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Khan MN, Harris ML. Association between maternal high-risk fertility behaviour and perinatal mortality in Bangladesh: Evidence from the Demographic and Health Survey. PLoS One 2023; 18:e0294464. [PMID: 38011092 PMCID: PMC10681254 DOI: 10.1371/journal.pone.0294464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 11/02/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND High-risk fertility behaviours including pregnancy early or late in the reproductive life course, higher parity and short birth intervals are ongoing concerns in Low- and Middle-Income Countries (LMICs) such as Bangladesh. Although such factors have been identified as major risk factors for perinatal mortality, there has been a lack of progress in the area despite the implementation of the Millennium and Sustatinable Development Goals. We therefore explored the effects of high-risk maternal fertility behaviour on the occurrence of perinatal mortality in Bangladesh. METHODS A total of 8,930 singleton pregnancies of seven or more months gestation were extracted from 2017/18 Bangladesh Demographic and Health Survey for analysis. Perinatal mortality was the outcome variable (yes, no) and the primary exposure variable was high-risk fertility behaviour in the previous five years (yes, no). The association between the exposure and outcome variable was determined using a mixed-effect multilevel logistic regression model, adjusted for covariates. RESULTS Forty-six percent of the total births that occurred in the five years preceding the survey were high-risk. After adjusting for potential confounders, a 1.87 times (aOR, 1.87, 95% CI, 1.61-2.14) higher odds of perinatal mortality was found among women with any high-risk fertility behaviour as compared to women having no high-risk fertility behaviours. The odds of perinatal mortality were also found to increase in line with an increasing number of high-risk behaviour. A 1.77 times (95% CI, 1.50-2.05) increase in odds of perinatal mortality was found among women with single high-risk fertility behaviour and a 2.30 times (95% CI, 1.96-2.64) increase in odds was found among women with multiple high-risk fertility behaviours compared to women with no high-risk fertility behaviour. CONCLUSION Women's high-risk fertility behaviour is an important predictor of perinatal mortality in Bangladesh. Increased contraceptive use to allow appropriate birth spacing, educational interventions around the potential risks associated with high risk fertility behaviour (including short birth interval) in future pregnacies, and improved continuity of maternal healthcare service use among this population are required to improve birth outcomes in Bangladesh.
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Affiliation(s)
- Md. Nuruzzaman Khan
- Deartment of Population Science, Jatiya Kabi Nazrul Islam University, Mymensingh, Bangladesh
- Centre for Women’s Health Research, University of Newcastle, Callaghan, Australia
| | - Melissa L. Harris
- Centre for Women’s Health Research, University of Newcastle, Callaghan, Australia
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Song D, Jelks A, Narasimhan SR, Jegatheesan P. Cord management strategies in multifetal gestational births. Semin Perinatol 2023:151743. [PMID: 37005172 DOI: 10.1016/j.semperi.2023.151743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
Multifetal gestations are associated with high risks of neonatal mortality and morbidities primarily due to prematurity. Delayed cord clamping and cord milking facilitate the postnatal transition and improve outcomes. Limited evidence shows that delayed cord clamping for 30-60 s and cord milking are feasible without causing harm and potentially beneficial in uncomplicated multifetal deliveries. However, data on maternal bleeding from the limited studies are inconsistent. Based on current knowledge of the risk vs. benefits, it is reasonable to perform delayed cord clamping or cord milking (>28 weeks of gestation) in uncomplicated monochorionic and dichorionic multiples. Clearly defined criteria for suitable candidates, indications for clamping or milking the cord during delivery, and improved obstetric techniques in Cesarean deliveries are critical to minimize risks and optimize neonatal transition. Research is needed to identify safe and optimal cord-management strategies for improving survival and long-term outcomes in this high-risk population.
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Affiliation(s)
- Dongli Song
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA 95128, USA; Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Andrea Jelks
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Santa Clara Valley Medical Center, San Jose, CA, USA; Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Sudha Rani Narasimhan
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA 95128, USA; Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Priya Jegatheesan
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA 95128, USA; Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
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Bruckner TA, Bustos B, Margerison C, Gemmill A, Casey J, Catalano R. Selection in utero against male twins in the United States early in the COVID-19 pandemic. Am J Hum Biol 2023; 35:e23830. [PMID: 36333973 PMCID: PMC10023263 DOI: 10.1002/ajhb.23830] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 10/13/2022] [Accepted: 10/16/2022] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES We aim to contribute to the literature reporting tests of selection in utero. The theory of reproductive suppression predicts that natural selection would conserve mechanisms, referred to collectively as selection in utero, that spontaneously abort fetuses unlikely to thrive as infants in the prevailing environment. Tests of this prediction include reports that women give birth to fewer than expected male twins, historically among the frailest of infants, during stressful times. The onset of the COVID-19 pandemic in the United States in Spring 2020 demonstrably stressed the population. We test the hypothesis that conception cohorts in gestation at the onset of the pandemic in the United States yielded fewer than expected live male twin births. METHODS We retrieved deidentified data on the universe of live births in the United States from the National Center for Health Statistics birth certificate records. We applied Box-Jenkins time-series methods to the twin secondary sex ratio computed for 77 monthly conception cohorts spanning August 2013 to December 2019 to detect outlying cohorts in gestation at the onset of the pandemic. RESULTS The twin secondary sex ratio fell below expected values in three conception cohorts (i.e., July, September, and October 2019, all p < .05) exposed in utero to the onset of the pandemic. CONCLUSIONS Our results add to prior findings consistent with selection in utero. The role of selection in utero in shaping the characteristics of live births cohorts, especially during the COVID-19 pandemic, warrants further scrutiny.
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Affiliation(s)
- Tim A Bruckner
- Department of Health, Society, and Behavior, and the Center for Population, Inequality, and Policy, University of California, Irvine, California, USA
| | - Brenda Bustos
- Program in Public Health, University of California, Irvine, California, USA
| | - Claire Margerison
- Deparment of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, USA
| | - Alison Gemmill
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Joan Casey
- Department of Environmental Health Sciences, Columbia Mailman School of Public Health, New York, USA
| | - Ralph Catalano
- School of Public Health, University of California, Berkeley, California, USA
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Loussert L, Deneux-Tharaux C, Seco A, Goffinet F, Korb D, Schmitz T. Postpartum severe acute maternal morbidity according to gestational age at delivery in twin pregnancies: A prospective cohort study. Int J Gynaecol Obstet 2022; 161:1019-1027. [PMID: 36527250 DOI: 10.1002/ijgo.14628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 11/22/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To assess the association between gestational age at delivery and postpartum severe acute maternal morbidity (SAMM) in twin pregnancies. METHODS Secondary analysis of the JUMODA cohort, a national, prospective, population-based study of twin pregnancies in France. We excluded women with delivery before 32 weeks of pregnancy, with a fetal death or medical termination, with antepartum SAMM, or with antepartum conditions responsible for postpartum SAMM. The primary outcome was a composite of postpartum SAMM. We assessed the association between gestational age at delivery and SAMM by using multivariable multilevel modified Poisson regression modeling. RESULTS Among the 7713 women included, 410 (5.3%) developed postpartum SAMM. Compared with the reference category of 37 weeks of pregnancy, the risk of postpartum SAMM was significantly lower for all categories of earlier gestational age at delivery (from an adjusted relative risk [RR] of 0.34, 95% confidence interval [CI] 0.17-0.68 at 32 weeks to an adjusted RR of 0.71, 95% CI 0.54-0.94 at 36 weeks), and did not differ for later gestational ages. CONCLUSION In twin pregnancies, compared with delivery at 37 weeks of pregnancy, delivery at earlier gestational ages was associated with a lower risk of postpartum SAMM. Continuing pregnancy beyond 37 weeks of pregnancy is not associated with an increased risk of postpartum SAMM.
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Affiliation(s)
- Lola Loussert
- Université de Paris, Centre for Research in Epidemiology and Statistics (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team - INSERM U1153, Paris, France.,Department of Obstetrics and Gynecology, CHU Toulouse, Toulouse, France
| | - Catherine Deneux-Tharaux
- Université de Paris, Centre for Research in Epidemiology and Statistics (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team - INSERM U1153, Paris, France
| | - Aurélien Seco
- Clinical Research Unit Necker Cochin, APHP, Paris, France
| | - François Goffinet
- Université de Paris, Centre for Research in Epidemiology and Statistics (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team - INSERM U1153, Paris, France.,Port-Royal Maternity Unit, Cochin Hospital, APHP, Paris, France
| | - Diane Korb
- Université de Paris, Centre for Research in Epidemiology and Statistics (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team - INSERM U1153, Paris, France.,Department of Obstetrics and Gynecology, Robert Debré Hospital, APHP, Paris, France
| | - Thomas Schmitz
- Université de Paris, Centre for Research in Epidemiology and Statistics (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team - INSERM U1153, Paris, France.,Department of Obstetrics and Gynecology, Robert Debré Hospital, APHP, Paris, France
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Mahamid A, Wainstock T, Sheiner E, Rosenberg E, Kluwgant D, Pariente G. Perinatal outcome and long-term infectious hospitalizations of offspring born to women with known drug allergy. Am J Reprod Immunol 2022; 88:e13608. [PMID: 36006619 DOI: 10.1111/aji.13608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/26/2022] [Accepted: 08/01/2022] [Indexed: 11/30/2022] Open
Abstract
PROBLEM Maternal drug allergy has been associated with altered immune status and an inflammatory environment, which may affect the risk of future infectious diseases in the offspring. OBJECTIVES We aimed to evaluate perinatal outcomes and long-term infectious hospitalization in the offspring of women with documented drug allergy. METHOD OF STUDY The study was conducted at the Soroka University Medical Center, a tertiary medical center. For perinatal outcomes, generalized estimation equation (GEE) models were used controlling for maternal age, maternal diabetes mellitus, smoking, and hypertensive disorders. The study groups were followed until 18 years of age for infectious-related hospitalizations. A Kaplan-Meier survival-curve was used to compare cumulative incidence of long-term infectious hospitalizations. A Cox proportional hazards model was conducted to control for confounders. RESULTS During the study period, 243,682 deliveries met the inclusion criteria, of which 9,756 (4.0%) occurred in women with documented drug allergy. Using GEE, maternal drug allergy was found to be a significant independent risk factor for hypertensive disorders, diabetes mellitus, intra-uterine growth restriction (IUGR) and preterm delivery. Offspring also had significantly higher rates of long-term infectious hospitalizations. Kaplan-Meier survival-curves demonstrated significantly higher cumulative incidence rates of infectious hospitalization (log rank p<0. 001). In a Cox proportional hazards model, being born to a mother with documented a drug allergy was independently associated with infectious hospitalization of the offspring in the long-term. CONCLUSIONS Maternal documented drug allergy is independently associated with adverse perinatal outcome such as IUGR and preterm delivery and increased risk of long- term infectious hospitalization of the offspring. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Assil Mahamid
- Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tamar Wainstock
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Elli Rosenberg
- Adult Clinical Immunology and Allergy Service, University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Dvora Kluwgant
- School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Gali Pariente
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Hayata E, Nakata M, Morita M. Time trend analysis of perinatal mortality, stillbirth, and early neonatal mortality of multiple pregnancies for each gestational week from the year 2000 to 2019: A population-based study in Japan. PLoS One 2022; 17:e0272075. [PMID: 35877663 PMCID: PMC9312402 DOI: 10.1371/journal.pone.0272075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 07/12/2022] [Indexed: 11/18/2022] Open
Abstract
Multiple pregnancies pose a high risk of morbidity and mortality in both mothers and infants; thus, obtaining reliable information based on a large population is essential to improve management. We used the maternal and child health statistics, which are published annually, from the database of the Ministry of Health, Labor, and Welfare. The data obtained were aggregated in 5-year intervals, and we used them to analyze the proportion of the number of births for each week of pregnancy to the total of each singleton and multiple pregnancy. For perinatal health indicators (perinatal mortality, stillbirth, and neonatal mortality), the obtained data were calculated and plotted on graphs for each week of pregnancy. Moreover, these indicators were calculated by dividing them into first twin and second twin fetuses. Stillbirth weights were aggregated in several groups, and a histogram was displayed. Between 2000 and 2019, there were 21,068,275 live births, 67,666 stillbirths, and 16,443 early neonatal deaths, excluding 7,148 (7,104 singletons, 44 multiple births) cases, in which the exact gestational weeks at birth were unknown. More than 95% of multiple pregnancies were twin births. Perinatal mortality, stillbirth, and early neonatal mortality rates in multiple pregnancies were the lowest at approximately 37 weeks of gestation and lower than those of single pregnancies at approximately 36 weeks of gestation. Perinatal mortality and stillbirth rates were higher during the delivery of the second twins than the first-born twins, but the early neonatal mortality rate remained approximately the same during the delivery of both twins. As the data in the government database are accumulated and published continuously, indicators can be calculated in the future using the method presented in this study. Further, our findings may be useful for policymaking related to managing multiple pregnancies.
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Affiliation(s)
- Eijiro Hayata
- Department of Obstetrics and Gynecology, Toho University School of Medicine, Tokyo, Japan
| | - Masahiko Nakata
- Department of Obstetrics and Gynecology, Toho University School of Medicine, Tokyo, Japan
- * E-mail:
| | - Mineto Morita
- Department of Obstetrics and Gynecology, Toho University School of Medicine, Tokyo, Japan
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Chen P, Li M, Mu Y, Wang Y, Liu Z, Li Q, Li X, Dai L, Xie Y, Liang J, Zhu J. Temporal trends and adverse perinatal outcomes of twin pregnancies at differing gestational ages: an observational study from China between 2012–2020. BMC Pregnancy Childbirth 2022; 22:467. [PMID: 35659606 PMCID: PMC9164484 DOI: 10.1186/s12884-022-04766-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 05/17/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
With the development of assisted reproductive technology, the twinning rate in China has been increasing. However, little is known about twinning from 2014 onwards. In addition, previous studies analysing optimal gestational times have rarely considered maternal health conditions. Therefore, whether maternal health conditions affect the optimal gestational time remains unclear.
Methods
Data of women delivered between January 2012 and December 2020 were collected through China’s National Maternal Near Miss Surveillance System. Interrupted time series analysis was used to determine the rates of twinning, stillbirth, smaller than gestational age (SGA), and low Apgar scores (< 4) among twins in China. To estimate the risk of each adverse perinatal outcome for separate gestational weeks, a multivariate generalised linear model was used. Infants born at 37 weeks of gestational age or foetuses staying in utero were used as reference separately. The analyses were adjusted for the sampling distribution of the population and the cluster effect at the hospital and individual levels were considered.
Results
There were 442,268 infants enrolled in this study, and the adjusted rates for twinning, stillbirth, SGA, and low Apgar scores were 3.10%, 1.75%, 7.70%, and 0.79%, respectively. From 2012 to 2020, the twinning rate showed an increasing trend. Adverse perinatal outcomes, including stillbirth, SGA, and low Apgar scores showed a decreasing trend. A gestational age between 34 and 36 weeks decreased most for rate of stillbirth (average changing rate -9.72%, 95% confidence interval [CI] -11.41% to -8.00%); and a gestational age of between 37 and 38 weeks decreased most for rates of SGA (average changing rate -4.64%, 95% CI -5.42% to -3.85%) and low Apgar scores (average changing rate -17.61%, 95% CI -21.73% to -13.26%). No significant difference in changes in twinning rate or changes of each perinatal outcome was observed during periods of different fertility policies. Infants born at 37 weeks of gestation had a decreased risk of stillbirth, SGA, and low Apgar scores. Maternal antepartum or medical complications increased the risk of SGA and low Apgar scores in different gestational weeks.
Conclusion
China’s twinning rate showed an increasing trend, while adverse perinatal outcomes decreased from 2012 to 2020. Fertility policy changes have had little effect on the twinning rate or the rate of adverse perinatal outcomes such as stillbirth, SGA, or low Apgar scores. The optimal gestational age for twins was 37 weeks. Women pregnant with twins and with antepartum or medical complications should be cautious due to an increased risk of SGA and low Apgar scores.
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Giles-Clark HJ, McGannon C, Mol BW. When should twins be delivered? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 59:713-714. [PMID: 35229929 DOI: 10.1002/uog.24894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 02/21/2022] [Indexed: 06/14/2023]
Affiliation(s)
- H J Giles-Clark
- Department of Obstetrics & Gynaecology, Monash University, Monash Medical Centre, Australia
| | - C McGannon
- Department of Obstetrics & Gynaecology, Monash University, Monash Medical Centre, Australia
| | - B W Mol
- Department of Obstetrics & Gynaecology, Monash University, Monash Medical Centre, Australia
- Aberdeen Centre for Women's Health Research, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
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Cho GJ, Cho KD, Kim HY, Ha S, Oh MJ, Won HS, Chung JH. Short-term neonatal and long-term infant outcome of late-preterm twins: nationwide population-based study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 59:763-770. [PMID: 34931725 DOI: 10.1002/uog.24838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 11/04/2021] [Accepted: 12/02/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To evaluate the short- and long-term outcome of late-preterm compared with term birth in twin pregnancy. METHODS This retrospective observational cohort study included all women who had a twin delivery between 1 January 2007 and 31 December 2010 recorded in the claims database of the Korea National Health Insurance, with at least one follow-up recorded in the database of the National Health Screening Program for Infants and Children. Outcomes were analyzed at the pregnancy level, with adverse outcome being defined as an adverse outcome in one or both twins, identified by a diagnosis according to the International Classification of Diseases 10th Revision. The primary short-term outcome was composite morbidity, which included any of the following: transient tachypnea, respiratory distress syndrome, necrotizing enterocolitis, intraventricular hemorrhage and bronchopulmonary dysplasia. Long-term adverse outcome included any neurological or neurodevelopmental outcome, defined by prespecified neurological and developmental diagnoses; these were assessed by following up all neonates until the end of 2018, by which time they were 8-11 years of age. Outcomes were compared between twins delivered late preterm (34 + 0 to 36 + 6 weeks) and those delivered at term (≥ 37 weeks). RESULTS Among 17 189 women who delivered twins at ≥ 34 weeks of gestation during the study period, 5032 (29.27%) women delivered in the late-preterm period. On multivariate analysis, compared with the twins delivered at term, the late-preterm twins had an increased risk for the primary short-term outcome of composite morbidity (adjusted odds ratio (aOR), 2.09; 95% CI, 1.90-2.30), including transient tachypnea (aOR, 1.85; 95% CI, 1.64-2.09), respiratory distress syndrome (aOR, 2.31; 95% CI, 2.04-2.62), necrotizing enterocolitis (aOR, 2.10; 95% CI, 1.20-3.69) and intraventricular hemorrhage (aOR, 2.13; 95% CI, 1.46-3.11). For the long-term outcome, the late-preterm twins also had an increased risk for any neurological or neurodevelopmental outcome (adjusted hazard ratio, 1.14; 95% CI, 1.07-1.21). CONCLUSIONS Twins delivered in the late-preterm period have an increased risk for short- and long-term morbidity compared with twins delivered at term. These results should be considered when determining the timing of delivery in uncomplicated twin pregnancy. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- G J Cho
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - K-D Cho
- Big Data Department, National Health Insurance Service, Gangwon-do, Korea
| | - H Y Kim
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - S Ha
- Graduate School of Statistics, Sungkyunkwan University, Seoul, Korea
| | - M-J Oh
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - H-S Won
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - J H Chung
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Wehby GL. Gestational Age, Newborn Metabolic Markers and Academic Achievement. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031549. [PMID: 35162571 PMCID: PMC8834716 DOI: 10.3390/ijerph19031549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/19/2022] [Accepted: 01/26/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Gestational age is associated with greater school achievement and variation in newborn metabolic markers. Whether metabolic markers are related to gestational age differences in achievement is unknown. This study examines whether newborn metabolic markers are associated with gestational age differences in performance on standardized school tests. METHODS This retrospective cohort study linked birth certificates of children born in Iowa between 2002 and 2010 to newborn screening records and school tests between 2009 and 2018. The analytical sample includes up to 229,679 children and 973,247 child-grade observations. Regression models estimate the associations between gestational age and 37 newborn metabolic markers with national percentile ranking (NPR) scores on math, reading comprehension, and science tests. RESULTS An additional gestational week is associated with 0.6 (95% CI: 0.6, 0.7), 0.5 (95% CI: 0.4, 0.5), and 0.4 (95% CI: 0.4, 0.5) higher NPRs on math, reading, and science, respectively. Compared to full term children (37-44 weeks), preterm children (32-36 weeks) have 2.2 (95% CI: -2.6, -1.8), 1.5 (95% CI: -1.9, -1.1), and 1.0 (95% CI: -1.4, -0.7) lower NPRs on math, reading comprehension, and science. Very preterm children (20-31 weeks) have 8.3 (95% CI: -9.4, -7.2), 5.2 (95% CI: -6.2, -4.0), and 4.7 (95% CI: -5.6, -3.8) lower NPRs than full term children on math, reading, and science. Metabolic markers are associated with 27%, 36%, and 45% of gestational age differences in math, reading, and science scores, respectively, and over half of the difference in test scores between preterm or very preterm and full term children. CONCLUSIONS Newborn metabolic markers are strongly related to gestational age differences in school test scores, suggesting that early metabolic differences are important markers of long-term child development.
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Affiliation(s)
- George L. Wehby
- Department of Health Management and Policy, University of Iowa, Iowa City, IA 52242, USA;
- Department of Economics, University of Iowa, Iowa City, IA 52242, USA
- Department of Preventive & Community Dentistry, University of Iowa, Iowa City, IA 52242, USA
- Public Policy Center, University of Iowa, Iowa City, IA 52242, USA
- National Bureau of Economic Research, Cambridge, MA 02138, USA
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Catalano R, Bruckner T, Casey JA, Gemmill A, Margerison C, Hartig T. Twinning during the pandemic: Evidence of selection in utero. Evol Med Public Health 2021; 9:374-382. [PMID: 34858596 PMCID: PMC8634460 DOI: 10.1093/emph/eoab033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/10/2021] [Indexed: 11/13/2022] Open
Abstract
Background and objectives The suspicion that a population stressor as profound as the COVID-19 pandemic would increase preterm birth among cohorts in gestation at its outset has not been supported by data collected in 2020. An evolutionary perspective on this circumstance suggests that natural selection in utero, induced by the onset of the pandemic, caused pregnancies that would otherwise have produced a preterm birth to end early in gestation as spontaneous abortions. We test this possibility using the odds of a live-born twin among male births in Norway as an indicator of the depth of selection in birth cohorts. Methodology We apply Box–Jenkins methods to 50 pre-pandemic months to estimate counterfactuals for the nine birth cohorts in gestation in March 2020 when the first deaths attributable to SARS-CoV-2 infection occurred in Norway. We use Alwan and Roberts outlier detection methods to discover any sequence of outlying values in the odds of a live-born twin among male births in exposed birth cohorts. Results We find a downward level shift of 27% in the monthly odds of a twin among male births beginning in May and persisting through the remainder of 2020. Conclusions and implications Consistent with evolutionary theory and selection in utero, birth cohorts exposed in utero to the onset of the COVID-19 pandemic yielded fewer male twins than expected. Lay Summary Our finding of fewer than expected male twin births during the onset of the COVID-19 pandemic provides more evidence that evolution continues to affect the characteristics and health of contemporary populations.
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Affiliation(s)
- Ralph Catalano
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Tim Bruckner
- Program in Public Health and Center for Population, Inequality and Policy, University of California, Irvine, Irvine, CA, USA
| | - Joan A Casey
- Environmental Health Sciences, Columbia University, New York, NY, USA
| | - Alison Gemmill
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Claire Margerison
- Department of Epidemiology & Biostatistics, Michigan State University, East Lansing, MI, USA
| | - Terry Hartig
- Institute for Housing and Urban Research, Uppsala University, Uppsala, Sweden
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Ratsch A, Bogossian F, Burmeister EA, Steadman K. Central Australian Aboriginal women's placental and neonatal outcomes following maternal smokeless tobacco, cigarette or no tobacco use. Aust N Z J Public Health 2021; 46:186-195. [PMID: 34821425 DOI: 10.1111/1753-6405.13186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 09/01/2021] [Accepted: 10/01/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To describe the placental characteristics and neonatal outcomes of Central Australian Aboriginal women based on maternal self-report of tobacco use. METHODS Placental and neonatal variables were collected from a prospective maternal cohort of 19 smokeless tobacco chewers, 23 smokers and 31 no-tobacco users. RESULTS Chewers had the lowest placental weight (460 g) while the no-tobacco group had the heaviest placental weight (565 g). Chewers and the no-tobacco group had placental areas of similar size (285 cm2 and 288 cm2 , respectively) while the placentas of smokers were at least 13 cm2 smaller (272 cm2 ). There were two stillbirths in the study and more than one-third (36%) of neonates (newborns) were admitted to the Special Care Nursery, with the chewers' neonates having a higher admission rate compared with smokers' neonates (44% vs. 23%). The cohort mean birthweight (3348 g) was not significantly different between the groups. When stratified for elevated maternal glucose, the chewers' neonates had the lowest mean birthweight (2906 g) compared to the neonates of the no-tobacco group (3242 g) and smokers (3398 g). CONCLUSIONS This research is the first to demonstrate that the maternal use of Australian Nicotiana spp. (pituri) as smokeless tobacco may negatively impact placental and neonatal outcomes. Implications for public health: Maternal smokeless tobacco use is a potential source of placental and foetal nicotine exposure. Maternal antenatal screening should be expanded to capture a broader range of tobacco and nicotine products, and appropriate cessation support is required.
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Affiliation(s)
- Angela Ratsch
- Wide Bay Hospital and Health Services, Queensland.,Rural Clinical School, The University of Queensland, Queensland
| | - Fiona Bogossian
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Queensland.,School of Nursing, Midwifery and Social Work, The University of Queensland, Queensland
| | - Elizabeth A Burmeister
- Wide Bay Hospital and Health Services, Queensland.,School of Nursing, Midwifery and Social Work, The University of Queensland, Queensland
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Yu FNY, Mak ASL, Chan NM, Siu KL, Ma TWL, Leung KY. Prospective risk of stillbirth and neonatal complications for monochorionic diamniotic and dichorionic diamniotic twins after 24 weeks of gestation. J Obstet Gynaecol Res 2021; 47:3127-3135. [PMID: 34137119 DOI: 10.1111/jog.14866] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 05/07/2021] [Accepted: 05/16/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Our study compared the prospective risks of intrauterine fetal death (IUFD), neonatal death (NND), perinatal death (PND), and neonatal morbidities in monochorionic diamniotic (MCDA) and dichorionic diamniotic (DCDA) twin pregnancies. METHODS This retrospective cohort study included twin pregnancies who had antenatal care and delivery in a public hospital from 2011 to 2018. Exclusion criteria included monoamnionicity, one/both twin miscarriage, twin-twin transfusion syndrome, or lethal congenital abnormalities. All twins were managed in multiple pregnancy clinic with standardized protocols. Gestational age-specific IUFD, NND, PND, and neonatal morbidity rates were compared according to chorionicity. RESULTS Three hundred seventy-eight MCDA and 1282 DCDA twins were included. MCDA twins had higher risks of PND (1.9% vs. 0.7% in DCDA twins, p = 0.05), composite neonatal morbidity (p = 0.01), preterm delivery (p < 0.01), and low birth weight (p < 0.01). The prospective risk of IUFD was 0.6% and 0.4% for MCDA and DCDA twins, respectively after 34 weeks' gestation. No NND occurred among deliveries after 30 weeks. The risk of neonatal morbidity of MCDA twins fell from 22.7% at 34 weeks to 2.7% at 37 weeks (p < 0.01). For DCDA twins, the risk of morbidity fell insignificantly from 36 to 38 weeks (4.0% vs. 3.4%, p = 0.60). Logistic regression analysis suggested that the increased risk of perinatal morbidities was related to the higher rate of preterm delivery in MCDA twins rather than chorionicity. CONCLUSION With close fetal monitoring, the risk of late IUFD in twin pregnancies without major complications is low. Perinatal morbidity can be minimized by avoiding late preterm deliveries in twin pregnancies.
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Affiliation(s)
- Florrie Nga Yui Yu
- Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, Hong Kong Special Administrative Region, China
| | - Annisa Shui Lam Mak
- Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, Hong Kong Special Administrative Region, China
| | - Ngai Man Chan
- Department of Paediatrics, Queen Elizabeth Hospital, Hong Kong Special Administrative Region, China
| | - Kiu Lok Siu
- Department of Paediatrics, Queen Elizabeth Hospital, Hong Kong Special Administrative Region, China
| | - Teresa Wei Ling Ma
- Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, Hong Kong Special Administrative Region, China
| | - Kwok Yin Leung
- Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, Hong Kong Special Administrative Region, China.,Gleneagles Hong Kong, Hong kong Special Administrative Region, China
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Amir-Ud-Din R, Naz L, Rubi A, Usman M, Ghimire U. Impact of high-risk fertility behaviours on underfive mortality in Asia and Africa: evidence from Demographic and Health Surveys. BMC Pregnancy Childbirth 2021; 21:344. [PMID: 33933011 PMCID: PMC8088561 DOI: 10.1186/s12884-021-03780-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 04/07/2021] [Indexed: 11/29/2022] Open
Abstract
Background Maternal age < 18 or > 34 years, short inter-pregnancy birth interval, and higher birth order are considered to be high-risk fertility behaviours (HRFB). Underfive mortality being disproportionately concentrated in Asia and Africa, this study analyses the association between HRFB and underfive mortality in selected Asian and African countries. Methods This study used Integrated Public Microdata Series-Demographic and Health Surveys (IPUMS-DHS) data from 32 countries in sub-Saharan Africa, Middle East, North Africa and South Asia from 1986 to 2017 (N = 1,467,728). Previous evidence hints at four markers of HRFB: women’s age at birth of index child < 18 or > 34 years, preceding birth interval < 24 months and child’s birth order > 3. Using logistic regression, we analysed change in the odds of underfive mortality as a result of i) exposure to HRFB individually, ii) exposure to any single HRFB risk factor, iii) exposure to multiple HRFB risk factors, and iv) exposure to specific combinations of HRFB risk factors. Results Mother’s age at birth of index child < 18 years and preceding birth interval (PBI) < 24 months were significant risk factors of underfive mortality, while a child’s birth order > 3 was a protective factor. Presence of any single HRFB was associated with 7% higher risk of underfive mortality (OR 1.07; 95% CI 1.04–1.09). Presence of multiple HRFBs was associated with 39% higher risk of underfive mortality (OR 1.39; 95% CI 1.36–1.43). Some specific combinations of HRFB such as maternal age < 18 years and preceding birth interval < 24 month significantly increased the odds of underfive mortality (OR 2.07; 95% CI 1.88–2.28). Conclusion Maternal age < 18 years and short preceding birth interval significantly increase the risk of underfive mortality. This highlights the need for an effective legislation to curb child marriages and increased public investment in reproductive healthcare with a focus on higher contraceptive use for optimal birth spacing. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03780-y.
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Affiliation(s)
- Rafi Amir-Ud-Din
- Department of Economics, COMSATS University Islamabad, Lahore Campus, Lahore, Pakistan
| | - Lubna Naz
- Department of Economics, Karachi University, Karachi, Pakistan
| | - Aneela Rubi
- Research Scholar, Department of Economics, COMSATS University Islamabad, Lahore, Pakistan
| | - Muhammad Usman
- Department of Management Sciences, COMSATS University, Islamabad, Lahore Campus, Lahore, Pakistan
| | - Umesh Ghimire
- New ERA, Kalopul, Rudramati Marga, Kathmandu, 44600, Bagmati, Nepal.
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