Paediatric and perinatal epidemiology最新文献

Background: Preeclampsia is a common pregnancy complication associated with maternal and neonatal mortality. Early aspirin treatment lowers the risk of preeclampsia in high-risk pregnancies. However, knowledge of aspirin's effects and possible side effects outside clinical trials is sparse, and the evaluation of maternal and foetal safety regarding aspirin treatment is hindered by the inherent risk of confounding by indication.

Objectives: To study if the introduction of national guidelines recommending aspirin as preeclampsia prophylaxis affects clinical practice in Denmark, measured by aspirin use and investigate if the guideline change was related to the proportion of preeclampsia, preterm delivery, postpartum haemorrhage (PPH), placental abruption or neonatal intracranial haemorrhage.

Methods: All singleton pregnancies (1997-2016) identified in the nationwide Danish registries (gestational age ≥ 10 weeks) were included. The population was divided into persons at high or low risk of preeclampsia, according to the 2012 Danish National Guideline for Prevention and Treatment of Preeclampsia. Aspirin use was estimated based on redeemed prescriptions. The proportion of outcomes was compared using interrupted time series analyses.

Results: Of 1,323,750 pregnant persons, 2.0% (n = 25,826) were considered at high risk of preeclampsia. After the 2012 guideline change, aspirin use in high-risk pregnancies increased from 2.2% to 12.4% in 4 years, a 0.88 (95% confidence interval [CI] 0.83, 0.93) percentage point change for every half year. Severe preeclampsia slightly decreased from 6.0% to 5.2% after the guideline change, with a -0.22 (95% CI -0.43, -0.01) percentage point change for every half year, while preterm delivery rates remained unchanged. PPH increased in high-risk pregnancies. There was no difference in the risks of placental abruption or neonatal intracranial haemorrhage.

Conclusions: After the introduction of preventive aspirin treatment, aspirin use in high-risk pregnancies increased, and severe preeclampsia decreased. However, PPH increased, while rates of preterm delivery, placental abruption and neonatal intracranial haemorrhage remained unchanged.

Background: Early term births (37-38 weeks), like preterm births (< 37 weeks) are associated with increased infant morbidity, mortality, and risk of future preterm births. While racial disparities in preterm births are well documented, longitudinal patterns of early term and preterm births by maternal race remain underexplored.

Objectives: To estimate the likelihood of second births that are preterm or early term, conditional on the gestational age category of the mother's first birth and maternal race.

Methods: This population-based cohort study used linked birth and hospital discharge records for non-Hispanic (NH) Black and White mothers in Georgia with a first and second singleton live birth between 2011 and 2020. We examined the unadjusted distributions of second birth gestational age (< 32, 32-36, 37-38, ≥ 39 weeks) stratified by first birth gestational age category and maternal race. Adjusted relative risk ratios (RRRs) were estimated using multinomial logit models.

Results: NH Black mothers delivered 31,768 births; NH White mothers delivered 58,113. Among mothers with a first preterm birth < 32 weeks, NH Black mothers had a higher likelihood of second births at < 32 (RRR 19.08, 95% CI 14.48, 24.98) than NH White mothers (10.17, 95% CI 7.00, 14.78) and had similar disparities for second births at 32-36 weeks. After early term first births, NH Black mothers had elevated risks of < 32 or 32-36 week births (RRRs 3.53, 95% CI 2.90, 4.30 and 2.88, 95% CI 2.64, 3.13 respectively) versus NH White mothers (1.73, 95% CI 1.41, 2.11 and 2.07, 95% CI 1.92, 2.22). Racial disparities extended to second births following full-term first births and persisted after restricting the sample to non-indicated first births.

Conclusions: NH Black mothers face relatively elevated risks of shortened gestation in subsequent births, regardless of the gestational age of their first birth, including after early term or full-term births.

Background: Familial and environmental factors contribute to neurodevelopmental disorders (NDDs). Prenatal psychotropic exposure may influence the risk of NDDs in children. As these medications are prescribed to women with mental disorders, which are genetically and environmentally linked to NDDs, accounting for familial confounding is essential when studying medication safety in pregnancy.

Objectives: To compare the prevalence of NDDs in pregnant women using psychotropics, their partners, and their previous children, with those not using these medications.

Methods: We included data from the most recent pregnancy of Norwegian women with mental disorders who gave birth between 2010 and 2018, using Norwegian registries. Maternal psychotropic use included antidepressants, antipsychotics, anxiolytics, hypnotics, and sedatives, as recorded in the Norwegian Prescription Database. NDDs were identified using ICD-10 codes for intellectual disabilities, language/scholastic disorders, pervasive developmental disorders, and attention-deficit hyperactivity disorders (ADHD) from the Norwegian Patient Registry. Modified Poisson regression estimated crude and adjusted relative risks (aRRs) for the association between psychotropic use and family history of NDDs.

Results: The study included 27,638 women. Among psychotropic users, NDDs prevalence was 9.6% in women, 5.4% in partners, and 10.0% in previous children, compared to 5.7%, 4.6%, and 8.0% in non-users, respectively. ADHD was the most prevalent NDD. Psychotropic use in pregnancy was associated with any NDD, particularly ADHD, in the women [any NDD aRR 1.77 (95% CI 1.60, 1.95); ADHD aRR 1.79 (95% CI 1.61, 1.98)], previous children [any NDD aRR 1.25 (95% CI 1.07, 1.47); ADHD aRR 1.26 (95% CI 1.02, 1.54)], and partners [any NDD aRR 1.21 (95% CI 1.06, 1.37); ADHD aRR 1.22 (95% CI 1.07, 1.39)].

Conclusions: Prenatal psychotropic use was associated with a higher prevalence of NDDs in mothers and their previous children, highlighting the need to account for familial neurodevelopmental patterns to distinguish the effects of psychotropics from underlying genetic or familial factors.

Background: Antidepressant switching is often indicative of treatment dissatisfaction; however, data regarding patterns, associated factors and timing of switching in children and adolescents remain limited.

Objectives: This study aimed to determine switching patterns of antidepressant use and predictors of switching in Australian children and adolescents.

Methods: A retrospective cohort study of children and adolescents aged 5-18 years who initiated antidepressants between 2014 and 2022 was conducted, using a 10% random sample of the national Pharmaceutical Benefits Scheme dispensing data. We determined the proportions of initiators who switched between antidepressants within 12 months of initiation. A Cox proportional hazards model was used to determine the risk of switching by patient characteristic factors, and adjusted hazard ratios (aHR) with 95% confidence intervals (CI) were reported.

Results: We included 44,381 child and adolescent antidepressant initiators, the most commonly initiated antidepressant being fluoxetine. Approximately one in six children and adolescents aged 5-18 years at initiation (15.0%) switched to a different antidepressant within the first 12 months. Most switches were to selective serotonin reuptake inhibitors. Individuals with a commonwealth healthcare concession card were less likely to switch antidepressants within 12 months (aHR 0.91, 95% CI 0.86, 0.96). Females (aHR 1.24, 95% CI 1.17, 1.31), those starting with antidepressants other than fluoxetine and concurrent anxiolytic users were more likely to switch.

Conclusions: Switching between antidepressants is a common practice among children and adolescents in Australia, with most switches occurring during the early phases of treatment and primarily to selective serotonin reuptake inhibitors. A better understanding of the reasons for switching is important for informing tailored management approaches and improving treatment outcomes.

Background: Undergoing medically assisted reproduction (MAR) has been linked to adverse mental health outcomes, yet research examining whether MAR is associated with paternal postpartum depression (PPD) remains sparse. We investigated the risk of PPD among fathers of children conceived with MAR compared to fathers of children conceived unassisted.

Methods: Using the nationwide health registers, we included all fathers of children born in Denmark between 2010 and 2019. We categorised children as conceived unassisted or by MAR, linking childbirths to MAR treatments and further classified MAR conception according to the type and duration of treatment, and by indication for MAR. PPD was identified using a hospital depression diagnosis or antidepressant prescriptions within 12 months postpartum. We conducted adjusted Poisson regression analyses accounting for relevant covariates, including socioeconomic factors and clustering due to multiple children born to the same fathers.

Results: The study population included 413,682 births, of which 31,128 (7.5%) were conceived with MAR. Fathers in the MAR group were older, more often first-time parents, and had higher education and income levels. Within each group, 0.9% (270 with MAR conception, 3542 with unassisted conception) experienced PPD. We observed a 22% higher risk of PPD among fathers with MAR conception compared to unassisted conception after adjustment (adjusted relative risk [aRR] 1.22, 95% confidence interval [CI] 1.07, 1.38). Elevated risks were consistent across MAR types, treatment duration, and infertility indications, with the highest risk associated with treatment durations exceeding 12 months (aRR 1.42, CI 1.11, 1.80).

Conclusions: We observed an increased risk of PPD among fathers of children conceived with MAR compared to fathers of children conceived unassisted. These findings suggest the need for greater awareness and targeted support for this group in early parenthood.

Background: Gestational weight gain (GWG), the maternal weight gained between pre-pregnancy and delivery, is an important risk factor for adverse maternal and infant health outcomes. In 1990, the National Academy of Medicine released GWG recommendations based on pre-pregnancy body mass index (BMI). These guidelines were revised in 2009, yet few studies have assessed temporal trends in GWG following the change.

Objectives: To evaluate temporal trends in total GWG within a large, ongoing pregnancy cohort.

Methods: We used data from a prospective cohort in Boston, Massachusetts, of 3675 participants with deliveries between 2007 and 2019. Using 29,037 serial weight measures (median = 7/participant), we fit mixed-effect models to predict weight at delivery. Total GWG (kg) was defined as the difference between the model-predicted weight at delivery and self-reported pre-pregnancy weight. We categorised GWG as below, within or above the 2009 BMI-specific guidelines. We analysed proportional trends in GWG categories: (a) overall and (b) stratified by maternal characteristics (pre-pregnancy BMI, race/ethnicity, educational level and parity). We analysed trends in covariate-adjusted geometric mean (GMs) of GWG using multiple linear regression.

Results: The proportion of participants gaining weight within the GWG guidelines decreased from 46% in 2007-2008 to 24% in 2018-2019, which was driven by an increase in those gaining above the guidelines (40% to 73%). Across maternal characteristics, the largest increases of proportions above the guidelines were among those of normal pre-pregnancy BMI (19% to 62%) and of non-Hispanic Black (48% to 85%) or non-Hispanic White (37% to 74%) race/ethnicity. Consistently, GMs increased from 8.3 kg (95% confidence interval [CI] 6.3, 10.8) in 2007-2008 to 10.9 kg (95% CI 7.9, 14.9) in 2018-2019.

Conclusions: Results from this large cohort study provide evidence that fewer women have been meeting the revised GWG guidelines and more have been gaining above the recommendations.