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.

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: 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.