- Title
- Adverse pregnancy outcomes in Australia: prevalence, recurrence, pattern of multiple outcomes and risk factors
- Creator
- Bizuayehu, Habtamu Mellie
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2021
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Introduction: The rates of adverse pregnancy outcomes (preterm birth and low birth weight) and labour interventions (episiotomy, instrumental birth and unplanned caesarean section) have progressively increased in high income countries in recent years. In particular, adverse outcomes have increased in Australia by about 10% over the past decade and are higher than reported in a number of other high income countries. Nearly one in ten births were preterm (8.7%) or low birth weight (6.7%), and about half of babies were born involving labour interventions (episiotomy [23%], instrumental birth [12.6%], and/or unplanned caesarean section [18.2%]) in Australia in 2017. While a range of biological, psychological, and social factors have previously been identified as being associated with adverse pregnancy outcomes and labour interventions, these have mainly come from cross-sectional secondary data which lacks temporality. Further, previous studies have failed to consider the examination of predictors within a framework that considers the influence of biological, psychological and social factors on these outcomes concurrently. This study therefore harnessed the power of national community-based longitudinal data by investigating adverse pregnancy outcomes and labour interventions among women prospectively followed for 19 years, using a comprehensive biopsychosocial framework. This thesis comprised four aims. Aim 1 was to determine the variation in preterm birth, low birth weight and caesarean sections (planned and unplanned) by maternal residential area; Aim 2 was to calculate the prevalence and recurrence rate of preterm birth and to assess the associated biopsychosocial factors; Aim 3 was to calculate the prevalence and recurrence rate of low birth weight and to assess the associated biopsychosocial factors; and Aim 4 was to describe the rate of patterns of labour interventions (episiotomy, instrumental birth, and unplanned caesarean section) and to determine the associated biopsychosocial factors. Methods: A mix of research methods and robust analysis techniques (path analysis, multilevel analysis of the longitudinal data), which have been less frequently applied by prior studies, were used. Firstly, an integrative review was carried out to assess the geographical variation in preterm birth, low birth weight, and caesarean section and biopsychosocial risk factors in Australia. Secondly, the prevalence and recurrence rate of adverse pregnancy outcomes, patterns of labour interventions and associated biopsychosocial factors were examined using the 1973-78 cohort of Australian Longitudinal Study on Women’s Health (ALSWH). Results: The integrative review found that while women who lived in rural and remote areas had higher rates of preterm birth and low birth weight and lower rates of caesarean section compared to their urban and city counterparts, the reviewed studies lacked quality due to being carried out using administrative secondary data and not considering the confounding associated with a range of biopsychosocial factors. The analysis of ALSWH data showed that adverse pregnancy outcomes were reported in about five per hundred babies. Labour interventions were used in about three fifth of births. Preterm birth was shown to be significantly associated with biological factors (hypertension, diabetes, asthma, birth order, age at menarche, and history of miscarriage) and social factors (educational status and relationship status). Low birth weight was also associated with biological factors including body mass index, diabetes, hypertension, age at menarche, and birth order. Labour interventions were found to be associated with both maternal biological factors (body mass index, diabetes, hypertension, age, height, length of labour, induction of labour) and social factors (educational status, relationship status, area, and private hospital insurance). Importantly, consistent across the studies, biological factors including hypertension, diabetes, body mass index and social factors including educational status, relationship status, and area were found to influence both adverse pregnancy outcomes and labour interventions. Conclusion: The key to preventing adverse pregnancy outcomes and labour interventions may lie in improving and developing evidence-based multi-sectoral policies to enhance the prevention of hypertension and diabetes and the monitoring of weight through nutritional and exercise interventions. Improving the utilization of preconception care and antenatal care are also required for the early detection and intervention of the risk factors of adverse pregnancy outcomes and labour interventions. Strengthening prevention of adverse pregnancy outcomes and labour interventions are keys for improving the health and wellbeing of mothers and babies, which are two main public health agendas, will have long-term benefits for not only this generation but future generations.
- Subject
- adverse pregnancy outcome; labour interventions; Australian Longitudinal Study on Women’s Health (ALSWH); integrative review; preterm birth; low birth weight; occurrence and recurrence rate; instrumental birth (forceps or ventouse); caesarean section; episiotomy; Australia; path analysis, multilevel analysis of the longitudinal data
- Identifier
- http://hdl.handle.net/1959.13/1500956
- Identifier
- uon:55048
- Rights
- Copyright 2021 Habtamu Mellie Bizuayehu
- Language
- eng
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 5 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 426 KB | Adobe Acrobat PDF | View Details Download |