Spatial epidemiology of gestational age and birth weight in Switzerland: census-based linkage study

Health of singleton neonates in Switzerland through time and crises: a cross-sectional study at the population level, 2007-2022

BACKGROUND

Being exposed to crises during pregnancy can affect maternal health through stress exposure, which can in return impact neonatal health. We investigated temporal trends in neonatal outcomes in Switzerland between 2007 and 2022 and their variations depending on exposure to the economic crisis of 2008, the flu pandemic of 2009, heatwaves (2015 and 2018) and the COVID-19 pandemic.

METHODS

Using individual cross-sectional data encompassing all births occurring in Switzerland at the monthly level (2007-2022), we analysed changes in birth weight and in the rates of preterm birth (PTB) and stillbirth through time with generalized additive models. We assessed whether the intensity or length of crisis exposure was associated with variations in these outcomes. Furthermore, we explored effects of exposure depending on trimesters of pregnancy.

RESULTS

Over 1.2 million singleton births were included in our analyses. While birth weight and the rate of stillbirth have remained stable since 2007, the rate of PTB has declined by one percentage point. Exposure to the crises led to different results, but effect sizes were overall small. Exposure to COVID-19, irrespective of the pregnancy trimester, was associated with a higher birth weight (+12 grams [95% confidence interval (CI) 5.5 to 17.9 grams]). Being exposed to COVID-19 during the last trimester was associated with an increased risk of stillbirth (odds ratio 1.24 [95%CI 1.02 to 1.50]). Exposure to the 2008 economic crisis during pregnancy was not associated with any changes in neonatal health outcomes, while heatwave effect was difficult to interpret.

CONCLUSION

Overall, maternal and neonatal health demonstrated resilience to the economic crisis and to the COVID-19 pandemic in a high-income country like Switzerland. However, the effect of exposure to the COVID-19 pandemic is dual, and the negative impact of maternal infection on pregnancy is well-documented. Stress exposure and economic constraint may also have had adverse effects among the most vulnerable subgroups of Switzerland. To investigate better the impact of heatwave exposure on neonatal health, weekly or daily-level data is needed, instead of monthly-level data.

Spatiotemporal Patterns of Adverse Pregnancy Outcomes in Rural Areas of Henan, China

The spatial patterns of adverse pregnancy outcomes (APOs) are complex, vary by place, and remain not entirely clear. This study investigated spatiotemporal patterns of APOs in rural areas of Henan, China. We used data from 1,315,327 singleton pregnancies during 2013-2016 in rural areas of Henan, China, from the National Free Pre-pregnancy Checkup Program (NFPCP). A spatiotemporal analysis of APOs was conducted based on the time of conception and current address. Results of seasonality decomposed showed a slight decline in the incidence rate of APOs (12.93% to 11.27% in the compound trend) among the participants from 2013 to 2016 and also variation in annual periodicity (peaking in autumn at 12.66% and hitting bottom in spring at 11.16%). Spatial clusters of APOs were concentrated in an intersection band of northwestern to southeastern Henan Province (with a relative risk ratio ranging from 3.66 to 1.20), the northwestern and northern portion for temporal variation (having a trend in the cluster ranged from -6.25% to 83.93). This study provides an overall picture of APOs that presented downward trends over time, seasonal fluctuation, and clustered patterns across space and over time in Henan Province-the most populated province in China. The findings of this study warrant future studies to investigate underlying influential factors of spatial variation of APOs.

Association of geographic distribution and birth weight with sociodemographic factors of the maternal and newborn child of hilly and mountain regions of eastern Nepal: a cross-sectional study

OBJECTIVES

To determine the association of geographic distribution, and birth weight with sociodemographic factors of the maternal and newborn child of hilly region (lower altitude) and mountain region (high altitude) of eastern Nepal as well as the prevalence of low birth weight (LBW) and large for gestational age (LGA) among term singleton deliveries in eastern Nepal.

METHODOLOGY

A cross-sectional study was conducted in the district-level hospitals of Dhankuta, Tehrathum, Solukhumbu and Taplejung districts of eastern Nepal of Province 1. Mothers with preterm or post-term delivery, multiple pregnancies, stillbirth/intrauterine fetal death and incomplete records were excluded from the study with only 1386 term pregnancies (37-42 weeks) delivered at the respective facilities between 17 July 2019 and 16 July 2020 were included. The appropriate data were entered in Microsoft Excel 2019 V.16.0 and statistical analysis was performed by using the statistical package for social sciences, IBM SPSS V.29.

RESULTS

The low maternal age, Dalit ethnic group, low gravidity, low parity, higher antenatal care (ANC) visits (≥4), incomplete deworming and dT vaccination status, breech deliveries and LBW newborns were significantly attributed to hilly region (lower altitude) (p value <0.05). Similarly, the hilly region, lower and/or no ANC visits and early term gestation had significant negative association with birth weight at the lower quantiles only. Meanwhile, the female newborn had significant and negative association with birth weight distribution at all seven quantiles. The prevalence of the LBW, average for gestational age and LGA newborn child among term singleton deliveries in Eastern Nepal is 6.6%, 85.8% and 7.6%, respectively.

CONCLUSIONS

The local organisations should focus on adequate antenatal care visits in mountain region and coverage of dT vaccine and deworming medications in hilly region. Appropriate measures and programmes should be initiated to bring down LBW in hilly region.

The impact of unemployment benefits on birth outcomes: Quasi-experimental evidence from European linked register data

Cash transfers have been shown to improve birth outcomes by improving maternal nutrition, increasing healthcare use, and reducing stress. Most of the evidence focuses on programs targeting the poorest in the US—a context with non-universal access to healthcare and strong health inequalities. It is thus unclear whether these results would apply to cash transfers targeting a less disadvantaged population and whether they apply to other contexts. We provide evidence on the impact of unemployment benefits on birth outcomes in Switzerland, where access to healthcare is near-universal and social assistance is relatively generous. Our study taps into a policy reform that reduced unemployment benefits by 56%. We use linked parent-child register data and difference-in-differences estimates as well as within sibling comparisons. We find that the reform did not impact birth outcomes when fathers were unemployed but reduced the birthweight of children when mothers were unemployed by 80g and body length by 6mm. There are stronger effects for children whose mothers were the primary earner before job loss, but effects do not differ systematically by household income. These results suggest that in the Swiss context, unemployment benefits improve birth outcomes by reducing (job search) stress rather than by improving nutrition or healthcare use. As such, cash transfers likely play a role for newborn health in most other contexts.

Green CURIOCITY: a study protocol for a European birth cohort study analysing childhood heat-related health impacts and protective effects of urban natural environments

INTRODUCTION

The European climate is getting warmer and the impact on childhood health and development is insufficiently understood. Equally, how heat-related health risks can be reduced through nature-based solutions, such as exposure to urban natural environments, is unknown. Green CURe In Outdoor CITY spaces (Green CURIOCITY) will analyse how heat exposure during pregnancy affects birth outcomes and how long-term heat exposure may influence children's neurodevelopment. We will also investigate if adverse effects can be mitigated by urban natural environments. A final goal is to visualise intraurban patterns of heat vulnerability and assist planning towards healthier cities.

METHODS AND ANALYSIS

We will use existing data from the Human Early-Life Exposure cohort, which includes information on birth outcomes and neurodevelopment from six European birth cohorts. The cohort is linked to data on prenatal heat exposure and impact on birth outcomes will be analysed with logistic regression models, adjusting for air pollution and noise and sociobehavioural covariates. Similarly, impact of cumulative and immediate heat exposure on neurodevelopmental outcomes at age 5 will be assessed. For both analyses, the potentially moderating impact of natural environments will be quantified. For visualisation, Geographical information systems data will be combined to develop vulnerability maps, demonstrating urban 'hot spots' where the risk of negative impacts of heat is aggravated due to sociodemographic and land use patterns. Finally, geospatial and meteorological data will be used for informing GreenUr, an existing software prototype developed by the WHO Regional Office for Europe to quantify health impacts and augment policy tools for urban green space planning.

ETHICS AND DISSEMINATION

The protocol was approved by the Comité Ético de Investigación Clínica Parc de Salut MAR, Spain. Findings will be published in peer-reviewed journals and presented at policy events. Through stakeholder engagement, the results will also reach user groups and practitioners.

Geographic Inequalities of Respiratory Health Services Utilization during Childhood in Edmonton and Calgary, Canada: A Tale of Two Cities

Young children are susceptible to respiratory diseases. Inequalities exist across socioeconomic groups for paediatric respiratory health services utilization in Alberta. However, the geographic distribution of those inequalities has not been fully explored. The aim of this study was to identify geographic inequalities in respiratory health services utilization in early childhood in Calgary and Edmonton, two major urban centres in Western Canada. We conducted a geographic analysis of data from a retrospective cohort of all singleton live births occurred between 2005 and 2010. We aggregated at area-level the total number of episodes of respiratory care (hospitalizations and emergency department visits) that occurred during the first five years of life for bronchiolitis, pneumonia, lower/upper respiratory tract infections, influenza, and asthma-wheezing. We used spatial filters to identify geographic inequalities in the prevalence of acute paediatric respiratory health services utilization in Calgary and Edmonton. The average health gap between areas with the highest and the lowest prevalence of respiratory health services utilization was 1.5-fold in Calgary and 1.4-fold in Edmonton. Geographic inequalities were not completely explained by the spatial distribution of socioeconomic status, suggesting that other unmeasured factors at the neighbourhood level may explain local variability in the use of acute respiratory health services in early childhood.