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Lwin MW, Timby E, Ivarsson A, Eurenius E, Vaezghasemi M, Silfverdal SA, Lindkvist M. Abnormal birth weights for gestational age in relation to maternal characteristics in Sweden: a five year cross-sectional study. BMC Public Health 2023; 23:976. [PMID: 37237290 DOI: 10.1186/s12889-023-15829-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 05/06/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Abnormal birth weight - small for gestational age (SGA) and large for gestational age (LGA) - are important indicators for newborn health. Due to changes in lifestyle in recent decades, it is essential to keep up-to-date with the latest information on maternal factors linked to abnormal birth weight. The aim of this study is to investigate SGA and LGA in relation to maternal individual, lifestyle and socioeconomic characteristics. . METHODS This is a register-based cross-sectional study. Self-reported data from Sweden's Salut Programme maternal questionnaires (2010-2014) were linked with records in the Swedish Medical Birth Register (MBR). The analytical sample comprised 5089 singleton live births. A Swedish standard method using ultrasound-based sex-specific reference curves defines the abnormality of birth weight in MBR. Univariable and multivariable logistic regressions were used to examine crude and adjusted associations between abnormal birth weights and maternal individual, lifestyle and socioeconomic characteristics. A sensitivity analysis, using alternative definitions of SGA and LGA under the percentile method, was undertaken. RESULTS In multivariable logistic regression, maternal age and parity were associated with LGA (aOR = 1.05, CI = 1.00, 1.09) and (aOR = 1.31, CI = 1.09, 1.58). Maternal overweight and obesity were strongly associated with LGA (aOR = 2.28, CI = 1.47, 3.54) and (aOR = 4.55, CI = 2.85, 7.26), respectively. As parity increased, the odds of delivering SGA babies decreased (aOR = 0.59, CI = 0.42, 0.81) and preterm deliveries were associated with SGA (aOR = 9.46, CI = 5.67, 15.79). The well-known maternal determinants of abnormal birthweight, such as unhealthy lifestyles and poor socioeconomic factors, were not statistically significant in this Swedish setting. CONCLUSIONS The main findings suggest that multiparity, maternal pre-pregnancy overweight and obesity are strong determinants for LGA babies. Public health interventions should address modifiable risk factors, especially maternal overweight and obesity. These findings suggest that overweight and obesity is an emerging public health threat for newborn health. This might also result in the intergenerational transfer of overweight and obesity. These are important messages for public health policy and decision making.
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Affiliation(s)
- Min Wai Lwin
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Erika Timby
- Department of Clinical Science, Obstetrics and Gynaecology, Umeå University, Umeå, Sweden
| | - Anneli Ivarsson
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Eva Eurenius
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Masoud Vaezghasemi
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | | | - Marie Lindkvist
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.
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2
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MacFarlane ME, Thompson JMD, Wilson J, Lawton B, Taylor B, Elder DE, Baker N, McDonald GK, Zuccollo J, Schlaud M, Fleming P, Mitchell EA. Infant Sleep Hazards and the Risk of Sudden Unexpected Death in Infancy. J Pediatr 2022; 245:56-64. [PMID: 35120985 DOI: 10.1016/j.jpeds.2022.01.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 01/20/2022] [Accepted: 01/26/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To examine the effects of infant sofa-sleeping, recent use by caregivers of alcohol, cannabis, and/or other drugs, and bed type and pillows, on the risk of sudden unexpected death in infancy (SUDI) in New Zealand. STUDY DESIGN A nationwide prospective case-control study was implemented between March 2012 and February 2015. Data were collected during interviews with parents/caregivers. "Hazards" were defined as infant exposure to 1 or more of sofa-sleeping and recent use by caregivers of alcohol, cannabis, and other drugs. The interaction of hazards with tobacco smoking in pregnancy and bed sharing, including for very young infants, and the difference in risk for Māori and non-Māori infants, also were assessed. RESULTS The study enrolled 132 cases and 258 controls. SUDI risk increased with infant sofa-sleeping (imputed aOR [IaOR] 24.22, 95% CI 1.65-356.40) and with hazards (IaOR 3.35, 95% CI 1.40-8.01). The SUDI risk from the combination of tobacco smoking in pregnancy and bed sharing (IaOR 29.0, 95% CI 10.10-83.33) increased with the addition of 1 or more hazards (IaOR 148.24, 95% CI 15.72-1398), and infants younger than 3 months appeared to be at greater risk (IaOR 450.61, 95% CI 26.84-7593.14). CONCLUSIONS Tobacco smoking in pregnancy and bed sharing remain the greatest SUDI risks for infants and risk increases further in the presence of sofa-sleeping or recent caregiver use of alcohol and/or cannabis and other drugs. Continued implementation of effective, appropriate programs for smoking cessation, safe sleep, and supplying safe sleep beds is required to reduce New Zealand SUDI rates and SUDI disparity among Māori.
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Affiliation(s)
| | - John M D Thompson
- Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Jessica Wilson
- Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Beverley Lawton
- Centre for Women's Health Research, Victoria University of Wellington, Wellington, New Zealand
| | - Barry Taylor
- Women's and Children's Health, University of Otago, Otago, New Zealand
| | - Dawn E Elder
- Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
| | - Nick Baker
- Department of Paediatrics, Nelson-Marlborough Hospital, Nelson, New Zealand
| | | | - Jane Zuccollo
- National Perinatal Pathology Service (NPPS), Auckland City Hospital, Auckland, New Zealand
| | - Martin Schlaud
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Peter Fleming
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, United Kingdom
| | - Edwin A Mitchell
- Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
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3
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Aradhya S, Katikireddi SV, Juárez SP. Immigrant ancestry and birthweight across two generations born in Sweden: an intergenerational cohort study. BMJ Glob Health 2022; 7:bmjgh-2021-007341. [PMID: 35470131 PMCID: PMC9058695 DOI: 10.1136/bmjgh-2021-007341] [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: 09/01/2021] [Accepted: 03/14/2022] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Differences in birthweight are often seen between migrants and natives. However, whether migrant-native birthweight inequalities widen, narrow or remain persistent across generations when comparing the descendants of immigrants and natives remains understudied. We examined inequalities in birthweight of mothers (G2) and daughters (G3) of foreign-born grandmothers (G1) compared with those of Swedish-born grandmothers. METHODS We used population registers with multigenerational linkages to identify 314 415 daughters born in Sweden during the period 1989-2012 (G3), linked to 246 642 mothers (G2) born in Sweden during 1973-1996, and to their grandmothers (G1) who were Swedish or foreign-born. We classified migrants into non-western, Eastern European, the rest of Nordic and Western. We used multivariable methods to examine mean birthweight and low birthweight (<2500 g; LBW). RESULTS Birthweight between individuals with Swedish background (G1) and non-western groups increased from -80 g to -147 g between G2 (mothers) and G3 (daughters), respectively. Furthermore, the odds of LBW increased among the G3 non-western immigrants compared with those with Swedish grandmothers (OR: 1.38, 95% CI 1.12 to 1.69). Birthweight increased in both descendants of Swedes and non-western immigrants, but less so in the latter (83 g vs 16 g). CONCLUSION We observed an increase in birthweight inequalities across generations between descendants of non-western immigrants and descendants of Swedes. This finding is puzzling considering Sweden has been lauded for its humanitarian approach to migration, for being one of the most egalitarian countries in the world and providing universal access to healthcare and education.
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Affiliation(s)
- Siddartha Aradhya
- Demography Unit (SUDA) and Department of Sociology, Stockholm University, Stockholm, Sweden,Centre for Economic Demography (CED), Lund University, Lund, Sweden
| | - Srinivasa Vittal Katikireddi
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK,Department of Public Health Sciences, Stockholm University, Stockholm, Sweden,Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden
| | - Sol P Juárez
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden,Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden
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4
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Maternal nicotine metabolism moderates the impact of maternal cigarette smoking on infant birth weight: A Collaborative Perinatal Project investigation. Drug Alcohol Depend 2022; 233:109358. [PMID: 35247723 PMCID: PMC8977115 DOI: 10.1016/j.drugalcdep.2022.109358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/11/2022] [Accepted: 02/12/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Maternal cigarette smoking is an important modifiable risk factor for low birth weight in the US. We investigated the maternal nicotine metabolite ratio (NMR; trans-3'-hydroxycotinine/cotinine) - a genetically-informed biomarker of nicotine clearance - as a moderator of links between prenatal cigarette use and birth weight. We also explored the role of race in these associations. METHODS Participants were 454 pregnant women (Mage = 25 years; 11% Black) who smoked cigarettes and their 537 infants from the Collaborative Perinatal Project. Cigarettes smoked per day were assessed at each prenatal visit; maternal NMR was assayed from third trimester serum. Birth weight was obtained from medical records. Generalized estimating equations were used to evaluate associations between cigarette smoking, NMR, race, and birth weight. RESULTS NMR moderated continuous associations between cigarettes per day over pregnancy and infant birth weight (p = .025). Among women who smoked at moderate levels (<15 cigarettes per day), those with slower NMR showed ~50-100 g decrements in birth weight versus those with faster NMR., while there were no significant associations between NMR and birth weight among women who smoked 15+ cigarettes per day. Although effects of NMR on birthweight were similar for Black and white women, Black women showed significantly slower NMR (p < .001). CONCLUSIONS This is the first demonstration that the maternal nicotine metabolism phenotype moderates associations between maternal smoking during pregnancy and birth weight. Infants of women with slower nicotine metabolism - including disproportionate representation of Black women - may be at heightened risk for morbidity from maternal smoking.
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Madley-Dowd P, Lundberg M, Heron J, Zammit S, Ahlqvist VH, Magnusson C, Rai D. Maternal smoking and smokeless tobacco use during pregnancy and offspring development: sibling analysis in an intergenerational Swedish cohort. Int J Epidemiol 2021; 50:1840-1851. [PMID: 34999852 PMCID: PMC8743113 DOI: 10.1093/ije/dyab095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2021] [Indexed: 11/24/2022] Open
Abstract
Background The association between maternal smoking in pregnancy and offspring intellectual disability (ID) is less well understood than that of smoking and fetal growth restriction. As fetal growth and cognitive development may share similar confounding structures, comparison of the two associations may improve understanding of the causal nature of the association with ID. Furthermore, comparisons of smoking with smokeless tobacco use may aid identification of mechanisms of action. Methods This was a cohort study of all Swedish births between 1999 and 2012 (n = 1 070 013), with prospectively recorded data. We assessed the association between maternal smoking during pregnancy and offspring outcomes ID and born small for gestational age (SGA). Analyses were repeated for snus use in pregnancy. Using a sibling design, we estimated within-family effects that control for shared sibling characteristics. Results Those exposed to maternal smoking in pregnancy had increased odds of ID [odds ratio (OR) = 1.24, 95% confidence interval (CI): 1.16-1.33] and SGA (OR = 2.19, 95% CI: 2.11-2.27) after confounder adjustment. Within-family effects were found for SGA (OR = 1.44, 95% CI: 1.27-1.63) but not ID (OR = 0.92, 95% CI: 0.74-1.14). For snus use, the results for ID were similar to smoking. We found increased odds of offspring SGA among mothers who used snus in pregnancy in sensitivity analyses but not in primary analyses. Conclusions Our findings are consistent with a causal effect of maternal smoking in pregnancy on risk of offspring born SGA but not on risk of ID. We found no evidence for a causal effect of snus use in pregnancy on ID and inconclusive evidence for SGA.
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Affiliation(s)
- Paul Madley-Dowd
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Michael Lundberg
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Jon Heron
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Stanley Zammit
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Viktor H Ahlqvist
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia Magnusson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Dheeraj Rai
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Avon and Wiltshire Partnership, NHS Mental Health Trust, Bristol, UK
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6
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Epigenetic Alterations of Maternal Tobacco Smoking during Pregnancy: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105083. [PMID: 34064931 PMCID: PMC8151244 DOI: 10.3390/ijerph18105083] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/29/2021] [Accepted: 05/04/2021] [Indexed: 12/11/2022]
Abstract
In utero exposure to maternal tobacco smoking is the leading cause of birth complications in addition to being associated with later impairment in child’s development. Epigenetic alterations, such as DNA methylation (DNAm), miRNAs expression, and histone modifications, belong to possible underlying mechanisms linking maternal tobacco smoking during pregnancy and adverse birth outcomes and later child’s development. The aims of this review were to provide an update on (1) the main results of epidemiological studies on the impact of in utero exposure to maternal tobacco smoking on epigenetic mechanisms, and (2) the technical issues and methods used in such studies. In contrast with miRNA and histone modifications, DNAm has been the most extensively studied epigenetic mechanism with regard to in utero exposure to maternal tobacco smoking. Most studies relied on cord blood and children’s blood, but placenta is increasingly recognized as a powerful tool, especially for markers of pregnancy exposures. Some recent studies suggest reversibility in DNAm in certain genomic regions as well as memory of smoking exposure in DNAm in other regions, upon smoking cessation before or during pregnancy. Furthermore, reversibility could be more pronounced in miRNA expression compared to DNAm. Increasing evidence based on longitudinal data shows that maternal smoking-associated DNAm changes persist during childhood. In this review, we also discuss some issues related to cell heterogeneity as well as downstream statistical analyses used to relate maternal tobacco smoking during pregnancy and epigenetics. The epigenetic effects of maternal smoking during pregnancy have been among the most widely investigated in the epigenetic epidemiology field. However, there are still huge gaps to fill in, including on the impact on miRNA expression and histone modifications to get a better view of the whole epigenetic machinery. The consistency of maternal tobacco smoking effects across epigenetic marks and across tissues will also provide crucial information for future studies. Advancement in bioinformatic and biostatistics approaches is key to develop a comprehensive analysis of these biological systems.
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Shreeve N, Depierreux D, Hawkes D, Traherne JA, Sovio U, Huhn O, Jayaraman J, Horowitz A, Ghadially H, Perry JRB, Moffett A, Sled JG, Sharkey AM, Colucci F. The CD94/NKG2A inhibitory receptor educates uterine NK cells to optimize pregnancy outcomes in humans and mice. Immunity 2021; 54:1231-1244.e4. [PMID: 33887202 PMCID: PMC8211638 DOI: 10.1016/j.immuni.2021.03.021] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/13/2020] [Accepted: 03/25/2021] [Indexed: 12/13/2022]
Abstract
The conserved CD94/NKG2A inhibitory receptor is expressed by nearly all human and ∼50% of mouse uterine natural killer (uNK) cells. Binding human HLA-E and mouse Qa-1, NKG2A drives NK cell education, a process of unknown physiological importance influenced by HLA-B alleles. Here, we show that NKG2A genetic ablation in dams mated with wild-type males caused suboptimal maternal vascular responses in pregnancy, accompanied by perturbed placental gene expression, reduced fetal weight, greater rates of smaller fetuses with asymmetric growth, and abnormal brain development. These are features of the human syndrome pre-eclampsia. In a genome-wide association study of 7,219 pre-eclampsia cases, we found a 7% greater relative risk associated with the maternal HLA-B allele that does not favor NKG2A education. These results show that the maternal HLA-B→HLA-E→NKG2A pathway contributes to healthy pregnancy and may have repercussions on offspring health, thus establishing the physiological relevance for NK cell education. Video Abstract
CD94/NKG2A educates uterine NK cells NKG2A-deficient dams display reduced utero-placental hemodynamic adaptations Asymmetric growth restriction and abnormal brain development in NKG2A-deficient dams Non-functional HLA-B→HLA-E→NKG2A pathway exposes women to greater pre-eclampsia risk
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Affiliation(s)
- Norman Shreeve
- Department of Obstetrics & Gynaecology, University of Cambridge, National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge CB2 0SW, UK; University of Cambridge Centre for Trophoblast Research, Cambridge, UK
| | - Delphine Depierreux
- Department of Obstetrics & Gynaecology, University of Cambridge, National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge CB2 0SW, UK; University of Cambridge Centre for Trophoblast Research, Cambridge, UK
| | - Delia Hawkes
- Department of Obstetrics & Gynaecology, University of Cambridge, National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge CB2 0SW, UK
| | | | - Ulla Sovio
- Department of Obstetrics & Gynaecology, University of Cambridge, National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge CB2 0SW, UK; University of Cambridge Centre for Trophoblast Research, Cambridge, UK
| | - Oisin Huhn
- Department of Obstetrics & Gynaecology, University of Cambridge, National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge CB2 0SW, UK; University of Cambridge Centre for Trophoblast Research, Cambridge, UK; Department of Pathology, University of Cambridge, Cambridge, UK; AstraZeneca, Granta Park, Cambridge CB21 6GH, UK
| | - Jyothi Jayaraman
- University of Cambridge Centre for Trophoblast Research, Cambridge, UK; Department of Pathology, University of Cambridge, Cambridge, UK; Department of Physiology, Development and Neurobiology, University of Cambridge, Cambridge, UK
| | - Amir Horowitz
- Department of Oncological Sciences, Precision Immunology Institute and Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - John R B Perry
- MRC Epidemiology Unit, University of Cambridge, Cambridge UK
| | - Ashley Moffett
- University of Cambridge Centre for Trophoblast Research, Cambridge, UK; Department of Pathology, University of Cambridge, Cambridge, UK
| | - John G Sled
- Department of Medical Biophysics, University of Toronto, Toronto, Canada; Translational Medicine, Hospital for Sick Children, Toronto, Canada
| | - Andrew M Sharkey
- University of Cambridge Centre for Trophoblast Research, Cambridge, UK; Department of Pathology, University of Cambridge, Cambridge, UK
| | - Francesco Colucci
- Department of Obstetrics & Gynaecology, University of Cambridge, National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge CB2 0SW, UK; University of Cambridge Centre for Trophoblast Research, Cambridge, UK.
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Ghimire PR, Mooney J, Fox L, Dubois L. Smoking Cessation during the Second Half of Pregnancy Prevents Low Birth Weight among Australian Born Babies in Regional New South Wales. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073417. [PMID: 33806144 PMCID: PMC8036667 DOI: 10.3390/ijerph18073417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/18/2021] [Accepted: 03/22/2021] [Indexed: 01/14/2023]
Abstract
Smoking during pregnancy is a modifiable risk behavior of adverse health outcomes including low birth weight (LBW), and LBW is a key marker of newborns immediate and future health. This study aimed to examine the association between smoking cessation during the second half of pregnancy and LBW among babies born in Southern New South Wales Local Health District (SNSWLHD). Routinely collected perinatal data on singleton live births for the period 2011–2019 in five public hospitals of SNSWLHD were utilized. Multivariate logistic regression models were fitted to examine the association between smoking cessation during the second half of pregnancy and LBW. Analyses showed that mothers who ceased smoking during the second half of pregnancy were 44% less likely to have LBW babies (adjusted odds ratio (aOR) = 0.56; 95% confidence interval (CI): 0.34, 0.94) compared to those who continued smoking throughout pregnancy. Mothers who reported an average daily dose of 1–10 or >10 cigarettes during the second half of pregnancy were significantly more likely to have babies with LBW than those who ceased smoking during the second half of pregnancy. Early identification of smoking behavior and promotion of smoking-cessation intervention for risk populations including pregnant women within the older age bracket (35–49 years) is imperative to reduce LBW.
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Affiliation(s)
- Pramesh Raj Ghimire
- Population Health, Southern New South Wales Local Health District, Queanbeyan, NSW 2620, Australia;
- Correspondence: ; Tel.: +61-436-852-496
| | - Julie Mooney
- Nursing and Midwifery, Southern New South Wales Local Health District, Queanbeyan, NSW 2620, Australia;
| | - Louise Fox
- Integrated Care and Allied Health, Southern New South Wales Local Health District, Queanbeyan, NSW 2620, Australia;
| | - Lorraine Dubois
- Population Health, Southern New South Wales Local Health District, Queanbeyan, NSW 2620, Australia;
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Harris ML, Hure AJ, Holliday E, Chojenta C, Anderson AE, Loxton D. Association between preconception maternal stress and offspring birth weight: findings from an Australian longitudinal data linkage study. BMJ Open 2021; 11:e041502. [PMID: 34006023 PMCID: PMC7942266 DOI: 10.1136/bmjopen-2020-041502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Examine the relationship between preconception stress and offspring birth weight. SETTING Population-based cohort study linked with state-based administrative perinatal data. PARTICIPANTS 6100 births from 3622 women from the 1973-1978 cohort of the Australian Longitudinal Study of Women's Health who (1) recorded a singleton birth between January 1997 and December 2011; (2) returned at least one follow-up survey within 3 years of conception; and (3) had complete data on perceived stress prior to conception. PRIMARY OUTCOME MEASURES Linear generalised estimating equations were used to examine the relationship between preconception stress and a continuous measure of birth weight, exploring differences based on birth order and stress chronicity. The minimal sufficient adjustment set of covariates was determined by a directed acyclic graph. RESULTS For all births, there was no relationship between moderate/high acute or chronic stress and offspring birth weight in grams. Among first births only, there was a trend towards a relationship between moderate/high chronic stress and offspring birth weight. Offspring sex was associated with birth weight in all models, with female babies born lighter than male babies on average, after adjusting for covariates (p<0.0001). CONCLUSIONS Effects of preconception stress on birth weight was largely driven by time to conception. With the timing of stress critical to its impact on obstetrical outcomes, preconception care should involve not only reproductive life planning but the space to provide interventions at critical periods so that optimal outcomes are achieved.
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Affiliation(s)
- Melissa L Harris
- Centre for Women's Health Research, University of Newcastle, Callaghan, New South Wales, Australia
| | - Alexis J Hure
- Centre for Women's Health Research, University of Newcastle, Callaghan, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Elizabeth Holliday
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Catherine Chojenta
- Centre for Women's Health Research, University of Newcastle, Callaghan, New South Wales, Australia
| | - Amy E Anderson
- Centre for Women's Health Research, University of Newcastle, Callaghan, New South Wales, Australia
| | - Deborah Loxton
- Centre for Women's Health Research, University of Newcastle, Callaghan, New South Wales, Australia
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Harron K, Gilbert R, Fagg J, Guttmann A, van der Meulen J. Associations between pre-pregnancy psychosocial risk factors and infant outcomes: a population-based cohort study in England. Lancet Public Health 2021; 6:e97-e105. [PMID: 33516292 PMCID: PMC7848754 DOI: 10.1016/s2468-2667(20)30210-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 09/08/2020] [Accepted: 09/11/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND Existing studies evaluating the association between maternal risk factors and specific infant outcomes such as birthweight, injury admissions, and mortality have mostly focused on single risk factors. We aimed to identify routinely recorded psychosocial characteristics of pregnant women most at risk of adverse infant outcomes to inform targeting of early intervention. METHODS We created a cohort using administrative hospital data (Hospital Episode Statistics) for all births to mothers aged 15-44 years in England, UK, who gave birth on or after April 1, 2010, and who were discharged before or on March 31, 2015. We used generalised linear models to evaluate associations between psychosocial risk factors recorded in hospital records in the 2 years before the 20th week of pregnancy (ie, teenage motherhood, deprivation, pre-pregnancy hospital admissions for mental health or behavioural conditions, and pre-pregnancy hospital admissions for adversity, including drug or alcohol abuse, violence, and self-harm) and infant outcomes (ie, birthweight, unplanned admission for injury, or death from any cause, within 12 months from postnatal discharge). FINDINGS Of 2 520 501 births initially assessed, 2 137 103 were eligible and were included in the birth outcome analysis. Among the eligible births, 93 279 (4·4%) were births to teenage mothers (age <20 years), 168 186 (7·9%) were births to previous teenage mothers, 51 312 (2·4%) were births to mothers who had a history of hospital admissions for mental health or behavioural conditions, 58 107 (2·7%) were births to mothers who had a history of hospital admissions for adversity, and 580 631 (27·2%) were births to mothers living in areas of high deprivation. 1 377 706 (64·5%) of births were to mothers with none of the above risk factors. Infants born to mothers with any of these risk factors had poorer outcomes than those born to mothers without these risk factors. Those born to mothers with a history of mental health or behavioural conditions were 124 g lighter (95% CI 114-134 g) than those born to mothers without these conditions. For teenage mothers compared with older mothers, 3·6% (95% CI 3·3-3·9%) more infants had an unplanned admission for injury, and there were 10·2 (95% CI 7·5-12·9) more deaths per 10 000 infants. INTERPRETATION Health-care services should respond proactively to pre-pregnancy psychosocial risk factors. Our study demonstrates a need for effective interventions before, during, and after pregnancy to reduce the downstream burden on health services and prevent long-term adverse effects for children. FUNDING Wellcome Trust.
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Affiliation(s)
- Katie Harron
- UCL Great Ormond Street Institute of Child Health, London, UK,Correspondence to: Dr Katie Harron, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
| | - Ruth Gilbert
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Jamie Fagg
- Imperial College NHS Foundation Trust, St Mary's Hospital, London, UK
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11
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Domínguez-Berjón MF, Pérez G, Gotsens M, Gènova R, Martín U, Ruiz-Ramos M. Socioeconomic Inequalities in Small-for-Gestational-Age Births Before and During the Economic Crisis: An Ecologic Study of Trends in 13 Spanish Cities. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2020; 52:159-167. [PMID: 32408791 DOI: 10.1177/0020731420923532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Economic recessions can increase socioeconomic inequalities in health. The objective of this study was to analyze socioeconomic inequalities in small-for-gestational-age (SGA) births before and during the Spanish economic crisis. We conducted an ecological study of trends based on 2 periods before the crisis (1999-2003 and 2004-2008) and another during the crisis (2009-2013). The study population was Spanish women resident in 13 cities who had given birth during 1999-2013. The prevalence of SGA was calculated for each census tract. A hierarchical Bayesian model was used to obtain the prevalence ratio (PR) and 95% credible intervals (CI). We analyzed the association between SGA and socioeconomic deprivation in each period for each city and for 3 age groups. The PR was above 1 and statistically significant for all 3 time periods in most of the 13 cities. The differences in PR between periods were only statistically significant for Madrid (PR = 1.56, 95% CI 1.48-1.65 for 1999-2003; PR = 1.28, 95% CI 1.19-1.38 for 2004-2008) and Barcelona (PR = 0.99, 95% CI 0.87-1.12 for 2004-2008; PR = 1.20, 95% CI 1.05-1.36 for 2009-2013). Socioeconomic inequalities in SGA births in small areas (census tracts) of most Spanish cities studied remained stable before and during the economic crisis.
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Affiliation(s)
| | - Glòria Pérez
- Sistemes d'Informació Sanitària, Agència de Salut Pública de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Institut de Recerca Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Mercè Gotsens
- Sistemes d'Informació Sanitària, Agència de Salut Pública de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Institut de Recerca Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Ricard Gènova
- Dirección General de Salud Pública, Consejería de Sanidad, Comunidad de Madrid, Madrid, Spain
| | - Unai Martín
- Department of Sociology 2, Universidad de País Vasco UPV/EHU, Leioa, Spain.,Social Determinants of Health and Demographic Change OPIK, Leoia, Spain
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12
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Sørbye IK, Vangen S, Juarez SP, Bolumar F, Morisaki N, Gissler M, Andersen AMN, Racape J, Small R, Wood R, Urquia ML. Birthweight of babies born to migrant mothers - What role do integration policies play? SSM Popul Health 2019; 9:100503. [PMID: 31993489 PMCID: PMC6978482 DOI: 10.1016/j.ssmph.2019.100503] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 10/16/2019] [Accepted: 10/16/2019] [Indexed: 11/18/2022] Open
Abstract
Birthweights of babies born to migrant women are generally lower than those of babies born to native-born women. Favourable integration policies may improve migrants’ living conditions and contribute to higher birthweights. We aimed to explore associations between integration policies, captured by the Migrant Integration Policy Index (MIPEX), with offspring birthweight among migrants from various world regions. In this cross-country study we pooled 31 million term birth records between 1998 and 2014 from ten high-income countries: Australia, Belgium, Canada, Denmark, Finland, Japan, Norway, Spain, Sweden and United Kingdom (Scotland). Birthweight differences in grams (g) were analysed with regression analysis for aggregate data and random effects models. Proportion of births to migrant women varied from 2% in Japan to 28% in Australia. The MIPEX score was not associated with birthweight in most migrant groups, but was positively associated among native-born (mean birthweight difference associated with a 10-unit increase in MIPEX: 105 g; 95% CI: 24, 186). Birthweight among migrants was highest in the Nordic countries and lowest in Japan and Belgium. Migrants from a given origin had heavier newborns in countries where the mean birthweight of native-born was higher and vice versa. Mean birthweight differences between migrants from the same origin and the native-born varied substantially across destinations (70 g–285 g). Birthweight among migrants does not correlate with MIPEX scores. However, birthweight of migrant groups aligned better with that of the native-born in destination counties. Further studies may clarify which broader social policies support migrant women and have impacts on perinatal outcomes. Favourable migrant integration policies, as measured by the MIPEX, did not correlate with offspring birthweight among migrants. However, the MIPEX correlated with birthweight among the offspring of native-born women. Migrants' birthweights were higher in countries with high birthweights in the local population and vice versa. Birthweight among native-born seems to have a pull-effect on the birthweight of migrant groups.
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Affiliation(s)
- Ingvil K. Sørbye
- Norwegian Advisory Unit for Women's Health, Department of Obstetrics, Oslo University Hospital, Norway
- Corresponding author. Norwegian Advisory Unit for Women's health, Department of Obstetrics, Oslo University Hospital, 0027, Oslo, Norway.
| | - Siri Vangen
- Norwegian Advisory Unit for Women's Health, Department of Obstetrics, Oslo University Hospital, Norway
| | - Sol P. Juarez
- Department of Public Health Sciences, Stockholm University, Sweden
| | - Francisco Bolumar
- Unit of Public Health, School of Medicine, University of Alcalá, Madrid, Spain
- City University of New York School of Public Health, New York, United States
| | - Naho Morisaki
- Department of Social Medicine, National Center for Child Health and Development, Japan
| | - Mika Gissler
- THL National Institute for Health and Welfare, Information Services Department, Helsinki, Finland
- Karolinska Institute, Department of Neurobiology, Care Sciences and Society, Stockholm, Sweden
| | | | - Judith Racape
- École de Santé Publique, Faculté de Médecine, Université Libre de Bruxelles, Belgium
| | - Rhonda Small
- Judith Lumley Centre, La Trobe University, Melbourne, Australia
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Rachael Wood
- NHS National Services Scotland, Information Services Division, Edinburgh, Scotland, UK
| | - Marcelo L. Urquia
- Manitoba Centre for Health Policy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Dalla Lana School of Public Health, Faculty of Medicine, University of Toronto, Ontario, Canada
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13
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Célind J, Hedlund M, Bygdell M, Sondén A, Elfvin A, Kindblom JM. Secular trends of birthweight in boys from 1950 to 2010. Pediatr Neonatol 2019; 60:543-548. [PMID: 30808557 DOI: 10.1016/j.pedneo.2019.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 10/12/2018] [Accepted: 01/25/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Birthweight is an indicator of fetal development and intrauterine conditions and is associated with future health outcomes. Secular birthweight trends prior to the 1970s are mostly unknown. Our aim was to explore secular birthweight trends in Swedish boys from 1950 to 2010. METHODS We have collected detailed growth data including birthweight from archived School Health Care records for children born in Gothenburg from 1946 and onwards and established a unique population-based cohort, the Body Mass Index Epidemiology Study (BEST). The birthweight cohort spans six decades (1950-2010) and includes 46,548 boys. RESULTS The mean birthweight of the complete study cohort was 3580 ± 562 g. Linear regression analysis of the entire period revealed a minimal negative secular trend for birthweight (BETA = -0.4 g/year; p < 0.01). However, three distinct trends appeared during sub-periods: a decrease 1950-80, an increase 1980-2000 and another decrease 2000-2010. CONCLUSION We demonstrate that birthweight in boys has undergone periodic decreases and subsequent increases, but the overall trend from the 1950s to the present is stable.
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Affiliation(s)
- Jimmy Célind
- Centre for Bone and Arthritis Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Pediatrics, The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Marie Hedlund
- Pediatrics, The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Maria Bygdell
- Centre for Bone and Arthritis Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Arvid Sondén
- Bioinformatics Core Facility, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anders Elfvin
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jenny M Kindblom
- Centre for Bone and Arthritis Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
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Litzky JF, Marsit CJ. Epigenetically regulated imprinted gene expression associated with IVF and infertility: possible influence of prenatal stress and depression. J Assist Reprod Genet 2019; 36:1299-1313. [PMID: 31127477 PMCID: PMC6642239 DOI: 10.1007/s10815-019-01483-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 05/09/2019] [Indexed: 12/28/2022] Open
Abstract
PURPOSE Despite the growing body of research implying an impact of in vitro fertilization (IVF) on imprinted genes and epigenetics, few studies have examined the effects of underlying subfertility or prenatal stress on epigenetics, particularly in terms of their role in determining infant birthweights. Both subfertility and prenatal stressors have been found to impact epigenetics and may be confounding the effect of IVF on epigenetics and imprinted genes. Like IVF, both of these exposures-infertility and prenatal stressors-have been associated with lower infant birthweights. The placenta, and specifically epigenetically regulated placental imprinted genes, provides an ideal but understudied mechanism for evaluating the relationship between underlying genetics, environmental exposures, and birthweight. METHODS AND RESULTS In this review, we discuss the impacts of IVF and infertility on birthweight, epigenetic mechanisms and genomic imprinting, and the role of these mechanisms in the IVF population and discuss the role and importance of the placenta in infant development. We then highlight recent work on the relationships between infertility, IVF, and prenatal stressors in terms of placental imprinting. CONCLUSIONS In combination, the studies discussed, as well as two recent projects of our own on placental imprinted gene expression, suggest that lower birthweights in IVF infants are secondary to a combination of exposures including the infertility and prenatal stress that couples undergoing IVF are experiencing. The work highlighted herein emphasizes the need for appropriate control populations that take infertility into account and also for consideration of prenatal psychosocial stressors as confounders and causes of variation in IVF infant outcomes.
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Affiliation(s)
- Julia F Litzky
- Department of Epidemiology, Geisel School of Medicine at Dartmouth College, Hanover, NH, 03755, USA
| | - Carmen J Marsit
- Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, CNR 202, Atlanta, GA, 30322, USA.
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15
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Klöfvermark J, Hjern A, Juárez SP. Acculturation or unequal assimilation? Smoking during pregnancy and duration of residence among migrants in Sweden. SSM Popul Health 2019; 8:100416. [PMID: 31193892 PMCID: PMC6543261 DOI: 10.1016/j.ssmph.2019.100416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 05/23/2019] [Accepted: 05/24/2019] [Indexed: 11/24/2022] Open
Abstract
A growing corpus of evidence reveals that smoking patterns of migrant women tend to converge with that of the host population over time ('acculturation paradox'). In this paper we aim to adopt a health equity perspective by studying the extent to which this pattern reflects a convergence with the group of natives who are more socioeconomically disadvantaged. Using population-based registers, we study 1,194,296 women who gave birth in Sweden between 1991 and 2012. Using logistic regression, we estimated odds ratios to assess the effect of duration of residence on the association between smoking during pregnancy and women's origin (classified according to inequality-adjusted Human Development Index (iHDI) of the country of birth). Sibling information and multilevel models were used to assess the extent to which our results might be affected by the cross-sectional nature of the data. Smoking during pregnancy increases with duration of residence among migrants from all levels of iHDI to such an extent that they tend to converge or increase in relation to the levels of the Swedish population with low education and low income, leaving behind the native population with high education and income. The results are robust to possible selection bias related to the cross-sectional nature of the data. Our findings indicate the need of a health equity perspective and suggest the use of 'unequal assimilation' rather than 'acculturation paradox' as a more suitable framework to interpret these findings.
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Affiliation(s)
- Josefin Klöfvermark
- Centre for Health Equity Studies, Stockholm University/Karolinska Institute. Department of Public Health Sciences, Stockholm University, Sveavägen 160, Sveaplan, SE-106 91, Stockholm, Sweden.,Clinical Epidemiology/Department of Medicine, Karolinska Institute, Karolinska University Hospital, Solna, SE-171 76, Stockholm, Sweden
| | - Anders Hjern
- Centre for Health Equity Studies, Stockholm University/Karolinska Institute. Department of Public Health Sciences, Stockholm University, Sveavägen 160, Sveaplan, SE-106 91, Stockholm, Sweden.,Clinical Epidemiology/Department of Medicine, Karolinska Institute, Karolinska University Hospital, Solna, SE-171 76, Stockholm, Sweden
| | - Sol Pía Juárez
- Centre for Health Equity Studies, Stockholm University/Karolinska Institute. Department of Public Health Sciences, Stockholm University, Sveavägen 160, Sveaplan, SE-106 91, Stockholm, Sweden
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16
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Are We Justified in Introducing Carbon Monoxide Testing to Encourage Smoking Cessation in Pregnant Women? HEALTH CARE ANALYSIS 2018; 27:128-145. [DOI: 10.1007/s10728-018-0364-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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17
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Hajdu T, Hajdu G. Smoking ban and health at birth: Evidence from Hungary. ECONOMICS AND HUMAN BIOLOGY 2018; 30:37-47. [PMID: 29908431 DOI: 10.1016/j.ehb.2018.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 04/20/2018] [Accepted: 05/31/2018] [Indexed: 06/08/2023]
Abstract
In 2012, smoking restrictions were extended to hospitality venues in Hungary. Women working in bars and restaurants were primarily affected by the intervention. In this research, we analyze the effect of this smoking ban on the outcomes of their pregnancies. Using individual live birth, fetal loss, and infant mortality registry data, we examine the probability of live birth, indicators of health at birth, and the probability of death in the first year of life. We apply a difference-in-differences framework and show that the smoking ban has improved health at birth. We observed birth weight to increase by 56 g (95% CI: 4.2 to 106.8) and gestation length by 0.19 weeks (95% CI: 0.02 to 0.36). Due to the ban, the probability of being born with very low and low birth weight has decreased by 1.2 and 2.2 percentage points, respectively (95% CI: -0.2 to -2.2 and 0.06 to -4.4), and we see a 0.9 percentage points reduction in the chance of being born very preterm (95% CI: -0.03 to -1.9). We also observe a decrease in the probability of being born with a low Ponderal index (decrease of 4.1 percentage points, 95% CI: -0.7 to -7.5). Performing a series of robustness and placebo tests, we provide evidence that supports the causal interpretation of our results. We also show that the ban was more beneficial for newborns of parents with low educational attainment and at the bottom of the fetal health endowment distribution.
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Affiliation(s)
- Tamás Hajdu
- Institute of Economics, Centre for Economic and Regional Studies, Hungarian Academy of Sciences, Tóth Kálmán u. 4., 1097 Budapest, Hungary.
| | - Gábor Hajdu
- Institute for Sociology, Centre for Social Sciences, Hungarian Academy of Sciences, Tóth Kálmán u. 4., 1097 Budapest, Hungary; MTA-ELTE Peripato Comparative Social Dynamics Research Group, Pázmány Péter sétány 1/A, 1117 Budapest, Hungary.
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18
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Arunda MO, Agardh A, Asamoah BO. Survival of low birthweight neonates in Uganda: analysis of progress between 1995 and 2011. BMC Pregnancy Childbirth 2018; 18:189. [PMID: 29843626 PMCID: PMC5975500 DOI: 10.1186/s12884-018-1831-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 05/15/2018] [Indexed: 12/01/2022] Open
Abstract
Background Although low birthweight (LBW) babies represent only 15.5% of global births, it is the leading underlying cause of deaths among newborns in countries where neonatal mortality rates are high. In Uganda, like many other sub-Saharan African countries, the progress of reducing neonatal mortality has been slow and the contribution of low birthweight to neonatal deaths over time is unclear. The aim of this study is to investigate the association between low birthweight and neonatal mortality and to determine the trends of neonatal deaths attributable to low birthweight in Uganda between 1995 and 2011. Methods Cross-sectional survey datasets from Uganda Demographic and Health Surveys between 1995 and 2011 were analyzed using binary logistic regression with 95% confidence interval (CI) and Kaplan-Meier survival analysis to examine associations and trends of neonatal mortalities with respect to LBW. A total of 5973 singleton last-born live births with measured birthweights were included in the study. Results The odds of mortality among low birthweight neonates relative to normal birthweight babies were; in 1995, 6.2 (95% CI 2.3 −17.0), in 2000–2001, 5.3 (95% CI 1.7 −16.1), in 2006, 4.3 (95% CI 1.3 − 14.2) and in 2011, 3.8 (95% CI 1.3 − 11.2). The proportion of neonatal deaths attributable to LBW in the entire population declined by more than half, from 33.6% in 1995 to 15.3% in 2011. Neonatal mortality among LBW newborns also declined from 83.8% to 73.7% during the same period. Conclusion Low birthweight contributes to a substantial proportion of neonatal deaths in Uganda. Although significant progress has been made to reduce newborn deaths, about three-quarters of all LBW neonates died in the neonatal period by 2011. This implies that the health system has been inadequate in its efforts to save LBW babies. A holistic strategy of community level interventions such as improved nutrition for pregnant mothers, prevention of teenage pregnancies, use of mosquito nets during pregnancy, antenatal care for all, adequate skilled care during birth to prevent birth asphyxia among LBW babies, and enhanced quality of postnatal care among others could effectively reduce the mortality numbers.
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Affiliation(s)
- Malachi Ochieng Arunda
- Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Jan Waldenströms gata 35, 205 02, Malmö, Sweden.
| | - Anette Agardh
- Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Jan Waldenströms gata 35, 205 02, Malmö, Sweden
| | - Benedict Oppong Asamoah
- Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Jan Waldenströms gata 35, 205 02, Malmö, Sweden
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19
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Mejia-Lancheros C, Mehegan J, Segurado R, Murrin C, Kelleher C. Parental population exposure to historical socioeconomic and political periods and grand-child's birth weight in the Lifeways Cross-Generation Cohort Study in the Republic of Ireland. SSM Popul Health 2018; 4:100-116. [PMID: 29349279 PMCID: PMC5769097 DOI: 10.1016/j.ssmph.2017.11.011] [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: 04/03/2017] [Revised: 10/03/2017] [Accepted: 11/27/2017] [Indexed: 11/16/2022] Open
Abstract
Exposure to deprived socioeconomic conditions during the peri-conception and early childhood periods can have a negative long-term impact on individuals' health and that of their progeny. We aimed to examine whether relatives' birth period affected index-child (grand-child) birthweight status in the Lifeways Cross-Generation Cohort in the Republic of Ireland. Participants were 943 mothers and offspring, 890 fathers, 938 maternal grandmothers (MGM), 700 maternal grandfathers (MGF) 537 paternal grandmothers (PGM) and 553 paternal grandfathers (PGF). Index-child's birthweight was sex-for-gestational age standardised (UK1990 population), and then classified into low birthweight (≤10th percentile) and high-birthweight (≥90th percentile) and compared against normal-birthweight (>10th to <90th percentiles). Four adult birth periods were considered: The Free State (FS, 1916-1938); Emergency Act (EA, 1939-1946); Post-World War-II Baby-Boom (PWWII-BB, 1947-1964); and Modern Ireland (MI, 1964 onwards). Logistic regression was used to assess the crude and adjusted relationship between index-child's birthweight status and relatives' birth periods. Overall, there were 8.7% (n=82) index-children in the low-birthweight category, 77.9% (n=735) and 13.4% (n=126) within the normal and high birthweight groups respectively. Index-children whose mothers were born during the PWWII-BB had higher birthweight infants (Crude OR(COR)=1.81 (1.08-3.03) which remained the case only for male index-children when adjusted for co-variables (Adjusted OR(AOR)=4.61(1.71-12.42)). Parents' combined PWWII-BB birth period was positively associated with male index-child higher birthweight, even adjusted for maternal characteristics (AOR=4.60(1.69-12.50)). MGFs born during the EA were more likely to have grandchildren with low birthweight after adjustment for maternal characteristics (AOR=2.45(1.03-5.85)), particularly for female index-children (AOR=4.74(1.16-19.25)). Both PGMs and PGFs born during the FS period had higher birthweight grandchildren, adjusted for maternal-related co-variables (PGM, AOR=3.23(1.21-8.63); PGF, AOR=3.93(1.11-13.96)), with the effect of PGM more evident in her granddaughter (AOR=6.53(1.25-34.04)). In conclusion, there is some evidence that period of grandparental birth is associated with their grandchildren's birthweights, suggesting that transgenerational exposures may be particular to historical context, meriting further exploration.
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Affiliation(s)
- Cilia Mejia-Lancheros
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Woodview House, Belfield, Dublin 4, Republic of Ireland
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20
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Voidazan S, Tarcea M, Abram Z, Georgescu M, Marginean C, Grama O, Buicu F, Ruţa F. Associations between lifestyle factors and smoking status during pregnancy in a group of Romanian women. Birth Defects Res 2018; 110:519-526. [PMID: 29318743 DOI: 10.1002/bdr2.1190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 11/26/2017] [Accepted: 12/04/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND There is an estimated birth rate of 9.27 births/1,000 population in Romania each year, with approximately 8.4% born with low birth weight (LBW). Our purpose was to evaluate the relationships between maternal smoking and LBW and preterm birth in Mureș County, Romania. METHODS We conducted a cross-sectional survey of 1,278 mothers who had given birth in Mureș County obstetrical wards in 2015, based on a lifestyle questionnaire of 109 items and personal and laboratory data from hospitals records. RESULTS The variables associated with smoking during pregnancy taken into account were: Rroma ethnicity, education <8 grades, income lower than 140 dollars (minimum wages in our country), and lack of facilities in their households. In a multivariable model, smoking during pregnancy was correlated with a low level of education (p = .02), coffee and alcohol use (p = .0001), and lack of interest in potential environmental and behavioral risks during pregnancy (including smoking and diet). The newborn baby's weight was associated with smoker status of the mother (OR 1.71, 95%CI 1.09-2.66, p = .01), by the lack of ownership of a household (OR 3.52, 95%CI 2.27-5.47, p = .0001), and by the pregnant woman not receiving proper information regarding a healthy behavior and diet during pregnancy (OR 1.91, 95%CI 1.33-2.74, p = .0005). CONCLUSION Our study aimed to emphasize the high rates of maternal smoking during pregnancy and its importance in LBW outcomes in Romanian pregnant women. Moreover, the study highlights disparities in smoking status observed in ethnic minorities and those living in poverty.
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Affiliation(s)
- S Voidazan
- Department of Epidemiology, University of Medicine and Pharmacy of Tîrgu Mureș, Tîrgu Mureș, Romania
| | - M Tarcea
- Department of Community Nutrition and Food safety, University of Medicine and Pharmacy of Tîrgu Mureș, Tîrgu Mureș, Romania
| | - Z Abram
- Department of Hygiene, University of Medicine and Pharmacy of Tîrgu Mureș, Tîrgu Mureș, Romania
| | - M Georgescu
- Ward No. Gynecology 1, Regional Emergency Hospital of Tîrgu Mureș, Tîrgu Mureș, Romania
| | - C Marginean
- Department of Gynecology II, University of Medicine and Pharmacy of Tîrgu Mureș, Tîrgu Mureș, Romania
| | - O Grama
- Department of Gynecology II, University of Medicine and Pharmacy of Tîrgu Mureș, Tîrgu Mureș, Romania
| | - F Buicu
- Department of Public Health, University of Medicine and Pharmacy of Tîrgu Mureș, Tîrgu Mureș, Romania
| | - F Ruţa
- Department of Community Nutrition and Food safety, University of Medicine and Pharmacy of Tîrgu Mureș, Tîrgu Mureș, Romania
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21
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Leyland AH, Ouédraogo S, Nam J, Bond L, Briggs AH, Gray R, Wood R, Dundas R. Evaluation of Health in Pregnancy grants in Scotland: a natural experiment using routine data. PUBLIC HEALTH RESEARCH 2017. [DOI: 10.3310/phr05060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background
Pregnancy and the period around birth are critical for the development and improvement of population health as well as the health of mothers and babies, with outcomes such as birthweight influencing adult health.
Objectives
We evaluated the clinical effectiveness and cost-effectiveness of the Health in Pregnancy (HiP) grants in Scotland, looking for differential outcomes when the scheme was in place, as well as before its implementation and after its withdrawal.
Design
The HiP grants were evaluated as a natural experiment using interrupted time series analysis. We had comparison groups of women who delivered before the grants were introduced and after the grants were withdrawn.
Setting
Scotland, UK.
Participants
A total of 525,400 singleton births delivered between 24 and 44 weeks in hospitals across Scotland between 1 January 2004 and 31 December 2014.
Intervention
The HiP grant was a universal, unconditional cash transfer of £190 for women in Great Britain and Northern Ireland reaching 25 weeks of pregnancy if they had sought health advice from a doctor or midwife. The grant was introduced for women with a due date on or after 6 April 2009 and subsequently withdrawn for women reaching the 25th week of pregnancy on or after 1 January 2011. The programme was paid for by Her Majesty’s Treasury.
Main outcome measures
Our primary outcome measure was birthweight. Secondary outcome measures included maternal behaviour, measures of size, measures of stage and birth outcomes.
Data sources
The data came from the Scottish maternity and neonatal database held by the Information and Services Division at the NHS National Services Scotland.
Results
There was no statistically significant effect on birthweight, with births during the intervention period being, on average, 2.3 g [95% confidence interval (CI) –1.9 to 6.6 g] lighter than would have been expected had the pre-intervention trend continued. Mean gestational age at booking (i.e. the first antenatal appointment with a health-care professional) decreased by 0.35 weeks (95% CI 0.29 to 0.41 weeks) and the odds of booking before 25 weeks increased by 10% [odds ratio (OR) 1.10, 95% CI 1.02 to 1.18] during the intervention but decreased again post intervention (OR 0.91, 95% CI 0.83 to 1.00). The odds of neonatal death increased by 84% (OR 1.84, 95% CI 1.22 to 2.78) and the odds of having an emergency caesarean section increased by 7% (OR 1.07, 95% CI 1.03 to 1.10) during the intervention period.
Conclusions
The decrease in the odds of booking before 25 weeks following withdrawal of the intervention makes it likely that the HiP grants influenced maternal health-care-seeking behaviour. It is unclear why neonatal mortality and emergency caesarean section rates increased, but plausible explanations include the effects of the swine flu outbreak in 2009 and the global financial crisis. The study is limited by its non-randomised design. Future research could assess an eligibility threshold for payment earlier than the 25th week of pregnancy.
Funding
The National Institute for Health Research Public Health Research programme. The Social and Public Health Sciences Unit is core funded by the Medical Research Council (MC_UU_12017/13) and the Scottish Government Chief Scientist Office (SPHSU13).
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Affiliation(s)
- Alastair H Leyland
- Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Samiratou Ouédraogo
- University of Montréal Hospital Research Centre, University of Montréal, Montréal, QC, Canada
| | | | - Lyndal Bond
- College of Health and Biomedicine, Victoria Hospital, Melbourne, VIC, Australia
| | | | - Ron Gray
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Rachael Wood
- Information Service Division, NHS National Services Scotland, Edinburgh, UK
| | - Ruth Dundas
- Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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Pereira PPDS, Da Mata FAF, Figueiredo ACG, de Andrade KRC, Pereira MG. Maternal Active Smoking During Pregnancy and Low Birth Weight in the Americas: A Systematic Review and Meta-analysis. Nicotine Tob Res 2017; 19:497-505. [PMID: 28403455 DOI: 10.1093/ntr/ntw228] [Citation(s) in RCA: 143] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 09/16/2016] [Indexed: 12/15/2022]
Abstract
Introduction Smoking during pregnancy may negatively impact newborn birth weight. This study investigates the relationship between maternal active smoking during pregnancy and low birth weight in the Americas through systematic review and meta-analysis. Methods A literature search was conducted through indexed databases and the grey literature. Case-control and cohort studies published between 1984 and 2016 conducted within the Americas were included without restriction regarding publication language. The article selection process and data extraction were performed by two independent investigators. A meta-analysis of random effects was conducted, and possible causes of between-study heterogeneity were evaluated by meta-regressions and subgroup analyses. Publication bias was assessed by visual inspection of Begg's funnel plot and by Egger's regression test. Results The literature search yielded 848 articles from which 34 studies were selected for systematic review and 30 for meta-analysis. Active maternal smoking was associated with low birth weight, OR = 2.00 (95% CI: 1.77-2.26; I2 = 66.3%). The funnel plot and Egger's test (p = .14) indicated no publication bias. Meta-regression revealed that sample size, study quality, and the number of confounders in the original studies did not account for the between-study heterogeneity. Subgroup analysis indicated no significant differences when studies were compared by design, sample size, and regions of the Americas. Conclusion Low birth weight is associated with maternal active smoking during pregnancy regardless of the region in the Americas or the studies' methodological aspects. Implications A previous search of the major electronic databases revealed that no studies appear to have been conducted to summarize the association between maternal active smoking during pregnancy and low birth weight within the Americas. Therefore, this systematic review may help to fill the information gap. The region of the Americas contains some of the most populous countries in the world; therefore, this study may provide useful data from this massive segment of the world's population.
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Affiliation(s)
| | - Fabiana A F Da Mata
- Department of Medical Sciences, Faculty of Medicine, University of Brasilia, Brasilia, Brazil
| | | | | | - Maurício Gomes Pereira
- Department of Medical Sciences, Faculty of Medicine, University of Brasilia, Brasilia, Brazil
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McConnachie A, Haig C, Sinclair L, Bauld L, Tappin DM. Birth weight differences between those offered financial voucher incentives for verified smoking cessation and control participants enrolled in the Cessation in Pregnancy Incentives Trial (CPIT), employing an intuitive approach and a Complier Average Causal Effects (CACE) analysis. Trials 2017; 18:337. [PMID: 28728583 PMCID: PMC5520300 DOI: 10.1186/s13063-017-2053-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 06/19/2017] [Indexed: 11/26/2022] Open
Abstract
Background The Cessation in Pregnancy Incentives Trial (CPIT), which offered financial incentives for smoking cessation during pregnancy showed a clinically and statistically significant improvement in cessation. However, infant birth weight was not seen to be affected. This study re-examines birth weight using an intuitive and a complier average causal effects (CACE) method to uncover important information missed by intention-to-treat analysis. Methods CPIT offered financial incentives up to £400 to pregnant smokers to quit. With incentives, 68 women (23.1%) were confirmed non-smokers at primary outcome, compared to 25 (8.7%) without incentives, a difference of 14.3% (Fisher test, p < 0.0001). For this analysis, randomised groups were split into three theoretical sub-groups: independent quitters - quit without incentives, hardened smokers - could not quit even with incentives and potential quitters - required the addition of financial incentives to quit. Viewed in this way, the overall birth weight gain with incentives is attributable only to potential quitters. We compared an intuitive approach to a CACE analysis. Results Mean birth weight of potential quitters in the incentives intervention group (who therefore quit) was 3338 g compared with potential quitters in the control group (who did not quit) 3193 g. The difference attributable to incentives, was 3338 – 3193 = 145 g (95% CI −617, +803). The mean difference in birth weight between the intervention and control groups was 21 g, and the difference in the proportion who managed to quit was 14.3%. Since the intervention consisted of the offer of incentives to quit smoking, the intervention was received by all women in the intervention group. However, “compliance” was successfully quitting with incentives, and the CACE analysis yielded an identical result, causal birth weight increase 21 g ÷ 0.143 = 145 g. Conclusions Policy makers have great difficulty giving pregnant women money to stop smoking. This study indicates that a small clinically insignificant improvement in average birth weight is likely to hide an important clinically significant increase in infants born to pregnant smokers who want to stop but cannot achieve smoking cessation without the addition of financial voucher incentives. Trial Registration ISRCTN Registry, ISRCTN87508788. Registered on 1 September 2011. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2053-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alex McConnachie
- Robertson Centre, Level 11, Boyd Orr Building, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Caroline Haig
- Robertson Centre, Level 11, Boyd Orr Building, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Lesley Sinclair
- Institute for Social Marketing, Centre for Tobacco and Alcohol Studies, Faculty of Health Sciences & Sport, University of Stirling, Stirling, FK9 4LA, UK
| | - Linda Bauld
- Institute for Social Marketing, Centre for Tobacco and Alcohol Studies, Faculty of Health Sciences & Sport, University of Stirling, Stirling, FK9 4LA, UK
| | - David M Tappin
- Section of Child Health, School of Medicine, Glasgow University, Scottish Cot Death Trust, 5th floor, West Glasgow Ambulatory Care Hospital, Yorkhill, Glasgow, G3 8SJ, UK.
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Epigenetic Influences During the Periconception Period and Assisted Reproduction. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 1014:15-39. [PMID: 28864983 DOI: 10.1007/978-3-319-62414-3_2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The periconception period starts 6 months before conception and lasts until the tenth week of gestation. In this chapter, we will focus on epigenetic modifications to DNA and gene expression within this period and during assisted reproduction. There are two critical times during the periconception window when significant epigenetic 'reprogramming' occur: one during gametogenesis and another during the pre-implantation embryonic stage. Furthermore, assisted conception treatments, laboratory protocols and culture media can affect the embryo development and birth weights in laboratory animals. There is, however, an ongoing debate as to whether epigenetic changes in humans, causing embryo mal-development, placenta dysfunction and birth defects, result from assisted reproductive technologies or are consequences of pre-existing medical and/or genetic conditions in the parents. The periconception period starts from ovarian folliculogenesis, through resumption of oogenesis, fertilisation, peri-implantation embryo development, embryogenesis until the end of organogenesis. In men, it is the period from spermatogenesis to epididymal sperm storage and fertilisation. Gametes and developing embryos are sensitive to environmental factors during this period, and epigenetic modifications can occur in response to adverse lifestyles and environmental factors. We now know that lifestyle factors such as advanced parentage age, obesity or undernutrition, smoking, excessive alcohol and caffeine intake and recreational drugs used during gamete production and embryogenesis could induce epigenetic alterations, which could impact adversely on pregnancy outcomes and health of the offspring. Furthermore, these can also result in a permanent and irreversible effect in a dose-dependent manner, which can be passed on to the future generations.
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Bakolis I, Kelly R, Fecht D, Best N, Millett C, Garwood K, Elliott P, Hansell AL, Hodgson S. Protective Effects of Smoke-free Legislation on Birth Outcomes in England: A Regression Discontinuity Design. Epidemiology 2016; 27:810-8. [PMID: 27428672 PMCID: PMC5424880 DOI: 10.1097/ede.0000000000000534] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Environmental tobacco smoke has an adverse association with preterm birth and birth weight. England introduced a new law to make virtually all enclosed public places and workplaces smoke free on July 1, 2007. We investigated the effect of smoke-free legislation on birth outcomes in England using Hospital Episode Statistics (HES) maternity data. METHODS We used regression discontinuity, a quasi-experimental study design, which can facilitate valid causal inference, to analyze short-term effects of smoke-free legislation on birth weight, low birth weight, gestational age, preterm birth, and small for gestational age. RESULTS We analyzed 1,800,906 pregnancies resulting in singleton live-births in England between 1 January 2005 and 31 December 2009. In the 1 to 5 months following the introduction of the smoke-free legislation, for those entering their third trimester, the risk of low birth weight decreased by between 8% (95% confidence interval [CI]: 4%, 12%) and 14% (95% CI: 5%, 23%), very low birth weight between 28% (95% CI: 19%, 36%) and 32% (95% CI: 21%, 41%), preterm birth between 4% (95% CI: 1%, 8%) and 9% (95% CI: 2%, 16%), and small for gestational age between 5% (95% CI: 2%, 8%) and 9% (95% CI: 2%, 15%). The estimated impact of the smoke-free legislation varied by maternal age, deprivation, ethnicity, and region. CONCLUSIONS The introduction of smoke-free legislation in England had an immediate estimated beneficial impact on birth outcomes overall, although we did not observe improvements across all age, ethnic, or deprivation groups.See video abstract at http://links.lww.com/EDE/B85.
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Affiliation(s)
- Ioannis Bakolis
- UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Dept. Epidemiology and Biostatistics, School of Public Health, Imperial College London W2 1PG, UK
- Department of Biostatistics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
- Department of Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
| | - Ruth Kelly
- Dept. Epidemiology and Biostatistics, School of Public Health, Imperial College London W2 1PG, UK
- The Medical Research Council, 14th floor, One Kemble Street, London, WC2B 4AN
| | - Daniela Fecht
- UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Dept. Epidemiology and Biostatistics, School of Public Health, Imperial College London W2 1PG, UK
| | - Nicky Best
- Dept. Epidemiology and Biostatistics, School of Public Health, Imperial College London W2 1PG, UK
| | - Christopher Millett
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, UK
| | - Kevin Garwood
- UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Dept. Epidemiology and Biostatistics, School of Public Health, Imperial College London W2 1PG, UK
| | - Paul Elliott
- UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Dept. Epidemiology and Biostatistics, School of Public Health, Imperial College London W2 1PG, UK
- Directorate of Public Health and Primary Care, Imperial College Healthcare NHS Trust, London, UK
| | - Anna L Hansell
- UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Dept. Epidemiology and Biostatistics, School of Public Health, Imperial College London W2 1PG, UK
- Directorate of Public Health and Primary Care, Imperial College Healthcare NHS Trust, London, UK
| | - Susan Hodgson
- MRC-PHE Centre for Environment and Health, Dept. Epidemiology and Biostatistics, School of Public Health, Imperial College London W2 1PG, UK
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Griffis H, Matone M, Kellom K, Concors E, Quarshie W, French B, Rubin D, Cronholm PF. Home visiting and perinatal smoking: a mixed-methods exploration of cessation and harm reduction strategies. BMC Public Health 2016; 16:764. [PMID: 27514836 PMCID: PMC4982407 DOI: 10.1186/s12889-016-3464-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 08/05/2016] [Indexed: 11/16/2022] Open
Abstract
Background Home visiting programs represent an important primary prevention strategy for adverse prenatal health behaviors; the various ways in which home visiting programs impact prenatal smoking cessation and reduction behaviors remain understudied. Methods Mixed methods approach using a retrospective cohort of propensity score matched home visiting clients and local-area comparison women with first births between 2008–2014 in a large Northeast state. Multivariable logistic and linear regression estimated third trimester prenatal tobacco smoking cessation and reduction. Additionally, qualitative interviews were conducted with 76 home visiting clients. Results A program effect was seen for smoking cessation such that clients who smoked less than ten cigarettes per day and those who smoked 20 or more cigarettes per day during the first trimester were more likely to achieve third trimester cessation than comparison women (p <0.01 and p = 0.01, respectively). Only for heavy smokers (20 or more cigarettes during the first trimester) was there a significant reduction in number of cigarettes smoked by the third trimester versus comparison women (p = 0.01). Clients expressed the difficulty of cessation, but addressed several harm-reduction strategies including reducing smoking in the house and wearing a smoking jacket. Clients also described smoking education that empowered them to ask others to not smoke or adopt other harm reducing behaviors when around their children. Conclusions While a significant impact on smoking cessation was seen, this study finds a less-clear impact on smoking reduction among women in home visiting programs. As home visiting programs continue to expand, it will be important to best identify effective ways to support tobacco-related harm reduction within vulnerable families. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3464-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Heather Griffis
- PolicyLab, The Children's Hospital of Philadelphia, 3535 Market, Suite 1424, Philadelphia, PA, 19104, USA.
| | - Meredith Matone
- PolicyLab, The Children's Hospital of Philadelphia, 3535 Market, Suite 1424, Philadelphia, PA, 19104, USA.,Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Katherine Kellom
- PolicyLab, The Children's Hospital of Philadelphia, 3535 Market, Suite 1424, Philadelphia, PA, 19104, USA
| | - Erica Concors
- PolicyLab, The Children's Hospital of Philadelphia, 3535 Market, Suite 1424, Philadelphia, PA, 19104, USA
| | - William Quarshie
- Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Benjamin French
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA
| | - David Rubin
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Peter F Cronholm
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Ganer Herman H, Miremberg H, Nini N, Feit H, Schreiber L, Bar J, Kovo M. The effects of maternal smoking on pregnancy outcome and placental histopathology lesions. Reprod Toxicol 2016; 65:24-28. [PMID: 27262664 DOI: 10.1016/j.reprotox.2016.05.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 05/14/2016] [Accepted: 05/31/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To study the effects of maternal smoking on pregnancy outcome and placental histopathology findings. MATERIALS & METHODS Maternal and labor characteristics and pathological reports were compared between term placentas of complicated and uncomplicated pregnancies of: heavy smokers (>10 cigarettes per day, H-smokers), moderate smokers (<10 cigarettes per day, M-smokers) and non-smokers (controls, N-smokers). RESULTS Birth-weights were lower in the H-smokers and M-smokers as compared to the N-smokers (p<0.001), with a higher rate of small for gestational age (SGA): 18.2%, 19.2% and 11.4%, respectively (p=0.01). Deliveries among smokers were characterized by higher rates of abnormal fetal heart rate tracings during labor as compared to non-smokers (p=0.01). Rates of placental maternal and fetal stromal-vascular supply lesions was similar between the groups. CONCLUSIONS Maternal smoking is associated with higher rates of SGA. Tobacco's potential influence is probably through the disruption of normal placental epigenetic patterns, not expressed in placental histopathology lesions.
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Affiliation(s)
- Hadas Ganer Herman
- Departments of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Hadas Miremberg
- Departments of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Neama Nini
- Departments of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hagit Feit
- Departments of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Letizia Schreiber
- Department of Pathology, The Edith Wolfson Medical Center, Holon, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Bar
- Departments of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Kovo
- Departments of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Birth characteristics and all-cause mortality: a sibling analysis using the Uppsala birth cohort multigenerational study. J Dev Orig Health Dis 2016; 7:374-83. [DOI: 10.1017/s2040174416000179] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This paper investigates the association between perinatal health and all-cause mortality for specific age intervals, assessing the contribution of maternal socioeconomic characteristics and the presence of maternal-level confounding. Our study is based on a cohort of 12,564 singletons born between 1915 and 1929 at the Uppsala University Hospital. We fitted Cox regression models to estimate age-varying hazard ratios of all-cause mortality for absolute and relative birth weight and for gestational age. We found that associations with mortality vary by age and according to the measure under scrutiny, with effects being concentrated in infancy, childhood or early adult life. For example, the effect of low birth weight was greatest in the first year of life and then continued up to 44 years of age (HR between 2.82 and 1.51). These associations were confirmed in within-family analyses, which provided no evidence of residual confounding by maternal characteristics. Our findings support the interpretation that policies oriented towards improving population health should invest in birth outcomes and hence in maternal health.
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Marceau K, Palmer RHC, Neiderhiser JM, Smith TF, McGeary JE, Knopik VS. Passive rGE or Developmental Gene-Environment Cascade? An Investigation of the Role of Xenobiotic Metabolism Genes in the Association Between Smoke Exposure During Pregnancy and Child Birth Weight. Behav Genet 2016; 46:365-77. [PMID: 26803317 PMCID: PMC4866639 DOI: 10.1007/s10519-016-9778-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 01/01/2016] [Indexed: 12/16/2022]
Abstract
There is considerable evidence that smoke exposure during pregnancy (SDP) environmentally influences birth weight after controlling for genetic influences and maternal characteristics. However, maternal smoking during pregnancy-the behavior that leads to smoke exposure during pregnancy-is also genetically-influenced, indicating the potential role of passive gene-environment correlation. An alternative to passive gene-SDP correlation is a cascading effect whereby maternal and child genetic influences are causally linked to prenatal exposures, which then have an 'environmental' effect on the development of the child's biology and behavior. We describe and demonstrate a conceptual framework for disentangling passive rGE from this cascading GE effect using a systems-based polygenic scoring approach comprised of genes shown to be important in the xenobiotic (substances foreign to the body) metabolism pathway. Data were drawn from 5044 families from the Avon Longitudinal Study of Parents and Children with information on maternal SDP, birth weight, and genetic polymorphisms in the xenobiotic pathway. Within a k-fold cross-validation approach (k = 5), we created weighted maternal and child polygenic scores using 18 polymorphisms from 10 genes that have been implicated in the xenobiotic metabolism pathway. Mothers and children shared variation in xenobiotic metabolism genes. Amongst mothers who smoked during pregnancy, neither maternal nor child xenobiotic metabolism polygenic scores were associated with a higher likelihood of smoke exposure during pregnancy, or the severity of smoke exposure during pregnancy (and therefore, neither proposed mechanism was supported), or with child birth weight. SDP was consistently associated with lower child birth weight controlling for the polygenic scores, maternal educational attainment, social class, psychiatric problems, and age. Limitations of the study design and the potential of the framework using other designs are discussed.
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Affiliation(s)
- Kristine Marceau
- Division of Behavioral Genetics, Department of Psychiatry, Rhode Island Hospital, Coro West Suite 204, 1 Hoppin St, Providence, RI, 02903, USA.
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA.
| | - Rohan H C Palmer
- Division of Behavioral Genetics, Department of Psychiatry, Rhode Island Hospital, Coro West Suite 204, 1 Hoppin St, Providence, RI, 02903, USA
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
| | - Jenae M Neiderhiser
- Psychology Department, The Pennsylvania State University, State College, PA, USA
| | - Taylor F Smith
- Department of Psychology and Child Development, California Polytechnic State University, San Luis Obispo, CA, USA
| | - John E McGeary
- Division of Behavioral Genetics, Department of Psychiatry, Rhode Island Hospital, Coro West Suite 204, 1 Hoppin St, Providence, RI, 02903, USA
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
| | - Valerie S Knopik
- Division of Behavioral Genetics, Department of Psychiatry, Rhode Island Hospital, Coro West Suite 204, 1 Hoppin St, Providence, RI, 02903, USA
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
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Mitao M, Philemon R, Obure J, Mmbaga BT, Msuya S, Mahande MJ. Risk factors and adverse perinatal outcome associated with low birth weight in Northern Tanzania: a registry-based retrospective cohort study. ASIAN PACIFIC JOURNAL OF REPRODUCTION 2016. [DOI: 10.1016/j.apjr.2015.12.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Authors' Reply to Sibel Yöntem and Colleagues' Comment on "Indigenous Medicine Use for Sex Selection During Pregnancy and Risk of Congenital Malformations: A Population-Based Case-Control Study in Haryana, India". Drug Saf 2015; 39:91-2. [PMID: 26507884 DOI: 10.1007/s40264-015-0356-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Crump C, Sundquist J, Sieh W, Winkleby MA, Sundquist K. Fetal growth and subsequent maternal risk of thyroid cancer. Int J Cancer 2015; 138:1085-93. [PMID: 26379007 DOI: 10.1002/ijc.29857] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 08/23/2015] [Accepted: 09/11/2015] [Indexed: 12/31/2022]
Abstract
Thyroid cancer has peak incidence among women of reproductive age, and growth factors, which have procarcinogenic properties, may play an important etiologic role. However, the association between fetal growth rate during a woman's pregnancy and her subsequent risk of thyroid cancer has not been previously examined. We conducted a national cohort study of 1,837,634 mothers who had a total of 3,588,497 live-births in Sweden in 1973-2008, followed up for thyroid cancer incidence through 2009. There were 2,202 mothers subsequently diagnosed with thyroid cancer in 36.8 million person-years of follow-up. After adjusting for maternal age, height, weight, smoking, and sociodemographic factors, high fetal growth (birth weight standardized for gestational age and sex) was associated with a subsequent increased risk of thyroid cancer in the mother (incidence rate ratio [IRR] per additional 1 standard deviation, 1.05; 95% CI, 1.01-1.09; p = 0.02). Each 1,000 g increase in the infant's birth weight was associated with a 13% increase in the mother's subsequent risk of thyroid cancer (IRR, 1.13; 95% CI, 1.05-1.22; p = 0.001). These findings appeared to involve both papillary and follicular subtypes, and did not vary significantly by the mother's height, weight or smoking status. In this large national cohort study, high fetal growth during a woman's pregnancy was independently associated with a subsequent increased risk of her developing thyroid cancer. If confirmed, these findings suggest an important role of maternal growth factors in the development of thyroid cancer, and potentially may help facilitate the identification of high-risk subgroups of women.
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Affiliation(s)
- Casey Crump
- Department of Medicine, Stanford University, Stanford, CA
| | - Jan Sundquist
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Weiva Sieh
- Department of Health Research and Policy, Stanford University, Stanford, CA
| | - Marilyn A Winkleby
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, CA
| | - Kristina Sundquist
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Malmö, Sweden
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Patel AB, Meleth S, Pasha O, Goudar SS, Esamai F, Garces AL, Chomba E, McClure EM, Wright LL, Koso-Thomas M, Moore JL, Saleem S, Liechty EA, Goldenberg RL, Derman RJ, Hambidge KM, Carlo WA, Hibberd PL. Impact of exposure to cooking fuels on stillbirths, perinatal, very early and late neonatal mortality - a multicenter prospective cohort study in rural communities in India, Pakistan, Kenya, Zambia and Guatemala. Matern Health Neonatol Perinatol 2015; 1:18. [PMID: 27057335 PMCID: PMC4823690 DOI: 10.1186/s40748-015-0019-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 05/25/2015] [Indexed: 01/03/2023] Open
Abstract
Background Consequences of exposure to household air pollution (HAP) from biomass fuels used for cooking on neonatal deaths and stillbirths is poorly understood. In a large multi-country observational study, we examined whether exposure to HAP was associated with perinatal mortality (stillbirths from gestation week 20 and deaths through day 7 of life) as well as when the deaths occurred (macerated, non-macerated stillbirths, very early neonatal mortality (day 0–2) and later neonatal mortality (day 3–28). Questions addressing household fuel use were asked at pregnancy, delivery, and neonatal follow-up visits in a prospective cohort study of pregnant women in rural communities in five low and lower middle income countries participating in the Global Network for Women and Children’s Health’s Maternal and Newborn Health Registry. The study was conducted between May 2011 and October 2012. Polluting fuels included kerosene, charcoal, coal, wood, straw, crop waste and dung. Clean fuels included electricity, liquefied petroleum gas (LPG), natural gas and biogas. Results We studied the outcomes of 65,912 singleton pregnancies, 18 % from households using clean fuels (59 % LPG) and 82 % from households using polluting fuels (86 % wood). Compared to households cooking with clean fuels, there was an increased risk of perinatal mortality among households using polluting fuels (adjusted relative risk (aRR) 1.44, 95 % confidence interval (CI) 1.30-1.61). Exposure to HAP increased the risk of having a macerated stillbirth (adjusted odds ratio (aOR) 1.66, 95%CI 1.23-2.25), non-macerated stillbirth (aOR 1.43, 95 % CI 1.15-1.85) and very early neonatal mortality (aOR 1.82, 95 % CI 1.47-2.22). Conclusions Perinatal mortality was associated with exposure to HAP from week 20 of pregnancy through at least day 2 of life. Since pregnancy losses before labor and delivery are difficult to track, the effect of exposure to polluting fuels on global perinatal mortality may have previously been underestimated. Trial registration ClinicalTrials.gov NCT01073475
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Affiliation(s)
- Archana B Patel
- Lata Medical Research Foundation, Nagpur, Maharashtra 440022 India
| | - Sreelatha Meleth
- RTI International, Research Triangle Park, North Carolina, 27709 USA
| | - Omrana Pasha
- Department of Community Health Sciences & Family Medicine, Aga Khan University, Karachi, Pakistan
| | | | | | - Ana L Garces
- IMSALUD, San Carlos University, Guatemala City, Guatemala
| | | | | | - Linda L Wright
- Center for Research of Mothers and Children, NIH, Rockville, MD 20852 USA
| | - Marion Koso-Thomas
- Center for Research of Mothers and Children, NIH, Rockville, MD 20852 USA
| | - Janet L Moore
- RTI International, Research Triangle Park, North Carolina, 27709 USA
| | - Sarah Saleem
- Department of Community Health Sciences & Family Medicine, Aga Khan University, Karachi, Pakistan
| | - Edward A Liechty
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202 USA
| | - Robert L Goldenberg
- Department of Obstetrics/Gynecology, Columbia University, New York, NY 10032 USA
| | | | | | - Waldemar A Carlo
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL 35233 USA
| | - Patricia L Hibberd
- Division of Global Health, Department of Pediatrics, Massachusetts General Hospital, Boston, MA 02114 USA
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Harris JE, Balsa AI, Triunfo P. Tobacco control campaign in Uruguay: Impact on smoking cessation during pregnancy and birth weight. JOURNAL OF HEALTH ECONOMICS 2015; 42:186-96. [PMID: 25985121 DOI: 10.1016/j.jhealeco.2015.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 04/13/2015] [Accepted: 04/20/2015] [Indexed: 05/08/2023]
Abstract
We analyzed a nationwide registry of all pregnancies in Uruguay during 2007-2013 to assess the impact of three types of tobacco control policies: (1) provider-level interventions aimed at the treatment of nicotine dependence, (2) national-level increases in cigarette taxes, and (3) national-level non-price regulation of cigarette packaging and marketing. We estimated models of smoking cessation during pregnancy at the individual, provider and national levels. The rate of smoking cessation during pregnancy increased from 15.4% in 2007 to 42.7% in 2013. National-level non-price policies had the largest estimated impact on cessation. The price response of the tobacco industry attenuated the effects of tax increases. While provider-level interventions had a significant effect, they were adopted by relatively few health centers. Quitting during pregnancy increased birth weight by an estimated 188 g. Tobacco control measures had no effect on the birth weight of newborns of non-smoking women.
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Affiliation(s)
- Jeffrey E Harris
- Department of Economics, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.
| | - Ana Inés Balsa
- Departamento de Economía, Facultad de Ciencias Empresariales y Economía, Universidad de Montevideo, Montevideo 11500, Uruguay.
| | - Patricia Triunfo
- Departamento de Economía, Facultad de Ciencias Sociales, Universidad de la República, Montevideo 11200, Uruguay.
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Alshaarawy O, Anthony JC. Month-wise estimates of tobacco smoking during pregnancy for the United States, 2002-2009. Matern Child Health J 2015; 19:1010-5. [PMID: 25112459 PMCID: PMC4326630 DOI: 10.1007/s10995-014-1599-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The timing of prenatal exposure to tobacco cigarette smoking can be crucial for the developing fetus. Pushing the field beyond prior pregnancy trimester-focused smoking estimates, we estimated month-specific prevalence proportions for tobacco cigarette smoking among pregnant and non-pregnant women of the United States, with consideration of tobacco dependence (TD) as well. In advance, we posited that pregnancy onset might prompt smoking cessation in early months, before the end of the 1st trimester, and that TD might account for sustained smoking in later months, especially months 8-9, when there are added reasons to quit. Estimates are from the 2002-2009 National Surveys on Drug Use and Health Restricted-Data Analysis System (R-DAS), with large nationally representative samples of US civilians, including 12-44 year old women (n ~ 70,000) stratified by pregnancy status and month of pregnancy, with multi-item assessment of TD as well as recently active smoking. Age was held constant via the Breslow-Day indirect standardization approach, a methodological detail of potential interest to other research teams conducting online R-DAS analyses. Among 12-44 year old women in Month 1 of pregnancy, as well as non-pregnant women, just over one in four was a recently active smoker (26-27 %), and approximately one-half of these smokers qualified as a TD case (52 %). Corresponding estimates for women in Month 3 were 17.6 % and two-thirds, respectively, lending some support for our advance hypotheses. Nonetheless, our a priori TD hypothesis about Months 8-9 seems to be contradicted: an increased concentration of TD among smokers surfaced early in pregnancy. Evidence of a possible ameliorative pregnancy effect on smoking prevalence as well as TD's effect on smoking persistence might be seen quite early in pregnancy. Substitution of a month-specific view for the traditional trimester view sheds new light on how pregnancy might shape smoking behavior before the end of trimester 1, with TD seeming to thwart a public health goal of 100 % cessation, early in pregnancy.
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Affiliation(s)
| | - James C. Anthony
- Address correspondence to James C. Anthony, Ph.D., Professor, Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI 48824
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Exploring the ‘Healthy Migrant Paradox’ in Sweden. A Cross Sectional Study Focused on Perinatal Outcomes. J Immigr Minor Health 2015; 18:42-50. [DOI: 10.1007/s10903-015-0157-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Räisänen S, Kramer MR, Gissler M, Saari J, Heinonen S. Unemployment at municipality level is associated with an increased risk of small for gestational age births--a multilevel analysis of all singleton births during 2005-2010 in Finland. Int J Equity Health 2014; 13:95. [PMID: 25326664 PMCID: PMC4207351 DOI: 10.1186/s12939-014-0095-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 10/07/2014] [Indexed: 11/17/2022] Open
Abstract
Introduction Neighbourhood level deprivation has been shown to influence adverse perinatal outcomes independent of individual level socioeconomic status (SES) in countries with high income inequality, such as the United States. The present study evaluates whether municipality level deprivation defined based on education (proportion of inhabitants with university level education), income (mean income per capita) and unemployment were associated with the prevalence of preterm birth (<37 weeks) and small for gestational age (SGA, birth weight <2 standard deviations) after adjustment for individual level socio-demographics (age, parity, prior preterm births, smoking during pregnancy and SES defined based on maternal occupation at birth) in Finland. Methods The study design was cross-sectional. The data gathered from the Medical Birth Register included all singleton births (n = 345,952) in 2005–2010. We fitted Generalized Estimating Equations (GEE) models to account for correlation of preterm birth and SGA clustering within municipality. Results Of all the women with singleton pregnancies, 4.5% (n = 15,615) gave birth preterm and 3.8% (n = 13,111) of their newborns were classified as SGA. Individual level SES and smoking were important risk factors for each outcome in adjusted models. Controlling for individual level factors, women living in intermediate and high unemployment class municipalities were 6.0% (adjusted odds ratio (aOR) = 1.06; 95% confidence interval (CI) 1.01-1.12) and 13.0% (aOR = 1.13; 95% CI 1.06-1.20), respectively, more likely to give birth to an SGA newborn than women living in low unemployment class municipalities. Conclusions After adjustment for individual level socio-demographics, the prevalence of SGA was around 6-13% higher in municipalities with an intermediate or high unemployment rate than municipalities with the lowest unemployment rate. The results suggested that the unemployment rate has an important public health effect with clinical implications since SGA is associated with a higher risk of adverse long-term health outcomes.
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Dundas R, Ouédraogo S, Bond L, Briggs AH, Chalmers J, Gray R, Wood R, Leyland AH. Evaluation of health in pregnancy grants in Scotland: a protocol for a natural experiment. BMJ Open 2014; 4:e006547. [PMID: 25324327 PMCID: PMC4202003 DOI: 10.1136/bmjopen-2014-006547] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 09/23/2014] [Accepted: 09/24/2014] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION A substantial proportion of low birth weight is attributable to the mother's cultural and socioeconomic circumstances. Early childhood programmes have been widely developed to improve child outcomes. In the UK, the Health in Pregnancy (HiP) grant, a universal conditional cash transfer of £190, was introduced for women reaching the 25th week of pregnancy with a due date on/or after 6 April 2009 and subsequently withdrawn for women reaching the 25th week of pregnancy on/or after 1 January 2011. The current study focuses on the evaluation of the effectiveness and cost-effectiveness of the HiP grant. METHODS AND ANALYSIS The population under study will be all singleton births in Scotland over the periods of January 2004 to March 2009 (preintervention), April 2009 to April 2011 (intervention) and May 2011 to December 2013 (postintervention). Data will be extracted from the Scottish maternity and neonatal database. The analysis period 2004-2013 should yield over 585,000 births. The primary outcome will be birth weight among singleton births. Other secondary outcomes will include gestation at booking, booking before 25 weeks; measures of size and stage; gestational age at delivery; weight-for-dates, term at birth; birth outcomes and maternal smoking. The main statistical method we will use is interrupted time series. Outcomes will be measured on individual births nested within mothers, with mothers themselves clustered within data zones. Multilevel regression models will be used to determine whether the outcomes changed during the period in which the HiP grants was in effect. Subgroup analyses will be conducted for those groups most likely to benefit from the payments. ETHICS AND DISSEMINATION Approval for data collection, storage and release for research purpose has been given (6 May 2014, PAC38A/13) by the Privacy Advisory Committee. The results of this study will be disseminated through peer-reviewed publications in journals, national and international conferences.
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Affiliation(s)
- Ruth Dundas
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Samiratou Ouédraogo
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Lyndal Bond
- Centre of Excellence in Intervention and Prevention Science, Melbourne, Australia
| | - Andrew H Briggs
- Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, UK
| | - James Chalmers
- Information Services Division, NHS National Services Scotland, Edinburgh, UK
| | - Ron Gray
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Rachael Wood
- Information Services Division, NHS National Services Scotland, Edinburgh, UK
| | - Alastair H Leyland
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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Keyes KM, Smith GD, Susser E. Commentary: Smoking in pregnancy and offspring health: early insights into family-based and 'negative control' studies? Int J Epidemiol 2014; 43:1381-8. [PMID: 25301865 PMCID: PMC4757959 DOI: 10.1093/ije/dyu166] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Katherine M Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA, New York State Psychiatric Institute, New York, USA and MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA, New York State Psychiatric Institute, New York, USA and MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - George Davey Smith
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA, New York State Psychiatric Institute, New York, USA and MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Ezra Susser
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA, New York State Psychiatric Institute, New York, USA and MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA, New York State Psychiatric Institute, New York, USA and MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
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Park BY, Lee BK. Use of meconium in perinatal epidemiology: potential benefits and pitfalls. Ann Epidemiol 2014; 24:878-81. [PMID: 25444889 DOI: 10.1016/j.annepidem.2014.09.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 09/12/2014] [Accepted: 09/15/2014] [Indexed: 11/18/2022]
Abstract
PURPOSE Meconium is a biomarker matrix that can be used to assess cumulative exposures in epidemiologic studies of prenatal risk factors. Depending on when meconium is collected, different exposure windows during pregnancy can be measured. However, little guidance exists regarding the extent to which timing of meconium collection will influence resulting effect estimates. METHODS We performed a simulation study of prenatal tobacco smoke exposure (assessed from meconium nicotine) and birth weight. We discuss four typical meconium collection methods capturing different exposure windows and assess the biases induced by these methods. RESULTS In simulations assuming that exposure to tobacco smoke only during late gestation was of etiologic relevance to birth weight, use of a meconium collection method that captured exposure windows other than late gestation resulted in biased estimates of the true nicotine-birth weight association. CONCLUSIONS Using meconium collection methods that do not reflect an exposure window of etiologic relevance can lead to biased results and erroneous conclusions regarding the nature of prenatal exposure-outcome associations. Understanding how prenatal exposure patterns vary across the pregnancy and exposure windows of etiologic relevance is essential in determining when and how to collect meconium for use in biomarker studies of prenatal exposure.
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Affiliation(s)
- Bo Y Park
- Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA.
| | - Brian K Lee
- Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA
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Juárez SP, Wagner P, Merlo J. Applying measures of discriminatory accuracy to revisit traditional risk factors for being small for gestational age in Sweden: a national cross-sectional study. BMJ Open 2014; 4:e005388. [PMID: 25079936 PMCID: PMC4120345 DOI: 10.1136/bmjopen-2014-005388] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Small for gestational age (SGA) is considered as an indicator of intrauterine growth restriction, and multiple maternal and newborn characteristics have been identified as risk factors for SGA. This knowledge is mainly based on measures of average association (ie, OR) that quantify differences in average risk between exposed and unexposed groups. Nevertheless, average associations do not assess the discriminatory accuracy of the risk factors (ie, its ability to discriminate the babies who will develop SGA from those that will not). Therefore, applying measures of discriminatory accuracy rather than measures of association only, our study revisits known risk factors of SGA and discusses their role from a public health perspective. DESIGN Cross-sectional study. We measured maternal (ie, smoking, hypertension, age, marital status, education) and delivery (ie, sex, gestational age, birth order) characteristics and performed logistic regression models to estimate both ORs and measures of discriminatory accuracy, like the area under the receiver operating characteristic curve (AU-ROC) and the net reclassification improvement. SETTING Data were obtained from the Swedish Medical Birth Registry. PARTICIPANTS Our sample included 731 989 babies born during 1987-1993. RESULTS We replicated the expected associations. For instance, smoking (OR=2.57), having had a previous SGA baby (OR=5.48) and hypertension (OR=4.02) were strongly associated with SGA. However, they show a very small discriminatory accuracy (AU-ROC≈0.5). The discriminatory accuracy increased, but remained unsatisfactorily low (AU-ROC=0.6), when including all variables studied in the same model. CONCLUSIONS Traditional risk factors for SGA alone or in combination have a low accuracy for discriminating babies with SGA from those without SGA. A proper understanding of these findings is of fundamental relevance to address future research and to design policymaking recommendations in a more informed way.
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Affiliation(s)
- Sol Pía Juárez
- Center for Economic Demography, Lund University, Sweden
- Department of Clinical Sciences, Unit of Social Epidemiology, Lund University, Malmö, Skåne University Hospital (SUS Malmö), Malmö, Sweden
| | - Phillip Wagner
- Department of Clinical Sciences, Unit of Social Epidemiology, Lund University, Malmö, Skåne University Hospital (SUS Malmö), Malmö, Sweden
| | - Juan Merlo
- Department of Clinical Sciences, Unit of Social Epidemiology, Lund University, Malmö, Skåne University Hospital (SUS Malmö), Malmö, Sweden
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