Pregnancy, delivery, and neonatal outcomes among women living with Down syndrome: a matched cohort study, utilizing a population database (original) (raw)

Abstract

Purpose

We utilized a population database to address the paucity of data around pregnancy outcomes in women with Down syndrome (DS).

Methods

We conducted a retrospective study using the Health Care Cost and Utilization Project-Nationwide Inpatient Sample Database over 11 years, from 2004 to 2014. A delivery cohort was created using ICD-9 codes. ICD-9 code 758.0 was used to extract the cases of maternal DS. Pregnant women with DS (study group) were matched based on age, race, income, and health insurance type to women without DS (control) at a ratio of 1:20.

Results

There were a total of 9,096,788 deliveries during the study period. Of those, 184 pregnant women were found to have DS. The matched control group was 3680. After matching, most of the pregnancy and delivery outcomes, such as pregnancy-induced hypertension, gestational diabetes, preterm premature rupture of membrane, chorioamnionitis, cesarean section, operative vaginal delivery, or blood transfusion were similar between participants with and without DS. However, patients with DS were at increased risk of giving birth prematurely (aOR 3.09, 95% CI 2.06–4.62), and having adverse neonatal outcomes such as small for gestational age (aOR 2.70, 95% CI 1.54–4.73), intrauterine fetal demise (aOR 22.45, 95% CI 12.02–41.93), congenital anomalies (aOR 7.92, 95% CI 4.11–15.24), and fetal chromosomal abnormalities.

Conclusion

Neonates to mothers with DS are at increased risk of prematurity and other neonatal adverse outcomes. Hence, counseling patients with DS about these risks and increased antenatal surveillance is advised.

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Data availability

Study utilized data from the Health Care Cost and Utilization Project-Nationwide Inpatient Sample database (HCUP-NIS).

References

  1. Ropper AH, Bull MJ (2020) Down syndrome. New Engl J Med 382(24):2344–2352. https://doi.org/10.1056/NEJMra1706537
    Article Google Scholar
  2. Antonarakis SE, Skotko BG, Rafii MS et al (2020) Down syndrome. Nat Rev Dis Prim 6(1):9. https://doi.org/10.1038/s41572-019-0143-7
    Article PubMed Google Scholar
  3. Asim A, Kumar A, Muthuswamy S, Jain S, Agarwal S (2015) Down syndrome: an insight of the disease. J Biomed Sci 22(1):41. https://doi.org/10.1186/s12929-015-0138-y
    Article PubMed PubMed Central Google Scholar
  4. Watts R, Vyas H (2013) An overview of respiratory problems in children with Down’s syndrome. Arch Dis Child 98(10):812–817. https://doi.org/10.1136/archdischild-2013-304611
    Article PubMed Google Scholar
  5. Shobha Rani A, Jyothi A, Reddy PP, Reddy OS (1990) Reproduction in Down’s syndrome. Int J Gynecol Obstet 31(1):81–86. https://doi.org/10.1016/0020-7292(90)90187-P
    Article CAS Google Scholar
  6. Pachajoa H, Riascos AJ, Castro D, Isaza C, Quintero JC (2014) Down syndrome passed from mother to child. Biomedica 34:326–329. https://doi.org/10.7705/biomedica.v34i3.1471
    Article PubMed Google Scholar
  7. Johnston AW, Jaslow RI (1963) Children of mothers with Down’s syndrome. New Engl J Med 269(9):439–443. https://doi.org/10.1056/NEJM196308292690902
    Article CAS PubMed Google Scholar
  8. Bovicelli L, Orsini LF, Rizzo N, Montacuti V, Bacchetta M (1982) Reproduction in Down syndrome. Obstet Gynecol 59(6 Suppl):13S-S17
    CAS PubMed Google Scholar
  9. Schupf N, Zigman W, Kapell D, Lee JH, Kline J, Levin B (1997) Early menopause in women with Down’s syndrome. J Intellect Disabil Res 41(3):264–267. https://doi.org/10.1046/j.1365-2788.1997.03838.x
    Article PubMed Google Scholar
  10. Parizot E, Dard R, Janel N, Vialard F (2019) Down syndrome and infertility: what support should we provide? J Assist Reprod Genet 36(6):1063–1067. https://doi.org/10.1007/s10815-019-01457-2
    Article PubMed PubMed Central Google Scholar
  11. Kainth DS, Chaudhry SA, Kainth HS, Suri FK, Qureshi AI (2013) Prevalence and characteristics of concurrent down syndrome in patients with moyamoya disease. Neurosurg 72(2):210–215. https://doi.org/10.1227/NEU.0b013e31827b9beb
    Article Google Scholar
  12. Graber E, Chacko E, Regelmann MO, Costin G, Rapaport R (2012) Down syndrome and thyroid function. Endocrinol Metab Clin North Am 41(4):735–745. https://doi.org/10.1016/j.ecl.2012.08.008
    Article PubMed Google Scholar
  13. Whooten R, Schmitt J, Schwartz A (2018) Endocrine manifestations of Down syndrome. Curr Opin Endocrinol Diabetes Obes 25(1):61–66. https://doi.org/10.1097/MED.0000000000000382
    Article CAS PubMed PubMed Central Google Scholar
  14. Verstegen RHJ, Chang KJJ, Kusters MAA (2020) Clinical implications of immune-mediated diseases in children with Down syndrome. Pediatr Allergy Immunol 31(2):117–123. https://doi.org/10.1111/pai.13133
    Article PubMed Google Scholar
  15. DE J, GE L, Rose T, HW F, RW E (1973) Down’s syndrome and diabetes. Psychol Med. 3(4): 455-457
  16. Kaushal M, Baxi A, Kadi P, Karandae J, Baxi D, Rao K (2010) Woman with Down syndrome delivered a normal child. Int J Infertil Fetal Med 1:45–47
    Google Scholar
  17. Sparks T, Griffin E, Page J, Fields A, Shaffer B, Caughey A (2015) 717: Down syndrome: what are the risks of stillbirth and adverse neonatal outcomes? Am J Obstet Gynecol 212(1):S349. https://doi.org/10.1016/j.ajog.2014.10.923
    Article Google Scholar
  18. Brock JK, Walsh JD, Allen VM (2021) The effect of fetal trisomy 21 on adverse perinatal obstetrical outcomes in Nova Scotia, 2000–2019. J Obstet Gynaecol Canada JOGC 43(5):583–588. https://doi.org/10.1016/j.jogc.2020.09.019
    Article Google Scholar
  19. Derraik JGB, Lundgren M, Cutfield WS, Ahlsson F, Cruz-Martinez RE (2016) Maternal height and preterm birth: a study on 192,432 Swedish Women. PLoS ONE. https://doi.org/10.1371/journal.pone.0154304
    Article PubMed PubMed Central Google Scholar
  20. Khanam R, Lee AC, Mitra DK et al (2019) Maternal short stature and under-weight status are independent risk factors for preterm birth and small for gestational age in rural Bangladesh. Eur J Clin Nutr 73(5):733–742. https://doi.org/10.1038/s41430-018-0237-4
    Article PubMed Google Scholar
  21. Morris JK, Wald NJ, Watt HC (1999) Fetal loss in Down syndrome pregnancies. Prenat Diagnosis 19(2):142–145. https://doi.org/10.1002/(SICI)1097-0223(199902)19:2%3c142::AID-PD486%3e3.0.CO;2-7
    Article CAS Google Scholar
  22. Stoll C, Dott B, Alembik Y, Roth MP (2015) Associated congenital anomalies among cases with Down syndrome. Eur J Med Genet 58(12):674–680. https://doi.org/10.1016/j.ejmg.2015.11.003
    Article PubMed Google Scholar
  23. Baghlaf HA, Badeghiesh AM, Suarthana E, Dahan MH (2022) The effect of Cushing’s syndrome on pregnancy complication rates: analysis of more than 9 million deliveries. J Matern Fetal Neonatal Med 35(25):6236–6242. https://doi.org/10.1080/14767058.2021.1910658
    Article Google Scholar

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Funding

There are no financial, personal, political, intellectual, or religious interests to declare.

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Authors and Affiliations

  1. Division of Maternal-Fetal Medicine, Obstetrics and Gynaecology, McGill University, Montreal, Canada
    Abdullah Alnoman & Haitham A. Baghlaf
  2. King Abdulaziz University, Jeddah, Saudi Arabia
    Abdullah Alnoman & Ahmad M. Badeghiesh
  3. Division of Reproductive Endocrinology and Infertility, Obstetrics and Gynaecology, Western University, London, Canada
    Ahmad M. Badeghiesh
  4. Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Canada
    Magdalena Peeva
  5. Division of Reproductive Endocrinology and Infertility, MUHC Reproductive Center, McGill University, Montreal, Canada
    Michael H. Dahan

Authors

  1. Abdullah Alnoman
  2. Haitham A. Baghlaf
  3. Ahmad M. Badeghiesh
  4. Magdalena Peeva
  5. Michael H. Dahan

Contributions

AA, HB, AB, and MD designed the study. HB, AB had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. HB, AB acquired the data and performed statistical analysis. AA, MP wrote and drafted the manuscript. MD contributed to the study design and to the statistical analysis and interpretation of data. All authors provided critical revision of the manuscript.

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Correspondence toAbdullah Alnoman.

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Alnoman, A., Baghlaf, H.A., Badeghiesh, A.M. et al. Pregnancy, delivery, and neonatal outcomes among women living with Down syndrome: a matched cohort study, utilizing a population database.Arch Gynecol Obstet 309, 2681–2687 (2024). https://doi.org/10.1007/s00404-023-07208-0

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