Paediatric and perinatal epidemiology最新文献

Background: Previous research has shown an association between neighbourhood context and adverse birth outcomes, but with high heterogeneity.

Objective: To examine the degree to which social support buffers against the adverse effects of neighbourhood deprivation on preterm birth and small for gestational age (SGA).

Methods: This study is a secondary analysis of data from the nuMoM2b (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be) longitudinal cohort study, which recruited participants between 2010 and 2013. We estimated prevalence differences (PD) for area deprivation index (ADI) and for social support with each adverse birth outcome, and we evaluated whether the effect of ADI was modified by perceived social support; we additionally stratified by race/ethnicity. All models were adjusted for maternal age and education.

Results: Our analytic sample included n = 8377 participants. Among the birth outcomes we investigated, high social support had the strongest association with preterm birth. Participants reporting high social support had three fewer cases of preterm birth per 100 pregnancies (PD = -0.03, 95% CI -0.05, 0.00), compared to participants reporting low or moderate social support. The only evidence of high social support buffering against the harmful effects of neighbourhood deprivation was seen with SGA. Among participants with low or moderate social support, a 25-percentile increase in ADI was associated with two excess cases of SGA per 100 pregnancies (PD = 0.02, 95% CI -0.01, 0.04); whereas among participants with high social support, there was a null effect (PD = 0.00, 95% CI -0.01, 0.01). This effect modification was seen mostly among non-Hispanic White individuals.

Conclusion: Social support might offer some protection against the effects of neighbourhood deprivation on SGA, perhaps more so for non-Hispanic White people. However, we did not find evidence of social support buffering against the effects of neighbourhood deprivation on preterm birth.

Background: The Lancet Ending Preventable Stillbirths series issued a global Call to Action to reduce stillbirths and improve bereavement care. To monitor progress, we developed a global scorecard to track performance on key indicators.

Objectives: To introduce the scorecard and demonstrate its utility with a worked example by comparing global and regional performance in 2022 versus 2018.

Methods: Descriptive analysis of performance across 20 nominated indicators spanning mortality targets, universal health coverage targets and milestones for ending preventable stillbirths. Data were extracted from global tracking processes undertaken by United Nations agencies and foundations. Data were summarised globally and by region, with performance against indicators coded as below expectation, in progress, on track, or fully achieved.

Results: Seven of the 20 indicators had no available data to assess performance, including those related to stillbirth rate equity, subnational stillbirth rates, national reproductive health plans, the quality of antenatal and intrapartum care, and national processes for stigma reduction. As yet, there is no global consensus on respectful care after a perinatal death. Data were sparse for all indicators in Oceania, Europe and North America, and Latin America and the Caribbean. For most regions and most of the 13 other indicators with available data or estimates, progress was often modest or lacking. Central and South Asia and East and South-East Asia were 'on track' for more indicators than other regions, and there was substantial progress on three indicators in Sub-Saharan Africa. However, for the 10 highest-burden countries, progress remained below expectations. Progress was highest for indicators assessing the existence of plans, and worst for indicators assessing implementation.

Conclusions: The Global Scorecard for Ending Preventable Stillbirths can be used to provide advocates, policymakers, and practitioners with a detailed status check on data availability and progress in ending preventable stillbirths and improving care after stillbirth.

Background: Lower gestational age (GA) is linked to higher mortality and morbidity. Long-term health and developmental difficulties of individuals born moderate (MPT, 32-33 GA) and late (LPT, 34-36 GA) preterm, and early term (ET, 37-38 GA) are less explored than those of their very preterm peers.

Objectives: To test how being born MPT, LPT, or ET affects health and development at age 10, compared to full-term (FT, 39-40 GA) births.

Methods: Data from two ongoing French nationwide birth cohorts, initiated in 2011, were collected at 10 years via telephone interview (n = 8372) and home visit (n = 6418). Weighting procedures accounted for study design, non-inclusion, and participation. Outcome-wide regressions (modified Poisson, linear), adjusted for socioeconomic situation and pregnancy complications, were used to calculate adjusted relative risks (aRR) and beta-coefficients (β).

Results: No increased risk of asthma/atopy was observed for our MPT, LPT, and ET populations, except for allergic rhinitis in MPT. Strabismus was more prevalent among MPT, LPT, and ET (2.3%-3.0%) than FT (1.3%), corresponding to aRR of 1.99 (95% CI 0.91, 4.39), 1.67 (95% CI 0.85, 3.28), and 2.18 (95% CI 1.37, 3.47), respectively. MPT and LPT had increased risk of balance problems, with aRR of 1.63 (95% CI 0.81, 3.32) and 1.80 (95% CI 1.14, 2.82), respectively. MPT scored on average lower on the WISC-V full-scale IQ Matrix β -0.6 (95% CI -1.17, -0.11) and performance IQ Puzzle β -0.7 (95% CI -1.23, -0.26) subtests, compared to FT, and had an increased risk of dental malposition, aRR 1.42 (95% CI 1.15, 1.75).

Conclusions: While most outcomes (respiratory, anthropometry, cardiometabolic) did not differ between MPT, LPT, ET, and their FT peers, others, including strabismus, were more prevalent among preterm and ET. Some outcomes were specific to MPT, including lower WISC-V average scores and dental issues.