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Neonatal-Perinatal Health Care Delivery: Epidemiology/Health Services Research

Neonatal-Perinatal Health Care Delivery 3: Epi/HSR Antenatal Exposures and Neonatal Outcomes

746 - Frequency and Overlap of Adverse Outcomes within the Birth Parent-Infant Dyad

Saturday, April 29, 2023

3:30 PM – 6:00 PM ET

Poster Number: 746
Publication Number: 746.246

Sara C. Handley, Children's Hospital of Philadelphia/University of Pennsylvania, Philadelphia, PA, United States; Brielle Formanowski, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Molly Passarella, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Katy B. Kozhimannil, University of Minnesota, Minneapolis, MN, United States; Stephanie A.. Leonard, Stanford University School of Medicine, Palo Alto, CA, United States; Elliott K.. Main, Stanford University School of Medicine, Stanford, CA, United States; Ciaran S. Phibbs, Stanford University School of Medicine, Stanford, CA, United States; Scott A. Lorch, The Children's Hospital of Philadelphia/University of Pennsylvnaia, Philadelphia, PA, United States

Presenting Author(s)

SH

Sara C. Handley, MD, MSCE (she/her/hers)

Assistant Professor of Pediatrics
Children's Hospital of Philadelphia/University of Pennsylvania
Philadelphia, Pennsylvania, United States

Background: Many perinatal studies focus on either adverse birth parent or infant outcomes. Yet, the health and outcomes of the birth parent and infant are interrelated. Understanding the frequency and overlap of adverse outcomes for the dyad as a whole is critical to advance perinatal care.

Objective: To describe the proportion and overlap of adverse birth parent, pregnancy (preterm birth), and infant outcomes across the birth parent-infant dyad.

Design/Methods: Retrospective observational study using linked vital statistics and administrative hospital discharge data from California, Michigan, Pennsylvania, and South Carolina from 2010-2018. Birth parents linked to infants with a gestational age 24 to 44 weeks, birth weight 400g to 8000g (not exceeding 5 SD for the mean for gestational age), and born in hospitals with >10 births/year were included. The primary outcomes were a composite of 1) any and 2) severe adverse birth parent, pregnancy, or infant outcome (listed in Table 1). Outcomes were examined as a composite, by type (birth parent, pregnancy, and infant), and individually.

Results: Among 6,293,819 dyads, 1,450,756 (23.1%) had any adverse outcome and 687,069 (10.9%) had a severe adverse outcome. Dyads experiencing any or a severe adverse outcome were more likely to have a birth parent ≥35 years of age, non-Hispanic Black, receiving government insurance, with pre-existing or pregnancy-associated comorbidities, multiple gestation, a cesarean birth, and a male infant. Any and severe adverse outcomes were more common among infants, 12.3% and 9.0% respectively, compared to birth parents 9.1% and 2.0%, respectively (Table 1). There was limited overlap among dyads experiencing more than one type of adverse outcome with only 0.8% of dyads experiencing all three types of any adverse outcome and 0.3% experiencing all three types of severe adverse outcomes (Figure 1). When examining individual outcomes, among birth parents with a severe adverse outcome the co-occurrence of infants with a severe adverse outcome ranged from 2%-48% (Figure 2, panel A). Whereas, among infants with a severe adverse outcome the co-occurrence of birth parents with a severe adverse outcome was rare, ranging from 0.1%-8% (Figure 2, panel B).

Conclusion(s): A large number of dyads experience adverse outcomes. Given the limited and variable overlap in these outcomes, these findings emphasize the importance of integrating dyadic outcomes into research and clinical care to better measure, support, and improve the care and health of the birth parent and infant as a whole.