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Sejer EPF, Ladelund AK, Bruun FJ, Slavensky JA, Mortensen EL, Kesmodel US. Preterm birth and subsequent intelligence and academic performance in youth: A cohort study. Acta Obstet Gynecol Scand 2024; 103:850-861. [PMID: 38348635 PMCID: PMC11019527 DOI: 10.1111/aogs.14796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/17/2024] [Accepted: 01/21/2024] [Indexed: 04/17/2024]
Abstract
INTRODUCTION Worldwide, more children than before survive preterm birth. Preterm birth can affect long-term cognitive outcomes. The aim of our study was to investigate the association between preterm birth and academic performance and intelligence in youth. MATERIAL AND METHODS This cohort study included all liveborn children in Denmark from 1978 to 2000. We used uni- and multivariable logistic and linear regressions to analyze associations between gestational age and school graduation, grade point average (GPA), attending conscription, and male intelligence scores at conscription. We adjusted for a priori defined potential confounders. RESULTS The study included 1 450 681 children and found an association between preterm birth and lower academic performance, with children born extremely preterm having the lowest odds of graduating from lower- and upper secondary education (LSE and USE) and appearing before the conscription board (odds ratios of 0.45 [0.38-0.54], 0.52 [0.46-0.59], and 0.47 [0.39-0.56] for LSE, USE, and conscription, respectively, compared to the term group). Statistically significant differences were observed in LSE for total GPA and core subject GPA with higher GPAs in the term group, which were considered clinically relevant for mathematics with a 0.71 higher grade point for the term compared to the extremely preterm. Conversely, USE differences were less evident, and in linear regression models we found that preterm birth was associated with higher GPAs in the adjusted analyses; however, this was not statistically significant. We demonstrated statistically significant differences in intelligence scores at conscription with lower scores in the three preterm groups (-5.13, -2.73, and - 0.76, respectively) compared to the term group. CONCLUSIONS Low gestational age at birth was associated with not graduating from LSE and USE, achieving lower GPAs in LSE, not attending conscription, and lower intelligence scores in young adulthood. The findings remained significant after adjusting for potential confounders.
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Affiliation(s)
| | | | - Frederik Jager Bruun
- Department of Obstetrics and GynecologyHerlev and Gentofte HospitalHerlevDenmark
| | - Julie Anna Slavensky
- Department of Obstetrics and GynecologyHerlev and Gentofte HospitalHerlevDenmark
| | | | - Ulrik Schiøler Kesmodel
- Department of Obstetrics and GynecologyHerlev and Gentofte HospitalHerlevDenmark
- Department of Obstetrics and GynecologyAalborg University HospitalAalborgDenmark
- Department of Clinical MedicineAalborg UniversityAalborgDenmark
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Petersen JP, Cueto H, Norman M. Births in the Nordics 2021 to 2022-Pandemic fluctuation or fundamental shift? Acta Paediatr 2024. [PMID: 38477867 DOI: 10.1111/apa.17209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 02/27/2024] [Accepted: 03/06/2024] [Indexed: 03/14/2024]
Affiliation(s)
- Jesper Padkaer Petersen
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
- The Danish Clinical Quality Program - National Clinical Registries (RKKP), Aarhus, Denmark
| | - Heidi Cueto
- The Danish Clinical Quality Program - National Clinical Registries (RKKP), Aarhus, Denmark
| | - Mikael Norman
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
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Lee EG, Perez A, Patel A, Patel AL, Waters T, Fricchione M, Johnson TJ. Impact of COVID-19 on Perinatal Outcomes and Birth Locations in a Large US Metropolitan Area. Healthcare (Basel) 2024; 12:340. [PMID: 38338226 PMCID: PMC10855483 DOI: 10.3390/healthcare12030340] [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: 12/20/2023] [Revised: 01/15/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
This was a population-based study to determine the impact of COVID-19 on birth outcomes in the Chicago metropolitan area, comparing pre-pandemic (April-September 2019) versus pandemic (April-September 2020) births. Multivariable regression models that adjusted for demographic and neighborhood characteristics were used to estimate the marginal effects of COVID-19 on intrauterine fetal demise (IUFD)/stillbirth, preterm birth, birth hospital designation, and maternal and infant hospital length of stay (LOS). There were no differences in IUFD/stillbirths or preterm births between eras. Commercially insured preterm and term infants were 4.8 percentage points (2.3, 7.4) and 3.4 percentage points (2.5, 4.2) more likely to be born in an academic medical center during the pandemic, while Medicaid-insured preterm and term infants were 3.6 percentage points less likely (-6.5, -0.7) and 1.8 percentage points less likely (-2.8, -0.9) to be born in an academic medical center compared to the pre-pandemic era. Infant LOS decreased from 2.4 to 2.2 days (-0.35, -0.20), maternal LOS for indicated PTBs decreased from 5.6 to 5.0 days (-0.94, -0.19), and term births decreased from 2.5 to 2.3 days (-0.21, -0.17). The pandemic had a significant effect on the location of births that may have exacerbated health inequities that continue into childhood.
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Affiliation(s)
- Esther G. Lee
- Division of Neonatology, Department of Pediatrics, Rush University Medical Center, Chicago, IL 60612, USA;
| | - Alejandra Perez
- Department of Health Systems Management, Rush University, Chicago, IL 60612, USA; (A.P.); (A.P.); (T.J.J.)
| | - Arth Patel
- Department of Health Systems Management, Rush University, Chicago, IL 60612, USA; (A.P.); (A.P.); (T.J.J.)
- Department of Clinical Excellence, University of Chicago Medicine, Chicago, IL 60637, USA
| | - Aloka L. Patel
- Division of Neonatology, Department of Pediatrics, Rush University Medical Center, Chicago, IL 60612, USA;
| | - Thaddeus Waters
- Department of Obstetrics & Gynecology, Rush University Medical Center, Chicago, IL 60612, USA;
- Department of Obstetrics & Gynecology, University at Buffalo, Buffalo, NY 14260, USA
| | - Marielle Fricchione
- Division of Infectious Diseases, Department of Pediatrics, Rush University Medical Center, Chicago, IL 60612, USA;
| | - Tricia J. Johnson
- Department of Health Systems Management, Rush University, Chicago, IL 60612, USA; (A.P.); (A.P.); (T.J.J.)
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Udholm LF, Ebdrup NH, Arendt LH, Knudsen UB, Hjortdal VE, Ramlau-Hansen CH. Congenital heart disease and the risk of impaired fertility: A Danish nationwide cohort study using time to pregnancy. Int J Cardiol 2023:S0167-5273(23)00573-9. [PMID: 37094718 DOI: 10.1016/j.ijcard.2023.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/16/2023] [Accepted: 04/14/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND The number of women with congenital heart disease (CHD) becoming pregnant are increasing. Although menstrual irregularities appear to occur more often in these patients, knowledge on their fertility is limited. In this nationwide cohort study, we evaluated the risk of impaired fertility in women with CHD compared with unaffected women using time to pregnancy (TTP). METHODS The Danish National Birth Cohort (DNBC) of pregnant women constituted the study population. Information on TTP and use of medically assisted reproduction (MAR) treatment was reported at a first trimester interview. Women with CHD were identified by linkage to the Danish National Patient Registry. TTP was divided into three categories; 0-5 months, 6-12 months (i.e. subfertile), and > 12 months or use of MAR treatment (i.e. infertile). Relative risk ratios (RRR) for subfertility and infertility with 95% confidence intervals were estimated using multinomial logistic regression. RESULTS Among 93,832 pregnancies in 84,922 women, CHD was diagnosed in 333 women (0.4%), contributing with 360 pregnancies. The CHD was of simple complexity in 291 women (87.4%). No association was found between CHD and longer TTP (RRR of 1.02 (95% CI: 0.75-1.40) for subfertility, and RRR of 0.86 (95% CI: 0.61-1.20) for infertility). Similar was observed when comparing women with simple CHD and unaffected women. The number of women with complex CHD was too low for evaluation. CONCLUSIONS Women with CHD had no increased risk of impaired fertility, assessed by TTP, when compared with unaffected women. Separate analysis of women with complex CHD was hampered by low numbers.
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Affiliation(s)
- Louise F Udholm
- Department of Clinical Medicine, Copenhagen University, 2200 Copenhagen N, Denmark; Department of Cardiothoracic Surgery, Copenhagen University Hospital, 2100 Copenhagen, Denmark; Department of Public Health, Research Unit for Epidemiology, Aarhus University, 8000 Aarhus, Denmark.
| | - Ninna H Ebdrup
- Department of Obstetrics and Gynaecology, Horsens Regional Hospital, 8700 Horsens, Denmark
| | - Linn H Arendt
- Department of Public Health, Research Unit for Epidemiology, Aarhus University, 8000 Aarhus, Denmark; Department of Obstetrics and Gynaecology, Horsens Regional Hospital, 8700 Horsens, Denmark
| | - Ulla B Knudsen
- Department of Obstetrics and Gynaecology, Horsens Regional Hospital, 8700 Horsens, Denmark; Department of Clinical Medicine, Aarhus University, 8200 Aarhus N, Denmark
| | - Vibeke E Hjortdal
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, 2100 Copenhagen, Denmark; Department of Clinical Medicine, Copenhagen University, 2200 Copenhagen N, Denmark
| | - Cecilia H Ramlau-Hansen
- Department of Public Health, Research Unit for Epidemiology, Aarhus University, 8000 Aarhus, Denmark
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Hedley PL, Bækvad‐Hansen M, Hedermann G, Hjalgrim H, Hougaard DM, Melbye M, Breindahl M, Krebs L, Hviid A, Lausten‐Thomsen U, Christiansen M. Preterm birth rates among twins during the Danish COVID-19 lockdown and when restrictions were relaxed. Acta Paediatr 2023; 112:298-300. [PMID: 36301145 PMCID: PMC9874850 DOI: 10.1111/apa.16583] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/10/2022] [Accepted: 10/25/2022] [Indexed: 01/28/2023]
Affiliation(s)
- Paula L. Hedley
- Department for Congenital DisordersStatens Serum InstitutCopenhagenDenmark,Brazen BioLos AngelesCaliforniaUSA
| | - Marie Bækvad‐Hansen
- Department for Congenital DisordersStatens Serum InstitutCopenhagenDenmark,Danish Center for Neonatal ScreeningStatens Serum InstitutCopenhagenDenmark
| | - Gitte Hedermann
- Department for Congenital DisordersStatens Serum InstitutCopenhagenDenmark,Department of Obstetrics and GynecologyCopenhagen University HospitalCopenhagenDenmark
| | - Henrik Hjalgrim
- Department of Epidemiology ResearchStatens Serum InstitutCopenhagenDenmark,Department of HaematologyCopenhagen University HospitalCopenhagenDenmark,Danish Cancer SocietyCopenhagenDenmark
| | - David M. Hougaard
- Department for Congenital DisordersStatens Serum InstitutCopenhagenDenmark,Danish Center for Neonatal ScreeningStatens Serum InstitutCopenhagenDenmark
| | - Mads Melbye
- Danish Cancer SocietyCopenhagenDenmark,Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark,Department of MedicineStanford University School of MedicineStanfordCaliforniaUSA
| | - Morten Breindahl
- Department of NeonatologyCopenhagen University HospitalCopenhagenDenmark
| | - Lone Krebs
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark,Department of Obstetrics and GynecologyCopenhagen University Hospital, Amager and Hvidovre HospitalCopenhagenDenmark
| | - Anders Hviid
- Department of Epidemiology ResearchStatens Serum InstitutCopenhagenDenmark,Department of Drug Development and Clinical Pharmacology, Pharmacovigilance Research Center, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | | | - Michael Christiansen
- Department for Congenital DisordersStatens Serum InstitutCopenhagenDenmark,Department of Biomedical SciencesUniversity of CopenhagenCopenhagenDenmark
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Lin L, St Clair S, Gamble GD, Crowther CA, Dixon L, Bloomfield FH, Harding JE. Nitrate contamination in drinking water and adverse reproductive and birth outcomes: a systematic review and meta-analysis. Sci Rep 2023; 13:563. [PMID: 36631499 PMCID: PMC9834225 DOI: 10.1038/s41598-022-27345-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/30/2022] [Indexed: 01/13/2023] Open
Abstract
Exposure to low levels of nitrate in drinking water may have adverse reproductive effects. We reviewed evidence about the association between nitrate in drinking water and adverse reproductive outcomes published to November 2022. Randomized trials, cohort or case-control studies published in English that reported the relationship between nitrate intake from drinking water and the risk of perinatal outcomes were included. Random-effect models were used to pool data. Three cohort studies showed nitrate in drinking water is associated with an increased risk of preterm birth (odds ratio for 1 mg/L NO3-N increased (OR1) = 1.01, 95% CI 1.00, 1.01, I2 = 23.9%, 5,014,487 participants; comparing the highest versus the lowest nitrate exposure groups pooled OR (ORp) = 1.05, 95% CI 1.01, 1.10, I2 = 0%, 4,152,348 participants). Case-control studies showed nitrate in drinking water may be associated with the increased risk of neural tube defects OR1 = 1.06, 95% CI 1.02, 1.10; 2 studies, 2196 participants; I2 = 0%; and ORp = 1.51, 95% CI 1.12, 2.05; 3 studies, 1501 participants; I2 = 0%). The evidence for an association between nitrate in drinking water and risk of small for gestational age infants, any birth defects, or any congenital heart defects was inconsistent. Increased nitrate in drinking water may be associated with an increased risk of preterm birth and some specific congenital anomalies. These findings warrant regular review as new evidence becomes available.
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Affiliation(s)
- Luling Lin
- grid.9654.e0000 0004 0372 3343Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Sophie St Clair
- grid.9654.e0000 0004 0372 3343Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Greg D. Gamble
- grid.9654.e0000 0004 0372 3343Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Caroline A. Crowther
- grid.9654.e0000 0004 0372 3343Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Lesley Dixon
- New Zealand College of Midwives, 376 Manchester Street, Richmond, Christchurch, 8014 New Zealand
| | - Frank H. Bloomfield
- grid.9654.e0000 0004 0372 3343Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Jane E. Harding
- grid.9654.e0000 0004 0372 3343Liggins Institute, University of Auckland, Auckland, New Zealand
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7
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Farhadi R, Noori H, GhaffariSaravi V, Moosazadeh M. Stillbirth and Preterm Birth During Lockdown Periods in 5 Waves of COVID-19 Pandemic in Northern Iran: A Region-Wide Cohort Study in Mazandaran Province. Health Serv Res Manag Epidemiol 2023; 10:23333928231180561. [PMID: 37347050 PMCID: PMC10280785 DOI: 10.1177/23333928231180561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 05/16/2023] [Accepted: 05/20/2023] [Indexed: 06/23/2023] Open
Abstract
Introduction Conflicting reports for preterm birth and stillbirth during the lockdown imposed during the COVID-19 pandemic have emerged. Most of the studies are related to the initial waves of the pandemic. Objectives This study aims to evaluate changes in preterm birth and stillbirth rates during various waves of COVID-19 in northern Iran. Methods This is a retrospective cohort study to evaluate preterm birth and stillbirth rate based on weight distribution per 1000 live births during lockdown periods in 5 peaks of the COVID-19 pandemic using the regional data registration system at Mazandaran University of Medical Sciences in northern Iran. We compared these rates with the corresponding months 4 years before the pandemic. The odds ratio for the primary outcome was estimated by logistic regression. Results We observed an overall increased rate of preterm birth during the pandemic compared to the pre-pandemic period (4.7% vs 2.8%, P < .001). The overall stillbirth rate increased during the COVID-19 pandemic compared to the pre-pandemic period (7.48/1000 vs 5.41/1000, odds ratio: 1.38 [1.21-1.57]). This increase in the rate of stillbirth was significantly observed in the fifth wave of the COVID-19 pandemic (P < .001). Conclusion Our study showed that adverse pregnancy outcomes increased during lockdown periods of a global pandemic. Further studies from geographically diverse regions to evaluate different behavior changes during pregnancy and access to prenatal services, and its impact on pregnancy outcomes is recommended.
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Affiliation(s)
- Roya Farhadi
- Pediatric Infectious Diseases Research
Center, Communicable Diseases Institute, Mazandaran University of Medical
Sciences, Sari, Iran
| | - Hanieh Noori
- Pediatric Infectious Diseases Research
Center, Communicable Diseases Institute, Mazandaran University of Medical
Sciences, Sari, Iran
| | - Vajiheh GhaffariSaravi
- Pediatric Infectious Diseases Research
Center, Communicable Diseases Institute, Mazandaran University of Medical
Sciences, Sari, Iran
| | - Mahmood Moosazadeh
- Health Sciences Research Center, Mazandaran University of Medical
Sciences, Sari, Iran
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Briana DD, Papaevangelou V, Malamitsi-Puchner A. Action is needed to tackle the clinical, psychological and socioeconomic impact of perinatal COVID-19. Acta Paediatr 2022; 111:2278-2283. [PMID: 35959999 PMCID: PMC9538449 DOI: 10.1111/apa.16513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/05/2022] [Accepted: 08/11/2022] [Indexed: 11/30/2022]
Abstract
The COVID-19 pandemic has turned perinatal healthcare into a worldwide public health challenge. Although initial data did not demonstrate pregnancy as a more susceptible period to adverse outcomes of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, an increasing number of reports now certify maternal illness as a high-risk condition for the development of maternal-fetal complications. Despite the rarity of SARS-CoV-2 vertical transmission, severe maternal illness might induce adverse perinatal and neonatal outcomes. Additionally, perinatal COVID-19 data may raise concerns about long-term harmful consequences to the offspring in the framework of non-communicable diseases. The World Health Organization, as well as scientific literature, consider the protection of the maternal-fetal dyad against COVID-19 as a critical issue and, therefore, strongly promote and encourage vaccination of pregnant and lactating women. Furthermore, the pandemic has triggered an unprecedented recession, leading to historic levels of unemployment and deprivation, while health, societal, economic and gender inequities particularly affecting low-income and middle-income countries, have increased. This mini-review provides an updated brief report on historical, clinical, psychological and socioeconomic aspects of the COVID-19 pandemic based on 10 lectures presented at the 9th Maria-Delivoria-Papadopoulos Perinatal Symposium, held virtually on 19 March 2022.
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Affiliation(s)
- Despina D Briana
- Third Department of Paediatrics, National and Kapodistrian University of Athens, Medical School, Greece
| | - Vassiliki Papaevangelou
- Third Department of Paediatrics, National and Kapodistrian University of Athens, Medical School, Greece
| | - Ariadne Malamitsi-Puchner
- Third Department of Paediatrics, National and Kapodistrian University of Athens, Medical School, Greece
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Wen J. Impact of COVID-19 pandemic on birth outcomes: A retrospective cohort study in Nanjing, China. Front Public Health 2022; 10:923324. [PMID: 35923970 PMCID: PMC9339802 DOI: 10.3389/fpubh.2022.923324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/28/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction The coronavirus disease 2019 (COVID-19) pandemic have significantly affected health care systems and daily wellbeing. However, the indirect impacts of the pandemic on birth outcomes are not fully understood. We aimed to examine whether the pandemic altered risk of adverse birth outcomes. Methods This retrospective cohort study included all singleton births during 2016–2020 identified in Women's Hospital of Nanjing Medical University. We compared birth outcomes during COVID-19 pandemic (January–December 2020) with before the pandemic (January–December 2016–2019) using Logstic regression adjusted for confounders. Results A total of 19,792 and 92,750 births occurred during and before the pandemic, respectively. Maternal characteristics were similar between groups, except maternal age was higher in pandemic cohort. We observed a reduction in preterm birth (PTB, <37 weeks) during the pandemic [5.9 vs. 5.1%, OR (95%CI) = 0.86 (0.80, 0.92)], but the difference disappeared after multivariable adjustment [adjusted OR (95%CI) = 1.02 (0.94, 1.11)]. Moreover, full term infants born during the pandemic had lower birth weights than those born before the pandemic [adjusted β (95% CI) = −17.4 (−23.9, −10.8)]. Consistently, the risks of low birthweight (LBW, <2,500 g) and small for gestational age (SGA, < P10) were increased [LBW: adjusted OR (95%CI) = 1.13 (1.02, 1.24); SGA: adjusted OR (95%CI) = 1.11 (1.02, 1.21)], and the risks of macrosomia (≥4,000 g) and large for gestational age (LGA, ≥P90) were decreased in the pandemic cohort [macrosomia: adjusted OR (95%CI) = 0.82 (0.77, 0.88); LGA: adjusted OR (95%CI) = 0.73 (0.69, 0.77)]. Conclusion In this study, we observed no change in preterm birth and a decrease in birth weight of full term infants during the pandemic in Nanjing, China.
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