Paediatric and perinatal epidemiology最新文献

Background: Prior research on fertility treatments and autism spectrum disorder (ASD) suggests minimal association but confounding by indication limits inference. To make clinically relevant conclusions, studies should include populations who receive treatment specifically for female-factor infertility.

Objectives: We investigated the association between ovulation-inducing medications and assisted reproductive technology (ART) and ASD. We conducted analyses in a subsample reporting female-factor infertility to reduce confounding by indication.

Methods: We used data from the Study to Explore Early Development (SEED), a 2007-2020 U.S. population-based case-control study. Children 2.5-5 years old with and without ASD were classified using in-person assessments. We identified fertility treatment via interview and included ovulation-inducing medications, ART, and a combination of both. The subsample included those who were told it would be difficult to conceive and/or who attempted to conceive for > 12 months. We estimated odds ratios and 95% confidence intervals for the whole sample and the subsample using logistic regression models adjusted for age, education, parity, pre-pregnancy body mass index, pregnancy history, smoking status, pre-existing hypertension, and other hormonal fertility treatments.

Results: There were 5210 participants in the whole sample and 1091 in the subsample. There was no association between ovulation-inducing medications and ASD in the full sample (adjusted odds ratio [aOR] 1.04, 95% confidence interval [CI] 0.77, 1.39) and the subsample (aOR 0.87, 95% CI 0.61, 1.2). There was an increased likelihood of ASD for ART and a combination of treatments in the whole sample (ART: aOR 1.33, 95% CI 0.70, 2.52; combination: aOR 1.39, 95% CI 0.95, 2.03) compared to the subsample (ART: aOR 1.16, 95% CI 0.57, 2.36; combination: aOR 1.08, 95% CI 0.69, 1.68).

Conclusions: In our data, fertility treatment was not associated with ASD. Additional research should restrict analyses to populations with similar indications to untangle whether observed associations are due to treatment or factors related to uptake.

Background: Disparities in the incidence, management, and outcomes of ectopic pregnancy have been documented among marginalised patients; however, there are few data on ectopic pregnancy in women with disabilities.

Objective: To compare the incidence and outcomes of surgically managed ectopic pregnancy in women with and without disability.

Methods: We conducted a population-based cross-sectional study using the National Inpatient Sample of discharges from US community hospitals (January 2016-December 2021). We analysed 9769 hospitalisations for surgically managed ectopic pregnancy among females aged 15-44 years. Disability was measured using a published administrative data diagnosis code algorithm. Outcomes were the incidence rate of ectopic pregnancy, surgical management approach (route, tubal removal versus sparing), complications (length of stay [LOS] ≥ 3 days, blood transfusion), and use of more extensive procedures than are standard (hysterectomy, oophorectomy, bilateral salpingectomy, tubal ligation). Weighted analyses were used to generate unadjusted incidence rate ratios (IRR) and outcome risk ratios (RR) from modified Poisson regression adjusted for year of surgery, socio-demographics, smoking, and comorbidities.

Results: The rate of surgically managed ectopic pregnancy was 2.8 per 1000 obstetric deliveries in disabled females and 2.3 per 1000 in non-disabled females (IRR 1.26, 95% CI 1.08, 1.45). Compared to non-disabled females, disabled females more often experienced prolonged LOS (adjusted RR 1.34, 95% CI 1.03, 1.74) and use of extensive procedures (adjusted RR 1.49, 95% CI 1.11, 2.00), including hysterectomy (adjusted RR 1.75, 95% CI 0.91, 3.36), oophorectomy (adjusted RR 1.43, 95% CI 0.96, 2.13), and bilateral salpingectomy (adjusted RR 1.30, 95% CI 0.71, 2.37); however, some estimates were imprecise due to low cell counts.

Conclusions: Disabled women faced slightly higher rates of surgically managed ectopic pregnancy and use of more extensive surgical procedures, including sterilisation. Targeted patient education on ectopic pregnancy and equity-focused guidance for surgeons may be beneficial.

Background: Surveillance of congenital anomaly prevalence over time can identify new teratogens. Anomalies with a genetic cause are excluded from the monitoring.

Objectives: We examined temporal changes in the proportion of genetic diagnoses among cases with a congenital anomaly.

Methods: Data was used from twenty EUROCAT congenital anomaly registries over the birth years 2013 and 2022. All pregnancy outcomes were included. Multilevel binomial regression models were fitted to estimate the annual change in the proportion of genetic diagnoses of all anomalies by registry. Results were additionally reported, excluding cases with trisomy 13, 18, or 21.

Results: Overall, 20% of the 100,099 cases in the study had a genetic diagnosis, and this proportion increased annually by 1.4% (95% CI, 0.8%-1.9%); an absolute increase of approximately 3% from 2013 to 2022. After excluding the trisomies, the overall proportion was 10% with an annual increase of 1.2% (95% CI 0.4%-2.0%). There was considerable variation in the proportion of genetic cases per registry. An increasing proportion of genetic diagnoses was found for five congenital anomaly groups, after excluding the trisomies. We hypothesise that the increase in genetic diagnoses is due to increased access to clinical genetic services, more extensive genetic testing, and the identification of new genes as causes of congenital anomalies.

Conclusions: The modest increase in genetic diagnoses among cases with a congenital anomaly is not expected to have a large impact on the surveillance of the non-genetic anomalies in the EUROCAT network. EUROCAT will continue to monitor the proportion of genetic diagnoses every five years.

Background: The risk of stillbirth increases as birthweight falls below the 25th centile. To mitigate this risk, many infants are delivered at late preterm or early term gestations, which increases the risk of neonatal and longer-term complications.

Objective: To develop a model to predict the risk of stillbirth for small infants after 34⁺⁰ weeks using information available antenatally.

Methods: This was a retrospective cohort study of non-anomalous singleton infants ≥ 34⁺⁰ weeks of gestation with birthweight (BW) < 25th centile, born between 2000 and 2021 in Queensland, Australia. The study outcome was antepartum stillbirth. We used survival analysis to model the number of gestational weeks each pregnancy is at risk of antepartum stillbirth. Competing risks regression models were then built to account for informative censoring due to planned birth. For ease of clinical translatability, we developed a clinical scoring rule to present the probabilities of stillbirth at each gestational week. The dataset was split into testing and discovery cohorts for assessment of internal validation, model discrimination, and concordance.

Results: There were 259,378 infants with BW < 25th centile, including 646 stillbirths (0.25%). The strongest predictors were BW centile < 1 (sub-hazard ratio [SHR] 5.84, 95% confidence interval [CI] 4.60, 7.42), BW centiles 1-2 (SHR 3.10, 95% CI 2.46, 3.91), < 5 antenatal visits (SHR 2.91, 95% CI 2.39, 3.55), BW centiles 3-4 (SHR 2.23, 95% CI 1.72, 2.89) and BMI ≥ 35 kg/m² (SHR 2.24, 95% CI 1.52, 3.29). Other predictors in the model were hypertension, anaemia, and asthma. Across all point scores, the cumulative incidence of stillbirth increased with gestation. Harrell's C-statistics were consistent across the discovery (0.71) and testing cohorts (0.73).

Conclusions: Our prediction model for small infants may be useful to risk-stratify women according to their stillbirth risk and support decisions around the timing of birth.

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.