Paediatric and perinatal epidemiology最新文献

Background: Globally, Down syndrome is the most common chromosomal anomaly, often co-occurring with cardiac or gastrointestinal anomalies. There is a lack of robust data on specific healthcare needs of children with Down syndrome compared to children with other major congenital anomalies.

Objectives: To quantify the healthcare needs of children with Down syndrome in the first year of life compared to children with major congenital anomalies in a large population-based cohort across Europe.

Methods: The EUROlinkCAT study was a multicentre data linkage study between congenital anomaly registries in Europe and hospital and mortality databases. Children born between 1st January 1997 and 31st December 2014 were included. Summary statistics were used to compare differences between children (those with Down syndrome compared to all major anomalies) and regions. Random-effects meta-analysis was used to pool results related to survival, need for intensive care and ventilation support.

Results: A total of 3554 children were born with Down syndrome out of 89,081 children with major congenital anomalies. The pooled 1-year survival was 95.4%. In every region, > 80% of children with Down syndrome had a hospital admission excluding the birth admission. Hospital length of stay in the first year was higher for children with Down syndrome compared to those with all anomalies (median: 14 versus 7 days). Despite having similar need for ventilation support (9.7% vs. 8.4%), children with Down syndrome had higher rates of intensive care admission than all children with anomalies (24.8% vs. 13.0%).

Conclusions: There is a high need for hospital care for children born with Down syndrome in the first year of life. Future work should continue to explore the long-term prognosis for children with Down syndrome to ensure their care needs are met.

Background: Population-based data are needed to reliably assess the impact of SARS-CoV-2 infection during pregnancy.

Objectives: To estimate the population-based incidence of SARS-CoV-2 infection and its severe forms in the obstetric population, identify risk factors of severe SARS-CoV-2 infection (severe COVID-19) and describe delivery, maternal and neonatal outcomes by disease severity, using a definition of severity based on organ dysfunction.

Methods: A prospective population-based study conducted over the three first pandemic waves between March 2020 and April 2021 in 281 maternity hospitals in six French regions included all women with SARS-CoV-2 infection during pregnancy or within 7 days post-partum, whether symptomatic or not, hospitalised or not. Severe COVID-19 forms were defined a priori using clinical, biological and management criteria of organ dysfunction. We calculated infection and severe infection rates and studied associations between sociodemographic, medical and pregnancy characteristics and severe COVID-19 by univariate and multivariate modified Poisson regression modelling.

Results: From a population of 385,214 deliveries in the participating regions, 6015 women with SARS-CoV-2 infection were identified, including 337 severe cases. The rates of severe COVID-19 were 1.1, 0.9 and 3.6 per 1000 deliveries during the first, second and third pandemic waves, respectively, and the proportions of severe COVID-19 were 8.6%, 3.4% and 9.3%, respectively. On multivariate analysis, the risk of severe COVID-19 was associated with younger and older age, migrant status, living with > 4 people, overweight or obesity, chronic hypertension or diabetes and infection ≥ 22 weeks of gestation rather than earlier in pregnancy. Neonatal morbidity occurred mostly with severe maternal infection.

Conclusion: Using an organ-based definition of severity and population-based data, rates of severe COVID-19 appeared lower than in previous studies. A permanent perinatal surveillance system is needed to assess efficiently and rapidly the impact of future pandemics.

Background: International comparisons of population birth data provide essential benchmarks for evaluating perinatal health policies.

Objectives: This study aimed to describe routine national data sources in Europe by their ability to provide core perinatal health indicators.

Methods: The Euro-Peristat Network collected routine national data on a recommended set of core indicators from 2015 to 2021 using a federated protocol based on a common data model with 16 data items. Data providers completed an online questionnaire to describe the sources used in each country. We classified countries by the number of data items they provided (all 16, 15-14, < 14).

Results: A total of 29 out of the 31 countries that provided data responded to the survey. Routine data sources included birth certificates (15 countries), electronic medical records (EMR) from delivery hospitalisations (16 countries), direct entry by health providers (9 countries), EMR from other care providers (7 countries) and Hospital Discharge Summaries (7 countries). Completeness of population coverage was at least 98%, with 17 countries reporting 100%. These databases most often included mothers giving birth in the national territory, regardless of nationality or place of residence (24 countries), whereas others register births to residents only. In 20 countries, routine sources were linked, including linkage between birth and death certificates (16 countries). Countries providing all 16 items (n = 8) were more likely to use EMRs from delivery hospitalisations (100%) compared to 50% and 11% in countries with 15-14 items (n = 12) and < 14 items (n = 9), respectively. Linkage was also more common in these countries (100%) versus 75% and 56%, respectively. Other data source characteristics did not differ by the ability to provide data on core perinatal indicators.

Conclusions: There are wide differences between countries in the data sources used to construct perinatal health indicators in Europe. Countries using EMR linking to other sources had the best data availability.

Background: Risk factors during adolescence appear to shape adult health, but little is known about how they are associated with pregnancy health.

Objectives: We aimed to assess whether a variety of adolescent risk factors with links to adult overweight or obesity are associated with pre-pregnancy obesity (Body Mass Index [BMI] ≥ 30 kg/m²) and high gestational weight gain (GWG; > 0.5 SD for pre-pregnancy BMI category and gestational age) in a cohort of women participating since adolescence in a longitudinal cohort.

Methods: At age 11-18 years participants reported on adolescent risk factors (overweight or obesity, healthy and unhealthy home food availability, food insufficiency, family meals, depressive symptoms, body dissatisfaction, weight teasing, binge eating, unhealthy weight control behaviours and dieting). Twenty years later, participants reporting a live birth (n = 656) recalled their pre-pregnancy weight and total GWG. Modified Poisson regression models were used to estimate associations of each factor with pre-pregnancy obesity and high GWG, adjusting for sociodemographics. We used Multivariate Imputation by Chained Equations to account for outcome misclassification using internal validation data.

Results: Eighteen percent of the sample had pre-pregnancy obesity and 26% had high GWG. Adolescent overweight or obesity (RR = 4.98, 95% CI 3.27, 7.57), body dissatisfaction (RR = 1.99; 95% CI: 1.31, 3.03) and unhealthy weight control behaviours (RR = 1.70; 95% CI: 1.06, 2.74), among other factors, were associated with pre-pregnancy obesity risk. For high GWG, there were imprecise associations with adolescent overweight or obesity (RR = 1.57; 95% CI: 1.06, 2.31), binge eating (RR = 1.36; 95% CI: 0.77, 2.39) and unhealthy weight control behaviours (RR = 1.38; 95% CI: 0.84, 2.25), among others.

Conclusions: Findings suggest that some risk markers for pre-pregnancy obesity (and possibly high GWG) may be apparent as early as adolescence. Supporting adolescent health and well-being might have a role in improving weight-related health in the perinatal period.