Paediatric and perinatal epidemiology最新文献

Background: Children with neurodisability often have complex healthcare and educational needs. Evidence from linked administrative health and education data could improve joint working between services.

Objective: To develop a diagnostic code list to identify neurodisability in hospital admission records; to assess the representativeness of this phenotype by characterising children with hospital-recorded neurodisability and their outcomes.

Methods: We developed a national cohort of singletons born in England between 2003 and 2009, including a nested cohort of children enrolled in primary school, using linked health and education data from the Education and Child Health Insights from Linked Data (ECHILD) database. With expert clinicians, we developed an algorithm based on diagnostic information from hospital records to phenotype children with hospital-recorded neurodisability. We described rates of mortality, planned/unplanned admissions up to 11 years old, and school-recorded special educational needs (SEN) provision, as proxy measures of the complexity of a child's needs, overall and for over 40 neurodisability subgroups.

Results: Of 3,580,225 children in the birth cohort, 3.6% had hospital-recorded neurodisability by age 11. The most frequent subgroups included developmental disorders, autism, epilepsy, perinatal brain injury, and cerebral palsy. Children with hospital-recorded neurodisability had higher mortality and planned/unplanned admission rates compared with their peers, and they accounted for 26% of all planned and 14% of all unplanned hospital admissions before age 11. The nested primary school cohort included 2,956,299 pupils (82.6% of all births), 3.7% of whom had hospital-recorded neurodisability. 75% of children with hospital-recorded neurodisability had any school-recorded SEN provision, and 39% had a record of more intensive provision (compared to 30% and 2.4%, respectively, for their peers).

Conclusions: We derived a phenotype for hospital-recorded neurodisability, which affects 1 in 28 primary school children in England, with high rates of hospital admissions and SEN provision. This phenotype and its subgroups can be used by service providers and researchers to examine inequalities and inform resource and service provision.

Background: Data on antihypertensive medication for non-severe gestational hypertension may suffer from immortal time and selection bias. Emulating target trials can prevent these biases by aligning follow-up with treatment initiation.

Objectives: We estimated the safety of antihypertensive medication initiation for the treatment of non-severe gestational hypertension on adverse birth outcomes in Botswana using sequential target trial emulation.

Methods: Data from the Tsepamo study (2014-2022), capturing birth outcomes at government delivery sites in Botswana, was used to examine antihypertensive medication initiation ≥ 24 weeks gestation for non-severe gestational hypertension (140-159 systolic or 90-109 diastolic blood pressure ≥ 20 weeks gestation without chronic hypertension). Sequential weekly target trial emulation compared initiation versus no initiation during 24-35 weeks' gestation on the risk of stillbirth and birth of infant small for gestational age (SGA), with secondary outcomes including very SGA, preterm birth, very preterm birth, neonatal death, and severe gestational hypertension. For each trial, eligible individuals were without chronic hypertension, had not previously initiated antihypertensive medication and had ≥ 2 non-severe blood pressure readings, at least one within 1 week of trial start. Log-binomial models estimated gestational week-specific and pooled risk ratios (RR) with 95% confidence intervals (CI) using bootstrapping.

Results: Of eligible individuals, there were 1676 antihypertensive initiator 'person-trials' and 5211 non-initiator 'person-trials'. In the pooled analysis, the adjusted RR for stillbirth and SGA comparing initiators to non-initiators was 0.92 (0.68, 1.19) and 1.09 (0.97, 1.23), respectively. The pooled adjusted RR for secondary outcomes were: very SGA, 1.05 (95% CI 0.88, 1.25); preterm birth, 1.09 (95% CI 0.96, 1.22); very preterm birth, 1.05 (95% CI 0.78, 1.47); neonatal death, 1.23 (95% CI 0.68, 2.24); severe gestational hypertension, 0.88 (95% CI 0.74, 1.07).

Conclusions: In this retrospective cohort study, antihypertensive medication initiation between 24 and 35 weeks' gestation for non-severe gestational hypertension was not associated with increased risk of adverse birth outcomes.

Background: As climate change worsens, instances of combined extreme heat and wildfire smoke events are becoming more frequent. Despite their increased vulnerability, investigations on the joint effect of wildfire smoke and extreme heat on children's health are limited.

Objective: To investigate the joint effects of extreme heat and wildfire smoke on paediatric acute care utilisation (ACU) in California from 2006 to 2019.

Methods: In this case-crossover analysis, we assembled a time-series dataset of warm seasons, (May-September) for 1772 ZIP Code Tabulation Areas (ZCTA) in California from 2006 to 2019 to evaluate daily ACUs in the paediatric population (0-19 years). For wildfire smoke, we identified ZCTA-days exposed using a previously developed time-series dataset. For extreme heat, we calculated the daily ZCTA-specific maximum heat index. There were four exposure types: exposed to extreme heat alone, exposed to wildfire smoke alone, exposed to both events simultaneously (compound event) and not exposed to either event. We quantified the synergistic effects by comparing a child's exposures on the day when an ACU occurred to the child's exposure during control days.

Results: We found 1100-105,788 ZCTA-days where exposure to both extreme heat and wildfire smoke events occurred across eight combinations of event definitions. The relative excess risk due to interaction (RERI) ranged up to 0.11 (95% confidence interval [CI]: 0.03, 0.19) with thresholds of the 95th percentile for extreme heat and 35 μg/m³ for wildfire PM_2.5, indicating a synergistic effect of extreme heat and wildfire smoke on paediatric ACUs. Positive RERIs were consistently observed for infectious enteritis, heat-related illness, asthma, endocrine nutritional and metabolic disease, and respiratory disease.

Conclusion: Investigating the synergistic effects of extreme heat and wildfire smoke events in paediatric populations is necessary to develop effective health protection strategies.

Background: Compared to undergoing prenatal care with a physician, care with a midwife reduces the risk of medical interventions and complications during labor and delivery among low-risk pregnant individuals. However, many analyses that assess the relationship between midwifery-led care and birth outcomes condition on live births, potentially inducing a type of collider bias.

Objective: The objective was to analyse the change in prevalence of caesarean deliveries, primary and secondary postpartum haemorrhage, obstetric trauma, and maternal infection under hypothetical scenarios where midwifery-led prenatal care was increased.

Methods: Our sample included commercially insured, midwifery-eligible pregnant people in an insurance claims data source. We used g-computation to assess the change in prevalence of caesarean deliveries, primary and secondary postpartum haemorrhage, obstetric trauma, and maternal infection if 10%, 20%, and 50% more pregnant people enrolled in prenatal care with a midwife rather than a physician, among a cohort of low-risk pregnant people with commercial insurance in the U.S. between 2004 and 2015.

Results: With a 50% increase in midwifery-led care compared with no increase, we found the prevalence of caesarean deliveries was reduced by 5.4 percentage points (95% confidence interval [CI] -5.7, -5.1) and of maternal infection decreased by 1.3 percentage points (95% CI -1.6, -1.0), while the prevalence of primary postpartum haemorrhage increased by 0.5 percentage points (95% CI 0.4, 0.6) and of secondary postpartum haemorrhage increased by 0.6 percentage points (95% CI 0.4, 0.7).

Conclusions: Increasing midwifery-led prenatal care reduced the prevalence of caesarean deliveries and maternal infections and slightly increased the prevalence of primary and secondary postpartum haemorrhage. Our results were similar to those of studies among live birth cohorts.

Background: Prior studies report associations between periconceptional exposure to natural and synthetic oestrogen and progesterone and autism spectrum disorder (ASD). Hormonal contraception contains synthetic forms of one or both hormones. Although hormonal contraception is highly effective when consistently used, unintended pregnancy can occur with irregular use. Given the popularity of hormonal contraception, foetal exposure in utero is possible, yet the potential consequences are unknown.

Objectives: We investigated the association between periconceptional hormonal contraception use and the development of ASD in offspring.

Methods: We analysed data from the Study to Explore Early Development (SEED), a population-based case-control study conducted in select US states, from 2007 to 2020. Children with and without ASD were identified from clinical/education sources and vital records, respectively, and enrolled at ages 2.5-5 years. We confirmed the ASD case status by in-person developmental assessment. We assessed hormonal contraception via a structured interview. We assessed the associations between ASD and hormonal contraception exposure separately for contraception discontinued in the 3 months prior to pregnancy and contraception continued during pregnancy using logistic models to estimate odds ratios (OR) adjusted for biological mother age, education, parity, pre-pregnancy body mass index (BMI), and presence of gynaecologic conditions and 95% confidence intervals (CI).

Results: Of 5210 participants, 9.9% reported discontinuing hormonal contraception use before pregnancy and 2.3% reported continuing use during pregnancy. A suggestive association was found between ASD and hormonal contraception use during pregnancy (aOR 1.38,95% CI 0.93, 2.05). There was no association with use prior to pregnancy (aOR 1.02, 95% CI 0.84, 1.25).

Conclusions: Discontinuation of hormonal contraception prior to conception was not associated with ASD. The prevalence of hormonal contraception use during pregnancy was low. Results were imprecise and may be impacted by recall bias and unmeasured confounding by indication and health behaviours related to planning pregnancy.