Influence of the wars in Croatia and Bosnia and Herzegovina on the incidence and outcome of singleton premature births in the Split University Hospital

Pavlinac, Ivana; Marı́n, A.; Valić, Maja; Marušić, Jelena; Roje, Damir; Pecotić, Renata; Tadin, Ivica; Đogaš, Zoran

doi:10.2478/s11536-008-0026-x

Cited by 5 publications

(6 citation statements)

References 19 publications

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“… 28 31 38 The Pavlinac et al study even showed significant decreases in the overall rates of stillbirth among all singleton births. 33 This study also demonstrates that there was a significant increase in stillbirths among mothers who had preterm births (p<0.001)(see online supplementary appendix table 2 ).…”

Section: Resultssupporting

confidence: 55%

“…In contrast, one study with a low risk of bias compared with the other included studies found an increase in post-term births in Somalian women 39 exposed to armed conflict and another study showed a significant decrease in the number of premature deliveries during the war. 33 However, Pavlinac et al 33 found that within the population of premature babies both stillbirth and early neonatal mortality rates increased during the period of armed conflict. The other studies found no such significant relationship between armed conflict and prematurity 28 37 (see online supplementary appendix table 2 ).…”

Section: Resultsmentioning

confidence: 99%

“…The studies found different results. Pavlinac 33 found that, overall, early neonatal deaths decrease significantly both during and after the war. However, in contrast, when limiting the analysis to early neonatal deaths of only premature births during the armed conflict, there was a significant increase in the early neonatal mortality rate.…”

Section: Resultsmentioning

confidence: 99%

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Adverse effects of exposure to armed conflict on pregnancy: a systematic review

2017

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IntroductionExposure to armed conflict has manifold implications for both military and civilian populations. Prenatal stress has detrimental effects on both obstetric outcomes, fetal development and the development of an individual later in life. As well as causing stress to the mother, armed conflicts can decimate local infrastructures making it increasingly difficult to access antenatal and general healthcare. The present review is particularly salient in light of the many ongoing current conflicts. It examines the impacts of exposure to armed conflicts on the pregnancy outcomes.MethodsA thorough literature search was carried out on three databases using MeSH and truncation terms. 13 studies were included in the final analysis relating to mothers exposed to armed conflicts since 1990.ResultsThe studies include data from 1 172 151 patients: mothers from Libya, Bosnia, Herzegovina, Israel, Palestine, Kosovo, Yugoslavia, Nepal, Somalia, Iraq, Kuwait and Afghanistan. There is evidence of an increased risk of mothers giving birth to babies of low birth weight as reported in nine included studies. All have a degree of bias, with four at lower and five at higher risk of bias, either not adjusting for confounders or not employing robust measures of exposure to conflict. Further evidence suggested an increase in the incidence of miscarriage, stillbirth, prematurity, congenital abnormalities, miscarriage and premature rupture of membranes among mothers exposed to armed conflict.ConclusionDespite the varying degrees of bias which must be considered for the available evidence, the data with the lowest risk of bias suggest a relationship between exposure to armed conflict and low birth weight. In light of the current level of displacement experienced by such populations, the identification of pregnancies at risk could improve the efficacy of antenatal care. Clinicians should consider additional ultrasound scanning where appropriate to monitor for restricted growth in such pregnancies.

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Section: Resultssupporting

confidence: 55%

Section: Resultsmentioning

confidence: 99%

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Adverse effects of exposure to armed conflict on pregnancy: a systematic review

2017

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“…Several studies point to changes in services provision or uptake as potential drivers of adverse neonatal health outcomes in conflict settings. Evidence from the Syrian refugee context and Croatia found decreased access to antenatal care and skilled childbirths during conflict [8,9]. A recent study found an association between conflict and decreased cesarean section rates in the oPt [10].…”

Section: Introductionmentioning

confidence: 99%

Service utilization patterns for childbirth and neonatal mortality in the occupied Palestinian territory during conflict

Siam

Leone

2020

European Journal of Public Health

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Background The global incidence of man-made crises has increased in the last decade. Evidence on deviations in service uptake during conflict is needed to better understand the link between conflict and adverse neonatal outcomes. We assessed the association between conflict intensity in the occupied Palestinian territory (oPt) at time of birth and (i) utilization patterns for childbirth across different providers; and (ii) neonatal mortality. Methods We combined data on conflict intensity with four demographic and health surveys (2004, 2006, 2010 and 2014) that included nationally representative samples of women of childbearing age. Our exposure variable was casualties per 100 000 population in defined sub-regions of the oPt. Our outcome specifications were a binary variable for neonatal deaths and a categorical variable for childbirth location. We used multivariate logistic and multinomial regressions to assess the associations. Results High conflict intensity was associated with fewer childbirths in the private sector (RR=0.97, P=0.04), and non-governmental organizations (RR=0.95, P=0.03) compared to public facilities. Conflict intensity was not associated with higher neonatal mortality beyond 2004. Conclusions Policy implications include better preparedness in the public sector for childbirth during conflict and exploring reasons for the slow decline in neonatal mortality in the territory beyond conflict at time of birth.

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“…This includes often patchy information about pregnancy histories in many countries, leading most research to focus on pregnancy outcomes related to live births, and, hence, relying on selected samples. A recent systematic review could find only a few analyses of the associations between conflict exposure and miscarriages (2 studies), stillbirth risk (5 studies), and perinatal mortality (2 studies) [14][15][16][17][18][19][20]. All these studies are observational and suffer from data and/or methodological limitations that make causal inference difficult [13] (fAU : Pleasenotethattextfootnotesarenotperm ive studies are before-and-after analyses without an adequate statistical control for observable and unobservable confounders [14][15][16][17]19].…”

Section: Introductionmentioning

confidence: 99%

Conflict violence reduction and pregnancy outcomes: A regression discontinuity design in Colombia

Buitrago

Moreno‐Serra

2021

PLoS Med

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Background The relationship between exposure to conflict violence during pregnancy and the risks of miscarriage, stillbirth, and perinatal mortality has not been studied empirically using rigorous methods and appropriate data. We investigated the association between reduced exposure to conflict violence during pregnancy and the risks of adverse pregnancy outcomes in Colombia. Methods and findings We adopted a regression discontinuity (RD) design using the July 20, 2015 cease-fire declared during the Colombian peace process as an exogenous discontinuous change in exposure to conflict events during pregnancy, comparing women with conception dates before and after the cease-fire date. We constructed the cohorts of all pregnant women in Colombia for each day between January 1, 2013 and December 31, 2017 using birth and death certificates. A total of 3,254,696 women were followed until the end of pregnancy. We measured conflict exposure as the total number of conflict events that occurred in the municipality where a pregnant woman lived during her pregnancy. We first assessed whether the cease-fire did induce a discontinuous fall in conflict exposure for women with conception dates after the cease-fire to then estimate the association of this reduced exposure with the risks of miscarriage, stillbirth, and perinatal mortality. We found that the July 20, 2015 cease-fire was associated with a reduction of the average number of conflict events (from 2.64 to 2.40) to which women were exposed during pregnancy in their municipalities of residence (mean differences −0.24; 95% confidence interval [CI] −0.35 to −0.13; p < 0.001). This association was greater in municipalities where Fuerzas Armadas Revolucionarias de Colombia (FARC) had a greater presence historically. The reduction in average exposure to conflict violence was, in turn, associated with a decrease of 9.53 stillbirths per 1,000 pregnancies (95% CI −16.13 to −2.93; p = 0.005) for municipalities with total number of FARC-related violent events above the 90th percentile of the distribution of FARC-related conflict events and a decrease of 7.57 stillbirths per 1,000 pregnancies (95% CI −13.14 to −2.00; p = 0.01) for municipalities with total number of FARC-related violent events above the 75th percentile of FARC-related events. For perinatal mortality, we found associated reductions of 10.69 (95% CI −18.32 to −3.05; p = 0.01) and 6.86 (95% CI −13.24 to −0.48; p = 0.04) deaths per 1,000 pregnancies for the 2 types of municipalities, respectively. We found no association with miscarriages. Formal tests support the validity of the key RD assumptions in our data, while a battery of sensitivity analyses and falsification tests confirm the robustness of our empirical results. The main limitations of the study are the retrospective nature of the information sources and the potential for conflict exposure misclassification. Conclusions Our study offers evidence that reduced exposure to conflict violence during pregnancy is associated with important (previously unmeasured) benefits in terms of reducing the risk of stillbirth and perinatal deaths. The findings are consistent with such beneficial associations manifesting themselves mainly through reduced violence exposure during the early stages of pregnancy. Beyond the relevance of this evidence for other countries beset by chronic armed conflicts, our results suggest that the fledgling Colombian peace process may be already contributing to better population health.

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Influence of the wars in Croatia and Bosnia and Herzegovina on the incidence and outcome of singleton premature births in the Split University Hospital

Cited by 5 publications

References 19 publications

Adverse effects of exposure to armed conflict on pregnancy: a systematic review

Adverse effects of exposure to armed conflict on pregnancy: a systematic review

Service utilization patterns for childbirth and neonatal mortality in the occupied Palestinian territory during conflict

Conflict violence reduction and pregnancy outcomes: A regression discontinuity design in Colombia

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