair, open reduction with internal fixation of bone fracture, and placement or revision of ventricular shunt.

Admissions were more likely to be emergent on the weekend (60.9%) than on the weekday (52.6%), and children admitted on the weekends were slightly older and more often male, white, and uninsured but had less comorbidity when discharged. Rates of death were not statistically significant before adjustment for confounders, with deaths occurring among 0.11% of children admitted on weekdays and 0.14% of children admitted on weekends.

Preadjusted rates of blood transfusion were greater for weekend admissions (0.71%) than for weekday admissions (0.60%, P = .002), as were accidental punctures or lacerations, with 0.21% among weekend cases and 0.18% among weekday cases (P = .018). Yet wound complications were less common among children admitted on the weekend (0.11%) than on weekdays (0.13%, P = .044). Hemorrhage and wound infections did not differ between the groups before adjustment.

After adjusting for age, sex, race, insurance status, comorbidities, geographic region, hospital type (rural and urban teaching or nonteaching), admission type, and procedure type, the researchers found children admitted on the weekend had 1.63 greater odds of death than children admitted on weekdays. Children admitted on the weekend also had 1.4 times greater odds of an accidental puncture or laceration and 1.14 times greater odds of a blood transfusion, despite similar rates of hemorrhage. Wound infections and other wound-related complications did not differ between the groups after adjustment.

"We believe these findings to be predominately a result of systems issues such as decreased availability of staff and other hospital resources that contribute to patient care in a manner that is multifactorial and difficult to individually ascertain," the researchers wrote.

"While the exact etiology of these findings is not clear, these findings motivate a careful search for systems-based deficiencies that may be a detriment to pediatric surgical care provided on the weekend," they wrote.

With regard to mortality, the researchers wrote, "The mortality associated with pediatric surgical procedures is generally very low, requiring the large patient numbers included in these cohorts to detect potential differences. As an illustration, the significant adjusted odds ratio for mortality of 1.63 represents an increase in actual unadjusted death rate of only 0.03% (0.14% from 0.11%)." Nonetheless, they estimated that reducing weekend mortality rates to those of weekdays would have prevented the deaths of approximately 30 patients during the study period, a 20% reduction of inpatient deaths.

The study was internally funded, and the authors had no disclosures.

Targeting weight loss in both overweight children and their parents can result in greater long-term weight loss for children than only targeting children’s weight, a recent study found.

"The results of this study demonstrate that effective treatment of overweight can be implemented in primary care, substituting [for] the traditional concept of referral to a specialty clinic the new concept of ‘co-management,’ requiring collaboration among health care providers with different sets of expertise," Dr. Teresa Quattrin of the University of Buffalo, The State University of New York, and her associates reported online (Pediatrics 2014 134:290-7).

The researchers randomly assigned 46 children to the family-based intervention and 50 children to the information control group, in which only the child’s weight control was addressed. The children all had a z score body mass index above the 85th percentile for their age and sex, and at least one of their parents had a BMI greater than 25 mg/m².

Over a 1-year period, the parents of children in both groups participated in 13 educational group meetings on diet and physical activity. However, the parents of children in the family-based intervention additionally received brief individual sessions on the same nights as the group meetings. These focused on both the parents’ and the children’s weight and involved parents’ tracking of diet and physical activity for themselves and their children.

The initial 12 months of the study period, completed by 83% of the participants, were followed with another 12 months of follow-up involving three meetings, completed by nearly 73% of the participants.

Percent over BMI values in both groups initially decreased over the first 6 months and then gradually increased through the end of the 2 years. However, the percent over BMI values showed a greater reduction in the intervention group during those first 6 months (P less than .001) and remained lower than in the control group (P = .001), as well as lower than baseline at 24 months. Parents also experienced a greater decrease in BMI in the intervention group than in the control group.

The study was supported by the National Institutes of Health. Dr. Epstein has consulted for Kurbo, an online pediatric weight support company in which he also holds equity. No other authors reported disclosures.

Targeting weight loss in both overweight children and their parents can result in greater long-term weight loss for children than only targeting children’s weight, a recent study found.

"The results of this study demonstrate that effective treatment of overweight can be implemented in primary care, substituting [for] the traditional concept of referral to a specialty clinic the new concept of ‘co-management,’ requiring collaboration among health care providers with different sets of expertise," Dr. Teresa Quattrin of the University of Buffalo, The State University of New York, and her associates reported online (Pediatrics 2014 134:290-7).

The researchers randomly assigned 46 children to the family-based intervention and 50 children to the information control group, in which only the child’s weight control was addressed. The children all had a z score body mass index above the 85th percentile for their age and sex, and at least one of their parents had a BMI greater than 25 mg/m².

Over a 1-year period, the parents of children in both groups participated in 13 educational group meetings on diet and physical activity. However, the parents of children in the family-based intervention additionally received brief individual sessions on the same nights as the group meetings. These focused on both the parents’ and the children’s weight and involved parents’ tracking of diet and physical activity for themselves and their children.

The initial 12 months of the study period, completed by 83% of the participants, were followed with another 12 months of follow-up involving three meetings, completed by nearly 73% of the participants.

Percent over BMI values in both groups initially decreased over the first 6 months and then gradually increased through the end of the 2 years. However, the percent over BMI values showed a greater reduction in the intervention group during those first 6 months (P less than .001) and remained lower than in the control group (P = .001), as well as lower than baseline at 24 months. Parents also experienced a greater decrease in BMI in the intervention group than in the control group.

The study was supported by the National Institutes of Health. Dr. Epstein has consulted for Kurbo, an online pediatric weight support company in which he also holds equity. No other authors reported disclosures.

Targeting weight loss in both overweight children and their parents can result in greater long-term weight loss for children than only targeting children’s weight, a recent study found.

"The results of this study demonstrate that effective treatment of overweight can be implemented in primary care, substituting [for] the traditional concept of referral to a specialty clinic the new concept of ‘co-management,’ requiring collaboration among health care providers with different sets of expertise," Dr. Teresa Quattrin of the University of Buffalo, The State University of New York, and her associates reported online (Pediatrics 2014 134:290-7).

The researchers randomly assigned 46 children to the family-based intervention and 50 children to the information control group, in which only the child’s weight control was addressed. The children all had a z score body mass index above the 85th percentile for their age and sex, and at least one of their parents had a BMI greater than 25 mg/m².

Over a 1-year period, the parents of children in both groups participated in 13 educational group meetings on diet and physical activity. However, the parents of children in the family-based intervention additionally received brief individual sessions on the same nights as the group meetings. These focused on both the parents’ and the children’s weight and involved parents’ tracking of diet and physical activity for themselves and their children.

The initial 12 months of the study period, completed by 83% of the participants, were followed with another 12 months of follow-up involving three meetings, completed by nearly 73% of the participants.

Percent over BMI values in both groups initially decreased over the first 6 months and then gradually increased through the end of the 2 years. However, the percent over BMI values showed a greater reduction in the intervention group during those first 6 months (P less than .001) and remained lower than in the control group (P = .001), as well as lower than baseline at 24 months. Parents also experienced a greater decrease in BMI in the intervention group than in the control group.

The study was supported by the National Institutes of Health. Dr. Epstein has consulted for Kurbo, an online pediatric weight support company in which he also holds equity. No other authors reported disclosures.

The quadrivalent human papillomavirus vaccine does not increase the risk of venous thromboembolism, a study showed.

Two previous studies finding an association, one based on the Vaccine Adverse Event Reporting System and the other on the Vaccine Safety Datalink, reported few vaccinated cases, many of whom had known venous thromboembolism (VTE) risk factors, Nikolai Madrid Scheller and his colleagues at Statens Serum Institut in Copenhagen reported in a research letter (JAMA 2014;312:187-8).

Women with VTE aged 10-44 years were followed until the end of the study or until emigration, death, or age 45 years during the study period from Oct. 1, 2006, to July 31, 2013. Among the 1.6 million women in the population cohort, 31% had received the quadrivalent HPV vaccine, and 4,375 women had VTE, 20% of whom had been vaccinated and served as the self-controlled cases.The team used the self-controlled case series method with the main risk period for a first diagnosis of VTE set at 1-42 days after vaccination. They excluded women who were likely pregnant at the time of the VTE or had undergone major surgery in the previous 4 weeks or had a cancer diagnosis in the previous year from the VTE.

The researchers found no association between the quadrivalent HPV vaccine and VTE (incidence ratio, 0.77). The lack of association remained in subsequent analyses adjusting for age and oral contraceptive use, and using only cases of VTE in which the women were receiving anticoagulants 4 weeks after diagnosis.

The study did not report external funding. The authors reported no disclosures.

The quadrivalent human papillomavirus vaccine does not increase the risk of venous thromboembolism, a study showed.

Two previous studies finding an association, one based on the Vaccine Adverse Event Reporting System and the other on the Vaccine Safety Datalink, reported few vaccinated cases, many of whom had known venous thromboembolism (VTE) risk factors, Nikolai Madrid Scheller and his colleagues at Statens Serum Institut in Copenhagen reported in a research letter (JAMA 2014;312:187-8).

Women with VTE aged 10-44 years were followed until the end of the study or until emigration, death, or age 45 years during the study period from Oct. 1, 2006, to July 31, 2013. Among the 1.6 million women in the population cohort, 31% had received the quadrivalent HPV vaccine, and 4,375 women had VTE, 20% of whom had been vaccinated and served as the self-controlled cases.The team used the self-controlled case series method with the main risk period for a first diagnosis of VTE set at 1-42 days after vaccination. They excluded women who were likely pregnant at the time of the VTE or had undergone major surgery in the previous 4 weeks or had a cancer diagnosis in the previous year from the VTE.

The researchers found no association between the quadrivalent HPV vaccine and VTE (incidence ratio, 0.77). The lack of association remained in subsequent analyses adjusting for age and oral contraceptive use, and using only cases of VTE in which the women were receiving anticoagulants 4 weeks after diagnosis.

The study did not report external funding. The authors reported no disclosures.

The quadrivalent human papillomavirus vaccine does not increase the risk of venous thromboembolism, a study showed.

Two previous studies finding an association, one based on the Vaccine Adverse Event Reporting System and the other on the Vaccine Safety Datalink, reported few vaccinated cases, many of whom had known venous thromboembolism (VTE) risk factors, Nikolai Madrid Scheller and his colleagues at Statens Serum Institut in Copenhagen reported in a research letter (JAMA 2014;312:187-8).

Women with VTE aged 10-44 years were followed until the end of the study or until emigration, death, or age 45 years during the study period from Oct. 1, 2006, to July 31, 2013. Among the 1.6 million women in the population cohort, 31% had received the quadrivalent HPV vaccine, and 4,375 women had VTE, 20% of whom had been vaccinated and served as the self-controlled cases.The team used the self-controlled case series method with the main risk period for a first diagnosis of VTE set at 1-42 days after vaccination. They excluded women who were likely pregnant at the time of the VTE or had undergone major surgery in the previous 4 weeks or had a cancer diagnosis in the previous year from the VTE.

The researchers found no association between the quadrivalent HPV vaccine and VTE (incidence ratio, 0.77). The lack of association remained in subsequent analyses adjusting for age and oral contraceptive use, and using only cases of VTE in which the women were receiving anticoagulants 4 weeks after diagnosis.

The study did not report external funding. The authors reported no disclosures.

Bed sharing was a risk factor for almost three-quarters of infant sleep deaths for children under age 1 year, but the contribution of this and other risk factors varied by the children’s age, according to a recent study.

Jeffrey D. Colvin, M.D., J.D., of Children’s Mercy Hospitals and Clinics in Kansas City, Mo., and his associates analyzed 8,207 sleep-related deaths of infants under age 1 year between 2004 and 2012 in 24 states, using data from the National Center for the Review and Prevention of Child Deaths (NCRPCD) Case Reporting System (Pediatrics 2014 July 14 [doi:10.1542/peds.2014-0401]).

©oksun70/Thinkstock.com

They calculated the odds of death for sleep position, sleep location, and having any object in the sleep environment after adjusting for race/ethnicity, gender, and having a complex chronic condition such as cerebral palsy, a congenital heart defect, or a chromosomal abnormality. Objects included blankets, pillows, bumper pads, hard furniture, toys, clothing, bags, cords, positional support wedges, cloths, bibs, and other items.

The median age at time of death was 2 months, 98.8% did not have a complex chronic condition, and just over a third of the total deaths (38.2%) were classified as unknown.

Although 69.2% of the infants were bed sharing, this factor was much more likely to be associated with the deaths of younger infants (73.8% for those under age 4 months) than older infants (58.9% for those aged 4 months to 1 year, P less than .001). Younger infants also were more likely to be sleeping on an adult bed and/or a person (51.6%), compared with older infants (43.8%, P less than .001), Dr. Colvin and his associates reported.

Yet a greater proportion of older infants (39.4%) than younger infants (33.5%) had at least one object in the sleeping environment, most commonly blankets (24.5%) or pillows (17.6%) for all the infants. Blankets, stuffed toys, bags, hard furniture, and cords were each implicated in a slightly higher percentage of older than younger infants’ deaths, the investigators said.

More younger infants (37.3%) than older infants (28.7%) were placed on their side or stomach (P less than .001), but only 13.8% of younger infants moved from their sides or backs to their stomachs during sleep, compared with 18.4% of older infants. Although 39.7% were placed on their backs, as recommended, the most common position the babies were found in was on their stomach (38.3%), particularly for older infants (42.2%), compared with younger infants (36.6%).

"The predominant risk factor for younger infants is bed sharing, whereas rolling to prone, with objects in the sleep area, is the predominant risk factor for older infants," Dr. Colvin and his associates wrote. "Parents should be reminded that cribs should be clear of any objects, so that if the infant rolls, there is no risk of rolling into something that may create an asphyxial environment."

The research was supported by the CJ Foundation for SIDS, the National Institutes of Health, and the maternal and child health branch of the Health Resources and Services Administration. The authors reported no disclosures.

Bed sharing was a risk factor for almost three-quarters of infant sleep deaths for children under age 1 year, but the contribution of this and other risk factors varied by the children’s age, according to a recent study.

Jeffrey D. Colvin, M.D., J.D., of Children’s Mercy Hospitals and Clinics in Kansas City, Mo., and his associates analyzed 8,207 sleep-related deaths of infants under age 1 year between 2004 and 2012 in 24 states, using data from the National Center for the Review and Prevention of Child Deaths (NCRPCD) Case Reporting System (Pediatrics 2014 July 14 [doi:10.1542/peds.2014-0401]).

©oksun70/Thinkstock.com

They calculated the odds of death for sleep position, sleep location, and having any object in the sleep environment after adjusting for race/ethnicity, gender, and having a complex chronic condition such as cerebral palsy, a congenital heart defect, or a chromosomal abnormality. Objects included blankets, pillows, bumper pads, hard furniture, toys, clothing, bags, cords, positional support wedges, cloths, bibs, and other items.

The median age at time of death was 2 months, 98.8% did not have a complex chronic condition, and just over a third of the total deaths (38.2%) were classified as unknown.

Although 69.2% of the infants were bed sharing, this factor was much more likely to be associated with the deaths of younger infants (73.8% for those under age 4 months) than older infants (58.9% for those aged 4 months to 1 year, P less than .001). Younger infants also were more likely to be sleeping on an adult bed and/or a person (51.6%), compared with older infants (43.8%, P less than .001), Dr. Colvin and his associates reported.

Yet a greater proportion of older infants (39.4%) than younger infants (33.5%) had at least one object in the sleeping environment, most commonly blankets (24.5%) or pillows (17.6%) for all the infants. Blankets, stuffed toys, bags, hard furniture, and cords were each implicated in a slightly higher percentage of older than younger infants’ deaths, the investigators said.

More younger infants (37.3%) than older infants (28.7%) were placed on their side or stomach (P less than .001), but only 13.8% of younger infants moved from their sides or backs to their stomachs during sleep, compared with 18.4% of older infants. Although 39.7% were placed on their backs, as recommended, the most common position the babies were found in was on their stomach (38.3%), particularly for older infants (42.2%), compared with younger infants (36.6%).

"The predominant risk factor for younger infants is bed sharing, whereas rolling to prone, with objects in the sleep area, is the predominant risk factor for older infants," Dr. Colvin and his associates wrote. "Parents should be reminded that cribs should be clear of any objects, so that if the infant rolls, there is no risk of rolling into something that may create an asphyxial environment."

The research was supported by the CJ Foundation for SIDS, the National Institutes of Health, and the maternal and child health branch of the Health Resources and Services Administration. The authors reported no disclosures.

Bed sharing was a risk factor for almost three-quarters of infant sleep deaths for children under age 1 year, but the contribution of this and other risk factors varied by the children’s age, according to a recent study.

Jeffrey D. Colvin, M.D., J.D., of Children’s Mercy Hospitals and Clinics in Kansas City, Mo., and his associates analyzed 8,207 sleep-related deaths of infants under age 1 year between 2004 and 2012 in 24 states, using data from the National Center for the Review and Prevention of Child Deaths (NCRPCD) Case Reporting System (Pediatrics 2014 July 14 [doi:10.1542/peds.2014-0401]).

©oksun70/Thinkstock.com

They calculated the odds of death for sleep position, sleep location, and having any object in the sleep environment after adjusting for race/ethnicity, gender, and having a complex chronic condition such as cerebral palsy, a congenital heart defect, or a chromosomal abnormality. Objects included blankets, pillows, bumper pads, hard furniture, toys, clothing, bags, cords, positional support wedges, cloths, bibs, and other items.

The median age at time of death was 2 months, 98.8% did not have a complex chronic condition, and just over a third of the total deaths (38.2%) were classified as unknown.

Although 69.2% of the infants were bed sharing, this factor was much more likely to be associated with the deaths of younger infants (73.8% for those under age 4 months) than older infants (58.9% for those aged 4 months to 1 year, P less than .001). Younger infants also were more likely to be sleeping on an adult bed and/or a person (51.6%), compared with older infants (43.8%, P less than .001), Dr. Colvin and his associates reported.

Yet a greater proportion of older infants (39.4%) than younger infants (33.5%) had at least one object in the sleeping environment, most commonly blankets (24.5%) or pillows (17.6%) for all the infants. Blankets, stuffed toys, bags, hard furniture, and cords were each implicated in a slightly higher percentage of older than younger infants’ deaths, the investigators said.

More younger infants (37.3%) than older infants (28.7%) were placed on their side or stomach (P less than .001), but only 13.8% of younger infants moved from their sides or backs to their stomachs during sleep, compared with 18.4% of older infants. Although 39.7% were placed on their backs, as recommended, the most common position the babies were found in was on their stomach (38.3%), particularly for older infants (42.2%), compared with younger infants (36.6%).

"The predominant risk factor for younger infants is bed sharing, whereas rolling to prone, with objects in the sleep area, is the predominant risk factor for older infants," Dr. Colvin and his associates wrote. "Parents should be reminded that cribs should be clear of any objects, so that if the infant rolls, there is no risk of rolling into something that may create an asphyxial environment."

The research was supported by the CJ Foundation for SIDS, the National Institutes of Health, and the maternal and child health branch of the Health Resources and Services Administration. The authors reported no disclosures.

The quadrivalent human papillomavirus vaccine does not increase the risk of venous thromboembolism, a study showed.

Two previous studies finding an association, one based on the Vaccine Adverse Event Reporting System and the other on the Vaccine Safety Datalink, reported few vaccinated cases, many of whom had known venous thromboembolism (VTE) risk factors, Nikolai Madrid Scheller and his colleagues at Statens Serum Institut in Copenhagen reported in a research letter (JAMA 2014;312:187-8).

©Design Pics

The team used the self-controlled case series method with the main risk period for a first diagnosis of VTE set at 1-42 days after vaccination. They excluded women who were likely pregnant at the time of the VTE or had undergone major surgery in the previous 4 weeks or had a cancer diagnosis in the previous year from the VTE.

Women with VTE aged 10-44 years were followed until the end of the study or until emigration, death, or age 45 years during the study period from Oct. 1, 2006, to July 31, 2013. Among the 1.6 million women in the population cohort, 31% had received the quadrivalent HPV vaccine, and 4,375 women had VTE, 20% of whom had been vaccinated and served as the self-controlled cases.

The researchers found no association between the quadrivalent HPV vaccine and VTE (incidence ratio, 0.77). The lack of association remained in subsequent analyses adjusting for age and oral contraceptive use, and using only cases of VTE in which the women were receiving anticoagulants 4 weeks after diagnosis.

The study did not report external funding. The authors reported no disclosures.

The quadrivalent human papillomavirus vaccine does not increase the risk of venous thromboembolism, a study showed.

Two previous studies finding an association, one based on the Vaccine Adverse Event Reporting System and the other on the Vaccine Safety Datalink, reported few vaccinated cases, many of whom had known venous thromboembolism (VTE) risk factors, Nikolai Madrid Scheller and his colleagues at Statens Serum Institut in Copenhagen reported in a research letter (JAMA 2014;312:187-8).

©Design Pics

The team used the self-controlled case series method with the main risk period for a first diagnosis of VTE set at 1-42 days after vaccination. They excluded women who were likely pregnant at the time of the VTE or had undergone major surgery in the previous 4 weeks or had a cancer diagnosis in the previous year from the VTE.

Women with VTE aged 10-44 years were followed until the end of the study or until emigration, death, or age 45 years during the study period from Oct. 1, 2006, to July 31, 2013. Among the 1.6 million women in the population cohort, 31% had received the quadrivalent HPV vaccine, and 4,375 women had VTE, 20% of whom had been vaccinated and served as the self-controlled cases.

The researchers found no association between the quadrivalent HPV vaccine and VTE (incidence ratio, 0.77). The lack of association remained in subsequent analyses adjusting for age and oral contraceptive use, and using only cases of VTE in which the women were receiving anticoagulants 4 weeks after diagnosis.

The study did not report external funding. The authors reported no disclosures.

The quadrivalent human papillomavirus vaccine does not increase the risk of venous thromboembolism, a study showed.

Two previous studies finding an association, one based on the Vaccine Adverse Event Reporting System and the other on the Vaccine Safety Datalink, reported few vaccinated cases, many of whom had known venous thromboembolism (VTE) risk factors, Nikolai Madrid Scheller and his colleagues at Statens Serum Institut in Copenhagen reported in a research letter (JAMA 2014;312:187-8).

©Design Pics

The team used the self-controlled case series method with the main risk period for a first diagnosis of VTE set at 1-42 days after vaccination. They excluded women who were likely pregnant at the time of the VTE or had undergone major surgery in the previous 4 weeks or had a cancer diagnosis in the previous year from the VTE.

Women with VTE aged 10-44 years were followed until the end of the study or until emigration, death, or age 45 years during the study period from Oct. 1, 2006, to July 31, 2013. Among the 1.6 million women in the population cohort, 31% had received the quadrivalent HPV vaccine, and 4,375 women had VTE, 20% of whom had been vaccinated and served as the self-controlled cases.

The researchers found no association between the quadrivalent HPV vaccine and VTE (incidence ratio, 0.77). The lack of association remained in subsequent analyses adjusting for age and oral contraceptive use, and using only cases of VTE in which the women were receiving anticoagulants 4 weeks after diagnosis.

The study did not report external funding. The authors reported no disclosures.

The quadrivalent human papillomavirus vaccine does not increase the risk of venous thromboembolism, a study showed.

Two previous studies finding an association, one based on the Vaccine Adverse Event Reporting System and the other on the Vaccine Safety Datalink, reported few vaccinated cases, many of whom had known venous thromboembolism (VTE) risk factors, Nikolai Madrid Scheller and his colleagues at Statens Serum Institut in Copenhagen reported in a research letter (JAMA 2014;312:187-8).

©Design Pics

The team used the self-controlled case series method with the main risk period for a first diagnosis of VTE set at 1-42 days after vaccination. They excluded women who were likely pregnant at the time of the VTE or had undergone major surgery in the previous 4 weeks or had a cancer diagnosis in the previous year from the VTE.

Women with VTE aged 10-44 years were followed until the end of the study or until emigration, death, or age 45 years during the study period from Oct. 1, 2006, to July 31, 2013. Among the 1.6 million women in the population cohort, 31% had received the quadrivalent HPV vaccine, and 4,375 women had VTE, 20% of whom had been vaccinated and served as the self-controlled cases.

The researchers found no association between the quadrivalent HPV vaccine and VTE (incidence ratio, 0.77). The lack of association remained in subsequent analyses adjusting for age and oral contraceptive use, and using only cases of VTE in which the women were receiving anticoagulants 4 weeks after diagnosis.

The study did not report external funding. The authors reported no disclosures.

The quadrivalent human papillomavirus vaccine does not increase the risk of venous thromboembolism, a study showed.

Two previous studies finding an association, one based on the Vaccine Adverse Event Reporting System and the other on the Vaccine Safety Datalink, reported few vaccinated cases, many of whom had known venous thromboembolism (VTE) risk factors, Nikolai Madrid Scheller and his colleagues at Statens Serum Institut in Copenhagen reported in a research letter (JAMA 2014;312:187-8).

©Design Pics

The team used the self-controlled case series method with the main risk period for a first diagnosis of VTE set at 1-42 days after vaccination. They excluded women who were likely pregnant at the time of the VTE or had undergone major surgery in the previous 4 weeks or had a cancer diagnosis in the previous year from the VTE.

Women with VTE aged 10-44 years were followed until the end of the study or until emigration, death, or age 45 years during the study period from Oct. 1, 2006, to July 31, 2013. Among the 1.6 million women in the population cohort, 31% had received the quadrivalent HPV vaccine, and 4,375 women had VTE, 20% of whom had been vaccinated and served as the self-controlled cases.

The researchers found no association between the quadrivalent HPV vaccine and VTE (incidence ratio, 0.77). The lack of association remained in subsequent analyses adjusting for age and oral contraceptive use, and using only cases of VTE in which the women were receiving anticoagulants 4 weeks after diagnosis.

The study did not report external funding. The authors reported no disclosures.

The quadrivalent human papillomavirus vaccine does not increase the risk of venous thromboembolism, a study showed.

Two previous studies finding an association, one based on the Vaccine Adverse Event Reporting System and the other on the Vaccine Safety Datalink, reported few vaccinated cases, many of whom had known venous thromboembolism (VTE) risk factors, Nikolai Madrid Scheller and his colleagues at Statens Serum Institut in Copenhagen reported in a research letter (JAMA 2014;312:187-8).

©Design Pics

The team used the self-controlled case series method with the main risk period for a first diagnosis of VTE set at 1-42 days after vaccination. They excluded women who were likely pregnant at the time of the VTE or had undergone major surgery in the previous 4 weeks or had a cancer diagnosis in the previous year from the VTE.

Women with VTE aged 10-44 years were followed until the end of the study or until emigration, death, or age 45 years during the study period from Oct. 1, 2006, to July 31, 2013. Among the 1.6 million women in the population cohort, 31% had received the quadrivalent HPV vaccine, and 4,375 women had VTE, 20% of whom had been vaccinated and served as the self-controlled cases.

The researchers found no association between the quadrivalent HPV vaccine and VTE (incidence ratio, 0.77). The lack of association remained in subsequent analyses adjusting for age and oral contraceptive use, and using only cases of VTE in which the women were receiving anticoagulants 4 weeks after diagnosis.

The study did not report external funding. The authors reported no disclosures.

Both elective and emergency cesarean sections in first births appear to slightly increase the risk of stillbirth and ectopic pregnancy in subsequent pregnancies, according to a new study.

Compared with women whose first birth was a spontaneous vaginal delivery, primiparous women with a primary C-section were 14% more likely to have a subsequent stillbirth and 9% more likely to have a later ectopic pregnancy, but were no more likely to have a subsequent miscarriage, reported Sinéad O’Neill of Cork University Maternity Hospital, Ireland, and her associates (PLoS Med. 2014 July 1 [doi:10.1371/journal.pmed.1001670]).

The analysis was limited by incomplete data, and the increased rate of stillbirths and/or ectopic pregnancies could be driven by underlying factors that contributed to the need for a C-section, the researchers noted.

They analyzed Danish national registry data on 832,996 primiparous women with a live birth between Jan. 1, 1982, and Dec. 31, 2010, followed until the next stillbirth, miscarriage, ectopic pregnancy, live birth, death or emigration. Miscarriage was defined as loss before 28 weeks’ gestation until April 2004, and before 22 weeks’ gestation from 2004 onward.

The fully-adjusted analysis controlled for the following:

• Maternal age, origin, and marital status.

• Previous stillbirth, miscarriage, or ectopic pregnancy.

• Birth year.

• Socioeconomic status (mother’s education and both parents’ gross income).

• Medical complications in the first live birth, including multiples, diabetes, gestational diabetes, placental abruption, placenta previa, and hypertensive disorders.

• Gestational age at birth and birth weight.

The researchers lacked data on maternal body mass index, smoking status, and fertility treatment, as well as causes of stillbirth, maternally requested C-sections, and the gestational ages of the stillbirths and miscarriages.

The increased rate of stillbirth (hazard ratio 1.14) among women with a primary C-section, compared with women with an initial spontaneous vaginal birth, translated to an absolute risk increase of 0.03% and a number needed to harm of 3,333. Emergency C-sections showed a barely higher risk (HR 1.15), but the risk with elective C-sections (HR 1.11) did not reach statistical significance (95% CI 0.91, 1.35).

"Almost 50% of the explained stillbirths in this cohort were due to antenatal complications (including placental abruption/infarction, intrauterine growth restriction, preeclampsia, prematurity, and poor placental growth)," the researchers wrote. "The clinical importance is that although many of these complications are largely not preventable, an increased awareness that the fetus is at risk may facilitate increased surveillance and optimally timed delivery and may lead to improved perinatal outcomes."

The increased risk of ectopic pregnancy (HR 1.09) with overall primary C-sections translated to an absolute risk increase of 0.1% and number needed to harm of 1,000 women. The increased risk was similar for emergency (HR 1.09) and elective (HR 1.12) C-sections, both statistically significant. Overall, primary C-sections were not associated with miscarriage, and miscarriage risk was decreased (HR 0.72) for maternally requested C-sections.

The authors reported that C-section rates among first-time Danish mothers increased during the study period from 12.8% in 1982 to 23% in 2010. "This increase, coupled with better surveillance and detection of adverse or underlying complications earlier in pregnancy, could explain the increased hazard of subsequent stillbirth found in this study among women with a prior cesarean section," they wrote.

Although the findings may be particularly relevant for expectant mothers requesting a non–medically indicated C-section, "it must be acknowledged that a cesarean section can be a vital intervention, and the likelihood of adverse outcome may be decreased, for example, by choosing an elective cesarean section to avoid fetal death due to a failed vaginal birth after cesarean or to prevent sudden stillbirth post-term," the researchers wrote.

The research was supported by the National Perinatal Epidemiology Centre in Cork, Ireland, and as part of the Health Research Board PhD Scholars program in Health Services Research. A coauthor, Dr. Louise C. Kenny, is a Science Foundation Ireland Principal Investigator and director of Centre, INFANT, funded by Science Foundation Ireland.

Both elective and emergency cesarean sections in first births appear to slightly increase the risk of stillbirth and ectopic pregnancy in subsequent pregnancies, according to a new study.

Compared with women whose first birth was a spontaneous vaginal delivery, primiparous women with a primary C-section were 14% more likely to have a subsequent stillbirth and 9% more likely to have a later ectopic pregnancy, but were no more likely to have a subsequent miscarriage, reported Sinéad O’Neill of Cork University Maternity Hospital, Ireland, and her associates (PLoS Med. 2014 July 1 [doi:10.1371/journal.pmed.1001670]).

The analysis was limited by incomplete data, and the increased rate of stillbirths and/or ectopic pregnancies could be driven by underlying factors that contributed to the need for a C-section, the researchers noted.

They analyzed Danish national registry data on 832,996 primiparous women with a live birth between Jan. 1, 1982, and Dec. 31, 2010, followed until the next stillbirth, miscarriage, ectopic pregnancy, live birth, death or emigration. Miscarriage was defined as loss before 28 weeks’ gestation until April 2004, and before 22 weeks’ gestation from 2004 onward.

The fully-adjusted analysis controlled for the following:

• Maternal age, origin, and marital status.

• Previous stillbirth, miscarriage, or ectopic pregnancy.

• Birth year.

• Socioeconomic status (mother’s education and both parents’ gross income).

• Medical complications in the first live birth, including multiples, diabetes, gestational diabetes, placental abruption, placenta previa, and hypertensive disorders.

• Gestational age at birth and birth weight.

The researchers lacked data on maternal body mass index, smoking status, and fertility treatment, as well as causes of stillbirth, maternally requested C-sections, and the gestational ages of the stillbirths and miscarriages.

The increased rate of stillbirth (hazard ratio 1.14) among women with a primary C-section, compared with women with an initial spontaneous vaginal birth, translated to an absolute risk increase of 0.03% and a number needed to harm of 3,333. Emergency C-sections showed a barely higher risk (HR 1.15), but the risk with elective C-sections (HR 1.11) did not reach statistical significance (95% CI 0.91, 1.35).

"Almost 50% of the explained stillbirths in this cohort were due to antenatal complications (including placental abruption/infarction, intrauterine growth restriction, preeclampsia, prematurity, and poor placental growth)," the researchers wrote. "The clinical importance is that although many of these complications are largely not preventable, an increased awareness that the fetus is at risk may facilitate increased surveillance and optimally timed delivery and may lead to improved perinatal outcomes."

The increased risk of ectopic pregnancy (HR 1.09) with overall primary C-sections translated to an absolute risk increase of 0.1% and number needed to harm of 1,000 women. The increased risk was similar for emergency (HR 1.09) and elective (HR 1.12) C-sections, both statistically significant. Overall, primary C-sections were not associated with miscarriage, and miscarriage risk was decreased (HR 0.72) for maternally requested C-sections.

The authors reported that C-section rates among first-time Danish mothers increased during the study period from 12.8% in 1982 to 23% in 2010. "This increase, coupled with better surveillance and detection of adverse or underlying complications earlier in pregnancy, could explain the increased hazard of subsequent stillbirth found in this study among women with a prior cesarean section," they wrote.

Although the findings may be particularly relevant for expectant mothers requesting a non–medically indicated C-section, "it must be acknowledged that a cesarean section can be a vital intervention, and the likelihood of adverse outcome may be decreased, for example, by choosing an elective cesarean section to avoid fetal death due to a failed vaginal birth after cesarean or to prevent sudden stillbirth post-term," the researchers wrote.

The research was supported by the National Perinatal Epidemiology Centre in Cork, Ireland, and as part of the Health Research Board PhD Scholars program in Health Services Research. A coauthor, Dr. Louise C. Kenny, is a Science Foundation Ireland Principal Investigator and director of Centre, INFANT, funded by Science Foundation Ireland.

Both elective and emergency cesarean sections in first births appear to slightly increase the risk of stillbirth and ectopic pregnancy in subsequent pregnancies, according to a new study.

Compared with women whose first birth was a spontaneous vaginal delivery, primiparous women with a primary C-section were 14% more likely to have a subsequent stillbirth and 9% more likely to have a later ectopic pregnancy, but were no more likely to have a subsequent miscarriage, reported Sinéad O’Neill of Cork University Maternity Hospital, Ireland, and her associates (PLoS Med. 2014 July 1 [doi:10.1371/journal.pmed.1001670]).

The analysis was limited by incomplete data, and the increased rate of stillbirths and/or ectopic pregnancies could be driven by underlying factors that contributed to the need for a C-section, the researchers noted.

They analyzed Danish national registry data on 832,996 primiparous women with a live birth between Jan. 1, 1982, and Dec. 31, 2010, followed until the next stillbirth, miscarriage, ectopic pregnancy, live birth, death or emigration. Miscarriage was defined as loss before 28 weeks’ gestation until April 2004, and before 22 weeks’ gestation from 2004 onward.

The fully-adjusted analysis controlled for the following:

• Maternal age, origin, and marital status.

• Previous stillbirth, miscarriage, or ectopic pregnancy.

• Birth year.

• Socioeconomic status (mother’s education and both parents’ gross income).

• Medical complications in the first live birth, including multiples, diabetes, gestational diabetes, placental abruption, placenta previa, and hypertensive disorders.

• Gestational age at birth and birth weight.

The researchers lacked data on maternal body mass index, smoking status, and fertility treatment, as well as causes of stillbirth, maternally requested C-sections, and the gestational ages of the stillbirths and miscarriages.

The increased rate of stillbirth (hazard ratio 1.14) among women with a primary C-section, compared with women with an initial spontaneous vaginal birth, translated to an absolute risk increase of 0.03% and a number needed to harm of 3,333. Emergency C-sections showed a barely higher risk (HR 1.15), but the risk with elective C-sections (HR 1.11) did not reach statistical significance (95% CI 0.91, 1.35).

"Almost 50% of the explained stillbirths in this cohort were due to antenatal complications (including placental abruption/infarction, intrauterine growth restriction, preeclampsia, prematurity, and poor placental growth)," the researchers wrote. "The clinical importance is that although many of these complications are largely not preventable, an increased awareness that the fetus is at risk may facilitate increased surveillance and optimally timed delivery and may lead to improved perinatal outcomes."

The increased risk of ectopic pregnancy (HR 1.09) with overall primary C-sections translated to an absolute risk increase of 0.1% and number needed to harm of 1,000 women. The increased risk was similar for emergency (HR 1.09) and elective (HR 1.12) C-sections, both statistically significant. Overall, primary C-sections were not associated with miscarriage, and miscarriage risk was decreased (HR 0.72) for maternally requested C-sections.

The authors reported that C-section rates among first-time Danish mothers increased during the study period from 12.8% in 1982 to 23% in 2010. "This increase, coupled with better surveillance and detection of adverse or underlying complications earlier in pregnancy, could explain the increased hazard of subsequent stillbirth found in this study among women with a prior cesarean section," they wrote.

Although the findings may be particularly relevant for expectant mothers requesting a non–medically indicated C-section, "it must be acknowledged that a cesarean section can be a vital intervention, and the likelihood of adverse outcome may be decreased, for example, by choosing an elective cesarean section to avoid fetal death due to a failed vaginal birth after cesarean or to prevent sudden stillbirth post-term," the researchers wrote.

The research was supported by the National Perinatal Epidemiology Centre in Cork, Ireland, and as part of the Health Research Board PhD Scholars program in Health Services Research. A coauthor, Dr. Louise C. Kenny, is a Science Foundation Ireland Principal Investigator and director of Centre, INFANT, funded by Science Foundation Ireland.

Severely malnourished children may be at higher risk for hypertension in adulthood because of potentially irreversible changes in cardiac function, according to a recent study of more than 100 adults.

Adult survivors of severe acute malnutrition in childhood had a mean diastolic blood pressure that was 4.3 mm Hg higher than that of controls (P = .007).

© 2011 American Heart Association, Inc.

In addition, a "striking" finding was that systemic vascular resistance was 5.5 mm Hg min/L higher in survivors than in controls, the researchers reported.

"A raised systemic vascular resistance suggests relative resistance vessel constriction and reduced density of small resistance arteries," reported Dr. Ingrid Tennant of the University of the West Indies in Kingston, Jamaica, and her associates. "Whatever its origin, increased systemic vascular resistance and diastolic blood pressure put severe acute malnutrition survivors at higher risk of developing hypertension than controls. This may have long-term cardiovascular consequences for the many people in the world who have experienced severe childhood malnutrition," they wrote (Hypertension 2014 June 30 [doi: 10.1161/HYPERTENSIONAHA.114.03230]).

The researchers tracked down 116 adult survivors of severe acute malnutrition who had been treated as children in the University of the West Indies Tropical Metabolism Research Unit between 1963 and 1993. The 62 survivors of edematous (kwashiorkor and marasmic kwashiorkor) and 54 survivors of nonedematous (marasmic) malnutrition were compared with 45 controls matched by age, sex, and body mass index from the same neighborhood as each survivor.

After an overnight fast, including no alcohol, caffeine, or strenuous exercise in the previous 12 hours, participants were assessed for height, weight, and blood pressure. They also received CT scans, vascular ultrasounds, and echocardiograms to measure body composition, arterial stiffness (pulse wave velocity), left ventricular mass, and other left ventricular and carotid artery indices.

The researchers also identified "greater left ventricular outflow tract diameter, stroke volume, cardiac output, and femoral intima-medial thickness" in controls than in survivors. "Their ejection fraction was lower but pulse wave velocity was higher than in severe acute malnutrition survivors," they wrote.

"The decrease in left ventricular outflow tract diameter, stroke volume, and cardiac output in severe acute malnutrition survivors when compared with controls might reflect a combination of pre- and postnatal insults because nutritional insults in both these developmentally plastic periods can limit organ development," Dr. Tennant’s team reported.

The research was funded by the New Zealand Health Research Council and the British Heart Foundation. The authors reported no disclosures.

Severely malnourished children may be at higher risk for hypertension in adulthood because of potentially irreversible changes in cardiac function, according to a recent study of more than 100 adults.

Adult survivors of severe acute malnutrition in childhood had a mean diastolic blood pressure that was 4.3 mm Hg higher than that of controls (P = .007).

© 2011 American Heart Association, Inc.

In addition, a "striking" finding was that systemic vascular resistance was 5.5 mm Hg min/L higher in survivors than in controls, the researchers reported.

"A raised systemic vascular resistance suggests relative resistance vessel constriction and reduced density of small resistance arteries," reported Dr. Ingrid Tennant of the University of the West Indies in Kingston, Jamaica, and her associates. "Whatever its origin, increased systemic vascular resistance and diastolic blood pressure put severe acute malnutrition survivors at higher risk of developing hypertension than controls. This may have long-term cardiovascular consequences for the many people in the world who have experienced severe childhood malnutrition," they wrote (Hypertension 2014 June 30 [doi: 10.1161/HYPERTENSIONAHA.114.03230]).

The researchers tracked down 116 adult survivors of severe acute malnutrition who had been treated as children in the University of the West Indies Tropical Metabolism Research Unit between 1963 and 1993. The 62 survivors of edematous (kwashiorkor and marasmic kwashiorkor) and 54 survivors of nonedematous (marasmic) malnutrition were compared with 45 controls matched by age, sex, and body mass index from the same neighborhood as each survivor.

After an overnight fast, including no alcohol, caffeine, or strenuous exercise in the previous 12 hours, participants were assessed for height, weight, and blood pressure. They also received CT scans, vascular ultrasounds, and echocardiograms to measure body composition, arterial stiffness (pulse wave velocity), left ventricular mass, and other left ventricular and carotid artery indices.

The researchers also identified "greater left ventricular outflow tract diameter, stroke volume, cardiac output, and femoral intima-medial thickness" in controls than in survivors. "Their ejection fraction was lower but pulse wave velocity was higher than in severe acute malnutrition survivors," they wrote.

"The decrease in left ventricular outflow tract diameter, stroke volume, and cardiac output in severe acute malnutrition survivors when compared with controls might reflect a combination of pre- and postnatal insults because nutritional insults in both these developmentally plastic periods can limit organ development," Dr. Tennant’s team reported.

The research was funded by the New Zealand Health Research Council and the British Heart Foundation. The authors reported no disclosures.

Severely malnourished children may be at higher risk for hypertension in adulthood because of potentially irreversible changes in cardiac function, according to a recent study of more than 100 adults.

Adult survivors of severe acute malnutrition in childhood had a mean diastolic blood pressure that was 4.3 mm Hg higher than that of controls (P = .007).

© 2011 American Heart Association, Inc.

In addition, a "striking" finding was that systemic vascular resistance was 5.5 mm Hg min/L higher in survivors than in controls, the researchers reported.

"A raised systemic vascular resistance suggests relative resistance vessel constriction and reduced density of small resistance arteries," reported Dr. Ingrid Tennant of the University of the West Indies in Kingston, Jamaica, and her associates. "Whatever its origin, increased systemic vascular resistance and diastolic blood pressure put severe acute malnutrition survivors at higher risk of developing hypertension than controls. This may have long-term cardiovascular consequences for the many people in the world who have experienced severe childhood malnutrition," they wrote (Hypertension 2014 June 30 [doi: 10.1161/HYPERTENSIONAHA.114.03230]).

The researchers tracked down 116 adult survivors of severe acute malnutrition who had been treated as children in the University of the West Indies Tropical Metabolism Research Unit between 1963 and 1993. The 62 survivors of edematous (kwashiorkor and marasmic kwashiorkor) and 54 survivors of nonedematous (marasmic) malnutrition were compared with 45 controls matched by age, sex, and body mass index from the same neighborhood as each survivor.

After an overnight fast, including no alcohol, caffeine, or strenuous exercise in the previous 12 hours, participants were assessed for height, weight, and blood pressure. They also received CT scans, vascular ultrasounds, and echocardiograms to measure body composition, arterial stiffness (pulse wave velocity), left ventricular mass, and other left ventricular and carotid artery indices.

The researchers also identified "greater left ventricular outflow tract diameter, stroke volume, cardiac output, and femoral intima-medial thickness" in controls than in survivors. "Their ejection fraction was lower but pulse wave velocity was higher than in severe acute malnutrition survivors," they wrote.

"The decrease in left ventricular outflow tract diameter, stroke volume, and cardiac output in severe acute malnutrition survivors when compared with controls might reflect a combination of pre- and postnatal insults because nutritional insults in both these developmentally plastic periods can limit organ development," Dr. Tennant’s team reported.

The research was funded by the New Zealand Health Research Council and the British Heart Foundation. The authors reported no disclosures.

The low-grade chronic inflammation that accompanies polycystic ovary syndrome increases during pregnancy, thereby increasing the risk of adverse pregnancy outcomes, according to a recent study of 300 women.

The results "confirmed higher markers of chronic low-grade inflammation in PCOS patients," and suggested "that pregnancy enhances the chronic low-grade inflammation typical of the syndrome," Dr. Stefano Palomba of the Istituto di Ricovero e Cura a Carattere Scientifico in Reggio Emilia, Italy, and his associates reported online May 29 in the Journal of Clinical Endocrinology & Metabolism (doi: 10.1210/jc.2014-1214).

The researchers recruited 150 women with PCOS and 150 healthy controls, matched by age and body mass index, who were pregnant for the first time and at less than 7 weeks’ gestation when they enrolled in the study between February 2003 and April 2012. Ovulation was stimulated by using gonadotropins or clomiphene citrate in 83 of the 150 women with PCOS to induce pregnancy; 118 of the PCOS patients had clinical or biochemical hyperandrogenism, or both.

At the start of the study, and then at 12, 20, and 32 weeks’ gestation, the women underwent a standard clinical assessment, received ultrasounds, and provided serum for white blood cell (WBC) counts and measurements of C-reactive protein (CRP) and ferritin. Each woman’s pregnancy and perinatal outcomes were classified as normal or pathological. Among the adverse (pathological) outcomes were miscarriages, gestational diabetes, preterm birth, pregnancy-induced hypertension, and being large or small for gestational age.

Nearly a third (32%) of the women with PCOS had adverse outcomes, compared with 11.3% of women without PCOS. The researchers identified in the PCOS patients an increased risk for adverse obstetric/neonatal outcomes for WBC (for 1 standard-deviation increase in WBC distribution, the hazard ratio was 1.52), as well as CRP and ferritin (for 1 SD increase in the distributions of CRP and ferritin, HR was 1.19 and 1.12, respectively). Yet in the women without PCOS, only an increased CRP (HR, 1.21) was associated with adverse outcomes.

No funding source was noted. The authors reported no disclosures.

The low-grade chronic inflammation that accompanies polycystic ovary syndrome increases during pregnancy, thereby increasing the risk of adverse pregnancy outcomes, according to a recent study of 300 women.

The results "confirmed higher markers of chronic low-grade inflammation in PCOS patients," and suggested "that pregnancy enhances the chronic low-grade inflammation typical of the syndrome," Dr. Stefano Palomba of the Istituto di Ricovero e Cura a Carattere Scientifico in Reggio Emilia, Italy, and his associates reported online May 29 in the Journal of Clinical Endocrinology & Metabolism (doi: 10.1210/jc.2014-1214).

The researchers recruited 150 women with PCOS and 150 healthy controls, matched by age and body mass index, who were pregnant for the first time and at less than 7 weeks’ gestation when they enrolled in the study between February 2003 and April 2012. Ovulation was stimulated by using gonadotropins or clomiphene citrate in 83 of the 150 women with PCOS to induce pregnancy; 118 of the PCOS patients had clinical or biochemical hyperandrogenism, or both.

At the start of the study, and then at 12, 20, and 32 weeks’ gestation, the women underwent a standard clinical assessment, received ultrasounds, and provided serum for white blood cell (WBC) counts and measurements of C-reactive protein (CRP) and ferritin. Each woman’s pregnancy and perinatal outcomes were classified as normal or pathological. Among the adverse (pathological) outcomes were miscarriages, gestational diabetes, preterm birth, pregnancy-induced hypertension, and being large or small for gestational age.

Nearly a third (32%) of the women with PCOS had adverse outcomes, compared with 11.3% of women without PCOS. The researchers identified in the PCOS patients an increased risk for adverse obstetric/neonatal outcomes for WBC (for 1 standard-deviation increase in WBC distribution, the hazard ratio was 1.52), as well as CRP and ferritin (for 1 SD increase in the distributions of CRP and ferritin, HR was 1.19 and 1.12, respectively). Yet in the women without PCOS, only an increased CRP (HR, 1.21) was associated with adverse outcomes.

No funding source was noted. The authors reported no disclosures.

The low-grade chronic inflammation that accompanies polycystic ovary syndrome increases during pregnancy, thereby increasing the risk of adverse pregnancy outcomes, according to a recent study of 300 women.

The results "confirmed higher markers of chronic low-grade inflammation in PCOS patients," and suggested "that pregnancy enhances the chronic low-grade inflammation typical of the syndrome," Dr. Stefano Palomba of the Istituto di Ricovero e Cura a Carattere Scientifico in Reggio Emilia, Italy, and his associates reported online May 29 in the Journal of Clinical Endocrinology & Metabolism (doi: 10.1210/jc.2014-1214).

The researchers recruited 150 women with PCOS and 150 healthy controls, matched by age and body mass index, who were pregnant for the first time and at less than 7 weeks’ gestation when they enrolled in the study between February 2003 and April 2012. Ovulation was stimulated by using gonadotropins or clomiphene citrate in 83 of the 150 women with PCOS to induce pregnancy; 118 of the PCOS patients had clinical or biochemical hyperandrogenism, or both.

At the start of the study, and then at 12, 20, and 32 weeks’ gestation, the women underwent a standard clinical assessment, received ultrasounds, and provided serum for white blood cell (WBC) counts and measurements of C-reactive protein (CRP) and ferritin. Each woman’s pregnancy and perinatal outcomes were classified as normal or pathological. Among the adverse (pathological) outcomes were miscarriages, gestational diabetes, preterm birth, pregnancy-induced hypertension, and being large or small for gestational age.

Nearly a third (32%) of the women with PCOS had adverse outcomes, compared with 11.3% of women without PCOS. The researchers identified in the PCOS patients an increased risk for adverse obstetric/neonatal outcomes for WBC (for 1 standard-deviation increase in WBC distribution, the hazard ratio was 1.52), as well as CRP and ferritin (for 1 SD increase in the distributions of CRP and ferritin, HR was 1.19 and 1.12, respectively). Yet in the women without PCOS, only an increased CRP (HR, 1.21) was associated with adverse outcomes.

No funding source was noted. The authors reported no disclosures.