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Thornton HV, Cornish RP, Lawlor DA. Non-linear associations of maternal pre-pregnancy body mass index with risk of stillbirth, infant, and neonatal mortality in over 28 million births in the USA: a retrospective cohort study. EClinicalMedicine 2023; 66:102351. [PMID: 38125933 PMCID: PMC10730341 DOI: 10.1016/j.eclinm.2023.102351] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/15/2023] [Accepted: 11/17/2023] [Indexed: 12/23/2023] Open
Abstract
Background Higher maternal pre-pregnancy body mass index (BMI) has been associated with higher risk of stillbirth, infant and neonatal mortality. Studies exploring underweight have varied in their conclusions. Our aim was to examine the risk of stillbirth, infant and neonatal mortality across the BMI distribution and establish a likely healthy BMI range. Methods In this retrospective cohort study, we used publicly available datasets (covering 1st January 2014 to 31st December 2021) from the US National Center for Health Statistics National Vital Statistics System. All births were eligible; analyses included those with non-missing data. Fractional polynomial multivariable logistic regression was used to examine the associations of maternal pre-pregnant BMI with stillbirth (birth with no signs of life at ≥24 weeks), infant mortality (death of a live born baby aged <365 days) and neonatal mortality (death of a live born baby aged <28 days). Findings There were 77,896/28,310,154 (2.8 per 1000 births) stillbirths, 143,620/28,231,807 (5.1 per 1000 live births) infant deaths and 94,246/28,231,807 (3.3 per 1000 live births) neonatal deaths among complete cases. Mean (SD) BMI was 27.1 kg/m2 (6.7 kg/m2). We found non-linear associations between BMI and all three outcomes; risk was elevated at both low and high BMIs although, for stillbirth, the increased risk at low BMI was less marked than for infant/neonatal mortality. The lowest risk was at a BMI of 21 kg/m2 for infant and neonatal mortality and 19 kg/m2 for stillbirth. Interpretation Public health messaging for preconception and postnatal care should focus on healthy weight to maximise maternal and child health, and not focus solely on maternal overweight or obesity. Funding European Research Council, US National Institute of Health, UK Medical Research Council and National Institute for Health and Care Research.
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Affiliation(s)
- Hannah V. Thornton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Rosie P. Cornish
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
| | - Deborah A. Lawlor
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Bristol National Institute for Health Research Biomedical Research Centre, University of Bristol, Bristol, UK
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2
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Abstract
Disparities in infant mortality by race and Hispanic origin groups continue to persist in the United States. Maternal and infant characteristics known to be associated with infant mortality vary by race and ethnicity. This report describes racial and ethnic disparities in infant mortality in the United States using the 2017-2018 cohort linked birth/infant death files from the National Vital Statistics System. Distributions of births and infant mortality rates are described by selected maternal and infant characteristics. Adjusted rates and rate ratios from logistic regression models, compared to unadjusted rates and ratios, show the extent to which race and Hispanic origin disparities would be attenuated if all groups had the same distributions of select maternal and infant factors. Results support the premise that the different distributions of several variables across racial/ethnic groups, most notably gestational age, account for a significant portion of the disparities in infant mortality between racial/ethnic groups.
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Affiliation(s)
- Anne K Driscoll
- Division of Vital Statistics, National Center for Health Statistics, USA.
| | - Danielle M Ely
- Division of Vital Statistics, National Center for Health Statistics, 3311 Toledo Rd, Rm 5442, Hyattsville, MD 20782, USA
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3
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Abebe SY, Goldsby EA, Hall G. Commentary: Infant Mortality Among African Americans, Using Life Course Perspective to Encourage Transformation. FAMILY & COMMUNITY HEALTH 2022; 45:160-162. [PMID: 35385416 DOI: 10.1097/fch.0000000000000325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Sheila Y Abebe
- School of Nursing, Ball State University, Muncie, Indiana
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4
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Letouzey M, Lorthe E, Marchand-Martin L, Kayem G, Charlier C, Butin M, Mitha A, Kaminski M, Benhammou V, Ancel PY, Boileau P, Foix-L'Hélias L. Early Antibiotic Exposure and Adverse Outcomes in Very Preterm Infants at Low Risk of Early-Onset Sepsis: The EPIPAGE-2 Cohort Study. J Pediatr 2022; 243:91-98.e4. [PMID: 34942178 DOI: 10.1016/j.jpeds.2021.11.075] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 10/06/2021] [Accepted: 11/21/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To assess the association between early empirical antibiotics and neonatal adverse outcomes in very preterm infants without risk factors for early-onset sepsis (EOS). STUDY DESIGN This is a secondary analysis of the EPIPAGE-2 study, a prospective national population-based cohort that included all liveborn infants at 22-31 completed weeks of gestation in France in 2011. Infants at high risk of EOS (ie, born after preterm labor or preterm premature rupture of membranes or from a mother who had clinical chorioamnionitis or had received antibiotics during the last 72 hours) were excluded. Early antibiotic exposure was defined as antibiotic therapy started at day 0 or day 1 of life, irrespective of the duration and type of antibiotics. We compared treated and untreated patients using inverse probability of treatment weighting based on estimated propensity scores. RESULTS Among 648 very preterm infants at low risk of EOS, 173 (26.2%) had received early antibiotic treatment. Early antibiotic exposure was not associated with death or late-onset sepsis or necrotizing enterocolitis (OR, 1.04; 95% CI, 0.72-1.50); however, it was associated with higher odds of severe cerebral lesions (OR, 2.71; 95% CI, 1.25-5.86) and moderate-severe bronchopulmonary dysplasia (BPD) (OR, 2.30; 95% CI, 1.21-4.38). CONCLUSIONS Early empirical antibiotic therapy administrated in very preterm infants at low risk of EOS was associated with a higher risk of severe cerebral lesions and moderate-severe BPD.
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Affiliation(s)
- Mathilde Letouzey
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team (Epopé), Inserm, INRA, F-75004 Paris, France; Department of Neonatal Pediatrics, Poissy Saint Germain Hospital, Poissy, France
| | - Elsa Lorthe
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team (Epopé), Inserm, INRA, F-75004 Paris, France; Unit of Population Epidemiology, Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Laetitia Marchand-Martin
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team (Epopé), Inserm, INRA, F-75004 Paris, France
| | - Gilles Kayem
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team (Epopé), Inserm, INRA, F-75004 Paris, France; Department of Gynecology and Obstetrics, Armand Trousseau Hospital, APHP, Paris Sorbonne University, Paris, France
| | - Caroline Charlier
- Division of Infectious Diseases and Tropical Medicine, Hôpital Université Necker-Enfants Malades, Université de Paris, APHP, Paris, France; Biology of Infection Unit, Institut Pasteur, French National Reference Center and WHO Collaborating Center for Listeria, Inserm U1117, Paris, France
| | - Marine Butin
- Department of Neonatal Pediatrics, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France
| | - Ayoub Mitha
- Department of Neonatal Medicine, Jeanne de Flandre Hospital, CHRU Lille, Lille, France
| | - Monique Kaminski
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team (Epopé), Inserm, INRA, F-75004 Paris, France
| | - Valerie Benhammou
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team (Epopé), Inserm, INRA, F-75004 Paris, France
| | - Pierre-Yves Ancel
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team (Epopé), Inserm, INRA, F-75004 Paris, France; URC-CIC P1419, Cochin Hotel-Dieu Hospital, APHP, Paris, France
| | - Pascal Boileau
- Department of Neonatal Pediatrics, Poissy Saint Germain Hospital, Poissy, France; Université Paris-Saclay, UVSQ, UFR Simone Veil Santé, Montigny Le Bretonneux, France
| | - Laurence Foix-L'Hélias
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team (Epopé), Inserm, INRA, F-75004 Paris, France; Department of Neonatal Pediatrics, Armand Trousseau Hospital, APHP, Paris Sorbonne University, Paris, France
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Prevalence and Social and Built Environmental Determinants of Maternal Prepregnancy Obesity in 68 Major Metropolitan Cities of the United States, 2013-2016. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2021; 2021:6650956. [PMID: 33959163 PMCID: PMC8075692 DOI: 10.1155/2021/6650956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 04/01/2021] [Accepted: 04/05/2021] [Indexed: 11/17/2022]
Abstract
Objective Maternal prepregnancy obesity is related to increased maternal morbidity and mortality and poor birth outcomes. However, prevalence and risk factors for prepregnancy obesity in US cities are not known. This study examines the prevalence and social and environmental determinants of maternal prepregnancy obesity (BMI ≥30), overweight/obesity (BMI ≥25), and severe obesity (BMI ≥40) in the 68 largest metropolitan cities of the United States. Methods We fitted logistic and Poisson regression models to the 2013–2016 national vital statistics birth cohort data (N = 3,083,600) to derive unadjusted and adjusted city differentials in maternal obesity and to determine social and environmental determinants. Results Considerable disparities existed across cities, with the prevalence of prepregnancy obesity ranging from 10.4% in San Francisco to 36.6% in Detroit. Approximately 63.0% of mothers in Detroit were overweight or obese before pregnancy, compared with 29.2% of mothers in San Francisco. Severe obesity ranged from 1.4% in San Francisco to 8.5% in Cleveland. Women in Anchorage, Buffalo, Cleveland, Fresno, Indianapolis, Louisville, Milwaukee, Oklahoma City, Sacramento, St Paul, Toledo, Tulsa, and Wichita had >2 times higher adjusted odds of prepregnancy obesity compared to those in San Francisco. Race/ethnicity, maternal age, parity, marital status, nativity/immigrant status, and maternal education were important individual-level risk factors and accounted for 63%, 39%, and 72% of the city disparities in prepregnancy obesity, overweight/obesity, and severe obesity, respectively. Area deprivation, violent crime rates, physical inactivity rates, public transport use, and access to parkland and green spaces remained significant predictors of prepregnancy obesity even after controlling for individual-level covariates. Conclusions Substantial disparities in maternal prepregnancy obesity among the major US cities remain despite risk-factor adjustment, with women in several Southern and Midwestern cities experiencing high risks of obesity. Sound urban policies are needed to promote healthier lifestyles and favorable social and built environments for obesity reduction and improved maternal health.
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Letouzey M, Foix-L’Hélias L, Torchin H, Mitha A, Morgan AS, Zeitlin J, Kayem G, Maisonneuve E, Delorme P, Khoshnood B, Kaminski M, Ancel PY, Boileau P, Lorthe E. Cause of preterm birth and late-onset sepsis in very preterm infants: the EPIPAGE-2 cohort study. Pediatr Res 2021; 90:584-592. [PMID: 33627822 PMCID: PMC7903216 DOI: 10.1038/s41390-021-01411-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 02/01/2021] [Accepted: 02/01/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND The pathogenesis of late-onset sepsis (LOS) in preterm infants is poorly understood and knowledge about risk factors, especially prenatal risk factors, is limited. This study aimed to assess the association between the cause of preterm birth and LOS in very preterm infants. METHODS 2052 very preterm singletons from a national population-based cohort study alive at 72 h of life were included. Survival without LOS was compared by cause of preterm birth using survival analysis and Cox regression models. RESULTS 437 (20.1%) had at least one episode of LOS. The frequency of LOS varied by cause of preterm birth: 17.1% for infants born after preterm labor, 17.9% after preterm premature rupture of membranes, 20.3% after a placental abruption, 20.3% after isolated hypertensive disorders, 27.5% after hypertensive disorders with fetal growth restriction (FGR), and 29.4% after isolated FGR. In multivariate analysis, when compared to infants born after preterm labor, the risk remained higher for infants born after hypertensive disorders (hazard ratio HR = 1.7, 95% CI = 1.2-2.5), hypertensive disorders with FGR (HR = 2.6, 95% CI = 1.9-3.6) and isolated FGR (HR = 2.9, 95% CI = 1.9-4.4). CONCLUSION Very preterm infants born after hypertensive disorders or born after FGR had an increased risk of LOS compared to those born after preterm labor. IMPACT Late-onset sepsis risk differs according to the cause of preterm birth. Compared with those born after preterm labor, infants born very preterm because of hypertensive disorders of pregnancy and/or fetal growth restriction display an increased risk for late-onset sepsis. Antenatal factors, in particular the full spectrum of causes leading to preterm birth, should be taken into consideration to better prevent and manage neonatal infectious morbidity and inform the parents.
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Affiliation(s)
- Mathilde Letouzey
- Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, Université de Paris, Paris, France. .,Department of Neonatal Pediatrics, Poissy Saint Germain Hospital, Paris Saclay University, UVSQ, Paris, France.
| | - Laurence Foix-L’Hélias
- Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, Université de Paris, Paris, France ,grid.462844.80000 0001 2308 1657Department of Neonatal Pediatrics, Trousseau Hospital, APHP, Sorbonne University, Paris, France
| | - Héloïse Torchin
- Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, Université de Paris, Paris, France ,grid.50550.350000 0001 2175 4109Department of Neonatal Pediatrics, Cochin Port Royal Hospital, APHP, Paris, France
| | - Ayoub Mitha
- Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, Université de Paris, Paris, France ,grid.414184.c0000 0004 0593 6676Department of Neonatal Medicine, Jeanne de Flandre Hospital, CHRU Lille, Lille, France
| | - Andrei S. Morgan
- Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, Université de Paris, Paris, France ,grid.83440.3b0000000121901201Institute for Women’s Health, University College London, London, UK
| | - Jennifer Zeitlin
- Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, Université de Paris, Paris, France
| | - Gilles Kayem
- Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, Université de Paris, Paris, France ,grid.462844.80000 0001 2308 1657Department of Gynecology and Obstetrics, Trousseau Hospital, APHP, Sorbonne University, Paris, France
| | - Emeline Maisonneuve
- Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, Université de Paris, Paris, France ,grid.50550.350000 0001 2175 4109Department of Fetal Medicine, Trousseau Hospital, APHP, Paris, France
| | - Pierre Delorme
- Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, Université de Paris, Paris, France ,grid.462844.80000 0001 2308 1657Department of Gynecology and Obstetrics, Trousseau Hospital, APHP, Sorbonne University, Paris, France
| | - Babak Khoshnood
- Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, Université de Paris, Paris, France
| | - Monique Kaminski
- Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, Université de Paris, Paris, France
| | - Pierre-Yves Ancel
- Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, Université de Paris, Paris, France ,grid.50550.350000 0001 2175 4109URC - CIC P1419, Cochin Hotel-Dieu Hospital, APHP, Paris, France
| | - Pascal Boileau
- grid.12832.3a0000 0001 2323 0229Department of Neonatal Pediatrics, Poissy Saint Germain Hospital, Paris Saclay University, UVSQ, Paris, France
| | - Elsa Lorthe
- Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, Université de Paris, Paris, France ,grid.150338.c0000 0001 0721 9812Unit of Population Epidemiology, Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
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7
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Huo N, Zhang K, Wang L, Wang L, Lv W, Cheng W, Jia G. Association of Maternal Body Mass Index With Risk of Infant Mortality: A Dose-Response Meta-Analysis. Front Pediatr 2021; 9:650413. [PMID: 33777870 PMCID: PMC7994890 DOI: 10.3389/fped.2021.650413] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 02/17/2021] [Indexed: 01/11/2023] Open
Abstract
Objective: This study presumed that a high or low body mass index (BMI) might increase the risk of infant mortality. Therefore, a meta-analysis was performed to systematically assess the association between maternal BMI and the risk of infant mortality. Methods: The electronic databases, including Pubmed, Embase database, and Cochrane Library, were systemically searched by two investigators from inception to November 26th, 2020, with no language restriction. In parallel, a dose-response was assessed. Results: Finally, 22 cohort studies involving 13,532,293 participants were included into this paper, which showed that compared with normal BMI, maternal overweight significantly increased the risks of infant mortality [risk ratio (RR), 1.16; 95% confidence interval (CI), 1.13-1.19], neonatal mortality (RR, 1.23; 95% CI, 1.08-1.39), early neonatal mortality (RR, 1.55; 95% CI, 1.26-1.92) and post-neonatal mortality (RR, 1.18; 95% CI, 1.07-1.29). Similarly, maternal obesity significantly increased the risk of infant mortality (RR, 1.55; 95% CI, 1.41-1.70), neonatal mortality (RR, 1.55; 95% CI, 1.28-1.67), early neonatal mortality (RR, 1.37; 95% CI, 1.13-1.67), and post-neonatal mortality (RR, 1.30; 95% CI, 1.03-1.65), whereas maternal underweight potentially decreased the risk of infant mortality (RR, 0.93; 95% CI, 0.88-0.98). In the dose-response analysis, the risk of infant mortality significantly increased when the maternal BMI was >25 kg/m2. Conclusions: Maternal overweight or obesity significantly increases the risks of infant mortality, neonatal mortality, early neonatal mortality, and post-neonatal mortality compared with normal BMI in a dose-dependent manner. Besides, maternal underweight will not increase the risk of infant mortality, neonatal mortality, early neonatal mortality, or postneonatal mortality; instead, it tends to decrease the risk of infant mortality. Early weight management may provide potential benefits to infants, and more large-scale prospective studies are needed to verify this finding in the future.
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Affiliation(s)
- Nana Huo
- Department of Obstetrics, Maternity and Child Health Care of Zaozhuang, Zaozhuang, China
| | - Kun Zhang
- Department of Obstetrics, Maternity and Child Health Care of Zaozhuang, Zaozhuang, China
| | - Li Wang
- Department of Obstetrics, Maternity and Child Health Care of Zaozhuang, Zaozhuang, China
| | - Lina Wang
- Department of Obstetrics and Gynecology, Maternity and Child Health Care of Zaozhuang, Zaozhuang, China
| | - Wenhui Lv
- Department of Obstetrics, Maternity and Child Health Care of Zaozhuang, Zaozhuang, China
| | - Wenke Cheng
- Department of Cardiology, Heart Center Leipzig at University Leipzig, Leipzig, Germany
| | - GuangZhu Jia
- Department of Obstetrics, Maternity and Child Health Care of Zaozhuang, Zaozhuang, China
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Mitchell EA, Yan X, Ren SY, Anderson TM, Ramirez JM, Lavista Ferres JM, Johnston R. Geographic Variation in Sudden Unexpected Infant Death in the United States. J Pediatr 2020; 220:49-55.e2. [PMID: 32061407 PMCID: PMC7995635 DOI: 10.1016/j.jpeds.2020.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 12/04/2019] [Accepted: 01/06/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To assess the geographic variation of sudden unexpected infant death (SUID) and test if variation in geographic factors, such as state, latitude, and longitude, play a role in SUID risk across the US. STUDY DESIGN We analyzed the Centers for Disease Control and Prevention's Cohort Linked Birth/Infant Death dataset (2005-2010; 22 882 SUID cases, 25 305 837 live births, rate 0.90/1000). SUID was defined as infant deaths (ages 7-364 days) that included sudden infant death syndrome, ill-defined and unknown cause of mortality, and accidental suffocation and strangulation in bed. SUID geographic variation was analyzed using 2 statistical models, logistic regression and generalized additive model (GAM). RESULTS Both models produced similar results. Without adjustment, there was marked geographic variation in SUID rates, but the variation decreased after adjusting for covariates including known risk factors for SUID. After adjustment, nine states demonstrated significantly higher or lower SUID mortality than the national average. Geographic contribution to SUID risk in terms of latitude and longitude were also attenuated after adjustment for covariates. CONCLUSION Understanding why some states have lower SUID rates may enhance SUID prevention strategies.
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Affiliation(s)
- Edwin A Mitchell
- Department of Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Xiaohan Yan
- AI For Good Research Lab, Microsoft, Redmond, WA
| | | | - Tatiana M Anderson
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA
| | - Jan-Marino Ramirez
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA; Department of Neurological Surgery, University of Washington School of Medicine, Seattle, WA; Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
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9
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Moreau M, Remy M, Nusinovici S, Rouger V, Molines L, Flamant C, Legendre G, Roze JC, Salle A, Van Bogaert P, Coutant R, Gascoin G. Neonatal and neurodevelopmental outcomes in preterm infants according to maternal body mass index: A prospective cohort study. PLoS One 2019; 14:e0225027. [PMID: 31805081 PMCID: PMC6894768 DOI: 10.1371/journal.pone.0225027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 10/28/2019] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Maternal obesity is associated with an increase in maternal, foetal and neonatal morbidity and mortality. The aim of our study was to evaluate the relationships between maternal pre-pregnancy body mass index and (1) neonatal outcome in preterm infants, and (2) neurodevelopmental outcome at 2 years of corrected age. METHOD We conducted a single-centre cohort study. Infants born between 24+0 and 33+6 weeks of gestation between January 2009 and December 2013, hospitalised in the neonatal intensive care unit of Angers University Hospital, and with available data regarding maternal pre-pregnancy body mass index were eligible. Three groups were defined according to maternal body mass index: normal (n = 418), overweight (n = 136) and obese (n = 89). The primary outcome was neurodevelopment at 2 years of corrected age. Children with a non-optimal neuromotor and/or psychomotor assessment and/or a sensory disability were regarded as having a "non-optimal neurodevelopmental outcome". Neuromotor function was regarded as non-optimal when cerebral palsy was present or when the clinical examination revealed neurological signs of abnormal muscular tone. Psychomotor assessment was regarded as non-optimal if the revised Brunet-Lézine test was < 85 or when the overall score in the parental Ages and Stages Questionnaire (ASQ) was < 185. Finally, sensory disabilities such as blindness and children who required a hearing aid were taken into account. The secondary outcome was the composite criteria of neonatal complications. Multivariable analysis included the following variables: mother's age, gestational age, smoking during pregnancy, magnesium sulphate and steroid treatment during pregnancy, twin status, gender, socioeconomic status and social security benefits for those with low incomes. RESULTS The study population was composed of 643 preterm infants. Among them, 520 were assessed at 2 years. There was no difference in the proportion of infants with non-optimal neurodevelopmental outcomes between the three groups (16.6% for obese, 13.5% for overweight, 16.9% for normal body mass index mothers; p = 0.73). According to multivariable analysis, being born from an overweight or obese mother was not associated with an increased risk of non-optimal neuro-development at 2 years (adjusted OR = 0.84 [0.40-1.76] for obese, adjusted OR = 0.83 [0.43-1.59] for overweight mothers). There was no difference in the proportion of preterm infants with a non-optimal composite criterion of neonatal complications between the three groups. In the multivariable analysis, being born from an overweight or obese mother was not associated with an increased risk of non-optimal neonatal outcomes (adjusted OR = 0.95 [0.49-1.83] for obese, adjusted OR = 1.18 [0.69-2.01] for overweight mothers). CONCLUSION In this large prospective cohort of preterm infants born before 34 weeks of gestation, we found no relationship between maternal body mass index and neurodevelopmental outcomes at 2 years of corrected age and no relationship between maternal body mass index and neonatal outcomes. Other prematurity-related factors may be more relevant for neurodevelopmental outcome than the mother's pre-pregnancy BMI.
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Affiliation(s)
- Marie Moreau
- Department of Neonatal Medicine, Angers University Hospital, Angers, France
| | - Mathilde Remy
- Department of Neonatal Medicine, Angers University Hospital, Angers, France
| | - Simon Nusinovici
- CIC 1413, Nantes University Hospital, Nantes, France
- Loire Infant Follow-Up Team (LIFT) Network, Pays de Loire, France
| | - Valérie Rouger
- Loire Infant Follow-Up Team (LIFT) Network, Pays de Loire, France
| | - Lisa Molines
- Department of Neonatal Medicine, Angers University Hospital, Angers, France
| | - Cyril Flamant
- Loire Infant Follow-Up Team (LIFT) Network, Pays de Loire, France
- Department of Neonatal Medicine, Nantes University Hospital, Nantes, France
| | - Guillaume Legendre
- Department of Obstetrics and Gynaecology, Angers University Hospital, Angers, France
| | - Jean-Christophe Roze
- Loire Infant Follow-Up Team (LIFT) Network, Pays de Loire, France
- Department of Neonatal Medicine, Nantes University Hospital, Nantes, France
| | - Agnès Salle
- Department of Endocrinology, Diabetology and Nutrition, Angers University Hospital, Angers, France
| | - Patrick Van Bogaert
- Loire Infant Follow-Up Team (LIFT) Network, Pays de Loire, France
- Department of Paediatric Neurology, Angers University Hospital, Angers, France
| | - Régis Coutant
- Department of Paediatric Endocrinology, Angers University Hospital, Angers, France
| | - Géraldine Gascoin
- Department of Neonatal Medicine, Angers University Hospital, Angers, France
- Loire Infant Follow-Up Team (LIFT) Network, Pays de Loire, France
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Pace ND, Siega-Riz AM, Olshan AF, Chescheir NC, Cole SR, Desrosiers TA, Tinker SC, Hoyt AT, Canfield MA, Carmichael SL, Meyer RE. Survival of infants with spina bifida and the role of maternal prepregnancy body mass index. Birth Defects Res 2019; 111:1205-1216. [PMID: 31322328 PMCID: PMC7285624 DOI: 10.1002/bdr2.1552] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/08/2019] [Accepted: 06/30/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To investigate first-year survival of infants born with spina bifida, and examine the association of maternal prepregnancy body mass index (BMI) with infant mortality. METHODS This is a retrospective cohort study of 1,533 liveborn infants with nonsyndromic spina bifida with estimated dates of delivery from 1998 to 2011 whose mothers were eligible for the National Birth Defects Prevention Study (NBDPS). NBDPS data were linked to death records to conduct survival analyses. Kaplan-Meier survival functions estimated mortality risk over the first year of life. Cox proportional hazards models estimated hazard ratios (HRs) for maternal prepregnancy BMI categorized as underweight (<18.5), normal (18.5-24.9), overweight (25-29.9), and obese (≥30). RESULTS Infant mortality risk among infants with spina bifida was (4.4% [3.52, 5.60%]). Infants with multiple co-occurring defects, very preterm delivery, multiple gestation, high-level spina bifida lesions, or non-Hispanic Black mothers had an elevated risk of infant mortality. Maternal prepregnancy underweight and obesity were associated with higher infant mortality (15.7% [7.20, 32.30%] and 5.82% [3.60, 9.35%], respectively). Adjusted HR estimates showed underweight and obese mothers had greater hazard of infant mortality compared to normal weight mothers (HR: 4.5 [1.08, 16.72] and 2.6 [1.36, 8.02], respectively). CONCLUSION The overall risk of infant mortality for infants born with spina bifida was lower than most previously reported estimates. Infants born with spina bifida to mothers who were underweight or obese prepregnancy were at higher risk of infant mortality. This study provides additional evidence of the importance of healthy maternal weight prior to pregnancy.
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Affiliation(s)
- Nelson D. Pace
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Anna Maria Siega-Riz
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Andrew F. Olshan
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Nancy C. Chescheir
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Stephen R. Cole
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Tania A. Desrosiers
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Sarah C. Tinker
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Adrienne T. Hoyt
- Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, Texas
| | - Mark A. Canfield
- Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, Texas
| | - Suzan L. Carmichael
- Department of Pediatrics, Division of Neonatology and Developmental Medicine, Stanford University School of Medicine, Stanford, California
| | - Robert E. Meyer
- Birth Defects Monitoring Program, North Carolina Department of Health and Human Services, Raleigh, North Carolina
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Maternal Undernutrition and Breast Milk Macronutrient Content Are Not Associated with Weight in Breastfed Infants at 1 and 3 Months after Delivery. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16183315. [PMID: 31505822 PMCID: PMC6765925 DOI: 10.3390/ijerph16183315] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/03/2019] [Accepted: 09/05/2019] [Indexed: 12/17/2022]
Abstract
This study examined whether maternal nutritional intake and breast milk macronutrient content influence the weight of breastfed infants. We investigated 129 healthy mothers with singleton babies born from July 2016 to December 2017 in a university hospital in Tokyo, Japan. Information was obtained by a self-administered food frequency questionnaire at 1 (valid response n = 92; mean age, 34 years) and 3 (n = 57) months after delivery. Breast milk was sampled at 1 and 3 months and the macronutrient contents were analyzed. The average pre-pregnancy body mass index and weight gain during pregnancy were 20.7 ± 2.6 kg/m2 and 9.6 ± 3.7 kg, respectively. At 1 month, average maternal calorie intake was 1993 ± 417 kcal/day, which was lower than the intake recommended by Japanese Dietary Reference Intakes for breastfeeding mothers. There were no significant differences with regard to maternal calorie and protein intake, and breast milk macronutrient content between breastfed infants with weight above and below the 25th percentile of its distribution at both 1 and 3 months. This study suggests that suboptimal calorie intake by breastfeeding mothers and breast milk macronutrient content were not associated with weight of their infants at 1 and 3 months after delivery.
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12
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Singh GK, DiBari JN. Marked Disparities in Pre-Pregnancy Obesity and Overweight Prevalence among US Women by Race/Ethnicity, Nativity/Immigrant Status, and Sociodemographic Characteristics, 2012-2014. J Obes 2019; 2019:2419263. [PMID: 30881701 PMCID: PMC6387712 DOI: 10.1155/2019/2419263] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 01/18/2019] [Indexed: 11/17/2022] Open
Abstract
This study examines racial/ethnic, nativity, and sociodemographic disparities in the prevalence of pre-pregnancy obesity and overweight in the United States. Logistic regression was fitted to the 2012-2014 national birth cohort data to derive unadjusted and adjusted differentials in pre-pregnancy obesity (BMI ≥30), severe obesity (BMI ≥40), and overweight/obesity (BMI ≥25) prevalence among 10.4 million US women of childbearing age. Substantial racial/ethnic differences existed, with pre-pregnancy obesity rates ranging from 2.6% for Chinese and 3.3% for Vietnamese women to 34.9% for American Indians/Alaska Natives (AIANs) and 60.2% for Samoans. Pre-pregnancy overweight/obese prevalence ranged from 13.6% for Chinese women to 61.7% for AIANs and 86.3% for Samoans. Compared to non-Hispanic whites, women in all Asian subgroups had markedly lower risks of pre-pregnancy obesity, severe obesity, and overweight/obesity, whereas Samoans, Hawaiians, AIANs, blacks, Mexicans, Puerto Ricans, and Central/South Americans had significantly higher risks. Immigrant women in each racial/ethnic group had lower rates of pre-pregnancy obesity than the US-born. Sociodemographic risk factors accounted for 33-47% of racial/ethnic disparities and 12-16% of ethnic-immigrant disparities in pre-pregnancy obesity and overweight/obesity. Further research is needed to assess the effects of diet, physical inactivity, and social environments in explaining the reported ethnic and nativity differences in pre-pregnancy obesity.
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Affiliation(s)
- Gopal K. Singh
- US Department of Health and Human Services, Health Resources and Services Administration, Office of Health Equity, 5600 Fishers Lane, Room 13N42, Rockville, MD 20857, USA
| | - Jessica N. DiBari
- US Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, Office of Epidemiology & Research, Division of Research, 5600 Fishers Lane, Room 18N120, Rockville, MD 20857, USA
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13
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Al-Rubaie ZT, Askie LM, Hudson HM, Ray JG, Jenkins G, Lord SJ. Assessment of NICE and USPSTF guidelines for identifying women at high risk of pre-eclampsia for tailoring aspirin prophylaxis in pregnancy: An individual participant data meta-analysis. Eur J Obstet Gynecol Reprod Biol 2018; 229:159-166. [DOI: 10.1016/j.ejogrb.2018.08.587] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 08/29/2018] [Accepted: 08/31/2018] [Indexed: 02/01/2023]
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15
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Palomba S, Santagni S, Daolio J, Gibbins K, Battaglia FA, La Sala GB, Silver RM. Obstetric and perinatal outcomes in subfertile patients who conceived following low technology interventions for fertility enhancement: a comprehensive review. Arch Gynecol Obstet 2018; 297:33-47. [PMID: 29082423 DOI: 10.1007/s00404-017-4572-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 10/18/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Low technology interventions for fertility enhancement (LTIFE) are strategies that avoid retrieval, handling, and manipulation of female gametes. The definition of LTIFE is yet to be widely accepted and clarified, but they are commonly used in milder cases of infertility and subfertility. Based on these considerations, the aim of the present study was comprehensively to review and investigate the obstetric and perinatal outcomes in subfertile patients who underwent LTIFE. METHODS A literature search up to May 2017 was performed in IBSS, SocINDEX, Institute for Scientific Information, PubMed, Web of Science, and Google Scholar. An evidence-based hierarchy was used according to The Oxford Centre for Evidence-Based Medicine to determine which articles to include and analyze, and to provide a level of evidence of each association between intervention and outcome. RESULTS This analysis identified preliminary and low-grade evidence on the influence of LTIFE on obstetric and perinatal outcomes in subfertile women. CONCLUSIONS LTIFE women should deserve major consideration from Clinicians/Researchers of Reproductive Medicine, because these treatments could be potentially responsible for mothers' and babies' complications. So far, the lack of well-designed and unbiased studies makes further conclusions difficult to be drawn.
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Affiliation(s)
- Stefano Palomba
- Unit of Obstetrics and Gynecology, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Via Melacrino, Reggio Calabria, Italy.
| | - Susanna Santagni
- Center of Reproductive Medicine and Surgery, Arcispedale Santa Maria Nuova (ASMN), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Reggio Emilia, Italy
| | - Jessica Daolio
- Center of Reproductive Medicine and Surgery, Arcispedale Santa Maria Nuova (ASMN), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Reggio Emilia, Italy
| | - Karen Gibbins
- Division of Maternal-Fetal Medicine, Utah University, Salt Lake City, UT, USA
| | - Francesco Antonino Battaglia
- Unit of Obstetrics and Gynecology, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Via Melacrino, Reggio Calabria, Italy
| | - Giovanni Battista La Sala
- Center of Reproductive Medicine and Surgery, Arcispedale Santa Maria Nuova (ASMN), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Reggio Emilia, Italy
- University of Modena and Reggio Emilia, Modena, Italy
| | - Robert M Silver
- Division of Maternal-Fetal Medicine, Utah University, Salt Lake City, UT, USA
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16
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Robson SJ, Norman RJ. It is ethical to recommend against assisted reproductive treatment for women with a high body mass index. Aust N Z J Obstet Gynaecol 2017; 57:575-578. [PMID: 28872659 DOI: 10.1111/ajo.12693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 07/24/2017] [Indexed: 12/13/2022]
Affiliation(s)
- Stephen J Robson
- Australian National University Medical School, Garran, Australian Capital Territory, Australia.,Royal Australian and New Zealand College of Obstetricians and Gynaecologists, East Melbourne, Victoria, Australia
| | - Robert J Norman
- Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia.,Fertility SA, Adelaide, South Australia, Australia
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Rai RK, Singh L, Singh PK. Is maternal body mass index associated with neonatal mortality? A pooled analysis of nationally representative data from nine Asian countries. Nutrition 2017; 41:68-72. [PMID: 28760430 DOI: 10.1016/j.nut.2017.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 01/16/2017] [Accepted: 04/07/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Children born to mothers with abnormal body mass index (BMI) have increased risk for mortality. The aim of this study was to investigate whether maternal BMI is a risk factor for neonatal death in select Asian countries, including the nature of association between maternal BMI and the discrete timing of neonatal death. METHODS Nationally representative, the standard Demographic and Health Survey data from nine Asian countries were used. In all, 55 629 mothers reported their index birth; 840 reported neonatal mortality. Descriptive statistics and multivariate logistic regression analyses were applied to attain the study objective. RESULTS Overweight mothers had higher odds of neonatal mortality than mothers with optimum weight. No significant association was registered for obese mothers, possibly due to insufficient power. During the first 7 d (0-1 and 2-6 d) of birth, children born to overweight mothers had higher odds of dying, whereas for the remaining period (7-27 d), maternal underweight was the risk factor for neonatal mortality. CONCLUSION Interventions should target high-risk pregnancies to reduce the rate of neonatal mortality. With the help of community health workers or physicians, preconception counseling of prospective mothers with abnormal BMI should be devised. If conceived, underweight or overweight or obese women should be marked as high-risk pregnancy during their antenatal care visits, and they must be encouraged for delivery at an institution equipped with an emergency obstetric and neonatal care unit.
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Affiliation(s)
- Rajesh Kumar Rai
- Society for Health and Demographic Surveillance, Suri, West Bengal, India.
| | - Lucky Singh
- National Institute of Medical Statistics, Indian Council of Medical Research, New Delhi, India
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Friedmann I, Balayla J. Gestational weight gain and the risk of infant mortality amongst women with normal prepregnancy BMI: the Friedmann-Balayla model. J Matern Fetal Neonatal Med 2017; 31:325-332. [PMID: 28110578 DOI: 10.1080/14767058.2017.1285889] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The study of the association between gestational weight gain (GWG) and infant mortality is riddled with methodological concerns, particularly with limitations in accounting for gestational age-specific weight gain. In our study, we developed a new model, which accounts for gestational age, to determine whether insufficient or excessive GWG is associated with an increased risk of infant death amongst women with normal prepregnancy BMI (18.5-24.9 kg/m2). METHODS We developed and implemented the Friedmann-Balayla model to mitigate gestational age-related biases in our assessment, and conducted a population-based cohort study using the CDC's 2013 Period-Linked Birth-Infant Death data. The impact of GWG according to the 2009 IOM guidelines on the risk of infant mortality was estimated using logistic regression analysis, adjusting for relevant confounders. RESULTS Our cohort consisted of 1,517,525 singleton deliveries and 6138 infant deaths. Overall, relative to women achieving adequate GWG, neither women gaining insufficient nor excessive weight had greater odds of infant death during the first year of life (OR [95%CI]): 1.06 [0.97-1.17] (p = 0.174), and 0.98 [0.91-1.04] (p = 0.523), respectively. This relationship did not change when restricting our analysis to term or preterm deliveries or when conducting sensitivity analyses accounting for maternal morbidities (p > 0.05). CONCLUSION Using this novel analytic approach, there does not appear to be an increased risk of infant mortality if GWG falls outside of the IOM guidelines in women with normal prepregnancy BMI. Future studies should apply this methodology to other BMI categories.
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Affiliation(s)
- Isabel Friedmann
- a Department of Experimental Medicine, Faculty of Medicine , McGill University , Québec , Canada
| | - Jacques Balayla
- b Department of Obstetrics and Gynecology , University of Montreal , Québec , Canada
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Mariona FG. Perspectives in obesity and pregnancy. WOMEN'S HEALTH (LONDON, ENGLAND) 2016; 12:523-532. [PMID: 29334009 PMCID: PMC5373261 DOI: 10.1177/1745505716686101] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 10/17/2016] [Accepted: 12/02/2016] [Indexed: 02/06/2023]
Abstract
Obesity is currently recognized as a health epidemic worldwide. Its prevalence has doubled in the last three decades. Obesity is a complex clinical picture associated with physical, physiologic, hormonal, genetic, cultural, socioeconomic and environmental factors. The rate of obesity is also increasing in the pregnant women population. Maternal obesity is associated with less than optimal obstetrical, fetal and neonatal outcomes. It is also associated with significant adverse long-term effects on both obese parturients and the infants born from obese women. A number of guidelines have been published to educate health care workers and the general population in an attempt to develop effective interventions on a large scale to prevent obesity. These guidelines are multiple, confusing and inconsistent. There are no standard recommendations regarding gestational weight gaining goals, nutrients and additional elements necessary for certain obese women who have been treated with bariatric surgical procedures, screening for metabolic diseases such as diabetes, additional preventive health care services indicated for obese women in the pregnancy planning stages, during prenatal care, in the immediate post-partum period and as a long-term approach for health preservation. In 2013, the American Medical Association supported by several US national medical specialty organizations published Resolution 420 (A-13) recognizing obesity as a disease state with multiple pathophysiological aspects requiring a range of interventions to improve its prevention and treatment. The goal of this decision was to encourage a broader spectrum of health care benefits insurance coverage for the prevention and treatment of obesity. There are a number of myths and misconceptions associated with obesity. These perspectives present our views and clinical experience with a partial review of recent bibliography addressing the associations between obese reproductive age women and their risks during pregnancy.
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Affiliation(s)
- Federico G. Mariona
- Division of Maternal-Fetal Medicine, Wayne State University School of Medicine, Detroit, MI, USA
- Michigan Perinatal Associates, Dearborn, MI, USA
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Palomba S, Santagni S, Gibbins K, La Sala GB, Silver RM. Pregnancy complications in spontaneous and assisted conceptions of women with infertility and subfertility factors. A comprehensive review. Reprod Biomed Online 2016; 33:612-628. [PMID: 27591135 DOI: 10.1016/j.rbmo.2016.08.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 08/10/2016] [Accepted: 08/11/2016] [Indexed: 12/20/2022]
Abstract
In the literature, there is growing evidence that assisted reproductive techniques increase the risk of pregnancy complications in subfertile couples. Moreover, many concomitant preconception risk factors for subfertility are frequently present in the same subject and increase the risk of pregnancy complications. This review aimed to summarize in a systematic fashion the best current evidence regarding the effects of preconception maternal factors on maternal and neonatal outcomes. A literature search up to March 2016 was performed in IBSS, SocINDEX, Institute for Scientific Information, PubMed, Web of Science and Google Scholar. An evidence-based hierarchy was used to determine which articles to include and analyse. Available data show that the risk of pregnancy complications in spontaneous and assisted conceptions is likely multifactorial, and the magnitude of this risk is probably very different according specific subgroups of patients. Notwithstanding the only moderate level and quality of the available evidence, available data suggest that the presence and the treatment of specific preconception cofactors of subfertility should be always taken into account both in clinical practice and for scientific purposes.
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Affiliation(s)
- Stefano Palomba
- Center of Reproductive Medicine and Surgery, Arcispedale Santa Maria Nuova (ASMN), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Reggio Emilia, Italy.
| | - Susanna Santagni
- Center of Reproductive Medicine and Surgery, Arcispedale Santa Maria Nuova (ASMN), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Reggio Emilia, Italy
| | - Karen Gibbins
- Division of Matenal-Fetal Medicine, Utah University, Salt Lake City, UT, USA
| | - Giovanni Battista La Sala
- Center of Reproductive Medicine and Surgery, Arcispedale Santa Maria Nuova (ASMN), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Reggio Emilia, Italy; University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Robert M Silver
- Division of Matenal-Fetal Medicine, Utah University, Salt Lake City, UT, USA
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