Paediatric and perinatal epidemiology最新文献

Background: Perinatal health was profoundly affected as a result of the socioeconomic hardships and public health measures during the COVID-19 pandemic. Few studies have evaluated changes and disparities in perinatal health using population-based data and rigorous methods.

Objective: To examine changes related to the COVID-19 pandemic in perinatal health and healthcare utilisation.

Methods: Using population-based data from the 2016-2021 Pregnancy Risk Assessment Monitoring System (N = 116,170), we employed a Bayesian structural time-series approach to examine deviations in perinatal health and healthcare utilisation outcomes from predicted trends following the onset of the COVID-19 pandemic in March 2020, adjusting for covariates.

Results: The onset of the COVID-19 pandemic was associated with delayed prenatal care initiation (1.1%, 95% confidence interval [CI] 0.2, 2.0), reduced prenatal care (-2.8%, 95% CI -3.6, -1.7), reduced postpartum visits (-1.0%, 95% CI -1.5, -0.4), and increased gestational hypertension (11.1%, 95% CI 5.4, 16.7), gestational diabetes mellitus (GDM), (17.6%, 95% CI 10.1, 26.2), and prenatal depression (7.3%, 95% CI 1.9, 13.0). Stratified models showed that Black participants experienced earlier prenatal care initiation; Native American participants experienced lower prenatal care visits and greater increases in gestational hypertension and GDM; Asian/Pacific Islander participants experienced delayed prenatal care initiation and heightened prenatal depression and postnatal depressive symptoms; and Hispanic participants experienced higher GWG and reduced postpartum visits.

Conclusions: As perinatal health imparts enduring impacts for pregnant people and infants, this study provides insight into the pandemic's potentially long-lasting population health effects. Future work should examine longer-term trends and how pandemic-related policies contributed to disparate impacts.

Background: International comparisons of population birth data provide essential benchmarks for evaluating perinatal health policies.

Objectives: This study aimed to describe routine national data sources in Europe by their ability to provide core perinatal health indicators.

Methods: The Euro-Peristat Network collected routine national data on a recommended set of core indicators from 2015 to 2021 using a federated protocol based on a common data model with 16 data items. Data providers completed an online questionnaire to describe the sources used in each country. We classified countries by the number of data items they provided (all 16, 15-14, < 14).

Results: A total of 29 out of the 31 countries that provided data responded to the survey. Routine data sources included birth certificates (15 countries), electronic medical records (EMR) from delivery hospitalisations (16 countries), direct entry by health providers (9 countries), EMR from other care providers (7 countries) and Hospital Discharge Summaries (7 countries). Completeness of population coverage was at least 98%, with 17 countries reporting 100%. These databases most often included mothers giving birth in the national territory, regardless of nationality or place of residence (24 countries), whereas others register births to residents only. In 20 countries, routine sources were linked, including linkage between birth and death certificates (16 countries). Countries providing all 16 items (N = 8) were more likely to use EMRs from delivery hospitalisations (100%) compared to 50% and 11% in countries with 15-14 items (N = 12) and < 14 items (N = 9), respectively. Linkage was also more common in these countries (100%) versus 75% and 56%, respectively. Other data source characteristics did not differ by the ability to provide data on core perinatal indicators.

Conclusions: There are wide differences between countries in the data sources used to construct perinatal health indicators in Europe. Countries using EMR linking to other sources had the best data availability.

Background: Risk factors during adolescence appear to shape adult health, but little is known about how they are associated with pregnancy health.

Objectives: We aimed to assess whether a variety of adolescent risk factors with links to adult overweight or obesity are associated with pre-pregnancy obesity (Body Mass Index [BMI] ≥ 30 kg/m²) and high gestational weight gain (GWG; > 0.5 SD for pre-pregnancy BMI category and gestational age) in a cohort of women participating since adolescence in a longitudinal cohort.

Methods: At age 11-18 years participants reported on adolescent risk factors (overweight or obesity, healthy and unhealthy home food availability, food insufficiency, family meals, depressive symptoms, body dissatisfaction, weight teasing, binge eating, unhealthy weight control behaviours and dieting). Twenty years later, participants reporting a live birth (n = 656) recalled their pre-pregnancy weight and total GWG. Modified Poisson regression models were used to estimate associations of each factor with pre-pregnancy obesity and high GWG, adjusting for sociodemographics. We used Multivariate Imputation by Chained Equations to account for outcome misclassification using internal validation data.

Results: Eighteen percent of the sample had pre-pregnancy obesity and 26% had high GWG. Adolescent overweight or obesity (RR = 4.98, 95% CI 3.27, 7.57), body dissatisfaction (RR = 1.99; 95% CI: 1.31, 3.03) and unhealthy weight control behaviours (RR = 1.70; 95% CI: 1.06, 2.74), among other factors, were associated with pre-pregnancy obesity risk. For high GWG, there were imprecise associations with adolescent overweight or obesity (RR = 1.57; 95% CI: 1.06, 2.31), binge eating (RR = 1.36; 95% CI: 0.77, 2.39) and unhealthy weight control behaviours (RR = 1.38; 95% CI: 0.84, 2.25), among others.

Conclusions: Findings suggest that some risk markers for pre-pregnancy obesity (and possibly high GWG) may be apparent as early as adolescence. Supporting adolescent health and well-being might have a role in improving weight-related health in the perinatal period.

Background: Postpartum haemorrhage (PPH) is associated with significant short-term morbidity and mortality. Whether PPH confers long-term all-cause mortality risk is unknown.

Objective: To examine the risk of long-term mortality associated with PPH.

Methods: The Collaborative Perinatal Project (CPP) Mortality Linkage Study is a prospective cohort study of pregnant persons (1959-1966) linked with vital status from the National Death Index and Social Security Death Master File for vital status through 2016. Postpartum haemorrhage was defined based on documentation of haemorrhage within or after 24 hours of delivery in obstetric records. We used Cox regression to examine associations of PPH with long-term all-cause mortality. All models adjusted for delivery characteristics, comorbid medical diagnoses, and sociodemographic characteristics. We further explored heterogeneity in all-cause mortality by sociodemographic characteristics.

Results: Of the 43,583 participants with a singleton pregnancy, 1532 (3.5%) experienced PPH, and 17,165 (39.4%) had died by 2016. The median follow-up time was 52 years (interquartile range 45-54). PPH was associated with increased all-cause mortality risk in unadjusted models (hazard ratio [HR] 1.12, 95% confidence interval [CI] 1.04, 1.21) but not in fully adjusted models (HR 1.02, 95% CI 0.94, 1.11). While HRs varied across sociodemographic subgroups, results were imprecise. We found no evidence of increased cause-specific mortality risk associated with PPH.

Conclusions: Although PPH is associated with short-term morbidity and mortality, our results are generally reassuring against the increased risk of long-term mortality associated with PPH.

Background: The New South Wales (NSW) and Australian Capital Territory (ACT) Cerebral Palsy (CP) Register is a database of clinical and demographic information from children with CP. A child with CP resulting from an insult to the developing brain sustained between 29 days and 2 years of age is classified as having post-neonatally acquired CP (PNN-CP). In clinical services, children may meet the criteria and timing for PNN-CP but have a singular diagnosis of acquired/traumatic brain injury.

Objectives: To implement and evaluate a new CP register ascertainment strategy focused on identifying children with PNN-CP attending acquired brain injury rehabilitation services.

Methods: Electronic medical records of children with an acquired brain injury attending the Sydney Children's Hospitals Network and John Hunter Hospital rehabilitation departments 2019-2024 were reviewed by researchers and rehabilitation paediatricians to identify children with PNN-CP. Children who fulfilled the criteria for CP were invited to participate in the CP Register. To evaluate this ascertainment strategy, we (i) ran descriptive statistics to analyse proportional changes of children with PNN-CP on the register and (ii) calculated temporal trends in prevalence per 10,000 live births for birth years 2003-2016, before and after the record ascertainment period.

Results: Of 1051 children with an acquired brain injury, 46 had PNN-CP (2003-2019) and had not previously been included on the register. This ascertainment strategy resulted in increased prevalence of PNN-CP in all 2-year time points between 2003 and 2016 and equated to a 31% improvement in ascertainment of children with PNN-CP on the register.

Conclusions: Ascertainment of children with PNN-CP for the NSW/ACT CP Register has been improved by systematically reviewing children with an acquired brain injury. This is now part of standard practice, and other registers should consider whether this strategy may improve ascertainment of PNN-CP in their regions.