Paediatric and perinatal epidemiology最新文献

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.

Background: Much research has focused on identifying predictors of late antenatal care initiation. Many of these predictors (e.g., young age, migration background, socioeconomic position) are impossible to modify, illustrating the need to explore other interventions.

Objectives: This study aims to investigate inequalities in antenatal care initiation and assess whether early pregnancy recognition may reduce these inequalities.

Methods: Data from Generation R were used (N = 4196), a population-based birth cohort study in Rotterdam, The Netherlands. The association of gestational age at pregnancy recognition with the timing of antenatal care initiation and associations of individual and socioeconomic factors with the timing of antenatal care initiation were assessed using linear regression analyses. G-methods were used to estimate the reduction of the inequalities in antenatal care initiation if everyone would have recognised the pregnancy within 6 weeks.

Results: Participants who recognised their pregnancy within 6 weeks (81.7%) had their first antenatal care visit 1.3 weeks (95% confidence interval [CI] -1.6, -0.9) earlier than those who recognised their pregnancy after 6 weeks. All individual and socioeconomic factors were associated with the timing of antenatal care initiation. Modelling a scenario where pregnancy recognition occurred within 6 weeks reduced inequalities in antenatal care initiation timing across several groups: age < 20 versus 30-35 (-0.4 weeks, 95% CI -0.7, -0.2), first-generation migrants versus no migration (-0.1 weeks, 95% CI -0.2, 0.0), unplanned/ambivalent versus planned pregnancies (-0.4 weeks, 95% CI -0.6, -0.2), lower versus higher educational attainment (-0.1 weeks, 95% CI -0.2, 0.0), unemployed versus employed (-0.1 weeks, 95% CI -0.2, 0.0), low versus high household income (-0.1 weeks, 95% CI -0.3, 0.0), renters versus homeowners (-0.1 weeks, 95% CI -0.2, 0.0), and high versus low neighbourhood deprivation (-0.1 weeks, 95% CI -0.2, -0.1).

Conclusions: Early recognition of pregnancy may help reduce the impact of socio-economic inequalities in the timely initiation of antenatal care.

Background: Extreme ambient heat has been linked to maternal and neonatal mortality and morbidity. However, less is known regarding the impact of extreme ambient heat on mental health outcomes, particularly among socially vulnerable pregnant people.

Objectives: We aimed to estimate the effect of ambient heat exposure on psychiatric emergency services encounters among pregnant people served by a public program in the metropolitan Boston area. We hypothesised that days of extreme heat would have higher odds of an encounter with psychiatric emergency services when compared to normal temperature days.

Methods: Using electronic health records from the Boston Emergency Services Team program, we identified 861 geocodable encounters for pregnant people who utilised psychiatric emergency services between 2005-2009 and 2017-2021. Using a time-stratified case-crossover design, we matched each case (psychiatric emergency services encounter) with 3-5 control dates (matched by day-of-week and month). We obtained daily temperature (degrees Celsius) measures (mean, minimum, maximum) at an 800 m gridded resolution for cases/controls. Extreme heat exposure was defined at the 95th percentile, and exposure-response relationships were analysed using distributed lag nonlinear models with a 5-day lag period. We used conditional logistic regression models to estimate the association between ambient temperature exposure and odds of psychiatric emergency services encounters, controlling for U.S. federal holidays, relative humidity, and week of case/control date. Effect measure modification by time was examined (e.g., 2005-2009, 2017-2021).

Results: Among socially vulnerable pregnant people, we found no evidence of an association between days of extreme heat and the odds of psychiatric emergency services encounters, compared to normal temperature days.

Conclusions: This study does not support our a priori hypothesis. Future research is needed to confirm to what extent this association is truly null, as opposed to being obscured by selection bias into psychiatric emergency services, among socially vulnerable pregnant people.

Background: Studies of perinatal and paediatric health often analyse data from consecutive pregnancies. However, little is known about the factors associated with maternal residential changes between births or how maternal mobility may affect the validity of epidemiological findings, particularly those involving geographic-based measurements.

Objectives: Using a statewide sibling cohort, we studied the pattern of residential mobility between births and its association with several major sociodemographic and perinatal factors. We discussed how maternal moving between births may affect the validity of epidemiologic research, focusing on sibling comparison analyses.

Methods: We geocoded maternal residential addresses extracted from the livebirth records of sibling pairs from 2007 to 2015 in California. We described moving patterns between births, and we estimated the risk ratio (RR) of maternal moving according to maternal sociodemographic, pregnancy, and neonatal factors of the preceding birth. We studied maternal social mobility by examining the changes in the neighbourhood Social Vulnerability Indexes (SVI) among the movers.

Results: Our sample included 995,342 sibling pairs. Overall, 49.8% of mothers moved between births; 34.9% to another ZIP code, and 9.3% to another county. Younger maternal age, smoking during pregnancy, self-reported non-Hispanic Black race, lower educational attainment, nulliparous status, no prenatal care or having used government insurance for prenatal care, and non-adverse birth outcomes at the precedent birth were associated with maternal moving between births. Maternal social mobility between births in the cohort also varied by age, race/ethnicity, and education levels.

Conclusions: Maternal residential mobility between births was more common within certain sociodemographic subgroups in California. We recommend measuring residential changes in sibling studies, and assessing the potential impacts on statistical power, time-varying confounding, carry-over effect, and generalisability of findings. Further research is warranted to better understand how maternal mobility influences various types of perinatal epidemiological studies.

Background: Survey data are essential in paediatric epidemiology, providing valuable insights into child health outcomes. The potential outcomes framework has advanced causal inference using observational data. However, traditional design-based adjustments, especially sample weights, are often overlooked. This omission limits the ability to generalise findings to the broader population.

Objective: This study demonstrates three approaches for estimating the population average treatment effect (PATE) in a practical example, examining the impact of household second-hand smoke (SHS) exposure on blood pressure in school-aged children.

Methods: Using data from the National Health and Nutrition Examination Survey (NHANES) 2017-2020, we assessed the effect of household SHS exposure, a non-randomised treatment, on blood pressure in school-aged children. We applied estimators based on Inverse Probability of Treatment Weighting (IPTW), G-computation, Targeted Maximum Likelihood Estimation (TMLE), and regression adjustment. Models without adjustments were run for comparison. We examined point estimates and the efficiency of the estimates obtained from these methods.

Results: The largest differences were observed between the unadjusted regression models and the fully adjusted methods (IPTW, G-computation, and TMLE), which account for both confounding and survey weights. While the inclusion of the sample weights leads to wider confidence intervals for all methods, G-computation and TMLE showed comparatively narrower confidence intervals. Confidence intervals for the models not adjusted for sample weights were likely underestimated.

Conclusions: This study highlights the important role of sample weights in causal inference. Generalisability of the average treatment effect as estimated on data sampled using common survey designs to a defined population requires the use of sample weights. The estimators described provide a framework for incorporating sample weights, and their use in health research is recommended.

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.