Paediatric and perinatal epidemiology最新文献

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.

Background: Limited longitudinal data exist on the associations of infertility with depressive symptoms across the lifecourse.

Objectives: To investigate how depressive symptoms change across specific life stages (pregnancy, postpartum, and midlife), with a focus on the differences between women with and without a history of infertility before index pregnancy.

Methods: Women enrolled in Project Viva (1999-2002) during early pregnancy (mean [SD] age 32.5 [4.7] years) completed the Edinburgh Postnatal Depression Scale (EPDS) in mid-pregnancy (median 27.9 weeks gestation) and at 6 months postpartum, and completed the Patient Health Questionnaire (PHQ-9) in midlife (2017-2021, 50.9 [5.1] years). We converted EPDS and PHQ-9 scores to externally standardised T-scores (mean = 50, SD = 10). We defined infertility before index pregnancy as ≥ 6 cycles to achieve pregnancy if ≥ 35 years of age or ≥ 12 cycles to achieve pregnancy if < 35 years of age, or claims for infertility treatments or prescriptions abstracted from medical records. We performed adjusted linear regression models to examine associations of infertility with depressive symptoms across the three-time spans (pregnancy-postpartum, postpartum-midlife, and pregnancy-midlife).

Results: Among 1368 participants, 281 (21%) experienced infertility at index pregnancy. Infertility was associated with a 1.83- point increase in depressive symptoms (T-score) between the postpartum period and midlife (adjusted $\beta$ 1.83, 95% confidence interval [CI] 0.00, 3.66). Infertility was unrelated to change in depressive symptoms between pregnancy and postpartum (adjusted $\beta$ 0.02, 95% CI -1.24, 1.28) or pregnancy and midlife (adjusted $\beta$ 1.30, -0.64, 3.23).

Conclusions: The experience of infertility among parous women is associated with a greater increase in depressive symptoms between the post-partum period and midlife.

Background: Infants born in the periviable period show an extremely high risk of infant death. At all gestational ages in the periviable period, non-Hispanic (NH) Black infants counterintuitively show relatively lower infant mortality risk than do NH white infants. The literature theorises that cohort variation over time in pregnancy loss (a form of left truncation in utero) could explain a portion of this survival advantage.

Objectives: We test this left truncation hypothesis in the US (Jan 1996 to Jun 2018) by focusing on NH Black singleton periviable males. We use twin sex ratios as a gauge of cohort left truncation against frail males.

Methods: We retrieved US birth and infant death records for all NH Black and NH white singleton infants born in the periviable range for 282 monthly conception cohorts. We used high and low outliers in the monthly sex ratio of extremely preterm twins (M:F), where a higher sex ratio indicates less selection against frail males. We applied augmented time-series methods which control for both autocorrelation and confounding.

Results: NH Black male periviable singleton infants show a stronger survival advantage (relative to NH whites) for cohorts with high outliers in left truncation (4.0 fewer deaths per 100 live births, 95% confidence interval 1.0, 7.2).

Conclusions: Elevated left truncation in utero may contribute to the survival advantage of NH Black male singletons in the periviable period. Observed racial/ethnic differences in infant mortality across conception cohorts vary, at least in part, from left truncation.

Background: In birth registries, incomplete recording of information leads to missing values. Multiple imputation (MI) by chained equations is a widely used method for analysing datasets with missing data. It is unknown whether using registry records from multiple pregnancies contributed by the same woman could potentially give more accurate values when resolving missing data.

Objectives: To investigate the relative performance of five methods to infer missing data on maternal characteristics using data from a medical birth registry, comparing longitudinal methods and MI with data from previous and future pregnancies.

Methods: We used data from the Medical Birth Registry of Norway (MBRN), selecting records among mothers with more than one pregnancy between 2004 and 2018. Longitudinal methods used reference pregnancies in three time directions: past, future and closest pregnancy record. MI was conducted with only index pregnancy records (single-pregnancy MI) and with both index and closest reference pregnancy records (multiple-pregnancy MI). Validity was assessed by comparing the actual values with inferred/imputed values. For continuous variables, we calculated the proportion of inferred values within predefined increments. For binary variables, we calculated five parameters: agreement rate, sensitivity, specificity, positive predictive value and negative predictive value.

Results: We included 578,670 pregnancies among 256,658 women. For continuous variables, the longitudinal methods showed the highest proportion within predefined increments, followed by multiple-pregnancy MI, and single-pregnancy MI showed the lowest value. For binary variables, longitudinal methods generally showed higher values among the five validity parameters than MI. Single-pregnancy MI had substantially lower agreement, while multiple-pregnancy MI performed similarly to longitudinal methods.

Conclusions: The longitudinal method outperformed MI in inferring missing data on maternal characteristics in a medical birth registry.

Background: In the United States, birthing parent-infant dyads may receive care from multiple healthcare systems. Linkage of an individual's electronic health records (EHR) across healthcare systems, in addition to birthing parent-infant linkage, may be necessary to obtain appropriate clinical data for perinatal health research.

Objectives: To develop a privacy-preserving process to link the health records of patients shared by two health systems for a perinatal health study, and to assess data enhancements associated with the linkage.

Methods: We included pregnant patients who received care from at least one of two healthcare systems based in Minnesota, USA and their infants born between December 2020 and September 2022 who had at least one well visit. We identified infants from one health system with birthing parents who potentially received care in the second health system based on the infant's delivery hospital. We implemented a one-way matching process using an algorithm to generate unique hash values for each record at each health system. Specifically, we used four hash ID rules based on six identifiers available in the EHR at both sites plus a consistent salt.

Results: One health system identified 3524 infants with birthing parents who potentially received care in the second system. The second system identified 39,321 infants delivered at the hospitals of interest during the study period. The algorithm matched 3406 (96.7%) infant records. After applying the study eligibility criteria, the birthing-parent records gained through hash matching increased the study population by 7.2% from 8100 to 8686. Overall, 13.6% of the study population had data from the second health system. Some demographic and pregnancy characteristics differed from those with data from the first system only.

Conclusions: The hash matching approach can increase study size, patient diversity, and data completeness in a privacy-preserving manner for perinatal health studies among patients that use multiple healthcare systems.

Background: Physical activity has time-varying associations with injury risk among children. While previous activity may predispose to injury through tissue damage, fatigue and insufficient recovery, it may protect against injury by strengthening tissues and improving fitness and skills. It is unclear what the relevant time window and relative importance of past activity are with regard to current injury risk in children.

Objectives: The objectives of this study were to assess how previous activity patterns are associated with injury risk among children.

Methods: Our data source was the Childhood Health, Activity, and Motor Performance School Study Denmark (CHAMPS-DK), a prospective cohort study of Danish school children conducted between 2008 and 2014. We applied flexible weighted cumulative exposure methods within a Cox proportional hazards model to estimate the time-varying association between the number of weekly activity sessions and time-to-first injury in each school year. We estimated several models with varying time windows and compared goodness-of-fit.

Results: Out of 1667 study participants, 986 (59.1%) were injured at least once, with a total of 1752 first injuries across school years. The best-fitting model included 20 weeks of past physical activity. Higher levels of activity performed 10-20 weeks ago were associated with decreased injury risk, while higher levels of activity performed 2-9 weeks ago were associated with higher injury risks. Compared to those who remained minimally active for the entire past 20-week period, children who were highly active in the past 10 weeks after being minimally active 11-20 weeks ago had an injury hazard ratio of 1.63 (95% confidence interval 1.18, 2.23).

Conclusions: Flexible weighted cumulative exposure methods suggest a complex temporal relationship between past physical activity history and injury in children.