Paediatric and perinatal epidemiology最新文献

Background: Given the high prevalence of both mental health and acute pain conditions during pregnancy, use of antidepressants and analgesic opioids in this period is widespread. Whether single and combined use of these medications is associated with spontaneous preterm birth (sPTB) remains unclear.

Objectives: To investigate the association between maternal prescription opioid and antidepressant medication exposures for co-occurring mental health and acute pain management, either alone or in combination, and sPTB.

Methods: We used Tennessee Medicaid data (2007-2019) linked to birth certificates to conduct a nested case-control study among 15- to 44-year-old pregnant patients with singleton live births. Cases were identified as spontaneous live births between 24 and <37 gestational weeks using a validated birth certificate-based algorithm. We selected up to 10 controls per case, matched on estimated pregnancy start date and other factors. We identified analgesic opioid and antidepressant pharmacy fills to define medication exposures in the 60 days before index date (case delivery date) and categorised them as unexposed, opioid-only, antidepressant-only and combined exposure. We estimated odds ratios (OR) and 95% confidence intervals (CI) using conditional logistic regression, adjusting for confounders. We assessed the additive interaction between opioids and antidepressants by estimating relative excess risk due to interaction.

Results: We identified 25,406 eligible cases of sPTB and 225,771 matched controls. Opioid-only and combined exposures were associated with higher odds of sPTB relative to unexposed (adjusted OR 1.29, 95% CI 1.23, 1.35 and 1.22, 95% CI 1.06, 1.40, respectively), while antidepressant-only exposure was not (1.04, 95% CI 0.96, 1.12). No additive interaction was identified for combined exposure.

Conclusions: Exposure to prescription opioids during pregnancy, but not antidepressants, was associated with increased relative odds of sPTB. Co-exposure to opioids and antidepressants did not elevate the odds of sPTB above what we observed for opioid-only exposure.

Background: Post-term pregnancy, defined as reaching or exceeding 42 + 0 weeks of gestation, is known to be associated with unfavourable birth outcomes. High-income countries have responded to this risk by widely adopting labour induction protocols in late-term, but many low- and middle-income countries have not. However, understanding underlying mechanisms linking post-term births to adverse newborn and infant outcomes remains limited.

Objective: To investigate the (a) prevalence of post-term, (b) the risk factors associated with post-term (c) the association between post-term births and the risk of small-for-gestational-age (SGA) neonates and of infant mortality in middle-income settings.

Methods: We used existing electronic datasets from the general population of Brazil, Mexico, and Palestinian refugees. Regression models were used to explore the associations between post-term birth and SGA and infant mortality.

Results: We analysed 21,335,033 live births in Brazil (2011-2018), 23,416,126 in Mexico (2008-2019), and 966,102 in Palestinian refugees (2010-2020) (N = 45,717,261). Post-term deliveries accounted for 3.1% of births in Brazil, 1.2% in Mexico, and 2.1% in Palestinian refugees. Post-term births had approximately three times the risk of resulting in SGA neonates compared to term births. Additionally, post-term neonates exhibited a 15% to 40% increased risk of infant mortality compared to term infants. Notably, post-term SGA neonates faced a significantly increased risk of infant mortality compared to term appropriate for gestational age neonates.

Conclusions: These findings emphasise the critical significance of implementing induction strategies to prevent post-term pregnancies and mitigate the associated risks of SGA neonates and subsequent infant mortality. Moreover, the study highlights the importance of accurately determining gestational age and using INTERGROWTH-21st charts to improve the identification of SGA cases, enabling targeted interventions. This is especially relevant because post-term SGA neonates may not exhibit low birthweight (a commonly used risk marker) and, therefore, may miss out on required specialised attention.

Background: Very preterm and/or very low birthweight (VP/VLBW; <32 weeks' gestation and/or <1500 g birthweight) individuals rated their partner and peer relationships lower than term-born individuals in emerging adulthood, but their quality of relationships with parents has been rarely investigated. Moreover, it is unclear whether previously reported differences in social relationship characteristics persist or lessen from emerging to established adulthood.

Objectives: To investigate changes in social relationship characteristics in VP/VLBW adults compared to term-born adults from 26 to 34 years and whether the association between VP/VLBW and social relationship characteristics varies according to sex.

Methods: In this prospective whole-population birth cohort study in South Bavaria, Germany, social relationship characteristics with parents, partners and peers, and overall social relationships across these domains were evaluated with a Life Course Interview at 26 and 34 years. Interview items related to these domains were extracted and scored as 0 (optimal) and 1 (non-optimal). Each score was summed into domain-specific composite scores and standardised according to the total sample.

Results: Participants included 262 VP/VLBW (52.7% males) and 230 term-born individuals (47.0% males). VP/VLBW adults had lower overall social relationship scores than term-born adults (β = -.61, 95% CI -0.85, -0.37). Specifically, partner (β = -.50, 95% CI-0.74, -0.27) and peer relationship scores (β = -.55, 95% CI-0.78, -0.32) were lower than those of term-born adults, but scores did not differ for parent relationships. On average, partner (β = .25, 95% CI 0.14, 0.35) and peer relationship scores increased (β = .16, 95% CI 0.03, 0.29), while parent relationship scores decreased (β = -.64, 95% CI-0.79, -0.49) from 26 to 34 years. These changes were similar for VP/VLBW and term-born individuals.

Conclusions: Patterns of change for the improved partner and peer but worsening parental social relationship scores were common across VP/VLBW and term-born adults, but differences between the two groups persisted from 26 to 34 years.