Paediatric and perinatal epidemiology最新文献

Background: Previous evidence on the relation between early head circumference (HC) growth and behavioural outcomes in preschoolers has been inconsistent.

Objective: We aimed to investigate whether HC growth from birth to 5 years of age was related to internalising or externalising behavioural problems at 5 years of age in a sex-specific manner.

Methods: Among 303 girls and 318 boys from the MINA-Brazil birth cohort, we examined the associations between changes in HC from birth to 5 years of age and internalising and externalising behaviour problem scores at 5 years according to the Strengths and Difficulties Questionnaire for parents. HC values were transformed into sex- and age-specific z-scores (HCZ) using World Health Organisation standards, and the differences between values at 5 years of age and birth were classified into quintiles. We estimated adjusted mean differences with 95% confidence intervals in behavioural problem scores between HCZ change quintiles using multivariable linear regression by sex. To examine nonlinear associations, we included cubic spline terms.

Results: Head circumference growth from birth to 5 years of age was inversely and nonlinearly associated with internalising problems in girls. Compared with girls at the lowest quintile of HC growth, those above had an adjusted 1.27 (95% confidence interval 0.28, 2.27) points lower mean internalising problems score. This association was mostly driven by HC growth during the first 2 years. We found no association between HC growth and externalising behaviour in either sex.

Conclusions: Impaired HC growth was related to higher mean internalising problem scores at 5 years of age in girls but not in boys. HC growth was not associated with externalising problems.

Background: Exposure to trauma across the life course may be associated with cardio-metabolic dysfunction during pregnancy; however, previous research has been inconsistent, particularly in highly exposed populations.

Objectives: To estimate associations between types and timing (first occurrence) of trauma exposure and hypertension experienced during pregnancy in a safety-net hospital in Atlanta, Georgia, 2011-2022.

Methods: Participants completed a 14-item trauma screener. We linked that information to data from the medical record on hypertension (including chronic hypertension, gestational hypertension or preeclampsia). We fit logistic regression models and used the estimates to calculate risk ratios for each trauma type and each critical window (0-9 years, 10-19 and 20+). We fit unadjusted models and adjusted for age, parity and education.

Results: We included 704 individuals with a delivery within 12 months following screening. The majority (94%, 661) reported at least one traumatic event, most commonly witnessing violence (79.4%). Overall, 18% experienced gestational hypertension, 10.8% chronic hypertension and 11.9% preeclampsia. Among individuals who reported trauma, 31.5% screened positive for probable posttraumatic stress disorder and 30.9% for probable depression, compared to 0 and 2.3% among those without reported trauma. No trauma type (violence, witnessing violence, non-interpersonal or sexual assault) was associated with increased hypertensive risk, regardless of timing.

Conclusions: In this sample with a high trauma and hypertension burden, trauma was not associated with an elevated risk of hypertension during pregnancy, despite a high burden of PTSD and depressive symptoms among people with trauma exposure.

Background: One in ten U.S. children lives with a grandparent, and more foster children are being placed in kinship care.

Objectives: Our objective was to compare early language and communication development and school readiness among children raised by grandparents (alone or in multigenerational households) to children raised by parents.

Methods: We included in this cross-sectional study children ages 1-5 years from the 2016-2020 National Survey of Children's Health to examine healthy and ready to learn school readiness outcomes and binary language and communication development (2018-2020 data only) by caregiver type (parent, multigenerational, and grandparent-only) with survey-weighted log-binomial regression adjusted for confounders. We stratified by survey years pre-COVID-19 pandemic versus during.

Results: Among 33,342 children, 86.0% (SE = 0.51) of children were 'On-Track' for language and communication development; only 37.2% (SE = 0.68) were 'On-Track' overall for school readiness. Children raised by grandparents or in multigenerational households were more often 'On-Track' for school readiness than children raised by parents, but only upon adjustment for covariates (adjusted prevalence ratio (aPR) for grandparent-only 1.13, 95% confidence interval (CI) 1.11, 1.15; aPR for multigenerational 1.13, CI 1.12, 1.15). Smaller and less consistent differences in prevalence were observed for the other outcomes (language and communication development, school readiness domains of early learning skills, social-emotional development, self-regulation development and physical well-being and motor development). A disparity in school readiness may have emerged during the COVID-19 pandemic; children in grandparent-only households had a lower prevalence of being 'On-Track' for school readiness (aPR 0.71, 95% CI 0.69, 0.73) compared to children in parent households, whereas children in multigenerational households continued to be more often school-ready than children in parent households.

Conclusion: Large proportions of children across caregiver types were not fully prepared for school. Consideration of key covariates is important because socio-economic disadvantage may mask other advantages grandparent-led and multigenerational households offer children's early development.

Background: Very preterm and/or very low birthweight (VP/VLBW; <32 weeks' gestation and/or <1500 g birthweight) individuals rated their partner and peer relationships lower than term-born individuals in emerging adulthood, but their quality of relationships with parents has been rarely investigated. Moreover, it is unclear whether previously reported differences in social relationship characteristics persist or lessen from emerging to established adulthood.

Objectives: To investigate changes in social relationship characteristics in VP/VLBW adults compared to term-born adults from 26 to 34 years and whether the association between VP/VLBW and social relationship characteristics varies according to sex.

Methods: In this prospective whole-population birth cohort study in South Bavaria, Germany, social relationship characteristics with parents, partners and peers, and overall social relationships across these domains were evaluated with a Life Course Interview at 26 and 34 years. Interview items related to these domains were extracted and scored as 0 (optimal) and 1 (non-optimal). Each score was summed into domain-specific composite scores and standardised according to the total sample.

Results: Participants included 262 VP/VLBW (52.7% males) and 230 term-born individuals (47.0% males). VP/VLBW adults had lower overall social relationship scores than term-born adults (β = -.61, 95% CI -0.85, -0.37). Specifically, partner (β = -.50, 95% CI-0.74, -0.27) and peer relationship scores (β = -.55, 95% CI-0.78, -0.32) were lower than those of term-born adults, but scores did not differ for parent relationships. On average, partner (β = .25, 95% CI 0.14, 0.35) and peer relationship scores increased (β = .16, 95% CI 0.03, 0.29), while parent relationship scores decreased (β = -.64, 95% CI-0.79, -0.49) from 26 to 34 years. These changes were similar for VP/VLBW and term-born individuals.

Conclusions: Patterns of change for the improved partner and peer but worsening parental social relationship scores were common across VP/VLBW and term-born adults, but differences between the two groups persisted from 26 to 34 years.

Background: Empirically evaluating the potential impact of recall bias on observed associations of prenatal medication exposure is crucial.

Objective: We sought to assess the effects of exposure misclassification on previous studies of the use of nonsteroidal anti-inflammatory drugs (NSAIDs) in early pregnancy and increased risk of amniotic band syndrome (ABS).

Methods: Using data from the National Birth Defects Prevention Study (NBDPS) on births from 1997 to 2011, we included 189 mothers of infants with ABS and 11,829 mothers of infants without congenital anomalies. We identified external studies of medication use during pregnancy to obtain validity parameters for a probabilistic bias analysis to adjust for exposure misclassification. Due to uncertainty about the transportability of these parameters, we conducted multidimensional bias analyses to explore combinations of values on the results.

Results: When we assumed higher specificity in cases or higher sensitivity in controls, misclassification-adjusted estimates suggested confounding-adjusted estimates were attenuated. However, in a few instances, when we assumed greater sensitivity in the cases than the controls (and Sp ≥ 0.9), the misclassification-adjusted estimates suggested upward bias in the confounding-adjusted estimates.

Conclusions: Results from our bias analysis highlighted that the magnitude of bias depended on the mechanism and the extent of misclassification. However, the parameters available from the validation studies were not directly applicable to our study. In the absence of reliable validation studies, considering mechanisms of bias and simulation studies to outline combinations of plausible scenarios to better inform conclusions on the effects of these medications on pregnancy outcomes remains important.