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Brumbaugh JE, Vohr BR, Bell EF, Bann CM, Travers CP, McGowan EC, Harmon HM, Carlo WA, Duncan AF, Hintz SR. Early-Life Outcomes in Relation to Social Determinants of Health for Children Born Extremely Preterm. J Pediatr 2023; 259:113443. [PMID: 37105408 PMCID: PMC10468025 DOI: 10.1016/j.jpeds.2023.113443] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/25/2023] [Accepted: 04/05/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVE To characterize the relationships between social determinants of health (SDOH) and outcomes for children born extremely preterm. STUDY DESIGN This is a cohort study of infants born at 22-26 weeks of gestation in National Institute of Child Health and Human Development Neonatal Research Network centers (2006-2017) who survived to discharge. Infants were classified by 3 maternal SDOH: education, insurance, and race. Outcomes included postmenstrual age (PMA) at discharge, readmission, neurodevelopmental impairment (NDI), and death postdischarge. Regression analyses adjusted for center, perinatal characteristics, neonatal morbidity, ethnicity, and 2 SDOH (eg, group comparisons by education adjusted for insurance and race). RESULTS Of 7438 children, 5442 (73%) had at least 1 risk-associated SDOH. PMA at discharge was older (adjusted mean difference 0.37 weeks, 95% CL 0.06, 0.68) and readmission more likely (aOR 1.27, 95% CL 1.12, 1.43) for infants whose mothers had public/no insurance vs private. Neither PMA at discharge nor readmission varied by education or race. NDI was twice as likely (aOR 2.36, 95% CL 1.86, 3.00) and death 5 times as likely (aOR 5.22, 95% CL 2.54, 10.73) for infants with 3 risk-associated SDOH compared with those with none. CONCLUSIONS Children born to mothers with public/no insurance were older at discharge and more likely to be readmitted than those born to privately insured mothers. NDI and death postdischarge were more common among children exposed to multiple risk-associated SDOH at birth compared with those not exposed. Addressing disparities due to maternal education, insurance coverage, and systemic racism are potential intervention targets to improve outcomes for children born preterm.
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Affiliation(s)
- Jane E Brumbaugh
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN.
| | - Betty R Vohr
- Department of Pediatrics, Women & Infants Hospital of Rhode Island, Warren Albert Medical School of Brown University, Providence, RI
| | - Edward F Bell
- Department of Pediatrics, University of Iowa, Iowa City, IA
| | - Carla M Bann
- Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, NC
| | - Colm P Travers
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL
| | - Elisabeth C McGowan
- Department of Pediatrics, Women & Infants Hospital of Rhode Island, Warren Albert Medical School of Brown University, Providence, RI
| | - Heidi M Harmon
- Department of Pediatrics, University of Iowa, Iowa City, IA
| | - Waldemar A Carlo
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL
| | - Andrea F Duncan
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Susan R Hintz
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA
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Liu X, Wu H, Fu X, Li J, Zhang M, Yan J, Ma J, Gao S. Association between endometrial thickness and birth weight in fresh IVF/ICSI embryo transfers: a retrospective cohort study of 9273 singleton births. Reprod Biomed Online 2021; 43:1087-1094. [PMID: 34600855 DOI: 10.1016/j.rbmo.2021.08.021] [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: 03/07/2021] [Revised: 07/21/2021] [Accepted: 08/23/2021] [Indexed: 01/23/2023]
Abstract
RESEARCH QUESTION What is the association between endometrial thickness (EMT) on HCG trigger day and outcomes related to birth weight in fresh IVF and intracytoplasmic sperm injection (ICSI) embryo transfer cycles? DESIGN A retrospective cohort study of 9273 singleton live births born to women undergoing fresh IVF/ICSI cycles in a single centre between January 2014 and December 2018. Multivariable logistic regression was used to investigate the associations between EMT, low birth weight (LBW) and small for gestational age (SGA). Multivariable-adjusted linear regression models incorporating restricted cubic splines were used to investigate the dose-response relationship between EMT, birth weight and birth weight z-score, respectively. An EMT of 8 mm was set as a reference value. RESULTS Compared with women with an EMT of 8.0 to < 14.0 mm the risk of delivering a SGA infant was increased with EMT < 8.0 mm (adjusted odds ratio [aOR] 1.78, 95% confidence interval [CI] 1.09 to 2.90) and decreased with EMT ≥ 14.0 mm (aOR 0.57, 95% CI 0.35 to 0.93, respectively). Birth weights of infants born to women with an EMT of 8.0 mm compared with women with EMT of 5.0, 6.0, and 7.0 mm were lower by 120 g (95% CI -175 g to -66 g), 80 g (95% CI -116 g to -44 g), and 40 g (95% CI -58 g to -22 g) respectively; infant birth weight z-scores were also decreased by 0.19 (95% CI -0.27 to -0.10), 0.12 (95% CI -0.18 to -0.07) and 0.06 (95% CI -0.09 to -0.03), respectively. CONCLUSIONS A thinner endometrium was associated with lower birth weight and birth weight z-score, and higher risk of SGA. Women with a thin endometrium warrant special attention during pregnancy.
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Affiliation(s)
- Xiaojie Liu
- Cheeloo College of Medicine, Shandong University, Jinan, China; Center for Reproductive Medicine, Reproductive Hospital Affiliated to Shandong University, No.157 Jingliu Road, Jinan 250000, China
| | - Han Wu
- Cheeloo College of Medicine, Shandong University, Jinan, China; Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xiao Fu
- Cheeloo College of Medicine, Shandong University, Jinan, China; Center for Reproductive Medicine, Reproductive Hospital Affiliated to Shandong University, No.157 Jingliu Road, Jinan 250000, China
| | - Jing Li
- Cheeloo College of Medicine, Shandong University, Jinan, China; Center for Reproductive Medicine, Reproductive Hospital Affiliated to Shandong University, No.157 Jingliu Road, Jinan 250000, China
| | - Meng Zhang
- Cheeloo College of Medicine, Shandong University, Jinan, China; Center for Reproductive Medicine, Reproductive Hospital Affiliated to Shandong University, No.157 Jingliu Road, Jinan 250000, China
| | - Junhao Yan
- Center for Reproductive Medicine, Reproductive Hospital Affiliated to Shandong University, No.157 Jingliu Road, Jinan 250000, China; National Research Centre for Assisted Reproductive Technology and Reproductive Genetic, Jinan, China
| | - Jinlong Ma
- Center for Reproductive Medicine, Reproductive Hospital Affiliated to Shandong University, No.157 Jingliu Road, Jinan 250000, China; National Research Centre for Assisted Reproductive Technology and Reproductive Genetic, Jinan, China
| | - Shanshan Gao
- Center for Reproductive Medicine, Reproductive Hospital Affiliated to Shandong University, No.157 Jingliu Road, Jinan 250000, China; National Research Centre for Assisted Reproductive Technology and Reproductive Genetic, Jinan, China.
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