Paediatric and perinatal epidemiology最新文献

Background: Increases in maternal age, obesity and other factors have led to an increase in hypertension, diabetes, and other chronic diseases among pregnant women. However, the impact of chronic diseases on maternal mortality has not been adequately studied.

Objectives: To quantify the contribution of maternal mortality associated with chronic disease to maternal mortality in the United States in 1999-2002 and 2018-2022.

Methods: The study was based on maternal deaths in the United States in 1999-2002 and 2018-2022, with data obtained from the mortality and live birth files of the National Center for Health Statistics. Maternal deaths and maternal deaths associated with chronic disease were identified based on the presence of pregnancy-related causes and chronic diseases among the multiple causes of death. Maternal mortality ratios (MMR) and ratios of MMRs and their 95% confidence intervals (CI) were estimated to assess period change. Temporal changes in MMRs were adjusted for maternal age using direct standardisation.

Results: Although overall MMRs were stable, direct obstetrical deaths decreased by 14% (95% CI 9, 23) from 1999-2002 to 2018-2022. Maternal deaths associated with chronic disease increased by 28% (95% CI 17, 40) from 5.41 in 1999-2002 to 6.92 per 100,000 live births in 2018-2022. The temporal increases in chronic disease-related maternal deaths were attenuated but not abolished following adjustment for maternal age (age-adjusted increase 16%, 95% CI 10, 23). MMRs associated with chronic disease increased in all age groups, especially among women aged < 20 and 30-39 years (57% and 17% increase, respectively). Non-Hispanic Black women had the highest MMRs associated with chronic disease (15.8 per 100,000 live births in 2018-2022), while age-adjusted MMRs increased among non-Hispanic White women (45% increase, 95% CI 33, 59).

Conclusions: A substantial fraction of maternal deaths in the United States is associated with chronic disease, although patterns vary by race/ethnicity.

Background: Research on new-onset hypertensive disorders of pregnancy (HDP) and long-term maternal cardiovascular disease (CVD) death has focused on mothers of small-for-gestational-age infants rather than large-for-gestational-age infants.

Objectives: We further explored this focus by investigating CVD death in mothers with HDP by gestational age at delivery across the full spectrum of infant birth size.

Methods: We used data from the Medical Birth Registry of Norway, the Norwegian National Population Register, and the Norwegian Cause of Death Registry, with information on mothers giving birth 1967-2020. This data was used to predict CVD death in the decades following pregnancy.

Results: We found the lowest CVD mortality among mothers with no HDP, term delivery, and a first infant with birthweight above average. These women constituted our reference group in the analyses. We found the highest risk of CVD death among mothers with preterm HDP and infants with above average birthweight for gestational age (HR 6.87, 95% CI 4.98, 9.48), not with infants below average birthweight for gestational age (HR 3.06, 95% CI 2.37, 3.93).

Conclusions: There is an interactive association between HDP and large infant birthweight in preterm first births. The high risk associated with the particular combination of HDP, preterm birth, and high infant birthweight for gestational age warrants further research to understand its causal underpinnings.

Background: Experts recommend assessing preterm infant growth against fetal growth patterns. However, obtaining accurate estimates of healthy fetal growth from preterm infants is challenging as many had intrauterine faltering growth.

Objectives: To improve preterm infant growth assessments by developing Fenton third-generation sex-specific preterm growth charts based on anthropometric distributions of preterm infants without abnormal fetal growth. We also aimed to evaluate the consistency of the new charts' growth velocities.

Data sources: From the last search for the 2013 Fenton growth charts to November 2024, MEDLINE and EMBASE databases, grey literature, as well as US Vital statistics and iNeo Consortium.

Study selection and data extraction: We followed systematic review methodology to identify population-based sex-specific anthropometric estimates of preterm cohorts without abnormal fetal growth beginning ≤ 24 weeks of gestation. Specified a priori, outcomes included newborn sex-specific estimates of birthweight, length, and head circumference.

Synthesis: We followed PRISMA guidelines. Literature screening and quality assessment were performed in duplicate. We harmonised weight, length, and head circumference weighted-average meta-analyses with the World Health Organization growth standard and rescaled the charts' x-axis from completed gestational weeks to exact gestational age (weeks and days).

Results: Seven studies from 15 countries (Australia, Brazil, Canada, China, Finland, Israel, Italy, Japan, Netherlands, New Zealand, Sweden, Switzerland, Spain, United Kingdom and United States) were included, representing 4.8 million births 22-42 weeks of gestation. 174,184 were < 30 weeks gestational age. The Fenton third-generation preterm growth charts' weights showed improved growth velocity across percentiles with consistent declines for weight, length and head circumference velocity as post-menstrual age increased. The birthweight meta-analysis curves had similar shapes to fetal ultrasound estimates.

Conclusions: The Fenton third-generation preterm infant growth chart curves demonstrate improved and more uniform slopes across percentiles and closer alignment with fetal ultrasound estimates, offering a growth standard for preterm infants.

Prospero registration: CRD42024589756.

Background: Studies have suggested that men with cardiometabolic conditions may have an increased risk of offspring perinatal mortality. However, this association remains underexplored.

Objectives: We aimed to study the association between fathers' cardiometabolic conditions and offspring perinatal mortality utilising linked data from national health registries in Norway.

Methods: In this population-based cohort study, males registered in the Medical Birth Registry of Norway (MBRN), born 1967-2005, were linked to their singleton offsprings born 2004-2020. The Norwegian Patient Registry and the Norwegian Prescription Database were used to define study exposures: history of hypertension, diabetes, dyslipidaemia, severe obesity or any of these at any time before/during the year of childbirth while fathers having no such conditions were the reference group. Perinatal mortality was defined as foetal death from 16 weeks' gestation or neonatal deaths within the first month after birth (from the MBRN). We fitted multilevel random-intercept Poisson regression models to account for the clustering of infants born to the same father. We reported incidence rate ratio (IRR) with 95% confidence Intervals (CI).

Results: Of 703,746 infants, 3.6% (n = 25,314) were born to fathers with any condition. Overall, 4827 (0.7%) of them died perinatally. In fully adjusted models, infants of fathers with hypertension had a 29% higher risk of dying perinatally (IRR 1.29, 95% CI 1.05, 1.57) relative to those of fathers without cardiometabolic conditions. Effect estimates for paternal diabetes, severe obesity and any condition also indicated a possible increased perinatal mortality associated with these conditions. In the sex-stratified analysis, the associations were stronger in male offspring (IRR 1.29, 95% CI 1.06, 1.58) than female offspring (IRR 1.01, 95% CI 0.78, 1.29).

Conclusions: The increased perinatal mortality in offspring to fathers with cardiometabolic conditions emphasises fathers' biological role in foetal and placental programming and development. Whether offspring sex impacts these associations needs further investigation.