1
|
Lichtwald A, Weiss C, Lange A, Ittermann T, Allenberg H, Grabe HJ, Heckmann M. Association between maternal pre-pregnancy body mass index and offspring's outcomes at 9 to 15 years of age. Arch Gynecol Obstet 2024; 309:105-118. [PMID: 37689592 PMCID: PMC10770235 DOI: 10.1007/s00404-023-07184-5] [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: 05/22/2023] [Accepted: 08/02/2023] [Indexed: 09/11/2023]
Abstract
OBJECTIVE Maternal pre-pregnancy underweight, overweight and obesity might increase the risk for worse short- and long-term outcome in the offspring. There is a need for further study into the relationship between maternal pre-pregnancy body mass index (BMI) and the combined outcome of physical development, state of health and social behavior in children. QUESTION Is maternal pre-pregnancy BMI associated with the child outcome in terms of physical development, state of health and social behavior (school and leisure time behavior) at the age of 9 to 15 years? METHODS In the population-based birth cohort study Survey of Neonates in Pomerania (SNIP) children at the age 9-15 years and their families were re-examined by questionnaire-based follow-up. 5725 mother-child pairs were invited to SNiP-follow-up. This analysis is based on the recall fraction of 24.1% (n = 1379). Based on the maternal pre-pregnancy BMI (ppBMI), 4 groups were formed: underweight (ppBMI < 19 kg/m2, n = 117), normal weight (ppBMI 19-24.99 kg/m2, n = 913, reference), overweight (ppBMI 25-30 kg). /m2, n = 237) and obesity (ppBMI > 30 kg/m2, n = 109). RESULTS In the multiple regression model, the BMI-z-score for children of mothers in the underweight group was -0.50 lower, and 0.50/1.07 higher in the overweight/obese group (p < 0.001) compared to reference at median age of 12 years. No differences were found in children of underweight mothers with regard to social behavior (interaction with friends and family), school and sports performance (coded from "very good" to "poor"), other leisure activities (watching television, using mobile phones, gaming), and health (occurrence of illnesses) compared to children of normal weight mothers. In contrast, maternal pre-pregnancy overweight and obesity were associated with lower school and sports performance, and higher screen time (smart phone, gaming, television) compared to children of normal weight mothers. CONCLUSION Maternal pre-pregnancy overweight and obesity but not underweight was negatively associated with school performance and leisure time behavior in the offspring at 9-15 years of age.
Collapse
Affiliation(s)
- Alexander Lichtwald
- Department of Neonatology and Pediatric Intensive Care, University Medicine Greifswald, Greifswald, Germany.
| | - Cathérine Weiss
- Department of Neonatology and Pediatric Intensive Care, University Medicine Greifswald, Greifswald, Germany.
| | - Anja Lange
- Department of Neonatology and Pediatric Intensive Care, University Medicine Greifswald, Greifswald, Germany
| | - Till Ittermann
- Institute of Community Medicine, Division of Health Care Epidemiology and Community Health, University Medicine Greifswald, Greifswald, Germany
| | - Heike Allenberg
- Department of Neonatology and Pediatric Intensive Care, University Medicine Greifswald, Greifswald, Germany
| | - Hans J Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Matthias Heckmann
- Department of Neonatology and Pediatric Intensive Care, University Medicine Greifswald, Greifswald, Germany
| |
Collapse
|
2
|
Lange AE, Mahlo-Nguyen J, Pierdant G, Allenberg H, Heckmann M, Ittermann T. Antenatal Care and Health Behavior of Pregnant Women—An Evaluation of the Survey of Neonates in Pomerania. CHILDREN 2023; 10:children10040678. [PMID: 37189927 DOI: 10.3390/children10040678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/22/2023] [Accepted: 03/28/2023] [Indexed: 04/05/2023]
Abstract
Background. The German maternity guidelines require regular medical checkup (MC) during pregnancy as a measure of prevention. Socioeconomic factors such as education, profession, income and origin, but also age and parity may influence the preventive and health behavior of pregnant women. The aim was to investigate the influence of these factors on the participation rate in MC of pregnant women. Method. The current analysis is based on the prospective population-based birth cohort study Survey of Neonates in Pomerania, which was conducted in Western Pomerania, Germany. The data of 4092 pregnant women from 2004 to 2008 were analyzed regarding the antenatal care and health behavior. Up to 12 MC were regularly offered; participation in 10 MC is defined as standard screening according to maternity guidelines. Results. Women participated in the first preventive MC on average in the 10th (±3.8 SD) week of pregnancy. 1343 (34.2%) women participated in standard screening and 2039 (51.9%) took a screening above standard. 547 (13.92%) women participated in less than the 10 standard MCs. In addition, about one-third of the pregnancies investigated in this study were unplanned. Bivariate analyses showed an association between better antenatal care behavior and higher maternal age, stabile partnerships and mother born in Germany, p < 0.05. On the contrary antenatal care below standard were more often found by women with unplanned pregnancies, less educational women and women with lower equivalent income, p < 0.001. Health behaviors also influenced antenatal care. Whereas the risk of antenatal care below standard increased by smoking during pregnancy (RRR 1.64; 95% CI 1.25, 2.14) and alcohol consumption (RRR 1.31; 95% CI 1.01, 1.69), supplementation intake was associated with decreased risk (iodine—RRR 0.66; 95% CI 0.53, 0.81; folic acid—RRR 0.56; 95% CI 0.44, 0.72). The health behavior of pregnant women also differs according to their social status. Higher maternal income was negatively correlated with smoking during pregnancy (OR 0.2; 95% CI 0.15, 0.24), but positively associated with alcohol consumption during pregnancy (OR 1.3; 95% CI 1.15, 1.48) and lower pre-pregnancy BMI (Coef. = 0.083, p < 0.001). Lower maternal education was positively correlated with smoking during pregnancy (OR 59.0; 95% CI 28.68, 121.23). Conclusions. Prenatal care according to maternity guidelines is well established with a high participation rate in MC during pregnancy of more than 85%. However, targeted preventive measures may address younger age, socioeconomic status and health-damaging behaviors (smoking, drinking) of the pregnant women because these factors were associated with antenatal care below standard.
Collapse
Affiliation(s)
- Anja Erika Lange
- Department of Neonatology & Paediatric Intensive Care Medicine, University of Greifswald, 17475 Greifswald, Germany
| | - Janine Mahlo-Nguyen
- Department of Neonatology & Paediatric Intensive Care Medicine, University of Greifswald, 17475 Greifswald, Germany
| | - Guillermo Pierdant
- Department of Obstetrics and Gynecology, University of Greifswald, 17475 Greifswald, Germany
| | - Heike Allenberg
- Department of Neonatology & Paediatric Intensive Care Medicine, University of Greifswald, 17475 Greifswald, Germany
| | - Matthias Heckmann
- Department of Neonatology & Paediatric Intensive Care Medicine, University of Greifswald, 17475 Greifswald, Germany
| | - Till Ittermann
- Institute of Community Medicine, Division of Health Care Epidemiology and Community Health, University of Greifswald, 17475 Greifswald, Germany
| |
Collapse
|
3
|
Pierdant G, Ittermann T, Freyer-Adam J, Siewert-Markus U, Grabe HJ, Dörr M, Heckmann M, Zygmunt M, Lange AE, Markus MRP. Maternal socioeconomic and lifestyle factors and life dissatisfaction associated with a small for gestational age infant. The Survey of Neonates in Pomerania (SNiP). Arch Gynecol Obstet 2023; 307:1243-1254. [PMID: 35599250 PMCID: PMC10023753 DOI: 10.1007/s00404-022-06598-x] [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: 01/21/2022] [Accepted: 04/27/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim is to investigate the associations of the mother's socioeconomic and lifestyle factors and life satisfaction with the delivery of a small for gestational age (SGA) infant. METHODS Data from 4598 participants of the population-based birth cohort study Survey of Neonates in Pomerania (SniP) including comprehensive information on pregnancies, mothers, and their offspring in Western Pomerania, Germany were used in this study. The associations were analyzed using linear and logistic regression models. RESULTS After logistic regression analysis adjusted for height of the mother, women who delivered SGA infants, had lower education (p < 0.01) and smoked more frequently during pregnancy (p < 0.01) compared with mothers of adequate for gestational age (AGA) neonates. A mother with less than 10 years of education and one who continued smoking during pregnancy had an odds ratio (OR) of 2.23 [95% confidence interval (CI) = 1.44 to 3.46] and 2.68 (95% CI = 2.06-3.49) of having an SGA infant, respectively. There was no association between the employment of the mother (p = 0.28), the monthly income (p = 0.09), the family status (p = 0.80), the number of friendships outside the household that the mother would not wish to relinquish (p = 0.47), the number of people that she could rely on in case of an emergency (p = 0.75), or alcohol consumption prior to (p = 0.14) or during the pregnancy (p = 0.99) with SGA. Finally, women who delivered SGA infants were more frequently dissatisfied with their employment (p = 0.03) and financial status (p < 0.01). CONCLUSIONS Women who delivered SGA infants had more associated socioeconomic and lifestyle risk factors and were more frequently dissatisfied with their life conditions than mothers of AGA neonates.
Collapse
Affiliation(s)
- Guillermo Pierdant
- Department of Gynecology and Obstetrics, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany.
| | - Till Ittermann
- Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
| | - Jennis Freyer-Adam
- DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
- Institute for Medical Psychology, University Medicine Greifswald, Greifswald, Germany
| | - Ulrike Siewert-Markus
- Institute for Medical Psychology, University Medicine Greifswald, Greifswald, Germany
| | - Hans Jörgen Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Marcus Dörr
- DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Matthias Heckmann
- Department of Neonatology and Pediatric Intensive Care, University Medicine Greifswald, Greifswald, Germany
| | - Marek Zygmunt
- Department of Gynecology and Obstetrics, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Anja Erika Lange
- Department of Neonatology and Pediatric Intensive Care, University Medicine Greifswald, Greifswald, Germany
| | - Marcello Ricardo Paulista Markus
- DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
- DZD (German Center for Diabetes Research), Partner site Greifswald, Greifswald, Germany
| |
Collapse
|
4
|
Domanski G, Lange AE, Ittermann T, Fallenberg J, Allenberg H, Zygmunt M, Heckmann M. Maternal pre-pregnancy underweight as a risk factor for the offspring: Survey of Neonates in Pomerania. Acta Paediatr 2021; 110:1452-1460. [PMID: 33283311 DOI: 10.1111/apa.15701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 11/03/2020] [Accepted: 11/27/2020] [Indexed: 01/16/2023]
Abstract
AIM The aim was to investigate socio-economic risk factors for maternal underweight before pregnancy and then associations of underweight with neonatal outcomes. METHODS Data of 3401 mother-child dyads from the population-based birth cohort Survey of Neonates in Pomerania (SNiP) were analysed. RESULTS Bivariate analysis showed that underweighted mothers were younger, smoked more often, had a lower equivalent income and lower socio-economic status (employment status and/or educational level) compared to women with normal weight. The final prediction model revealed that only younger maternal age (OR = 0.93; 95%-CI = 0.90-0.97) and maternal smoking during pregnancy (OR = 2.52; 95%-CI = 1.74-3.66) were associated with underweight. Compared to women with normal pre-pregnancy BMI, underweight women had an increased chance of premature labour (OR = 1.73; 95% CI: 1.29-2.31) and a reduced placental weight. The offspring of underweight women had an increased risk of late preterm birth (OR = 1.82; 95% CI: 1.21-2.74) and birthweight < 2500 g (OR = 1.91; 95% CI: 1.23-2.95). CONCLUSION Smoking during pregnancy and a younger age were identified as risk factors for maternal pre-pregnancy underweight which then was associated with late preterm birth and low birthweight.
Collapse
Affiliation(s)
- Grzegorz Domanski
- Dept. of Neonatology and Pediatric Intensive Care University Medicine Greifswald Greifswald Germany
| | - Anja Erika Lange
- Dept. of Neonatology and Pediatric Intensive Care University Medicine Greifswald Greifswald Germany
| | - Till Ittermann
- Institute for Community Medicine Div. SHIP – Clinical Epidemiological Research University Medicine Greifswald Greifswald Germany
| | - Jonas Fallenberg
- Dept. of Neonatology and Pediatric Intensive Care University Medicine Greifswald Greifswald Germany
| | - Heike Allenberg
- Dept. of Neonatology and Pediatric Intensive Care University Medicine Greifswald Greifswald Germany
| | - Marek Zygmunt
- Department of Gynecology and Obstetrics University Medicine Greifswald Greifswald Germany
| | - Matthias Heckmann
- Dept. of Neonatology and Pediatric Intensive Care University Medicine Greifswald Greifswald Germany
| |
Collapse
|
5
|
Shamsipour M, Pirjani R, Jeddi MZ, Effatpanah M, Rastkari N, Kashani H, Shirazi M, Hassanvand MS, Shariat M, Javadi FS, Shariatpanahi G, Hassanpour G, Peykarporsan Z, Jamal A, Ardestani ME, Hoseini FS, Dalili H, Nayeri FS, Mesdaghinia A, Naddafi K, Shahtaheri SJ, Nasseri S, Yunesian F, Rezaeizadeh G, Amini H, Yokoyama K, Vigeh M, Yunesian M. Tehran environmental and neurodevelopmental disorders (TEND) cohort study: Phase I, feasibility assessment. JOURNAL OF ENVIRONMENTAL HEALTH SCIENCE & ENGINEERING 2020; 18:733-742. [PMID: 33312598 PMCID: PMC7721759 DOI: 10.1007/s40201-020-00499-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 06/15/2020] [Indexed: 06/12/2023]
Abstract
PURPOSE To advance knowledge about childhood neurodevelopmental disorders and study their environmental determinants, we conducted a study in Tehran, Iran to assess the feasibility of prospective birth cohort study. METHODS We evaluated participation of pregnant women, feasibility of sampling biological material, and health care services availability in Tehran in four steps: (1) first trimester of pregnancy; (2) third trimester of pregnancy; (3) at delivery; and (4) two to three months after delivery. We collected related data through questionnaires, also various biological samples were obtained from mothers (blood, urine, milk and nails-hands and feet) and newborns (umbilical cord blood, meconium, and urine samples) from February 2016 to October 2017. RESULTS overall 838 eligible pregnant women were approached. The participation rate was 206(25%) in our study and about 185(90%) of subjects were recruited in hospitals. Out of 206 participants in the first trimester, blood, urine, hand nail, and foot nail samples were collected from 206(100%),193(93%), 205(99%), and 205(99%), respectively. These values dropped to 65(54%), 83(69%), 84(70%), and 84(70%) for the remaining participants 120(58%) in the third trimester, respectively. Also, we gathered milk samples from 125(60%) of mothers at two to three months after delivery. CONCLUSION Our findings suggest that hospitals were better places for recruitment of subjects in a birth cohort in Tehran. We further concluded that birth cohort study recruitment can be improved by choosing appropriate gestational ages. Obtaining the newborn's urine, meconium, and umbilical cord blood were challenging procedures and require good collaboration between hospital staff and researchers.
Collapse
Affiliation(s)
- Mansour Shamsipour
- Department of Research Methodology and Data Analysis, Institute for Environmental Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Reihaneh Pirjani
- Obstetrics and Gynecology Department, Arash women’s hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Zare Jeddi
- Division of Toxicology, Wageningen University & Research, Stippeneng 4, 6708 E Wageningen, the Netherlands
| | - Mohammad Effatpanah
- School of Medicine, Ziaeian Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Noushin Rastkari
- Center for Air Pollution Research, Institute for Environmental Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Homa Kashani
- Department of Research Methodology and Data Analysis, Institute for Environmental Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahboobeh Shirazi
- Maternal, fetal and neonatal research center, Tehran University of medical sciences, Tehran, Iran
| | - Mohammad Sadegh Hassanvand
- Center for Air Pollution Research, Institute for Environmental Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Mamak Shariat
- Maternal Fetal and Neonatal Research Center, Family Health Institute, Imam Khomeini Hospitals Complexes, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Ghazal Shariatpanahi
- Pediatric department, Ziaeian Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Gholamreza Hassanpour
- Center for Research of Endemic Parasites of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Peykarporsan
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Akram Jamal
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mina Ebad Ardestani
- Department of Research Methodology and Data Analysis, Institute for Environmental Research, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Hosein Dalili
- Breastfeeding Research Center, Family Health Institute, Imam Khomeini Hospitals Complexes, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Sadat Nayeri
- Maternal Fetal and Neonatal Research Center, Family Health Institute, Imam Khomeini Hospitals Complexes, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Mesdaghinia
- Center for Water Quality Research, Institute for Environmental Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Kazem Naddafi
- Center for Air Pollution Research, Institute for Environmental Research, Tehran University of Medical Sciences, Tehran, Iran
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Jamaleddin Shahtaheri
- Department of Occupational Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Simin Nasseri
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Center for Water Quality Research, Institute for Environmental Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzad Yunesian
- Environmental Engineer, Data Management Unit in Trial Contract Research Organization, Tehran, Iran
| | - Golnaz Rezaeizadeh
- Maternal Fetal and Neonatal Research Center, Family Health Institute, Imam Khomeini Hospitals Complexes, Tehran University of Medical Sciences, Tehran, Iran
| | - Heresh Amini
- Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Kazuhito Yokoyama
- Department of Epidemiology and Environmental Health, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421 Japan
| | - Mohsen Vigeh
- Maternal Fetal and Neonatal Research Center, Family Health Institute, Imam Khomeini Hospitals Complexes, Tehran University of Medical Sciences, Tehran, Iran
- Department of Epidemiology and Environmental Health, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421 Japan
| | - Masud Yunesian
- Department of Research Methodology and Data Analysis, Institute for Environmental Research, Tehran University of Medical Sciences, Tehran, Iran
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
6
|
Kantorczyk E, Domanski G, Lange AE, Ittermann T, Allenberg H, Zygmunt M, Heckmann M. Survey of Neonates in Pomerania (SNiP): Study design and cohort update. Paediatr Perinat Epidemiol 2020; 34:204-213. [PMID: 32003026 DOI: 10.1111/ppe.12645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 11/19/2019] [Accepted: 12/08/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND The health status of newborns is a major concern for parents and medical personnel. Recent studies have provided increasing evidence that factors from the foetal and perinatal periods of life influence health later in life. The "Follow-up of the Survey of Neonates in Pomerania" (SNiP-I-Follow-up) is the first follow-up of the population-based birth cohort study, SNiP-I, established in north-east Germany. OBJECTIVES The primary aim of SNiP-I-Follow-up study was the collection of longitudinal data on children and adolescents. The associations will be analysed between risk factors in pregnancy and the perinatal period and health status in infancy and later childhood. POPULATION The population-based cohort study SNiP-I was conducted in Pomerania in north-east Germany between February 2002 and November 2008. All mothers from the SNiP-I birth cohort were recontacted when their children were from 9 to 15 years of age. DESIGN The SNiP-I-Follow-up study was carried out between December 2016 and August 2017 and is a questionnaire-based survey. METHODS Physical development, health status, and social behaviour (school and leisure behaviour) of children were analysed using a questionnaire comprising medical, epidemiological, and socio-economic data, associated health care risk factors, and life circumstances of newborns, children, and their parents. PRELIMINARY RESULTS Out of 5725 children invited to participate in the SNiP-I-Follow-up study between December 2016 and August 2017, 29% (n = 1665) children participated in the SNiP-I-Follow-up study, providing data on 1665 mothers-child dyads. Responders had higher socio-economic status, especially in relation to maternal education status. CONCLUSION As a longitudinal birth cohort from rural Germany, the SNiP cohort will be a resource to address urgent research needs and contribute to overall population health.
Collapse
Affiliation(s)
- Elisa Kantorczyk
- Department of Neonatology and Pediatric Intensive Care, University Medicine Greifswald, Greifswald, Germany
| | - Grzegorz Domanski
- Department of Neonatology and Pediatric Intensive Care, University Medicine Greifswald, Greifswald, Germany
| | - Anja Erika Lange
- Department of Neonatology and Pediatric Intensive Care, University Medicine Greifswald, Greifswald, Germany
| | - Till Ittermann
- Institute for Community Medicine, Div. SHIP - Clinical Epidemiological Research, University Medicine Greifswald, Greifswald, Germany
| | - Heike Allenberg
- Department of Neonatology and Pediatric Intensive Care, University Medicine Greifswald, Greifswald, Germany
| | - Marek Zygmunt
- Department of Gynecology and Obstetrics, University Medicine Greifswald, Greifswald, Germany
| | - Matthias Heckmann
- Department of Neonatology and Pediatric Intensive Care, University Medicine Greifswald, Greifswald, Germany
| |
Collapse
|
7
|
Weise J, Heckmann M, Bahlmann H, Ittermann T, Allenberg H, Domanski G, Lange AE. Analyses of pathological cranial ultrasound findings in neonates that fall outside recent indication guidelines: results of a population-based birth cohort: survey of neonates in Pommerania (SNiP-study). BMC Pediatr 2019; 19:476. [PMID: 31805885 PMCID: PMC6894314 DOI: 10.1186/s12887-019-1843-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 11/20/2019] [Indexed: 11/10/2022] Open
Abstract
Background Recent guidelines recommend a cranial ultrasound (CU) in neonates born at < 30 weeks gestation, admitted to the neonatal intensive care unit (NICU), or with a CU indication. Here, we addressed the need to extend these recommendations. Methods We retrospectively reviewed 5107 CUs acquired in the population-based Survey of Neonates in Pomerania, conducted in 2002 to 2008. Neonates with conspicuous CUs that were ≥ 30 weeks gestation without recent indications for CU were identified and assigned to the following groups: with (I) or without (II) admission to neonatal care. We designated CU conspicuities as mild (MC) or significant (SC), and we investigated related neurodevelopment during follow-up. Results Of 5107 neonates, 5064 were born at ≥30 weeks gestation and of those, 4306 received CUs without any indication for this examination. We found conspicuities in 7.7% (n = 47/610) of group I (n = 30 MC, n = 17 SC), and 3.2% (n = 117/3696) of group II (n = 100 MC, n = 17 SC). In group II, SC comprised, e.g., bilateral cysts, partial agenesis of the corpus callosum, and periventricular leukomalacia. Follow-up was available in 75% of infants in group II with MCs and SCs; of these, 12.8% had an abnormal neurological follow-up. Conclusions We detected a high number of conspicuities in neonates without a CU indication. However, we could not demonstrate that ultrasound findings were associated with the neurological follow-up or any advantage to an earlier diagnosis. Our data did not support extending current guidelines or a general CU screening policy for all neonates.
Collapse
Affiliation(s)
- Judith Weise
- Dept. of Neonatology & Paediatric Intensive Care Medicine, University Greifswald, F.-Sauerbruchstr, 17475, Greifswald, Germany
| | - Matthias Heckmann
- Dept. of Neonatology & Paediatric Intensive Care Medicine, University Greifswald, F.-Sauerbruchstr, 17475, Greifswald, Germany
| | - Hagen Bahlmann
- Dept. of Neonatology & Paediatric Intensive Care Medicine, University Greifswald, F.-Sauerbruchstr, 17475, Greifswald, Germany
| | - Till Ittermann
- Institute of Community Medicine, Div. of Health Care Epidemiology and Community Health, University Greifswald, Greifswald, Germany
| | - Heike Allenberg
- Dept. of Neonatology & Paediatric Intensive Care Medicine, University Greifswald, F.-Sauerbruchstr, 17475, Greifswald, Germany
| | - Grzegorz Domanski
- Dept. of Neonatology & Paediatric Intensive Care Medicine, University Greifswald, F.-Sauerbruchstr, 17475, Greifswald, Germany
| | - Anja Erika Lange
- Dept. of Neonatology & Paediatric Intensive Care Medicine, University Greifswald, F.-Sauerbruchstr, 17475, Greifswald, Germany.
| |
Collapse
|
8
|
Brandstetter S, Toncheva AA, Niggel J, Wolff C, Gran S, Seelbach-Göbel B, Apfelbacher C, Melter M, Kabesch M. KUNO-Kids birth cohort study: rationale, design, and cohort description. Mol Cell Pediatr 2019; 6:1. [PMID: 30627823 PMCID: PMC6326917 DOI: 10.1186/s40348-018-0088-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 12/10/2018] [Indexed: 01/07/2023] Open
Abstract
Background Birth cohort studies can contribute substantially to the understanding of health and disease — in childhood and over the life course. The KUNO-Kids birth cohort study was established to investigate various aspects of child health, using novel omics technologies in a systems medicine approach. Results After 3 years of recruitment, 2515 infants and their families have joined the study. Parents with higher education are overrepresented as in many other birth cohorts and are more likely to complete follow-up assessments via self-report questionnaires. The vast majority of participants consented to clinical examinations of their child and to the non-invasive collection of diverse biosamples, which were processed specifically for their integrated use in omics technology covering genomics, epigenomics, transcriptomics, metabolomics, and microbiome analyses of the skin, oral cavity, and stool. Conclusions The data and diverse biomaterial collected in the KUNO-Kids birth cohort study will provide extensive opportunities for investigating child health and its determinants in a holistic approach. The combination of a broad range of research questions in one study will allow for a cost-effective use of biomaterial and omics results and for a comprehensive analysis of biological and social determinants of health and disease. Aiming for low attrition and ensuring participants’ long-term commitment will be crucial to fully exploit the potential of the study.
Collapse
Affiliation(s)
- Susanne Brandstetter
- University Children's Hospital Regensburg (KUNO-Clinics), University of Regensburg, Clinic St. Hedwig, Steinmetzstr. 1-3, 93049, Regensburg, Germany.
| | - Antoaneta A Toncheva
- University Children's Hospital Regensburg (KUNO-Clinics), University of Regensburg, Clinic St. Hedwig, Steinmetzstr. 1-3, 93049, Regensburg, Germany
| | - Jakob Niggel
- University Children's Hospital Regensburg (KUNO-Clinics), University of Regensburg, Clinic St. Hedwig, Steinmetzstr. 1-3, 93049, Regensburg, Germany
| | - Christine Wolff
- University Children's Hospital Regensburg (KUNO-Clinics), University of Regensburg, Clinic St. Hedwig, Steinmetzstr. 1-3, 93049, Regensburg, Germany
| | - Silvia Gran
- University Children's Hospital Regensburg (KUNO-Clinics), University of Regensburg, Clinic St. Hedwig, Steinmetzstr. 1-3, 93049, Regensburg, Germany
| | - Birgit Seelbach-Göbel
- Clinic of Obstetrics and Gynecology St. Hedwig, University of Regensburg, Regensburg, Germany
| | - Christian Apfelbacher
- Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - Michael Melter
- University Children's Hospital Regensburg (KUNO-Clinics), University of Regensburg, Clinic St. Hedwig, Steinmetzstr. 1-3, 93049, Regensburg, Germany
| | - Michael Kabesch
- University Children's Hospital Regensburg (KUNO-Clinics), University of Regensburg, Clinic St. Hedwig, Steinmetzstr. 1-3, 93049, Regensburg, Germany
| | | |
Collapse
|
9
|
Domanski G, Lange AE, Ittermann T, Allenberg H, Spoo RA, Zygmunt M, Heckmann M. Evaluation of neonatal and maternal morbidity in mothers with gestational diabetes: a population-based study. BMC Pregnancy Childbirth 2018; 18:367. [PMID: 30200916 PMCID: PMC6131836 DOI: 10.1186/s12884-018-2005-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 08/31/2018] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is the most frequent complication during pregnancy. Untreated GDM is a severe threat to maternal and neonatal health. Based on recent evidence, up to 15% of all pregnancies may be affected by GDM. We hypothesized that in a rural birth cohort, higher maternal BMI and adverse socioeconomic conditions would promote GDM, which in turn would lead to adverse effects on pregnancy outcomes. METHODS The current study is a part of a population-based cohort study examining the health and socioeconomic information from 5801 mothers and their children. The study, titled the Survey of Neonates in Pomerania (SNiP), was based in northeastern Pomerania, Germany (2002-2008). RESULTS The cumulative incidence of GDM was 5.1%. Multiple logistic regression revealed prepregnancy overweight (OR 1.84 (95% CI 1.27-2.68)), prepregnancy obesity (OR 3.67 (2.48-5.44)) and maternal age (OR 1.06 (1.03-1.08)) as risk factors for GDM (p = 0.001). Alcohol use during pregnancy (OR 0.61 (0.41-0.90), a higher monthly income (OR 0.62 (0.46-0.83)), and the highest level of education (OR 0.44 (0.46-0.83)) decreased the risk of GDM. Newborns of GDM mothers had an increased risk of hypoglycaemia (OR 11.71 (7.49-18.30)) or macrosomia (OR 2.43 (1.41-4.18)) and were more often delivered by primary (OR 1.76 (1.21-2.60)) or secondary C-section (OR 2.00 (1.35-2.97)). Moreover, they were born 0.78 weeks (95% CI -1.09 - -0.48 weeks) earlier than infants of mothers without diabetes, resulting in higher percentage of late preterm infants with a gestational age of 32-36 weeks (11.1% vs. 6.96%). CONCLUSIONS Age and BMI before pregnancy were the predominant mediators of the increased risk of GDM, whereas a higher income and educational level were protective. GDM affected relevant perinatal and neonatal outcomes based on its association with an increased risk of delivery by C-section, preterm birth, macrosomia at birth and neonatal hypoglycaemia.
Collapse
Affiliation(s)
- Grzegorz Domanski
- Department of Neonatology and Pediatric Intensive Care, University Medicine Greifswald, Ferdinand-Sauerbruch-Strasse, 17487 Greifswald, Germany
| | - Anja Erika Lange
- Department of Neonatology and Pediatric Intensive Care, University Medicine Greifswald, Ferdinand-Sauerbruch-Strasse, 17487 Greifswald, Germany
| | - Till Ittermann
- Institute for Community Medicine, Div. SHIP – Clinical Epidemiological Research, University Medicine Greifswald, Walter Rathenau Str. 48, 17475 Greifswald, Germany
| | - Heike Allenberg
- Department of Neonatology and Pediatric Intensive Care, University Medicine Greifswald, Ferdinand-Sauerbruch-Strasse, 17487 Greifswald, Germany
| | - Robert Andreas Spoo
- Department of Neonatology and Pediatric Intensive Care, University Medicine Greifswald, Ferdinand-Sauerbruch-Strasse, 17487 Greifswald, Germany
| | - Marek Zygmunt
- Department of Gynecology and Obstetrics, University Medicine Greifswald, Ferdinand-Sauerbruch-Str, 17487 Greifswald, Germany
| | - Matthias Heckmann
- Department of Neonatology and Pediatric Intensive Care, University Medicine Greifswald, Ferdinand-Sauerbruch-Strasse, 17487 Greifswald, Germany
| |
Collapse
|
10
|
Lange AE, Lange J, Ittermann T, Napp M, Krueger PC, Bahlmann H, Kasch R, Heckmann M. Population-based study of the incidence of congenital hip dysplasia in preterm infants from the Survey of Neonates in Pomerania (SNiP). BMC Pediatr 2017; 17:78. [PMID: 28302080 PMCID: PMC5356283 DOI: 10.1186/s12887-017-0829-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 03/08/2017] [Indexed: 11/18/2022] Open
Abstract
Background Some etiological factors involved in developmental dysplasia of the hip (DDH) occur in the last trimester of pregnancy, which could result in a decreased incidence of DDH in preterm infants. The aim of this study was to compare the incidence of DDH between preterm and term infants. Methods Ultrasound of the hip joint was performed in 2,534 term infants and 376 preterm infants within the population-based Survey of Neonates in Pomerania (SNiP) study. Results A total of 42 (1.66%) term infants had DDH (Graf type II c, 0.8%; type D, 0.3% left and 0.4% right; type III a, 0.2% left). Eighteen infants had bilateral findings. Hip dysplasia occurred more frequently in female neonates (32/1,182 vs. 10/1,302, p < 0.023; 95% CI 0.012–0.022, χ2 test). A familial disposition for DDH was found in 169 (6.7%) term infants and 181 (7.1%) infants in the overall population. In preterm infants, dysplasia of the hip was found in only three late preterm infants with gestational age between 36 and 37 weeks (n = 97) and not in preterm infants <36 weeks gestational age (n = 279). Regression analysis revealed a narrowly significant association between gestational week of birth and DDH (relative risk = 1.17; 95% confidence interval 0.99–1.37; p = 0.065). Conclusion Our study suggests that preterm infants <36 weeks gestational age have a decreased risk of DDH.
Collapse
Affiliation(s)
- A E Lange
- Departments of Paediatrics and Neonatology & Paediatric Intensive Care Medicine, University of Greifswald, Greifswald, Germany. .,Klinik und Poliklinik für Kinder- und Jugendmedizin, F.-Sauerbruch-Str., 17487, Greifswald, Germany.
| | - J Lange
- Department of Trauma Surgery, University of Greifswald, Greifswald, Germany
| | - Till Ittermann
- Institute for Community Medicine, Div. SHIP - Clinical Epidemiological Research, University Medicine Greifswald, Greifswald, Germany
| | - M Napp
- Department of Trauma Surgery, University of Greifswald, Greifswald, Germany
| | | | - H Bahlmann
- Departments of Paediatrics and Neonatology & Paediatric Intensive Care Medicine, University of Greifswald, Greifswald, Germany
| | - R Kasch
- Department of Orthopaedics and Orthopaedic Surgery, University of Greifswald, Greifswald, Germany
| | - M Heckmann
- Departments of Paediatrics and Neonatology & Paediatric Intensive Care Medicine, University of Greifswald, Greifswald, Germany
| |
Collapse
|
11
|
The LIFE Child study: a population-based perinatal and pediatric cohort in Germany. Eur J Epidemiol 2017; 32:145-158. [PMID: 28144813 DOI: 10.1007/s10654-016-0216-9] [Citation(s) in RCA: 128] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 12/02/2016] [Indexed: 12/11/2022]
Abstract
The LIFE Child study is a large population-based longitudinal childhood cohort study conducted in the city of Leipzig, Germany. As a part of LIFE, a research project conducted at the Leipzig Research Center for Civilization Diseases, it aims to monitor healthy child development from birth to adulthood and to understand the development of lifestyle diseases such as obesity. The study consists of three interrelated cohorts; the birth cohort, the health cohort, and the obesity cohort. Depending on age and cohort, the comprehensive study program comprises different medical, psychological, and sociodemographic assessments as well as the collection of biological samples. Optimal data acquisition, process management, and data analysis are guaranteed by a professional team of physicians, certified study assistants, quality managers, scientists and statisticians. Due to the high popularity of the study, more than 3000 children have already participated until the end of 2015, and two-thirds of them participate continuously. The large quantity of acquired data allows LIFE Child to gain profound knowledge on the development of children growing up in the twenty-first century. This article reports the number of available and analyzable data and demonstrates the high relevance and potential of the study.
Collapse
|
12
|
Lange A, Nautsch A, Weitmann K, Ittermann T, Heckmann M. Breastfeeding motivation in Pomerania: Survey of neonates in Pomerania (SNiP-Study). Int Breastfeed J 2017; 12:3. [PMID: 28070209 PMCID: PMC5217157 DOI: 10.1186/s13006-016-0093-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 12/12/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Nationale Stillkommission was founded in Germany in 1994 to increase the acceptance of breastfeeding as the primary means of infant nutrition. Scientific studies like "Stillen und Säuglingsernährung (SuSe-Studie)", and regional studies in Bavaria, Freiburg, Hamburg, and Berlin demonstrated breastfeeding initiation rates of 90 to 95%, but the total breastfeeding rate decreased to 25-61% after infants were 6 months old. One predictor of breastfeeding duration may be maternal motivation. The present study aimed to describe breastfeeding motivation. METHODS We analysed data collected in 2004-2008, during a previous study, the Survey of Neonates in Pomerania (SNiP). We retrieved data regarding maternal breastfeeding motivation, family environment, and socioeconomic factors. We constructed a quantitative breastfeeding-motivation score to identify factors involved in maternal breastfeeding. RESULTS Ninety five percent of mothers who gave birth in the study period and area provided information in the survey. The breastfeeding initiation rate was 88.4%. Mothers' intentions to provide exclusive breastfeeding (only breast milk, no other liquids or infant formula) increased linearly from 71.9% in 2005 to 76.8% in 2008. Women motivated to provide exclusive breastfeeding were, on average, older, primiparous, and able to deliver spontaneously more often than women with less breastfeeding motivation. Furthermore, women with no motivation to provide exclusive breastfeeding and women that intended to provide breastfeeding combined with a complementary nutrition source had visited prenatal classes less frequently, had lower levels education, had lower average incomes, had a German nationality more often, and used tobacco more often than women motivated to provide exclusive breastfeeding. CONCLUSIONS Breastfeeding intentions increased during the SNiP Study. This study identified several factors that might serve for targeted breastfeeding promotion in mothers younger than 25 years, mothers with low education, and multiparous mothers or women who have received a caesarean section. Furthermore, breastfeeding motivation might be enhanced during pregnancy and/or after delivery by providing prenatal classes.
Collapse
Affiliation(s)
- Anja Lange
- Department of Pediatrics and Neonatology & Paediatric Intensive Care, University Medicine Greifswald, F.-Sauerbruchstr, 17475 Greifswald, Germany
| | - Anke Nautsch
- Department of Pediatrics and Neonatology & Paediatric Intensive Care, University Medicine Greifswald, F.-Sauerbruchstr, 17475 Greifswald, Germany
| | - Kerstin Weitmann
- Institute of Community Medicine, Division of Health Care Epidemiology and Community Health, SHIP-KEF, University of Greifswald, Greifswald, Germany
| | - Till Ittermann
- Institute of Community Medicine, Division of Health Care Epidemiology and Community Health, SHIP-KEF, University of Greifswald, Greifswald, Germany
| | - Matthias Heckmann
- Department of Pediatrics and Neonatology & Paediatric Intensive Care, University Medicine Greifswald, F.-Sauerbruchstr, 17475 Greifswald, Germany
| |
Collapse
|
13
|
Generation and validation of a universal perinatal database and biospecimen repository: PeriBank. J Perinatol 2016; 36:921-929. [PMID: 27629376 DOI: 10.1038/jp.2016.130] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 07/28/2016] [Accepted: 07/12/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVE There is a dearth of biospecimen repositories available to perinatal researchers. In order to address this need, here we describe the methodology used to establish such a resource. STUDY DESIGN With the collaboration of MedSci.net, we generated an online perinatal database with 847 fields of clinical information. Simultaneously, we established a biospecimen repository of the same clinical participants. RESULTS The demographic and clinical outcomes data are described for the first 10 000 participants enrolled. The demographic characteristics are consistent with the demographics of the delivery hospitals. Quality analysis of the biospecimens reveals variation in very few analytes. Furthermore, since the creation of PeriBank, we have demonstrated validity of the database and tissue integrity of the biospecimen repository. CONCLUSION Here we establish that the creation of a universal perinatal database and biospecimen collection is not only possible, but allows for the performance of state-of-the-science translational perinatal research and is a potentially valuable resource to academic perinatal researchers.
Collapse
|
14
|
Lange AE, Thyrian JR, Wetzka S, Flessa S, Hoffmann W, Zygmunt M, Fusch C, Lode HN, Heckmann M. The impact of socioeconomic factors on the efficiency of voluntary toxoplasmosis screening during pregnancy: a population-based study. BMC Pregnancy Childbirth 2016; 16:197. [PMID: 27473047 PMCID: PMC4966761 DOI: 10.1186/s12884-016-0966-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 07/12/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Congenital toxoplasmosis is associated with severe complications. German state health insurance covers rubella, but not toxoplasmosis, immunity screening. We analysed the effect of socioeconomic factors on the efficiency of private toxoplasmosis screening during pregnancy. METHODS Toxoplasmosis and rubella screening data (n = 5402 mothers) were collected within the population-based Survey of Neonates in Pomerania (SNiP). RESULTS At the first-trimester screening, 34.4 % (88.1 %) of expecting mothers were immune to toxoplasmosis (rubella). Susceptibility for toxoplasmosis (rubella) was observed in 39.6 % (8.9 %) and 25.8 % (2.95 %) were not tested. Data on a 2(nd) screening were available in a subgroup of women with negative immunity showing less than 45 % participation rate. Active toxoplasmosis (no rubella) infection was observed in 0.3 % (n = 17) of pregnant women. A multiple logistic regression model (AIC = 719.67; AUC = 0.725) revealed that the likelihood of participating in a second toxoplasmosis screening increased among women with a good level of education and a steady partnership and decreased with paternal unemployment and the absence of breastfeeding. The highest probability of non-participation in toxoplasmosis screening was found among women with temporal burden and family responsibilities. A cost-benefit analysis showed that covering general screening for toxoplasmosis with health insurance saved costs. CONCLUSION Toxoplasmosis carried a substantial risk of infection during pregnancy. Although increased socioeconomic status was positively associated with the participation in toxoplasmosis screening, this was not the case when pregnant women had strong temporal burden and family responsibilities. This data supports the need for toxoplasmosis screening among pregnant women as a general healthcare benefit covered by insurance.
Collapse
Affiliation(s)
- A. E. Lange
- Department of Pediatrics and Neonatology & Paediatric Intensive Care, University Medicine Greifswald, F.-Sauerbruchstr, 17475 Greifswald, Germany
| | - J. R. Thyrian
- Division of Health Care Epidemiology and Community Health, Institute of Community Medicine, University of Greifswald, Greifswald, Germany
| | - S. Wetzka
- Department of Health Care Management, Faculty of Law and Economics, Ernst-Moritz-Arndt-University of Greifswald, Greifswald, Germany
| | - S. Flessa
- Department of Health Care Management, Faculty of Law and Economics, Ernst-Moritz-Arndt-University of Greifswald, Greifswald, Germany
| | - W. Hoffmann
- Division of Health Care Epidemiology and Community Health, Institute of Community Medicine, University of Greifswald, Greifswald, Germany
| | - M. Zygmunt
- Department of Gynaecology and Obstetrics, University of Greifswald, Greifswald, Germany
| | - C. Fusch
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, ON Canada
| | - H. N. Lode
- Department of Pediatrics and Neonatology & Paediatric Intensive Care, University Medicine Greifswald, F.-Sauerbruchstr, 17475 Greifswald, Germany
| | - M. Heckmann
- Department of Pediatrics and Neonatology & Paediatric Intensive Care, University Medicine Greifswald, F.-Sauerbruchstr, 17475 Greifswald, Germany
| |
Collapse
|
15
|
[Incidence and duration of therapy of pathological hip findings in U2 and U3 examinations (SNiP study)]. DER ORTHOPADE 2015; 43:129-35. [PMID: 24464331 DOI: 10.1007/s00132-013-2200-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION AND OBJECTIVES Determination of the efficacy of an early ultrasound examination followed by immediate treatment of hip joint dysplasia as well as measuring the therapeutic success in a population-based cohort study of neonates. MATERIAL AND METHODS The Survey of Neonates in Pomerania (SNiP) study included 4,093 neonates which represents 95.1 % of the total neonatal population. Of these children 2,534 (61.9 %) underwent ultrasound examination of the hip joint during the U2 stage (3-10 days after birth). The mean gestational age was 38.9 weeks. The sonographic classification was performed according to Graf. RESULTS Initially (U2 stage) 42 (1.66 %) children were reported to be in need of therapy (stage IIc or higher according to Graf). The analysis showed a significantly higher incidence in girls (32 girls vs. 10 boys, p < 0.023, χ(2) test) and in children who had a breech birth (116, 4.6 %). A genetic predisposition was ascertained in 180 (7.1 %) children. The children could be subdivided into two groups: 1) children who underwent hip joint ultrasound during both U2 and U3 and 2) children who were first screened at the U3 stage. Of the 49 out of 54 neonates where the ultrasound findings were positive at the U2 examination the hip joint was matured in 32 children at U3 (4-8 weeks), 11 children had to be treated for 8-12 weeks 5 children were treated for over 3 months and1 child needed surgical correction. CONCLUSION The early diagnosis of hip maturation disorders and joint dysplasia facilitates early implementation of effective treatment. At our clinic over 60 % of the infants underwent the U2 check up and, given a pathological finding, could undergo early treatment. It was possible to successfully treat 78 % of these children with a Tübingen hip flexion splint in just 4-8 weeks. In contrast, infants who were first examined at the U3 stage needed treatment for 4-12 months. In our opinion, early diagnosis at the age of 3-10 days should be carried out for all newborns.
Collapse
|
16
|
Ernst SA, Günther K, Frambach T, Zeeb H. Prenatal recruitment of participants for a birth cohort study including cord blood collection: results of a feasibility study in Bremen, Germany. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2015; 13:Doc04. [PMID: 25908931 PMCID: PMC4397994 DOI: 10.3205/000208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 04/07/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Prospective birth cohort studies comprising follow up of children from pregnancy or birth over a long period of time, and collecting various biological samples at different times through the life-course offer a promising approach to enhance etiologic knowledge of various diseases. Especially for those where early lifetime exposures and conditions are thought to play an important role. The collection and storage of biological samples is a critical component in epidemiological studies, notably for research regarding prenatal exposures to various environmental factors as well as for DNA extraction. Our feasibility study for a birth cohort within the scope of etiology of childhood leukemia with prospective sampling of mothers and their future newborns aimed to investigate the willingness of pregnant women to participate in a birth cohort study involving collection of blood and umbilical cord blood samples. The overall aim was to develop practice-based research recommendations for a possible German birth cohort study. METHODS The study was conducted in Bremen, Germany, between January 2012 and March 2013. Pregnant women were eligible for recruitment if (i) their expected date of delivery was during the study recruitment phase (September 2012-February 2013), (ii) they planned to give birth at the cooperating hospital's obstetric unit and (iii) their knowledge of the German language was sufficient to understand study materials, details of participation and to fill out the prenatal self-administered questionnaire. Maternal blood and umbilical cord blood samples to be used for later research activities were collected and stored at a stem cell bank already collaborating with the hospital. 22 primary care gynecologists were invited to enroll pregnant women for the study and cooperation with one hospital was established. Expectant women were recruited during the last trimester of pregnancy, either during one of their prenatal care visits at their primary care gynecologist or later on in hospital by the attending obstetricians or project staff. RESULTS Of the 22 invited primary care gynecologists requested to enroll pregnant women for the study, 8 gynecologists actually collaborated. A total of 200 eligible women were invited to participate in the study, 48 (24%) of whom agreed. 34 women were enrolled by primary care gynecologists, with one gynecologist enrolling 26 women. Twelve of 14 women recruited via hospitals were enrolled by study staff. A total of 41 women consented to the collection of umbilical cord blood and maternal blood samples, and samples could be stored for 54% of them. Reason for non-participation were the uncertainty whether or not the full study would be conducted and the fact that the participants were not willing to decide for their children whether or not genetic information (cord blood) can be stored for research purposes. CONCLUSION Enrolling parents in a birth cohort study that includes biosampling is a challenge, but participation can be improved through close collaboration with primary care gynecologists and maternity hospitals. Cord blood collection may impede participation, especially when maternity hospitals offer an alternative option for cord blood donation.
Collapse
Affiliation(s)
| | - Kathrin Günther
- Leibniz-Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
| | | | - Hajo Zeeb
- Leibniz-Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
| |
Collapse
|
17
|
Chronic diseases in pregnant women: prevalence and birth outcomes based on the SNiP-study. BMC Pregnancy Childbirth 2014; 14:75. [PMID: 24552439 PMCID: PMC3943445 DOI: 10.1186/1471-2393-14-75] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 02/11/2014] [Indexed: 11/29/2022] Open
Abstract
Background The subject of “pregnancy and disease” is of particular importance for maternal well-being and neonatal outcomes. The international literature has focused on acute diseases during pregnancy; however, there are only a few studies investigating chronic diseases in pregnant women. The focus of this study is on diseases of women in childbearing age that are not related to the pregnancy. The objective of the paper is to deliver population based prevalences of chronic dieases in childbearing women and compare the two groups of chronically ill women and healthy women in detail regarding sociodemography, peri- and prenatal parameters and birth outcomes. Methods Data of n = 5320 childbearing women were evaluated in the context of the population-based Survey of Neonates in Pomerania (SNiP). Data were obtained via face-to-face interviews, self-applied questionnaires, and abstraction from medical records at the time of giving birth. Sociodemographic and health status data were assessed, including chronic diseases that were taken out of medical records. A comprehensive set of pre- and perinatal varaiables were assessed. Results In the SNiP, every fifth pregnant woman suffers from at least one chronic disease, and higher prevalence rates have been reported in the literature. There was a significant difference between chronically ill women and healthy women in age, education and income. Prenatal complications were more frequent in the healthy group than in the chronic disease group. Women with chronic diseases delivered by Cesarean section more frequently than women in the healthy group. Every tenth woman with at least one chronic disease gave birth to a premature infant, while only one in every 13 woman in the healthy control group gave birth to a premature infant. Conclusions This analysis is the first population-based study in which all chronic diseases could be taken into consideration. The population-based prevalences rates in the SNiP data are consistently lower than those found in the literature. There are differences between chronically ill women and healthy women in peri- and prenatal variables as well as birth outcome on the population level. However, they are less frequent than expected and further analyses are need focusing on specific diseases.
Collapse
|
18
|
Reichert J, Schemken M, Manthei R, Steinbronn R, Bucher U, Albrecht M, Rüdiger M. [Health insurance expenses for children in the first five years of life - a cohort-based analysis]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2013; 107:451-60. [PMID: 24238022 DOI: 10.1016/j.zefq.2013.08.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 07/26/2013] [Accepted: 08/30/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The development of paediatrics is characterised by several changes in the past few years, concerning, in particular holistic treatments or preventive check-ups, but also the transfer of treatment from the inpatient to the outpatient sector. There are no reference values for assessing emerging health insurance expenses. The aim of this study was to obtain a frame of reference for the costs of the treatment for neonates, infants, and young children using the example of the expenditures of one health insurance fund. METHODS The individual health insurance expenditures were analysed for the first five years of life of children insured with the AOK PLUS in Saxony, Germany, in 2005. Costs of hospital treatment, ambulatory care, remedies, tools, medicines and care were included. RESULTS The costs per insured child and year amounted to approximately 1,277 Euro (N = 11,147), with the highest costs arising in the first two years. 858 Euro were spent annually for an "average" child; 5,691 Euro per year incurred for a child with special medical needs. DISCUSSION The present cost analysis describes both the height and structure of a health insurance's spendings on children within the first five years of their life in consideration of regional medical care offers. The question of whether this analysis provides valid reference values for other health insurances or other service areas will have to be answered by other analyses.
Collapse
|
19
|
McDonald SW, Lyon AW, Benzies KM, McNeil DA, Lye SJ, Dolan SM, Pennell CE, Bocking AD, Tough SC. The All Our Babies pregnancy cohort: design, methods, and participant characteristics. BMC Pregnancy Childbirth 2013; 13 Suppl 1:S2. [PMID: 23445747 PMCID: PMC3561154 DOI: 10.1186/1471-2393-13-s1-s2] [Citation(s) in RCA: 114] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background The prospective cohort study design is ideal for examining diseases of public health importance, as its inherent temporal nature renders it advantageous for studying early life influences on health outcomes and research questions of aetiological significance. This paper will describe the development and characteristics of the All Our Babies (AOB) study, a prospective pregnancy cohort in Calgary, Alberta, Canada designed to examine determinants of maternal, infant, and child outcomes and identify barriers and facilitators in health care utilization. Methods Women were recruited from health care offices, communities, and through Calgary Laboratory Services before 25 weeks gestation from May 2008 to December 2010. Participants completed two questionnaires during pregnancy, a third at 4 months postpartum, and are currently being followed-up with questionnaires at 12, 24, and 36 months. Data was collected on pregnancy history, demographics, lifestyle, health care utilization, physical and mental health, parenting, and child developmental outcomes and milestones. In addition, biological/serological and genetic markers can be extracted from collected maternal and cord blood samples. Results A total of 4011 pregnant women were eligible for recruitment into the AOB study. Of this, 3388 women completed at least one survey. The majority of participants were less than 35 years of age, Caucasian, Canadian born, married or in a common-law relationship, well-educated, and reported household incomes above the Calgary median. Women who discontinued after the first survey (n=123) were typically younger, non-Caucasian, foreign-born, had lower education and household income levels, were less likely to be married or in a common-law relationship, and had poor psychosocial health in early pregnancy. In general, AOB participants reflect the pregnant and parenting population at local and provincial levels, and perinatal indicators from the study are comparable to perinatal surveillance data. Conclusions The extensive and rich data collected in the AOB cohort provides the opportunity to answer complex questions about the relationships between biology, early experiences, and developmental outcomes. This cohort will contribute to the understanding of the biologic mechanisms and social/environmental pathways underlying associations between early and later life outcomes, gene-environment interactions, and developmental trajectories among children.
Collapse
Affiliation(s)
- Sheila W McDonald
- Department of Paediatrics, University of Calgary, Calgary, AB, Canada.
| | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Elger BS, Biller-Andorno N. Biobanks and Research: Scientific Potential and Regulatory Challenge. THE INTERNATIONAL LIBRARY OF ETHICS, LAW AND TECHNOLOGY 2011. [DOI: 10.1007/978-94-007-1673-5_3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
|
21
|
Changing maternity leave policy: short-term effects on fertility rates and demographic variables in Germany. Soc Sci Med 2010; 71:672-6. [PMID: 20594953 DOI: 10.1016/j.socscimed.2010.05.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Revised: 04/26/2010] [Accepted: 05/04/2010] [Indexed: 11/23/2022]
Abstract
Changes in reproductive behaviour and decreasing fertility rates have recently led to policy actions that attempt to counteract these developments. Evidence on the efficacy of such policy interventions, however, is limited. The present analysis examines fertility rates and demographic variables of a population in Germany in response to new maternity leave regulations, which were introduced in January 2007. As part of a population-based survey of neonates in Pomerania (SNiP), all births in the study region from the period 23 months prior to January 1st, 2007 until 23 months afterwards were examined. Crude Birth Rates (CBR) per month, General Fertility Rates (GFR) per month, parity and sociodemographic variables were compared using bivariate techniques. Logistic regression analysis was performed. No statistically significant difference in the CBR or GFR after Jan. 1st, 2007 was found. There were statistically significant differences in other demographic variables, however. The proportion of mothers who (a) were employed full-time before pregnancy; (b) came from a higher socioeconomic status; and (c) had higher income levels all increased after January 1st, 2007. The magnitude of these effects was higher in multigravid women. Forward stepwise logistic regression found an odds ratio of 1.79 for women with a family income of more than 3000 euro to give birth after the new law was introduced. This is the first analysis of population-based data that examines fertility rates and sociodemographic variables in response to new legal regulations. No short-term effects on birth rates were detected, but there was a differential effect on the subgroup of multigravidae. The focus of this policy was to provide financial support, which is certainly important, but the complexity of having a child suggests that attitudinal and motivational aspects also need to be taken into account. Furthermore, these analyses were only able to evaluate the short-term consequences of the policy; further studies are needed to assess for different, long-term effects.
Collapse
|