REPRODUCTION AND CHILDBEARING HEALTH: REAL-WORLD EVIDENCE FROM ADMINISTRATIVE DATABASES

Introduction. Over the last three decades, especially in high-income countries, reproduction has undergone significant changes, influenced by a combination of social, economic, technological, and cultural factors. The delay in the age at which individuals and couples decide to have children is one of the most important changes. In this context, addressing the new clinical and sociological challenges requires comprehensive health and public policy action. Objectives. The main objective of this work was to monitor reproductive and childbearing health. The various projects identified conditions and factors affecting the health of children and mothers from an epidemiological, clinical, social and pharmaco-epidemiological point of view. In particular, the impact of pregnancy-associated cancers on pregnancy and birth outcomes, the consequences of advances in assisted reproductive technologies, and patterns of drug prescription during pregnancy and postpartum were the main research questions. Materials & Methods. Sources. Regional administrative databases on health care utilisation are large repositories of data on health care systems that are routinely collected by health care providers and other institutions. For the purposes of the projects carried out, data were obtained from the following databases: i) an archive of beneficiaries of the regional health service, ii) the hospital discharge register, iii) the outpatient drug prescribing register, iv) the outpatient specialistic visits register, and v) the certificates of delivery assistance (CeDAP) database. Particularly, CedAP is the richest source of health, epidemiological, and socio-demographic information on births at national level and is an essential tool for for planning and supporting public health policies related to childbirth at national and regional levels. Design. Historical population-based cohort studies. The birth cohorts were identified from the hospital discharge register and CedAP. The different databases were linked to each other with record linkage technique, an algorithmic procedure whose purpose is to identify and merge records from one or more data sources that correspond to the same individual. Statistical analysis. Standard descriptive statistics, including frequencies and percentages for categorical data and means and medians for quantitative data, were calculated to assess the distribution of maternal sociodemographic and clinical characteristics. The Chi-square test and absolute standardised differences were used when appropriate for testing differences in categorical variables. Independent samples t-test was used to compare numerical variables. Logistic or log-binomial regressions were fitted to estimate the odds ratio or prevalence ratio and 95% confidence interval (95% CI) of specific outcomes associated with specific exposure approached in each study. Models were adjusted for potential confounders. Ad hoc analyses were performed for single studies. Results. Pregnancy-associated cancer. A first study aimed to assess the association between a diagnosis of pregnancy-associated cancer and adverse perinatal outcomes. It found that women with oncological condition tended to have a higher incidence of iatrogenic preterm birth. The need for timely and appropriate medical interventions to manage both the cancer and the pregnancy can sometimes lead to induced preterm birth even in the absence of a specific oncological indication, compromising the wellbeing of the newborn. The second study, which investigated the impact of a cancer diagnosis on pregnancy outcome, found a downward trend in the number of abortions in favour of live births. Advances in research and clinical practice, together with increased awareness of the potential of treating oncological conditions in pregnant women, have contributed to this trend. Assisted reproductive technologies. The relationship between assisted reproductive technologies and twinning rates and adverse perinatal outcomes, such as preterm birth and birth defects, has been investigated in a number of studies. The results showed a notable decrease in multiple pregnancies, which was attributed to the increasingly common practice of single embryo transfer. This approach is consistent with a focus on reducing the risks and challenges often associated with multiple pregnancies, including preterm birth. Other analyses with a sociological perspective have shown that little attention has been paid to the contribution of assisted reproduction to desired family size, with the main objective remaining to reduce childlessness. Prescribing patterns during pregnancy and postpartum. More and more women may need to be treated with medication during pregnancy, monitoring of medication prescription patterns during pregnancy could be a tool for assessing compliance with recommended supplement and medication use in clinical practice. An overview of drugs prescriptions was provided. The study focused on initiation of antidepressant use during postpartum found that mothers who experienced a preterm birth had an excess risk of antidepressant use, suggesting an association between preterm birth and maternal mental illness. Conclusion. It is essential that attention and resources are focused on continuous and close monitoring of reproductive and childbearing health to promote and ensure healthy pregnancies, safe childbirth, and the well-being of mothers and couples.