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Association of umbilical cord venoarterial differences, ΔpH, to morbidity and mortality up to 20 years of follow-up: a cohort study

Sundberg, Tiia-Marie LU orcid ; Källén, Karin LU and Zaigham, Mehreen LU orcid (2026) In European Journal of Obstetrics & Gynecology and Reproductive Biology: X 29.
Abstract
Introduction
Umbilical cord blood measurement is the gold standard of evaluating neonatal metabolic status at birth. Dual sampling of cord blood vessels is clinical routine, yet the long-term value of venoarterial differences (ΔpH) is undetermined. The objective was to investigate the association of ΔpH, to long-term mortality and morbidity up to 20 years.

Material and methods
This was a retrospective cohort study with singleton births 1997–2012 at Skåne University hospital, Malmö, Sweden. Validated umbilical cord blood records were crosslinked to data from high quality national registers. Hazard ratios (HR) for diagnosis according to International Classification of Disease version 10 (00−99) during the follow-up period... (More)
Introduction
Umbilical cord blood measurement is the gold standard of evaluating neonatal metabolic status at birth. Dual sampling of cord blood vessels is clinical routine, yet the long-term value of venoarterial differences (ΔpH) is undetermined. The objective was to investigate the association of ΔpH, to long-term mortality and morbidity up to 20 years.

Material and methods
This was a retrospective cohort study with singleton births 1997–2012 at Skåne University hospital, Malmö, Sweden. Validated umbilical cord blood records were crosslinked to data from high quality national registers. Hazard ratios (HR) for diagnosis according to International Classification of Disease version 10 (00−99) during the follow-up period were calculated for the ≤ 10th/10th–90th/≥ 90th percentiles of ΔpH, adjusted for maternal age, smoking, body mass index, parity and gestational age.

Results
The study population was comprised of 35 171 births meeting the inclusion criteria after validation. Of the included births 4 956/14.1% had a small ΔpH (≤0.040), 26 690/75.9% normal ΔpH (0.041–0.150) and 3 525/10.0% large ΔpH (≥0.151). HR were statistically significant for small ΔpH for diseases of the eye and adnexa, crude HR:1.095 (95%CI:1.021–1.175), adjusted HR:1.081 (95%CI 1.007–1.160). No other organ system diseases were associated with small/large ΔpH.

Conclusion
ΔpH showed no strong long-term association of increased risk of organ-system related morbidity or mortality with twenty years of follow-up time. Multiple comparison may explain statistically significant finding of HR diseases of the eye and adnexa. Dual umbilical cord blood sampling remains vital clinically, ensuring correct sampling. (Less)
Abstract (Swedish)
Introduction: Umbilical cord blood measurement is the gold standard of evaluating neonatal metabolic status at birth. Dual sampling of cord blood vessels is clinical routine, yet the long-term value of venoarterial differences
(ΔpH) is undetermined. The objective was to investigate the association of ΔpH, to long-term mortality and morbidity up to 20 years.
Material and methods: This was a retrospective cohort study with singleton births 1997–2012 at Skåne University hospital, Malmo, Sweden. Validated umbilical cord blood records were crosslinked to data from high quality national registers. Hazard ratios (HR) for diagnosis according to International Classification of Disease version 10 (00− 99) during the follow-up period were... (More)
Introduction: Umbilical cord blood measurement is the gold standard of evaluating neonatal metabolic status at birth. Dual sampling of cord blood vessels is clinical routine, yet the long-term value of venoarterial differences
(ΔpH) is undetermined. The objective was to investigate the association of ΔpH, to long-term mortality and morbidity up to 20 years.
Material and methods: This was a retrospective cohort study with singleton births 1997–2012 at Skåne University hospital, Malmo, Sweden. Validated umbilical cord blood records were crosslinked to data from high quality national registers. Hazard ratios (HR) for diagnosis according to International Classification of Disease version 10 (00− 99) during the follow-up period were calculated for the ≤ 10th/10th–90th/≥ 90th percentiles of ΔpH, adjusted for maternal age, smoking, body mass index, parity and gestational age.
Results: The study population was comprised of 35 171 births meeting the inclusion criteria after validation. Of the included births 4 956/14.1% had a small ΔpH (≤0.040), 26 690/75.9% normal ΔpH (0.041–0.150) and 3 525/10.0% large ΔpH (≥0.151). HR were statistically significant for small ΔpH for diseases of the eye and
adnexa, crude HR:1.095 (95%CI:1.021–1.175), adjusted HR:1.081 (95%CI 1.007–1.160). No other organ system diseases were associated with small/large ΔpH.
Conclusion: ΔpH showed no strong long-term association of increased risk of organ-system related morbidity or mortality with twenty years of follow-up time. Multiple comparison may explain statistically significant finding
of HR diseases of the eye and adnexa. Dual umbilical cord blood sampling remains vital clinically, ensuring correct sampling. (Less)
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author
; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
kohortstudie, acidos, longterm effects, venoarterial differences, obstetrics, mortalitet, morbiditet, Retrospective cohort study
in
European Journal of Obstetrics & Gynecology and Reproductive Biology: X
volume
29
article number
100447
publisher
Elsevier
external identifiers
  • scopus:105030848916
  • pmid:41767784
ISSN
2590-1613
DOI
10.1016/j.eurox.2026.100447
project
Use of Umbilical Cord Blood Gases in Determining Mortality and Morbidity after Birth Asphyxia
language
English
LU publication?
yes
id
917eddac-5593-4145-b37f-b70409b871dd
date added to LUP
2026-02-27 10:40:39
date last changed
2026-05-30 03:00:15
@article{917eddac-5593-4145-b37f-b70409b871dd,
  abstract     = {{Introduction<br/>Umbilical cord blood measurement is the gold standard of evaluating neonatal metabolic status at birth. Dual sampling of cord blood vessels is clinical routine, yet the long-term value of venoarterial differences (ΔpH) is undetermined. The objective was to investigate the association of ΔpH, to long-term mortality and morbidity up to 20 years.<br/><br/>Material and methods<br/>This was a retrospective cohort study with singleton births 1997–2012 at Skåne University hospital, Malmö, Sweden. Validated umbilical cord blood records were crosslinked to data from high quality national registers. Hazard ratios (HR) for diagnosis according to International Classification of Disease version 10 (00−99) during the follow-up period were calculated for the ≤ 10th/10th–90th/≥ 90th percentiles of ΔpH, adjusted for maternal age, smoking, body mass index, parity and gestational age.<br/><br/>Results<br/>The study population was comprised of 35 171 births meeting the inclusion criteria after validation. Of the included births 4 956/14.1% had a small ΔpH (≤0.040), 26 690/75.9% normal ΔpH (0.041–0.150) and 3 525/10.0% large ΔpH (≥0.151). HR were statistically significant for small ΔpH for diseases of the eye and adnexa, crude HR:1.095 (95%CI:1.021–1.175), adjusted HR:1.081 (95%CI 1.007–1.160). No other organ system diseases were associated with small/large ΔpH.<br/><br/>Conclusion<br/>ΔpH showed no strong long-term association of increased risk of organ-system related morbidity or mortality with twenty years of follow-up time. Multiple comparison may explain statistically significant finding of HR diseases of the eye and adnexa. Dual umbilical cord blood sampling remains vital clinically, ensuring correct sampling.}},
  author       = {{Sundberg, Tiia-Marie and Källén, Karin and Zaigham, Mehreen}},
  issn         = {{2590-1613}},
  keywords     = {{kohortstudie; acidos; longterm effects; venoarterial differences; obstetrics; mortalitet; morbiditet; Retrospective cohort study}},
  language     = {{eng}},
  publisher    = {{Elsevier}},
  series       = {{European Journal of Obstetrics & Gynecology and Reproductive Biology: X}},
  title        = {{Association of umbilical cord venoarterial differences, ΔpH, to morbidity and mortality up to 20 years of follow-up: a cohort study}},
  url          = {{http://dx.doi.org/10.1016/j.eurox.2026.100447}},
  doi          = {{10.1016/j.eurox.2026.100447}},
  volume       = {{29}},
  year         = {{2026}},
}